Biomedical subjects

Astrid E Fletcher

Publications and source records attributed to Astrid E Fletcher.

At least 19 recordsLinked to original sources

PubMed2007

Prevalence of lens opacities in North India: the INDEYE feasibility study.

PURPOSE: To obtain estimates of the prevalence of lens opacities in an Indian setting by using photographically acquired lens images. METHODS: In 11 randomly sampled villages from a rural district of Haryana, North India, 1443 people (median age 60 years), 52% women, were identified from enumeration of the > or =50-year age group; 87% attended an eye examination. Digital images of cortical and posterior subcapsular opacities and photographs of nuclear opacities were graded using the Lens Opacity Classification System (LOCS) II. The prevalence of opacities was based on a grade of 2 or higher in the worse eye for nuclear, cortical, or posterior subcapsular opacities. RESULTS: Of the participants, 1071 people had gradable images; a further 163 had undergone surgery or had dense opacities. Nuclear opacities were the most common type, with an overall prevalence of 56.9% (95% CI, 53.0-60.6). Posterior subcapsular opacities occurred in 20.6% (95% CI, 17.9-25.8) and cortical opacities in 21.6% (95% CI, 17.9-25.8). Prevalence rose steeply with age for all opacities and was higher in the women than in the men for cortical opacities (P = 0.03). The prevalence of any type of lens opacity including surgical cases and dense opacities was 75.3% (95% CI, 71.4-78.81). CONCLUSIONS: These results highlight the substantial excess of lens opacities in India compared with Western populations.

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PubMed2006

Fracture risk and the use of a diuretic (indapamide SR) +/- perindopril: a substudy of the Hypertension in the Very Elderly Trial (HYVET).

BACKGROUND: The Hypertension in the Very Elderly Trial (HYVET) is a placebo controlled double blind trial of treating hypertension with indapamide Slow Release (SR) +/- perindopril in subjects over the age of 80 years. The primary endpoints are stroke (fatal and non fatal). In view of the fact that thiazide diuretics and indapamide reduce urinary calcium and may increase bone mineral density, a fracture sub study was designed to investigate whether or not the trial anti-hypertensive treatment will reduce the fracture rate in very elderly hypertensive subjects. METHODS: In the trial considerable care is taken to ascertain any fractures and to identify risk factors for fracture, such as falls, co-morbidity, drug treatment, smoking and drinking habits, levels of activity, biochemical abnormalities, cardiac irregularities, impaired cognitive function and symptoms of orthostatic hypotension. POTENTIAL RESULTS: The trial is expected to provide 10,500 patient years of follow-up. Given a fracture rate of 40/1000 patient years and a 20% difference in fracture rate, the power of the sub study is 58% to detect this difference at the 5% level of significance. The corresponding power for a reduction of 25% is 78%. CONCLUSION: The trial is well under way, expected to complete in 2009, and on target to detect, if present, the above differences in fracture rate.

Journal Article↗

PubMed2006

A randomised controlled trial investigating the effect of n-3 long-chain polyunsaturated fatty acid supplementation on cognitive and retinal function in cognitively healthy older people: the Older People And n-3 Long-chain polyunsaturated fatty acids (OPAL) study protocol [ISRCTN72331636].

