Assessment of the health status of middle-aged and elderly men with head scale, SF-36, IIEF5, AMS, and IPSS

Zhu, Yi; Li, Jian-Hui; Zhao, **g; Zheng, Jun-Biao; Liang, Qun-Feng; Yu, **ao-Hua; Zhang, Shu-Cheng; Shi, Hui-Juan; Zhou, Wei-**; Zhu, Qian-**

doi:10.1186/s12877-021-02595-y

Assessment of the health status of middle-aged and elderly men with head scale, SF-36, IIEF5, AMS, and IPSS

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Published: 12 November 2021

Volume 21, article number 641, (2021)
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Assessment of the health status of middle-aged and elderly men with head scale, SF-36, IIEF5, AMS, and IPSS

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Yi Zhu¹,
Jian-Hui Li²,
**g Zhao³,
Jun-Biao Zheng⁴,
Qun-Feng Liang⁵,
**ao-Hua Yu⁴,
Shu-Cheng Zhang⁶,
Hui-Juan Shi²,
Wei-** Zhou² &
…
Qian-** Zhu²

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Abstract

Background

Identifying practical and distinguished indicators and influencing factors of male aging may be useful in predicting subsequent aging trends, designing personalized prevention, and improving lifestyle and health.

Methods

A cross-sectional, population-based study was performed in Jiashan County, China in 2016. A total of 690 local male residents, aged 40 to 80 years, were eligible for recruitment. Demographic and lifestyle information was collected through structured interviews. A self-designed head scale, the Medical Outcomes Study 36-item Short Form (SF-36), International Index of Erectile Function (IIEF5), Aging Males’ Symptoms (AMS), and International Prostate Symptom Score (IPSS) were used. Analysis of variance, local polynomial regression smoothing curves, multiple linear regression, and partial correlation analyses were performed.

Results

All the scales deteriorated with increasing age (P < 0.01), especially from the age of 60. The most significant changes between adjacent age groups were found in IIEF5 scores (16.7, 43.5 and 39.4%). Income, nutrition, personality and neighborhood relationship had an effect on SF-36 and AMS after adjusting for age (P < 0.01). Furthermore, neighborhood relationship modified the age effect on the head scale score and IIEF5 (P = 0.03); nutrition modified the relationship between age and SF-36 (P < 0.01).

Conclusions

Recession of reproductive health may be a distinct predictor of male aging. The associations of social inequalities or personality and health offer potential interventions for men’s health in aging. Self-reported scales may limit the precision and more physical fitness tests could be combined for a more precise assessment.

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Background

With an overall increase in life expectancy, quantifying the aging of different individuals has been brought into focus. The rates of biological aging are highly variable among individuals of the same chronological age. However, to date, there are no acknowledged aging markers to measure the biological age of an individual.

The epigenetic clock is thought to be the most promising molecular estimator of the biological age [1]. Some, including Horvath’s epigenetic clock, Hannum’s clock, and Levine’s clock, have been developed based on DNA methylation biomarkers for predicting aging for lifespan and healthspan [2,3,4,5]. Telomere length and epigenetic clock estimates are thought to be independent predictors of chronological age and mortality risk [6]. However, molecular biomarkers preclude their application to large-scale screens and routine physical examinations due to population specificity, invasiveness, and high costs.

In clinical settings, health-related quality of life (HRQoL) has been assessed using the Medical Outcomes Study 36-item Short Form (SF-36) questionnaire to evaluate the effect of disease or treatment [7, 8]. However, the application of SF-36 in the general population remains contradictory. An 18-year longitudinal study of civil servants (initially aged 35–55 years) based in London showed that physical health deteriorated while mental health tended to improve with age [9]. A general decline in the SF-36 score was found between 1995 and 2016 in the French population, but with wide disparities in trends between age groups [10]. A 2001–2011 US study found a declining SF-36 score in younger age groups, whereas older age groups tended to report higher mental scores [11].

