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Pérès K, Zamudio-Rodriguez A, Dartigues JF, Amieva H, Lafitte S. Prospective pragmatic quasi-experimental study to assess the impact and effectiveness of an innovative large-scale public health intervention to foster healthy ageing in place: the SoBeezy program protocol. BMJ Open 2021; 11:e043082. [PMID: 33926977 PMCID: PMC8094369 DOI: 10.1136/bmjopen-2020-043082] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION With the accelerating pace of ageing, healthy ageing has become a major challenge for all societies worldwide. Based on that Healthy Ageing concept proposed by the WHO, the SoBeezy intervention has been designed through an older person-centred and integrated approach. The programme creates the environments that maximise functional ability to enable people to be and do what they value and to stay at home in best possible conditions. METHODS AND ANALYSIS Five levers are targeted: tackling loneliness, restoring feeling of usefulness, finding solutions to face material daily life difficulties, promoting social participation and combating digital divide. Concretely, the SoBeezy programme relies on: (1) a digital intelligent platform available on smartphone, tablet and computer, but also on a voice assistant specifically developed for people with digital divide; (2) a large solidarity network which potentially relies on everyone's engagement through a participatory intergenerational approach, where the older persons themselves are not only service receivers but also potential contributors; (3) an engagement of local partners and stakeholders (citizens, associations, artisans and professionals). Organised as a hub, the system connects all the resources of a territory and provides to the older person the best solution to meet his demand. Through a mixed, qualitative and quantitative (before/after analyses and compared to controls) approach, the research programme will assess the impact and effectiveness on healthy ageing, the technical usage, the mechanisms of the intervention and conditions of transferability and scalability. ETHICS AND DISSEMINATION Inserm Ethics Committee and the Comité Éthique et Scientifique pour les Recherches, les Études et les Évaluations dans le domaine de la Santé approved this research and collected data will be deposited with a suitable data archive.
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Affiliation(s)
- Karine Pérès
- Univ. Bordeaux, INSERM, Bordeaux Population Health, U1219, Bordeaux, France
| | | | | | - Hélène Amieva
- Univ. Bordeaux, INSERM, Bordeaux Population Health, U1219, Bordeaux, France
| | - Stephane Lafitte
- University Hospital Centre Bordeaux Cardiology Hospital Anaesthesiology and Reanimation, Pessac, Nouvelle-Aquitaine, France
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James EG, Hausdorff JM, Leveille SG, Travison T, Bean JF. Ankle control differentiation as a mechanism for mobility limitations. Neurosci Lett 2020; 732:135085. [PMID: 32461108 DOI: 10.1016/j.neulet.2020.135085] [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: 09/19/2019] [Revised: 05/04/2020] [Accepted: 05/21/2020] [Indexed: 11/25/2022]
Abstract
Independent control of the right and left ankles (differentiation) may be a motor control mechanism linking impaired coordination and mobility limitations. We tested the hypotheses that motor control differentiation of the ankles, as measured using Cross-Sample Entropy, during antiphase coordination at two movement frequencies, is associated with impaired coordination (high ankle coordination variability) and mobility limitations (Short Physical Performance Battery score ≤9). We conducted a cross-sectional study of community-dwelling older adults (N = 133) aged 80.04 (±4.67) years. In linear regression modeling, low ankle Cross-Sample Entropy (low motor control differentiation) was associated with poor (i.e., high) coordination variability at the slower (P = 0.026), but not the faster (P = 0.447), ankle movement frequency. In logistic regression modeling, low Cross-Sample Entropy at the slower (OR = 1.67; 95 % CI: 1.07-2.59) and faster (OR = 2.38; 95 % CI: 1.43-3.94) ankle movement frequencies were associated with increased odds for mobility limitations. Our findings support the hypothesis that ankle differentiation may be a motor control mechanism that links impaired coordination with mobility limitations.
