Association Between Socio-Demographic and Cardiovascular Disease

The provided document is an assignment that analyzes the relationship between socio-demographic factors and cardiovascular disease (CVD), stroke, diabetes, and smoking. The data includes information on quintiles based on household income, education, and occupation, as well as the level of physical exercise. The results show significant associations with CVD, stroke, and smoking, highlighting the importance of considering socio-demographic factors in healthcare research and policy-making.

DISSERTATION
(The association between cognitive functioning and physical
capabilities in elderly in England)

Table of Contents
CHAPTER 1 : INTRODUCTION...................................................................................................1
CHAPTER 2 : BACKGROUND.....................................................................................................3
CHAPTER 3: LITERATURE REVIEW.........................................................................................6
3.1 Introduction......................................................................................................................6
3.2 Cognitive function............................................................................................................6
3.3 Physical function..............................................................................................................8
3.4 Cognitive and physical function association..................................................................11
CHAPTER 4 : RESEARCH METHODOLOGY..........................................................................14
Description of study.............................................................................................................14
Description of analytical sample including flow chart.........................................................16
Variables (Outcomes, exposures, covariates).......................................................................16
Assessment of verbal fluency...............................................................................................17
Assessment of grip strength..................................................................................................17
Assessment of walking speed...............................................................................................18
Covariates.............................................................................................................................18
Assessment of education......................................................................................................18
Assessment of wealth...........................................................................................................18
Assessment of CVD.............................................................................................................19
Assessment of diabetes.........................................................................................................19
Assessment of stroke............................................................................................................19
Assessment of smoking........................................................................................................19
Assessment of physical exercise..........................................................................................19
Assessment of depression.....................................................................................................20
Sample size...........................................................................................................................20
Ethical issues........................................................................................................................20
CHAPTER 5: RESULTS...............................................................................................................21
CHAPTER 6 : DISCUSSION........................................................................................................26
CHAPTER 7 : CONCLUSION.....................................................................................................31
7.1 Conclusion......................................................................................................................31
7.2 Recommendation............................................................................................................32

REFERENCES..............................................................................................................................34

CHAPTER 1 : INTRODUCTION
Retention of cognitive functioning and physical capabilities play significant role in old
age. That leads elder people in living an independent and healthy life. Most of the old people
suffer from various health issues and acute diseases. Functional limitations create problems for
them that impairs performance of daily activities of these persons . These physical limitations
increase mortality rate of old age group (Physical and cognitive capabilities among persons aged
65–79 yearsin Germany, 2013 ). Functional limitations related to age causes stroke, dementia,
osteoarthritis, obesity problems among elder persons.
Motor capabilities and maintaining cognitive with the increasing age are very difficult for
elder people. Verbal ability, knowledge, memory, processing speed starts declining after midlife.
It is fact that after certain age walking speed of persons get slow and they become unable to
perform several functions of their routine life (The Dynamic Relationship Between Physical
Function and Cognition in Longitudinal Aging Cohorts, 2013). On average, people those who are
above 60 they have less muscle strength, poor memory, slow speed as compare to young adults.
Cognitive functioning and physical capabilities both are related with biologic ageing. When
people grow older than impairment in functioning occur. After midlife, risk of dependences and
premature death get increased among these elder persons. Physical functioning and cognitive
capabilities both are associated and with the increasing age both elements start declining.
Older persons have less psychical capabilities to perform their functions rapidly. Their
walking speed is low as compare to young people (Physical and cognitive function, 2017 ).
Biologic process show that with the increasing age physical and cognitive functioning start
declining in human being. In this condition they have to depend on other for their daily activities.
Changes in cognitive and physical functioning are universal.
Health literacy is essential for the public, that make them able to take care of themselves
properly and prevent themselves from various diseases. It is fact that people does not have proper
knowledge about their health thus, they are unable to manage their health effectively ( 5Physical
and Cognitive Differences Between Older and Younger Workers, 2017 ). That is why association
between cognitive functioning and physical capability in elderly in England is interesting topic
that can support in making people aware with the physical and cognitive limitation. England is
the country where death rate of elder persons is very high. After midlife these old people become
unable to manage their health well and they face huge trouble in performing their routine
1

activities. If they have proper knowledge about health literacy then these old age persons can
take care of themselves and can reduce their independence issues. By this way they will be able
to life healthy and quality life for longer duration (6 The Health of Aging Populations, 2016).
Low health literacy creates harmful consequences for elder persons and they become unable to
manage their chronic disease. This study will be beneficial for common people in knowing about
relationship between cognitive functioning and physical capabilities in old age. By this way they
will be able to prevent themselves from various health issues ( The dynamic relationship between
cognitive function and walking speed: the English Longitudinal Study of Ageing, 2014). That
would support in minimizing death rate in England.
The main aim of this investigation is to investigate association between measures of
physical capabilities and cognitive functioning among older English adults. For that researcher
will take support of STATA tool and will examine association between walking speed at wave 2
and memory at wave 7 ( Physical and cognitive capabilities among persons aged 65–79 years in
Germany, 2013). Furthermore, relationship between grip strength at wave 2 and verbal fluency at
wave 7 will be examined in this study .
Aim:
“To investigate association between measures of physical capability at baseline and cognitive
performance measures (i.e. memory and verbal fluency ) ten years later among older English
adults”
Objectives:
 To examine the association between walking speed at wave 2 and memory at wave 7
 To examine the association between grip strength at wave 2 and verbal fluency at wave 7
 To examine the association between walking speed at wave 2 and memory at wave 7
 To examine the association between grip strength at wave 2 and verbal fluency at wave 7
2

CHAPTER 2 : BACKGROUND
Physical function can be defined as ability of individual to perform normal daily
activities. As age of individual get increased disability get occurred frequently. That crates
problem for aged persons and they become unable to perform their daily functions properly. In
addition, memory, speed etc. start declining in elder persons (Physical and cognitive function,
2017). In the year 1980 world health organization has clarified difference between impairment
and handicap. Impairment can be defined as abnormalities in body structure, functional
performance and organ appearance (Physical and cognitive capabilities among persons aged 65–
79 years in Germany, 2013). This impairment creates problem for older people because due to
which they become unable to perform their work effectively and they become unable to manage
their health effectively.
International classification of functioning, disability and health (ICF) has accepted the
concept that after midlife person's functional performance and physical capability get reduced to
great extent. Age related changes are complex and due to which individual become unable to live
their life independently (The Dynamic Relationship Between Physical Function and Cognition in
Longitudinal Aging Cohorts, 2013 ). That increases risk in the human body and increase chances
of death as well. Cognitive functioning is related with the knowledge, memory, attention and
language. Progressive age is associated with declining memory and making sound decisions.
Physical capabilities and cognitive functioning are interrelated aspects (The Dynamic
Relationship Between Physical Function and Cognition in Longitudinal Aging Cohorts, 2013).
With the increasing age, speed of persons get reduced and they become unable to make their own
decisions. Older persons have to depend upon their family members and they are unable to live
their life independently. It is because, in this age their muscles and speed get reduced that
increases health consequences ( 6 The Health of Aging Populations, 2016). Health outcome
reflects dynamic state of mental, social and physical condition of human being, Positive health
outcome can be defined as well mental condition, good physical capability etc. Whereas negative
health outcome can be explained as loss of functions, increasing death rate etc. Older people
suffer from various health issues that increases their trouble because they become unable to
perform their work effectively. Age is the strong element that impacts on human well-being to
great extent (The dynamic relationship between cognitive function and walking speed: the
English Longitudinal Study of Ageing, 2014 ). Old age person loss their physical capabilities and
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due to which risk of dependency get increased among them. England is the place where most of
the old person live in old age home and they get proper care from medical professionals.
There are various factors that influence and impact on the condition of individual. These
are such as environment or contextual elements. These play significant role in this respect.
Physical impairment is completely depends upon the environmental factors. It is fact that
cardiovascular disease occur mostly due to cognitive impairment in general population (The
dynamic relationship between cognitive function and walking speed: the English Longitudinal
Study of Ageing, 2014). Old age person become demanding and they complaint for each activity.
They become little irritating and get frustrated soon if they find any mistakes in their
surrounding. Change in brain volume is faster in young adults as compare to elder persons.
Volume of hippocampus is also associated with the age that is why with increasing age
individual become unable to perform their memory function effectively. After midlife brain
structure of human being start shrinking and person become unable to remember recent incidents
(Physical and cognitive capabilities among persons aged 65–79 years in Germany, 2013).
Furthermore, cerebral metabolism is also get influenced with increasing age. It is fact that
increasing age reduces regional cerebral metabolic rate for oxygen, glucose. Elder persons also
face trouble in their blood rotation due to changes in body structure. That is why most of the old
population of England is suffering from asthma and other heart diseases (Physical and cognitive
function, 2017 ).
The main aim of the study is to identify association between measures of physical
capabilities at baseline and cognitive performance measures among old English people. Earlier
there have been many researches conducted on the same topic but these were unable to explore
health literacy among elder persons. Present study will focus on education, wealth,
cardiovascular conditions, physical exercise for well-being of old age population of England.
Present investigation will examine association between walking speed and memory at wave 7
(5Physical and Cognitive Differences Between Older and Younger Workers, 2017 ).
Furthermore, it will explain association between grip strength and verbal fluency at wave 7.
Cardiorespiratory fitness is another element which is associated with cognitive function
and physical capabilities of individual. Old persons those who participate in physical activity
perform slow as compare to young persons. With the increasing age their body structure become
weak then elder persons suffer from various diseases. It is essential to have proper knowledge of
4

health so that old persons can take care of themselves (6 The Health of Aging Populations,
2016). With the increasing age, person's heart condition, memory sharpness etc. start declining.
That create problem for individual because due to this person's capabilities to perform their daily
functions get reduced. In this condition they take too much time to complete any activity. In
addition, they have to depend on others in order to make sound decision because they become
unable to make their own decision.
5

