Given population aging and the productive potential of older people, it is important to examine how individual and societal developments affect social engagement in later life. The study aimed to disentangle the effects of age, aging, and cohort on volunteering among the young old. Using data from the Longitudinal Aging Study Amsterdam, we examined volunteering rates of young olds (N=2,745) in two decades: those being 55-69 years old in 1992 and their age-peers in 2002. Six-year follow-up on both cohorts allowed for cohort-sequential analyses. Multilevel logistic regression analyses revealed that (i) regardless of age, the 2002 cohort volunteered more often than the 1992 cohort, (ii) in 6 years’ time volunteering increased for the 55- to 59-year-olds, stabilized among the 60- to 64-year-olds, and declined among the 65- to 69-year-olds, and (iii) these age-differential changes were observed in both cohorts. These effects remained significant after adjusting for gender, education, religious involvement, health, employment status, network size, and partner status. A higher education, religious involvement, staying in good health, and maintaining a large network increased the likelihood of volunteering. Unobserved factors, such as a more positive view on aging within society, may also account for the large increase in volunteering among the recent cohort of young olds.

This study examined whether past grandparental child care is related to present support from adult children. On the basis of social exchange theory, the authors expected that grandparental child care creates a debt that is repaid in the form of receiving support later in life. Using data from the Longitudinal Aging Study Amsterdam (N = 349 parents, N = 812 adult children), the authors found that grandparents who frequently provided child care for sons in the past more often received instrumental and emotional support from these sons approximately 13 years later than grandparents who less frequently provided child care. Investments in daughters did not pay off. Instrumental support other than child-care provision did not predict receiving support from either sons or daughters, but emotional support did. These results support the notion of long-term reciprocity in parent–child relationships, but its importance depends on the child\\\'s gender and the type of earlier investment.

Objectives: Data from the Netherlands indicate a recent increase in prevalence of chronic diseases and a stable prevalence of disability, suggesting that diseases have become less disabling. We studied the association between chronic diseases and activity limitations in the Netherlands from 1990 to 2008. Methods: Five surveys among noninstitutionalized persons aged 55 to 84 years (n=54847) obtained self-reported data on chronic diseases (diabetes, heart disease, peripheral arterial disease, stroke, lung disease, joint disease, back problems, and cancer) and activity limitations (Organisation for Economic Cooperation and Development [OECD] long-term disability questionnaire or 36-item Short Form Health Survey [SF-36]). Results: Prevalence rates of chronic diseases increased over time, whereas prevalence rates of activity limitations were stable (OECD) or slightly decreased (SF-36). Associations between chronic diseases and activity limitations were also stable (OECD) or slightly decreased (SF-36). Surveys varied widely with regard to disease and limitation prevalence rates and the associations between them. Conclusions: The hypothesis that diseases became less disabling from 1990 to 2008 was only supported by results based on activity limitation data as assessed with the SF-36. Further research on how diseases and disability are associated over time is needed.

Background: It is known that people who suffer from depression are more likely to have other physical illnesses, but the extent of the association between depression and non-psychiatric hospitalisation episodes has never been researched in great depth. We therefore aimed to investigate whether depressed middle-aged and older people were more likely to be hospitalised for causes other than mental illnesses, and whether the outcomes for this group of people were less favourable. Methods & Findings: Hospital events from 1995 to 2006 were obtained from the Dutch National Medical Register and linked to participants of the Longitudinal Aging Study Amsterdam (LASA). Linkage was accomplished in 97% of the LASA sample by matching gender, year of birth and postal code. Depression was measured at each wave point of the LASA study using the Centre for Epidemiologic Studies Depression (CES-D). Hospital outcomes including admission, length of stay, readmission and death while in hospital were recorded at 6, 12 and 24 months intervals after each LASA interview. Generalised Estimating Equation models were also used to investigate potential confounders. After 12 months, 14% of depressed people were hospitalised compared to 10% of non-depressed individuals. There was a 2-fold increase in deaths while in hospital amongst the depressed (0.8% vs 0.4%), who also had longer total length of stay (2.6 days vs 1.4 days). Chronic illnesses and functional limitations had major attenuating effects, but depression was found to be an independent risk factor for length of stay after full adjustment (OR = 1.33, 95% CI: 1.22–1.46 after 12 months). Conclusions: Depression in middle and old age is associated with non-psychiatric hospitalisation, longer length of stay and higher mortality in clinical settings. Targeting of this high-risk group could reduce the financial, medical and social burden related to hospital admission.

No abstract available.

Background: There has been little research on the relative importance of frailty markers. The objective was to investigate the association among seven frailty domains (nutrition, physical activity, mobility, strength, energy, cognition, and mood) and their relative contribution in explaining differences among individuals in five samples of older persons. Methods: Data from five studies of aging were analyzed using multiple correspondence analysis. Aggregation of frailty markers was evaluated using graphical output. Decomposition of variability was used to assess the relative contribution of each marker in each sample. Results were combined across the samples to assess the average contribution. Results: Frailty markers were found to consistently aggregate in each sample, suggesting a possible underlying construct. Physical strength had the highest contribution on average in explaining differences among individuals. Mobility and energy also had large contributions. Nutrition and cognition had the smallest contributions. Conclusions: Our results provide further evidence supporting the notion that frailty domains may belong to a common construct. Physical strength may be the most important discriminating characteristic.

Het sociale leven van oudere volwassenen is gedurende de laatste twee decennia behoorlijk veranderd als gevolg van maatschappelijke ontwikkelingen. Onderliggende processen bij deze veranderingen zijn individualisering en het loslaten van tradities. Er is meer persoonlijke vrijheid in de keuze van leefstijl en identiteit, en grotere persoonlijke verantwoordelijkheid voor het ontwikkelen en in stand houden van een persoonlijk netwerk van sociale relaties.

Cross-national comparisons used welfare state regimes to explain differences in care use in the European older population, yet these classifications do not cover all care-related societal characteristics and limit our understanding of which specific societal characteristics are most important. This study explores to the familialistic culture, welfare state context, and socio-economic and demographic composition add to our understanding of informal and formal care use of older adults in 11 European countries. Using the Survey of Ageing, Health and Retirement (2006), multilevel logistic regression analyses show that, in addition to individual determinants, societal determinants are salient for understanding informal and formal care use. In countries with a less familialistic culture, a high availability of home based services, a larger proportion of women in part-time work and a smaller proportion of 65 years and older in the population, older adults are more likely to receive formal home care, particularly when they have functional limitations. In countries with more residential care, more spending in pensions, more women in part-time employment and a more aged population, older adults with functional limitations are less likely to receive informal care. We can tentatively conclude that the incorporation of societal determinants rather than commonly used welfare state classifications yields more insight in factors that determine older adults informal and formal care use.

Purpose: To assess the degree of participation of the visually impaired elderly and to make a comparison with population-based reference data. Method: This cross-sectional study included visually impaired elderly persons (≥55 years; n=173) who were referred to a low-vision rehabilitation centre. Based on the International Classification of Functioning, Disability and Health (ICF) participation in: 1) domestic life, 2) interpersonal interactions and relationships, 3) major life areas, and 4) community, social and civic life was assessed by means of telephone interviews. In addition, we assessed perceived participation restrictions. Results: Comparison with reference data of the elderly showed that visually impaired elderly persons participated less in heavy household activities, recreational activities and sports activities. No differences were found for the interpersonal interactions and relationships domain. Participants experienced restrictions in household activities (84%), socializing (53%), paid or voluntary work (92%), and leisure activities (88%). Conclusions: Visually impaired elderly persons participate in society, but they participate less than their peers. They experience restrictions as a result of vision loss. These findings are relevant, since participation is an indicator for successful aging and has a positive influence on health and subjective well-being.

Purpose: To determine whether a change in physical, psychological and social dimensions of quality of life of older people living at home is associated with receiving formal care, compared to informal care and no care. Method: Data from the observation cycles in 1998 and 2001 of the Longitudinal Aging Study Amsterdam (LASA) were used. Older people receiving formal homecare in 1998 were compared to older people receiving informal care and to older people receiving no care at all in 1998 on subjective scores on 3-year changes in self-perceived health, loneliness, positive affect and satisfaction with life. The data were analysed using linear regression analysis and ANOVA. Results: In all groups there is a change for the worse between 1998 and 2001 in the four aspects of quality of life. Self-perceived health declines significantly more in the group receiving formal care compared to the group without care, but this is explained by a higher score on functional limitations in 1998. Loneliness increases significantly more in the group receiving formal care, even after correction for confounders. In the group receiving formal care the satisfaction with life decreases significantly more compared to the group receiving no care and the group with informal care. An interaction effect with gender was found, showing that after correction for confounders this difference is maintained for the women but not for the men. There is no significant difference between the three care groups regarding changes in positive affect. Conclusion: Older men and women who receive formal home care experience an increase in loneliness, and older women who receive formal care experience less satisfaction with life, compared to women who receive informal care or no care. Future research should confirm these results and investigate the mechanisms underlying these changes.

Although religiousness may, to a certain extent, be expected to alleviate emotional suffering in the last week of life, some religious beliefs might also provoke emotional distress. For the current study, after-death interviews with proxy respondents of deceased sample members of the Longitudinal Aging Study Amsterdam provided information on depressive mood and anxiety in the last week of life, as well as on the presence of a sense of peace at the approaching end of life. Proxy respondents also were asked about serious physical symptoms in the last week of life of the respondent, the respondent’s cognitive decline, and their estimate of the salience of religion for the sample member. Other characteristics were derived from the last interviews with the sample members when still alive: depressive symptoms, chronic diseases, religious affiliation, church attendance, belief in Heaven, belief in Hell, and salience of religion. None of the characteristics of religiousness was significantly associated with depressive mood or anxiety, as estimated by the proxy respondent. A sense of peace, however, was predicted by higher church attendance, belief in Hell (among church-members), and the proxy’s estimate of the salience of religion. It can be concluded that religiousness did not affect depressive mood or anxiety in the last week of life in the current sample. It is possible that religiousness supports a sense of peace, which may be a more-existential facet of mood and is discussed as relevant in the last phase of life and in palliative care.

No abstract available.

Objectives: The study examined the accumulated as well as the differential influence of negative life events on cognitive decline in older persons, and whether this association was different for persons with normal and poor cognitive functioning, and for ApoE ε4 carriers and noncarriers. Methods: We used data from the Longitudinal Aging Study Amsterdam (N = 1,356). Data were analyzed using linear mixed models. Results: We found differential associations for different negative life events with cognitive decline none of which were mediated by depressive symptoms. The death of a child or grandchild, which may be considered a highly stressful event, was associated to a higher rate of cognitive decline, whereas more chronic stressors, such as the illness of a partner or relative, or serious conflicts, were associated with better cognitive function. The associations between life events and cognitive function were stronger in ApoE ϵ4 carriers compared with noncarriers, suggesting that this gene plays a role in the association between stress and cognitive function. Discussion: Highly stressful events seem to be associated with a higher rate of cognitive decline, whereas mild chronic stressors may have an arousing function that stimulates cognitive performance.

Objectives: Chronic diseases are important predictors of self-rated health (SRH). This study investigated whether multimorbidity has a synergistic or cumulative impact on SRH. Moderation by gender and age was examined. Methods: Data originated from the Longitudinal Aging Study Amsterdam (N = 2,046, aged 57–98 years). We assessed the presence of lung disease, cardiac disease, peripheral atherosclerosis, stroke, diabetes mellitus, arthritis, and cancer. SRH was measured with the question “How is your health in general?” including 5 response categories. Generalized ordered probit models were applied; possible synergism was examined by testing for nonlinearity of the association. Results: The association between multimorbidity and SRH was nonlinear in that the effect of having a single disease was larger than the added effects of co-occurring diseases. However, from the second disease onward, each additional co-occurring disease caused cumulative declines in SRH. Only in the oldest old (85+), the impact of a single disease was similar to that of co-occurring diseases. Results were similar for men and women. Discussion: Our findings help to improve understanding of the impact multimorbidity has on SRH: Having a single disease increases the chance of poor health more than each co-occurring disease, indicating some overlap between diseases or adaptation to declining health.

Background: It is not clear whether recent increases in life expectancy are accompanied by a concurrent postponement of activity limitations. The objective of this study was to give best estimates of the trend in the prevalence of activity limitations among the non-institutionalized population aged 55–84 years over the period 1990–2007 in The Netherlands. Methods: We examined self-reports on 12 measures of moderate or severe activity limitations in stair climbing, walking and getting dressed as assessed by OECD long-term disability questionnaire or Short Form-36 (SF-36) items, using original data from five population-based cross-sectional and longitudinal surveys (n = 54 847 respondents). To account for heterogeneity between surveys, we used meta-analyses to study time trends. Results: Time trends of 10 out of the 12 activity limitation variables studied were stable. The prevalence of at least moderate activity limitations in stair climbing [odds ratio (OR) = 1.03)] and getting dressed (OR = 1.04) based on OECD items increased over the study period. Age- and gender-stratified time trend analyses showed consistent patterns. Conclusions: No declines were observed in the prevalence of activity limitations in the Dutch older population over the period 1990–2007. The increase in life expectancy in this period is accompanied by a stable prevalence of most activity limitations.

The authors aimed to explore optimal cutoffs for high-risk waist circumference (WC) in older adults to assess the health risks of obesity. Prospective data from 4,996 measurements in 2,232 participants aged ≥70 years were collected during 5 triennial measurement cycles (1992/1993–2005/2006) of a population-based cohort study, the Longitudinal Aging Study Amsterdam (Amsterdam, the Netherlands). Cross-sectional associations of WC with pain, mobility limitations, incontinence, knee osteoarthritis, cardiovascular disease, and diabetes were studied. Generalized estimating equations models were fitted with restricted cubic spline functions in order to carefully study the shapes of the associations. Model fits for applying different cutoffs to categorize WC in the association with all outcomes were tested using the quasi-likelihood under the Independence Criterion (QIC). On the basis of the spline regression curves, potential WC cutoffs of approximately 109 cm in men and 98 cm in women were proposed. Based on the model fit, cutoffs between 100 cm and 106 cm were equally applicable in men but should not be higher. In women, the QIC confirmed an optimal cutoff of 99 cm.

No abstract available.

How did the study come about? The Longitudinal Aging Study Amsterdam (LASA) was initiated by the Dutch Ministry of Welfare, Health and Culture (currently Ministry of Health, Welfare and Sports). By the end of the 1980s, ministry officials recognized that ageing would be a major demographic driving force, shaping the need for health care in the Dutch population in the near future. Therefore, they became increasingly interested in the process of ageing and ageing-related determinants of health-care use, and wanted to develop policies for older people in The Netherlands who were in need of extra care and support. Maintaining independent functioning, quality of life and participation of older people were recognized to be major challenges for Dutch society. Multi-disciplinary and longitudinal scientific research was considered to be needed to inform the ministry’s policy and monitor functioning and well-being of older Dutch people, leading to the start of the LASA study in 1991. The study was designed by researchers from the VU University and VU University Medical Center in Amsterdam, in a close collaboration between social and biomedical scientists. This collaboration ensured a thoroughly multi-disciplinary approach fitting the scope of the intended focus of LASA.

Objective: To what extent endogenous subclinical thyroid disorders contribute to impaired physical and cognitive function, depression, and mortality in older individuals remains a matter of debate. Design: A population-based, prospective cohort of the Longitudinal Aging Study Amsterdam. Methods: TSH and, if necessary, thyroxine and triiodothyronine levels were measured in individuals aged 65 years or older. Participants were classified according to clinical categories of thyroid function. Participants with overt thyroid disease or use of thyroid medication were excluded, leaving 1219 participants for analyses. Outcome measures were physical and cognitive function, depressive symptoms (cross-sectional), and mortality (longitudinal) Results: Sixty-four (5.3%) individuals had subclinical hypothyroidism and 34 (2.8%) individuals had subclinical hyperthyroidism. Compared with euthyroidism (nZ1121), subclinical hypo-, and hyperthyroidism were not significantly associated with impairment of physical or cognitive function, or depression. On the contrary, participants with subclinical hypothyroidism did less often report more than one activity limitation (odds ratio 0.44, 95% confidence interval (CI) 0.22–0.86). After a median follow-up of 10.7 years, 601 participants were deceased. Subclinical hypo- and hyper-thyroidism were not associated with increased overall mortality risk (hazard ratio 0.89, 95% CI 0.59–1.35 and 0.69, 95% CI 0.40–1.20 respectively). Conclusions: This study does not support disadvantageous effects of subclinical thyroid disorders on physical or cognitive function, depression, or mortality in an older population.

No abstract available.

We examined the associations between extracerebral markers of cholesterol homeostasis and cognitive decline over 6 years of follow-up, and studied the modifying effect of apolipoprotein E (ApoE) e4. Data were collected in the Longitudinal Aging Study Amsterdam (n = 967, with longitudinal data on cognition, ages ≥ 65 years) and analyzed using linear mixed models. General cognition (Mini-Mental State Examination; MMSE), memory (Auditory Verbal Learning Test), and information processing speed (Coding task) were measured. The results show that ApoE e4 was a significant effect modifier. Significant associations were found only in ApoE e4 noncarriers (n = 718). We found a nonlinear negative association between the ratio of lanosterol to cholesterol (≤ 189.96 ng/mg), a marker for cholesterol synthesis, and general cognition. Lower cholesterol absorption, i.e., lower ratios of campesterol and sitosterol to cholesterol, as well as a higher rate of cholesterol synthesis relative to absorption were associated with lower information processing speed. In ApoE e4 carriers, the negative association between the ratio of campesterol to cholesterol and memory reached borderline significance. Future research should focus on the interaction between (disturbed) cholesterol homeostasis and ApoE e4 status with respect to dementia.

Patients with Parkinson’s disease (PD) are likely to become physically inactive, because of their motor, mental, and emotional symptoms. However, specific studies on physical activity in PD are scarce, and results are conflicting. Here, we quantified daily physical activities in a large cohort of PD patients and another large cohort of matched controls. Moreover, we investigated the influence of disease-related factors on daily physical activities in PD patients. Daily physical activity data of PD patients (n = 699) were collected in the ParkinsonNet trial and of controls (n = 1,959) in the Longitudinal Aging Study Amsterdam (LASA); data were determined using the LAPAQ, a validated physical activity questionnaire. In addition, variables that may affect daily physical activities in PD were recorded, including motor symptoms, depression, disability in daily life, and comorbidity. Patients were physically less active; a reduction of 29% compared to controls (95% CI, 10–44%). Multivariate regression analyses demonstrated that greater disease severity, gait impairment, and greater disability in daily living were associated with less daily physical activity in PD (R2 = 24%). In this large study, we show that PD patients are about one-third less active compared to controls. While disease severity, gait, and disability in daily living predicted part of the inactivity, a portion of the variance remained unexplained, suggesting that additional determinants may also affect daily physical activities in PD. Because physical inactivity has many adverse consequences, work is needed to develop safe and enjoyable exercise programs for patients with PD.

Background: Thirty percent of people aged 65 years or older fall at least once a year, and about a quarter seek medical attention. Existing falls risk profiles are too complex for daily use. We describe a falls decision tree consisting of three simple questions that provides a quick indication of the risk of recurrent falls in older people who have recently fallen down Methods: We investigated simple, easy to measure predictors of repeated falls in 408 community-dwelling older people (65+ years) who had consulted a GP or gone to an accident and emergency (A&E) department after falling down. These predictors were then used to develop a falls decision tree, to indicate when a new fall can be expected. The decision tree was validated in a second sample of patients. Results: Three predictors, namely, falls history, fear of falling, and use of a walking aid, in combination provided an adequate indication of the risk of a new fall. The risk of a new fall was 9% if none of the predictors was present and 42% if all three predictors were present. If high falls risk was defined as a higher than 30% risk of new falls, then 80% of the participants in the development sample and 70% of the participants in the validation sample were correctly classified as having a high falls risk. Conclusion: The falls decision tree is a simple tool for use in GP surgeries or in A&E departments to assess the risk of a new fall in older individuals who have recently fallen down.

Objective: To determine the possible longitudinal relationships between hearing status and depression, and hearing status and loneliness in the older population. Design : Multiple linear regression analyses were used to assess the associations between baseline hearing and 4-year follow-up of depression, social loneliness, and emotional loneliness. Hearing was measured both by self-report and a speech-in-noise test. Each model was corrected for age, gender, hearing aid use, baseline wellbeing, and relevant confounders. Subgroup effects were tested using interaction terms. Study sample : We used data from two waves of the Longitudinal Aging Study Amsterdam (2001 – 02 and 2005 – 06, ages 63 – 93). Sample sizes were 996 (self-report (SR) analyses) and 830 (speech-in-noise test (SNT) analyses). Results : Both hearing measures showed signifi cant adverse associations with both loneliness measures (p  0.05). However, stratifi ed analyses showed that these effects were restricted to specifi c subgroups. For instance, effects were signifi cant only for non-hearing aid users(SR-social loneliness model) and men (SR and SNT-emotional loneliness model). No signifi cant effects appeared for depression. Conclusions : We found signifi cant adverse effects of poor hearing on emotional and social loneliness for specifi c subgroups of older persons. Future research should confi rm the subgroup effects and may contribute to the development of tailored prevention and intervention programs.

Health consequences of retirement have not been included in the current public debate about increasing the age at retirement, which might be due to the fact that studies aimed at health consequences of retirement show ambiguous results. The literature indicates that various contextual characteristics might explain conflicting results. The current study examines the effect of retirement and age at retirement (55–64 years) on self-perceived health. Characteristics tested for confounding and effect modification were: demographic, health, psychological, job, and retirement characteristics. Subjects were 506 participants in the Longitudinal Aging Study Amsterdam (LASA). After three years, 216 retired and 290 remained employed. Multinomial logistic regression analyses show no main effect for retirement compared to continued employment. Modal (59–60) retirees were more likely to attain excellent or good self-perceived health (less than good self-perceived health as the reference category). Early (55–58) and late (61–64) retirees were unaffected by retirement if they did not receive a disability pension. Early and late retirees who received a disability pension were less likely to attain excellent self-perceived health after retirement. Higher educated were less likely to attain excellent selfperceived health after retirement, especially at late retirement age, although health selection might explain this result. Finally, mastery possibly acts as an adjustment resource. The paper concludes with a discussion on explanations for the effect of retirement and age at retirement.

There has been a debate for over a decade in the Netherlands about whether physicians should be allowed to provide assistance with suicide to older people who are ‘weary of life’. Actual knowledge about these older people is missing in this debate. The purpose of this article is to explore and discuss the expectations older people who are ‘weary of life’ have of their future, and to what extent they perceive their suffering as hopeless. In this qualitative study, 31 older people who were ‘weary of life’ were interviewed The results of this study show that most respondents who were ‘weary of life’ did not plan to end their life within a short time frame. The burden to their loved ones played a large role in their decision in addition to the awareness of still having reasons to live. Most respondents tried not to think too much about the future, and hoped death would come soon. Most respondents could not name a condition that would diminish their wish to die, that they also found desirable and feasible. The results of this study suggest that people who develop thoughts about death do so when they give up finding solutions to improve their situation.

Objectives: To investigate whether specific domains of cognitive functioning predict the natural course of depressive symptoms in older people. Design and Participants: Using the nationally representative, population-based cohort of the Longitudinal Aging Study Amsterdam, 281 participants with clinically relevant depressive symptoms (Center for Epidemiological Studies Depression Scale &#8805;16) aged 55 years and older were followed longitudinally during a period of 6 years. Measurements: Using a maximum of 14 successive Center for Epidemiological Studies Depression Scale observations, three clinical course types of depressive symptoms were defined. At baseline, general cognitive functioning was assessed using the Mini-Mental State Exam, memory performance (immediate recall and retention) by means of the auditory verbal learning test, and processing speed by means of a timed coding task. Results: Remission, fluctuating course, and chronic course were seen in 22%, 50%, and 28%, respectively. In univariate analyses, a slowed processing speed was associated with a chronic course of depressive symptoms, as compared with remission (mean: 21.5, SD: 6.6, versus mean: 24.6, SD: 6.8, t = 2.78, df = 139, p < 0.001). Using multivariate regression techniques, this association remained significant after correcting for potential confounders and a number of risk factors for vascular brain damage (odds ratio: 1.08, 95% confidence interval: 1.01–1.14). Neither global cognitive functioning nor memory performance was associated with any course type of depressive symptoms. Conclusion: We found an independent association of a slowed processing speed with a poor natural course of depressive symptoms in older people. In clinical practice, when dealing with an older depressed person with comorbid cognitive decline, processing speed might be a more useful tool than the Mini-Mental State Exam in predicting the prognosis.

Undernutrition may be an important modifiable risk factor for poor clinical outcomes in older individuals. To achieve earlier detection or prevention of undernutrition, more information is needed about risk factors for the development of undernutrition in community-dwelling older individuals. The objective was to identify early determinants of incident undernutrition in a prospective population-based study. Baseline data (1992–3) on socio-economic, psychological, medical, functional, lifestyle and social factors of 1120 participants aged 65–85 years of the Longitudinal Aging Study Amsterdam were used. Undernutrition, defined as a BMI , 20 kg/m2 or self-reported involuntary weight loss $ 5% in the last 6 months, was assessed every 3 years during a 9-year follow-up period. Cox proportional-hazards regression analysis was used to investigate the association between early determinants at baseline and incident undernutrition. In 9 years, 156 participants (13·9 %) developed undernutrition. In univariate analyses, female sex, depressive symptoms, anxiety symptoms, multiple chronic diseases, high medication use (women), poor appetite, no alcohol use v. light alcohol use, loneliness, not having a partner, limitations in performing normal activities due to a health problem, low physical performance (participants aged , 75 years) and reporting difficulties walking stairs (participants aged , 75 years) were statistically significantly associated with incident undernutrition. In a multivariate model, poor appetite and reporting difficulties walking stairs (participants aged , 75 years) remained early determinants. The results of the present study can be used to identify subgroups of older individuals with increased risk of undernutrition and to identify modifiable determinants for the purpose of prevention of undernutrition.

BACKGROUND: In the past decades knowledge on adequate treatment of affective disorders and awareness of the negative consequences of long-term benzodiazepine use increased. Therefore, a decrease in benzodiazepine use is expected, particularly in prolonged use. The aim of this study was to assess time trends in benzodiazepine use. METHODS AND MATERIAL: Data from the Longitudinal Aging Study Amsterdam (LASA) were used to investigate trends in benzodiazepine use between 1992 and 2002 in two population-based samples aged 55-64 years. Differences between the two samples with respect to benzodiazepine use and to sociodemographic, physical health and mental health characteristics were described and tested with chi-square tests and logistic regression analyses. RESULTS: Benzodiazepine use remained stable over 10 years, with 7.8% in LASA-1 (n = 874) and 7.9% in LASA-2 (n = 919) (p = 0.90) with a persisting preponderance in women and in people with low education, low income, chronic physical diseases, functional limitations, cognitive impairment, depression, anxiety complaints, sleep problems and when using antidepressants. Long-term use remained high with 70% in 1992 and 80% in 2002 of total benzodiazepine use. CONCLUSION: In the Dutch population aged 55-64, overall benzodiazepine use remained stable from 1992 to 2002, with a high proportion of long-term users, despite the effort to reduce benzodiazepine use and the renewal of the guidelines. More effort should be made to decrease prolonged benzodiazepine use in this middle-aged group, because of the increasing risks with ageing.

Friendship has increased in importance during the last few decades. The study examines whether friendship has become more prevalent in personal networks of older adults. Three cohorts of older persons have been followed since 1992 for 17 years in the Longitudinal Aging Study Amsterdam. The younger cohort had friends more often and retained friends longer than two older cohorts. The differences are related to personal choice, relational competence and greater structural opportunities for making and keeping friends that were available to the younger cohort. Women retained same-sex friends longer than men. The oldest women lost cross-sex friends more often than did men. This is related to different gender-specific survival rates and to women’s tendency to retain friendships longer.

The mental and physical health of 146 Dutch males exposed to severe war stress during their young adulthood were examined in 1986-1987 when they were at ages 61 to 66 years. The veterans\\\'data were compared with a randomly selected population-based sample of same-aged males. In 2005, 70% of the war stress veterans had died, and only 35% of the comparison group. The baseline quality of life was significantly poorer in the war stress veterans than in the comparison group. Baseline variables explained 42% of the increased risk of mortality among war stress veterans. Smoking was the largest single contributor to mortality.

This article discusses the consequences of sarcopenia in older persons. The focus is on three specific consequences: (1) functional status, (2) falls, and (3) mortality. The described relationship between sarcopenia and these outcomes is based on the results of epidemiologic studies in large cohorts of older men and women. The original definition of sarcopenia refers to the age-related loss of muscle mass. However, it is important to realize that as yet very limited data have been published on repeated measures of muscle mass in older persons to establish that the age-related change is muscle mass and to subsequently relate this change to negative health outcomes. Therefore, this overview is mainly based on both cross-sectional and longitudinal, epidemiologic studies using a single assessment of muscle mass. In these studies, the health outcomes of older persons with a lower muscle mass have been compared with those of older persons with a higher muscle mass. In other studies the term “sarcopenia” was used to define older persons with a low muscle mass. These sarcopenic persons were then contrasted with older persons with a normal muscle mass to investigate potential differences in various health outcomes. In the scientific literature the term “sarcopenia” has also been used in a much broader sense, for example to indicate the age-related loss of muscle strength or the presence of poor muscle strength in older persons. In this article, the term “dynapenia” is used to describe this process. Sarcopenia and dynapenia are distinct processes with different pathophysiology. Although the two processes may occur simultaneously in some individuals, they do not necessarily overlap.1 The use of these two different terms allows a clear distinction between the consequences of low muscle mass and those of low muscle strength.

Background: Increased mortality risk at low body mass index values is well established for older persons. It is, however, unclear how the underlying body mass components (fat and muscle mass – FM and MM, respectively) are associated with mortality in old age. Objective: This study aimed to examine the mortality risk of four body composition measures (appendicular skeletal MM, leg, arm and trunk FM) with 12-year mortality in community-dwelling older men and women. As a secondary objective, the influence of cancer, obstructive lung disease, smoking and previous weight loss on these associations was examined. Methods: Data were used from the Longitudinal Aging Study Amsterdam, a random population-based cohort study (55–85 years) in the Netherlands. Body composition was determined in 1995–1996 by dual energy X-ray absorptiometry. The present study included 477 community-dwelling persons aged &#8807;65 years who were followed until 2007 for their vital status. Results: Twelve-year mortality rates were 133/242 (55%) in men and 92/235 (39%) in women. Since most associations were U- or J-shaped, only observations below the sample mean were included to calculate hazard ratios (HRs) per one SD lower value. Adjusted for height, age and each other, lower appendicular skeletal MM [HR 1.59 (95% CI: 1.04–2.42)] and lower leg FM [1.68 (1.04–2.72)] in men and lower trunk FM [1.61 (1.02–2.53)] in women were associated with an increased mortality risk. Associations attenuated and became statistically nonsignificant in men after adjustment for cancer, obstructive pulmonary disease and smoking and in women after additional adjustment for previous 3-year weight change. Conclusions: In older men, lower MM and lower leg FM are associated with an increased mortality risk, while in older women only lower trunk FM is associated with an increased risk. The causality of these associations is debated. Suggested sex differences deserve further study.

This paper presents a case study of the challenges and requirements associated with harmonising data from two independently-conceived datasets from The Netherlands and the United Kingdom: the Longitudinal Aging Study Amsterdam (LASA) and the Nottingham Longitudinal Study of Activity and Ageing (NLSAA). The objectives were to create equivalent samples and variables, and to identify the methodological differences that affect the comparability of the samples. Data are available from the two studies\\\' 1992–93 surveys for respondents born during 1908–20, and the common data set had 1,768 records and enabled the creation of 26 harmonised variables in the following domains: demographic composition and personal finances, physical health, mental health and loneliness, contacts with health services, physical activity, religious attendance and pet ownership. The ways in which the methodological differences between the two studies and their different selective attrition might lead to sample differences were carefully considered. It was concluded that the challenges of conducting cross-national comparative research using independent datasets include differences in sampling, study design, measurement instruments, response rates and selective attrition. To reach conclusions from any comparative study about substantive socio-cultural differences, these challenges must first be identified and addressed.

Serious life events, such as the loss of a relative or the onset of a chronic condition may influence cognitive functioning. We examine whether the cognitive impact of such events is stronger if conditions very early in life were adverse, using Dutch longitudinal data of older persons. We exploit exogenous variation in early-life conditions as generated by the business cycle.

Achtergrond: De vraag hoe religie met depressie samenhangt, laat zich vaak in verband brengen met schuldgevoelens en ook met christelijke doctrines over schuld. Doel: In de huidige verkennende studie komt de vraag aan de orde hoe aspecten van het godsbeeld (in godsdienstpsychologische zin) samenhangen met schuldgevoelens, zowel onder niet-depressieve ouderen als bij ouderen met aanwijsbare depressieve symptomen. Methoden: Het betreft een cross-sectionele studie in 2005 onder de oudere bevolking in Sassenheim (N = 67, 68-93 jaar), welke is opgezet als een pilot studie voor de Longitudinal Aging Study Amsterdam. Depressieve symptomen zijn gemeten met de Center for Epidemiologic Studies Depression Scale (CES-D), waaraan één item over schuld is toegevoegd. Godsbeeld is onderzocht met de Vragenlijst Godsbeeld, twee subschalen van de God Image Scale en met items van de brief RCOPE. Resultaten: Bij niet depressieve ouderen (CES-D < 16; n = 44) hangen schuldgevoelens significant samen met positieve gevoelens naar God en een perceptie van God als steunend. Ook bestond er een sterke samenhang met schuldattributie, als wijze van religieuze coping. Bij depressieve ouderen (CES-D >= 16; n = 15) zijn deze samenhangen van gelijke sterkte, maar door de kleine groepsgrootte niet meer significant. Wel hangen schuldgevoelens in de depressieve groep sterk samen met de perceptie van God als heersend en straffend, en met de perceptie van God als stimulerend en uitdagend. Schuldgevoelens bij depressieven zijn meer uitgesproken aanwezig bij protestanten dan bij rooms-katholieken. Conclusie: Bij ouderen lijken schuldgevoelens in de normale situatie een weergave van een als steunend beleefde omgang met God. Bij ouderen met depressieve symptomen blijken schuldgevoelens te getuigen van belevingen naar God als heersend, straffend, of op de proef stellend. Mogelijk lopen depressogene cognities parallel aan dit meer autoritaire godsbeeld, al dan niet gelijktijdig met een depressieve episode.

Objective: The prevalence rate of depression among patients with Parkinson’s disease (PD) has been estimated at 25%, although prevalence figures range between 7–76%. Relatively few studies on PD and depression are based on random samples in the general population. Some depressive symptoms can also be understood as symptoms of parkinsonism, and the current study aims to describe which ‘overlap’ symptoms can be identified in a community sample. Methods: Data are employed from the EURODEP collaboration. Nine study centres, from eight western European countries, provided data on depression (most GMS-AGECAT), depressive symptoms (EUROD items and anxiety), parkinsonism (self-report of PD or clinical signs of PD), functional disability and dementia diagnosis. Results: Data were complete for 16 313 respondents, aged 65 and older; 306 (1.9%) reported or had signs of parkinsonism. The rate of depression was about twice as high among respondents with parkinsonism (unadjusted Odds Ratio 2.44, 95% Confidence Interval 1.88–3.17), also among those without functional disability. ‘Overlap’ symptoms between parkinsonism and depression, were represented by motivation and concentration problems, appetite problems and especially the symptom of fatigue (energy loss). However, principal component analysis showed that these ‘overlap’ symptoms loaded on different factors of the EURO-D scale. Conclusions: As among clinical patients with PD, depression is highly common in community dwelling older people with parkinsonism, even among those without functional disability. Although fatigue did not strongly relate to motivational symptoms, both types of ‘overlap’ symptoms possibly trigger a final common pathway towards a full depressive syndrome.

The study compares the formal and informal social participation of 60–69 year olds in The Netherlands in 1992 and 2002, and examines which attributes of the two cohorts favour social participation. Using data from the Longitudinal Aging Study Amsterdam, it was found that cohort differences in formal participation (as members of organisations, in volunteer work and in religious organisations) and in informal participation (having a large social network, and in cultural and recreational activities) associated with cohort differences in individual characteristics (level of education, health, employment status and marital status). Descriptive analyses showed an increase between 1992 and 2002 in all forms of participation except religious involvement. The 2002 cohort members were more educated and more engaged in employment, but in worse health and had a higher prevalence of divorce than the 1992 cohort members. Logistic regression analyses showed that the positive effect on social participation of the recent cohort\\\\\\\\\\\\\\\'s higher educational level was suppressed by the negative effect of their worse health. Being divorced had mixed effects on formal and informal participation, but the difference in the number of divorcees did not explain cohort differences in social participation. Interaction effects showed that the influence of sex and health on volunteer work and religious involvement changed over time. The paper concludes with a discussion of the prospects for higher levels of formal and informal social participation among future cohorts of young-older people.

Given population aging and the productive potential of older people, it is important to examine how individual and societal developments affect social engagement in later life. The study aimed to disentangle the effects of age, aging, and cohort on volunteering among the young old. Using data from the Longitudinal Aging Study Amsterdam, we examined volunteering rates of young olds (N&#8201;=&#8201;2,745) in two decades: those being 55–69 years old in 1992 and their age-peers in 2002. Six-year follow-up on both cohorts allowed for cohort-sequential analyses. Multilevel logistic regression analyses revealed that (i) regardless of age, the 2002 cohort volunteered more often than the 1992 cohort, (ii) in 6 years’ time volunteering increased for the 55- to 59-year-olds, stabilized among the 60- to 64-year-olds, and declined among the 65- to 69-year-olds, and (iii) these age-differential changes were observed in both cohorts. These effects remained significant after adjusting for gender, education, religious involvement, health, employment status, network size, and partner status. A higher education, religious involvement, staying in good health, and maintaining a large network increased the likelihood of volunteering. Unobserved factors, such as a more positive view on aging within society, may also account for the large increase in volunteering among the recent cohort of young olds.

Context: Numerous studies have investigated the effect of serum IGF-I concentration on aging and different aging-related diseases, e.g. cardiovascular disease (CVD) and cancer. Decreased as well as increased levels have been reported to be associated with reduced life expectancy in humans. Objective: This study investigates the association of serum IGF-I concentration with all-cause and cause-specific mortality of community-dwelling older persons and the development of CVD and cancer. Design, Setting, and Participants: Data were used from the Longitudinal Aging Study Amsterdam (LASA), an ongoing multidisciplinary cohort study in the general Dutch population of older persons (
65 yr old)whereserumIGF-Iwasmeasured (n
1273).The mortality information was ascertained using the International Classification of Diseases, 10th revision, and the presence or absence of CVD and cancer by self-reports with a follow-up of 11.6 yr. Main Outcome Measure: We measured all-cause, CVD, and cancer mortality and nonfatal CVD and cancer. Results: Fully adjusted Cox proportional hazards models demonstrated an increased risk of allcause mortality for older persons with IGF-I values in the lowest quintile as compared to the middle quintile [hazard ratio (HR), 1.28; 95% confidence interval (CI), 1.01–1.63]. A more than 2-fold increased risk of CVD mortality was revealed for both low-normal (HR, 2.39;95%CI, 1.22–4.66) and high-normal (HR, 2.03; 95% CI, 1.02–4.06) IGF-I values. Significant associations of serum IGF-I with nonfatal CVD and fatal and nonfatal cancer were not observed. Conclusions: Results suggest a U-shaped relationship between IGF-I level and mortality, with fatal CVD as the most critical outcome in community-dwelling older persons.

Objective: To investigate whether serum cortisol levels are associated with cognitive performance and cognitive decline in elderly persons and whether this association differs by age, sex, and depression status. Design: Data from the Longitudinal Aging Study Amsterdam, with repeated measurements of cognitive performance after 3 and 6 years. Participants: A total of 1,154 persons, aged 65–88 years. Measurements: Serum concentrations of total cortisol (CRT) and corticosteroid binding globulin (CBG) were measured at baseline, and from these free cortisol index (CRT/CBG) was computed. At baseline and 3 and 6 years of follow-up, global cognitive functioning, verbal memory performance, and speed of information processing were assessed. Results: After adjustment for demographics, health, and life style variables, a significant association between high levels of free cortisol and poorer performance on verbal learning (B = -0.32; 95% confidence interval: -0.64 to -0.01) was found in both women and men. Additional adjustment for depression did not change this association. In women, but not in men, high levels of free cortisol (B = -0.85; 95% confidence interval: -1.40 to -0.31) were associated with slower speed of information processing. The associations between cortisol and cognitive performance were the same for the younger and the older old and for depressed and nondepressed persons. Higher levels of cortisol were not associated with cognitive decline over a period of 6 years. Conclusion: Our study provides further evidence that high levels of cortisol measured during the day are associated with lower memory function and speed of information processing but not with decline in cognitive functioning over 6 years of time.

This study examines the consequences of retirement for the continuation of work-related personal ties. The hypothesis is that their inclusion in personal networks after retirement has become more likely because these relationships have become less role based in today’s social-cultural context. Data are from the Longitudinal Aging Study Amsterdam. Members of two cohorts born during the periods 1928–1937 (N = 109) and 1938–1947 (N = 131) were interviewed in 1992 and 2002, respectively, with a follow-up 3 years later. Among retirees, the likelihood of having work-related relationships in their personal network after retirement increased by 19% in 10 years. This suggests that retirement has become less disruptive. Retirees seem more inclined to form intrinsically rewarding work-related relationships that continue to be important following retirement.

No abstract available.

Midlife is a period during which ageing-related health problems first emerge. In view of increasing life expectancy, it is of great importance that people in midlife adapt to possible health problems, to be able to lead productive and engaged lives as long as possible. It may be expected that given the better circumstances in which more recent cohorts grew up, they are better equipped to adapt to health problems than earlier cohorts. This study addresses the question if the way people in midlife adapt to health problems is or is not improving in the Netherlands. The study is based on the nationally representative 1992–1993 and 2002–2003 cohorts of the Longitudinal Aging Study Amsterdam (ages 55–64 years), with follow-up cycles in 1995–1996 (n = 811) and 2005–2006 (n = 829), respectively. Mastery is considered as a measure of adaptation, and 3-year change in mastery is compared in subjects without and with health problems at baseline. A rise was observed in the prevalence of diabetes, chronic lung disease, arthritis, subthreshold depression, and disability. Subjects without health problems in the recent cohort had better mastery than their counterparts in the early cohort. Regardless of cohort membership, mastery declined over 3 years for those with subthreshold depression, mild disability, chronic lung disease, and stroke. In the recent cohort only, mastery declined for those with cognitive impairment, but improved for those with heart disease. These findings do not support the expectation that recent cohorts are better equipped to deal with health problems for conditions other than heart disease.

Background: It has been hypothesized that stressful life events are associated with changes in hypothalamic–pituitary–adrenal (HPA) axis regulation, which increases susceptibility to psychiatric disorders. We investigated the association of early and late life events with HPA axis regulation in older persons. Method: Within the Longitudinal Aging Study Amsterdam (LASA) 1055 participants (47% male), aged 63–93 years, collected saliva within 30 min after waking and late in the evening. Early and late life events were assessed during a home interview. The associations between life events and cortisol levels were examined using linear regression and analysis of covariance with adjustments for demographics, cardiovascular risk factors and depressive symptoms. Results: Within our sample, the median morning and evening cortisol levels were 15.0 nmol/l [interdecile range (10–90%): 7.4–27.0 nmol/l] and 2.8 nmol/l (10–90%: 1.5–6.3 nmol/l), respectively. Persons who reported early life events showed lower levels of natural log-transformed morning cortisol [B=-0.10, 95% confidence interval (CI) -0.17 to -0.04] and flattened diurnal variability of cortisol (B=-1.06, 95% CI -2.05 to -0.08). Those reporting two or more late life events showed higher levels of natural log-transformed morning cortisol (B=0.10, 95% CI 0.02–0.18) and higher diurnal variability (B=1.19, 95% CI 0.05–2.33). No associations were found with evening cortisol. Conclusions: The results of this large population-based study of older persons suggest a differential association of early and late life events with HPA axis regulation ; early life events were associated with a relative hypo-secretion of morning cortisol and flattened diurnal variability, while late life events were associated with elevated secretion of morning cortisol and high diurnal variability of cortisol.

No abstract available.

No abstract available.

Background: There is an ongoing debate about the applicability of current criteria for large waist circumference (WC) in older adults. Objectives: Our aim was to explore cut-off values for large WC in adults aged 70 years and older, using previously used and new methods. Design: Prospective cohort study. Participants: Data of 1049 participants of the Longitudinal Aging Study Amsterdam (LASA) (1995-1996), aged 70-88y, were used. Measurements: Measured BMI and WC, and self-reported mobility limitations. Results Linear regression analyses showed that the values of WC corresponding to BMI of 25kg/m2 and 30kg/m2 were higher than the current cut-offs. Cut-offs found in men were 97 and 110cm, whereas 88 and 98cm represented the cut-offs in women. Areas under the Receiver Operating Characteristic (ROC) curves showed that the accuracy to predict mobility limitations improved when the higher cut-offs were applied. Spline regression curves showed that the relationship of WC with mobility limitations was U-shaped in men, while in women, the risk for mobility limitations increased gradually with increasing WC. However, at the level of current cut-off values for WC the odds for mobility limitations were not increased. Conclusion: Based on results of extensive analyses, this study suggests that the cut-offs for large WC should be higher when applied to older adults. The association of WC with other negative health outcomes needs to be investigated to establish the final cut-points.

No abstract available.

Objective: The prevalence of both low testosterone levels and depression increases with age. Currently, there is no consensus regarding the existence of an association. Our study analyses the cross-sectional association of testosterone levels with depressive symptoms and its prospective association with the development of incident depressive symptoms. Design: Longitudinal population-based study; based on the data of the Longitudinal Aging Study Amsterdam (LASA) including 608 men aged &#8805;65&#8201;years (median age 75·6 years). Measurements: Linear and logistic regression between total and free testosterone levels and depressive symptoms as measured by the Center of Epidemiologic Studies Depression (CES-D) scale, taking into account medical and lifestyle factors. Cox Proportional Hazards model was used to assess incident depressive symptoms. Results: Unadjusted linear regression between square-root transformed CES-D scores and free testosterone levels showed a significant inverse association as a continuous variable (&#946;&#8201;=&#8201;&#8722;0·10, P&#8201;<&#8201;0·05), lowest quartile compared to highest (&#946;&#8201;=&#8201;0·12, P&#8201;< 0·05) and with a threshold value of 170&#8201;pmol/l (&#946;&#8201;=&#8201;0·13, P&#8201;<&#8201;0·05). The results remained significant for the group below threshold after adjustment for all confounders (&#946;&#8201;=&#8201;0·09, P&#8201;<&#8201;0·05). Cox Proportional Hazards Model showed a decreased risk for incident depressive symptoms for men with higher free testosterone levels [HR&#8201;=&#8201;0·997 CI (0·995-1·000)]. Men with the threshold value below 220&#8201;pmol/l were at increased risk of incident depressive symptoms [HR&#8201;=&#8201;1·989 CI (1·173-3·374)]. Conclusions: Free testosterone levels below 170&#8201;pmol/l are associated with depressive symptoms, while free testosterone levels below 220&#8201;pmol/l (lowest quintile of our population) predict the onset of depressive symptoms.

No abstract available.

Evolutionary explanations of low fertility in modern affluent societies commonly state that low fertility is the outcome of high parental investments in the quality of their children. Although the empirical evidence that modern parents do face a quantity–quality trade-off is strong, two issues that are relevant from an evolutionary perspective have not received much attention. First, sex differences in the proximate aspects of quality have been largely ignored. Second, the relationship between the quantity of children and their reproductive success in contemporary low-fertility societies remains unclear. In this article, we study the quantity–quality trade-off as a trade-off between the number of children and the mate value and reproductive success of those children. We examine the trade-off in two steps. First, a lower number of children is expected to increase the mate value of these children. Second, greater mate value is expected to lead to greater reproductive success. Using sex-specific indicators of mate value, we test these hypotheses in a representative sample of the Dutch population aged 55–85 in 1992 (n=3229). This sample contains information on three successive generations in which the middle generation has completed fertility. We find support for the first hypothesis, but only partial support for the second hypothesis. A higher number of children is traded off against the mate value of the children, but not against their reproductive success. We conclude that the conditions under which the quantity of children is traded off against their reproductive success depend on the social environment.

The aim of the current study was to examine the association between homocysteine and 6-year cognitive decline, and the modifying role of the inflammatory markers Interleukin-6 (IL-6), C-reactive protein (CRP) and alpha-1-antichymotrypsin (ACT). Data were collected within the Longitudinal Aging Study Amsterdam (ages &#8805;65 years) and analyzed using multiple longitudinal regression models (N = 1257 of whom N = 1076 had longitudinal data). Cognition was measured with the Mini-Mental State Examination (general cognition), Auditory Verbal Learning Test (memory), Coding Task (information processing speed) and Raven Coloured Progressive Matrices (fluid intelligence). Higher homocysteine at baseline was negatively associated with prolonged lower cognitive functioning and a faster rate of decline in information processing speed and fluid intelligence. The negative association between higher homocysteine and immediate recall was strongest in persons with a high level of IL-6. Only in the highest tertile of CRP, higher homocysteine was negatively associated with retention. In the middle tertile of ACT, higher homocysteine was associated with lower information processing speed and faster decline. Both in the lower and middle tertile of CRP, higher homocysteine was associated with a faster rate of decline in information processing speed. The results implicate that a combination of both risk factors may be used as a marker for cognitive impairment.

No abstract available.

This article discusses challenges of language differences in qualitative research, when participants and the main researcher have the same non-English native language and the non-English data lead to an English publication. Challenges of translation are discussed from the perspective that interpretation of meaning is the core of qualitative research. As translation is also an interpretive act, meaning may get lost in the translation process. Recommendations are suggested, aiming to contribute to the best possible representation and understanding of the interpreted experiences of the participants and thereby to the validity of qualitative research.

Objective: To assess psychometric quality of the vision-related quality of life core measure (VCM1) and feasibility in a community-based sample. Study Design and Setting: Cross-sectional data were used from an observational study among visually impaired patients (n5296) and a community-based sample with low vision (n598) from the Longitudinal Aging Study Amsterdam. Calibration was performed within the graded response model on the patient sample, including item fit, differential item functioning (DIF), DIF impact, and psychometric information. DIF between both samples was investigated for assessing feasibility of the VCM1 in community-based studies. Results: All items fitted the model. There was no significant DIF within the patient sample, except between self-report and proxy report subgroups. The maximum difference in expected scores was -0.42. Item information was highest for item 4 ‘‘depression’’ and lowest for item 1 ‘‘embarrassment.’’ Test information showed full coverage of the disability continuum. DIF was present between patient and community-based samples. However, DIF items had low impact on the expected test scores. Conclusions: DIF that was found on single items between administration type subgroups and sample subgroups was negligible at the level of the expected test scores. This means that DIF had no substantial impact on the VCM1. Therefore, psychometric quality and feasibility of the VCM1 can be considered satisfactory.

This article examines the effect that family structure has on the contact between older adults and their (step)children. A comparison is made among 3 family structures: biological families, complex stepfamilies, and simple stepfamilies. The sample consists of respondents aged 55 years or older from the “Living Arrangements and Social Networks of Older Adults in the Netherlands” survey of 1992. The contact between biological relationships and steprelationships is measured by means of two items: contact frequency and whether contact is perceived as regular and important. Parents have less contact with their biological children in stepfamilies compared with parents with their children in biological families. The contact with biological children is perceived as more often regular and important in biological families and complex stepfamilies compared with simple stepfamilies. No difference was found in the contact between stepparents and stepchildren in simple and complex stepfamilies. However, the contact with stepchildren is perceived as more often regular and important in simple stepfamilies in comparison to complex stepfamilies. It is not so much the difference between biological children and stepchildren that counts when studying the contact between (step)parents and (step)children, as what the structure of the aging (step)family is.

This study tests whether the relationship between physical activity and (recurrent) falling is U-shaped. Among 1,337 community-dwelling older persons, no evidence for a nonlinear association was found. If all older persons increase their physical activity level with 100 units, 4% may be prevented to become recurrent fallers. INTRODUCTION: Previous studies suggest a U-shaped relationship between physical activity and falling. This study tests this hypothesis and examines whether this relationship is modified by level of physical functioning. METHODS: Community-dwelling persons (65+) from the Longitudinal Aging Study Amsterdam (LASA) were prospectively followed on falls for 3 years after baseline assessment in 1995/1996 (n = 1,337). Outcome measures were time to first fall and time to recurrent falling. The LASA Physical Activity Questionnaire was used to calculate physical activity in minutes per day weighted for intensity (range 0-2000). Physical functioning was measured with physical performance tests and self reported functional limitations. Confounders were age, sex, body mass index, chronic diseases, psychotropic medication, cognitive functioning, depressive symptoms, and fear of falling. RESULTS: No evidence for a nonlinear association was found (p for physical activity(2) > 0.20). No significant association was found between physical activity and time to first fall. An increase in physical activity of 100 units led to a 4% decrease in risk of recurrent falling (adjusted hazard ratio 0.96, 95% confidence interval 0.92, 0.99). No interactions with physical performance or functional limitations were found (p > 0.50). CONCLUSIONS: The hypothesized U-shaped relationship between physical activity and falling could not be confirmed. At higher levels of physical activity, the risk of recurrent falling decreased, while no association was found with fall risk.

