Project 3: Preservation of Musculoskeletal Health and Functioning in Early Old Age

SWAN-Aging U19的总体目标是确定中年因素对成功衰老的影响，特别关注更年期过渡（MT）期间的变化和中年健康指标的变化对老年早期功能和健康的影响。66-75岁这一人生阶段是社会角色转变和向老年过渡的关键时期，此时健康以及身体和认知功能的不利变化开始累积。SWAN-Aging的一个主要目标是评估中年健康和MT的种族/民族差异是否解释早期老年健康和功能的种族/民族差异。第三个目标是将SWAN-Aging的发现转化为妇女和卫生保健提供者。项目3侧重于MT特征以及MT相关和通常的中年相关健康指标变化对肌肉骨骼健康和身体功能的保存的作用。项目3还将研究身体和认知功能之间的接口，因为成功的衰老和维持独立性需要这些功能领域的相对保存到老年。项目3的具体目标是：1)确定和量化中年健康指标的MT特征和轨迹对维持老年早期瘦质量和肌肉力量、减少骨量损失和脂肪量增加以及保持身体功能的影响；2)确定并量化MT特征和中年健康指标轨迹对老年早期避免跌倒和骨折的影响；3)确定和量化老年早期肌肉骨骼健康和身体功能的种族/民族差异在多大程度上可归因于MT特征和中年健康指标的种族/民族差异；4)将SWAN-Aging肌肉骨骼研究结果传达给女性和医疗保健提供者。为了实现这些目标，拟议的SWAN-Aging访问（队列中位年龄为71岁）将包括测量骨密度、身体成分、肌肉力量和身体功能，并确定（与判决）中期跌倒和骨折。整合各个项目，我们将描述肌肉骨骼健康和功能轨迹的心血管前因（项目2）；认知功能轨迹（项目1）与跌倒之间的关系；以及身体功能轨迹与残疾发展和轻度认知障碍发病之间的关系（项目1）。估计mt相关因素和中年因素对老年早期肌肉骨骼健康和功能的影响大小，将为未来研究的预防和干预提供关键目标。确定可改变的中年因素，量化其对老年早期肌肉骨骼健康和功能的影响，以及了解身体和认知功能的交集，是开发和测试有针对性的筛查策略和早期干预措施以优化老年人独立性和生活质量的关键的第一步。

The overarching goal of the SWAN-Aging U19 is to determine the impact of midlife factors on successful aging, with a specific focus on the effects of changes during the menopause transition (MT) and midlife changes in health indicators on functioning and health in early old age. This period in the life course, ages 66-75 years, is a pivotal time of changing social roles and transitioning into old age, when adverse changes in health as well as physical and cognitive functioning begin to accumulate. A major goal of SWAN-Aging is to assess whether racial/ethnic differences in midlife health and the MT explain racial/ethnic disparities in health and functioning in early old age. The third goal is to translate SWAN-Aging findings to women and health care providers. Project 3 focuses on the role of MT characteristics and MT-related and usual midlife-aging-related changes in health indicators on preservation of musculoskeletal health and physical functioning. Project 3 will also examine the interface between physical and cognitive function, because successful aging and maintenance of independence require relative preservation of both of these functional domains into old age. The specific aims of Project 3 are to: 1) determine and quantify the impact of MT characteristics and trajectories of midlife health indicators on maintaining lean mass and muscle strength, minimizing loss of bone mass and increases in fat mass, and preserving physical functioning in early old age; 2) determine and quantify the impact of MT characteristics and trajectories of midlife health indicators on avoidance of falls and fractures in early old age; 3) determine and quantify the extent to which racial/ethnic disparities in musculoskeletal health and physical functioning in early old age are attributable to racial/ethnic differences in MT characteristics and midlife health indicators; and 4) translate SWAN-Aging musculoskeletal findings to women and health care providers. To achieve these aims, the proposed SWAN-Aging visit (when cohort median age will be 71 years) will include measurement of bone mineral density, body composition, muscle strength, and physical functioning, and ascertainment (with adjudication) of interim falls and fractures. Integrating across Projects, we will describe cardiovascular antecedents (Project 2) of trajectories of musculoskeletal health and functioning; the relationship between cognitive function trajectories (Project 1) and falls; and the relation between physical functioning trajectories and the development of disability and the onset of mild cognitive impairment (Project 1). Estimation of the size of the effects of MT-related and midlife factors on musculoskeletal health and functioning in early old age will inform key targets for prevention and intervention in future studies. Identifying modifiable midlife factors and quantifying their impact on preservation of musculoskeletal health and functioning in early old age as well as understanding the intersection of physical and cognitive function are critical first steps needed for developing and testing targeted screening strategies and early interventions to optimize independence and quality of life in older adults.