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Henderson IL, Bone RW, Stevens R, Barnes RK, Roberts N, Sheppard JP, McManus RJ. The association between restricted activity and patient outcomes in older adults: systematic literature review and meta-analysis. BMC Geriatr 2024; 24:316. [PMID: 38575915 PMCID: PMC10993524 DOI: 10.1186/s12877-024-04866-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 03/03/2024] [Indexed: 04/06/2024] Open
Abstract
BACKGROUND Restricted activity is a potential early marker of declining health in older adults. Previous studies of this association with patient outcomes have been inconclusive. This review aimed to evaluate the extent to which restricted activity is associated with decline in health. METHODS A search was conducted for studies including people over 65 years old which investigated the association between measures of restricted activity and hospitalisation, cognitive decline, and mortality. Following data extraction by two reviewers, eligible studies were summarised using Inverse Variance Heterogeneity meta-analysis. RESULTS The search identified 8,434 unique publications, with 11 eligible studies. Three measures of restricted activity were identified: bed rest, restricted movement, and dependency for activities of daily living (ADL). Three studies looked at hospitalisations, with two finding a significant association with bed rest or restricted movement and one showing no evidence of an association. Restricted activity was associated with a significant increase in mortality across all three measures (bed rest odds ratio [OR] 6.34, 95%CI 2.51-16.02, I2 = 76%; restricted movement OR 5.38 95%CI 2.60-11.13, I2 = 69%; general ADL dependency OR 4.65 95%CI 2.25-9.26, I2 = 84%). The significant heterogeneity observed could not be explained by restricting the analysis by length of follow-up, or measure of restricted activity. No meta-analysis was conducted on the limited evidence for cognitive decline outcomes. CONCLUSIONS Limited studies have considered the prognostic value of restricted activity in terms of predicting future declining health. Current evidence suggests restricted activity is associated with hospitalisation and mortality, and therefore could identify a group for whom early intervention might be possible.
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Affiliation(s)
- Ishbel L Henderson
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, OX2 6GG, UK
| | - Rory W Bone
- NHS 24, NHS Scotland, Glasgow, G51 4EB, Scotland
| | - Richard Stevens
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, OX2 6GG, UK
| | - Rebecca K Barnes
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, OX2 6GG, UK
| | - Nia Roberts
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, OX2 6GG, UK
| | - James P Sheppard
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, OX2 6GG, UK
| | - Richard J McManus
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, OX2 6GG, UK.
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Moriyama N, Nishikawa Y, Hoshi W, Kuga T, Iwasa H, Murayama T, Itagaki T, Saito Y, Yasumura S. Association of Instrumental Activities of Daily Living, Physical Function, and Mental Health among Older Returnees after the Fukushima Daiichi Nuclear Power Station Accident. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182111639. [PMID: 34770151 PMCID: PMC8583483 DOI: 10.3390/ijerph182111639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/18/2021] [Revised: 10/23/2021] [Accepted: 11/03/2021] [Indexed: 11/16/2022]
Abstract
The 2011 Great East Japan Earthquake and consequent Fukushima Daiichi Nuclear Power Station accident caused a large-scale evacuation, generating various health issues. Although residents gradually returned, their independence of daily living and associated factors remain unknown. This study examines the hypothesis that physical and mental status are associated with the instrumental activities of daily living (IADL) of older returnees (65 years and above) after the disaster. Older returnees to Kawauchi Village, Fukushima Prefecture, located 20–30 km southwest of the power plants, were recruited. IADL was assessed using the Japan Science and Technology Agency Index of Competence, physical function via the 30-s chair stand test, and mental health via the Japanese version of the World Health Organization Five Well-Being Index. To examine the association of IADL and possible factors, a t-test or Pearson’s product-moment correlation coefficient was used, stratified by sex. The data of 29 participants (75.5 ± 7.4 years, 19 female) were analyzed. Physical function was associated with IADL in females. Mental health was associated with IADL in males and females. Taking measures to strengthen physical function in females, as well as to improve mental health in both sexes, for enhancing IADL ability could be beneficial.
