The prevalence of functional limitations and disability in older persons in the US: data from the National Health and Nutrition Examination Survey III

Abdominal fat distribution and functional limitations and disability in a biracial cohort: the Atherosclerosis Risk in Communities Study

OBJECTIVE

To examine the associations of abdominal fat and obesity with functional limitations and disability in late adulthood.

DESIGN

Longitudinal, cohort study.

PARTICIPANTS

African American and white men and women aged 45-64 y at baseline with measured waist circumference, waist-to-hip ratio (WHR), and body mass index (BMI) who participated in the Atherosclerosis Risk in Communities (ARIC) Study (n = 9416).

OUTCOME MEASURES

Self-reported functional limitations, activities of daily living (ADLs), and instrumental activities of daily living (IADLs) at ages 52-75 y.

RESULTS

Waist circumference, WHR, and BMI were positively associated with functional limitations and ADL and IADL impairment approximately 9 y later among African American and white men and women. For example, in African American women the odds ratios (95% CI) associated with a one standard deviation (s.d.) increment in waist circumference (13.3 cm) for severe functional limitations and ADL and IADL impairment were 2.36 (2.00-2.79), 1.41 (1.25-1.58), and 1.49 (1.34-1.66), respectively. In white women, the odds ratios (95% CI) were 2.66 (2.39-2.96), 1.60 (1.47-1.74), and 1.42 (1.31-1.53), respectively. Similar associations were found in men. A 1 s.d. increment in WHR (0.08 U) and BMI (5.06 kg/m2) produced similar results. The associations of waist circumference and WHR with functional limitations and ADL and IADL impairment were attenuated but, in general, remained statistically significant when BMI was added to the models.

CONCLUSIONS

Maintaining a healthy body weight and avoiding increases in abdominal fat should be investigated for their potential to reduce the risk of functional limitations and disability in an aging population.

Influence of sarcopenia on the development of physical disability: the Cardiovascular Health Study

OBJECTIVES

To examine the temporal relationship between sarcopenia and disability in elderly men and women.

DESIGN

Cardiovascular Health Study, a longitudinal study of cardiovascular disease and its risk factors in older people.

SETTING

Four U.S. communities.

PARTICIPANTS

Five thousand thirty-six men and women aged 65 and older.

MEASUREMENTS

Whole-body skeletal muscle mass was measured at baseline, and subjects were classified as having normal muscle mass, moderate sarcopenia, or severe sarcopenia based on previously established thresholds. Disability was measured via questionnaire at baseline in up to eight annual follow-up examinations. The cross-sectional relationship between sarcopenia and prevalent disability at baseline was examined using logistic regression models. The longitudinal relation between sarcopenia and incident disability over 8 years of follow-up was examined using Cox proportional hazards models.

RESULTS

At baseline, the likelihood of disability was 79% greater in those with severe sarcopenia (P<.001) but was not significantly greater in those with moderate sarcopenia (P=.38) than in those with normal muscle mass. During the 8-year follow-up, the risk of developing disability was 27% greater in those with severe sarcopenia (P=.006) but was not statistically greater in those with moderate sarcopenia (P=.23) than in those with normal muscle mass.

CONCLUSION

Severe sarcopenia was a modest independent risk factor for the development of physical disability. The effect of sarcopenia on disability was considerably smaller in the longitudinal analysis than in the cross-sectional analysis.

Being Old and Doing Time: Functional Impairment and Adverse Experiences of Geriatric Female Prisoners

The number of older prisoners is increasing exponentially. For example, the number of geriatric female prisoners in California has increased 350% in the past decade. Despite an increasing population of geriatric female prisoners, the degree of functional impairment in this population is unknown. Therefore, the goals of this study were to describe the prevalence and nature of functional impairment in geriatric female prisoners in California and to identify aspects of the prison environment that may exacerbate functional impairments. Questionnaires were analyzed from 120 geriatric women in California state prisons. Functional impairment was defined as impairment in activities of daily living (ADLs) or in prison ADLs (PADLs), including dropping to the floor for alarms, standing for count, getting to meals, hearing orders, and climbing onto the top bunk. The mean age of participants was 62; 16% were dependent in one ADL, and 69% reported one PADL impairment. Increasing severity of functional impairment was associated with worse health status and more adverse prison experiences. For example, fall rates ranged from 33% in women without impairment to 57% with PADL impairment to 63% with ADL dependence (P=.02). Several prison environmental stressors were identified that likely exacerbate functional impairment. For example, 29% of geriatric women were assigned to a top bunk. Geriatric female prisoners report high rates of functional impairment. ADL and PADL impairment were associated with worse health status and adverse prison experiences. Therefore, the evaluation of functional impairment in geriatric female prisoners needs to consider the unique demands of the prison environment.