The number of individuals with age-related cognitive impairment is rising dramatically in the UK and globally. There is considerable interest in the general hypothesis that improving the diet of older people may slow the progression of cognitive decline. To date, there has been little attention given to the possible protective role of n-3 long-chain polyunsaturated fatty acids (n-3 LCPs) most commonly found in oily fish, in age-related loss of cognitive function. The main research hypothesis of this study is that an increased dietary intake of n-3 LCPs will have a positive effect on cognitive performance in older people in the UK. To test this hypothesis, a double-blind randomised placebo-controlled trial will be carried out among adults aged 70-79 years in which the intervention arm will receive daily capsules containing n-3 LCP (0.5 g/day docosahexaenoic acid and 0.2 g/day eicosapentaenoic acid) while the placebo arm will receive daily capsules containing olive oil. The main outcome variable assessed at 24 months will be cognitive performance and a second major outcome variable will be retinal function. Retinal function tests are included as the retina is a specifically differentiated neural tissue and therefore represents an accessible window into the functioning of the brain. The overall purpose of this public-health research is to help define a simple and effective dietary intervention aimed at maintaining cognitive and retinal function in later life. This will be the first trial of its kind aiming to slow the decline of cognitive and retinal function in older people by increasing daily dietary intake of n-3 LCPs. The link between cognitive ability, visual function and quality of life among older people suggests that this novel line of research may have considerable public health importance.

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PubMed2006

Is the NEI-VFQ-25 a useful tool in identifying visual impairment in an elderly population?

BACKGROUND: The use of self-report questionnaires to substitute for visual acuity measurement has been limited. We examined the association between visual impairment and self reported visual function in a population sample of older people in the UK. METHODS: Cross sectional study of people aged more than 75 years who initially participated in a trial of health screening. The association between 25-item National Eye Institute Visual Function Questionnaire (NEI-VFQ) scores and visual impairment (defined as an acuity of less than 6/18 in the better eye) was examined using logistic regression. RESULTS: Visual acuity and NEI-VFQ scores were obtained from 1807 participants (aged 77 to 101 years, 36% male), from 20 general practices throughout the UK. After adjustment for age, gender, practice and NEI-VFQ sub-scale scores, those complaining of poor vision in general were 4.77 times (95% CI 3.03 to 7.53) more likely to be visually impaired compared to those who did not report difficulty. Self-reported limitations with social functioning and dependency on others due to poor vision were also associated with visual impairment (odds ratios, 2.52, 95% CI 1.55 to 4.11; 1.73, 95% CI 1.05 to 2.86 respectively). Those reporting difficulties with near vision and colour vision were more likely to be visually impaired (odds ratios, 2.32, 95% CI 1.30 to 4.15; 2.25, 95% CI 1.35 to 3.73 respectively). Other NEI-VFQ sub-scale scores were unrelated to measures of acuity. Similar but weaker odds ratios were found with reduced visual acuity (defined as less than 6/12 in the better eye). Although differences in NEI-VFQ scores were small, scores were strongly associated with visual acuity, binocular status, and difference in acuity between eyes. CONCLUSION: NEI-VFQ questions regarding the quality of general vision, social functioning, visual dependency, near vision and colour vision are strongly and independently associated with an objective measure of visual impairment in an elderly population.

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PubMed2006

Prevalence of age-related maculopathy in older Europeans: the European Eye Study (EUREYE).

OBJECTIVE: To estimate the prevalence of age-related maculopathy in an older population from 7 European countries. METHODS: Randomly sampled people 65 years and older were invited to an eye examination in centers across 7 European countries (Norway, Estonia, United Kingdom, France, Italy, Greece, and Spain). Fundus images of each eye were graded at a single reading center. Prevalence rates were calculated for stage of age-related maculopathy with 95% confidence intervals (CIs) estimated for clustered data. RESULTS: Of 5040 participants (45% response rate), 4753 (2128 men and 2625 women) had gradable fundus images. The prevalences were grade 0, 47.59% (95% CI, 43.53%-51.65%); grade 1, 36.48% (95% CI, 32.66%-40.30%); grade 2, 10.14% (95% CI, 8.92% to 11.37%); grade 3, 2.46% (95% CI, 1.79%-3.13%); and grade 4 (age-related macular degeneration [AMD]), 3.32% (95% CI, 2.52%-4.13%) and large drusen only (> or = 125 microm), 15.41% (95% CI, 13.61%-17.21%). The prevalence of geographic atrophic AMD was 1.2% (95% CI, 0.8%-1.7%) and of neovascular AMD, 2.3% (95% CI, 1.7%-2.9%). The prevalence of bilateral AMD was 1.4% (95% CI, 1.0%-1.8%). CONCLUSION: Age-specific prevalences of age-related maculopathy in the European Eye Study (EUREYE) are similar to other population-based studies in Western populations.

