The Association Between Cognitive Function and Physical Capabilities

This dissertation examines the association between cognitive functioning and physical capabilities in elderly individuals residing in England. The study investigates the impact of aging on health outcomes, focusing on the decline in cognitive abilities, such as memory and verbal fluency, and physical capabilities, including walking speed and grip strength. The research aims to determine how these factors are interrelated and influence the overall well-being of the elderly population. The study utilizes the STATA tool to analyze the relationship between baseline physical capabilities and cognitive performance ten years later, considering covariates such as education, wealth, cardiovascular conditions, physical exercise, and health literacy. The findings are expected to provide valuable insights into the challenges faced by the elderly, potentially informing strategies to improve their quality of life and reduce the risk of age-related health issues. The research emphasizes the importance of health literacy in enabling older adults to manage their health effectively and maintain independence.

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
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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
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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
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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.
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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
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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
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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,
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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.
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