Journal articles
Scarlett, A. Kero, M.H. Depledge, D. (In Press). Age-related impairments of mobility associated with cobalt and other heavy metals: data from NHANES 1999-2004. Journal of Toxicology and Environmental Safety
Hall A, Fullam JA, Lang I, endacott R, Goodwin V (In Press). Community physiotherapy for people with dementia following hip fracture: fact or fiction. Dementia: the international journal of social research and practice
Hall A, Lang I, Goodwin V (In Press). Functional exercise for the rehabilitation of community dwelling people with dementia who fracture their hip – a feasibility study (protocol). Not published
Wilkinson K, Boyd K, Pearson M, Farrimond H, Lang L, Fleischer D, Poole A, Ralph N, Rappert B (In Press). Making Sense of Evidence: Using Research Training to Promote Organisational Change. Police Practice and Research: an International Journal
Hancock J, Matthews JN, Ukoumunne O, Lang I, Wenman J, Somerfield D, Dickens C (In Press). Variation in ambulance call rates for care homes in Torbay, UK. Health and Social Care in the Community
Webster L, Amador S, Rapaport P, Mukadam N, Sommerlad A, James T, Javed S, Roche M, Lord K, Bharadia T, et al (2023). Tailoring STrAtegies for RelaTives for Black and South Asian dementia family carers in the United Kingdom: a mixed methods study.
Int J Geriatr Psychiatry,
38(1).
Abstract:
Tailoring STrAtegies for RelaTives for Black and South Asian dementia family carers in the United Kingdom: a mixed methods study.
OBJECTIVES: We culturally adapted STrAtegies for RelaTives (START), a clinically and cost-effective intervention for dementia family carers, for Black and South Asian families. It had previously been delivered to family carers around the time of diagnosis, when most people with dementia had very mild, mild or moderate dementia. METHODS: We interviewed a maximum variation sample of family carers (phase one; n = 15 South Asian; n = 11 Black) about what aspect of START, required cultural adaptation, then analysed it thematically using the Cultural Treatment Adaptation Framework then adapted it in English and into Urdu. Facilitators then delivered START individually to carers (phase two; n = 13 South Asian; n = 8 Black). We assessed acceptability and feasibility through the number of sessions attended, score for fidelity to the intervention and interviewing family carers about their experiences. We used the Hospital Anxiety and Depression Scale. to examine whether immediate changes in family carers' mental health were in line with previous studies. RESULTS: in phase one we made adaptations to peripheral elements of START, clarifying language, increasing illustrative vignettes numbers, emphasising privacy and the facilitator's cultural competence and making images ethnically diverse. In phase two 21 family carers consented to receive the adapted intervention; 12 completed ≥5/8 sessions; four completed fewer sessions and five never started. Baseline HADS score (n = 21) was 14.4 (SD = 9.8) but for those who we were able to follow up was 12.3 (SD 8.1) and immediately post-intervention was 11.3 (n = 10; SD = 6.1). Family carers were positive about the adapted START and continued to use elements after the intervention. CONCLUSIONS: Culturally adapted START was acceptable and feasible in South Asian and Black UK-based family carers and changes in mental health were in line with those in the original clinical trial. Our study shows that culturally inclusive START was also acceptable. Changes made in adaptations were relevant to all populations. We now use the adapted version for all family carers irrespective of ethnicity.
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Kinsey D, Orr N, Anderson R, Lang I (2022). A conceptual model of the impact of including carers in museum programmes for people with dementia.
Dementia (London),
21(8), 2584-2600.
Abstract:
A conceptual model of the impact of including carers in museum programmes for people with dementia.
BACKGROUND: Research has highlighted a need for more theoretical work in arts interventions, including the role of the dyad. This study aimed to test theories from a literature review on the impact of including carers in museum programmes for people with dementia, and develop a model which can be used in other programmes to consider the impact of including carers more broadly. METHODS: Using a realist evaluation approach, theory was developed through interviews and participant-observation at six museums in the UK. FINDINGS: the impacts of including carers fell into seven broad areas - caring responsibility, session function, controlling access, preventing engagement, comparisons and losses, long-term impact of in-the-moment activities, and reducing social isolation and opening up the museum. CONCLUSIONS: Including carers may have both unanticipated benefits and negative consequences, and greater attention is needed on how both carers and people with dementia can be supported in shared sessions. Carers should be viewed as participants of programmes, and can even be the main beneficiaries, even where the programme is ostensibly 'for' the person with dementia - it's not simply that carers are the enablers of, or barriers to, the impacts on the person with dementia.
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Lord K, Kelleher D, Ogden M, Mason C, Rapaport P, Burton A, Leverton M, Downs M, Souris H, Jackson J, et al (2022). Co-designing complex interventions with people living with dementia and their supporters.
Dementia (London),
21(2), 426-441.
Abstract:
Co-designing complex interventions with people living with dementia and their supporters.
BACKGROUND AND OBJECTIVES: We engaged people living with dementia, family carers and health and social care professionals in co-designing two dementia care interventions: for family carers and people living with dementia (New Interventions for Independence in Dementia Study (NIDUS)-family and home-care workers (NIDUS-professional training programme). RESEARCH DESIGN AND METHODS: over October 2019-March 2020, we invited public and patient (PPI) and professional members of our NIDUS co-design groups to complete the PPI Engagement Evaluation Tool (designed to assess engagement activities), and non-professional PPI members to participate in qualitative telephone interviews. We thematically analysed and integrated mixed-methods findings. RESULTS: Most (15/20; 75%) of the PPI members approached participated. We identified four themes: (1) Creating the right atmosphere: participants found group meetings positive and enabling, though one health professional was unsure how to position themselves within them; (2) Participants influencing the outcome: while most members felt that they had some influence, for one carer consultation seemed too late to influence; (3) Having the right information: several carers wanted greater clarity and more regular updates from researchers; (4) Unique challenges for people living with dementia: memory problems presented challenges in engaging with substantial information, and within a large group. DISCUSSION AND IMPLICATIONS: We reflect on the importance of providing accessible, regular updates, managing power imbalances between co-design group members with lived and professional experiences; and ensuring needs and voices of people living with dementia are prioritised. We encourage future studies to incorporate evaluations of co-design processes into study design.
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Zabihi S, Duffy L, Kelleher D, Lord K, Dar A, Koutsoubelis F, Banks S, Rapaport P, Mason C, Vickerstaff V, et al (2022). Feasibility and acceptability of NIDUS-Professional, a training and support intervention for homecare workers caring for clients living with dementia: a cluster-randomised feasibility trial protocol.
BMJ Open,
12(12).
Abstract:
Feasibility and acceptability of NIDUS-Professional, a training and support intervention for homecare workers caring for clients living with dementia: a cluster-randomised feasibility trial protocol.
INTRODUCTION: Most people living with dementia want to remain living in their own homes, and are supported to do so by family carers and homecare workers. There are concerns that homecare is often unable to meet the needs of this client group, with limited evidence regarding effective interventions to improve it for people living with dementia. We have developed a training and support programme for homecare workers (NIDUS-Professional) to be delivered alongside support sessions for people living with dementia and their family carers (NIDUS-Family). We aim to assess (1) its acceptability among homecare workers and employing agencies, and (2) the feasibility of homecare workers, people living with dementia and their family carers completing the outcomes of intervention in a future randomised controlled trial. METHODS AND ANALYSIS: This is a cluster-randomised (2:1) single-blind, multisite feasibility trial. We aim to recruit 60-90 homecare workers, 30-60 clients living with dementia and their family carers through 6-9 English homecare agencies. In the intervention arm, homecare staff will be offered six group sessions on video call over three months, followed by monthly group sessions over the subsequent three-month period. Outcome measures will be collected at baseline and at six months. ETHICS AND DISSEMINATION: the study received ethical approval on 7 January 2020 from the Camden & King's Cross Research Ethics Committee. Study reference: 19/LO/1667. Findings will be disseminated through a peer-reviewed journal, conference presentation and blog to research and clinical audiences; we will attend forums to present findings to participating homecare agencies and their clients. TRIAL REGISTRATION NUMBER: ISRCTN15757555.
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Lang I, King A, Jenkins G, Boddy K, Khan Z, Liabo K (2022). How common is patient and public involvement (PPI)? Cross-sectional analysis of frequency of PPI reporting in health research papers and associations with methods, funding sources and other factors.
BMJ Open,
12(5).
Abstract:
How common is patient and public involvement (PPI)? Cross-sectional analysis of frequency of PPI reporting in health research papers and associations with methods, funding sources and other factors.
OBJECTIVES: Patient and public involvement (PPI) in health research is required by some funders and publications but we know little about how common it is. In this study we estimated the frequency of PPI inclusion in health research papers and analysed how it varied in relation to research topics, methods, funding sources and geographical regions. DESIGN: Cross-sectional. METHODS: Our sample consisted of 3000 research papers published in 2020 in a general health-research journal (BMJ Open) that requires a statement on whether studies included PPI. We classified each paper as 'included PPI' or 'did not include PPI' and analysed the association of this classification with location (country or region of the world), methods used, research topic (journal section) and funding source. We used adjusted regression models to estimate incident rate ratios of PPI inclusion in relation to these differences. RESULTS: 618 (20.6%) of the papers in our sample included PPI. The proportion of papers including PPI varied in relation to location (from 44.5% (95% CI 40.8% to 48.5%) in papers from the UK to 3.4% (95% CI 1.5% to 5.3%) in papers from China), method (from 38.6% (95% CI 27.1% to 50.1%) of mixed-methods papers to 5.3% (95% CI -1.9% to 12.5%) of simulation papers), topic (from 36.9% (95% CI 29.1% to 44.7%) of papers on mental health to 3.4% (95% CI -1.3% to 8.2%) of papers on medical education and training, and funding source (from 57.2% (95% CI 51.8% to 62.6%) in papers that received funding from the UK's National Institute for Health Research to 3.4% (95% CI 0.7% to 6.0%) in papers that received funding from a Chinese state funder). CONCLUSIONS: Most research papers in our sample did not include PPI and PPI inclusion varied widely in relation to location, methods, topic and funding source.
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Poppe M, Duffy L, Marchant NL, Barber JA, Hunter R, Bass N, Minihane AM, Walters K, Higgs P, Rapaport P, et al (2022). The APPLE Tree programme: Active Prevention in People at risk of dementia through Lifestyle, bEhaviour change and Technology to build REsiliEnce—randomised controlled trial.
Trials,
23(1).
Abstract:
The APPLE Tree programme: Active Prevention in People at risk of dementia through Lifestyle, bEhaviour change and Technology to build REsiliEnce—randomised controlled trial
Abstract
. Background
. Large-scale trials of multidomain interventions show that modifying lifestyle and psychological risk factors can slow cognitive decline. We aim to determine if a lower intensity, personally tailored secondary dementia prevention programme for older people with subjective or mild objective memory decline, informed by behaviour change theory, reduces cognitive decline over 2 years.
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. Methods
. A multi-site, single-blind randomised controlled trial recruiting 704 older adults at high dementia risk due to mild cognitive impairment (MCI) or subjective cognitive decline (SCD). Participants are randomised using 1:1 allocation ratio to the APPLE Tree intervention versus control arm (dementia prevention information), stratified by site. The intervention explores and implements strategies to promote healthy lifestyle, increase pleasurable activities and social connections and improve long-term condition self-management. Two facilitators trained and supervised by a clinical psychologist deliver ten, 1-h group video call sessions over 6 months (approximately every fortnight), video-call ‘tea breaks’ (less structured, facilitated social sessions) in intervening weeks and individual goal-setting phone calls every 2 weeks. From 6 to 12 months, participants meet monthly for ‘tea breaks’, with those not attending receiving monthly goal-setting phone calls. Participants receive a food delivery, pedometer and website access to cognitive training and information about lifestyle modification. Follow-ups for all outcome measures are at 12 and 24 months. The primary outcome is cognition (Neuropsychological Test Battery (NTB) score) at 24 months. Secondary outcomes are quality of life, cost per quality-adjusted life year (QALY) and wellbeing and lifestyle factors the intervention targets (diet, vascular risk, body weight, activity, sleep, anxiety, depression, social networks and loneliness, alcohol intake and smoking). Participants from purposively selected sites participate in qualitative process evaluation interviews, which will be analysed using thematic analytic methods.
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. Discussion
. If effective, the intervention design, involving remote delivery and non-clinical facilitators, would facilitate intervention roll-out to older people with memory concerns.
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. Trial registration
. ISRCTN17325135. Registration date 27 November 2019
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Abstract.
Wilkinson K, Day J, Thompson-Coon J, Goodwin V, Liabo K, Coxon G, Cox G, Marriott C, Lang IA (2021). A realist evaluation of a collaborative model to support research co-production in long-term care settings in England: the ExCHANGE protocol.
Res Involv Engagem,
7(1).
Abstract:
A realist evaluation of a collaborative model to support research co-production in long-term care settings in England: the ExCHANGE protocol.
BACKGROUND: Collaborative working between academic institutions and those who provide health and social care has been identified as integral in order to produce acceptable, relevant, and timely research, and for outputs to be useful and practical to implement. The ExCHANGE Collaboration aims to bring together researchers and people working, living in and visiting care homes to build capacity, share and mobilise knowledge, and identify key areas for future research. This paper describes an embedded, formative, realist and theory-driven evaluation which aims to gather information about how successful the ExCHANGE Collaboration is perceived to be in achieving its aims. An existing realist programme theory from the literature - Closer Collaboration - will be supplemented by two substantive theories: Co-production and Knowledge Brokering. This will result in an initial programme theory which will be tested by this formative evaluation to refine understanding of how the ExCHANGE Collaboration works. METHODS: the evaluation will employ mixed qualitative methods, including: analysis of documents such as feedback forms, Knowledge Broker journal/diary, event attendance records, risk and issues logs and other relevant paperwork gathered as part of project delivery; observations of events/activities; and interviews with care home providers and staff, care home residents, residents' family members, and researchers who are involved in the project (both project design/delivery, and also attendance or involvement in project activities/events). Framework Analysis will be used to interpret the data collected; analysis will be strategic, by focusing on particular key areas of importance in the developing theory of how the ExCHANGE Collaboration might achieve change. RESULTS: the results of this study are expected to be published in 2022. DISCUSSION: This evaluation will investigate how successful the ExCHANGE Collaboration is perceived to be in achieving its aims, in what way, in which contexts, and how this may differ for those involved. It will do this by testing an initial programme theory about how the collaboration works, for whom, under which circumstances, and in what way. Findings will be shared through written publication, an end of project learning event for those involved/interested in the project, and a lay summary to be made publically available.
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Sheaff R, Doran N, Harris M, Lang I, Medina-Lara A, Fornasiero M, Ball S, McGregor-Harper J, Bethune R (2021). Categories of context in realist evaluation.
Evaluation,
27(2), 184-209.
Abstract:
Categories of context in realist evaluation
Realist evaluation has become widespread partly because of its sensitivity to the influence of contexts on policy implementation. In many such evaluations, the range of contexts considered relevant nevertheless remains disparate and under-conceptualised. This article uses findings from a realist evaluation of English Patient Safety Collaboratives during 2015–2018 to develop a realist taxonomy of contexts, differentiating contexts according to how they affect the corresponding policy mechanism. By analysing the main context-mechanism-outcome configurations that made up the English Patient Safety Collaboratives, we derive a taxonomy of the contexts that affected implementation and outcomes. The categories of context were structural (network, hierarchy, market and organisational contexts); resource-based (actors, material, financial); motivational (receptivity, outcome headroom), and temporal (continuity, history and convergence). To the categories found in previous studies, this study adds the three temporal contexts.
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Burton A, Rapaport P, Palomo M, Lord K, Budgett J, Barber J, Hunter R, Butler L, Vickerstaff J, Rockwood K, et al (2021). Clinical and cost-effectiveness of a New psychosocial intervention to support Independence in Dementia (NIDUS-family) for family carers and people living with dementia in their own homes: a randomised controlled trial.
Trials,
22(1).
Abstract:
Clinical and cost-effectiveness of a New psychosocial intervention to support Independence in Dementia (NIDUS-family) for family carers and people living with dementia in their own homes: a randomised controlled trial.
