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Zhou J, Xu Y, Yang D, Zhou Q, Ding S, Pan H. Risk prediction models for disability in older adults: a systematic review and critical appraisal. BMC Geriatr 2024; 24:806. [PMID: 39358747 PMCID: PMC11448436 DOI: 10.1186/s12877-024-05409-z] [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: 01/06/2024] [Accepted: 09/25/2024] [Indexed: 10/04/2024] Open
Abstract
BACKGROUND The amount of prediction models for disability in older adults is increasing but the prediction performance of different models varies greatly, and the quality of prediction models is still unclear. OBJECTIVES To systematically review and critically appraise the studies on risk prediction models for disability in older adults. METHODS A systematic literature search was conducted on PubMed, Embase, Web of Science, Cochrane Library, Cumulative Index to Nursing and Allied Health Literature (CINAHL), China National Knowledge Infrastructure (CNKI), China Science and Technology Journal Database (VIP), and Wanfang Database, published up until June 30, 2023. Data were extracted according to the Checklist for critical Appraisal and data extraction for systematic Reviews of prediction Modelling Studies (CHARMS). The Prediction Model Risk of Bias Assessment Tool (PROBAST) was used to assess the risk of bias and applicability of the included studies. In addition, all included studies were evaluated for clinical value. RESULTS A total of 5722 articles were initially retrieved from databases, 16 studies and 17 prediction models were finally included after screening. The sample sizes of studies ranged from 420 to 90,889. Model development methods mainly included logistic regression analysis, Cox proportional hazards regression, and machine learning methods. The C statistic or area under the curve (AUC) of models ranged from 0.650 to 0.853, and nine models had C statistic/AUC higher than 0.75. Age, chronic disease, gender, self-rated health, body mass index (BMI), drinking, smoking and education level were the most common predictors. According to the PROBAST, all included studies were at high risk of bias, and 10 studies were at high concerns for applicability. Only two studies reported following the Transparent Reporting of a Multivariate Prediction Model for Individual Prognosis or Diagnosis (TRIPOD) statement. After evaluation, only two models reached the standard of clinical value. CONCLUSION Although most of the included prediction models had acceptable discrimination, the overall quality and clinical value of the current studies were poor. In the future, researchers should follow the TRIPOD statement and PROBAST checklist to develop prediction models with larger sample sizes, more reasonable study designs, and more scientific analysis methods, to improve the predictive performance and application value. TRIAL REGISTRATION The review protocol was registered in PROSPERO (registration ID: CRD42023446657).
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Affiliation(s)
- Jinyan Zhou
- Nursing Department, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, 3 Qingchun East Road, Hangzhou, 310016, China
| | - Yihong Xu
- Nursing Department, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, 3 Qingchun East Road, Hangzhou, 310016, China
| | - Dan Yang
- Nursing Department, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, 3 Qingchun East Road, Hangzhou, 310016, China
| | - Qianya Zhou
- School of Nursing, Zhejiang Chinese Medical University, Hangzhou, China
| | - Shanni Ding
- Nursing Department, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, 3 Qingchun East Road, Hangzhou, 310016, China
| | - Hongying Pan
- Nursing Department, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, 3 Qingchun East Road, Hangzhou, 310016, China.
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Smythe T, Kuper H. The association between disability and all-cause mortality in low-income and middle-income countries: a systematic review and meta-analysis. Lancet Glob Health 2024; 12:e756-e770. [PMID: 38614629 DOI: 10.1016/s2214-109x(24)00042-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 01/17/2024] [Accepted: 01/19/2024] [Indexed: 04/15/2024]
Abstract
BACKGROUND There are 1·3 billion people with disabilities globally. On average, they have poorer health than their non-disabled peers, but the extent of increased risk of premature mortality is unknown. We aimed to systematically review the association between disability and mortality in low-income and middle-income countries (LMICs). METHODS We searched MEDLINE, Global Health, PsycINFO, and EMBASE from Jan 1, 1990 to Nov 14, 2022. Longitudinal epidemiological studies in any language with a comparator group that measured the association between disability and all-cause mortality in people of any age were eligible for inclusion. Two reviewers independently assessed study eligibility, extracted data, and assessed risk of bias. We used a random-effects meta-analysis to calculate the pooled hazard ratio (HR) for all-cause mortality by disability status. We then conducted meta-analyses separately for different impairment and age groups. FINDINGS We identified 6146 unique articles, of which 70 studies (81 cohorts) were included in the systematic review, from 22 countries. There was variability in the methods used to assess and report disability and mortality. The meta-analysis included 54 studies, representing 62 cohorts (comprising 270 571 people with disabilities). Pooled HRs for all-cause mortality were 2·02 (95% CI 1·77-2·30) for people with disabilities versus those without disabilities, with high heterogeneity between studies (τ2=0·23, I2=98%). This association varied by impairment type: from 1·36 (1·17-1·57) for visual impairment to 3·95 (1·60-9·74) for multiple impairments. The association was highest for children younger than 18 years (4·46, [3·01-6·59]) and lower in people aged 15-49 years (2·45 [1·21-4·97]) and people older than 60 years (1·97 [1·65-2·36]). INTERPRETATION People with disabilities had a two-fold higher mortality rate than people without disabilities in LMICs. Interventions are needed to improve the health of people with disabilities and reduce their higher mortality rate. FUNDING UK National Institute for Health and Care Research; and UK Foreign, Commonwealth and Development Office.
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Affiliation(s)
- Tracey Smythe
- International Centre for Evidence in Disability, London School of Hygiene & Tropical Medicine, London, UK; Division of Physiotherapy, Department of Health and Rehabilitation Sciences, Stellenbosch University, Cape Town, South Africa.