State and metropolitan-area estimates of disability in the United States, 2001

OBJECTIVES

We sought to provide estimates of disability prevalence for states and metropolitan areas in the United States.

METHODS

We analyzed Behavioral Risk Factor Surveillance System data from 2001 for all 50 states and the District of Columbia and 103 metropolitan areas. We performed stratified analyses by demographics for 20 metropolitan areas with the highest prevalence of disability.

RESULTS

State disability estimates ranged from 10.5% in Hawaii to 25.9% in Arizona. Metropolitan disability estimates ranged from 10.2% in Honolulu, Hawaii to 27.1% in Tucson, Ariz. Regional metropolitan medians for disability (range, 17.0-19.7%) were similar across the Northeast, Midwest, and South and were highest in the West. In the 20 metropolitan areas with the highest disability estimates, the prevalence of disability generally increased with age and was higher for women and those with a high-school education or less.

CONCLUSIONS

State and metropolitan-area estimates may be used to guide state and local efforts to prevent, delay, or reduce disability and secondary conditions in persons with disabilities.

Racial disparities in disability: recent evidence from self-reported and performance-based disability measures in a population-based study of older adults

OBJECTIVE

Although disability levels have been declining in older adults, there is little current information on racial differences in disability.

METHODS

Our data came from a longitudinal, population-based study of 6,158 Black and White adults aged 65 and older from the south side of Chicago. Data were collected during three face-to-face interviews between 1993 and 2002. We ascertained disability using three self-report measures and a performance-based measure of physical function. Using longitudinal data analysis, we examined overall racial differences in disability and the degree to which they varied by age and gender.

RESULTS

After an average of 6 years of follow-up, Blacks reported significantly higher disability levels than Whites after adjustment for age and sex. There was a significant increase in disability during follow-up on all four measures. Racial differences in disability did not vary consistently by age at baseline or over time but were greater among women. Findings were largely similar for self-reported and performance-based measures of disability. Adjustment for socioeconomic status substantially reduced racial differences in disability, although some of the differences remained significant, especially among women.

CONCLUSION

Racial disparities in disability have not been eliminated, are greater among women, and have their origins earlier in adulthood.

A harmonized measure of activities of daily living was a reliable and valid instrument for comparing disability in older people across countries

BACKGROUND AND OBJECTIVES

Our aim was to construct a harmonized measure of activities of daily living (ADL) across six countries, and to evaluate the reliability and validity of this measure.

METHODS

A population of 9,297 persons, aged 65-89 years, was drawn from the Comparison of Longitudinal European Studies on Aging (CLESA) study, which includes data from five European countries and Israel. Because the number, type, and response format of the ADL items differed across the six studies, a four-item scale was constructed to harmonize the data, using items common to most countries. A procedure was devised to substitute or construct items that were not available in two of the countries.

RESULTS

Cronbach's alpha for the four-item ADL measure varied from 0.81 in Spain to 0.92 in Finland, and was similar to the alpha of scales including five or six items. Kappa scores between substituted or constructed items and the actual items varied from 0.50 to 0.78. In all countries, the percentage of persons with ADL disability differed significantly across age and was associated with chronic diseases, poor self-rated health, global disability, and home help utilization.

CONCLUSION

The harmonized four-item ADL measure seems a reliable and valid instrument for comparing ADL disability in older people across countries.

Hospitalization and development of dependence in activities of daily living in a cohort of disabled older women: the Women's Health and Aging Study I

BACKGROUND

Changes in self-reported function in older adults are known to occur in the 2 weeks prior to, during, and in the first few months after hospitalization. The long-term outcome of hospitalization on functional status in disabled older adults is not known. The objective of this study was to determine whether hospitalization predicts long-term Activities of Daily Living (ADL) dependence in previously ADL independent, although disabled, older women.