BACKGROUND: Most people living with dementia want to remain living in their own homes and are supported to do so by family carers. No interventions have consistently demonstrated improvements to people with dementia's life quality, functioning, or other indices of living as well as possible with dementia. We have co-produced, with health and social care professionals and family carers of people with dementia, a new intervention (NIDUS-family). To our knowledge, NIDUS-family is the first manualised intervention that can be tailored to personal goals of people living with dementia and their families and is delivered by facilitators without clinical training. The intervention utilizes components of behavioural management, carer support, psychoeducation, communication and coping skills training, enablement, and environmental adaptations, with modules selected to address dyads' selected goals. We will evaluate the effect of NIDUS-family and usual care on goal attainment, as measured by Goal Attainment Scaling (GAS) rated by family carers, compared to usual care alone at 12-month follow-up. We will also determine whether NIDUS-family and usual care is more cost-effective than usual care alone over 12 months. METHODS: a randomised, two-arm, single-masked, multi-site clinical trial involving 297 people living with dementia-family carer dyads. Dyads will be randomised 2:1 to receive the NIDUS-family intervention with usual care (n = 199) or usual care alone (n = 98). The intervention group will be offered, over 1 year, via 6-8 video call or telephone sessions (or face to face if COVID-19 restrictions allow in the recruitment period) in the initial 6 months, followed by telephone follow-ups every 1-2 months to support implementation, with a trained facilitator. DISCUSSION: Increasing the time lived at home by people living with dementia is likely to benefit lives now and in the future. Our intervention, which we adapted to include remote delivery prior to trial commencement due to the COVID-19 pandemic, aims to address barriers to living as well and as independently as possible that distress people living with dementia, exacerbate family carer(s) stress, negatively affect relationships, lead to safety risks, and frequently precipitate avoidable moves to a care home. TRIAL REGISTRATION: International Standard Randomised Controlled Trials Number ISRCTN11425138. Registered on 7 October 2019.
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Amador S, Rapaport P, Lang I, Sommerlad A, Mukadam N, Stringer A, Hart N, Nurock S, Livingston G (2021). Implementation of START (STrAtegies for RelaTives) for dementia carers in the third sector: Widening access to evidence-based interventions.
PLoS One,
16(6).
Abstract:
Implementation of START (STrAtegies for RelaTives) for dementia carers in the third sector: Widening access to evidence-based interventions.
Family members remain the main care providers for the increasing numbers of people with dementia, and often become depressed or anxious. In an implementation research project, we aimed to widen access to Strategies for RelaTives (START), a clinically and cost-effective intervention for the mental health of family carers, by laying the foundations for its implementation in the third sector. We used the integrated Promoting Action on Research Implementation in Health Services (i-PARIHS) framework to guide implementation of START, a manual-based, individually-delivered, multicomponent eight-session coping strategy intervention. We interviewed a maximum variation sample of twenty-seven stakeholders from the English Alzheimer's Society (AS), about possible difficulties in management, training, and delivery of START. We trained and supervised three AS dementia support workers in different locations, to each deliver START to three family carers. Two researchers independently coded pre-intervention interviews for themes. We assessed intervention feasibility through monitoring delivery fidelity, rating audio-recordings from 1-5 (5 being high) and interviewing facilitators, family carers and AS managers about their experiences. We assessed effectiveness on family carers' mental health using the Hospital Anxiety and Depression Scale (HADS) before and after receiving START (scores 0-42). We changed START's format by reflecting carer diversity more and increasing carer stories prominence, but core content or delivery processes were unchanged. All carers received START and attended every session. The mean fidelity score was 4.2. Mean HADS-total score reduced from baseline 18.4 (standard deviation 7.4) to follow-up 15.8 (9.7). Six (67%) carers scored as clinically depressed on baseline HADS and 2 (22%) at follow-up. Facilitators and carers rated START positively. Appropriately experienced third sector workers can be trained and supervised to deliver START and it remains effective. This has the potential for widened access at scale.
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Cooper C, Mansour H, Carter C, Rapaport P, Morgan-Trimmer S, Marchant NL, Poppe M, Higgs P, Brierley J, Solomon N, et al (2021). Social connectedness and dementia prevention: Pilot of the APPLE-Tree video-call intervention during the Covid-19 pandemic.
Dementia (London),
20(8), 2779-2801.
Abstract:
Social connectedness and dementia prevention: Pilot of the APPLE-Tree video-call intervention during the Covid-19 pandemic.
BACKGROUND AND OBJECTIVES: the Covid-19 pandemic reduced access to social activities and routine health care that are central to dementia prevention. We developed a group-based, video-call, cognitive well-being intervention; and investigated its acceptability and feasibility; exploring through participants' accounts how the intervention was experienced and used in the pandemic context. RESEARCH DESIGN AND METHOD: We recruited adults aged 60+ years with memory concerns (without dementia). Participants completed baseline assessments and qualitative interviews/focus groups before and after the 10-week intervention. Qualitative interview data and facilitator notes were integrated in a thematic analysis. RESULTS: 12/17 participants approached completed baseline assessments, attended 100/120 (83.3%) intervention sessions and met 140/170 (82.4%) of goals set. Most had not used video calling before. In the thematic analysis, our overarching theme was social connectedness. Three sub-themes were as follows: Retaining independence and social connectedness: social connectedness could not be at the expense of independence; Adapting social connectedness in the pandemic: participants strived to compensate for previous social connectedness as the pandemic reduced support networks; Managing social connections within and through the intervention: although there were tensions, for example, between sharing of achievements feeling supportive and competitive, participants engaged with various lifestyle changes; social connections supported group attendance and implementation of lifestyle changes. DISCUSSION AND IMPLICATIONS: Our intervention was acceptable and feasible to deliver by group video-call. We argue that dementia prevention is both an individual and societal concern. For more vulnerable populations, messages that lifestyle change can help memory should be communicated alongside supportive, relational approaches to enabling lifestyle changes.
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Cooper C, Aguirre E, Barber JA, Bass N, Brodaty H, Burton A, Higgs P, Hunter R, Huntley J, Lang I, et al (2020). APPLE-Tree (Active Prevention in People at risk of dementia: Lifestyle, bEhaviour change and Technology to REducE cognitive and functional decline) programme: Protocol.
Int J Geriatr Psychiatry,
35(8), 811-819.
Abstract:
APPLE-Tree (Active Prevention in People at risk of dementia: Lifestyle, bEhaviour change and Technology to REducE cognitive and functional decline) programme: Protocol.
BACKGROUND: Observational studies indicate that approximately a third of dementia cases are attributable to modifiable cardiometabolic, physical and mental health, and social and lifestyle risk factors. There is evidence that intensive behaviour change interventions targeting these factors can reduce cognitive decline. [Figure: see text] METHODS AND ANALYSIS: We will design and test a low intensity, secondary dementia-prevention programme (Active Prevention in People at risk of dementia: Lifestyle, bEhaviour change and Technology to REducE cognitive and functional decline, "APPLE-Tree") to slow cognitive decline in people with subjective cognitive decline with or without objective cognitive impairment. We will embed our work within social science research to understand how dementia prevention is currently delivered and structured. We will carry out systematic reviews and around 50 qualitative interviews with stakeholders, using findings to coproduce the APPLE-Tree intervention. We plan a 10-session group intervention, involving personalised goal-setting, with individual sessions for those unable or unwilling to attend groups, delivered by psychology assistants who will be trained and supervised by clinical psychologists. The coproduction group (including public and patient involvement [PPI], academic and clinical/third-sector professional representatives) will use the Behaviour Change Wheel theoretical framework to develop it. We will recruit and randomly allocate 704 participants, 1:1 to the intervention: informational control group. This sample size is sufficient to detect a between-group difference at 2 years of 0.15 on the primary outcome (cognition: modified neuropsychological test battery; 90% power, 5% significance, effect size 0.25, SD 0.6). DISSEMINATION: We will work with Public Health England and third-sector partners to produce an effective national implementation approach, so that if our intervention works, it is used in practice.
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Lord K, Beresford-Dent J, Rapaport P, Burton A, Leverton M, Walters K, Lang I, Downs M, Manthorpe J, Boex S, et al (2020). Developing the New Interventions for independence in Dementia Study (NIDUS) theoretical model for supporting people to live well with dementia at home for longer: a systematic review of theoretical models and Randomised Controlled Trial evidence.
Soc Psychiatry Psychiatr Epidemiol,
55(1), 1-14.
Abstract:
Developing the New Interventions for independence in Dementia Study (NIDUS) theoretical model for supporting people to live well with dementia at home for longer: a systematic review of theoretical models and Randomised Controlled Trial evidence.
PURPOSE: to build an evidence-informed theoretical model describing how to support people with dementia to live well or for longer at home. METHODS: We searched electronic databases to August 2018 for papers meeting predetermined inclusion criteria in two reviews that informed our model. We scoped literature for theoretical models of how to enable people with dementia to live at home independently, with good life quality or for longer. We systematically reviewed Randomised Controlled Trials (RCTs) reporting psychosocial intervention effects on time lived with dementia at home. Two researchers independently rated risk of bias. We developed our theoretical model through discussions with experts by personal, clinical and academic experiences, informed by this evidence base. RESULTS: Our scoping review included 52 studies. We divided models identified into: values and approaches (relational and recovery models; optimising environment and activities; family carer skills and support); care strategies (family carer-focused; needs and goal-based; self-management); and service models (case management; integrated; consumer-directed). The 11 RCTs included in our systematic review, all judged at low risk of bias, described only two interventions that increased time people with dementia lived in their own homes. These collectively encompassed all these components except for consumer-directed and integrated care. We developed and revised our model, using review evidence and expert consultation to define the final model. CONCLUSIONS: Our theoretical model describes values, care strategies and service models that can be used in the design of interventions to enable people with dementia to live well and for longer at home. TRIAL REGISTRATION: PROSPERO 2018 registration number: CRD42018099693 (scoping review). PROSPERO 2018 registration number: CRD42018099200 (RCT systematic review).
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Whitty E, Mansour H, Aguirre E, Palomo M, Charlesworth G, Ramjee S, Poppe M, Brodaty H, Kales HC, Morgan-Trimmer S, et al (2020). Efficacy of lifestyle and psychosocial interventions in reducing cognitive decline in older people: Systematic review.
Ageing Res Rev,
62Abstract:
Efficacy of lifestyle and psychosocial interventions in reducing cognitive decline in older people: Systematic review.
It is unclear what non-pharmacological interventions to prevent cognitive decline should comprise. We systematically reviewed lifestyle and psychosocial interventions that aimed to reduce cognitive decline in healthy people aged 50+, and people of any age with Subjective Cognitive Decline or Mild Cognitive Impairment. We narratively synthesised evidence, prioritising results from studies rated as at lower Risk of Bias (ROB) and assigning Centre for Evidence Based Medicine grades. We included 64 papers, describing: psychosocial (n = 12), multi-domain (n = 10), exercise (n = 36), and dietary (n = 6) interventions. We found Grade a evidence that over 4+ months: aerobic exercise twice weekly had a moderate effect on global cognition in people with/ without MCI; and interventions that integrate cognitive and motor challenges (e.g. dance, dumb bell training) had small to moderate effects on memory or global cognition in people with MCI. We found Grade B evidence that 4+ months of creative art or story-telling groups in people with MCI; 6 months of resistance training in people with MCI and a two-year, dietary, exercise, cognitive training and social intervention in people with or without MCI had small, positive effects on global cognition. Effects for some intervention remained up to a year beyond facilitated sessions.
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Gordon EH, Peel NM, Chatfield MD, Lang IA, Hubbard RE (2020). Frailty: a cost incurred by reproduction?.
Sci Rep,
10(1).
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Frailty: a cost incurred by reproduction?
Evolutionary theories of senescence, such as the 'disposable soma' theory, propose that natural selection trades late survival for early fecundity. 'Frailty', a multidimensional measure of health status, may help to better define the long-term consequences of reproduction. We examined the relationship between parity and later life frailty (as measured by the Frailty Index) in a sample of 3,534 adults aged 65 years and older who participated in the English Longitudinal Study of Ageing. We found that the most parous adults were the most frail and that the parity-frailty relationship was similar for both sexes. Whilst this study provided some evidence for a 'parity-frailty trade-off', there was little support for our hypothesis that the physiological costs of childbearing influence later life frailty. Rather, behavioural and social factors associated with rearing many children may have contributed to the development of frailty in both sexes.
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Day J, Dean SG, Reed N, Hazell J, Lang I (2020). Knowledge needs and use in long‐term care homes for older people: a qualitative interview study of managers’ views. Health & Social Care in the Community, 30(2), 592-601.
Husk K, Blockley K, Lovell R, Bethel A, Lang I, Byng R, Garside R (2020). What approaches to social prescribing work, for whom, and in what circumstances? a realist review.
Health and Social Care in the Community,
28(2), 309-324.
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What approaches to social prescribing work, for whom, and in what circumstances? a realist review
The use of non-medical referral, community referral or social prescribing interventions has been proposed as a cost-effective alternative to help those with long-term conditions manage their illness and improve health and well-being. However, the evidence base for social prescribing currently lags considerably behind practice. In this paper, we explore what is known about whether different methods of social prescribing referral and supported uptake do (or do not) work. Supported by an Expert Advisory Group, we conducted a realist review in two phases. The first identified evidence specifically relating to social prescribing in order to develop programme theories in the form of ‘if-then’ statements, articulating how social prescribing models are expected to work. In the second phase, we aimed to clarify these processes and include broader evidence to better explain the proposed mechanisms. The first phase resulted in 109 studies contributing to the synthesis, and the second phase 34. We generated 40 statements relating to organising principles of how the referral takes place (Enrolment), is accepted (Engagement), and completing an activity (Adherence). Six of these statements were prioritised using web-based nominal group technique by our Expert Group. Studies indicate that patients are more likely to enrol if they believe the social prescription will be of benefit, the referral is presented in an acceptable way that matches their needs and expectations, and concerns elicited and addressed appropriately by the referrer. Patients are more likely to engage if the activity is both accessible and transit to the first session supported. Adherence to activity programmes can be impacted through having an activity leader who is skilled and knowledgeable or through changes in the patient's conditions or symptoms. However, the evidence base is not sufficiently developed methodologically for us to make any general inferences about effectiveness of particular models or approaches.
Abstract.
Kinsey D, Lang I, Orr N, Anderson R, Parker D (2019). The impact of including carers in museum programmes for people with dementia: a realist review. Arts & Health, 13(1), 1-19.
Ballard C, Lang I (2018). Alcohol and dementia: a complex relationship with potential for dementia prevention. The Lancet Public Health, 3(3), e103-e104.
Lang IA, Ronquillo C, Day J, Britten N, Stein KWT, Warmoth KM (2018). An Implementation Science Perspective on Deprescribing. Public Policy & Aging Report, 28, 134-139.
Hall AJ, Burrows L, Lang I, Endacott R, Goodwin V (2018). Are physiotherapists employing person-centred care for people with dementia? an exploratory qualitative study examining the experiences of people with dementia and their carers. BMC Geriatrics
Ranson JM, Kuźma E, Hamilton W, Lang I, Llewellyn DJ (2018). Case-finding in clinical practice: an appropriate strategy for dementia identification?.
Alzheimer's and Dementia: Translational Research and Clinical Interventions,
4, 288-296.
Abstract:
Case-finding in clinical practice: an appropriate strategy for dementia identification?
Earlier diagnosis of dementia is increasingly being recognized as a public health priority. As screening is not generally recommended, case-finding in clinical practice is encouraged as an alternative dementia identification strategy. The approaches of screening and case-finding are often confused, with uncertainty about what case-finding should involve and under what circumstances it is appropriate. We propose a formal definition of dementia case-finding with a clear distinction from screening. We critically examine case-finding policy and practice and propose evidence requirements for implementation in clinical practice. Finally, we present a case-finding pathway and discuss the available evidence for best practice at each stage, with recommendations for research and practice. In conclusion, dementia case-finding is a promising strategy but currently not appropriate due to the substantial gaps in the evidence base for several components of this approach.
Abstract.
Hudson RB (2018). Gerontology’s Political Blind Spot. Public Policy & Aging Report, 28(1), 4-8.
Fitzgerald I, Ewings P, Lang I, Appelboam A (2018). Testing of a novel Valsalva Assist Device with supine and modified positions in healthy volunteers.
Emergency Medicine Journal,
36(1), 27-31.
Abstract:
Testing of a novel Valsalva Assist Device with supine and modified positions in healthy volunteers
© 2019 Author(s). Background the Valsalva manoeuvre (VM) is used to treat supraventricular tachycardia (SVT) by inducing a vagal response (drop in HR). There is debate as to the best position in which to carry out the VM and how the strain should be delivered in practice. We aimed to compare vagal responses induced with supine and modified VMs using strains delivered with a standardised manometer or novel Valsalva Assist Device (VAD), a simple device to provide resistance to exhalation. Methods We conducted a repeated measures randomised trial of four VMs (two supine VM and two modified VMs), in healthy adult volunteers, with strains delivered using an adapted sphygmomanometer (manometer) or a VAD. Changes in HR, pressure and duration of strain and adverse events were monitored and compared between the techniques and devices. The trial was approved by the University of Exeter Medical School Research ethics committee. Results 75 healthy participants aged 19-55 years were recruited over a 4-month period. A mixed-effects linear regression showed the modified VM resulted in a 3.8 beats per min (bpm) greater drop in HR compared with the supine VM (p=0.002, 95% CI 2.2 to 5.4). VM strains produced by the VAD were of a similar pressure but of slightly shorter duration and resulted in a 1.9 bpm smaller drop in HR compared with the manometer (p=0.01, 95% CI 0.4 to 3.4). There were no differences in adverse events. Conclusions Modified VM was associated with a greater drop in HR than a supine VM with no increase in adverse events in healthy volunteers. The VAD can be used to safely generate the recommended VM strain pressure, but produced a smaller drop in HR compared with a manometer and requires modification to enable the recommended strain duration to be achieved consistently.