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Affiliation(s)
- Eric G James
- Department of Physical Medicine and Rehabilitation, University of Texas Southwestern Medical Center, Dallas, TX, USA.
| | - Jeffrey M Hausdorff
- Center for the Study of Movement, Cognition and Mobility, Neurological Institute, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel; Department of Physical Therapy, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Suzanne G Leveille
- College of Nursing and Health Sciences, University of Massachusetts, Boston, MA, USA
| | - Thomas Travison
- Institute for Aging Research, Hebrew Senior Life, Boston, MA, USA
| | - Jonathan F Bean
- New England Geriatric Research Education and Clinical Center, Boston Veterans Administration Health System, Boston, MA, USA; Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA, USA
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Wachs D, Roman-Urrestarazu A, Brayne C, Onrubia-Fernández J. Dependency ratios in healthy ageing. BMJ Glob Health 2020; 5:e002117. [PMID: 32399256 PMCID: PMC7204924 DOI: 10.1136/bmjgh-2019-002117] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Revised: 02/21/2020] [Accepted: 03/15/2020] [Indexed: 11/04/2022] Open
Abstract
Although people are living longer, there is no discernible pattern about the quality of life in an increasing lifespan. This restricts our capacity to predict and prepare for the consequences of population ageing. Accordingly, we propose a population ageing indicator that combines demographic and disability prevalence data through a characteristics approach and explore different scenarios to account for uncertainty in life quality projections. Our results, available for 186 countries, show that countries that rank older under conventional chronological ageing measures may rank younger under our qualitative measure. Additionally, we find substantial differences in our projections depending on different health assumptions, demonstrating the risk of using ageing indicators that make implicit assumptions about health characteristics.
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Affiliation(s)
- Diego Wachs
- Economics, Universidad Complutense de Madrid, Madrid, Spain
| | | | - Carol Brayne
- Cambridge Institute of Public Health, University of Cambridge, Cambridge, Cambridgeshire, UK
| | - Jorge Onrubia-Fernández
- Complutense Institute for International Studies (ICEI), Complutense University of Madrid, Madrid, Comunidad de Madrid, Spain
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Schmidt CT, Ward RE, Suri P, Kiely DK, Goldstein R, Pensheng N, Anderson DE, Bean JF. Which Neuromuscular Attributes Are Associated With Changes in Mobility Among Community-Dwelling Older Adults With Symptomatic Lumbar Spinal Stenosis? Arch Phys Med Rehabil 2018; 99:2190-2197. [PMID: 29753734 PMCID: PMC6640144 DOI: 10.1016/j.apmr.2018.04.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Revised: 03/31/2018] [Accepted: 04/15/2018] [Indexed: 11/18/2022]
Abstract
OBJECTIVES To identify neuromuscular attributes associated with mobility and changes in mobility over 2 years of follow-up among patients with and without symptomatic lumbar spinal stenosis (SLSS). DESIGN Secondary analysis of a longitudinal cohort study. SETTING Outpatient rehabilitation center. PARTICIPANTS Community-dwelling older adults ≥65 years with self-reported mobility limitations (N=430). SLSS was determined using self-reported symptoms of neurogenic claudication and imaging-detected lumbar spinal stenosis. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURE Basic and advanced mobility as measured by the Late-Life Function and Disability Instrument (LLFDI). RESULTS Among 430 community-dwelling older adults, 54 (13%) patients met criteria for SLSS, while 246 (57%) did not. On average LLFDI basic and advanced mobility scores decreased significantly from baseline through year 2 for participants with SLSS (basic: P=.04, 95% CI 0.18, 5.21; advanced P=.03, 95% CI 0.39, 7.84). Trunk extensor muscle endurance (trunk endurance) and leg strength were associated with baseline basic mobility (R2=0.27, P<.001) while leg strength and knee flexion range of motion (ROM) were associated with baseline advanced mobility among participants with SLSS (R2=0.47, P<.001). Among participants without SLSS trunk endurance, leg strength and ankle ROM were associated with baseline basic mobility (R2=0.38, P<.001), while trunk endurance, leg strength, leg strength asymmetry, and knee flexion ROM were associated with advanced mobility (R2=0.20, P<.001). Trunk endurance and leg strength were associated with change in basic mobility (R2=0.29, P<.001), while trunk endurance and knee flexion ROM were associated with change in advanced mobility (R2=0.42, P<.001) among participants with SLSS. Among participants without SLSS trunk endurance, leg strength, knee flexion ROM, and ankle ROM were associated with change in basic mobility (R2=0.22, P<.001), while trunk endurance, leg strength, and knee flexion ROM were associated with change in advanced mobility (R2=0.36, P<.001). CONCLUSIONS Patients with SLSS experience greater impairment in the neuromuscular attributes: trunk endurance, leg strength, leg strength asymmetry, knee flexion and extension ROM, and ankle ROM compared to patients without SLSS. Differences exist in the neuromuscular attributes associated with mobility at baseline and decline in mobility over 2 years of follow-up for patients with and without SLSS. These findings may help guide rehabilitative care approaches for patients with SLSS.
