Population attributable risk for functional disability associated with chronic conditions in Canadian older adults

Podiatry intervention versus usual care to prevent falls in care homes: pilot randomised controlled trial (the PIRFECT study)

Background

Common foot problems are independent risk factors for falls in older people. There is evidence that podiatry can prevent falls in community-dwelling populations. The feasibility of implementing a podiatry intervention and trial in the care home population is unknown. To inform a potential future definitive trial, we performed a pilot randomised controlled trial to assess: (i) the feasibility of a trial of a podiatry intervention to reduce care home falls, and (ii) the potential direction and magnitude of the effect of the intervention in terms of number of falls in care home residents.

Methods

Informed by Medical Research Council guidance on developing and evaluating complex interventions, we conducted a single blind, pilot randomised controlled trial in six care homes in the East of Scotland. Participants were randomised to either: (i) a three month podiatry intervention comprising core podiatry care, foot and ankle exercises, orthoses and footwear provision or (ii) usual care. Falls-related outcomes (number of falls, time to first fall) and feasibility-related outcomes (recruitment, retention, adherence, data collection rates) were collected. Secondary outcomes included: generic health status, balance, mobility, falls efficacy, and ankle joint strength.

Results

474 care home residents were screened. 43 (9.1%) participants were recruited: 23 to the intervention, 20 to control. Nine (21%) participants were lost to follow-up due to declining health or death. It was feasible to deliver the trial elements in the care home setting. 35% of participants completed the exercise programme. 48% reported using the orthoses ‘all or most of the time’. Completion rates of the outcome measures were between 93% and 100%. No adverse events were reported. At the nine month follow-up period, the intervention group per-person fall rate was 0.77 falls vs. 0.83 falls in the control group.

Conclusions

A podiatry intervention to reduce falls can be delivered to care home residents within a pilot randomised controlled trial of the intervention. Although not powered to determine effectiveness, these preliminary data provide justification for a larger trial, incorporating a full process evaluation, to determine whether this intervention can significantly reduce falls in this high-risk population.

Trial registration

ClinicalTrials.gov identifier: NCT02178527; Date of registration: 17 June 2014.

Electronic supplementary material

The online version of this article (doi:10.1186/s12877-017-0541-1) contains supplementary material, which is available to authorized users.

Morbidity and medication consumption among users of home telecare services

Telecare is a healthcare resource based on new technologies that, through the services offered, attempt to help elderly people to continue living in their homes. In this sense, first-generation telecare services have quickly developed in Europe. The aim of this work was to define the profile, pattern of medication consumption and disease frequencies of elderly users of a telecare service. The cross-sectional study involved 742 Spanish community-dwelling elders (85.3% of the total users aged 65 years and over who used a telecare service before the end of the data collection period). Data were collected between March and September 2012. Subjects' mean age was 83.3 (SD 6.6) years, and the majority lived alone (78.3%) and were female (85.8%). The mean Charlson comorbidity index score was 1.13 (SD 1.1), and the mean number of prescribed medications per day was 5.6 (SD 3.0). The most frequent diseases were hypertension (51.1%) and rheumatic disorders (44%); and the most consumed medications were those for the cardiovascular (75%) and nervous (65.2%) systems. For the total sample, the three main determinants of polymedication (five or more medications) were hypertension, anxiety-depressive symptoms and coronary heart disease. Regardless of the social elements contributing to the implementation of telecare services, specific health characteristics of potential users, such as morbidity and polypharmacy, should be carefully considered when implementing telecare services in the coming years.

Age and gender differences in the association between social participation and instrumental activities of daily living among community-dwelling elderly

BACKGROUND

Although many studies have suggested social participation (SP) has beneficial effects on elderly people's health, most of them failed to deal with paid work. Additionally, few studies have focused on the age effect between SP and older people's health. To investigate whether the association between SP, including paid work, and instrumental activities of daily living (IADL), exhibits not only in gender, but also in age among community-dwelling older adults.

METHODS

In 2014, we distributed self-administered questionnaires to all community-dwelling elderly aged ≥65 in two medium-sized cities in Nara Prefecture, Japan (n = 32,825). 22,845 residents submitted the questionnaire (response rate, 69.6%). Analyzed subjects were limited to 17,680 persons who had neither dependency in basic ADL nor missing data for required items. SP was assessed based on participation frequency in seven types of social activities: volunteer groups, sports groups, hobby groups, cultural groups, senior citizens' clubs, neighborhood community associations, and paid work. Using Poisson regression models, prevalence ratio for poor IADL was calculated. To examine age and gender differences in the association between SP and IADL, we performed stratified analyses by age and gender group; male young-old (aged 65-74), male old-old (aged ≥75), female young-old, and female old-old.

RESULTS

Prevalence of those with poor IADL was 17.1% in males and 4.5% in females, showing a significant gender difference. After adjustment for relevant covariates, volunteer groups were inversely associated with poor IADL only in males and the relationship was stronger in the old-old group than in the young-old group. Conversely, only females had a significant inverse association between paid work and poor IADL, and the association was not reliant on their ages but only those who participated infrequently had a favorable effect. Influence of age in the beneficial association between SP and IADL was generally larger in the old-old group than in the young-old group, but hobby groups were inversely associated with poor IADL, regardless of age, gender, and frequency.

CONCLUSIONS

Our results suggest that SP in older age is positively associated with IADL, however, the association seems to differ depending on the type of activities participated in, the participants' gender, and their age.

Visual Loss and Subsequent Activity Limitations in the Elderly: The French Three-City Cohort

OBJECTIVES

To investigate the relationship between vision and disability in the elderly.

METHODS

We used a baseline visual indicator (combining near acuity with Snellen equivalent < 20/30 and self-reported distance visual loss) to explore the association between visual loss and subsequent disability (mobility, instrumental activities of daily living [IADLs], ADLs, and participation restriction) from 1999 to 2007 in 8491 elderly participants of the French Three-City Cohort (Bordeaux, Dijon, and Montpellier).

RESULTS

In multiadjusted analyses, near visual impairment, alone or associated with distance visual function loss, was associated with greater risk of developing ADL limitations (P = .027), IADL limitations (P = .002), and participation restriction (P < .001), but not mobility (P = .848). The disabling impact of visual loss was significant for 11 of the 15 activities, when analyzed one by one.

CONCLUSIONS

Both near and distance visual loss was associated with greater functional decline over time, and the combination of the two could be even worse. Public Health Implications. In the context of rapid aging of the population, maintaining good vision in the elderly represents a promising prevention track, visual impairment being common in the elderly, largely undermanaged, and mostly reversible. Further research, especially trials, is necessary to estimate the public health impact of such interventions.