CHAPTER 3: LITERATURE REVIEW
3.1 Introduction
This is an important part in research that enables to determine different type of research
that are already conducted by some other researcher. Further, it is helpful enough to provide in-
depth understanding of the research topic (Falck, Landry and Liu-Ambrose, 2017 ). With ageing
there are many changes that take place and it require proper support of other so that they will be
able to perform their basic needs fulfilled. This generally happens when functions or the cells
gets affected in negative manner due to ageing. In this context, below given are some of the
researches that are already conducted on similar topic and this will enable to deliver in depth
understanding.
3.2 Cognitive function
According to Zhu, Howard and Hooker, (2015 ) cognitive function can be determined to
be as cerebral activity which is helpful to lead knowledge that consist of mechanisms and means
of acquiring. Further, it consist of memory, language, memory, leading activities, reason, etc. is
possible. With time there are negative impact faced by people as these cognitive functions gets
affected and individuals fail to perform their part of role with consuming time (Kolanowski,
Mogle and Clare, 2015). The functioning of young and old people will be different as the time
that is taken by the cells to react over sudden reactions gets slower with time. There are different
set of factors that are included in this process and generally it is identified that people are not
able to perform when cells gets older. Swiger, Martin and Spertus, (2015 ) stated that, there are
different type of cognitive functions that are performed each day and individuals are unaware of
it. Further, there are different forms that are taken like remembering names, calculations,
noticing colour, etc. Most functions of brain vary using functional magnetic resonance imaging.
Within mental functions, there are different type of distinct types of cognitive abilities.
3.2.1 Cognitive function in older age
There are many type of changes that are identified when the cognitive functions are
compared with old people and young. In this context, it can be stated that there are changes
notices in which the health condition affects in negative manner ( Lehtisalo, Lindström and
Luchsinger, 2016). In order to identify the difference, there are different type of test that are
6

conducted. With this respect, as per one of the test that was conducted for typing. It was
identified that individuals who were aged 20 were able to perform 75% faster when compared
with individuals who were 75 years old (Tsutsumimoto , Doi and Shimada, 2017). There are
negative perception that are developed by people in which with ageing, cognitive abilities are
lost inevitably and nothing can be done in order to reduce its impact. From the research it is
identified that researchers do not believe this. There are certain areas that gets affected but other
remain same that also for some of people. The functions that that remain stable are related with
intelligence, memory, attention, speed of processing, reasoning and problem solving. These
given functions can be gets negatively affected and the efficiency of individuals who are ageing
also gets negatively affected (Bossers, Scherder and van Heuvelen, 2014 ). With this respect,
some of the reasons include medications that are taken due to which side effects are caused like
mental dullness or drowsiness. Further, there are different type of reasons or causes that are
identified due to which when ageing the above mentioned stable functions also gets affected in
negative manner.
3.2.2 Trajectories of cognitive decline
According to Carvalho, Rea and Cusack, (2014) there are different type of considerations
that are required to be made so that one will be able to reduce the negative impact of cognitive
function. One of the effective ways is by understanding the type of areas in which issues are
faced at young age ( Pettersson, Wahlund and Crisby, 2017). There are conditions identified in
which people face serious issue accidently. It is important to make sure that individuals have
proper diet and nutritious food so that when the age factor arises, then they are able to reduce the
negative impact at high extent. In this context, it is identified that there are research conducted in
which the age of people living in China have more life expectancy when compared with any
other country. This is because the type of culture that are developed by these people are effective
enough to live healthy life and that also with proper functioning (Berendsen, Kang and van de
Rest, 2017). When compared with other countries, the type of food that is consumed is not
favourable enough to and this problems reduces the functioning of the body due to age factor.
3.2.3 Environmental factors (education, wealth, physical activity, smoking )
The cognitive functions gets negative affected with ageing but it is a slow process. For
some of the individuals it will be high rate. This totally depends upon what type of hygiene one
7

consumes (Tolea and Galvin, 2015 ). Further, it is being identified that consumption of alcohol
affects the functions and the rate of age in which the functions slowly gets affected gets reduced.
In order words, the average age in which functions become weak is from 45. However, when
there is consumption of tobacco, then the age falls to 40. From this, it can be stated that the type
hygiene that is taken has high negative impact when it is not proper (de Souto Barreto, Delrieu
and Rolland, 2016). Another set of factor is related with wealth, when a person has enough
wealth, then they are able to look after their body and in fulfilling all their requirements. Further,
the type of treatment that are required for cognitive functioning is high. Individuals are able to
satisfy their requirements. This way people are able live a healthy life but there are conditions in
which the health has negative impact and people fail to fulfil their requirements in relation with
needs of body (Semenov, Bigelow and Agrawal, 2015).
3.2.4 Health status (CVD, stroke, diabetes, depression
As per Lau, Ludin and Shahar, (2017) cardiovascular disease that contains heart or blood
vessels. When ageing, the supply of blood to the brain gets reduced this way the proper
functioning is reduced. Similarly, there are other related disease like depression, diabetes, stroke,
etc. that affects the functions of the business. Like for example, in the condition of depression
that type of food and the enzymes that are developed by the body is different. In this context, it
has negative impact in which the body functioning gets destroyed ( Grzywacz, Segel-Karpas and
Lachman, 2016). Further, there are cells that are helpful enough to protect the body from getting
disease all these cells are affected when there are conditions of depressions identified. Further,
other type of diseases destroy the efficiency of cognitive functions at a high rate. There are
negative impact on brain when an individual face cardiovascular disease. It also affects
neurocognitive function that can causes the issue of dementia, stroke or cognitive impairment
(Falck, Landry and Liu-Ambrose, 2017). This way, it can be stated that individuals need to look
after their health timely so that they may not get affected due to any type of diseases and when
there are such diseases caused, then it reduces the efficiency of cognitive functions.
3.3 Physical function
With time, physical condition or functioning is not stable. The physical functioning
includes walking, running, picking up things, bending down, etc. ( Zhu, Howard and Hooker,
8

2015). This are type of physical functions and due to ageing, it has negative impact. The rate of
speed or the ability to perform any type of task gets reduced. With age the main effect that faced
is on cells, nerves and muscle tissues. There is a systematic process in which the information is
passed by the vessels to the brain and brain takes up necessary actions (Kolanowski, Mogle and
Clare, 2015). With this respect, the type of process gets negatively affected and the total time
that is taken for such process increases. This is a type of cause that occurs due to ageing.
3.3.1 Physical function in older age
As per one of the research that was conducted in America, it was found that older people
are the least physically active. Further, they also generate highest health care expenditure
(Swiger, Martin and Spertus, 2015). In order to maintain physical functions or health, physical
activities are highly important. In order to understand this aspect, the individuals who start up
their exercise will feel high pain for the movements that are done by them. Physical activity has
myriad efforts which is stemmed from physiological adaptations that are helpful for transferring
the clinical outcomes like in reducing the risk of falls ( Lehtisalo, Lindström and Luchsinger,
2016). It is important to have certain amount of tissues that are required so that one will be able
to perform any type of work. All the body functions can operated in effective manner when they
get proper care and nutrition. Further, background of the individuals also need to be considered
as it enables to provide detailed information about the type of history. As per Tsutsumimoto, Doi
and Shimada, (2017) there are research conducted in which the individuals who smoked and who
did not were examined. It was identified that the people who smoked faced serious issues in
relation with performing physical activities. Further, the total time that was taken by smokers
was more when compared with the people who do not smoke ( de Souto Barreto, Delrieu and
Rolland, 2016). In addition to this, there is positive relationship between physical functioning
and activities among elderly people. All the older people who are highly active physically are
less likely to be experience limitation in relation with functions. All the older people need to give
proper priority for making themselves engaged towards physical activities so that due to ageing
individuals may not perform their function in effective manner or the help of someone else
(Bossers, Scherder and van Heuvelen, 2014). One should have proper awareness and the type of
food and diet that should be taken by them so that the physical needs can be satisfied.
9

3.3.2 Physical capability assessment
Carvalho, Rea and Cusack, (2014) assessment of physical capabilities is done in number
of ways. At the initial stage, it is important that the issues that are faced by the person is
identified. There are different type of health related issues that are identified due to which the
functioning is not properly done. In this context, one of the effective ways to assess physical
capability is by determining the time for which an individual sleeps. Further, each day there are
certain type of work that are perform (Pettersson, Wahlund and Crisby, 2017 ). Analysis can be
made by identifying the total time that is consumed by individual to complete the task. When the
total time consumed is high or more, then it can be stated that the physical capability is getting
reduced. In such condition it can also be determined the physical functions or its efficiency is
getting reduced. Further, when compared with young people, the die of older people is low.
When time the rate of consumption make gets reduced. This can be determined to be a negative
impact over health as they amount of food that was consumed is not being taken, this ways the
efficiency with respect to the physical functioning is reduced ( Berendsen, Kang and van de Rest,
2017). Each individual contains certain age that has determined by themselves in which they
develop their understanding. Individuals willing or the rate of interest also affected the
performance. In case a person has thinks that he/she can not learn new things, then they will not
able to do so. In other words, the type of perception that are carried out by individuals highly
affect the physical functioning. In conditions when a person is depressed, then the rate of
performance is negatively affected and they fail to complete the task in effective manner (Tolea
and Galvin, 2015 ). Moreover, the total time period taken by them will be more when compared
with others.
3.3.3 Objective test of physical capability
As per de Souto Barreto, Delrieu and Rolland, (2016) physical capability can be
determined to be the concept that is referred to physical functioning which is helpful enough to
describe capacity of individuals to perform any type of physical task for daily living. In
accordance with the research conducted, it is identified that physical performance like walking
speed, grip strength, standing balance and chair rising all act as the characterise of physical
capability (Semenov, Bigelow and Agrawal, 2015). It can be determined that some of the
objective measures of capabilities related with physical are reductive of health related problems.
As stated above, there are different type of objectives measures that can be considered. However,
10

it is not possible to make proper evaluation of all the set of objectives. In this context, proper
consideration is made on the walking. Huge amount of energy is required so that one will be able
to walk to a certain distance (Lau, Ludin and Shahar, 2017). For the individuals who have
continuous walk have the skills through which they maintain their stamina and their health. It is
important that proper focus is make by older people so that they are able to perform their work in
effective manner. However, there are issues identified in which people are not able to walk
certain distance and this is when they are aged and have just started their exercise of walking.
Body of individuals need time adjust with the type of change that they are willing to make. In
order to be fit and healthy, it is important to make time to time exercise so that they can maintain
their health and the type of physical activities can be performed effectively and efficiently
(Grzywacz, Segel-Karpas and Lachman, 2016). In order to perform any type of objectives
measure efficiently, it is required to make sure that individuals have proper stamina, when the
rate of stamina is high, then it becomes favourable enough to carry out the walking part properly.
3.3.4 Pattern of change in physical capability
The pattern of changes within the body take place individuals are ageing. This a type of
condition when people are not able to perform their basic requirements (Falck, Landry and Liu-
Ambrose, 2017). It is important that all the individuals have proper understand and knowledge
about the type of diet that they consume. This is effective enough to make sure that proper the
physical functioning are performing in effective manner. As stated above stamina is highly
important so that the all the objectives measures can be performed. However, smoking has high
negative impact over stamina. Further, for running, it requires to have proper intake of oxygen
but due to smoking lung get negatively affected. This way when one gets older, then they are not
even able perform the rate of work in effective manner (Zhu, Howard and Hooker, 2015). In
addition to this, physical capabilities are also affected due to diseases like stroke, CVD,
depression, etc.
3.4 Cognitive and physical function association
Kolanowski, Mogle and Clare, (2015 ) stated that both physical and cognitive functions
gets affected in negative manner when there is factor of ageing. There are many type of research
that are conducted in it includes both cognitive and physical functioning. As per one of the
11