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Affiliation(s)
- Nobuaki Moriyama
- Department of Public Health, Fukushima Medical University School of Medicine, Fukushima 960-1295, Japan; (T.K.); (H.I.); (S.Y.)
- Correspondence:
| | - Yoshitaka Nishikawa
- Kawauchi Village National Health Insurance Clinic, Kawauchi 979-1202, Japan; (Y.N.); (T.M.)
- Department of Internal Medicine, Hirata Central Hospital, Hirata 963-8202, Japan
- Department of Health Informatics, Kyoto University School of Public Health, Kyoto 606-8315, Japan
| | - Wataru Hoshi
- Department of Rehabilitation, Hirata Central Hospital, Hirata 963-8202, Japan; (W.H.); (T.I.); (Y.S.)
| | - Tomomi Kuga
- Department of Public Health, Fukushima Medical University School of Medicine, Fukushima 960-1295, Japan; (T.K.); (H.I.); (S.Y.)
| | - Hajime Iwasa
- Department of Public Health, Fukushima Medical University School of Medicine, Fukushima 960-1295, Japan; (T.K.); (H.I.); (S.Y.)
| | - Tomoo Murayama
- Kawauchi Village National Health Insurance Clinic, Kawauchi 979-1202, Japan; (Y.N.); (T.M.)
| | - Tatsuya Itagaki
- Department of Rehabilitation, Hirata Central Hospital, Hirata 963-8202, Japan; (W.H.); (T.I.); (Y.S.)
| | - Yuta Saito
- Department of Rehabilitation, Hirata Central Hospital, Hirata 963-8202, Japan; (W.H.); (T.I.); (Y.S.)
| | - Seiji Yasumura
- Department of Public Health, Fukushima Medical University School of Medicine, Fukushima 960-1295, Japan; (T.K.); (H.I.); (S.Y.)
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Kang H. Correlates of Frailty in Community-Dwelling Older Adults with Cancer: 2017 Survey of Living Condition of Elderly Study in South Korea. Asia Pac J Oncol Nurs 2021; 8:287-294. [PMID: 33850962 PMCID: PMC8030589 DOI: 10.4103/2347-5625.311130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Accepted: 12/22/2020] [Indexed: 11/04/2022] Open
Abstract
Objective Frailty is prevalent among community-dwelling older adults with cancer and is associated with increased mortality and complications of treatments. However, evidence on the multiple factors influencing frailty in this population is scarce. This paper aimed to identify the demographic, sociobehavioral, and health status-related correlates of frailty in community-dwelling older adults with cancer. Methods This was a descriptive cross-sectional study using data from the fourth wave of the Living Condition of Elderly Study in South Korea conducted in 2017. Among the 10,299 individuals aged ≥65 years who participated in the survey, data of 391 individuals with cancer were analyzed. Frailty status (robust, prefrailty, and frailty) was assessed using the Korean version of the 5-item: Fatigue, Resistance, Ambulation, Illnesses, and Loss of weight scale. We performed descriptive statistical analysis to report summary measures, and bivariate (t-test, Chi-squared test, and analysis of variance) and multivariate regression analyses. Results Frailty and prefrailty were prevalent in 24.8% and 50.6% of the participants, respectively. The strongest correlate of frailty was a greater level of depression, followed by low levels of physical activity, dependency in instrumental activities of daily living, a greater number of comorbidities, an advanced age, a lower household income, and a widowed marital status. Conclusions Community-dwelling older adults who had cancer and depression had the highest risk of frailty. Given the adverse impact of frailty on health outcomes in this population, health-care providers need to provide interventions incorporating the management of depression, physical activity, and comorbidities to prevent or manage frailty.
