H70

Summary

Strengths The so-called H70 study, which started in 1971, is a unique population-based study that is being continued by the EpiLife consortium. H70 focuses on aging among 70-yearoldsand includes both medical and cognitive measures. Five different birth cohorts have been studied so far at age 70 and beyond, and the researchers have discovered several trends with respect to mental and physical health. Some groups have been followed longitudinally over three decades. A total of 4,500 participants have been followed from age 70 to age 100. New results deepen the understanding of the aging process. The study has so far concluded that 70-yearolds of today are more happily married and more sexually active than 70-year-olds used to be, and that forgetfulness is not an efficient predictor of who is going to develop dementia. Several research teams are involved in the H70 study, mainly from geriatrics, psychiatry, primary health care, clinical nutrition, psychology and epidemiology. In addition to the EpiLife team, visiting researchers have been collaborating on several of the population studies. International cooperation is regarded as very important. The research teams are involved in international research collaborations with studies involving all age groups, from the very young to the very old.’ All samples are systematically obtained, based on birth dates, from the Swedish Population Register, which covers names and addresses of all people living in Sweden. The studies include both persons living in private households as well as in institutions. Weaknesses Response rates 60-85%. With increasing age subjective measures become of less value as the individual could suffer from dementia or other forms of cognitive disorders.

Type of data

Data Source
Registry + Survey

Type of Study
Survey same
Survey different
Crosssection regular
Cohort study

Data gathering method
Telephone
Face-to-face
Registries
Self administered questionnaire
Other: Physical examinations, cognitive testing

Access to data

Conditions of access
Access possible after contacts with principal investigator/responsible research group. Data can be analysed at site and at times as unidentifiable files within the consideration of Swedish rules of data protection and ethical regards.

Type of available data (e.g. anonymised microdata, aggregated tables, etc.)
anonymised data

Formats available
Primarily SAS and SPSS, but the data set is compatible with other formats.

Coverage

Coverage Years of collection, reference years, and sample sizes
Cohort 1901-02: In 1971-72, a systematic, representative sample of 70-year-olds born between July 1, 1901 and June 30, 1902 (N=973, 85% response rate) were examined. A systematic subsample of 392 individuals was examined by psychiatrists. All participants were re-examined at ages 75, 79, 81, 83, 85, 88, 90, 92, 95, 97, 99 and 100 years. Cohort 1930: In 2000-2001, 70-year-olds born in 1930 (N=522) were examined with identical methods as in 1971-72. They were re-examined at ages 75 and 79. At age 75, the sample was extended to include 753 75-year-olds to make up a large enough sample for new follow-ups. Of these, 723 had survived and 578 (80%) took part in the examinations at age 79. During 2013, we plan to make a short follow-up to detect individuals who have developed dementia, depression or have had a stroke. Another, more comprehensive, follow-up will be conducted at age 85 (in 2015). Thereafter, we plan to do new follow-ups at ages 88, 90, 92, 95, 97, 99 and 100 years, as was done with the birth cohort born in 1901-02, thus making it possible to compare two birth cohorts followed longitudinally 30 years apart. Birth cohorts of 70-year-olds born in 1906-07 (N=416) and in 1922 (N=286 women) have also been examined with identical methods. Cohort 1943-1944: In 2013-2014, we plan to examine a new birth cohort of 70-year-olds born between July 1, 1943 and June 30, 1944 (N=approximately 900), 13 years after the last H70 examination of 70-year-olds.

First year of collection
1971-72

Stratification if applicable
Yes – in relation to socio-economic status, education and living conditions and general medical conditions, age, gender and region