research conducted, it is identified that there sleep disorder or disturbance that a5re identified
among older people (Swiger, Martin and Spertus, 2015 ). There was research conducted in about
389 patients were examined who were older. It was identified that about 40% of the people had
issues with respect of sleep. They were not able to have proper sleep. Moreover, this is a type of
problem due to which the efficiency get negatively. One needs to have proper sleep so that they
will be able to perform their role. Sleep fills up energy within the body but there is no proper
sleep, then it affects cognitive and physical functioning in negative manner (Lehtisalo, Lindström
and Luchsinger, 2016). Further, there were 76 % of the people who had physical limitations.
Moreover, there were 47 % of the people who were not able to perform in effective manner due
to short physical performance battery. In short, it can be stated that people need to have proper
understanding about the changes that take place with respect to ageing. This is effective enough
to make sure that all the type of problems that are faced due to improper care can be eliminated.
Further, it is also important that only with awareness individuals are not able to overcome the
problems with relation to cognitive and physical function. In order to overcome this type of
problem, proper consideration should be made in which the type of knowledge that one has
should be followed (Tsutsumimoto, Doi and Shimada, 2017). When one becomes old, then they
are not able to perform their role in effective manner due to effective support from body. One
becomes slow and the rate of work that are performed that are also gets affected. With age the
walking speed gets reduced drastically. As per the findings, it is identified that about 1 out of 40
can walk more slowly than 0.4 metres/sec. (age 60 to 64). Further, there was high level of
forgetfulness faced among older people. There are about 2/3 from the group of older who forget
to carry out actions that are being instructed. It is identified that the rate of stability that an
individual should have is low (Bossers, Scherder and van Heuvelen, 2014). In this context, one is
not able to show up their strength and the rate of performance gets negatively affected. Further, it
is identified that the type of metal stability of the alertness is also lost or gets reduced. Older
people need to have proper understanding about the type of changes that take place in relation
with their health.
Further, it is also identified that the rate of health related problems are high and the
individuals who face diseases in older age is also high (Pettersson, Wahlund and Crisby, 2017).
Within the body there are cells that are helpful enough to protect themselves from diseases but
these cells are gets weak ( Carvalho, Rea and Cusack, 2014). This can be determined to be the
12

main reason due to which older people easily get caught by diseases. In this context, some of the
main diseases includes depression. When a person is depressed, then the functions for physical
and cognitive negatively gets affected. Individuals are not able to understand their required and
to fulfil them. Their mental stability is lost and thus it also causes other related problems with
respect to health. In addition to this, there are other related problems that are faced by people
who are old. In this context, it includes eyesight, hearing problem and incontinence of urine.
More specifically, the problem of eyesight arise at the age of 70 from 12.6 % and it becomes
32.7 % at the age of 65 to 69. Further, the issue in relation with hearing arises at the age of 60
that also from 15.6 % and in the year 55 to 59 it becomes 39.2 % (Berendsen, Kang and van de
Rest, 2017 ). The problems in relation with incontinent urine is mainly seen females. On the
other hand, the rate issues or problems faced by male who are older is low
13

CHAPTER 4 : RESEARCH METHODOLOGY
Research methodology is the essential part of dissertation. It is essential for the scholar to
select appropriate tool that can support in gathering relevant information about the subject
matter. Selection of research methodology completely depends upon the type of investigation.
Present study on association between physical capabilities and cognitive functioning in old age
persons in England (The dynamic relationship between cognitive function and walking speed:
the English Longitudinal Study of Ageing, 2014 ). For gathering the data on the topic and to
analysis information in effective manner researcher has conducted quantitative study. Researcher
has used STATA tool in order to identify relationship between walking speed and memory status
in elder people. Statistical methods are more suitable for the present dissertation because with the
help of this tool scholar ca get optimistic results and can identify effects on cognitive functioning
and physical capabilities on elder persons after 60 age (Physical and cognitive function, 2017).
Outcome :
Description of study
It is the most important part of dissertation that supports scholar in selecting appropriate
tools to collect relevant information about the topic. Association between cognitive functioning
and physical capabilities in elderly in England is the interesting topic. The German health
interview and examination survey studies are conducted for adults for health monitoring system
of elder people. Most of the data set is being used from the English Longitudinal study of Ageing
(ELSA). ELSA is on-going study that has supported in gathering in-depth information about
persons, health, economic and social circumstances that impact on health of elder people
(Physical and cognitive capabilities among persons aged 65 –79 yearsin Germany, 2013). This
research is being conducted on population those who are in the age of 50 and are facing issues
related with physical capabilities and declining cognitive functioning. Researcher has recruited
those individuals in ELSA that are drawn from Health Survey for England (HSE). All these
participants are from England and they were not institutionalized in 1998,1999 and 2001. In the
year 2002- 03 first wave of ELSA was collected as baseline. In this process there were 11,391
core members. All involved persons were able to circulate necessary information which are
important to achieve objective of the research (The dynamic relationship between cognitive
function and walking speed: the English Longitudinal Study of Ageing, 2014).
14

Scholar has taken support of personal interview and questionnaire technique in order to
gather in-depth information about the subject matter. Individual has organized computer assisted
personal interview with respondents. This tool that helped in developing better understanding
about reason of declining physical capabilities and cognitive functioning in human being after
the age of 50. Researchers of ELSA has taken follow up of all collected data in every two years.
Researcher in present study has also involved participants of HSE in this investigation (5Physical
and Cognitive Differences Between Older and Younger Workers, 2017 ). That has supported in
maintaining size so that sample can represent the facts properly. Participants of HSE have been
added at waves three, four, six and seven.
In the present subject matter scholar has also used data from wave 2 as well. It was used
as baseline of physical capability and covariates and wave for cognitive functioning. With the
help of this technique investigator become able to analyses the association between physical
capabilities and cognitive functioning in elderly in England (Physical and cognitive function,
2017). In the present study researcher has taken support of wave 7 for analysis because scholar
wanted to reflect current ELSA participants' cognitive functioning from prediction 10 year ago.
The main reason of involving wave 7 participants was to identify grip strength in old age
persons, their capabilities of word finding and their prospective memory. Researcher has set the
criteria for including walking speed test, individual has decided to include participants for
walking speed test only if they were > 60 years. In addition, researcher has also included those
participants those who were part of interview by nursing in person at wave 2 (The Dynamic
Relationship Between Physical Function and Cognition in Longitudinal Aging Cohorts, 2013).
The concept and design of DEGS are described. DEGSI has conducted the first wave in
the year 2008-2011 and has taken support of interview, examination and tests. Scholar will also
include chair test in order to measure physical capabilities and cognitive functioning of old age
persons. Study was drawn by health authority, postcode sector and non-manual socio-economic
groups. ELSA has conducted study in the year 2002-2003 in which researcher has included
11392 participants in wave 1 (Physical and cognitive capabilities among persons aged 65 –
79 yearsin Germany, 2013). After that in order to take follow up of all these data researcher has
conducted survey in every 2 year. In order to meet with ethical criteria individual has taken
approval from multicentre research and ethics committee. Before conducting this investigation
researcher has sent consent form to all participants and they have sign the form. That written
15

consent has helped the scholar in investigating the cases in effective manner (5Physical and
Cognitive Differences Between Older and Younger Workers, 2017 ).
Description of analytical sample including flow chart
In order to examine relationship between physical capabilities and cognitive functioning
scholar has taken support of longitudinal data analysis tool. By using this data analysis tool
researcher has measured physical capability at wave 2 and cognitive functioning measured in
wave 7. Investigator has measured ten different variables such as sex, age, education, diabetes,
stroke, smoking, physical exercise, wealth, cardiovascular disease and depression etc. All these
variables at measured at wave 2 (The dynamic relationship between cognitive function and
walking speed: the English Longitudinal Study of Ageing, 2014). Researcher has taken support
of wave 2 data (n= 22,391) after exclusion of individuals who have missing baseline data in
wave two (n= 8780) and individuals with missing baseline data in any of the variables used in
the analyses (n= 8,432). For gathering in-depth information about old people and association
between physical capabilities and cognitive functioning researcher has involved population of
England those who are above 50 year and are over for grip strength. Scholar has also involved
participants of 60 year age (6 The Health of Aging Populations, 2016).
Variables (Outcomes, exposures, covariates)
Outcomes:
Assessment of memory
Research has taken support of prospective memory from ELSA for knowing about
memory capabilities of elder people. In cognitive assessment module, scholar has communicated
with participants in which they were informed that they will be asked questions after certain time
period about the same session as well. Data needs to be recorded in effective manner so that it
can be further reused for getting optimistic results. Researcher has requested to participants in
task for ELSA that to write down their initials on top left side at the corner. That may helped the
researcher in taking feedback after certain time period with them. It is essential for the scholar
that to take proper action on behalf of responses given by participants (Physical and cognitive
function, 2017). For conducting the investigation in effective manner and to get in-depth
information about association between physical capabilities and cognitive functioning, researcher
has asked to participants that to perform task first and wait for five seconds. That data of ELSA
is based on four tests; delayed verbal memory, immediate, verbal fluency and attention.
16

Assessment of verbal fluency
Researcher has taken support of verbal fluency technique or can be said as word finding.
This tool explains and help in measuring how quickly respondents can recall the world properly.
Verbal fluency was the first test in which respondents were asked to say name of animals as
much they can say in one mint (5Physical and Cognitive Differences Between Older and
Younger Workers, 2017). Delayed verbal memory will show the difference in young and old
person cognitive functioning. Participants were again asked to recall other words as much as they
can. Thinking capacity of respondents can be measured with the help this tool. Researcher has
categorized the animals in groups such as dogs, wild, birds, etc. The number of different animal
names that ELSA participants produced on the verbal-fluency task ranged from 0 to 52 (101).
Respondents were asked to recall many words in short time period during the cognitive tests
(Physical and cognitive capabilities among persons aged 65–79 years in Germany, 2013). On the
bases of their scores researcher has measured domains of cognitive functions of different age
group people. Score of recall the animals name in one mint was conducted for measuring the
executive functioning in human being those who are above 50 years. By adding all numbers
scholar has measured memory capability of an individual. Both outcome were taken by trained
interviewers at wave 7 of ELSA in 2014-15 (Physical and cognitive function, 2017).
Exposures:
Assessment of grip strength
All respondents who were willing to take the grip strength test were asked by the
researcher to do the test. Safety issues and certain circumstances were excluded from the study.
If any participant has swelling or injury in their hand or if they have surgery to the hand in
preceding six months. Scholar has adjusted gripometer to suit the participant hand and
positioning their hand correctly. In this process respondents were asked to squeeze gripometer as
hard as they can for couple of seconds ( 6 The Health of Aging Populations, 2016). All involved
persons were asked to do this activity for three times and record three values for each hand
movement. If there is any mistake in measurement then this value will not be taken for
measurement. Researcher has taken support of those data which are recorded on dominant hand
and used the mean weight of three values as recorded. Scholar has involved participants those
who were age 50 or over (The dynamic relationship between cognitive function and walking
speed: the English Longitudinal Study of Ageing, 2014).
17

