Location: Jean Mayer Human Nutrition Research Center On Aging
2022 Annual Report
Objectives
Objective 1: Continue to study the oldest old that survive in the existing Geisinger Rural Aging Study cohort in relation to longitudinal health outcomes and mortality. Perform sub-analyses on all of those who survive to 100 years of age or older, whether currently surviving or not, with a focus on nutrition risk, quality of life and health outcomes as predictors of living to become a centenarian. [NP107, C5, PS5A]
Sub-objective 1.A: Continue to study the oldest old that survive in the existing Geisinger Rural Aging Study cohort in relation to longitudinal health outcomes and mortality.
Sub-objective 1.B: Perform sub-analyses on all of those eligible to survive to 100 years of age or older, whether currently surviving or not, with a focus on nutrition risk, quality of life and health outcomes as predictors of living to become a centenarian.
Objective 2: Conduct secondary analyses of the entire existing Geisinger Rural Aging Study dataset to relate nutrition risk and other lifestyle variables at baseline enrollment with additional health outcomes not previously explored in our investigations (e.g., dementia). [NP107, C5, PS5A]
Sub-objective 2.A: Conduct secondary analyses of the entire existing Geisinger Rural Aging Study dataset to relate nutrition risk and other lifestyle variables at baseline enrollment to dementia outcomes.
Sub-objective 2.B: Conduct secondary analyses of the entire existing Geisinger Rural Aging Study dataset to relate nutrition risk and other lifestyle variables at baseline enrollment to additional health outcomes not previously explored.
Approach
The Geisinger Rural Aging Study (GRAS) was initiated between 1994-99 as a longitudinal study of health outcomes in relation to nutritional status among 21,645 individuals =65-years of age. Participants have been rescreened at 3-4-year intervals with questionnaires that encompass multiple domains of nutrition risk. Our investigations have found high prevalence of poor quality diets, obesity, and ill health. We continue to validate our diet quality screening questionnaire (DQSQ) in relation to health outcomes and mortality. We have found that DQSQ scores are significantly correlated with Healthy Eating Index (HEI) scores, which were based on 24-hour dietary recall. Those that were considered not at nutritional risk as determined by the DQSQ score had significantly higher HEI scores compared to those who were in the at-risk or possibly at risk groups. These results suggest that the DQSQ is a valid measure of diet quality even in the oldest old. Recent analysis has also revealed that higher diet quality is associated with lower mortality. Participants with the lowest diet quality scores had significantly increased risk of mortality compared to those with the highest scores. These findings suggest that diet quality may play an integral role in healthy aging with potential impact on dietary guidance for older adults. Further research will afford a unique opportunity to better characterize the impact of diet quality in a cohort of the oldest old which include a growing number of centenarians. Out of the original Geisinger Rural Aging Study (GRAS) cohort of 21,645 community-dwelling Pennsylvanians aged =65-years who completed a baseline nutrition risk screening at over 100 Geisinger clinic sites between 1994-1999, we have identified 4,245 participants that remain active in the Geisinger Healthcare System. Our analysis indicates that we already have 130 confirmed centenarians (living or expired) and we project that an additional 70-170 will become available for investigation over the coming 5-years. We will continue to study the oldest old in relation to health outcomes and mortality. By performing sub-analyses on those eligible to have survived =100 years, we will discern whether nutrition risk, quality of life and health outcomes are predictors of living to become a centenarian. In particular, our robust longitudinal dataset now spans more than two decades and will provide unparalleled opportunities for secondary analyses that explore nutrition risk in relation to additional health outcomes like dementia. By studying the oldest old we can identify potentially modifiable diet and lifestyle factors to promote healthy aging.
Progress Report
Mortality: Our most recent data confirmed 16,503 deaths out of the 21,645 (76%) original Geisinger Rural Aging Study (GRAS) participants which have increased from 74% from our last reporting. This corresponds to an additional 352 participants with deceased status. There remain 2053 original GRAS participants in active follow-up (defined as an encounter within the electronic health record occurring within the last two years).
Centenarians: There are currently 173 GRAS participants confirmed as centenarians and another 19 who are pending confirmation for a projected total of 192 centenarians (out of an estimated 200-300 centenarians as the project goal). All of these data have been extracted from the Electronic Health Records. There are approximately 26 others in the GRAS database that remain active in Geisinger healthcare and are age 99. We expect several of these to become centenarians within the next year.
Dementia: Of 13,938 with eligible follow-up in the electronic health record (median follow-up 10.8 years), there were 2,760 with diagnosed dementia. The overall 10-year incidence of new dementia was 15.6% and it increased with baseline age (see table).
N total N total 1-year 3-year 5-year 10-year 15-year
Age <70 2,589 0.2% 0.9% 1.8% 5.9% 12.6%
Age 70-79 8,249 1.4% 3.7% 5.9% 14.2% 26.8%
Age 80-89 2,842 4.8% 10.9% 16.3% 32.2% 50.1%
Age 90+ 258 9.3% 19.1% 27.3% 46.0% 52.0%
We conducted a prospective study to examine the association between overall diet quality as assessed by the diet quality screening tool and the longitudinal risk of dementia over a 12-year follow-up duration in a rural cohort among 2,232 adults, aged 80 years or greater. Across a mean of 6.90 years of follow-up, having higher diet quality was not significantly associated with incident all-cause dementia. Findings were similar for different sub-types of dementia. When we examined dementia onset that occurred during the first 4 years of follow-up, trends suggested possible associations of higher diet quality with reduced risk of all-cause dementia, but these did not achieve statistical significance. It remains possible that sustained dietary intake of high quality from young or middle-aged adulthood will be associated with a reduced risk of incident all-cause dementia later in life. Since our data encompasses only follow-up from age 65 years or older, we are unable to address this important question.
An abstract was presented. Flores AC, Jensen GL, Mitchell DC, Na M, Wood C, Still CD, Gao X. Prospective study of diet quality and the risk of dementia in the Oldest Old, Electronic poster presentation presented at Nutrition 2022 Live Online, the American Society for Nutrition’s (ASN) flagship meeting, virtual conference, June 14 – 16 2022.
A manuscript is in preparation. Flores AC, Jensen GL, Mitchell DC, Na M, Wood C, Still CD, Gao X. Prospective study of diet quality and the risk of dementia in the Oldest Old.
Other variables: As noted for Sub-objective 2b above, we are now pursuing additional analysis of nutrition risk, food security and related variables from our initial baseline screening data collected nearly 20 years ago and their relationships to health outcomes and mortality. In addition, we reviewed newly acquired data on COVID-19 test results and COVID-19 outcomes. We found 331 individuals that had a positive COVID-19 test of which 70 died within one month of the positive result. We intend to continue review of these data to determine suitability for an analysis examining relationships between diet quality and COVID-19 among the oldest old.
Accomplishments
1. The key problem that our research has targeted is limited understanding of the relationship between nutrition risk and health outcomes among persons older persons of advanced age. For the accomplishment shared in this year’s annual report, our approach aimed to identify whether diet quality is associated with risk of dementia. The action taken was to examine overall diet quality as assessed by a diet quality screening tool and the longitudinal risk of dementia over a 12-year follow-up in a rural Pennsylvania cohort of 2,232 adults, aged 80 years or greater. Our results revealed that higher diet quality was not significantly associated with incident all-cause dementia over a mean of 6.90 years of follow-up. Since it remains possible that sustained dietary intake of high quality from young or middle-aged adulthood may be associated with a reduced risk of incident all-cause dementia later in life, longitudinal research with a younger cohort is indicated. Customers of these findings include researchers, health professionals, government agencies, non-government agencies, and older persons.