Abstract.
Manzi S, Chalk D, Day J, Pearson M, Lang I, Stein K, Pitt M (2017). A novel modelling and simulation capacity development initiative for the National Health Service. BMJ Simulation and Technology Enhanced Learning, 4(2), 97-98.
Lovell R, Husk K, Blockley KV, Bethel A, Bloomfield D, Sara W, Pearson MGN, Lang IA, Byng R, Garside R, et al (2017). A realist review and collaborative development of what works in the social prescribing process. Lancet, 390, s62-s62.
Kuźma E, Airdrie J, Littlejohns TJ, Lourida I, Thompson-Coon J, Lang IA, Scrobotovici M, Thacker EL, Fitzpatrick A, Kuller LH, et al (2017). Coronary Artery Bypass Graft Surgery and Dementia Risk in the Cardiovascular Health Study.
Alzheimer Disease and Associated Disorders,
31(2), 120-127.
Abstract:
Coronary Artery Bypass Graft Surgery and Dementia Risk in the Cardiovascular Health Study
Introduction: the association between history of coronary artery bypass graft surgery (CABG) and dementia risk remains unclear. Methods: We conducted a prospective cohort analysis using data on 3155 elderly adults free from prevalent dementia from the US population-based Cardiovascular Health Study (CHS) with adjudicated incident all-cause dementia, Alzheimer disease (AD), vascular dementia (VaD), and mixed dementia. Results: in the CHS, the hazard ratio (HR) for all-cause dementia was 1.93 [95% confidence interval (CI), 1.36-2.74] for those with CABG history compared with those with no CABG history after adjustment for potential confounders. Similar HRs were observed for AD (HR=1.71; 95% CI, 0.98-2.98), VaD (HR=1.42; 95% CI, 0.56-3.65), and mixed dementia (HR=2.73; 95% CI, 1.55-4.80). The same pattern of results was observed when these CHS findings were pooled with a prior prospective study, the pooled HRs were 1.96 (95% CI, 1.42-2.69) for all-cause dementia, 1.71 (95% CI, 1.04-2.79) for AD and 2.20 (95% CI, 0.78-6.19) for VaD. Discussion: Our results suggest CABG history is associated with long-term dementia risk. Further investigation is warranted to examine the causal mechanisms which may explain this relationship or whether the association reflects differences in coronary artery disease severity.
Abstract.
Lourida I, Abbott RA, Rogers M, Lang IA, Stein K, Kent B, Thompson Coon J (2017). Dissemination and implementation research in dementia care: a systematic scoping review and evidence map.
BMC Geriatr,
17(1).
Abstract:
Dissemination and implementation research in dementia care: a systematic scoping review and evidence map.
BACKGROUND: the need to better understand implementing evidence-informed dementia care has been recognised in multiple priority-setting partnerships. The aim of this scoping review was to give an overview of the state of the evidence on implementation and dissemination of dementia care, and create a systematic evidence map. METHODS: We sought studies that addressed dissemination and implementation strategies or described barriers and facilitators to implementation across dementia stages and care settings. Twelve databases were searched from inception to October 2015 followed by forward citation and grey literature searches. Quantitative studies with a comparative research design and qualitative studies with recognised methods of data collection were included. Titles, abstracts and full texts were screened independently by two reviewers with discrepancies resolved by a third where necessary. Data extraction was performed by one reviewer and checked by a second. Strategies were mapped according to the ERIC compilation. RESULTS: Eighty-eight studies were included (30 quantitative, 34 qualitative and 24 mixed-methods studies). Approximately 60% of studies reported implementation strategies to improve practice: training and education of professionals (94%), promotion of stakeholder interrelationships (69%) and evaluative strategies (46%) were common; financial strategies were rare (15%). Nearly 70% of studies reported barriers or facilitators of care practices primarily within residential care settings. Organisational factors, including time constraints and increased workload, were recurrent barriers, whereas leadership and managerial support were often reported to promote implementation. Less is known about implementation activities in primary care and hospital settings, or the views and experiences of people with dementia and their family caregivers. CONCLUSION: This scoping review and mapping of the evidence reveals a paucity of robust evidence to inform the successful dissemination and implementation of evidence-based dementia care. Further exploration of the most appropriate methods to evaluate and report initiatives to bring about change and of the effectiveness of implementation strategies is necessary if we are to make changes in practice that improve dementia care.
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Hall AJ, Lang IA, Endacott R, Hall A, Goodwin VA (2017). Physiotherapy interventions for people with dementia and a hip fracture—a scoping review of the literature. Physiotherapy, 103(4), 361-368.
Warmoth KM, Tarrant M, Abraham, Lang (2017). Relationship between perceptions of ageing and frailty in English older adults. Psychology, Health and Medicine, 23(4), 465-474.
Hall AJ, Watkins R, Lang IA, Endacott R, Goodwin VA (2017). The experiences of physiotherapists treating people with dementia who fracture their hip.
BMC Geriatr,
17(1).
Abstract:
The experiences of physiotherapists treating people with dementia who fracture their hip.
BACKGROUND: it is estimated that people with dementia are approximately three times more likely to fracture their hip than sex and age matched controls. A report by the Chartered Society of Physiotherapy found that this population have poor access to rehabilitation as inpatients and in the community. A recent scoping review found a paucity of research in this area, indeed there has been no qualitative research undertaken with physiotherapists. In order to address this evidence gap, the aim of this current study was to explore the experiences of physiotherapists treating this population. METHODS: Semi-structured interviews with physiotherapists were undertaken in order to gain an in-depth understanding of how they manage this population. Physiotherapists were recruited from all over the UK and a purposive sampling strategy was employed. Thematic analysis was utilised. RESULTS: a total of 12 physiotherapists were interviewed, at which stage data saturation was reached as no new themes were emerging. The participants had a broad range of experience both in physical and mental health settings. Analysis identified three separate themes: challenges, "thinking outside the box" and realising potential. Physiotherapists felt significant pressures and challenges regarding many aspects of the management of this population. Mainly this was the result of pressures placed on them by guidelines and targets that may not be achievable or appropriate for those with dementia. The challenges and importance of risk taking was also highlighted for this population with an appreciation that standard treatment techniques may need adapting. "Rehabilitation potential" was highlighted as an important consideration, but challenging to determine. CONCLUSION: Interventions for the management of people with dementia and hip fracture need to consider that a traditional biomedical physiotherapy approach may not be the most appropriate approach to use with this population. However physiotherapists reported feeling pressurised to conform to a biomedical approach.
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Warmoth K, Lang IA, Phoenix C, Abraham C, Andrew MK, Hubbard RE, Tarrant M (2016). 'Thinking you're old and frail': a qualitative study of frailty in older adults.
Ageing and Society,
36(7), 1483-1500.
Abstract:
'Thinking you're old and frail': a qualitative study of frailty in older adults
Many older adults experience what is clinically recognised as frailty but little is known about the perceptions of, and attitudes regarding, being frail. This qualitative study explored adults' perceptions of frailty and their beliefs concerning its progression and consequences. Twenty-nine participants aged 66-98 with varying degrees of frailty, residing either in their homes or institutional settings, participated in semi-structured interviews. Verbatim transcripts were analysed using a Grounded Theory approach. Self-identifying as 'frail' was perceived by participants to be strongly related to their own levels of health and engagement in social and physical activity. Being labelled by others as 'old and frail' contributed to the development of a frailty identity by encouraging attitudinal and behavioural confirmation of it, including a loss of interest in participating in social and physical activities, poor physical health and increased stigmatisation. Using both individual and social context, different strategies were used to resist self-identification. The study provides insights into older adults' perceptions and attitudes regarding frailty, including the development of a frailty identity and its relationship with activity levels and health. The implications of these findings for future research and practice are discussed.
Abstract.
Lang IA, Hardwick R (2016). Knowledge, knowledge mobilisation and the third sector.
Voluntary Sector Review,
7(2), 209-218.
Abstract:
Knowledge, knowledge mobilisation and the third sector
This paper is about third sector organisations (TSOs) and how they use knowledge. Drawing from the emerging field of knowledge mobilisation, we argue that current policy and thinking about knowledge and TSOs too often employ a simplistic set of assumptions. We propose that there are many benefits to be had from taking an approach that acknowledges complexity and engages TSOs more deeply in knowledge production and use.
Abstract.
Warmoth K, Tarrant M, Abraham C, Lang IA (2016). Older adults' perceptions of ageing and their health and functioning: a systematic review of observational studies.
Psychol Health Med,
21(5), 531-550.
Abstract:
Older adults' perceptions of ageing and their health and functioning: a systematic review of observational studies.
Many older people perceive ageing negatively, describing it in terms of poor or declining health and functioning. These perceptions may be related to older adults' health. The aim of this review was to synthesise existing research on the relationship between older adults' perceptions of ageing and their health and functioning. A systematic search was conducted of five electronic databases (ASSIA, CINAHL, IBSS, MEDLINE and PsycINFO). Citations within identified reports were also searched. Observational studies were included if they included perceptions of ageing and health-related measures involving participants aged 60 years and older. Study selection, data extraction and quality appraisal were conducted using predefined criteria. Twenty-eight reports met the criteria for inclusion. Older adults' perceptions of ageing were assessed with a variety of measures. Perceptions were related to health and functioning across seven health domains: memory and cognitive performance, physical and physiological performance, medical conditions and outcomes, disability, care-seeking, self-rated health, quality of life and death. How ageing is perceived by older adults is related to their health and functioning in multiple domains. However, higher quality and longitudinal studies are needed to further investigate this relationship.
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Kuźma E, Soni M, Littlejohns TJ, Ranson JM, van Schoor NM, Deeg DJH, Comijs H, Chaves PHM, Kestenbaum BR, Kuller LH, et al (2016). Vitamin D and Memory Decline: Two Population-Based Prospective Studies.
J Alzheimers Dis,
50(4), 1099-1108.
Abstract:
Vitamin D and Memory Decline: Two Population-Based Prospective Studies.
BACKGROUND: Vitamin D deficiency has been linked with dementia risk, cognitive decline, and executive dysfunction. However, the association with memory remains largely unknown. OBJECTIVE: to investigate whether low serum 25-hydroxyvitamin D (25(OH)D) concentrations are associated with memory decline. METHODS: We used data on 1,291 participants from the US Cardiovascular Health Study (CHS) and 915 participants from the Dutch Longitudinal Aging Study Amsterdam (LASA) who were dementia-free at baseline, had valid vitamin D measurements, and follow-up memory assessments. The Benton Visual Retention Test (in the CHS) and Rey's Auditory Verbal Learning Test (in the LASA) were used to assess visual and verbal memory, respectively. RESULTS: in the CHS, those moderately and severely deficient in serum 25(OH)D changed -0.03 SD (95% CI: -0.06 to 0.01) and -0.10 SD (95% CI: -0.19 to -0.02) per year respectively in visual memory compared to those sufficient (p = 0.02). In the LASA, moderate and severe deficiency in serum 25(OH)D was associated with a mean change of 0.01 SD (95% CI: -0.01 to 0.02) and -0.01 SD (95% CI: -0.04 to 0.02) per year respectively in verbal memory compared to sufficiency (p = 0.34). CONCLUSIONS: Our findings suggest an association between severe vitamin D deficiency and visual memory decline but no association with verbal memory decline. They warrant further investigation in prospective studies assessing different memory subtypes.
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Littlejohns TJ, Kos K, Henley WE, Lang IA, Annweiler C, Beauchet O, Chaves PHM, Kestenbaum BR, Kuller LH, Langa KM, et al (2016). Vitamin D and Risk of Neuroimaging Abnormalities.
PLoS One,
11(5).
Abstract:
Vitamin D and Risk of Neuroimaging Abnormalities.
Vitamin D deficiency has been linked with an increased risk of incident all-cause dementia and Alzheimer's disease. The aim of the current study was to explore the potential mechanisms underlying these associations by determining whether low vitamin D concentrations are associated with the development of incident cerebrovascular and neurodegenerative neuroimaging abnormalities. The population consisted of 1,658 participants aged ≥65 years from the US-based Cardiovascular Health Study who were free from prevalent cardiovascular disease, stroke and dementia at baseline in 1992-93. Serum 25-hydroxyvitamin D (25(OH)D) concentrations were determined by liquid chromatography-tandem mass spectrometry from blood samples collected at baseline. The first MRI scan was conducted between 1991-1994 and the second MRI scan was conducted between 1997-1999. Change in white matter grade, ventricular grade and presence of infarcts between MRI scan one and two were used to define neuroimaging abnormalities. During a mean follow-up of 5.0 years, serum 25(OH)D status was not significantly associated with the development of any neuroimaging abnormalities. Using logistic regression models, the multivariate adjusted odds ratios (95% confidence interval) for worsening white matter grade in participants who were severely 25(OH)D deficient (
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Husk K, Blockley K, Lovell R, Bethel A, Bloomfield D, Warber S, Pearson M, Lang I, Byng R, Garside R, et al (2016). What approaches to social prescribing work, for whom, and in what circumstances? a protocol for a realist review.
Syst Rev,
5Abstract:
What approaches to social prescribing work, for whom, and in what circumstances? a protocol for a realist review.
BACKGROUND: the use of non-drug, non-health-service interventions has been proposed as a cost-effective alternative to help those with long-term conditions manage their illness and improve their health and well-being. Interventions typically involve accessing activities run by the third sector or community agencies and may also be described as non-medical referral, community referral or social prescribing. To be effective, patients need to be "transferred" from the primary care setting into the community and to maintain their participation in activities. However, it is not currently known how and why these approaches enable which people under what circumstances to reach community services that may benefit their health and well-being. METHODS: Database searches and extensive searching of grey sources will be carried out in an attempt to find evidence associated with referral and retention in social prescribing. After initial scoping searches, two main phases of searching will be conducted: (a) will focus on the identification of programme theories to illustrate how approaches to social prescribing work for different people and in different contexts and (b) will consist of targeted searches to locate evidence to refine these candidate theories into configurations of the contexts in which populations and the main mechanisms outcomes are achieved. Inclusion criteria will initially be broad in order to develop a clear picture of the ways in which social prescriptions might operate but may iteratively become more focused in response to initially identified evidence, for example, in terms of the population group. An expert advisory group consisting of professionals working in a range of organisations involved in social prescribing will be convened to check the approaches in the review and provide real-life experience of social prescribing. Findings from the review will be disseminated to commissioners, published in a peer-reviewed journal and used to help refine an intervention model for an outdoor nature-based group intervention. DISCUSSION: This realist review will explore why mechanisms of social prescribing work, for what groups of people and their impact on enrolment, attendance and adherence to programmes. The use of realist approaches to detail the social prescribing process is novel and will offer insights into effective transfer of patients. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42016039491.
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Hubbard RE, Lang I (2015). Avoiding depression, dementia, and frailty: do you feel lucky?.
J Am Med Dir Assoc,
16(4), 270-271.
Author URL.
Steel N, Hardcastle AC, Bachmann MO, Richards SH, Mounce LTA, Clark A, Lang I, Melzer D, Campbell JL (2015). Economic inequalities in burden of illness, diagnosis and treatment of five long-term conditions in England: panel study.
BMJ Open,
4(10).
Abstract:
Economic inequalities in burden of illness, diagnosis and treatment of five long-term conditions in England: panel study.
Objective We compared the distribution by wealth of self-reported illness burden (estimated from validated scales, biomarker and reported symptoms) for angina, cataract, depression, diabetes and osteoarthritis, with the distribution of self-reported medical diagnosis and treatment. We aimed to determine if the greater illness burden borne by poorer participants was matched by appropriately higher levels of diagnosis and treatment.Design the English Longitudinal Study of Ageing, a panel study of 12
765 participants aged 50
years and older in four waves from 2004 to 2011, selected using a stratified random sample of households in England. Distribution of illness burden, diagnosis and treatment by wealth was estimated using regression analysis.Outcome measures the main outcome measures were ORs for the illness burden, diagnosis and treatment, respectively, adjusted for age, sex and wealth. We estimated the illness burden for angina with the Rose Angina scale, diabetes with fasting glycosylated haemoglobin, depression with the Centre for Epidemiologic Studies Depression Scale, osteoarthritis with self-reported pain and disability and cataract with self-reported poor vision. Medical diagnoses were self-reported for all conditions. Treatment was defined as β-blocker prescription for angina, surgery for osteoarthritis and cataract, and receipt of predefined effective interventions for diabetes and depression.Results Compared with the wealthiest, the least wealthy participant had substantially higher odds for illness burden from any of the five conditions at all four time points, with ORs ranging from 4.2 (95% CI 2.6 to 6.8) for diabetes to 15.1 (11.4 to 20.0) for osteoarthritis. The ORs for diagnosis and treatment were smaller in all five conditions, and ranged from 0.9 (0.5 to 1.4) for diabetes treatment to 4.5 (3.3 to 6.0) for angina diagnosis.Conclusions the substantially higher illness burden in less wealthy participants was not matched by appropriately higher levels of diagnosis and treatment.