Assessment of walking speed
In this test scholar has involved people those who were age 60 or over and were willing
to walk on their own behalf. Researcher has asked them to cover distance of eight feet in this
walking test. Nurses have conducted the walking test of participants. The data have been
recorded with two successive walks separately by using stopwatch to calculate the time of
walking in seconds. Researcher has used mean value of speed of each respondent of both
walking times. These values were treated as continuous variables in this investigation (6 The
Health of Aging Populations, 2016). Both exposures measurement were taken by nurses, it was
conducted at wave 2 of ELSA in the year 2004.
Covariates
The stamina of the people get reduced with the age factor they tend to have low power of
capacity in the work. To determine this factor the test has been taken on the basis of which the
level of capacity of performing the activities can be analyses in the effective way. It can be
measure with the help of the 3 way of qualification split that is sex, age, education. The people
are suffering from many diseases such are as blood pressure, heart attack, heart failure diabetes
depression etc. many of them are smoker which tends to decline the stamina level in the large
manner (5Physical and Cognitive Differences Between Older and Younger Workers, 2017).
Mainly the disease are the main source due to which people used to work in the less effective
way as compare to those who are fit and healthy people. All diseases have its own impact which
leads to less working efficiency of the people.
Assessment of education
The high amount of the education qualification has been found on the stage of the
baseline (The Dynamic Relationship Between Physical Function and Cognition in Longitudinal
Aging Cohorts, 2013). The education level has been judged on the basis of the 7 categories. The
division has been made on the basis of 3 way qualification splits which is even lesser that the O-
level.
Assessment of wealth
The wealth plays the essential role any factor. Without the well-functioning of this no activities
can be performed in the effective manner (6 The Health of Aging Populations, 2016 ). Financial
wealth is inclusive of the following factors like cash, saving, investment and the debts that a
household had. The wealth factor has also been divided in the different categories. The health
18

factor is also very essential in this regard (5Physical and Cognitive Differences Between Older
and Younger Workers, 2017 ).
Assessment of CVD
This term is inclusive of the things like high blood pressure, heart attack, heart failure
heart murmur and heart condition and the bad cholesterol like diseases. The report of the several
diseases is based on how many score they earned on the basis of the self report of eh record that
is ascertained with the help of the high blood pressure and heart attack and other kind of the
activities. First of all they are diagnosed by the doctor of the high blood pressure. It should be
ascertained in the well and proper (6 The Health of Aging Populations, 2016).
Assessment of diabetes
Research has done assessment for testing diabetes in old age persons. This test was done
to identify whether they have high blood sugar or not. The determination of diabetes status was
completely based on self report. In the ELSA, all participants were having relevant experience
and involved persons were those who reported taking medication or injecting insulin for their
diabetes by doctors in wave 2 (Physical and cognitive capabilities among persons aged 65–
79 yearsin Germany, 2013). This diabetes test has helped the scholar in knowing chances of
having high blood sugar in elder people.
Assessment of stroke
This was another test which was done to identify chances of occurring stroke in old age
persons. It was again based on self report. The involved participants were those who were having
stroke since two years and they were diagnosed by qualified doctors (5Physical and Cognitive
Differences Between Older and Younger Workers, 2017).
Assessment of smoking
In ELASA researchers had collected the information through interview method. All
respondents were taken interview by scholar about their smoking issue. Smoking status was
grouped as current smoke or non-smoker (6 The Health of Aging Populations, 2016).
Assessment of physical exercise
The physical activity in ELSA included the activity status of both leisure time and
working time if they are still working. In this assessment item for frequency and strength were
modified from Whitehall study 2. Researcher has grouped different frequency and strength
19

activities into four major categories such as sedentary, low, moderate and high (The Dynamic
Relationship Between Physical Function and Cognition in Longitudinal Aging Cohorts, 2013).
Assessment of depression
The eight-item version of CES-D was used by the scholar in order to estimate prevalence
of depression symptoms. In this method researcher has asked questions about the degree to
which respondent had experienced depressive symptoms. This has included restless sleep, being
unhappy etc (The dynamic relationship between cognitive function and walking speed: the
English Longitudinal Study of Ageing, 2014 ). Scholar has grouped scores 0 to 2 as negative and
3 to 8 as positive.
Researcher has taken support of liner mixed effect model in order to analysis association
between cognitive functioning and physical capabilities in old age people. Researcher has not
used time-varying predictors.
Sample size
Initial sample size was selected from HSE in order to obtain number of men and women.
Overall response rate was 67% for individual and 70% for household in ELSA.
Ethical issues
Researcher has taken approval from London Multicentre Research Ethics committed
under National research Ethics services. All participants were sent consent form and they have
given their positive concern that they are ready to share their views with scholar. ELSA can also
be used by public and it can be download from UK data services.
20

CHAPTER 5: RESULTS
From the calculations it is found that after excluding non-core members and people who
have missing data in various fields the final sample size is found 8432. It can be said that there
are total 8432 men and women. Outcome shows that participants with missing information were
less than O- level respondents. It is found that figures of o-level participants are 59.47 % and
equivalent educational qualifications are 22.19 %. Lower wealth quintiles are 27.51% on other
hand the highest wealth quintiles are 13.97 %. It is found that difference between female and
male candidates between age and sex are such as 52.59% verse 47.41%, age group 50-59:
27.59%, 60-69:21.55 %, 80 plus: 26.72 % and 7.-79: 24.14%.
Sex:
From the results it is found that there were 44.88% male participants and 55.12% female
respondents. The mean value of age group 52 to 99 candidates is 66.78. When individuals has
calculated mean separately for male and female then it is found that mean value of female
candidates is 67 and mean value of male persons is 66.
Age group:
Scholar has categorized the age group into four different groups; 50 to 59, 60 to 69, 70 to
79 and above 80. It is found that maximum people were in the age group of 60 to 69. There were
2799 participants, on other hand in the 50 to 59 age group there were 2501 respondents. In 70 to
79 group there were 24.95% answers. In the above 80 age group there were 1028 participants
and it is 12.19% of total participants. Statistics show that female participants are more in number
as compare to male persons. When scholar has compared both data then it is found that in the age
group of 50-59 there were 53.74% female participants. On other hand in the same group there
were 46.26% male respondents. In addition, in the age 60-69 there age female candidates were
53.95% and male persons were 46.05%. In above 80 category there are 62.74% female
participants and 37.26% were male participants.
Education:
Education was another variables on the bases of which researcher has conducted the
study. Scholar has split the qualification into three major categories. In the less than o-level
criteria there were 52.67% respondents. In this section there are 4441 people. In o-level group
there are 1973 participants and in higher education section there are 2018 participants which is
23.93% of total population.
21

Wealth:
Wealth is another variable in this dissertation, researcher has divided it into 5 different
quintiles. Results show that slightly rising from low to high category participants are 18.03%,
19.75%, 20.23%, 20.55% and 21.44%. When it compares with sex then it is found that
distribution of wealth in male participants are 15.88%, 19.13%, 20.11%, 21.80% and 23.07%.
But when compare it with female then it is 19.77%, 19.77%, 19.75%, 20.23%, 20.55% and
21.44% from lowest to highest.
CVD:
It was another parameter or variables in this dissertation. CVD condition was measured
on different sub variables. It is found that 64.12% candidates are in non CVD condition, 2155
participants or 25.56% are in one CVD condition and there were only 870 participants who were
in 2 or more CVD condition, it was 10.32% of overall participants. Results show that if
participants are in more CVD condition then mean age also get increased. When it compares
between male and female candidates then it is resulted that there are 65.27% male members and
63.19% female members those who are in non CVD conditions. In addition, people those are in 1
CVD condition are 24.76% male and 26.20% female. Furthermore, 9.96% male and 10.61%
female are in more than two CVD condition.
Diagnosis:
 Diabetes: Researcher has diagnosed the candidates whether they have diabetes or not.
Results show that 95.87% participants were into no diabetes condition. Apart from this
there were 95.11% male respondents and 96.49% female candidates. Mean age in
younger for non diagnosed participants is 66.70% and for diagnoses participants it is
n68.79%. Stroke: Results explains that there were 98.22% participants those who were diagnosed
with stroke. There were 1.78% candidates who have stroke. Out of 150 there are 70 male
persons and 80 female who were diagnosed stroke. It can be sad that male candidates
have less chances to have stroked as compare to female persons.
 Smoke: It was another diagnoses criteria in which 84.82% participants were found non
smoker. Out of 7152 there are 1280 respondents are current smoker. Mean age of non
smoker is 67.35% and current smoker is 63.65%.
Physical analysis:
22

Out of 8432 there are 4180 respondents those who have moderate physical activity level.
On other hand there are 2286 answers those who have high physical activity level. 1441 persons
have low physical activity level as well. In addition, there are 525 respondents those who have
sedentary physical activity level. When it is compared with male and female then it is found that
57.51% female are in sedentary condition and there are 42.29% male persons those are in the
same sedentary physical activity level. From the statistical analysis it is found that percentage
gets decreased when participants increase their activity level. When they increase their level then
mean age in sedentary is 75.13%, low 70.12%, high 63.60% and moderate 66.33%
Verbal fluency:
In this test there are 4289 participants it is found that age increases then mean score get
reduced. In the age group 50-59 mean value is 22.69. In 60-69 age group it is 20.00, in 70-79 age
group it is 16.85 and in above 80 age mean value is 13.77. Results show that as educational level
is higher than mean of grip strength also get increased among respondents. For higher level
education it is 22.67 but for less than o-level it is 17.71. When it compares with the wealth
variable then it is found that mean of grip strength gets increased with wealth level. For lowest
quintiles it is 17.68, for 2nd quintiles it is 18.90, for 3rd v it is 19.81, for 4th it is 20.58 and for
highest quintiles mean of grip strength is 22.26. When participants have lesser CVD condition
then mean value gets increased. Results show that in 0 CVD condition mean value is 20.49, in 1
CVD it is 19.93 and in 2 CVD it is 18.88.
Mean value of verbal fluency is high if the person has not suffered with diabetes, stork. It
is found that mean value of grip strength is increased with increasing physical activity level. In
the sedentary level it is 15.82, in low physical activity level it is 18.31, in moderate it is 19.96
and in high physical activity level it is 21.58. From the results it is found that mean of grip
strength is low with depressive status.
Memory:
In the memory test there were 4282 participants, it is found that mean score is quit higher
in younger people as compare to old age persons. With the increasing age memory start
declining. In the age group 50-59 mean value is 11.49, in 60-69 it is 9.86, in 70-79 it is 7056 and
in above 80 age group persons mean score is 5.17. Mean score of memory gets increased with
the increasing educational level. For higher A level it is 11.22 and for less than o-level it is 8.45.
Mean also gets increased with increasing wealth condition. In lowest quintiles it is 8.03 but when
23