METHODS

The Women's Health and Aging Study I is a population-based, prospective cohort study of disabled, community-dwelling women > or =65 years old. We evaluated participants who were independent in ADLs at baseline and excluded women with incident stroke, lower extremity joint surgery, amputation, or hip fracture. We examined the association between self-reported incident hospitalization at three consecutive 6-month intervals and incident dependence in at least one ADL at 18 months (n = 595).

RESULTS

Of 595 women evaluated, 32% had at least one hospitalization. Women who were hospitalized were more likely to become dependent in ADLs than were women who were not hospitalized (17% vs 8%, p =.001). In a multivariate model, hospitalization was independently predictive of development of ADL dependence that persisted at 18 months after baseline (odds ratio [OR], 3.2; 95% confidence interval [CI], 1.7-5.8), adjusting for age, race, education, baseline walking speed, difficulty with ADLs, self-reported health status, depressive symptoms, cognitive status, and presence of congestive heart failure, diabetes, or pulmonary disease. Increasing numbers of 6-month intervals with hospitalizations were independently predictive of higher risk in an adjusted model: one (OR, 2.3; 95% CI, 1.1-4.6), two (OR, 5.8; 95% CI, 2.4-14.4), and three (OR, 12.5; 95% CI, 2.7-57.6).

CONCLUSIONS

These results suggest that hospitalization has an independent and dose-response effect on loss of ADL independence in disabled older women over an 18-month period.

Muscle mass, muscle strength, and muscle fat infiltration as predictors of incident mobility limitations in well-functioning older persons

BACKGROUND

Lower muscle mass has been correlated with poor physical function; however, no studies have examined this relationship prospectively. This study aims to investigate whether low muscle mass, low muscle strength, and greater fat infiltration into the muscle predict incident mobility limitation.

METHODS

Our study cohort included 3075 well-functioning black and white men and women aged 70-79 years participating in the Health, Aging, and Body Composition study. Participants were followed for 2.5 years. Muscle cross-sectional area and muscle tissue attenuation (a measure of fat infiltration) were measured by computed tomography at the mid-thigh, and knee extensor strength by using a KinCom dynamometer. Incident mobility limitation was defined as two consecutive self-reports of any difficulty walking one-quarter mile or climbing 10 steps.

RESULTS

Mobility limitations were developed by 22.3% of the men and by 31.8% of the women. Cox's proportional hazards models, adjusting for demographic, lifestyle, and health factors, showed a hazard ratio of 1.90 [95% confidence interval (CI), 1.27-2.84] in men and 1.68 (95% CI, 1.23-2.31) in women for the lowest compared to the highest quartile of muscle area (p <.01 for trend). Results for muscle strength were 2.02 (95% CI, 1.39-2.94) and 1.91 (95% CI, 1.41-2.58), p <.001 trend, and for muscle attenuation were 1.91 (95% CI, 1.31-2.83) and 1.68 (95% CI, 1.20-2.35), p <.01 for trend. When included in one model, only muscle attenuation and muscle strength independently predicted mobility limitation (p < .05). Among men and women, associations were similar for blacks and whites.

CONCLUSION

Lower muscle mass (smaller cross-sectional thigh muscle area), greater fat infiltration into the muscle, and lower knee extensor muscle strength are associated with increased risk of mobility loss in older men and women. The association between low muscle mass and functional decline seems to be a function of underlying muscle strength.

Improving depression care for older, minority patients in primary care

OBJECTIVE

Few older minorities receive adequate treatment of depression in primary care. This study examines whether a collaborative care model for depression in primary care is as effective in older minorities as it is in nonminority elderly patients in improving depression treatment and outcomes.

STUDY DESIGN

A multisite randomized clinical trial of 1801 older adults comparing collaborative care for depression with treatment as usual in primary care. Twelve percent of the sample were black (n = 222), 8% were Latino (n = 138), and 3% (n = 53) were from other minority groups. We compared the 3 largest ethnic groups (non-Latino white, black, and Latino) on depression severity, quality of life, and mental health service use at baseline, 3, 6, and 12 months after randomization to collaborative care or usual care.