Background: This study explored the associations between various types of activities, their underlying physical components, and recurrent falling in community-dwelling older persons. Methods: This study included 1,329 community-dwelling persons (>/=65 years) of the Longitudinal Aging Study Amsterdam (LASA). The time spent in walking, cycling, light and heavy household activities, and two sports was measured using the LASA Physical Activity Questionnaire (LAPAQ). Physical activity components included strength, intensity, mechanical strain, and turning. Time to second fall in a 6-month period was measured during 3 years with fall calendars. Cox proportional hazards models were adjusted for confounders and stratified for physical performance and sex in case of significant (p < .10) interaction. RESULTS: During 3 years, 325 (24.5%) persons became recurrent fallers. In women, doing light (hazard ratios [HRs] = 0.40, 95% confidence intervals [CIs] = 0.20-0.79) or heavy household activities (HR = 0.63, CI = 0.44-0.79) was associated with a decreased risk of recurrent falling. In persons with good physical performance, doing sports (HR = 1.56, CI = 1.07-2.28), high intensity (HR > 1.75, CI = 1.09-3.16), and high mechanical strain (HR = 1.70, CI = 1.01-2.83) activities was associated with an increased risk of recurrent falling. CONCLUSIONS: The results suggest that the relationship between physical activity and recurrent falling differs per type of activity and is modified by physical performance. Doing household activities was associated with a decreased risk of recurrent falling in women. In physically fit older persons, doing sports or activities with high intensity or mechanical strain demands was associated with an increased risk of recurrent falling.

Objectives: The fall risk profile developed in the Longitudinal Aging Study Amsterdam (LASA) identifies community-dwelling elderly at high risk for recurrent falling. This study assessed the predictive validity of this profile in older persons seeking care after a fall. Study Design and Setting: The LASA fall risk profile was completed for 408 persons of 65 years and older who consulted the emergency department or general practitioner after a fall. Falls were prospectively reported with a calendar during 1 year. Recurrent falling was defined as >2 falls within a period of 6 months. Results: During 1 year of followup, 76 (18.6%) participants became recurrent fallers. The area under the receiver operating characteristic curve was 0.65 (95% confidence interval [95% CI]: 0.58e0.72). At a cutoff value of 8, the sensitivity was 56.6% (CI: 51.8e61.4), the specificity was 71.4% (CI: 67.0e75.8), the positive predictive value was 34.1% (CI: 29.5e38.7), and the negative predictive value was 85.6% (CI: 82.2e89.0). Conclusion: The discriminative ability of the LASA fall risk profile was moderate. The predictive validity of the LASA fall risk profile to identify recurrent fallers is limited among older persons who consulted the emergency department or general practitioner after a fall.

This paper presents an approach that assesses the role of early life and contemporaneous macroconditions in explaining health at older ages. In particular, we investigate the role of exposure to diseases and economic conditions during infancy and childhood, as well as the effect of current health care facilities. Specific attention is paid to the impact of unobserved heterogeneity, selective attrition, and omitted relevant macrovariables. We apply our approach to self-reports on functional limitations of Dutch older individuals. The prevalence of functional limitations is found to increase in the 1990s, in part due to restricted access to hospital care.

No abstract available.

No abstract available.

Ongeveer 30% van de Nederlanders voelt zich wel eens eenzaam. Maar wat is eenzaamheid eigenlijk en in hoeverre is het een probleem? En kunnen we ook iets doen aan eenzaamheid?

Objective: To examine the association of personality with recurrence of depression in later life. Method: A subsample of 91 subjects from the Longitudinal Aging Study Amsterdam (LASA; baseline sample size n=3107; aged &#8805;55 years) depressed at baseline, who had recovered in the course of three years (first follow-up cycle) was identified. 41 (45%) respondents experienced a recurrence during the subsequent six years. The influences of personality and late life stress (demographic factors, health and social factors) on recurrence were investigated prospectively. Results: Recurrence of depression was associated with a high level of neuroticism and low level of mastery, residual depressive symptoms at time of recovery, female gender, pain complaints and feelings of loneliness. In multivariable analysis entering all predictors significant in single variable analysis, residual depressive symptoms and lack of mastery remained significantly associated with recurrence. Conclusion: In predicting the recurrence of depression in later life, the direct effects of personality remain important and comparable in strength with other late life stressors related to recurrence.

Background: It is evident that physical activity has many benefits, but it often remains unclear which types of activity are optimal for health and functioning in old age. The aim of this methodological study was to propose a method for distinguishing four components underlying self reported physical activity of older adults: intensity, muscle strength, turning actions and mechanical strain. Methods: Physical activity was assessed by the validated LAPAQ questionnaire among 1699 older adults of the Longitudinal Aging Study Amsterdam. Based on expert consultation and literature review, the four component scores for several individual daily and sports activities were developed. Factor analysis was performed to confirm whether the developed components indeed measured different constructs of physical activity. Results: Based on the factor analyses, three components were distinguished: 1. intensity and muscle strength loaded on the same factor, 2. mechanical strain and 3. turning actions. Analyses in gender, age and activity level subgroups consistently distinguished three factors. Conclusion: Future research using these components may contribute to our understanding of how specific daily and sports activities may have a different influence on health and physical functioning in old age.

Background: Low body mass index is a general measure of thinness. However, its measurement can be cumbersome in older persons and other simple anthropometric measures may be more strongly associated with mortality. Therefore, associations of low mid-upper arm circumference, calf circumference, and body mass index with mortality were examined in older persons. Methods: Data of the Longitudinal Aging Study Amsterdam, a population-based cohort study in the Netherlands, were used. The present study included community-dwelling persons 65 years and older in 1992–1993 (n = 1,667), who were followed until 2007 for their vital status. Associations between anthropometric measures and 15-year mortality were examined by spline regression models and, below the nadir, Cox regression models, transforming all measures to sex-specific Z scores. Results: Mortality rates were 599 of 826 (73%) in men and 479 of 841 (57%) in women. Below the nadir, the hazard ratio of mortality per 1 standard deviation lower mid-upper arm circumference was 1.79 (95% confidence interval, 1.48–2.16) in men and 2.26 (1.71–3.00) in women. For calf circumference, the hazard ratio was 1.45 (1.22–1.71) in men and 1.30 (1.15–1.48) in women and for body mass index 1.38 (1.17–1.61) in men and 1.56 (1.10–2.21) in women. Excluding deaths within the first 3 years after baseline did not change these associations. Excluding those with a smoking history, obstructive lung disease, or cancer attenuated the associations of calf circumference (men) and body mass index (women). Conclusions: Based on the stronger association with mortality and given a more easy assessment in older persons, mid-upper arm circumference seems a more feasible and valid anthropometric measure of thinness than body mass index in older men and women.

In a standardized personal interview, elderly (65+)Dutch respondents (N=233),were asked detailed retrospective questions about six physical activities like walking, cycling and their performance of household tasks. Surprisingly, the proportion of inadequate answers was small, suggesting that the interviewers—four professional research nurses—have done their very best to eventually obtain adequate answers. They used three different types of control of the interview process. Firstly, an optimal execution of the prescribed ‘open loop control’, that is, precisely following the text of the questionnaire. Secondly, via the ‘feedback loop control’ of repair: if nevertheless inadequate answers are given, further probing is performed until eventually an adequate answer is obtained. Thirdly, by decomposing a general question into its components, making the question easier to answer (partial questioning). Interaction analysis of transcripts of the interviews showed that the type of control exercised by the interviewers, strongly differed by topic of the question. It appeared that question topics requiring more complex cognitive activities of the respondents, not only lead to more (need for) repair, but also to larger differences between the interviewers concerning their readiness to use partial questioning as an alternative for the open loop control as designed by the researcher.

The hypothalamic-pituitary-adrenal (HPA)-axis regulates the response to stressful events and is expected to be involved in the pathogenesis of depression. The glucocorticoid receptor (GR) regulates the activity of the HPA-axis. Both GR gene polymorphisms and childhood adversity are known to be associated with increased risk for depression. In the Longitudinal Aging Study Amsterdam, a large population based sample of older men and women, 906 subjects were genotyped. An association study was performed to determine the relationship between GR gene polymorphisms, childhood adversity, HPA-axis markers and depressive symptoms. A gene–environment interaction between the GR polymorphisms 22/23EK and 9beta and childhood adversity resulted in an increased risk of clinically relevant depressive symptoms. Without childhood adversity no increased risk was present. The 22/23EK variant was also associated with a lower Free Cortisol Index in the presence of childhood adversity. Persons that are heterozygous for the BclI variant, in contrast with wild-type and BclI-homozygotes, had lower serum levels of cortisol binding globulin and had no increased risk of recurrent depressive symptoms in the presence of childhood adversity. We found a gene–environment (G
E) interaction between common variants of the GR gene and childhood adversity, demonstrating a vulnerable phenotype for developing clinically relevant depressive symptoms at old age. This G
E interaction also influencedHPA-axismarkers providing support for the involvement of theHPA-axis in both stress regulation and the pathogenesis of depression.

The influence of seven highly prevalent somatic chronic diseases on changes in cognitive functioning is investigated in older persons in a prospective design covering a 6-year follow-up period. The data were collected as part of the Longitudinal Aging Study Amsterdam (LASA). The associations between chronic diseases and cognitive functioning during 6 years of follow-up were analyzed among 1358 respondents (age 62–85) using generalized estimated equations (GEE). Cognitive tests were used to assess: general cognitive functioning, fluid intelligence, information processing speed and memory performance. In the fully adjusted models diabetes mellitus, stroke and peripheral artherosclerosis were associated with cognitive decline during a 6-year follow-up period in older persons. In the unadjusted models cardiac disease was negatively associated with memory function. However, after the correction for possible confounders this association became positive. Cancer was also associated with better memory function. A faster decline in especially memory function was found for diabetes mellitus, stroke, cancer, and peripheral artherosclerosis. The study shows that in older persons specific chronic diseases (diabetes mellitus, stroke, cancer, and peripheral artherosclerosis) are associated with decline in one or more domains of cognitive functioning during a 6-year follow-up period. These findings further stress that careful clinical evaluation of cognitive functioning in older persons with these diseases is required in order to provide adequate care.

In deze bijdrage wordt uiteengezet hoe de prevalentie van ziekten,beperkingen en kwetsbaarheid stijgt met de leeftijd in de algemene oudere bevolking. Tevens wordt aandacht besteed aan de rol van inflammatie bij deze aspecten van de gezondheid. Hierbij wordt gebruik gemaakt van de voor Nederlandse ouderen representatieve gegevens van de Longitudinal Aging Study Amsterdam.

In this article, a report is provided of results from the Longitudinal Aging Study Amsterdam (LASA). LASA is a study on determinants and consequences of changes in daily functioning. In this article, the focus is on changes in physical functioning. From longitudinal data, it is observed that many older people experience function loss, especially at higher ages. A host of factors are associated with function loss, such as chronic diseases, cognitive decline, depressive complaints, socio-economic status, and life style. A few of these factors are causal, others are characteristics of groups with raised chances of function loss. From trend analyses, it is apparent that the prevalence of functional limitations is not fixed, but varies over time. The LASA study shows that this prevalence is increasing. In view of the absolute and relative rise of the number of older people in the population, it is of great importance to realise a lower prevalence of function loss and a delay of function loss to older ages. Based on the findings presented, some suggestions for this are given. Also, some directions for future research are described.

No abstract available.

Objective: To investigate the cross-sectional association between personality characteristics and hypothalamic-pituitary-adrenal (HPA) axis regulation in older persons. Methods: The study sample consisted of 1,150 participants (mean age 74.8 ± 7.1 years, 48% male) from the population-based Longitudinal Aging Study Amsterdam. HPA axis activity was measured with salivary cortisol collected after awakening and late in the evening. Outcome measures were awakening and evening cortisol levels (natural log transformed) and the diurnal pattern of cortisol. Determinants were scores on questionnaires assessing neuroticism, mastery, and self-esteem. Results: Multiple linear regression analyses adjusted for potential confounders did not show significant associations between any of the personality characteristics and any of the cortisol measures. On evening cortisol, a significant interaction was observed between neuroticism and age (B = &#8722;0.001; T = &#8722;2.50, df = 1,139; p value = 0.01). After stratification in two age groups, the authors observed that high levels of neuroticism were associated with elevated levels of evening cortisol in subjects aged <75 years (B = 0.02; 95% confidence interval: 0.01–0.03; T = 2.15, df = 630, p = 0.03) but not in subjects aged 75 years or older. Conclusions: The findings of this large population-based study of older persons suggest that the personality characteristics mastery and self-esteem are not associated with HPA axis regulation as measured with salivary awakening and evening cortisol. However, high neuroticism may be associated with elevated levels of evening cortisol in the younger old but not in the older old.

De arbeidsparticipatie van ouderen moet omhoog, aldus de Commissie Arbeidsparticipatie. Dit is niet alleen goed voor de samenleving, ook voor de ouderen zelf. Ouderen zijn immers gezond en werken betekent een maatschappelijke bijdrage leveren. Dit artikel laat zien dat Nederlandse ouderen actief en betrokken zijn bij de maatschappij. Deels via arbeid, maar veel vaker via vrijwilligerswerk, mantelzorg dan wel via meer persoonlijke vormen van participatie, als recreatieve en culturele activiteiten. Chronische ziekten komen echter veelvuldig voor bij ouderen en leiden tot een substantiële afname van zowel arbeids- als maatschappelijke participatie. Verder stelt de Commissie Arbeidsparticipatie dat de levensverwachting toeneemt en dat hiermee zou ook de pensioenleeftijd omhoog zou kunnen. De levensverwachting van Nederlanders neemt inderdaad toe, ook, zij het in mindere mate, op 65 jarige leeftijd. Echter, op deze leeftijd is de verwachting dat mannen en vrouwen slechts 4 respectievelijk 5 jaar doorbrengen zonder chronische ziekten. Bovendien zijn er verschillen in levensverwachting en gezonde levensverwachting tussen hoog- en laagopgeleide ouderen.

Objectives: We examine the extent of emotional and social loneliness among older people and how the evaluation of the functioning and quality of marriages plays a role. Methods: Data on 755 respondents aged 64 – 92 are taken from the Longitudinal Aging Study Amsterdam (Wave 2001 – 2002). Hierarchical negative binomial regression analysis is used. Results: Between 1 in 4 and 5 older adults who are married exhibit moderate or strong emotional or social loneliness. Stronger emotional and social loneliness is observed in adults whose spouse has health problems, who do not often receive emotional support from the spouse, who have nonfrequent conversations or are in disagreement, or who evaluate their current sex life as not (very) pleasant or not applicable. Emotional loneliness is stronger among women in second marriages, whereas marked social loneliness is especially characteristic of older men with disabled spouses. Moreover, smaller social networks and less contact with children also increase emotional and social loneliness in later life. Discussion: Differentiating marital quality and gender provides greater insight into emotional and social loneliness in married older people.

Objectives: Research in older persons with deteriorative health shows a decrease in well-being. The aim of this study was to examine the role of psychological coping resources in the association between health decline and well-being, in a longitudinal design. Method: Data were used from the Longitudinal Aging Study Amsterdam (LASA). Health decline was defined as persistent deterioration of functioning (PDF), persistent decline in cognitive functioning and/or physical functioning, and/or increase of chronic diseases. Measurements of well-being included life satisfaction and positive affect. Measurements of coping resources included self-esteem, mastery, and self-efficacy. Results: Multivariate linear regression analyses showed that self-efficacy, mastery, and self-esteem mediated the association between PDF and change in well-being. Mastery also was a moderator of the association between PDF and life satisfaction. In older persons with a decreasing mastery, PDF was associated with a significant decrease on life satisfaction; this effect was not observed in older persons with stable or increasing mastery. Discussion: This study suggests that coping resources are of importance in explaining associations between persistent health decline and decreasing well-being. Stable or improving mastery even proves to protect older persons with PDF from decreasing well-being.Therefore, it may be of importance to develop interventions for older persons aimed at maintaining or improving psychological coping resources when health declines.

With ageing, older people can become frail, and this has been shown to be associated with a decrease in well-being. Observational studies provide evidence of a positive effect of coping resources on well-being. The question is: can coping resources be improved in vulnerable older people? The Chronic Disease Self-Management Program (CDSMP) is a target group-specific intervention which aims to promote the self-management of older people who are confronted with deteriorating health. The aim of this study was to review intervention studies focusing on the CDSMP and to draw conclusions on the benefits of the program. A systematic search was conducted in PubMed and PsychINFO to identify randomized controlled trials (RCTs) focusing on the CDSMP. Nine RCTs focusing on relatively young older adults, 75% of whom with an average age between 49 and 65 years, were included. We found that the CDSMP was consistently beneficial for Health behaviour, especially with regard to the variables of exercise and self-care. For Health status, the majority of studies only showed improvement in the domain of health distress. Most of the studies that investigated Self-efficacy showed convincing improvement in self-efficacy, cognitive symptom management and mental stress management. In Health care utilization, there was no significant decrease. On the whole, the studies showed that CDSMP led to an increase in physical exercise, a decrease in health distress, an improvement in self-care, and it had a beneficial effect on self-efficacy.

In this prospective study we examined whether total cholesterol and the oxysterols 24S- and 27-hydroxycholesterol were related to cognitive performance and rate of cognitive decline in elderly, and whether these associations were modified by ApoE _4. Data were collected during 6 years of follow-up as part of the Longitudinal Aging Study Amsterdam (N= 1181, age ?65 years), and analyzed using generalized estimating equations. Cognitive performance was measured with the mini-mental state examination (general cognition), the auditory verbal learning test (memory) and the coding task (information processing speed). Lower cholesterol at baseline was negatively associated with both general cognition (p = .012) and information processing speed (p = .045). ApoE modified the association between cholesterol and cognitive decline, and the association between the ratio of 27-hydroxycholesterol to cholesterol and cognitive functioning. In ApoE _4 carriers, lower cholesterol was related to a higher rate of decline on information processing speed (p = .006), and a higher ratio of 27-hydroxycholesterol to cholesterol was related to a lower level of general performance (p = .002) and memory functioning (p = .045). The results implicate that lower total cholesterol may be considered as a frailty marker, predictive of lower cognitive functioning in elderly.

Aim: To evaluate previously developed classification models to make implementation in primary care possible and aid early identification of persons at risk for dementia. Methods: Data were drawn from the OCTO-Twin study. At baseline, 521 persons &#8805; 80 years of age were nondemented, and for 387 a blood sample was available. Predictors of dementia were collected and analyzed in initially nondemented persons using generalized estimating equations and Cox survival analyses. Results: In the basic model using predictors already known or easily obtained (basic set), the mean 2-year predictive value increased from 6.9 to 28.8% in persons with memory complaints and an MMSE score &#8804; 25. In the extended model, using both the basic set and an extended set of predictors requiring further assessment, the 8-year predictive value increased from 15.0 to 45.8% in persons with low cholesterol and an MMSE score &#8804; 24. Conclusion: Both models can contribute to an improved early identification of persons at risk for dementia in primary care.

Context: Serum 25-hydroxyvitamin D [25(OH)D] may influence serum PTH and other parameters of bone health up to a threshold concentration, which may be between 25 and 80 nmol/liter. OBJECTIVE: The aim of the study was to assess the threshold serum 25(OH)D with regard to PTH, bone turnover markers, and bone mineral density (BMD). Design and setting: This was part of the Longitudinal Aging Study Amsterdam, an ongoing cohort study. Participants: A total of 1319 subjects (643 men and 676 women) between the ages of 65 and 88 yr participated in the study. Main Outcome Measures: Serum 25(OH)D, PTH, osteocalcin, urinary deoxypyridinoline/creatinine, quantitative ultrasound of the heel, BMD of lumbar spine and hip, total body bone mineral content, and physical performance. The relationship between the variables was explored by analysis of covariance and the locally weighted regression (LOESS) plots. Results: Serum 25(OH)D was below 25 nmol/liter in 11.5%, below 50 nmol/liter in 48.4%, below 75 nmol/liter in 82.4%, and above 75 nmol/liter in 17.6% of the respondents. Mean serum PTH decreased gradually from 5.1 pmol/liter when serum 25(OH)D was below 25 nmol/liter to 3.1 pmol/liter when serum 25(OH)D was above 75 nmol/liter (P < 0.001) without reaching a plateau. All BMD values were higher in the higher serum 25(OH)D groups, although only significantly for total hip (P = 0.01), trochanter (P = 0.001), and total body bone mineral content (P = 0.005). A threshold of about 40 nmol/liter existed for osteocalcin and deoxypyridinoline/creatinine, 50 nmol/liter for BMD, and 60 nmol/liter for physical performance. Conclusions: Low serum 25(OH)D concentrations are common in the elderly. Bone health and physical performance in older persons are likely to improve when serum 25(OH)D is raised above 50-60 nmol/liter.

Objectives: Vascular depression is regarded as a subtype of depression, especially in––but not limited strictly to––older persons, and characterized by a specific clinical presentation and an association with (cerebro)vascular risk and disease. It is also known that depression is a risk factor in the development of myocardial infarction. The possibility of identifying depressed subjects at risk of a first cardiac event by their clinical presentation in general practice would have significant implications. Methods: We studied the baseline depression symptom profiles of subjects in the Longitudinal Aging Study Amsterdam and compared the profile of depressed subjects who had and had not suffered a first cardiac event at a follow-up after eight years. Results: We could not confirm the specific symptom profile in depressed subjects who suffered from a first cardiac event at follow-up. Most notably, the presumed specific symptoms of vascular depression, psychomotor retardation, and anhedonia were not significantly associated with the occurrence of a first cardiac event at follow-up. Conclusions: In this large community study we failed to identify a difference in the depression symptom profile between incident cardiac and non-cardiac cases.

No abstract available.

Several guidelines on osteoporosis have proposed algorithms to identify persons at high risk of fractures. Although these algorithms include well-known risk factors, it is not clear how they can best be operationalized for use in general practice. The aim of this study was to compare the predictive performance of different operationalizations of four categories of risk factors for fractures that can be used in general practice. This study included 4157 women of &#8805;60 yr of age (mean ± SD: 74.1 ± 9.1 yr) with a median follow-up of 8.9 yr of the Rotterdam Study and 762 women of &#8805;65 yr of age (mean ± SD: 76.0 ± 6.7.yr) with a median follow-up of 6.0 yr of the Longitudinal Aging Study Amsterdam (LASA). At baseline, information on four categories of risk factors was obtained, including (1) family history of hip fractures, (2) type of prior fractures, (3) low body weight/body mass index (BMI), and (4) mobility impairment. The occurrence of fragility fractures, including hip, pelvic, humerus, and wrist fractures, was used as outcome measure. We quantified the predictive performance of each risk factor by a &#967;2 statistic, calculated as the difference in –2 Log likelihood attributable to the risk factor, with adjustment for age and other risk factors. In the Rotterdam Study, 399 fragility fractures occurred during 31,472 person-years (PY) of follow-up. In this study, any prior fracture in the past 5 yr (&#967;2 = 6; p = 0.02), body weight < 64 kg (versus &#8805;64 kg; &#967;2 = 6.7; p = 0.01), BMI < 22 kg/m2 (versus &#8805;22 kg/m2; &#967;2 = 8.7; p = 0.003), and use of a walking aid (&#967;2 = 7.5; p = 0.004) were the most practical operationalizations of the risk factor categories, after adjustment for age and other risk factors. In LASA, 52 fragility fractures occurred during 3935 PY of follow-up. Associations were similar as in the Rotterdam Study, except that low body weight and BMI were not associated with fragility fracture. None of the usual operationalizations of family history of hip fractures was independently associated with fragility fracture in either study. Prior osteoporotic fracture, body weight <64 kg, a BMI <22 kg/m2, and the use of a walking aid are practical operationalizations of risk factors for fragility fractures. On the basis of the results of this study, a simple, practical algorithm can be developed for use in general practice.

The aim of this prospective study was to develop a risk score, based on putative risk factors in current guidelines, which can be used to identify women at high risk of fractures in general practice. The study sample included 4157 women &#8805;60 yr of age (mean ± SD: 74.1 ± 9.1 yr), with a median follow-up of 8.9 yr of the Rotterdam Study (ERGO), and 762 women &#8805;65 yr of age (mean ± SD: 76.0 ± 6.7.yr), with a median follow-up of 6.0 yr of the Longitudinal Aging Study Amsterdam (LASA). Potential risk factors were those proposed in risk scores of three recent guidelines on osteoporosis: age, family history of fractures, prior fracture, low body weight/body mass index (BMI), serious immobility, rheumatoid arthritis, current smoking, alcohol consumption >2 units daily, prevalent vertebral fracture, and systemic corticosteroid use. Five-year absolute risk of hip fracture was 3.9% in the Rotterdam Study and 3.1% in LASA, and 10-yr absolute risk of hip fracture was 8.4% in the Rotterdam Study. Using Cox regression analysis, age (70–79 and 80+ versus <60–69) and four other risk factors were included in the risk profiles of hip fractures and fragility fractures: any prior fracture after age 50, body weight <64 kg, use of a walking aid as a proxy measure of serious immobility, and current smoking. Estimated 10-yr absolute risk of hip fracture ranged from 1.4% in women, age 60–69 years, without any of these predictors to 29% in women, &#8805;80 yr of age, having two or more positive risk factors. A simple risk score can satisfactorily identify older women at high risk of osteoporotic fractures in general practice. Future studies are needed to validate this score.

Background: It is well-known that the use of care services is most intensive in the last phase of life. However, so far only a few determinants of end-of-life care utilization are known. The aims of this study were to describe the utilization of acute and long-term care among older adults in their last year of life as compared to those not in their last year of life, and to examine which of a broad range of determinants can account for observed differences in care utilization. Methods: Data were used from the Longitudinal Aging Study Amsterdam (LASA). In a random, age and sex stratified population-based cohort of 3107 persons aged 55 – 85 years at baseline and representative of the Netherlands, follow-up cycles took place at 3, 6 and 9 years. Those who died within one year directly after a cycle were defined as the \\\"end-of-life group\\\" (n = 262), and those who survived at least three years after a cycle were defined as the \\\"survivors\\\". Utilization of acute and long-term care services, including professional and informal care, were recorded at each cycle, as well as a broad range of health-related and psychosocial variables. Results: The end-of-life group used more care than the survivors. In the younger-old this difference was most pronounced for acute care, and in the older-old, for long-term care. Use of both acute and long-term home care in the last year of life was fully accounted for by health problems. Use of institutional care at the end of life was partly accounted for by health problems, but was not fully explained by the determinants included. Conclusion: This study shows that severity of health problems are decisive in the explanation of the increase in use of care services towards the end-of-life. This information is essential for an appropriate allocation of professional health care to the benefit of older persons themselves and their informal caregivers.

Background: Because of the demographic changes, appropriate measures are needed to prevent early exit from work and to encourage workers to prolong their working life. To date, few studies have been performed on the factors motivating continuing to work after the official age of retirement. In addition, most of those studies were based on quantitative data. The aims of this study were to examine, using both quantitative and qualitative data: (1) the reasons for voluntary early retirement; (2) the reasons for continuing working life after the official retirement age; and (3) the predictive value of the reasons mentioned. Methods: Quantitative data analyses were performed with a prospective cohort among persons aged 55 years and older. Moreover, qualitative data were derived from interviews with workers together with discussions from a workshop among occupational physicians and employers. Results: Results showed that the presence of challenging work was among the most important reasons for not taking early retirement. In addition, this motive appeared to positively predict working status after three years. The financial advantages of working and the maintenance of social contacts were the reasons reported most frequently for not taking full retirement, with the financial aspect being a reasonably good predictor for working status after three years. From the interviews and the workshop, five themes were identified as important motives to prolong working life: challenges at work, social contacts, reward and appreciation, health, and competencies and skills. Further, it was brought forward that each stakeholder can and should contribute to the maintenance of a healthy and motivated ageing workforce. Conclusion: Based on the findings, it was concluded that measures that promote challenges at work, together with financial stimuli, seem to be promising in order to prolong workforce participation.

Frailty is a term often used by researchers and clinicians to describe a state in which older persons are at risk for adverse outcomes such as falls, disability, institutionalization and mortality. However, no study so far examined what frailty means to older persons. Therefore the aim of this study was to describe the meaning that older community-dwelling persons attach to frailty. Twenty-five semi-structured interviews were conducted. The interviews were analyzed using the grounded theory method. Frailty was described as being in poor health, having walking difficulties, feeling down, being anxious, having few social contacts and not being able to do the things one likes to do. Men described in more detail the physical dimension whereas women elaborated in more depth on the psychological and social component. Existing definitions of frailty should be adjusted to better reflect the meaning of frailty for older persons.

Background: There is growing evidence that higher levels of inflammatory markers are associated with physical decline in older persons, possibly through the catabolic effects of inflammatory markers on muscle. The aim of this study was to investigate the association between serum levels of inflammatory markers and loss of muscle mass and strength in older persons. Methods: Using data on 2,177 men and women in the Health, Aging, and Body Composition Study, we examined 5-year change in thigh muscle area estimated by computed tomography and grip and knee extensor strength in relation to serum levels of interleukin-6 (IL-6), C-reactive protein, tumor necrosis factor-alpha (TNF-), and soluble receptors (measured in a subsample) at baseline. Results: Higher levels of inflammatory markers were generally associated with greater 5-year decline in thigh muscle area. Most associations, with the exception of soluble receptors, were attenuated by adjustment for 5-year change in weight. Higher TNF- and interleukin-6 soluble receptor levels remained associated with greater decline in grip strength in men. Analyses in a subgroup of weight-stable persons showed that higher levels of TNF- and its soluble receptors were associated with 5-year decline in thigh muscle area and that higher levels of TNF- were associated with decline in grip strength. Conclusions: TNF- and its soluble receptors showed the most consistent associations with decline in muscle mass and strength. The results suggest a weight-associated pathway for inflammation in sarcopenia.

Context: High cortisol level is known to be associated with osteoporosis, hypertension, diabetes mellitus, susceptibility to infections and depression and may protect against chronic obstructive pulmonary disease (COPD). Objective: This study assesses the association between cortisol level, 6-7.5 year mortality risk and prevalence of chronic diseases. Design/setting/participants: Subjects were selected from the Longitudinal Aging Study Amsterdam (LASA), an ongoing multidisciplinary cohort study in a general population of older persons (>/=65 years). Serum cortisol was measured in 1181 men and women in 1995/96 (second cycle) and salivary cortisol in 998 men and women in 2001/02 (fourth cycle). Main outcome measures: Six to seven and a half year mortality and prevalence of chronic diseases. Results: Men with high salivary morning cortisol had a higher mortality risk than men with low levels (HR=1.63, p=0.04 for the third versus the lowest tertile). Women with high salivary evening cortisol had a higher mortality risk than women with low levels (HR=1.82, p=0.04 for the third versus the lowest tertile). In men, high serum cortisol was independently associated with chronic non-specific lung disease (CNSLD): OR=0.72, p<0.01; hypertension: OR=1.38, p<0.01; diabetes mellitus: OR=1.38, p=0.02. In women, high salivary evening cortisol was independently associated with diabetes mellitus: OR=1.33, p=0.01 and CNSLD: OR=0.58, p=0.02. No independent association between cortisol and number of chronic diseases was found. Conclusion: High salivary cortisol levels are associated with increased mortality risk in a general older population. High cortisol levels are associated with higher risks of hypertension and diabetes mellitus and lower risk of CNSLD.

Background: A single nucleotide polymorphism (rs5848) located in the 3\\\'- untranslated region of GRN has recently been associated with a risk of frontotemporal lobar degeneration (FTLD) in North American population particularly in pathologically confirmed cases with neural inclusions immunoreactive for ubiquitin and TAR DNA-binding protein 43 (TDP-43), but negative for tau and alpha-synuclein (FTLD-TDP). Methodology/Principal Findings: In an effort to replicate these results in a different population, rs5848 was genotyped in 256 FTLD cases and 1695 controls from the Netherlands. Single SNP gender-adjusted logistic regression analysis revealed no significant association between variation at rs5848 and FTLD. Fisher\\\'s exact test, failed to find any significant association between rs5848 and a subset of 23 pathology confirmed FTLD-TDP cases. Conclusions/Significance: The evidence presented here suggests that variation at rs5848 does not contribute to the etiology of FTLD in the Dutch population.

Objectives: Although it is well known that recurrence of late-life depression is very common, little is known about the characteristics of older people who are vulnerable for recurrence. In order to identify characteristics of those who are at risk, the present study aimed to investigate the strength of the associations of the big five personality factors with recurrence in later life. Secondly, we studied whether there are gender and age differences in the strength of these associations. Methods: Using data from the longitudinal aging study Amsterdam (LASA) a subsample with clinically relevant depressive symptoms at one or more of the first three LASA-cycles, but who had recovered at the fourth cycle, was approached to participate in a fifth cycle to determine recurrence (n¼92). Respondents completed self-report questionnaires on personality (NEO-FFI) and depression (CES-D). By means of logistic regression analyses the associations between the Big Five and recurrence of depression at fifth cycle was investigated. Results 58 (63%) had a recurrence of depressive symptoms. A high level of neuroticism was significantly associated with recurrence. No gender differences or age-related differences in strength of the associations of personality with recurrence were found. Conclusion: In later life, neuroticism still is associated with the recurrence of depression. Efforts to prevent recurrence of late-life depression should focus on those with high levels of neuroticism and future research should aim at further unravelling the association between depression and personality in later life.

Objective: To examine the association of personality with recurrence of depression in later life. Method: A subsample of 91 subjects from the Longitudinal Aging Study Amsterdam (LASA; baseline sample size n=3107; aged >/=55 years) depressed at baseline, who had recovered in the course of three years (first follow-up cycle) was identified. 41 (45%) respondents experienced a recurrence during the subsequent six years. The influences of personality and late life stress (demographic factors, health and social factors) on recurrence were investigated prospectively. Results: Recurrence of depression was associated with a high level of neuroticism and low level of mastery, residual depressive symptoms at time of recovery, female gender, pain complaints and feelings of loneliness. In multivariable analysis entering all predictors significant in single variable analysis, residual depressive symptoms and lack of mastery remained significantly associated with recurrence. Conclusion: In predicting the recurrence of depression in later life, the direct effects of personality remain important and comparable in strength with other late life stressors related to recurrence.

The positive trend in volunteering among the Dutch young old may in part be due to a relatively favorable disposition to volunteer. Using data from the Longitudinal Aging Study Amsterdam, volunteering rates of 55–64 year olds in 1992 and 2002 were compared and associated with (among others) three types of dispositional factors: religious involvement, age-related engagement norms, and parental socialization. The recent cohort was less religiously involved, but more supportive of social engagement at older age, and more often had parents who volunteered, were religiously involved or higher educated. Multivariate analyses revealed that cohort differences were largely explained by cohort differences in educational level and religious involvement. It is concluded that their lower religious level suppresses the volunteering rate of the current young old. To compensate for the decline in religious young old, family and the broader society will become more important for stimulating volunteer work in the future.

No abstract available.

Objective: To study the relationship between 4 components of physical activity and the 12-year incidence of clinical knee osteoarthritis (OA) among older adults. Methods: Longitudinal data from 1,678 men and women, ages 55-85 years, were collected in the Longitudinal Aging Study Amsterdam. Incident clinical knee OA was defined by an algorithm using self-report and general practitioner data. Physical activity was assessed by a validated questionnaire from which 4 physical activity component scores were created: muscle strength, intensity, mechanical strain, and turning actions. Cox proportional hazards models were conducted to examine the relationship between these scores and incident knee OA and reported as hazard ratios (HRs) with 95% confidence intervals (95% CIs). Results: During 12 years of followup, 463 respondents (28%) developed clinical knee OA. A high mechanical strain score (HR 1.43, 95% CI 1.15-1.77) and a low muscle strength score (HR 1.30, 95% CI 1.01-1.68) were associated with an increased risk of knee OA after adjustment for age, sex, region of living, education, lifetime physical work demands, lifetime general physical activity, body mass index, current total physical activity level, and depression. No association was observed in the intensity and turning actions components. The results were similar for men and women, and for obese and nonobese respondents. Conclusion: Older adults who perform low muscle strength activities or activities causing high mechanical strain had an increased risk of clinical knee OA. These results suggest that specific components of physical activity may influence the development of knee OA.

Objectives: To study the onset and compare risk factors for pure depression (DEP), pure anxiety (ANX), and comorbid anxiety-depression (ANXDEP) in the aging population. Design: Prospective study with 3-year intervals over a 9-year period. Setting: Data of the Longitudinal Aging Study Amsterdam were used, which is a populationbased study among older adults (55–85 years at baseline). Participants: Older adults free of depression and anxiety at baseline (N = 1,712). Measurements: Clinically relevant levels of depression and anxiety were measured with the Center for Epidemiologic Studies Depression scale &#8805;16 and Hospital Anxiety and Depression Scale &#8805;7, respectively. A broad range of potential sociodemographic, health, and psychosocial risk factors for anxiety and/or depression were examined by using polytomous logistic regression analyses. Results: Within 9 years, 184 subjects (10.8%) developed DEP, 93 (5.4%) ANX, and 103 (6.0%) ANXDEP. Concerning sociodemographics, higher age and lower educational level were predictors for DEP. Health indicators were predictive for DEP and ANXDEP but not for ANX. Depressive symptoms at baseline were predictive for DEP, whereas initial anxiety symptoms were predictive for ANX and ANXDEP. Neuroticism increased the risk of DEP and ANXDEP. Mixed effects of psychosocial variables were found: DEP was associated with recent widowhood, whereas ANX and ANXDEP were associated with other life events such as having an ill partner. Conclusion: Although onset of ANXDEP demonstrated communality in risk factors, comparing risk factors associated with DEP and ANX revealed more differences than similarities. This underlines the need to distinguish anxiety from depression in preventive strategies.

Objectives: High-cortisol levels in depressed persons could possibly give rise to the metabolic syndrome. This study investigated cross-sectionally whether depression and high-cortisol levels increased the odds of metabolic syndrome in an older community-based sample. Methods: In 1,212 participants, aged > or =65 years, enrolled in the Longitudinal Aging Study Amsterdam, depression (major [1-month diagnosis] or subthreshold [no 1-month diagnosis, but symptoms]), metabolic syndrome (modified Adult Treatment Panel III criteria), and free cortisol index (total serum cortisol/cortisol binding globulin) were assessed. Results: Major depression was not associated with the metabolic syndrome (odds ratio [OR] = 1.16, 95% confidence interval [CI] = 0.54-2.49), but subthreshold depression was associated with a decreased odds (OR = 0.55, 95% CI = 0.37-0.82). Persons with higher levels of free cortisol index showed a higher odds of metabolic syndrome (OR per standard deviation increase = 1.21, 95% CI = 1.06-1.39). Conclusions: As persons with high-cortisol levels more often had metabolic syndrome, hypercortisolemia within depressed persons may increase the risk of metabolic syndrome.

No abstract available.

Objectives: This study investigates whether, and if so how, anxiety symptoms are related to cognitive decline in elderly persons and whether anxiety symptoms precede cognitive decline. Method: Data were obtained from the Longitudinal Aging Study Amsterdam. Anxiety symptoms were measured with the Hospital Anxiety and Depression Scale. General cognitive functioning was measured with the Mini-Mental State Examination, episodic memory with the Auditory Verbal Learning Test, fluid intelligence with the Raven’s Coloured Progressive Matrices and information processing speed with the coding task. Multilevel analyses were performed to investigate the relationship between anxiety symptoms and cognitive decline over 9 years, taking into account confounding variables. Results: Although not consistent across all dimensions of cognitive functioning, a curvilinear effect of anxiety on cognitive performance was found. Furthermore, we found that previous measurement of anxiety symptoms were not predictive of cognitive decline at a later time-point. Conclusion: This study suggests that the effect of anxiety on cognition depends on the severity of the present anxiety symptoms with mild anxiety associated with better cognition, whereas more severe anxiety is associated with worse cognition. The effect of anxiety symptoms on cognitive functioning seems to be a temporary effect, anxiety is not predictive of cognitive decline.

Using the convoy model (R. L. Kahn & T. C. Antonucci, 1980), this study examined the differential impact of relocation, depending on the distance moved, on the size of 3 types of role networks. A total of 890 Dutch nonmovers and 445 movers (aged 55–86 years) were selected from the Longitudinal Aging Study Amsterdam. Results of analyses of variance showed that the neighbor networks changed most after relocation. Long-distance movers discontinued the largest number of relationships with fellow club members. As expected, moving did not affect coworker networks. The findings show that, consistent with the convoy model, role networks proved to be unstable. Older adults, however, restored their partial networks at the second observation by starting new relationships.

In this study, we examined life course events of older Dutch adults in relation to three types of moves and the moving distance. Using the frameworks developed by Litwak and Longino (1987) and Mulder and Hooimeijer (1999), we stipulated life events or triggers and conditions in various life domains. We selected a total of 1160 men and 1321 women (aged 54 to 91) from the Longitudinal Aging Study Amsterdam. We conducted multinomial logistic regression analyses to predict moves to a residential care facility, adapted housing or regular housing and to predict the moving distance. Retirement, an empty nest, widowhood and a decline in health each triggered specific moves. In additional analyses, the effects of triggers, especially health changes, were moderated by conditions. There is no indication of a specific trajectory of moves associated with consecutive life events, as suggested by Litwak and Longino. By combining triggers and conditions, however, the framework developed by Mulder and Hooimeijer allows for a more valid analysis.

Affective or emotional aspects of religiousness are considered to be crucial in the association between religiousness and well-being, especially in later life. Such affective aspects can be understood as pertaining to the God-object relationship, corresponding to feelings of trust towards God or to religious discontent. Personality characteristics, such as those defined by the Five-Factor Model of Personality, are expected to correspond with God image. A small sample of older mainline church members in Sassenheim, The Netherlands (n = 53), aged 68-93, filled out a questionnaire, including 120 items of the NEO-PI-R, the Questionnaire God Image, frequency of prayer, church attendance, and depressive symptoms. Neuroticism was associated with feelings of anxiety towards God as well as discontent towards God. Agreeableness was associated with perceiving God as supportive and with prayer. These findings persisted after adjustment for depressive symptoms. For the other three personality factors, no clear patterns emerged. Results were compared with those from studies of God image and the Five-Factor Model of personality among younger people.

No abstract available.

Religious involvement is frequently found to be associated with less depression in later life. The emotional aspects of religiousness, such as pertaining to the God-object relationship, have not received substantial attention in empirical research among older adults, and especially not in European samples. As part of a pilot study of the Longitudinal Aging Study Amsterdam, a small sample of older church-members (n = 60), aged 68-93, filled out a questionnaire, including the Questionnaire God Image on feelings to God and perceptions of God, two of the God Image Scales designed by Lawrence on perceptions of God, the brief positive and negative religious coping scale designed by Pargament, and items on hopelessness, depressive symptoms, and feelings of guilt. Feelings of discontent towards God correlated positively with hopelessness, depressive symptoms, feelings of guilt, and also with depressive symptoms assessed 13 years earlier; these findings pertained to Protestant participants in particular. Most facets of God image, positive, critical, and about punishment reappraisals, were associated with more feelings of guilt. A possible explanation for the most pervasive finding, that feelings of discontent towards God are related to depressive symptoms, is that both, throughout life, remain rooted in insecure attachment styles.

Background: Previous studies have reported conflicting results concerning the association between several inflammatory markers and depression. The association between inflammation and depression may depend on the presence of specific chronic diseases or be relevant in specific sub-groups of depressed patients only. Objective: To assess associations between inflammatory markers and depression in older people, taking account of confounding and effect-modifying factors. Method: Population-based study of 1285 participants of the Longitudinal Aging Study Amsterdam, aged 65 and over. Plasma concentrations of Interleukin-6 (IL-6) and C-reactive protein (CRP) were measured. Major depression (first- or recurrent episode)and sub-threshold depression were assessed. Associations were adjusted for confounding variables. Associations with inflammatory markers were further studied with regard to severity and duration of depression, and with regard to specific depressive symptoms. Results: High levels of IL-6 (above 5 pg/mL) were associated with major depression (odds ratio 2.49 (1.07–5.80), both in recurrent and first episodes. No significant effect of either one of the markers on specific symptom dimensions of depression was found. Mildly elevated plasma levels of CRP (above 3.2 mg/L) were associated with higher CES-D scores, but not after correction for the confounding effect of age and chronic diseases. Limitations: The cross-sectional design limits conclusions regarding causality. Conclusions: A high plasma level of IL-6, but not CRP, is associated with an increased prevalence of major depression in older people, independent of age, chronic diseases, cognitive functioning and anti-depressants. Present results suggest new directions for clinical research into the prevention of physical consequences of depression.

No abstract available.

Aim: In elder care, frailty is a current concept, although no unequivocal definition of its exists. This hampers research striving at an evidence base for practice. This article proposes criteria of frailty that are based on the most recent state of the art in international research, namely the findings from the Longitudinal Aging Study Amsterdam (LASA). Method: The LASA study collects data in three-year cycles from a nationally representative cohort of over 3000 persons who were 55-85 years of age at enrollment. For this study, data are used spanning the period 1992-2002. Frailty is operationally defined by nine criteria: low body weight, decreased lung function, physical inactivity, cognitive impairment, poor vision, poor hearing, incontinence, depressive symptoms, and a low sense of mastery over one’s own life. An alternative definition of frailty is based on relevant decline in these nine criteria. To be categorised as frail, the participants in the study had to meet at least three criteria. The validity of the frailty definitions is examined by assessing their predictive ability for the outcomes functional decline, institutionalisation, and mortality. Results: Both definitions of frailty proved to have predictive ability for each of the three outcomes. From the separate criteria, poor hearing and incontinence were least predictive. The mental criteria cognition and depression proved to have added value above a purely physical definition of frailty. Frailty itself was predicted by a low blood level of vitamin D and by the use of anti-inflammatory drugs. Discussion: Based on these findings, a simple screening instrument can be developed for use in the daily practice of elder care.

Cross-sectional studies suggest an association between BMI and pain. This prospective study investigated the associations of measured BMI and waist circumference with prevalent and incident pain in older adults. The study included participants of the Longitudinal Aging Study Amsterdam, aged 55–85 years at baseline (1992–1993). Pain was assessed using a subscale of the Nottingham Health Profile at baseline (N = 2,000), after 3 years (N = 1,478) and 6 years (N = 1,271) of follow-up. The overall prevalence of pain was 32.7% at baseline and increased significantly with higher quartiles of BMI or waist circumference. After adjustment for age, education, depression, smoking, physical activity, and chronic diseases, multiple logistic regression analyses showed odds ratios (ORs (95% confidence interval)) for prevalent pain of 2.16 (1.32–3.54) in men and 1.93 (1.26–2.95) in women comparing the highest with the lowest quartile of BMI. Of the participants without pain at baseline, those in the highest quartile of BMI had a twofold increased odds for incident pain after 3 years of follow-up. After 6 years of follow-up, ORs for incident pain were 2.34 (1.17–4.72) in men and 2.78 (1.36–5.70) in women. Additional adjustment for weight change did not change these associations. Similar results were found for the associations between waist circumference and pain. Exploring the reversed causal relation, analyses showed no significant associations between prevalent pain and weight gain. In conclusion, the prevalence of pain is higher among obese older men and women compared to their normal-weight peers. Furthermore, obese older adults are at increased odds to develop pain.

Objectives: This study compares educational differences in the functional limitations of 55–65-year-olds in the Netherlands in 1992 and 2002 and examines whether changes are explained by cohort lifestyle and psychosocial changes. Methods: Data from two cohorts of 55–65-year-olds (n = 948 in 1992 and n = 980 in 2002) in the Longitudinal Aging Study Amsterdam are analysed. Results: Men’s disability ratios are similar in both cohorts. The women’s disability ratio is higher in 2002 than in 1992. In 2002 the male and female cohorts both report unhealthier behavior than in 1992. Multivariate logistic regression analyses show that adjusted for age, cohort, lifestyle and psychosocial resources, poorly educated men have higher odds of functional limitations than well-educated men (OR = 2.62, 95 % CI = 1.57–4.37). Analyses among women show a significant interaction effect between education and cohort. Poorly educated women have higher odds of functional limitations in 2002 than in 1992 (OR = 3.33, 95 % CI = 1.02–10.87). Conclusions: The results underscore the need for policies focused on improving the health and lifestyle of the poorly educated.

Context: Depression has incidentally been related to altered levels of 25-hydroxyvitamin D [25(OH)D] and parathyroid hormone (PTH), but this relation has never been studied systematically. Objective: To determine in a large population-based cohort whether there is an association between depression and altered 25(OH)D and PTH levels. Design: Population-based cohort study (Longitudinal Aging Study Amsterdam). Participants: One thousand two hundred eighty-two community residents aged 65 to 95 years. Setting: The Netherlands. Main Outcome Measure: Depression was measured using self-reports (Center for Epidemiologic Studies–Depression scale) and diagnostic interviews (Diagnostic Interview Schedule). Levels of 25(OH)D and PTH were assessed. Potentially confounding factors (ie, age, sex, smoking status, body mass index, number of chronic conditions, and serum creatinine concentration) and explanatory factors (ie, season of data acquisition, level of urbanization, and physical activity) were also measured. Results: Levels of 25(OH)D were 14% lower in 169 persons with minor depression and 14% lower in 26 persons with major depressive disorder compared with levels in 1087 control individuals (P < .001). Levels of PTH were 5% and 33% higher, respectively (P = .003). Depression severity (Center for Epidemiologic Studies Depression Scale) was significantly associated with decreased serum 25(OH)D levels (P = .03) and increased serum PTH levels (P = .008). Conclusion: The results of this large population-based study show an association of depression status and severity with decreased serum 25(OH)D levels and increased serum PTH levels in older individuals.

Loneliness is an indicator of social well-being and pertains to the feeling of missing an intimate relationship (emotional loneliness) or missing a wider social network (social loneliness). The 11-item De Jong Gierveld scale has proved to be a valid and reliable measuring instrument for overall, emotional and social loneliness, although its length has sometimes rendered it difficult to use the scale in large surveys. In this study, we empirically tested a shortened version of the scale on data from tow surveys (N = 9448). Confirmatory factor analyses confirmed the specification of two latent factors. Congruent validity and the relationship with determinants (partner status, health) proved to be optimal. The 6-item De Jong Gierveld scale is a reliable and valid measuring instrument for overall, emotional and social loneliness, which is suitable for large surveys.

Background and aims: It is often assumed that aging is accompanied by diverse and constant functional and cognitive decline, and it is therefore surprising that the well-being of older persons does not appear to decline in the same way. This study investigates longitudinally whether well-being in older persons changes due to Persistent Deterioration of Functioning (PDF). Methods: Data were collected in the context of the Longitudinal Aging Study Amsterdam (LASA). Conditions of PDF are persistent decline in cognitive functioning, physical functioning and increase in chronic diseases. Measurements of well-being included life satisfaction, positive affect, and valuation of life. T-tests were used to analyse mean difference scores for well-being, and univariate and multivariate regression analyses were performed to examine changes in three well-being outcomes in relation to PDF. Results: Crosssectional analyses showed significant differences and associations between the two PDF subgroups and non-PDF for well-being at T3. In longitudinal analyses, we found significant decreases in and associations with wellbeing over time in respondents fulfilling one PDF condition (mild PDF). For respondents fulfilling two or more PDF conditions (severe PDF), longitudinally no significan associations were found. Conclusions: Cognitive aspects of well-being (life satisfaction and valuation of life) and the affective element (positive affect) of well-being appear to be influenced negatively by mild PDF, whereas well-being does not seem to be diminished in persons with more severe PDF. This may be due to the ability to accept finally the inevitable situation of severe PDF.

Objective: Self-perceived health describes how a person perceives his or her own health. It is a widely used measure of health status and an important predictor of mortality. The aim of this study is to investigate the stability of self-perceived health between 1992/’93 and 2002/’03 of men and women aged 55-64. And to what extent a possible shift can be explained by demographic factors, lifestyle factors and objective health. Methods: Data of two age-, sex- and region-stratified samples are used from the Longitudinal Aging Study Amsterdam (LASA), an ongoing cohort study in a population-based sample of older persons in the Netherlands. Self-perceived health is defined by the answer to the following question: How would you rate your health in general? with possible answers: 1 = excellent, 2 = good, 3 = fair, 4 = sometimes good/sometimes poor and 5 = poor. In the analyses, answers 4 and 5 are combined because of the small number of answers in the category ‘poor’. The difference in self-perceived health between the two cohorts is tested using the &#967;²-test. Multinomial regression analyses are used to examine which cohort- and/or period-factors are responsible for the cohort-difference. Results: The youngest cohort rated more excellent and poor health than the oldest, and less good and fair health. The youngest cohort had a higher prevalence of chronic illness, functional limitation and depressive symptoms, which negatively affected self-perceived health. The cohort- and period-factors only partly contributed to the explanation of the cohort difference. Conclusion: There is a shift in self-perceived health over time. In comparison with the oldest cohort the self-perceived health of the youngest improved, taken the deteriorated objective health of the youngest cohort into account.

No abstract available.