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PubMed2006

Weight, shape, and mortality risk in older persons: elevated waist-hip ratio, not high body mass index, is associated with a greater risk of death.

BACKGROUND: Guidelines for optimal weight in older persons are limited by uncertainty about the ideal body mass index (BMI) or the usefulness of alternative anthropometric measures. OBJECTIVE: We investigated the association of BMI (in kg/m(2)), waist circumference, and waist-hip ratio (WHR) with mortality and cause-specific mortality. DESIGN: Subjects aged >/=75 y (n = 14 833) from 53 family practices in the United Kingdom underwent a health assessment that included measurement of BMI and waist and hip circumferences; they also were followed up for mortality. RESULTS: During a median follow-up of 5.9 y, 6649 subjects died (46% of circulatory causes). In nonsmoking men and women (90% of the cohort), compared with the lowest quintile of BMI (<23 in men and <22.3 in women), adjusted hazard ratios (HRs) for mortality were <1 for all other quintiles of BMI (P for trend = 0.0003 and 0.0001 in men and women, respectively). Increasing WHR was associated with increasing HRs in men and women (P for trend = 0.008 and 0.0002, respectively). BMI was not associated with circulatory mortality in men (P for trend = 0.667) and was negatively associated in women (P for trend = 0.004). WHR was positively related to circulatory mortality in both men and women (P for trend = 0.001 and 0.005, respectively). Waist circumference was not associated with all-cause or circulatory mortality. CONCLUSIONS: Current guidelines for BMI-based risk categories overestimate risks due to excess weight in persons aged >/=75 y. Increased mortality risk is more clearly indicated for relative abdominal obesity as measured by high WHR.

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PubMed2005

Cause-specific mortality in old age in relation to body mass index in middle age and in old age: follow-up of the Whitehall cohort of male civil servants.

BACKGROUND: The relevance of body mass index (BMI) to cause-specific mortality in old age is uncertain. OBJECTIVES: To examine cause-specific 5 year mortality in old age by BMI in old age and middle age (40-69 years). METHODS: Cox proportional hazards for mortality rates among 4862 former male civil servants in relation to quartiles of BMI measured when screened in 1968-70 and when resurveyed in 1997-98 (median age 76 years). RESULTS: The association between all-cause mortality after resurvey and BMI in old age was U-shaped with hazard ratios (HRs) of 1.3 (95% CI 1.1-1.5) for the lightest and heaviest categories relative to the middle two. Among 'healthy' men the lightest (<22.7 kg/m2) had greatest all-cause mortality. The heaviest men (>26.6 kg/m2) had increased risk of cardiovascular disease (CVD) mortality in the first two years or for the whole period if never-smokers. Respiratory mortality was inversely associated with BMI in old age [adjusted HR for trend per BMI category increase 0.6 (0.5-0.7)] but cancer mortality lacked a clear pattern. Net gain or loss of 10 kg or more between middle and old age was a strong predictor of all-cause and CVD mortality. CONCLUSIONS: The shape of the association between BMI in old age and mortality differs by cause of death. Major weight change over time is a warning signal for higher CVD mortality. Having BMI<22.7 kg/m2 in old age is associated with above-average mortality rates even if apparently healthy.

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PubMed2005

Cause-specific visual impairment and mortality: results from a population-based study of older people in the United Kingdom.