it compares with the highest quintiles then it is 11.15. It is higher in those candidates those who
have not been diagnosed stroke. Mean score of memory status gets increased with increasing
physical activity level. In sedentary activity level mean score is 7.19 whereas in high level
physical activity it is 10.64. Furthermore , mean score is lower with depressive status.
Grip strength
Total involved persons in grip strength statistical analysis were 7230. It is found that
mean value of grip strength is higher in male as compare to female candidates. In mean value is
37.87 in male whereas in female it is 21.97. With the increasing age grip strength is decreased. In
50-59 age group people mean of grip strength is 33.81, in 60- 69 it is 30.27, in 70-79 it is 26.24
and in above 80 age group people it is 20.14. On other hand results found that if educational
level is increasing then mean of grip strength also gets increased. In higher than A level
educational group mean of grip strength is 33.44 whereas in o-level it is 30.74 and in less than o-
level it is 26.43. It is also found that if wealth level is increasing then mean score of grip strength
also get increased. In lowest quintiles it is 24.93, in 2nd quuintiles it is 27.75 in 3rd quintiles it is
30.65 and in the highest quintiles it is 32.14. It is found that participants those who have lesser
CVD condition have higher mean score. People those who are in 0 CVD condition have 29.73
mean score, 1 CVD condition's participants mean score is 28.48 and 2 CVD condition people
have mean score of 27.61. Mean of grip strength is higher if participants have not found diabetes.
People those who have diabetes mean score of grip strength is 29.27 whereas those who have not
diagnosed diabetes have mean 27.43. If physical activity is increasing then mean of grip strength
also gets increased with it. In the sedentary level mean is 21.59 , in low phase it is 24.64, in
moderate condition it is 29.39 and in high physical activity level it is 32.95. It is found that mean
of grip strength is low with depressive status.
Walking speed
The mean time is higher in older age group people. In 60- 69 age group it is 2.91 whereas
in 80 plus participants it is 4.75. If educational level is lower than mean of walking speed is
higher. In less than o-level it is 3.71, in o-level it is 3.01 and in higher than A level it is 2.85. If
quintiles is higher than mean of walking speed is low. In highest quintiles it is 2.72 and in
lowest quintiles it is 4.29. Mean is higher in stroke participants, people those who have
diagnosed stroke have mean of walking speed 4.75 whereas those who have not been found
stroke have mean of 3.36. If physical activities are higher than mean is low.
24

When researcher has done the test with education data ion ELSA wave 2 then it is found
that missing data was less than o-level and it was higher than a-level in the missing data set.
Missing data was more in moderate physical activity in the missing data. It was 43.70 %. It is
found that 2199 participants were there whose glucose level was normal. But depressive
symptoms were 53.26 %. 569 persons were there who were in the normal glucose level but
having mild depressive symptoms.
Table 1a shows that old female adults those who are above 60 age have faster walking
speed as compare to male adults. Table 1b explains that old male adults who have >50 age have
good grip strength as compare to female adults of the same age group. Table 1c and 1d explain
that memory distribution and verbal fluency are similar in both male and female.
25

CHAPTER 6 : DISCUSSION
From the overall analysis made, it is identified that there are bidirectional relationship
among fluid cognition and walking speed (Falck, Landry and Liu-Ambrose, 2017). When
individuals get adjust with the sex and age, then people tend to form better base line performance
for the test of other related executive functions like memory and processing speed experienced
the decline in walking speed. Further, this was identified with the 6 year follow up period.
Moreover, people who experienced less decline for each cognitive domain were able to walk
faster. From the analysis made, it was identified that there are changes identified among both
male and females (Zhu, Howard and Hooker, 2015 ). When compared with these two genders,
major changes were identified among women. They type of food or the diet that are consumed
by them is different and there only few of the respondents who actually look after their diet. Due
to improper diet that are consumed by them negatively affected are faced due to which the total
time that were taken by them gets reduced. According to Kolanowski, Mogle and Clare, (2015)
individuals are not able to cop up with the changing needs that are required by their body. In this
context, it is important that the willingness and the interest that is need are properly maintained.
As per the analysis made, it is identified that majority of people do focus on following a fixed
diet for the health but with time majority of them are not able to do so (Swiger, Martin and
Spertus, 2015).
In order to walk a certain distance, it requires to proper mental and physical stability and
stamina. Both male and female are seen fit till the age of 40. However, when the age increases,
then they are not able to maintain the exercise and the diet that they should maintain (Lehtisalo,
Lindström and Luchsinger, 2016). When compared with male and female, it is identified that
female are not able to maintain their health. The rate of disease and issues in cognitive
functioning are all negatively affected to females. Total time in which the evaluation made, it
was found that there was greater changes in faced the rate of walking . As per Tsutsumimoto,
Doi and Shimada, (2017) the rate of proteins and vitamins are highly helpful for the human body
so that they get properly maintain their health with the help of which they tent to raise their life
expectancy. When the required elements are not attained, then the rate of life expectancy gets
reduced. In order to over come these type of issues in relation with health, it was identified that
proper training need to be provided so that they will be able to list out the areas in which
development need to be made (Bossers, Scherder and van Heuvelen, 2014). In this context, all
26

the respondents or the older people should have proper understanding about the requirements so
that they are able to be provided with training. This is highly effective in making evaluation and
listing out the requirement of body and this way proper development can be made (Carvalho,
Rea and Cusack, 2014 ).
From the total respondents who are taken, there are about 5% of them who have the habit
of smoking. As per the data that are taken from these respondents, it is identified that the walking
speed that these individuals were very low when compared with female and other individuals
who do not smoke. As per Pettersson, Wahlund and Crisby, (2017 ) the lungs gets affected and
this has high inverse effect on breathing. Due to this issue, these respondents are not able to walk
the minimum distance which they were able to walk few years back. This shows that the smokers
are highly getting affected and this has also caused them to get affected with some of the
diseases. On the other hand, when there are females who smoke, then the issues or the problems
is very high when compared with male who smoke (Berendsen, Kang and van de Rest, 2017).
This can be determined that smoking is highly injurious that affected the cognitive and physical
functioning of individuals when they become old.
As per the data, there are 2 % of the respondents who are facing issue in relation with
depression. Tolea and Galvin, (2015) stated that depression make the individuals to become
mentally and physically disturbed and they are not able to operate their function. The rate of
walk that are made by these individuals are also less. This shows that people who are facing
depression need to focus on developing steps with the help of which they can perform their work
in effective manner. In this respect, when training is to be provided to individuals who are older,
then they are required to make proper analysis so that they will be able to determine people who
are facing problems in relation with depression (de Souto Barreto, Delrieu and Rolland, 2016).
As per the findings made, steps should be taken so that they can overcome their problems and
effectively perform their roles.
Semenov, Bigelow and Agrawal, (2015) stated that memory get negatively affected when
age grown. The data collected presents that majority of the individuals were facing problems in
relation with memory. However, it was identified that individuals whose educational background
is strong, they face less of problems in relation with memory. In this context. Lau, Ludin and
Shahar, (2017) stated that when individuals are well aware of their health and the type of steps
that should be followed, then it becomes favourable enough to raise the functioning of the body
27

in relation with cognitive and physical functioning (Grzywacz, Segel-Karpas and Lachman,
2016). There are conditions that are identified in which people do not tent to make use of their
knowledge as they prefer not to. These create issues are they are not able to perform their roles
and their health related conditions gets negatively affected.
According to Falck, Landry and Liu-Ambrose, (2017) wealth is helpful enough to
maintain the cognitive and physical functioning of individual. When a person has enough wealth,
then they are able to make sure that all the problems in relation with health are properly
maintained and they also spend highly so that they are able to over come the issues (Zhu,
Howard and Hooker, 2015). However, it is being identified that there are about 27% of the
individuals who are wealthy. They are able to work over their diseases but in order to perform
their physical functioning, they lack stability. Different countries have diverse set of policies are
followed in which individuals are able to get proper treatments. However, there are countries in
the rate of services that they get from hospitals are very low due to which they are not able to get
treatment. With this respect, when there is wealth, then all those people are able to get proper
treatment for the type of issues with health (Kolanowski, Mogle and Clare, 2015). Further, it
consist of CVD and it was found that there are 64.12 % of the respondents who did not have this
is type of problem. On the other hand, remaining people were facing CVD. In addition to this,
from the remaining percentage, majority of women were the one who were facing these type of
disease. From the over all analysis, it can be stated that from all type of test and analysis made, it
can be stated that females were the one who were facing serious issues in relation with health
(Swiger, Martin and Spertus, 2015). Further, it can also be determined that male are more
concern or the body type that they carry is helpful for them to maintain their body functioning in
effective manner.
According to Lehtisalo, Lindström and Luchsinger, (2016), lungs play vital role in
providing proper supply of oxygen to brain, when individuals smoke, then their lungs gets
negatively affected. This is a type of problem in which the rate of walking is affected. There are
other issues that are faced when individual’s lungs get affected due to smoking. With this
respect, there are diseases that are faced by people due to which the rate of performance is
negative and they are also not able to maintain their performance level (Tsutsumimoto, Doi and
Shimada, 2017). Further, there are conditions in which females get stroke attack when compared
with male. From this, it can also be determined that the rate of deaths that happen for women is
28

high when compared with males. In addition to this, the rate of physical activity level of older
people are moderated of the respondents selected. There almost half of the respondents who
faced issues in relation with physical activity (Bossers, Scherder and van Heuvelen, 2014). This
shows that majority of the people are not at all concern with their health. Further, the rate of
knowledge that each one has is also low due to which people do not proper information about the
things that should be considered through which they can stay healthy. Both physical activity and
education are highly linked with each other. When the rate of education that individuals have is
high, then those people are able to have effective physical activity level (Carvalho, Rea and
Cusack, 2014). On the other hand, when the rate of education is low, then they are not able to
maintain their health. Individuals feel tired when they stand for long time. In this context, people
who are aware of what all things that are to be conducted, then it becomes favourable enough to
improve the performance level. As per Pettersson, Wahlund and Crisby, (2017) in order to
perform any type of task, it requires to have proper intake of vitamins, proteins or stability of
mind and body. When these are not present, then it becomes difficult to conduct the task in
effective manner.
The rate of verbal fluency is also low with age. Again this is affected with the type of
education that are carried by individuals. As per the findings, all the respondents are divided in to
three levels in which it consist of lowest level, average and high level (Berendsen, Kang and van
de Rest, 2017). All the respondents who fall under high level are able to maintain their health
and to get proper functioning of cognitive and physical. The rate of fluency gets reduced with
ageing, individuals are not able to express. This generally happens due to lack of words or loss in
memory due to which individuals are not able to convey information. Diabetes slow down the
process of recovering the injury that is caused to the body. In this context, there are responds
who are facing serious issues in relation with operating their functions (Tolea and Galvin, 2015).
Further, it is also essential for the person to take up appropriate steps so that they will be able to
maintain their health in effective manner.
As per the strength of the study, it can be stated that the sample size that is taken in to
consideration is high. This is highly favourable enough to come up with an appropriate outcome
(de Souto Barreto, Delrieu and Rolland, 2016). When the sample size is large, then proper
analysis is made in which all the perceptions that are carried can be properly analysed. Further,
the range of information that will be gathered from this will also be high. Researcher and the
29

other viewers will be able to get benefited from the data. In this research there are some of the
issues that are also faced in which there were some of the respondents who were not able to
support as they were not able to take part in the walking test due to health restrictions (Semenov,
Bigelow and Agrawal, 2015 ). Further, there are different type of areas that are considered but
there were certain set of limitations in which all the areas were not properly covered. From this,
can be stated that the result under estimated the strength of association among walking speed and
cognition. Majority of the conducted analysis were used and these were helpful in providing
information in which it stated that all ne females need to get proper knowledge and awareness
about the health and the diet that should be taken (Lau, Ludin and Shahar, 2017 ). When they
lack information, then they are not able to have effective physical and cognitive functioning.
Further, consideration are made in which they are able to determine that females face serious
issues in relation with age. Older women have diseases and the rate of physical activates also
gets reduced. They fail in performing the rate of work in effective manner, when it is compared
with the young people (Grzywacz, Segel-Karpas and Lachman, 2016 ). in addition to this, proper
training and steps should be taken with the help of which the rate of information are raised
among individuals so that they take care of their health take up proper diet in order to raise their
expectancy of life.
30