Abstract.
Lu L, Pearce H, Roome C, Shearer J, Lang IA, Stein K (2015). Erratum to: Cost Effectiveness of Oromucosal Cannabis-Based Medicine (Sativex<sup>®</sup>) for Spasticity in Multiple Sclerosis [Pharmacoeconomics, 30, 2, 2012, (1157-1171), DOI 10.2165/11598470-000000000-00000]. PharmacoEconomics, 33(6).
Lu L, Pearce H, Roome C, Shearer J, Lang IA, Stein K (2015). Erratum to: cost effectiveness of Oromucosal cannabis-based medicine (Sativex(®)) for spasticity in multiple sclerosis.
Pharmacoeconomics,
33(6).
Author URL.
Littlejohns TJ, Kos K, Henley WE, Cherubini A, Ferrucci L, Lang IA, Langa KM, Melzer D, Llewellyn DJ (2015). Serum leptin and risk of cognitive decline in elderly italians.
J Alzheimers Dis,
44(4), 1231-1239.
Abstract:
Serum leptin and risk of cognitive decline in elderly italians.
BACKGROUND: US studies suggest that leptin, a fat-derived hormone, may be protective against the development of dementia. OBJECTIVE: to investigate the complex relationship between leptin levels and cognitive decline in elderly Italians. METHODS: We studied circulating fasting leptin levels in 809 elderly adults free from dementia who participated in the prospective Italian population-based InCHIANTI study between 1998 and 2009 (mean follow-up of 8.0 years). Global cognitive decline was defined as a reduction of ≥5 points on the Mini-Mental State Examination (MMSE). Trail-Making Tests a and B were also incorporated, with cognitive decline defined as discontinued testing or the worst 10% of change from baseline. We also investigated whether any association could be explained by midlife weight and whether cognitive decline was associated with changing leptin levels. RESULTS: the multivariate adjusted relative risk ([RR]; 95% confidence interval [CI]) of cognitive decline on the MMSE was 0.84 (95% CI 0.73-0.97) in relation to baseline sex-standardized log-leptin levels. High leptin levels showed a non-significant trend toward a reduced risk of decline on the Trail-Making Tests a (RR = 0.85, 95% CI 0.71-1.02) and B (RR = 0.90, 0.79-1.02). Adjusting for midlife weight or change in weight did not alter the pattern of results, and cognitive decline was not associated with changing leptin levels. CONCLUSIONS: High leptin levels were independently associated with a reduced risk of cognitive decline in elderly Italians.
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Hubbard RE, Goodwin VA, Llewellyn DJ, Warmoth K, Lang IA (2014). Frailty, financial resources and subjective well-being in later life.
Archives of Gerontology and Geriatrics,
58(3), 364-369.
Abstract:
Frailty, financial resources and subjective well-being in later life
Though frailty status has recently been linked to poorer quality of life, the impact of income on this relationship has not previously been investigated. Data from a population-based panel study, the English Longitudinal Study of Aging, on 3225 participants aged 65-79 years were analyzed cross-sectionally. A Frailty Index (FI) was determined for each participant as a proportion of accumulated deficits and participants were categorized into four groups on the basis of their FI score: very fit (0.00-0.10), well (0.11-0.14), vulnerable (0.15-0.24), and frail (≥0.25). Subjective well-being was assessed using the CASP-19 instrument, and levels of financial resources quantified using a range of questions about assets and income from a range of sources. Linear regression models were used to assess the relationship between frailty and well-being. There was a significant negative correlation between frailty and well-being; the correlation coefficient between FI and CASP-19 scores was -0.58. The relationship was robust to adjustment for sex, age, and relevant health behaviors (smoking and physical activity) and persisted when participants with depressive symptoms were excluded from analysis. Those with greater financial resources reported better subjective well-being with evidence of a "dose-response" effect. The poorest participants in each frailty category had similar well-being to the most well-off with worse frailty status. Hence, while the association between frailty and poorer subjective well-being is not significantly impacted by higher levels of wealth and income, financial resources may provide a partial buffer against the detrimental psychological effects of frailty. © 2014 Elsevier Ireland Ltd.
Abstract.
Kuźma E, Llewellyn DJ, Langa KM, Wallace RB, Lang IA (2014). History of alcohol use disorders and risk of severe cognitive impairment: a 19-year prospective cohort study.
Am J Geriatr Psychiatry,
22(10), 1047-1054.
Abstract:
History of alcohol use disorders and risk of severe cognitive impairment: a 19-year prospective cohort study.
OBJECTIVE: to assess the effects of a history of alcohol use disorders (AUDs) on risk of severe cognitive and memory impairment in later life. METHODS: We studied the association between history of AUDs and the onset of severe cognitive and memory impairment in 6,542 middle-aged adults born 1931 through 1941 who participated in the Health and Retirement Study, a prospective nationally representative U.S. cohort. Participants were assessed at 1992 baseline and follow-up cognitive assessments were conducted biannually from 1996 through 2010. History of AUDs was identified using the three-item modified CAGE questionnaire. Cognitive outcomes were assessed using the 35-item modified Telephone Interview for Cognitive Status at last follow-up with incident severe cognitive impairment defined as a score ≤ 8, and incident severe memory impairment defined as a score ≤ 1 on a 20-item memory subscale. RESULTS: During up to 19 years of follow-up (mean: 16.7 years, standard deviation: 3.0, range: 3.5-19.1 years), 90 participants experienced severe cognitive impairment and 74 participants experienced severe memory impairment. History of AUDs more than doubled the odds of severe memory impairment (odds ratio [OR] = 2.21, 95% confidence interval [CI] = 1.27-3.85, t = 2.88, df = 52, p = 0.01). The association with severe cognitive impairment was statistically non-significant but in the same direction (OR = 1.80, 95% CI = 0.97-3.33, t = 1.92, df = 52, p = 0.06). CONCLUSION: Middle-aged adults with a history of AUDs have increased odds of developing severe memory impairment later in life. These results reinforce the need to consider the relationship between alcohol consumption and cognition from a multifactorial lifespan perspective.
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Thompson Coon J, Abbott R, Rogers M, Whear R, Pearson S, Lang I, Cartmell N, Stein K (2014). Interventions to reduce inappropriate prescribing of antipsychotic medications in people with dementia resident in care homes: a systematic review.
J Am Med Dir Assoc,
15(10), 706-718.
Abstract:
Interventions to reduce inappropriate prescribing of antipsychotic medications in people with dementia resident in care homes: a systematic review.
BACKGROUND: Antipsychotic medications are commonly used to manage the behavioral and psychological symptoms of dementia. Several large studies have demonstrated an association between treatment with antipsychotics and increased morbidity and mortality in people with dementia. AIMS: to assess the effectiveness of interventions used to reduce inappropriate prescribing of antipsychotics to the elderly with dementia in residential care. METHOD: Systematic searches were conducted in 12 electronic databases. Reference lists of all included studies and forward citation searching using Web of Science were also conducted. All quantitative studies with a comparative research design and studies in which recognized methods of qualitative data collection were used were included. Articles were screened for inclusion independently by 2 reviewers. Data extraction and quality appraisal were performed by 1 reviewer and checked by a second with discrepancies resolved by discussion with a third if necessary. RESULTS: Twenty-two quantitative studies (reported in 23 articles) were included evaluating the effectiveness of educational programs (n = 11), in-reach services (n = 2), medication review (n = 4), and multicomponent interventions (n = 5). No qualitative studies meeting our inclusion criteria were identified. Eleven studies were randomized or controlled in design; the remainder were uncontrolled before and after studies. Beneficial effects were seen in 9 of the 11 studies with the most robust study design with reductions in antipsychotic prescribing levels of between 12% and 20%. Little empirical information was provided on the sustainability of interventions. CONCLUSION: Interventions to reduce inappropriate prescribing of antipsychotic medications to people with dementia resident in care homes may be effective in the short term, but longer more robust studies are needed. For prescribing levels to be reduced in the long term, the culture and nature of care settings and the availability and feasibility of nondrug alternatives needs to be addressed.
Abstract.
Littlejohns TJ, Kos K, Henley WE, Cherubini A, Ferrucci L, Lang IA, Langa KM, Melzer D, Llewellyn DJ (2014). SERUM LEPTIN AND RISK OF COGNITIVE DECLINE IN ELDERLY ITALIANS: a PROSPECTIVE COHORT STUDY.
JOURNAL OF EPIDEMIOLOGY AND COMMUNITY HEALTH,
68, A4-A4.
Author URL.
Littlejohns TJ, Henley WE, Lang IA, Annweiler C, Beauchet O, Chaves PHM, Fried L, Kestenbaum BR, Kuller LH, Langa KM, et al (2014). Vitamin D and the risk of dementia and Alzheimer disease.
Neurology,
83(10), 920-928.
Abstract:
Vitamin D and the risk of dementia and Alzheimer disease.
OBJECTIVE: to determine whether low vitamin D concentrations are associated with an increased risk of incident all-cause dementia and Alzheimer disease. METHODS: One thousand six hundred fifty-eight elderly ambulatory adults free from dementia, cardiovascular disease, and stroke who participated in the US population-based Cardiovascular Health Study between 1992-1993 and 1999 were included. Serum 25-hydroxyvitamin D (25(OH)D) concentrations were determined by liquid chromatography-tandem mass spectrometry from blood samples collected in 1992-1993. Incident all-cause dementia and Alzheimer disease status were assessed during follow-up using National Institute of Neurological and Communicative Disorders and Stroke/Alzheimer's Disease and Related Disorders Association criteria. RESULTS: During a mean follow-up of 5.6 years, 171 participants developed all-cause dementia, including 102 cases of Alzheimer disease. Using Cox proportional hazards models, the multivariate adjusted hazard ratios (95% confidence interval [CI]) for incident all-cause dementia in participants who were severely 25(OH)D deficient (
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Lang IA, Marlow R, Goodman R, Meltzer H, Ford T (2013). Influence of problematic child-teacher relationships on future psychiatric disorder: population survey with 3-year follow-up.
Br J Psychiatry,
202(5), 336-341.
Abstract:
Influence of problematic child-teacher relationships on future psychiatric disorder: population survey with 3-year follow-up.
BACKGROUND: Teacher-pupil relationships have been found to mediate behavioural, social and psychological outcomes for children at different ages according to teacher and child report, but most studies have been small. AIMS: to explore later psychiatric disorder among children with problematic teacher-pupil relationships. METHOD: Secondary analysis of a population-based cross-sectional survey of children aged 5-16 with a 3-year follow-up. RESULTS: of the 3799 primary-school pupils assessed, 2.5% of parents reported problematic teacher-pupil relationships; for secondary-school pupils (n = 3817) this rose to 6.6%. Among secondary-school pupils, even when children with psychiatric disorder at baseline were excluded and we adjusted for baseline psychopathology score, problematic teacher-pupil relationships were statistically significantly related to higher levels of psychiatric disorder at 3-year follow-up (odds ratio (OR) = 1.93, 95% CI 1.07-3.51 for any psychiatric disorder, OR = 3.00, 95% CI 1.37-6.58 for conduct disorder). Results for primary-school pupils were similar but non-significant at this level of adjustment. CONCLUSIONS: This study underlines the need to support teachers and schools to develop positive relationships with their pupils.
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Jenkinson CE, Dickens AP, Jones KS, Thompson–Coon J, Taylor RS, Rogers M, Bambra CL, Lang I, Richards SH (2013). Is volunteering a public health intervention? a systematic review and meta-analysis of the health and survival of volunteers.
BMC Public Health,
13(1), 773-773.
Abstract:
Is volunteering a public health intervention? a systematic review and meta-analysis of the health and survival of volunteers
Background
Volunteering has been advocated by the United Nations, and American and European governments as a way to engage people in their local communities and improve social capital, with the potential for public health benefits such as improving wellbeing and decreasing health inequalities. Furthermore, the US Corporation for National and Community Service Strategic Plan for 2011–2015 focused on increasing the impact of national service on community needs, supporting volunteers’ wellbeing, and prioritising recruitment and engagement of underrepresented populations. The aims of this review were to examine the effect of formal volunteering on volunteers’ physical and mental health and survival, and to explore the influence of volunteering type and intensity on health outcomes.
Methods
Experimental and cohort studies comparing the physical and mental health outcomes and mortality of a volunteering group to a non-volunteering group were identified from twelve electronic databases (Cochrane Library, Medline, Embase, PsychINFO, CINAHL, ERIC, HMIC, SSCI, ASSIA, Social Care Online, Social Policy and Practice) and citation tracking in January 2013. No language, country or date restrictions were applied. Data synthesis was based on vote counting and random effects meta-analysis of mortality risk ratios.
Results
Forty papers were selected: five randomised controlled trials (RCTs, seven papers); four non-RCTs; and 17 cohort studies (29 papers). Cohort studies showed volunteering had favourable effects on depression, life satisfaction, wellbeing but not on physical health. These findings were not confirmed by experimental studies. Meta-analysis of five cohort studies found volunteers to be at lower risk of mortality (risk ratio: 0.78; 95% CI: 0.66, 0.90). There was insufficient evidence to demonstrate a consistent influence of volunteering type or intensity on outcomes.
Conclusion
Observational evidence suggested that volunteering may benefit mental health and survival although the causal mechanisms remain unclear. Consequently, there was limited robustly designed research to guide the development of volunteering as a public health promotion intervention. Future studies should explicitly map intervention design to clear health outcomes as well as use pragmatic RCT methodology to test effects.
Abstract.
Lourida I, Soni M, Thompson-Coon J, Purandare N, Lang IA, Ukoumunne OC, Llewellyn DJ (2013). Mediterranean diet, cognitive function, and dementia: a systematic review.
Epidemiology,
24(4), 479-489.
Abstract:
Mediterranean diet, cognitive function, and dementia: a systematic review
BACKGROUND:: Adherence to a Mediterranean diet has been associated with lower risk of various age-related diseases including dementia. Although narrative reviews have been published, no systematic review has synthesized studies on the association between Mediterranean diet adherence and cognitive function or dementia. METHODS:: We conducted a systematic review of 11 electronic databases (including Medline) of published articles up to January 2012. Reference lists, selected journal contents, and relevant websites were also searched. Study selection, data extraction, and quality assessment were performed independently by two reviewers using predefined criteria. Studies were included if they examined the association between a Mediterranean diet adherence score and cognitive function or dementia. RESULTS:: Twelve eligible papers (11 observational studies and one randomized controlled trial) were identified, describing seven unique cohorts. Despite methodological heterogeneity and limited statistical power in some studies, there was a reasonably consistent pattern of associations. Higher adherence to Mediterranean diet was associated with better cognitive function, lower rates of cognitive decline, and reduced risk of Alzheimer disease in nine out of 12 studies, whereas results for mild cognitive impairment were inconsistent. CONCLUSIONS:: Published studies suggest that greater adherence to Mediterranean diet is associated with slower cognitive decline and lower risk of developing Alzheimer disease. Further studies would be useful to clarify the association with mild cognitive impairment and vascular dementia. Long-term randomized controlled trials promoting a Mediterranean diet may help establish whether improved adherence helps to prevent or delay the onset of Alzheimer disease and dementia. © 2013 Lippincott Williams & Wilkins.
Abstract.
Lu L, Pearce H, Roome C, Shearer J, Lang IA, Stein K (2012). Cost effectiveness of oromucosal cannabis-based medicine (Sativex®) for spasticity in multiple sclerosis.
Pharmacoeconomics,
30(12), 1157-1171.
Abstract:
Cost effectiveness of oromucosal cannabis-based medicine (Sativex®) for spasticity in multiple sclerosis.