OBJECTIVE: To assess the association between mortality and cause-specific visual impairment in older people. METHODS: Visual acuity and causes of visual impairment were collected in 13 569 participants 75 years and older participating in a randomized trial of health screening. Participants were followed up for mortality for a median of 6.1 years. RESULTS: Compared with those with 6/6 (or 20/20 Snellen) or better visual acuity, the age- and sex-adjusted rate ratio for visually impaired people (binocular visual acuity <6/18 or <20/60 Snellen) was 1.60 (95% confidence interval, 1.47-1.74), which was markedly attenuated (rate ratio, 1.17; 95% confidence interval, 1.07-1.27) after adjustment for confounding factors. People whose visual impairment was due to cataract or age-related macular degeneration had excess risks of all-cause and cardiovascular mortality, which disappeared after adjustment. People with refractive error remained at small risk, despite adjustment, probably owing to residual confounding from factors associated with minimal use of eye services rather than underlying eye disease. There were no associations with cancer mortality. CONCLUSION: Associations reported for visual impairment and mortality or for specific causes of visual impairment reflect confounding by comorbidities, risk factors, and other factors related to susceptibility to death rather than an independent biological association of vision problems or specific eye diseases.

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PubMed2005

Are older people dying of depression? Findings from the Medical Research Council trial of the assessment and management of older people in the community.

OBJECTIVES: To examine the relationship between symptoms of depression and mortality in older people. DESIGN: Prospective longitudinal study. SETTING: Fifty-three general practices in the United Kingdom. PARTICIPANTS: Thirteen thousand ninety-seven people aged 75 and older participating in the Medical Research Council Trial of the Assessment and Management of Older People in the Community. MEASUREMENTS: Depression was measured using the 15-item Geriatric Depression Scale (GDS-15); the main outcome was all-cause mortality. RESULTS: Morbidity, disability, and lifestyle factors can explain most of the observed relationship between symptoms of depression and mortality (hazard ratio=1.75, 95% confidence interval (CI)=1.53-1.99), but after mutual adjustment for these factors, subjects who reported six or more symptoms of depression on the GDS-15 were still 27% more likely to have died by the end of the follow-up period than those below the threshold for depression (95% CI=1.11-1.45). CONCLUSION: The findings from this study suggest that depression confers a small risk for mortality in older people, not explained solely by poor health. The results support the encouragement of effective diagnosis, treatment, and support for individuals with depression as highlighted by the World Health Organization and the UK National Service Framework for older people.

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PubMed2004

Validity of the Clock-Drawing Test as a screening tool for cognitive impairment in the elderly.

The authors studied the validity of the Clock-Drawing Test (CDT) in comparison with the Mini-Mental State Examination (MMSE) and the association between the CDT and mortality in a large general population sample of persons aged 75 years or more. Data were obtained from the MRC Trial of the Assessment and Management of Older People in the Community. Baseline assessments were conducted between 1995 and 1999 in the United Kingdom. A total of 13,557 subjects with both CDT and MMSE scores were included in the analysis. The median follow-up period was 4.7 years. The sensitivity and specificity of the CDT for detecting moderate-to-severe cognitive impairment (MMSE score <or= 17) were 77% and 87%, respectively, for nurse administration and 40% and 91%, respectively, for postal administration. Sensitivity was higher among females and increased with age. In Cox proportional hazards regression, a worse CDT score was associated with increased risk of all-cause mortality and mortality from cerebrovascular and respiratory diseases, even after adjustment for potential confounders. The authors conclude that the CDT may have value as a brief face-to-face screening tool for moderate/severe cognitive impairment in an older community population but is relatively poor at detecting milder cognitive impairment.

Age Distribution↗

PubMed2004

Trends in influenza vaccination uptake among people aged over 74 years, 1997-2000: survey of 73 general practices in Britain.