Base used for sampling

Geographical coverage and breakdowns
Gothenburg

Age range
Individuals aged 70-100 years

Statistical representativeness
Population representative

Coverage of main and cross-cutting topics
H70 is a population-based study of normative aging in 70 year old populations, which focuses on both medical and cognitive measures. The H70 study is coordinated by several research groups, primarily Geriatrics, Primary Health Care, Psychiatry, and Epidemiology. All samples are systematically obtained, based on birth dates, from the Swedish Population Register, which covers names and addresses of all people living in Sweden. The studies include both persons living in private households as well as in institutions. Response rates 60-85%. Examinations have been virtually identical at each examination year to enhance possibilities of comparisons, and include psychiatric examinations, key informant interviews, physical examinations, nurse examinations, and examinations by physiotherapists, and psychometric testings. We also examine ADL and IADL, cognitive and emotional function, physical activity, sensory functions, social function (social network) and psychiatric function, as well as chronic diseases. Data on socioeconomic status, marital status, living conditions, housing, social network and other social circumstances, education, religious activity, hobbies and life events are collected. Neurobiological examinations include CT scan of the head, and CSF examinations. Blood sampling is also included, and includes genetic testings of frozen blood samples. This is led by prof Kaj Blennow. We process whole frozen blood for DNA using standard procedures. We collaborate with professor John Hardy, London in a genome-wide association study (GWAS), which focus on associations between single-nucleotide polymorphisms (SNPs) and traits like major diseases. The psychiatric examinations were performed by trained psychiatrists at an outpatient department, in the subject's home or at an institution until 2000. Since then, the examinations are performed by experienced psychiatric research nurses. To minimise the methodological problems with this approach, we perform extensive training programs. The inter-rater reliability tests between nurses and specialists in psychiatry is high, with Kappa values for the presence versus absence of signs and symptoms of depression and dementia between 0.62 and 1.00 indicating “good or excellent” agreement. The psychiatric examinations are semi-structured and include ratings of psychiatric symptoms and signs with the Comprehensive Psychopathological Rating Scale, the Mini-D, and questions about previous mental disorders, sexuality, sleep, and use of psychotropic drugs. Suicidal feelings are rated according to Paykel. The examination also includes tests of mental functioning (e.g. memory, proverbs, language, apraxia, construction, finger agnosia, agraphia, alexia, acalculia, and right-left disorientation), the Mini Mental State Examination, and ratings of other signs common in dementia (e.g. personality changes and motor symptoms). Personality inventories (MNT, CMPS och EPI) are also included. Somatic examinations include history of medical conditions (e.g. hypertension, myocardial infarction, diabetes mellitus, stroke, cardiac failure, atrial fibrillation, pulmonary diseases, fractures, thyroid diseases, head trauma, neurological disorders, cancer), use of health services and questions about urinary function, falls, hearing and vision, dizziness, alcohol and tobacco use. Family history of several psychiatric and somatic disorders is also included. The prescribed and actually taken medication is recorded and classified according to the Anatomical Therapeutic Chemical (ATC) classification system recommended by the World Health Organisation. The examinations also include anthropometric measurements, blood pressure, electrocardiogram (ECG), lung function, measures of atherosclerosis, a battery of blood tests, grip strengths and walking capacity. Blood samples are taken after overnight fasting, and include a variety of measurements such as hemoglobin, HbA1c, thyroid function, cholesterol (total, HDL, LDL, triglycerides), homocystein, B12 and folate. Blood, serum and plasma are frozen for future analyses. Psychological examinations regarding memory and intelligence are performed in all examinations. Responsible for these examinations is Professor Boo Johanson, Dept. of Psychology, Göteborg University. Measures include SRB-1, SRB-2, SRB-3, Thurstone Picture Memory, Ten Word Memory List, Clock Test, Prose Recall, Digit Span Forward and Backward. Functional ability: Data is collected on basic abilities in activities of daily living (ADL), instrumental ADL and other abilities, and physical activities, such as walking and exercising. Social factors: Data on socioeconomic status, marital status, living conditions, housing, social network and other social circumstances, education, religious activity, hobbies and life events are collected. Close informant interview. After the examination, the participant is asked for permission to interview a close informant. The interview with a close informant is semi-structured and comprises IQCODE (Jorm), other questions about changes in behavior and intellectual function (e.g. changes in personality, memory, difficulties in finding one’s way in familiar surroundings, intellectual ability, language, psychiatric symptoms, activities of daily living, incontinence, neurological symptoms), family history, medical history (e.g. hypertension, myocardial infaction, diabetes mellitus, stroke, cardiac failure, atrial fibrillation, fractures, thyroid diseases, head trauma, neurological disorders, cancer) and, in case of dementia, questions about age at onset and course. Psychiatric symptoms include e.g. hallucinations, delusions and depression.

Linkage

Standardisation
The Diagnostic and Statistical Manual of Mental Disorders (DSM by American Psychiatric Association and other medical taxonomies. ADL-models also used.

Possibility of linkage among databases
Good technical opportunities to link to other Swedish datasets or registries due to the use of ID – personal identification number, but policies of data protection and ethical considerations have to be regarded.

Data quality

Entry errors if applicable
Possible selection bias due to rejecting in participation in the H70 study.

Breaks
Over the years the procedure has been retained as identical as possible. Participants have been invited to study and offered a health control. The investigation comprised a physical examination, blood and urine tests, ECG, impedance measurement and the testing of visual accuracy and hearing. Additionally, in subgroups psychological and psychiatric examinations, audiometric tests, analyses of body composition, oral health, dietary interviews, movement analyses and muscular ability tests were carried out.

Consistency of terminology or coding used during collection
See above

Governance

Contact information
Ingmar Skoog
Dept of Neuroscience and Physiology
Wallinsgatan 6
431 41 Mölndal Sweden Phone: 00709-433 681
Email: ingmar.skoog(at)neuro.gu.se
Url: http://snd.gu.se/en/catalogue/study/SND0016; http://www.epilife.sahlgrenska.gu.se/cooperation/International/

Timeliness, transparency
It takes about 3-5 years until the data is released following collection.