BACKGROUND: Spasticity is common in patients with multiple sclerosis (MS) and is a major contributor to disability. Sativex®, an oromucosal spray containing cannabis-based medicinal products, has been found to be effective in reducing spasticity symptoms. OBJECTIVE: Our objective was to estimate the cost effectiveness of Sativex® plus oral anti-spasticity medicines compared with the current standard treatment for moderate or severe spasticity in MS in the UK. METHODS: a Markov model was used to assess the costs and benefits of Sativex® plus oral anti-spasticity medicines or current standard treatment based on their effects on the quality of life of patients. The main outcome was the incremental cost-effectiveness ratio (ICER) in terms of costs per additional QALY gained over 5 years of treatment. One-way, multi-way and probabilistic sensitivity analyses were conducted to explore the impact of uncertainties on the findings. RESULTS: in the base case, Sativex® plus oral anti-spasticity medicines resulted in incremental costs of £7600 and a QALY gain of 0.15 per person over 5 years (ICER = £49 300 per QALY).[year 2009 data for costs]. Findings were sensitive to the costs of Sativex® (price and dose) and differences in utilities between responders and non-responders. CONCLUSIONS: Using a willingness-to-pay threshold of £30 000 per QALY, Sativex® appears unlikely to be considered cost effective by UK funders of healthcare for spasticity in MS. This is unfortunate, since it appears that Sativex® use is likely to benefit some patients in the management of this common consequence of MS.
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Author URL.
Weich S (2012). In England, a peak in poor mental health in middle-aged people is present only among low-income households. Evidence-Based Mental Health, 15(1).
Rappert B, Moyes R, Lang I (2012). The case for addressing explosive weapons: Conflict, violence and health.
Social Science and Medicine,
75(11), 2047-2054.
Abstract:
The case for addressing explosive weapons: Conflict, violence and health
In recent years, states and non-governmental organizations have expressed concern about the humanitarian consequences of the category of technologies labelled 'explosive weapons', particularly in relation to their use in populated areas. This article seeks to outline the magnitude of these consequences as well as what can be done to reduce harms. In particular, it makes a case for how health approaches could help prevent the harms associated with this category of weapons. Attention is given to the types of evidence and argument that might be required to characterize explosive weapons. An overarching aim is to consider how alternative ways of understanding weapons and violence can create new opportunities for addressing harms from conflict. © 2012 Elsevier Ltd.
Abstract.
Rappert B, Moyes R, Lang I (2012). The case for addressing explosive weapons: conflict, violence and health.
Soc Sci Med,
75(11), 2047-2054.
Abstract:
The case for addressing explosive weapons: conflict, violence and health.
In recent years, states and non-governmental organizations have expressed concern about the humanitarian consequences of the category of technologies labelled 'explosive weapons', particularly in relation to their use in populated areas. This article seeks to outline the magnitude of these consequences as well as what can be done to reduce harms. In particular, it makes a case for how health approaches could help prevent the harms associated with this category of weapons. Attention is given to the types of evidence and argument that might be required to characterize explosive weapons. An overarching aim is to consider how alternative ways of understanding weapons and violence can create new opportunities for addressing harms from conflict.
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Author URL.
Soni M, Kos K, Lang IA, Jones K, Melzer D, Llewellyn DJ (2012). Vitamin D and cognitive function.
Scand J Clin Lab Invest Suppl,
243, 79-82.
Abstract:
Vitamin D and cognitive function.
The role of vitamin D in skeletal health is well established, but more recent findings have also linked vitamin D deficiency to a range of non-skeletal conditions such as cardiovascular disease, cancer, stroke and metabolic disorders including diabetes. Cognitive impairment and dementia must now be added this list. Vitamin D receptors are widespread in brain tissue, and vitamin D's biologically active form [1,25(OH)(2)D3] has shown neuroprotective effects including the clearance of amyloid plaques, a hallmark of Alzheimer's Disease. Associations have been noted between low 25-hydroxyvitamin D [25(OH)D] and Alzheimer's disease and dementia in both Europe and the US. Similarly, the risk of cognitive impairment was up to four times greater in the severely deficient elders (25(OH)D < 25 nmol/L) in comparison with individuals with adequate levels (≥ 75 nmol/L). Further studies have also shown associations between low 25(OH)D concentrations and cerebrovascular events such as large vessel infarcts, risk of cerebrovascular accident and fatal stroke. Cross-sectional studies cannot establish temporal relationships because cognitive decline and the onset of dementia itself may influence vitamin D concentrations through behavioural and dietary changes. However, two large prospective studies recently indicated that low vitamin D concentrations may increase the risk of cognitive decline. Large, well designed randomized controlled trials are now needed to determine whether vitamin D supplementation is effective at preventing or treating Alzheimer's disease and dementia.
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Rice NE, Lang IA, Henley W, Melzer D (2011). Common health predictors of early retirement: findings from the English Longitudinal Study of Ageing.
Age Ageing,
40(1), 54-61.
Abstract:
Common health predictors of early retirement: findings from the English Longitudinal Study of Ageing.
BACKGROUND: facing the costs of population ageing, many governments aim to keep older people in employment for longer. Summary health measures predict early retirement, but more specific symptoms and conditions need to be identified to guide efforts to delay retirement. OBJECTIVE: to identify common symptoms and conditions that predict early work exit, at the population level. DESIGN: cohort study of community dwelling respondents to the English Longitudinal Study of Ageing. SETTING AND PARTICIPANTS: a total of 1,693 workers aged 50 and over at baseline who were younger than the contemporaneous retirement age (60 for women, 65 for men) at 4-year follow-up. RESULTS: a total of 308 (18.2%) individuals moved out of employment during the follow-up period. Advancing age, female gender, partner retirement, greater pension wealth, high alcohol consumption and fair or poor self-rated health were all associated with work exit. Accounting for these factors, reported difficulty walking a quarter mile was predictive of early work exit (odds ratio (OR) = 2.23; 95% confidence interval (CI) 1.42-3.52), especially where symptoms included lower limb pain and/or shortness of breath. Symptomatic depression (measured by Centre for Epidemiological Studies Depression scale) was also predictive of early work exit (OR = 1.52, CI 1.07, 2.18). About 50.8% of early retirees reported one or more of these specific health symptoms (depression, general pain, mobility limitations and leg pain when walking). CONCLUSION: older workers who report depressive symptoms or impaired physical mobility, especially with lower limb pain and shortness of breath, are at increased risk of early transition out of work. Health interventions targeting these conditions may enable older workers to remain in the labour force.
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Lang IA, Llewellyn DJ, Hubbard RE, Langa KM, Melzer D (2011). Income and the midlife peak in common mental disorder prevalence.
Psychol Med,
41(7), 1365-1372.
Abstract:
Income and the midlife peak in common mental disorder prevalence.
BACKGROUND: the prevalence of psychological distress and common mental disorders has been shown to peak in midlife but analyses have ignored the association of poor material circumstances with prevalence. This study aimed to test the hypothesis that the midlife prevalence peak occurs only in lower-income households. METHOD: Pooled data were used from the annual Health Survey for England, a nationally representative cross-sectional study, on community-dwelling individuals aged ≥ 16 years from years 1997 to 2006 (n=100 457). 12-item General Health Questionnaire scores, reported mental illness diagnoses and receipt of relevant medication were assessed in relation to household income and age. Analyses were separated by gender and adjusted for age, ethnicity, smoking, social class, education and co-morbidities. RESULTS: Prevalence of psychological distress, diagnoses and treatments rose with age until early middle age and declined subsequently. In analyses conducted separately by income categories, this pattern was marked in low-income groups but absent in high-income groups. Income-related inequalities in the prevalence of psychological distress were greatest in midlife; for example, in men aged 45-54 years the odds ratio of receiving psychiatric medication in the lowest income group compared with the highest was 7.50 [95% confidence interval (CI) 4.24-13.27] and in women aged 45-54 years the odds ratio of reporting mental illness was 10.25 (95% CI 6.16-17.05). CONCLUSIONS: an increased prevalence of psychological distress, common mental disorder diagnoses and treatment in midlife is not a universal phenomenon but is found only in those in low-income households. This implies the phenomenon is not inevitable but is potentially manageable or preventable.
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Dutta A, Henley W, Lang I, Llewellyn D, Guralnik J, Wallace RB, Melzer D (2011). Predictors of extraordinary survival in the Iowa established populations for epidemiologic study of the elderly: cohort follow-up to "extinction".
J Am Geriatr Soc,
59(6), 963-971.
Abstract:
Predictors of extraordinary survival in the Iowa established populations for epidemiologic study of the elderly: cohort follow-up to "extinction".
OBJECTIVES: to identify predictors of extraordinary survival. DESIGN: Longitudinal study of a cohort of elderly people followed up until almost all have died. SETTING: Two counties in Iowa; a part of the Established Populations for Epidemiologic Study of the Elderly. PARTICIPANTS: Two thousand eight hundred ninety community-dwelling citizens aged 65 to 85 at baseline and surviving at least 3 years. MEASUREMENTS: Data relating to age, sex, birth order, parental longevity, marital status, education, family income, social support, self-reported health, chronic diseases, blood pressure, body mass index, physical ability, exercise, life attitude and mental health were obtained. Extraordinary survivors (ESs) were defined to include approximately 10% of the longest survivors in their sex group. RESULTS: the 253 ESs were far more likely never to have smoked. In models adjusted for age, sex, and smoking, the earlier-life factors such as parental longevity, being earlier in the birth order (in women only), and body mass index at age 50 were associated with extraordinary survival. In similar models for predictors at age 65 to 85, extraordinary survival was associated with excellent self-reported health, fewer chronic diseases, better physical mobility and memory, and positive attitude toward life, but it was not associated with depression, anxiety, or sleep quality. In multivariable models, attitude toward life was not an independent predictor. Women in the top third of a cumulative score of independent predictors were 9.3 (95% confidence interval=4.4-19.6, P
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Dutta A, Henley W, Lang IA, Murray A, Guralnik J, Wallace RB, Melzer D (2011). The coronary artery disease-associated 9p21 variant and later life 20-year survival to cohort extinction.
Circ Cardiovasc Genet,
4(5), 542-548.
Abstract:
The coronary artery disease-associated 9p21 variant and later life 20-year survival to cohort extinction.
BACKGROUND: Common variation at chromosome 9p21 (marked by rs10757278 or rs1333049) is associated with coronary artery disease (CAD) and peripheral vascular disease. A decreasing effect at older age was suggested, and effects on long-term mortality are unclear. We estimated 9p21 associations with CAD and all-cause mortality in a CAD diagnosis-free older population. We also estimated classification gains on adding the variant to the Framingham Risk Score (FRS) for CAD. METHODS AND RESULTS: DNA was from an Established Populations for Epidemiological Study of the Elderly-Iowa cohort from 1988 (participants >71 years), with death certificates obtained to 2008 for 92% of participants. Cox regression models were adjusted for confounders and CAD risk factors. of 1095 CAD diagnosis-free participants, 52% were heterozygous (CG) and 22% were homozygous (CC) for the risk C allele rs1333049. Unadjusted CAD-attributed death rates in the CC group were 30 vs 22 per 1000 person-years for the GG group. The C allele was associated with all-cause (hazard ratio, 1.19; 95% CI, 1.08-1.30) and CAD (hazard ratio, 1.29; 95% CI, 1.08-1.56) mortality, independent of CAD risk factors. There was no association with stroke deaths. Variant associations with CAD mortality were attenuated after the age of 80 years (age-interaction term P=0.05). In age group 71 to 80 years, FRS classified as high risk 21% of respondents who died of CAD within 10 years; adding 9p21 identified 27% of respondents. CONCLUSIONS: in 71- to 80-year-old subjects free of CAD diagnoses, 9p21 is associated with excess mortality, mainly attributed to CAD mortality. Adding 9p21 to the FRS may improve the targeting of CAD prevention in older people, but validation in independent samples is needed for confirmation.
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Lang IA, Kipping RR, Jago R, Lawlor DA (2011). Variation in childhood and adolescent obesity prevalence defined by international and country-specific criteria in England and the United States.
European Journal of Clinical Nutrition,
65(2), 143-150.
Abstract:
Variation in childhood and adolescent obesity prevalence defined by international and country-specific criteria in England and the United States
Objective: to compare childhood obesity prevalence in England and the United States using different criteria.Subjects/Methods: Participants included 2- to 17-year olds in the Health Survey for England (HSE, n = 33 563) and the US National Health and Nutrition Examination Survey (NHANES, n = 14 540) 1999 through 2006. Mean body mass index (BMI) and prevalence of obesity were compared using the UK 1990, US 2000 Centers for Disease Control and International Obesity Task Force (IOTF) criteria.Results: English children at ages 2-5 years had a higher mean BMI than US children (mean difference (English minus US) = 0.41 kg/m2, 95% confidence intervals (CI) 0.31-0.52). At age 8 years, mean BMI was lower in England (for ages 8-11 years, mean difference = -1.00 kg/m 2, 95% CI 1.26 to 0.75; for ages 12-17 years, mean difference = 1.37 kg/m2, 95% CI 1.59 to 1.14). The IOTF criteria produced the lowest estimates of obesity prevalence. The 2000 Centre for Disease Control and Prevention (CDC) criteria produced the highest estimates in younger children and the UK 1990 criteria produced the highest in adolescents. Children aged 2-5 years in England had higher prevalence of obesity than those in the United States when using the 2000 CDC and UK 1990 criteria. US adolescents had the highest prevalence of obesity by age group using each of the three criteria.Conclusion: the 2000 CDC and UK 1990 criteria give a higher prevalence of obesity in England than in the United States at ages 2-5 years; however, at age ≥8 years, the reverse is true. Estimates of childhood obesity prevalence rely on the criteria used, which has implications for surveillance and clinical practice. © 2011 Macmillan Publishers Limited all rights reserved.
Abstract.
Llewellyn DJ, Lang IA, Langa KM, Muniz-Terrera G, Phillips CL, Cherubini A, Ferrucci L, Melzer D (2011). Vitamin D and Risk of Cognitive Decline in Elderly Persons EDITORIAL COMMENT.
OBSTETRICAL & GYNECOLOGICAL SURVEY,
66(6), 354-355.
Author URL.
Llewellyn DJ, Lang IA, Langa KM, Melzer D (2011). Vitamin D and cognitive impairment in the elderly U.S. population.
Journals of Gerontology - Series a Biological Sciences and Medical Sciences,
66 A(1), 59-65.
Abstract:
Vitamin D and cognitive impairment in the elderly U.S. population
Background: Recent European studies suggest that vitamin D deficiency may be associated with increased odds of cognitive impairment in older persons, although findings from the United States are equivocal. Our objective was to investigate the association between vitamin D deficiency and cognitive impairment in the elderly U.S. population. Methods: Three thousand and three hundred twenty-five adults aged 65 years or more completed cognitive assessments, medical examinations, and physical performance measures and provided blood samples in the Third National Health and Nutrition Examination Survey, a nationally representative cross-sectional study of the U.S. noninstitutionalized population. We determined whether low levels of serum 25-hydroxyvitamin D (25(OH)D) were associated with increased odds of cognitive impairment using logistic regression models. Cognitive impairment was assessed using measures of immediate and delayed verbal memory, orientation, and attention (impairment was defined as the worst 10% of the distribution of combined scores). Results: the multivariate adjusted odds ratios (95% confidence interval) of cognitive impairment in participants who were 25(OH)D insufficient (≥50 < 75 nmol/L), deficient (≥25 < 50 nmol/L), and severely deficient (
Abstract.
Llewellyn DJ, Lang IA, Langa KM, Melzer D (2011). Vitamin D and cognitive impairment in the elderly U.S. population.
J Gerontol a Biol Sci Med Sci,
66(1), 59-65.
Abstract:
Vitamin D and cognitive impairment in the elderly U.S. population.
BACKGROUND: Recent European studies suggest that vitamin D deficiency may be associated with increased odds of cognitive impairment in older persons, although findings from the United States are equivocal. Our objective was to investigate the association between vitamin D deficiency and cognitive impairment in the elderly U.S. population. METHODS: Three thousand and three hundred twenty-five adults aged 65 years or more completed cognitive assessments, medical examinations, and physical performance measures and provided blood samples in the Third National Health and Nutrition Examination Survey, a nationally representative cross-sectional study of the U.S. noninstitutionalized population. We determined whether low levels of serum 25-hydroxyvitamin D (25(OH)D) were associated with increased odds of cognitive impairment using logistic regression models. Cognitive impairment was assessed using measures of immediate and delayed verbal memory, orientation, and attention (impairment was defined as the worst 10% of the distribution of combined scores). RESULTS: the multivariate adjusted odds ratios (95% confidence interval) of cognitive impairment in participants who were 25(OH)D insufficient (≥ 50 < 75 nmol/L), deficient (≥ 25 < 50 nmol/L), and severely deficient (
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Author URL.
Llewellyn DJ, Lang IA, Langa KM, Muniz-Terrera G, Phillips CL, Cherubini A, Ferrucci L, Melzer D (2011). Vitamin D and risk of cognitive decline in elderly persons. Obstetrical and Gynecological Survey, 66(6), 354-355.
Dickens AP, Lang IA, Langa KM, Kos K, Llewellyn DJ (2011). Vitamin D, cognitive dysfunction and dementia in older adults.