PRINCIPAL FINDINGS

Compared with care as usual, collaborative care significantly improved rates and outcomes of depression care in older adults from ethnic minority groups and in older whites. At 12 months, intervention patients from ethnic minorities (blacks and Latinos) had significantly greater rates of depression care for both antidepressant medication and psychotherapy, lower depression severity, and less health-related functional impairment than usual care participants (64%, 95% confidence interval [CI] 55-72 versus 45%, CI 36-55, P = 0.003 for antidepressant medication; 37%, CI 28-47 versus 13%, CI 6-19, P = 0.002 for psychotherapy; mean = 0.9, CI 0.8-1.1 versus mean = 1.4, CI 1.3-1.5, P < 0.001 for depression severity, range 0-4; mean = 3.7, CI 3.2-4.1, versus mean = 4.7, CI 4.3-5.1, P < 0.0001 for functional impairment, range 0-10).

CONCLUSIONS

Collaborative Care is significantly more effective than usual care for depressed older adults, regardless of their ethnicity. Intervention effects in ethnic minority participants were similar to those observed in whites.

Disability and its effects on quality of life among older people living in Antalya city center, Turkey

The problems of older people become more prevalent with aging of the population. Occurrence of disability and its effects on living conditions are two of the major factors that determine the quality of life of elderly people. The aim of this study is to find out the frequency and severity level of disability for people aged 65 and older living in Antalya city center. We also aim to determine the effects of disability over living conditions and to detect the variables associated with disability. World Health Organization-Disability Assessment Schedule (WHO-DAS-II) was implemented to 840 people who were selected from the research population with cluster sampling method. Disability status of these 840 people was measured for six different fields of life (domains). The domains that disability was the most frequent were; "participation in society (86.7%)", "getting around (70.2%)" and "life activities (68.8%)". The fields that were found to contain the most severe disabilities were "life activities" (50.5 +/- 32.5 points), "getting around" (40.6 +/- 27.0 points) and "self care" (34.2 +/- 23.4 points). It was found that disability frequency was positively associated with age, number of chronic diseases and number of acute complaints (odds ratios are 1.05, 1.31 and 1.43, respectively). Disability was also found to be 1.71 times more frequent for women, 2.54 times more frequent for people who live in separate houses and 4.50 times more frequent for illiterates. Disability affects the fields of lives of elderly people with rates of 90.4% for "self care", 88.6% for "getting around" and 85.2% for "life activities". For the elderly population participating in our study, disability is most frequently seen in "participation in society", the most severe disability is seen in "life activities" and the most effected field is found to be "self care". These findings must to be incorporated into planning procedures as expenditure is allocated in order to decrease disability.

Dairy, fruit, and vegetable intakes and functional limitations and disability in a biracial cohort: the Atherosclerosis Risk in Communities Study

BACKGROUND

Dairy, fruit, and vegetable intakes may be associated with functional limitations and disability through their role in muscle function, osteoporosis, and prevention of the oxidative damage associated with aging and chronic disease.

OBJECTIVE

The associations between dairy, fruit, and vegetable intakes and functional limitations and disability were examined in African Americans and whites (baseline age: 45-64 y; n=9404) in the Atherosclerosis Risk in Communities (ARIC) Study.

DESIGN

Logistic regression analyses were used to ascertain the associations between usual dairy, fruit, and vegetable intakes obtained at baseline by using a food-frequency questionnaire and lower-extremity function, activities of daily living (ADLs), and instrumental ADLs (IADLs) self-reported approximately 9 y later in models stratified by race and sex.

RESULTS

Baseline dairy, fruit, and vegetable intakes tended to be inversely associated with impaired lower-extremity function, ADLs, and IADLs approximately 9 y later, particularly in African American women. For example, in African American women, baseline dairy intakes were inversely associated with impaired ADLs and IADLs [odds ratio (95% CI): 0.60 (0.40, 0.90) and 0.69 (0.48, 0.98), respectively [corrected] in the 3rd versus the [corrected] 1st tertile of intake (P [corrected] for trend<0.05]. Combined baseline intakes of fruit and vegetables were also inversely associated with impaired lower-extremity function, ADLs, and IADLs [odds ratio (95% CI): 0.67 (0.47, 0.95), 0.52 (0.36, 0.76), and 0.64 (0.45, 0.90), respectively; P for trend<0.05].

CONCLUSIONS

Dairy, fruit, and vegetable intakes may be inversely associated with functional limitations and disability. Further research is needed to ascertain the effect of diet on subsequent functional limitations and disability.

