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Lai A, Morgan A, Richardson J, Griffith LE, Kuspinar A, Smith-Turchyn J. Pre-Clinical Mobility Limitation (PCML) Outcomes in Rehabilitation Interventions for Middle-Aged and Older Adults: A Scoping Review. Can J Aging 2023:1-12. [PMID: 37981438 DOI: 10.1017/s0714980823000685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2023] Open
Abstract
Individuals with pre-clinical mobility limitation (PCML) are at a high risk of future functional loss and progression to disability. The purpose of this scoping review was to provide a comprehensive understanding of PCML intervention studies in middle-aged and older adults. We present the interventions that have been tested or planned, describe how they have been conducted and reported, identify the knowledge gaps in current literature, and make recommendations about future research directions. An initial search of 2,291 articles resulted in 14 articles that met criteria for inclusion. Findings reveal that: (1) there is limited published work on PCML interventions, especially in middle-aged populations; and (2) the complexity and variety of PCML measures make it difficult to compare findings across PCML studies. Despite the diversity of measures, this review provides preliminary evidence that rehabilitation interventions on PCML help to delay or prevent disability progression.
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Affiliation(s)
- Aiping Lai
- School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada
| | - Ashley Morgan
- School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada
| | - Julie Richardson
- School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Lauren E Griffith
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Ayse Kuspinar
- School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada
| | - Jenna Smith-Turchyn
- School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada
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2
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Richardson J, Beauchamp M, Bean J, Brach J, Chaves PHM, Guralnik JM, Jette AM, Leveille SG, Hoenig H, Manini T, Marottoli R, Porter MM, Sinclair S, Letts L, Kuspinar A, Vrkljan B, Morgan A, Mirbaha S. Defining and Measuring Preclinical Mobility Limitation: An Expert Consensus Exercise Informed by a Scoping Review. J Gerontol A Biol Sci Med Sci 2023; 78:1641-1650. [PMID: 37300461 DOI: 10.1093/gerona/glad143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Indexed: 06/12/2023] Open
Abstract
BACKGROUND Early change in function in older adults has been termed preclinical disability (PCD). PCD has been understudied compared to other stages of disability because it is unlikely to receive comparative priority in clinical settings. It has major implications for prevention and population health as it may be the optimal time to intervene to prevent further decline. A standardized approach to research in PCD, including a common definition and measurement approaches, is needed to advance this work. METHODS The process to establish how PCD should be defined and measured was undertaken in 2 stages: (1) a scoping review of the literature, which was used to inform (2) a web-enabled consensus meeting with content experts. RESULTS The scoping review and the consensus meeting support the use of the term preclinical mobility limitation (PCML) and that it should be measured using both patient-reported and performance-based measures. It was agreed that the definition of PCML should include modification of frequency and/or method of task completion, without overt disability, and that requisite mobility tasks include walking (distance and speed), stairs, and transfers. CONCLUSIONS Currently, there are few standardized assessments that can identify PCML. PCML is the term that most clearly describes the stage where people experience a change in routine mobility tasks, without a perception of disability. Further evaluation into the reliability, validity, and responsiveness of outcome measures is needed to advance research on PCML.
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Affiliation(s)
- Julie Richardson
- School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada
- Department of Health Research Methods, Evidence, and Impact (HEI), McMaster University, Hamilton, Ontario, Canada
| | - Marla Beauchamp
- School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada
| | - Jonathan Bean
- Faculty of Health Sciences, Department of PM&R, Harvard Medical School, Boston, Massachusetts, USA
- New England Geriatric Research Education and Clinical Center, VA Boston Healthcare System, Bedford VAMC, Boston, Massachusetts, USA
| | - Jennifer Brach
- School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Paulo H M Chaves
- Benjamin Leon Center for Geriatric Research and Education, Florida International University, Miami, Florida, USA
- Department of Translational Medicine, Herbert Wertheim College of Medicine, Florida International University, Miami, Florida, USA
| | - Jack M Guralnik
- Epidemiology & Public Health, School of Medicine, University of Maryland, Baltimore, Baltimore, Maryland, USA
| | - Alan M Jette
- Department of Physical Therapy & Athletic Training, College of Health and Rehabilitation Sciences, Boston University, Boston, Massachusetts, USA
| | - Suzanne G Leveille
- Manning College of Nursing and Health Sciences, University of Massachusetts Boston, Boston, Massachusetts, USA
| | - Helen Hoenig
- Duke University School of Medicine, Physical Medicine and Rehabilitation Service, Durham VA Medical Center, Durham, North Carolina, USA
| | - Todd Manini
- Institute on Aging, Department of Aging & Geriatric Research, College of Medicine, University of Florida, Gainesville, Florida, USA
| | - Richard Marottoli
- Department of Geriatric Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Michelle M Porter
- Centre on Aging, University of Manitoba, Winnipeg, Manitoba, Canada
- Faculty of Kinesiology and Recreation Management, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Susanne Sinclair
- School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada
| | - Lori Letts
- School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada
| | - Ayse Kuspinar
- School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada
| | - Brenda Vrkljan
- School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada
| | - Ashley Morgan
- School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada
| | - Shaghayegh Mirbaha
- School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada
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Shuman V, Brach JS, Bean JF, Freburger JK. Prevalence and Predictors of Ambulatory Care Physicians' Documentation of Mobility Limitations in Older Adults. Arch Phys Med Rehabil 2023; 104:719-727. [PMID: 36731767 PMCID: PMC10164109 DOI: 10.1016/j.apmr.2022.11.018] [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: 09/20/2022] [Revised: 11/15/2022] [Accepted: 11/21/2022] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To determine how often physicians document mobility limitations in visits with older adults, and which patient, physician, and practice characteristics associate with documented mobility limitations. DESIGN We completed a cross-sectional analysis of National Ambulatory Medical Care Surveys, years 2012-2016. Multivariate analyses were conducted to identify patient, physician, and practice-level factors associated with mobility limitation documentation. SETTING Ambulatory care visits. PARTICIPANTS We analyzed visits with adults 65 years and older. Final sample size represented 1.3 billion weighted visits. INTERVENTION Not applicable. MAIN OUTCOME MEASURE We defined the presence/absence of a mobility limitation by whether any International Classification of Diseases (ICD)-9 or ICD-10 code related to mobility limitations, injury codes, or the patient's "reasons for visit" were documented in the visits. RESULTS The overall prevalence of mobility limitation documentation was 2.4%. The most common codes were falls-related. Patient-level factors more likely to be associated with mobility limitation documentation were visits by individuals over 85 years of age, relative to 65-69 years, (odds ratio 2.32, 95% confidence interval 1.76-3.07]; with a comorbid diagnosis of arthritis (odds ratio 1.35, 1.18-2.01); and with a comorbid diagnosis of cerebrovascular disease (odds ratio 1.60, 1.13-2.26). Patient-level factors less likely to be associated with mobility limitation documentation were visits by men (odds ratio 0.80, 0.64-0.99); individuals with a cancer diagnosis (odds ratio 0.76, 0.58-0.99); and by individuals seeking care for a chronic problem (relative to a new problem [odds ratio 0.36, 0.29-0.44]). Physician-level factors associated with an increased likelihood of mobility limitation documentation were visits to neurologists (odds ratios 4.48, 2.41-8.32) and orthopedists (odds ratio 2.67, 1.49-4.79) compared with primary care physicians. At the practice-level, mobility documentation varied based on the percentage of practice revenue from Medicare. CONCLUSIONS Mobility limitations are under-documented and may be primarily captured when changes in function are overt.
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Affiliation(s)
- Valerie Shuman
- Department of Physical Therapy, School of Health and Rehabilitation Science, University of Pittsburgh, Pittsburgh, PA.
| | - Jennifer S Brach
- Department of Physical Therapy, School of Health and Rehabilitation Science, University of Pittsburgh, Pittsburgh, PA
| | - Jonathan F Bean
- New England Geriatric Research and Education Clinical Center (GRECC), VA Boston Healthcare System, Boston, MA; Department of PM&R, Harvard Medical School, Boston, MA; Spaulding Rehabilitation Hospital, Boston, MA, USA
| | - Janet K Freburger
- Department of Physical Therapy, School of Health and Rehabilitation Science, University of Pittsburgh, Pittsburgh, PA
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Malaguarnera M, Catania VE, Malaguarnera M. Carnitine derivatives beyond fatigue: an update. Curr Opin Gastroenterol 2023; 39:125-128. [PMID: 36821461 PMCID: PMC10516168 DOI: 10.1097/mog.0000000000000906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
Abstract
PURPOSE OF REVIEW Carnitine is an essential micronutrient that transfer long-chain fatty acids from the cytoplasm into the mitochondrial matrix for the β-oxidation. Carnitine is also needed for the mitochondrial efflux of acyl groups in the cases wherein substrate oxidation exceeds energy demands. RECENT FINDINGS Carnitine deficiency can affect the oxidation of free fatty acids in the mitochondria resulting in the aggregation of lipids in the cytoplasm instead of entering the citric acid cycle. The aggregation leads a lack of energy, acetyl coenzyme A accumulation in the mitochondria and cytotoxic production. SUMMARY Carnitine and its derivatives show great clinical therapeutic effect without significant side effects.
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Malaguarnera G, Catania VE, Bertino G, Chisari LM, Castorina M, Bonfiglio C, Cauli O, Malaguarnera M. Acetyl-L-carnitine Slows the Progression from Prefrailty to Frailty in Older Subjects: A Randomized Interventional Clinical Trial. Curr Pharm Des 2022; 28:3158-3166. [PMID: 36043711 DOI: 10.2174/1381612828666220830092815] [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: 02/08/2022] [Accepted: 06/14/2022] [Indexed: 01/28/2023]
Abstract
BACKGROUND Ageing is characterized by a gradual decline in body function, representing the clinical situation called "frailty". Prefrailty is the intermediate stage between frailty and robust condition. L-carnitine (LC) plays an important role in energy production from long-chain fatty acids in mitochondria, and its serum level is lower in prefrail and frail subjects. OBJECTIVE This study aims to evaluate the effect of Acetyl-L-carnitine (ALCAR) in pre-frail older patients. METHODS We scheduled 3 months of treatment and then 3 months of follow-up. A total of 92 subjects were selected from May, 2009 to July, 2017, in a randomized, observational, double-blind, placebo-controlled study. We scheduled 3 months of treatment and then 3 months of follow-up. ALCAR (oral 1.5 g/bis in die - BID) or placebo groups were used. RESULTS After the treatment, only the treated group displayed a decrease in C reactive protein (CRP) p < 0.001 and an increase in serum-free carnitine and acetylcarnitine (p < 0.05) in Mini-Mental state (MMSE) p < 0.0001 and 6-walking distance (p < 0.0001); ALCAR group vs. placebo group showed a decrease in HDL cholesterol and CRP (p < 0.01), an increase in MMSE score (p < 0.001) and in the 6-walking distance (p < 0.001). CONCLUSIONS ALCAR treatment delays the incidence and severity of onset of degenerative disorders of the elderly in prefrail subjects with improvement in memory and cognitive processes.
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Affiliation(s)
- Giulia Malaguarnera
- Department of Biomedical and Biotechnological Science, University of Catania, Catania, Italy
| | - Vito Emanuele Catania
- Department of Medical, Surgical Sciences and Advanced Technologies "G.F. Ingrassia", University of Catania, Catania, Italy
| | - Gaetano Bertino
- Hepatology Unit, A.O.U. Policlinico- San Marco, Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Laura Maria Chisari
- Department of Biomedical and Biotechnological Science, University of Catania, Catania, Italy
| | | | | | - Omar Cauli
- Department of Nursing, Faculty of Nursing and Podiatry, University of Valencia, c/Jaume Roig s/n, 46010 Valencia, Spain.,Frailty and Cognitive Impairment Organized Group (FROG), University of Valencia, 46010 Valencia, Spain
| | - Michele Malaguarnera
- Department of Biomedical and Biotechnological Science, University of Catania, Catania, Italy.,Department of Psychobiology, Facultad de Psicología, Universidad de Valencia, Avda. Blasco Ibáñez, 21, 46010, Valencia, Spain
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Buta B, Zheng S, Langdon J, Adeosun B, Bandeen-Roche K, Walston J, Xue QL. Agreement between standard and self-reported assessments of physical frailty syndrome and its components in a registry of community-dwelling older adults. BMC Geriatr 2022; 22:705. [PMID: 36008767 PMCID: PMC9403951 DOI: 10.1186/s12877-022-03376-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 08/09/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The ability to identify frail older adults using a self-reported version of the physical frailty phenotype (PFP) that has been validated with the standard PFP could facilitate physical frailty detection in clinical settings. METHODS We collected data from volunteers (N = 182), ages 65 years and older, in an aging research registry in Baltimore, Maryland. Measurements included: standard PFP (walking speed, grip strength, weight loss, activity, exhaustion); and self-reported questions about walking and handgrip strength. We compared objectively-measured gait speed and grip strength to self-reported questions using Cohen's Kappa and diagnostic accuracy tests. We used these measures to compare the standard PFP with self-reported versions of the PFP, focusing on a dichotomized identification of frail versus pre- or non-frail participants. RESULTS Self-reported slowness had fair-to-moderate agreement (Kappa(k) = 0.34-0.56) with measured slowness; self-reported and objective weakness had slight-to-borderline-fair agreement (k = 0.10-0.21). Combining three self-reported slowness questions had highest sensitivity (81%) and negative predictive value (NPV; 91%). For weakness, three questions combined had highest sensitivity (72%), while all combinations had comparable NPV. Follow-up questions on level of difficulty led to minimal changes in agreement and decreased sensitivity. Substituting subjective for objective measures in our PFP model dichotomized by frail versus non/pre-frail, we found substantial (k = 0.76-0.78) agreement between standard and self-reported PFPs. We found highest sensitivity (86.4%) and NPV (98.7%) when comparing the dichotomized standard PFP to a self-reported version combining all slowness and weakness questions. Substitutions in a three-level model (frail, vs pre-frail, vs. non-frail) resulted in fair-to-moderate agreement (k = 0.33-0.50) with the standard PFP. CONCLUSIONS Our results show potential utility as well as challenges of using certain self-reported questions in a modified frailty phenotype. A self-reported PFP with high agreement to the standard phenotype could be a valuable frailty screening assessment in clinical settings.