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Affiliation(s)
- Hyunwook Kang
- Department of Nursing, College of Nursing, Kangwon National University, Gangwon-do, Korea
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4
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Orellano-Colón EM, Abdalla-Mukhaimer N, Rodríguez-Ramos BA, Rodríguez-Robles R, Rivero-Méndez M, Lizama-Troncoso M, Jutai JW, Jiménez-Velázquez IZ, Varas-Díaz N, Hallman-Navarro D. Self-Management Strategies Used by Older Hispanic Women to Overcome Functional Disabilities. PHYSICAL & OCCUPATIONAL THERAPY IN GERIATRICS 2021. [DOI: 10.1080/02703181.2020.1788691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Elsa M. Orellano-Colón
- Occupational Therapy Master Program, University of Puerto Rico Medical Sciences Campus, San Juan, Puerto Rico
| | - Nelly Abdalla-Mukhaimer
- Occupational Therapy Master Program, University of Puerto Rico Medical Sciences Campus, San Juan, Puerto Rico
| | - Bryan A. Rodríguez-Ramos
- Occupational Therapy Master Program, University of Puerto Rico Medical Sciences Campus, San Juan, Puerto Rico
| | - Rebecca Rodríguez-Robles
- Occupational Therapy Master Program, University of Puerto Rico Medical Sciences Campus, San Juan, Puerto Rico
| | - Marta Rivero-Méndez
- School of Nursing, University of Puerto Rico Medical Sciences Campus, San Juan, Puerto Rico
| | - Mauricio Lizama-Troncoso
- Puerto Rico Assistive Technology Program, Central Administration, University of Puerto Rico, San Juan, Puerto Rico
| | - Jeffrey W. Jutai
- Interdisciplinary School of Science, University of Ottawa, Ottawa, Canada
| | | | - Nelson Varas-Díaz
- Global and Sociocultural Studies, Florida International University, Miami, Florida, USA
| | - Deanna Hallman-Navarro
- School of Medicine, University of Puerto Rico Medical Sciences Campus, San Juan, Puerto Rico
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Fukui S, Kawakami M, Otaka Y, Ishikawa A, Yashima F, Hayashida K, Oguma Y, Fukuda K, Liu M. Preoperative Instrumental Activities of Daily Living Predicts Survival After Transcatheter Aortic Valve Implantation. Circ Rep 2020; 2:83-88. [PMID: 33693212 PMCID: PMC7929760 DOI: 10.1253/circrep.cr-19-0109] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Background:
This aim of this study was to clarify prognosis after transcatheter aortic valve implantation (TAVI) in patients with aortic stenosis (AS) and to identify baseline factors associated with mortality. Methods and Results:
We prospectively enrolled 257 consecutive elderly persons with AS who were referred to Keio University Hospital and who underwent assessment of cardiac, physical (walking speed), cognitive, and renal functions, nutritional status, activities of daily living (ADL), instrumental ADL (IADL) assessed with the Frenchay activities index (FAI), and comorbidities. The primary outcome was postoperative death. Differences in basic characteristics were compared between a group that survived for a median of 661 days (IQR, 0–1,289 days) after TAVI and a group that did not. Multivariate hazard ratios (HR) were calculated for independent factors selected in Cox proportional hazard models. Thirty-one individuals died during follow-up. Walking speed was significantly faster (0.87±0.25 vs. 0.70±0.24 m/s, P<0.001) and FAI was significantly higher (21.2±8.0 vs. 15.7±8.0, P=0.026) in the survival group compared with those who died. Multivariate HR for mortality according to walking speed was 0.05 (95% CI: 0.028–0.091) in model 1 and 0.04 (95% CI: 0.020–0.081) in model 2, and those for FAI were 0.94 (95% CI: 0.92–0.95) and 0.92 (95% CI: 0.90–0.92), respectively. Conclusions:
Preoperative walking speed and IADL are crucial factors associated with prognosis after TAVI even after adjustment.
