TY - JOUR AB - BACKGROUND: The number of people using long-term care (LTC) is increasing steadily, hence, demand for adequate services is rising. The purpose of this exploratory study was to identify relevant gender-linked determinants for utilization of LTC in community-dwelling older adults. METHODS: We examined 4077 females (52.7%) and males ≥ 65 years old (range: 65-97 years) between 2011/12 (t1) and 2016 (t2). Data originated from the population-based Cooperative Health Research in the Region of Augsburg (KORA)-Age study in southern Germany. A descriptive analysis assessed the amount of LTC used. Cross-sectional generalized estimating equation logistic models identified determinants for utilization of (in)formal LTC. Determinants for transition to LTC between t1 and t2 were examined using a longitudinal logistic regression model. Potential determinants were chosen according to Andersen's Behavioral Model of Health Services Use. RESULTS: At t2, 820 (20.1%) were LTC users with 527 (64.3%) being female. The average amount of informal LTC was higher in males, whereas the amount of formal LTC was higher in females. In both genders, higher age, multimorbidity, and disability were associated with utilization of and transition to LTC. Living alone was significantly associated with utilization of LTC in both genders, but its effect was two times stronger in males. Thus, it is considered the essential gender-linked determinant. CONCLUSIONS: Gender-linked determinants must be considered when establishing demand-oriented policies. Future health programs should specifically target older individuals, especially males, living alone to improve their capabilities in activities of daily living to allow them to remain living longer and independently within community settings. AU - Steinbeisser, K. AU - Schwarzkopf, L. AU - Grill, E.* AU - Schwettmann, L. AU - Peters, A. AU - Seidl, H. C1 - 62771 C2 - 51055 CY - The Boulevard, Langford Lane, Kidlington, Oxford Ox5 1gb, England TI - Gender-linked determinants for utilization of long-term care in community-dwelling adults 65+ in Germany: Results from the population-based KORA-Age study. JO - Exp. Gerontol. VL - 153 PB - Pergamon-elsevier Science Ltd PY - 2021 SN - 0531-5565 ER - TY - JOUR AB - Objectives: We explored the male-female health-survival paradox in the context of health expectancy (HE) at age 65 and thereafter, using three different morbidity measures and different severity cut-offs with and without adjustments for the share of nursing home residents. Methods: HE at ages 65, 70, 75, 80, and 85 was estimated with the Sullivan method, linking morbidity prevalence from the KORA (Cooperative Health Research in the Region of Augsburg)-Age study to 2016 Bavarian mortality data. Morbidity measures comprised deficit accumulation (Frailty Index, FI, cut-offs 0.08 and 0.25), disability (Health Assessment Questionnaire-Disability Index, HAQ-DI, cut-off >0) and participation (Global Activity Limitation Indicator, GALI, “limited” vs “not limited”). Results: Morbidity data were available for 4083 participants (52.7% female). HE was lower in women than in men at all ages. Differences in morbidity prevalence, absolute HE, and health proportions of life expectancy (relative HE) increased with age for FI ≥ 0.25 and GALI, but not for HAQ-DI > 0 and FI > 0.08. Accounting for the share of nursing home residents resulted in a slight reduction of HE estimates but had no impact on estimated sex differences. Conclusions: In HE at age 65 and thereafter, women's health disadvantage was larger than their life expectancy advantage over men. AU - Stephan, A.J.* AU - Schwettmann, L. AU - Meisinger, C. AU - Ladwig, K.-H. AU - Linkohr, B. AU - Thorand, B. AU - Schulz, H. AU - Peters, A. AU - Grill, E.* C1 - 60831 C2 - 49623 CY - The Boulevard, Langford Lane, Kidlington, Oxford Ox5 1gb, England TI - Living longer but less healthy: The female disadvantage in health expectancy. Results from the KORA-Age study. JO - Exp. Gerontol. VL - 145 PB - Pergamon-elsevier Science Ltd PY - 2021 SN - 0531-5565 ER - TY - JOUR AB - Aims: This study examines exposure to anticholinergic and sedative (AS) medications in the general aging population using the Drug Burden Index (DBI) and to analyze the association of AS burden with vertigo, dizziness and balance problems (VDB, primary outcome) and falls (secondary outcome).Methods: We performed a cross-sectional analysis of data from the second follow-up (FF4) in 2013/14 of the Cooperative Health Research in the Region of Augsburg (KORA)-S4 study. AS burden was classified as DBI > 0. Self-reported data of VDB and falls during the previous 12 months were collected. Multivariable logistic regression was used to estimate the association of AS burden with VDB and falls.Results: 883 participants were included in this study (mean age 73.8 years, 48.4% female). AS burden was present in 167 (18.9%) participants, with the highest prevalence in those aged >= 80 years old (26.3%). In the adjusted analysis, AS burden was independently and significantly associated with VDB (Adjusted Odds Ratio (AOR): 1.73 [95% CI: 1.16, 2.56]).Conclusion: This study provides reliable prevalence estimates of AS burden in older people using the DBI in Germany, also indicating a positive and significant association with VDB. As VDB are among the main reasons for falls, we do recommend including the AS burden calculation as routine risk assessment in ambulatory medical care. AU - Phillips, A.