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Affiliation(s)
- Brian Buta
- Center On Aging and Health, Johns Hopkins University, 2024 E. Monument Street, Suite 2-700, MD, 21205, Baltimore, USA.
- Department of Medicine, Division of Geriatric Medicine and Gerontology, Johns Hopkins University School of Medicine, Baltimore, USA.
| | - Scott Zheng
- Duke University School of Medicine, Durham, USA
| | - Jackie Langdon
- Department of Medicine, Division of Geriatric Medicine and Gerontology, Johns Hopkins University School of Medicine, Baltimore, USA
| | - Bukola Adeosun
- Department of Medicine, Division of Geriatric Medicine and Gerontology, Johns Hopkins University School of Medicine, Baltimore, USA
| | - Karen Bandeen-Roche
- Center On Aging and Health, Johns Hopkins University, 2024 E. Monument Street, Suite 2-700, MD, 21205, Baltimore, USA
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | - Jeremy Walston
- Center On Aging and Health, Johns Hopkins University, 2024 E. Monument Street, Suite 2-700, MD, 21205, Baltimore, USA
- Department of Medicine, Division of Geriatric Medicine and Gerontology, Johns Hopkins University School of Medicine, Baltimore, USA
| | - Qian-Li Xue
- Center On Aging and Health, Johns Hopkins University, 2024 E. Monument Street, Suite 2-700, MD, 21205, Baltimore, USA
- Department of Medicine, Division of Geriatric Medicine and Gerontology, Johns Hopkins University School of Medicine, Baltimore, USA
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de Souza LF, Canever JB, Moreira BDS, Danielewicz AL, de Avelar NCP. Association Between Fear of Falling and Frailty in Community-Dwelling Older Adults: A Systematic Review. Clin Interv Aging 2022; 17:129-140. [PMID: 35173427 PMCID: PMC8843349 DOI: 10.2147/cia.s328423] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 01/25/2022] [Indexed: 01/10/2023] Open
Abstract
Background/Objective Fear of falling (FoF) and frailty are common problems in older adults. FoF can lead to self-imposed restriction of activities and then further decline in physical capacities that predispose older adults to frailty. Evaluating the association of these two geriatric syndromes may be the first step for understanding their complex relationship and might ultimately lead to establishing therapeutic goals and guiding treatments for older adults with frailty. This systematic review was conducted to provide evidence regarding the association between FoF and frailty. Methods All the articles that provided information on the association between FoF and frailty were selected from PubMed, Scopus, CINAHL, and EMBASE in search of relevant papers. Articles reporting information on the association between FoF (exposure) and frailty (outcome), with older adults (age ≥60 years) living in the community (ie, living either at home or in places of residence that do not provide nursing care or rehabilitation) were included. Only original articles with observational design (cross-sectional or longitudinal/cohort) were included. The methodological quality of included articles was evaluated independently by the two assessors through the Newcastle-Ottawa Scale (NOS) and the Joanna Briggs Institute (JBI) critical appraisal checklist for longitudinal and cross-sectional studies, respectively. Results The initial searches found 4,342 articles, of which 10 articles were included in this review: 7 cross-sectional and 2 longitudinal studies, and 1 study with cross-sectional and longitudinal analyses. The total sample was composed of 6,294 community-dwelling older adults (61.8% women). Among the longitudinal studies, adjusted odds ratios ranged from 1.18 (95% CI = 1.02; 1.36) to 9.87 (95% CI = 5.22; 18.68), while the adjusted odds ratios of the cross-sectional studies ranged from 1.04 (95% CI = 1.02; 1.07) to 7.16 (95% CI = 2.34; 21.89). Conclusion FoF increases the risk of frailty in community-dwelling older adults. The knowledge of this association is of utmost importance in clinical practice, since it can help health professionals in the development of rehabilitation, prevention, and health promotion protocols. In addition, these findings can contribute to the development of public health policies and actions aimed at reducing the FoF and consequently the frailty. Prospero CRD42021276775.
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Affiliation(s)
- Larissa Franciny de Souza
- Laboratory of Aging, Resources and Rheumatology, Department of Health Sciences, Federal University of Santa Catarina, Araranguá, Santa Catarina, Brazil
| | - Jaquelini Betta Canever
- Laboratory of Aging, Resources and Rheumatology, Department of Health Sciences, Federal University of Santa Catarina, Araranguá, Santa Catarina, Brazil
| | - Bruno de Souza Moreira
- René Rachou Institute, Oswaldo Cruz Foundation (Fiocruz Minas), Belo Horizonte, Minas Gerais, Brazil
- Correspondence: Bruno de Souza Moreira, René Rachou Institute, Oswaldo Cruz Foundation (Fiocruz Minas), Augusto de Lima Avenue 1715, Barro Preto, Belo Horizonte, Minas Gerais, 30190-002, Brazil, Tel +55 31 3349-7707, Email
| | - Ana Lúcia Danielewicz
- Laboratory of Aging, Resources and Rheumatology, Department of Health Sciences, Federal University of Santa Catarina, Araranguá, Santa Catarina, Brazil
| | - Núbia Carelli Pereira de Avelar
- Laboratory of Aging, Resources and Rheumatology, Department of Health Sciences, Federal University of Santa Catarina, Araranguá, Santa Catarina, Brazil
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Speiser JL, Callahan KE, Ip EH, Miller ME, Tooze JA, Kritchevsky SB, Houston DK. Predicting Future Mobility Limitation in Older Adults: A Machine Learning Analysis of Health ABC Study Data. J Gerontol A Biol Sci Med Sci 2021; 77:1072-1078. [PMID: 34529794 DOI: 10.1093/gerona/glab269] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Mobility limitation in older adults is common and associated with poor health outcomes and loss of independence. Identification of at-risk individuals remains challenging because of time-consuming clinical assessments and limitations of statistical models for dynamic outcomes over time. Therefore, we aimed to develop machine learning models for predicting future mobility limitation in older adults using repeated measures data. METHODS We used annual assessments over nine years of follow-up from the Health, Aging, and Body Composition study to model mobility limitation, defined as self-report of any difficulty walking a quarter mile or climbing 10 steps. We considered 46 predictors, including demographics, lifestyle, chronic conditions and physical function. With a split sample approach, we developed mixed models (generalized linear and Binary Mixed Model forest) using: 1) all 46 predictors, 2) a variable selection algorithm, and 3) the top five most important predictors. Age was included in all models. Performance was evaluated using area under the receiver operating curve (AUC) in two internal validation datasets. RESULTS AUC ranged from 0.80-0.84 for the models. The most important predictors of mobility limitation were ease of getting up from a chair, gait speed, self-reported health status, body mass index and depression. CONCLUSIONS Machine learning models using repeated measures had good performance for identifying older adults at-risk of developing mobility limitation. Future studies should evaluate the utility and efficiency of the prediction models as a tool in clinical settings for identifying at-risk older adults who may benefit from interventions aimed to prevent or delay mobility limitation.
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Affiliation(s)
- Jaime Lynn Speiser
- Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, NC
| | - Kathryn E Callahan
- Department of Internal Medicine, Section on Gerontology and Geriatric Medicine, Wake Forest School of Medicine, Winston-Salem, NC
| | - Edward H Ip
- Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, NC
| | - Michael E Miller
- Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, NC
| | - Janet A Tooze
- Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, NC
| | - Stephen B Kritchevsky
- Department of Internal Medicine, Section on Gerontology and Geriatric Medicine, Wake Forest School of Medicine, Winston-Salem, NC
| | - Denise K Houston
- Department of Internal Medicine, Section on Gerontology and Geriatric Medicine, Wake Forest School of Medicine, Winston-Salem, NC
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Kline CE, Colvin AB, Pettee Gabriel K, Karvonen-Gutierrez CA, Cauley JA, Hall MH, Matthews KA, Ruppert KM, Neal-Perry GS, Strotmeyer ES, Sternfeld B. Associations between longitudinal trajectories of insomnia symptoms and sleep duration with objective physical function in postmenopausal women: the Study of Women's Health Across the Nation. Sleep 2021; 44:6168369. [PMID: 33705558 DOI: 10.1093/sleep/zsab059] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 02/17/2021] [Indexed: 12/26/2022] Open
Abstract
STUDY OBJECTIVES Examine the association between trajectories of self-reported insomnia symptoms and sleep duration over 13 years with objective physical function. METHODS We utilized data from 1627 Study of Women's Health Across the Nation (SWAN) participants, aged 61.9±2.7 y at the end of the 13-y follow-up. Latent class growth models identified trajectories of insomnia symptoms (trouble falling asleep, frequent night-time awakenings, and/or early-morning awakening) and sleep duration over 13 y. Physical function tests were performed at the end of the 13-y period: 40-ft walk, 4-m walk, repeated chair stand, grip strength, and balance. Multivariable regression analyses examined each physical function measure according to the insomnia symptom or sleep duration trajectory group. RESULTS Five insomnia symptom trajectories and two sleep duration trajectories were identified. Women with a consistently high likelihood of insomnia symptoms and women with a decreased likelihood of insomnia symptoms (i.e., improving) had slower gait speed (3.5% slower 40-ft walk [consistently high], 3.7% slower 4-m walk [improving]; each P≤.05) than those with a consistently low likelihood of insomnia symptoms. In contrast, women with a steep increase in the likelihood of insomnia symptoms over time and women with persistent insufficient sleep duration had lower odds of having a balance problem (odds ratio [OR]=0.36 and OR=0.61, respectively; each P<.02) compared to those with a consistently low likelihood of insomnia symptoms and those with persistent sufficient sleep duration, respectively. CONCLUSION These results suggest that women's sleep during midlife has important implications for maintaining physical function during the transition into older adulthood.
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Affiliation(s)
| | | | | | | | - Jane A Cauley
- Department of Epidemiology, University of Pittsburgh
| | - Martica H Hall
- Department of Psychiatry, University of Pittsburgh.,Department of Psychology, University of Pittsburgh
| | - Karen A Matthews
- Department of Psychiatry, University of Pittsburgh.,Department of Psychology, University of Pittsburgh
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10
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Evidence from two cohorts for the frailty syndrome as an emergent state of parallel dysregulation in multiple physiological systems. Biogerontology 2020; 22:63-79. [PMID: 33064226 PMCID: PMC8557952 DOI: 10.1007/s10522-020-09903-w] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Accepted: 10/12/2020] [Indexed: 12/23/2022]
Abstract
Frailty is a clinical syndrome often present in older adults and characterized by a heightened vulnerability to stressors. The biological antecedents and etiology of frailty are unclear despite decades of research: frailty is associated with dysregulation in a wide range of physiological systems, but no specific cause has been identified. Here, we test predictions stemming from the hypothesis that there is no specific cause: that frailty is an emergent property arising from the complex systems dynamics of the broad loss of organismal homeostasis. Specifically, we use dysregulation of six physiological systems using the Mahalanobis distance approach in two cohorts of older adults to test the breadth, diffuseness, and nonlinearity of associations between frailty and system-specific dysregulation. We find clear support for the breadth of associations between frailty and physiological dysregulation: positive associations of all systems with frailty in at least some analyses. We find partial support for diffuseness: the number of systems or total amount of dysregulation is more important than the identity of the systems dysregulated, but results only partially replicate across cohorts. We find partial support for nonlinearity: trends are exponential but not always significantly so, and power is limited for groups with very high levels of dysregulation. Overall, results are consistent with-but not definitive proof of-frailty as an emergent property of complex systems dynamics. Substantial work remains to understand how frailty relates to underlying physiological dynamics across systems.
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11
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Hruby A, Sahni S, Bolster D, Jacques PF. Protein Intake and Functional Integrity in Aging: The Framingham Heart Study Offspring. J Gerontol A Biol Sci Med Sci 2020; 75:123-130. [PMID: 30247514 PMCID: PMC6909900 DOI: 10.1093/gerona/gly201] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Higher protein intake is linked to maintenance of muscle mass and strength, but few studies have related protein to physical function and disability in aging. METHODS In participants of the Framingham Heart Study Offspring, we examined associations between protein intake (g/d), estimated from food frequency questionnaires, and maintenance of functional integrity, as a functional integrity score based on responses to 17 questions from Katz Activities of Daily Living, Nagi, and Rosow-Breslau questionnaires, repeated up to five times (1991/1995-2011/2014) over 23 years of follow-up. Cox proportional hazard models were used to estimate risk of incident loss of functional integrity (functional integrity score ≤ 15th percentile). RESULTS In 2,917 participants (age 54.5 [9.8] years), baseline protein intake was 77.2 (15.6) g/d. The functional integrity score (baseline, mean 98.9, range 82.4-100.0) was associated with objective performance (gait speed, grip strength) and lower odds of falls, fractures, and frailty. Across follow-up, there were 731 incident cases of loss of functional integrity. In fully adjusted models, participants in the highest category of protein intake (median 92.2 g/d) had 30% lower risk of loss of functional integrity (hazard ratio [95% confidence interval] 0.70 [0.52, 0.95], p trend = .03), versus those with the lowest intake (median 64.4 g/d). However, sex-stratified analyses indicated the association was driven by the association in women alone (hazard ratio [95% confidence interval] 0.49 [0.32, 0.74], p trend = .002) and was nonsignificant in men (hazard ratio [95% confidence interval] 1.14 [0.70, 1.86], p trend = .59). CONCLUSIONS Higher protein intake was beneficially associated with maintenance of physical function in middle-aged, high-functioning U.S. adults over the span of two decades. This association was particularly evident in women.