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Affiliation(s)
- Catherine T Schmidt
- Center for Interprofessional Studies and Innovation, MGH Institute of Health Professions, Boston, MA.
| | - Rachel E Ward
- New England Geriatric Research Education and Clinical Center, VA Boston Healthcare System, GRECC, Boston, MA
| | - Pradeep Suri
- Division of Rehabilitation Care Services, VA Puget Sound Health Care System, Seattle, WA
| | - Dan K Kiely
- Spaulding Rehabilitation Hospital, Cambridge, MA
| | - Richard Goldstein
- Department of Physical Medicine and Rehabilitation, Spaulding Hospital, Charlestown, MA
| | - Ni Pensheng
- Health and Disability Research Institute, Boston University, Boston, MA
| | - Dennis E Anderson
- Center for Advanced Orthopedic Studies, Beth Israel Deaconess Medical Center, Boston, MA
| | - Jonathan F Bean
- New England Geriatric Research Education and Clinical Center, VA Boston Healthcare System, GRECC, Boston, MA
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James EG, Leveille SG, Hausdorff JM, Travison T, Cote S, Conatser P, Karabulut M, Mendes AC, Kennedy DN, Tucker KL, Al Snih S, Markides KS, Bean JF. Rhythmic Interlimb Coordination Impairments Are Associated With Mobility Limitations Among Older Adults. Exp Aging Res 2017; 43:337-345. [DOI: 10.1080/0361073x.2017.1333819] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Eric G. James
- Department of Physical Medicine and Rehabilitation, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Suzanne G. Leveille
- College of Nursing Health Sciences, University of Massachusetts, Boston, Massachusetts, USA
| | - Jeffrey M. Hausdorff
- Center for the Study of Movement, Cognition Mobility, Neurological Institute, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel; Department of Physical Therapy, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Thomas Travison
- Institute for Aging Research, Hebrew Senior Life, Boston, Massachusetts, USA
| | - Sarah Cote
- Department of Physical Therapy, University of Massachusetts, Lowell, Massachusetts, USA
| | - Philip Conatser
- Department of Health Human Performance, University of Texas Rio Grande Valley, Brownsville, Texas, USA
| | - Murat Karabulut
- Department of Health Human Performance, University of Texas Rio Grande Valley, Brownsville, Texas, USA
| | - Andrea C. Mendes
- Department of Physical Therapy, University of Massachusetts, Lowell, Massachusetts, USA
| | - David N. Kennedy
- Department of Psychiatry, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Katherine L. Tucker
- Department of Clinical Laboratory Nutritional Sciences, University of Massachusetts, Lowell, Massachusetts, USA
| | - Soham Al Snih
- Division of Rehabilitation Sciences, University of Texas Medical Branch, Galveston, Texas, USA
| | - Kyriakos S. Markides
- Sealy Center on Aging, University of Texas Medical Branch, Galveston, Texas, USA
| | - Jonathan F. Bean
- Department of Physical Medicine Rehabilitation, Harvard Medical School, Boston, Massachusetts, USA
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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. A Novel Approach to Identifying Trajectories of Mobility Change in Older Adults. PLoS One 2016; 11:e0169003. [PMID: 28006024 PMCID: PMC5179086 DOI: 10.1371/journal.pone.0169003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Accepted: 12/10/2016] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES To validate trajectories of late-life mobility change using a novel approach designed to overcome the constraints of modest sample size and few follow-up time points. METHODS Using clinical reasoning and distribution-based methodology, we identified trajectories of mobility change (Late Life Function and Disability Instrument) across 2 years in 391 participants age ≥65 years from a prospective cohort study