Objective: To develop two classification models for use in primary care to aid early identification of persons at risk for persistent cognitive decline. Methods: Data were used from the Longitudinal Aging Study Amsterdam (LASA), an ongoing populationbased study. The study sample consisted of 2,021 non-demented men and women aged 58–88 years. Data on relevant predictors of persistent cognitive decline were collected at baseline. Results: The incidence of persistent cognitive decline after three years of follow-up was 4.0 %. In the first model, in which predictors already known or otherwise easily assessed (first set) were included, age was the strongest predictor of persistent cognitive decline, with an increased risk for persons > 75. In addition, having memory problems, low education, and a MMSE score of &#8804; 24, resulted in a predictive value for persistent cognitive decline of 43.5 %. In the second classification model, in addition to the first set, predictors requiring additional measurement (e.g. markers determined in blood) were included in the analyses. Age was again the strongest predictor of persistent cognitive decline. In persons > 75 years, having a low total cholesterol level (< 5.0 mmol/L) and a MMSE score of &#8804; 24 resulted in a predictive value of 30.0 %. Conclusions: Both models lead to a substantial increase of the predictive value for persistent cognitive decline, that is from 4.0 % to 43.5 % and 30.0 %, and may identify to a large extent a different subsample of persons who are at risk for persistent cognitive decline. The developed classification trees could be useful for case-finding of persons at risk for future persistent cognitive decline who are therefore at risk for dementia, in a feasible and cost-effective manner.

Objectives: This study examines the effects of own and spousal disability on social and emotional loneliness among married adults aged 65 and over. Methods: Data from 710 men and 379 women of a Dutch community sample were analyzed with linear regression analyses. Results: For men, only their wives’ disability was related to higher levels of social loneliness, whereas for women mainly their own disability was related to higher levels of social loneliness. Own disability and spousal disability were related to higher levels of emotional loneliness among both men and women. Effects of disability remained unaffected after controlling for characteristics of the social network and the marital relationship. Discussion: Findings underscore the importance of considering effects of both spouses’ health on measures of individual wellbeing. Also, the traditional division of social roles makes older married men relatively vulnerable to social loneliness when their wives suffer from disability.

Objective: Cortisol levels increase with age and hypercortisolism is associated with muscle weakness. This study examines the relationship between cortisol, muscle mass and muscle strength in community-dwelling older persons and the role of genetic variations in the glucocorticoid receptor (GR). Design/patients: The study was conducted within the Longitudinal Ageing Study Amsterdam (LASA, 1992-ongoing), a cohort study in a population-based sample of older persons in the Netherlands. Data were used from 1196 and 1046 participants in the second (1995-1996) and fourth (2001-2002) cycle, respectively. Measurements: Total serum cortisol and free cortisol were measured in the mornings of the second cycle while salivary cortisol sampled early in the morning and late at night were measured in the fourth cycle. The GR gene polymorphisms (ER22/23EK, N363SS, 9&#946; and BclI) were genotyped by Taqman. Appendicular skeletal muscle mass (ASMM) was measured using DXA in the second cycle and 3 years later (third cycle). Grip strength was assessed using a handgrip dynamometer in the second, third, fourth and fifth cycle. Results: A relationship was found between both morning and evening salivary cortisol, and loss of grip strength: participants in the highest quartile of cortisol concentration had a twofold higher risk of loss of grip strength than participants in the lowest quartile (P < 0·05). No relationships were found between serum cortisol (loss of) ASMM, and (loss of) grip strength. The ER22/23EK and N363S-polymorphisms modified the relationships between serum cortisol, ASMM and grip strength, respectively. Due to limited power, these relationships were not significant after stratification for the polymorphisms. Conclusion: High salivary cortisol is associated with a higher risk of loss of grip strength in older persons. GR genotypes modify the relationship between muscle mass and muscle strength.

Objective Progressive declines in serum levels of testosterone parallel the decline in physical performance and muscle strength in ageing men, although findings are not conclusive. We examined whether levels of testosterone were associated with 3-year decline in physical performance and muscle strength in older men. Design Longitudinal data were available for 486 men (mean age 74·9 years, SD 6·4) from the Longitudinal Ageing Study Amsterdam (LASA) and 1071 well-functioning men (mean age 73·7 years, SD 2·8) from the Health, Ageing and Body Composition (Health ABC) study. Measurements Three-year change in physical performance score and grip strength according to categories of total testosterone (TT) and free testosterone (FT) levels. Results The mean 3-year change in physical performance was –1·1 (SD 2·7, –13·6%) in LASA and –0·3 (SD 1·5, –2·9%) in Health ABC. The mean 3-year change in grip strength was –9·7 kg (SD 12·2, –13·2%) in LASA and –4·4 kg (SD 11·4,–5·8%) in Health ABC. Low levels of TT were not associated with decline in physical performance or with decline in muscle strength [e.g. mean change in physical performance –1·09 (SD 0·26) in the lowest quartile (Q1) and –0·88 (0·24) in the highest quartile (Q4) of total testosterone in LASA, and –0·26 (0·07) vs.–0·36 (0·11) in Health ABC]. Similar results were found for FT. Conclusions Low levels of TT and FT were neither associated with 3-year decline in physical performance nor with 3-year decline in muscle strength in two independent samples of older men.

The evidence on the association between vitamin D deficiency and fracture incidence is contradictory. Therefore, the objective of this study was to examine whether low serum 25-hydroxyvitamin D (25(OH)D) levels are associated with osteoporotic fractures. The study was conducted among 1311 community-dwelling older men and women of the Longitudinal Aging Study Amsterdam (LASA), an ongoing multidisciplinary cohort study. Serum 25(OH)D was determined using a competitive protein binding assay. Fractures were assessed during six years of follow-up. The data were analyzed using Cox proportional hazards model. In total, 11.3% of the persons had a serum 25(OH)D below 10 ng/ml, 48.4% had a value below 20 ng/ml, and 82.4% had a value below 30 ng/ml. Furthermore, 115 persons (8.5%) had one or more osteoporotic fractures. Different cut points of serum 25(OH)D were examined with a cut point of 12 ng/ml giving the best discrimination between persons with and without fractures (17.5% of the persons fell below this cut point). The lowest percentage of fractures (5.6%) was found above 30 ng/ml. Because an interaction effect with age was found (p = 0.04), further analyses were conducted separately for persons aged 65–75 years (n = 656) and for persons aged 75–89 years (n = 664) at baseline. After adjustment for age, sex, season of blood collection, body mass index, number of chronic diseases, serum creatinine, cognition, smoking and alcohol use, serum 25(OH)D below or equal to 12 ng/ml was associated with an increased fracture risk in the youngest age group (HR = 3.1; 95% CI: 1.4–6.9), but not in the oldest age group (HR = 1.3; 95% CI: 0.7–2.2). For commonly used cut points of serum 25(OH)D (< 10 ng/ml, 10–19.9 ng/ml, 20–29.9 ng/ml, &#8805; 30 ng/ml), no statistically significant associations were found after adjustment for confounding. Serum 25(OH)D levels below or equal to 12 ng/ml were associated with an increased fracture risk in persons aged 65–75 years. The relatively low cut point of serum 25(OH)D in our population is possibly caused by high calcium intake in the Netherlands.

Objective: The aim of the study was to investigate how settings and registry characteristics affect the prevalence and nature of multimorbidity in elderly individuals. Study Design and Setting: We used data from three population-based studies, two general practitioner registries, one hospital discharge register, and one nursing home registry to estimate the prevalence of multimorbidity. Individuals aged 55 years and over were included. Results: Multimorbidity was most prevalent in nursing homes (82%), followed by the general population and general practitioner registries (56%–72%) and the hospital setting (22%). There were large differences in the nature of multimorbidity between settings. Combinations of hypertension, heart disease, and osteoarthritis were dominant in the population-based setting, whereas hypertension in combination with osteoarthritis, obesity, disorders of lipid metabolism, and diabetes dominated in the general practitioner setting. In the hospital setting, combinations of heart diseases had the highest prevalence. Combinations of dementia, hypertension, and stroke were dominant within the nursing home setting. Conclusion: This study shows that setting and registry characteristics have an important influence on the outcome of multimorbidity studies. We recommend provision of at least information about the setting, the (list of) conditions included, the data collection method, and the time frame used, when reporting about the size and nature of multimorbidity.

No abstract available.

Background: In the past 15 years, antidepressant use in adults has increased, mainly due to a rise in SSRI-use. The question is if this is true for older adults as well. Methods: Data from the Longitudinal Aging Study Amsterdam were used to investigate trends in antidepressant use from 1992 through 2002 in a population-based sample aged 65–85 years. Results: Antidepressant use increased from 2% to 6%. In the group with major depressive disorder, treatment with antidepressants showed an increase from 15% to 30%. This increase was larger in the older-old than in the younger old. Also, the increase was mainly due to a rise in SSRI-use. Daily TCA-dosages often were too low; dosages of the other antidepressants seemed to be sufficient. However, rates of depression remained stable, in the treated as well as in the untreated group. Limitations: Non-response was associated with depression, the indication for prescription of antidepressants was not known, and serum concentrations of antidepressants were not available. Conclusions: Antidepressant use in older people increased over the past 15 years, mainly due to a rise in SSRI-use. Daily dosages of antidepressants had become more adequate. Still only a minority of the more severely depressed used antidepressants.

No abstract available.

No abstract available.

Context: Previous research suggests that depression is a risk factor for stroke. However, the reliability of much research is limited by the lack of documentation on the presence of preexistent cardiovascular disease and by the use of limited measures of depression or stroke. Objectives: To test the hypotheses that (1) clinically relevant depressive symptoms are an independent risk factor of incident stroke in cardiac and noncardiac patients and (2) more chronic and severe depressive symptoms are associated with incident stroke. Design: A cohort of elderly Dutch people (aged > or = 55 years) was followed up for 9 years in the Longitudinal Aging Study Amsterdam (baseline measurements were taken in 1992 or 1993, and the study concluded in 2001 or 2002, respectively). Setting: General community. Participants: Randomly selected population-based sample (N=2965) without a history of stroke. Main Outcome Measures: The study end point was a first stroke (nonfatal or fatal). Depression was measured using the National Institute of Mental Health Diagnostic Interview Schedule and the Center for Epidemiological Studies–Depression Scale. Multivariate Cox proportional hazards regression analyses of stroke incidence were performed. The association of the chronicity and severity of depressive symptoms was studied in extended models with time-dependent variables. Results: The sample’s mean (SD) age was 70.5 (8.7) years, 52.1% were women, and the mean (SD) follow-up was 7.7 (3.1) years. Inclusion of an interaction between cardiac disease and clinically relevant depressive symptoms improved the model for stroke (P=.03). In participants with preexistent cardiac disease, but not in participants without cardiac disease, clinically relevant depressive symptoms at baseline (hazard ratio [HR], 2.18; 95% confidence interval [CI], 1.17-4.09) and the severity (range, 0-60; HR, 1.08; 95% CI, 1.02-1.13) and chronicity (HR, 3.51; 95% CI, 1.13-10.93) of symptoms during follow-up were associated with stroke. Conclusions: Preexistent cardiac disease moderates the association between depressive symptoms and incident stroke. In cardiac patients, baseline depressive symptoms and both the severity and chronicity of symptoms during follow-up are associated with incident stroke.

Background/Aims: Anxiety and depression are common inpatients with cognitive decline and Alzheimer\'s disease (AD), and recognition and treatment of these symptoms can improve their quality of life. The present study investigates anxiety and depression in different phases of cognitive decline. Methods: The sample consisted of five groups of elderly people in different phases of cognitive decline; four from a community-based sample (Longitudinal Aging Study Amsterdam), and one group of elderly people diagnosed with AD. ANOVAs were performed to investigate group differences in the severity and prevalence of anxiety and depression, and comorbid anxiety and depressive symptoms. Results: The prevalence rates of anxiety, comorbid anxiety and depressive symptoms and depressive symptoms follow a pattern of an increasing prevalence as cognitive performance declines and a decrease in the prevalence when cognitive functioning is severely impaired. AD patients report fewest anxiety symptoms. Conclusion: We found that the prevalence of anxiety symptoms, depressive symptoms and comorbid anxiety and depressive symptoms seems to increase in the early phase of cognitive decline, and decreases as cognitive functioning further declines. Elderly diagnosed with AD report less anxiety as expected, probably due to lack of insight caused by AD.

Objective This study investigates the effects of benzodiazepine (BZ) use on cognitive performance in elderly persons in a longitudinal design. Study design and setting Data were obtained from the Longitudinal Aging Study Amsterdam (LASA), in the Netherlands.2,105 respondents (
62 years of age) were included and had repeated measurements over a period of 9 years. For all BZs the type, dosage, frequency and duration of use was measured. The equivalent of a dose of diazepam was determined with regard to type and dosage and a cumulative dosage was calculated. General cognitive functioning was measured with the Mini-Mental State Examination, information processing speed was measured with the coding task, fluid intelligence with Raven’s Coloured Progressive Matrices and episodic memory with the Auditory Verbal Learning Test. Multilevel analyses were used to investigate the relationship between BZ use and cognitive decline. Results A negative effect of BZ use on cognitive performance was found. However, the effect sizes were very small. Conclusion This study suggests that both duration and cumulative exposure to BZ has a small negative effect on the long-term cognitive functioning of elderly people in the community.

Objective: Prayer is generally recognized as an important aspect of religiousness. Relatively few empiric studies examined the relation between prayer and depressive symptoms in later life, and findings so far are mixed. Method: Respondents, aged 60-91 years, participated in the third (N = 1,702) and fourth (N = 1,346) assessment cycles, with three-year intervals, of the Longitudinal Aging Study Amsterdam. Data were collected on frequency of prayer, perceived meaningfulness of prayer, religious affiliation, church attendance, salience of religion, demographics, and health variables. Depressive symptoms were assessed with the Center for Epidemiologic Studies-Depression Scale. Results: In the total sample, there was no significant association between frequency of prayer and depressive symptoms. Among those who were not religiously affiliated, prayer was associated with higher levels of depressive symptoms. The results were particularly pronounced among nonaffiliated widowed respondents; odds ratio for praying daily associated with having Center for Epidemiologic Studies-Depression Scale scores of 16 and higher amounted to 3.59 (99% confidence interval: 1.01-11.79). At three-year follow up, prayer did not predict change of depressive symptoms. Conclusions: As secularization in Western Europe progresses, the current results suggest that clinical exploration of private religiousness among older patients remains relevant, also among people who seem to be less religious.

Given the paucity of information on historical kin relations, this study uses survey data in order to investigate how family forms influenced the relationships among elderly siblings born in farming families between 1903 and 1937 in three regions of the Netherlands. In the area with stem families, impartible inheritance, and a custom of neighbor help, social networks are largest and contain more siblings. Multilevel analyses show that even when controlling for other factors, this particular family form positively affects contact frequency in sibling relationships. Our results not only show the persistence of differential kinship values. Since respondents’ networks were linked back to their families of socialization in the early twentieth century, findings also reflect regional disparities in kin relations in the past.

The personal networks of older people reflect their social opportunities and personal choices to maintain a specific set of relationships with relatives, neighbors, friends, acquaintances and so on. Network analysis is the method used to identify and examine the structural and functional features of the network of the older adult. The conceptualization and operationalization of the personal network depend on the subject of research. Five approaches to define personal network membership are presented and discussed. The five approaches differ regarding the part of the personal network that is mapped, and result in networks of different sizes and compositions. Regardless of the type of network delineation, a distinction can be drawn between the star network (data available on relationships with the focal person) and the full network (data available on all the network relationships). Features of the structure and content of both types of personal networks are presented. Finally, network analysis methods are presented and discussed, including ways to analyze hierarchical databases.

Ouderen met kleine netwerken van persoonlijke relaties waarin weinig familieleden en buurtgenoten zijn opgenomen, hebben een verhoogd risico voor sociale isolatie en psychische gezondheidsproblemen. Vooral 75-plussers, alleenstaande mannen, ouderen met een laag-economische status, die wonen in een grote stad behoren met name tot deze risicogroep. Ouderen die niet regelmatig steun uitwisselen met leden van hun netwerk, hebben een verhoogd risico op het ontberen van steun op latere leeftijd. Vorming en onderhoud van netwerken vindt tijdens de levensloop continu plaats; op latere leeftijd moet men ‘oogsten’ wat men eerder in het leven in relaties heeft geïnvesteerd. Informele zorg is een taak voor verschillende leden van het persoonlijk relatienetwerk, waarbij overleg moet plaatsvinden over afstemming en samenwerking. Eenzaamheid is het resultaat van een tekort schietend netwerk; er zijn onvoldoende relaties of men krijgt niet de ondersteuning die men zich wenst. Voorafgaand aan een interventie moet eerst de oorzaak van eenzaamheid achterhaald worden.

Hoe zal de informele zorg er in 2020 eruit zien? Wat kan de overheid doen aan eventuele knelpunten in de informele zorg? Vaak wordt aangenomen dat er in de toekomst minder informele zorg zal zijn. Ramingen laten echter zien dat ook in de toekomst het aantal hulpverleners en ontvangers in evenwicht zal blijven. Niettemin zijn er belangrijke sociale en culturele trends die de informele zorgverlening onder druk zetten. De stijgende arbeidsparticipatie van vrouwen en ouderen, de toenemende geografische afstand tussen verwanten en een hoger opleidingsniveau hebben een negatieve invloed op het zorgaanbod. Daarnaast is het zo dat veel hulpbehoevenden juist professionele zorg prefereren omdat zij zich bezwaard voelen om hulp van hun naasten te ontvangen. Er zijn ook positieve ontwikkelingen, zoals de stijging van het aantal potentiële hulpverleners bij ouderen. De balans van aanbod en gebruik hangt niet alleen af van de keuzes die de mensen zelf maken. Het overheidsbeleid is wel degelijk van invloed. Zo combineren steeds meer mensen arbeid en zorg. Dit betekent dat het belang van de verlofregelingen alleen maar groter wordt. In deze uitgave heeft het SCP, op verzoek van het ministerie van Volksgezondheid, Welzijn en Sport, een aantal achtergrondstudies over de toekomst van de informele zorg gebundeld. In juni 2007 is hiervan reeds een samenvatting uitgebracht onder de titel Blijvend in balans.

Background. The study investigates whether persons who have experienced childhood adversity are more likely to develop depressive symptoms when faced with recent events. Method. Data were used from a population-based sample, aged 55 to 85 years (n = 1887), which were not depressed at baseline. Childhood adversities and recent stressful life events were retrospectively assessed. Depressive symptoms were measured with the CES-D. Results. 14.4% of our sample experienced adverse events during childhood (< 18 yrs) and 35.4% experienced recent events. Associations of depressive symptoms were found with both, childhood adversity (OR 1.80, 95% CI 1.21–2.69) and recent life events (OR 1.42, 95% CI 1.01–2.00). The effect of recent events on depressive symptoms was not modified by childhood adversity. Limitations. Underreporting may be present due to unwillingness to report embarrassing events or to disclose painful memories. Conclusions. No evidence was found for the assumption that older persons were more vulnerable for depression in reaction to recent life events when they were exposed to childhood adversity.

Changes between 1992 and 2002 in the use of care by older adults after hospital discharge are examined. Data were used from four waves of the population-based Longitudinal Aging Study Amsterdam, including persons aged 64-85 years at each wave. Admission to hospital in the past six months, use of care and dissatisfaction with care were assessed at each wave. The proportion of persons recently admitted to a hospital remained about 10%. Characteristics of those recently admitted to a hospital remained the same: they had more often serious functional limitations, multiple chronic diseases and a low level of education than those not admitted. The total amount of care used after hospital discharge remained the same, but there was an increase in the use of spousal care and a decrease in the use of professional care. Over time a larger proportion of persons was dissatisfied with the care received, in particular after a recent discharge from the hospital. It is concluded that during the implementation of improvements, specific attention should be given to the transition from hospital to home care of older people.

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Objective: Recent evidence suggests that the metabolic syndrome and inflammation affect cognitive decline in old age and that they reinforce each other. However, it is not known what the roles of the individual components of the metabolic syndrome on cognition are. @@placeholder@@Research design and methods:@@placeholder@@The sample consisted of 1,183 participants in the Longitudinal Aging Study Amsterdam who were aged 65–88 years. Metabolic syndrome (U.S. National Cholesterol Education Program definition) and its individual components and the inflammatory markers C-reactive protein (CRP) and 1-antichymotrypsin (ACT) were assessed. Cognitive assessments included general cognition (Mini-Mental State Examination), memory (verbal learning test), fluid intelligence (Raven\'s Matrices), and information processing speed (coding task). Results: Of the sample, 36.3% had metabolic syndrome. Metabolic syndrome was significantly associated with all cognitive measures (P < 0.05). Of the individual components, hyperglycemia was most strongly and significantly associated with cognitive function (multivariate adjusted models; B values, indicating differences in scores between both groups, ranging from –0.38 to –1.21). There was a significant interaction between metabolic syndrome and inflammation on cognition (P < 0.01–0.09). Metabolic syndrome was negatively associated with cognition in subjects with high inflammation (highest tertile for both CRP and ACT; B values ranging from –0.86 to –1.94, P < 0.05), whereas an association was absent in subjects with low inflammation (B values ranging from –0.10 to –0.70). Conclusions: Subjects with metabolic syndrome showed poorer cognitive performance than subjects without metabolic syndrome, especially those with high levels of inflammation. Hyperglycemia was the main contributor of the association of metabolic syndrome with cognition.

No abstract available.

Context: Adult stature is a complex genetic trait. The vitamin D endocrine system has pleiotropic effects on several physiological processes, especially on skeletal metabolism. We recently identified promoter and 3_-untranslated region (UTR) haplotype alleles that influence vitamin D receptor (VDR) mRNA expression. Objective: We studied whether VDR gene variants contribute to the genetic variation in height. Design and Subjects: We studied VDR haplotype alleles and body height in two independent populations (n _ 7187). In a meta-analysis (n _ 14,157 from 27 studies and our current data), we evaluated the effect of the Bsm I polymorphism. Results: Haplotypes of the linkage disequilibrium block 3 and block 5 were associated with body height differences with evidence for additive effects in the Rotterdam Study (P_0.00002) and the Longitudinal Aging Study Amsterdam study (P _ 0.001). Height differences between the extreme genotypes were 1.4 and 2.7 cm, respectively. The relationship was independent of age, gender, presence of vertebral fractures, and age-related height loss. In the Rotterdam population, we found the combined genotype to be associated with decreased vertebral area (P_0.03) and femoral narrow neck width (P _ 0.002). In the meta-analysis, subjects with the “BB” genotype were 0.6 cm (95% confidence interval, 0.2–1.1 cm) taller than those with the “bb” genotype (P _ 0.006). Conclusion: VDR gene variants are associated with differences in body height as evidenced by our study and by a meta-analysis. It remains for further studies to confirm whether the underlying mechanism of the association involves lower VDR expression in cells important for determining bone size.

This article focuses on the most important findings of a unique evaluation study of loneliness interventions among older adults. Eighteen interventions have recently been carried out and closely monitored in various parts of the Netherlands. In ten of these interventions the number of participants was sufficiently large to quantitatively determine the effect of the intervention on loneliness. It does not appear to be easy to overcome loneliness: no more than two of the ten interventions resulted in a reduction in loneliness among participants that may be attributed to the intervention. Two other interventions may have had a preventive effect: whereas loneliness increased among members of the control group, it remained more or less constant over time among participants. The effect measurements were followed by process evaluations in an effort to gain insight into the possible reasons why feelings of loneliness were not alleviated among participants in the case of most of the interventions. This resulted in a number of lessons for the future, which may be used as a checklist when designing new interventions projects.

Objective: This article addresses the association between course of chronic disease and lifestyle. Method: We examined differences in unhealthy lifestyles—smoking, excessive alcohol use, being sedentary—and transitions herein after 6 years in prevalent and incident chronic disease categories—lung and cardiovascular disease, diabetes, and osteoarthritis and/or rheumatic arthritis—among 2,184 respondents aged 55 years and older from the Netherlands. We also examined if transitions in lifestyle co-occurred with changes in isease-related symptomatology. Results: Proportions of respondents who smoked decreased over time, whereas proportions of respondents who were sedentary increased. Respondents with incident cardiovascular disease demonstrated more lifestyle transitions than respondents from other disease categories. Respondents demonstrating healthy lifestyle transitions did not differ from those persisting in unhealthy lifestyles in change in disease-related symptoms. Discussion: Health promotion may benefit from these findings in a way that patient groups at risk for not initiating healthy lifestyles might be identified sooner.

The convoy model conceptualizes older adults’ networks of personal relationships as convoys of social support. This prospective study examined how contact and support in several relationships changed due to widowhood. Using observations between 1992 and 2002 from the Longitudinal Aging Study Amsterdam, multilevel models describe change in contact and support of 227 widowed and 408 married older adults. Contact and support were low before widowhood, and increased in all relationships after widowhood, and more so in child and sibling relationships. Around 2.5 years after widowhood, contact and support started to decrease. Our findings increase our understanding of the heterogeneity of network changes in old age and of the instability of the network as a social convoy in late life.

Background: The association between depression and an increased risk of death in elderly persons has been established in both clinical and community studies. Co-occurrence of depression and generalized anxiety has been shown to represent more severe and more chronic psychopathology. However, little is known about the relation between generalized anxiety disorder, mixed anxiety-depression (generalized anxiety disorder and depression) and excess mortality in the elderly. Objective: To investigate whether generalized anxiety and mixed anxiety-depression are associated with mortality. Method: Generalized anxiety disorder, mixed anxiety-depression and depression were assessed in 4051 older persons with a ten-year follow-up of community death registers. The mortality risk of generalized anxiety, depression and mixed anxiety-depression was calculated after adjustment for demographic variables, physical illness, functional disabilities and social vulnerability. Results: In generalized anxiety disorder and mixed anxiety-depression no significant excess mortality was found. In depression a significant excess mortality was found in men [HR 1.44 (1.09-1.89)] but not in women [HR 1.04 (0.87-1.24)] after adjustment for the different variables. Conclusions: In elderly persons depression increases the risk of death in men. Neither generalized anxiety nor mixed anxiety-depression are associated with excess mortality. Generalized anxiety disorder may even predict less mortality in depressive elderly people. The relation between generalized anxiety disorder and its possibly protective effect on mortality has to be further explored.

Cognitive decline without dementia is common among older persons. A variety of clinical concepts have been introduced in the past 30 years, in order to describe these cognitive deficits arising in older persons. The most frequently used concept is Mild Cognitive Impairment (MCI). MCI is generally seen as a prodromal phase of Alzheimer disease (AD). Several concepts are described, with the neuropsychiatric features and predictors of conversion to dementia c.q. AD. Finally, consequences of preclinically diagnoses for health care are clarified.

Anti-Mullerian hormone (AMH) inhibits primordial follicle recruitment in the mouse ovary. We hypothesize that in women AMH signaling also regulates the usage of the primordial follicle pool and hence influences the onset of menopause. Since age at menopause has a strong genetic component, we investigated the role of AMH signaling using a candidate gene approach. Methods: In two large population-based cohorts of Dutch postmenopausal women (n52381 and n5248), we examined the association between two polymorphisms, one in the AMH gene and one in the AMH type II receptor (AMHR2) gene, and natural age at menopause. Results: The AMH Ile49Ser polymorphism (rs10407022) was not associated with age at menopause in either cohort. In the Rotterdam cohort, the AMHR2 2482 A>G polymorphism (rs2002555) was associated with age at menopause in interaction with the number of offspring (P50.001). Nulliparous women homozygous for the G-allele entered menopause 2.6 years earlier compared with nulliparous women homozygous for the A-allele (P50.005). In the LASA cohort, women with the G/G genotype tended to enter menopause 2.8 years earlier compared with the A/A genotype (P50.063). Conclusions: The observed association of the AMHR2 2482 A>G polymorphism with natural age at menopause suggests a role for AMH signaling in the usage of the primordial follicle pool in women.

Objective: Sex steroids play an important role in the maintenance of bone health. Association studies on sex steroids and fractures are not consistent. Our objective was to examine whether serum oestradiol (E2) and testosterone (T) are associated with quantitative ultrasound (QUS), bone mineral density (BMD), bone turnover markers and fracture incidence. Design: The Longitudinal Ageing Study Amsterdam (LASA), an ongoing cohort study including 623 men and 634 women, aged 65–88 years. Measurements: Serum levels of E2, T, SHBG, albumin, bone turnover markers serum osteocalcin (OC) and urinary deoxypyridinoline (DPD/Cr) were measured. QUS of the heel and BMD of the hip were assessed, and a 6-year fracture follow-up was performed. Results: Men in the lowest quartile (Q1) of bioavailable E2 (bioE2) had higher levels of bone turnover and lower BMD (B= –0·09, P < 0·01) and QUS than men in the highest quartile (Q4). This also applied to Q1 of bioT. Women in Q1 of bioE2 had higher levels of bone turnover and lower BMD (B = –0·07, P < 0·01) and QUS than women in Q4. In men and women, levels of bioE2 below the median were associated with an increased risk of osteoporotic fractures after all adjustments [hazard ratio (HR) 1·53, 95% confidence interval (CI) 1·02–2·29]. In men, univariate analysis revealed that low bioT was associated with an increased fracture risk (HR 1·91, 95% CI 1·03–3·56), but after adjustment for age, this association was no longer significant. Conclusions: Low levels of bioE2 and bioT were found to be associated with high bone turnover, low QUS and BMD and high risk of osteoporotic fractures in both men and women.

This study investigates whether the frequency of contact and support exchanged in relationships between parents and adult children declines over successive cohorts and over individual time in the Netherlands. Respondents included a birth cohort from 1928 - 1937 with data collected in 1992 (N = 941) and in 2002 (N = 574) and a birth cohort from 1938 - 1947 with data collected in 2002 (N = 884). We assessed cohort and time-sequential changes. Parents of the later cohort had more contact and support exchanges with their children than the earlier cohort, revealing that families have not declined in importance. Furthermore, longitudinally, contact and supportive exchanges with adult children decreased, suggesting that parents and children devote less time to intergenerational relationships during this \'empty nest\' phase.

Objective: Hypercortisolism is associated with muscle weakness. This study examines the relationship between cortisol and physical performance in older persons. Design/patients: The study was conducted within the Longitudinal Aging Study Amsterdam (LASA), an ongoing cohort study in a population-based sample of healthy older persons in the Netherlands. Data from the second (1995/1996) and fourth (2001/2002) cycle were used pertaining to 1172 (65–88 years) and 884 (65–94 years) men and women, respectively. Measurements: Physical performance was measured by adding up scores on the chair stands, tandem stand and walk test (range 0–12). In the second cycle serum total and calculated free cortisol were assessed; in the fourth cycle evening salivary cortisol was assessed. Regression analysis (stratified for sex, adjusted for age, body mass index, alcohol use, physical activity and region) was performed to examine the cross-sectional relationship between cortisol and physical performance. Results: Women with higher calculated free cortisol scored less well on physical performance (b=–0·28 per SD higher cortisol, P=0·016), which was mainly explained by poorer performance on the tandem stand (OR=1·32 for a lower score per SD higher cortisol, P=0·003). Men with higher salivary cortisol scored less well on physical performance (b=–0·90 in the highest vs. the lowest quartile, P=0·008), which was mainly explained by poorer performance on the chair stands and walk test (OR=1·88, P=0·020 and OR=1·81, P=0·027, respectively, in the highest vs. the lowest quartile). Conclusion: Physical performance is negatively associated with high cortisol levels in older persons.

Background and aims: This study aimed at examining the association between unhealthy lifestyle in young age, midlife and/or old age and physical decline in old age, and between chronic exposure to an unhealthy lifestyle throughout life and physical decline in old age. Methods: The study sample included 1297 respondents of the Longitudinal Aging Study Amsterdam (LASA). Lifestyle in old age (55-85 y) was assessed at baseline, whereas lifestyle in young age (around 25 y) and midlife (around 40 y) were assessed retrospectively. Lifestyle factors included physical activity, body mass index (BMI), number of alcohol drinks per week and smoking. Physical decline was calculated as a change in physical performance score between baseline and six-year follow-up. Results: Of the lifestyle factors present in old age, a BMI of 25-29 vs BMI <25 kg/m2 (OR=1.6; 95% CI: 1.1-2.2) and a BMI of ?30 vs BMI <25 kg/m2 (OR=1.8; 95% CI: 1.2-2.7) were associated with physical decline in old age. Being physically inactive in old age was not significantly associated with an increased risk of physical decline, although, being physically inactive in both midlife and old age increased the odds of physical decline in old age to 1.6 (95% CI: 1.1-2.4), compared with respondents who were physically inactive in midlife and physically active in old age. Being overweight in both age periods was associated with an OR of 1.5 (95% CI: 1.1-2.2). Conclusions: These data suggest that overweight in old age, and chronic exposure to physical inactivity or overweight throughout life, increases the risk of physical decline in old age. Therefore, physical activity and prevention of excessive weight at all ages should be stimulated, to prevent physical decline in old age.

Quality of life is a commonly used but seldom defined concept and there is no consensus on how to define it. The aim of this study was to explore the meaning of quality of life to older frail and non-frail persons living in the community. Qualitative interviews were conducted with 25 older men and women. The audio-taped interviews were transcribed and coded for content and analyzed using the grounded-theory approach. Five themes emerged: (physical) health, psychological well-being, social contacts, activities, and home and neighborhood. Factors that influenced quality of life were having good medical care, finances and a car. Respondents compared themselves mostly to others whose situation was worse than their own, which resulted in a satisfactory perceived quality of life. However, the priorities of the domains of quality of life were observed to change. Moreover, the health of the frail limited the amount and scope of activities that they performed. This led to a lower quality of life perceived by the frail compared to the non-frail.

Objective:To examine the relationship between endogenous cortisol and bone, and the role of genetic variations in the glucocorticoid receptor (GR). Design and patients:The Longitudinal Ageing Study Amsterdam (LASA), a population-based cohort study in older men and women. Measurements:Serum fasting cortisol was assessed by competitive immunoassay (n=1214); bone mineral density (BMD) by dual X-ray absorptiometry (DXA) (n=502); broadband ultrasound attenuation (BUA) by ultrasound (n=1209); fractures by self-report (n=1211); and GR gene polymorphisms (ER22/23EK, N363S, 9beta, BclI) were genotyped by Taqman (n=858). Results:Higher serum fasting cortisol was significantly associated with lower BMD at all sites and BUA at the heel in women, although most relationships were attenuated by age and body mass index (BMI). The effect on femoral neck BMD remained statistically significant in the fully adjusted model (r=–0·135, P=0·04). No significant associations in men were found. Female 9beta G-allele carriers had 50·2nmol/l lower cortisol and 1·2lower free cortisol levels than AA homozygotes [P=0·01 for (free) cortisol]. Furthermore, female BclI GG homozygotes had 54·8nmol/l higher cortisol levels than C-carriers (P=0·03). In the total population, BclI GG homozygotes had 0·05g/cm2 lower trochanteric region BMD (P=0·03). For the other GR gene polymorphisms, no significant associations were found. Conclusions:Higher cortisol levels are associated with lower femoral neck BMD in elderly women. The G allele of the 9beta polymorphism was associated with lower serum cortisol levels in women. Female BclI GG homozygotes had higher serum cortisol levels, and BclI GG homozygotes had lower trochanteric region BMD in the total population.

Background: Anxiety disorders in older people are highly prevalent, yet there is little evidence to guide targeted prevention strategies. Aims: To identify subgroups at increased risk of developing anxiety in later life. Method: Anxiety was measured with the Hospital Anxiety and Depression anxiety sub-scale in1931people aged 55-85 years followed over 3 years. Risk factors were identified that had a high combined attributable fraction, indicative of substantial health gains when the adverse effect of the risk factors can be contained. Results: Factors significantly associated with increased risk of developing anxiety included sub-threshold anxiety, depression, two or more chronic illnesses, poor sense of mastery, poor self-rated health and low educational level. Conclusions: The identified risk groups are small, thus providing prevention with a narrow focus, and health gains are likely to be more substantial than in groups not exposed to these risk factors. Nevertheless, more research is needed to produce evidence on target groups where prevention has optimal impacts. Declaration of interest: None.

No abstract available.

Background: Evidence is accumulating that the vitamin D endocrine system has physiological functions beyond bone health including a role in the regulation of blood pressure. Effects of poor vitamin D status on blood pressure may be mediated by elevated parathyroid hormone (PTH) levels. Aim: To evaluate whether serum 25-hydroxyvitamin D [25(OH)D] and PTH levels are independently associated with blood pressure in a population-based study of older men and women. Methods: Subjects were participants of the Longitudinal Aging Study Amsterdam, aged 65 years and older. In 1205 participants, serum 25(OH)D and PTH levels were determined and diastolic and systolic blood pressure were measured. Linear and logistic regression analyses were performed with adjustments for age, sex, region, season, lifestyle factors (physical activity, smoking, alcohol intake), and waist circumference. Results: Serum 25(OH)D was not significantly associated with diastolic (beta 0.00, P = 0.98) or systolic (beta 0.06, P = 0.11) blood pressure. In contrast, higher ln-PTH levels were significantly associated with higher diastolic (beta 1.93, P = 0.03) and systolic (beta 4.67, P = 0.01) blood pressure. Higher PTH levels were associated with a substantially higher prevalence of hypertension (OR 2.00, 95% CI 1.31-3.06 for the highest versus the lowest quartile), whereas 25(OH)D showed no significant association (OR 0.89, 95% CI 0.47-1.69 for the lowest versus the highest 25(OH)D category). Conclusion: These results indicate that PTH is a potentially modifiable determinant of blood pressure in the general elderly population. Serum 25(OH)D, however, was not associated with blood pressure, possibly due to the relatively high levels in our population.

Background: Evidence is accumulating that the vitamin D endocrine system has physiological functions beyond bone health including a role in the regulation of blood pressure. Effects of poor vitamin D status on blood pressure may be mediated by elevated parathyroid hormone (PTH) levels. Aim: To evaluate whether serum 25-hydroxyvitamin D [25(OH)D] and PTH levels are independently associated with blood pressure in a population-based study of older men and women. Methods: Subjects were participants of the Longitudinal Aging Study Amsterdam, aged 65 years and older. In 1205 participants, serum 25(OH)D and PTH levels were determined and diastolic and systolic blood pressure were measured. Linear and logistic regression analyses were performed with adjustments for age, sex, region, season, lifestyle factors (physical activity, smoking, alcohol intake), and waist circumference. Results: Serum 25(OH)D was not significantly associated with diastolic (beta 0.00, P ¼ 0.98) or systolic (beta 0.06, P ¼ 0.11) blood pressure. In contrast, higher ln-PTH levels were significantly associated with higher diastolic (beta 1.93, P ¼ 0.03) and systolic (beta 4.67, P ¼ 0.01) blood pressure. Higher PTH levels were associated with a substantially higher prevalence of hypertension (OR 2.00, 95% CI 1.31– 3.06 for the highest versus the lowest quartile), whereas 25(OH)D showed no significant association (OR 0.89, 95% CI 0.47–1.69 for the lowest versus the highest 25(OH)D category). Conclusion: These results indicate that PTH is a potentially modifiable determinant of blood pressure in the general elderly population. Serum 25(OH)D, however, was not associated with blood pressure, possibly due to the relatively high levels in our population.

Objective: The authors examined whether personality characteristics such as mastery, self-efficacy, and neuroticism predict the likelihood of recovery of depression among elderly in the community. It was hypothesized that these personality characteristics do predict recovery but that their effect is overwhelmed by the effect of deteriorations in physical health, cognitive decline, and loss of social resources. The second research question investigated whether these personality characteristics moderate the negative impact of the other prognostic factors on the chance of recovery. Methods: A prospective (nine-year) follow-up study of 206 depressed elderly (55–85 years at baseline) participants of the Longitudinal Aging Study Amsterdam. Data on chance of recovery were analyzed using Cox proportional regression analyses. Results: Both in the univariate and in the multivariate model, the personality characteristics, especially neuroticism, predicted recovery of depression. The effect of neuroticism was similar to that of physical health and stronger than the impact of cognitive decline or social resources. No support was found for personality as a moderator of the negative impact of age-related stressors. Conclusions: Personality characteristics, i.e., neuroticism and physical health-related variables are separate but equally important domains for the chance of recovery of depression in later life.

No abstract available.

Age-related height loss may affect the calculation of body mass index (BMI) and subsequently the classification of under- and overweight in older men and women. Objective: To quantify the effect of using body height measured 9 years earlier instead of using current body height on the prevalence rates of under- and overweight in a population-based sample of older men and women. Design: Complete data on current, measured body height and weight (2001-02) and measured body height and weight 9 years earlier were available for 1163 men and women aged 63 to 93 years who participated in the Longitudinal Aging Study Amsterdam. Results: The mean loss of height was –0.8 ± 1.9 (mean ± SD) and –1.3 ± 1.7 cm in men and women, respectively, resulting in a mean overestimation of BMI by 0.3 ± 0.6 and 0.4 ± 0.6 kg/m². This overestimation increased with increasing age group (P-value for trend P<0.0001) and was highest in women aged 85+ years (0.9 ± 0.7) kg/m². When BMI was calculated using current height, 5.6% of the older men and women were classified one BMI category higher (eg overweight instead of normal weight) than when using height measured 9 years earlier. Estimates of longitudinal change in BMI during follow-up were biased when age-related height loss was not taken into account. Conclusions: The results of this study suggest a substantial overestimation of the point prevalence rates of overweight and obesity and of the longitudinal increase in BMI with aging in older men and women when ignoring the age-related height loss.

Context: Vitamin D deficiency is common among older people and can cause mineralization defects, bone loss, and muscle weakness. Objective: The aim of this study was to investigate the association of serum 25-hydroxyvitamin D (25-OHD) concentration with current physical performance and its decline over 3 yr among elderly. Design: The study consisted of a cross-sectional and longitudinal design (3-yr follow-up) within the Longitudinal Aging Study Amsterdam. Setting: An age- and sex-stratified random sample of the Dutch older population was used. Other Participants: Subjects included 1234 men and women (aged 65 yr and older) for cross-sectional analysis and 979 (79%) persons for longitudinal analysis. Main Outcome Measure(s): Physical performance (sum score of the walking test, chair stands, and tandem stand) and decline in physical performance were measured. Results: Serum 25-OHD was associated with physical performance after adjustment for age, gender, chronic diseases, degree of urbanization, body mass index, and alcohol consumption. Compared with individuals with serum 25-OHD levels above 30 ng/ml, physical performance was poorer in participants with serum25-OHDless than 10 ng/ml [regression coefficient (B) = – 1.69; 95% confidence interval (CI) =–2.28; –1.10], and with serum 25-OHD of 10–20 ng/ml (B=-0.46; 95% CI = –0.90; –0.03). After adjustment for confounding variables, participants with 25-OHD less than 10 ng/ml and 25-OHD between 10 and 20 ng/ml had significantly higher odds ratios (OR) for 3-yr decline in physical performance (OR = 2.21; 95% CI _=1.00–4.87; and OR =2.01; 95% CI = 1.06–3.81), compared with participants with 25-OHD of at least 30 ng/ml. The results were consistent for each individual performance test. Conclusions: Serum 25-OHD concentrations below 20 ng/ml are associated with poorer physical performance and a greater decline in physical performance in older men and women. Because almost 50% of the population had serum 25-OHD below 20 ng/ml, public health strategies should be aimed at this group.

No abstract available.

Objectives: To assess country-specific gender differences in depressive symptoms and to explore if exposures and vulnerabilities vary by gender among older men and women from four European countries and Israel. Methods: Data on 4,449 subjects between 75 and 84 years old were derived from CLESA (‘‘Cross-national determinants of quality of life and health services for the elderly’’. A ratio score of depressive symptoms derived form the CESD and GDS scales was regressed on education, marital status, living arrangements, comorbidity and disability and all interactions of these factors with gender and country. Results: The prevalence of depressive symptoms is higher in women than in men in every country, except Sweden. Women are more likely to be exposed to socio-structural risks, and have poorer health and more disability than men in most of the countries. However, women are not more vulnerable to these risk factors. Conclusions: Findings indicate that the female excess in depressive symptoms remains after taking into account the higher prevalence of socio-structural and health-related risk factors and that older women are not more vulnerable than older men to these known risk factors, suggesting the existence of additional pathways linked to gender and/or biological sex.

Background and Objective: To estimate the effects of reducing the prevalence of smoking in lower educated groups on educational differences in life expectancy. Methods: A dynamic Markov-type multistate transition model estimated the effects on life expectancy of two scenarios. A ‘‘maximum scenario’’ where educational differences in prevalence of smoking disappear immediately, and a ‘‘policy target-scenario’’ where difference in prevalence of smoking is halved over a 20-year period. The two scenarios were compared to a reference scenario, where smoking prevalences do not change. Five Dutch cohort studies, involving over 67,000 participants aged 20 to 90 years, provided relative mortality risks by educational level, and smoking habits were assessed using national data of more than 120,000 persons. Results: In the reference scenario, the difference in life expectancy at age 40 between highest and lowest educated groups was 5.1 years for men and 2.7 years for women. In the ‘‘maximum scenario’’ these differences were reduced to 3.6 years for men and 1.7 years for women (reduction &#8776;30%), and in the ‘‘policy target-scenario’’ differences were 4.7 years for men and 2.4 years for women (reduction &#8776;10%). Conclusion: Theoretically, educational differences in life expectancy would be reduced by 30% at maximum, if variations in smoking prevalence were eliminated completely. In practice, tobacco control policies that are targeted at the lower educated may reduce the differences in life expectancy by approximately 10%.

No abstract available.

No abstract available.

Objectives. Gerotranscendence has been conceptualized as a potential development accompanying normal aging. Gerotranscendence is defined as a shift in metaperspective from a materialistic and pragmatic world view to a more cosmic and transcendent one. In the past decade, population-based studies have tested Tornstam\'s Gerotranscendence Scale. Its Cosmic Transcendence subscale, in particular, emerged as consistent. The aim of the present study was to examine (a) how cosmic transcendence relates to having a framework of meaning in life and (b) whether religiousness and demographic characteristics influence possible relationships. Methods. Participants were 928 older Dutch adults who responded to a questionnaire that included the Cosmic Transcendence scale, aspects of religiousness, and the Framework of Meaning in Life subscale of the Life Regard Index. Results. A substantial, positive association between cosmic transcendence and framework of meaning in life was observed. This association was much more pronounced among participants who were less involved in religion, who were women, who were age 75 or older, or who were widowed. Discussion. The current study indicates that the personal relevance of cosmic transcendence depends on cultural factors such as secularization. Furthermore, cosmic transcendence seems to unfold as an important domain in the life view of women, the older old, and the widowed.

No abstract available.

Objective: Depressive disorders have been shown to be associated with cardiac diseases and death, but the underlying disease mechanism is unclear. The authors hypothesized that the cardiac morbidity and mortality after depression in late life is mediated by subclinical atherosclerosis and is thus confined to ischemic heart diseases. Method: Using the population-based cohort of the Longitudinal Aging Study Amsterdam, 2,403 men and women aged 55 and over without cardiac disease were followed to assess the onset of cardiac disease or cardiac death. Ischemic heart diseases (angina pectoris, [non]fatal myocardial infarction) were distinguished from other cardiac diseases (congestive heart failure, arrhythmia). Major depressive disorder (MDD) was defined according to Diagnostic and Statistical Manual of Mental Disorders, Third Edition (DSM-III) criteria. Subthreshold depression was defined as clinically relevant depressive symptoms not fulfilling DSM criteria. Results: After a mean follow up of 7.2 years, 444 first cardiac events occurred, of which 252 were primary ischemic events and 192 other cardiac events. Cox regression analysis adjusted for physical health variables showed that, when compared with nondepressed respondents, those with MDD had a relative risk (RR) of 2.09 (95% confidence interval: 1.13–3.85) for any cardiac event. Considering only ischemic events, the RR conferred by MDD increased to 3.00 (1.51–5.93), whereas the RR declined to 0.96 (0.24 –3.89) for all other cardiac events. Subthreshold depression did not increase the risk of future cardiac events. Conclusion: Major depression in older age predicts first cardiac events. The excess cardiac morbidity and cardiac mortality after major depression could entirely be attributed to ischemic heart diseases.

No abstract available.

No abstract available.

This study investigates the variations by older people’s socio-economic status (SES) (i.e. educational level and social class) in the use of informal and formal help from outside the household in Great Britain, Italy, Belgium and The Netherlands. In all these countries, it was older people in low SES groups who mostly used such help. Multinomial logistic regression analyses showed that, in each country and for both types of help, there were SES gradients in the utilisation of both formal and informal care, and that differences in age, health and marital status largely accounted for the former but not the latter. Crossnational differences in the use of both informal and formal help remained when variations in sex, age, SES, health, marital status, home ownership and the use of privately-paid help were taken into account. Significant interaction effects were found, which indicated that older people in low SES groups in Great Britain and The Netherlands had higher odds of using informal help from outside the household than their counterparts in Italy, and similarly that those in The Netherlands were more likely to use formal help than their Italian peers. The results are discussed in relation to the cultural differences and variations in the availability of formal services among the countries.

Background: It is well-established that the incidence of major depressive disorder is increased in subjects with subthreshold depression. A new research area focuses on the possibilities of preventing the onset of major depressive disorders in subjects with subthreshold depression. An important research question for this research area is which subjects with subthreshold depression will develop a full-blown depressive disorder and which will not. Methods: We selected 154 older subjects with subthreshold depression (CES-D>16) but no DSM mood disorder from a longitudinal study among a large population based cohort aged between 55 and 85 years in The Netherlands. Of these subjects, 31 (20.1%) developed a mood disorder (major depression and/or dysthymia) at three-year or six-year follow-up. We examined risk factors and individual symptoms of mood disorder as predictors of onset of mood disorder. Results: Two variables were found to be significant predictors in both bivariate and multivariate analyses: eating problems and sleep problems. The incidence of mood disorders differed strongly for different subpopulations, varying from 9% (for those not having any of the two risk factors) to 57% (for those having both risk factors). Conclusions: It appears to be possible to predict to a certain degree whether a subject with subthreshold depression will develop a mood disorder during the following years.

No abstract available.

No abstract available.

Background: Several studies have described etiological and clinical differences between elderly depressed patients with early onset of their illness compared to late onset. While most studies have been carried out in clinical samples it is unclear whether the findings can be generalized to the elderly population as a whole. The aim of this study was to compare early-onset (EOD) and late-onset (LOD) depressive illness in a community-based sample. Methods: Large (n = 3107) representative sample of older persons (55-85 years) in the Netherlands. Two-stage screen procedure to identify elderly with MDD. The Center for Epidemiologic Studies Depression scale (CES-D) was used as a screen and the Diagnostic Interview Schedule (DIS) to diagnose MDD. Data on 90 older persons with early-onset depression and 39 with late-onset depression were available. Results: Those with LOD were older, and more often widowed. Family psychiatric history, vascular pathology, and stressful early and late life events did not differ between groups. EOD subjects had more often double depression and more anxiety. Conclusions: In a community-based sample we did not detect clear differences in etiology and phenomenology between EOD and LOD. This discrepancy with reports from clinical samples could be due to selection bias in clinical studies. Consequently, all patients with late-life depression deserve a diagnostic work-up of both psychosocial and somatic risk factors and treatment interventions should be focused accordingly.

No abstract available.

Loneliness is an indicator of social well-being and pertains to the feeling of missing an intimate relationship (emotional loneliness) or missing a wider social network (social loneliness). The 11-item De Jong Gierveld Loneliness Scale has proved to be a valid and reliable measurement instrument for overall, emotional, and social loneliness, although its length has sometimes rendered it difficult to use in large surveys. In this study, the authors empirically tested a shortened version of the scale on data from two surveys (N = 9,448). Confirmatory factor analyses confirmed the specification of two latent factors. Congruent validity and the relationship with determinants (partner status, health) proved to be optimal. The 6-item De Jong Gierveld Loneliness Scale is a reliable and valid measurement instrument for overall, emotional, and social loneliness that is suitable for large surveys.

No abstract available.

Background: This study examines the association between socioeconomic status and changes in physical function in younger- (aged 55–70 years) and older-old (aged 70–85 years) adults and seeks to determine the relative contribution of diseases, behavioral, and psychosocial factors in explaining this association. Methods: Data were from 2,366 men and women, aged 55–85 years, participating in the Longitudinal Aging Study Amsterdam (LASA). Two indicators of socioeconomic status were used: education and income. Physical function was measured by self-reported physical ability over nine years of follow-up. Results: In older adults, low socioeconomic status was related to a poorer level of physical function during nine years of follow-up. In subjects who were between 55 and 70 years old, there was an additional significant socioeconomic-differential decline in physical function, while socioeconomic differentials did not further widen in subjects 70 years and older. Behavioral factors, mainly BMI and physical activity, largely explained the socioeconomic differences in physical function in the youngest age group, while psychosocial factors reduced socioeconomic status differences most in the oldest age group. Conclusion: The findings indicate age-specificity of both the pattern of socioeconomic status differences in function in older persons and the mechanisms underlying these associations.

Objective: The objective of this study was to examine the association between socioeconomic status (SES) and the onset of depression in older adults and to determine the relative contribution of psychosocial factors, physical health status, and behavioral factors in explaining this link. Methods: Data were from 2593 men and women, aged 55–85 years, participating in the Longitudinal Aging Study Amsterdam. Two indicators of SES were used: education and income. The onset of depression was measured over 9 years of follow-up. Results: Adjusted hazard ratios of incident depression were significantly higher in those with low education and low income. Psychosocial factors explained on average 16% of the SES differences in incident depression, physical health status on average 7%, and behavioral factors less than 5%. Conclusion: In older adults, low SES predicted the incidence of depression. Part of this association was explained by psychosocial factors and physical health status.

No abstract available.