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Affiliation(s)
- Adela Hruby
- Jean Mayer USDA Human Nutrition Research Center on Aging, Tufts University, Boston, Massachusetts.,The Friedman School of Nutrition Science and Policy, Boston, Massachusetts
| | - Shivani Sahni
- Institute for Aging Research, Hebrew SeniorLife, Boston, Massachusetts.,Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Douglas Bolster
- Research and Innovation, Danone North America, Louisville, Colorado
| | - Paul F Jacques
- Jean Mayer USDA Human Nutrition Research Center on Aging, Tufts University, Boston, Massachusetts.,The Friedman School of Nutrition Science and Policy, Boston, Massachusetts
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12
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Beauchamp MK. Screening for Preclinical Balance Limitations in Younger Older Adults: Time for a Paradigm Shift? Phys Ther 2020; 100:589-590. [PMID: 31965177 DOI: 10.1093/ptj/pzaa017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Accepted: 01/20/2020] [Indexed: 11/13/2022]
Affiliation(s)
- Marla K Beauchamp
- School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada
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13
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Pedersen MM, Kjær-Sørensen P, Midtgaard J, Brown CJ, Bodilsen AC. A Danish version of the life-space assessment (LSA-DK) - translation, content validity and cultural adaptation using cognitive interviewing in older mobility limited adults. BMC Geriatr 2019; 19:312. [PMID: 31729972 PMCID: PMC6858667 DOI: 10.1186/s12877-019-1347-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Accepted: 11/06/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Identification and prevention of mobility limitations in older adults is important to reduce adverse health outcomes. The Life-Space Assessment (LSA) provides a single measure of mobility including environmental and social resources of the older adult. Availability of the LSA for non-English speaking countries is still sparse. Therefore, we translated the LSA into Danish and performed a content validity analysis of the translation in older adults with mobility limitations. METHODS After translation into Danish, the Danish version (LSA-DK) was content validated using cognitive interviewing in older mobility limited adults (+ 65) from an outpatient rehabilitation center (n = 12), medical wards at a university hospital (n = 11), and an assisted living facility (n = 7). The interviews were transcribed and analyzed according to the four stages of the Information Processing Model. Based on the analyses, recommendations for changes to the LSA-DK and to the manual were made and presented to the developers of the LSA. RESULTS Consensus was reached on the LSA-DK. Thirty cognitive interviews were carried out. A wide range of sources of error primarily related to the comprehension, memory and decision process were identified. The frequency and type of error sources were most prevalent among assisted living facility informants and included difficulties in defining the geographical extension of neighborhood, town and outside town. The results led to adaptations to the questionnaire and manual to support implementation of the LSA-DK in clinical practice. CONCLUSIONS The Life-Space Assessment was translated into Danish and content validated based on cognitive interviews. Adaptations were made to support that the Danish version can be implemented in clinical practice and used in the assessment of mobility in older Danish adults.
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Affiliation(s)
- Mette Merete Pedersen
- Clinical Research Centre, Copenhagen University Hospital Hvidovre, Kettegård Alle 30, 2650, Hvidovre, Denmark. .,Physical Medicine Research-Copenhagen (PMR-C), Copenhagen University Hospital Hvidovre, Hvidovre, Denmark.
| | - Pia Kjær-Sørensen
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Julie Midtgaard
- The University Hospitals' Centre for Health Research, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark.,Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Cynthia J Brown
- Birmingham/Atlanta Geriatric Research, Education and Clinical Center, University of Alabama at Birmingham, Birmingham, AL, USA
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14
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Meng H, Peterson LJ, Feng L, Dobbs D, Hyer K. The Use of Mobility Devices and Personal Assistance: A Joint Modeling Approach. Gerontol Geriatr Med 2019; 5:2333721419885291. [PMID: 31696144 PMCID: PMC6820176 DOI: 10.1177/2333721419885291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Revised: 09/30/2019] [Accepted: 10/04/2019] [Indexed: 11/15/2022] Open
Abstract
Objective: To examine whether mobility device use substitutes for personal assistance among U.S. older adults. Method: Using the National Health and Aging Trends Study, we identified 3,211 community-living older adults (aged 65 and older) who reported mobility difficulties at baseline. We used recursive bivariate probit models to simultaneously estimate the effect of covariates on the likelihood of using (a) mobility devices and (b) personal assistance to accommodate mobility difficulty. Independent variables included age, gender, race, physical/mental health status, cognition, and comorbidities. Results: Predictors of the use of personal assistance and mobility devices exhibit important similarities and differences. Device use reduced the odds of receiving personal assistance by 50% (odds ratio [OR] = 0.50, 95% confidence interval [CI] = [0.29, 0.86]). Discussion: Findings suggest device use substitutes for personal assistance. Practitioners and policymakers should promote the appropriate use of mobility devices while recognizing the importance of assistance with some groups and the potential of increasing mobility device use.
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15
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Imran TF, Orkaby A, Chen J, Selvaraj S, Driver JA, Gaziano JM, Djoussé L. Walking pace is inversely associated with risk of death and cardiovascular disease: The Physicians' Health Study. Atherosclerosis 2019; 289:51-56. [PMID: 31450014 PMCID: PMC6743067 DOI: 10.1016/j.atherosclerosis.2019.08.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2018] [Revised: 07/21/2019] [Accepted: 08/15/2019] [Indexed: 12/19/2022]
Abstract
BACKGROUND Walking pace is increasingly being used to assess functional status in ambulatory settings. METHODS We conducted a prospective analysis within the Physicians' Health Study to examine whether walking pace is associated with mortality and incident cardiovascular disease (fatal or nonfatal myocardial infarction, coronary artery bypass grafting and percutaneous transluminal coronary angioplasty). Participants included 21,919 male physicians with a mean age of 67.8 ± 9.0 years. RESULTS After a median follow-up of 9.4 years (IQR: 7.9-10.3), 3906 deaths and 2487 incident CVD events occurred. In a multivariable Cox proportional hazards model adjusting for age, body mass index, smoking, exercise frequency, and prevalent hypertension, diabetes mellitus, heart failure, peripheral vascular disease, cancer, and total weekly walking time, hazard ratios for mortality were 0.72 (95% CI: 0.64-0.81) for walking pace of 2-2.9mph, 0.63 (95% CI: 0.55-0.73) for walking pace of 3-3.9mph and 0.63 (95% CI: 0.48-0.83) for walking pace of ≥4mph compared to the group that reported not walking regularly (p trend <0.0001). Similar findings were observed for incident CVD: HRs were 0.88 (95% CI: 0.75-1.03) for a walking pace of 2-2.9mph, 0.75 (95% CI: 0.63-0.89) for a walking pace of 3-3.9mph and 0.70 (0.53-0.94) for a walking pace of ≥4mph compared to the group that reported not walking regularly (p trend 0.0001). These associations persisted after excluding those who exercised regularly. CONCLUSION We found that walking pace is inversely associated with risk of mortality and CVD among US male physicians.
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Affiliation(s)
- Tasnim F Imran
- Boston Medical Center, Boston University School of Medicine, 72 E Concord St, Boston, MA, 02118, USA; Boston Veterans Affairs Healthcare System, 150 S Huntington Ave, Boston, MA, 02130, USA; Department of Medicine, Division of Aging, Brigham and Women's Hospital, Harvard Medical School, 1620 Tremont St, Boston, MA, 02120, USA.
| | - Ariela Orkaby
- Boston Veterans Affairs Healthcare System, 150 S Huntington Ave, Boston, MA, 02130, USA; Department of Medicine, Division of Aging, Brigham and Women's Hospital, Harvard Medical School, 1620 Tremont St, Boston, MA, 02120, USA
| | - Jiaying Chen
- Boston Veterans Affairs Healthcare System, 150 S Huntington Ave, Boston, MA, 02130, USA; Department of Medicine, Division of Aging, Brigham and Women's Hospital, Harvard Medical School, 1620 Tremont St, Boston, MA, 02120, USA
| | - Senthil Selvaraj
- Boston Veterans Affairs Healthcare System, 150 S Huntington Ave, Boston, MA, 02130, USA; Department of Medicine, Division of Aging, Brigham and Women's Hospital, Harvard Medical School, 1620 Tremont St, Boston, MA, 02120, USA
| | - Jane A Driver
- Boston Veterans Affairs Healthcare System, 150 S Huntington Ave, Boston, MA, 02130, USA; Department of Medicine, Division of Aging, Brigham and Women's Hospital, Harvard Medical School, 1620 Tremont St, Boston, MA, 02120, USA
| | - J Michael Gaziano
- Boston Veterans Affairs Healthcare System, 150 S Huntington Ave, Boston, MA, 02130, USA; Department of Medicine, Division of Aging, Brigham and Women's Hospital, Harvard Medical School, 1620 Tremont St, Boston, MA, 02120, USA
| | - Luc Djoussé
- Boston Veterans Affairs Healthcare System, 150 S Huntington Ave, Boston, MA, 02130, USA; Department of Medicine, Division of Aging, Brigham and Women's Hospital, Harvard Medical School, 1620 Tremont St, Boston, MA, 02120, USA
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Maekawa H, Kume Y. Imbalance of nonparametric rest-activity rhythm and the evening-type of chronotype according to frailty indicators in elderly community dwellers. Chronobiol Int 2019; 36:1208-1216. [PMID: 31234663 DOI: 10.1080/07420528.2019.1626416] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Background: Sleep health-related issues, such as poor subjective sleep quality during the night and nocturnal wakefulness, have been a focus of recent research on frailty. However, current trends regarding the chronotypes of older individuals with frailty have not been well documented, and information on the impact of frailty on circadian rest-activity patterns is limited. The aim of this research was to clarify the relationship among frailty, nonparametric rest-activity patterns, and chronotype in older community-dwelling subjects. Method: A survey was conducted between June and December 2018, and the participants of this study were recruited from among community-dwellers aged 60 years or older living in Akita prefecture, Japan. The frailty phenotype defined by the National Center for Geriatrics and Gerontology Study of Geriatric Syndromes (NCGG-SGS) was used to evaluate the frailty status of each participant. To evaluate nonparametric rest-activity rhythm (RAR) parameters (e.g., interdaily stability [IS], intradaily variability [IV], and relative amplitude [RA]), each participant wore an Actiwatch Spectrum Plus device on his or her non-dominant wrist for seven continuous days without removal. The Munich chronotype questionnaire-Japanese version (MCTQ-J) was also used to measure the midpoint of sleep in free days (MSF). Results: The final study cohort was composed of 105 participants (85.7% women) and was divided into 58 non-frail subjects, 45 pre-frail subjects, and 2 frail subjects. According to a binomial logistic regression analysis, the pre-frail individuals had a weaker grip strength (coefficient [beta], -0.18; odds ratio, 0.84; 95% confidence interval [CI], 0.76-0.93; p = .001) and a lower RA (beta, -8.78; odds ratio, 0.0002; 95% CI, 0.00-0.15; p = .01). In addition, correlation analyses also showed that the MSF was negatively associated with the RA in the pre-frail group (r = -0.30, p < .05) and positively correlated with the RA in the non-frail group (r = 0.26, p < .05); furthermore, the MSF of the pre-frail group occurred at a later time than that of the non-frail one (p = .03). Conclusion: The present study provides grounds for our proposal that pre-frailty is significantly associated with a low grip power and relative imbalance between rest and active statuses as indexed using nonparametric RAR parameters. Furthermore, elderly individuals with pre-frailty or frailty may have a later MSF time. However, these potential findings need to be validated in future research.
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Affiliation(s)
- Hiroki Maekawa
- a Graduate School of Medicine, Master Course in Health Sciences, Reha · pot co. Ltd., Akita University , Akita , Japan
| | - Yu Kume
- b Graduate School of Medicine, Doctorial Course in Health Sciences, Department of Occupational Therapy, Akita University , Akita , Japan
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17
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Beauchamp MK, Ward RE, Jette AM, Bean JF. Meaningful Change Estimates for the Late-Life Function and Disability Instrument in Older Adults. J Gerontol A Biol Sci Med Sci 2019; 74:556-559. [PMID: 30285090 PMCID: PMC6417450 DOI: 10.1093/gerona/gly230] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND The Late-Life Function and Disability Instrument (LLFDI) is a well-validated and frequently used patient-reported outcome for older adults. The aim of this study was to estimate the minimal clinically important difference (MCID) of the LLFDI-Function Component (LLFDI-FC) and its subscales among community-dwelling older adults with mobility limitations. METHODS We performed a secondary analysis of the Boston Rehabilitative Impairment Study of the Elderly, a longitudinal cohort study of older adults with mobility limitations residing in the community. The MCID for each LLFDI-FC scale over 1 year of follow-up was estimated using both anchor- and distribution-based methods, including mean change scores on a patient-reported global rating of change in function scale, the standard error of measurement (SEM), and the minimal detectable change with 90% confidence (MDC90). RESULTS Data from 320 older adults were used in the analysis (mean age 76 years, 69% female, mean of four chronic conditions). Meaningful change estimates for "small change" based on the global rating of change and SEM were 2, 3, 4, and 4 points for the LLFDI-FC overall function scale and basic lower-extremity, advanced lower-extremity, and upper-extremity subscales, respectively. Estimates for "substantial change" based on the global rating of change and minimal detectable change with 90% confidence were 5, 6, 9, and 10 points for the overall function scale and basic lower-extremity, advanced lower-extremity, and upper-extremity subscales, respectively. CONCLUSION This study provides the first MCID estimates for the LLFDI-FC, a widely used patient-reported measure of function. These values can be used to interpret the outcomes of longitudinal investigations of functional status in similar populations of community-dwelling older adults.