The International Index of Erectile Function (IIEF5), Aging Males’ Symptoms (AMS) and International Prostate Symptom Score (IPSS) are commonly used scales for assessing the natural degradation of reproductive health in aging males [12, 13]. IIEF5, AMS and IPSS are used to assess erectile dysfunction, symptomatic late-onset hypogonadism, and lower urinary tract symptoms, respectively. The relationship among these scales has received attention [14, 15], but the relationship between reproductive health and overall health has seldom been studied. Recently, several studies in women indicated that reproductive health was a predictor of overall health. Irregular and long menstrual cycles in adolescence and adulthood were associated with a greater risk of premature mortality (age < 70 years), and these relationships were strongest for deaths related to cardiovascular disease [16]. Young women with a low number of harvested oocytes had an increased risk of aging-related events, such as cardiovascular diseases or osteoporosis, and early ovarian aging might serve as a marker of later accelerated aging [17]. For men and women, Sexual Health and Overall Wellness (SHOW) survey showed a strong association between satisfaction with sex and overall health [18]. However, relevant studies on men in order to elaborate the relationship or the predictive effect of reproductive health on overall health are still lacking.

Apart from health degradation, aging is accompanied by changes in appearance. Facial aging is considered the most prominent and readily accessible phenotype of human aging [Full size image

Correlation analysis showed that age, head scale score, SF-36, IIEF5, AMS and IPSS displayed pairwise correlations. The highest correlation was observed between IIEF5 and age (r = 0.63). Furthermore, when age, income, nutrition, personality, and neighborhood relationship were adjusted, the absolute values of correlation coefficients (partial r) decreased, and the significance of the correlation still existed, except between head scale score and IPSS or SF-36 and IIEF5 (Table 3).

Table 3 Pearson correlations and partial correlations between variables

Full size table

Discussion

All the indices, including the head scale scores, SF-36, IIEF5, AMS, and IPSS, deteriorated with increasing age, especially from the age of 60. IIEF5 showed the most significant degeneration; however, SF-36 showed the smallest degeneration. Income, nutrition, personality, and neighborhood relationship had effects and/or modified effects on health deterioration.

Various changes occur in human faces during aging. Chen utilized three-dimensional human facial morphologies for markers of aging [20].

IIEF5, AMS and IPSS are commonly used scales for assessing male reproductive health. Most studies, including the Massachusetts Male Aging Study (MMAS) and the Men’s Attitudes to Life Events and Sexuality (MALES), reported the deterioration of the three aspects with increase in age in middle-aged and elderly men [14, 15, 29,30,31]. We identified some special features in our study. IIEF5 decreased with increased age more saliently than the other four indices, especially in the 61–70 years age groups. The longitudinal data confirmed that IIEF5 had a sharp turning period in the 60–70 years age range [13]. IPSS deteriorated later than IIEF5 and AMS.

The AMS score was susceptible to all four socioeconomic factors. Jankowska et al. also reported that age and education level constitute major determinants of the intensity of AMS [32]. There was a correlation between nutrition and IPSS, but none between nutrition and IIEF5. The results coincide with a study conducted in Southern China that reported that adequate fruit and vegetable intake, especially dark and leafy vegetables, were associated with IPSS among elderly Chinese men, but lacked an association with IIEF5 [33]. Interestingly, close or alienated neighborhood relationship showed a bifurcate impact on 55–75 year olds. This means that the interaction of neighborhood relationship and age increased the vulnerability of erectile function in older age. Plausible reasons for such an increase have been related to a long latency period of the effects of unhealthy experiences in earlier life, accumulation and interaction of economic and social capital throughout life, and increasing vulnerability in old age making differential exposure more harmful [9, 21].

Partial pairwise correlations between most outcomes still existed after adjusting for age. Vela-Navarrete et al. found that the relationship between IPSS and SF-36 was linear, with general increases in IPSS corresponding to impairment in quality of life, independent of age [31]. Aging on multisystem is concomitant, but the trigger mechanisms are still poorly understood.

Some limitations of this work should be acknowledged. Jiashan County is a representative county in East China. Subjects had poor awareness of self-care, and seldom exercised or sought medical treatment for health problems, except for serious diseases. The data were not significantly affected by treatment for reproductive health. Meanwhile, subjects might not have reported their health status precisely because of deficient health consciousness. That, to a certain extent, could explain the lack of discrimination of SF-36. Disease is related to scale scores, but the causal relationship is complicated. Disease may be an intermediate variable between socioeconomic factors and health status. Therefore, we did not include disease factors in the models to avoid overadjustment.

Analysis of personality types and relationship with neighbours provide new perspectives of the mental effects on aging. In our study, most assessment data were reported by subjects themselves. An individual’s perception of a decline health is recognized as a predictor of later poor health outcomes. In future studies, physical fitness tests could be combined for a more objective assessment, and follow-up data with subsequent morbidity will be needed.