Introduction: The aim of the prospective study reported here was to develop a risk profile that can be used to identify community-dwelling elderly at a high risk of recurrent falling. Materials and Methods: The study was designed as a 3-year prospective cohort study. A total of 1365 community-dwelling persons, aged 65 years and older, of the population-based Longitudinal Aging Study Amsterdam participated in the study. During an interview in 1995/1996, physical, cognitive, emotional and social aspects of functioning were assessed. A follow-up on the number of falls and fractures was conducted during a 3-year period using fall calendars that participants filled out weekly. Recurrent fallers were identified as those who fell at least twice within a 6-month period during the 3-year follow-up. Results: The incidence of recurrent falls at the 3-year follow-up point was 24.9% in women and 24.4% in men. Of the respondents, 5.5% reported a total of 87 fractures that resulted from a fall, including 20 hip fractures, 21 wrist fractures and seven humerus fractures. Recurrent fallers were more prone to have a fall-related fracture than those who were not defined as recurrent fallers (11.9% vs. 3.4%; OR: 3.8; 95% CI: 2.3-6.1). Backward logistic regression analysis identified the following predictors in the risk profile for recurrent falling: two or more previous falls, dizziness, functional limitations, weak grip strength, low body weight, fear of falling, the presence of dogs/cats in the household, a high educational level, drinking 18 or more alcoholic consumptions per week and two interaction terms (high education x 18 or more alcohol consumptions per week and two or more previous falls x fear of falling) (AUC=0.71). Discussion: At a cut-off point of 5 on the total risk score (range 0-30), the model predicted recurrent falling with a sensitivity of 59% and a specificity of 71%. At a cut-off point of 10, the sensitivity and specificity were 31% and 92%, respectively. A risk profile including nine predictors that can easily be assessed seems to be a useful tool for the identification of community-dwelling elderly with a high risk of recurrent falling.

This study aimed to examine the association between unhealthy lifestyle in young age, midlife and/or old age and physical decline in old age, and to examine the association between chronic exposure to an unhealthy lifestyle throughout life and physical decline in old age. The study sample included 1297 respondents of the Longitudinal Aging Study Amsterdam (LASA). Lifestyle in old age (55-85 y) was assessed at baseline, while lifestyle in young age (around 25 y) and midlife (around 40 y) were assessed retrospectively. Lifestyle factors included physical activity, body mass index (BMI), number of alcohol drinks per week and smoking. Physical decline was calculated as change in physical performance score between baseline and six-year follow-up. Of the lifestyle factors present in old age, a BMI of 25-29 vs. BMI <25 kg/m2 (odds ratio (OR) 1.6; 95% confidence interval (CI) 1.1-2.2) and a BMI of > or =30 vs. BMI <25 kg/m2 (OR 1.8; 95% CI 1.2-2.7) were associated with physical decline in old age. Being physically inactive in old age was not significantly associated with an increased risk of physical decline, however, being physically inactive both in midlife and in old age increased the odds of physical decline in old age to 1.6 (95% CI 1.1-2.4) as compared to respondents who were physically inactive in midlife and physically active in old age. Being overweight in both age periods was associated with an OR of 1.5 (95% CI 1.1-2.2). These data suggest that overweight in old age, and chronic exposure to physical inactivity or overweight throughout life increases the risk of physical decline in old age. Therefore, physical activity and prevention of overweight at all ages should be stimulated to prevent physical decline in old age.

No abstract available.

Background: Osteoporosis and fracture risk are considered to be under genetic control. Extensive work is being performed to identify the exact genetic variants that determine this risk. Previous work has suggested that a G/T polymorphism affecting an Sp1 binding site in the COLIA1 gene is a genetic marker for low bone mineral density (BMD) and osteoporotic fracture, but there have been no very-large-scale studies of COLIA1 alleles in relation to these phenotypes. Methods and Findings: Here we evaluated the role of COLIA1 Sp1 alleles as a predictor of BMD and fracture in a multicenter study involving 20,786 individuals from several European countries. At the femoral neck, the average (95% confidence interval [CI]) BMD values were 25 mg/cm2 (CI, 16 to 34 mg/cm2) lower in TT homozygotes than the other genotype groups (p < 0.001), and a similar difference was observed at the lumbar spine; 21 mg/cm2 (CI, 1 to 42 mg/cm2), (p = 0.039). These associations were unaltered after adjustment for potential confounding factors. There was no association with fracture overall (odds ratio [OR] = 1.01 [CI, 0.95 to 1.08]) in either unadjusted or adjusted analyses, but there was a non-significant trend for association with vertebral fracture and a nominally significant association with incident vertebral fractures in females (OR = 1.33 [CI, 1.00 to 1.77]) that was independent of BMD, and unaltered in adjusted analyses. Conclusions: Allowing for the inevitable heterogeneity between participating teams, this study—which to our knowledge is the largest ever performed in the field of osteoporosis genetics for a single gene—demonstrates that the COLIA1 Sp1 polymorphism is associated with reduced BMD and could predispose to incident vertebral fractures in women, independent of BMD. The associations we observed were modest however, demonstrating the importance of conducting studies that are adequately powered to detect and quantify the effects of common genetic variants on complex diseases.

In the USA, the use of advance directives (ADs) has been studied extensively, in order to identify opportunities to increase their use. We investigated the prevalence of ADs and the factors associated with formulation of an AD in The Netherlands, using samples of three groups: the general population up to 60 years of age, the general population over 60 years of age, and the relatives of patients who died after euthanasia or assisted suicide. The associated factors were grouped into three components: predisposing factors (e.g. age, gender), enabling factors (e.g. education) and need factors (e.g. health-related factors). We found that living wills had been formulated by 3% of younger people, 10% of older people, and 23% of the relatives of a person who died after euthanasia or assisted suicide. Most living wills concerned a request for euthanasia. In all groups, 26–29% had authorized someone to make decisions if they were no longer able to do so themselves. Talking to a physician about medical end-of-life treatment occurred less frequently, only 2% of the younger people and 7% of the older people had done so. Most people were quite confident that the physician would respect their end-of-life wishes, but older people more so than younger people. In a multivariate analysis, many predisposing factors were associated with the formulation of an AD: women, older people, non-religious people, especially those who lived in an urbanized area, and people with less confidence that the physician would respect their end-of-life wishes were more likely to have formulated an AD. Furthermore, the enabling factor of a higher level of education, the need factor of contact with a medical specialist in the past 6 months, and the death of a marital partner were associated with the formulation of an AD.

Gerotranscendence defines a shift in meta-perspective from earlier materialistic and pragmatic concerns, toward more cosmic and transcendent ones in later life. Population-based studies that have empirically examined this concept using Tornstam’s gerotranscendence scale, highlight cosmic transcendence as a core component, which includes a sense of belongingness with past and future generations. Such generative concerns may increase expectations regarding the quality of the bond with one’s children in later life. This study examined whether the association between emotional support exchanged with children and feelings of loneliness later in life varied by the degree of cosmic transcendence of the older parent. Data from 1,845 older parents participating in a population-based study living in The Netherlands were analyzed from the 1995/1996 cycle of the Longitudinal Aging Study Amsterdam. Interviews included self-report measures of cosmic transcendence, loneliness, emotional support exchanged with children, health indicators, and marital status. Results indicated that a negative association between loneliness and level of emotional support exchanged with children was more pronounced among older parents with higher cosmic transcendence scores, in particular among the married. It is argued that cosmic transcendence reflects a sense of generativity and an increased emotional dependency on children in later life. Under favorable social conditions (supportive relationships with children and being married) cosmic transcendent views had a positive impact on social well-being in later life. When children no longer met emotional needs of older parents, cosmic transcendence increased feelings of loneliness.

Purpose: The objective of this study was to investigate whether high levels of serum interleukin (IL)-6, C-reactive protein (CRP), and ?1-antichymotrypsin (ACT) were associated with the loss of muscle strength or muscle mass (sarcopenia) in older persons. Subjects: The study included 986 men and women of the Longitudinal Aging Study Amsterdam, with a mean age of 74.6 years (standard deviation 6.2). Methods: Grip strength (n = 986) and appendicular muscle mass (n = 328, using dual-energy x-ray absorptiometry) were obtained in 1995 and 1996 and repeated after a 3-year follow-up. Loss of muscle strength was defined as a loss of grip strength greater than 40%, and sarcopenia was defined as a loss of muscle mass greater than 3%, approximating the lowest 15% of the study sample. Results: Multiple linear and logistic regression analyses revealed that higher levels of IL-6 were associated with greater decline in muscle strength, which decreased by ?3.21 kg (standard error 0.81) per standard deviation increase in log-transformed IL-6. After adjustment for confounders, including sociodemographic, health, and lifestyle factors, high IL-6 (>5 pg/mL) and high CRP (>6.1 >?g/mL) were associated with a 2 to 3-fold greater risk of losing greater than 40% of muscle strength. Persons with high levels of ACT (>181% of the normal human pooled plasma) were 40% less likely to experience loss of muscle strength and tended (P = .07) to have a smaller decline in muscle mass compared with those in the lowest quartile of ACT. No consistent associations of IL-6 and CRP with sarcopenia were found. Conclusion: The findings of this prospective, population-based study suggest that higher levels of IL-6 and CRP increase the risk of muscle strength loss, whereas higher levels of ACT decrease the risk of muscle strength loss in older men and women.

The aim of this longitudinal study was to investigate 3-year change in serum albumin concentration as a determinant of incident cardiovascular disease (CVD) and all-cause mortality. Data were from 713 respondents of the Longitudinal Aging Study Amsterdam initially aged 55–85 years. Serum albumin was measured at baseline (1992/1993) and after 3 years. At the 6-year follow-up, incident CVD (among 456 respondents with no prevalent CVD at the 3-year follow-up) and all-cause mortality were ascertained. Overall, 18.9% developed CVD and 10.9% died. After adjustment for potential confounders, a higher level of serum albumin at the 3-year follow-up was associated with a lower risk for incident CVD (relative risk = 0.88, 95% confidence interval (CI): 0.79, 0.98). The risk of incident CVD was 0.88 (95% CI: 0.78, 0.99) per unit (g/liter) increase in change in albumin between 3-year follow-up and baseline. Chronic low serum albumin (43 g/liter at baseline and 3-year follow-up) was not associated with incident CVD (p = 0.22). A clinically relevant decrease in serum albumin (1 standard deviation (2.5 g/liter) between baseline and 3-year follow-up) tended to be associated with a twofold risk (relative risk = 2.00, 95% CI: 0.91, 4.39). For all-cause mortality, no associations were observed. These findings suggest that older persons with a decrease in serum albumin concentration, even within the normal range, might be at increased risk of incident CVD. Change in serum albumin may be used as an early marker for CVD risk.

This study examined to what degree the income inequality in the use of professional home care by older adults can be explained by differences in three types of determinants: need (physical and mental health related), predisposing (preference and personality characteristics) and enabling (situational characteristics) variables. The data are derived from the 1394 independent living elderly aged between 63 and 94, who participated in the wave 2001/2002 of the Longitudinal Aging Study Amsterdam. Results of logistic regression analysis showed that older adults with low income were more likely to use professional home care compared to older adults with high income (OR = 4,66, 95% CI = 2,98 – 7,29). Adjusting for the larger health problems, the fewer social resources and the weaker personality of the low income persons, decreased their odds ratio to 1,07 (95% CI = 0,57 – 1,98). Poor health contributed most to the income inequality in the use of home care. It is concluded that inequality in professional home care is justified as it serves the most vulnerable older adults. Decreasing professional care budgets increases the risk for older persons with low incomes, few social resources and a weak personality to be excluded from the care they need for their severe health problems.

Context: Clinically relevant late-life depression has aprevalence of 16% and is associated with substantial societalcosts through its disease burden and unfavorable prognosis.From the public health perspective, depression prevention maybe an attractive, if not imperative, means to generate healthgains and reduce future costs.Objective: To target high-risk groups for depression preventionsuch that maximum health gains are generated against the lowestcost.Design: Population-based cohort study over 3 years.Setting: General population in the Netherlands.Participants: Twenty-two hundred community residents aged55 to 85 years. Of these, 1925 were not depressed at baseline.Main Outcome Measure The onset of clinically relevantdepression was measured with the Center for EpidemiologicalStudies Depression Scale. For each of the risk factors (andtheir combinations), we calculated indices of potential healthgain and the effort (costs) required to generate those healthgains.Results: One in every 5 cases of clinically relevant late-lifedepression is a new case. Consequently, depression preventionhas to play a key role in reducing the influx of new cases.This is best done by directing prevention efforts toward elderlypeople who have depressive symptoms, experience functional impairment,and have a small social network, in particular women, as wellas people who have attained only a low educational level orwho suffer from chronic diseases.Conclusions: Directing prevention efforts toward selectedhigh-risk groups could help reduce the incidence of depressionand is likely to be more cost-effective than alternative approaches.This article further shows that we have the methodology at ourdisposal to conduct ante hoc cost-benefit analysis in preventivepsychiatry. This helps set a rational research and developmentagenda before testing the cost-effectiveness of interventionsin time-consuming and expensive trials.

No abstract available.

Background: Falls frequently occur in the elderly and are a major cause of morbidity and mortality. Objective: The objective of the study was to prospectively investigate the association between serum 25-hydroxyvitamin D [25(OH)D] levels and risk of recurrent falling in older men and women. Design: This was a prospective cohort study. Setting: An age- and sex-stratified random sample of the Dutch older population was determined. Subjects: Subjects included 1231 men and women (aged 65 yr and older) participating in the Longitudinal Aging Study Amsterdam. Measurements: Baseline serum 25(OH)D was determined by a competitive protein binding assay. During 1 yr, falls were prospectively recorded by means of a fall calendar. Results: Low 25(OH)D (<10 ng/ml) was associated with an increased risk of falling. After adjustment for age, sex, education level, region, season, physical activity, smoking, and alcohol intake, the odds ratios (95% confidence interval) were 1.78 (1.06–2.99) for subjects who experienced two falls or more as compared with those who did not fall or fell once and 2.23 (1.17–4.25) for subjects who fell three or more times as compared with those who fell two times or less. There was a statistically significant effect modification by age, and stratified analyses (<75 and 75 yr) showed that the associations were particularly strong in the younger age group; the odds ratios (95% confidence interval) were 5.21 (2.03–13.40) for two falls or more and 4.96 (1.52–16.23) for three falls or more. Conclusions: Poor vitamin D status is independently associated with an increased risk of falling in the elderly, particularly in those aged 65–75 yr.

No abstract available.

Background: This study addresses the question whether personality is a predictor for becoming depressed in late life. We expect that personality traits are significantly associated with the onset of depression, but that the effect of personality is overwhelmed by the effect of health related variables. The second research question concerns whether the strength of this association is affected by the influence of age or age-related deteriorations in the other prognostic factors. We hypothesize to find that a high neuroticism level or low levels of mastery, self-efficacy or self-esteem strengthen the impact of the health-related variables and social situational factors on the onset of depression in late life. Methods: Out of a population-based baseline sample (Longitudinal Aging Study Amsterdam) of 1511 non-depressed elderly respondents (55–85 years at baseline), 255 (17%) developed a clinically relevant level of depressive symptoms during the 6-year follow-up period. Data on the effect of personality on onset were analysed using logistic regression analyses. Results: Both at univariate and multivariate level, the personality traits studied predicted the onset of depression. The effect of neuroticism was more strongly related to onset than health-related and social factors. Results revealed no significant interaction effects between the personality characteristics and age or the other prognostic factors on the association with onset of depression. Discussion: Personality, neuroticism in particular, was found to be a consistent and important predictor of the onset of depressive symptoms in late life, even more important than health-related and situational factors, and aging did not affect the strength of this association.

Abstract: Abstract Following the press-competence model (PCM) of Lawton and associates, we tested two expectations as to the adaptations older adults make to their socio-physical environment following health decline: (1) depending on the change in their functional limitations, older adults use adaptive strategies ranging from mobilizing informal care to moving into a residential setting; (2) the more people succeed in realizing suitable adaptations, the higher their wellbeing, measured as depressive symptoms, after a health decline. Data come from two waves of a longitudinal study among Dutch people aged 60–85 and living independently at baseline (Longitudinal Aging Study Amsterdam, LASA). The 819 respondents with a decline in self-reported functional disability within 3 years time were selected for analysis. Results of multivariate logistic and regression analyses show that (1) all adaptive strategies under study occur in response to health decline; (2) mobilization of informal care and moving to a care setting alleviates the negative effect of health decline on depressive symptoms. Furthermore, mobilization of professional home care was associated with more depressive symptoms independent of health decline, whereas adjustment of the home had no effect on depressive symptoms. We argue that some support was found for Lawton\'s PCM, but that evidence can be improved by studying more closely which adaptive strategies alleviate the environmental stress induced by specific physical disabilities.

Background: Polymorphisms of the vitamin D receptor (VDR) gene have been implicated in the genetic regulation of bone mineral density (BMD). However, the clinical impact of these variants remains unclear. Objective: To evaluate the relation between VDR polymorphisms, BMD, and fractures. Design: Prospective multicenter large-scale association study. Setting: The Genetic Markers for Osteoporosis consortium, involving 9 European research teams. Participants: 26 242 participants (18 405 women). Measurements: Cdx2 promoter, FokI, BsmI, ApaI, and TaqI polymorphisms; BMD at the femoral neck and the lumbar spine by dual x-ray absorptiometry; and fractures. Results: Comparisons of BMD at the lumbar spine and femoral neck showed nonsignificant differences less than 0.011 g/cm2 for any genotype with or without adjustments. A total of 6067 participants reported a history of fracture, and 2088 had vertebral fractures. For all VDR alleles, odds ratios for fractures were very close to 1.00 (range, 0.98 to 1.02) and collectively the 95% CIs ranged from 0.94 (lowest) to 1.07 (highest). For vertebral fractures, we observed a 9% (95% CI, 0% to 18%; P _ 0.039) risk reduction for the Cdx2 A-allele (13% risk reduction in a dominant model). Limitations: The authors analyzed only selected VDR polymorphisms. Heterogeneity was detected in some analyses and may reflect some differences in collection of fracture data across cohorts. Not all fractures were related to osteoporosis. Conclusions: The FokI, BsmI, ApaI, and TaqI VDR polymorphisms are not associated with BMD or with fractures, but the Cdx2 polymorphism may be associated with risk for vertebral fractures.

No abstract available.

Objective: To measure the impact of PTSD and subthreshold PTSD on daily life functioning, well-being and health care use in a community based-sample of the elderly population in the Netherlands. Methods: Consequences of PTSD were investigated in an elderly community-based population (LASA study) by comparing three groups: subjects with PTSD, with subthreshold PTSD, and a reference group. Indicators of well-being (loneliness, self-perceived health and satisfaction with life), disability (days spent in bed and disability days) and use of health care (general practitioners, medical specialists, psychiatrists, mental health care, social workers and professional home care) were investigated. Results: In comparison to the reference group, subjects with PTSD or subthreshold PTSD spent more days in bed due to illness and had more disability days, even when corrected for concurring other diseases or functional limitations. They were less satisfied with life in general, used health care for predominantly somatic care and evaluated the care they received to be inadequate. Psychotropic drugs, if prescribed, were predominantly benzodiazepines and seldom antidepressants. Conclusions: The findings strongly suggest that elderly with either PTSD or subthreshold PTSD suffer grave impairments in daily life, are less satisfied with life and do not receive optimum treatment. Especially elderly with PTSD frequently visit medical specialists but are rarely treated by psychiatrists or other mental health professionals, nor do they receive antidepressant treatment from their GP. Lack of adequate treatment may be the cause of dissatisfaction with the care they receive.

In a survey after physical activities and fall incidents among elderly people, the interviewers used in more than half of the interviews an interview strategy that substantially deviates from the wording of the questionnaire. In the deviating ‘partial’ strategy the interviewer actually decomposes the broad questions of the questionnaire into smaller, and hopefully easier to answer, sub-questions. Whether this decomposition leads to better data quality still remains an issue. On the one hand, it leads to less rounding off and less overestimation of the average time spend on household tasks, and thus to more precise and accurate data. On the other hand, the correlation between the estimation based on the questionnaire, and that based on a 7-day diary, is lower than with the prescribed ‘integral’ strategy. So the integral strategy gives a better prediction of the differences among respondents regarding the time they spend on the performance of household tasks. It also leads to the most efficient process of data collection, requiring less than half of the time needed for the use of the partial strategy.

Background. The loss of a spouse has been found to have a negative effect on physical and mental health and leads to increased mortality. Whether conjugal bereavement also affects memory functioning has largely been unexamined. The present study investigates the effect of widowhood on memory functioning in older persons. Method. The sample consisted of 474 married women and 690 married men aged 60–85 years in 1992, followed up in 1995 and 1998. During the study 135 (28%) of the women and 69 (10%) of the men lost their spouse. Linear regression analysis was used to examine whether widowed men and women differed from those who had not been widowed in rate of memory change over 6 years. Cross-domain latent-change models were subsequently used to evaluate the extent to which changes in memory are related to changes in other domains of functioning that may be affected by widowhood. Results. Older adults who lost a spouse during follow-up showed a greater decline in memory over 6 years than those who remained married. A higher level of depressive symptoms at baseline was related to lower levels of memory functioning and a greater decline. Memory decline was unrelated to changes in depressive symptoms and physical health. Conclusions. Loss of the spouse is related to a greater decline in memory in older adults. The absence of an association with physical functioning and the weak association with mental functioning suggest that losing a spouse has an independent effect on memory functioning.

The relationship between the growth hormone/insulinlike growth factor (GH-IGF)-I status and memory performance is studied in 24 elderly males and females, aged 75–85 years. Positron emission tomography (PET) was used to measure differences in regional cerebral blood flow during the performance of a delayed-non-match-tosample (DNMTS) working memory task. Quality and speed of performance on the DNMTS task were measured separately for the easy items (3, 4 and 5 letters) and difficult items (6, 7 and 8 letters). Results were analyzed in two different groups based on the IGF-I level of the subjects (low or high IGF-I). Error rates on the working memory task were not different, but the high IGF-I group had shorter reaction times on the easy items. The high IGF-I group showed a significantly greater increase in cerebral blood flow in the left premotor cortex (easy items) and left dorsolateral prefrontal cortex (difficult items) compared to the low IGF-I group. It is concluded that elderly with high IGF-I levels are capable of faster working memory performance and increased recruitment of task-associated prefrontal regions.

Background and aims: The present study investigated stability and change in emotional well-being in a prospective study of a large sample of community-dwelling older adults (? 55 years). Emotional functioning was conceptualized according to the tripartite model distinguishing three aspects: general negative affect (NA), depression, and anxiety. The study tested models for the decline of mental health in late life based on the diathesis–stress model. In previous studies, support has been found for the diathesis–stress model (for an overview, see [Goldberg, D.P., Huxley, P., 1992. Common mental disorders: a biosocial model. Routledge, London; Zuckerman, M., 1999. Vulnerability to psychopathology. American Psychological Association, Washington, DC.]). The predictive ability of vulnerability factors (the personality characteristics mastery and neuroticism) and stressful life events and their interaction was tested for an increase in general negative affect, decreased positive affect (PA), and increased anxiety. More specifically, we tested the hypothesis that loss leads to decreased positive affect in subjects with low mastery, whereas threat leads to anxiety in subjects with high neuroticism. Methods: Data from the Longitudinal Aging Study Amsterdam (LASA) were used. LASA is a longitudinal study in a large representative sample of adults aged 55 to 85 (N=1837). Self-report data on depression, anxiety, and negative affect were collected from adults over a 6-year period in three waves. The data were analyzed using multilevel analysis. Results: The findings revealed an association between low mastery, high neuroticism, and an increase in negative affect, lack of positive affect, and anxiety. Furthermore, high mastery protected against the negative impact of loss events, but neuroticism did not augment the negative impact of threat events on emotional health. Conclusion: Partial support was found for a diathesis–stress model of change in emotional functioning in late life. Furthermore, support was found for distinguishing between symptoms of negative affect, depression, and anxiety.

Objective: The authors investigated the relationship between anxiety and cognition in older persons, taking account of comorbid depression. Methods: Data were used from the Longitudinal Aging Study Amsterdam (LASA), a large epidemiological study of 3,107 elderly citizens in The Netherlands. Anxiety and depression were measured with the Hospital Anxiety and Depression Scale-Anxiety subscale and the Center for Epidemiologic Studies-Depression Scale. In measuring cognitive performance, general cognitive functioning was measured by means of Mini-Mental State Ecam, episodic memory was measured with the Auditory Verbal Learning Test (AVLT), fluid intelligence by using the RAVEN, and information-processing speed by the coading task. Analysis of variance examined the association between anxiety symptoms and cognition in persons with and without depression. Results: Main effects of anxiety symptoms were found for learning and delayed recall of the AVLT. Depression symptoms showed significant main effects on almost all cognitive performance tests. Mild anxiety symptoms were associated with better cognitive performance, whereas severe anxiety symptoms were negatively associated with cognitive functioning. In contrast, depressive symptoms showed a linear association with cognition; more depression was associated with worse cognition. Conclusion: This study suggests that anxiety has a curvilinear relationship with cognition. Depressive symptoms, however, were always negatively associated with cognitive performance.

No abstract available.

Background: Associations between physical health and depression are consistent across cultures aong adults up to 65 years of age. In later life, the impact of physical health on depression is much more substantial and may depend on sociocultural factors. Aims: To examine cross-national differences in the association between physical health and depressive symptoms in elderly people across western Europe. Method: Fourteen community-based studies on depression in later life in nine western European countries contributed to a total study sample of 22 570 respondents aged 65 years and older. Measures were harmonised for depressive symptoms (EURO-D scale), functional limitations and chronic physical conditions. Results: In the majority of the participating samples, the association of depressive symptoms with functional disability was stronger than with chronic physical conditions. Associations were slightly more pronounced in the UK and Ireland. Conclusion: The association between physical health and depressive symptoms in later life is consistent across western Europe. Declaration of interest: None. Funding detailed in Acknowledgements.

No abstract available.

The study investigated the impact of change in cognitive functioning and cognitive decline on disability, well-being, and the use of healthcare services among older persons in the Longitudinal Aging Study Amsterdam (LASA). Data were collected from 1,349 subjects, aged 65–85 years, who had scores of 24 and higher on the Mini-Mental State Examination (MMSE) at baseline, over a period of 6 years in three waves. The results indicate that cognitive decline and changes in cognitive functioning in older persons who were either not impaired or only mildly cognitively impaired at baseline have an impact on disability, well-being, and the use of healthcare services. With the aging of the population, the number of persons with cognitive impairment is likely to increase, and appropriate services should be available to them.

No abstract available.

Purpose: Longitudinal data have provided evidence on factors that increase the risk of incidence of functional limitations. However, little insight exists in course types of functional limitations other than simple incidence or recovery. Methods: This contribution examines the variety of course types across the first three cycles of the Longitudinal Aging Study Amsterdam (n = 3107, initial ages 55?–?85 years, 6-year period covered). Using cluster analysis, course types were determined among both the survivors and the deceased. Multinomial analyses were performed to determine the predictive ability of baseline physical and mental chronic conditions for each course type. Results: Eight course types were distinguished: (1) stable not limited (53%) (2) stable mild (8%) (3) stable severe (3%) (4) gradual increase (4%) (5) delayed increase (5%) (6) not limited, died t3 (8%) (7) increase t1?–?t2, died t3 (4%) (8) died t2 (15%). Socio-demographic and chronic conditions differentially predicted the course types. Arthritis was predictive mainly of course types not ending in death, cancer of course types ending in death. The other physical and mental conditions were predictive of both. Conclusion: These longitudinal data show the usefulness of distinguishing between course types of functional limitations beyond incidence and recovery.

Background: Long-term health consequences of disasters have not been studied extensively, one reason amongst others is that no pre-disaster observation is available. This study focuseson an aeroplane crash on an Amsterdam suburb. The ongoing LongitudinalAging Study Amsterdam has one pre-disaster and several post-disasterobservations, making it possible to study changes in health,taking pre-disaster health characteristics into account. Methods:Three exposure groups are distinguished: those living withina radius of 1 km from the disaster (initial n=39), those livingbetween a radius of 1 and 2 km from the disaster (initial n=56),and those living in the rest of the city of Amsterdam (initial n=508). Health measures include general health, health in comparisonwith age peers, functional limitations, disability and cognitivefunctioning. These measures are based on self-ratings, interviewerobservations, or both. Results: Older persons living closestto the disaster area are likely to experience health declinein the wake of a disaster, over and above the health declinethat would occur normally with aging. The disaster-associatedhealth decline is small, and most obvious in the ability toperform actions (such as mobility), but is not observed in eitherdisability in daily functioning, nor in self-perceptions ofhealth. Cognitive functioning even shows a short-term improvement.Conclusion: These findings suggest substantial resilience inolder adults, despite their common health problems.

During their life course, older persons’ income level may become discrepant with the socio-economic status of their neighbourhood. This study examines whether and how such discrepancies affect older persons’ physical and mental health. Using baseline data from the Longitudinal Aging Study Amsterdam, 2,540 non-institutionalised persons aged 55–85years were classified based on self-reported income and neighbourhood status. Two categories defined discrepancies: discrepant-low (DL, low income in high-status neighbourhood), and discrepant-high (DH, high income in low-status neighbourhood). Both categories were compared with the same reference category: matched-high (MH, high personal and high neighbourhood income status). A range of health indicators were examined, as well as mediating effects of neighbourhood and individual characteristics. Among the 504 persons who reported a high income, 16% lived in a low-status neighbourhood (DH). Conversely, among the 757 persons living in a high-status neighbourhood, 24% had a low income (DL). The DL category mainly lived in rural areas, and the DH category predominantly in large cities. The data show discrepant income effects (DL vs. MH) on physical and cognitive ability, self-rated health, and loneliness, and discrepant neighbourhood effects (DH vs. MH) on physical and cognitive ability, depressive symptoms, and loneliness. Personal income effects were partly mediated by other personal characteristics, and neighbourhood effects were fully mediated by socio-economic neighbourhood characteristics as well as by older persons’ perceptions of their neighbourhood and their income. It is concluded that discrepancies between personal income and neighbourhood status, accrued throughout the life course, are associated with poor health.

Hyperhomocysteinemia may contribute to the development of osteoporosis. The relationship of Hcy and vitamin B12 with bone turnover markers, BUA, and fracture incidence was studied in 1267 subjects of the Longitudinal Aging Study Amsterdam. High Hcy and low vitamin B12 concentrations were significantly associated with low BUA, high markers of bone turnover, and increased fracture risk. Introduction: Hyperhomocysteinemia may contribute to the development of osteoporosis. Vitamin B12 is closely correlated to homocysteine (Hcy). The main objective of our study was to examine the association of Hcy and vitamin B12 status and the combined effect of these two with broadband ultrasound attenuation (BUA), bone turnover markers, and fracture. Materials and Methods: Subjects were 615 men and 652 women with a mean age of 76 ± 6.6 (SD) years of the Longitudinal Aging Study Amsterdam (LASA). At baseline (1995/1996), blood samples were taken after an overnight fast for dairy products. Plasma Hcy was measured with IMx, serum vitamin B12 with competitive immunoassay (IA) luminescence, serum osteocalcin (OC) with immunoradiometric assay (IRMA), and urinary excretion of deoxypyridinoline (DPD) with competitive IA and corrected for creatinine (Cr) concentration. CVs were 4%, 5%, 8%, and 5%, respectively. BUA was assessed in the heel bone twice in both the right and left calcaneus. Mean BUA value was calculated from these four measurements. CV was 3.4%. After baseline measurements in 1995, a 3-year prospective follow-up of fractures was carried out until 1998/1999. Subjects were grouped by using two different approaches on the basis of their vitamin B12 concentration, normal versus low (<200 pM) or lowest quartile (Q1) versus normal quartiles (Q2-Q4), and Hcy concentration, normal versus high (>15 M) or highest quartile (Q4) versus normal quartiles (Q1-Q3). Analysis of covariance was performed to calculate mean values of BUA, OC, and DPD/Crurine based on the specified categories of Hcy and vitamin B12 and adjusted for several confounders (potential confounders were age, sex, body weight, body height, current smoking [yes/no], mobility, cognition). The relative risk (RR) of any fracture was assessed with Cox regression analysis. Quartiles were used when Hcy and vitamin B12 were separately studied in their relationship with fracture incidence. Results: Fourteen percent of the men and 9% of the women had high Hcy (>15 M) and low vitamin B12 (<200 pM) concentrations. Women with vitamin B12 levels <200 pM and Hcy concentrations >15 M had lower BUA, higher DPD/Cr, and higher OC concentrations than their counterparts. In men, no differences were found between the different Hcy and vitamin B12 categories in adjusted means of BUA, OC, or DPD/Crurine. Twenty-eight men and 43 women sustained a fracture during the 3-year follow-up period. The adjusted RR for fractures (95% CI) for men with high Hcy and/or low vitamin B12 concentrations was 3.8 (1.2-11.6) compared with men with normal Hcy and vitamin B12 concentrations. Women with high Hcy and/or low vitamin B12 concentrations had an adjusted RR for fractures of 2.8 (1.3-5.7). Conclusions: High Hcy and low vitamin B12 concentrations were significantly associated with low BUA, high markers of bone turnover, and increased fracture risk.

Objective: To assess whether serum levels of the inflammatory proteins _1-antichymotrypsin (ACT), C-reactive protein (CRP), interleukin-6 (IL-6), and albumin are associated with cognitive decline in older persons. Methods: The study sample consisted of 1,284 participants in the Longitudinal Aging Study Amsterdam, aged 62 to 85 years. Cognition was assessed on general cognition (Mini-Mental State Examination [MMSE]), memory (Auditory Verbal Learning Test), fluid intelligence (Raven’s Colored Progressive Matrices), and information-processing speed (Coding Task) at baseline and at 3-year follow-up. Results: The highest tertile of ACT was associated with an increased risk of decline on the MMSE (age-, sex-, education-adjusted odds ratio [OR] 1.60; 95% CI: 1.05 to 2.43) but not on any other cognitive test score. CRP, IL-6, and albumin were not associated with cognitive decline on any cognitive test in our study. Conclusions: This population-based study showed that the serum inflammatory protein _1-antichymotrypsin is associated with cognitive decline in older persons, whereas C-reactive protein, interleukin-6, and albumin are not.

This study examines loneliness and its correlates – health, residential care, partner status, and network size – over a seven-year period among adults born between 1908 and 1937. The four waves of data are from the Dutch ‘Living Arrangements and Social Networks of Older Adults’ and the ‘Longitudinal Aging Study of Amsterdam’ programs. Data from at least two waves are available for 2925 respondents. Results show that older adults generally become lonelier as time passes. The increase is greater for the oldest, the partnered, and those with a better functional capacity at baseline. Older adults who lose their partner by death show the greatest increase in loneliness. Not all older adults become more lonely: improvement in functional capacity and network expansion lead to less loneliness. Entry into residential care does not affect loneliness. The longitudinal design provides new insights into factors that protect against loneliness compared to cross-sectional studies.

To prepare the care system for a rising population of older people, it is important to understand what factors predict the use of care. This paper reports a study of transitions in the use of informal and professional care using Andersen-Newman models of the predictive predisposing, enabling and need factors. The study has drawn on Longitudinal Ageing Study Amsterdam (LASA) data on the use of care and the contextual factors. The data were collected at three-yearly intervals from a random, sex- and age-stratified, population-based sample of adults aged 55–85 years. In summary, the findings for those who initially did not receive care were that almost one-third received some kind of care three years later, most of which was provided by informal care-givers. Need factors were important predictors of most transitions in care, and predisposing and enabling factors, such as age, partner status and income, also played a role. On the relationship between informal and professional care, evidence was found for both ‘compensatory processes’, i.e informal care substitutes for professional care, and ‘bridging processes’, i.e. informal care facilitates professional care. In view of the increasing discrepancy between the demand for professional care and its supply, the significant impact of predisposing and enabling factors offers opportunities for intervention.

The main pathway of the disablement process consists of four consecutive phases: Pathology (presence of disease/injury), Impairments (dysfunctions/structural abnormalities), Functional Limitations (restrictions in basic physical/mental actions), and Disability (difficulty doing activities of daily life, ADL). This study determines the presence of the main pathway of disablement in a cohort aged 55 years and older and examines whether progression of the main pathway of disablement is accelerated in the presence of depression. Based on baseline (T1) and two three-year followup interviews (T2 and T3) from the Longitudinal Aging Study Amsterdam (LASA) in a population-based cohort of 1110 Dutch persons, we first analysed the intermediate effect of the different consecutive phases of the disablement process by means of multiple regression, adjusted for covariates. Then, depression was used as interaction term in multiple regression analyses linking the consecutive phases of the disablement process. We found that Impairments mediated the association between Pathology and Functional Limitations, and that Functional Limitations mediated the association between Impairments and Disability. Depression significantly modified the associations between Pathology and subsequent Impairments, and between Functional Limitations and subsequent Disability. In sum, the main pathway of the disablement process was identified in our sample. In addition, we found an accelerating effect of depression, particularly in the early and late stages of the model. Reduction of depression may help slow down the process of disablement for persons who find themselves in those stages of the model.

Background and Objectives: Information on socioeconomic inequalities in incidence of and recovery from disability is still scarce, as is information on socioeconomic inequalities in performance-based disability as compared to self-reported disability. This study aimed to estimate educational inequalities in the prevalence, incidence, and recovery of self-reported and performance-based disability in two European populations. Study Design and Setting: We analyzed data from two longitudinal studies on aging. At each wave, participants were asked to what degree they experienced difficulty with several functional tasks, and interviewers rated their performance on several tasks. Educational inequalities in both outcomes were expressed in terms of prevalence, incidence, and recovery ratios. Results: Educational inequalities in both prevalence and incidence of disability were observed. No large educational inequalities in recovery from disability could be demonstrated. Compared to inequalities in self-reports of disability, inequalities in performance-based disability were equally large in the Dutch study, but smaller in the Italian study. Conclusions: Inequalities in performance-based measures of disability stress the importance of the association of socioeconomic position with disability among older populations. Our results suggest that higher education serves to postpone or avoid disability, but provides less benefit when disability is already present.

Many older people die in hospitals, whereas research indicates that they would prefer to die at home. Little is known about the factors associated with place of death. The aim of this study was to investigate the care received by older people in the last three months of their life, the transitions in care and the predictors of place of death. In this population-based study interviews were held with 270 proxy respondents to obtain data on 342 deceased participants (79% response rate) in the Longitudinal Aging Study Amsterdam (LASA). In the last three months of life the utilization of formal care increased. Half of the community- dwelling older people and their families were confronted with transitions to institutional care. For people who only received informal care the odds of dying in a hospital was 3.68 times the odds for those who received a combination of formal and informal home care. The chance of dying in a hospital was also related to the geographical region. The authors argue that future research is needed into the association found in the present study, i.e. that decedents who received both formal and informal care were more likely to die at home. In view of the differences found in geographical region in relation to place of death, further investigation of regional differences in the availability and accessibility of care is indicated.

No abstract available.

Background: The apolipoprotein E (ApoE) e4 polymorphism is linked to increased mortality rates, Alzheimer\'s disease, and cardiovascular disease in older people, but previous studies have largely failed to detect an effect on self-reported mobility disability. We hypothesized that poor performance on mobility-related tests may provide a better measure of effects, and we aimed to estimate the extent to which the ApoE e4 allele increases risks of poor performance on measured mobility and self-reported mobility disability compared to e3/3, in a medium-sized population cohort. Methods: Data were from 1262 people at baseline older than 65 years from the Longitudinal Aging Study Amsterdam (LASA), followed up for 6 years. Age- and sex-adjusted logistic regression models were used to explore associations. Results: At baseline, those individuals with an e4 allele had an odds ratio of 2.26 (95% confidence interval, 1.31–3.90) for poor performance on gait speed testing (<0.4 m/s) and 1.94 (95% confidence interval, 1.19–3.16) for five chair stands (20 s), compared to those with e3/3 status. At follow-up, associations between e4 status and incident poor performance on the chair stand test was significant. Associations with self-reported inability or need for help walking for 5 minutes or for climbing 15 steps were nonsignificant throughout. Conclusions: The ApoE e4 polymorphism is associated with a substantial excess of mobility limitation. The impact is detectable by performance testing, but not by self-reports. Poor results on mobility performance tests may provide a phenotype of ageing.

Purpose: Multiple factors contribute to mortality in the elderly, but the extent to which traditional factors contribute independently to mortality in different countries is not known. Our objective is to determine the differential impact of socio-demographic variables, selected diseases, health habits and disability on all-cause mortality, among older people living in five European countries and Israel. Methods: From six longitudinal studies on aging (TamELSA-Tampere (Finland), CALAS-Israel, ILSA-Italy, LASA-Netherlands, ALLegane ´s (Spain), SATSA-Sweden), a harmonized common database was created in the context of the CLESA Project (Cross-national determinants of quality of life and health services for the elderly). A common five-year follow-up was used. Results: The highest mortality rate was found in Tampere among females (98.7‰) and in Israel among males (108.3‰), whereas the lowest was observed in Legane´s for males (72.3‰) and in The Netherlands for females (44.6‰). In multivariate models, some predictors were homogeneously, significantly distributed across the six countries, including older age (HRZ1.57) and male sex (HRZ1.60) among the socio-demographic variables; smoking status (HRZ1.15) and alcohol consumption (HRZ0.81) among the health habits variables; presence of heart disease (HRZ1.34), diabetes (HRZ1.46), cancer (HRZ1.93), respiratory disease (HRZ1.19), and disability (HRZ2.92) among the health status variables. Marital status, education, and drug use did not have homogeneous effects in the six countries. Discussion: This large international study shows that multiple factors contribute to increased risk of all cause mortality among older people and that most risk factors are similar across countries. Disability, age greater than 80 years, cancer and male sex were identified as the strongest common risk factors of mortality.

This study focused on two conceptually distinct measures of the filial responsibility expectations of older adults: a vignette technique and an attitude item scale. Data were based on 1,553 respondents aged 61 to 92 years who participated in the Longitudinal Aging Study Amsterdam in 1998to 1999.The results showed that the item scale had multiple dimensions of filial expectations. Older adults distinguished between emotional-, instrumental-, contact-, and information-oriented expectations. The vignette technique resulted in a unidimensional measurement of expectations. The intercorrelation between the scores of the item scale and vignette technique was modest, indicating a certain amount of overlap. Child characteristics incorporated into the vignettes added to the specificity of measurements of the filial expectations. The authors observed that older adults were more likely to have expectations for care from an adult child who is not employed and does not have children. Minor differences between sons and daughters were observed.

Objectives: To examine whether anemia is associated with a higher incidence of recurrent falls. Design: Prospective cohort study.Setting: Community-dwelling sample in the Netherlands. Participants: Three hundred ninety-four participants aged 65 to 88 from the Longitudinal Aging Study Amsterdam. Measurements: Anemia was defined according to World Health Organization criteria as a hemoglobin concentration less than 12 g/dL in women and less than 13 g/dL in men. Falls were prospectively determined using fall calendars that participants filled out weekly for 3 years. Recurrent fallers were identified as those who fell at least two times within 6 months during the 3-year follow-up. Results: Of the 394 persons, 11.9% (18 women and 29 men) had anemia. The incidence of recurrent falls was 38.3% of anemic persons versus 19.6% of nonanemic persons (P=.004). After adjustment for sex, age, body mass index, and diseases, anemia was significantly associated with a 1.91 times greater risk for recurrent falls (95% confidence interval=1.09–3.36). Poor physical function (indicated by muscle strength, physical performance, and limitations) partly mediated the association between anemia and incidence of recurrent falls. Conclusion: Late-life anemia is common and associated with twice the risk of recurrent falls. Muscle weakness and poor physical performance appear to partly mediate this association.

Background and Objectives: Our aim was to construct a harmonized measure of activities of daily living (ADL) across six countries, and to evaluate the reliability and validity of this measure. Methods: A population of 9,297 persons, aged 65–89 years, was drawn from the Comparison of Longitudinal European Studies on Aging (CLESA) study, which includes data from five European countries and Israel. Because the number, type, and response format of the ADL items differed across the six studies, a four-item scale was constructed to harmonize the data, using items common to most countries. A procedure was devised to substitute or construct items that were not available in two of the countries. Results: Cronbach\\\\\\\'s &#945; for the four-item ADL measure varied from 0.81 in Spain to 0.92 in Finland, and was similar to the &#945; of scales including five or six items. Kappa scores between substituted or constructed items and the actual items varied from 0.50 to 0.78. In all countries, the percentage of persons with ADL disability differed significantly across age and was associated with chronic diseases, poor self-rated health, global disability, and home help utilization. Conclusion: The harmonized four-item ADL measure seems a reliable and valid instrument for comparing ADL disability in older people across countries.

In this study we apply a lifecourse perspective to an examination of older adults ’ attitudes about gender roles and moral issues. The study goes beyond previous research in that it examines the relationships between older adults ’attitudes and: (a) experiences in the parental home, (b) people ’s own marital and work experiences through the entire lifecourse, and (c) the marital and work experiences of their children. The sample consists of respondents aged 55 or more years from the ‘Living Arrangements and Social Networks of Older Adults in The Netherlands ’ survey of 1992 and the ‘Longitudinal Ageing Study Amsterdam ’. It is shown that a large majority of older adults subscribe to the view that people have the freedom to make their own choices about the issues of voluntary childlessness, abortion and euthanasia. Similarly, most older adults favour equality between men and women. Multivariate analyses show that people ’s attitudes are generally consistent with their lifecourse experiences. It is found that unconventional lifecourse experiences, particularly with respect to childbearing, associate with more progressive attitudes in late life. The behaviour and lifecourse experiences of their children are also related to older adults ’attitudes. Particularly, if their children co-habited, older adults tend to be more progressive. These findings suggest that an important mechanism by which societal change may have affected older adults is through their children ’s experiences.

Purpose: The aim of this study was to estimate the longitudinal relationship between transitions in the use of long-term care and older adults\' depressive symptoms and to investigate whether this relationship could be explained by markers of older adults\' underlying health, or other variables including demographics, personality, and partner status. Design and Methods: Data were from the Longitudinal Aging Study Amsterdam, which consists of a random, community-based sample of 3,107 older Dutch people (55–85 years of age) stratified by age and gender. The use of informal care, professional home care, and institutional care was recorded, and respondents were screened on depressive symptoms. Follow-up measurements took place at 3 and 6 years. Results: Longitudinal analyses showed significant associations between the enduring use of professional long-term care and an increase in depressive symptoms. Transitions to professional home care or institutional care were also associated with considerably more depressive symptoms after 3 years, whereas transitions from professional home care or institutional care to no care or informal care only were not associated with a change in depressive symptoms. Most of the associations remained significant after indicators of underlying health and other covariates were adjusted for, and also after the data were reanalyzed for respondents with and without functional limitations. Implications: This study does not involve a controlled experiment of professional long-term care among older adults. However, the findings suggest the possibility that receiving professional long-term care could introduce new stressors and increase the risk of depressive symptoms. Our analyses illuminate the concerns of elders regarding their use of professional long-term care and may help in planning for more effective delivery of this type of care.

The aim of this study was to determine the effect of frailty on the risk of residential/nursing home admission independently of chronic diseases and functional limitations. Frailty consists of multisystem decline and is considered to be a consequence of changes in neuromuscular, endocrine and immune system functioning that occur as people age. Frailty is a combination of multiple impairments in functioning that might lead to functional limitations and disability but it is not clear whether frailty has an independent effect on residential/nursing home admission. Data were used from the Longitudinal Aging Study Amsterdam. The respondents participated at both T 1 (1992/1993) and T 2 (1995/1996), lived independently at T 2, and were aged 65 and over (n=1,503). Nine frailty markers were assessed at two cycles (T 1 and T 2). The frailty markers were defined in two ways: low functioning at T 2 (static frailty); and change in functioning between T 1 and T 2 (dynamic frailty). The outcome variable was residential/nursing home admission between T 2 and T 4 (2001/2002). Cox proportional hazard analyses were used adjusting for chronic diseases, functional limitations, care received, partner status, income, age and sex. Static (RR 1.93, 95%CI 1.36–2.74) and dynamic frailty (RR 1.69, 95%CI 1.19–2.39) were associated with institutionalization in both men and women independently of the effect of chronic diseases and functional limitations. Additional analyses of the total number of both sets of frailty markers present revealed an increased risk of institutionalization when the number increased. In conclusion, frailty is associated with institutionalization, independently of the effect of chronic diseases and functional limitations.

Objective: To determine the effect of frailty on decline in physical functioning and to examine if chronic diseases modify this effect. Methods: The study sample was derived from the Longitudinal Aging Study Amsterdam and included respondents with initial ages 65 and over at T2 (1995/1996), who participated at T1 (1992/1993) and T2 and performed physical performance tests (n = 1,152) or reported functional limitations (n = 1,321) at T2 and T3 (1998/1999). Nine frailty markers were determined in two ways: low functioning at T2 (static definition); and decline in functioning between T1 and T2 (dynamic definition). Using logistic regression analyses, the effect of frailty was examined on change in physical functioning between T2 and T3, adjusting for sex, age, education, and additionally chronic diseases. Results: Static frailty was associated with performance decline only in the middle–old group (OR 2.43; 95%CI 1.23–4.80) and associated with decline in self-reported functioning (OR 2.44; 95%CI 1.77–3.36). Dynamic frailty was associated with decline in performance only in women (OR 1.72; 95%CI 1.11–2.67) and with self-reported functional decline (OR 1.77; 95%CI 1.29–2.43). These associations were independent of chronic diseases. Conclusion: Frailty is more strongly associated with self-reported functional decline in older persons than with performance decline.

Objective: To examine the association of serum concentrations of 25-hydroxyvitamin D (25(OH)D), interleukin-6 (IL-6), C-reactive protein (CRP), and insulin-like growth factor-1 (IGF-1) with prevalent and incident frailty. Design: The Longitudinal Aging Study Amsterdam, a prospective cohort study with three-yearly measurement cycles. Setting: General population-based sample. Participants: The respondents were men and women aged 65 and over, who participated at T1 (1995/1996, N=1,720) and T2 (1998/1999, N=1,509). Blood samples were obtained at T1 (N=1,271). Measurements: The presence of frailty at T1 and 3-year incidence of frailty. Frailty is defined as the presence of three out of nine frailty indicators. Results: At T1, 242 (19.0%) of all respondents were frail. Those who were frail at T1 had higher CRP and lower 25(OH)D levels. Serum 25(OH)D remained associated with frailty after adjustment for potential confounders with odds ratios of 2.60 (95%CI 1.60-4.21) for 25(OH)D< 25nmol/l and 1.72 (95%CI 1.19-2.47) for 25(OH)D 25-50 nmol/l versus high levels of 25 (OH)D. Of the non-frail at T1, 125 respondents (14.1%) became frail at T2. After adjustment, moderately elevated CRP levels (3-10 ug/ml) (OR 1.69, 95%CI 1.09-2.63) and low 25(OH)D (OR 2.04, 95%CI 1.01-4.13) were associated with incident frailty. No consistent associations were observed for IL-6 and IGF-1. Conclusion: Low 25(OH)D levels were strongly associated with prevalent and incident frailty; moderately elevated levels of CRP were associated with incident frailty.

Objectives: To determine the effect of static and dynamic frailty on mortality in older men and women. Design: A prospective cohort study with three 3-year measurement cycles. Setting: Population based. Participants: The sample was derived from the Longitudinal Aging Study Amsterdam and consisted of respondents who participated in two cycles (T1: 1992/1993 and T2: 1995/1996) and for whom there was complete data on disability and chronic diseases (N=2,257). Measurements: Nine frailty markers were assessed at T1 and T2. The frailty markers were defined in two ways: low functioning at T2 (static frailty) and change in functioning between T1 and T2 (dynamic frailty). Survival time, calculated in days from T2 to January 1, 2000, was used as the outcome variable. Predictive ability was examined using Cox proportional hazards analyses separately for men and women. Results: Women were frailer than men. Static frailty was significantly associated with mortality in men (relative risk (RR)=2.4) and in women (RR=2.6). Dynamic frailty was also associated with mortality in women (RR=2.6), but it was not significantly associated with mortality in men (RR=1.3). When disability and chronic diseases were included in the model as possible mediators, these RRs dropped to 1.6, 2.0, 2.1, and 1.2, respectively, of which the first three were still significant. Conclusion: Frailty was associated with mortality to a greater extent in women than in men, and this effect was independent of disability and chronic disease. In men, the static definition of frailty was more predictive of mortality than the dynamic definition.

Objective:The objective of this study was to examine whether low levels of oestradiol and testosterone are associated with impaired mobility, low muscle strength and the incidence of falls in a population-based sample of older men and women. Design: cross-sectional population-based study, based on data of the Longitudinal Aging Study Amsterdam (LASA), including 623 men and 663 women, aged 65-88 years. Measurements: Serum levels of oestradiol, testosterone, albumin and sex hormone binding globulin (SHBG) were measured. Physical performance, functional limitations and muscle strength were assessed, and a follow-up on falls was performed prospectively during three years. Results: After adjustment for age, level of education, alcohol use, physical activity, chronic disease and body mass index (BMI), men in the highest quartile of the oestradiol/SHBG ratio had significantly higher physical performance scores than men in the lowest quartile (?=0.103). Serum levels of total testosterone were positively associated with muscle strength (?=0.085). Calculated bioavailable testosterone levels were positively associated with physical performance and muscle strength (?=0.128 and 0.109 respectively). No associations of oestradiol levels with mobility were seen in women. Levels of oestradiol and testosterone were not associated with falls. Conclusions: It can be concluded that low levels of sex hormones were associated with impaired mobility and low muscle strength in men, but not in women. Levels of sex hormones were not associated with the incidence of falls neither in men, nor in women.