BACKGROUND: Influenza vaccination policy for elderly people in Britain has changed twice since 1997 to increase protection against influenza but there is no information available on how this has affected vaccine uptake, and socioeconomic variation therein, among people aged over 74 years. METHODS: Vaccination information for 1997-2000 was collected directly from general practices taking part in a MRC-funded Trial of the Assessment and Management of Older People in the Community. This was linked to information collected during assessments carried out as part of the Trial. Regression modelling was used to assess relative probabilities (as relative risks, RR) of having vaccination according to year, gender, age, area and individual socioeconomic characteristics. RESULTS: Out of 106 potential practices, 73 provided sufficient information to be included in the analysis. Uptake was 48% (95% CI 45%, 55%) in 1997 and did not increase substantially until 2000 when the uptake was a third higher at 63% (50%, 66%). Vaccination uptake was lower among women than men (RR 0.9), people aged 85 or more compared to people aged under 80 (RR 0.9), those in the most deprived areas (RR 0.8) compared to the least deprived, and was relatively high for those in owner-occupied homes with central heating compared to other non-supported housing (RR for remainder = 0.9). This pattern did not change over the years studied. CONCLUSIONS: Increased uptake in 2000 may have resulted from the additional financial resources given to practices; it was not at the expense of more disadvantaged socioeconomic groups but nor did they benefit disproportionately.

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PubMed2004

Age-related macular degeneration causing visual impairment in people 75 years or older in Britain: an add-on study to the Medical Research Council Trial of Assessment and Management of Older People in the Community.

PURPOSE: Age-related macular degeneration (AMD) is the most commonly occurring cause of visual loss in people registered as blind or partially sighted. There are no nationally representative data on the prevalence of AMD in the British population. We aimed to estimate the prevalence of AMD causing visual impairment in people 75 years or older in Britain. DESIGN: Population-based cross-sectional study. PARTICIPANTS: Thirteen thousand nine hundred people 75 years or older in 49 practices taking part in the Medical Research Council Trial of the Assessment and Management of Older People in the Community. METHODS: Trial nurses tested visual acuity in everyone 75 years or older in participating practices. We collected data on the cause of visual loss for everyone who was visually impaired. We obtained these data from review of the general practice medical notes and by sending a questionnaire to the hospital ophthalmologist. Visual impairment was defined as a binocular acuity of less than 6/18. MAIN OUTCOME MEASURE: Prevalence of AMD causing visual impairment. RESULTS: There were 976 visually impaired people for whom a cause of visual loss was established. Of these, 516 (53%) had AMD as a cause of visual loss. We estimate that 3.7% (95% confidence interval, 3.2%-4.2%) of the population 75 years or older and 14.4% (11.6%-17.2%) of the population 90 years or older are visually impaired due to AMD. There are an estimated 192 000 people 75 years or older visually impaired due to AMD in the United Kingdom (95% confidence interval, 144 000-239 000). CONCLUSION: Our results, from the largest and most representative study of the causes of vision loss in older people in the British population, confirm the substantial burden of AMD in people 75 years and older. As the population ages, this problem will get worse. The needs of this group for vision aids and other support in the community should be addressed; research on the causes of AMD and possible preventive measures should be given priority.

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PubMed2004

Micronutrient supplementation in later life: limited evidence for benefit.

The importance of attaining adequate macronutrient and micronutrient intake throughout the life course is essential for the maintenance of health. Claims have been made for the benefits of micronutrient supplementation in later life, and this review considers the strength of the evidence behind these claims focusing on studies with cardiovascular, cancer, eye health, immune, and cognitive end points. While observational data suggest the presence of a link between dietary micronutrient intake and health outcomes, evidence from large randomized controlled trials does not support the use of antioxidant vitamin or mineral supplements among well-nourished older populations. Moreover, there is evidence of possible adverse affects of micronutrient supplementation. In conclusion, the considerable enthusiasm for the use of micronutrient, especially antioxidant, supplements as anti-aging treatments or as treatments for specific diseases of later life is not supported by the currently available scientific literature.

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PubMed2004

Effects of immediate versus delayed antihypertensive therapy on outcome in the Systolic Hypertension in Europe Trial.