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Affiliation(s)
- Marla K Beauchamp
- School of Rehabilitation Science, Ontario, Canada
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
- Respiratory Research, West Park Healthcare Centre, Toronto, Ontario, Canada
| | - Rachel E Ward
- New England Geriatric Research Education and Clinical Center, Veterans Administration Boston Health System, Massachusetts
| | - Alan M Jette
- Health and Disability Research Institute, Boston University School of Health, Massachusetts
| | - Jonathan F Bean
- New England Geriatric Research Education and Clinical Center, Veterans Administration Boston Health System, Massachusetts
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, Massachusetts
- Spaulding Rehabilitation Hospital, Boston, Massachusetts
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18
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Perälä MM, von Bonsdorff MB, Männistö S, Salonen MK, Simonen M, Pohjolainen P, Kajantie E, Rantanen T, Eriksson JG. The Healthy Nordic Diet and Mediterranean Diet and Incidence of Disability 10 Years Later in Home-Dwelling Old Adults. J Am Med Dir Assoc 2018; 20:511-516.e1. [PMID: 30366763 DOI: 10.1016/j.jamda.2018.09.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Revised: 09/03/2018] [Accepted: 09/04/2018] [Indexed: 12/25/2022]
Abstract
BACKGROUND/OBJECTIVE Diet has a major impact on a person's health. However, limited information exists on the long-term role of the whole diet on disability. We investigated the association of the healthy Nordic diet and the Mediterranean diet with incident disability 10 years later. DESIGN Longitudinal, with a follow-up of 10 years. SETTINGS/PARTICIPANTS A total of 962 home-dwelling men and women from the Helsinki Birth Cohort Study, mean age 61.6 years, who were free of disability at baseline. MEASUREMENTS At baseline, 2001-2004, the Nordic diet score (NDS) and modified Mediterranean diet score (mMDS) were calculated using a validated 128-item food-frequency questionnaire. Higher scores indicated better adherence to the diet. Participants' incident disability was assessed during 2011-2013 by a self-reported questionnaire and was based on mobility limitations and difficulties to perform self-care activities. Analyses were performed using logistic regression and adjusted for potential confounding factors. RESULTS In total, 94 participants (9.8%) developed mobility limitations and 45 participants (4.7%) developed difficulties in self-care activities during 10 year follow-up. The likelihood of having mobility limitations (odds ratio (OR) 0.42, 95% confidence interval (CI) 0.22-0.80) and difficulties in self-care activities (OR 0.38, 95% CI 0.15-0.94) were lower among those in the highest NDS tertile than among those in the lowest NDS tertile. Greater mMDS was associated with a lower disability incidence; however, the association was not statistically significant. CONCLUSIONS/IMPLICATIONS Adherence to the healthy Nordic diet predicts 10-year incidence of mobility limitations and difficulties to perform self-care activities in old age and may thus be protective against disability in Nordic population.
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Affiliation(s)
- Mia-Maria Perälä
- Department of Public Health Solutions, National Institute for Health and Welfare, Helsinki, Finland; Folkhälsan Research Center, Helsinki, Finland.
| | - Mikaela B von Bonsdorff
- Folkhälsan Research Center, Helsinki, Finland; Gerontology Research Center, Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
| | - Satu Männistö
- Department of Public Health Solutions, National Institute for Health and Welfare, Helsinki, Finland
| | - Minna K Salonen
- Department of Public Health Solutions, National Institute for Health and Welfare, Helsinki, Finland; Folkhälsan Research Center, Helsinki, Finland
| | - Mika Simonen
- Department of Social Research, University of Helsinki, Helsinki, Finland
| | | | - Eero Kajantie
- Department of Public Health Solutions, National Institute for Health and Welfare, Helsinki, Finland; Hospital for Children and Adolescents, Helsinki University Hospital and University of Helsinki, Helsinki, Finland; PEDEGO Research Unit, MRC Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Taina Rantanen
- Gerontology Research Center, Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
| | - Johan G Eriksson
- Department of Public Health Solutions, National Institute for Health and Welfare, Helsinki, Finland; Folkhälsan Research Center, Helsinki, Finland; Department of General Practice and Primary Health Care, University of Helsinki and Helsinki University Hospital, Unit of General Practice, Helsinki, Finland; Vaasa Central Hospital, Vaasa, Finland
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19
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Thorpe RJ, Wynn AJ, Walker JL, Smolen JR, Cary MP, Szanton SL, Whitfield KE. Relationship Between Chronic Conditions and Disability in African American Men and Women. J Natl Med Assoc 2018; 108:90-8. [PMID: 26928493 DOI: 10.1016/j.jnma.2015.12.012] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
BACKGROUND Race differences in chronic conditions and disability are well established; however, little is known about the association between specific chronic conditions and disability in African Americans. This is important because African Americans have higher rates and earlier onset of both chronic conditions and disability than white Americans. METHODS We examined the relationship between chronic conditions and disability in 602 African Americans aged 50 years and older in the Baltimore Study of Black Aging. Disability was measured using self-report of difficulty in activities of daily living (ADL). Medical conditions included diagnosed self-reports of asthma, depressive symptoms, arthritis, cancer, diabetes, cardiovascular disease (CVD), stroke, and hypertension. RESULTS After adjusting for age, high school graduation, income, and marital status, African Americans who reported arthritis (women: odds ratio (OR)=4.87; 95% confidence interval(CI): 2.92-8.12; men: OR=2.93; 95% CI: 1.36-6.30) had higher odds of disability compared to those who did not report having arthritis. Women who reported major depressive symptoms (OR=2.59; 95% CI: 1.43-4.69) or diabetes (OR=1.83; 95% CI: 1.14-2.95) had higher odds of disability than women who did not report having these conditions. Men who reported having CVD (OR=2.77; 95% CI: 1.03-7.41) had higher odds of disability than men who did not report having CVD. CONCLUSIONS These findings demonstrate the importance of chronic conditions in understanding disability in African Americans and how it varies by gender. Also, these findings underscore the importance of developing health promoting strategies focused on chronic disease prevention and management to delay or postpone disability in African Americans. PUBLICATION INDICES Pubmed, Pubmed Central, Web of Science database.
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Affiliation(s)
- Roland J Thorpe
- Hopkins Center for Health Disparities Solutions, Johns Hopkins Bloomberg School of Public Health, Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Center for Biobehavioral Health Disparities Research, Duke University.
| | - Anastasia J Wynn
- Hopkins Center for Health Disparities Solutions, Johns Hopkins Bloomberg School of Public Health
| | | | - Jenny R Smolen
- Hopkins Center for Health Disparities Solutions, Johns Hopkins Bloomberg School of Public Health
| | | | - Sarah L Szanton
- Hopkins Center for Health Disparities Solutions, Johns Hopkins Bloomberg School of Public Health, Center for Biobehavioral Health Disparities Research, Duke University, Johns Hopkins School of Nursing, Johns Hopkins University
| | - Keith E Whitfield
- Center for Biobehavioral Health Disparities Research, Duke University, Department of Psychology and Neuroscience, Duke University
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20
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Intake of B vitamins and impairment in physical function in older adults. Clin Nutr 2018; 37:1271-1278. [DOI: 10.1016/j.clnu.2017.05.016] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2016] [Revised: 04/13/2017] [Accepted: 05/14/2017] [Indexed: 11/23/2022]
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21
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Arias-Fernández L, Machado-Fragua MD, Graciani A, Guallar-Castillón P, Banegas JR, Rodríguez-Artalejo F, Lana A, Lopez-Garcia E. Prospective Association Between Nut Consumption and Physical Function in Older Men and Women. J Gerontol A Biol Sci Med Sci 2018; 74:1091-1097. [DOI: 10.1093/gerona/gly171] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2018] [Indexed: 12/17/2022] Open
Affiliation(s)
- Lucía Arias-Fernández
- Department of Medicine, Preventive Medicine and Public Health Area, School of Medicine and Health Sciences, Universidad de Oviedo, Spain
- Department of Preventive Medicine and Public Health, School of Medicine, IdiPAZ, Universidad Autónoma de Madrid, Spain
| | - Marcos D Machado-Fragua
- Department of Preventive Medicine and Public Health, School of Medicine, IdiPAZ, Universidad Autónoma de Madrid, Spain
- CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Auxiliadora Graciani
- Department of Preventive Medicine and Public Health, School of Medicine, IdiPAZ, Universidad Autónoma de Madrid, Spain
- CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Pilar Guallar-Castillón
- Department of Preventive Medicine and Public Health, School of Medicine, IdiPAZ, Universidad Autónoma de Madrid, Spain
- CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - José R Banegas
- Department of Preventive Medicine and Public Health, School of Medicine, IdiPAZ, Universidad Autónoma de Madrid, Spain
- CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Fernando Rodríguez-Artalejo
- Department of Preventive Medicine and Public Health, School of Medicine, IdiPAZ, Universidad Autónoma de Madrid, Spain
- CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain
- IMDEA-Food Institute, CEI UAM+CSIC, Madrid, Spain
| | - Alberto Lana
- Department of Medicine, Preventive Medicine and Public Health Area, School of Medicine and Health Sciences, Universidad de Oviedo, Spain
- Department of Preventive Medicine and Public Health, School of Medicine, IdiPAZ, Universidad Autónoma de Madrid, Spain
| | - Esther Lopez-Garcia
- Department of Preventive Medicine and Public Health, School of Medicine, IdiPAZ, Universidad Autónoma de Madrid, Spain
- CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain
- IMDEA-Food Institute, CEI UAM+CSIC, Madrid, Spain
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22
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Potente C, Monden C. Disability pathways preceding death in England by socio-economic status. Population Studies 2018; 72:175-190. [PMID: 29770728 DOI: 10.1080/00324728.2018.1458993] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
The role of socio-economic status (SES) in the last years of life is an under-researched aspect of health inequalities. This study examines disability patterns preceding death using data from the English Longitudinal Study of Ageing. We use repeated measures latent class analysis to identify the most common pathways preceding death in terms of walking ability and limitations in activities of daily living. Three pathways emerge: one characterized by consistently low disability; a second by a constant high level of functional limitations; and a third by medium impairment. We examine how different SES indicators predict belonging to each disability pathway. Conditional on income, higher wealth is associated with a lower likelihood of belonging to the high disability pathway. Contrary to our expectations, we find no educational gradient in the pathways preceding death. Health inequalities in the last years of life seem to exist especially between individuals with different levels of wealth.
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23
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Stocks J, Valdes AM. Effect of dietary omega-3 fatty acid supplementation on frailty-related phenotypes in older adults: a systematic review and meta-analysis protocol. BMJ Open 2018; 8:e021344. [PMID: 29773704 PMCID: PMC5961576 DOI: 10.1136/bmjopen-2017-021344] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
INTRODUCTION The beneficial effect of dietary omega-3 supplementation in younger adults or older people with acute or chronic disease is established. Knowledge is now needed about the effect in medically stable older people. The objective of this study is to examine and assess the evidence for a role of dietary omega-3 polyunsaturated fatty acid (PUFA) supplementation in older adults on (1) muscle mass and muscle strength, (2) inflammatory biomarkers and (3) physical activity. METHODS AND ANALYSIS A systematic review and data synthesis will be conducted of randomised controlled trials in older people not recruited for any given disease diagnosis. Placebo-controlled studies reporting interventions involving dietary supplementation of omega-3 PUFAs, eicosapentaenoic acid and docosahexaenoic acid will be included. Outcomes must include changes from baseline to last available follow-up for one or more of the following: muscle mass, inflammatory biomarkers, physical activity, walking speed, weight change, hand grip strength or muscle strength. Once the search strategy has been carried out, two independent researchers will assess relevant papers for eligibility. Articles up until 31 December 2017 in any language will be included. We will provide a narrative synthesis of the findings from the included studies. Studies will be grouped for meta-analysis according to the outcome(s) provided. Where studies have used the same type of intervention, with the same outcome measure, we will pool the results using a random effects meta-analysis, with standardised mean differences for continuous outcomes and risk ratios for binary outcomes, and calculate 95% CI and two-sided p values for each outcome. ETHICS AND DISSEMINATION No research ethics approval is required for this systematic review as no confidential patient data will be used. The results of this systematic review will be disseminated through publication in an open-access peer-reviewed journal and through conference presentations. PROSPERO REGISTRATION NUMBER CRD42017080240.
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Affiliation(s)
- Joanne Stocks
- NIHR Nottingham BRC, Nottingham, UK
- Arthritis Research UK Pain Centre, University of Nottingham, Nottingham, UK
- Division of Rheumatology, Orthopaedics and Dermatology, School of Medicine, University of Nottingham, Nottingham, UK
| | - Ana M Valdes
- NIHR Nottingham BRC, Nottingham, UK
- Arthritis Research UK Pain Centre, University of Nottingham, Nottingham, UK
- Division of Rheumatology, Orthopaedics and Dermatology, School of Medicine, University of Nottingham, Nottingham, UK
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Athanasopoulou S, Chondrogianni N, Santoro A, Asimaki K, Delitsikou V, Voutetakis K, Fabbri C, Pietruszka B, Kaluza J, Franceschi C, Gonos ES. Beneficial Effects of Elderly Tailored Mediterranean Diet on the Proteasomal Proteolysis. Front Physiol 2018; 9:457. [PMID: 29765333 PMCID: PMC5938393 DOI: 10.3389/fphys.2018.00457] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Accepted: 04/13/2018] [Indexed: 12/22/2022] Open
Abstract
Aging is a multifactorial process characterized by the accumulation of proteins undergoing oxidative modifications, either due to enhanced levels of oxidative stress or due to their decreased clearance; both facts are related to the establishment of chronic inflammatory processes. These processes are directly associated with functional and structural modifications of a key cellular component, namely the proteasome. In this study, levels of oxidized proteins, along with proteasome and immunoproteasome composition and activity on a selected group of 120 elderly volunteers were analyzed before and after the administration of a specific dietary protocol, based on an elderly tailored Mediterranean diet (the "NU-AGE diet"). A significant negative correlation between levels of oxidized/carbonylated proteins and proteasome function was confirmed, both before and after intervention. Furthermore, it was demonstrated that subgroups of non-frail subjects and women receive a greater benefit after the intervention, concerning specifically the proteasome content and activity. These data highlight the putative beneficial effects of Mediterranean diet on the major cellular proteolytic mechanism, the proteasome, in elderly people.