Background and aims: This study examines whether a three-year change in serum albumin concentration is associated with subsequent decline in functional status in older persons. Methods: A total of 588 participants from the Longitudinal Aging Study Amsterdam aged 65-85 years were followed for six years. The three-year change in serum albumin was classified in four groups: chronic low (< or =43 g/L at both time points), decrease (decrease of 2.4% or more) from normal to low, decrease but still normal, and stable normal albumin (reference group). During the subsequent three years, absolute change and a decline of one standard deviation or more (termed substantial decline) in functional status was assessed. Functional status was measured in two ways: using performance tests and self-reported functional ability. Results: Substantial decline in functional performance and functional ability was observed in 243 persons (41.3%) and 133 persons (22.6%), respectively. After adjustment for baseline functional status and potential confounders, chronic low albumin and a decrease from normal to low albumin were associated with a greater absolute decline in functional performance and in self-reported functional ability. Using the outcome substantial decline in functional status, only decrease to low serum albumin was associated with decline in functional ability [odds ratio (OR)=1.97; one-sided 95% Confidence Limit (CL)=1.09]. Conclusions: This study indicates that chronic low serum albumin is a determinant of decline in functional status. However, a decrease in serum albumin from normal to low levels but within the normal range was a stronger determinant of future decline in functional status. Change in serum albumin level within the normal range measured between two points in time may be used as a general marker of future functional decline.

To examine whether low serum albumin is associated with low muscle strength and future decline in muscle strength in community-dwelling older men and women. Design: Population-based cohort study. Setting: The Longitudinal Aging Study Amsterdam. Participants: Six hundred seventy-six women and 644 men aged 65 to 88. Measurements: Serum albumin was determined at baseline. Muscle strength was assessed using grip strength at baseline, after 3 (n51,009), and 6 (n5741) years. The outcomes were continuous baseline muscle strength, 3- and 6-year change in muscle strength, and a dichotomous indicator for substantial decline (a decrease if _1 standard deviations for women511 kg, for men512 kg) in muscle strength. Results: Mean serum albumin concentration _ standard deviation was 45.0 _ 3.3 g/L for women and 45.2 _ 3.2 g/L for men. At baseline, adjusting for age, lifestyle factors, and chronic conditions, lower serum albumin was cross-sectionally associated with weaker muscle strength (Po.001) in women and men. After 3 years of follow-up, mean decline in muscle strength was _5.6 _ 10.9 kg in women and _9.6 _ 11.9 kg in men. After adjustment for potential confounders, lower serum albumin was associated with muscle strength decline over 3 years (Po.01) in women and men (b50.57, standard error (SE)5 0.18; b50.37, SE50.16, respectively). Lower serum albumin was also associated with substantial decline in muscle strength in women (per unit albumin (g/L) adjusted odds ratio (OR)51.14, one-sided 95% confidence limit (CL)51.07) and men (per unit albumin (g/L) adjusted OR51.14, 95% CL51.08). Similar but slightly weaker associations were found between serum albumin and 6-year change in muscle strength (Po.05). Conclusion: These results suggest that low serum albumin, even within the normal range, is independently associated with weaker muscle strength and future decline in muscle strength in older women and men.

No abstract available.

Vertebral deformities and spinal osteoarthritis are common disorders in elderly persons and are associated with back pain, impaired physical functioning, and loss of quality of life. The objectives of this study were to assess the impact of vertebral deformities and osteoarthritis on quality of life in a population-based sample, and to compare this with the impact of six other important chronic diseases on quality of life. The study was performed as a substudy of the Longitudinal Aging Study Amsterdam. Vertebral deformities and osteoarthritis were assessed by spinal radiographs; chronic diseases were assessed by self-report; quality of life was estimated by the SF-12, EQ-5D (EuroQol) and Qualeffo-41 (n=336). In univariate analyses, severe osteoporosis of the vertebrae significantly worsened the physical component summary scale of the SF-12 and the total score of Qualeffo-41, while osteoarthritis of the spine did not significantly reduce quality of life. The other chronic diseases reduced quality of life, although not all changes reached statistical significance. In multivariate analyses, severe osteoporosis of the vertebrae, cardiac disease, peripheral arterial disease, and diabetes mellitus significantly reduced quality of life. In conclusion, most persons in an elderly population suffer from one or more chronic diseases, and therefore experience loss of quality of life. After adjustment for age, sex, and other chronic diseases, severe osteoporosis of the vertebrae, cardiac disease, peripheral arterial disease, and diabetes mellitus significantly reduced quality of life in the general population.

Objective: To examine long-term outcome of late-life anxiety disorders and utilization of mental health care services.Method: A cohort of subjects (aged ?55years) with an anxiety disorder (n=112) was identified in the Longitudinal Aging Study Amsterdam (n=3107). At 6year follow-up, the rate of persistence and prognostic factors for persistence of anxiety were established. Results: Six years after baseline 23% of our sample met the criteria for an anxiety disorder. Another 47% suffered from subclinical anxiety symptoms. Persistence of anxiety was associated with a high score on neuroticism at baseline. Use of benzodiazepines was high (43%), while use of mental health care facilities (14%) and anti-depressants (7%) remained low in those with persistent anxiety. Conclusion: Results indicate that those high in neuroticism are at greater risk for persistence of anxiety. Efforts to enhance appropriate referral of anxious older adults do not seem to have had the desired effect.

Objective: In small case-control studies, obesity was associated with worse vitamin D status. Our aim was to assess the association of adiposity (anthropometric measures as well as dual energy x-ray absorptiometry) with serum 25-hydroxyvitamin D (25-OH-D) and serum PTH levels in a large population-based study including older men and women. Methods: Subjects were participants of the Longitudinal Aging Study Amsterdam and were aged 65 yr and older. In 453 participants, serum 25-OH-D and PTH were determined, and body mass index, waist circumference, waist to hip ratio, sum of skin folds, and total body fat percentage by dual energy x-ray absorptiometry were measured. Results: After adjustment for potential confounders, higher body mass index, waist circumference, and sum of skin folds were statistically significantly associated with lower 25-OH-D (standardized _ values were _0.136, _0.137, and _0.140, respectively; all P _ 0.05) and with higher PTH (0.166, 0.113, and 0.114, respectively; all P _ 0.05). Total body fat percentage was more strongly associated with 25-OH-D and PTH (_0.261 and 0.287, respectively; both P _ 0.001) compared with anthropometric measures. Total body fat percentage remained associated with 25-OH-D after adjustment for PTH, and with PTH after adjustment for 25-OH-D. Conclusion: Precisely measured total body fat is inversely associated with 25-OH-D levels and is positively associated withPTHlevels. The associations were weaker if anthropometric measures were used, indicating a specific role of adipose tissue. Regardless of the possible underlying mechanisms, it may be relevant to take adiposity into account when assessing vitamin D requirements.

Data from the Longitudinal Aging Study Amsterdam were used to study the relationship between neuroticism and aging. At baseline, cross-sectional analyses of data from 2,117 respondents (aged 55–85 years, M = 70) showed no significant age differences. The magnitude of the 3- and 6-year stability coefficients was high, and 12% of the elderly participants showed a clinically relevant mean level change. Longitudinal multilevel analyses showed a small but statistical significant change with aging, but the mean change was not considered clinically relevant. A U-formed course was found, showing a slight decrease until respondents reached the age of 70. Adjusting the model for physical health-related variables slightly increased the stability. An additional interaction analysis showed that the individual trajectory of neuroticism was not affected by the physical health status. In conclusion, neuroticism remains rather stable in middle and older adulthood, with some apparent increase in late life.

No abstract available.

Objective: To describe the lifestyle of men and women aged 55-64 years in the Netherlands in 2002/’03 and compare it with the lifestyle of people of the same age in 1992/’93. Design: Descriptive. Method: Data were used from the Longitudinal Aging Study Amsterdam. The study comprised two randomly selected samples from local municipal registers in 1992/’93 (n = 966) and 2002/’03 (n = 1002), stratified according to sex, age and expected 5-year survival. Participants were from 11 municipalities in the west, northeast and south of the Netherlands. Data were collected from interviews, measurements and a written questionnaire. The response was 62% in 1992/ ’93 and 57% in 2002/’03. Results: In 1992/’93, 9.5% of the men and 20.5% of the women were obese. Ten years later these percentages were 18.4 and 27.5. The percentage of current smokers was stable over time and included one-third of men and one-quarter of women. More people used alcohol in 2002/’03; excessive alcohol use was found in 15.7% of the men (11.7% in 1992/’93) and 19.5% of the women (11.1% in 1992/’93). The energy expended through walking, bicycling, household activities and sports was one-fifth less in 2002/’03. Conclusion: The lifestyle of people aged 55-64 years in the Netherlands was less healthy in 2002/’03 than in 1992/’93. Because positive changes in lifestyle can reduce the risk of chronic diseases, functional limitations and early death, more attention to healthy living is necessary in this age group.

Purpose: In survey interviews information is transferred to the researchers via a communication process between interviewers and respondents. This process is controlled directly by the interviewers, and indirectly by the researchers who constructed the questionnaire and instructed and supervised the interviewers. In spite of these control activities, errors occur. This paper investigates the sources of these errors. Design/methodology/approach: In order to investigate the sources of these errors, transcripts of 200 interviews were analyzed using a detailed coding scheme. Findings: In 30 percent of all question-answer sequences interviewer and respondent stick to the “script” designed by the researcher. In these “paradigmatic” sequences the open loop control by the researcher works well. In 25 percent of the sequences this control is not sufficient, but additional closed loop control, via “repair” activities of the interviewers, appears to be successful. In the remaining sequences both the open loop control of the researcher and the closed loop control by the interviewer failed. Originality/value: The recently developed systematic analysis of question-answer sequences in survey interviews, employed in this research, offers detailed insight into the errors occurring during the interview process, and illustrates the need for improved question design and improved training of interviewers.

Abstract The associations between prevalence, incidence and recovery from activities of daily living (ADL) disability and social ties among community-dwelling persons over 65 in Finland, The Netherlands and Spain are examined. Data were harmonized in the CLESA study. The baseline sample was composed of 3,648 subjects between 65 and 85 years old, living in Finland, The Netherlands and Spain. Disability in four activities of daily living was determined at baseline and at follow-up. Social participation, number of family ties and presence of friends were added to obtain a social ties index. Logistic regressions were fitted to the prevalence, incidence and recovery data to estimate the associations between disability and social ties, adjusting for education, comorbidity and self-rated health. The modifying effects of country, age and sex were tested in all models. For every country, the social ties index, having friends and social participation were negatively associated with ADL disability prevalence. ADL incidence was negatively related to the number of family ties, with a stronger relationship in Spain than in The Netherlands or Finland. ADL recovery was associated with the social ties index. No age or gender differences in these associations were found. Social ties appear to generate a beneficial effect on the maintenance and restoration of ADL function. While social ties play an important role in maintaining and restoring function in all three countries, family ties appear to generate a stronger effect on protection from disability incidence than does social participation, and the strength of this effect varies by culture.

Background: Gender differences in level of cognitive functioning are frequently observed, but little is known about gender differences in rate of decline of cognitive functioning. Objective: The present study aims to describe variability between and within men and women specified for four different cognitive abilities at baseline, and variability in change in these abilities among men and women over 6 years. Methods: We started with a study sample of 1,132 men and 1,175 women, with a measurement interval of 3 years. At wave 3 of the study, 1,552 of the respondents from wave 1 were still present. Differences in level and rate of change were estimated with latent change models. Results: Women have higher levels of memory functioning then men, but no gender differences were observed for speed or non- verbal reasoning changes. Conclusion: In spite of evidence for a stronger age- related atrophy of the brain structure of men, no gender differences in decline of cognitive functions could be observed.

The effects of cognitive and physical decline on changes in the size and composition of four types of personal networks over a period of six years were investigated in a Dutch sample of 1552 older adults, aged 55–85 years. The effects of age and a decline in cognitive and physical functioning on the probability of changes in all possible network types were investigated. Transitions related to age and to cognitive and physical decline were observed for about one-third of the study sample. Greater age was associated with an increase in the number of family members in the network. Physical decline was associated with a replacement of friends and neighbors by family members only if the network was large. In small networks, no such association occurred. Cognitive decline was associated with a loss of relationships, most likely friends and neighbors, who were not found to be replaced by family members. Physical decline appears to be associated with an increase in the potential number of supporters in the network, whereas cognitive decline is associated with a decrease in the number of potential supporters.

Achtergrond: Betrouwbare gegevens over het natuurlijk beloop van depressieve stoornissen bij ouderen zijn nauwelijks beschikbaar. Doel: Het onderzoeken van het langerdurende beloop van depressie bij ouderen; het zoeken naar aanwijzingen dat het beloop verslechtert met de leeftijd; en nagaan of het bij aanvang al dan niet voldoen aan DSM-criteria voor affectieve stoornissen het beloop voorspelt. Methode: Het onderzoek was ingebed in de Longitudinal Aging Study Amsterdam. Van 277 bij aanvang depressieve ouderen zijn beloopgegevens bekend(gemiddeld 9,8 observaties per respondent over een periode van 6 jaar). Resultaten: De gemiddelde ernst van de symptomatologie bleef gedurende 6 jaar boven de 85ste percentielscore van ouderen in de algemene bevolking. Minder dan 15% van de respondenten was minder dan 20% van de tijd depressief. Drieëntwintig procent bleek een remissie te hebben, 12% had remissie met terugval, 32% had een chronisch-intermitterend beloop en 32% een chronisch beloop. Zowel leeftijd bij aanvang als aan leeftijd gebonden risicofactoren voorspelden een slechter beloop. Respondenten die aan het begin voldeden aan DSM-criteria voor depressieve stoornis of dysthymestoornis hadden het meest ongunstige beloop. Het beloop van de groep met \'subthreshold\'-depressie was allesbehalve gunstig en veel slechter dan dat van een controlegroep. Conclusie: Het natuurlijk beloop van depressie bij ouderen in de algemene bevolking is ongunstig en waarschijnlijk ongunstiger dan dat van jongere volwassenen. DSM-criteria voor depressieve stoornis en dysthyme stoornis helpen om de groep met het slechtste beloop te identificeren. Echter, de meerderheid van de ouderen met depressieve symptomen voldoet niet aan deze criteria. Dit \'grijze gebied\' in de classificatie van affectieve stoornissen is zowel klinisch als vanuit de volksgezondheid buitengewoon relevant en verdient nader (interventie) onderzoek.

Background: Dysthymia (DD) may be thought of as depression associated with personality disorder, a phase in the pleomorphic natural history of unipolar depression or a result of exposure to chronic physical illness. Prevalence, clinical features, risk factors and prognosis may change with age. Method: Large (n = 3056) representative sample of elderly (55–85) in the Netherlands. Two-stage screen procedure to identify elderly with DD. The Center for Epidemiologic Studies Depression scale (CES-D) was used as a screen and the Diagnostic Interview Schedule (DIS) to diagnose DD. Data on 277 depressed elderly were available to assess the 6-year prognosis of DD. Results: The prevalence of DD (4.61%) was higher in women and declined with age. The symptom profiles of DD and MDD were very similar. Those with DD were very likely to have had MDD earlier in life (44% in pure DD and 80% in those with double depression). The average age at onset (31 years) was earlier than in MDD (53 years). Environmental and personal vulnerability dominated the risk-factors. The prognosis was unfavourable in most cases. Limitations: Considerable attrition and retrospective data on age at onset and previous histories of depression. Conclusion: Although the prevalence declines with age, DD remains common in later life. Many cases arise later than is often thought and clinical features intertwine with those of MDD in the course of life. Given the unfavourable prognosis, provision of effective treatment is warranted.

No abstract available.

Psychosocial coping resources have been found to protect against depressive symptoms in people with and without chronic diseases. It has not been established, however, whether these resources have the same effects across patients with different diseases. Therefore, the aim of the study was to estimate the direct and buffer effects of psychosocial resources on depression, and to examine whether these effects are different for various chronic diseases. Data were obtained from the Longitudinal Aging Study Amsterdam. In all, 2288 community-dwelling respondents (age 55–85) were included and followed for a maximum of 6 years. Depressive symptoms (using the Center for Epidemiologic Studies-Depression scale), the presence of seven frequently occurring chronic diseases, social support and personal coping resources, physical functioning and sociodemographic variables were assessed by structured interviews .Generalized estimating equation models were estimated for each disease, social support and personal coping resources. All resources, except social network size, showed a direct effect on depressive symptoms regardless of the presence of chronic diseases. Having a partner, high self-esteem, mastery, self-efficacy and feeling less lonely additionally buffered the negative effect of some, but not all, specific chronic diseases. Unexpectedly, in patients with cardiac disease, none of the psychosocial resources exerted a buffer effect on depressive symptoms. For instrumental and emotional support only direct (unfavorable) effects and no buffer effects could be observed. In conclusion, our study provides evidence that buffer effects of psychosocial resources are different across various chronic diseases. This suggests that interventions to enhance specific resources may ameliorate depressive symptoms in specific chronic patients groups.

Objective: The purposes of this study were to examine the differences in influence of various chronic diseases on depressive symptomatology over time and to determine whether there were differences in such influence depending on physical limitations and time of onset of disease. Study Design and Setting: Data for this study were obtained from the Longitudinal Aging Study Amsterdam. Two thousand two hundred eighty-eight respondents (age 55–85) were included and followed for a maximum of 6 years. Depressive symptoms (using the CES-D scale), the presence of seven frequently occurring chronic diseases, physical limitations, and sociodemographic variables were assessed by structured interviews. Generalized estimating equation models were estimated for each disease and compared with each other. Results: Lung disease, arthritis, cardiac disease, and cancer were all positively associated with increased depressive symptoms over time. Stroke was associated with depressive symptoms, but these associations were not found when adjusted for physical limitations. For atherosclerosis and diabetes mellitus only weak or no associations with depressive symptoms were found. Recent onset of disease resulted in less strong associations for in cancer, lung disease, and arthritis. Conclusion: The results demonstrate that the level of depressive symptoms varies across type of chronic disease. In cardiac disease, arthritis, cancer, and lung disease increased depressive symptoms could not be attributed to physical limitations, but in stroke the association found with depressive symptoms was to a large extent attributable to physical limitations.

Visual impairment has been implicated as a risk factor for falling and fractures, but results of previous studies have been inconsistent. The relationship between several aspects of vision and falling/fractures were examined in a prospective cohort study in 1509 older men and women. The analyses showed that impaired vision is an independent risk factor for both recurrent falling and fractures. Introduction: falls and fractures are a major health problem among the elderly. Visual impairment has been implicated as a risk factor for both falls and fractures. However, results from studies are inconsistent. The inconsistency between findings can primarily be attributed to differences in the designs of these studies. Most studies have been cross-sectional or case-control studies, and many have not correctly adjusted for potential confounders. Furthermore, until now, the potential mediating effects of functional limitation, physical performance, and physical activity have not been examined. Materials and Methods: A total of 1509 people was examined in 1995-1996. Contrast sensitivity was assessed with the VCTS_6000-1 chart for near vision. In addition, self-reported visual impairment was assessed by questions on recognizing faces from a distance of 4 m, reading the small print in the newspaper, and problems with glare. Furthermore, many potential confounders and mediators were assessed. Falls and fractures were assessed prospectively during a 3-year follow-up period. The associations between the vision variables and falls and fractures were examined using Cox proportional hazards analyses. Results: After adjustment for potential confounders, contrast sensitivity was shown to be associated with recurrent falling (hazard ratio [HR] = 1.5), and the question on recognizing faces was shown to be associated with fractures (HR = 3.1). Furthermore, functional limitations and physical performance were shown to be mediators in the relationship between vision variables and recurrent falling/fractures. Conclusions: The results indicate that impaired vision is an independent risk factor for falling and fractures, but different aspects of visual functioning may have different relationships to falling and fractures.

Objectives: Expanding on cross-sectional studies, associations are examined between religious involvement and the 6-year course of depressive symptoms in older adults. Methods: Subjects are1,840 community-dwelling older adults (aged 55 to 85) participatingin three measurement cycles of the Longitudinal Aging Study,Amsterdam. Assessments include aspects of religious involvement,depressive symptoms, physical health, self-perceptions, socialintegration, urbanization, and alcohol use. Results: Churchattendance is negatively associated with the course of depressivesymptoms, also after adjustment for explanatory variables. Amongrespondents with functional limitations, lower depression scoresare found for those who attend church on a regular basis. Forrespondents who are bereaved or nonmarried, however, slightlyhigher depression scores are found for those with high levelsof orthodox beliefs. Discussion: There is a consistent negativeassociation over time between church attendance and depressivesymptoms in older Dutch citizens. Both stress-buffering as wellas depression-evoking effects of religious involvement are found.

Associations between disability and depression have been shown to be consistent across cultures among middle-aged adults. In later life the association between disability and depression is much more substantial and may be amenable to influences by health care facilities as well as economic and sociocultural factors. Fourteen community-based studies on depression in later life in 11 western European countries contribute to a total study sample of 22,570 respondents aged 65years or older. Measures are harmonised for depressive symptoms (EURO-D scale) and disability. Using multilevel modelling to control for the stratified data structure we examined whether the association between disability and depressive symptoms is modified by national health care and mental health care availability, national economic circumstances, demographic characteristics and religious tradition. The association between depressive symptoms and disability is attenuated by health care expenditure and availability of mental health care and also by gross domestic product; it was more pronounced in countries with high levels of orthodox religious beliefs. Higher levels of depressive symptoms are found in countries with a larger gross domestic product (per capita) and higher health care expenses but are interpreted with care because of measurement differences between the centres. The findings from this contextual perspective indicate that general and mental health care should be geared to one another wherever possible.

This study describes and explains the social-economic inequality in the care older parents receive from their children. Income is the indicator of social-economic status. The explanation of inequality is based on expected differences in the need, predisposition and opportunities to receive care. 259 parents report whether their children assist with personal and/or domestic care activities. Logistic regression analyses show that low-income parents are 3,6 times more likely to receive help from their children compared to high-income parents. The difference is explained by the fact that low-income parents are more often female, older and single, less often use privately paid help, prefer family care to professional care, and have more children living within proximity. It is concluded that the predisposition to use care (e.g. preferences) and, in particular, the opportunities to use care (e.g. no alternative sources of care) explain the differences in the use of informal care by older parents.

The course of cognitive functioning in older persons is studied over a period of six years. The first aim was to distinguish cognitive decline as a temporary state from progressive cognitive decline. The second aim was to identify predictors which may be useful in discriminating persons with temporary cognitive decline from persons with progressive cognitive decline at an early stage. Data were derived from the Longitudinal Aging Study Amsterdam (LASA), a population-based study in the Netherlands. The results show that 18.2% of the sample of older persons showed cognitive decline over a period of three years. Of this group, 44% recovered from cognitive decline or stayed stable in the next three years. Especially older age, memory complaints and an increase of cardiovascular diseases at follow-up predict further deterioration.

Background and Aims: Some prospective studies show that depression is a risk factor for cognitive decline. Thus far, the explanation for the background of this association remained unclear. In the present study it is investigated (1) whether depression is etiologically linked to cognitive decline; (2) whether depression and cognitive decline may be the consequence of the same underlying subcortical pathology, or (3) whether depression is a reaction to global cognitive deterioration. Methods: A cohort of 133 depressed and 144 non-depressed older persons, was followed at eight successive observations during three years. All subjects were participants of the Longitudinal Aging Study Amsterdam (LASA). Depression symptoms were measured by means of the CES-D at eight successive waves. Cognitive function (memory function, information processing speed and global cognitive functioning) was assessed at baseline and at the last CES-D measurement. Results: Our results show that the severity and duration of depressive symptoms were not associated with subsequent decline in memory functioning or global cognitive decline. There was an association between both chronic mild depression and chronic depression, and decline in speed of information processing. Conclusions: These results support the hypothesis that in older persons chronic depression as well as cognitive decline may be the consequence of the same underlying subcortical pathology.

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Background: There are inconsistent reports as to whether peoplewith anxiety disorders have a higher mortality risk. Aims: To determine whether anxiety disorders predict mortalityin older men and women in the community. Method: Longitudinal data were used from a large, community-basedrandom sample (n=3107) of older men and women (55–85years) in The Netherlands, with a follow-up period of 7.5 years.Anxiety disorders were assessed according to DSM–IIIcriteria in a two-stage screening design. Results: In men, the adjusted mortality risk was 1.78 (95% CI1.01–3.13) in cases with diagnosed anxiety disordersat baseline. In women, no significant association was foundwith mortality. Conclusions: The study revealed a gender difference in the associationbetween anxiety and mortality. For men, but not for women, anincreased mortality risk was found for anxiety disorders. Declaration of interest: None.

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This population-based study employing after-death interviews with proxies describes older persons’ preferences regarding medical care at the end of life. Interviews were held with 270 proxy respondents of 342 deceased persons (age range 59–91) in the Netherlands, The deceased were respondents to the Longitudinal Aging Study Amsterdam. The prevalence of advance directives (ADs), preferences for medical decisions at the end of life (i.e. withholding treatment, physician-assisted suicide euthanasia) and preferences about the focus of treatment in the last week of life (i.e. comfort care versus extending life) were examined. Written ADs were present in 14% of the sample. A quarter had designated a surrogate decision-maker. Co-morbidity and perceived self-efficacy (PSE) were positively associated with ADs. About half the sample had expressed a preference in favour or against one or more medical decisions at the end of life. Predictors positively associated with expressing a preference were co-morbidity, dying from cancer, and PSE. Being religious was negatively associated with expressing a preference. The knowledge of the proxy regarding the older person’s preference for the focus of treatment was dependent on the patient’s symptom burden as perceived by the proxy. The majority of older persons had died without either an AD, or having expressed preferences for end-of-life care. Stimulating the formulation of ADs may help professionals who work with older people to understand these preferences better, especially in the case of non-cancer patients and those with low PSE.

In order to investigate symptom burden in the last week of life, we conducted after-death interviews with close relatives of deceased older persons from a population-based sample of older people in The Netherlands (n = 270). Results show that fatigue, pain, and shortness of breath were common (83%, 48% and 50%, respectively). Other symptoms were confusion (36%), anxiety (31%), depression (28%), and nausea and/or vomiting (25%). Cancer patients and patients with chronic obstructive pulmonary disease were clearly at a disadvantage with respect to pain and shortness of breath, respectively. Furthermore, cognitive decline turned out to be predictive of specific symptom burden. Persons with cognitive decline in the last three months had a higher symptom burden and different symptoms compared to patients with no cognitive decline. It is suggested that older persons with cognitive decline require specific attention.

Dit onderzoek richt zich op determinanten van ervaren belasting bij partners en kinderen die zorg verlenen aan ouderen. De zorgontvangers in dit onderzoek zijn ouderen die al sinds 1992 participeren in de Longitudinal Aging Study Amsterdam (LASA). Een selectie van 155 chronisch zieke ouderen met zorgbehoefte, 78 partners en 337 volwassen kinderen, hebben deelgenomen aan de LASA-deelstudie naar zorgverlening binnen families. De resultaten wijzen uit dat 32% van de partners en 40% van de kinderen de oudere helpt bij persoonlijke verzorging en/of huishoudelijke taken. De zorgverlenende partners leveren vaak al jaren zorg in zowel het huishouden als met de persoonlijke verzorging. De zorgverlenende kinderen verrichten overwegend huishoudelijke hulp en delen deze taken met hun broers en zusters. Kinderen geven vaak zorg aan ouders die alleen staan of wiens partner niet in staat is tot zorgverlening. De beschikbaarheid van formele zorg maakt geen verschil voor de zorg van kinderen. De helft van de zorgende partners en een-vijfde van de zorgende kinderen kan als zwaarbelast worden aangemerkt. Degenen die een hoge belasting ervaren, leveren vaker persoonlijke zorg, rapporteren meer negatieve gevolgen, en hebben meer behoefte aan hulp bij de zorg. Zwaarbelaste kind-mantelzorgers rapporteren daarnaast ook lagere competentieverwachtingen, weinig overleg met broers en zusters en onenigheid over de zorgverlening. Deze bevindingen wijzen erop dat zorgverlening geen individuele aangelegenheid is, maar een ‘taak’ voor het gehele gezin. Ondersteuning van mantelzorgers moet dan niet alleen gericht zijn op een vermindering van de zorglast en een versterking van de individuele draagkracht, maar ook op een verdeling van de lasten door het inschakelen van andere (al dan niet verwante) betrokkenen.

Objective: To assess the association of decline in physical functioning with number of chronic diseases and with specific comorbidity in different index diseases.Methods: A longitudinal design was employed using data from 2,497 older adults participating in the Longitudinal Aging Study Amsterdam. Logistic regression analyses were used to determine influence of chronic diseases on change in physical functioning, operationalized using the Edwards-Nunnally index.Results: Decline in physical functioning was associated with number of chronic diseases (adjusted ORs from 1.58 for 1, to 4.05 for greater than or equal to3 diseases). Comorbidity of chronic nonspecific lung disease and malignancies had the strongest exacerbating influence on decline. An exacerbating effect was also found for arthritis in subjects with diabetes or malignancies and for stroke in subjects with chronic nonspecific lung disease or malignancies. A weaker effect than expected was observed for diabetes in subjects with stroke, malignancies, cardiac disease, or peripheral atherosclerosis.Conclusion: Comorbidities involving chronic diseases that share etiologic factors or pathophysiologic mechanisms appear to have a weaker negative influence on decline in physical functioning than expected. Results indicate that combinations of diseases that both influence physical functioning, but through different mechanisms (locomotor symptoms vs. decreased endurance capacity) may be more detrimental than other combinations.

Background: Clinical studies suggest that vascular depression presents with typical symptom patterns. The aim of the present study is to examine whether depressed older persons in the open population with and without vascular disease show different symptom patterns. Methods: In the Longitudinal Aging Study Amsterdam (LASA), a depressed cohort with (n=114) and without (n=292) vascular disease was identified. Depression was measured using self-reports (CES-D). Vascular disease was confirmed or ruled out using a combination of self-reported data, medication use and reports from general practitioners. Results: No significant differences were found in depressive symptom patterns, in symptom clusters nor individual items of the CES-D. Depressed subjects with vascular disease showed much more disability than those without vascular disease. Age of onset of depression did not show statistically significant difference. Conclusions: From our study in the open population, there is no evidence to support the hypothesis that depressed older persons with vascular disease have a distinct depressive symptom profile, but they do show more disability.

Background: Disability questions require older people to report difficulties with everyday activities, using broad categorical responses. Relatively little is known about population group differences in the thresholds for reporting difficulty or inability with medium-distance mobility against tested mobility-related performance. We aimed to estimate the thresholds on tested performance at which self-reports change from one category to another, across a range of sociodemographic subgroups. We also aimed to compare reported and tested performance across two national population studies. Methods: The samples were from the third U.S. National Health and Nutrition Examination Study (NHANES III) and the Longitudinal Aging Study Amsterdam (LASA). Measures of gait speed, chair stands, and peak expiratory flow rate in both studies yielded the validated index of mobility-related physical limitations (MOBLI). Latent probit models were used to estimate cutpoints (thresholds) on the index for reporting difficulty or inability to walk a medium distance. Results: Thresholds for reporting difficulty or inability were studied by age, sex, race, educational level, and income in NHANES III. In models adjusting for the other factors, performance thresholds for reporting disability categories varied by age and income. The younger elderly persons in NHANES III on average reported difficulties or inabilities only when they reached a more severe level of tested limitation compared with older old persons. A similar pattern exists for those on higher incomes. For race, differences in threshold were present only for reporting inability, but not difficulty. Significant differences in thresholds were not present between groups defined by sex or for years of education. Comparisons between the NHANES and LASA studies show that lower reported mobility difficulty or inability prevalence in the Dutch sample is attributable both to reporting at higher levels of limitation and to better functioning. Conclusions: There is evidence of differences in thresholds for reporting mobility disability, especially across age and income groups in older Americans. Further work is needed to understand the perceptual, attitudinal, or environmental factors that cause these reporting differences.

Background: Very high plasma homocysteine levels are characteristicof homocystinuria, a rare autosomal recessive disease accompaniedby the early onset of generalized osteoporosis. We thereforehypothesized that mildly elevated homocysteine levels mightbe related to age-related osteoporotic fractures.Methods: We studied the association between circulating homocysteinelevels and the risk of incident osteoporotic fracture in 2406subjects, 55 years of age or older, who participated in twoseparate prospective, population-based studies. In the RotterdamStudy, there were two independent cohorts: 562 subjects in cohort1, with a mean follow-up period of 8.1 years; and 553 subjectsin cohort 2, with a mean follow-up period of 5.7 years. In theLongitudinal Aging Study Amsterdam, there was a single cohortof 1291 subjects, with a mean follow-up period of 2.7 years.Multivariate Cox proportional-hazards regression models wereused for analysis of the risk of fracture, with adjustment forage, sex, body-mass index, and other characteristics that maybe associated with the risk of fracture or with increased homocysteinelevels.Results: During 11,253 person-years of follow-up, osteoporoticfractures occurred in 191 subjects. The overall multivariable-adjustedrelative risk of fracture was 1.4 (95 percent confidence interval,1.2 to 1.6) for each increase of 1 SD in the natural-log–transformedhomocysteine level. The risk was similar in all three cohorts studied, and it was also similar in men and women.A homocysteinelevel in the highest age-specific quartile was associated withan increase by a factor of 1.9 in the risk of fracture (95 percentconfidence interval, 1.4 to 2.6). The associations between homocysteinelevels and the risk of fracture appeared to be independent ofbone mineral density and other potential risk factors for fracture.Conclusions: An increased homocysteine level appears to be astrong and independent risk factor for osteoporotic fracturesin older men and women.

Disability-free life expectancy (DFLE) was compared in six countries taking part in the Cross-national Determinants of Quality of Life and Health Services for the Elderly (CLESA) project. Data from six existing longitudinal studies were used: TamELSA (Tampere, Finland), CALAS (Israel), ILSA (Italy), LASA (The Netherlands), Aging in Leganés (Leganés, Spain) and SATSA (Sweden). A harmonised four-item disability measure (bathing, dressing, transferring, toileting) was used to calculate DFLE; the harmonised measure was dichotomised into independent in all four activities vs. dependent in at least one. Calculations of DFLE were made using the multistate life table approach and the IMaCh program (INED/EuroREVES, http://eurorevesinedfr/imach/) for subjects aged 65–89 years. Prevalence ratios of disability varied significantly across countries, with Italy and Leganés having the highest percentages among men and among women, respectively, while The Netherlands presented the lowest for both sexes. At 75 years of age the estimated total life expectancy among men ranged from 7.8 years in Tampere and Sweden to 9.0 years in Israel; among women it ranged from 9.5 years in Israel to 11.6 years in Italy. For both sexes Italy showed the lowest total life expectancy without disability (72% among men, 61% among women) and Sweden the highest (89% among men and 71% among women). The results yielded a north/south gradient, with residents in Tampere, The Netherlands and Sweden expected to spend a higher percentage of their lives without disability than those in Italy, Israel and Leganés.

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Objectives: To examine whether the collagen type I alpha1 (COLIA1) Sp1 polymorphism is associated with osteoporosis and/or intervertebral disc degeneration in older men and women. Methods: COLIA 1 genotype was determined in 966 men and women (>=65 years) of the Longitudinal Aging Study Amsterdam (LASA). The guanine (G)-to-thymidine (T) polymorphism in the first intron of the COLIA1 gene was detected by PCR and MscI digestion. In the total sample, quantitative ultrasound measurements (QUS) were assessed, as well as serum osteocalcin (OC) and urine deoxypyridinolin (DPD/Crurine). Moreover, a follow-up of fractures was done each three months. In a subsample, total body bone mineral content (BMC) (n=485) and bone mineral density (BMD) of the hip and lumbar spine (n=512) were measured with dual-energy X-ray absorptiometry (DXA). Prevalent vertebral deformities and intervertebral disk degeneration were identified on radiographs (n=517). Results: Compared to persons with the GG and GT genotypes, those with the TT genotype had a higher risk of disc degeneration (OR=3.6; 95% CI: 1.3-10). Moreover, higher levels of OC were found in men with the T-allele compared to men without the T-allele (GG vs. [GT + TT] was 1.96 ± 0.06 nmol/l vs. 2.19 ± 0.09 nmol/l). COLIA1 polymorphism was not significantly associated with other measures of osteoporosis in either men or women. Conclusion: Our findings suggest that the COLIA1 Sp1 polymorphism may be a possible genetic risk factor related to intervertebral disc degeneration in older persons. We could not confirm the previously reported association between the COLIAI Sp1 genotype and lower BMD or QUS values, higher levels of DPD/Cr, and an increased fracture risk in either men or women.

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Background: Both serum albumin and total cholesterol are potential markers of frailty. A decline in functional status is one of the key components of frailty. Objective: The aim of this study was to investigate the association of serum albumin and total cholesterol, separately and combined, with future decline in functional performance. Design: The Longitudinal Aging Study Amsterdam, an ongoing population-based longitudinal study, started in 1992/1993 with a follow-up every 3 years. Participants: 1,064 men and women aged 55-85 years with complete data on serum albumin and total cholesterol at baseline, and functional performance at baseline and 3-year follow-up. Measurements: At baseline, serum albumin and total cholesterol were measured. At baseline and 3 years later, decline in functional status was measured with three performance tests (chair stand, 3-metre walk, putting on and taking off a cardigan). Associations were adjusted for age, life-style and health-related factors. Results: Albumin concentration was not associated with decline in functional performance in men and women. Women with lower serum total cholesterol concentration (</=5.2 mmol/l) were more likely to decline in functional status compared to women with higher serum total cholesterol concentration (reference; OR = 2.50; 95% CI 1.07-5.84). Men with lower serum albumin (</=43 g/l) and lower serum total cholesterol concentration were three times more likely to decline in functional performance compared to men with higher levels (OR = 3.00; 95% CI 1.00-8.97). In women, a similar trend was found (OR = 1.73; 95% CI 0.34-8.94), although not statistically significant. Conclusions: A combination of low albumin and low cholesterol levels may increase the risk of future functional decline.

Objective: This study examined whether three aspects of functioning (i.e., functional limitations, physical performance, and physical activity) were associated with fractures in older men and women. Design: A 3-year prospective cohort study. Participants and setting: A total of 715 men and 762 women, aged 65 years and older, of the population-based Longitudinal Aging Study Amsterdam. Measurements: During an interview at home, three aspects of functioning were assessed: functional limitations (what people say they can do), physical performance, i.e., three performance tests and handgrip strength (what people are able to do), and physical activity (what people actually do). Afterward, a follow-up on fractures was conducted for 3 years. Results: 77 patients (5.2%) suffered a fracture during 3-year follow-up. Most patients suffered a hip fracture (1.6%) or a wrist fracture (1.4%). The fracture rate per 1,000 person-years was 20.1. During 3-year follow-up, a fracture was reported by 12%, 10%, 12%, and 6% of the respondents with functional limitations, low performance test score, poor handgrip strength, and low physical activity, respectively. Using Cox proportional hazard analysis, functional limitations (RR=3.5; 95%CI, 2.1 to 6.0), low performance test score (RR=1.9; 95% CI, 1.1 to 3.3), low handgrip strength (RR=2.5; 95% CI, 1.5 to 4.1), and low physical activity (RR=1.9; 95% CI, 1.1 to 3.5) were significantly associated with fractures after adjustment for age and sex. Functional limitations (RR=3.2; 95% CI, 1.8 to 5.5), low performance test score (RR=1.8; 95% CI, 1.0 to 3.3) and low handgrip strength (RR=2.0; 95% CI, 1.1 to 3.6) remained significantly associated with fractures after additional adjustment for body composition, chronic diseases, psychosocial factors, life style factors, and the other levels of functioning. No significant interaction terms were found. Conclusions: Functional limitations and poor physical performance were independent risk factors for fractures.

Objectives. 1) to examine consequences of falls in older men and women; 2) to examine risk factors for health service use and functional decline among older fallers. Methods. The study was performed within the Longitudinal Aging Study Amsterdam (LASA). In 1998/1999, potential risk factors were assessed during the third data collection. In 1999/2000, 204 community-dwelling persons (?65 years) who reported at least one fall in the year before the interview were asked about consequences of their last fall, including physical injury, health service use, treatment, and functional decline (i.e. decline in functional status, social and physical activities). Results. As a consequence of falling, respondents reported physical injury (68.1%), major injury (5.9%), health service use (23.5%), treatment (17.2%), and decline in functional status (35.3%), and social (16.7%) and physical activities (15.2%). Using multivariate logistic regression, specific risk factors for health service use after falling could not be identified. Female gender (OR=2.8;95%CI:1.5-5.1), higher medication use (OR=1.5;95%CI:1.0-2.2), and depressive symptoms (OR=1.9;95%CI:1.3-2.8) were independently associated with functional decline after falling. Depressive symptoms (OR=2.0;95%CI:1.2-3.3) and falls inside (OR=2.6;95%CI:1.1-6.5) were risk factors for decline in social activities, while female gender (OR=2.7;95%CI:1.1-7.0) and depressive symptoms (OR=1.9;95%CI:1.2-3.0) were risk factors for decline in physical activities after falling. Conclusions. Almost seventy percent of the respondents suffered physical injury, almost a quarter used health services and more than one-third suffered functional decline after falling. No risk factors were found for health service use needed after falling. Female gender, higher medication use, depressive symptoms and falls inside were risk factors for functional decline after falling.

Purpose. First, to validate the LASA Physical Activity Questionnaire (LAPAQ) by a 7-day diary and a pedometer in older persons. Second, to assess the repeatability of the LAPAQ. Third, to compare the feasibility of these methods. Methods The study was performed in a subsample (n=439, aged 69-92 years) of the Longitudinal Aging Study Amsterdam (LASA). The LAPAQ was completed twice (1998/1999, 1999/2000). Respondents completed a 7-day activity diary and wore a pedometer for seven days (1999/2000). Results. The LAPAQ was highly correlated with the 7-day diary (r = 0.70, p < 0.001), and moderately with the pedometer (r = 0.53, p < 0.001). The repeatability of the LAPAQ was reasonably good (weighted kappa: 0.65-0.75; Pearson: 0.55-0.63). The LAPAQ was completed in 5.7?2.7 minutes and 0.5% of the respondents had missing values. Conclusion. The LAPAQ appears to be a valid and reliable instrument for classifying physical activity in older people. The LAPAQ was easier to use than the 7-day diary and pedometer.

Loneliness is experienced in many cultures. To properly assess cross-cultural differences, attention should be paid to the level, determinants and measurement of loneliness. However, cross-cultural studies have rarely taken into account more than one of these. Differences in the level of loneliness were hypothesized on the basis of national differences in partnership, kinship and friendship, which were assumed to be related to cultural standards within a society. Differences were examined among married and widowed older adults aged 70 to 89 years living independently in the Netherlands (N = 1847), Tuscany, Italy (N = 562) and Manitoba, Canada (N = 1134). Loneliness was measured with an 11-item scale. The Manitobans were high on emotional loneliness and the Tuscans were high on social loneliness. Partner status excepted, the determinants were nearly the same across the three locations. Differential item functioning (DIF) related to the three locations was observed for most items. Interactions with gender and the availability of a partner relationship were observed.

Frequency of contacts with the family represents an indicator of the strength of intergenerational exchange and potential support for older people. Although the availability of children clearly represents a constraint on potential family support, the extent of interaction with and support received from children, depends on factors other than demographic availability alone. In this paper we examine the effects of socio-economic and demographic variables on weekly contacts with children in Great Britain, Italy, Finland and the Netherlands using representative survey data which included information on availability of children, as well as extent of contact. Our results confirm the higher level of parent adult-child contact in Italy, in comparison with Northern European countries, but levels of contact in all the countries considered were high. Multivariate analysis showed that in most countries characteristics such as divorce were associated with a reduced probability of contact between fathers and children; in Finland this also influenced contact between mothers and children. Analyses of possible future scenarios of contact with children, that combine the observed effects of the explanatory variables with hypothetical changes in population distribution, are also included.

This article compares the trends in living arrangements of older people in several European countries and in the United States. Trends and cross-country variability in several factors that could account for these cross-national differences, including marital status, fertility, labour force participation and attitudes are also examined. In most countries the proportion of older people living alone increased substantially between 1970 and 1990. However, the increase in living alone stabilised or even declined between 1990 and 2000 in most of the countries analysed indicating a possible reversal in the trend. Increases in proportions of older women who are married and reductions in the proportions childless may partially explain this. Considerable variability in both trends and levels of older people’s living arrangements was seen especially between north-western and southern European countries. These variations mirrored contrasts in attitudes towards residential care and parent-child co-residence between the countries.

Objective: This study examined the features of informal end-of-life care of older people living in the community and the association between informal care characteristics and dying at home. Methods: Retrospective data were obtained from interviews and self-administered questionnaires of 56 persons who had been primary caregivers of older relatives in the last three months of their lives. Results: Results showed that informal caregivers of terminally ill older people living in the community provided a considerable amount of personal, household, and management care. Secondary informal caregivers and formal caregivers assisted resident primary caregivers less often than non-resident primary caregivers. Primary caregivers who felt less burdened, who gave personal care more intensively, and/or who were assisted by secondary caregivers, were more likely to provide informal end-of-life care at home until the time of death. Conclusions: Our study showed that informal care at the end of life of older people living in the community is complex, since the care required is considerable and highly varied, and involves assistance from secondary informal caregivers, formal home caregivers as well as institutional care. Burden of informal care is one of the most important factors associated with home death. More attention is needed to help ease the burden on informal caregivers, specifically with regard to resident caregivers and spouses. Since these resident caregivers were disadvantaged in several respects (i.e. health, income, assistance from other carers) compared to non-resident caregivers, interventions by formal caregivers should also be directed towards these persons, enabling them to bear the burden of end-of-life care.

Objective: This study examined the features of informal end-of-life care of older people living in the community and the association between informal care characteristics and dying at home. Methods: Retrospective data were obtained from interviews and self-administered questionnaires of 56 persons who had been primary caregivers of older relatives in the last three months of their lives. Results: Results showed that informal caregivers of terminally ill older people living in the community provided a considerable amount of personal, household, and management care. Secondary informal caregivers and formal caregivers assisted resident primary caregivers less often than nonresident primary caregivers. Primary caregivers who felt less burdened, who gave personal care more intensively, and/or who were assisted by secondary caregivers, were more likely to provide informal end-of-life care at home until the time of death. Conclusions: Our study showed that informal care at the end of life of older people living in the community is complex, since the care required is considerable and highly varied, and involves assistance from secondary informal caregivers, formal home caregivers as well as institutional care. Burden of informal care is one of the most important factors associated with home death. More attention is needed to help ease the burden on informal caregivers, specifically with regard to resident caregivers and spouses. Since these resident caregivers were disadvantaged in several respects (i.e., health, income, assistance from other carers) compared to nonresident caregivers, interventions by formal caregivers should also be directed towards these persons, enabling them to bear the burden of end-of-life care

Achtergrond: Er is weinig bekend over de gevoeligheid van screeningsinstrumenten voor symptomen van de posttraumatischestressstoornis (PTSS) door toevallig optredende gebeurtenissen die voor het publiek schokkend zijn. Doel: Het in kaart brengen van de veranderingen in de rapportage van PTSS als gevolg van de aanslagen op 11 september en de moord op Pim Fortuyn. Methode: Statistische analyse van veranderingen in de Zelfinventarisatielijst (ZIL) afgenomen in het kader van langlopend onderzoek onder Nederlandse ouderen, ten tijde van de schokkende gebeurtenissen. Tevens bespreking van de resultaten die beschikbaar zijn in de internationale literatuur naar aanleiding van de aanslagen op 11 september, zowel toevalsbevindingen binnen langlopend onderzoek, als resultaten uit specifiek onderzoek, dat was opgezet om de gevolgen van de aanslagen in kaart te brengen. Resultaten: Respondenten die werden geïnterviewd na de aanslagen op 11 september hadden een significant hogere score dan 3 jaar ervoor, een effect dat afnam met het verstrijken van de tijd. De scores in de week na de moord op Pim Fortuyn waren significant hoger dan voor en na deze week. Conclusie: Twee schokkende gebeurtenissen, de aanslagen op 11 september en de moord op Pim Fortuyn, laten een duidelijk effect zien op een schaal voor PTSS-symptomen die ten tijde van deze gebeurtenissen werd afgenomen onder oudere Nederlanders.

Background: Previous longitudinal studies of cognitive aging have focused on long-term performance changes. A recent surge of research has demonstrated that there are reliable interindividual differences in short-term cognitive performance changes. Objective: The present study links these two pathways of cognitive aging research by examining the association between short-term (learning, practice) versus long-term (development) changes in processing speed. Methods: Data from 963 elderly participants come from the Longitudinal Aging Study Amsterdam (LASA). Results: Nested latent growth curve analyses show that the amount of learning or practice in processing speed at first measurement occasion is positively related (r = 0.72) to individual differences in development of processing speed across six years. Conclusions: Short-term learning or practice gains in processing speed are positively associated with long-term developmental changes in processing speed in the elderly.

The article gives a summary of the study \\\'Activity in older adults: Cause or consequence of cognitive functioning? A longitudinal study on everyday activities and cognitive performance in older adults\\\' (Aartsen et al., 2002). In that study the impact of everyday activities on cognitive functioning over a period of six years was studied in a large 55-85 year old population-based sample (n=2,076). A cross-lagged regression model was applied. None of the activities were found to enhance cognitive functioning six years later when controlling for age, gender, level of education, and health, as well as for unknown confounding variables. Conversely, one cognitive function (i.e. information processing speed) appeared to affect developmental activity. It is suggested that although everyday activities do not contribute to maintenance of cognitive functioning, an active life may help to maintain the level of physical or mental health.

No abstract available.

Objectives. Global social support measures have been shown to be related to several health outcomes, but little is known about the effects of different social ties and their support on the risk for decline in physical functioning among older people without as compared to those with chronic diseases. This study examines whether different types of social ties and support differentially mitigate the negative effects of chronic diseases on decline in physical functioning. Methods. Using data from two cycles of the Longitudinal Aging Study Amsterdam (N = 2357), logistic regression analyses adjusted for baseline functioning, age, gender, and incidence of chronic diseases were conducted to assess the effect of different social ties for subgroups with different numbers of chronic diseases. Information about presence of different social ties included partner status and numbers of daughters, sons, other family members and non-kin relationships. Social support included instrumental and emotional support and the experience of loneliness. Decline in physical functioning was determined by substantial change after three years on a 6-item self-report scale. Results. Having a partner had a protective effect on decline in physical functioning in people without chronic diseases at baseline, but this was not found for those with chronic diseases. Total network size had an adverse effect in older people without chronic diseases, but a positive effect when chronic diseases were present. This was mainly due to a positive effect for the number of daughters and non-kin relationships. Discussion. Our results provide evidence that different types of social relationships and the support they provide differentially influence the risk for decline in physical functioning in older people with or without a chronic disease.

Dit artikel geeft een overzicht van de sociaal-economische status (SES) verschillen in fysieke en psychische gezondheid bij ouderen, met bijzondere aandacht voor degenen die hun leven lang in een lage sociaal-economische status verkeren. De gegevens zijn afkomstig van 1471 mannen en 1468 vrouwen (55-85 jaar) die in 1992/1993 deelnamen aan de Longitudinal Aging Study Amsterdam (LASA). Op grond van het opleidingsniveau van de oudere zelf en van diens ouders, zijn de respondenten in vier groepen verdeeld: degenen met een blijvend lage SES, met een neerwaartse dan wel opwaartse mobiliteit in SES, en met een blijvend hoge SES. Logistische regressie-analyses wijzen uit dat ouderen met een gestegen of een blijvend hoge SES een significant kleinere kans hebben op functionele beperkingen, chronische ziekten (alleen mannen), voortijdig overlijden, depressie, en eenzaamheid dan de ouderen in de blijvend lage SES groep. De nadelige positie inzake leeftijd, gezondheid en psychosociale condities van de lage SES ouderen verklaren de SES verschillen in depressie, maar de SES verschillen in sterfte (bij mannen) en functionele beperkingen (bij mannen en vrouwen) worden niet verklaard door de onderzochte risicofactoren. SES verschillen in eenzaamheid zijn te verklaren vanuit verschillen in psychosociale factoren. Leefstijl kenmerken dragen niet bij tot een verklaring voor de gevonden SES verschillen. Er werden slechts geringe verschillen aangetroffen tussen degenen met een blijvend lage SES en degenen met een dalende mobiliteit in SES. Geconcludeerd wordt dat een laag opleidingsniveau (ongeacht het niveau van de ouders) een grotere kans geeft op ongunstige psychosociale condities, gezondheidsproblemen en onwelbevinden, waarmee de kans op ‘een goede oude dag’ aanzienlijk afneemt.

Background and aims: Socioeconomic status (SES) differences in health decline in late life may be underestimated, because the relatively higher risks of attrition of lower-SES persons are seldom taken into account. This longitudinal study aimed at comparing income differences in the course of disability, non-mortality attrition and mortality in older adults. Methods: A sample population of 3107 older adults who participated in the 1992/1993 baseline of the Longitudinal Aging Study Amsterdam was examined regarding changes in functional disability in 1998/1999. SES was indicated by household income. Results: Multinomial regression analyses revealed that, for men without disability at baseline, the relative rate for attrition was four times higher and the mortality rate was twice as high for low-income vs high-income persons. For non-disabled women, the relative risk for the onset of disability was nearly twice as high for low-income vs high-income persons. For both men and women, these risks decreased only slightly when behavioral and psychosocial risk factors were taken into account. Among persons with disability at baseline, the relative risks for attrition (for women) and mortality (for men) were twice as high for low-income persons, but no income differences were found with respect to recovery and decline. Adjustment for risk factors decreased the relative risks for attrition and mortality to a non-significant level. Conclusions: Income inequality in health in late life is to a large degree explained by the higher incidence of disability among lower-status women and by the higher attrition and mortality risks among lowerstatus men.