designed to identify modifiable impairments predictive of mobility in late-life. We validated our approach using model fit indices and comparing baseline mobility-related factors between trajectories. RESULTS Model fit indices confirmed that the optimal number of trajectories were between 4 and 6. Mobility-related factors varied across trajectories with the most unfavorable values in poor mobility trajectories and the most favorable in high mobility trajectories. These factors included leg strength, trunk extension endurance, knee flexion range of motion, limb velocity, physical performance measures, and the number and prevalence of medical conditions including osteoarthritis and back pain. CONCLUSIONS Our findings support the validity of this approach and may facilitate the investigation of a broader scope of research questions within aging populations of varied sizes and traits.
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Affiliation(s)
- Rachel E. Ward
- New England GRECC, Boston VA Healthcare System, Boston, MA, United States of America
- Harvard Medical School, Cambridge, MA, United States of America
- Spaulding Rehabilitation Hospital, Cambridge, MA, United States of America
| | - 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, United States of America
| | - Suzanne G. Leveille
- Harvard Medical School, Cambridge, MA, United States of America
- College of Nursing and Health Sciences, University of Massachusetts Boston, Boston, MA, United States of America
| | - Sanja Percac-Lima
- Harvard Medical School, Cambridge, MA, United States of America
- Massachusetts General Hospital, Boston, MA, United States of America
| | - Laura Kurlinski
- Harvard Medical School, Cambridge, MA, United States of America
- Spaulding Rehabilitation Hospital, Cambridge, MA, United States of America
| | - Pengsheng Ni
- Health and Disability Research Institute, Boston University School of Public Health, Boston, MA, United States of America
| | - Richard Goldstein
- Harvard Medical School, Cambridge, MA, United States of America
- Spaulding Rehabilitation Hospital, Cambridge, MA, United States of America
| | - Alan M. Jette
- Health and Disability Research Institute, Boston University School of Public Health, Boston, MA, United States of America
| | - Jonathan F. Bean
- New England GRECC, Boston VA Healthcare System, Boston, MA, United States of America
- Harvard Medical School, Cambridge, MA, United States of America
- Spaulding Rehabilitation Hospital, Cambridge, MA, United States of America
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Beard JR, Officer A, de Carvalho IA, Sadana R, Pot AM, Michel JP, Lloyd-Sherlock P, Epping-Jordan JE, Peeters GMEEG, Mahanani WR, Thiyagarajan JA, Chatterji S. The World report on ageing and health: a policy framework for healthy ageing. Lancet 2016; 387:2145-2154. [PMID: 26520231 PMCID: PMC4848186 DOI: 10.1016/s0140-6736(15)00516-4] [Citation(s) in RCA: 1286] [Impact Index Per Article: 160.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Although populations around the world are rapidly ageing, evidence that increasing longevity is being accompanied by an extended period of good health is scarce. A coherent and focused public health response that spans multiple sectors and stakeholders is urgently needed. To guide this global response, WHO has released the first World report on ageing and health, reviewing current knowledge and gaps and providing a public health framework for action. The report is built around a redefinition of healthy ageing that centres on the notion of functional ability: the combination of the intrinsic capacity of the individual, relevant environmental characteristics, and the interactions between the individual and these characteristics. This Health Policy highlights key findings and recommendations from the report.