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Affiliation(s)
- Shogo Fukui
- Department of Rehabilitation Medicine, Keio University School of Medicine Tokyo Japan.,Graduate School of Health Management, Keio University Tokyo Japan
| | - Michiyuki Kawakami
- Department of Rehabilitation Medicine, Keio University School of Medicine Tokyo Japan
| | - Yohei Otaka
- Department of Rehabilitation Medicine I, School of Medicine, Fujita Health University Toyoake Japan
| | - Aiko Ishikawa
- Department of Rehabilitation Medicine, Keio University School of Medicine Tokyo Japan
| | - Fumiaki Yashima
- Department of Cardiology, Keio University School of Medicine Tokyo Japan
| | - Kentaro Hayashida
- Department of Cardiology, Keio University School of Medicine Tokyo Japan
| | - Yuko Oguma
- Graduate School of Health Management, Keio University Tokyo Japan.,Sports Medicine Research Center, Keio University Tokyo Japan
| | - Keiichi Fukuda
- Department of Cardiology, Keio University School of Medicine Tokyo Japan
| | - Meigen Liu
- Department of Rehabilitation Medicine, Keio University School of Medicine Tokyo Japan
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Miller MD, Yaxley A, Villani A, Cobiac L, Fraser R, Cleland L, James M, Crotty M. A trial assessing N-3 as treatment for injury-induced cachexia (ATLANTIC trial): does a moderate dose fish oil intervention improve outcomes in older adults recovering from hip fracture? BMC Geriatr 2010; 10:76. [PMID: 20964865 PMCID: PMC2984449 DOI: 10.1186/1471-2318-10-76] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2010] [Accepted: 10/22/2010] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Proximal femoral fractures are associated with increased morbidity and mortality. Pre-existing malnutrition and weight loss amongst this patient group is of primary concern, with conventional nutrition support being largely ineffective. The inflammatory response post proximal femoral fracture surgery and the subsequent risk of cachexia may explain the inability of conventional high energy high protein management to produce an anabolic response amongst these patients. Omega-3 fatty acids derived from fish oils have been extensively studied for their anti-inflammatory benefits. Due to their anti-inflammatory properties, the benefit of fish oil combined with individualized nutrition support amongst proximal femoral fracture patients post surgery is an attractive potential therapeutic strategy. The aim of the ATLANTIC trial is to assess the potential benefits of an anti-inflammatory dose of fish oil within the context of a 12 week individualised nutrition program, commencing seven days post proximal femoral fracture surgery. METHODS/DESIGN This randomized controlled, double blinded trial, will recruit 150 community dwelling elderly patients aged ≥65 years, within seven days of surgery for proximal femoral fracture. Participants will be randomly allocated to receive either a 12 week individualized nutrition support program complemented with 20 ml/day anti-inflammatory dose fish oil (~3.6 g eicosapentaenoic acid, ~2.4 g docosahexanoic acid; intervention), or, a 12 week individualized nutrition support program complemented with 20 ml/day low dose fish oil (~0.36 g eicosapentaenoic acid, ~0.24 g docosahexanoic acid; control). DISCUSSION The ATLANTIC trial is the first of its kind to provide fish oil combined with individualized nutrition therapy as an intervention to address the inflammatory response experienced post proximal femoral fracture surgery amongst elderly patients. The final outcomes of this trial will assist clinicians in the development of effective and alternative treatment methods post proximal femoral fracture surgery which may ultimately result in a reduction in systemic inflammation, loss of weight and lean muscle and improvements in nutritional status, mobility, independence and quality of life among elderly patients. TRIAL REGISTRATION ACTRN12609000241235.