In welke mate leidt de veroudering van de bevolking uiteindelijk tot toename van de vraag naar professionele zorg? Deze zorgbehoefte kan niet los gezien worden van twee voorafgaande vragen: ten eerste, zal de manier waarop ouderen in de toekomst omgaan met gezondheidsproblemen veranderen? Ten tweede, hoe hangen (on)gezondheid en zorg met elkaar samen als het om ouderen gaat?

Abstract: Purpose: This study addresses the question of how the relation between self-rated health (SRH) and mortality differs between genders. In addition to the general question, four specific concepts of SRH are distinguished: SRH in comparison with age peers, SRH in comparison with one\'s own health 10 years ago, and current and future health perceptions. For these concepts, the gender-specific risks of mortality were evaluated for a short and a longer follow-up period. Design and Methods: Baseline and mortality data from the Longitudinal Aging Study Amsterdam (N = 1917, initial ages 55-85 years) were used. Mortality risks were evaluated in Cox regression models at 3 and 7.5 years of follow-up, both adjusted for age and for sociodemographic characteristics, indicators of functional and mental health, lifestyle, and social involvement. All SRH measures were scaled from 1 (positive) to 5 (negative). Results: Baseline correlations between SRH concepts were similar for men and women. After 3 years, 12% of the men and 7% of the women had died; after 7.5 years, these percentages were 27 and 15, respectively. In fully adjusted models, current health perceptions predicted 3-year mortality in men (risk ratio of 1.33). At 7.5 years, mortality in men was predicted by current health perceptions and by SRH compared with age peers (risk ratios of 1.25 and 1.23, respectively). In women, no SRH concept predicted either 3-year or 7.5-year mortality. Implications: SRH was a predictor of mortality only in men, not in women. The gender difference showed most clearly at longer follow-up, in the SRH concept \"comparison with age peers.\"

No abstract available.

No abstract available.

No abstract available.

Physical activity has shown to be inversely associated with cognitive decline in older people. Whether this association is already present in early life has not been investigated previously. The association between early life physical activity and cognition was studied in 1,241 subjects aged 62-85 years, in a prospective population-based study. Physical activity between ages 15-25 years was asked retrospectively. The findings suggest a positive association between regular physical activity early in life and level of information processing speed at older age in men, not in women. The association could not be explained by current physical activity or other lifestyle factors. This finding supports the cognitive reserve hypothesis, and might suggest that early life physical activity may delay late-life cognitive deficits.

Insulin-like growth factor I (IGF-I) deficiency may be involved in cognitive deficits seen with aging, and in neurodegenerative diseases such as Alzheimer’s disease. The objective of this study was to investigate whether IGF-I is associated with cognitive performance and 3-year cognitive decline in 1,318 subjects, aged 65 to 88 years. Cross-sectionally, IGF-I was directly related to information processing speed, memory, fluid intelligence, and Mini-Mental State Examination (MMSE) score, but these associations did not remain significant after adjustment for age and other factors. Analysis in quintiles of IGF-I revealed a threshold effect of low IGF-I on information processing speed, with lower speed in subjects in the lowest quintile of IGF-I (<9.4 nmol/L)* versus those in the other four quintiles (fully adjusted B=-0.89; 95% CI, -1.72 to -0.05). This threshold of low IGF-I was also observed for 3-year decline in information processing speed (adjusted RR=1.78; 95% CI, 1.19 to 2.68). In summary, this study suggests that IGF-I levels below 9.4 nmol/L are negatively associated with both the level and decline of information processing speed. Erratum in Neurobiology of Aging, 2004, 25, 271.

Background: depressed mood is common in late life, more prevalent among the chronically diseased than in the general population, and has various health-related consequences. So far, the association between depression and unhealthy lifestyles among chronically diseased has not been examined longitudinally in older persons. Primary objective: to determine if depressed mood is associated with unhealthy lifestyles in late middle aged and older people, with or without chronic somatic diseases. Methods: in a sample of 1,280 community-dwelling people from the Netherlands, the associations between depressive symptoms and lifestyle domains were analysed cross-sectionally and longitudinally - using logistic regression analyses and multivariate analyses of variance. Results: after controlling for confounders, depressed people (n=176 at baseline) were more likely to be smokers (odds ratio 1.71; 95% confidence interval 1.17-2.52). A persistent depression was associated with an increase in cigarette consumption (P=0.036). Having an emerging depression (n=155) was most likely to co-occur with a person\'s change from being physically active to being sedentary (relative risk-ratio 1.62; 95% confidence interval 1.05-2.52), and was associated with the largest decrease in minutes of physical activity (P=0.038). This effect was not modified or confounded by chronic somatic disease. A persistent depression tended to be associated with incident excessive alcohol use (relative risk-ratio 4.04; 95% confidence interval 0.97-16.09; P=0.056). Conclusions: depression is associated with smoking behaviour, and with an increase in cigarette consumption. An emerging depression is associated with becoming sedentary, irrespective of a person\'s disease status at baseline, and is associated with decrease in minutes of physical activity.

No abstract available.

No abstract available.

Objective: To investigate the protective effect of NSAIDs and aspirin separately on cognitive decline in elderly subjects, controlling for consistent use of these agents over a prolonged period of time. Methods: The study sample consisted of 1007 subjects, drawn from a population-based random sample of elderly individuals, 62–85 years old, who participated in a 3-year follow-up study. From this sample subjects were selected, who did use NSAIDs and completed all cognitive tests at both measurements (n=137), and subjects who did not use NSAIDs and completed all cognitive tests (n=475). Cognitive tests included the Mini-Mental State Examination (MMSE), tests for episodic memory (Auditory Verbal Learning Test) and information processing speed (coding task). Cognitive decline was computed using Edwards–Nunnally method. Multiple logistic regression analyses were performed to examine the association between NSAID (with and without aspirin) and decline in cognitive performance. Besides, the interaction of NSAIDs with age on cognitive decline was determined. Results: The relative risk estimates of decline in episodic memory (immediate recall) adjusted for age, gender, education, baseline MMSE, vascular diseases, diabetes mellitus and (rheumatoid) arthritis for aspirin users only was more than three times reduced (OR: 0.30, 95% CI: 0.09–0.82). The odds ratio for decline in memory of NSAID use without aspirin, adjusted for age, gender, education, baseline MMSE, vascular diseases, diabetes mellitus and (rheumatoid) arthritis was not significant (OR: 1.00, 95% CI: 0.39–2.93). The effect of aspirin was significant only in persons of 75 years and over (OR: 0.10, 95% CI: 0.01–0.81), not in subjects younger than 75 years (OR: 0.52, 95% CI: 0.14–1.96). NSAIDs did not have benefit on information processing speed. In 92% of aspirin users a low dose of 100 mg daily or less was used. Conclusion: Low-dose aspirin might be protective for decline in memory in individuals of 75 years and over. The benefit of a low-dose aspirin does not support an anti-inflammatory effect, but suggests an antiplatelet effect. Therefore, a possible protective effect of low-dose aspirin on cognitive decline is likely only in subjects with aspirin use over a prolonged period of time.

This study evaluates the quality of data obtained from after-death interviews with significant others of deceased older persons regarding the prevalence of chronic diseases and symptoms in the terminal phase of life. These data are compared with reports from physicians and earlier self-reports from the deceased person. There were significant increases in nonresponse and nonavailability of significant others for decedents who had been divorced or had never been married, thus introducing some selection bias. At the level of the total sample, significant others seem to give accurate information about the prevalence of chronic diseases when compared with self-reports and reports from physicians. At the level of the individual sample member, after-death interviews with significant others provide valid information for the assessment of the prevalence of malignant neoplasms, diabetes mellitus, chronic obstructive pulmonary disease and cerebrovascular disease, but not for osteo- and rheumatoid arthritis and artherosclerotic disease. At the level of the total sample, the prevalence of symptoms assessed by significant others did not differ greatly from the assessment made by physicians. However, at the level of the individual sample member, the validity of symptom assessment by significant others could not be supported by data obtained from the physicians. With regard to the type of significant others interviewed, children reported more symptoms than partners. The use of significant others in after-death interviews can be a valid method with regard to the assessment of chronic diseases and symptoms on a group level. On an individual level this can be concluded only for chronic diseases with clearly observable consequences.

Background. Interpreting self-reported disability differences between diverse older populations is complicated by differences in attitudes and environment. We have previously reported on the index of mobility-related limitation tests (MOBLI), and shown that it predicts mortality over 4 years. In this article, we examine whether the index is responsive to changes in self- reported mobility disability. Methods. Data on gait speed, time to complete 5 chair stands, and peak expiratory flow rate, with self-reported difficulty walking for 5 minutes, were available from the baseline and two 3-year follow-ups in the Longitudinal Aging Study Amsterdam. Analysis used data on changes in the index (or walking speed alone) and corresponding change over 3 years in self-reported difficulty or inability with a medium- distance walk. Results. During all follow-ups, groups reporting deterioration in functioning had relatively larger changes in gait speed and MOBLI score than did the \"no deterioration\" groups. In comparative analyses of responsiveness, the MOBLI score had a larger responsiveness index, higher odds ratios, and larger receiving operating characteristic area than gait speed alone. Conclusions. The MOBLI index of mobility-related physical limitation tests is responsive to changes in self- reported mobility disability over two 3-year periods, and performs better than gait speed alone. This property is strongly supportive of its validity for epidemiological comparison of older populations across countries or over longer periods of time.

Background and aims: The Comparison of Longitudinal European Studies on Aging (CLESA) Project, here presented for the first time, is a collaborative study involving five European and one Israeli longitudinal study on aging. The aim of this paper is to describe the methodology developed for the harmonization of data and the creation of a Common Data Base (CDB), and to investigate the distribution of some selected common variables among the six countries. The design of each study is briefly introduced and the methodology leading to the harmonization of the common variables is described. Methods: The study base includes data from five European countries (Finland, Italy, the Netherlands, Spain, Sweden) and Israel, for older people aged 65-89 living both in the community and in institutions (total, 11557 subjects). For two age classes (65-74 and 75-84), the prevalence ratios or the mean values of the following selected variables are provided: a) sociodemographic variables; b) health habits: c) health status; d) physical functioning; e) social networks and support; and f) health and social services utilization. Results: Statistically significant differences were found between most of the investigated characteristics across the CLESA countries, with very few exceptions. While some of the differences found may be due to cultural variations, others require further investigation and should be encompassed in the main framework of the Project, which is to identify predictors of hospitalization, mortality, institutionalization and functional decline. Conclusions: A common data base is available for the study of the aging process in five European and one Israeli population. These data provide a unique opportunity to identify common risk factors for mortality and functional decline and increase our understanding of country-specific exposures and vulnerability.

Background and aims: Independence in Instrumental Activities of Daily Living (IADLs) is determined not only by physical ability but also by the environmental and cultural surroundings of the individual. The present study describes the harmonization of data on IADL functioning of the Comparison of Longitudinal European Studies on Aging (CLESA) Project. The focus of this report is to examine the comparability of IADLs across countries and to study the association of IADLs with age, gender and socioeconomic status, and the scalability of the measure. Methods: The study base includes data from five European countries (Finland, Italy, the Netherlands, Spain, Sweden) and Israel, for older people aged 65-89 living both in the community and in institutions, for a total of 11557 subjects. In this report, only community-dwelling respondents were included (N=8420). The common IADL items in all six countries were: preparing meals, shopping, and doing housework. The analyses include how these items are distributed by age group and gender, and the associations between independence in these items and socioeconomic status (SES) with logistic regression modeling. The scale properties of these three items are also examined. Results: Independence in IADLs decreases steadily with age in all countries. Associations with gender and SES follow largely similar patterns across countries. The reliability of the 3-item scale is satisfactory in most countries, and Cronbach\'s cc-coefficient for the complete CLESA sample was 0.75. Conclusions: The associations between sociodemographic variables and independence in preparing meals, shopping, and doing housework are similar across countries. Results suggest that the predictors of IADLs in different countries are comparable.

Aims/hypothesis. There is accumulating evidence that depression is common in people with Type 2 diabetes. However, most prevalence-studies are uncontrolled and could also be inaccurate from selection-bias, as they are conducted in specialized treatment settings. We studied the prevalence and risk factors of co-morbid depression in a community-based sample of older adults, comparing Type 2 diabetic patients with healthy control subjects. Methods. A large (n=3107) community- based study in Dutch adults (55-85 years of age) was conducted. Pervasive depression was defined as a CES-D score greater than 15. Diagnosis of Type 2 diabetes was obtained from self-reports and data from general practitioners. Results. A number of 216 patients (7%) were identified as having Type 2 diabetes. The prevalence of pervasive depression was increased in people with Type 2 diabetes and co-morbid chronic disease (20%) but not in patients with Type 2 diabetes only (8%), compared with the healthy control subjects (9%). Regression analyses in diabetic patients yielded that being single, being female, having functional limitations, receiving instrumental support and having an external locus of control were associated with higher levels of depression. Conclusions/interpretation. The Results suggest that the prevalence of pervasive depression is increased in patients with Type 2 diabetes and co-morbid disease(s), but not in patients with Type 2 diabetes only. Functional limitations that often accompany co-morbid chronic disease could play an essential role in the development of depression in Type 2 diabetes. These findings can enable clinicians and researchers to identify high-risk groups and set up prevention and treatment programs.

No abstract available.

Context: Several randomized controlled trials have been performed to examine the effectiveness of external hip protectors in reducing the incidence of hip fractures, but the results are controversial. Objective: To examine the effectiveness of hip protectors in reducing the incidence of hip fractures in an elderly high-risk population. Design, Setting, and Participants: Randomized controlled trial of elderly persons aged 70 years or older, who have low bone density, and are at high risk for falls. Participants lived in apartment houses for the elderly, homes for the elderly, and nursing homes in Amsterdam and surrounding areas in the Netherlands. They were enrolled in the study between March 1999 and March 2001; the mean follow-up was 69.6 weeks. Of the 830 persons who were screened, 561 persons were enrolled. Intervention: External hip protector. Both groups received written information on bone health and risk factors for falls. Main Outcome Measure: Time to first hip fracture. Survival analysis was used to include all participants for the time they participated. Results: In the intervention group, 18 hip fractures occurred versus 20 in the control group. Four hip fractures in the intervention group occurred while an individual was wearing a hip protector. At least 4 hip fractures in the intervention group occurred late at night or early in the morning. Both in univariate analysis (log-rank P=.86) and in multivariate analysis (hazard ratio [HR], 1.05; 95% confidence interval [CI], 0.55-2.03), no statistically significant difference between the intervention group and control group. was found with regard to time to first hip fracture. In addition, the per protocol analysis in compliant participants did not show a statistically significant difference between the groups (HR, 0.77; 95% Cl, 0.25-2.38). Conclusion: The hip protector studied was not effective in preventing hip fractures.

No abstract available.

No abstract available.

Objectives. In older people, a diagnosis of depression is frequently missed, and proper treatment is subsequently hampered. We investigated antidepressant and benzodiazepine use in an older community sample, and assessed possible risk factors associated with non-treatment in depressed elderly. Methods. Data were used from the baseline measurements of the Longitudinal Aging Study Amsterdam (LASA). In a random, age and sex stratified community sample of 3107 older Dutch people (55 to 85 years), respondents were screened on depression with the Center for Epidemiologic Studies Depression Scale (CES-D). In the depressed subsample depressive disorder according to DSM- III was assessed using the Diagnostic Interview Schedule (DIS). The use of antidepressants and anxiolytics (benzodiazepines) in the depressed subsample was measured, and associations with age, sex, cognitive impairment, physical health and anxiety symptoms were investigated. Results. Only 16% of the respondents with a major depressive disorder used antidepressants. More than half of them used non-therapeutic dosages. Lower antidepressant use was associated with cognitive impairment. Benzodiazepine use was more likely than antidepressant. use, which was especially evident in females in the major depressive disorder group. Conclusions. Depressed older people were undertreated, particularly when they were cognitively impaired. A high rate of benzodiazepine use was found, particularly in females.

Objectives. To develop a classification tree for predicting the risk of recurrent falling in community-dwelling older persons using tree-structured survival analysis (TSSA). Methods. This prospective cohort study was performed in 1365 community-dwelling persons (>=65 years) of the Longitudinal Aging Study Amsterdam (LASA). In 1995, physical, cognitive, emotional and social aspects of functioning were assessed. Subsequently, a prospective fall follow-up was conducted for three years. The main outcome measure was recurrent falls (two falls within six months). Results. The classification tree included eleven end groups differing in risk of recurrent falling based on a minimum of two and a maximum of six predictors. The first split in the tree involved ‘two or more falls’ versus ‘less than two falls’ in the year preceding the interview. Respondents with two or more falls in the year preceding the interview (n = 193), and with at least two functional limitations (n = 98) had 75 percent risk of becoming a recurrent faller, while respondents with less than two functional limitations were further divided into a group with regular dizziness (n = 11, risk of 68 percent) and respondents with no regular dizziness (n = 84, risk of 30 percent). In respondents with less than two falls in the year preceding the interview (n = 1172), the risk of becoming a recurrent faller varied between 9 to 70 percent. Predictors in this branch of the tree were low performance, low handgrip strength, alcohol use, pain, high level of education, and high level of physical activity. Conclusions. This classification tree included eleven end groups differing in the risk of recurrent falling based on specific combinations of maximally six easily measurable predictors. The classification tree can identify subjects who are eligible for preventive measures in public health strategies.

Objectives. To examine whether easily measurable measures for balance and muscle strength predicted recurrent falling as well as sophisticated measurements. To examine which of the modifiable risk factors were most strongly associated with recurrent falling.Methods The study was performed in a subsample (n = 439, aged 69-92 years) of the Longitudinal Aging Study Amsterdam (LASA). Balance, muscle strength, physical activity and performance tests were assessed. Falls were recorded during one year. The outcome measure was recurrent falls (³2 falls within one year). Results. The area under the curve (AUC) of medio-lateral sway (AUC = 0.67; 95%CI:0.57-0.77), tandem stand (AUC = 0.61; 95%CI:0.49-0.73), leg extension strength (AUC = 0.58; 95%CI:0.51-0.64) and handgrip strength (AUC = 0.57; 95%CI:0.51-0.64) were not significantly different. In a multivariate model, medio-lateral sway (OR = 2.8; 95%CI:1.1-6.9), tandem stand (OR = 2.1; 95%CI:1.1-3.8), and walking test (OR = 2.2; 95%CI:1.1-4.1) were significantly associated with recurrent falling. Conclusions. The easily measurable tandem stand and handgrip strength predicted recurrent falling as well as the sophisticated measures. Medio-lateral sway was most strongly associated with recurrent falling.

No abstract available.

This article reports on the relation between aging and personal adjustment. Current personality scales are not developed for older persons. Scales contain items which are not valid for an aging population and contain too many items for administration in older populations. As part of the Longitudinal Aging Study Amsterdam (LASA) Neuroticism in older persons was measured with a shortened version of the Inadequacy (IN) and Social Inadequacy (SI) scales of the Dutch Personality Questionnaire (DPQ). The utility of these shortened scales was assessed based on internal consistency, inter-item correlations, test-retest reliability and factor analysis. The consistency of the personality dimension Neuroticism was assessed based on cohort-differences and a 6-year longitudinal comparison. The research-population contained 2118 respondents at baseline, aged between 55 and 85 years, 49% were male and they were not living in an institution. The shortened scales appeared to be reliable and valid instruments to measure Neuroticism in the elderly. The gaining of time due to the administration of the shortened scales enlarges the feasibility of the scales for measuring Neuroticism in older persons. Results showed no significant age-difference on the IN-scale, but revealed a significant difference on the SI-scale (p < .01). The 65+ elderly (65-74 and 75-85) have higher scores on Social Inadequacy than the youngest elderly (55-64). Longitudinal analyses showed an interaction between age at baseline and the stability and change of the level of Neuroticism. On both scales the youngest age-group showed a significant decline in mean level of Neuroticism (p < .01). The mean level of Social Inadequacy in the oldest age-group showed an increase during the 6-year follow-up period (p < .05). However, the differences were very small. Future research is needed to assess the effect of related variables on Neuroticism in older persons.

Relationships with neighbors are considered exchange relationships, in which the continuation of exchanges depends on balance in previous exchanges. Our study tested whether this is the case. An exchange relationship implies that neighbor relationships are isolated units. We expected, however, that neighborhood integration also affects the continuation of exchange among neighbors. Data were from a longitudinal study among 1,692 independently living Dutch adults of ages 55 to 85 years at baseline and their 7,415 relationships with proximate network members. At a four-year follow-up, both perceived balance and neighborhood integration at baseline increased the chance of instrumental support exchange occurring. We concluded that it is too limited to view relationships between neighbors as exchange relationships, as these relationships are embedded in larger communities, where such communities exist.

Retirement is an important life cycle marker and has a major impact on an individual\'s functioning. Based upon the social convoy model, it is hypothesized that retirement decreases the likelihood of continuation of coworker relationships. Socio-emotional selectivity theory predicts a decline in the number of peripheral relationships with aging and thereby in network size and number of coworker relationships among working and retired people. Data comes from the Longitudinal Aging Study Amsterdam with five observations between 1992 and 2002. At baseline 226 men aged 54-81 years were employed; 166 men retired in the course of the study. The results of multilevel regression analyses showed a stable network size both for working and retired men. Among all men the number of work-related network members declined, but more strongly among retirees. It is concluded that the convoy model fits better with the data than socio-emotional selectivity theory.

The paper examines associations between beliefs of mastery and two important kinds of productive activities in the third age, participation in education and volunteering. Within the broad concept of mastery beliefs, differential aspects of self-regulatory cognitions were studied, that is self-esteem, control beliefs, effort to complete behavior, persistence in the face of adversity, and willingness to initiate behavior. Effects of these aspects on carrying out activities were investigated and controlled for the impact of some situational and demographic factors. Findings suggest that a general sense of mastery, as reflected in self-esteem and control beliefs, is not a precondition for study and volunteering work in the third age. However, special components of self-efficacy turned out to play a part. Willingness to initiate behavior emerged to be a strong predictor for taking on educational activities, persistence in the face of adversity for being active as a volunteer. In the discussion possibilities were looked at of how better to match productive activities in later life to personal dispositions.

The age-related change in hormone concentrations has been hypothesized to play a role in the loss of muscle mass and muscle strength with aging, also called sarcopenia. The aim of this prospective study was to investigate whether low serum 25-hydroxyvitamin D (25-OHD) and high serum PTH concentration were associated with sarcopenia. In men and women aged 65 yr and older, participants of the Longitudinal Aging Study Amsterdam, grip strength (n = 1008) and appendicular skeletal muscle mass (n = 331, using dual-energy x-ray absorptiometry) were measured in 1995-1996 and after a 3-yr follow-up. Sarcopenia was defined as the lowest sex-specific 15th percentile of the cohort, translating into a loss of grip strength greater than 40% or a loss of muscle mass greater than 3%. After adjustment for physical activity level, season of data collection, serum creatinine concentration, chronic disease, smoking, and body mass index, persons with low (<25 nmol/liter) baseline 25-OHD levels were 2.57 (95% confidence interval 1.40-4.70, based on grip strength) and 2.14 (0.73-6.33, based on muscle mass) times more likely to experience sarcopenia, compared with those with high (>50 nmol/liter) levels. High PTH levels (greater than or equal to4.0 pmol/liter) were associated with an increased risk of sarcopenia, compared with low PTH (<3.0 pmol/liter): odds ratio = 1.71 (1.07-2.73) based on grip strength, odds ratio = 2.35 (1.05-5.28) based on muscle mass. The associations were similar in men and women. The results of this prospective, population-based study show that lower 25-OHD and higher PTH levels increase the risk of sarcopenia in older men and women

No abstract available.

Background: A validated screening instrument for PTSD in community dwelling older people is lacking. This study evaluates a newly developed measure, the self-rating inventory for posttraumatic stress disorder (SRIP) on its usefulness in survey research. The predictive value of the SRIP in a community setting is investigated. Methods: In a two-phase epidemiologic design the criterion validity of the SRIP was tested against diagnosis made with the comprehensive international diagnostic interview (CIDI) in 1721 older (55-90 years) inhabitants of the Netherlands. Optimal sensitivity and specificity was determined using a weighted receiver operator characteristic (ROC)-curve. Results: Optimal sensitivity (74.2%) and specificity (81.4%) was reached with a cut-off of 39 points. Limitations: According to a strictly applied CIDI algorithm the number of \'true\' cases was limited. Conclusion: Overall findings indicate that posttraumatic stress disorder can be identified adequately in a community-based population of older adults using the SRIP. Use of the SRIP may improve recognition and diagnosis of posttraumatic stress disorder in the community.

Background: Posttraumatic stress disorder (PTSD) has scarcely been researched in the elderly. There is no population-based information on prevalence and risk factors in older persons. Patients with PTSD are often not recognized or incorrectly diagnosed. As the disorder has great implications for the quality of life, a correct diagnosis and treatment are crucial. Increased knowledge on vulnerability factors for PTSD can facilitate diagnostic procedures and health management in the elderly. Methods: PTSD cases were found following a two-phase sampling procedure: a random selection of 1,721 subjects were screened and in 422 subjects a psychiatric diagnostic interview was administered. Prevalence of PTSD and subthreshold PTSD were calculated. Vulnerability factors regarding demographics, physical health, personality, social factors, recent distress and adverse events in early childhood were assessed. Results: 6-month prevalence of PTSD and of subthreshold PTSD was 0.9 and 13.1%, respectively. The strongest vulnerability factors for both PTSD and subthreshold PTSD were neuroticism and adverse events in early childhood. Conclusions: This is the first population-based study on PTSD in older persons. With a 6-month prevalence of almost 1% the disease is not rare. Comparisons with younger populations suggest some accumulation of cases among older people reflecting the chronic risk factors, which are found in this study: neuroticism and adverse events in early childhood.

The impact of three types of everyday activities (i.e., social, experiential, and developmental) on four cognitive functions (i.e., immediate recall, learning, fluid intelligence, and information-processing speed) and one global indicator of cognitive functioning (Mini-Mental State Exam score) over a period of 6 years was studied in a large 55-85 year-old population-based sample (N = 2,076). A cross-lagged regression model with latent variables was applied to each combination of 1 cognitive function and 1 type of activity, resulting in 15 (3 x 5) different models. None of the activities were found to enhance cognitive functioning 6 years later when controlling for age, gender, level of education, and health, as well as for unknown confounding variables. Conversely, one cognitive function (i.e., information-processing speed) appeared to affect developmental activity. It is suggested that no specific activity, but rather socioeconomic status to which activities are closely connected, contributes to maintenance of cognitive functions.

Background: Accurate assessment of the natural history of late- life depression requires frequent observation over time. In later life, depressive disorders fulfilling rigorous diagnostic criteria are relatively rare, while subthreshold disorders are common. The primary aim was to study the natural history of late-life depression, systematically comparing those who did with those who did not fulfill rigorous diagnostic criteria. Methods: Within the Longitudinal Aging Study Amsterdam, a large cohort of depressed elderly persons (n = 277) was identified and followed up for 6 years, using 14 observations. Depression was measured using self-reports (the Center for Epidemiological Studies Depression Scale) and diagnostic interviews (the Diagnostic Interview Schedule). The natural history, was assessed for symptom severity (Center for Epidemiological Studies Depression Scale score), symptom duration, clinical course type, and stability of diagnoses. Results: The average symptom severity remained above the 85th percentile of the population average for 6 years. Symptoms were short-lived in only 14%. There were remissions in 23%, an unfavorable but fluctuating course in 44%, and a severe chronic course in 32% (percentages do not total 100 because of rounding). Comparing the outcome, there was a clear gradient in which those with subthreshold disorders had the best outcome, followed by those with major depressive disorder, dysthymic disorder, and double depression. However, the prognosis of subthreshold disorders was unfavorable in most cases, while this group was at high risk of developing DSM affective disorders. Conclusions: The natural history of late-life depression in the community is poor. DSM affective disorders are relatively rare among elderly persons, but do identify those with the worst prognosis, However, subthreshold depression is serious and chronic in many cases.

Objective: To study the impact of depression on the wellbeing, disability and use of health services of older adults. Method: Prospective community-based study, using a large (n = 2200) sample of the elderly (55-85) in the Netherlands. Using a 3- year follow-up, the effect of depressive symptoms (CES-D) on disability, wellbeing and service utilization was assessed, controlling for competing need for-care (chronic physical illness, functional limitation and cognitive decline), enabling (partner status, size of the social network, social support and locus of control), and predisposing factors (age, sex and level of education). Results: Depressive symptoms have considerable impact on the wellbeing and disability of older people and clear economic consequences caused by inappropriate service utilization. Compared with other need-for-care variables the impact of depression is weaker (service utilization), similar (disability) or stronger (wellbeing). Conclusion: The steeply rising prevalence of competing health risks in later life does not influence the significance of depression.

No abstract available.

Background: The objective is to investigate whether memory complaints in older persons without manifest cognitive decline are associated with depressive symptoms, anxiety symptoms, physical health and personality characteristics. Furthermore, it is investigated whether personality characteristics have a modifying effect on the association of memory complaints with depressive and anxiety symptoms and physical health. Methods: The study was carried out using the Longitudinal Aging Study Amsterdam (LASA). Participants were examined during three observation cycles covering a period of 6 years. They were asked about memory complaints, and were examined on cognitive functioning, physical health, depressive and anxiety symptoms, and the personality characteristics: mastery, perceived self- efficacy and neuroticism. The data were analysed by means of Generalised Estimating Equations (GEE). Results: Memory complaints were associated with physical health problems, depressive and anxiety symptoms, low feelings of mastery, low perceived self-efficacy and high neuroticism. The associations between memory complaints and physical health problems, depressive and anxiety symptoms were significantly stronger in people with high mastery, high perceived self-efficacy and low neuroticism. Limitations: We used a conservative criterion for cognitive decline and therefore we might have included some people with cognitive decline during our follow-up. In order to minimise selection bias we included actual cognitive performance in our regression models. Conclusions: Our findings suggest that when older persons complain about their memory and do not show actual cognitive decline, one should be aware that these complaints might reflect psycho-affective or health problems.

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This study focuses on gender differences in health profiles, and examines which health profiles drive gender differences in remaining life expectancy in women and men aged 65 and over in the Netherlands. Data from the first two cycles of the Longitudinal Aging Study Amsterdam (n = 2141 and 1659, respectively) were used to calculate health profiles for individuals of 65-85 years. For both women and men, six profiles were found: I. cancer; II. \\\\\\\'other\\\\\\\' chronic diseases; III. cognitive impairment; IV. frailty or multimorbidity; V. cardiovascular diseases; and VI. good health. The further characterization of these types showed some gender differences. Remaining life expectancy for women was greater than for men in each health profile. A decomposition into health expectancies showed that both women and men could expect to live about 5 years in good health from age 66. The greatest gender differences in years spent with health problems were found for profile IV and for profile III. Their greater number of years spent in these health states have direct consequences for the type and cost of care women need.

This study addresses the relation between attrition and characteristics of the study protocol, specifically contact frequency, and respondent burden. The study is based on data from a longitudinal study with side studies on various topics, so that respondents have differential exposure to these study characteristics. Attrition outcomes are refusal and ineligibility through frailty. The effect of side study contact frequency and respondent burden on these outcomes is examined in two analytical samples: (1) baseline participants surviving to the first follow-up after 10 months (sample I), and (2) first follow-up participants surviving to the second follow-up after 3 years (sample II). Attrition during the first study interval was higher than during the second study interval, 15.5 and 5.4%, respectively. In sample I, the request to participate in a side study on social network implied an increased risk of refusal to participate at first follow-up if subjects refused the request (RR 8.34). However, if subjects participated in the network study, their risk of refusal was decreased (RR 0.42). In sample II, requests to participate in one to four side study cycles increased the risk of refusal to participate at second follow-up if subjects participated in fewer cycles than requested (RR 9.21). If subjects participated in all side study cycles that they were approached for, even if the number of cycles was five or more, this had an opposite effect: it decreased the risk of refusal (RR 0.18). Ineligibility was not significantly associated with contact frequency or respondent burden. Furthermore, neither contact frequency nor respondent burden related refusal was selective with respect to socio-demographic characteristics and physical and mental health indicators. It is concluded that contact frequency is nonlinearly associated with attrition. The findings further suggest that designing a series of side studies within the \"longitudinal paradigm\" does not severely damage the study\'s validity in terms of selective attrition.

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Background. The aim of this study was to investigate the association between the use of medication and depression in the elderly. Method. A cross-sectional population-based study was conducted. Associations between the use of medication and depression are corrected for eight other etiological correlates of depression. The sample consisted of 2646 elderly people living in 11 municipalities in the Netherlands. Subjects were taken from the Longitudinal Aging Study Amsterdam, a 10-year longitudinal study on predictors and consequences of changes in well-being and autonomy in the older population. Associations are expressed in odds ratios (95% Confidence Intervals) between the use of (groups of) medication and depression. Results are adjusted for age, sex, urbanity, socioeconomic status, physical health, social and interpersonal support, comorbidity with other psychiatric disease and personality. The Population Attributable Risk percentage was calculated for selected groups of medication. Results. After correction for competing risk factors of depression, 22 individual medications and nine groups of medications had unique associations with depression. Conclusions. The use of depressogenic medication is an independent etiological factor in the pathogenesis of depression.

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Background. The association between depression and mortality has become a topic of interest. Little is known about the association between the course of depression and mortality. Methods. In an initially non-depressed cohort (N = 325) and a depressed cohort (N = 327), depression was measured using the Center for Epidemiologic Studies Depression scale (CES-D) at eight successive waves over a period of 3 years. Both cohorts were then followed with respect to mortality status for up to 3-5 additional years. Clinical course types as well as theoretical course type parameters (basic symptom levels, increases in symptoms and instability over time) were distinguished to study the effect of the course of depression on mortality. Results. Contrary to transient states of depression, both chronic depression and chronic intermittent depression predicted mortality at follow-up. Additionally, evidence was found that the effect on mortality is related to severity of depression; high basic symptom levels and increases in symptoms over time were predictive of mortality. A high degree of instability over time was not associated with mortality. Conclusions. Since the mortality effect of depression is a function of both exposure time and symptom severity, more attention should be paid to the treatment of depression in order to prevent severe longstanding depression.

Objective. Better understanding of the relationship between pain and depression in older adults in the community is of particular importance considering the high prevalence of both conditions in these adults. In the present study, the longitudinal relationship between pain and depression in older adults was examined, thereby taking into account the role of physical disability and the possibly modifying effect of sex and age. Methods. The study is based on a sample which at the outset consisted of 325 non-depressed and 327 depressed persons (55-85) drawn from a larger random community-based sample in the Netherlands. Depression (CES-D) and pain (subscale of the Nottingham Health Profile) were measured at eight successive waves over 3 years. Results. Pain was very persistent over time as was to a lesser extent depression. The prognosis of comorbid pain and depression was poor. In longitudinal analyses (Generalized Estimating Equations), pain and depression were strongly associated. At the symptom level, the pain-depression relationship was found to be stronger in men than in women. There was no effect of age on the pain-depression relationship. No support was found for the hypothesis that the pain- depression relationship is mediated by disability. Conclusion. The persistent nature of pain and to a lesser extent depression and the intimate and probably reciprocal association between them stress the need for adequate treatment strategies.

No abstract available.

A significant percentage of men and women aged fifty and over attain new partner relationships after divorce or widowhood. Partner relationships investigated in this article include remarriage, unmarried cohabitation, and Living Apart Together (LAT). Drawing on the Dutch NESTOR-LSN survey data (n = 4494) as well as in-depth reinterviewing of repartnered older adults (n = 46), this article examines elderly people\'s main considerations in the decision making process leading to remarriage, a consensual union, or a LAT relationship.

A considerable percentage of men and women aged fifty or over become involved in new partner relationships after divorce or widowhood. Partner relationships investigated in this article include remarriage, consensual unions and Living-Apart-Together (LAT). Drawing on NESTOR-LSN survey data (n = 4494) as well as in-depth interviewing of repartnered older adults (n = 46) this article explicates the motivational, socioeconomic and demographic determinants of starting a new partner relationship. Results from multinomial logistic regression analysis and the motives provided in the in-depth interviews reveal that a traditional versus a more individualistic value orientation, socioeconomic status, and financial motives in particular, contribute to the understanding of older adults\' decisions to either remarry, start a consensual union or a LAT-relationship.

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Objectives: This study examines the association of hearing impairment and chronic diseases (diabetes mellitus, lung disease, cardiac disease, stroke, cancer, peripheral artery disease, osteoarthritis, rheumatoid arthritis) with psychosocial status (depression, self-efficacy, mastery, loneliness, social network size) in older persons. Methods: The sample consists of 3,107 persons (55 to 85 years) participating in the Longitudinal Aging Study Amsterdam. MANOVA, adjusted for covariates, was used to test the effect of hearing impairment on the combined outcomes. The association of hearing impairment and chronic diseases with psychosocial status was studied using multivariate regression analyses. Results: Hearing impaired elderly report significantly more depressive symptoms, lower self-efficacy and mastery, more feelings of loneliness, and a smaller social network than normally hearing peers. Whereas chronic diseases show significant associations with some outcomes, hearing impairment is significantly associated with all psychosocial variables. Discussion: The findings emphasize the negative effect of hearing impairment on quality of life.

The aim of this study was to examine whether the presence of apolipoprotein E epsilon4 (ApoE epsilon4) is associated with a lower bone mineral density (BMD), lower quantitative ultrasound (QUS) measurements, higher bone turnover and fracture risk, and whether these relations are modified by gender and age. A total of 1406 elderly men and women (greater than or equal to 65 years) of the Longitudinal Aging Study Amsterdam (LASA) participated in this study. In all participants, QUS measurements were assessed, as well as serum osteocalcin (OC) and urine deoxypyridinolin (DPD/Cr urine). Follow-up of fractures was done each three months. In a subsample (n = 604), total body bone mineral content (BMC) and BMD of the hip and lumbar spine were measured. In addition, prevalent vertebral deformities were identified on radiographs. In women, the presence of ApoE epsilon4 was associated with significantly lower femoral neck BMD (g/cm(2); mean +/- SEM; epsilon4+, 0.64 +/- 0.01 vs. epsilon4-, 0.67 +/- 0.01; p = 0.04), lower trochanter BMD (g/cm(2); mean +/- SEM; epsilon4+, 0.58 +/- 0.01 vs. epsilon4-, 0.61 +/- 0.01; p = 0.01) and lower total body BMC (g; mean +/- SEM; epsilon4+, 1787 +/- 40.0 vs. epsilon4-, 1863 +/- 23.8; p = 0.04). Women with ApoE epsilon4 also had a higher risk of severe vertebral deformities (OR=2.78; 95%CI: 1.21-6.34). In men, the associations between ApoE status and both hip BMD and QUS depended on age. Only among the younger men (65-69 years) was the presence of ApoE epsilon4 associated with lower BMD values. Bone markers and fractures were not associated with ApoE epsilon4 in either women, or men. In conclusion, this large community-based study confirms the importance of ApoE epsilon4 as a possible genetic risk factor related to BMD and vertebral deformities and demonstrates that its effect is gender related, and depends on age in men only.

It is not clear which specific cognitive function is strongest related to falls. To investigate this, not only \"general cognitive functioning,\" but also \"nonverbal and abstract reasoning,\" \"information processing speed,\" and \"immediate memory\" were related to falls. Furthermore, relevant effect modifiers, confounders, and mediators were identified. This study was performed within the Longitudinal Aging Study Amsterdam (LASA), a multidisciplinary, prospective cohort study. In this study (n = 1437), an interaction between \"immediate memory\" and age was found. In persons aged 75 years and over, \"immediate memory,\" as measured by the 15 Words Test, showed to be an independent risk factor for falls. Part of this relationship was explained by the mediating effects of activity, mobility, and grip strength. The association between the other cognitive functions and falls was only statistically significant in univariate analysis. We conclude that \"immediate memory\" is an independent risk factor for recurrent falls in persons aged 75 years and older.

A negative effect of good health on the instrumental support received can be viewed as an effect of the mobilization. of helpers. A positive effect of good health on the personal network size and the instrumental support given demonstrates that people in poor health have difficulty actively maintaining their relationships. Furthermore, the support received and given is positively related to the support given and received in the past. In four waves of a seven-year longitudinal study, personal interviews were conducted with 2,302 older Dutch adults (aged 60 to 85) who live on their own. The hypotheses have been confirmed. An implication is that investing in relationships by giving support might pay off in times of need.

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Objectives: This study examined the association of (change in) physical activity and decline in mobility performance in older men and women. Design: A 3-year prospective study using data of the Longitudinal Aging Study. Setting: Netherlands. Participants: Two thousand one hundred nine men and women aged 55 to 85. Measurements: Total physical activity (expressed as hours per day and kilocalories per day) and sports participation were measured using a validated, intervieweradministered questionnaire. Mobility performance was assessed using two timed tests: 6-meter walk and repeated chair stands. Results: Mobility performance declined for 45.6% of the sample. At baseline, the mean time ± standard deviation spent on total physical activity was 3.0 ± 2.1 h/d or 719 ± 543 kcal/d, and 56.6% of the sample participated in sports. Sports participation and a higher level of total physical activity, walking, or household activity were associated with a smaller mobility decline. After 3 years, total physical activity declined, and only 53.4% of those reporting sports at baseline continued doing so. Continuation of physical activity over time was associated with the smallest decline in mobility. The observed associations were similar for those with and without chronic disease (P>0.3). The conclusions did not change after adjustment for potential confounders, including demographic and lifestyle variables, depression, and cognitive status. Conclusions: Physical activity, and especially a regularly active lifestyle, may slow the decline in mobility performance. A beneficial effect was observed for sports and nonsports activities, independent of the presence of chronic disease.

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Background: The present study was designed to assess onset and persistence of late-life depression, systematically comparing the factors associated with prevalence, onset and prognosis. Methods: The data were derived from a large (n = 2200), random, age and sex stratified sample of the elderly (55-85 years) in The Netherlands. Using a 3-year, prospective longitudinal design, both the onset and the persistence of depression were assessed. Depression was measured using the Center for Epidemiologic Studies Depression Scale. Risk factors associated with prevalence, onset and persistence were compared using both bivariate and multivariate analyses. Results: In those not depressed at index assessment, the onset of depression was 9.7%. Among those depressed at baseline, persistence occurred in 50.4%. Risk factors predicting onset were almost identical to those associated with prevalence, Persistence was predicted by very few factors (external locus of control and chronic physical illness). Conclusions: The data suggest that cross- sectional studies are biased due to their overrepresenting chronic depressive episodes. However, the risk factors derived from cross-sectional studies do seem to adequately reflect factors associated with onset. The prognosis is not adequately predicted by variables usually included in epidemiological studies of late life depression. It is speculated that including more biological correlates of depression and data concerning positive life-changes may improve our understanding of the prognosis of late life depression.

No abstract available.

Background. Little research has been done on the uniqueness of risk profiles for depression and anxiety in late life. Aims. Delineating risk factors for the decline of mental health in older persons, comparing risk profiles for developing symptoms of pure depression, pure anxiety and both anxiety and depression in a prospective design. Method. Self-report data on depression and anxiety were collected from community-dwelling older respondents (greater than or equal to 55 years) on two occasions, 3 years apart. Data from emotionally healthy respondents (n = 1810) were used to investigate the effects of long-standing vulnerability factors and stressful life events. Results. After 3 years 9% of the subjects had scored beyond the thresholds for symptoms. Vulnerability for depression and anxiety was quite similar, but life events differed: onset of depression was predicted by death of a partner or other relatives; onset of anxiety was best predicted by having a partner who developed a major illness. No support for moderator effects between vulnerability factors and stress was found; the effects were purely additive. Conclusions. Depression and anxiety have many risk factors in common, but specific risk factors also were found, especially in subjects developing both depression and anxiety.

Background. The protective effects of religion against late life depression may depend on the broader sociocultural environment. This paper examines whether the prevailing religious climate is related to cross-cultural differences of depression in elderly Europeans. Methods. Two approaches were employed, using data from the EURODEP collaboration. First, associations were studied between church-attendance, religious denomination and depression at the syndrome level for six EURODEP study centres (five countries, N = 8398). Secondly, ecological associations were computed by multi-level analysis between national estimates of religious climate, derived from the European Value Survey and depressive symptoms, for the pooled dataset of 13 EURODEP study centres (11 countries, N = 17739). Results. In the first study, depression rates were lower among regular church-attenders, most prominently among Roman Catholics. In the second study, fewer depressive symptoms were found among the female elderly in countries, generally Roman Catholic, with high rates of regular church-attendance. Higher levels of depressive symptoms were found among the male elderly in Protestant countries. Conclusions. Religious practice is associated with less depression in elderly Europeans, both on the individual and the national level. Religious practice, especially when it is embedded within a traditional value-orientation, may facilitate coping with adversity in later life.

Een verhaal uit de praktijk van een geheugenpoli. Een mevrouw klaagt over haar geheugen, is somber en bang voor dementie. Ze wordt jarenlang regelmatig onderzocht. Een chronologisch verslag van de bevindingen.

Objective To investigate whether depressive symptoms predict specific types of cognitive decline in order to elucidate the association between late life depression and cognitive decline. Background Mechanisms underlying the association between late life depression and cognitive decline are still unclear. Method Six hundred and forty-one elderly persons of the Longitudinal Aging Study Amsterdam (LASA) aged 70-85 were examined by means of two measurement occasions over a period of 3 years. Depressive symptoms were assessed by means of the CES-D. Various cognitive functions were examined using neuropsychological tests. Results Depressive symptoms were associated with decline in speed of information processing over a 3-year period, whereas there was no association between depression and increasing memory impairment or global mental deterioration. Conclusion These findings suggest that depressive symptoms are associated with subcortical pathology, most probable white matter lesions.

Objective. To investigate to what extent subjective memory complaints and APOE-epsilon4 predict future cognitive decline in cognitively intact elderly, evaluating both their separate and combined effects. Methods. We selected 1,168 subjects from the population-based Longitudinal Aging Study Amsterdam (LASA), aged 62-85 years, with no obvious cognitive impairment at baseline (Mini-Mental State Examination (MMSE) >= 27). Memory complaints and APOE phenotypes were assessed at baseline. We studied cognitive decline using the MMSE, the Auditory Verbal Learning Test (memory: immediate and delayed recall) and the Coding Task (information processing speed). Follow-up data were collected after three and six years. Data were analyzed with Generalized Estimating Equations (GEE), adjusted for age, sex, education and depression. Results. Baseline memory complaints were reported by 25.5% of the cognitively intact elderly. Overall, 25.3% were carrier of at least one APOE-epsilon4 allele. Memory complaints were associated with a greater rate of decline on all cognitive measures, except on immediate recall. Also, APOE-epsilon4 carriers showed a greater rate of decline on MMSE and information processing speed after six years. The effects of both memory complaints and APOE-epsilon4 were additive, with an almost two times higher decline compared to subjects without both factors. Conclusions. Both memory complaints and APOE-epsilon4 predict cognitive decline at an early stage. This highlights the importance of subjective memory complaints, also at an early stage when objective tests are still unable to detect cognitive deficits, and especially in elderly with APOE-epsilon4 since they carry an additional risk.

Background. The temporal relationship between depression and adverse functional outcomes in older adults is ambiguous. In the present eight-wave prospective community-based study, the longitudinal effect of depression on functional limitations and disability (in terms of disability days and bed days) was studied, thereby taking into account the role of chronic physical diseases. Methods. The study is based on a sample which at the outset consisted of 325 non-depressed and 327 depressed persons (55-85 years) drawn from a larger random community based sample in the Netherlands. Generalized estimating equations time-lag models were used to examine the longitudinal relation between depression and both functional limitations and disability. Results. Functional limitations were very persistent over time, whereas disability days and bed days were more fluctuating functional outcomes. Only in the presence of chronic physical diseases, there was a significant longitudinal association between depression at the previous measurement and functional limitations, disability days and bed days at the next measurement. The effect on functional limitations was small, which was probably partly due to their persistent nature. Conclusions. The finding of a longitudinal relationship between depression and functional outcomes in older adults with a compromised health status provides a rationale for treatment of chronic physical diseases as well as depression in depressed chronically ill elderly, in order to prevent a spiralling decline in psychological and physical health.

Abstract: We studied the effect of low levels of vitamin B-12 and folic acid, alone or combined, on cognitive performance in a population-based sample of 698 older adults (mean age = 68.7 years). No evidence was found for a vitamin-related memory deficit, but research participants with low levels of vitamin B12 exhibited reduced information processing speed relative to participants with normal vitamin B12 levels.

No abstract available.

Background: Depression may be a potential risk factor for subsequent cardiac death. The impact of depression on cardiac mortality has been suggested to depend on cardiac disease status, and to be stronger among cardiac patients. This study examined and compared the effect of depression on cardiac mortality in community-dwelling persons with and without cardiac disease. Methods: A cohort of 2847 men and women aged 55 to 85 years was evaluated for 4 years. Major depression was defined according to psychiatric DSM-III criteria. Minor depression was defined by Center for Epidemiologic Studies- Depression Scale scores of 16 or higher. Effects of minor and major depression on cardiac mortality were examined separately in 450 subjects with a diagnosis of cardiac disease and in 2397 subjects without cardiac disease after adjusting for demographics, smoking, alcohol use, blood pressure, body mass index, and comorbidity. Results: Compared with nondepressed cardiac patients, the relative risk of subsequent cardiac mortality was 1.6 (95% confidence interval ICI], 1.0-2.7) for cardiac patients with minor depression and 3.0 (95% CI, 1.1- 7.8) for cardiac patients with major depression, after adjustment for confounding variables. Among subjects without cardiac disease at baseline, similar increased cardiac mortality risks were found for minor depression (1.5 [95% CI, 0.9-2.61) and major depression (3.9 [95% CI, 1.4-10.9]). Conclusion: Depression increases the risk for cardiac mortality in subjects with and without cardiac disease at baseline. The excess cardiac mortality risk was more than twice as high for major depression as for minor depression

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This study aimed to assess the relative importance of several determinants of bone mineral density (BMD) and to examine to what extent these potential determinants influence total hip BMD through body composition. The study population consisted of 522 participants (264 women and 258 men) of the Longitudinal Aging Study Amsterdam (LASA), aged 65 years and over, and living in Amsterdam and its vicinity. BMD of the total hip was measured using dual-energy X-ray absorptiometry (DXA). Potential determinants of BMD were age, weight change since age 25 years, lifestyle factors, chronic diseases, medication use, and hormonal factors. Potential mediators between the possible determinants and BMD were two measures of body composition: fat mass (FM) and appendicular muscle mass (AMM). Multiple regression analyses including all potential determinants in one model without body composition identified age, weight change, walking activity, and sex hormone-binding globulin (SHBG) as independent determinants for total hip BMD in women. In men, current smoking, participation in sports, and parathyroid hormone (PTH) concentration were independently associated with total hip BMD. When total hip BMD was regressed on the potential determinants and each measure of body composition, it appeared that FM, and to a lesser extent, muscle mass (MM), were independently related to BMD. In women, adjustment for FM reduced the strength of the associations of weight change, walking activity, and SHBG with total hip BMD. Adjustments for MM did not influence the associations between the determinants and BMD. In men, neither FM nor MM appeared to play a mediating role between the determinants and BMD. It can be concluded that (1) FM and MM are strong independent determinants of total hip BMD and that (2) FM possibly plays a mediating role in the association of weight change, walking activity, and SHBG with total hip BMD in women.

No abstract available.

With the trend toward aging, increases in health care expenditures are expected. Insight into (future) needs for care services requires a taxonomy of older persons\' health conditions: how health status develops as people age and how these health conditions determine residual life expectancy. In this paper we provide this information for the Netherlands. We apply a flexible nonparametric method-the Grade of Membership method-to a national database and summarize the multidimensional concept of health status into a limited set of interpretable indices. We then use these indices in our panel data model for health status and mortality. The model results are used to calculate age-health profiles and expected residual life-times in specific health states.

This large prospective cohort study was undertaken to construct a fall-risk model for elderly. The emphasis of the study rests on easily measurable predictors for any falls and recurrent falls. The occurrence of falls among 1285 community-dwelling elderly aged 65 years and over was followed during 1 year by means of a \"fall calendar.\" Physical, cognitive, emotional and social functioning preceding the registration of falls were studied as potential predictors of fall-risk. Previous falls, visual impairment, urinary incontinence and use of benzodiazepines were the strongest predictors identified in the risk profile model for any falls (area under the curve [AUC] = 0.65), whereas previous falls, visual impairment, urinary incontinence and functional limitations: proved to be the strongest predictors in the model for recurrent falls (AUC = 0.71). The probability of recurrent falls for subsequent scores of the screening lest ranged from 4.7% (95% Confidence Interval [CI]: 4.0-5.4%) to 46.8% (95% CI: 43.0-50.6%). Our study provides: a fall-risk screening test based on four easily measurable predictors that can be used for fall-risk stratification in community-dwelling elderly.

The procedure of standardized repeated measurement, as used in panel studies, may hamper the quality of the data, due to the potential ‘reactivity’ of survey interviewing on respondents’ attitudes and behavior. In case respondents are interviewed in subsequent waves by different interviewers, differential interviewer effects may occur. These threats to data quality are illustrated with data from a longitudinal study among 2,819 older adults, conducted in The Netherlands. From an analysis of 100 interview protocols it appears that the behavior of the interviewers has a significant impact on the data obtained. Interviewers seem to adjust their interviewing strategy, on the one hand to a norm regarding a \'normal\' personal network, and on the other hand to a norm about the appropriate interviewing time. Suggestions are formulated to prevent misestimating of actual change within respondents over time leading to incorrect conclusions about causal relationships.