CNS Drugs,
25(8), 629-639.
Abstract:
Vitamin D, cognitive dysfunction and dementia in older adults.
The physiologically active form of vitamin D, 1,25-dihydroxyvitamin D(3), is a fat-soluble steroid hormone with a well established role in skeletal health. A growing body of evidence suggests low vitamin D levels also play a role in the pathogenesis of a wide range of non-skeletal, age-associated diseases including cancer, heart disease, type 2 diabetes mellitus and stroke. Low levels of serum 25-hydroxyvitamin D [25(OH)D], a stable marker of vitamin D status, are also associated with increased odds of prevalent cognitive dysfunction, Alzheimer's disease and all-cause dementia in a number of studies, raising the possibility that vitamin D plays a role in the aetiology of cognitive dysfunction and dementia. To date, the majority of human studies reporting associations between vitamin D and cognition or dementia have been cross-sectional or case-control designs that do not permit us to exclude the possibility that such associations are a result of disease progression rather than being causal. Animal and in vitro experiments have identified a number of neuroprotective mechanisms that might link vitamin D status to cognitive dysfunction and dementia, including vasoprotection and amyloid phagocytosis and clearance, but the clinical relevance of these mechanisms in humans is not currently clear. Two recent, large, prospective studies go some way to establish the temporal relationship with cognitive decline. The relative risk of cognitive decline was 60% higher (relative risk = 1.6, 95% CI 1.2, 2.0) in elderly Italian adults with severely deficient 25(OH)D levels (
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Rice NE, Lang IA, Henley W, Melzer D (2010). Baby boomers nearing retirement: the healthiest generation?.
Rejuvenation Res,
13(1), 105-114.
Abstract:
Baby boomers nearing retirement: the healthiest generation?
BACKGROUND: the baby-boom generation is entering retirement. Having experienced unprecedented prosperity and improved medical technology, they should be the healthiest generation ever. METHODS: We compared prevalence of disease and risk factors at ages 50-61 years in baby boomers with the preceding generation and attributed differences to period or cohort effects. Data were from the Health Survey for England (HSE) from 1994 to 2007 (n = 48,563). Logistic regression models compared health status between birth cohorts. Age-period-cohort models identified cohort and period effects separately. RESULTS: Compared to the wartime generation, the baby-boomer group was heavier (3.02 kg; 95% confidence interval [CI], 2.42-3.63; p < 0.001) and reported more diagnoses of hypertension (odds ratio [OR] = 1.48; CI, 1.27-1.72; p < 0.001), diabetes (OR = 1.71; CI, 1.37-2.12; p < 0.001), and mental illness (OR = 1.90; CI, 1.54-2.53; p < 0.001). Baby boomers reported fewer heart attacks (OR = 0.61; CI, 0.47-0.79; p < 0.001) and had lower measured blood pressures (systolic -9.51 mmHg; CI, -8.7 to -10.31; p
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Melzer D, Lang I (2010). Chronological and Functional Ageing. , 65-69.
Zivin K, Llewellyn DJ, Lang IA, Vijan S, Kabeto MU, Miller EM, Langa KM (2010). Depression among older adults in the United States and England.
Am J Geriatr Psychiatry,
18(11), 1036-1044.
Abstract:
Depression among older adults in the United States and England.
CONTEXT: Depression negatively affects health and well being among older adults, but there have been no nationally representative comparisons of depression prevalence among older adults in England and the United States. OBJECTIVE: the authors sought to compare depressive symptoms among older adults in these countries and identify sociodemographic and clinical correlates of depression in these countries. DESIGN AND SETTING: the authors assessed depressive symptoms in non-Hispanic whites aged 65 years and older in 2002 in two nationally representative, population-based studies: the U.S. Health and Retirement Study and English Longitudinal Study of Ageing. PARTICIPANTS: a total of 8,295 Health and Retirement Study respondents and 5,208 English Longitudinal Study of Ageing respondents. MAIN OUTCOME MEASURES: the authors measured depressive symptoms using the eight-item Center for Epidemiologic Studies Depression Scale. The authors determined whether depressive symptom differences between the United States and England were associated with sociodemographic characteristics, chronic health conditions, and health behaviors. RESULTS: Significant depressive symptoms (Center for Epidemiologic Studies Depression Scale score ≥4) were more prevalent in English than U.S. adults (17.6% versus 14.6%, adjusted Wald test F([1, 1593]) = 11.4, p < 0.001). Adjusted rates of depressive symptoms in England were 19% higher compared with the United States (odds ratio: 1.19, 95% confidence interval: 1.01-1.40). U.S. adults had higher levels of education, and net worth, but lower levels of activities of daily living/instrumental activities of daily living impairments, tobacco use, and cognitive impairment, which may have contributed to relatively lower levels of depressive symptoms in the United States. CONCLUSIONS: Older adults in the United States had lower rates of depressive symptoms than their English counterparts despite having more chronic health conditions. Future cross-national studies should identify how depression treatment influences outcomes in these populations.
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Hubbard RE, Lang IA, Llewellyn DJ, Rockwood K (2010). Frailty, body mass index, and abdominal obesity in older people.
Journals of Gerontology - Series a Biological Sciences and Medical Sciences,
65 A(4), 377-381.
Abstract:
Frailty, body mass index, and abdominal obesity in older people
Background. Frailty has been conceptualized as a wasting disorder with weight loss as a key component. However, obesity is associated with disability and with physiological markers also recently linked with frailty, for example, increased inflammation and low antioxidant capacity. We aimed to explore the relationship between frailty and body mass index (BMI) in older people. Methods Data were from 3,055 community-dwelling adults aged 65 years and older who participated in the English Longitudinal Study of Ageing. Frailty was defined both by an index of accumulated deficits and by the Fried phenotype. BMI was divided into five categories, and waist circumference 88 cm or more (for women) and 102 cm or more (for men) was defined as high. Analyses were adjusted for sex, age, wealth, level of education, and smoking status. Results the association between BMI and frailty showed a U-shaped curve. This relationship was consistent across different frailty measures. The lowest frailty index (FI) scores and lowest prevalence of Fried frailty were in those with BMI 25-29.9. At each BMI category, and using either measure of frailty, those with a high waist circumference were significantly more frail. Conclusions Both the phenotypic definition of frailty and the FI show increased levels of frailty among those with low and very high BMIs. In view of the rise in obesity in older populations, the benefits and feasibility of diet and exercise for obese older adults should be a focus of urgent inquiries. The association of frailty with a high waist circumference, even among underweight older people, suggests that truncal obesity may be an additional target for intervention. © the Author 2009. Published by Oxford University Press on behalf of the Gerontological Society of America. All rights reserved.
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Llewellyn DJ, Langa KM, Friedland RP, Lang IA (2010). Serum Albumin Concentration and Cognitive Impairment.
CURRENT ALZHEIMER RESEARCH,
7(1), 91-96.
Author URL.
Llewellyn DJ, Langa KM, Friedland RP, Lang IA (2010). Serum albumin concentration and cognitive impairment.
Curr Alzheimer Res,
7(1), 91-96.
Abstract:
Serum albumin concentration and cognitive impairment.
Results from clinical samples suggest low serum albumin may be associated with cognitive impairment, though evidence from population-based studies is inconclusive. Participants were 1,752 adults (699 men and 1,053 women) aged 65 years and over from the Health Survey for England 2000, a nationally representative population-based study. Cognitive impairment was assessed using the Abbreviated Mental Test Score. The cross-sectional relation of serum albumin quartiles to cognitive impairment was modelled using logistic regression. Two hundred and twelve participants were cognitively impaired (68 men and 144 women). Odds ratios (95% confidence intervals) for cognitive impairment in the first (2.2-3.8 g/dl), second (3.9-4.0 g/dl), and third (4.1-4.3 g/dl) quartiles of serum albumin compared with the fourth (4.4-5.3 g/dl) were 2.5 (1.3-5.1), 1.7 (0.9-3.5), and 1.5 (0.7-2.9), after adjustment for age, sex, education and additional risk factors for cognitive impairment (p for linear trend = 0.002). A highly similar pattern of associations was observed for men and women. Our data provide new evidence to suggest that low serum albumin is independently associated with increased odds of cognitive impairment in the elderly population.
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Lang I, Canning R (2010). The use of citations in educational research: the instance of the concept of 'situated learning'.
Journal of Further and Higher Education,
34(2), 291-301.
Abstract:
The use of citations in educational research: the instance of the concept of 'situated learning'
This article provides a citation analysis of Lave and Wenger's work on 'communities of practice' and 'situated learning' over the period 1991- 2001. The data relate to educational research in the UK, although comparisons are made with the USA. The findings indicate that although the text was incorporated and heavily used within educational research over the period of the study there were very few citations that could be identified as cumulative. The discussion considers the value of using citations as an indicator of quality within any research excellence framework and argues the case for taking a broader, more qualitative approach to assessing research quality in the social sciences. © 2010 UCU.
Abstract.
Llewellyn DJ, Lang IA, Matthews FE, Plassman BL, Rogers MA, Morgenstern LB, Fisher GG, Kabeto MU, Langa KM (2010). Vascular health, diabetes, APOE and dementia: the Aging, Demographics, and Memory Study.
Alzheimers Res Ther,
2(3).
Abstract:
Vascular health, diabetes, APOE and dementia: the Aging, Demographics, and Memory Study.
INTRODUCTION: Evidence from clinical samples and geographically limited population studies suggests that vascular health, diabetes and apolipoprotein epsilon4 (APOE) are associated with dementia. METHODS: a population-based sample of 856 individuals aged 71 years or older from all contiguous regions of the United States received an extensive in-home clinical and neuropsychological assessment in 2001-2003. The relation of hypertension, diabetes, heart disease, stroke, medication usage, and APOE epsilon4 to dementia was modelled using adjusted multivariable logistic regression. RESULTS: Treated stroke (odds ratio [OR] 3.8, 95% confidence interval [CI] 2.0, 7.2), untreated stroke (OR 3.5, 95% CI 1.7, 7.3), and APOE epsilon4 (OR 2.8, 95% CI 1.7, 4.5) all increased the odds of dementia. Treated hypertension was associated with lower odds of dementia (OR 0.5, 95% CI 0.3, 1.0). Diabetes and heart disease were not significantly associated with dementia. A significant interaction was observed between APOE epsilon4 and stroke (P = 0.001). CONCLUSIONS: Data from the first dementia study that is representative of the United States population suggest that stroke, the APOE epsilon4 allele and their interaction are strongly associated with dementia.
Abstract.
Author URL.
Williams B, Lang I, Llewellyn D, Melzer D, Rice N (2010). Vitamin D and lower reproductive tract infections in women: National Health and Nutrition Examination Survey (NHANES) 2001-2004.
HIV MEDICINE,
11, 76-76.
Author URL.
Llewellyn DJ, Lang IA, Langa KM, Muniz-Terrera G, Phillips CL, Cherubini A, Ferrucci L, Melzer D (2010). Vitamin D and risk of cognitive decline in elderly persons.
Arch Intern Med,
170(13), 1135-1141.
Abstract:
Vitamin D and risk of cognitive decline in elderly persons.
BACKGROUND: to our knowledge, no prospective study has examined the association between vitamin D and cognitive decline or dementia. METHODS: We determined whether low levels of serum 25-hydroxyvitamin D (25[OH]D) were associated with an increased risk of substantial cognitive decline in the InCHIANTI population-based study conducted in Italy between 1998 and 2006 with follow-up assessments every 3 years. A total of 858 adults 65 years or older completed interviews, cognitive assessments, and medical examinations and provided blood samples. Cognitive decline was assessed using the Mini-Mental State Examination (MMSE), and substantial decline was defined as 3 or more points. The Trail-Making Tests a and B were also used, and substantial decline was defined as the worst 10% of the distribution of decline or as discontinued testing. RESULTS: the multivariate adjusted relative risk (95% confidence interval [CI]) of substantial cognitive decline on the MMSE in participants who were severely serum 25(OH)D deficient (levels /=75 nmol/L) was 1.60 (95% CI, 1.19-2.00). Multivariate adjusted random-effects models demonstrated that the scores of participants who were severely 25(OH)D deficient declined by an additional 0.3 MMSE points per year more than those with sufficient levels of 25(OH)D. The relative risk for substantial decline on Trail-Making Test B was 1.31 (95% CI, 1.03-1.51) among those who were severely 25(OH)D deficient compared with those with sufficient levels of 25(OH)D. No significant association was observed for Trail-Making Test A. CONCLUSION: Low levels of vitamin D were associated with substantial cognitive decline in the elderly population studied over a 6-year period, which raises important new possibilities for treatment and prevention.
Abstract.
Author URL.
Melzer D, Lang IA, Galloway TS (2009). Association of Bisphenol a with Diabetes and Other Abnormalities Reply.
JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION,
301(7), 721-722.
Author URL.
Langa KM, Llewellyn DJ, Lang IA, Weir DR, Wallace RB, Kabeto MU, Huppert FA (2009). Cognitive health among older adults in the United States and in England.
BMC Geriatr,
9Abstract:
Cognitive health among older adults in the United States and in England.
BACKGROUND: Cognitive function is a key determinant of independence and quality of life among older adults. Compared to adults in England, US adults have a greater prevalence of cardiovascular risk factors and disease that may lead to poorer cognitive function. We compared cognitive performance of older adults in the US and England, and sought to identify sociodemographic and medical factors associated with differences in cognitive function between the two countries. METHODS: Data were from the 2002 waves of the US Health and Retirement Study (HRS) (n = 8,299) and the English Longitudinal Study of Ageing (ELSA) (n = 5,276), nationally representative population-based studies designed to facilitate direct comparisons of health, wealth, and well-being. There were differences in the administration of the HRS and ELSA surveys, including use of both telephone and in-person administration of the HRS compared to only in-person administration of the ELSA, and a significantly higher response rate for the HRS (87% for the HRS vs. 67% for the ELSA). In each country, we assessed cognitive performance in non-hispanic whites aged 65 and over using the same tests of memory and orientation (0 to 24 point scale). RESULTS: US adults scored significantly better than English adults on the 24-point cognitive scale (unadjusted mean: 12.8 vs. 11.4, P <. 001; age- and sex-adjusted: 13.2 vs. 11.7, P <. 001). The US cognitive advantage was apparent even though US adults had a significantly higher prevalence of cardiovascular risk factors and disease. In a series of OLS regression analyses that controlled for a range of sociodemographic and medical factors, higher levels of education and wealth, and lower levels of depressive symptoms, accounted for some of the US cognitive advantage. US adults were also more likely to be taking medications for hypertension, and hypertension treatment was associated with significantly better cognitive function in the US, but not in England (P =. 014 for treatment x country interaction). CONCLUSION: Despite methodological differences in the administration of the surveys in the two countries, US adults aged >/= 65 appeared to be cognitively healthier than English adults, even though they had a higher burden of cardiovascular risk factors and disease. Given the growing number of older adults worldwide, future cross-national studies aimed at identifying the medical and social factors that might prevent or delay cognitive decline in older adults would make important and valuable contributions to public health.
Abstract.
Author URL.
Stevens KN, Lang IA, Guralnik JM, Melzer D (2009). Erratum: Epidemiology of balance and dizziness in a national population: Findings from the English Longitudinal Study of Ageing (Age and Ageing 2008) vol. 37 (3) (300-305)). Age and Ageing, 38(1).
Llewellyn DJ, Lang IA, Langa KM, Naughton F, Matthews FE (2009). Exposure to secondhand smoke and cognitive impairment in non-smokers: national cross sectional study with cotinine measurement.
BMJ,
338Abstract:
Exposure to secondhand smoke and cognitive impairment in non-smokers: national cross sectional study with cotinine measurement.
OBJECTIVE: to examine the association between a biomarker of exposure to secondhand smoke (salivary cotinine concentration) and cognitive impairment. DESIGN: Cross sectional analysis of a national population based study. SETTING: Stratified random sample of households throughout England. PARTICIPANTS: 4809 non-smoking adults aged 50 years or more from the 1998, 1999, and 2001 waves of the Health Survey for England who also participated in the 2002 wave of the English Longitudinal Study of Ageing and provided saliva samples for cotinine assay and a detailed smoking history. MAIN OUTCOME MEASURE: Cognitive impairment as defined by the lowest 10% of scores on a battery of neuropsychological tests. RESULTS: Participants who did not smoke, use nicotine products, or have salivary cotinine concentrations of 14.1 ng/ml or more were divided into four equal size groups on the basis of cotinine concentrations. Compared with the lowest fourth of cotinine concentration (0.0-0.1 ng/ml) the odds ratios (95% confidence intervals) for cognitive impairment in the second (0.2-0.3 ng/ml), third (0.4-0.7 ng/ml), and highest fourths (0.8-13.5 ng/ml) were 1.08 (0.78 to 1.48), 1.13 (0.81 to 1.56), and 1.44 (1.07 to 1.94; P for trend 0.02), after adjustment for a wide range of established risk factors for cognitive impairment. A similar pattern of associations was observed for never smokers and former smokers. CONCLUSIONS: Exposure to secondhand smoke may be associated with increased odds of cognitive impairment. Prospective nationally representative studies relating biomarkers of exposure to cognitive decline and risk of dementia are needed.