Few studies take into account the trajectories of both overall health and reproductive health decline with increase in age, as well as the different effects of socioeconomic factors on health. Although the reproductive health of elderly men is still a neglected field, recession on the reproductive health of men may be an early predictor of aging. The results of our study revealed IIEF5, AMS, and a self-designed head scale as reliable, sensible, and convenient aging markers. Due to ceiling effects and indiscriminate traits with increasing age, the SF-36 scale still need to be assessed in the general population in China.

Conclusions

Assessing the overall and reproductive health status may be useful to predict subsequent health trends, help track the aging process, design personalized medical treatment, and improve lifestyle and health. The associations between social inequalities or mental status and overall health or reproductive health offer potential avenues for facilitating remission and delay progression using nonpharmacological interventions. The benefits of such interventions for overall health in men may be far-reaching.

Availability of data and materials

The datasets during and/or analysed during the current study available from the corresponding author on reasonable request.

Abbreviations

AMS:: Aging Males’ Symptoms
ANOVA:: Analysis of variance
BMI:: The body mass index
HRQoL:: Health-related quality of life
IIEF5:: International Index of Erectile Function
IPSS:: International Prostate Symptom Score
SES:: socioeconomic status
SF-36:: Medical Outcomes Study 36-item Short Form
SHOW:: Sexual Health and Overall Wellness survey
WHR:: Waist-to-hip ratio

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Acknowledgements

We thank our study participants and health facility managers of Jiashan county for their support and collaboration.

Funding

This work was supported by Natural Science Foundation of Shanghai [grant number 19ZR1444600] and National Science and Technology Basic Work Program of China [grant number 2013FY110523]. The funder awarded funds based on their evaluation of a project proposal but had no role in design of the study, data collection, analysis, or interpretation of data, nor in writing the manuscript.

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Authors and Affiliations

Intensive Care Unit, The Fourth People’s Hospital of Zhenjiang, Zhenjiang, 212001, China
Yi Zhu
Department of Reproductive Epidemiology and Social Science, NHC Key Lab of Reproduction Regulation, Shanghai Institute for Biomedical and Pharmaceutical Technologies, Fudan University, 779 Old Hu Min Road, Shanghai, 200237, China
Jian-Hui Li, Hui-Juan Shi, Wei-** Zhou & Qian-** Zhu
Department of Cardiology, the Key Laboratory of Cardiovascular Disease, The First Hospital of Lanzhou University, Lanzhou, 730000, China
**g Zhao
Department of Urology, The First People’s Hospital of Jiashan, Zhejiang, 314102, China
Jun-Biao Zheng & **ao-Hua Yu
Risk Adapted Prevention (RAD) Group, Division of Preventive Oncology, National Center for Tumor Diseases (NCT), German Cancer Research Center (DKFZ), 69120, Heidelberg, Germany
Qun-Feng Liang
Department of Cell Biology, Research Institute of National Health Commission of China, Bei**g, 100081, China
Shu-Cheng Zhang

Authors

Yi Zhu
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Jian-Hui Li
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**g Zhao
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Jun-Biao Zheng
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**ao-Hua Yu
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Shu-Cheng Zhang
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Hui-Juan Shi
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Wei-** Zhou
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Qian-** Zhu
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Contributions

QXZ is the primary investigator of the study, and completed proposal writing. QXZ, XHY, SCZ, HJS, and WJZ all provided support and advice during all stage of research and writing. QXZ and YZ analysed data and wrote manuscript. JHL, JZ, JBZ, and QFL collected and analysed data. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Qian-** Zhu.

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Ethics approval was provided by the Institutional Ethical Review Committee of Shanghai Institute for Biomedical and Pharmaceutical Technologies (PJ2015–18). The data used in this study was anonymized before its use.

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The authors declare that they have no competing interests.

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Zhu, Y., Li, JH., Zhao, J. et al. Assessment of the health status of middle-aged and elderly men with head scale, SF-36, IIEF5, AMS, and IPSS. BMC Geriatr 21, 641 (2021). https://doi.org/10.1186/s12877-021-02595-y

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Received: 14 May 2021
Accepted: 26 October 2021
Published: 12 November 2021
DOI: https://doi.org/10.1186/s12877-021-02595-y

Assessment of the health status of middle-aged and elderly men with head scale, SF-36, IIEF5, AMS, and IPSS