| | - Hannah Kuper
- International Centre for Evidence in Disability, London School of Hygiene & Tropical Medicine, London, UK
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Kuper H, Rotenberg S, Azizatunnisa' L, Banks LM, Smythe T. The association between disability and mortality: a mixed-methods study. Lancet Public Health 2024; 9:e306-e315. [PMID: 38702095 DOI: 10.1016/s2468-2667(24)00054-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 03/04/2024] [Accepted: 03/12/2024] [Indexed: 05/06/2024]
Abstract
BACKGROUND Globally, 1·3 billion people have a disability and are more likely to experience poor health than the general population. However, little is known about the mortality or life expectancy gaps experienced by people with disabilities. We aimed to undertake a systematic review and meta-analysis of the association between disability and mortality, compare these findings to the evidence on the association of impairment types and mortality, and model the estimated life expectancy gap experienced by people with disabilities. METHODS We did a mixed-methods study, which included a systematic review and meta-analysis, umbrella review, and life expectancy modelling. For the systematic review and meta-analysis, we searched MEDLINE, Global Health, PsycINFO, and Embase for studies published in English between Jan 1, 2007, and June 7, 2023, investigating the association of mortality and disability. We included prospective and retrospective cohort studies and randomised controlled trials with a baseline assessment of disability and a longitudinal assessment of all-cause mortality or cause-specific mortality. Two reviewers independently assessed study eligibility, extracted the data, and assessed risk of bias. We did a random-effects meta-analysis to calculate a pooled estimate of the mortality rate ratio for people with disabilities compared with those without disabilities. We did an umbrella review of meta-analyses examining the association between different impairment types and mortality. We used life table modelling to translate the mortality rate ratio into an estimate of the life expectancy gap between people with disabilities and the general population. The systematic review and meta-analysis is registered with PROSPERO, CRD42023433374. FINDINGS Our search identified 3731 articles, of which 42 studies were included in the systematic review. The meta-analysis included 31 studies. Pooled estimates showed that all-cause mortality was 2·24 times (95% CI 1·84-2·72) higher in people with disabilities than among people without disabilities, although heterogeneity between the studies was high (τ2=0·28, I2=100%). Modelling indicated a median gap in life expectancy of 13·8 years (95% CI 13·1-14·5) by disability status. Cause-specific mortality was also higher for people with disabilities, including for cancer, COVID-19, cardiovascular disease, and suicide. The umbrella review identified nine meta-analyses, which showed consistently elevated mortality rates among people with different impairment types. INTERPRETATION Mortality inequities experienced by people with disabilities necessitate health system changes and efforts to address inclusion and the social determinants of health. FUNDING National Institute for Health and Care Research, Rhodes Scholarship, Indonesia Endowment Funds for Education, Foreign, Commonwealth and Development Office (Programme for Evidence to Inform Disability Action), and the Arts and Humanities Research Council.
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Affiliation(s)
- Hannah Kuper
- Department of Population Health, International Centre for Evidence in Disability, London School of Hygiene & Tropical Medicine, London, UK; Missing Billion Initiative, Seattle, WA, USA.
| | - Sara Rotenberg
- Department of Population Health, International Centre for Evidence in Disability, London School of Hygiene & Tropical Medicine, London, UK; Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Luthfi Azizatunnisa'
- Department of Population Health, International Centre for Evidence in Disability, London School of Hygiene & Tropical Medicine, London, UK; Department of Health Behavior, Environment, and Social Medicine, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Lena Morgon Banks
- Department of Population Health, International Centre for Evidence in Disability, London School of Hygiene & Tropical Medicine, London, UK
| | - Tracey Smythe
- Department of Population Health, International Centre for Evidence in Disability, London School of Hygiene & Tropical Medicine, London, UK; Department of Health and Rehabilitation Sciences, Division of Physiotherapy, Stellenbosch University, Cape Town, South Africa
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Lopes Vieira MM, Borges VS, Oliveira EJP, Bof de Andrade F. Functional limitation in the older Brazilian adults: Association with multimorbidity and socioeconomic conditions. PLoS One 2023; 18:e0294935. [PMID: 38032910 PMCID: PMC10688755 DOI: 10.1371/journal.pone.0294935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Accepted: 11/11/2023] [Indexed: 12/02/2023] Open
Abstract
The aim of this study was to assess the association between multimorbidity and the presence of functional limitation in basic (BADL) and instrumental activities of daily living (IADL) among Brazilian older adults and to verify whether this association is moderated by socioeconomic conditions. Cross-sectional study with data from the Brazilian National Health Survey (PNS) (2019) for the Brazilian population aged 60 years and over. The dependent variables were functional limitation, based on self-reported difficulty in performing one or more activities of daily living, including six BADL (feeding, bathing, using the toilet, dressing, crossing a room on the same floor and getting out of bed) and four IADL (shopping, managing money, taking medication and using transportation). The independent variables were multimorbidity (presence of two or more self-reported chronic diseases) and socioeconomic measures (per capita household income, asset score, and education level). The association between multimorbidity and outcomes was assessed using adjusted logistic regression models. The moderating effect of socioeconomic conditions on the association between multimorbidity and functional limitations was assessed by including an interaction term. The final sample consisted of 22,725 individuals. The prevalence of functional limitation was 8.5% (95%CI: 7.9-9.2) and 18.6% (95%CI: 17.8-19.5) in BADL and IADL, respectively. Multimorbidity was associated with BADL [OR: 2.30 (95%CI: 1.93-2.74)] and IADL [OR: 2.26 (95%CI: 1.98-2.57)]. The odds of functional limitation were higher among individuals with lower levels of education and income, but there was no interaction between multimorbidity and socioeconomic position measures. Multimorbidity was associated with functional limitation (BADL and IADL) and socioeconomic conditions, and this association was constant across socioeconomic position levels.
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Affiliation(s)
| | | | | | - Fabíola Bof de Andrade
- René Rachou Institute, Oswaldo Cruz Foundation (FIOCRUZ), Belo Horizonte, Minas Gerais, Brasil
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Gobbens RJ, Santiago LM, Uchmanowicz I, van der Ploeg T. Predicting Disability Using a Nomogram of the Tilburg Frailty Indicator (TFI). Healthcare (Basel) 2023; 11:healthcare11081150. [PMID: 37107984 PMCID: PMC10137888 DOI: 10.3390/healthcare11081150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Revised: 03/02/2023] [Accepted: 04/10/2023] [Indexed: 04/29/2023] Open
Abstract
Disability is associated with lower quality of life and premature death in older people. Therefore, prevention and intervention targeting older people living with a disability is important. Frailty can be considered a major predictor of disability. In this study, we aimed to develop nomograms with items of the Tilburg Frailty Indicator (TFI) as predictors by using cross-sectional and longitudinal data (follow-up of five and nine years), focusing on the prediction of total disability, disability in activities of daily living (ADL), and disability in instrumental activities of daily living (IADL). At baseline, 479 Dutch community-dwelling people aged ≥75 years participated. They completed a questionnaire that included the TFI and the Groningen Activity Restriction Scale to assess the three disability variables. We showed that the TFI items scored different points, especially over time. Therefore, not every item was equally important in predicting disability. 'Difficulty in walking' and 'unexplained weight loss' appeared to be important predictors of disability. Healthcare professionals need to focus on these two items to prevent disability. We also conclude that the points given to frailty items differed between total, ADL, and IADL disability and also differed regarding years of follow-up. Creating one monogram that does justice to this seems impossible.