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Affiliation(s)
- Sophia Athanasopoulou
- Institute of Biology, Medicinal Chemistry and Biotechnology, National Hellenic Research Foundation, Athens, Greece
| | - Niki Chondrogianni
- Institute of Biology, Medicinal Chemistry and Biotechnology, National Hellenic Research Foundation, Athens, Greece
| | - Aurelia Santoro
- Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
- C.I.G. Interdepartmental Centre “L. Galvani”, University of Bologna, Bologna, Italy
| | - Konstantina Asimaki
- Institute of Biology, Medicinal Chemistry and Biotechnology, National Hellenic Research Foundation, Athens, Greece
| | - Vasiliki Delitsikou
- Institute of Biology, Medicinal Chemistry and Biotechnology, National Hellenic Research Foundation, Athens, Greece
| | - Konstantinos Voutetakis
- Institute of Biology, Medicinal Chemistry and Biotechnology, National Hellenic Research Foundation, Athens, Greece
| | - Cristina Fabbri
- Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
- C.I.G. Interdepartmental Centre “L. Galvani”, University of Bologna, Bologna, Italy
| | - Barbara Pietruszka
- Department of Human Nutrition, Warsaw University of Life Sciences – SGGW, Warsaw, Poland
| | - Joanna Kaluza
- Department of Human Nutrition, Warsaw University of Life Sciences – SGGW, Warsaw, Poland
| | - Claudio Franceschi
- Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
- Institute of Neurological Sciences (IRCCS), Bologna, Italy
| | - Efstathios S. Gonos
- Institute of Biology, Medicinal Chemistry and Biotechnology, National Hellenic Research Foundation, Athens, Greece
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Struijk EA, Banegas JR, Rodríguez-Artalejo F, Lopez-Garcia E. Consumption of meat in relation to physical functioning in the Seniors-ENRICA cohort. BMC Med 2018; 16:50. [PMID: 29622014 PMCID: PMC5887175 DOI: 10.1186/s12916-018-1036-4] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2017] [Accepted: 03/13/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Meat is an important source of high-quality protein and vitamin B but also has a relatively high content of saturated and trans fatty acids. Although protein and vitamin B intake seems to protect people from functional limitations, little is known about the effect of habitual meat consumption on physical function. The objective of this study was to examine the prospective association between the intake of meat (processed meat, red meat, and poultry) and physical function impairment in older adults. METHODS Data were collected for 2982 participants in the Seniors-ENRICA cohort, who were aged ≥60 years and free of physical function impairment. In 2008-2010, their habitual diet was assessed through a validated computer-assisted face-to-face diet history. Study participants were followed up through 2015 to assess self-reported incident impairment in agility, mobility, and performance-based lower-extremity function. RESULTS Over a median follow-up of 5.2 years, we identified 625 participants with impaired agility, 455 with impaired mobility, and 446 with impaired lower-extremity function. After adjustment for potential confounders, processed meat intake was associated with a higher risk of impaired agility (hazard ratio [HR] for highest vs. lowest tertile: 1.33; 95% confidence interval [CI]: 1.08-1.64; p trend = 0.01) and of impaired lower-extremity function (HR for highest vs. lowest tertile: 1.31; 95% CI: 1.02-1.68; p trend = 0.04). No significant associations were found for red meat and poultry. Replacing one serving per day of processed meat with one serving per day of red meat, poultry, or with other important protein sources (fish, legumes, dairy, and nuts) was associated with lower risk of impaired agility and lower-extremity function. CONCLUSIONS A higher consumption of processed meat was associated with a higher risk of impairment in agility and lower-extremity function. Replacing processed meat by other protein sources may slow the decline in physical functioning in older adults.
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Affiliation(s)
- Ellen A Struijk
- Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid, Avda. Arzobispo Morcillo, 4, 28029, Madrid, Spain. .,CIBERESP (CIBER of Epidemiology and Public Health), Madrid, Spain.
| | - José R Banegas
- Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid, Avda. Arzobispo Morcillo, 4, 28029, Madrid, Spain.,CIBERESP (CIBER of Epidemiology and Public Health), Madrid, Spain
| | - Fernando Rodríguez-Artalejo
- Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid, Avda. Arzobispo Morcillo, 4, 28029, Madrid, Spain.,CIBERESP (CIBER of Epidemiology and Public Health), Madrid, Spain.,IMDEA Food Institute, CEI UAM+CSIC, Madrid, Spain
| | - Esther Lopez-Garcia
- Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid, Avda. Arzobispo Morcillo, 4, 28029, Madrid, Spain.,CIBERESP (CIBER of Epidemiology and Public Health), Madrid, Spain.,IMDEA Food Institute, CEI UAM+CSIC, Madrid, Spain
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Barry LC, Hatchman L, Fan Z, Guralnik JM, Gao RX, Kuchel GA. Design and Validation of a Radio-Frequency Identification-Based Device for Routinely Assessing Gait Speed in a Geriatrics Clinic. J Am Geriatr Soc 2018; 66:982-986. [PMID: 29473949 DOI: 10.1111/jgs.15315] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To evaluate the feasibility, acceptability, and validity of a radio-frequency identification (RFID)-based system to measure gait speed in a clinical setting as a first step to using unobtrusive gait speed assessment in routine clinical care. DESIGN Feasibility study comparing gait speed assessed using an RFID-based system with gait speed assessed using handheld stopwatch, the criterion standard. SETTING Outpatient geriatrics clinic at a Connecticut-based academic medical center. PARTICIPANTS Clinic attendees who could walk independently with or without an assistive device (N=50) and healthcare providers (N=9). MEASUREMENTS Gait speed was measured in twice using 2 methods each time before participants entered an examination room. Participants walked at their usual pace while gait speed was recorded simultaneously using the RFID-based system and a handheld stopwatch operated by a trained study investigator. After 2 trials, participants completed a brief survey regarding their experience. At the end of the study period, clinic healthcare providers completed a separate survey. RESULTS Test-retest reliability of the RFID-based system was high (intraclass correlation coefficient = 0.953). The mean difference ± standard deviation in gait speed between the RFID-based system and the stopwatch was -0.003±0.035 m/s (p=.53) and did not differ significantly according to age, sex, or use of an assistive walking aid. Acceptability of the device was high, and 8 of 9 providers indicated that measuring gait speed using the RFID-based system should be a part of routine clinical care. CONCLUSION RFID technology may offer a practical means of overcoming barriers to routine measurement of gait speed in real-world outpatient clinical settings.
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Affiliation(s)
- Lisa C Barry
- Health Center, Center on Aging, University of Connecticut, Farmington, Connecticut
| | - Laura Hatchman
- School of Medicine, University of Connecticut, Farmington, Connecticut
| | | | - Jack M Guralnik
- School of Medicine, University of Maryland, Baltimore, Maryland
| | - Robert X Gao
- Case Western Reserve University, Cleveland, Ohio
| | - George A Kuchel
- Health Center, Center on Aging, University of Connecticut, Farmington, Connecticut
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Ramírez Torres M, Ruiz Valenzuela RE, Esparza-Romero J, López Teros MT, Alemán-Mateo H. The fat mass index, not the fat-free mass index, is associated with impaired physical performance in older adult subjects: Evidence from a cross-sectional study. Clin Nutr 2018; 38:877-882. [PMID: 29501367 DOI: 10.1016/j.clnu.2018.02.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Revised: 12/26/2017] [Accepted: 02/10/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND Impaired physical performance (IPP) and physical disability (PD) are two serious public health problems in older adult populations worldwide. While studies show that changes in body composition are important risk factors for developing these conditions, there is little evidence that the fat-free mass (FFM) and fat mass (FM) indices (FFMI and FMI, respectively) are associated with IPP in older men and women. This study assessed the association among FFMI, FMI, and IPP using Short Physical Performance Battery (SPPB) in Mexican men and women aged over 60 years. METHODS This cross-sectional study included 217 older people (men 34.6%, women 65.4%; 60-92 years). FFM and FM were assessed by dual X-ray absorptiometry, assuming a two-compartment model. FFM and FM were adjusted by height squared and the indices were obtained. After assessment of physical performance by SPPB, subjects with scores ≤6 were classified as having IPP. Associations were tested by multiple logistic regression analysis in separated models. RESULTS IPP prevalence was 14.3%. Women were affected more than men. Regression analysis showed no significant association between FFMI and IPP, but FMI was strongly-associated, as for each unit increase in FMI, the risk of IPP rose significantly (OR: 1.14), and this result remained significant after adjusting for age, comorbidity, polypharmacy, and the appendicular skeletal muscle mass index (OR: 1.23; p ≤ 0.001). These results emphasize the importance of preventing increases in FM and avoiding overweight and obesity in older men and women.
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Affiliation(s)
- Maribel Ramírez Torres
- Coordinación de Nutrición, Centro de Investigación en Alimentación y Desarrollo (CIAD), A.C., Mexico
| | - Roxana E Ruiz Valenzuela
- Coordinación de Nutrición, Centro de Investigación en Alimentación y Desarrollo (CIAD), A.C., Mexico; Departamento de Salud, Universidad Iberoamericana, Ciudad de México-Tijuana, Av. Centro Universitario 2501, Playas de Tijuana, Tijuana, Baja California C.P. 22500, Mexico
| | - Julián Esparza-Romero
- Coordinación de Nutrición, Centro de Investigación en Alimentación y Desarrollo (CIAD), A.C., Mexico
| | - Miriam T López Teros
- Departamento de Salud, Universidad Iberoamericana, Ciudad de México, Prolongación Paseo de Reforma 880, Lomas de Santa Fe, Ciudad de México, D.F. C.P. 01219, Mexico
| | - Heliodoro Alemán-Mateo
- Coordinación de Nutrición, Centro de Investigación en Alimentación y Desarrollo (CIAD), A.C., Mexico.
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Welsh J, Korda RJ, Joshy G, Butterworth P, Brown A, Banks E. Psychological distress and ischaemic heart disease: cause or consequence? Evidence from a large prospective cohort study. J Epidemiol Community Health 2017; 71:1084-1089. [PMID: 28928223 DOI: 10.1136/jech-2017-209535] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Revised: 07/20/2017] [Accepted: 08/31/2017] [Indexed: 11/04/2022]
Abstract
BACKGROUND Ischaemic heart disease (IHD) incidence is elevated in people reporting psychological distress. The extent to which this relationship is causal or related to reverse causality-that is, undiagnosed disease causing distress-is unclear. We quantified the relationship between psychological distress and IHD, with consideration of confounding and undiagnosed disease. METHODS Questionnaire data (2006-2009) from 151 811 cardiovascular disease-free and cancer-free Australian general population members aged ≥45years (45 and Up Study) were linked to hospitalisation and mortality data, to December 2013. A two-stage approach estimated HRs for incident IHD (IHD-related hospitalisation or death) for low (Kessler-10 scores: 10-<12), mild (12-<16), moderate (16-<22) and high (22-50) psychological distress, adjusting for demographic and behavioural characteristics, and then restricting to those with no/minor functioning limitations (likely free from undiagnosed disease). RESULTS Over 859 396 person-years, 5230 incident IHD events occurred (rate: 6.09/1000person-years). IHD risk was increased for mild (age-adjusted and sex-adjusted HR: 1.18, 95% CI 1.11 to 1.26), moderate (1.36, 1.25 to 1.47), and high (1.69, 1.52 to 1.88) versus low distress. HRs attenuated to 1.15 (1.08 to 1.22), 1.26 (1.16 to 1.37) and 1.41 (1.26 to 1.57) after adjustment for demographic and behavioural characteristics and were further attenuated by 35%-41% in those with no/minor limitations, leaving a significant but relatively weak dose-response relationship: 1.11 (1.02 to 1.20), 1.21 (1.08 to 1.37) and 1.24 (1.02 to 1.51) for mild, moderate and high versus low distress, respectively. The observed adjustment-related attenuation suggests measurement error/residual confounding likely contribute to the remaining association. CONCLUSION A substantial part of the distress-IHD association is explained by confounding and functional limitations, an indicator of undiagnosed disease. Emphasis should be on psychological distress as a marker of healthcare need and IHD risk, rather than a causative factor.
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Affiliation(s)
- Jennifer Welsh
- National Centre for Epidemiology and Population Health, Research School of Population Health, Australian National University, Canberra, Australia
| | - Rosemary J Korda
- National Centre for Epidemiology and Population Health, Research School of Population Health, Australian National University, Canberra, Australia
| | - Grace Joshy
- National Centre for Epidemiology and Population Health, Research School of Population Health, Australian National University, Canberra, Australia
| | - Peter Butterworth
- Centre for Mental Health, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia.,Melbourne Institute of Applied Economic and Social Research, University of Melbourne, Melbourne, Australia
| | - Alex Brown
- South Australian Health & Medical Research Institute, Adelaide, Australia.,Sansom Institute, University of South Australia, Adelaide, Australia
| | - Emily Banks
- National Centre for Epidemiology and Population Health, Research School of Population Health, Australian National University, Canberra, Australia.,The Sax Institute, Sydney, Australia
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Peterson LJ, Meng H, Dobbs D, Hyer K. Gender Differences in Mobility Device Use Among U.S. Older Adults. J Gerontol B Psychol Sci Soc Sci 2017; 72:827-835. [PMID: 27495837 DOI: 10.1093/geronb/gbw081] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2015] [Accepted: 06/24/2016] [Indexed: 11/14/2022] Open
Abstract
Objectives Research has shown greater mobility limitations among women than men. We aimed to examine (a) gender differences in the use of canes for mobility and (b) what factors contribute to these differences under the frameworks of the disablement model and the Theory of Planned Behavior. Method Using National Health and Aging Trends Study data, we estimated hierarchical logistic regression models to predict the likelihood of cane use among older adults who completed performance-based measures (n = 5,503). We tested the interactions between gender and selected variables to further understand gender difference. Results In unadjusted analysis, 22% of women and 16% of men used canes. In models adjusted in steps for sociodemographics, health, physical impairments, capacity, psychosocial, and social environment factors, women were progressively less likely to use canes, significantly so at the last step. Suppression effect analyses showed the influence of living alone and receiving mobility help variables. Interaction analyses showed that women reporting poor health or balance were less likely to use canes; obese women were more likely. Discussion Significant gender differences exist in cane use among older community-living adults. Findings suggest that health and function partly account for these differences. Future research is needed to understand social/cultural factors involved.