Prevalence of disability and associated social and health-related factors among the elderly in Spain: a population-based study

OBJECTIVES

To estimate the prevalence of disability and its association with morbidity and other social and health-related factors among Spain's non-institutionalized elderly population.

METHODS

Cross-sectional survey, by home-based personal interview, covering a sample of 4000 subjects representative of the non-institutionalized Spanish population aged 60 years and over. The relationship between disability and social and health-related study variables was studied using logistic regression.

RESULTS

A total of 72.9% of subjects reported some type of disability: 59.1% in agility, 51.6% in mobility, 40.1% in instrumental activities and 19.1% in activities of daily living. After adjusting for all relevant variables, disability showed to be significantly more frequent for: female gender (OR = 1.83; 1.53-2.19); more advanced age (OR = 4.54; 3.27-6.32); low/no educational level (OR = 2.01; 1.67-2.42); deteriorated cognitive status (OR = 1.67; 1.24-2.23); at least two chronic diseases (OR = 2.54; 2.01-3.20); poor perceived health status (OR = 3.02; 2.48-3.69); little physical activity (OR = 2.57; 1.94-3.42); and greater use of hospital care (OR = 1.34; 1.10-1.64).

CONCLUSIONS

Prevalence of disability among Spain's non-institutionalized elderly population is very high. This might be explained by a greater number of chronic diseases, a higher percentage of subjects with low educational level and a higher proportion of community-dwelling elderly persons than in Anglo-Saxon countries.

National databases and rheumatology research II: the National Health and Nutrition Examination Surveys

Three National Health and Nutrition Examination Surveys were conducted in the United States between 1971 and 1994 to provide data on the nutritional and health status of the population and on specific target conditions. This article describes features of the surveys and provides examples of research on musculoskeletal disorders that used the survey data.

Age- and sex-stratified prevalence of physical disabilities and handicap in the general population

BACKGROUND AND AIMS

Our aim was to provide age- and sex-stratified prevalence estimates of physical disabilities and handicap in the general Belgian population.

METHODS

A cross-sectional and demographically representative health interview survey was conducted nationwide in Belgium in 1997. The 8836 persons aged 15 years and over who answered the health interview were included in this study. Seventeen items from the survey encompassing main activities of daily living (ADL) and confining were analyzed. To provide prevalence estimates as detailed as possible, neither aggregation nor dichotomization were applied.

RESULTS

Women consistently reported more disability than men: mobility (p < 0.001), transfer in-out bed (p < 0.001), transfer in-out chair (p < 0.001), dressing (p = 0.004), washing hands and face (p = 0.029), getting to and using toilet (p = 0.003), continence (p < 0.001), seeing (p < 0.001) and mastication (p < 0.001). As expected, there was a marked trend for increased prevalence of disability with increasing age for both sexes. Moderate disability arose mainly from the 25-34 age group for both sexes. For both genders, severe disability appeared mainly at higher ages, particularly for the 65-74 age group. Nevertheless, the data suggest that continence problems for women, mobility and transfer issues for men, as well as mastication problems for both genders, clearly emerge earlier than age 65. Regarding handicap, observed prevalence rates were increasing, in age as was the case for disability, but no differences were found between men or women, except for confinement to house/garden, for which women presented a higher rate in general (p < 0.001) and in the 75-84 age group (p = 0.036) in particular.

CONCLUSIONS

This study shows the wide range of disability types in the general population and their association with handicap. While elderly individuals consistently report higher degrees of disability and handicap, attention should also be paid to younger age groups. Disability calls for wide, coherent and relevant medical as well as social responses.

Higher 25-hydroxyvitamin D concentrations are associated with better lower-extremity function in both active and inactive persons aged > or =60 y

BACKGROUND

Vitamin D may improve muscle strength through a highly specific nuclear receptor in muscle tissue.

OBJECTIVES

We investigated whether there is an association between 25-hydroxyvitamin D [25(OH)D] concentrations and lower-extremity function in ambulatory older persons, whether that association differs by activity level, and, if so, whether there is an identifiable threshold in the association.