The association of multimorbidity and disability in a community-based sample of elderly aged 80 or older in Shanghai, China

Background

Both multimorbidity and activities of daily living (ADL) disability and instrument activities of daily living (IADL) disability are common among elderly individuals. ADL/IADL disability may reduce individuals’ capacities for independent living and quality of life. This study aimed to examine the association between multimorbidity and ADL/IADL disability.

Methods

A multi-stage cluster sample of 2058 residents aged 80 or older was investigated in Shanghai, China. Multimorbidity was defined as the simultaneous presence of two or more chronic diseases with ten common chronic conditions under consideration. Subjects who responded that they “need partial or full assistance” to any ADL/IADL items were defined as having ADL/IADL disability. We examined the association of multimorbidity with ADL/IADL disability, adjusted for socio-demographic characteristics by using logistic regression.

Results

Of respondents, 23.23 % had ADL disability, 37.90 % had IADL disability, and 49.17 % had multimorbidity. After adjusted socio-demographic characteristics, a graded association was showed between ADL disability and the quantity of chronic conditions: odds ratio (OR) for 1 condition, 1.53(95 % confidence interval [CI], 1.04-2.24); OR for 2 conditions, 2.06(95 % CI, 1.43-2.96); OR for 3 conditions, 3.23(95 % CI, 2.14-4.86); OR for 4 or more conditions, 5.61(95 % CI, 3.26-9.66). Similar associations were also observed between the quantity of chronic conditions and IADL disability.

Conclusions

The quantity of chronic conditions had relatively strong association with both ADL and IADL disability. Initiating prevention of additional chronic conditions and interventions on clusters of diseases may decrease the potential risk of ADL/IADL disability. Additionally, more attention should been given to the older low-income women living with relatives/non-relatives with multimorbidity.

Obesity, Apolipoprotein E ε4, and Difficulties in Activities of Daily Living Among Older Adults: a 6-Year Follow-up Study

BACKGROUND

Obesity has been associated with increased physical limitations among older adults, although few studies have adjusted for important covariates. There is limited information about the relationship between apolipoprotein E (APOE) polymorphisms and physical limitations, and the findings have been inconsistent.

PURPOSE

This study examined the longitudinal associations of obesity and APOE ε4 with difficulties in activities of daily living (ADLs) over a 6-year follow-up period controlling for multiple covariates.

METHODS

Data were analyzed from the Social Environment and Biomarkers of Aging Study (SEBAS) in Taiwan collected in 2000 and 2006, involving a cohort of 639 participants (mean age = 66). Body mass index (BMI) was used to define obesity at a baseline, and the APOE genotype was classified into an APOE ε4 carrier and non-carrier status. The combination of basic and instrumental activities of daily living (ADLs and IADLs) was used to define impaired ADLs.

RESULTS

APOE ε4 carriers had greater difficulties in combined ADLs (incident rate ratio; IRR = 1.87, 95 % CI = 1.40-2.51) than non-carriers. Obese but not overweight adults had greater difficulties in activities of daily living (IRR = 1.59, 95 % CI = 1.20-2.10) compared with the normal/underweight group. Obese older adults without APOE ε4 had greater subsequent difficulties in ADLs than non-obese non-carriers. Among APOE ε4 carriers, obesity was not a significant risk factor for the development of impaired ADLs in older adults, indicating an interaction between genotype and obesity.

CONCLUSIONS

The interaction between genotype and obesity phenotype adds new information about the determinants of physical impairment.

Multimorbidity, health and aging in Canada and Australia: a tale of two countries

BACKGROUND

Multimorbidity has been recognized as a major public health issue, negatively affecting health-related quality of life, including physical, functional, mental, emotional, and social domains, as well as increasing health care utilization. This exploratory study examines selected health outcomes associated with multimorbidity across older age groups/cohorts and gender, comparing Canada and Australia.

METHODS

Data were drawn from the 2008/09 Canadian Community Health Survey and the 2009 Australian HILDA survey. Seven major chronic conditions were identical across the two data sets, and were combined into an additive measure of multimorbidity. OLS and logistic regression models were performed within age group (45-54, 55-64, 65-74, 75+) and gender to estimate associations between multimorbidity and several health-related outcomes, including: loneliness, life satisfaction, perceived health, mobility restriction, and hospital stays, adjusting for marital status, education and foreign born status.

RESULTS

Overall, country-level differences were identified for perceptions of loneliness, life satisfaction, and perceived health. Australians tended to experience a greater risk of loneliness and lower self-rated health in the face of multimorbidity than Canadians, especially among older men. Canadians tended to experience lower life satisfaction associated with multimorbidity than Australians. No country-level differences were identified for associations between multimorbidity and hospital stays or mobility limitations.

CONCLUSIONS

The associations between multimorbidity and health are similar between the two countries but are variable depending on population, age group/cohort, and gender. The strongest country-level associations are for indicators of health-related quality of life, rather than health care or mobility limitation outcomes.

Disability trends among older adults in ten European countries over 2004–2013, using various indicators and Survey of Health, Ageing and Retirement in Europe (SHARE) data

In the context of the prospective increase in the numbers of older adults in Europe and of conflicting findings regarding recent disability trends, the present study uses cross-sectional data from four waves of the Survey of Health, Ageing and Retirement in Europe (SHARE), covering the period 2004–2013, and aims at the assessment of trends in disability by sex and broad age group (50–64 and 65 and over) for the ten countries participating in all waves, based on four different measures: limitations in activities of daily living (ADLs), limitations in instrumental ADLs, mobility difficulties and the Global Activity Limitation Indicator. The analysis uses logistic regression models adjusted for age and, subsequently, also for chronic conditions. The findings indicate improvements both in mild/moderate activity restrictions and in functional limitations for several countries, especially among men and women aged 65 and over. Regarding severe disability (ADLs) there is mostly a lack of any significant trend and only a few declines. In several instances, the observed trends are linked to changes in chronic conditions; significant improvements net of chronic conditions are found mainly in Sweden but also in the Netherlands, Austria, Germany, Italy and France. Overall, the estimated trends often differentiate by country, age group and sex while they depend upon the specificities of the measures used in the analysis.

Performance on the Functional Movement Screen in older active adults

BACKGROUND

The Functional Movement Screen (FMS™) has become increasingly popular for identifying functional limitations in basic functional movements. This exploratory and descriptive study was undertaken to confirm feasibility of performing the FMS™ in older active adults, assess prevalence of asymmetries and to evaluate the relationship between functional movement ability, age, physical activity levels and body mass index (BMI).

METHODS

This is an observational study; 97 men (n = 53) and women (n = 44) between the ages of 52 and 83 participated. BMI was computed and self-reported physical activity levels were obtained. Subjects were grouped by age (5-year intervals), BMI (normal, over-weight, and obese) and sex. Each participant's performance on the FMS™ was digitally recorded for later analysis.