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Affiliation(s)
- Michelle D Miller
- Nutrition and Dietetics, Flinders University, GPO Box 2100, Adelaide SA 5001, Australia
| | - Alison Yaxley
- Rehabilitation and Aged Care, Flinders University, GPO Box 2100, Adelaide SA 5001, Australia
| | - Anthony Villani
- Nutrition and Dietetics, Flinders University, GPO Box 2100, Adelaide SA 5001, Australia
| | - Lynne Cobiac
- Nutrition and Dietetics, Flinders University, GPO Box 2100, Adelaide SA 5001, Australia
| | - Robert Fraser
- Department of Medicine, Flinders University, GPO Box 2100, Adelaide SA 5001, Australia
| | - Leslie Cleland
- Rheumatology Unit, Royal Adelaide Hospital, North Terrace, Adelaide SA 5000, Australia
| | - Michael James
- Rheumatology Unit, Royal Adelaide Hospital, North Terrace, Adelaide SA 5000, Australia
| | - Maria Crotty
- Rehabilitation and Aged Care, Flinders University, GPO Box 2100, Adelaide SA 5001, Australia
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Gitlin LN, Hauck WW, Winter L, Dennis MP, Schulz R. Effect of an In-Home Occupational and Physical Therapy Intervention on Reducing Mortality in Functionally Vulnerable Older People: Preliminary Findings. J Am Geriatr Soc 2006; 54:950-5. [PMID: 16776791 DOI: 10.1111/j.1532-5415.2006.00733.x] [Citation(s) in RCA: 90] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To evaluate the effect of a multicomponent intervention on mortality and the role of control-oriented strategy use as the change mechanism. DESIGN Two-group randomized design with survivorship followed for 14 months. Participants were randomized to intervention or a no-treatment control group. SETTING Urban, community-living older people. PARTICIPANTS Three hundred nineteen people aged 70 and older with functional difficulties. INTERVENTION Occupational therapy and physical therapy sessions involving home modifications, problem solving, and training in energy conservation, safe performance, balance, muscle strength, and fall recovery techniques. MEASUREMENTS Survival time was number of days between baseline interview and date of death or final interview if date unknown. Control-oriented strategy use was measured using eight items. RESULTS Intervention participants exhibited a 1% rate of mortality, compared with a 10% rate for no-treatment control participants (P=.003, 95% confidence interval=2.4-15.04%). At baseline, those who subsequently died had more days hospitalized and lower control-oriented strategy use 6 months before study enrollment than survivors. No intervention participants with previous days hospitalized (n=31) died, whereas 21% of control group counterparts did (n=35; P=.001). Although intervention participants with low and high baseline control strategy use had lower mortality risk than control participants, mortality risk was lower for intervention participants with low strategy use at baseline (P=.007). CONCLUSION An occupational and physical therapy intervention to ameliorate functional difficulties may reduce mortality risk in community-dwelling older people overall and benefit those most compromised. Instruction in control-oriented strategies may account for the intervention's protective effects on survivorship.
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Affiliation(s)
- Laura N Gitlin
- Center for Applied Research on Aging and Health, Thomas Jefferson University, 130 S. 9th Street, Philadelphia, PA 19130, USA.
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DeSalvo KB, Bloser N, Reynolds K, He J, Muntner P. Mortality prediction with a single general self-rated health question. A meta-analysis. J Gen Intern Med 2006; 21:267-75. [PMID: 16336622 PMCID: PMC1828094 DOI: 10.1111/j.1525-1497.2005.00291.x] [Citation(s) in RCA: 1427] [Impact Index Per Article: 79.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVE Health planners and policy makers are increasingly asking for a feasible method to identify vulnerable persons with the greatest health needs. We conducted a systematic review of the association between a single item assessing general self-rated health (GSRH) and mortality. DATA SOURCES Systematic MEDLINE and EMBASE database searches for studies published from January 1966 to September 2003. REVIEW METHODS Two investigators independently searched English language prospective, community-based cohort studies that reported (1) all-cause mortality, (2) a question assessing GSRH; and (3) an adjusted relative risk or equivalent. The investigators searched the citations to determine inclusion eligibility and abstracted data by following a standardized protocol. Of the 163 relevant studies identified, 22 cohorts met the inclusion criteria. Using a random effects model, compared with persons reporting "excellent" health status, the relative risk (95% confidence interval) for all-cause mortality was 1.23 [1.09, 1.39], 1.44 [1.21, 1.71], and 1.92 [1.64, 2.25] for those reporting "good,""fair," and "poor" health status, respectively. This relationship was robust in sensitivity analyses, limited to studies that adjusted for co-morbid illness, functional status, cognitive status, and depression, and across subgroups defined by gender and country of origin. CONCLUSIONS Persons with "poor" self-rated health had a 2-fold higher mortality risk compared with persons with "excellent" self-rated health. Subjects' responses to a simple, single-item GSRH question maintained a strong association with mortality even after adjustment for key covariates such as functional status, depression, and co-morbidity.