DESIGN

The study was a population-based survey of the ambulatory US population aged 60 to > or =90 y (n = 4100). Lower-extremity function according to serum 25(OH)D concentrations was assessed by linear regression analyses and regression plots after control for activity level (inactive or active) and several other potential confounders. Separate analyses were performed for the timed 8-foot (ie, 2.4 m) walk test and a repeated sit-to-stand test.

RESULTS

The 8-foot walk test compared subjects in the lowest and highest quintiles of 25(OH)D; the latter group had an average decrease of 0.27 s [95% CI: -0.44, -0.09 s (or 5.6%); P for trend < 0.001]. The sit-to-stand test compared subjects in the lowest and highest quintiles of 25(OH)D; the latter group had an average decrease of 0.67 s [95% CI: -1.11, -0.23 s (or 3.9%); P for trend = 0.017]. In the 25(OH)D reference range of 22.5-94 nmol/L, most of the improvement occurred in subjects with 25(OH)D concentrations between 22.5 and approximately 40 nmol/L, and further improvement was seen in the range of 40-94 nmol/L. Stratification by activity level showed no significant effect modification.

CONCLUSION

In both active and inactive ambulatory persons aged > or =60 y, 25(OH)D concentrations between 40 and 94 nmol/L are associated with better musculoskeletal function in the lower extremities than are concentrations < 40 nmol/L.

The healthcare costs of sarcopenia in the United States

OBJECTIVES

To estimate the healthcare costs of sarcopenia in the United States and to examine the effect that a reduced sarcopenia prevalence would have on healthcare expenditures.

DESIGN

Cross-sectional surveys.

SETTING

Nationally representative surveys using data from the U.S. Census, Third National Health and Nutrition Examination Survey, and National Medical Care and Utilization Expenditure Survey.

PARTICIPANTS

Representative samples of U.S. adults aged 60 and older.

MEASUREMENTS

The healthcare costs of sarcopenia were estimated based on the effect of sarcopenia on increasing physical disability risk in older persons. In the first step, the healthcare cost of disability in older Americans was estimated from national surveys. In the second step, the proportion of the disability cost due to sarcopenia (population-attributable risk) was calculated to determine the healthcare costs of sarcopenia. These calculations relied upon previously published relative risk values for disability in sarcopenic individuals and sarcopenia prevalence rates in the older population.

RESULTS

The estimated direct healthcare cost attributable to sarcopenia in the United States in 2000 was $18.5 billion ($10.8 billion in men, $7.7 billion in women), which represented about 1.5% of total healthcare expenditures for that year. A sensitivity analysis indicated that the costs could be as low as $11.8 billion and as high as $26.2 billion. The excess healthcare expenditures were $860 for every sarcopenic man and $933 for every sarcopenic woman. A 10% reduction in sarcopenia prevalence would result in savings of $1.1 billion (dollars adjusted to 2000 rate) per year in U.S. healthcare costs.

CONCLUSION

Sarcopenia imposes a significant but modifiable economic burden on government-reimbursed healthcare services in the United States. Because the number of older Americans is increasing, the economic costs of sarcopenia will escalate unless effective public health campaigns aimed at reducing the occurrence of sarcopenia are implemented.

The black/white disability gap: persistent inequality in later life?

OBJECTIVES

Previous research on differences between Black and White older adults has produced inconsistent results on whether a gap in disability exists and whether it persists over time. The present research identifies several reasons for the inconsistent results to date and examines Black/White differences in disability trajectories over 6 years.

METHODS

Data from the North Carolina Established Populations for the Epidemiologic Studies of the Elderly (1986-1992) are used to estimate the disability gap and trajectory over time for both Black and White older adults.

RESULTS

Results indicate that a disability gap between Black and White adults exists, but after socioeconomic resources, social integration, and other health indicators are adjusted for, the trajectories of disability by race are not significantly different. Controlling for incident morbidity over time accounts for the significant difference in level of disability between the two groups.

DISCUSSION

This research supports the "persistent inequality" interpretation, indicating that Black adults have higher morbidity and disability earlier in life compared with White adults, and that the gap neither converges nor diverges over time.

Oxygen-uptake (VO2) kinetics and functional mobility performance in impaired older adults

BACKGROUND

Measures of maximal oxygen uptake (VO(2max)) are limited in disabled older adults, and measures of submaximal oxygen uptake (VO(2)) may better predict functional mobility limitations. These measures may include oxygen-uptake kinetics at the onset of submaximal exercise or during recovery. We sought to determine whether the lag in oxygen uptake at the beginning of exercise (oxygen deficit) and excess oxygen uptake above rest following exercise (excess postexercise oxygen consumption) (a) predict physical performance in impaired older adults with decreased aerobic function, and (b) predict physical performance better than peak VO(2).