RESULTS

The youngest age group (50-54 years) scored highest in all seven tests and the oldest age group (75+) scored lowest in most of the tests compared to all other age groups. The subjects in the "normal weight" group performed no different than those who were in the "overweight" group; both groups performed better than the "obese" group. Of the 97 participants 54 had at least one asymmetry. The pairwise correlations between the total FMS™ score and age (r = -0.531), BMI (r = -0.270), and the measure of activity level (r = 0.287) were significant (p < 0.01 for all).

CONCLUSION

FMS™ scores decline with increased BMI, increased age, and decreased activity level. The screen identifies range of motion- and strength-related asymmetries. The FMS™ can be used to assess functional limitations and asymmetries. Future research should evaluate if a higher total FMS™ score is related to fewer falls or injuries in the older population.

Low Vision Rehabilitation, Age-Related Vision Loss, and Risk: A Critical Interpretive Synthesis

PURPOSE

Given the centrality of risk in geriatric rehabilitation, it is critically important to attend to how conceptualizations of risk shape research, policies, and rehabilitation practices. This paper presents a critical interpretive synthesis (CIS) of literature addressing risk and low vision rehabilitation for older adults with age-related vision loss (ARVL) to identify key guiding assumptions regarding risk and discuss implications for what gets attended to, and not attended to, within research and rehabilitation.

DESIGN AND METHODS

This CIS combined guidelines proposed by Dixon-Woods and colleagues (2006-Conducting a critical interpretive synthesis of the literature on access to healthcare by vulnerable groups. BMC Medical Research Methodology, 6, 35) and Alvesson and Sandberg (2011-Generating research questions through problematization. Academy of Management Review, 36, 247-271; 2013-Constructing research questions: Doing interesting research. London: Sage). The iterative review process involved 3 steps: literature search and selection, data extraction, and syntheses to identify boundary assumptions. The dataset included 83 research and practice description articles.

RESULTS

Older adults with ARVL were constructed as "at risk" for various adverse outcomes, particularly dependency and self-harm, and as posing risks to others. An epidemiological approach to risk based in assumptions aligned with a technico-scientific perspective was dominant, with risk conceptualized as an embodied, individual-level phenomenon that is to be determined and managed through objective screening and expert monitoring.

IMPLICATIONS

Key concerns include a lack of: attention to the tensions created when rehabilitation research and practice attempt to promote independence while simultaneously reducing risk, incorporation of aging adults' perspectives on risk, and analysis of environmental factors that shape risks. Research that starts by valuing older adults' experiences and attends to context can inform rehabilitation practices that support health-promoting, risk-taking, and facilitate collaborative approaches to risk management.

[Functional capacity in the elderly: analyzing questions on mobility and basic and instrumental activities of daily living using Item Response Theory]

This article aims to evaluate the items used to measure functional capacity in the 2010 Health Survey in Greater Metropolitan Belo Horizonte, Minas Gerais State, Brazil, using Item Response Theory. We analyzed the scale's dimensionality, the items' position and discriminatory power, and the precision of the functional capacity estimate. The study was based on a sample of 2,174 individuals aged 60 to 99 years, 61% of whom were women, with a median of 4 years of schooling. The instrument with 21 items (4 response options) showed a Cronbach's alpha coefficient of 0.98. Factor analysis identified one factor that explained 92% of the variability between the items. The results indicated: (i) redundancy in items; (ii) precise estimation of functional capacity only for elderly below the median on the scale; and (iii) inability of the elderly to differentiate between response options. The analysis suggests the need to discuss items included in the instrument in order to cover a wider range of the scale and seek more appropriate response options.

Functional gain following knee replacement in patients aged 75 and older: a prospective follow-up study

BACKGROUND AND AIMS

The aim of this prospective follow-up study was to analyze which patient characteristics predict better functional ability, as well as improvement in the ability, following knee replacement in the aged. The focus was on the impact of specific comorbidities and radiologic data.

METHODS

Knee osteoarthritis patients aged ≥75 years (n = 167) scheduled for knee replacement answered to a questionnaire asking about performance in the activities of daily living (ADL) before the operation, and 1 year afterwards. Radiologic data were evaluated from the latest radiographs, and comorbidity data from patient records. The primary outcome was a sum score indicating how many ADLs (out of 10) the patient was able to perform without difficulty. The factors associated with ADL performance were analyzed with adjustment for age, gender, Charlson's comorbidity index and Kellgren-Lawrence score.

RESULTS

Knee replacement resulted in improved performance in almost all the analyzed ADL activities. Except for cardiac diseases, the effect of the analyzed comorbidities on ADL performance was not significant. Older patients and women attained lower final functional ability than younger patients and men, but improved similarly. In more progressed osteoarthritis, the final ability was lower, but the improvement gained was greater.

CONCLUSIONS

Comorbidity, age, or more progressed osteoarthritis should not be considered an impediment to knee replacement. Even though the final functional ability may be lower in some, the improvement gained by surgery is similar regardless of comorbidity, and was more pronounced in more progressed disease.

Associations of chronic conditions, APOE4 allele, stress factors, and health behaviors with self-rated health

Background

Self-rated health (SRH) has been widely used to measure the overall health status of older adults. Research has shown that SRH is determined by a large array of factors, such as chronic disease conditions, genetic markers (e.g., Apolipoprotein E, APOE, NM_000041), stress factors, and health behaviors. However, few studies have incorporated these factors simultaneously in the analytic framework of SRH. The aim of this study is to examine the associations of these four sets of factors with SRH.

Methods

Using a dataset from a population-based, random-cluster survey of 1,005 elderly respondents aged 54–91 conducted in Taiwan in 2000, we use logistic regressions to examine associations of chronic health conditions, the APOE4 allele stress factors, and health behaviors with SRH. The four disease conditions include diabetes, heart diseases, gastric ulcers, and chronic obstructive pulmonary disease. Stress factors are measured by traumatic events (having an earthquake-damaged house) and chronic life stress (financial difficulty). Health behaviors include smoking, drinking alcohol, vegetable and fruit intake, daily milk intake, and physical exercise.

Results

Diabetes, heart diseases, gastric ulcers, and chronic obstructive pulmonary disease are found to be associated with 2.63 (95 % CI: 1.75–3.95), 1.72 (95 % CI: 1.15–2.58), 1.94 (95 % CI: 1.35–2.80), and 2.54 (95 % CI: 1.66–3.92) odds ratios of poor SRH. The APOE4 allele is found to be significantly associated with poor SRH with odd ratio of 1.58 (95 % CI: 1.02–2.41). Financial difficulty is associated with increased likelihood of poor SRH, with odds ratios of 1.76 (95 % CI: 1.22–2.54) Doing exercise more than 5 times per week are associated with reduced likelihood of poor SRH by 44 % (odds ratio is 0.56, 95 % CI: 0.39–1.82). The interaction term between gender and gastric ulcer showed that the impact of gastric ulcer on SRH is more pronounced in women than in men, with an odds ratio of 2.63 (95 % CI: 1.24–5.58).