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Affiliation(s)
- Robbert J Gobbens
- Faculty of Health, Sports and Social Work, Inholland University of Applied Sciences, 1081 HV Amsterdam, The Netherlands
- Zonnehuisgroep Amstelland, 1186 AA Amstelveen, The Netherlands
- Department Family Medicine and Population Health, Faculty of Medicine and Health Sciences, University of Antwerp, 2610 Antwerp, Belgium
- Department of Tranzo Academic Centre for Transformation in Care and Welfare, Faculty of Behavioural and Social Sciences, Tilburg University, 5037 AB Tilburg, The Netherlands
| | - Livia M Santiago
- Faculty of Medicine, Federal University of Rio de Janeiro, Rio de Janeiro 21941-912, Brazil
| | - Izabella Uchmanowicz
- Department of Nursing and Obstetrics, Faculty of Health Sciences, Wroclaw Medical University, 50-367 Wroclaw, Poland
- Institute of Heart Diseases, University Hospital, 50-566 Wroclaw, Poland
| | - Tjeerd van der Ploeg
- Faculty of Health, Sports and Social Work, Inholland University of Applied Sciences, 1081 HV Amsterdam, The Netherlands
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Nagata H, Miura K, Tanaka S, Kadota A, Hayakawa T, Kondo K, Fujiyoshi A, Takashima N, Kita Y, Okayama A, Okamura T, Ueshima H. Relationship of Higher-level Functional Capacity With Long-term Mortality in Japanese Older People: NIPPON DATA90. J Epidemiol 2023; 33:136-141. [PMID: 34248110 PMCID: PMC9909170 DOI: 10.2188/jea.je20210077] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Basic and instrumental activities of daily living (BADL and IADL, respectively) are known predictors of mortality. However, the relationship between higher-level functional capacity (HLFC) and mortality and related sex differences have rarely been investigated. METHODS A prospective population-based cohort study was conducted in 1,824 older residents (≥65 years) with independent BADL from 300 randomly selected areas in Japan from 1995, and the participants were followed up until 2010. Using the Cox proportional hazards model, the relationship between HLFC and mortality risk was investigated, with adjustment for possible confounders. HLFC was assessed using the Tokyo Metropolitan Institute of Gerontology Index of Competence. Baseline data were collected using a questionnaire or by home-visit interviews. RESULTS During an average 12.2-year follow-up, all-cause death was observed in 836 (45.8%) participants. Impaired HLFC was significantly associated with mortality (hazard ratio [HR] 1.37; 95% confidence interval [CI], 1.13-1.65). Lower social role was significantly associated with higher mortality risk in men (HR 1.38; 95% CI, 1.13-1.68). Lower IADL and intellectual activity were significantly associated with higher mortality risk in women (HR 1.50; 95% CI, 1.15-1.95 and HR 1.46; 95% CI, 1.19-1.79, respectively). The relationship between HLFC and mortality risk showed a similar tendency among cardiovascular diseases, stroke, cancer, and pneumonia. CONCLUSION Impaired HLFC was associated with a high risk of all-cause mortality among community-dwelling older people with independent BADL. In particular, social role in men and IADL and intellectual activity in women were associated with long-term mortality risk.
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Affiliation(s)
- Hideki Nagata
- Center for Epidemiologic Research in Asia, Shiga University of Medical Science.,Department of Rehabilitation, Japanese Red Cross Nagoya Daini Hospital
| | - Katsuyuki Miura
- Center for Epidemiologic Research in Asia, Shiga University of Medical Science.,Department of Public Health, Shiga University of Medical Science
| | - Sachiko Tanaka
- Department of Medical Statistics, Shiga University of Medical Science
| | - Aya Kadota
- Center for Epidemiologic Research in Asia, Shiga University of Medical Science.,Department of Public Health, Shiga University of Medical Science
| | - Takehito Hayakawa
- Research Center for Social Studies of Health and Community Ritsumeikan University
| | - Keiko Kondo
- Department of Public Health, Shiga University of Medical Science
| | | | | | | | | | - Tomonori Okamura
- Department of Preventive Medicine and Public Health, Keio University
| | - Hirotsugu Ueshima
- Center for Epidemiologic Research in Asia, Shiga University of Medical Science.,Department of Public Health, Shiga University of Medical Science
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Kariya H, Yamaoka-Tojo M, Hamazaki N, Obara S, Kitasato L, Matsunaga A, Ako J. Association between instrumental activities of daily living frequency and clinical outcomes in older patients with cardiovascular disease. Eur J Cardiovasc Nurs 2023; 22:64-72. [PMID: 35670158 DOI: 10.1093/eurjcn/zvac043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Revised: 05/11/2022] [Accepted: 05/15/2022] [Indexed: 01/14/2023]
Abstract
AIMS Impairment in activities of daily living (ADL) is an independent predictor of poor prognosis in older patients. Nevertheless, the effects of instrumental ADL (IADL) frequency on prognosis in older patients with cardiovascular disease (CVD) are unclear. We investigate the associations between IADL frequency and all-cause mortality and hospital readmission due to cardiovascular events in older patients with CVD. METHODS AND RESULTS A total of 638 consecutive outpatients ≥65 years old with CVD were enrolled. A questionnaire, including Frenchay Activities Index (FAI) parameters, was used to determine IADL frequency at the start of the study as the baseline observation. The primary endpoint was all-cause mortality, and the secondary endpoint was readmission for cardiovascular events. We examined the relationship between IADL frequency and each endpoint. Among the 632 patients evaluated {median age 74.0 [interquartile range (IQR) 70.0-78.0] years; 439 males}, there were 39 deaths and 105 cardiovascular events during the median follow-up period of 4.0 (IQR, 2.3-4.0) years. After adjusting for clinical confounding factors, the hazard ratios for all-cause mortality and cardiovascular events in the FAI points were 0.957 [95% confidence interval (CI), 0.920-0.996] and 0.973 (95% CI, 0.950-0.997), respectively. CONCLUSION A higher IADL frequency was independently associated with better outcomes in older patients with CVD, suggesting that the preservation of instrumental activities should be focused on as the components of cardiovascular rehabilitation.