De suggestie van de \"gereformeerde depressie\" staat in deze empirische studie ter discussie. Daarbij luidt de onderzoeksvraag of onder (groepen van) gereformeerde ouderen meer depressie voorkomt, en zo ja, of het dan depressieve klachten betreft die te rijmen zijn met de gereformeerde leer. Deze vraag wordt onderzocht aan de hand van interviewgegevens verkregen bij 3020 deelnemers van de Longitudinal Aging Study Amsterdam. De mate van depressieve symptomen en depressie (ook na drie jaar), gemeten met de CES-D, is gerelateerd aan kerkelijke gezindte en aan politiek-religieus klimaat per woongemeente. Uit de resultaten blijkt dat de depressiepercentage het laagst zijn onder synodaal gereformeerde ouderen. Onder ouderen van een bevindelijk gereformeerde signatuur, die in de huidige steekproef met name in Genemuiden voorkomen, wordt echter veel depressie gevonden, in gelijke mate als in Amsterdam. De symptomatologie verschilt echter niet voor de Genemuidenaren. De suggestie van de \"gereformeerde depressie\" kan derhalve beter worden verruild voor \"depressies onder gereformeerden\".

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Objective: The aim of the study was to investigate patterns of comorbidity among the anxiety disorders in a community-based older population: and the relationship of these disorders with major depression, use of alcohol and benzodiazepines, cognitive impairment and chronic somatic illnesses. Method: The data were derived from the Longitudinal Aging Study Amsterdam (LASA) study. A two-stage screening design was adopted to identify respondents with anxiety disorders. Results: In total, 10%, of the elderly with an anxiety diagnosis suffered from two or more anxiety disorders. Major depression (13% vs. 3%), benzodiazepine use (24% vs. 11%) and chronic somatic diseases (12% vs. 7%) were significantly more prevalent in respondents with an anxiety disorder than in respondents without anxiety disorders. Heavy or excessive alcohol intake (5% vs. 4%) and cognitive impairment (11% vs. 13%) were not significantly associated with any anxiety disorder. Conclusion: When anxiety disorders are diagnosed, in older people there is a relatively high probability of comorbid conditions being present.

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Objective: The purpose of this study was to examine the comorbidity of and communality of risk factors associated with major depressive disorder and anxiety disorders in later life. Method: A random age- and sex-stratified community-based sample (N=3,056) of the elderly (age 55-85 years) in the Netherlands was studied. A two-stage screening design was used, with the Center for Epidemiologic Studies Depression Scale as a screening instrument and the National Institute of Mental Health Diagnostic Interview Schedule as a criterion instrument. Risk factors were measured with well-validated instruments and represented a broad range of vulnerability and stress-related factors associated with anxiety and depression. Multivariate analyses examined risk factors associated with pure major depressive disorder, pure anxiety disorders, and comorbid conditions. Results: Comorbidity was highly prevalent: 47.5% of those with major depressive disorder also met criteria for anxiety disorders, whereas 26.1% of those with anxiety disorders also met criteria for major depressive disorder. While the only variables associated with pure major depressive disorder were younger age and external locus of control, risk factors representing a wide range of both vulnerability and stress were associated with pure anxiety disorders. External locus of control was the only common factor. The group with anxiety disorders plus major depressive disorder had a distinct risk factor profile and may represent those with a more severe disorder. Conclusions: Although high levels of comorbidity between major depressive disorder and anxiety disorders were found, comparing risk factors associated with pure major depressive disorder and pure anxiety disorders revealed more differences than similarities. Anxiety disorders in later life merit separate study.

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Background. Data on the course of anxiety in late life are scarce. The present study sets out to investigate the course of anxiety, as measured by the HADS-A (Zigmond & Snaith, 1983) in community dwelling older persons, and to evaluate predictive factors for change over 3 years in anxiety symptoms following the vulnerability/stress model. Method. Based on the first anxiety assessment, two cohorts were formed: subjects with and subjects without anxiety symptoms. In the non-anxious cohort (N = 1602) we studied risk factors for the development of anxiety symptoms; in the anxious cohort (N = 563) the same factors were evaluated on their predictive value for restitution of symptoms. Risk factors included vulnerability factors (demographics, health status, personality characteristics and social resources) and stressors (life events occurring in between both anxiety assessments). Logistic regression models estimated the effects of vulnerability factors, stress and their interaction on the likelihood of becoming anxious and chronicity of anxiety symptoms. Results. It was indicated that the best predictors for becoming anxious were being female, high neuroticism, hearing/eyesight problems and Life-events. Female sex and neuroticism also increased the likelihood of chronicity of anxiety symptoms in older adults, but life events were not related to chronicity. The main stressful event in late life associated with anxiety was death of one\\\'s partner. Vulnerability factors and stress added on to each other rather than their interaction being associated with development or chronicity of anxiety. Conclusion. The vulnerability/stress model offers a useful framework for organizing risk factors for development and chronicity of anxiety symptoms in older persons, but no support was attained for the hypothesis that vulnerability and stress amplify each others effects. Finally, the results indicate to whom preventive efforts should be directed: persons high in neuroticism, women, and those who experience distressing life events.

The prognostic value of physical health for changes in anxiety symptoms in older people was investigated in a prospective longitudinal study design with data from the Longitudinal Aging Study Amsterdam (LASA). Anxiety symptoms were measured twice over a three year interval with the anxiety subscale of the Hospital Anxiety and Depression Scale (HADS-A). Utilizing a cut-off value of 4 on the HADS-A, subjects were considered as anxious or as non-anxious. Based on the first assessment two groups were formed: subjects with and subjects without anxiety symptoms. In the non-anxious cohort the effect of physical health on the development of anxiety symptoms was studied; in the anxious cohort the same factors were evaluated on their predictive value for chronicity of anxiety. Indices of physical health included the presence of chronic diseases, functional limitations, and self-perceived health at the first assessment and changes on these variables over time. Results revealed that poor self-perceived health, and suffering from more than one chronic disease were factors predictive of becoming anxious and chronicity of anxiety; a decrease in self-perceived health and an increase in functional limitations were also associated with developing and keeping anxiety symptom. The subjective rating of health was more strongly related to change in anxiety than the number of chronic diseases. Specific chronic diseases were not strongly related to anxiety levels. Thus, somatic diseases not only lead to depression, a finding reported in numerous studies, but also increase the likelihood of anxiety symptoms at a later point in time.

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In 1981, the OECD published a questionnaire to measure the prevalence of long-term disabilities in the open population. We measured the test-retest reliability of this questionnaire in an older population (55-85 years of age). 356 older persons received the questionnaire three times by mail, of which the second time 6 weeks, and the third time 18 weeks after the first time. 216 persons (61%) returned first and the second questionnaire; 231 (65%) the first and the third questionnaire. The test-retest reliability (as indicated by the values of the weighted and unweigted kappa) did not differ markedly between the second and third replication of the questionnaire. The item \"able to have a conversation with one other person\" was poorly reproducible (unweighted kappa 0.09; weighted kappa 0.22). The unweighted kappa of other items varied from 0.33 to 0.72; the weighted kappa\'s varied from 0.38 to 0.90. The correlation between the sum of all items of both measurement times was very high (0.92 and 0.94). In those respondents who had not contacted a physician in the month before the second measurement, kappa\'s were not appreciably higher. In most cases, however, kappa’s were higher than observed in an earlier studie of the Netherlands Central Bureau of Statistics. The reproducibility of most individual items of the questionnaire is satisfactory; reproducibility of the sumscore of all items is very high.

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Objectives. The type of symptoms in depression is likely to be influenced by cultural environment. As religion represents an important cultural resource for older adults, it is hypothesised that religious denomination represents a symptom-formation factor of depression in the older generation. Focusing on older Dutch citizens, it is expected that depressed Calvinists report: (1) less depressed affect, (2) more vegetative symptoms, and (3) more guilt feelings, than Roman Catholics and non-church members. Methods and procedures. The Center for Epidemiologic Studies Depression Scale (CES-D) was used to distinguish depressed (N = 395) and non-depressed (N = 2333) older adults. and to assess depressive symptom-profiles. The Diagnostic Interview Schedule (DIS) was used to assess major depressive episodes and criterion-symptoms of depression. Results. Depressed Calvinists, especially males, had higher scores on the vegetative CES-D subscale. The same was found for non-church members with Calvinist parents. Among those who have had a major depressive episode in later life (N = 84), support was found for all hypotheses. Feelings of guilt were also more prevalent among Roman Catholics. Conclusions. Religious denomination modified the type of symptoms in late-lift depression. As a Calvinist background was associated with less depressive affect and more inhibition, there is a risk of underdiagnosis of major depression in older Calvinists in the Netherlands.

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In dit artikel is nagegaan in hoeverre sociaal-economische verschillen in (veranderingen in) gezondheid bij ouderen bestaan en zo ja, of deze sekse- en leeftijdsgebonden zijn. Drie dimensies van gezondheid (functionele beperkingen, ervaren gezondheid en sterfte) zijn gerelateerd aan drie dimensies van sociaal-economische status (opleidingsniveau, inkomen en beroepsniveau). Cross-sectionele en longitudinale gegevens zijn afkomstig van 3107 ouderen (55-85 jaar) die deelnamen aan waarnemingen van LASA in 1992/93 en 1995/96. Resultaten wijzen uit dat SES-verschillen in functionele beperkingen en ervaren gezondheid tot op hoge leeftijd bestaan, maar bij mannen het grootst zijn onder de 65 jaar en bij vrouwen tussen de 65 en 75 jaar. In alle leeftijdsgroepen geldt dat hoe lager de SES, hoe groter de kans op beperkingen en een als slecht ervaren gezondheid. Longitudinaal bezien houdt SES, na controle voor leeftijd en gezondheid in 1992/93, bij de manen maar niet bij de vrouwen, een effect op de toename in beperkingen, op afname in ervaren gezondheid en op sterfte. Bij de mannen is de differentiatie in sterfte het grootst onder de 65 jaar. Bij de vrouwen bestaan alleen in de oudste groep een differentiatie in de toename van functionele beperkingen. Geconcludeerd wordt dat SES-differentiatie in gezondheid en sterfte tot op hoge leeftijd bestaat, maar verschilt naar sekse en gehanteerde gezondheidsmaat.

This article describes to what degree socio-economic differences exist among community living older men and women, and to what degree these differences are to be explained by health, behavior, childhood and psychosocial conditions. The data are available from 1427 men and 1503 women (aged 55-85), participating in the Longitudinal Aging Study Amsterdam (LASA) in 1992/1993. As an indicator of socio-economic status (SES) we used the highest level of education and net monthly income. Age-adjusted mortality risks for men and women with low income and for men with a low level of education are about 1.5 times as high compared to the persons with high income and educational level. Among men, but not among women, the difference in mortality risk remains between low and high status persons after adjustment for age, health status, and several risk factors. Differences in lifestyle, parental SES and psychosocial characteristics explain little to nothing of the age-adjusted SES-differentiation in mortality. It is concluded that SES-inequalities in mortality are present among Dutch men and, to a lesser extent among women, until high age, and are partly explained by the relatively large health problems of the lower status group.

In dit artikel sluiten wij aan bij de maatschappelijke discussie over de rol van familieleden en professionals in de zorg voor ouderen. Onze inbreng heeft tot doel meer inzicht te leveren in het perspectief van de huidige ouderen: wat zijn hun verwachtingen en wat de feiten betreffende het gebruik van informele en formele zorg? Aan de hand van gegevens van de Longitudinal Aging Study Amsterdam (LASA) bespreken wij de informele en formele hulpbronnen van ouderen, de zorgverwachtingen van ouderen en de zorg van kinderen voor hun ouders.

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Since the middle of the 19th century, there have been considerable gains in life expectancy at all ages, especially during the first two decades of the 20th century. Throughout this period, women have had greater survival chances than males. Nevertheless, there are some notable sex differences in survival gains. Male infant survival increased faster than female infant survival, indicating narrowing sex differentials. The opposite is observed for survival to older ages. For instance, female survival to ages 50 and 65 increased faster than male survival to these ages, indicating a widening sex differential. The question is raised, how these differences in cohort survival history affect health and mortality at ages above 65 years. The role of cohort survival history was examined as an explanatory factor of sex differences in three-year survival in older persons in two surveys on health and aging, the Dutch Longitudinal Study among the Elderly (DLSE, baseline 1955-1957) and the Longitudinal Aging Study Amsterdam (LASA, baseline 1992-93). Both surveys are based on representative samples across the Netherlands, stratified by age and sex, with over 2000 persons in the common age group of 65-84 years. Cohort survival history was expressed as the percent surviving up to ages 1, 15, 40, 50, and 65 based on cohort survival tables of the birth cohorts included in the study. Both in 1955-57 and in 1992-93, when controlling for number of chronic diseases, functional limitations, and self-rated health, multiple logistic regression models showed that survival was significantly associated with sex, indicating that females had better survival than males. Inclusion of cohort survival history in the model raised these Risk Ratios to values closer to 1. Inclusion of survival to age 1 in DLSE resulted in a reversal of the sex differential. In LASA, inclusion of survival to age 1 increased the Risk Ratio significantly, but did not bring about a reversal of the risk. Inclusion of survival to age 50 in both surveys resulted in sex being no longer significantly associated with survival. The consistent findings in both surveys suggest that the more favorable cohort survival history of females explains part of the female over male advantage in survival in later life, given the same level of health. This is true even for infant mortality experience of the cohort. The better survival of females at all ages appears to perpetuate itself in older age.

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Background and Purpose. Stroke and apolipoprotein E epsilon4 (ApoE epsilon4) are individually important risk factors for cognitive decline, including Alzheimer disease. It has been suggested that ApoE epsilon4 multiplies the risk for cognitive decline following stroke. In a population-based sample, using well-defined sensitive cognitive measures, this study investigates whether cognitive decline following stroke is worse for patients who carry the ApoE epsilon4 allele. Methods. Subjects were participants in the Longitudinal Aging Study Amsterdam (LASA). The sample consisted of 1224 subjects, aged 62 to 85 years, who participated in the 3-year follow-up examination and for whom ApoE and stroke data were complete. We assessed cognitive decline using the Mini-Mental State Examination, the Auditory Verbal Learning Test (memory: immediate and delayed recall), and the Coding Task (information processing speed). The effects of stroke and ApoE epsilon4 on cognitive decline were evaluated with ANOVA and multiple logistic regression analysis, adjusted for age, sex, education, and baseline cognition. Results. A synergistic effect modification for stroke and ApoE epsilon4 on cognitive decline was not observed. Unexpectedly, instead, stroke patients carrying the epsilon4 allele demonstrated a nonsignificantly lowered risk for Mini-Mental State Examination decline (OR=0.3; 95% CI 0.1 to 1.1). ApoE epsilon4 was associated with declines in information processing speed (OR=1.5; 95% CI 1.1 to 2.1) and small declines for immediate and delayed recall. Conclusions. Stroke and ApoE epsilon4 may impair cognition through distinct nonsynergistic mechanisms. The slowing of information processing speed for ApoE epsilon4 carriers was more evident than impairment in memory.

Objective: To investigate whether the association between APOE-epsilon4 and memory decline is modified by baseline cognition and age in a population-based elderly sample. Methods: The study sample consisted of 1,243 subjects, 62 to 85 years old, with a Mini-Mental State Examination (MMSE) score between 21 and 30 and known APOE phenotypes. Memory performance was measured with an abbreviated Auditory Verbal Learning Test (AVLT) at baseline and repeated after 3 years (n = 854). Memory decline was defined as a decrease of at least 1 SD from the mean change score on immediate recall (IR), delayed recall (DR), and retention, based on the AVLT. Results: Multivariate logistic regression analyses showed that APOE-epsilon4 is associated with memory decline in cognitively impaired subjects (MMSE score, 21 to 26) (OR for decline on IR adjusted for age, sex, education, and baseline recall score, 3.8; 95% CI, 1.4 to 10.0; adjusted OR for decline on DR, 2.9; 95% CI, 1.2 to 7.0; adjusted OR for decline on retention, 3.3; 95% CI, 1.1 to 10. 1), but not in cognitively normal subjects (MMSE score, 27 to 30) (adjusted OR for decline on IR, 1.1; 95% CI, 0.6 to 2.0; adjusted OR for decline on DR, 1.0; 95% CI, 0.6 to 1.8; adjusted OR for decline on retention, 1.5; 95% CI, 0.7 to 3.0). In particular, cognitively impaired epsilon4 carriers older than 75 years were at high risk of memory decline (adjusted OR for decline on IR, 4.5; 95% CI, 1.4 to 13.8; adjusted OR for decline on DR, 3.6; 95% CI, 1.2 to 10.8; adjusted OR for decline on retention, 6.6; 95% CI, 1.5 to 29.7). Conclusions: APOE-epsilon4 was associated with memory decline in subjects with cognitive impairment, but not in normally functioning subjects. Contrary to AD studies, our study suggests that the risk of APOE-epsilon4 on memory decline does not decrease at higher ages.

Objectives. It is supposed that selection bias precludes the extrapolation of results of studies carried out in a clinical setting to the general population. There is little empirical evidence demonstrating the degree to which those depressed in the community are different From those treated in clinical settings. This study compared elderly patients with major depression admitted to a psychiatric hospital with those living in the community. Methods. All elderly (55 years and older) patients admitted between 1990 and 1992 to a psychiatric hospital with DSM major depression as the primary diagnosis (n = 104), were compared with all elderly patients with the same diagnosis (n = 59) who were participating in a large community study (Longitudinal Aging Study, Amsterdam). Data were gathered from the clinical sample using chart-reviews while the community-based sample was interviewed. The two groups were compared with respect to differences in demographic variables, presenting symptoms, risk factors and treatment. Results. The following characteristics were significantly more prevalent in the clinical sample: late onset of the depression, threat of suicide, conflicts with significant others and use of antidepressant medication. Chronic physical illness was the only characteristic that was more prevalent in the community sample. Conclusion. The results confirm that elderly patients treated in clinical psychiatry represent a group with more threatening and more disruptive depressive illness. Major depression in the community was more often associated with chronic physical illness, which may hamper the recognition and treatment of depression. As the two samples were similar in all other respects, selection bias, hampering comparison of results of studies carried out across treatment settings, appears to have a very limited effect.

Background. Depression may be associated with cognitive decline in elderly people with impaired cognition. Aims. To investigate whether depressed elderly people with normal cognition are at increased risk of cognitive decline and Alzheimer\'s disease. Methods. Two independent samples of older people with normal cognition were selected from the community-based Amsterdam study of the Elderly (AMSTEL) and the Longitudinal Aging Study Amsterdam (LASA). In AMSTEL, depression was assessed by means of the Geriatric Mental State Schedule. Clinical diagnoses of incident Alzheimer\'s disease were made using a two-step procedure. In LASA, depression was assessed with the Center for Epidemiologic Studies Depression Scale. Cognitive decline was defined asa drop of greater than or equal to 3 on the Mini-Mental State Examination at follow-up. Results. Both in the AMSTEL and the LASA sample, depression was associated with an increased risk of Alzheimer\'s disease and cognitive decline, respectively, but only in subjects with higher levels of education. Conclusions. In a subgroup of more highly educated elderly people, depression may be an early manifestation of Alzheimer\'s disease before cognitive symptoms become apparent.

Background. Poor physical health has long been recognized to be one of the most important risk factors for depression in older adults. Since many aspects of physical health can be targeted for improvement in primary care, it is important to know whether physical health problems predict the onset and/or the persistence of depression. Methods. The study is based on a sample which at the outset consisted of 327 depressed and 325 non-depressed older adults (55-85) drawn from a larger random community-based sample in the Netherlands. Depression was measured using the Center for Epidemiologic Studies Depression scale (CES-D) at eight successive waves. Results. From all incident episodes, the majority (57 %) was short-lived. These short episodes could generally not be predicted by physical health problems. The remaining incident episodes (43 %) were not short-lived and could be predicted by poor physical health. Chronicity (34 %) was also predicted by physical health problems. Conclusions. The study design with its frequent measurements recognized more incident cases than previous studies; these cases however did have a better prognosis than is often assumed. The prognosis of prevalent cases was rather poor. Physical health problems were demonstrated to be a predictor of both the onset and the persistence of depression. This may well have implications for prevention and intervention.

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The objective of this study was to investigate whether the association between Apolipoprotein E4 (ApoE4) and memory decline is modified by baseline general cognitive impairment and age in a population-based elderly sample. Subjects were participants in the Longitudinal Aging Study Amsterdam (LASA). The study sample consisted of 1,243 subjects, 62-85 years old, with a Mini-Mental State Examination (MMSE) score between 21-30 and known ApoE phenotypes. Memory performance was measured with a short version of the Auditory Verbal Learning Test (AVLT) at baseline and repeated after three years (N = 854). Memory decline was defined as a decrease of at least one standard deviation from the mean change score on immediate recall, delayed recall and retention. ApoE4 was associated with memory decline in cognitively impaired subjects (MMSE 21-26), but not in cognitively normal subjects (MMSE 27-30). In particular cognitively impaired E4 carriers older than 75 years were at high risk of memory decline. Contrary to AD studies, our study suggests that the risk of ApoE4 on memory decline does not decrease with ageing.

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This study examines the environmental and psychosocial determinants of depression in older adults. Based on Lawton’s environmental docility thesis, the question is posed: is the strong association between functional limitations and depressive symptomatology affected when environmental conditions, objective and subjective efficacy, and docile or proactive behaviour are taken into account. Data were used from LASA (the Longitudinal Aging Study Amsterdam), a national survey of the population between 55 and 85 years of age, stratified by age and sex. Hierarchical regression analyses were performed on the data of 2,981 respondents. Empirical support was found for the extended Lawton model, including both environmental, efficacy and behavioural factors. In particular, living in a more urbanised area, not being able to perform heavy household tasks, having a low self-efficacy, not feeling safe, receiving help from others and having few social contacts within the neighbourhood, increase depressive symptoms in general but, in particular, when combined with lower functional status. It is concluded that both being able and feeling able to influence one’s environment increases proactive behaviour and decreases depressive symptomatology in older adults with low functional status.

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Background: The impact of chronicity and changes in depression on physical decline over time in older persons has not been elucidated. Methods: This prospective cohort study of 2121 community-dwelling persons aged 55-85 years uses two measurement occasions of depression (CES-D scale) over 3 years to distinguish persons with chronic, remitted, or emerging depression and persons who were never depressed. physical function is assessed by self-reported physical ability as well as by observed performance on a short battery of tests. Results: After adjustment for baseline physical function, health status and sociodemographic factors, chronic depression was associated with significantly greater decline in self- reported physical ability over 3 years when compared to never depressed persons (odds ratio (OR) = 2.83, 95% confidence interval (CI)= 1.86-4.30). In the oldest old, but not in the youngest old, chronic depression was also significantly predictive of greater decline in observed physical performance over 3 years (OR = 2.22, 95% CI = 1.43-3.79). Comparable effects were found for older persons with emerging depression. persons with remitted depression did not have greater decline in reported physical ability or observed performance than persons who were never depressed. Conclusions: Our findings among community-dwelling older persons show that chronicity of depression has: a large impact on physical decline over time. Since persons with remitted depression did not have greater physical decline than never depressed persons, these findings suggest that early recognition and treatment of depression in older persons could be protective for subsequent physical decline.

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The objectives of this study were to ascertain the prevalence of the number and severity of vertebral deformities in elderly people, and to determine the extent to which these are associated with several aspects of functioning. The study was conducted in a subsample of the Longitudinal Aging Study Amsterdam (LASA) consisting of 527 participants (260 men and 267 women), aged 65 years or over. Lateral radiographs of the spine (T4-L5) were made of each participant and a semiquantitative method was used to assess the number and degree of vertebral deformities. The prevalence of having at least one vertebral deformity was 39% in both men and women. 6% of the men and 5% of the women had at least three vertebral deformities. For severe deformities, the prevalence was 8% in men and 12% in women. The number of vertebral deformities was significantly associated with a height loss of more than 5 cm, difficulties in activities of daily living, a poor performance, more than 3 days in bed and more than 3 days with limited activities due to health problems past month and a poor self perceived health. For most of these outcome measures, associations were strongest when three or more deformities were present. The presence of a severe deformity was associated with a height loss of more than 5 cm, a poor performance, more than 3 days with limited activities in the past month, and a poor self-perceived health. None of the associations between number and severity of vertebral deformities and the level of functioning were modified by sex. We can conclude that vertebral deformities are very common in both older men and older women and that vertebral deformities, even if they are not clinically manifest, have a substantial impact on the level of functioning and well-being of older people.

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The main focus of this paper is the development of an appropriate framework to characterize the process of long-term care utilization by the Dutch elderly. Three broad categories of care services are considered, namely, informal care, formal care at home, and institutional care. The use of these care alternatives is modelled jointly, and stochastic dependence is allowed between the various care options. Special attention is given to the concept of health status and to the potential endogeneity of this variable in the model. We apply a flexible non-parametric method to summarize the multidimensional concept of health status into a limited set of interpretable indices. The model is applied on the Longitudinal Aging Study Amsterdam (LASA). We find strong effects of health status, gender, socio-economic variables, and prices on the utilization of long-term care services.

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Methods are discussed which may keep participation in a longitudinal study among the elderly high, for example adaptation of the interviews and proxy interviews. The LASA sample is described from the start at 1992 until now. The non-response is evaluated and we found that refusals are particularly important in the first part of the longitudinal traject. Also data quality is studied in relation to the aging of the respondents. Although there are theoretical reasons to expect that aging of respondents may impair data quality, no support for this hypothesis was found in the present study. Data quality was stable during a period of six years. But data quality seemed poorer for those respondents who dropped out of the study. Item non-response and duration of the interview were higher for drop outs.

Objective: The primary aim of this study was to assess sex differences in depression in later life. Method: In a random, age and sex-stratified community sample of 3056 older Dutch people (55-85 years) the prevalence, symptom-reporting and risk factors associated with depression in later life were studied. Depression was measured with the Center for Epidemiologic Studies Depression scale (CES-D). Bivariate, multivariate and factor analyses were used. Results: Prevalence of depression in women was almost twice as high as in men. Controlling for age and competing risk factors reduced the relative risk for females with more than half. Symptom-patterns in men and women were very much alike. Sex differences in associations with risk factors were small, but exposure to these risk factors was considerably higher in females. Conclusion: Very little evidence for a typical \'female depression\' was found. Female preponderance in depression was related to a greater exposure to risk factors.

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In order to promote well-being and alleviate loneliness among older women, a course was developed to help them improve or develop new friendships. Thirty-two participants in the course were interviewed on their friendships and loneliness at two points in time, immediately following the course and a year later. Loneliness scores were compared to those of a matched control group. Both groups were very lonely initially and demonstrated a significant reduction in loneliness a year later. However, more women in the friendship course were successful in reducing their loneliness; a majority had made new friends, slightly less than half had improved existing friendships. There was a significant increase in the complexity of their friendship networks following the course.

The aim of the research is to assess whether there is change in the size and composition of older adults\' personal network. Furthermore, change in contact frequency and received instrumental support within the relationships is studied. Five relationship types are distinguished: children, other kin, friends, neighbors and acquaintances. Older adults with a decline in physical capacity are compared with those with stable and increased capacities. Furthermore, differences according to (change in) partner status and age are investigated. Data are from the Longitudinal Aging Study Amsterdam, including the first and fourth observation of 1634 older adults living independently. The observation interval is 7 years. A decline in physical capacities is observed for 35% of the older adults, the capacities are stable for 60% and an increase is observed for 5%. In general, network size and composition did not change. The frequency of contact within the relationships decreased. Decline was high for parent - child relationships, but relatively low among older adults who faced a moderate to strong physical decline. Among older adults who did not have a partner at the fourth observation and among the oldest the frequency of contact with children increased independent from the degree of physical decline. The decline in contact with neighbors was nearly absent for older adults who faced a moderate to strong physical decline; the contact increased when there was no partner at the fourth observation. The instrumental support received increased within all relationship types, independent from the degree of physical decline. It is concluded that research into determinants of the decline in parent-child contacts is needed and that the meaning of neighbors should receive attention.

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Objective: Low muscle strength is associated with poorer physical function, but limited empirical evidence is available to prove the relationship between muscle mass and physical function. We tested the hypothesis that persons with lower muscle mass or muscle strength have poorer lower-extremity performance (LEP). Design: A cross-sectional, population-based study. Participants: A cohort of 449 men and women aged 65 years and older living in Amsterdam and its surroundings participating in the second examination (1995-1996) of the Longitudinal Aging Study Amsterdam. Measurements: Leg skeletal muscle mass was measured using dual-energy X-ray absorptiometry. Grip strength was used as an indicator of muscle strength. Timed functional performance tests, including walking and repeated chair stands, were used to assess LEP. Results: After adjustment for body height and age, leg muscle mass was positively associated with LEP in men (regression coefficient .178 (95% confidence interval .013-.343), p=.035). In women an inverse association was observed, which became positive after additional adjustment for body mass index (.202 (-.001-.405), p=.052). Grip strength was positively associated with LEP in men and women. After additional adjustment for behavioral, physiological, and psychological variables, the associations between leg muscle mass and LEP disappeared, whereas grip strength remained to be independently associated with LEP in men (.079 (.042-.116), p=.0001), with a tendency in women (.046 (-.009-.101), p=.11). Results were similar when quartiles of leg muscle mass or grip strength were used. Conclusion: These results suggest that low muscle strength, but not low muscle mass, is associated with poor physical function in elderly men and women. However, prospective studies are needed to investigate the association between loss of muscle mass and physical function.

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Background. Despite considerable interest, there is no consensus regarding the prevalence of depression in later life. Aims. To assess the prevalence of late-life depression in the community. Method. A systematic review of community-based studies of the prevalence of depression in later life (55+). Literature was analysed by level of caseness at which depression was defined and measured. Results. Thirty-four studies eligible for inclusion were found. The reported prevalence rates vary enormously (0.4-35%). Arranged according to level of caseness, major depression is relatively rare among the elderly (weighted average prevalence 1.8%), minor depression is more common (weighted average prevalence 9.8%), while all depressive syndromes deemed clinically yield an average prevalence of 13.5%. There is consistent evidence for higher prevalence rates for women and among older people living under adverse socio-economic circumstances. Conclusions. Depression is common in later life. Methodological differences between studies preclude firm conclusions about cross-cultural and geographical variation. Improving the comparability of epidemiological research constitutes an important step forward.

Background. Although anxiety is quite prevalent in late life, its impact on disability, well-being, and health care utilization of older persons has not been studied. Older persons are a highly relevant age group for studying the consequences of anxiety, since their increasing numbers put an extra strain on already limited health care resources. Methods, Data of a large community-based random probability sample (N = 659) of older subjects (55-85 year) in the Netherlands were used to select three groups: subjects with a diagnosed anxiety disorder, subjects with merely anxiety symptoms and a reference group without anxiety. These groups were compared with regard to their functioning, subjective well-being, and use of health care services, while controlling for potentially confounding variables. Results. Anxiety was associated with increased disability and diminished well-being. Older persons with a diagnosed anxiety disorder were equally affected in their functioning as those with merely anxiety symptoms. Although use of health services was increased in anxiety sufferers, their use of appropriate care was generally low. Conclusions. Anxiety has a clear negative impact on the functioning and well-being of older subjects. The similarity of participants with an anxiety disorder and those having merely anxiety symptoms regarding quality of life variables and health care use was quite striking. Finally, in spite of its grave consequences for the quality of life, appropriate care for anxiety is seldom received. Efforts to improve recognition, disseminate effective treatments in primary care, and referring to specialized care may have positive effects on the management of anxiety in late life.

The EURODEP Consortium is a large, international collaboration which aggregates data to permit methodologically sound secondary analyses of extant epidemiological data across multiple sites throughout Europe. The effort, as exemplified in the papers presented here, can help clarify issues which have been debated among old age psychiatrists throughout the developed world for many years. Perhaps of more importance, however, is that the cross-national nature of the study can bring new questions to the centre of discussions about late-life depression, questions of far more interest, in my opinion, than some of the questions which have dominated the epidemiological study of mood disorders among the elderly in recent years (Blazer,1997). I first address the methods of this collaboration, which must be understood by anyone who reviews these reports critically. Next I focus upon a question addressed by the investigators which should fade to the background with the publication of these studies and a review of studies already published. I then suggest another question, raised by the investigators, that should proceed to centre stage.

This study examines whether the degree of conservatism of the religious climate affects the geographical distribution of late life depressive symptoms. A U-shaped relationship is hypothesized: high levels of depressive symptoms at the extremes (both a-religious and hyperconservative), and a low level in the middle (moderate-conservative). Subjects are 3051 older Dutch citizens (55-85 years), living in 11 municipalities. Depressive symtoms are assessed using the CES-D. Religious climate is estimated on the municipality level, using percentages votes on political parties with a Christian background (moderate-conservative versus hyperconservative). Using multi-level analysis, the results support the U-curve hypothesis.

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This study examined the changes in support intensity in parent-child relationships of older parents who experienced an onset of physical impairment in one year time. The relationships were compared with the support in the child relationships of parents who remained in good health. The results indicated that, given the onset of impairment, both sons and daughters are likely to increase the intensity of instrumental and emotional support to their parent, but the increase is the strongest in the mother-daughter relationships. Multivariate regression analyses showed that the intensity of support was significantly determined by the onset of parental physical impairment, but even more so by the type of parent-child relationship.

Background. This is the first report of results from the EURODEP Programme. Aims. To assess the prevalence of the depression judged suitable for intervention in randomised samples of those aged ³ 65 in nine European centres. Method. The GMS-AGECAT package. Results. Differences in prevalence are apparent, 8.8% (Iceland) to 23.6% (Munich). When sub-cases and cases are added together, five high- and four low-scoring centres emerge. Women predominated over men. Proportions of sub-cases to cases revealed striking differences but did not explain prevalence. There was no constant association between prevalence and age. A meta-analysis (n=13 808) gave an overall prevalence of 12.3%, 14.1% for women and 8.6% for men. Conclusions. Considerable variation occurs in the levels of depression across Europe, the cause for which is not immediately obvious. Case and sub-case levels taken together show greater variability, suggesting that it is not a matter of case/sub-case selection criteria, which were standardised by computer. Substantial levels of depression are shown but 62-82% of persons had no depressive level. Opportunities for treatment exist.

Background. Stereotypes of older people suggest that they are depressed. Aims. To examine depression symptoms among people aged ³ 65 in the general population and to ask the following questions. Are there high proportions of depressive symptoms among otherwise people? Do these levels reflect the prevalence of depression? Do key symptoms vary with age and do they confirm stereotypes? Method. Nine centres contributed data from community-based random samples, using standardised methods (GMS-AGECAT package). Results. Proportions of depressive symptoms varied between centres. Some often associated with ageing were rare. Many were more common in women. Low-prevalence centres tended to have fewer symptoms among \'well\' people, but there were inconsistencies. Low levels of symptoms among the well population of a centre did not necessarily predict lower levels in the depressed. Conclusions. Variations in the prevalence of depressive symptoms occurred between centres, not always related to levels of illness. There was no consistent relationship between proportions of symptoms in well persons and cases for all centres. Few symptoms were present in >60% of the older population - stereotypes of old age were not upheld.

BACKGROUND: The EURODEP collaboration was formed to take advantage of existing studies of random community samples of older people in Europe, using GMS-AGECAT for case identification and diagnosis. Later, other centres joined, and the EURO-D scale was developed to harmonise the different methods used with the GMS. Previous studies had revealed different levels of depression in Europe but had been confounded by the use of unreconcilable methods. These studies attempt to overcome this problem. AIMS: To introduce the first set of publications from the EURODEP collaboration. METHOD, RESULTS AND CONCLUSIONS: Presented in five accompanying papers (pp. 307-345, this issue). DECLARATION OF INTEREST:The European Commission BIOMED/initiative funded this Concerted Action Programma.

In order to obtain repeated measurements of depression in an efficient and relatively inexpensive design, a mixture of face-to-face interviews and mail questionnaires was employed. The aims of the study were to examine mode effects of face-to-face interviews versus mail questionnaires on depression scores and to test potential interactions between mode of data collection and sex and age of the respondents. In the study sample, which at the outset consisted of 327 depressed and 325 non-depressed older adults (55-85 years) drawn from a larger random community based sample in the Netherlands, depression was measured in successive waves (cycles), using the Center for Epidemiologic Studies of Depression scale (CES-D). With mode of data collection and sex and age of the respondents of the respondents as independent variables, differences in CES-D scores were analysed. The CES-D scores were higher when collected by mail questionnaires than when face-to-face interviews were used. No systematic interactions between sex and age of the respondents with mode of data collection were found. For the scores based on mail questionnaires, a transformation is proposed, resulting in scores that are comparable to those obtained by interviews. In studying depression in older adults, more cost-effective mail questionnaires may be used in addition to face-to-face interviews, provided that a transformation is performed before embarking on the analysis.

This study focuses on sex differences in depression of the widowed. Previous research showed different results in sex differences and in depression after bereavement. We assessed the effects of widowhood on depressive symptoms for men and women and examined whether environmental strain like social support, finances and housekeeping-concerns explain these effects. Data were used from a large community-based study of older people in three regions of the Netherlands. Our study sample consists of 2626 widowed and married subjects in the age group of 55-85 years. Depression was measured using the CES-D scale; the various strains were obtained by structured interviews. Multiple linear regression, performed for men and women separately, were used. The results show that widowhood is associated with higher levels of depressive symptoms and that this association is stronger for men than for women. The effect of widowhood is mediated by different types of environmental strain for men and women. However, a strong direct main effect of widowhood on depression remains. The difference in depression rates between men and women is most evident among those widowed for a longer period of time. It appears that, over times, women adapt to widowhood more successfully than men. From a clinical point of view this is important, as it suggests that men who remain alone after losing their partner are at a higher risk of developing symptoms of chronic depression.

Objectives: The aim of this study was to examine the effect of health factors on memory performance in a population-based sample of 679 older people (mean age=69.2 years). Methods: Both subjective and objective indices of health were used as predictor variables. Memory performance was measured with an immediate recall test and a delayed recall test. Results: Some of the objective health indices were correlated with performance on the memory tasks, but regression analysis showed that they hardly had a unique effect on memory performance. Conclusion: Health factors have only a weak relationship with memory performance in older adults.

Exchange theory assumes that people prefer balanced support exchanges in their relationships. If there is an imbalance and no expectation of change in the future, a relationship might be terminated. The question is which relationships are discontinued. The data are from a longitudinal study of 2,057 older adults who identify 18,915 relationships at T1. A relationship is regarded as discontinued if it is not identified by the older adult at the second and third measurement moments. Of the T1 relationships, 4,042 have since been discontinued. The results of a multilevel logistic regression analysis show that the more intensive the support exchanges are at T1, the more likely it is for relationships to be continued. Relationships where older adults are overbenefited with instrumental support, i.e. receive more than they give, have a higher chance of being continued. However, if older adults are overbenefited with emotional support, this decreases the chance of the relationships continuing. The type of relationship has a significant effect on whether or not it is continued. Close kin relationships are most likely to be continued, and relationships with less close kin, friends and neighbors have a higher chance of being discontinued. The costs of the relationship are also decisive; the higher the contact frequency and the lower the traveling time to the network member, the higher the chance of the relationship being continued. Furthermore, the larger the network of the older adult, the more likely it is for an unbalanced relationship to be discontinued.

The paper of Tepper et al. (Tepper S., Sutton J., Beatty P., DeJong G. Alternative definitions of disability: relationship to health-care expenditure. Disability and Rehabilitation 1997; 19: 556-558.) deals with the relationship between alternative definitions of disability and individual health expenditures. Unfortunately, the main issue, namely that alternative definitions of a determinant may influence the magnitude o the outcomes, is obscured by the fact that the paper lacks a clear focus: the message is obscured by the broader issues referred to in both the introduction and the discussion sections, which are not substantiated by the data. In addition, there appear to be several methodological shortcomings in the paper that are not addressed properly. As a result, we feel that the importance of the results presented is generalized for beyond what the study and the data allow. In this commentary, we will first discuss the paper of Tepper et al. and, thereafter, provide a more generalized view on the policy relevance of alternative definitions of determinants in relation to health-care expenditures.

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Objectives. This study examined the effect of depression on the incidence of physical disability and the role of confounding and explanatory variables in this relationship. Methods. A cohort of 6247 subjects 65 years and older who were initially free of disability was followed up for 6 years. Baseline depression was assessed by the Center for Epidemiological Studies Depression Scale. Disability in mobility and disability in activities of daily living were measured annually. Results. Compared with the 5751 nondepressed subjects, the 496 depressed subjects had a relative risk (95% confidence interval) of 1.67 (1.44, 1.95) and 1.73 (1.54, 1.94) for incident disability in activities of daily living and mobility, respectively. Adjustment for sociodemographic characteristics and baseline chronic conditions reduced the risks to 1.39 (1.18, 1.63) and 1.45 (1.29, 1.93), respectively. Less physical activity and fewer social contacts among depressed persons further explained part of their increased disability risk. Conclusions. Depression in older persons may increase the risk for incident disability. This excess risk is partly explained by depressed persons\' decreased physical activity and social interaction. The role of other factors (e.g., biological mechanisms) should be examined.

Objectives: This study examines whether patterns of social network size, functional social support, and loneliness are different for older persons with different types of chronic diseases. Methods: In a community-based sample of 2,788 men and women age 55 to 85 years participating in the Longitudinal Aging Study Amsterdam, chronic diseases status, social network size, support exchanges, and loneliness were assessed. Results: Social network size and emotional support exchanges were not associated with disease status. The only differences between healthy and chronically ill people were found for receipt of instrumental support and loneliness. Disease characteristics played a differential role: greater feelings of loneliness were mainly found for persons with lung disease or arthritis, and receiving more instrumental support was mainly found for persons with arthritis or stroke. Discussion: The specifics of a disease appear to play a (small) role in the receipt of instrumental support and feelings of loneliness of chronically ill older persons.

Background: The association between depression and mortality in older community-dwelling populations is still unresolved. This study determined the effect of both minor and major depression on mortality and examined the role of confounding and explanatory variables on this relationship. Methods: A cohort of 3056 men and women from the Netherlands aged 55 to 85 years were followed up for 4 years. Major depression was defined according to DSM-III criteria by means of the Diagnostic Interview Schedule. Minor depression was defined as clinically relevant depression (defined by a Center for Epidemiologic Studies Depression score 16) not fulfilling diagnostic criteria for major depression. Results: After adjustment for confounding variables (sociodemographics, health status), men with minor depression had a 1.80-fold higher risk of death (95% confidence interval, 1.35-2.39) during follow-up than nondepressed men. In women, minor depression did not significantly increase the mortality risk. Irrespective of sex, major depression was associated with a 1.83-fold higher mortality risk (95% confidence interval, 1.09-3.10) after adjustment for sociodemographics and health status. Health behaviors such as smoking and physical inactivity explained only a small part of the excess mortality risk associated with depression. Conclusion: Even after adjustment for sociodemographics, health status, and health behaviors, minor depression in older men and major depression in both older men and women increase the risk of dying.

With the aging of society, issues concerning the reform of the Dutch health care systems are ranked high on the political agenda. Sensible reforms of the health care system for the elderly require a thorough understanding of the health status of the old and of its dynamics preceding death. The health status of the elderly is intrinsically a multidimensional and dynamic concept and a rich set of indicators is needed to capture this concept in its full extent. This feature of health requires techniques to reduce dimensionality as, in general, it is difficult to simultaneously handle all indicators in any economic analysis. In the first part of this paper we focus on methods that comprise these multidimensional measures into a limited number of indices. The Grade of Membership (GoM) approach introduces by Manton and Woodbury (Methods of Information in Medicine 1982; 21) is specially designed to characterize the complex concept of health. The method simultaneously identifies all dimensions of the concept of interest and the degrees to which an individual belongs to each of these types (i.e. grades of membership). We apply the method to a set of 21 indicators from a rich database of the Longitudinal Aging Study Amsterdam (LASA). The individual degrees of involvement in the different health dimensions obtained from this method are used in subsequent analyses of health and mortality.

Background. In an II-country European collaboration, 14 population-based surveys included 21 724 subjects aged ³ 65 years. Most participating centres used the Geriatric Mental Stale (GMS), but other measures were also used. Aims. To derive from these instruments a common depression symptoms scale, the EURO-D, to allow comparison of risk factor profiles between centres. Method. Common items were identified from the instruments. Algorithms for fitting items to GMS were derived by observation of item correspondence or expert opinion. The resulting 12-item scale was checked for internal consistency, criterion validity and uniformity of factor-analytic profile. Results. The EURO-D is internally consistent, capturing the essence of its parent instrument. A two-factor solution seemed appropriate: depression, tearfullness and wishing to die loaded on the first factor (affective suffering), and loss of interest, poor concentration and lack of enjoyment on the second (motivation). Conclusions. The EURO-D scale should permit valid comparison of risk-factor associations between centres, even if between-centre variation remains difficult to attribute.

Background. Data from surveys involving 21 724 subjects aged ³ 65 years were analysed using a harmonised depression symptom scale, the EURO-D. Aims. To describe and compare the effects of age, gender and mental status on depressive symptoms across Europe. Method. We tested for the effects of centre, age, gender and marital status on EURO-D score. Between-centre variance was partitioned according to centre characteristics: region, religion and survey instrument used. Results. EURO-D scores tended to increase with age, women scored higher than men, and widowed and separated subjects scored higher than others. The EURO-D scale could be reduced into two factors: affective suffering, responsible for the gender difference, and motivation, accounting for the positive association with age. Conclusions. Large between-centre differences in depression symptoms were not explained by demography or by the depression measure used in the survey. Consistent, small effects of age, gender and marital status were observed across Europe. Depression may be overdiagnosed in older persons because of an increase in lack of motivation that may be affectively neutral, and is possibly related to cognitive decline.

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The authors studied whether the ability of cognitive functioning to predict mortality is pervasive or specific, and they considered the role of health in the cognition-mortality association. Data were taken from a sample of 2,380 persons aged 55-85 years who took part in the Netherlands\' Longitudinal Aging Study Amsterdam in 1992-1993. Five cognitive measures were distinguished: general cognitive functioning, information processing speed, fluid intelligence, learning, and proportion retained. Mortality data were obtained during an average follow-up period of 1,215 days. Cox proportional hazards regression models revealed that all cognitive functions predicted mortality independent of age, sex, education, and depressive symptoms. When health (self-rated health, medication use, physical performance, functional limitations, lung function, specific chronic diseases) was also taken into account, information processing speed, fluid intelligence, and proportion retained remained independent predictors of mortality; whereas the ability of general cognitive functioning and learning to determine mortality was lost. The authors concluded that the ability of cognitive functioning to predict mortality is pervasive to all cognitive functions that were included in the study when age, sex, education, and depressive symptoms are considered and is more specific to some functions when also controlling for health.

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Changes in the networks and the health of a general sample of 2,903 Dutch older adults were studied, based on three observations with a total time span of four years. The better the functional capacity and the self-rated health of the old people, the larger their network was, the less instrumental support was received from their network members, and the more instrumental support was given. The positive effect of poor health on instrumental support received can be considered as an effect of the mobilization of helpers. The negative effect of poor health on instrumental support given, reflects the fact that people in poor health have difficulty in actively maintaining their relationships. Both tendencies affect the network size in different directions, which might be a reason for the relatively small effect of health on the network size. An extended version is published as: van Tilburg, T.G. (1998). Changes over time in the personal networks and health of older adults. In D.J.H. Deeg, A.T.F. Beekman, D.M.W. Kriegsman, & M. Westendorp-de Serière (Eds.), Autonomy and well-being in the aging population II: Report from the Longitudinal Aging Study Amsterdam 1992-1996 (pp. 123-140).

The performance of Quantitative Ultrasound (QUS) measurements of the tibia and calcaneus was studied in 109 elderly (age range 65 -87 years). Broadband ultrasound attenuation (BUA) and speed of sound (SOS) were measured at the calcaneus and SOS was assessed at the tibia. Short-term precision of tibial QUS was studied in 16 volunteers. The coefficient of variation (CV) was 0.4% and the standardized CV (sCV) was 4.4%. We compared the calcaneal and tibial QUS measurements with bone mineral density (BMD) measurements of the lumbar spine, femoral neck, trochanter and total body assessed by dual X-ray absorptiometry (DXA). Calcaneal BUA showed higher correlations with BMD values of the lumbar spine, femoral neck, trochanter and total body than calcaneal and tibial SOS (r = 0.48-0.64, r = 0.30-0.47, r = 0.35-0.47, respectively; p < 0.001). Body weight modified the relationships between calcaneal and tibial QUS and BMD measurements of the hip. Higher body weight was associated with higher BMD values at the femoral neck and trochanter for the same calcaneal and tibial QUS values. After adjustments for body weight correlations of tibial and calcaneal QUS with BMD improved and were very similar. This suggests that correction for body weight is important and could add to the predictive value of QUS measurements.

Smoking is reported to be positively related to abdominal fat in young and middle-aged persons, however, it is unclear whether this relationship exists in elderly persons. Behavioral influence on fat distribution is of importance due to the accumulation of abdominal fat with age and its associated health risks. The relationship was investigated in a population-based sample of 1,178 men and 1,163 women aged 55-85 years, representative of the Dutch older population in 1992-1993. Waist and hip circumference and their ratio (WHR) were used as indices of fat distribution. Past and current smoking habits were obtained by questionnaire. Smoking was associated with waist/hip-ratio (WHR) in men, with current smokers having the highest WHR and never smokers the lowest. A dose-response relationship between the daily number of cigarettes smoked and WHR was observed in men. These associations remained significant after adjustment for confounding due to age, education, body mass index, health status, alcohol intake, and sport activity. The dose-response relationship did not change after additional adjustment for duration of smoking. Among former smoking men, recent quitters had a higher WHR compared to longterm quitters. Additional analysis showed that smoking was more strongly associated with waist than with hip circumference. In women the relationship between smoking and fat distribution was not clear. In conclusion, past and current smoking habits are positively associated with abdominal fat in older men, but not in older women.

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Objective. To study the prevalence and risk factors of anxiety disorders in the older (55-85) population of The Netherlands. Method. The Longitudinal Aging Study Amsterdam (LASA) is based on a random sample of 3107 older adults stratified for age and sex, which was drawn from the community registries of 11 municipalities in three regions in The Netherlands. Anxiety disorders were diagnosed using the Diagnostic Interview Schedule in a two-stage screening design. The risk factors under study comprise vulnerability, stress and network-related variables. Both bivariate and multivariate statistical methods were used to evaluate the risk factors. Results. The overall prevalence of anxiety disorders was estimated at 10.2%. Generalized anxiety disorder was the most common disorder (7.3), followed by phobic disorders (3.1%). Both panic disorder (1.0%) and obsessive compulsive disorder (0.6%) were rare. These figures are roughly similar to previous findings. Ageing itself did not change much with age. Vulnerability factors (female sex, lower levels of education, having suffered extreme experiences during World War II and external locus of control) appeared to dominate, while stresses commonly experienced by older people (recent losses in the family and chronic physical illness) also played a part. Of the network-related variables, only a smaller size of the network was associated with anxiety disorders. Conclusions. Anxiety disorders are common in later life. The risk factors support using a vulnerability-stress model to conceptualize anxiety disorders. Although the prevalence of risk factors changes dramatically with age, their impact is not age-dependent. The risk factors indicate which groups of older people are at a high risk for anxiety disorders and in whom active screening and treatment may be warranted.

Depression in survivors of stroke is both common and clinically relevant. It is associated with excess suffering, handicap, suicidal ideation and mortality and it hampers rehabilitation. Most of the data currently available are derived from clinical studies. The objective of the present study was to study the prevalence, risk factors and consequences of depression in survivors of stroke, in a large (n = 3050) community-based study of older (55-85 years) people in three regions of the Netherlands. Depression was measured using the CES-D scale: histories of stroke were obtained using self-reports and data from general practitioners. The study was designed as a case- control study, using both bivariate and multivariate analyses. The prevalence of depression in stroke survivors was 27%, which was significantly higher than the base rate (OR 2.28. 95% CI 1.61- 3.24). Both stroke-related disease characteristics and psychosocial characteristics of the respondents were predictors of depression. The consequences of depression were most evident in the realm of disability and impairment of well-being. The patterns of service utilization showed that depressed survivors of stroke are relatively high users of a wide range of health services.

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A confirmatory factor analysis of the factor structure of the adapted General Self-Efficacy Scale, created by Sherer et al. 1982 [Psychological Reports 51, 663-671], was conducted to assess whether the scale\'s purported 3 factors emerged. The results generally supported the 3-factor model, but a model with 3 correlated factors and one higher-order factor (general self-efficacy), proved to fit the data even better.

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This study describes the distribution of depressive symptoms in older Dutch citizens (n=3,020) across religious denominations. Reformed-Calvinists had the lowest depression scores (CES-D); Protestants from liberal denominations the highest; Roman Catholics, Dutch Reformed and non-church members were in between. Two types of explanatory mechanisms are examined, (1) social integration and (2) positive self-perceptions, which both help to prevent depression. Alternatively, strict Calvinist doctrines are hypothesized to enforce negative self-perceptions, facilitating depression. For 2,509 respondents, complete data were available on social integration and self-perceptions, as well as on the parental religious denomination. Explanatory effects were tested using hierarchic regression models. The negative association between Calvinist background and depressive symptoms was partly explained by size of social network, and between Roman Catholic background and depressive symptoms by self-esteem. Leaving church had a positive association with depressive symptoms. This depressogenic effect remained after controlling for explanatory variables.