Conclusions

Chronic conditions and the APOE4 allele are significantly associated with increased likelihood of reporting poor health, and the associations appear differently among women and men. To better understand the mechanism of how people self-assess their overall health, chronic conditions and genetic components should be considered together with conventional factors such as life stress and health behaviors.

Multimorbidity and functional decline in community-dwelling adults: a systematic review

BACKGROUND

Multimorbidity affects up to one quarter of primary care populations. It is associated with reduced quality of life, an increased risk of mental health difficulties and increased healthcare utilisation. Functional decline is defined as developing difficulties with activities of daily living and is independently associated with poorer health outcomes. The aim of this systematic review was to examine the association between multimorbidity and functional decline and to what extent multimorbidity predicts future functional decline.

METHODS

A systematic literature search (1990-2014) and narrative analysis was conducted.

INCLUSION CRITERIA

Population; Community-dwelling adults (≥18 years), Risk; Multimorbidity defined as the presence of ≥2 chronic medical conditions in an individual, Primary outcome; Physical functional decline measured using a validated instrument, Study design; cross-sectional or cohort studies. The following databases were included: PubMed, EMBASE, CINAHL, the Cochrane Library and the International Research Community on Multimorbidity (IRCMo) publication list. Methodological quality assessment of included studies was conducted with a suitable risk of bias tool.

RESULTS

A total of 37 studies were eligible for inclusion (28 cross-sectional studies and 9 cohort studies). The majority of cross-sectional studies (n = 24/28) demonstrated a consistent association between multimorbidity and functional decline. Twelve of these studies reported that increasing numbers of chronic condition counts were associated with worsening functional decline. Nine cohort studies included 14,133 study participants with follow-up periods ranging from one to six years. The majority (n = 5) found that multimorbidity predicted functional decline. Of the five studies that reported the impact of increasing numbers of conditions, all reported greater functional decline with increasing numbers of conditions. One study examined disease severity and found that this also predicted greater functional decline. Overall, cohort studies were of good methodological quality but were mixed in terms of participants, multimorbidity definitions, follow-up duration, and outcome measures.

CONCLUSIONS

The available evidence indicates that multimorbidity predicts future functional decline, with greater decline in patients with higher numbers of conditions and greater disease severity. This review highlights the importance of considering physical functioning when designing interventions and systems of care for patients with multimorbidity, particularly for patients with higher numbers of conditions and greater disease severity.

Multimorbidity and functional decline in community-dwelling adults: a systematic review

BACKGROUND

Multimorbidity affects up to one quarter of primary care populations. It is associated with reduced quality of life, an increased risk of mental health difficulties and increased healthcare utilisation. Functional decline is defined as developing difficulties with activities of daily living and is independently associated with poorer health outcomes. The aim of this systematic review was to examine the association between multimorbidity and functional decline and to what extent multimorbidity predicts future functional decline.

METHODS

A systematic literature search (1990-2014) and narrative analysis was conducted.

INCLUSION CRITERIA

Population; Community-dwelling adults (≥18 years), Risk; Multimorbidity defined as the presence of ≥2 chronic medical conditions in an individual, Primary outcome; Physical functional decline measured using a validated instrument, Study design; cross-sectional or cohort studies. The following databases were included: PubMed, EMBASE, CINAHL, the Cochrane Library and the International Research Community on Multimorbidity (IRCMo) publication list. Methodological quality assessment of included studies was conducted with a suitable risk of bias tool.

RESULTS

A total of 37 studies were eligible for inclusion (28 cross-sectional studies and 9 cohort studies). The majority of cross-sectional studies (n = 24/28) demonstrated a consistent association between multimorbidity and functional decline. Twelve of these studies reported that increasing numbers of chronic condition counts were associated with worsening functional decline. Nine cohort studies included 14,133 study participants with follow-up periods ranging from one to six years. The majority (n = 5) found that multimorbidity predicted functional decline. Of the five studies that reported the impact of increasing numbers of conditions, all reported greater functional decline with increasing numbers of conditions. One study examined disease severity and found that this also predicted greater functional decline. Overall, cohort studies were of good methodological quality but were mixed in terms of participants, multimorbidity definitions, follow-up duration, and outcome measures.

CONCLUSIONS

The available evidence indicates that multimorbidity predicts future functional decline, with greater decline in patients with higher numbers of conditions and greater disease severity. This review highlights the importance of considering physical functioning when designing interventions and systems of care for patients with multimorbidity, particularly for patients with higher numbers of conditions and greater disease severity.

Global Multimorbidity Patterns: A Cross-Sectional, Population-Based, Multi-Country Study

BACKGROUND

Population ageing challenges health care systems due to the high prevalence and impact of multimorbidity in older adults. However, little is known about how chronic conditions present in certain multimorbidity patterns, which could have great impact on public health at several levels. The aim of our study was to identify and describe multimorbidity patterns in low-, middle-, and high-income countries.

METHODS

We analyzed data from the Collaborative Research on Ageing in Europe project (Finland, Poland, and Spain) and the World Health Organization's Study on Global Ageing and Adult Health (China, Ghana, India, Mexico, Russia, and South Africa). These cross-sectional studies obtained data from 41,909 noninstitutionalized adults older than 50 years. Exploratory factor analysis was performed to detect multimorbidity patterns. Additional adjusted binary logistic regressions were performed to identify associations between sociodemographic factors and multimorbidity.

RESULTS

Overall multimorbidity prevalence was high across countries. Hypertension, cataract, and arthritis were the most prevalent comorbid conditions. Two or three multimorbidity patterns were found per country. Several patterns were identified across several countries: "cardio-respiratory" (angina, asthma, and chronic obstructive pulmonary disease), "metabolic" (diabetes, obesity, and hypertension), and "mental-articular" (arthritis and depression).

CONCLUSIONS

A high prevalence of multimorbidity occurs in older adults across countries, with low- and middle-income countries gradually approaching the figures of richer countries. Certain multimorbidity patterns are present in several countries, which suggest that common underlying etiopathogenic factors may play a role. Deeper understanding of these patterns may lead to the development of preventive actions to diminish their prevalence and also give rise to new, comprehensive approaches for the management of these co-occurring conditions.

