Browsing by Author "Brasher, Melanie Sereny"

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    A U-shaped Association Between Blood Pressure and Cognitive Impairment in Chinese Elderly.
    (Journal of the American Medical Directors Association, 2017-02) Lv, Yue-Bin; Zhu, Peng-Fei; Yin, Zhao-Xue; Kraus, Virginia Byers; Threapleton, Diane; Chei, Choy-Lye; Brasher, Melanie Sereny; Zhang, Juan; Qian, Han-Zhu; Mao, Chen; Matchar, David Bruce; Luo, Jie-Si; Zeng, Yi; Shi, Xiao-Ming

    Objectives

    Higher or lower blood pressure may relate to cognitive impairment, whereas the relationship between blood pressure and cognitive impairment among the elderly is not well-studied. The study objective was to determine whether blood pressure is associated with cognitive impairment in the elderly, and, if so, to accurately describe the association.

    Design

    Cross-sectional data from the sixth wave of the Chinese Longitudinal Healthy Longevity Survey (CLHLS) conducted in 2011.

    Setting

    Community-based setting in longevity areas in China.

    Participants

    A total of 7144 Chinese elderly aged 65 years and older were included in the sample.

    Measures

    Systolic blood pressures (SBP) and diastolic blood pressures (DBP) were measured, pulse pressure (PP) was calculated as (SBP) - (DBP) and mean arterial pressures (MAP) was calculated as 1/3(SBP) + 2/3(DBP). Cognitive function was assessed via a validated Mini-Mental State Examination (MMSE).

    Results

    Based on the results of generalized additive models (GAMs), U-shaped associations were identified between cognitive impairment and SBP, DBP, PP, and MAP. The cutpoints at which risk for cognitive impairment (MMSE <24) was minimized were determined by quadratic models as 141 mm Hg, 85 mm Hg, 62 mm Hg, and 103 mm Hg, respectively. In the logistic models, U-shaped associations remained for SBP, DBP, and MAP but not PP. Below the identified cutpoints, each 1-mm Hg decrease in blood pressure corresponded to 0.7%, 1.1%, and 1.1% greater risk in the risk of cognitive impairment, respectively. Above the cutpoints, each 1-mm Hg increase in blood pressure corresponded to 1.2%, 1.8%, and 2.1% greater risk of cognitive impairment for SBP, DBP, and MAP, respectively.

    Conclusion

    A U-shaped association between blood pressure and cognitive function in an elderly Chinese population was found. Recognition of these instances is important in identifying the high-risk population for cognitive impairment and to individualize blood pressure management for cognitive impairment prevention.
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    Gender-dependent association of body mass index and waist circumference with disability in the Chinese oldest old.
    (Obesity (Silver Spring), 2014-08) Yin, Zhaoxue; Shi, Xiaoming; Kraus, Virginia B; Brasher, Melanie Sereny; Chen, Huashuai; Liu, Yuzhi; Lv, Yuebin; Zeng, Yi
    OBJECTIVES: To explore associations of BMI and waist circumference (WC) with disability among the Chinese oldest old. METHODS: The 5,495 oldest old in the sixth wave of Chinese Longitudinal Healthy Longevity Study conducted in 2011 were included in this study. Disability was assessed by activities of daily living (ADL); height and weight for BMI and WC were measured; information including socio-demographics, lifestyles, and health status was collected. RESULTS: Generalized additive models analysis showed that the association of BMI/WC with ADL disability was nonlinear. Among the males, logistic regression results supported a "J" shape association between ADL disability with BMI/WC-the highest tertile group in BMI or WC was significantly associated with an increased risk of ADL disability: odds ratio 1.78 (95% confidence interval (CI): 1.26-2.52) for BMI and 2.01 (95% CI: 1.44-2.82) for WC. Among females, an inverse "J" shape association was found, only the lowest tertile group before the cutoff point had an increased risk of ADL disability: odds ratio 1.42 (95%CI: 1.02-1.97) for BMI and 1.47 (95% CI:1.06-2.04) for WC. CONCLUSIONS: Associations of BMI and WC with ADL disability are significant even in the oldest old, but differ between the genders.
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    Incorporating biomarkers into the study of socio-economic status and health among older adults in China.
    (SSM - population health, 2017-12) Brasher, Melanie Sereny; George, Linda K; Shi, Xiaoming; Yin, Zhaoxue; Zeng, Yi
    The social gradient in health - that individuals with lower SES have worse health than those with higher SES- is welldocumented using self-reports of health in more developed countries. Less is known about the relationship between SES and health biomarkers among older adults residing in less developed countries. We use data from the ChineseLongitudinal Healthy Longevity Survey (CLHLS) longevity areas sub-sample to examine the social gradient in healthamong rural young-old and oldest-old adults (N=2,121). Our health indicators include individual biomarkers, metabolic syndrome, and self-reports of health. We found a largely positive relationship between SES and health. SES was more consistently associated with individual biomarkers among the oldest-old than the young-old, providing evidence for cumulative disadvantage. We discuss the implications of our findings for older adults who have lived through different social, economic, and health regimes.
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    Low-density lipoprotein cholesterol was inversely associated with 3-year all-cause mortality among Chinese oldest old: data from the Chinese Longitudinal Healthy Longevity Survey.
    (Atherosclerosis, 2015-03) Lv, Yue-Bin; Yin, Zhao-Xue; Chei, Choy-Lye; Qian, Han-Zhu; Kraus, Virginia Byers; Zhang, Juan; Brasher, Melanie Sereny; Shi, Xiao-Ming; Matchar, David Bruce; Zeng, Yi