Abstract.
Author URL.
Hubbard RE, Lang IA, Rockwood K (2009). Frailty and anthropometry in older people.
JOURNAL OF THE AMERICAN GERIATRICS SOCIETY,
57, S87-S88.
Author URL.
Melzer D, Lang IA, Galloway TS (2009). In reply. JAMA, 301(7), 721-722.
Lang IA, Melzer D (2009). Moderate Alcohol Consumption in Later Life: Time for a Trial?.
JOURNAL OF THE AMERICAN GERIATRICS SOCIETY,
57(6), 1110-1112.
Author URL.
Lang IA, Hubbard RE, Andrew MK, Llewellyn DJ, Melzer D, Rockwood K (2009). Neighborhood deprivation, individual socioeconomic status, and frailty in older adults.
J Am Geriatr Soc,
57(10), 1776-1780.
Abstract:
Neighborhood deprivation, individual socioeconomic status, and frailty in older adults.
OBJECTIVES: to assess how individual socioeconomic status and neighborhood deprivation affect frailty. DESIGN: Nationally representative population-based study, the English Longitudinal Study of Aging (ELSA), analyzed cross-sectionally. PARTICIPANTS: Four thousand eight hundred eighteen individuals aged 65 and older. MEASUREMENTS: Outcome was a frailty index (FI), based on 58 potential deficits, with a theoretical range from 0 to 1; exposures were individual wealth and neighborhood deprivation (lack of local resources, financial and otherwise), based on a set of standard indicators. RESULTS: the FI score varied independently according to wealth and neighborhood deprivation. The mean FI score for an individual in the highest 20% of wealth and least deprived 20% of neighborhoods was 0.09 (95% confidence interval (CI)=0.09-0.09) and for an individual in the lowest 20% of wealth and most deprived 20% of neighborhoods was 0.17 (95% CI=0.16-0.17). CONCLUSION: Frailty in older adults is independently associated with individual and neighborhood socioeconomic factors. Older adults who are poor and live in deprived neighborhoods are most vulnerable. Policies and interventions intended to prevent or reduce frailty must take into account individual circumstances and the broader social settings in which individuals are located.
Abstract.
Author URL.
Parahyba MI, Stevens K, Henley W, Lang IA, Melzer D (2009). Reductions in disability prevalence among the highest income groups of older Brazilians.
Am J Public Health,
99(1), 81-86.
Abstract:
Reductions in disability prevalence among the highest income groups of older Brazilians.
OBJECTIVES: We sought to identify the income-disability prevalence relationship among older Brazilians. METHODS: Data were from 63,985 individuals 60 years and older from the 1998 and 2003 Brazilian National Household Surveys. Generalized additive logistic models with cubic regression splines were used to estimate the disability-income relationships. RESULTS: There was a strong linear relationship between increased income and reduced disability prevalence for most of the income distribution. Benefits were still present above the 90th percentile of income but were more modest. Because incomes among the wealthiest few are disproportionately large, odds ratios of disability nevertheless showed marked improvements, even across the very highest income groups. CONCLUSIONS: Among older Brazilians, reduced disability is associated with higher income, and these associations are present even above the 90th percentile of income. In addition to understanding mechanisms of disability reduction among impoverished individuals, work is needed to understand these mechanisms in middle- and high-income groups.
Abstract.
Author URL.
Llewellyn DJ, Langa KM, Lang IA (2009). Serum 25-hydroxyvitamin D concentration and cognitive impairment.
J Geriatr Psychiatry Neurol,
22(3), 188-195.
Abstract:
Serum 25-hydroxyvitamin D concentration and cognitive impairment.
Vitamin D may be of interest in the prevention of cognitive impairment, though previous findings are inconclusive. Participants were 1766 adults aged 65 years and older from the Health Survey for England 2000, a nationally representative population-based study. Cognitive impairment was assessed using the Abbreviated Mental Test Score. The cross-sectional relation of serum 25-hydroxyvitamin D quartiles to cognitive impairment was modeled using logistic regression. In all, 212 participants (12%) were cognitively impaired. Odds ratios (95% confidence intervals) for cognitive impairment in the first (8-30 nmol/L), second (31-44 nmol/L), and third (45-65 nmol/L) quartiles of serum 25-hydroxyvitamin D compared with the fourth (66-170 nmol/L) were 2.3 (1.4-3.8), 1.4 (0.8-2.4), and 1.1 (0.6-1.9), after adjustment for age, sex, education, ethnicity, season of testing, and additional risk factors for cognitive impairment (P for linear trend =. 001). Our data suggest low serum 25-hydroxyvitamin D is associated with increased odds of cognitive impairment.
Abstract.
Author URL.
Llewellyn DJ, Langa KM, Friedland RP, Lang IA (2009). Serum Albumin Concentration and Cognitive Impairment.
Curr Alzheimer ResAbstract:
Serum Albumin Concentration and Cognitive Impairment.
Results from clinical samples suggest low serum albumin may be associated with cognitive impairment, though evidence from population-based studies is inconclusive. Participants were 1,752 adults (699 men and 1,053 women) aged 65 years and over from the Health Survey for England 2000, a nationally representative population-based study. Cognitive impairment was assessed using the Abbreviated Mental Test Score. The cross-sectional relation of serum albumin quartiles to cognitive impairment was modelled using logistic regression. Two hundred and twelve participants were cognitively impaired (68 men and 144 women). Odds ratios (95% confidence intervals) for cognitive impairment in the first (2.2-3.8 g/dl), second (3.9-4.0 g/dl), and third (4.1-4.3 g/dl) quartiles of serum albumin compared with the fourth (4.4-5.3 g/dl) were 2.5 (1.3-5.1), 1.7 (0.9-3.5), and 1.5 (0.7-2.9), after adjustment for age, sex, education and additional risk factors for cognitive impairment (p for linear trend = 0.002). A highly similar pattern of associations was observed for men and women. Our data provide new evidence to suggest that low serum albumin is independently associated with increased odds of cognitive impairment in the elderly population.
Abstract.
Lang IA, Galloway TS, Scarlett A, Henley WE, Depledge M, Wallace RB, Melzer D (2008). Association of urinary bisphenol a concentration with medical disorders and laboratory abnormalities in adults.
JAMA,
300(11), 1303-1310.
Abstract:
Association of urinary bisphenol a concentration with medical disorders and laboratory abnormalities in adults.
CONTEXT: Bisphenol a (BPA) is widely used in epoxy resins lining food and beverage containers. Evidence of effects in animals has generated concern over low-level chronic exposures in humans. OBJECTIVE: to examine associations between urinary BPA concentrations and adult health status. DESIGN, SETTING, AND PARTICIPANTS: Cross-sectional analysis of BPA concentrations and health status in the general adult population of the United States, using data from the National Health and Nutrition Examination Survey 2003-2004. Participants were 1455 adults aged 18 through 74 years with measured urinary BPA and urine creatinine concentrations. Regression models were adjusted for age, sex, race/ethnicity, education, income, smoking, body mass index, waist circumference, and urinary creatinine concentration. The sample provided 80% power to detect unadjusted odds ratios (ORs) of 1.4 for diagnoses of 5% prevalence per 1-SD change in BPA concentration, or standardized regression coefficients of 0.075 for liver enzyme concentrations, at a significance level of P <. 05. MAIN OUTCOME MEASURES: Chronic disease diagnoses plus blood markers of liver function, glucose homeostasis, inflammation, and lipid changes. RESULTS: Higher urinary BPA concentrations were associated with cardiovascular diagnoses in age-, sex-, and fully adjusted models (OR per 1-SD increase in BPA concentration, 1.39; 95% confidence interval [CI], 1.18-1.63; P =. 001 with full adjustment). Higher BPA concentrations were also associated with diabetes (OR per 1-SD increase in BPA concentration, 1.39; 95% confidence interval [CI], 1.21-1.60; P <. 001) but not with other studied common diseases. In addition, higher BPA concentrations were associated with clinically abnormal concentrations of the liver enzymes gamma-glutamyltransferase (OR per 1-SD increase in BPA concentration, 1.29; 95% CI, 1.14-1.46; P <. 001) and alkaline phosphatase (OR per 1-SD increase in BPA concentration, 1.48; 95% CI, 1.18-1.85; P =. 002). CONCLUSION: Higher BPA exposure, reflected in higher urinary concentrations of BPA, may be associated with avoidable morbidity in the community-dwelling adult population.
Abstract.
Author URL.
Lang IA (2008). Author's Response. Public Health, 122(1), 105-106.
Llewellyn DJ, Lang IA, Langa KM, Huppert FA (2008). Cognitive function and psychological well-being: findings from a population-based cohort.
Age Ageing,
37(6), 685-689.
Abstract:
Cognitive function and psychological well-being: findings from a population-based cohort.
BACKGROUND: depression is associated with poor cognitive function, though little is known about the relationship between psychological well-being and cognitive function. OBJECTIVE: to investigate whether psychological well-being is associated with levels of cognitive function. DESIGN: nationally representative population-based cohort study. SETTING AND PARTICIPANTS: 11,234 non-institutionalised adults aged 50 years and over of the English Longitudinal Study of Ageing in 2002. METHODS: psychological well-being was measured using the CASP-19, and cognitive function was assessed using neuropsychological tests of time orientation, immediate and delayed verbal memory, prospective memory, verbal fluency, numerical ability, cognitive speed and attention. The relation of psychological well-being to cognitive function was modelled using linear regression. RESULTS: on a global cognitive score combining all cognitive tests, those in the fifth quintile of psychological well-being scored an average of 0.30 SD units higher than those in the lowest quintile (95% CI 0.24-0.35) after adjustment for depressive symptoms and sociodemographics. This association remained after additional adjustment for physical health and health behaviours. The same pattern of association was observed for men and women, and across all cognitive domains. CONCLUSIONS: in a large population of community living adults, higher levels of psychological well-being were associated with better cognitive function.
Abstract.
Author URL.
Stevens KN, Lang IA, Guralnik JM, Melzer D (2008). Epidemiology of balance and dizziness in a national population: findings from the English Longitudinal Study of Ageing (vol 37, pg 300, 2008).
AGE AND AGEING,
37(5), 610-610.
Author URL.
Stevens KN, Lang IA, Guralnik JM, Melzer D (2008). Epidemiology of balance and dizziness in a national population: findings from the English Longitudinal Study of Ageing.
Age Ageing,
37(3), 300-305.
Abstract:
Epidemiology of balance and dizziness in a national population: findings from the English Longitudinal Study of Ageing.
OBJECTIVE: to identify socio-economic, behavioural and disease status risks for impaired balance or self-reported dizziness in older people from a large population-based study. METHODS: data were from the English Longitudinal Study of Ageing (ELSA), for 2,925 participants, aged 65+. Multivariate models were used to assess the associations between balance and dizziness and disease status, health behaviours, grip strength and socio-economic markers. RESULTS: there were 21.5% (n = 619) participants with impaired balance and 11.1% (n = 375) reported dizziness. Impaired balance was statistically significantly associated with age, diabetes (OR = 1.53), arthritis (OR = 1.33), eyesight (OR = 1.94) and grip strength. The wealthiest 20% of participants were less likely to have impaired balance than the poorest 20% (OR = 0.46). Dizziness problems were not associated with age, gender or wealth, but were significantly associated with an abnormal heart rhythm (OR = 1.85), hearing (OR = 1.81), eyesight (OR = 1.72) and grip strength. CONCLUSION: the epidemiology of impaired balance differs from that of dizziness, and risk assessment approaches to prevent falls may need to elicit information on different problem-specific factors. Impaired balance test performance in older people may be added to the many outcomes showing strong socio-economic gradients.
Abstract.
Author URL.
Rice NE, Patel BD, Lang IA, Kumari M, Frayling TM, Murray A, Melzer D (2008). Filaggrin gene mutations are associated with asthma and eczema in later life.
J Allergy Clin Immunol,
122(4), 834-836.
Author URL.
Llewellyn DJ, Lang IA, Xie J, Huppert FA, Melzer D, Langa KM (2008). Framingham Stroke Risk Profile and poor cognitive function: a population-based study.
BMC Neurol,
8Abstract:
Framingham Stroke Risk Profile and poor cognitive function: a population-based study.
BACKGROUND: the relationship between stroke risk and cognitive function has not previously been examined in a large community living sample other than the Framingham cohort. The objective of this study was to examine the relationship between 10-year risk for incident stroke and cognitive function in a large population-based sample. METHODS: Participants were 7377 adults aged 50 years and over of the 2002 wave of the English Longitudinal Study of Ageing, a prospective cohort study. A modified version of the Framingham Stroke Risk Profile (incorporating age, sex, systolic blood pressure, antihypertensive medication, diabetes, smoking status, cardiovascular disease, and atrial fibrillation) was used to assess 10-year risk of stroke. Linear regression models were used to determine the cross-sectional relationship of stroke risk to global cognitive function and performance in multiple cognitive domains. RESULTS: in unadjusted models 10 percentage point increments of 10-year stroke risk were associated with poor global cognitive function (-0.40 SD units, 95% CI -0.43 - -0.38), and lowered performance in all cognitive domains. After statistical adjustment for age, sex, testing interval and other correlates of cognitive function the association with stroke risk was attenuated though remained significant for global cognitive function (-0.06 SD units, 95% CI -0.09 - -0.03), immediate and delayed verbal memory, semantic verbal fluency and processing speed. CONCLUSION: in individuals free from a history of stroke or dementia, high subclinical cerebrovascular disease burden was associated with worse cognitive function in multiple domains.
Abstract.
Author URL.
Lang IA, Melzer D (2008). Moderate alcohol consumption in older adults is associated with better cognition and well-being than abstinence - Reply.
AGE AND AGEING,
37(1), 121-121.
Author URL.
Lang IA, Llewellyn DJ, Langa KM, Wallace RB, Huppert FA, Melzer D (2008). Neighborhood deprivation, individual socioeconomic status, and cognitive function in older people: analyses from the English Longitudinal Study of Ageing.
J Am Geriatr Soc,
56(2), 191-198.
Abstract:
Neighborhood deprivation, individual socioeconomic status, and cognitive function in older people: analyses from the English Longitudinal Study of Ageing.
OBJECTIVES: to assess the relationship between cognitive function, socioeconomic status, and neighborhood deprivation (lack of local resources of all types, financial and otherwise). DESIGN: Nationally representative cross-section. SETTING: the English Longitudinal Study of Ageing (ELSA). PARTICIPANTS: Seven thousand one hundred twenty-six community-dwelling individuals aged 52 and older and resident in urban areas. MEASUREMENTS: Individual cognitive function score and index of multiple deprivation (IMD) at the Super Output Area level, adjusting for health, lifestyle, and sociodemographic confounders. Analyses were conducted separately according to sex and age group (52-69 and > or = 70). RESULTS: IMD affected cognitive function independent of the effects of education and socioeconomic status. For example, in fully adjusted models, women aged 70 and older had a standardized cognitive function score (z-score) that was 0.20 points (95% confidence interval (CI)=0.01-0.39) lower in the bottom 20% of wealth than the top 20%, 0.44 points (95% CI=0.20-0.69) lower in the least-educated group than in the most educated, and 0.31 points (95% CI 0.15-0.48) lower if resident lived in an area in the bottom 20% of IMD than in the top 20%. CONCLUSION: in community-based older people in urban neighborhoods, neighborhood deprivation--living in a neighborhood with high levels of deprivation, compared with national levels--is associated with cognitive function independent of individual socioeconomic circumstances. The mechanisms underlying this relationship are unclear and warrant further investigation.
Abstract.
Author URL.
Lang IA, Gibbs SJ, Steel N, Melzer D (2008). Neighbourhood deprivation and dental service use: a cross-sectional analysis of older people in England.
J Public Health (Oxf),
30(4), 472-478.
Abstract:
Neighbourhood deprivation and dental service use: a cross-sectional analysis of older people in England.