Arranjos domiciliares, condições de saúde física e psicológica dos idosos e sua satisfação com as relações familiares

ObjetivoInvestigar as relações entre a configuração familiar, as condições de saúde física e psicológica dos idosos e sua satisfação com os relacionamentos familiares.MétodoA amostra, composta por 134 idosos sem déficit cognitivo sugestivo de demência, foi representativa dos cadastrados em uma Unidade Básica de Saúde do município de Santo Antônio de Jesus-BA. Foram feitas análises de conglomerados mediante o método da partição, considerando a formação de três agrupamentos.Resultados:A maioria era de idosos chefes de família (72,4%); que contribuíam total (49,2%) ou parcialmente (44%) para o sustento da família; viviam em arranjos multigeracionais (64,9%); tinham boa funcionalidade física; não tinham depressão (82,9%) nem ansiedade (76,9%) e julgavam boa a funcionalidade familiar (85,8%). As variáveis que mais contribuíram para a formação dos conglomerados foram atividades básicas de vida diária (R2=0,725) e funcionalidade familiar (R2=0,757). Os conglomerados foram: 1) Idosos com necessidade de ajuda instrumental para o desempenho de atividades de vida diária, com ansiedade e insatisfeitos com os relacionamentos familiares; 2) Idosos dependentes para o desempenho de atividades de vida diária, com ansiedade e satisfeitos com os relacionamentos familiares; 3) Idosos independentes nas atividades básicas e instrumentais e satisfeitos com os relacionamentos familiares.ConclusõesHá relações recíprocas entre a satisfação dos idosos sobre a própria família e o nível de independência e saúde mental apresentado por eles.

Surgical outcomes of hip and knee arthroplasties for primary osteoarthritis in patients with Alzheimer's disease: a nationwide registry-based case-controlled study

We compared the length of hospitalisation, rate of infection, dislocation of the hip and revision, and mortality following primary hip and knee arthroplasty for osteoarthritis in patients with Alzheimer's disease (n = 1064) and a matched control group (n = 3192). The data were collected from nationwide Finnish health registers. Patients with Alzheimer's disease had a longer peri-operative hospitalisation (median 13 days vs eight days, p < 0.001) and an increased risk for hip revision with a hazard ratio (HR) of 1.76 (95% confidence interval (CI) 1.03 to 3.00). Dislocation was the leading indication for revision. There was no difference in the rates of infection, dislocation of the hip, knee revision and short-term mortality. In long-term follow-up, patients with Alzheimer's disease had a higher mortality (HR 1.43; 95% CI 1.22 to 1.70), and only one third survived ten years post-operatively. Increased age and comorbidity were associated with longer peri-operative hospitalisation in patients with Alzheimer's disease.

Estimating multiple morbidity disease burden among older persons: a convergent construct validity study to discriminate among six chronic illness measures, CCHS 2008/09

Background

Since approximately two in three older adults (65+) report having two or more chronic diseases, causes and consequences of multimorbidity among older persons has important personal and societal issues. Indeed, having more than one chronic condition might involve synergetic effects, which can increase impact on disabilities and quality of life of older adults. Moreover, persons with multimorbidity require more health care treatments, implying burden for the person, her/his family and the health care system.

Methods

Using the 2008/09 Canadian Community Health Survey (CCHS), this paper assesses the convergent construct validity of six measures of multimorbidity for persons aged 65 and over. These measures include: 1) Multimorbidity Dichotomized (0, 1+ conditions); 2) Multimorbidity Dichotomized (0/1, 2+); 3) Multimorbidity Additive Scale; 4) Multimorbidity Weighted by the Health Utility (HUI3) Scale; 5) Multimorbidity Weighted by the OARS Activity of Daily Living (ADL) Scale; and 6) Multimorbidity Weighted by HUI3 (using beta coefficients). Convergent construct validity was assessed using correlations and OLS regression coefficients for each of the multimorbidity measures with the following social-psychological and health outcome variables: life satisfaction, perceived health, number of health professional visits, and medication use.

Results

Overall, the two dichotomies (scales #1 & #2) showed the weakest construct validity with the health outcome variables. The additive chronic illness scale (#3) and the multimorbidity weighted by ADLs (#5), performed better than the other two weighted scales using (HUI #4 & #6). Measurement errors apparent in the dichotomous multimorbidity measures were amplified for older women, especially for life satisfaction and perceived health, but decreased when using the scales, suggesting stronger validity of scales #3 through #6.

Conclusions

To properly represent multimorbidity, using dichotomous measures should be used with caution. When only prevalence data are available for chronic conditions, such as in the CCHSs or CLSA, an additive multimorbidity scale can better measure total illness burden than simple dichotomous or other discrete measures.

Impact of multimorbidity on disability and quality of life in the Spanish older population

Background

Population aging is closely related to high prevalence of chronic conditions in developed countries. In this context, health care policies aim to increase life span cost-effectively while maintaining quality of life and functional ability. There is still, however, a need for further understanding of how chronic conditions affect these health aspects. The aim of this paper is to assess the individual and combined impact of chronic physical and mental conditions on quality of life and disability in Spain, and secondly to show gender trends.

Methods

Cross-sectional data were collected from the COURAGE study. A total of 3,625 participants over 50 years old from Spain were included. Crude and adjusted multiple linear regressions were conducted to detect associations between individual chronic conditions and disability, and between chronic conditions and quality of life. Separate models were used to assess the influence of the number of diseases on the same variables. Additional analogous regressions were performed for males and females.

Results

All chronic conditions except hypertension were statistically associated with poor results in quality of life and disability. Depression, anxiety and stroke were found to have the greatest impact on outcomes. The number of chronic conditions was associated with substantially lower quality of life [β for 4+ diseases: −18.10 (−20.95,−15.25)] and greater disability [β for 4+ diseases: 27.64 (24.99,30.29]. In general, women suffered from higher rates of multimorbidity and poorer results in quality of life and disability.

Conclusions

Chronic conditions impact greatly on quality of life and disability in the older Spanish population, especially when co-occurring diseases are added. Multimorbidity considerations should be a priority in the development of future health policies focused on quality of life and disability. Further studies would benefit from an expanded selection of diseases. Policies should also deal with gender idiosyncrasy in certain cases.

Self-management priority setting and decision-making in adults with multimorbidity: a narrative review of literature

OBJECTIVES

The purpose of this narrative review was to synthesize current research findings related to self-management, in order to better understand the processes of priority setting and decision-making among adults with multimorbidity.

DESIGN

A narrative literature review was undertaken, synthesizing findings from published, peer-reviewed empirical studies that addressed priority setting and/or decision-making in self-management of multimorbidity.

DATA SOURCES

A search of PubMed, PsychINFO, CINAHL and SocIndex databases was conducted from database inception through December 2013. References lists from selected empirical studies and systematic reviews were evaluated to identify any additional relevant articles.

REVIEW METHODS

Full text of potentially eligible articles were reviewed and selected for inclusion if they described empirical studies that addressed priority setting or decision-making in self-management of multimorbidity among adults. Two independent reviewers read each selected article and extracted relevant data to an evidence table. Processes and factors of multimorbidity self-management were identified and sorted into categories of priority setting, decision-making, and facilitators/barriers.