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Affiliation(s)
- Lindsay J Peterson
- Florida Policy Exchange Center on Aging, School of Aging Studies, University of South Florida, Tampa
| | - Hongdao Meng
- Florida Policy Exchange Center on Aging, School of Aging Studies, University of South Florida, Tampa
| | - Debra Dobbs
- Florida Policy Exchange Center on Aging, School of Aging Studies, University of South Florida, Tampa
| | - Kathryn Hyer
- Florida Policy Exchange Center on Aging, School of Aging Studies, University of South Florida, Tampa
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Could Activity Modifications Indicate Physical Decline Among Adults With Symptomatic Knee Osteoarthritis? Am J Phys Med Rehabil 2017; 97:96-103. [PMID: 28763325 DOI: 10.1097/phm.0000000000000802] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Mobility activity modifications indicate early functional losses that act as precursors to future declines among community-dwelling older adults. However, there is scarce evidence on whether activity modifications indicate poorer physical health among adults with symptomatic osteoarthritis, a major cause of disability. Our purpose was to investigate whether patient-reported mobility activity modifications indicated poorer physical health among adults with symptomatic knee osteoarthritis. DESIGN Secondary cross-sectional analysis of randomized trial data was performed. Preclinical Disability Questionnaire was used to group participants into the following three categories: difficulty, modified, and no difficulty walking/stair climbing. Kruskal Wallis and χ tests were used to compare clinical factors across groups. RESULTS Among 121 participants (median age = 60 yrs; 73% female; 60% white), less than 10% had modified walking/stair climbing. Compared with those with no walking difficulty, participants with modified walking had significantly less balance (P = 0.01) and global health (P = 0.01) as well as greater knee pain (P = 0.05) and physical disability (P = 0.04). Those with modified stair climbing had significantly smaller walking distances (P = 0.03) compared with those with no difficulty stair climbing. CONCLUSIONS Activity modifications may signal early impairments in physical health among people with symptomatic knee osteoarthritis. If confirmed, patient-reported activity modifications may enhance symptom evaluation in osteoarthritis and enable a better understanding of the disablement process.
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Tanaka S, Matsumoto S, Kawashima T, Mitani S, Miura Y. Walking speed affects instrumental activities of daily living in patients with hip osteoarthritis. J Back Musculoskelet Rehabil 2017; 30:309-316. [PMID: 27791992 DOI: 10.3233/bmr-160524] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND The symptoms of hip osteoarthritis (OA) influence instrumental activities of daily living (IADL). Evidence form previous studies suggest that body functions and walking speed are important etiological factors for IADL. However, no studies have investigated which factors that have the greatest influence on IADL. OBJECTIVE The aims of this study were (1) to analyze factors related to IADL in patients with hip OA, including 10 m walking speed (10 mWS), and (2) to establish cut-off values for factors that predict maintenance of IADL. METHODS Forty-eight patients participated in this study. IADL was treated as dependent variable. Range of motion (ROM), muscle strength of the hips and knees, and 10 mWS were measured as independent variables. Other potential confounding factors were also measured. Data were analyzed using hierarchical multiple regression and Receiver Operating Characteristic curve analysis. RESULTS The hip flexion ROM on the affected side and 10 mWS were selected as significant variables in this study. The cut-off values obtained were 92.5 degrees for the hip flexion ROM on the affected side and 42.3 m/min for 10 mWS. CONCLUSIONS The suggested target associated with maintaining IADL in patients with hip OA is the cut-off value of 42.3 m/min for 10 mWS found in this study.
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Affiliation(s)
- Shigeharu Tanaka
- Department of Physical Therapy, Kawasaki Junior College of Rehabilitation, Kurashiki, Japan.,Department of Rehabilitation Science, Kobe University Graduate School of Health Sciences, Kobe, Japan
| | - Shinsuke Matsumoto
- Department of Physical Therapy, Kawasaki Junior College of Rehabilitation, Kurashiki, Japan
| | - Takaki Kawashima
- Rehabilitation Center, Kawasaki Medical School Hospital, Kurashiki, Japan
| | - Shigeru Mitani
- Department of Bone and Surgery, Kawasaki Medical School, Kurashiki, Japan
| | - Yasushi Miura
- Department of Rehabilitation Science, Kobe University Graduate School of Health Sciences, Kobe, Japan
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Zeki Al Hazzouri A, Mayeda ER, Elfassy T, Lee A, Odden MC, Thekkethala D, Wright CB, Glymour MM, Haan MN. Perceived Walking Speed, Measured Tandem Walk, Incident Stroke, and Mortality in Older Latino Adults: A Prospective Cohort Study. J Gerontol A Biol Sci Med Sci 2017; 72:676-682. [PMID: 27549992 PMCID: PMC5964741 DOI: 10.1093/gerona/glw169] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2016] [Accepted: 07/18/2016] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Walking speed is associated with functional status and all-cause mortality. Yet the relationship between walking speed and stroke, also a leading cause of disability, remains poorly understood, especially in older Latino adults who suffer from a significant burden of stroke. METHODS A total of 1,486 stroke-free participants from the Sacramento Area Latino Study on Aging, aged 60 and older at baseline in 1998-1999, were followed annually through 2010. Participants reported their usual walking speed outdoors which was classified into slow, medium, or fast. We also assessed timed tandem walk ability (unable or eight or more errors vs less than eight errors). We ascertained three incident stroke endpoints: total stroke, nonfatal stroke, and fatal stroke. Using Cox proportional hazards models, we estimated hazard ratios (HRs) for stroke at different walking speed and timed tandem walk categories. RESULTS Over an average of 6 years of follow-up (SD = 2.8), the incidence rate of total strokes was 23.2/1,000 person-years for slow walkers compared to 15.6/1,000 person-years for medium walkers, and 7.6/1,000 person-years for fast walkers. In Cox models adjusted for sociodemographics, cardiovascular risk, cognition and functional status, and self-rated health, the hazard of total stroke was 31% lower for medium walkers (HR: 0.69, 95% confidence interval [CI]: 0.47, 1.02) and 56% lower for fast walkers (HR: 0.44, 95% CI: 0.24, 0.82) compared with slow walkers. We found similar associations with timed tandem walk ability (fully adjusted HR: 0.66, 95% CI: 0.45, 0.98). CONCLUSIONS Our findings suggest perceived walking speed captures more than self-rated health alone and is a strong risk factor for stroke risk in Latino older adults.
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Affiliation(s)
- Adina Zeki Al Hazzouri
- Division of Epidemiology, Department of Public Health Sciences, University of Miami, Florida
| | - Elizabeth Rose Mayeda
- Department of Epidemiology & Biostatistics, School of Medicine, University of California San Francisco
| | - Tali Elfassy
- Division of Epidemiology, Department of Public Health Sciences, University of Miami, Florida
| | - Anne Lee
- Department of Epidemiology & Biostatistics, School of Medicine, University of California San Francisco
| | - Michelle C Odden
- College of Public Health and Human Sciences, Oregon State University, Corvallis
| | - Divya Thekkethala
- College of Public Health and Human Sciences, Oregon State University, Corvallis
| | - Clinton B Wright
- Department of Neurology, Miller School of Medicine and
- Evelyn F. McKnight Brain Institute, Miller School of Medicine, University of Miami, Florida
| | - Maria M Glymour
- Department of Epidemiology & Biostatistics, School of Medicine, University of California San Francisco
| | - Mary N Haan
- Department of Epidemiology & Biostatistics, School of Medicine, University of California San Francisco
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Arima K, Abe Y, Nishimura T, Okabe T, Tomita Y, Mizukami S, Kanagae M, Aoyagi K. Association of vertebral compression fractures with physical performance measures among community-dwelling Japanese women aged 40 years and older. BMC Musculoskelet Disord 2017; 18:176. [PMID: 28454529 PMCID: PMC5410022 DOI: 10.1186/s12891-017-1531-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2016] [Accepted: 04/17/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Numerous reported studies have shown that vertebral compression fractures are associated with impaired function or disability; however, few examined their association with objective measures of physical performance or functioning. METHODS We examined the association of vertebral compression fractures with physical performance measures in 556 Japanese women aged 40-89 years. Lateral spine radiographs were obtained and radiographic vertebral compression fractures were assessed by quantitative morphometry, defined as vertebral heights more than 3 SD below the normal mean. Measures of physical performance included walking speed, chair stand time and functional reach. Adjusted means of performance-based measures according to the number and severity of vertebral compression fractures were calculated using general linear modeling methods. RESULTS After adjusting for age, body mass index, back pain, number of painful joints, number of comorbidities and regular physical activities, the walking speed of women with two or more compression fractures (1.17 m/s) was significantly slower than that of women without compression fracture (1.24 m/s) (p = 0.03). Compared with women without compression fracture, chair stand time was longer in women with two or more compression fractures (p = 0.01), and functional reach was shorter (p = 0.01). No significant differences were observed in walking speed, chair stand time, or functional reach between women with one compression fracture and those without compression fracture. CONCLUSIONS Having multiple vertebral compression fractures affects physical performance in community-dwelling Japanese women. Poor physical functioning may lead to functional dependence, accelerated bone loss, and increased risk for falls, injuries, and fractures. Preventing vertebral compression fracture is considered important for preserving the independence of older adults.
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Affiliation(s)
- Kazuhiko Arima
- Department of Public Health, Nagasaki University Graduate School of Biomedical Sciences, 1-12-4 Sakamoto, Nagasaki, 852-8523, Japan.
| | - Yasuyo Abe
- Department of Public Health, Nagasaki University Graduate School of Biomedical Sciences, 1-12-4 Sakamoto, Nagasaki, 852-8523, Japan
| | - Takayuki Nishimura
- Department of Public Health, Nagasaki University Graduate School of Biomedical Sciences, 1-12-4 Sakamoto, Nagasaki, 852-8523, Japan
| | - Takuhiro Okabe
- Department of Public Health, Nagasaki University Graduate School of Biomedical Sciences, 1-12-4 Sakamoto, Nagasaki, 852-8523, Japan.,Department of Rehabilitation, Nishi-Isahaya Hospital, Isahaya, Japan
| | - Yoshihito Tomita
- Department of Public Health, Nagasaki University Graduate School of Biomedical Sciences, 1-12-4 Sakamoto, Nagasaki, 852-8523, Japan.,Department of Rehabilitation, Nishi-Isahaya Hospital, Isahaya, Japan
| | - Satoshi Mizukami
- Department of Public Health, Nagasaki University Graduate School of Biomedical Sciences, 1-12-4 Sakamoto, Nagasaki, 852-8523, Japan.,Department of Rehabilitation, Nishi-Isahaya Hospital, Isahaya, Japan
| | - Mitsuo Kanagae
- Department of Public Health, Nagasaki University Graduate School of Biomedical Sciences, 1-12-4 Sakamoto, Nagasaki, 852-8523, Japan.,Department of Rehabilitation, Nishi-Isahaya Hospital, Isahaya, Japan
| | - Kiyoshi Aoyagi
- Department of Public Health, Nagasaki University Graduate School of Biomedical Sciences, 1-12-4 Sakamoto, Nagasaki, 852-8523, Japan
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Houston DK, Tooze JA, Garcia K, Visser M, Rubin S, Harris TB, Newman AB, Kritchevsky SB. Protein Intake and Mobility Limitation in Community-Dwelling Older Adults: the Health ABC Study. J Am Geriatr Soc 2017; 65:1705-1711. [PMID: 28306154 DOI: 10.1111/jgs.14856] [Citation(s) in RCA: 74] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVES The current Recommended Dietary Allowance (RDA) for protein is based on short-term nitrogen balance studies in young adults and may underestimate the amount needed to optimally preserve physical function in older adults. We examined the association between protein intake and the onset of mobility limitation over 6 years of follow-up in older adults in the Health ABC study. DESIGN Prospective cohort study. SETTING Memphis, Tennessee and Pittsburgh, Pennsylvania. PARTICIPANTS Community-dwelling, initially well-functioning adults aged 70-79 years (n = 1998). MEASUREMENTS Protein intake (g/kg body weight/d) was calculated using an interviewer-administered 108-item food frequency questionnaire at baseline. Mobility limitation was assessed semi-annually and defined as reporting any difficulty walking one-quarter of a mile or climbing 10 steps on 2 consecutive 6-month contacts. The association between protein intake and incident mobility limitation was examined using Cox proportional hazard regression models adjusting for demographics, behavioral characteristics, chronic conditions, total energy intake, and height. RESULTS Mean (SD) protein intake was 0.91 (0.38) g/kg body weight/d, with 43% reporting intakes less than the RDA (0.8 g/kg body weight/d). During 6 years of follow-up, 705 participants (35.3%) developed mobility limitations. Compared to participants in the upper tertile of protein intake (≥1.0 g/kg body weight/d), participants in the lower two tertiles of protein intake (<0.7 and 0.7 -<1.0 g/kg body weight/d) were at greater risk of developing mobility limitation over 6 years of follow-up (RR (95% CI): 1.86 (1.41-2.44) and 1.49 (1.20-1.84), respectively). CONCLUSION Lower protein intake was associated with increased risk of mobility limitation in community-dwelling, initially well-functioning older adults. These results suggest that protein intakes of ≥1.0 g/kg body weight/d may be optimal for maintaining physical function in older adults.