* AU - Heier, M. AU - Strobl, R.* AU - Linkohr, B. AU - Holle, R. AU - Peters, A. AU - Grill, E.* C1 - 56564 C2 - 47130 CY - The Boulevard, Langford Lane, Kidlington, Oxford Ox5 1gb, England TI - Exposure to anticholinergic and sedative medications using the Drug Burden Index and its association with vertigo, dizziness and balance problems in older people - Results from the KORA-FF4 Study. JO - Exp. Gerontol. VL - 124 PB - Pergamon-elsevier Science Ltd PY - 2019 SN - 0531-5565 ER - TY - JOUR AB - While socio-economic characteristics have been shown to be associated with health deficit accumulation (DA) trajectories, their effect on the age at DA onset remains unclear. The objective of this study was to compare the median age at DA onset across nine European countries and to investigate the effects of income, occupation and wealth on DA onset after age 50. We used population samples aged 50 years and older from the SHARE (Survey of Health, Aging and Retirement in Europe) study. Participants from nine European countries with longitudinal data from at least three of the 2004/05, 2006/07, 2010/11, 2012/13 and 2014/15 waves were included in the analysis. A Frailty Index (FI, range 0-1) was constructed from 50 health deficits. DA onset was defined as having FI values > 0.08 in at least two consecutive measurements following an initial FI value <= 0.08. We investigated the effect of income, occupation and wealth on DA onset using a random effects model for time-to-event data. Potential confounding variables were identified using directed acyclic graphs. Out of 8616 (mean age 62 years, 49.0% female) participants initially at risk, 2640 (30.6%) experienced a subsequent DA onset. Median age at onset was 71 years overall, ranging from 66 years (Germany) to 76 years (Switzerland). Wealth and occupation were found to have significant effects on DA onset which decreased with age. In sum, the median age at DA onset differs between European countries. On an individual-level, wealth and occupation, but not income influence the age at DA onset. AU - Stephan, A.J.* AU - Strobl, R.* AU - Holle, R. AU - Grill, E.* C1 - 54431 C2 - 45554 CY - The Boulevard, Langford Lane, Kidlington, Oxford Ox5 1gb, England SP - 74-79 TI - Wealth and occupation determine health deficit accumulation onset in Europe - Results from the SHARE study. JO - Exp. Gerontol. VL - 113 PB - Pergamon-elsevier Science Ltd PY - 2018 SN - 0531-5565 ER - TY - JOUR AB - OBJECTIVES: This study examined associations between well-being and serum levels of insulin-like growth factor 1 (IGF-I) and its primary binding protein IGFBP-3 in a large population-based study of older adults. Additionally, the influence of physical activity on the effect of hormone levels on positive mental health was examined. METHODS: Cross-sectional data from 985 participants of the KORA-Age study (age range 64-93) was used in sex-specific multivariable regression analyses to assess associations between both IGF-I and IGFBP-3 with well-being (World Health Organization (WHO) -5) or ill-being (geriatric depression scale (GDS) -15). Models were increasingly adjusted for age, leisure time physical activity, sleep patterns, BMI, smoking, and cognitive scores based on causal diagrams. Well-being and depression scales were standardized to facilitate comparisons of growth hormone effects. Adjusted means of the WHO-5 score were assessed for the interaction between quintile levels of IGF-I or IGFBP-3 with high or low levels of physical activity. RESULTS: Fully adjusted models demonstrated that increased IGFBP-3 was positively associated with the WHO-5 in women (β estimate=0.14, standard error (SE)=0.06) and less so in men (β=0.11, SE=0.07). IGF-I was positively associated with the GDS-15 depression scale (β=0.11, SE=0.06) and negatively associated with well-being (β=-0.11, SE=0.06) in women and similar but not statistically discernable effects were observed in men. Adjusted mean WHO-5 scores illustrated the positive effect of both physical activity and higher IGFBP-3 on well-being in women only. CONCLUSIONS: These data demonstrate opposite and independent associations of IGF-I and IGFBP-3 on well-being in women, and suggest a neuroprotective effect of IGFBP-3 in older age. AU - Emeny, R.T. AU - Bidlingmaier, M.* AU - Lacruz, M.E. AU - Linkohr, B. AU - Peters, A. AU - Reincke, M.* AU - Ladwig, K.