RESULTS

Thirteen articles were selected for inclusion; most were qualitative studies describing processes, facilitators, and barriers of multimorbidity self-management. The findings revealed that patients prioritize a dominant chronic illness and re-prioritize over time as conditions and treatments change; that multiple facilitators (e.g. support programs) and barriers (e.g. lack of financial resources) impact individuals' self-management priority setting and decision-making ability; as do individual beliefs, preferences, and attitudes (e.g., perceived personal control, preferences regarding treatment).

CONCLUSIONS

Health care providers need to be cognizant that individuals with multimorbidity engage in day-to-day priority setting and decision-making among their multiple chronic illnesses and respective treatments. Researchers need to develop and test interventions that support day-to-day priority setting and decision-making and improve health outcomes for individuals with multimorbidity.

Avaliação da capacidade funcional dos idosos e fatores associados à incapacidade

O objetivo deste estudo foi avaliar a capacidade funcional e analisar as características associadas à incapacidade dos idosos atendidos em uma Estratégia da Saúde da Família em Montes Claros-MG. Utilizou-se a escala de Lawton e Brody e a escala de Katz, analisadas pela regressão logística multinomial. Foram entrevistados 286 idosos cuja idade variou de 60 a 103 anos, média de 71,2 anos (DP ± 8,3). Destes, 61,9% autorreferiram independentes quanto à capacidade funcional. A dependência apenas na AIVD foi positivamente associada à faixa etária ≥ 75 anos (OR = 8,38), ao sexo feminino (OR = 3,64) e com doença cardíaca (OR = 3,24). A dependência tanto nas AIVD como nas ABVD foi positivamente associada à faixa etária ≥ 75 anos (OR = 6,40), sem companheiro (OR = 3,26), aos que apresentavam AVE (OR = 51,85), doença cardíaca (OR = 4,18) e aos com diabetes (OR = 3,35). A maior proporção de idosos foi considerada independente para a realização de atividades básicas e instrumentais de vida diária. Contudo, uma parcela expressiva ainda apresenta comprometimento do estado funcional. É essencial que as equipes da Estratégia da Saúde da Família busquem a promoção da saúde e a prevenção de doenças, além de intervenções terapêuticas que possam minimizar os fatores que interferem na capacidade funcional.

Integrating physiotherapists within primary health care teams: perspectives of family physicians and nurse practitioners

The international literature suggests a number of benefits related to integrating physiotherapists into primary health care (PHC) teams. Considering the mandate of PHC teams in Canada, emphasizing healthy living and chronic disease management, a broad range of providers, inclusive of physiotherapists is required. However, physiotherapists are only sparsely integrated into these teams. This study explores the perspectives of "core" PHC team members, family physicians and nurse practitioners, regarding the integration of physiotherapists within Ontario (Canada) PHC teams. Twenty individual semi-structured in-depth interviews were conducted, transcribed verbatim, and then analyzed following an iterative process drawing from an interpretive phenomenological approach. Five key themes emerged which highlighted "how physiotherapists could and do contribute as team members within PHC teams particularly related to musculoskeletal health and chronic disease management". The perceived value of physiotherapists within Ontario, Canada PHC teams was a unanimous sentiment particularly in terms of musculoskeletal health, chronic disease management and maximizing health human resources efficiency to ensure the right care, is delivered by the right practitioner, at the right time.

Implementing telemonitoring in heart failure care: barriers from the perspectives of patients, healthcare professionals and healthcare organizations

The increasing prevalence of chronic diseases, such as heart failure, presents a substantial challenge to healthcare systems. Telemonitoring is believed to be a useful instrument in the delivery of heart failure care. However, a widespread use of telemonitoring is currently failing for various reasons. This article provides an overview of the barriers for the implementation of telemonitoring in heart failure patients from the perspectives of its users: patients, healthcare professionals and healthcare organisations. In doing so, identified barriers are grouped according to the perceived attributes of innovation by Rogers. Recommendations are provided as to how research can improve the implementation of telemonitoring in heart failure.

Disability status as an antecedent to chronic conditions: National Health Interview Survey, 2006-2012

Introduction

A strong relationship exists between disability and poor health. This relationship could exist as a result of disabilities emerging from chronic conditions; conversely, people with disabilities may be at increased risk of developing chronic conditions. Studying health in relation to age of disability onset can illuminate the extent to which disability may be a risk factor for future poor health.

Methods

We used data from the 2006–2012 National Health Interview Survey and conducted weighted logistic regression analyses to compare chronic conditions in adults with lifelong disabilities (n = 2,619) and adults with no limitations (n = 122,395).

Results

After adjusting for sociodemographic differences, adults with lifelong disabilities had increased odds of having the following chronic conditions compared with adults with no limitations: coronary heart disease (adjusted odds ratio [AOR] = 2.92; 95% confidence interval [CI], 2.33–3.66) cancer (AOR = 1.61; 95% CI, 1.34–1.94), diabetes (AOR = 2.57; 95% CI, 2.10–3.15), obesity (AOR = 1.81; 95% CI, 1.63–2.01), and hypertension (AOR = 2.18; 95% CI, 1.94–2.45). Subpopulations of people with lifelong disabilities (ie, physical, mental, intellectual/developmental, and sensory) experienced similar increased odds for chronic conditions compared with people with no limitations.

Conclusion

Adults with lifelong disabilities were more likely to have chronic conditions than adults with no limitations, indicating that disability likely increases risk of developing poor health. This distinction is critical in understanding how to prevent health risks for people with disabilities. Health promotion efforts that target people living with a disability are needed.

[Chronic disease, mortality and disability in an elderly Spanish population: the FRADEA study]

INTRODUCTION

The objective of this study was to analyse the relationships between the major chronic diseases and multiple morbidity, with mortality, incident disability in basic activities of daily living, and loss of mobility in the elderly.

MATERIAL AND METHODS

A total of 943 participants were selected from the FRADEA Study, using available baseline data of chronic diseases, and at the follow-up visit of mortality, incident disability, and loss of mobility. The analysis was made of the unadjusted and adjusted association between the number of chronic diseases, the number of 14 pre-selected diseases, and the presence of two or more chronic diseases (multiple morbidity) with adverse health events recorded.

RESULTS

Participants with a higher number of diseases (OR 1.11; 95% CI: 1.02-1.22), and 14 pre-selected diseases (OR 1.19; 95% CI: 1.03-1.38) had a higher adjusted mortality risk, but not a higher incident disease or mobility loss risk. Subjects with multiple morbidity had a higher non-significant mortality risk (HR 1.45; 95% CI: 0.87-2.43), than those without multiple morbidity. Disability-free mean time in participants with and without multiple morbidity was 846±34 and 731±17 days, respectively (Log-rank χ(2) 7.45. P=.006), and with our without mobility loss was 818±32 and 696±13 days, respectively (Log rank χ(2) 10.99. P=.001).