BACKGROUND: To assess the impact of immediate versus delayed antihypertensive treatment on the outcome of older patients with isolated systolic hypertension, we extended the double-blind placebo-controlled Systolic Hypertension in Europe (Syst-Eur) trial by an open-label follow-up study lasting 4 years. METHODS: The Syst-Eur trial included 4695 randomized patients with minimum age of 60 years and an untreated blood pressure of 160-219 mmHg systolic and below 95 mmHg diastolic. The double-blind trial ended after a median follow-up of 2.0 years (range 1-97 months). Of 4409 patients still alive, 3517 received open-label treatment consisting of nitrendipine (10-40 mg daily) with the possible addition of enalapril (5-20 mg daily), hydrochlorothiazide (12.5-25 mg daily), or both add-on drugs. Non-participants (n = 892) were also followed up. RESULTS: Median follow-up increased to 6.1 years. Systolic pressure decreased to below 150 mmHg (target level) in 2628 participants (75.0%). During the 4-year open-label follow-up, stroke and cardiovascular complications occurred at similar frequencies in patients formerly randomized to placebo and those continuing active treatment. These rates were similar to those previously observed in the active-treatment group during the double-blind trial. Considering the total follow-up of 4695 randomized patients, immediate compared with delayed antihypertensive treatment reduced the occurrence of stroke and cardiovascular complications by 28% (P = 0.01) and 15% (P = 0.03), respectively, with a similar tendency for total mortality (13%, P = 0.09). In 492 diabetic patients, the corresponding estimates of long-term benefit (P < 0.02) were 60, 51 and 38%, respectively. CONCLUSIONS: Antihypertensive treatment can achieve blood pressure control in most older patients with isolated systolic hypertension. Immediate compared with delayed treatment prevented 17 strokes or 25 major cardiovascular events per 1000 patients followed up for 6 years. These findings underscore the necessity of early treatment of isolated systolic hypertension.

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PubMed2004

Association of quality of life in old age in Britain with socioeconomic position: baseline data from a randomised controlled trial.

STUDY OBJECTIVE: To identify socioeconomic differentials in quality of life among older people and their explanatory factors. DESIGN: Baseline data from a cluster randomised controlled trial of the assessment and management of older people in primary care. Outcome measures were being in the worst quintile of scores for, respectively, the Philadelphia geriatric morale scale and four dimensions of functioning from the sickness impact profile (home management, mobility, self care, and social interaction). SETTING: 23 general practices in Britain. PARTICIPANTS: People aged 75 years and over on GP registers at the time of recruitment, excluding those in nursing homes or terminally ill. Of 9547 people eligible, 90% provided full information on quality of life and 6298 also did a brief assessment. RESULTS: The excess risk of poor quality of life for independent people renting rather than owning their home ranged from 27% for morale (95% CI 9% to 48%) to 62% for self care (95% CI 35% to 94%). Self reported health problems plus smoking and alcohol consumption accounted for half or more of the excess, depending on the outcome. Having a low socioeconomic position in middle age as well as in old age exacerbated the risks of poor outcomes. Among people living with someone other than spouse the excess risk from renting ranged from 24% (95% CI -10% to 70%) for poor home management to 93% (95% CI 30% to 180%) for poor morale. CONCLUSIONS: Older people retain the legacy of past socioeconomic position and are subject to current socioeconomic influences.

Activities of Daily Living↗

PubMed2003

Screening older people for impaired vision in primary care: cluster randomised trial.