Gerotranscendence has been defined as a shift in meta-perspective, from a materialistic and rationalistic perspective to a more cosmic and transcendent one that accompanies the process of aging. The present study describes scale characteristics of the Dutch translation of Tornstam\'s gerotranscendence scale, using data from a sample among adults aged 56-76 years (N=556). Two subscales evolve from scale analysis, similar to those found by Tornstam: cosmic transcendence and egotranscendence. Scores on both subscales are higher for the older old, as well as for the unmarried, divorced or widowed respondents who suffer from physical impairments. Scale scores are also higher for respondents with depressive complaints. On the subscale cosmic transcendence Roman Catholics have higher scores than Protestants and non-church members. On the subscale egotranscendence well educated respondents and those with few social contacts have higher scores than persons with less education and those with many contacts. The strength of the associations is modest and the variance explained is small. The findings warrant further research into the question whether gerotranscendence adds to competence in later life.

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The increase in life expectancy observed over the last decade has particular relevance for mental health conditions of old age, such as dementia. Although mental disorders have been estimated to be responsible for 60% of all disabilities, until recently population health indicators such as health expectancies have concentrated on calculating disability-free life expectancy based on physical functioning. In 1994, a European Network for the Calculation of Health Expectancies (Euro-REVES) was established, one of its aims being the development and promotion of mental health expectancies. Such indicators may have an important role in monitoring future changes in the mental health of populations and predicting service needs. This article summarizes the proceedings and recommendations of the first European Conference on Mental Health Expectancy.

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In older persons, the association between poverty and social participation is a subtle one. Older persons with a low income maintain fewer personal relationships, are less involved in clubs and organizations, and participate less in socio-cultural activities than older persons with a higher income. However, older age and poorer health are better predictors of all these forms of social participation than a low income is. Moreover, no association was demonstrated between low income and loneliness.

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The aim of this study was to examine the effects of physical activity and the possible mediating role of perceived physical self-efficacy (PPSE) on self-rated health (SRH) in the 55- to 89-year-old Dutch population. The data are based on a structured interview carried out in a random sample of 120 subjects-60 men and 60 women with the average ages of 69 and 71 years, respectively-in Sassenheim, the Netherlands, as a pilot study of the Longitudinal Aging Study Amsterdam (LASA). The results of linear multiple regression analyses showed that physical activity was a significant predictor of self-rated health. Moreover, the results supported the role of PPSE as a mediator in the association between physical activity and self-rated health status even when age, gender, and chronic diseases were controlled. These findings suggest that in the elder population, increasing perceived physical self-efficacy may be more important for perceived health than raising the level of physical activity.

The role of duration of depressed mood in the prediction of cardiovascular disease (CVD) requires further study, since it has been suggested that emerging depressive symptoms may be a better predictor than persistent depressive symptoms. This prospective cohort study among 3,701 men and women aged >70 years uses three measurement occasions of depressive symptomatology (CES-D) over 6 years to distinguish persons who were newly (depressed at baseline but not at 3 and 6 years prior to baseline) and chronically depressed (depressed at baseline and at 3 or 6 years prior to baseline). Their risk of subsequent CVD events and all-cause mortality was compared to persons who were never depressed in the 6 year period. Outcome events were based on death certificates and Medicare hospitalization records. During a median follow-up of 4.0 years, there were 732 deaths (46.2 per 1, 000 person-years) and 933 new CVD events (64.7 per 1,000 person-years). In men, but not in women, newly depressed mood was associated with an increased risk of CVD-mortality (Relative Risk=1.75, 95% CI=1.00-3.05), new CVD events (Relative Risk=2.07, 95%CI=1.44-2.96) and new coronary heart disease events (Relative Risk=2.03, 95%CI=1.28-3.24) after adjustment for traditional CVD risk factors. The association between newly depressed mood and all-cause mortality was smaller (Relative Risk=1.40, 95%CI=0.95-2.07). Chronic depressed mood was not associated with new CVD events or all-cause mortality. Our findings suggest that newly depressed older men, but not women, were approximately twice as likely to have a CVD event than those who were never depressed. In men, recent onset of depressed mood is a better predictor of CVD than long-term depressed mood.

Effects of psychosocial coping resources on depressive symptoms were examined and compared in older persons with no chronic disease or with recently symptomatic diabetes mellitus, lung disease, cardiac disease, arthritis, or cancer. The 719 persons without diseases reported less depressive symptoms than the chronically ill. Direct favorable effects on depressive symptoms were found for having a partner, having many close relationships, greater feelings of mastery, greater self-efficacy expectations, and high self-esteem. Buffer effects were observed for feelings of mastery, having many diffuse relationships, and receiving emotional support. Buffer effects were differential across diseases for emotional support (in cardiac disease and arthritis only) and for diffuse relationships (in lung disease). Receiving instrumental support was associated with more depressive symptoms, especially in diabetes patients.

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Objectives: Previous studies have shown that most older people have a significant number of relationships. However, the question of whether the aging of old people produces losses in their personal network remains open for discussion. This study models the individual variability of the changes affecting multiple personal network characteristics. Methods: Personal interviews were conducted with 2,903 older Dutch adults (aged 55-85) in three waves of a four-year longitudinal study. Results: A stable total network size was observed, with an increasing number of close relatives and a decreasing number of friends. Contact frequency decreased in relationships, and the instrumental support received and emotional support given increased. Age moderated the effect of time for some of the network characteristics and for many of them, effects of regression towards the mean were detected. Furthermore, major variations in the direction and the speed of the changes were detected among individual respondents, and non-linear trends were observed. Discussion: The widely varying patterns of losses and gains among the respondents squares with the focus on the heterogeneity of developments among aging people. The instability of the network composition might reflect the natural circulation in the membership of networks.

No abstract available.

The objective of this study was to identify easily measurable predictors for falls, recurrent falls, and fractures, using a population-based prospective cohort study of 1469 elderly, born before 1931, in three regions of the Netherlands. The baseline at-home interview was in 1992. In 1995, falls experienced in the preceding year and fractures over the preceding 38-month period were registered. In a period of 1 year, 32% of the participants fell at least once, and 15% fell two or more times. The rate of recurrent falls was similar in men and women up until the age of 75 years. The total number of fractures was 85, including 23 wrist fractures, 12 hip fractures, and 9 humerus fractures. The incidence density per 1000 person-years for any fracture was 25.1 (95% confidence interval [CI], 18.9-31.4) for women and 8.2 (95% CI: 4.5-12.0) for men, respectively. Multiple logistic regression identified urinary incontinence, impaired mobility, use of analgetics and use of anti-epileptic drugs as the predictors most strongly associated with recurrent falls. Female gender, living alone, past fractures, inactivity, body height, and use of analgetics proved to be the predictors most strongly associated with fractures. The probabilities of recurrent falls were 4.7% (95% CI, 2.9 - 7.5%) to 59.2% (95% CI, 24.1 - 86.9%) with zero to four predictors, respectively. The probability of fractures ranged from 0.0% (95% CI, 0.0 - 0.4%) without any of the identified predictors to 12.9% (95% CI, 4.4 - 32.2%) with all six predictors present. Our study shows that the risk of recurrent falls and of fractures can be predicted using up to, respectively, four and six easily measurable predictors. This study emphasizes the importance of impaired mobility and inactivity as predictors for falls and fractures.

No abstract available.

No abstract available.

The Center for Epidemiologic Studies Depression scale (CES-D) has been widely used in studies of late-life depression. Psychometric properties are generally favourable, but data on the criterion validity of the CES-D in elderly community based samples are lacking. In a sample of older (55-85 years) inhabitants of the Netherlands, 487 subjects were selected to study criterion validity of the CES-D. Using the one-month prevalence of major depression derived from the Diagnostic Interview Schedule (DIS) as criterion, the weighted sensitivity of the CES-D was 100%; specificity 88%; and positive predictive value 13,2%. False positives were not more likely among elderly with physical illness, cognitive decline or anxiety. We conclude that the criterion validity of the CES-D for major depression was very satisfactory in this sample of older adults.

Studied depression at the syndrome level and at the diagnostic level in a large random sample of older adults as part of the Longitudinal Aging Study Amsterdam (D.J.H. Deeg et al., 1993) . Human Ss: 3,056 male and female Dutch middle-age, old, and very old adults (aged 55-85 yrs) (major depression in some Ss) (residents of 3 regions of the Netherlands). Ss were interviewed. A 2-stage screening procedure was used to diagnose depression. The Diagnostic and Statistical Manual of Mental Disorders-III (DSM-III) criteria for major depression were used. Tests used: The Center for Epidemiologic Studies Depression Scale, the Diagnostic Interview Schedule; National Institute of Mental Health and the Mini-Mental State Examination.

Background. The consequences of major depression for disability, impaired well-being and service utilization have been studied primarily in younger adults. In all age groups the consequences of minor depression are virtually unknown. In later life, the increased co-morbidity with physical illness may modify the consequences of depression, warranting special study of the elderly. With rising numbers of elderly people, excess service utilization by depressed elderly represents an increasingly important issue. Methods. Based on a large, random community- based sample of older inhabitants of the Netherlands (55-85 years) the associations of major and minor depression with various indicators of disability, well-being and service utilization were assessed, controlling for potential confounding factors. Depression was diagnosed using a two-stage screening design. Diagnosis took place in all subjects with high depressive symptom levels and a random sample of those with low depressive symptom levels. The study sample consists of all participants to diagnostic interviews (N = 646). Results. As in younger adults, associations of both major and minor depression with disability and well-being remained significant after controlling for chronic disease and functional limitations. Adequate treatment is often not administered, even in subjects with major depression. As the vast majority of those depressed were recently seen by their general practitioners, treatment could have been provided in most cases. Bivariate analyses show that major and minor depression are associated with an excess use of non-mental health services, underscoring the importance of recognition. In multivariate analyses the evidence of excess service utilization was less compelling. Conclusions. Both major and minor depression are consequential for well-being and disability, supporting efforts to improve the recognition and treatment in primary care. However, controlled trials are necessary to assess the impact this may have on service utilization.

Background: In later life, declining physical health is often thought to be one of the most important risk factors for depression. Major depressive disorders are relatively rare, while depressive syndromes which do not fulfil diagnostic criteria (minor depression) are common. Methods: Community-based sample of older adults (55-85) in the Netherlands: baseline sample n=3056; study sample in two stage screening procedure n=646. Both relative (odds ratios) and absolute (population attributable risks) measures of associations reported. Results: In multivariate analyses minor depression was related to physical health, while major depression was not. General aspects of physical health had stronger associations with depression than specific disease categories. Significant interactions between ill health and social support were found only for minor depression. Major depression was associated with variables reflecting long-standing vulnerability. Conclusion: Major and minor depression differ in their association with physical health. Limitation: Cross-sectional study relying largely on self-reported data. Clinical relevance: In major depression, with or without somatic co-morbidity, primary treatment of the affective disorder should not be delayed. In minor depression associated with declining physical health, intervention may be aimed at either of both conditions.

No abstract available.

In het kader van TSG\'s 75-jarige bestaan behandelt dit artikel de ontwikkelingen in sterfte en gezonde levensverwachting gedurende de afgelopen 75 jaar en de gezonde levensverwachting van de huidige 75-jarige. In de 75 jaar na 1920 steeg de levensverwachting bij de geboorte zo\'n 15 jaar, samengaand met een sterke daling van de bruto sterftecijfers voor infectieziekten, maar een toename van die voor \'welvaartziekten\'als hart- en vaatziekten en kanker. Na standaardisatie voor leeftijd en geslacht blijft van deze laatste toename echter weinig over. Trends in gezonde levensverwachting (gebaseerd op ervaren gezondheid) en levensverwachting zonder beperkingen (gebaseerd op vragen naar trap kunnen lopen en zichzelf kunnen wassen en aankleden) op 65-jarige leeftijd worden besproken voor het eerste en laatste moment waarvoor de noodzakelijke gegevens beschikbaar zijn, namelijk 1956 (gegevens van het Longitudinaal Gezondheidsonderzoek onder Bejaarden) en 1994 (CBS gezondheidsenquête). Sinds 1956 lijkt het aantal \'gezonde\'levensjaren te zijn afgenomen en het aantal jaren zonder beperkingen toegenomen. De eerste bevinding kan zowel verklaard worden door verschillen in de vraagformuleringen als door veranderingen in het aspiratieniveau van de respondenten. De levensverwachting van de huisige 75-jarige is ruim 10 jaar. Globaal de helft van deze tijd wordt doorgebracht met beperkingen en in minder goede ervaren gezondheid. Desondanks is de algemene tevredenheid over het leven tijdens bijna 90% van de resterende levensjaren goed tot zeer goed. Aanzienlijk meer jaren worden doorgebracht met een depressief syndroom dan met dementie.

This article reports on the investigation of the factor structure, reliability and validity of the General Self-Efficacy Scale (GSES; Sherer et al., 1982) administrated to two large samples of persons of 55 years and older. The Dutch version of the GSES (ALCOS-12) was subjected to exploratory and confirmatory factor analyses. The results generally supported a 3-factor model that is in line with previous findings. However, a 3-factor model subordinate to one second-order factor proved to be the most adequate model. The ALCOS-12 as well as the subscales appeared to be moderately reliable (internally consistent and homogeneous) and valid instruments to measure (aspects of) generalized expectations of self-efficacy.

Purpose: Successful physical functioning is thought to have a positive influence on the perception of physical competence. How people perceive their physical competence may act as an important mediator between the capacities they have and their behavioral performance, thereby influencing autonomous functioning. The presentation will focus on the association between physical activity and perceived competence and possible impact of chronic disease and pain. Methods: Interview and questionnaire data were obtained from 3107 subjects between 55 and 85 years of age as part of the Longitudinal Aging Study Amsterdam (LASA). Results: Perceived competence and physical activity are positively associated, while a gradual decrease on both factors is shown as age increases. Furthermore, women systematically perceive their physical competence as weaker than men. Furthermore, both perceived competence and physical activity are negatively influenced by chronic disease and pain, although a few exceptions are noted. Conclusion: Perceived physical competence and physical activity are positively associated, while chronic disease and pa in have a negative impact on the interrelationship.

Examined the association between religious involvement and depression in older Dutch citizens, focusing on models of the mechanism in which religious involvement impacts other factors related to depression. Ss were 2,817 older adults aged 55-85 yrs living in the community who participated in the Longitudinal Aging Study Amsterdam. Depressive symptoms were assessed using the Center for Epidemiologic Studies Depression Scale, and religious involvement was assessed using items on frequency of church attendance and strength of church affiliation. Further data were collected on physical health, size of social network, social support, sense of mastery, and self-esteem. As in North American studies, religious involvement appeared to be inversely associated with depression, both on symptom and syndrome levels. Controlling for sociodemographics, physical impairment and network support did not substantially affect this association, particularly among 75-85 yr old Ss. The inverse association between religious involvement and depression was not selectively more pronounced among older people with physical impairments. However, the association appeared to be most specific for Ss with a small social network and those with a low sense of mastery.

This study examines the impact of religiosity on incidence and course of depressive syndromes in a community-based sample of older persons in the Netherlands (n=177). The course of depression was assessed in five waves of measurements, covering one year. Religiosity was operationalized as salience of religion as compared to the salience of other aspects of life. Religious salience was not associated with incidence of depression, but had a relatively strong association with improvement of depression among the respondents who were depressed at the first measurement. This association was most prominent among those with a poor physical health.

Depressie onder ouderen vormt een gezondheidsvraagstuk waarvoor de aandacht toeneemt. Ondermeer is gebleken dat depressies bij ouderen het algemeen functioneren op nadelige wijze beinvloeden, met name als er sprake is van lichamelijke problemen. Het gaat hierbij niet alleen om ernstige depressies, maar ook om de veel voorkomende, moeilijk traceerbare milde depressies. Ouderen in verstedelijkte gebieden blijken meer depressive klachten te rapporteren dan ouderen op het platteland. Andere, deels geografisch bepaalde risicofactoren zijn sociaal-economische en culturele kenmerken. Religie blijkt bijvoorbeeld voor veel ouderen een beschermende fator te zijn, al wordt een streng calvinistisch milieu verondersteld kwetsbaar te maken voor depressie.

No abstract available.

Examined the type and stability of social support networks providing instrumental and/or emotional support to a sample of 2,709 older Dutch adults aged 55-89 yrs. Results show that the hierarchy of instrumental support differs by partner status of the older adult, but the hierarchy in emotional support does not vary with the availability of partner or children. Multi-level regression analyses using data at an 11 mo followup indicate that 46 bereaved older adults received increased instrumental support from their network, while their receipt of emotional support remained unchanged. Shifts in the hierarchy of instrumental support were observed, but not in the hierarchy of emotional support. Older people who suffered a decrease in physical mobility received more instrumental and emotional support, but the ranking of supporter types changed little. It is concluded that despite changes in intensity of support, the hierarchies of types of supporters have generally remained stable over time.

Blootstelling aan ondervoeding op jonge leeftijd kan gevolgen hebben voor de kans op ziekten op latere leeftijd. In de bevolking van ons land zijn tegenwoordig echter verschillen in voedingstoestand op jongere leeftijd relatief klein, zodat een mogelijk effect tussen alle andere risicofactoren voor chronisch ziekten niet of nauwelijks zichtbaar wordt. De grote en systematische verschillen in voedingstoestand tussen mensen woonachtig in verschillende gebieden in Nederland tijdens de Hongerwinter van 1944-1945 bieden echter wel de mogelijkheid het effect van ondervoeding te bestuderen.

Many longitudinal data bases are underused. On reason is the researchers\' limited knowledge of suitable statistical methods. It is argued that this is not only a technical, but also a substantial problem. Researchers may feel that they are addressing one clear question, but dependent on the method of analysis chosen, they are addressing one of several possible subquestions. The relatedness of analytical technique and substance of the findings is illustrated using data from a series of four measurement points with intervals of three months on average, in the context of the Longitudinal Aging Study Amsterdam. The data were collected to assess the influence of self-perceived health on the course of depressive symptoms in older persons. Five different methods of analysis were derived from the literature on the relation health-depression. These methods distinguish themselves particularly with respect to the expression of the dependent variable: endpoint level, rate of change over time, or changeability. The expression of the independent variable may change as well: initial level, or rate of change. It is demonstrated that limitation to just one method of analysis usually corresponds to only one expression of the original research question, and therefore to only one aspect of the course of self-perceived health and depression. This aspect ought to be selected prior to the analyses, followed by the selection of the appropriate method of analysis.

Quality of life is often defined as satisfaction with a series of aspects of life. This procedure yields a quality of life score that is considered to be generalizable across groups of older persons. However, the aspects of life selected need not be equally important to all older individuals, and thus may not have any relevance to their quality of life. Data from the Longitudinal Aging Study Amsterdam (nationally representative cohort, ages 55-85 years, n=2254) were used to examine to which aspects of life older persons attach priority, how this prioritization is associated with availability of each aspect, and whether a discrepancy between priority and availability affects quality of life. Subjects were asked to rank nine aspects of life: physical and mental health, housing, income, marriage, family, friends, religious belief, and time spending. For the purpose of this study, the three aspects ranked as most important are considered a priority. The great majority of older persons attached priority to good physical health. Over one half indicated a good marriage as very important. The other aspects of life were a priority to one-third or less. Older persons who did not have or no longer had an aspect available, attached lower priority to this aspect. Furthermore, having no longer available an aspect that was considered important (= a discrepancy between priority and availability), was associated with lower quality of life for the aspects marriage and religious belief. A possible explanation of this finding is sought in the notion of cognitive adaptation. It is concluded that the association between life conditions and quality of life is not a linear one, but is affected by the importance older persons attach to specific aspects of life.

No abstract available.

No abstract available.

No abstract available.

Research evidence shows that in older individuals self-efficacy measures of metamemory predict memory performance. However, such findings have been based on experimental samples, and studies have usually been carried out in laboratory settings. As such, they may not be representative of everyday situations in which memory is called on. We examined the metamemory-memory relationship—using the Metamemory in Adulthood Questionnaire (MIA)—in a population-based sample of older adults. The memory tests were carried out at the respondents\' home, with the individuals informed only about being subject to an extensive interview, not about having to perform memory tests. Achievement and Anxiety, both affect-related MIA subscales, predicted the memory test performance in this study. The results suggest that for elderly persons, motivation and anxiety during testing are more important to memory functioning than self-efficacy dimensions of metamemory. The setting in which memory performance is required appears to affect the kind of metamemory aspects that influence performance.

No abstract available.

Study objectives. To determine, whether disease specific characteristics, reflecting clinical disease severity, add to the explanation of mobility limitations in patients with specific chronic diseases. Design and setting. Cross sectional study of survey data from community dwelling elderly people, aged 55-85 years, in the Netherlands. Participants and methods. The additional explanation of mobility limitations by disease specific characteristics was examined by logistic regression analyses on data from 2830 community dwelling elderly people. Main results. In the total sample, chronic non-specific lung disease, cardiac disease, peripheral atherosclerosis, diabetes mellitus, stroke, arthritis and cancer (the index diseases), were all independently associated with mobility limitations. Adjusted for age, sex, comorbidity, and medical treatment disease specific characteristics that explain the association between disease and mobility mostly reflect decreased endurance capacity (shortness of breath and disturbed night rest in chronic non-specific lung disease, angina pectoris and congestive heart failure in cardiac disease), or are directly related to mobility function (stiffness and lower body complaints in arthritis). For atherosclerosis and diabetes mellitus, disease specific characteristics did not add to the explanation of mobility limitations. Conclusions. The results provide evidence that, to obtain more detailed information about the differential impact of chronic diseases on morbidity, disease specific characteristics are important to take into account.

The present study explores whether different structural (presence of partner and children) and functional (amounts of instrumental and emotional support provided by partner and children) family characteristics buffer the influence of chronic diseases on physical functioning. Logistic regression analyses were performed in a population-based sample of 2830 community-dwelling elderly people with chronic diseases as independent, and mobility difficulties as dependent variable, for separate strata of family characteristics. The presence of buffer effects was ascertained by comparing the associations between disease variables and mobility difficulties across the strata of family characteristics, using the odds ratios and 95% confidence intervals. Living together with a partner appears to buffer the association between the presence of one chronic disease and mobility difficulties, but no such effect is present among subjects with more than one disease. Regarding specific chronic diseases, partner presence has a beneficial influence only on the association between stroke and mobility difficulties, regardless of whether the partner provides little or much support. For patients with chronic non-specific lung disease (asthma, chronic bronchitis or pulmonary emphysema), a small amount of instrumental support (help with daily chores in and around the house) received from the partner is associated with a higher risk for mobility difficulties, compared to patients who receive a large amount of instrumental support and to patients who are not living with a partner. Neither the presence of children, nor the amounts of support received from them, influence associations between specific chronic diseases and mobility difficulties. The present study provides limited evidence supporting a buffer effect of family characteristics on the association between chronic diseases and mobility. Only in elderly people with a relatively low burden of disease, family support mitigates the adverse effects of disease on physical functioning.

No abstract available.

Examined the direct and buffer effects of various aspects of social support and personal coping resources on depressive symptoms in a community-based sample of 1,690 55-85 yr olds, of whom 719 had no chronic disease, 612 had mild arthritis and 359 had severe arthritis. Results showed that persons with arthritis had more depressive symptoms than persons with no chronic diseases. Irrespective of arthritis, the presence of partner, having many close social relationships, feelings of mastery and a high self-esteem were found to have direct, favorable effects on psychological functioning. Mastery, having many diffuse social relationships, and receiving emotional support seem to mitigate the influence of arthritis on depressive symptoms, which is in conformity with the buffer hypothesis. Favorable effects of these variables on depressive symptomatology were only, or more strongly, found in persons with severe arthritis.

This study focuses on the role of social support and personal coping resources in relation to mortality among older persons in the Netherlands. Data are from a sample of 2,829 noninstitutionalized people aged between 55 and 85 years who took part in the Longitudinal Aging Study Amsterdam in 1992-1995. Social support was operationally defined by structural, functional, and perceived aspects, and personal coping resources included measures of mastery, self-efficacy, and self-esteem. Mortality data were obtained during a follow-up of 29 months, on average. Cox proportional hazards regression models revealed that having fewer feelings of loneliness and greater feelings of mastery are directly associated with a reduced mortality risk when age, sex, chronic diseases, use of alcohol, smoking, self-rated health, and functional limitations are controlled for. In addition, persons who received a moderate level of emotional support (odds ratio (OR) = 0.49, 95% confidence interval (CI) 0.33-0.72) and those who received a high level of support (OR = 0.68, 95% CI 0.47-0.98) had reduced mortality risks when compared with persons who received a low level of emotional support. Receipt of a high level of instrumental support was related to a higher risk of death (OR = 1.74, 95% CI 1.12-2.69). Interaction between disease status and social support or personal coping resources on mortality could not be demonstrated.

A relatively high prevalence and incidence of dementia have been found in population strata with low levels of education in comparison to population strata with high level of education. However, doubt remains whether this may be an artifact of education bias in the screening tests used. To investigate this matter, we analyzed results of two Dutch population surveys in which unbiased measures of memory decline were used. In the Longitudinal Aging Study Amsterdam (n = 1774) the percentage of words retained in a verbal learning test was found to be disproportionately low in the oldest age cohort (80-85 years) with less than 11 years of education. The Amsterdam Study of the Elderly (n = 4051) found a \"dose-response\" relationship between education and dementia prevalence. Cross-sectional and longitudinal results showed that, in less educated people, memory decline is faster and sets in at an earlier age. These findings indicate that the relationship between dementia and education is not just an artifact of case detection methods.

In two large-scale surveys among elderly respondents we evaluated the accuracy of answers obtained to three differently formulated age questions. Respondents included 6,149 individuals aged 65-86 living in The Netherlands. Because criterion age data were available from different sources, it was possible to compare the respondent\'s reported age with his or her actual age. Refusal rates were low for all three questions. Both age and cognitive capabilities influenced accuracy of the answers to the age questions. The results indicated that the most accurate data were obtained with the question, \"What is your date of birth?\" in combination with interview date.

The consequences of suggestive interviewer behaviour as a potential source of bias in obtaining valid answers in survey settings are discussed. It is hypothesized that: (1) suggestive interviewer behaviour while asking closed questions, or during probing, influences the responses and their distributions; and (2) parameter estimations of relationships with variables measured with questions influenced by suggestive behaviour are affected too. Three kinds of more or less suggestive interviewer behaviour concerning the presentation of response alternatives, following a closed question about consequences of aging, were systematically varied in a field experiment across different groups of randomly selected older (55+) respondents (N = 235). After obtaining a response to the question, the interviewer asked for any reasons for that particular response, thereby systematically suggesting a particular aspect of aging. After these manipulations, respondents were asked to evaluate a number of aspects, among them those previously suggested to the respondent. The distributions of the responses to the closed question proved to differ between experimental groups: suggested answers were indeed mentioned more often (p <.001). Suggestive probing had an effect too: one of the suggested aspects was evaluated as having greater effect than aspects that were not suggested (p = .35). Finally, the correlation between the responses to the closed question and another variable, age, turned out to be dependent on the experimental condition, with correlation coefficients ranging from r = .03 to r = .35. The experiment shows that suggestive interviewing indeed affects the quality of the data collected.

Percentile age norms for ages 55 to 85 using overlapping intervals at specified age midpoints are presented for the sum scores of sections A and B of Raven\'s Coloured Progressive Matrices (RCPM). The representative age and gender stratified sampled (N = 2.815) used is derived from the Longitudinal Aging Study Amsterdam (the Netherlands). As RCPM scores appear to be strongly associated with education, percentile norms for three educational levels are presented: low (0-9 years), middle (10-15 years) and high (16 years and more).

The present study focused on the association between aspects of emotional and cognitive functioning and two stages of the disablement process model (Verbrugge & Jette, 1994), functional limitations and Instrumental Activities of Daily Living (IADL) disability. The age and sex stratified sample aged 55-89 years consisted of 100 inhabitants of a small Dutch town who scored 24 or higher on the MMSE. Controlling for background factors (health problems, age, education and gender), depressive symptoms and fluid intelligence were independently associated with functional limitations. Of the cognitive functions, only everyday memory was independently associated with IADL disability. These findings expand on the disablement process model and demonstrate the importance of emotional functioning, fluid intelligence and everyday memory for the disablement process.

No abstract available.

No abstract available.

Physical activity is reported to be inversely associated with abdominal fat in young and middle-aged populations, which may partly explain its beneficial effect on health. However, it is unclear whether this inverse association exist in older people. The authors investigated the relationship of total and sport activity with fat distribution in a population-based sample of 1, 178 men and 1,163 women aged 55-85 years, representative of the Dutch elderly population in 1992-1993. Waist and hip circumference and their ratio (WHR) were used as indicators of fat distribution. Physical activity of the previous 2 weeks was obtained by questionnaire. Among men, total physical activity time was negatively associated with waist (98.3+/- 0.4 cm in the most active quartile vs. 100.5+/- 0.4 cm in the least active quartile, p=0.0001 (mean+/- standard error)) and WHR (0.98+/- 0.00 vs. 0.99+/- 0.00, p=0.005) after adjustment for age, education level, body mass index, smoking, and season of the year. This association was not observed among women. Men and women who participated in sports activity had a smaller waist and WHR than those who did not. After adjustment, the time spent on sports activity was negatively associated with waist (p=0.004 for men and p=0.07 for women) and WHR (p=0.03 for men and 0.09 for women) in both sexes. No relation between total physical activity time and body fat distribution was observed among respondents who were not participating in any sports activity (p3 0.17), suggesting that performance of activities of low/moderate intensity has no effect on body fat distribution. No associations with hip circumference were observed. The results did not change after additional adjustment for chronic illness. The results of this large-scale study show that physical activity, and specifically intensive activity, is negatively associated with abdominal fat in older people.

No abstract available.

No abstract available.

This study focussed on the effects of chronic diseases and pain on physical self-efficacy and physical activity in persons between 55 and 85 years of age. Data were used from the Longitudinal Aging Study Amsterdam (LASA). A total of 1694 subjects, 862 men and 832 women, had complete data on all measurements. After controlling for age and sex, subjects with chronic diseases had lower physical self-efficacy scores and were physically less active than subjects without chronic diseases. Physical self-efficacy of subjects with chronic diseases who experienced pain was lower than in subjects with chronic diseases but without pain. Nevertheless, the presence or absence of pain in the chronically diseased did not influence the amount of time that was spent in physical activities. For subjects without pain, physical self-efficacy and physical activity of subjects with chronic diseases were lower than for subjects without chronic diseases. Chronic diseases had a negative influence on physical self-efficacy and physical activity of the elderly. Within the group of respondents with chronic diseases, pain diminished physical self-efficacy even more, but had, contrary to the expectation, no negative influence on physical activity.

Among elderly in the community of Sassenheim (The Netherlands) is examined whether protestants suffer more depressive symptoms than Roman-Catholics and non-church members. Taken into account are salience of religion among the chronic diseased and, in a second sample, a measure of traditionality of belief-contents (orthodoxy). Concluded is that a depressogenic effect of protestantism can be detected among those elderly who do not consider religion to be salient and who disagree with a traditional content of belief.

This contribution examines the association between (i) conditions frequently occurring in the older population and (ii) aspects of physical ability and mortality. Self-reported data on chronic diseases (cardiovascular diseases, stroke, diabetes, chronic respiratory disease, cancer, arthritis), depressive syndromes (Center for Epidemiologic Studies Depression scale), and cognitive impairments (MiniMental State Examination) were collected in the nationally representative, age- and sex stratified sample of the Longitudinal Aging Study Amsterdam (3107 participants aged 55-85 years). Performance tests of physical ability measured flexibility, mobility, strength, balance and gait. Mortality was ascertained one and a half years after baseline. Multiple regression models of performance tests and mortality on all chronic conditions were evaluated, controlling for age and sex. Among the most disabling physical conditions were stroke, diabetes, and arthritis. Depressive syndromes and cognitive impairment were even more strongly associated with physical performance. A raised mortality risk was associated with arterial disease, diabetes, respiratory disease, and cognitive impairment. Physical performance explained part of the association with mortality only for respiratory diseases and cognitive impairment. These findings clarify pathways from specific conditions to disability and mortality, and indicate that physical disability and mortality can be considered as largely exclusive aspects of severity of disease. These findings also highlight the significance of mental conditions for physical disability.

This study is based on data which were collected in the context of the Longitudinal Aging Study Amsterdam (LASA), conducted at the departments of Psychiatry of the Faculty of Medicine and the Department of Sociology and Social Gerontology of the Faculty of Social and Cultural Sciences of the Vrije Universiteit in Amsterdam. The study is funded bu the Dutch State Ministry of Welfare, Health, and Sports. We wish to thank the members of the department of Social Research methodology for their fruitful comments on an earlier version of this paper.

No abstract available.

No abstract available.

Previous studies found modest associations between cognitive functioning and depressive symptoms in community samples of older adults. Low levels of cognitive functioning are associated with depressive symptoms. The present study investigates whether personality (locus of control and neurotism) moderates this relation, and whether gender-differences in moderating effects can be established. The study is based on data of the baseline sample of 3107 participants of the Longitudinal Aging Study Amsterdam, which was age (55-89 years) and sex-stratified. Multiple regression analyses are used to detect moderating effects. The findings show modest effects, indicating that personality is a moderator of the relation between cognitive functioning and depressive symptoms, particularly in women. In women, a relatively strong internal locus of control is protective of becoming depressed when experiencing impairment in general cognitive functioning (MMSE), and impairment in fluid intelligence and information processing speed. In men a low level of neurotism is protective of becoming depressed when experiencing memory impairment. If these findings are replicated and extended in future studies, pertinent interventions such as cognitive therapy or memory training may be designed to alleviate depressive symptoms.

The purpose of the present study was to examine the implications of changes in the network and changes in health for loneliness in old age. Respondents were 2895 men and women ranging in age from 55 to 89. All were interviewed in 1992 and 1993 in a face-to-face setting. The results of the panel study indicate that changes in the network and in health were associated with 'appropriate' changes in loneliness. For example, those who lost their partner over the course of the year were more lonely at T2, while those whose health improved became less lonely. However, contrary to expectations, when no changes in the network and health were observed, the loneliness score still changed, and always in the direction of a reduction of loneliness. Several substantial and methodological explanations for the latter finding are discussed.

Self-reports and general practitioner information on the presence of chronic diseases in community-dwelling elderly: a study on the accuracy of patients\' self-reports and on determinants of inaccuracy. The object of the study is to investigate the (in)accuracy of patients\' self-reports, as compared to general practitioners\' information, regarding the presence of specific chronic diseases, and the influence of patient characteristics. Questionnaire data of 2380 community-dwelling elderly patients, aged 55-85 years, on the presence of chronic non-specific lung disease, cardiac disease, peripheral atherosclerosis, stroke, diabetes, malignancies, and osteoarthritis/rheumatoid arthritis were compared with data from the general practitioners, using the kappa-statistic. Associations between the accuracy of self-reports and patient characteristics were studied by multiple logistic regression analyses. Kappa\'s ranged from 0.30-0.40 for osteoarthritis/rheumatoid arthritis and atherosclerosis, to 0.85 for diabetes mellitus. In the multivariate analyses, educational level, level of urbanization, deviations in cognitive function, and depressive symptomatology had no influence on the level of accuracy. An influence of gender, age, mobility limitations and recent contact with the general practitioner was shown for specific diseases. For chronic non-specific lung disease, both \'underreporting\' and \'overreporting\' are more prevalent in males, compared to females. Furthermore, males tend to \'overreport\' stroke and \'underreport\' malignancies and arthritis, whereas females tend to \'overreport\' malignancies and arthritis. Both \'overreporting\' and \'underreporting\' of cardiac disease are more prevalent as people are older. Also, older age is associated with \'overreporting\' of stroke, and with \'underreporting\' of arthritis. The self-reported presence of mobility limitations is associated with \'overreporting\' of all specific diseases studied, except for diabetes mellitus, and its absence is associated with \'underreporting\', except for diabetes mellitus and atherosclerosis. Recent contact with the general practitioner is associated with \'overreporting\' of cardiac disease, atherosclerosis, malignancies and arthritis, and with less frequent \'underreporting\' of diabetes and arthritis. Results suggest that patients\' self-reports on selected chronic diseases are fairly accurate, with the exceptions of atherosclerosis and arthritis. The associations found with certain patient characteristics may be explained by the tendency of patients to label symptoms, denial by the patient, or inaccuracy of medical records.

The authors discuss the process of asking and answering yes/no-questions in personal survey interviews form a conversational perspective. They examine the process with regard to yes/no-questions as given in the questionnaire and with regard to the yes/no-questions that interviewers may pose in the subsequent stages of sequence, when they are probing on the respondent\'s initial answer or are trying to solve other problems. Hypotheses are derived from the co-operation principle and the politeness principle of conversation, and then empirically evaluated for survey interview settings. In the relatively informal stages of the answering process (subsequences) the conversations appear to go quite well according to the conversation rules, but in the beginning formal stage to a much lesser degree. In particular it has been observed that interviewers strongly prefer to ask one-sided positive yes/no-questions. It is argued that this \'normal\' conversation strategy may seriously affect the validity of the information obtained, and, more generally, that the practical demands from the conversation rules on the interviewer\'s behaviour set limits on the researcher\'s abstract demands on that behaviour.

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Psychological status, including depressive symptoms, anxiety and mastery, was measured in a community-based sample of 3076 persons aged 55 to 85 with various chronic diseases. Strong, linear associations were found between the number of chronic diseases and depressive symptoms and anxiety, indicating that psychological distress among elderly people is more apparent in the presence of (more) diseases. Furthermore, in contrast to general assumptions that mastery is a relatively stable state, our results indicated that mastery is affected by having chronic diseases. The eight groups of chronically ill patients (with cardiac disease, peripheral atherosclerosis, stroke, diabetes, lung disease, osteoarthritis, rheumatoid arthritis or cancer) did differ in their associations with psychological distress. Psychological distress is most frequently experienced by patients with osteoarthritis, rheumatoid arthritis and stroke, while diabetic and cardiac patients appear to be least psychologically distressed. Differences in disease-characteristics, such as functional incapacitation and illness-controllability, may partly explain these observed psychological differences across diseases.

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The Longitudinal Aging Study Amsterdam (LASA) is a longitudinal survey on predictors and consequences of changes in physical, cognitive, emotional and social functioning in elderly people. The study constitutes a random sample of the urban and rural population in three culturally distinct geographical areas in the West, East, and South of the Netherlands. Key variables in the study are mobility, coordination, vision, ADL, intelligence, memory, depression and social participation. About 1600 subjects (> 65 year) will participate in an additional study on easily measurable risk factors for osteoporotic fractures. The emphasis rests on risk factors for falls, factors which modify the impact of the fall and risk factors which influence bone mass, bone structure and bone quality. The additional study includes a medical interview, balance tests, chair stands, grip strength, anthropometry, biochemical markers and ultrasound attenuation of the heel. More complex parameters such as body composition, bone mass and a spine radiograph will be measured in one region (600 subjects) for comparison with the easily measurable variables. The measurements of the additional study have started in October 1995 and will take approximately one year to be completed. A follow up on falls and fractures will be done during 3 years after initial examination This includes a calender on falls and fractures with follow-up every 3 months. For this follow-up study a memory-aid calender will be provided to assist the subjects\' recall of falls and fractures. The subjects will asked to fill out a questionnaire about new falls and fractures every 3 months. The study will participate in an EEC study in the program \"European Prospective Osteoporosis Study\" (EPOS).

Physical health and depression are closely related in the elderly. This has been found in both cross-sectional and longitudinal studies. In this study the relation between four aspects of physical health and depressive symptom levels are studied in a community-based sample of older inhabitants of a small town in the Netherlands (n=224). Results indicate that depression as measured with the CES-D is sufficiently different from physical health to be distinguished from it, and that it is sufficiently related to physical health to be relevant for further study. The more subjective measures of physical health used in this study (pain and subjective health) appear to have a much stronger relation with depression than the more objective health-measures (chronic diseases and functional limitations). Physical health and aspects of the social environment such as marital status appear to have independent effects on mood. In this study these effects were moderated by age and sex. In women and the young-old none of the associations between physical health and depression were significant. In men and the old-old all associations were highly significant.

In this review the course of depression in elderly patients treated at psychiatric in- or outpatient clinics is compared to results of studies carried out among community- dwelling elderly. With psychiatric treatment 50%-80% of elderly depressed patients have a favourable response. A considerable percentage of patients relapses, of which most recover with treatment. Comparing the findings of 15 studies, employing global criteria, a favourable long term course can be expected in about 50%-60% of treated elderly patients. Physical illness, the duration and severity of the index-episode, age at onset, and comorbid cognitive and personality disorders appear to be predictors of the course. All other variables studied either have no association with the course, or show equivocal results. In community based studies the course of depression appears to be less favourable than among patients treated at psychiatric services. Using 10 criteria, methodological shortcomings of the available studies are elaborated on. In the conclusions section the relevance of these findings for clinical practice and for future research are discussed.

Presents results from the Longitudinal Aging Study Amsterdam regarding the prevalence of both major (MaD) and minor depression (MiD) and age-related shifts in the patterns of associations with both vulnerability and stress. A random sample of 3,056 adults (aged 55-85 yrs) was obtained from 3 regions in the Netherlands. The prevalence of MaD was 2.02% and that of MiD, 12.9%. 14.9% had clinically relevant levels of depressive symptoms. Except in the youngest age group, women had higher prevalence rates for both MaD and MiD. Rising rates of depression with age were only found for women. Bivariate associations of both MaD and MiD with a broad range of risk factors did not differ dramatically between the sexes or age groups. Results suggest that MaD in the elderly is more often the exacerbation of a chronic mood disturbance, with roots in long-standing vulnerability, while MiD is more often a reaction to the stress encountered in later life.

This article is a report on the course of depressive syndromes in a community-based sample of older subjects in the Netherlands (n=238). Following base-line, the course of depression was assessed in five waves of follow-up measurements, covering 1 year. 52% of the subjects were never depressed; 16% suffered an incident depression, half of which remitted during the study; 8% had a depression at outset, which remitted during the study; 14% were chronically depressed and in 10% the course was variable. Of those depressed at the start of the study, 32% remitted without relapse, 25% remitted but relapsed later and 43% were chronically depressed. While demographic variables were not predictive, health-related variables were predictive of both the onset and the course of depressive syndromes. Chronicity was associated with recent visits to general practitioners, indicating that treatment could have been provided relatively easily in many cases.

This study examined the relationship between physical performance and physical self-efficacy beliefs in older adults. It was hypothesized that subjects who perform better on physical tasks would show more positive beliefs of physical self-efficacy. Information was obtained from 124 subjects (61 men and 63 women) aged 55 to 85 years. Tests of mobility, strength, and dexterity were administered, as well as a self-report questionnaire of physical self-efficacy. Although most physical performance indexes were observed to be at lower levels after 75 years of age, physical self-efficacy beliefs in women did not show this pattern if the drop in physical performance was relatively small. Male subjects in the age group of 75 years and older however, showed substantial lower levels of performance in most of the tests, which was associated with more negative beliefs of physical self-efficacy. This was corroborated by multiple regression analyses, showing that sex was a significant predictor of physical self-efficacy beliefs in most performance tests. This prediction was moderated by age such that older men had more negative beliefs of physical self-efficacy than older women.

This chapter briefly reviews possible agents instrumental in promoting and maintaining quality of life. The broad objective of promotion of health-related quality of life can be specified in two directions. First, to provide adequate health care, either cure or care or both. Second, to find non-health factors that compensate for a loss of good health. In this chapter the second direction to substantiated. Evidence from a study of 243 persons aged 55-59 through 85-89 years suggests that as people are confronted with disease, they employ a cognitive strategy that enables them to maintain their life satisfaction by reconsidering the importance of good health in favor of other domains of life. This may help them to find compensation for their loss of health in non-health factors by shifting their priorities to other domains of life.

The issue addressed in this chapter is how differences in informal and formal care received by older women with similar levels of health can be explained by material and immaterial resources. Data were used pertaining to 1600 women aged 55-85 years in various parts of the Netherlands. Self-perceived health variables appeared to be the most important correlates of care received. In excess of these, only material resources explained some variation in care received. Women in more rural towns received more help. Also, women with higher education levels received more care. Marital status or living arrangements did not affect care received. Equally, personality characteristics did not differentiate between women with respect to care received.

The paper offers a procedure for assessing the variability of covariance structures of respondent variables between interviewers, and the explanation of that variability by interviewer characteristics. The data of illustration are adopted from the Longitudinal Aging Study Amsterdam, containing data from interviews administered to 3107 elderly respondents nested within 43 interviewers. The data consist of the Center for Epidemiologic Studies Depression scale (CES-D), measuring four latent constructs. It turned out that both interviewer age and boldness cause a decrease in the original between-interviewer covariances.

This paper aims to elaborate some psychometric properties of the covaraice structure of items in within the multilevel context. It proposes especially a procedure for assessing the effects of interviewer characteristics on the \'prediction functions\' of respondents\' score on latent constructs on the basis of their scores on relevant items. The procedure is based on the influences of interviewer characteristics on prediction functions of the covariances among the constructs, and not in the variances of the separate latent constructs. It is directed to the question to which degree those between-interviewer covariances can be attributed to interviewer characteristics. The data are adopted from the LASA-project and contain 20 items under four latent constructs, 2838 respondents and 43 interviewers. Having used the repeated measures design of multilevel analysis, it turns out that the latent construct covariance structure indeed differs across interviewers. Moreover, it apears that this \'bias\' can partly be attributed to an interviewer\'s age.

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Until recently, the study of interviewer effects has focused on establishing direct effects of interviewer chracteristics on respondent response. An alternative approach emphasizes the conditioning influence of the interviewer characteristic on the respondent\'s answering process. This paper supports the alternative approach with empirical evidence. First, the answering process is described at the level of the respondent. Subsequently, respondent-specific parameters are related to interviewer-specific vaiables. This two-level model is applied to data collected in the Longitudinal Study Amsterdam (LASA; 2838 respondents within 43 interviewers). The dependent variables are the items belonging to the \'postivie affect\' dimension of well-being (Center for Epidemiologic Studies Depression Scale); relevant variables on respondent level and interviewer level are incorporated in the analysis. It turns out that all items depend on respondent characteristics, and that the means of the items \'worthfulness\', \'hopefulness\' and \'pleasure in life\' per interviewer depend on their age. The means of \'worthfulness\' also depend on \'interviewer security\'. A more interesting outcome is that the regressions of \'worthfulness\' and \'hopefulness\' on respondent age, are effected by interviewer age.

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Studied the interrelation of 6 facets of control and their ability to predict well-being in 90 older Dutch persons in an age and gender stratified community sample (aged 55-89 yrs). Assessment instruments included translated versions of the Sense of Coherence questionnaire, the General Self-efficacy scale, and Multiple Health Locus of Control scale. An interview and a postal questionnaire included measures of the control facets and the Affect Balance Scale. Correlations between control measures were mostly modest. Negative affect was predicted by neuroticism and sense of coherence. Tendencies of independent association of mastery with global well-being and of social inadequacy with positive affect were established.

The association between aspects of social participation and components of cognitive functioning and the ability of these aspects to predict cognitive performance was studies in an age and gender stratified sample of 116 individuals aged 65 to 89 years in The Netherlands. Measures of social participation included questionnaires on societal participation, socio-cultural activities and media use. Cognitive functioning was measured by tests of fluid intelligence, processing speed, word learning and recall, and everyday memory. All aspects of social participation showed significant bivariate correlations with all components of cognitive functioning. Independant of age, gender, education and functional limitations, societal participation and socio-cultural activities contributed significantly to the prediction of processing speed. Societal participation also contributed to the prediction of delayed recall. Tendencies of independant association were apparent between both societal participation and socio-cultural activities and word learning. No aspects of social participation independently predicted fluid intelligence or everyday memory. The evidence suggests independent associations between environmental stimulation and basic components of cognitive functioning, such as information-processing speed and measures of learning and delayed recall. Further research needs to clarify the process underlying the causal relation between cognitive functioning and forms of participation.

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Discusses the use of the Center for Epidemiologic Studies Depression Scale (L.S. Radloff, 1977) to measure depression in old people in the Netherlands. The characteristics of the CES-D are described, and studies of the reliability, validity, dimensions, and robustness of the scale are reviewed. The results of several applications of the CES-D to Dutch old people are assessed. It is concluded that the CES-D is a valid instrument for use on old people in the Netherlands.

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Studied the correlation between strength of religiosity and presence or absence of depressive symptoms in old people. The extent to which this correlation was affected by chronic illness was also assessed. 172 elderly adults (aged 55-89 yrs) were interviewed to determine the strength of their religiosity and the presence of chronic illness. Ss also completed the Center for Epidemiologic Studies Depression Scale (L.S. Radloff, 1977). The results were statistically analyzed.

Ter verkrijging van nader inzicht in de gezondheidstoestand en de zorgbehoefte van de Nederlandse oudere bevolking worden voor vier veelvoorkomende chronische ziekten (hartziekten, diabetes, luchtwegaandoeningen en reuma) trends in mortaliteit, morbiditeit, en gevolgen in termen van gezondheidsbeperkingen (functionele beperkingen en minder goede subjectieve gezondheid) afgeleid uit twee landelijke onderzoekingen onder 65- tot 84-jarigen die 37 jaar na elkaar zijn uitgevoerd. Het oudste onderzoek is het Landelijk Longitudiaal Gezondheidsonderzoek onder Bejaarden; het recente onderzoek is de Longitudinal Aging Study Amsterdam. Combinatie van de gegevens uit beide onderzoekingen geeft een gedifferentieerd beeld van veranderingen in de prevalentie van chronische ziekten en hun samenhang met gezondheidsbeperkingen. In de oudere bevolking is de prevalentie van drie van de vier bestudeerde ziekten toegenomen. Uit analyse van de samenhang met gezondheidsbeperkingen blijkt dat tegenwoordig functionele beperkingen vaker voorkomen bij diabetes, reuma en comorbiditeit (vrouwen), maar in mindere mate bij hartziekten (mannen). Bovendien wordt het huidige, lagere niveau van subjectieve gezondheid gedeeltelijk verklaard door reuma (vrouwen).

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In deze literatuurstudie worden gegevens over prevalentie, incidentie en beloop van depressie bij ouderen besproken. Depressie in engere zin blijkt een zeldzame aandoening te zijn bij ouderen in de bevolking. Depressieve syndromen komen echter veel voor. De betekenis van deze milde depressieve syndromen is vrijwel ononderzocht. Uit de gegevens die beschikbaar zijn onstaat een weinig optimistisch beeld. Ook het beloop van \"depressies in engere zin\" is bij ouderen vaak niet gunstig. In tegenstelling tot wat vaak wordt gedacht blijkt leeftijd een weinig consistent effect te hebben op depressie. Sekse, sociaal-economische variabelen, lichamelijk functioneren en sociale steun hebben de meeste invloed. Verandering van lichamelijk functioneren is hiervan de belangrijkste. Persoonlijkheidsvariabelen zijn vrijwel ononderzocht. Gepleit wordt voor beloopstudies waarbij depressieve verschijnselen in samenhang met andere aspecten van functioneren in de tijd worden vervolgd. Op grond hiervan kan worden beoordeeld of er een blinde vlek in onze huidige psychiatrische classificatiesystemen bestaat. Het is de vraag of er een grote groep ouderen is die een potentieel heilzame behandeling van hun depressieve symptomen wordt onthouden. Deze vraag kan alleen worden beantwoord aan de hand van interventiestudies.

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This study supports the reliability of an adapted version of the Perceived Physical Activity Scale of Ryckman et al. (1982). In a sample of 144 persons of 55-89 years, Cronbach's alpha was high (alpha = 0.93). Men scored significantly higher on the scale.

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The definition of disability-free life expectancy hinges on the criterium used for distinguishing a state of independence from a state in which one is dependent on others for help in order to sustain oneself. The calculated value of disability-free life expectancy, however, depends on the measurement instrument used to indicate dependence. In this paper, distinction is made between two types of dependence: functional and situational disability. Conventional self-report measures of activities of daily living (ADL) used to indicate disability and dependence do not distinguish these two types of disability. The distinction appears particularly relevant for instrumental ADL, due to sex differences. For the older population of the Netherlands, even when using a sex-balanced IADL scale there appear to be considerable sex differences in functional and situational disability. The help needed on the basis of situational disability amounts to 21 per cent of the total help needed in women, and to 33 per cent of the help needed in men. By eliminating situational disability from the population, disability-free life expectancy from age 55 years onward would increase by the amount of 3.5 years in both men and women.

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In dit onderzoek werd aan personen van 55 jaar en ouder gevraagd hun lichamelijke en algemene competentie te schatten in vergelijking tot leeftijdsgenoten. Bovendien werden de beide daarvoor gebruikte schalen retrospectief gebruikt, d.w.z. dat competentie werd getaxeerd in vergelijking tot 10 jaar geleden. De betrouwbaarheid van de schalen was voldoende (Cronbach\'s alpha\'s boven .80). De validiteit van de schalen werd onderzocht door te vragen naar gezondheid en de wijze waarop zij in het dagelijks leven functioneren. De respondenten rapporteren dat hun algemene en lichamelijke competentie vergeleken met 10 jaar geleden, achteruitgaat. Dit was overeenkomstig de voorspelling. Er werd echter geen leeftijdsverschil in taxatie gevonden wanneer de repondenten gevraagd wordt om zichzelf te vergelijken met leeftijdsgenoten.

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