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Affiliation(s)
- Karen B DeSalvo
- Section of General Internal Medicine, Tulane University School of Medicine, New Orleans, LA 70112, USA.
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Timonen L, Rantanen T, Mäkinen E, Timonen TE, Törmäkangas T, Sulkava R. Effects of a group-based exercise program on functional abilities in frail older women after hospital discharge. Aging Clin Exp Res 2006; 18:50-6. [PMID: 16608136 DOI: 10.1007/bf03324640] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND AND AIMS An acute illness may place older frail people at increased risk of losing independence in functional abilities. Physical exercise may reduce the risk by improving muscle strength and balance. However, the effects of physical training on functional abilities have not been studied among frail, very old people recovering from an acute illness. The aim of this study was to determine the effects of a group-based exercise program on their ability to carry out self-care (ADL) and instrumental activities (IADL) relevant to daily life after discharge from hospital. METHODS This randomized controlled trial examined 68 community-dwelling women aged 75 years or older (mean age 83.0, SD 3.9) who were hospitalized due to an acute illness, and were mobility-impaired at admission. Participants were recruited from the geriatric ward of a primary-care health-center hospital, and were randomized into group-based strength training (n=34) and control (n=34) groups. The 10-week group-based intervention included strength training and functional exercises. The control group received instructions for a home exercise training program, including functional exercises but no further encouragement to exercise. The level of independence in ADL and IADL was evaluated, using a 13-item scale with stepwise grading from fully independent to fully dependent. Measurements took place immediately before and after the intervention, and three and nine months later. RESULTS The intervention did not have any significant main effect (p = 0.407), nor was there any significant interaction between follow-up time and intervention (p = 0.854). CONCLUSIONS The multicomponent outpatient strength training program did not improve autonomy in expert-evaluated ADL/IADL functions.
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Affiliation(s)
- Leena Timonen
- Health Center of the City of Joensuu, FIN-80130 Joensuu, Finland.
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10
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van den Brink CL, Tijhuis M, van den Bos GAM, Giampaoli S, Nissinen A, Kromhout D. The contribution of self-rated health and depressive symptoms to disability severity as a predictor of 10-year mortality in European elderly men. Am J Public Health 2005; 95:2029-34. [PMID: 16195527 PMCID: PMC1449479 DOI: 10.2105/ajph.2004.050914] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To investigate the effect of disability severity and the contribution of self-rated health and depressive symptoms to 10-year mortality. METHODS Longitudinal data were collected from 1141 men aged 70 to 89 years from the Finland, Italy, and the Netherlands Elderly Study from 1990 to 2000. Disability severity was classified into 4 categories: no disability, instrumental activities, mobility, and basic activities of daily living. Self-rated health and depressive symptoms were classified into 2 and 3 categories, respectively. Multivariate Cox proportional hazard models were used to calculate mortality risks. RESULTS Men with severe disability had a risk of mortality that was more than 2-fold higher (hazard ratio [HR]=2.41; 95% confidence interval [CI]=1.84, 3.16) than that of men without disability. Men who had severe disability and did not feel healthy had the highest mortality risk (HR = 3.30; 95% CI = 2.52, 4.33). This risk was lower at lower levels of disability and higher levels of self-rated health. The same trend was observed for depressive symptoms. CONCLUSIONS For adequate prognoses on mortality or for developing intervention strategies, not only physical aspects of health but also other health outcomes should be taken into account.