CHAPTER 7 : CONCLUSION
7.1 Conclusion
From the above study it can be articulated that staying alert and being healthy are very
essential for the human being. With the increasing age cognitive functioning and physical
capabilities of the person get reduced. Health literacy is very important for all age group persons
because that can support in identifying issues that can causes difficulty in old age to them.
Reducing walking speed, increasing CDV, memory loss, verbal issues etc. are very common in
elder persons. From the discussion it can be concluded that increasing age reduces grip strength
in old age people. In 50- 59 age group people mean of grip strength is 33.81 whereas in above 80
age group people mean of grip strength is 20.14. With the increasing educational level mean of
grip strength gets increased. From the study it can be concluded that age related changes are
complex and due to which individual become unable to live their life independently. That
increases risk in the human body and increase chances of death as well. From the research
conducted, it can be concluded that individuals need to maintain their health so that they will be
able to live a health life. This is only possible when people are concern about the things that need
to be considered so that health can protected. From the first chapter, there are proper description
given about the areas that are to be focused in research. With this respect, consideration are made
in areas like education, memory, walking time, etc . From the findings, it is identified that with
age all their efficiency gets reduced as their cells get weaker with time. In such situation, those
people are saved who have proper education and have proper knowledge about the ways that can
enable to reduce the rate of cells getting damaged. In this context, it requires to take proper diet
which includes vitamins, proteins, etc. In addition to this, it is also essential to make sure that
each day there is proper exercise is done. When these small steps are considered , then it
becomes favourable enough to perform any type of roles even the person is old.
Further, there are negative impact over health when there is high consumption of tobacco.
Cigarette which has high amount of tobacco has high negative impact over lungs due to which
the stamina which individuals have gets reduced. This is an important element that enables to
maintain the rate of walking . When the rate of stamina within body is less, then this becomes
difficult to perform the tasks and one get tired. Individual getting older need to make sure that
they take up proper information about health. There are diseases that are faced by people getting
old and one of the diseases includes diabetes. As per the research conducted, it is identified that
31

women face this type of disease when compared with male. In addition to this, it can be stated
that the speed of individuals gets reduced when age increases. Further, the speed of females is
much less when compared with males speed. Lastly , cognitive functions and age has close
relation with each other. When the age increases, then the functions related with cognitive gets
reduced. The only gets affected, when individuals have are not concern with their health
conditions. Further, this also can be stated that government need to provide proper support so
that people will be able to realize the health related aspects and they will take up proper steps so
that they can maintain their health and live healthy life.
7.2 Recommendation
From the overall research conducted, it can be stated that there are certain set of
recommendations that should be followed so that individuals who are older will be able to
overcome the health related issues. With this respect, below given are some of the
recommendations that can be adopted in England:
Awareness : In England, the rate of awareness that older people have in order to protect
their health is very low. There are certain set of consideration that has to be followed so that they
will be able to make sure that all the function within the body are properly performing. Both
male and female need to focus on develop their understanding and knowledge in relation with
health. This way the rate of life expectancy and the rate of diseases can be reduced.
Tasking support of government : Government of England need to understand that all the
individuals are not able to get proper treatment due to high rates that are asked by the health care
firms. It is important that government take up appropriate steps so that people will be able to get
proper treatment for the health related issues. In addition to this, the rate of problems that are
face by women is high compared with male. With this respect, females should be focused more
and they need to be proper informed about the steps that has to be considered in which they have
proper diet and hygienic food products.
Training to care providers : When individuals visit hospitals, then care providers needs to
have proper understanding about the health related aspects that need to be conveyed to patients.
When information if conveyed, then it is helpful for other to know the seriousness. In this
context, proper training should be provided as it will enables to clarify all the doubts that they
have and they can also clarify the doubts that are asked by the patients. Hospitals and
32

government should work together so that people are information and the rate of life expectancy
can be raised.
33

REFERENCES
Books and Journals
Online
5Physical and Cognitive Differences Between Older and Younger Workers, 2017. [Online]
Available through: <https://www.ncbi.nlm.nih.gov/books/NBK207703/>. [Accessed on
22nd August 2017 ].
6 The Health of Aging Populations, 2016. [Online] Available through:
<https://www.ncbi.nlm.nih.gov/books/NBK98373/>. [Accessed on 22nd August 2017.
Physical and cognitive capabilities among persons aged 65–79 yearsin Germany, 2013. [Online]
Available through:
<http://edoc.rki.de/oa/articles/re9x6K8JTj3i/PDF/27tPL7f6OwuzM.pdf>. [Accessed on
22nd August 2017].
Physical and cognitive function, 2017. [Online] Available through:
<https://www.ifs.org.uk/elsa/report03/ch7.pdf>. [Accessed on 22nd August 2017].
The dynamic relationship between cognitive function and walking speed: the English
Longitudinal Study of Ageing, 2014. [Online] Available through:
<https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4119879/>. [Accessed on 22nd August
2017].
The Dynamic Relationship Between Physical Function and Cognition in Longitudinal Aging
Cohorts, 2013. [Online] Available through:
<https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3578448/>. [Accessed on 22nd August
2017].
34

Appendix
Frequency Percent
Not Missing 8,432 96.04
Missing 348 3.96
Total 8,780 100.00
Missing data outcome in wave 7
Variables Missing Non-missing
Fluency 4,382 4,398
Memory 4,389 4,391
Missing data exposure in wave 2
Variables Missing Non-missing
Grip strength 1,272 7,508
Walking speed 3,302 5,478
Missing data in covariates in wave 2
Variables missing Non-missing
Education 10 (0.11%) 8,770
Wealth 119 (1.36%) 8,661
Smoking 5 (0.06%) 8,775
Physical activity level 94 (1.07%) 8,686
Depression 221 (2.52%) 8,559
N= 22, 391
Drop non wave 2 core participants
(N=13, 611)
N= 8,780
Drop missing data in covariate (N=348)
(sex, age, education, wealth, diabetes, stroke,
smoking, physical active level, and depression)
N= 8,432
35

grip strength w
a
l
k
i
n
g
s
p
e
e
d
N coef. (95%
CI)
P value N coef. (95% CI) P value
memor
y
395
4
0.04 (0.03,
0.05)
<0.001 249
7
-0.70 (-0.82, -
0.59)
<0.001
fluenc
y
396
0
0.13 (0.11,
0.15)
<0.001 249
8
-1.27 (-1.49, -
1.06)
<0.001
Outcomes:
Memory
f
l
u
e
n
c
y
N 4282
4
2
8
9
coef. (95% CI) P value coef. (95% CI) P value
Sex 0.58 (0.35, 0.81) <0.001 -0.60 (-1.04, -0.16) 0.007
Age 0.58 (0.35, 0.81) 0.007 -0.33 (-0.35, -0.30) <0.001
Education
less than O-level Ref.
R
e
f
.
O-level or equivalent 2.20 (1.94, 2.47) <0.001 3.70 (3.19, 4.21) <0.001
higher than A-level 2.77 (2.51, 3.02) <0.001 4.96 (4.47, 5.46) <0.001
36

Wealth
lowest quintile Ref.
R
e
f
.
2nd quintile 1.22 (0.81, 1.63) <0.001 1.22 (0.43, 2.01) 0.002
3rd quintile 1.65 (1.25, 2.05) <0.001 2.13 (1.37, 2.89) <0.001
4th quintile 2.05 (1.67, 2.44) <0.001 2.90 (2.16, 3.65) <0.001
highest quintile 3.12 (2.73, 3.50) <0.001 4.58 (3.86, 5.31) <0.001
CVD
1 -0.39 (-0.66, -0.12) 0.005 -0.56 (-1.07, -0.05) 0.032
2 -1.06 (-1.47, -0.65) <0.001 -1.61 (-2.39, -0.84) <0.001
Stroke -3.47 (-4.66, -2.27) <0.001 -4.91 (-7.17, -2.64) <0.001
Diabetes -1.11 (-1.74, -0.47) 0.001 -1.49 (-2.69, -0.29) 0.015
Smoking -0.29 (-0.63, 0.05) 0.092 -0.89 (-1.53, -0.25) 0.006
physical exercise
Sedentary Ref.
R
e
f
.
Low 1.57 (0.74, 2.40) <0.001 2.49 (0.92, 4.06) 0.002
Moderate 2.58 (1.80, 3.36) <0.001 4.15 (2.66, 5.63) <0.001
High 3.45 (2.66, 4.24) <0.001 5.76 (4.26, 7.26) <0.001
depression -1.28 (-1.62, -0.94) <0.001 -2.23 (-2.88, -1.58) <0.001
Exposures:
Grip Strength W
a
l
k
i
n
g
S
p
e
e
37

d
N 7320
5
3
5
2
coef. (95% CI) P value coef. (95% CI) P value
Sex -15.9 (-16.29, -15.52) <0.001 0.43 (0.32, 0.53) <0.001
Age -0.45 (-0.48, -0.43) <0.001 0.08 (0.07, 0.09) <0.001
Education
less than O-level Ref.
R
e
f
.
O-level or equivalent 4.30 (3.68, 4.93) <0.001 -0.71 (-0.84, -0.57) <0.001
higher than A-level 7.01 (6.38, 7.63) <0.001 -0.87 (-1.00, -0.73) <0.001
Wealth
lowest quintile Ref.
R
e
f
.
2nd quintile 2.82 (1.96, 3.68) <0.001 -0.62 (-0.79, -0.45) <0.001
3rd quintile 4.42 (3.57, 5.28) <0.001 -0.98 (-1.14, -0.81) <0.001
4th quintile 5.72 (4.88, 6.57) <0.001 -1.20 (-1.37, -1.03) <0.001
highest quintile 7.21 (6.37, 8.04) <0.001 -1.57 (-1.73, -1.40) <0.001
CVD
1 -1.25 (-1.87, -0.64) <0.001 0.23 (0.10, 0.35) <0.001
2 -2.13 (-3.02, -1.24) <0.001 0.49 (0.32, 0.66) <0.001
Stroke -5.86 ( -7.96, -3.76) <0.001 1.38 (1.00, 1.77) <0.001
Diabetes -1.84 (-3.21, -0.46) 0.009 0.64 (0.38, 0.90) <0.001
Smoking 0.34 (-0.41, 1.09) 0.371 0.15 (-0.01, 0.31) 0.064
physical exercise
Sedentary Ref.
R
e
f
.
Low 3.05 (1.80, 4.30) <0.001 -1.85 (-2.10, -1.62) <0.001
38