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Affiliation(s)
- Hidenori Kariya
- Department of Rehabilitation, Kitasato University Hospital, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa 252-0373, Japan
| | - Minako Yamaoka-Tojo
- Kitasato University Regenerative Medicine and Cell Design Research Facility, Sagamihara, Japan.,Department of Rehabilitation, Kitasato University School of Allied Health Sciences, Sagamihara, Japan
| | - Nobuaki Hamazaki
- Department of Rehabilitation, Kitasato University Hospital, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa 252-0373, Japan
| | - Shinichi Obara
- Department of Rehabilitation, Kitasato University Hospital, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa 252-0373, Japan
| | - Lisa Kitasato
- Department of Cardiovascular Medicine, Kitasato University School of Medicine, Sagamihara, Japan
| | - Atsuhiko Matsunaga
- Department of Rehabilitation, Kitasato University School of Allied Health Sciences, Sagamihara, Japan
| | - Junya Ako
- Department of Cardiovascular Medicine, Kitasato University School of Medicine, Sagamihara, Japan
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Sex Differences in Frequency of Instrumental Activities of Daily Living after Cardiac Rehabilitation and Its Impact on Outcomes in Patients with Heart Failure. J Cardiovasc Dev Dis 2022; 9:jcdd9090289. [PMID: 36135434 PMCID: PMC9502306 DOI: 10.3390/jcdd9090289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Revised: 08/19/2022] [Accepted: 08/29/2022] [Indexed: 11/26/2022] Open
Abstract
Although instrumental activities of daily living (IADL) are included in the outcomes of cardiac rehabilitation (CR), the relationship between IADL frequency at the end of CR and outcomes between the sexes remains unclear. We aimed to investigate the differences in frequency of IADL between the sexes and its impact on the outcomes. We retrospectively investigated 490 consecutive patients who were admitted for heart failure (HF) and participated in CR post-discharge. IADL frequency was assessed using the questionnaire-based Frenchay Activities Index (FAI). The primary endpoint was all-cause death, and the secondary endpoint was a composite of all-cause death and readmission due to HF. The cut-off values of the FAI for all-cause death in the overall cohort, females, and males were 23, 22, and 23 points, respectively. After adjusting for several factors, IADL assessed using the FAI was independently associated with all-cause mortality (hazard ratio [HR]: 0.961, 95% confidence interval [CI]: 0.937–0.986) and combined events (HR: 0.968, 95% CI: 0.952–0.985), respectively. Additionally, there was no interaction between sex and all-cause mortality. In conclusion, higher IADL frequency after CR was associated with favourable outcomes in patients with HF.
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Landré B, Fayosse A, Ben Hassen C, Machado-Fragua MD, Dumurgier J, Kivimaki M, Sabia S, Singh-Manoux A. Terminal decline in objective and self-reported measures of motor function before death: 10 year follow-up of Whitehall II cohort study. BMJ 2021; 374:n1743. [PMID: 34348957 PMCID: PMC8336001 DOI: 10.1136/bmj.n1743] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVES To examine multiple objective and self-reported measures of motor function for their associations with mortality. DESIGN Prospective cohort study. SETTING UK based Whitehall II cohort study, which recruited participants aged 35-55 years in 1985-88; motor function component was added at the 2007-09 wave. PARTICIPANTS 6194 participants with motor function measures in 2007-09 (mean age 65.6, SD 5.9), 2012-13, and 2015-16. MAIN OUTCOME MEASURES All cause mortality between 2007 and 2019 in relation to objective measures (walking speed, grip strength, and timed chair rises) and self-reported measures (physical component summary score of the SF-36 and limitations in basic and instrumental activities of daily living (ADL)) of motor function. RESULTS One sex specific standard deviation poorer motor function in 2007-09 (cases/total, 610/5645) was associated with an increased mortality risk of 22% (95% confidence interval 12% to 33%) for walking speed, 15% (6% to 25%) for grip strength, 14% (7% to 23%) for timed chair rises, and 17% (8% to 26%) for physical component summary score over a mean 10.6 year follow-up. Having basic/instrumental ADL limitations was associated with a 30% (7% to 58%) increased mortality risk. These associations were progressively stronger when measures were drawn from 2012-13 (mean follow-up 6.8 years) and 2015-16 (mean follow-up 3.7 years). Analysis of trajectories showed poorer motor function in decedents (n=484) than survivors (n=6194) up to 10 years before death for timed chair rises (standardised difference 0.35, 95% confidence interval 0.12 to 0.59; equivalent to a 1.2 (men) and 1.3 (women) second difference), nine years for walking speed (0.21, 0.05 to 0.36; 5.5 (men) and 5.3 (women) cm/s difference), six years for grip strength (0.10, 0.01 to 0.20; 0.9 (men) and 0.6 (women) kg difference), seven years for physical component summary score (0.15, 0.05 to 0.25; 1.2 (men) and 1.6 (women) score difference), and four years for basic/instrumental ADL limitations (prevalence difference 2%, 0% to 4%). These differences increased in the period leading to death for timed chair rises, physical component summary score, and ADL limitations. CONCLUSION Motor function in early old age has a robust association with mortality, with evidence of terminal decline emerging early in measures of overall motor function (timed chair rises and physical component summary score) and late in basic/instrumental ADL limitations.