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Affiliation(s)
- Carolien L van den Brink
- National Institute for Public Health and the Environment, Center for Prevention and Health Services Research, PO Box 1, 3720 BA Bilthoven, The Netherlands.
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11
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Stessman J, Hammerman-Rozenberg R, Maaravi Y, Cohen A. Effect of exercise on ease in performing activities of daily living and instrumental activities of daily living from age 70 to 77: the Jerusalem longitudinal study. J Am Geriatr Soc 2002; 50:1934-8. [PMID: 12473003 DOI: 10.1046/j.1532-5415.2002.50603.x] [Citation(s) in RCA: 59] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVES To determine the prevalence of independence and ease of performance in activities of daily living (ADLs) and instrumental activities of daily living (IADLs) at ages 70 and 77 in a well-characterized cohort and to measure the effect of regular exercise at age 70 on independence and ease of performance 7 years later. DESIGN Two stages of a longitudinal study of an age-homogeneous cohort employing extensive interview data, physical examination, and clinical laboratory investigation. SETTING Home-based interviews and examinations in Jerusalem. PARTICIPANTS Two hundred eighty-seven west Jerusalem residents, born between June 1920 and May 1921, who participated fully in two phases of an ongoing longitudinal cohort study. Subjects were culled from a larger study population of 605 in the first phase and 1,021 in the second phase. MEASUREMENTS Two-stage comprehensive demographic, social, and economic profile; medical history and examination; cognitive and affective assessment; and clinical laboratory studies performed in 1990-91 and 1997-98. The investigation questionnaire included details of ADL and IADLs and voluntary exercise. RESULTS Most aspects of personal and social life did not change from age 70 to 77. Independence in ADLs remained high, as did self-reliance in IADLs for women. A more-sensitive marker of diminished function was reported ease in performance, which declined for use of the toilet, dressing, and all spheres of IADLs. For nearly every task, subjects who reported exercising 4 days a week at age 70 were more likely to report ease in performance at age 77. In a logistic regression accounting for the presence of diabetes mellitus, hypertension, obesity, chronic back pain, loneliness, and performance with ease at age 70 and deterioration in self-assessed health from age 70 to 77, ease of performance in at least three of four ADL tasks was independently related to exercise at age 70 for women (odds ratio (OR) = 8.5, 95% confidence interval (CI) = 2.0-36.2) and for men (OR = 4.3, 95% CI = 1.1-17.1). Ease of independent function in at least four of five IADL tasks also correlated to exercise for men in this regression (OR = 3.7, 95% CI = 1.1-12.2) but not for women (OR = 2.0, 95% CI = 0.6-6.3). Ease in shopping, alternatively, correlated with physical activity for men (OR = 4.3, 95% CI = 1.5-12.0) and women (OR = 2.6, 95% CI = 1.1-6.1). CONCLUSIONS Subjects remained active and independent at age 77. Reported ease of performance declined and revealed changes in function. Exercise at least four times a week at age 70 preserved ease of performance at age 77 independent of the influence of specific disease or general self-assessed health.
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Affiliation(s)
- Jochanan Stessman
- Department of Rehabilitation and Geriatrics, Hadassah-University Hospital, Mt. Scopus, Jerusalem, Israel
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12
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Ho HK, Matsubayashi K, Wada T, Kimura M, Kita T, Saijoh K. Factors associated with ADL dependence: A comparative study of residential care home and community-dwelling elderly in Japan. Geriatr Gerontol Int 2002. [DOI: 10.1046/j.1444-1586.2002.00026.x] [Citation(s) in RCA: 41] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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