Moderate 7.80 (6.66, 8.94) <0.001 -3.16 (-3.38, -2.94) <0.001
High 11.36 (10.18, 12.55) <0.001 -3.58 (-3.81, -3.35) <0.001
depression -5.03 (-5.77, -4.30) <0.001 1.38 (1.23, 1.53) <0.001
Table A
Distribution for all the covariates by sex
TOTAL Male
F
e
m
a
l
e
N % N % N %
Age
50-59 2,501 29.66 1,157 30.58 1,344 28.92
60-69 2,799 33.19 1,289 34.06 1,510 32.49
70-79 2,104 24.95 955 25.24 1,149 24.72
80+ 1,028 12.19 383 10.12 645 13.88
Educa
tion
Less than o-level 4,441 52.67 1,757 46.43 2,684 57.75
o-level or equivalent 1,973 23.40 882 23.31 1,091 23.47
Higher than A-level 2,018 23.93 1,145 30.26 873 18.78
Wealt
h
Lowest quintile 1,520 18.03 601 15.88 919 19.77
2nd quintile 1,665 19.75 724 19.13 941 20.25
3rd quintile 1,706 20.23 761 20.11 945 19.54
4th quintile 1,733 20.55 825 21.80 908 19.54
Highest quintile 1,808 21.44 873 23.07 935 20.12
39

CVD
conditions
0 5,407 64.12 2,470 65.27 2,937 63.19
1 2,155 25.26 937 24.76 1,218 26.20
2 870 10.32 377 9.96 493 10.61
Diabetes
or high
blood sugar
Yes 348 4.13 185 4.89 163 3.51
No 8,048 95.87 3,599 95.11 4,485 96.49
stro
ke
Yes 150 1.78 70 1.85 80 1.72
No 8,282 98.22 3,714 98.15 4,568 98.28
smoki
ng
Non-smoker 7,152 84.82 3,203 84.65 3,949 84.96
smoker 1,280 15.18 581 15.35 699 15.04
Physical
exercise
Sedentary 525 6.23 222 5.87 303 6.52
Low 1,441 17.09 511 13.50 930 20.01
Moderate 4,180 49.57 1,844 48.73 2,336 50.26
High 2,286 27.11 1,207 31.90 1,079 23.21
Depre
ssion
Yes 1,325 15.71 448 11.84 877 18.87
No 7,107 84.29 3,336 88.16 3,771 81.13
1a. Distribution of walking speed by sex
Mean SD Frequency
40

Male 3.15 1.74 2,382
Female 3.58 2.17 2,970
Total 3.39 2.00 5,352
1b. Distribution of grip strength (dominant hand) by sex
Mean SD Frequency
Male 37.87 9.93 3,329
Female 21.97 6.78 3,991
Total 29.20 11.52 7,320
1c. Distribution of memory by sex
Mean SD Frequency
Male 9.56 3.66 1,867
Female 10.13 3.95 2,415
Total 9.88 3.84 4,282
1d. Distribution of verbal fluency by sex
Mean SD Frequency
Male 20.55 7.27 1,870
Female 19.95 7.29 2,419
Total 20.21 7.28 4,289
Model 1
fluency 7
N = 3960
coef. (95% CI) Std. Err. P value
grip strength 0.13 (0.11, 0.16) 0.01 <0.001
sex 1.81 (1.18, 2.46) 0.16 <0.001
age -0.28 (-0.31, -0.29) 0.01 <0.001
cons 32.82 (30.27,
35.37)
25.23 <0.001
fluency 7
N = 2498
coef. (95% CI) Std. Err. P value
41

walking
speed
-0.98 (-1.19, -0.76) 0.11 <0.001
sex 0.03 (-051, 0.56) 0.27 0.92
age -0.28 (-0.32, -0.23) 0.02 <0.001
cons 40.49 (37.52,
43.45)
1.51 <0.001
memory 7
N = 3954
coef. (95% CI) Std. Err. P value
grip strength 0.05 (0.04, 0.07) 0.01 <0.001
sex 1.63 (1.31, 1.95) 0.16 <0.001
age -0.21 (-0.22, -0.19) 0.01 <0.001
cons 20.47 (19.19,
21.75)
0.65 <0.001
memory 7
N = 2497
coef. (95% CI) Std. Err. P value
walking
speed
-0.50 (-0.61, -0.39) 0.06 <0.001
sex 0.94 (0.67, 1.22) 0.14 <0.001
age -0.22 (-0.25, -0.20 0.01 <0.001
cons 25.04 (23.52,
26.56)
0.78 <0.001
Model 2
fluency 7 m
e
m
o
r
y
42

7
N = 3960 N
=
3
9
5
4
coef. (95% CI) P value coef. (95% CI) P value
Grip Strength 0.10 (0.07, 0.13) <0.001 0.03 (0.01, 0.04) <0.001
sex 1.71 (1.08, 2.33) <0.001 1.52 (1.21, 1.83) <0.001
age -0.25 (-0.28, -0.22) <0.001 -0.19 (-0.20, -0.16) <0.001
Education (3
way
qualification)
less than O-level Ref. R
e
f
.
O-level or
equivalent
2.08 (1.57, 2.60) <0.001 1.15 (0.90, 1.40) <0.001
higher than A-
level
2.99 (2.46, 3.52) <0.001 1.63 (1.37, 1.90) <0.001
Wealth
lowest quintile Ref. R
e
f
.
2nd quintile 0.09 (-0.67, 0.85) 0.810 0.68 (0.31, 1.05) <0.001
3rd quintile 0.78 (0.04, 1.52) 0.038 1.01 (0.65, 1.37) <0.001
4th quintile 1.14 (0.41, 1.87) 0.002 1.17 (0.81, 1.53) <0.001
highest quintile 1.99 (1.25, 2.73) <0.001 1.84 (1.47, 2.20) <0.001
cons 29.72 (27.16, 32.28) <0.001 18.34 (17.08, 19.60) <0.001
fluency 7 m
e
m
o
43

r
y
7
N = 2498 N
=
2
4
9
7
coef. (95% CI) P value coef. (95% CI) P value
Walking Speed -0.67 (-0.89, -0.45) <0.001 -0.31 (-0.42, -0.20) <0.00
1
sex 0.49 (-0.04, 1.01) 0.070 1.20 (0.93, 1.47) <0.00
1
age -0.24 (-0.29, -0.20) <0.001 -0.20 (-0.22, -0.19) <0.00
1
Education (3
way
qualification)
less than O-level Ref. R
e
f
.
O-level or
equivalent
1.90 (1.23, 2.56) <0.001 1.11 (0.77, 1.44) <0.00
1
higher than A-
level
3.05 (2.38, 3.73) <0.001 1.54 (1.19, 1.88) <0.00
1
Wealth
lowest quintile Ref. R
e
f
.
2nd quintile 0.64 (-0.30, 1.59) 0.183 0.90 (0.42, 1.38) <0.00
1
3rd quintile 1.31 (0.40, 2.23) 0.005 0.98 (0.52, 1.45) <0.00
1
4th quintile 1.16 (0.24, 2.07) 0.013 1.10 (0.64, 1.57) <0.00
1
highest quintile 1.92 (0.96, 2.85) <0.001 1.70 (1.22, 2.17) <0.00
1
cons 34.46 (31.35, 37.58) <0.001 21.10 (19.51, 22.68) <0.00
1
44

Model 3
fluency 7 m
e
m
o
r
y
7
N = 3960 N
=
3
9
5
4
coef. (95% CI) P value coef. (95% CI) P value
Grip Strength 0.10 (0.07, 0.13) <0.001 0.03 (0.01, 0.04) <0.001
sex 1.69 (1.06, 2.32) <0.001 1.51 (1.20, 1.81) <0.001
age -0.25 (-0.28, -0.22) <0.001 -0.19 (-0.20, -0.17) <0.001
Education (3
way
qualification)
less than O-level Ref. R
e
f
.
O-level or
equivalent
2.08 (1.57, 2.60) <0.001 1.15 (0.89, 1.40) <0.001
higher than A-
level
3.00 (2.47, 3.54) <0.001 1.64 (1.38, 1.90) <0.001
Wealth
lowest quintile Ref. R
e
f
.
2nd quintile 0.08 (-0.69, 0.84) 0.833 0.67 (0.30, 1.90) <0.001
3rd quintile 0.75 (0.01, 1.49) 0.046 0.98 (0.62, 1.34) <0.001
4th quintile 1.11 (0.38, 1.84) 0.003 1.14 (0.78, 1.50) <0.001
highest quintile 1.96 (1.21, 2.70) <0.001 1.81 (1.44, 2.17) <0.001
45

CVD
1 0.19 (-0.29, 0.67) 0.434 0.04 (-0.19, 0.28) 0.729
2 0.06 (-0.70, 0.81) 0.879 -0.08 (-0.45, 0.29) 0.660
Stroke -2.40 (-4.59, -0.21) 0.032 -1.94 (-3.02, -0.87) <0.001
Diabetes -0.18 (-1.35, 0.99) 0.759 -0.14 (-0.71, 0.43) 0.632
cons 29.72 (27.15, 32.28) <0.001 18.34 (17.08, 19.60) <0.001
fluency 7 m
e
m
o
r
y
7
N = 2498 N
=
2
4
9
7
coef. (95% CI) P value coef. (95% CI) P value
Walking Speed -0.68 (-0.90, -0.46) <0.001 -0.31 (-0.42, -0.20) <0.001
sex 0.51 (-0.01, 1.04) 0.057 1.20 (0.94, 1.47) <0.001
age -0.24 (-0.29, -0.20) <0.001 -0.20 (-0.22, 1.89) <0.001
Education (3
way
qualification)
less than O-level Ref. R
e
f
.
O-level or
equivalent
1.90 (1.23, 2.56) <0.001 1.10 (0.77, 1.44) <0.001
higher than A-
level
3.06 (2.39, 3.74) <0.001 1.55 (1.20, 1.89) <0.001
46