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Affiliation(s)
- Benjamin Landré
- Université de Paris, Inserm U1153, CRESS, Epidemiology of Ageing and Neurodegenerative diseases, Paris, France
| | - Aurore Fayosse
- Université de Paris, Inserm U1153, CRESS, Epidemiology of Ageing and Neurodegenerative diseases, Paris, France
| | - Céline Ben Hassen
- Université de Paris, Inserm U1153, CRESS, Epidemiology of Ageing and Neurodegenerative diseases, Paris, France
| | - Marcos D Machado-Fragua
- Université de Paris, Inserm U1153, CRESS, Epidemiology of Ageing and Neurodegenerative diseases, Paris, France
| | - Julien Dumurgier
- Université de Paris, Inserm U1153, CRESS, Epidemiology of Ageing and Neurodegenerative diseases, Paris, France
- Cognitive Neurology Center, Lariboisière - Fernand Widal Hospital, AP-HP, Université de Paris, Paris, France
| | - Mika Kivimaki
- Department of Epidemiology and Public Health, University College London, London, UK
| | - Séverine Sabia
- Université de Paris, Inserm U1153, CRESS, Epidemiology of Ageing and Neurodegenerative diseases, Paris, France
- Department of Epidemiology and Public Health, University College London, London, UK
| | - Archana Singh-Manoux
- Université de Paris, Inserm U1153, CRESS, Epidemiology of Ageing and Neurodegenerative diseases, Paris, France
- Department of Epidemiology and Public Health, University College London, London, UK
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Loureiro LMR, Almeida LFF, Machado CJ, Pessoa MC, Duarte MSL, Franceschini SCC, Ribeiro AQ. Food Consumption and Characteristics Associated in a Brazilian Older Adult Population: A Cluster Analysis. Front Nutr 2021; 8:641263. [PMID: 34026806 PMCID: PMC8138584 DOI: 10.3389/fnut.2021.641263] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Accepted: 03/19/2021] [Indexed: 01/15/2023] Open
Abstract
Epidemiological studies support diet as a factor in the prevention and treatment of non-communicable chronic diseases, whose occurrence increases with age due to the poor choices or the adoption of a monotonous diet. The aim of this study was to construct the food consumption profiles of older adults of a Brazilian city to identify the main food groups and eating habits that contribute to these profiles and to estimate its association with socioeconomic characteristics, health and use of health services, lifestyle, and anthropometric indicators. This is a population-based cross-sectional study conducted with a representative sample of 621 community-dwelling older adults (≥60 years) in Viçosa, Minas Gerais, Brazil. The food consumption profile was the dependent variable obtained from a Food Frequency Questionnaire, utilizing the two-step cluster method. The multiple multinomial logistic regression model was used to estimate the independent associations, obtaining the odds ratios and 95% confidence intervals. Three clusters were generated, namely, (1) "unhealthy" (2) "less unhealthy," and (3) "fairly healthy." The cluster "unhealthy" was characterized by a regular consumption of beans, fats, fatty/processed meats, and whole milk. The factors independently associated with this cluster were lower education level, lower individual income, history of at least one doctor's appointment in the year preceding this study, and being a former smoker. The cluster "less unhealthy" was characterized by a regular consumption of beans, green vegetables, vegetables and fruits, as well as fats, fatty/processed meats, and whole milk. The factors independently associated with the "less unhealthy" cluster were lower education level and history of at least six doctor's appointments in the prior year. The cluster "fairly healthy" was characterized by the same pattern of "less unhealthy," except for skim milk and low-fat dairy products. The evidence of the associations indicates the profile of older adults who require greater attention and care related to improved nutrition. The illiterate or semi-literate aged individuals, those with low income, and those who neglect to seek medical advice must be the focus of healthy eating actions and programs.
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Affiliation(s)
- Laís M. R. Loureiro
- Department of Nutrition and Health, Universidade Federal de Viçosa, Viçosa, Brazil
| | | | - Carla J. Machado
- Department of Preventive and Social Medicine, School of Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Milene C. Pessoa
- Department of Nutrition and Health, Universidade Federal de Viçosa, Viçosa, Brazil
| | | | | | - Andréia Q. Ribeiro
- Department of Nutrition and Health, Universidade Federal de Viçosa, Viçosa, Brazil
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11
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Nóbrega JCL, Medeiros JB, Santos TTDM, Alves SAV, Freitas JLGDS, Silva JMM, Simões RFM, Brito ADL, Weller M, Santos JLDF, Menezes TN, Duarte YADO, Zatz M, Matheson D, Santos S. Socioeconomic Factors and Health Status Disparities Associated with Difficulty in ADLs and IADLs among Long-Lived Populations in Brazil: A Cross-Sectional Study. INQUIRY: The Journal of Health Care Organization, Provision, and Financing 2021; 58:469580211007264. [PMID: 33834861 PMCID: PMC8040385 DOI: 10.1177/00469580211007264] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Objective: To evaluate the association between socioeconomic factors, health status, and Functional Capacity (FC) in the oldest senior citizens in a metropolis and a poor rural region of Brazil. Method: Cross-sectional study of 417 seniors aged ≥80 years, data collected through Brazil’s Health, Well-being and Aging survey. FC assessed by self-reporting of difficulties in Activities of Daily Living (ADLs) and Instrumental Activities of Daily Living (IADLs). Chi-square tests and multiple logistic regression analyses were performed using “R” statistical software. Results: Socioeconomic and demographic inequalities in Brazil can influence FC in seniors aged 80 years and older. Comparatively, urban long-lived people had a higher prevalence of difficulties for ADLs and rural ones showed more difficulties for IADLs. Among urban oldest seniors, female gender and lower-income were correlated with difficulties for IADLs. Among rural oldest seniors, female gender, stroke, joint disease, and inadequate weight independently were correlated with difficulties for ADLs, while the number of chronic diseases was associated with difficulties for IADLs. Conclusion: Financial constraints may favor the development of functional limitations among older seniors in large urban centers. In poor rural areas, inadequate nutritional status and chronic diseases may increase their susceptibility to functional decline.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Mathias Weller
- Universidade Estadual da Paraíba, Campina Grande, Brazil
| | | | | | | | - Mayana Zatz
- Universidade de São Paulo, São Paulo, Brazil
| | | | - Silvana Santos
- Universidade Estadual da Paraíba, Campina Grande, Brazil
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12
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Association between instrumental activities of daily living with the change in left ventricular function in older patients with cardiovascular disease. Heart Vessels 2021; 36:1298-1305. [PMID: 33683410 DOI: 10.1007/s00380-021-01812-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2020] [Accepted: 02/19/2021] [Indexed: 01/09/2023]
Abstract
Left ventricular dysfunction is a pathophysiologic characteristic of heart failure. Impaired instrumental activities of daily living are associated with an elevated risk of mortality and heart failure in older adults. Nevertheless, the relationship between these activities and left ventricular function changes remains unclear. We determined whether instrumental activities of daily living are associated with subsequent left ventricular function changes in older cardiovascular disease patients. This retrospective cohort study included 383 outpatients with cardiovascular disease (74.5 ± 5.3 years, 273 males). Patients were divided according to the Frenchay activities index tertile and followed for six months after cardiovascular disease diagnosis. The left ventricular ejection fraction and annular early diastolic velocity (e') were measured for left ventricular systolic and diastolic function, respectively, at baseline and after one year. After adjusting for confounders, changes in the left ventricular ejection fraction were not significantly different. However, changes in the e' in the highest tertile group were significantly greater than in other groups. In the general linear model with multiple regression analysis, Frenchay activities index independently predicted the absolute change in the e'. In older cardiovascular disease patients, higher instrumental activities of daily living were associated with preserved left ventricular relaxation.