CONCLUSIONS

Multiple morbidity was not associated with mortality, incident disability in ADL, or mobility loss in adults older than 70 years, although if mortality is taken into account, the number of chronic diseases is linear.

Population impact of depression on functional disability in elderly: results from "São Paulo Ageing & Health Study" (SPAH)

With the fast population aging, functional disability among the elderly is becoming a major public health issue. Depression is highly prevalent in this phase of life and may be associated with a significant proportion of the disability among elderly populations. We investigated the association of depressive symptoms and ICD-10 depression with functional disability in older adults and estimated the corresponding population attributable fractions (PAF). A cross-sectional one-phase population-based study was carried out with 2,072 individuals aged 65 years or over living in a low-income area of São Paulo, Brazil. Depressive symptoms and ICD-10 depression were assessed with the Geriatric Mental State and the Neuropsychiatric Inventory. We assessed functional disability with the WHO Disability Assessment Schedule Instrument. Prevalence Ratios and PAF were calculated using Poisson regression. The prevalence of depressive symptoms and ICD-10 depression was 21.4 and 4.8 %, respectively. Depression and depressive symptoms were strongly associated with high functional disability, even after adjustment for demographic factors, socioeconomic conditions, physical morbidities, and dementia. The PAFs for depressive symptoms and ICD-10 depression were 12.0 % for each of the psychiatric morbidity. Depressive symptoms contributed as much as ICD-10 depression to the population burden of functional disability in the elderly. Effective management of clinically significant depressive symptoms, delivered mainly at the primary care level, may reduce the total population disability.

[Risks for impaired daily life function in the elderly with type 2 diabetes in Japan]

AIM

The purpose of the present investigation was to explore the process towards functional disability and predicting factors in Japanese diabetic elderly.

METHODS

We recruited 317 older patients aged 65 or over among participants in the large-scale prospective study of the Japanese Elderly Diabetes Intervention Trial (J-EDIT). We analyzed the changes of daily life function prospectively for 6 years. Information about diabetes, blood examinations and complications was obtained, and basic activity of daily living (ADL) and instrumental ADL (IADL) were assessed by total Barthel index score and the Tokyo Metropolitan Institute of Gerontology Index of Competence (TMIG index), respectively.

RESULTS

During 6 years of follow-up, 13.6% of subjects had developed a new ADL disability (bADL) and 38.3% had developed a new functional impairment assessed by TMIG index. In the 65-74 years age group, basic ADL decreased only in males, while females became functionally impaired. In 75-84 years age group, basic and IADL decreased in both men and women. Older age and metabolic syndrome negatively affected ADL, while baseline IADL impairment, cognitive dysfunction, physical inactivity, and insulin therapy were significant predictors of a future decline in the IADL.

CONCLUSION

This study identified the disability process and prognostic factors, including the future decline of basic ADL and IADL in diabetic elderly patients. There are modifiable factors for ADL impairment, comprehensive treatment and care are required to keep Japanese diabetic elderly patients healthy in daily life functioning.

Risk factors for a 6-year decline in physical disability and functional limitations among elderly people with type 2 diabetes in the Japanese Elderly Diabetes Intervention Trial

AIM

Type 2 diabetes increases the risk of disability. The purpose of this study was to clarify the explanatory factors for disability in Japanese diabetic elderly.

METHODS

The 6-year decline in physical disability and functional limitations was investigated among 317 elderly people with type 2 diabetes recruited in a large-scale prospective study of the Japanese Elderly Diabetes Intervention Trial. Information about diabetes, blood examinations and complications was obtained, and basic activities of daily living (ADL) and instrumental ADL (IADL) were assessed by total score of the Barthel index and the Tokyo Metropolitan Institute of Gerontology Index of Competence, respectively.

RESULTS

After 6 years of follow up, 13.6% of patients had developed a new ADL disability and 38.3% had developed a new functional impairment. In the 65-74 years age group, basic ADL decreased only in males, whereas females became functionally impaired. In the 75-84 years age group, basic and IADL decreased in both males and females. Older age and metabolic syndrome were prognostic for impairment of basic ADL, whereas baseline IADL problems, lower cognitive function, physical inactivity and insulin therapy were significant predictors of a future decline in the IADL.

CONCLUSION

This study identified several factors predicting the future decline of basic ADL and IADL in diabetic elderly patients, and provided a conceptual framework that might help to clarify the pathways leading to disability. Because the specific causes of each functional problem are modifiable, comprehensive treatment and care are needed to allow Japanese diabetic elderly patients to have more favorable living conditions.

Resourcefulness training intervention: assessing critical parameters from relocated older adults' perspectives

The population of American elders is increasing rapidly and relocation to retirement communities has been found to adversely affect their adjustment. This pilot study of 38 relocated elders evaluated, from elders' perspectives, six critical parameters of a resourcefulness training (RT) intervention designed to help elders adjust to relocation. Within the context of Zauszniewski's theory of resourcefulness, a pre-/post-test design with random assignment to RT or to diversionary activities (DA) was used. Objective questionnaires measured demographic and relocation factors. An intervention evaluation questionnaire was designed and given to the relocated elders in order to assess the six critical parameters--necessity, acceptability, feasibility, safety, fidelity, and effectiveness. Data concerning the critical parameters were collected during structured interviews within a week after the intervention. Seventy-six of the elders who scored less than 120 in the resourcefulness scale indicated a strong need for RT. While all non-white elders reported needing RT, 43% of white elders reported the same need. Elders indicated that learning about the experiences of others and taking part in discussions were the most interesting part of the RT. Approximately 95% of participants mentioned that they learned all parts of the intervention; few suggested having a stronger leader to keep the group on track. The qualitative findings from this pilot intervention study will inform future, larger clinical trials to help recently relocated elders adjust to relocation.

Association of vision loss in glaucoma and age-related macular degeneration with IADL disability

PURPOSE

To determine if glaucoma and/or age-related macular degeneration (AMD) are associated with disability in instrumental activities of daily living (IADLs).

METHODS

Glaucoma subjects (n = 84) with bilateral visual field (VF) loss and AMD subjects (n = 47) with bilateral or severe unilateral visual acuity (VA) loss were compared with 60 subjects with normal vision (controls). Subjects completed a standard IADL disability questionnaire, with disability defined as an inability to perform one or more IADLs unassisted.

