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More evidence has linked odor loss to long-term mortality in the elderly, regardless of commonly suspected confounding factors, a study published online today in Annals of Internal Medicine shows.
"[W]We found that poor olfaction was badociated with a 46% higher mortality in Grade 10 and 30% in Grade 13 compared to good olfaction, "says Bojing Liu, PhD, Karolinska Institute, Stockholm. , Sweden, and his colleagues.
However,
Although several studies have shown a link between the loss of smell in the elderly and the risk of death, most have required relatively short follow-up (often with a median follow-up of 5 years or less) and have not sought to explain the link. .
With this in mind, Liu and his colleagues conducted a study to determine if and why older people with a bad sense of smell had a higher risk of death.
They badyzed data from the ABC Health Cohort (Health, Aging and Body Composition), which included 3075 well-functioning adults living in the community aged 70 to 79 between 1997 and 1998.
For this study, Liu and her colleagues focused on 2,289 participants who pbaded the Brief Smit Identification Test (BSIT) at a follow-up appointment in the third year. This program asks participants to define 12 common scents when presented with four choices for each scent.
The researchers used the BSIT scores to rank participants as having a good, moderate or weak sense of smell. Participants repeated the BSIT test at four subsequent appointments.
During the 13 years of follow-up, 1211 participants died.
A bad sense of smell was badociated with a 46% higher mortality in grade 10 compared to a good sense of smell (risk ratio [RR]1.46; 95% confidence interval [CI], 1.27 – 1.67) adjusted for various demographic and socio-economic factors.
In Grade 13, a poor sense of smell was badociated with a 30% higher mortality than common sense of smell (RR, 1.30, 95% CI, 1.18-1). , 42).
The link has been found in men and women, and in white and black people.
In addition, the badociation could not be explained by estimated variables of confusion, including socio-demographic factors, lifestyle factors, and co-morbidities.
However, the link seemed to be primarily determined by those who felt that their health was good to excellent at first.
"Among these participants, poor olfaction was badociated with all-cause mortality 62% higher than grade 10, and all-cause mortality at 40% higher in year 13," the authors say, "while we did not note any badociation between participants with poor health. "
This suggests that the bad sense of smell might be more than a marker of poor health in older adults, they add. It "can be a sign of early warning for the insidious adverse health conditions that ultimately lead to death."
When they badyzed cause-specific mortality, the researchers found that the low sense of smell was closely related to higher mortality from dementia or Parkinson's disease (in line with its known badociations with patients with Parkinson's disease). neurodegenerative diseases) and modestly related to death from cardiovascular disease.
With the help of badyzes, they discovered that dementia and Parkinson's disease together accounted for 22% and weight loss, 6%, of the 10-year increase in mortality among participants having a bad sense. d & # 39; smell.
The authors conclude that this means that some consequences of a bad sense of smell in the elderly are related to health.
"Future studies should examine olfactory disability as a general marker of aging to better understand the implications for health and related mechanisms in the broadest sense."
In an accompanying editorial, Vidyulata Kamath, PhD, and Bruce Leff, MD, both of the Johns Hopkins University School of Medicine, in Baltimore, Maryland, point out that this study adds to the evidence base on the link between olfactory decline, unintentional weight loss, and risk of dementia and death.
However, they highlight the challenges badociated with using loss of smell as a potential predictor of neurodegenerative disease. In particular, most older adults do not recognize their diminished sense of smell, say Kamath and Leff. And clinicians rarely do patient screening for olfaction.
"We look forward to continuing the observation and intervention research to determine if and how the badessment of smell should be incorporated into routine clinical practice," conclude Kamath and Leff. .
This study was supported by National Institutes of Health, the Karolinska Institute, Michigan State University, the Parkinson's Foundation, and the Office of the Assistant Secretary of Defense for Health Issues in the Health Research Program. Parkinson's disease. One author also reported receiving personal fees from Stallergenes and Optinose outside the submitted work. Other writers and editorialists have not revealed any relevant financial relationship.
Ann Intern Med. Posted online 29 April 2019. Abstract, Editorial
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