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13
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The prediction of mortality by quality of life assessed with the WHOQOL-BREF: a longitudinal analysis at the domain and item levels using a seven-year follow-up period. Qual Life Res 2021; 30:1951-1962. [PMID: 33620614 DOI: 10.1007/s11136-021-02790-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/05/2021] [Indexed: 10/22/2022]
Abstract
PURPOSE To determine the predictive value of quality of life for mortality at the domain and item levels. METHODS This longitudinal study was carried out in a sample of 479 Dutch people aged 75 years or older living independently, using a follow-up of 7 years. Participants completed a self-report questionnaire. Quality of life was assessed with the WHOQOL-BREF, including four domains: physical health, psychological, social relationships, and environment. The municipality of Roosendaal (a town in the Netherlands) indicated the dates of death of the individuals. RESULTS Based on mean, all quality of life domains predicted mortality adjusted for gender, age, marital status, education, and income. The hazard ratios ranged from 0.811 (psychological) to 0.933 (social relationships). The areas under the curve (AUCs) of the four domains were 0.730 (physical health), 0.723 (psychological), 0.693 (social relationships), and 0.700 (environment). In all quality of life domains, at least one item predicted mortality (adjusted). CONCLUSION Our study showed that all four quality of life domains belonging to the WHOQOL-BREF predict mortality in a sample of Dutch community-dwelling older people using a follow-up period of 7 years. Two AUCs were above threshold (psychological, physical health). The findings offer health care and welfare professionals evidence for conducting interventions to reduce the risk of premature death.
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14
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Varan HD, Kizilarslanoglu MC, Dogrul RT, Arik G, Esme M, Kara O, Kilic MK, Halil M, Cankurtaran M, Yavuz BB. Comparative Evaluation of Predictive Ability of Comprehensive Geriatric Assessment Components Including Frailty on Long-Term Mortality. Exp Aging Res 2021; 47:220-231. [PMID: 33491575 DOI: 10.1080/0361073x.2021.1876395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Background: This study aims to compare the predictive value of all comprehensive geriatric assessment (CGA) parameters with the predictive value of frailty assessment (with Edmonton Frailty Scale (EFS) and Fried Frailty Index (FFI)) for long-term mortality, in older adults.Methods: A total of 967 patients were included, consecutively. At the first admission, age, gender, comorbidities, number of drugs, and laboratory values of the patients were recorded. Each patient underwent CGA which consisted of anthropometric measurements, functional, cognitive, mood, nutritional, gait, fall, sleep duration, and frailty assessment. Fifty-seven months after the first admission, CGA parameters were analyzed to determine their predictive abilities on long-term mortality due to all causes, comparatively.Results: The median age was 73 years (range 65-94 years). The median follow-up time was 39.9 months (range 0.5-57.3 months). Serum albumin level, FFI, EFS, instrumental activity of daily living (IADL) score, and walking time were the best predictors of mortality. There was no significant difference between these parameters in predicting mortality.Conclusion: FFI and EFS have similar predictive value for mortality. In busy clinical practice, a new index based on IADL, walking time, and serum albumin level may be an alternative of frailty assessment for predicting mortality.
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Affiliation(s)
- Hacer Dogan Varan
- Department of Internal Medicine, Division of Geriatric Medicine, Hacettepe University Faculty of Medicine, Ankara, Turkey.,Department of Internal Medicine, Division of Geriatric Medicine, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Muhammet Cemal Kizilarslanoglu
- Department of Internal Medicine, Division of Geriatric Medicine, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Rana Tuna Dogrul
- Department of Internal Medicine, Division of Geriatric Medicine, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Gunes Arik
- Department of Internal Medicine, Division of Geriatric Medicine, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Mert Esme
- Department of Internal Medicine, Division of Geriatric Medicine, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Ozgur Kara
- Department of Internal Medicine, Division of Geriatric Medicine, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Mustafa Kemal Kilic
- Department of Internal Medicine, Division of Geriatric Medicine, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Meltem Halil
- Department of Internal Medicine, Division of Geriatric Medicine, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Mustafa Cankurtaran
- Department of Internal Medicine, Division of Geriatric Medicine, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Burcu Balam Yavuz
- Department of Internal Medicine, Division of Geriatric Medicine, Hacettepe University Faculty of Medicine, Ankara, Turkey
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15
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Gobbens RJJ, van der Ploeg T. The Prediction of Mortality by Disability Among Dutch Community-Dwelling Older People. Clin Interv Aging 2020; 15:1897-1906. [PMID: 33116444 PMCID: PMC7547136 DOI: 10.2147/cia.s271800] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2020] [Accepted: 08/09/2020] [Indexed: 11/23/2022] Open
Abstract
Objective To predict mortality by disability in a sample of 479 Dutch community-dwelling people aged 75 years or older. Methods A longitudinal study was carried out using a follow-up of seven years. The Groningen Activity Restriction Scale (GARS), a self-reported questionnaire with good psychometric properties, was used for data collection about total disability, disability in activities in daily living (ADL) and disability in instrumental activities in daily living (IADL). The mortality dates were provided by the municipality of Roosendaal (a city in the Netherlands). For analyses of survival, we used Kaplan–Meier analyses and Cox regression analyses to calculate hazard ratios (HR) with 95% confidence intervals (CI). Results All three disability variables (total, ADL and IADL) predicted mortality, unadjusted and adjusted for age and gender. The unadjusted HRs for total, ADL and IADL disability were 1.054 (95%-CI: [1.039;1.069]), 1.091 (95%-CI: [1.062;1.121]) and 1.106 (95%-CI: [1.077;1.135]) with p-values <0.001, respectively. The AUCs were <0.7, ranging from 0.630 (ADL) to 0.668 (IADL). Multivariate analyses including all 18 disability items revealed that only “Do the shopping” predicted mortality. In addition, multivariate analyses focusing on 11 ADL items and 7 IADL items separately showed that only the ADL item “Get around in the house” and the IADL item “Do the shopping” significantly predicted mortality. Conclusion Disability predicted mortality in a seven years follow-up among Dutch community-dwelling older people. It is important that healthcare professionals are aware of disability at early stages, so they can intervene swiftly, efficiently and effectively, to maintain or enhance the quality of life of older people.