Wealth
lowest quintile Ref. R
e
f
.
2nd quintile 0.66 (-0.29, 1.60) 0.174 0.89 (0.41, 1.37) <0.001
3rd quintile 1.32 (0.40, 2.24) 0.005 0.96 (0.49, 1.42) <0.001
4th quintile 1.18 (0.26, 2.10) 0.012 1.09 (0.62, 1.55) <0.001
highest quintile 1.95 (1.01, 2.88) <0.001 1.68 (1.21, 2.15) <0.001
CVD
1 0.09 (-0.50, 0.68) 0.761 0.10 (-0.20, 0.40) 0.519
2 0.28 (-0.62, 1.17) 0.541 0.07 (-0.38, 0.53) 0.758
Stroke -1.41 (-3.78, 0.96) 0.243 -1.54 (-2.74, 0.96) 0.012
Diabetes 1.02 (-0.36, 2.40) 0.148 0.26 (-0.45, 0.96) 0.473
cons 34.41 (31.29, 37.53) <0.001 21.06 (19.48, 22.65) <0.001
Model 4
fluency 7 m
e
m
o
r
y
7
N = 3960 N
=
3
9
5
4
coef. (95% CI) P value coef. (95% CI) P value
Grip Strength 0.09 (0.06, 0.12) <0.001 0.02 (0.01, 0.04) 0.001
sex 1.60 (0.98, 2.23) <0.001 1.47 (1.16, 1.78) <0.001
47

age -0.25 (-0.28, -0.22) <0.001 -0.19 (-0.20, -0.17) <0.001
Education (3
way
qualification)
less than O-level Ref. R
e
f
.
O-level or
equivalent
2.00 (1.48, 2.52) 0.921 1.11 (0.85, 1.36) <0.001
higher than A-
level
2.87 (2.33, 3.41) <0.001 1.58 (1.32, 1.84) <0.001
Wealth
lowest quintile Ref. R
e
f
.
2nd quintile -0.04 (-0.80, 0.72) 0.921 0.62 (0.25, 0.99) 0.001
3rd quintile 0.52 (-0.23, 1.26) 0.174 0.88 (0.51, 1.24) <0.001
4th quintile 0.81 (0.06, 1.55) 0.033 1.01 (0.64, 1.37) <0.001
highest quintile 1.64 (0.88, 2.40) <0.001 1.67 (1.29, 2.04) <0.001
CVD
1 0.23 (-0.25, 0.71) 0.340 0.06 (-0.17, 0.29) 0.618
2 0.11 (-0.64, 0.86) 0.776 -0.06 (-0.43, 0.31) 0.755
stroke -2.22 (-4.41, -0.04) 0.046 -1.85 (-2.93, -0.78) 0.001
diabetes -0.08 (-1.25, 1.08) 0.888 -0.08 (-0.65, 0.49) 0.787
smoking -0.77 (-1.39, -0.16) 0.014 -0.24 (-0.54, 0.07) 0.128
Physical
Exercise
sedentary Ref. R
e
f
.
low 1.11 (-0.42, 2.65) 0.155 0.67 (-0.08, 1.43) 0.082
48

moderate 1.50 (0.04, 2.96) 0.045 0.96 (0.24, 1.68) 0.009
high 2.14 (0.66, 3.63) 0.005 1.21 (0.48, 1.95) 0.001
cons 28.89 (25.90, 31.88) <0.001 17.63 (16.16, 19.10) <0.001
fluency 7 m
e
m
o
r
y
7
N = 2498 N
=
2
4
9
7
coef. (95% CI) P value coef. (95% CI) P value
walking speed -0.61 (-0.84-0.38) <0.001 -0.28 (-0.40, -0.17) <0.001
sex 0.51 (-0.02, 1.03) 0.060 1.20 (0.93, 1.47) <0.001
age -0.25 (-0.29, -0.20) <0.001 -0.20 (-0.23, -0.18) <0.001
Education (3
way
qualification)
less than O-level Ref. R
e
f
.
O-level or
equivalent
1.82 (1.16, 2.49) <0.001 1.05 (0.71, 1.39) <0.001
higher than A-
level
2.99 (2.31, 3.67) <0.001 1.49 (1.15, 1.84) <0.001
Wealth
lowest quintile Ref. R
e
f
.
2nd quintile 0.57 (-0.38, 1.52) 0.237 0.83 (0.35, 1.31) 0.001
49

3rd quintile 1.14 (0.22, 2.07) 0.015 0.84 (0.37, 1.31) <0.001
4th quintile 0.94 (0.02, 1.87) 0.046 0.94 (0.47, 1.41) <0.001
highest quintile 1.70 (0.76, 2.65) <0.001 1.52 (1.04, 2.00) <0.001
CVD
1 0.14 (-0.45, 0.73) 0.637 0.12 (-0.17, 0.43) 0.400
2 0.31 (-0.58, 1.20) 0.495 0.09 (-0.36, 0.54) 0.694
stroke -1.33 (-3.70, 1.03) 0.269 -1.49 (-2.69, -0.29) 0.015
diabetes 1.01 (-0.37, 2.39) 0.150 0.26 (-0.44, 0.96) 0.467
smoking -1.15 (-2.01, -0.29) 0.009 -0.85 (-1.29, -0.41) <0.001
Physical
Exercise
sedentary Ref. R
e
f
.
low 1.54 (-0.33, 3.40) 0.106 0.25 (-0.69, 1.20) 0.597
moderate 1.57 (-0.23, 3.37) 0.087 0.30 (-0.61, 1.21) 0.515
high 2.08 (0.24, 3.92) 0.027 0.57 (-0.36, 1.50) 0.229
cons 33.17 (29.44, 36.91) <0.001 21.14 (19.25,
23.03)
<0.001
Model 5
fluency 7 m
e
m
o
r
y
7
N = 3960 N
=
3
9
50

5
4
coef. (95% CI) P
value
coef. (95% CI) P value
grip strength 0.09 (0.06, 0.12) <0.00
1
0.02 (0.01, 0.03) 0.002
sex 1.63 (1.00, 2.25) <0.00
1
1.49 (1,18, 1.79) <0.001
age -0.25 (-0.28, -0.22) <0.00
1
-0.19 (-0.20, -1.18) <0.001
Education (3
way
qualification)
less than O-level Ref. R
e
f
.
O-level or
equivalent
1.99 (1.48, 2.51) <0.00
1
1.10 (0.85, 1.36) <0.001
higher than A-
level
2.88 (2.34, 3.42) <0.00
1
1.59 (1.33, 1.85) <0.001
Wealth
lowest quintile Ref. R
e
f
.
2nd quintile -0.09 (-0.85, 0.67) 0.825 0.59 (0.21, 0.96) 0.002
3rd quintile 0.45 (-0.30, 1.20) 0.237 0.83 (0.47, 1.20) <0.001
4th quintile 0.70 (-0.05, 1.45) 0.067 0.93 (0.56, 1.30) <0.001
highest quintile 1.51 (0.75, 2.27) <0.00
1
1.58 (1.21, 1.95) <0.001
CVD
1 0.25 (-0.23, 0.73) 0.304 0.07 (-0.16, 0.31) 0.545
2 0.18 (-0.58, 0.93) 0.648 -0.01 (-0.38, 0.36) 0.952
stroke -2.26 (-4.44, -0.07) 0.043 -1.88 (-2.95, -0.81) 0.001
diabetes -0.05 (-1.22, 1.12) 0.935 -0.05 (-0.62, 0.52) 0.856
smoking -0.74 (-1.35, -0.12) 0.019 -0.21 (-0.51, 0.09) 0.173
51

Physical
Exercise
sedentary Ref. R
e
f
.
low 1.05 (-0.48, 2.58) 0.180 0.63 (-0.12, 1.39) 0.100
moderate 1.36 (-0.10, 2.83) 0.067 0.87 (0.15, 1.59) 0.018
high 1.99 (0.50, 3.47) 0.009 1.11 (0.37, 1.84) 0.003
depression -1.03 (-1.66, -0.41) 0.001 -0.74 (-1.05, -0.44) <0.001
cons 29.34 (26.34, 32.34) <0.00
1
17.94 (16.47,
19.42)
<0.001
fluency 7 m
e
m
o
r
y
7
N = 2498 N
=
2
4
9
7
coef. (95% CI) P value coef. (95% CI) P value
Walking Speed -0 57 (-0.80, -0.34) <0.001 -0.25 (-0.37, -0.14) <0.001
sex 0.59 (0.06, 1.12) 0.028 1.26 (1.00, 1.53) <0.001
age -0.25 (-0.29, -0.20) <0.001 -0.20 (-0.23, -0.18) <0.001
Education (3
way
qualification)
less than O-level Ref. R
e
f
.
O-level or
equivalent
1.78 (1.12, 2.44) <0.001 1.02 (0.69, 1.36) <0.001
higher than A-
level
3.00 (2.32, 3.67) <0.001 1.50 (1.16, 1.84) <0.001
52

Wealth
lowest quintile Ref. R
e
f
.
2nd quintile 0.54 (-0.41, 1.48) 0.266 0.80 (0.32, 1.28) 0.001
3rd quintile 1.07 (0.15, 2.00) 0.023 0.79 (0.32, 1.25) 0.001
4th quintile 0.82 (-0.10, 1.75) 0.081 0.85 (0.38, 1.32) <0.001
highest quintile 1.57 (0.62, 2.52) 0.001 1.42 (0.95, 1.90) <0.001
CVD
1 0.16 (-0.43, 0.75) 0.595 0.14 (-0.16, 0.44) 0.407
2 0.37 (-0.51, 1.27) 0.495 0.14 (-0.31, 0.59) 0.541
stroke -1.32 (-3.68, 1.05) 0.274 -1.49 (-2.69, -0.29) 0.015
-1.48 (-2.67, -0.28)
diabetes 1.07 (-0.31, 2.45) 0.128 0.30 (-0.39, 1.00) 0.394
smoking -1.10 (-1.97, -0.24) 0.012 -0.81 (-1.25, -0.38) <0.001
Physical
Exercise
sedentary Ref. R
e
f
.
low 1.55 (-0.31, 3.40) 0.103 0.26 (-0.68, 1.20) 0.587
moderate 1.53 (-0.27, 3.32) 0.096 0.27 (-0.64, 1.18) 0.559
high 2.02 (0.19 3.86) 0.031 0.53 (-0.40, 1.46) 0.262
depression -1.39 (-2.21, -0.57) 0.001 -1.03 (-1.44, -0.62) <0.001
cons 33.23 (29.51, 36.95) <0.001 21.18 (19.30,
23.06)
<0.001
53