RESULTS

Disability in one or more IADLs was present in 18.3% of controls as compared with 25.0% of glaucoma subjects (P = 0.34) and 44.7% of AMD subjects (P = 0.003). The specific IADL disabilities occurring more frequently in both AMD and glaucoma subjects were preparing meals, grocery shopping, and out-of-home travelling (P < 0.05 for both). In multivariate logistic regression models run adjusting for age, sex, mental status, comorbidity, and years of education, AMD (odds ratio [OR] = 3.4, P = 0.02) but not glaucoma (OR = 1.4, P = 0.45) was associated with IADL disability. However, among glaucoma and control patients, the odds of IADL disability increased 1.6-fold with every 5 dB of VF loss in the better-seeing eye (P = 0.001). Additionally, severe glaucoma subjects (better-eye MD worse than -13.5 dB) had higher odds of IADL disability (OR = 4.2, P = 0.02). Among AMD and control subjects, every Early Treatment of Diabetic Retinopathy Study line of worse acuity was associated with a greater likelihood of IADL disability (OR = 1.3).

CONCLUSIONS

VA loss in AMD and severe VF loss in glaucoma are associated with self-reported difficulties with IADLs. These limitations become more likely with increasing magnitude of VA or VF loss.

Monitoring physical functioning as the sixth vital sign: evaluating patient and practice engagement in chronic illness care in a primary care setting--a quasi-experimental design

BACKGROUND

In Canada, one in three adults or almost 9 million people report having a chronic condition. Over two thirds of total deaths result from cardiovascular disease, diabetes, cancer and respiratory illness and 77% of persons ≥65 years have at least one chronic condition. Persons with chronic disease are at risk for functional decline; as a result, there is an increased awareness of the significance of functional status as an important health outcome. The purpose of this study was to determine whether patients who receive a multi-component rehabilitation intervention, including online monitoring of function with feedback and self-management workshops, showed less functional decline than case matched controls who did not receive this intervention. In addition, we wanted to determine whether capacity building initiatives within the Family Health Team promote a collaborative approach to Chronic Disease Management.

METHODS

A population-based multi-component rehabilitation intervention delivered to persons with chronic illnesses (≥ 44 yrs) (n = 60) was compared to a group of age and sex matched controls (n = 60) with chronic illnesses receiving usual care within a primary healthcare setting. The population-based intervention consisted of four main components: (1) function-based individual assessment and action planning, (2) rehabilitation self-management workshops, (3) on-line self-assessment of function and (4) organizational capacity building. T-tests and chi-square tests were used for continuous and categorical variables respectively in baseline comparison between groups.

RESULTS

Two MANOVA showed significant between group differences in patient reported physical functioning (Λ = 0.88, F = (2.86) = 5.97. p = 0.004) and for the physical performance measures collectively as the dependent variable (Λ = 0.80, F = (6.93) = 3.68. p = 0.0025). There were no within group differences for the capacity measures.

CONCLUSION

It is feasible to monitor physical functioning as a health outcome for persons with chronic illness in primary care. The timeline for this study was not sufficient to show an increase in the capacity within the team; however there were some differences in patient outcomes. The short timeline was likely not sufficient to build the capacity required to support this approach.

TRIAL REGISTRATION

NCT00859638.

Evaluation of the pressure-redistributing properties of prefabricated foot orthoses in older people after at least 12 months of wear

Foot problems are highly prevalent in older people. To treat such problems in this age-group prefabricated ('off-the-shelf') foot orthoses are frequently prescribed. However, such devices are susceptible to material compression and deformation, which may reduce their effectiveness over time. Therefore, the aim of this study was to compare the pressure-redistributing properties of new prefabricated orthoses to orthoses worn for at least 12 months. Thirty-one adults (10 males, 21 females) aged over 65 years (mean 75.4, SD 5.2) participated. Plantar pressure data were collected under the rearfoot, midfoot and forefoot using the Pedar(®) in-shoe system while participants walked along an 8m walkway wearing shoes only, new orthoses and old orthoses (orthoses were full length, dual-density prefabricated Formthotic™ devices). Compared to the shoe-only condition, both the new and old orthoses produced significant reductions in peak pressure and maximum force in the rearfoot with corresponding increases in force and contact area in the midfoot. Compared to the new orthoses, the old orthoses exhibited small but significant increases in peak pressure in the rearfoot (6%, p=0.001) and maximum force in the rearfoot (5%, p<0.001) and forefoot (2%, p=0.032). These findings indicate that the prefabricated orthoses evaluated in this study are only slightly less effective at redistributing plantar pressure after at least 12 months of wear.

Intelligent Systems For Assessing Aging Changes: home-based, unobtrusive, and continuous assessment of aging

OBJECTIVES

To describe a longitudinal community cohort study, Intelligent Systems for Assessing Aging Changes, that has deployed an unobtrusive home-based assessment platform in many seniors homes in the existing community.

METHODS

Several types of sensors have been installed in the homes of 265 elderly persons for an average of 33 months. Metrics assessed by the sensors include total daily activity, time out of home, and walking speed. Participants were given a computer as well as training, and computer usage was monitored. Participants are assessed annually with health and function questionnaires, physical examinations, and neuropsychological testing.

RESULTS

Mean age was 83.3 years, mean years of education was 15.5, and 73% of cohort were women. During a 4-week snapshot, participants left their home twice a day on average for a total of 208 min per day. Mean in-home walking speed was 61.0 cm/s. Participants spent 43% of days on the computer averaging 76 min per day.

DISCUSSION

These results demonstrate for the first time the feasibility of engaging seniors in a large-scale deployment of in-home activity assessment technology and the successful collection of these activity metrics. We plan to use this platform to determine if continuous unobtrusive monitoring may detect incident cognitive decline.

Musculoskeletal comorbidities in cardiovascular disease, diabetes and respiratory disease: the impact on activity limitations; a representative population-based study

Background

The purpose of this study was to quantify the contribution of comorbidity to activity limitations in populations with chronic cardiovascular disease, diabetes or respiratory disease (index conditions), with emphasis on musculoskeletal comorbidity (arthritis or back problems).

Methods

Analysis of the 2005 Canadian Community Health Survey 3.1 (age 20+ years, n = 115,915). Prevalence ratios for activity limitations in people with the index conditions and co-occurring musculoskeletal disease, adjusted for age, gender, and socioeconomic factors, were used to estimate population associated fractions (PAF).

Results

Comorbid arthritis and back problems significantly increased the risk of activity limitations across all index conditions with prevalence ratios of 1.60 and 1.46 for cardiovascular disease, 1.51 and 1.36 for diabetes, and 1.38 and 1.44 for respiratory disease for arthritis and back problems respectively. Arthritis and back problems accounted for at least 13% and 9% of activity limitations in the index populations.

Conclusions

While chronic musculoskeletal conditions are not always considered priorities in chronic disease prevention, they account for a substantial proportion of activity restrictions seen in people with cardiovascular disease, diabetes and respiratory disease, with implications for prevention and control strategies.