-H. C1 - 31919 C2 - 34860 SP - 58-64 TI - Mind over hormones: Sex differences in associations of well-being with IGF-I, IGFBP-3 and physical activity in the KORA-Age study. JO - Exp. Gerontol. VL - 59 PY - 2014 SN - 0531-5565 ER - TY - JOUR AB - High-density lipoprotein (HDL) particles exhibit multiple antiatherogenic effects. They are key players in the reverse cholesterol transport which shuttles cholesterol from peripheral cells (e.g. macrophages) to the liver or other tissues. This complex process is thought to represent the basis for the antiatherogenic properties of HDL particles. The amount of cholesterol transported in HDL particles is measured as HDL cholesterol (HDLC) and is inversely correlated with the risk for coronary artery disease: an increase of 1 mg/dL of HDLC levels is associated with a 2% and 3% decrease of the risk for coronary artery disease in men and women, respectively. Genetically determined conditions with high HDLC levels (e.g. familial hyperalphalipoproteinemia) often coexist with longevity, and higher HDLC levels were found among healthy elderly individuals. HDLC levels are under considerable genetic control with heritability estimates of up to 80%. The identification and characterization of genetic variants associated with HDLC concentrations can provide new insights into the background of longevity. This review provides an extended overview on the current genetic-epidemiological evidence from association studies on genes involved in HDLC metabolism. It provides a path through the jungle of association studies which are sometimes confusing due to the varying and sometimes erroneous names of genetic variants, positions and directions of associations. Furthermore, it reviews the recent findings from genome-wide association studies which have identified new genes influencing HDLC levels. The yet identified genes together explain only a small amount of less than 10% of the HDLC variance, which leaves an enormous room for further yet to be identified genetic variants. This might be accomplished by large population-based genome-wide meta-analyses and by deep-sequencing approaches on the identified genes. The resulting findings will probably result in a re-drawing and extension of the involved metabolic pathways of HDLC metabolism. AU - Boes, E.* AU - Coassin, S.* AU - Kollerits, B.* AU - Heid, I.M. AU - Kronenberg, F.* C1 - 353 C2 - 26187 SP - 136-160 TI - Genetic-epidemiological evidence on genes associated with HDL cholesterol levels: A systematic in-depth review. JO - Exp. Gerontol. VL - 44 IS - 3 PB - Pergamon, Elsevier Science PY - 2009 SN - 0531-5565 ER - TY - JOUR AB - Low levels of the antioxidative serum bilirubin are associated with vascular aging and an increased risk for coronary artery disease (CAD). UGT1A1 is the major gene influencing bilirubin concentrations. Therefore, we investigated an association of bilirubin levels and two polymorphisms in the promoter of UGT1A1 I (-53(TA-repeat) polymorphism and T-3279C) in 477 patients with premature, familial CAD and 619 age-and sex-matched controls. Bilirubin concentrations were significantly lower in cases than in controls (0.62 +/- 0.36 vs. 0.76 +/- 0.41 mg/dl for men, p = 1.2 x 10(-10) and 0.42 +/- 0.29 vs. 0.55 +/- 0.23 mg/dl, p = 1.9 x 10(-9) for women). Both polymorphisms showed a strong association with bilirubin levels with higher levels for homozygote carriers of the minor allele. These associations were most pronounced in male controls and patients (p = 5.9 x 10(-26) and p = 3.4 x 10(-16), respectively, for the -53(TA-repeat) polymorphism). Logistic regression analysis revealed low bilirubin levels but not the UGT1A1 polymorphisms to be significantly associated with CAD: OR (95% CI) 0.90 (0.86-0.94), p = 2.6 x 10(-6) for men and 0.77 (0.68-0.87), p = 3.2 x 10(-5) for women, respectively for each 0.1 mg/dl increase of bilirubin. These results indicate that it is rather decreased bilirubin levels in general than the changes in the genetic variation of this gene that increase the risk for CAD. AU - Lingenhel, A.* AU - Kollerits, B.* AU - Schwaiger, J.P.* AU - Hunt, S.C.* AU - Gress, R.* AU - Hopkins, P.N.* AU - Schoenborn, V.* AU - Heid, I.M. AU - Kronenberg, F.* C1 - 4377 C2 - 25866 SP - 1102-1107 TI - Serum bilirubin levels, UGT1A1 polymorphisms and risk for coronary artery disease. JO - Exp. Gerontol. VL - 43 IS - 12 PB - Elsevier PY - 2008 SN - 0531-5565 ER - TY - JOUR AU - Grallert, H. AU - Huth, C. AU - Kolz, M. AU - Meisinger, C. AU - Herder, C.* AU - Strassburger, K.* AU - Giani, G.* AU - Wichmann, H.-E. AU - Adamski, J. AU - Illig, T. AU - Rathmann, W.* C1 - 4609 C2 - 23927 SP - 737-745 TI - IL-6 promoter polymorphisms and quantitative traits related to the metabolic syndrome in KORA S4. JO - Exp. Gerontol. VL - 41 PY - 2006 SN - 0531-5565 ER - TY - JOUR AU - Philbroock, C.* AU - Fritz, E. AU - Weiher, H.* C1 - 4094 C2 - 23241 SP - 671-678 TI - Expressional and functional studies of Wolframin, the gene function deficient in Wolfram syndrome, in mice and patient cells. JO - Exp. Gerontol. VL - 40 PY - 2005 SN - 0531-5565 ER -