METHODS

Two groups of community-dwelling volunteers aged 65 or older were recruited according to their performance on a maximal graded exercise test. Using the Social Security Administration criterion of disability of a peak VO(2) <or = 18 ml/kg/min, we compared the performance of an impaired aerobic capacity group at a peak VO(2) < 18 ml/kg/min (Impaired, n = 20, mean +/- SEM age 82 +/- 1 years) with an unimpaired group at Peak VO(2) > 18 (Unimpaired, n = 21, mean +/- SEM age 76 +/- 1 years).

RESULTS

The mean +/- SEM peak VO(2) was 58% lower in the Impaired (14 +/- 1 ml/kg/min) than the Unimpaired (24 +/- 1 ml/kg/min) adults. The time constant for oxygen deficit, tc(deficit), was more than twice as high in the Impaired than the Unimpaired (p <.05), and the time constant for excess postexercise oxygen consumption, tc(EPOC), tended to be higher in the Impaired than the Unimpaired (by 43%, p =.09). Measures of submaximal oxygen-uptake kinetics were as strong or more strongly predictive of functional mobility performance than peak VO(2) in both Unimpaired and Impaired older adults. The major predictor of functional performance for the Unimpaired was a measure of oxygen deficit accruing during exercise (tc(deficit)), and for the Impaired, it was a measure of oxygen debt during recovery, tc(EPOC).

CONCLUSIONS

Measurement of submaximal oxygen-uptake kinetics may provide a more practical and relevant assessment of deconditioning in frail older adults, and may eventually supplant maximal (peak) oxygen uptake as a predictor of functional disability in older adults.

Summary measure of dietary musculoskeletal nutrient (calcium, vitamin D, magnesium, and phosphorus) intakes is associated with lower-extremity physical performance in homebound elderly men and women

BACKGROUND

Nutritional intake has been overlooked as a possible contributing factor to lower-extremity physical performance, especially in homebound elderly persons.

OBJECTIVES

Our objectives were to examine the association of a summary measure of calcium, vitamin D, magnesium, and phosphorus intakes with 1) the inability to perform lower-extremity physical performance tests and 2) declining levels of summary lower-extremity physical performance.

DESIGN

Baseline data from the Nutrition and Function Study were used to calculate a summary musculoskeletal nutrient (SMN) score as a measure of nutrient intake (factor analysis) and to examine the association of SMN intake with physical performance (multivariable regression models) among recipients of home-delivered meals who completed an in-home assessment (anthropometric measures and performance-based physical tests) and three 24-h dietary recalls.

RESULTS

Among the 321 participants, elderly age, black race, body mass index (in kg/m2) > or = 35, arthritis, frequent fear of falling, and lowest SMN intake were independently associated with being unable to perform functional tests. The lowest SMN intake and the highest BMI were both significantly associated with increasingly worse levels of lower-extremity physical performance, after adjustment for health and demographic characteristics.

CONCLUSIONS

Considering the importance of identifying short- and long-term outcomes that help elderly persons maintain adequate nutritional status and remain functionally independent at home, the results of this study suggest the need to identify intervention strategies that target the improvement of dietary intake and physical performance. Further investigation is indicated to identify the manner in which nutritional status contributes to the preservation or deterioration of physical performance in homebound elderly persons.

A adiposidade corporal e a idade prejudicam a capacidade funcional para realizar as atividades da vida diária de mulheres acima de 47 anos