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Affiliation(s)
| | - Janet A Tooze
- Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Katelyn Garcia
- Wake Forest School of Medicine, Winston-Salem, North Carolina
| | | | - Susan Rubin
- University of California, San Francisco, California
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Song J, Gilbert AL, Chang RW, Pellegrini CA, Ehrlich-Jones LS, Lee J, Pinto D, Semanik PA, Sharma L, Kwoh CK, Jackson RD, Dunlop DD. Do Inactive Older Adults Who Increase Physical Activity Experience Less Disability: Evidence From the Osteoarthritis Initiative. J Clin Rheumatol 2017; 23:26-32. [PMID: 28002153 PMCID: PMC5180208 DOI: 10.1097/rhu.0000000000000473] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Physical inactivity is a leading risk factor for developing disability. Although randomized clinical trials have demonstrated improving physical activity can reduce this risk in older adults with arthritis, these studies did not specifically evaluate inactive adults. OBJECTIVES The aim of this study was to evaluate the relationship of changes in physical activity with disability changes among initially inactive adults with or at high risk of knee osteoarthritis from Osteoarthritis Initiative. METHODS Inactive persons were identified at baseline based on the US Department of Health and Human Services classification (no [zero] 10-minute session of moderate-to-vigorous [MV] activity over 1 week) from objective accelerometer monitoring. Two years later, physical activity change status was classified as follows: (1) met Federal physical activity guidelines (≥150 MV minutes/week acquired in bouts ≥10 minutes), (2) insufficiently increased activity (some but <150 MV bout minutes/week), or (3) remained inactive. Disability at baseline and 2 years was assessed by Late Life Disability Instrument limitation and frequency scores. Multiple regression evaluated the relationship of physical activity change status with baseline-to-2-year changes in disability scores adjusting for socioeconomics, health factors, and baseline disability score. RESULTS Increased physical activity showed a graded relationship with improved disability scores in Late Life Disability Instrument limitation (P < 0.001) and frequency scores (P = 0.027). While increasing MV activity to guideline levels showed the greatest reduction, even insufficiently increased physical activity was related to reduced disability. CONCLUSIONS Findings support advice to increase MV physical activity to reduce disability among inactive adults with or at high risk of knee osteoarthritis, even when guidelines are not met.
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Affiliation(s)
- Jing Song
- Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | | | - Rowland W. Chang
- Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | | | | | - Jungwha Lee
- Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Daniel Pinto
- Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | | | - Leena Sharma
- Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - C. Kent Kwoh
- University of Arizona Arthritis Center, Tucson, Arizona
| | | | - Dorothy D. Dunlop
- Northwestern University Feinberg School of Medicine, Chicago, Illinois
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Edwards RR. Age Differences in the Correlates of Physical Functioning in Patients With Chronic Pain. J Aging Health 2016; 18:56-69. [PMID: 16470966 DOI: 10.1177/0898264305280976] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES Pain-related disability in the elderly is a major contributor to poor quality of life. In this study, the author examined age-related differences in the factors associated with physical disability in the context of chronic pain. METHOD A large cohort of chronic pain patients was categorized into four age groups, and correlates of physical disability were evaluated within each age category. RESULTS Several important age differences in the predictors of physical disability were noted. Affective distress was unrelated to physical disability among the elderly, whereas this association was quite strong among younger patients. In contrast, pain severity was a weak predictor of disability within the younger group, but it accounted for more than one fourth of the variance in physical disability in those older than 65. DISCUSSION These data suggest that the determinants of functioning may vary across the life span, implying a potential for pain management programs tailored to a patient's age.
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Petersson I, Fisher AG, Hemmingsson H, Lilja M. The Client-Clinician Assessment Protocol (C-CAP): Evaluation of its Psychometric Properties for Use with People Aging with Disabilities in Need of Home Modifications. OTJR-OCCUPATION PARTICIPATION AND HEALTH 2016. [DOI: 10.1177/153944920702700404] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The objective of this study was to evaluate aspects of the validity and reliability of the Client-Clinician Assessment Protocol (C-CAP) Part I. C-CAP data for 103 people aging with disabilities in need of home modification services were analyzed using the Rasch rating scale model. The C-CAP Part I consists of a client self-report of ability in daily life tasks comprising three scales (independence, difficulty, and safety). The analysis demonstrated support for internal scale validity, person response validity, and person separation reliability of the C-CAP Part I, although the results differed among the three scales. The results of this study indicated that the C-CAP Part I has psychometric strengths and limitations. The instrument has the potential to be used in the home environment with people who are aging with disabilities. The C-CAP could complement already existing tools that are used to assess functioning in activities of daily living, especially regarding the focus on the clients' self-report of difficulty and safety in daily life at home and in the community.
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Terhorst L, Holm MB, Toto PE, Rogers JC. Performance-Based Impairment Measures as Predictors of Early-Stage Activity Limitations in Community-Dwelling Older Adults. J Aging Health 2016; 29:880-892. [PMID: 27166414 DOI: 10.1177/0898264316648113] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE The objective of the current investigation was to explore performance-based predictors of decline in the performance quality of everyday tasks as a first step for early identification, screening, and referral to minimize disability in community-dwelling older adults. METHOD This was a secondary analysis of data from 256 community-based older women. Mobility, activities of daily living (ADLs), and instrumental activities of daily living (IADLs) were measured using the Performance Assessment of Self-Care Skills (PASS). Logistic regression models explored cognitive and motor predictors of performance quality while controlling for demographics and diagnoses. RESULTS Functional reach ( p = .049) and cognition ( p = .012) were predictive of mobility quality, whereas balance ( p = .007) and the Keitel Function ( p = .005) were predictive of ADL quality. Manipulation and cognitive measures were predictive of cognitive and physical IADL quality. DISCUSSION Cognitive and physical screens are both important to identify older adults at risk for disability.
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Zhang C, Zhang G, Chen KJ, Lu AP. Integration of chinese medicine with western medicine could lead to future medicine: molecular module medicine. Chin J Integr Med 2016; 22:243-50. [DOI: 10.1007/s11655-016-2495-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2016] [Indexed: 01/02/2023]
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Ward RE, Beauchamp MK, Latham NK, Leveille SG, Percac-Lima S, Kurlinski L, Ni P, Goldstein R, Jette AM, Bean JF. Neuromuscular Impairments Contributing to Persistently Poor and Declining Lower-Extremity Mobility Among Older Adults: New Findings Informing Geriatric Rehabilitation. Arch Phys Med Rehabil 2016; 97:1316-22. [PMID: 27056644 DOI: 10.1016/j.apmr.2016.03.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2015] [Revised: 01/07/2016] [Accepted: 03/02/2016] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To identify neuromuscular impairments most predictive of unfavorable mobility outcomes in late life. DESIGN Longitudinal cohort study. SETTING Research clinic. PARTICIPANTS Community-dwelling primary care patients aged ≥65 years (N=391) with self-reported mobility modifications, randomly selected from a research registry. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Categories of decline in and persistently poor mobility across baseline, 1 and 2 years of follow-up in the Lower-Extremity Function scales of the Late-Life Function and Disability Instrument. The following categories of impairment were assessed as potential predictors of mobility change: strength (leg strength), speed of movement (leg velocity, reaction time, rapid leg coordination), range of motion (ROM) (knee flexion/knee extension/ankle ROM), asymmetry (asymmetry of leg strength and knee flexion/extension ROM measures), and trunk stability (trunk extensor endurance, kyphosis). RESULTS The largest effect sizes were found for baseline weaker leg strength (odds ratio [95% confidence interval]: 3.45 [1.72-6.95]), trunk extensor endurance (2.98 [1.56-5.70]), and slower leg velocity (2.35 [1.21-4.58]) predicting a greater likelihood of persistently poor function over 2 years. Baseline weaker leg strength, trunk extensor endurance, and restricted knee flexion motion also predicted a greater likelihood of decline in function (1.72 [1.10-2.70], 1.83 [1.13-2.95], and 2.03 [1.24-3.35], respectively). CONCLUSIONS Older adults exhibiting poor mobility may be prime candidates for rehabilitation focused on improving these impairments. These findings lay the groundwork for developing interventions aimed at optimizing rehabilitative care and disability prevention, and highlight the importance of both well-recognized (leg strength) and novel impairments (leg velocity, trunk extensor muscle endurance).
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Affiliation(s)
- Rachel E Ward
- New England Geriatric Research Education and Clinical Center, Boston Veterans Affairs Healthcare System, Boston, MA; Harvard Medical School, Boston, MA; Spaulding Rehabilitation Hospital, Cambridge, MA.
| | - Marla K Beauchamp
- School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada
| | - Nancy K Latham
- Health and Disability Research Institute, Boston University School of Public Health, Boston, MA
| | - Suzanne G Leveille
- Harvard Medical School, Boston, MA; College of Nursing and Health Sciences, University of Massachusetts Boston, Boston, MA
| | - Sanja Percac-Lima
- Harvard Medical School, Boston, MA; Massachusetts General Hospital, Boston, MA
| | - Laura Kurlinski
- Harvard Medical School, Boston, MA; Spaulding Rehabilitation Hospital, Cambridge, MA
| | - Pengsheng Ni
- Health and Disability Research Institute, Boston University School of Public Health, Boston, MA
| | - Richard Goldstein
- Harvard Medical School, Boston, MA; Spaulding Rehabilitation Hospital, Cambridge, MA
| | - Alan M Jette
- Health and Disability Research Institute, Boston University School of Public Health, Boston, MA
| | - Jonathan F Bean
- New England Geriatric Research Education and Clinical Center, Boston Veterans Affairs Healthcare System, Boston, MA; Harvard Medical School, Boston, MA; Spaulding Rehabilitation Hospital, Cambridge, MA
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Taylor K, Reginatto B, Patterson MR, Power D, Komaba Y, Maeda K, Inomata A, Caulfield B. Context focused older adult mobility and gait assessment. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2016; 2015:6943-6. [PMID: 26737889 DOI: 10.1109/embc.2015.7319989] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
This paper presents an initial overview of insights gained into how older adults mobilize in the home and community, based on data from inertial sensors which were worn by study participants over a 7-day period. The addition of a wearable camera provided additional contextual information which can be used to assess mobility and understand the factors that influence it in the free living environment. Seven days of data collected from a group of older adults who had experienced one or more falls in the previous six months was compared to that of a control group with no history of falling. Results showed that both groups spent relatively little time walking in challenging environmental conditions, and that the fallers spent significantly less time walking under regular conditions (no effect on gait) and outdoors. Analysis of gait metrics showed that the fallers were slightly slower in general, and more noticeable differences were observed when the participants were regrouped according to mobility levels determined from baseline assessments using traditional methods.
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[German version of the de Morton mobility index. First clinical results from the process of the cross-cultural adaptation]. Z Gerontol Geriatr 2015; 48:154-63. [PMID: 25388543 DOI: 10.1007/s00391-014-0648-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
BACKGROUND The English version of the de Morton Mobility Index (DEMMI) enables allied health professions in an inpatient setting to assess the mobility of geriatric patients in a reliable, valid, easy and fast way, without showing any floor or ceiling effects. The aim of this study was the DEMMI's cross-cultural adaption into German language with further analysis of some of its psychometric properties based on this process. MATERIAL AND METHODS Translation was done in a multistage procedure following international recommendations. Within clinical pilot testing the DEMMI was routinely applied over a period of 3 weeks in a geriatric hospital. User experiences were evaluated in a qualitative way and DEMMI test results were analyzed with the focus on practicability and responsiveness. RESULTS A German DEMMI version has been translated and performed with 133 patients. The test takes approximately 10 min to administer, is save and easy to use and does not show any floor or ceiling effects. The DEMMI is valid for the whole mobility spectrum, that is why mobility changes can be realized sufficiently in contrast to the Timed Up And Go Test. CONCLUSION The DEMMI is already applicable in the German-speaking world. However, further research on its validity and reproducibility are desirable.
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Siordia C. INTERSECTING SELF-REPORTED MOBILITY AND GAIT SPEED TO CREATEA MULTI-DIMENSIONAL MEASURE OF AMBULATION: THE "AMBULATION SPEED-ENDURANCE" (ASE) TYPOLOGY. J Frailty Aging 2015; 4:56-63. [PMID: 26258113 DOI: 10.14283/jfa.2015.42] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Assessing mobility through readily available and affordable protocols may help advance public health by providing early detection and implementing intervention therapies aimed at mitigating the progression from physiological vitality to disability at older ages. Until now, little attention has been given to how self-reported mobility (SRM) and gait speed can be combined in a categorization scheme. OBJECTIVES The specific aim of this report is to introduce the Ambulation Speed-Endurance (ASE) Typology to the literature-a classification system that intersects SRM and gait speed to create a multi-dimensional measure of ambulation. DESIGN Cross-sectional. SETTING Community-dwelling older adults in the United States. PARTICIPANTS Evidence is provided from the National Health and Aging Trends Study (NHATS) that community-dwelling older adults (n=5,403) may be found in each of the ASE Typologies. The discussion is complimented by investigating the cross-sectional predictors of a "Discrepancy Score" (measure of gap between speed and endurance) amongst those with gait speeds < 0.99 m/sec (n=4,521). RESULTS Multivariable linear regression results indicate level of severity in speed-endurance discrepancy is higher amongst: non-Latino-Blacks (β=0.48); Latinos (β=0.42); older ages; and lower educated. Models also show that severity in speed-endurance discrepancy is lower amongst: females (β=-0.38); those with higher body mass index; with more chronic health conditions; and poorer self-rated health. CONCLUSION Research should continue to investigate how to optimize SRM.