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Affiliation(s)
- John R Beard
- Ageing and Life Course, World Health Organization, Geneva, Switzerland.
| | - Alana Officer
- Ageing and Life Course, World Health Organization, Geneva, Switzerland
| | | | - Ritu Sadana
- Ageing and Life Course, World Health Organization, Geneva, Switzerland
| | - Anne Margriet Pot
- Ageing and Life Course, World Health Organization, Geneva, Switzerland
| | | | | | | | | | - Wahyu Retno Mahanani
- Health statistics and information systems, World Health Organization, Geneva, Switzerland
| | | | - Somnath Chatterji
- Health statistics and information systems, World Health Organization, Geneva, Switzerland
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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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Díaz-Venegas C, Reistetter TA, Wang CY, Wong R. The progression of disability among older adults in Mexico. Disabil Rehabil 2016; 38:2016-27. [PMID: 26729017 DOI: 10.3109/09638288.2015.1111435] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE This paper seeks to document the progression of disability in a developing country and to examine gender differences in this process. METHODS The data come from the Mexican Health and Aging Study (MHAS), a nationally representative sample of older adults. An ordinal logistic regression (n = 3283) is used to measure the progression of disability that considers: (1) no disability, (2) mobility problems, (3) mobility problems with IADLs limitations, (4) mobility problems with ADLs limitations, (5) combinations of the latter three and (6) death. RESULTS Approximately 43% of the sample remained in the same level of disability after 2 years. The patterns of progression with two disabilities differ for men and women. CONCLUSIONS Our model reflects the importance of separating ADLs and IADLs in the study of disability progression in Mexico. Varying risk profiles and cultural differences might influence the divergent disability paths followed by each gender. Implications for Rehabilitation The disablement process involving transitions from mobility impairments to IADL and ADL limitations seen in developed countries differs for older adults in Mexico. Cultural differences may influence the progression from non-disabled to becoming disabled in different ways for females in developing countries like Mexico. One-fifth of individuals showed greater function and independence over time, suggesting that the disablement process is reversible. This finding highlights the need to focus on improving mobility, ADL, and IADL skills to facilitate successful aging. Although disability is often conceptualised as a combination of ADL and IADL limitations, gender differences seen in Mexico indicate the need to separate ADL and IADL when developing approaches to prevent or ameliorate disability.
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Affiliation(s)
- Carlos Díaz-Venegas
- a Rehabilitation Sciences Academic Division & Research Center , University of Texas Medical Branch , Galveston , TX , USA
| | - Timothy A Reistetter
- b Department of Physical Therapy , University of Texas Medical Branch , Galveston , TX , USA
| | - Ching-Yi Wang
- c School of Physical Therapy, Chung Shan Medical University , Taichung City , Taiwan
| | - Rebeca Wong
- d Preventive Medicine & Community Health, University of Texas Medical Branch , Galveston , TX , USA
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What physical attributes underlie self-reported vs. observed ability to walk 400 m in later life? An analysis from the InCHIANTI Study. Am J Phys Med Rehabil 2014; 93:396-404. [PMID: 24322434 DOI: 10.1097/phm.0000000000000034] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The aims of this study were to evaluate and contrast the physical attributes that are associated with self-reported vs. observed ability to walk 400 m among older adults. DESIGN Analysis of baseline and 3-yr data from 1026 participants 65 yrs or older in the InCHIANTI (Invecchiare in Chianti) study was conducted. Observed and self-reported ability to walk 400 m at baseline and at 3 yrs were primary outcomes. Predictors included leg speed, leg strength, leg strength symmetry, range of motion, balance, and kyphosis. RESULTS Balance, leg speed, leg strength, kyphosis, leg strength symmetry, and knee range of motion were associated with self-reported ability to walk 400 m at baseline (P < 0.001, c = 0.85). Balance, leg speed, and knee range of motion were associated with observed 400-m walk (P < 0.001, c = 0.85) at baseline. Prospectively, baseline leg speed and leg strength were predictive of both self-reported (P < 0.001, c = 0.79) and observed (P < 0.001, c = 0.72) ability to walk 400 m at 3 yrs. CONCLUSIONS The profiles of attributes that are associated with self-reported vs. observed walking ability differ. The factor most consistently associated with current and future walking ability is leg speed. These results draw attention to important foci for rehabilitation.