Este estudo teve como objetivo verificar o efeito da idade, peso, altura, índice de massa corporal e adiposidade corporal na capacidade funcional de mulheres acima de 47 anos para realizar as atividades da vida diária. Para tanto, a amostra foi constituída por 129 mulheres na faixa etária de 47 a 77 anos de idade. A adiposidade total (Adp T) foi considerada por meio do somatório das dobras cutâneas bíceps (BI), tríceps (TRI), subescapular (SB), axilar média (AM), supra-ilíaca (SI), abdominal (ABD), coxa anterior (CA) e panturrilha medial (PM). A adiposidade central (Adp C) representou o somatório de SB, AM, SI e ABD, e a adiposidade periférica (Adp P), o somatório de BI, TRI, CA e PM. A capacidade funcional para realizar as atividades da vida diária foi predita mediante os testes: velocidade para se levantar de uma posição sentada (VLPS) e para se levantar de uma posição deitada (VLPD), velocidade para calçar e amarrar o tênis (VCAT) e velocidade para subir escada (VSE). Foi calculado o quartil (Q) para todas as variáveis independentes (idade, peso, altura, índice de massa corporal e adiposidade corporal [total, central e periférica]). A análise estatística utilizada foi a ANOVA one way e os coeficientes de correlação linear de Pearson e Spearman rank-order. As diferenças estatisticamente significativas ocorreram principalmente entre os quartis das extremidades (Q1 x Q4) para VLPS e VLPD (exceção para peso e IMC), enquanto para VSE foi entre Q2 x Q4 (idade). As variáveis independentes exerceram efeito nulo sobre VCAT. A magnitude de variação percentual ocorreu entre a amplitude de 14,1% (idade [VLPD: Q3 x Q4]) e 36,1% (Adp T [VLPS: Q2 x Q4]). Em ordem, as variáveis independentes que exerceram maior repercussão negativa sobre a performance nos testes de capacidade funcional (VLPS, VLPD, VSE) para realizar as atividades da vida diária foram Adp C, idade, Adp T, Adp P, IMC e peso.

The impact of somatic and cognitive disorders on the functional status of the elderly

To estimate the relative effects of coexisting nondementia illnesses on the probability of functional disability, depending on the presence of cognitive impairment or dementia, we used data from the baseline case-control assessment of a longitudinal study of aging and dementia. Our study included 668 subjects (345 nondemented, 98 cognitively impaired, and 225 demented), aged 75 and older. Demented subjects had greater disability prevalence on all specific instrumental activities of daily living (IADL) and activities of daily living (ADL) items than cognitively impaired subjects who, in turn, had greater disability than nondemented subjects. Somatic illnesses were found to be associated with particular tasks in item specific models; decreasing MMSE was strongly associated with the probability of IADL and ADL disability, which increased dramatically in the presence of somatic illnesses among cognitively impaired as well as demented subjects. Attention to illnesses among cognitively impaired and demented people may shed light on remediable factors crucial to their daily functioning.

Waist circumference and weight change are associated with disability among elderly Hispanics

BACKGROUND

Studies have suggested that both high and low body mass index (BMI) and weight change are related to functional disability in elderly populations. Elderly Hispanics have a high prevalence of both obesity and disability, yet few studies have examined their interrelationship in this population. Therefore, we examined these relationships in a mostly Puerto Rican group of Hispanic elders.

METHODS

We investigated associations between a three-level disability score created from responses to a questionnaire on activities of daily living and BMI, waist circumference (WC), and weight change since age 50, using the proportional odds model in a cross-sectional study of 763 elderly Hispanics, aged 60 to 92 years, residing in Massachusetts.

RESULTS

After adjusting for potential confounders, men with a WC > or =109.3 cm (vs <90 cm), or with a reported weight loss of -0.32 to -0.01 kg/year, or a weight gain > or =0.55 kg/year since age 50 (vs relatively stable weight, -0.01 to +0.21 kg/year [y]) were each significantly associated with an approximately threefold higher risk for greater disability. Women with a BMI > or =35 kg/m(2) were almost four times as likely to have higher disability as those with a BMI of 20 to 25 kg/m(2). Compared with women with a WC < or =85.2 cm, those with a WC of 91.5 to 106.6 cm were two times more likely, and those with a WC > or =106.6 cm were five times more likely, to have higher disability scores. Compared with relatively stable weight (-0.05 to +0.23 kg/y), weight gain > or =0.23 kg/year was associated with a twofold higher risk of greater disability among women. When BMI and WC were included in the same model, WC, but not BMI, remained significantly associated with disability.

CONCLUSIONS

Abdominal obesity (WC > or =109.3 cm for men, or WC > or =91.5 cm for women) and weight gain > or =0.55 kg/year after age 50 in men or > or =0.23 kg/year in women may increase the risk of disability among elderly Hispanics.