    Objective

    Low-density lipoprotein cholesterol (LDL-C) is a risk factor for survival in middle-aged individuals, but conflicting evidence exists on the relationship between LDL-C and all-cause mortality among the elderly. The goal of this study was to assess the relationship between LDL-C and all-cause mortality among Chinese oldest old (aged 80 and older) in a prospective cohort study.

    Methods

    LDL-C concentration was measured at baseline and all-cause mortality was calculated over a 3-year period. Multiple statistical models were used to adjust for demographic and biological covariates.

    Results

    During three years of follow-up, 447 of 935 participants died, and the overall all-cause mortality was 49.8%. Each 1 mmol/L increase of LDL-C concentration corresponded to a 19% decrease in 3-year all-cause mortality (hazard ratio [HR] 0.81, 95% confidence interval [CI] 0.71-0.92). The crude HR for abnormally higher LDL-C concentration (≥3.37 mmol/L) was 0.65 (0.41-1.03); and the adjusted HR was statistically significant around 0.60 (0.37-0.95) when adjusted for different sets of confounding factors. Results of sensitivity analysis also showed a significant association between higher LDL-C and lower mortality risk.

    Conclusions

    Among the Chinese oldest old, higher LDL-C level was associated with lower risk of all-cause mortality. Our findings suggested the necessity of re-evaluating the optimal level of LDL-C among the oldest old.
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    Older Parents Benefit More in Health Outcome From Daughters' Than Sons' Emotional Care in China.
    (J Aging Health, 2016-12) Zeng, Yi; Brasher, Melanie Sereny; Gu, Danan; Vaupel, James W
    OBJECTIVE: To examine whether older parents in China would benefit more from daughters' care than from sons' emotional care. METHOD: Analysis of the unique data sets of the Chinese Longitudinal Healthy Longevity Survey conducted in 2002, 2005, and 2008-2009 in 22 provinces. RESULTS: As compared with having son(s), having daughter(s) is significantly more beneficial at older ages in China, with regard to maintaining higher cognitive capacity and reducing mortality risk. Such daughter advantages in providing emotional care to older parents are more profound among the oldest-old aged 80+ as compared with the young-old aged 65 to 79 and surprisingly more profound in rural areas as compared with urban areas, even though son preference is much more common among rural residents. DISCUSSION: We describe how educational campaigns aimed at informing the public about the benefits of daughter(s) for older parents' health outcome could help promote gender equality and reduce traditional son preference, especially in rural China.