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Affiliation(s)
- Robbert J J Gobbens
- Faculty of Health, Sports and Social Work, Inholland University of Applied Sciences, Amsterdam, the Netherlands.,Zonnehuisgroep Amstelland, Amstelveen, the Netherlands.,Department of Primary and Interdisciplinary Care, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Tjeerd van der Ploeg
- Faculty of Engineering, Design and Computer Technology, Inholland University of Applied Sciences, Alkmaar, the Netherlands
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16
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CAUSES, mortality rates and risk factors of death in community-dwelling Europeans aged 50 years and over: Results from the Survey of Health, Ageing and Retirement in Europe 2013-2015. Arch Gerontol Geriatr 2020; 89:104035. [PMID: 32325305 DOI: 10.1016/j.archger.2020.104035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Revised: 11/11/2019] [Accepted: 02/18/2020] [Indexed: 12/31/2022]
Abstract
OBJECTIVE To determine mortality rates and to rank the causes and predictors of mortality using a wide range of sociodemographic and clinical variables. MATERIALS AND METHODS It is a prospective population-based cohort study of adults living in the community, 2013-15 N = 48,691, age ≥50; deceased = 1,944. Clinical and sociodemographic data were obtained from the Survey of Health, Ageing and Retirement in Europe SHARE: Age, Gender, Marital Status, Years of Schooling, Income, Loneliness, Cognition, Self-Rated Health, Diseases, Activities of daily living ADL, and Frailty. Mortality rates were calculated. A Cox proportional hazards model were used to determine risk-adjusted mortality ratios. RESULTS The crude mortality rate was 18.39 (1000 person-years at risk), (99 % CI, 18.37-18.42). The factors most associated with an increased mortality risk were older age, lower self-rated health, lower cognition, male gender, ADL deficits, higher comorbidity, frailty and loneliness. The diseases with a higher mortality risk were: cancer (Hazard ratio, HR = 2.67), dementia (HR = 2.19), depressive symptoms (HR = 2.10), fractures (hip, femur) (HR = 1.57), stroke (HR = 1.55), chronic lung disease (HR = 1.52), diabetes (HR = 1.36) and heart attack (HR = 1.21). CONCLUSIONS The main mortality risk factors, associated independently in the eight diseases were: older age, poor self-rated health, ADL deficits, male gender, lower cognition, comorbidity and the presence of depressive symptoms, with a different influence in the European regions. The need to evaluate and treat the depressive symptoms that accompanies diseases with higher risk of mortality is stressed.
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17
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de Cock TP, Rosato M, Ferry F, Curran E, Leavey G. Patterns of long-term conditions in older age and subsequent mortality: a national study of inequalities in health. Eur J Public Health 2019; 30:588-594. [DOI: 10.1093/eurpub/ckz194] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
AbstractBackgroundMultiple long-term health conditions in older people are associated with increased mortality. The study aims to identify patterns of long-term health in a national ageing population using a census-based self-reported indicator of long-term health conditions. We assessed associations with subsequent mortality and socio-economic and demographic risk factors.MethodsUsing linked administrative data from the Northern Ireland Mortality Study, we assessed the presence of latent classes of morbidity in self-reported data on 11 long-term health conditions in a population aged 65 or more (N = 244 349). These classes were associated with demographic and socio-economic predictors using multi-nomial logistic regression. In a 3.75-year follow-up, all-cause and cause-specific mortality were regressed on morbidity patterns.ResultsFour latent classes of long-term ill-health conditions were derived, and labelled: ‘low impairment’; ‘pain/mobility’; ‘cognitive/mental’; ‘sensory impairment’. Groupings reflecting higher levels of long-term ill-health were associated with class-specific increases in all-cause and cause-specific mortality. Strongest effects were found for the ‘cognitive/mental’ group, which predicted all-cause mortality [hazard ratio (HR) = 2.96: 95% confidence interval (CI) = 2.83, 3.10) as well as some cause-specific mortality (i.e. dementia-related death: HR = 10.78: 95% CI = 9.39, 12.15). Class membership was predicted by a range of socio-demographic factors. Lower socio-economic status was associated with poorer health.ConclusionResults indicate that long-term ill-health clusters in specific patterns, which are both predicted by socio-demographic factors and are themselves predictive of mortality in the elderly. The syndromic nature of long-term ill-health and functioning in ageing populations has implications for healthcare planning and public health policy in older populations.
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Affiliation(s)
- T Paul de Cock
- Bamford Centre for Mental Health and Wellbeing, Ulster University, Northern Ireland, UK
| | - Michael Rosato
- Bamford Centre for Mental Health and Wellbeing, Ulster University, Northern Ireland, UK
| | - Finola Ferry
- Bamford Centre for Mental Health and Wellbeing, Ulster University, Northern Ireland, UK
| | - Emma Curran
- Bamford Centre for Mental Health and Wellbeing, Ulster University, Northern Ireland, UK
| | - Gerard Leavey
- Bamford Centre for Mental Health and Wellbeing, Ulster University, Northern Ireland, UK
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18
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Valenzuela PL, Castillo-García A, Morales JS, Izquierdo M, Serra-Rexach JA, Santos-Lozano A, Lucia A. Physical Exercise in the Oldest Old. Compr Physiol 2019; 9:1281-1304. [PMID: 31688965 DOI: 10.1002/cphy.c190002] [Citation(s) in RCA: 64] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Societies are progressively aging, with the oldest old (i.e., those aged >80-85 years) being the most rapidly expanding population segment. However, advanced aging comes at a price, as it is associated with an increased incidence of the so-called age-related conditions, including a greater risk for loss of functional independence. How to combat sarcopenia, frailty, and overall intrinsic capacity decline in the elderly is a major challenge for modern medicine, and exercise appears to be a potential solution. In this article, we first summarize the physiological mechanisms underlying the age-related deterioration in intrinsic capacity, particularly regarding those phenotypes related to functional decline. The main methods available for the physical assessment of the oldest old are then described, and finally the multisystem benefits that exercise (or "exercise mimetics" in those situations in which volitional exercise is not feasible) can provide to this population segment are reviewed. In summary, lifetime physical exercise can help to attenuate the loss of many of the properties affected by aging, especially when the latter is accompanied by an inactive lifestyle and benefits can also be obtained in frail individuals who start exercising at an advanced age. Multicomponent programs combining mainly aerobic and resistance training should be included in the oldest old, particularly during disuse situations such as hospitalization. However, evidence is still needed to support the effectiveness of passive physical strategies including neuromuscular electrical stimulation or vibration for the prevention of disuse-induced negative adaptations in those oldest old people who are unable to do physical exercise. © 2019 American Physiological Society. Compr Physiol 9:1281-1304, 2019.