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Affiliation(s)
- C Siordia
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh ; Center for Aging and Population Health, University of Pittsburgh, Pennsylvania
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Day L, Hill KD, Stathakis VZ, Flicker L, Segal L, Cicuttini F, Jolley D. Impact of tai-chi on falls among preclinically disabled older people. A randomized controlled trial. J Am Med Dir Assoc 2015; 16:420-6. [PMID: 25769960 DOI: 10.1016/j.jamda.2015.01.089] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2015] [Revised: 01/20/2015] [Accepted: 01/21/2015] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To investigate the effectiveness of tai-chi in preventing falls among community-dwelling older people. DESIGN Multisite parallel group individually randomized controlled trial. SETTING Melbourne, Australia. PARTICIPANTS Preclinically disabled community-dwelling people 70 + years (n = 503), without major medical conditions or moderate to severe cognitive impairment. INTERVENTION Sixty-minute modified Sun style tai-chi group-based exercise program twice weekly for 48 weeks; control intervention was a seated group-based flexibility exercise program of the same dose. MEASUREMENTS All falls, self-reported using a monthly calendar, analyzed at 24 weeks and 48 weeks. Injurious falls reported in follow-up telephone interviews for each reported fall. RESULTS The adjusted fall incidence rate ratios at 24 and 48 weeks were 1.08 [(95% confidence interval (CI) 0.64-1.81)], and 1.12 (95% CI 0.75-1.67), respectively. A higher proportion of intervention participants ceased attendance in the first 24 weeks (difference 17.9%, 95% CI 9.6-25.8), and the second 24 weeks (2.7%, 95% CI -5.0 to 10.4). Intervention participants who ceased attendance had lower left quadriceps strength (difference 3.3 kg 95% CI 0.15-6.36) and required longer to complete the timed up and go test (difference 1.7 seconds 95% CI 0.22-3.17) at baseline. CONCLUSIONS This study does not support modified Sun style tai-chi as a falls prevention measure among relatively well community-dwelling older people with modified mobility and at increased risk of disability. Insufficient intervention intensity, or low exercise class attendance may have contributed to the lack of effect, as may have attrition bias among the intervention group.
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Affiliation(s)
- Lesley Day
- Falls Prevention Research Unit, Monash Injury Research Institute, Monash University, Melbourne, Australia.
| | - Keith D Hill
- Faculty of Health Sciences, School of Physiotherapy and Exercise Science, Curtin University, Perth, Australia.
| | - Voula Z Stathakis
- Falls Prevention Research Unit, Monash Injury Research Institute, Monash University, Melbourne, Australia
| | - Leon Flicker
- Center for Medical Research, University of Western Australia, Perth, Australia
| | - Leonie Segal
- Division of Health Sciences, School of Population Health, University of South Australia, Adelaide, Australia
| | - Flavia Cicuttini
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Damien Jolley
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
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Self-reported walking speed: a useful marker of physical performance among community-dwelling older people? J Am Med Dir Assoc 2014; 16:323-8. [PMID: 25523286 DOI: 10.1016/j.jamda.2014.11.004] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2014] [Accepted: 11/04/2014] [Indexed: 12/31/2022]
Abstract
BACKGROUND Walking speed is central to emerging consensus definitions of sarcopenia and frailty as well as being a major predictor of future health outcomes in its own right. However, measurement is not always feasible in clinical settings. We hypothesized that self-reported walking speed might be a good marker of objectively measured walking speed for use in this context. METHODS We investigated the relationship between self-reported and measured walking speed and their associations with clinical characteristics and mortality using data from 730 men and 999 women, aged 61 to 73 years, who participated in the Hertfordshire Cohort Study. Walking speed was measured over 3 meters. Participants rated their walking speed as "unable to walk," "very slow," "stroll at an easy pace," "normal speed," "fairly brisk," or "fast." RESULTS Self-reported walking speed was strongly associated with measured walking speed among men and women (P < .001). Average walking speeds ranged from 0.78 m/s (95% CI 0.73-0.83) among men with "very slow" self-reported walking speed to 0.98 m/s (95% CI 0.93-1.03) among "fast" walkers (corresponding figures for women were 0.72 m/s [95% CI 0.68-0.75] and 1.01 m/s [95% CI 0.98-1.05]). Self-reported and measured walking speeds were similarly associated with clinical characteristics and mortality; among men and women, slower self-reported and measured walking speeds were associated (P < .05) with increased likelihood of poor physical function, having more systems medicated and with increased mortality risk, with and without adjustment for sociodemographic and lifestyle factors (hazard ratios for mortality per slower band of self-reported walking speed, adjusted for sociodemographic and lifestyle characteristics: men 1.44 [95% CI 1.11-1.87]; women 1.35 [95% CI 1.02-1.81]). CONCLUSION AND IMPLICATIONS Self-reported walking speed is a good marker of measured walking speed and could serve as a useful marker of physical performance in consensus definitions of sarcopenia and frailty when direct measurement of walking speed is not feasible.
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Lorenz RA, Budhathoki CB, Kalra GK, Richards KC. The relationship between sleep and physical function in community-dwelling adults: a pilot study. FAMILY & COMMUNITY HEALTH 2014; 37:298-306. [PMID: 25167070 PMCID: PMC4286147 DOI: 10.1097/fch.0000000000000046] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
More than 50% of community-dwelling adults have sleep complaints. Because aging is associated with decline in physical function, coexistent sleep difficulties may exacerbate functional decline. This pilot study explored the relationships between sleep, age, chronic disease burden, and physical function among 50 community-dwelling older adults. Findings revealed significant relationships between total sleep time and preclinical disability (r = -0.33, P ≤ .05) and mobility difficulty (r = -0.36, P ≤ .05). A regression analysis showed that total sleep time was significantly associated with mobility difficulty and preclinical disability, even after controlling for chronic disease burden. These findings suggest that total sleep time may be a catalyst for functional decline.
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Winters-Stone KM, Dobek JC, Bennett JA, Dieckmann NF, Maddalozzo GF, Ryan CW, Beer TM. Resistance training reduces disability in prostate cancer survivors on androgen deprivation therapy: evidence from a randomized controlled trial. Arch Phys Med Rehabil 2014; 96:7-14. [PMID: 25194450 DOI: 10.1016/j.apmr.2014.08.010] [Citation(s) in RCA: 80] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2014] [Revised: 08/05/2014] [Accepted: 08/08/2014] [Indexed: 12/29/2022]
Abstract
OBJECTIVES To investigate whether functionally based resistance exercise could improve strength, physical function, and disability among prostate cancer survivors (PCS) on androgen deprivation therapy (ADT); and to explore potential mediators of changes in outcomes from exercise. DESIGN Randomized controlled trial. SETTING Academic medical center. PARTICIPANTS PCS (N=51; mean age, 70.2y) on ADT. INTERVENTION PCS were randomized to moderate to vigorous intensity resistance training or stretching (placebo control) for 1 year. MAIN OUTCOME MEASURES Maximal leg press and bench press strength, objective and self-reported physical function, and self-reported disability. Hierarchical linear modeling was used to test for significant group × time differences adjusting for covariates. RESULTS Retention in the study was 84%, and median attendance to supervised classes was 84% in the resistance group. No study-related injuries occurred. Maximal leg strength (P=.032) and bench press strength (P=.027) were improved after 1 year of resistance training, whereas little change occurred from stretching. Self-reported physical function improved with resistance training, whereas decreases occurred from stretching (P=.016). Disability lessened more with resistance training than stretching (P=.018). One-year change in leg press strength mediated the relation between groups (resistance or stretching) and 1-year change in self-reported disability (P<.05). CONCLUSIONS One year of resistance training improved muscle strength in androgen-deprived PCS. Strengthening muscles using functional movement patterns may be an important feature of exercise programs designed to improve perceptions of physical function and disability. Findings from this study contribute to the mounting evidence that exercise should become a routine part of clinical care in older men with advanced prostate cancer.
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Affiliation(s)
- Kerri M Winters-Stone
- Knight Cancer Institute, Oregon Health & Science University, Portland, OR; School of Nursing, Oregon Health & Science University, Portland, OR.
| | - Jessica C Dobek
- School of Nursing, Oregon Health & Science University, Portland, OR
| | - Jill A Bennett
- Knight Cancer Institute, Oregon Health & Science University, Portland, OR; School of Nursing, Oregon Health & Science University, Portland, OR
| | | | - Gianni F Maddalozzo
- Department of Exercise and Sport Science, School of Biologic and Population Health, Oregon State University, Corvallis, OR
| | - Christopher W Ryan
- Knight Cancer Institute, Oregon Health & Science University, Portland, OR; School of Medicine, Oregon Health & Science University, Portland, OR
| | - Tomasz M Beer
- Knight Cancer Institute, Oregon Health & Science University, Portland, OR; School of Medicine, Oregon Health & Science University, Portland, OR
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Higgins TJ, Janelle CM, Manini TM. Diving below the surface of progressive disability: considering compensatory strategies as evidence of sub-clinical disability. J Gerontol B Psychol Sci Soc Sci 2014; 69:263-74. [PMID: 24170713 PMCID: PMC3968860 DOI: 10.1093/geronb/gbt110] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2012] [Accepted: 09/19/2013] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES To provide a comprehensive review regarding the role of activity and participation compensations within the disablement process, identify directions for future research, and discuss the implications of compensation pertaining to public health initiatives aimed at preventing and reversing disability. METHOD This article evaluated how using compensatory strategies to cope with functional deficits reveals important transitions within the disablement process and signifies a unique opportunity to identify early declines in function. RESULTS Previous research suggests that (a) adopting compensatory strategies to maintain activity/participation is strongly associated with functional decline and disease severity and significantly predicts the onset of limitations/restrictions; (b) compensation can be reliably quantified; and (c) contextual knowledge about how individuals adapt to functional decline can be used to describe transitions in the disablement process. DISCUSSION Characterizing subtle adaptations prior to the onset of activity limitations and participation restrictions will not only aid in understanding the complex disablement process but also help inform social services and future prevention strategies. Overall, this article integrates the concept of compensation into the current model of disability and proposes a framework for identifying and interpreting compensatory behavior.
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Affiliation(s)
- Torrance J Higgins
- Correspondence should be addressed to Todd M. Manini, Department of Aging and Geriatrics, University of Florida, 210 Mowry Road, Gainesville, Gainesville, FL 32611. E-mail:
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Ramos-Pichardo JD, Cabrero-García J, González-Llopis L, Cabañero-Martínez MJ, Muñoz-Mendoza CL, Sanjuan-Quiles A, Richart-Martínez M, Reig-Ferrer A. What do older people understand by mobility-related difficulties? Arch Gerontol Geriatr 2014; 59:122-30. [PMID: 24613103 DOI: 10.1016/j.archger.2014.02.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2013] [Revised: 12/28/2013] [Accepted: 02/06/2014] [Indexed: 10/25/2022]
Abstract
UNLABELLED Despite the centrality of the difficulty concept in the study of disability, there has been little research on its significance from the point of view of people with functional limitations. The main objective of this study was to describe what older people understand when asked about difficulty in undertaking mobility activities. As a secondary objective, we considered whether there are any differences depending on the type of activities, according to the International Classification of Functioning (ICF) mobility domains. METHODS Seventeen community-dwelling men and women aged 70 years old or over were interviewed by means of a questionnaire containing 55 items covering the ICF mobility domains. The participants responded to the items while thinking aloud, saying what led them to give a specific answer about their level of difficulty. Inductive content analysis was conducted and categories, subthemes and themes were identified. RESULTS Causes of difficulty (pathologies, impairments, symptoms) and accommodations (task modifications and use of aids) were the two themes identified; and their importance (and that of the subthemes included) varied across the types of activity. All the participants said that they had no difficulty in at least one task, despite mentioning changes in the way they performed them. CONCLUSIONS Older people's opinions were consistent with theoretical models of disability and with the standard practice of measuring functional limitations by asking about the degree of difficulty; however, the design of these measures needs to be improved in order to detect perceptions of no difficulty in the presence of task modification.
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Affiliation(s)
| | | | | | | | | | | | | | - Abilio Reig-Ferrer
- Department of Health Psychology, University of Alicante, Alicante, Spain.
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50
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Tikkanen P, Lönnroos E, Sipilä S, Nykänen I, Sulkava R, Hartikainen S. Effects of comprehensive geriatric assessment-based individually targeted interventions on mobility of pre-frail and frail community-dwelling older people. Geriatr Gerontol Int 2014; 15:80-8. [DOI: 10.1111/ggi.12231] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/25/2013] [Indexed: 12/20/2022]
Affiliation(s)
- Päivi Tikkanen
- Social and Health Services; City of Kuopio; Kuopio Finland
- School of Pharmacy; Faculty of Health Sciences; University of Eastern Finland; Kuopio Finland
- Institute of Public Health and Clinical Nutrition; Department of Public Health; University of Eastern Finland; Kuopio Finland
| | - Eija Lönnroos
- Institute of Public Health and Clinical Nutrition; Department of Geriatrics; University of Eastern Finland; Kuopio Finland
| | - Sarianna Sipilä
- Gerontology Research Center and Department of Health Sciences; University of Jyväskylä; Jyväskylä Finland
| | - Irma Nykänen
- School of Pharmacy; Faculty of Health Sciences; University of Eastern Finland; Kuopio Finland
- Kuopio Research Centre of Geriatric Care; University of Eastern Finland; Kuopio Finland
| | - Raimo Sulkava
- Institute of Public Health and Clinical Nutrition; Department of Geriatrics; University of Eastern Finland; Kuopio Finland
- Department of Neurology; Kuopio University Hospital; Kuopio Finland
| | - Sirpa Hartikainen
- School of Pharmacy; Faculty of Health Sciences; University of Eastern Finland; Kuopio Finland
- Kuopio Research Centre of Geriatric Care; University of Eastern Finland; Kuopio Finland
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