OBJECTIVE: To determine the effectiveness of screening for visual impairment in people aged 75 or over as part of a multidimensional screening programme. DESIGN: Cluster randomised trial. SETTING: General practices in the United Kingdom participating in the MRC trial of assessment and management of older people in the community. PARTICIPANTS: 4340 people aged 75 years or over randomly sampled from 20 general practices, excluding people resident in hospitals or nursing homes. INTERVENTION: Visual acuity testing and referral to eye services for people with visual impairment. Universal screening (assessment and visual acuity testing) was compared with targeted screening, in which only participants with a range of health related problems were offered an assessment that included acuity screening. MAIN OUTCOME MEASURES: Proportion of people with visual acuity less than 6/18 in either eye; mean composite score of 25 item version of the National Eye Institute visual function questionnaire. RESULTS: Three to five years after screening, the relative risk of having visual acuity < 6/18 in either eye, comparing universal with targeted screening, was 1.07 (95% confidence interval 0.84 to 1.36; P = 0.58). The mean composite score of the visual function questionnaire was 85.6 in the targeted screening group and 86.0 in the universal group (difference 0.4, 95% confidence interval -1.7 to 2.5, P = 0.69). CONCLUSIONS: Including a vision screening component by a practice nurse in a pragmatic trial of multidimensional screening for older people did not lead to improved visual outcomes.

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PubMed2003

Factors associated with depression in a representative sample of 14 217 people aged 75 and over in the United Kingdom: results from the MRC trial of assessment and management of older people in the community.

BACKGROUND: Several social, demographic and physical factors have been shown to be associated with depression in later life, but results have been inconsistent. We aimed to assess factors associated with depression in old age, using data from the MRC trial of assessment and management of older people in the community. METHOD: Analysis of cross-sectional data. Depression was measured with a threshold of <6/6+ on the GDS-15. Independent associations with social, demographic, physical and social network variables were assessed by logistic regression. RESULTS: In a fully adjusted analysis, odds ratios (OR) for depression were greater in older people, (adjusted OR for those aged 80-84 years = 1.1, 85-90 years = 1.5 and 90+ years = 1.8), those in rented (OR:1.3) or sheltered/residential accommodation (OR:1.5), and those widowed, divorced or separated (OR:1.2). Life events, (OR:1.4), smoking (OR:1.6), having two or more physical illnesses (OR:1.6) or no confiding relationship (OR:3.4) were also significantly associated with depression. Higher alcohol consumption was not predictive. Female sex and living alone were associated with depression in a crude analysis, but not after full adjustment for confounding. CONCLUSIONS: The importance of these results lies in the large size and representative nature of the sample. In contrast to some previous reports, increasing age was associated with increasing risk of depression, but sex, living alone and alcohol were not associated. Social isolation was more important than living alone per se. Other associations largely concurred with previous work.

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PubMed2003

Antioxidant vitamins and mortality in older persons: findings from the nutrition add-on study to the Medical Research Council Trial of Assessment and Management of Older People in the Community.

BACKGROUND: Older persons are at risk of both poor nutrition and increased oxidative stress. Plasma ascorbate concentrations fall with increasing age, and concentrations of other antioxidants may also be reduced. OBJECTIVE: The goal was to examine the association between antioxidants and mortality in older persons. DESIGN: We randomly selected persons aged 75-84 y from the lists of 51 British family practitioners taking part in a randomized trial of assessment of older persons. A total of 1214 participants provided a blood sample and were interviewed about their usual diet with the use of a food-frequency questionnaire. Statistical analyses were based on deaths after a median of 4.4 y of follow-up, and hazard ratios were estimated for quintiles of dietary or blood antioxidants. RESULTS: We found strong inverse trends for blood ascorbate concentrations with all-cause and cardiovascular disease mortality, which were only marginally reduced after adjustment for confounders or supplement use. Those in the lowest fifth (< 17 micromol/L) had the highest mortality, whereas those in the highest fifth (> 66 micromol/L) had a mortality risk nearly half that (hazard ratio = 0.54; 95% CI: 0.34, 0.84). Similar results were found after the exclusion of those subjects with cardiovascular disease or cancer at baseline (hazard ratio = 0.51; 0.28, 0.93). In fully adjusted models, there was no evidence for an influence of alpha-tocopherol, beta-carotene, or retinol on total mortality. Dietary antioxidants measured by the food-frequency questionnaire were not associated with all-cause or cardiovascular disease mortality. CONCLUSION: Low blood vitamin C concentrations in the older British population are strongly predictive of mortality.

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