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Affiliation(s)
- Pedro L Valenzuela
- Department of Systems Biology, University of Alcalá, Madrid, Spain
- Department of Sport and Health, Spanish Agency for Health Protection in Sport (AEPSAD), Madrid, Spain
| | | | - Javier S Morales
- Faculty of Sport Sciences, Universidad Europea de Madrid, Madrid, Spain
| | - Mikel Izquierdo
- Biomedical Research Networking Center on Frailty and Healthy Aging (CIBERFES), Madrid, Spain
- Department of Health Sciences, Public University of Navarra, Navarrabiomed, Idisna, Pamplona, Spain
| | - José A Serra-Rexach
- Biomedical Research Networking Center on Frailty and Healthy Aging (CIBERFES), Madrid, Spain
- Department of Geriatric, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Alejandro Santos-Lozano
- i+HeALTH, European University Miguel de Cervantes, Valladolid, Spain and Research Institute Hospital 12 de Octubre (ì+12'), Madrid, Spain
| | - Alejandro Lucia
- Faculty of Sport Sciences, Universidad Europea de Madrid, Madrid, Spain
- Biomedical Research Networking Center on Frailty and Healthy Aging (CIBERFES), Madrid, Spain
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19
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Silva SLAD, Peixoto SV, Lima-Costa MF, Simões TC. [Effect of age, period, and birth cohort on incapacity in community-dwelling elderly: the Bambuí Elderly Cohort (1997-2012)]. CAD SAUDE PUBLICA 2019; 35:e00156018. [PMID: 31508696 DOI: 10.1590/0102-311x00156018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Accepted: 03/14/2019] [Indexed: 11/22/2022] Open
Abstract
Time trends in the prevalence rates of incapacity in the elderly can occur due to the effects of age, period, or cohort. Age is related to biological factors, the period to the subject's environmental context, and the cohort to the subject's exposures from birth to the present. The study aimed to verify which time dimensions most influence the evolution in the prevalence of incapacity in the elderly over the course of 15 years. Data were used from the Bambuí Elderly Cohort, and incapacity was assessed by report of "great difficulty" or "inability" to perform at least one of the activities related to mobility and basic and instrumental activities of daily living. The analysis was done with the age-period-cohort model for aggregate data, with calculation of the effects of time dimensions by analysis of deviance. A Poisson regression model determined the associations between age, period, and cohort and prevalence of incapacity, considering the total population and stratification by sex and schooling. Period effect was the most important for the three dimensions of incapacity, with an increase in prevalence at the start of the period, followed by a reduction over time, with minor differences in relation to sex and schooling. Cohort effect was significant, although less important than period effect. The results highlight the importance of analyzing the elder's environment for reducing prevalence of incapacity, with an emphasis on policies and programs that can positively impact the time trend in this outcome, given the consistent effect of period observed in this study.
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Affiliation(s)
| | - Sérgio Viana Peixoto
- Instituto de Pesquisas René Rachou, Fundação Oswaldo Cruz, Belo Horizonte, Brasil.,Universidade Federal de Minas Gerais, Belo Horizonte, Brasil
| | | | - Taynãna César Simões
- Instituto de Pesquisas René Rachou, Fundação Oswaldo Cruz, Belo Horizonte, Brasil
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20
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Mendes J, Santos A, Borges N, Afonso C, Moreira P, Padrão P, Negrão R, Amaral TF. Vitamin D status and functional parameters: A cross-sectional study in an older population. PLoS One 2018; 13:e0201840. [PMID: 30130370 PMCID: PMC6103509 DOI: 10.1371/journal.pone.0201840] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Accepted: 07/23/2018] [Indexed: 12/16/2022] Open
Abstract
The present study aims to clarify the association of vitamin D status with functionality, measured through gait speed and hand grip strength, in a sample of older adults, considering sex-specific characteristics and the potential confounding effect of lifestyle factors, disease, skin phenotype, season of blood collection and vitamin D supplementation. The Nutrition UP 65 cross-sectional study was conducted in a population-based sample of 1,425 older adults ≥ 65 years old. Serum levels of 25-hydroxyvitamin D were quantified through electrochemiluminescence immunoassay. Multinomial logistic regressions were carried out using quartiles of gait speed and of hand grip strength as dependent variables. Participants at risk of vitamin D inadequacy (30.0-49.9 nmol/L) and deficiency (< 30.0 nmol/L) presented higher adjusted odds ratio of the lowest values of gait speed and hand grip strength than those with adequate vitamin D levels (≥ 50.0 nmol/L). These associations were strongest among men at risk of vitamin D deficiency [adjusted odds ratio for the lowest quartile of gait speed = 3.24; 95% CI: 1.56–6.73 and for the lowest quartile of hand grip strength = 3.28; 95% CI: 1.47-7.31] than in women at risk of vitamin D deficiency [adjusted odds ratio for the lowest quartile of gait speed = 2.72; 95% CI: 1.37-5.41 and for the lowest quartile of hand grip strength = 1.56; 95% CI: 0.81–3.00]. In conclusion, in older adults, particularly in men, the risk of vitamin D deficiency was directly associated with the lowest values of gait speed and of hand grip strength. However, randomized controlled trials are needed to overcome the possibility of reverse causation and residual confounding. Present results emphasise the need for strategies to promote the reduction of the high prevalence of low vitamin D status among the Portuguese older adult population.
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Affiliation(s)
- J. Mendes
- Department of Biomedicine, Biochemistry Unit, Faculty of Medicine, University of Porto, Porto, Portugal
- I3S - Institute for Research and Innovation in Health, University of Porto, Porto, Portugal
- * E-mail:
| | - A. Santos
- I3S - Institute for Research and Innovation in Health, University of Porto, Porto, Portugal
- Faculty of Nutrition and Food Sciences, University of Porto, Porto, Portugal
| | - N. Borges
- Faculty of Nutrition and Food Sciences, University of Porto, Porto, Portugal
- CINTESIS - Centre for Health Technology and Services Research, Porto, Portugal
| | - C. Afonso
- Faculty of Nutrition and Food Sciences, University of Porto, Porto, Portugal
| | - P. Moreira
- Faculty of Nutrition and Food Sciences, University of Porto, Porto, Portugal
- EPIUnit, Institute of Public Health, University of Porto, Porto, Portugal
- The Research Centre in Physical Activity, Health and Leisure, University of Porto, Porto, Portugal
| | - P. Padrão
- Faculty of Nutrition and Food Sciences, University of Porto, Porto, Portugal
- EPIUnit, Institute of Public Health, University of Porto, Porto, Portugal
| | - R. Negrão
- Department of Biomedicine, Biochemistry Unit, Faculty of Medicine, University of Porto, Porto, Portugal
- I3S - Institute for Research and Innovation in Health, University of Porto, Porto, Portugal
| | - T. F. Amaral
- Faculty of Nutrition and Food Sciences, University of Porto, Porto, Portugal
- System Integration and Process Automation Unit (UISPA), Mechanical Engineering Institute (IDMEC), Faculty of Engineering, University of Porto, Porto, Portugal
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