BACKGROUND: Appropriate dental care is an important part of maintaining good oral health. We examined the relationship between socioeconomic status, neighbourhood deprivation levels and older people's dental service use. METHODS: We used logistic regression analysis to assess the relationship between self-reported dental service use and neighbourhood deprivation, adjusting for individual socioeconomic and health factors, in individuals aged 65+ in the 2005 Health Survey for England (n = 4240). RESULTS: Among dentulous respondents, 69.9% reported attending for regular check-ups, 6.2% occasional check-ups, 18.4% only saw a dentist when in trouble and 5.6% never went to a dentist. In our adjusted model age, sex, region, education level, occupational social class, self-reported health and smoking status, but not degree of urbanization, were associated with use of dental services. Following adjustment for these other factors those living in the most deprived 20% of neighbourhoods, compared with those in the least deprived, had a relative risk ratio of 2.25 (95% confidence interval 1.59-3.17) of using dental services only when symptomatic, rather than going for regular or occasional check-ups. When alternative outcomes of reporting having recently seen a doctor or been a hospital inpatient were assessed these deprivation-related patterns in service use were not evident. CONCLUSION: Levels of neighbourhood deprivation are associated with the use of dental services by older people. Action is needed to ensure older people in deprived communities access appropriate and comprehensive dental services.
Abstract.
Author URL.
Lang IA, Llewellyn DJ, Langa KM, Wallace RB, Melzer D (2008). Neighbourhood deprivation and incident mobility disability in older adults.
Age Ageing,
37(4), 403-410.
Abstract:
Neighbourhood deprivation and incident mobility disability in older adults.
OBJECTIVE: to assess whether incident mobility disability and neighbourhood deprivation in older people are associated independent of the effects of individual socio-economic status, health behaviours and health status. METHODS: prospective cohort study with a 2-year follow-up. SETTING: the English Longitudinal Study of Ageing (ELSA), a national probability sample of non-institutionalised older people. PARTICIPANTS: 4,148 participants aged 60 years and over. MEASUREMENTS: exposure was a census-based index of neighbourhood deprivation [the Index of Multiple Deprivation (IMD)]; outcomes were measured and self-reported incident mobility difficulties. RESULTS: neighbourhood deprivation had a statistically significant effect on physical function following adjustment for individual socio-economic factors, health behaviours and health status. Compared to those living in the least deprived 20% of neighbourhoods, those in the most deprived neighbourhoods had a risk ratio (RR) of incident self-reported mobility difficulties of 1.75 (95% CI 1.14-2.70) and RR of incident-impaired gait speed of 1.63 (95% CI 1.01-2.62). In adjusted models, 4.0 per 100 (95% CI 3.0-5.4) older adults in neighbourhoods in the least deprived 20% had incident mobility difficulties over a 2-year period, whereas 13.6 per 100 (95% CI 10.5-17.4) older adults had incident mobility difficulties in neighbourhoods in the most deprived 20%. CONCLUSIONS: older people living in deprived neighbourhoods are significantly more likely to experience incident mobility difficulties than those in less-deprived neighbourhoods. The mechanisms underlying this relationship are unclear and research to identify mechanisms and appropriate interventions is needed.
Abstract.
Author URL.
Lang IA, Llewellyn DJ, Alexander K, Melzer D (2008). Obesity, physical function, and mortality in older adults.
J Am Geriatr Soc,
56(8), 1474-1478.
Abstract:
Obesity, physical function, and mortality in older adults.
OBJECTIVES: to estimate the effects of excess body weight on objective and subjective physical function and mortality risks in noninstitutionalized older adults. DESIGN: Population-based cohort study. SETTING: the English Longitudinal Study of Ageing (ELSA). PARTICIPANTS: Three thousand seven hundred ninety-three participants in the ELSA aged 65 and older followed up for 5 years. MEASUREMENTS: Analyses compared the risks of impaired physical function and mortality for subjects who were at the recommended weight (body mass index (BMI)=20.0-24.9) with those who were overweight (BMI=25.0-29.9), obese (BMI=30.0-34.9) or severely obese (BMI>or=35.0). Outcome measures were difficulties with activities of daily living (ADLs), score on the Short Physical Performance Battery, and mortality. RESULTS: Participants in higher BMI categories had greater risk of impaired physical function at follow-up but little or no greater risk of mortality. For example, compared with men of recommended weight, obese men (BMI=30.0-34.9) had relative risk ratios of difficulties with ADLs of 1.99 (95% confidence interval (CI)=1.42-2.78), of measured functional impairment of 1.51 (95% CI=1.05-2.16), and of mortality of 0.99 (95% CI=0.60-1.61). Findings were robust when excluding those who lost weight, smoked, or had poor self-rated health. CONCLUSION: Excess body weight in people aged 65 and older is associated with greater risk of impaired physical function but not with greater mortality risk. Societies with growing numbers of overweight and obese older people are likely to face increasing burdens of disability-associated health and social care costs.
Abstract.
Author URL.
Steel N, Clark A, Lang IA, Wallace RB, Melzer D (2008). Racial disparities in receipt of hip and knee joint replacements are not explained by need: the Health and Retirement Study 1998-2004.
J Gerontol a Biol Sci Med Sci,
63(6), 629-634.
Abstract:
Racial disparities in receipt of hip and knee joint replacements are not explained by need: the Health and Retirement Study 1998-2004.
BACKGROUND: Hip and knee joint replacement rates vary by demographic group. This article describes the epidemiology of need for joint replacement, and of subsequent receipt of a joint replacement by those in need. METHODS: Data from the Health and Retirement Study were used to assess need for hip or knee joint replacement in a total of 14,807 adults aged 60 years or older in 1998, 2000, and 2002 and receipt of needed surgery 2 years later. "Need" classification was based on difficulty walking, joint pain, stiffness, or swelling and receipt of treatment for arthritis, without contraindications to surgery. RESULTS: Need in 2002 was greater in participants who were older than 74 years (vs 60-64: adjusted odds ratio 2.06; 95% confidence interval, 1.68-2.53), women (vs men: 1.81; 1.53-2.14), less educated (vs college educated: 1.27; 1.06-1.52), in the poorest third (vs richest: 2.20; 1.78-2.72), or obese (vs nonobese: 2.39; 2.02-2.81). One hundred sixty-eight participants in need received a joint replacement, with lower receipt in black or African American participants (vs white: 0.47; 0.26-0.83) or less educated (vs college educated: 0.65; 0.44-0.96). These differences were not explained by current employment, access to medical care, family responsibilities, disability, living alone, comorbidity, or exclusion of those younger than Medicare eligibility age. CONCLUSIONS: After taking variations in need into consideration, being black or African American or lacking a college education appears to be a barrier to receiving surgery, whereas age, sex, relative poverty, and obesity do not. These disparities maintain disproportionately high levels of pain and disability in disadvantaged groups.
Abstract.
Author URL.
Lang IA, Melzer D (2008). Reply [6]. Age and Ageing, 37(1).
Lang IA, Llewellyn D, Melzer D (2008). VITAMIN D DEFICIENCY IN OLDER PEOPLE: PREVALENCE AND RELATION TO NEIGHBOURHOOD DEPRIVATION.
GERONTOLOGIST,
48, 758-758.
Author URL.
Lang IA (2007). Demographic, socioeconomic, and attitudinal associations with children's cycle-helmet use in the absence of legislation.
Injury Prevention,
13(5), 355-358.
Abstract:
Demographic, socioeconomic, and attitudinal associations with children's cycle-helmet use in the absence of legislation
The association of demographic, socioeconomic, and attitudinal factors with children's cycle-helmet use was investigated using self-reported data from 9775 children aged 8-12 in England, where there are currently no legal requirements that cyclists (of any age) wear helmets. The results suggest that demographic factors, socioeconomic status, and attitudes influence whether children wear bicycle helmets but that attitudinal factors are most important.
Abstract.
Lang I, Wallace RB, Huppert FA, Melzer D (2007). Moderate alcohol consumption in older adults is associated with better cognition and well-being than abstinence.
Age Ageing,
36(3), 256-261.
Abstract:
Moderate alcohol consumption in older adults is associated with better cognition and well-being than abstinence.
BACKGROUND: There is evidence of a U-shaped association between alcohol consumption and physical health outcomes in older people, such that moderate drinking is associated with better outcomes than abstinence or heavy drinking, but whether moderate drinking in older people is associated with better cognition and mental health than non-drinking has not been explored. OBJECTIVE: to assess the relationship between drinking and cognitive health in middle-aged and older people. DESIGN: Prospective observational study. SETTING/PARTICIPANTS: Six thousand and five individuals aged 50 and over who participated in Wave 1 of the English Longitudinal Study of Ageing (ELSA) and who were not problem drinkers. Exposure and outcome variables: we examined cognitive function, subjective well-being, and depressive symptoms, and compared the risks associated with having never drunk alcohol, having quit drinking, and drinking at
Abstract.
Author URL.
Lang IA, Guralnik JM, Melzer D (2007). Physical activity in middle-aged adults reduces risks of functional impairment independent of its effect on weight.
J Am Geriatr Soc,
55(11), 1836-1841.
Abstract:
Physical activity in middle-aged adults reduces risks of functional impairment independent of its effect on weight.
OBJECTIVES: to assess the association between physical activity and subsequent physical functioning in middle-aged adults across a range of body mass index (BMI) categories. DESIGN: Prospective nationally representative cohort studies. SETTING: the United States and England. PARTICIPANTS: Eight thousand seven hundred two individuals in the United States and 1,507 in England aged 50 to 69 and free of impairment at baseline, followed up for 6 years. MEASUREMENTS: Self-reported and measured BMI and self-reported level of physical activity. Outcome measures were score on a physical performance battery and self-reported mobility impairment. RESULTS: in both studies, being overweight and being obese were associated with greater risk of impairment (than being of recommended weight). In all weight categories and both countries, higher levels of physical activity were associated with lower risks of mobility impairment. For example, U.S. respondents of recommended weight (BMI 20-25) who were active on 3 or more days per week had a relative risk (RR) of incident mobility difficulties, compared with those who were less active, of 0.56 (95% confidence interval (CI)=0.40-0.78); for those who were obese (BMI >/=30) the corresponding RR was 0.59 (95% CI=0.45-0.76). CONCLUSION: Excess bodyweight is a risk factor for impaired physical function in middle-aged and older people. Physical activity is protective of impaired physical functioning in this age group in subjects with recommended weight, overweight, and obesity. Older adults should be encouraged to engage in appropriate levels of physical activity irrespective of their weight.
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Lang IA, Rice NE, Wallace RB, Guralnik JM, Melzer D (2007). Smoking cessation and transition into retirement: analyses from the English Longitudinal Study of Ageing.
Age Ageing,
36(6), 638-643.
Abstract:
Smoking cessation and transition into retirement: analyses from the English Longitudinal Study of Ageing.
BACKGROUND: Transitions such as retirement may represent points at which changes in health behaviour occur. OBJECTIVE: to assess whether transition into retirement is associated with increased rates of smoking cessation. DESIGN: Population-based prospective cohort study in England. SETTING AND PARTICIPANTS: One thousand seven hundred and twelve smokers aged 50 years and over, followed up for 5 to 6 years. MEASUREMENTS: Work status (working/retired) and smoking status (non-smoker/smoker) at baseline and follow-up. RESULTS: at baseline, 381 (22.2%) of our respondents had retired, 444 (25.9%) were working and remained in work at follow-up, and 167 (9.8%) transitioned from work to retirement. Seven hundred and twenty (42.1%) had some other status (e.g. unpaid work/unemployment). A total of 42.5% (95% CI 34.9-50.1) of those who retired quit smoking; for those remaining in employment this figure was 29.3% (95% CI 25.0-33.6), and for those already retired it was 30.2% (95% CI 25.5-34.9). In adjusted regression analyses, those aged 55-70 who retired were more than twice as likely (fully adjusted odds ratio 2.50 (95% CI 1.35-4.62)) to quit smoking as those who continued to work. Results were robust when those who retired for reasons of ill-health were excluded. CONCLUSIONS: Our results suggest individuals who undergo the transition into retirement are more likely to quit smoking than those who do not. Interventions should be developed to specifically target those who are retiring, or soon to retire, and those who are due to retire should be helped to incorporate smoking cessation into their retirement planning.
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Lang I, Gardener E, Huppert FA, Melzer D (2007). Was John Reid right? Smoking, class, and pleasure: a population-based cohort study in England.
Public Health,
121(7), 518-524.
Abstract:
Was John Reid right? Smoking, class, and pleasure: a population-based cohort study in England.
OBJECTIVES: to assess whether there is a relationship between smoking and levels of overall quality of life, or with the pleasure domain of quality of life, in lower socio-economic groups (SES). STUDY DESIGN: Cohort study involving 9176 individuals aged 50 years and over who participated in the Health Survey for England and were followed up in Wave 1 of the English Longitudinal Study of Ageing in 2002. METHODS: We classified smokers as never-smokers, ex-smokers and current smokers, and used household wealth as a marker for socio-economic position. Pleasure was assessed using the pleasure subscale of the CASP-19 instrument, a 19-point measure of quality of life that covers four theoretical domains: control, autonomy, self-realization and pleasure. RESULTS: We found that the odds ratio for experiencing lower than median levels of pleasure for smokers with low SES was 1.42 (95% CI 1.16-1.74), and for all smokers was 1.33 (95% CI 1.17-1.51). The same pattern of associations was found when the outcome was total CASP-19 score or positive GHQ-12 score. CONCLUSIONS: We found no evidence to support a claim that smoking is associated with heightened levels of pleasure, either in people with low SES or in the general population. In fact, our results suggest the opposite: that smoking is associated with lower levels of pleasure and poorer overall quality of life. Policy decisions on smoking should consider its potentially harmful effect on quality of life and pleasure as well as on other aspects of health.
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Lang I, Guralnik J, Wallace RB, Melzer D (2007). What level of alcohol consumption is hazardous for older people? Functioning and mortality in U.S. and English national cohorts.
J Am Geriatr Soc,
55(1), 49-57.
Abstract:
What level of alcohol consumption is hazardous for older people? Functioning and mortality in U.S. and English national cohorts.
OBJECTIVES: to estimate disability plus mortality risks in older people according to level of alcohol intake. DESIGN: Two population-based cohort studies. SETTING: the Health and Retirement Study (United States) and the English Longitudinal Study of Aging (England). PARTICIPANTS: Thirteen thousand three hundred thirty-three individuals aged 65 and older followed for 4 to 5 years. MEASUREMENTS: Difficulties with activities of daily living (ADLs), instrumental activities of daily living (IADLs), poor cognitive function, and mortality. RESULTS: One-tenth (10.8%) of U.S. men, 28.6% of English men, 2.9% of U.S. women, and 10.3% of English women drank more than the U.S. National Institute on Alcohol Abuse and Alcoholism recommended limit for people aged 65 and older. Odds ratios (ORs) of disability, or disability plus mortality, in subjects drinking an average of more than one to two drinks per day were similar to ORs in subjects drinking an average of more than none to one drink per day. For example, those drinking more than one to two drinks per day at baseline had an OR of 1.0 (95% confidence interval (CI)=0.8-1.2) for ADL problems, 0.7 (95% CI=0.6-1.0) for IADL problems, and 0.8 (95% CI=0.6-1.1) for poor cognitive function. Findings were robust across alternative models. The shape of the relationship between alcohol consumption and risk of disability was similar in men and women. CONCLUSION: Functioning and mortality outcomes in older people with alcohol intakes above U.S. recommended levels for the old but within recommendations for younger adults are not poor. More empirical evidence of net benefit is needed to support screening and intervention efforts in community-living older people with no specific contraindications who drink more than one to two drinks per day.
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Mey G, Mruck K, Domínguez Figaredo D, Lang I (2006). Editorial. Forum Qualitative Sozialforschung, 7(2).
Henwood K, Lang I (2005). Qualitative social science in the UK: a reflexive commentary on the "State of the art".
Forum Qualitative Sozialforschung,
6(3).
Abstract:
Qualitative social science in the UK: a reflexive commentary on the "State of the art"
UK social science is characterised by an ever increasing expectation that it should be able to demonstrate excellence not only in terms of scientific and intellectual considerations. In addition, it must link its relevance and worth to a wide range of stakeholders and users of research. This "climate of change" is seen in the unprecedented level of strategic initiatives that are currently underway. The purpose of this article is to consider some of these strategic developments and how they seek to promote leading edge developments in social science methodology. Attention is focussed, in particular, on the place of qualitative methodologies and methods within these developments. One of the sections of the article reports on the main findings of a consultation exercise with UK social scientists on qualitative research resources. A key interest throughout the article is in articulating the explicit and implicit agendas that are energising and motivating what may be called the "turn to methodology" in funded UK social science in the early 21st century © 2005 FQS.
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Canning R, Lang I (2004). Modern apprenticeships in Scotland.
Journal of Education Policy,
19(2), 163-177.
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Modern apprenticeships in Scotland
The paper provides an analysis of the take-up of modern apprenticeships in Scotland for the period 1999-2001. The methodology includes secondary data sources and a case study. The findings indicate that, although the numbers participating in the MA scheme have increased, there remain major concerns both with completion rates and the quality of the programme. The authors also question the relevance of using pedagogically driven theoretical models to understand the complex and dynamic nature of work-based employment practices.
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