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Song L, Ji Y, Nielsen ME. Quality of life and health status among prostate cancer survivors and noncancer population controls. Urology 2014; 83:658-63. [PMID: 24581528 DOI: 10.1016/j.urology.2013.12.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2013] [Revised: 11/27/2013] [Accepted: 12/03/2013] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To examine whether quality of life (QOL), health status, and the relationships between them varied by having a prostate cancer history. This study helps to inform the interface between aging-related health decline and the survival state among older men with prostate cancer, which is an important yet understudied public health issue. METHODS Hierarchical linear models were used to analyze the cross-sectional data from the nationally representative population-based Medical Expenditure Panel Survey. Using propensity score matching, survivors (respondents with prostate cancer history) and controls (respondents without a history of any cancer) (N = 193 pairs) were matched based on 7 sociodemographic and health-related factors. QOL was measured using the mental and physical component scores of the SF-12 (SF-36.org). Health status included comorbidities, activities of daily living (ADL), instrumental ADL, and depressed mood. RESULTS In bivariate analyses, survivors reported worse physical (42.72 vs 45.45 respectively; P = .0040) and mental QOL (51.59 vs 53.73 respectively; P = .0295) and more comorbidities (3.25 vs 2.78 respectively; P = .0139) than controls. In multivariate analyses, for both survivors and controls, better physical QOL was associated with fewer comorbidities (P <.0001), no need help with ADL (P = .0011) and IADL (P = .0162), and less depressed mood (P <.0001); better mental QOL was associated with no need help with IADL (P = .0005) and less depressed mood (P <.0001). CONCLUSION QOL of older men is affected by physical, functional, and psychological factors rather than prostate cancer history. Clinicians need to attend to aging-related health issues when providing care for prostate cancer survivors to improve QOL.
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Affiliation(s)
- Lixin Song
- Department of Adult and Geriatric Health, School of Nursing, University of North Carolina (UNC), Chapel Hill, NC; Lineberger Comprehensive Cancer Center, UNC, Chapel Hill, NC.
| | - Yingchun Ji
- Asia Research Institute, National University of Singapore, Singapore
| | - Mathew E Nielsen
- Department of Adult and Geriatric Health, School of Nursing, University of North Carolina (UNC), Chapel Hill, NC; Division of Urologic Surgery, School of Medicine, UNC, Chapel Hill, NC
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Bean JF, Latham NK, Holt N, Kurlinksi L, Ni P, Leveille S, Percac-Lima S, Jette A. Which neuromuscular attributes are most associated with mobility among older primary care patients? Arch Phys Med Rehabil 2013; 94:2381-2388. [PMID: 23973445 DOI: 10.1016/j.apmr.2013.07.026] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2013] [Accepted: 07/31/2013] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To identify the neuromuscular attributes that are associated with self-reported mobility status among older primary care patients. DESIGN Cohort study. SETTING Metropolitan-based health care system. PARTICIPANTS Community-dwelling primary care patients aged ≥65 years (N=430), with self-reported modification of mobility tasks resulting from underlying health conditions. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Basic and Advanced Lower Extremity Function as measured by the Late Life Function and Disability Instrument. RESULTS We constructed multivariable linear regression models evaluating both outcomes. For Basic Lower Extremity Function, leg strength, leg velocity, trunk extensor muscle endurance, and ankle range of motion (ROM) were statistically significant predictors (P<.001, R(2)=.21). For Advanced Lower Extremity Function, leg strength, leg strength asymmetry, leg velocity, trunk extensor muscle endurance, and knee flexion ROM were statistically significant predictors (P<.001, R(2)=.39). Sensitivity analyses conducted using multiple imputations to account for missing data confirmed these findings. CONCLUSIONS This analysis highlights the relevance and importance of 5 categories of neuromuscular attributes: strength, speed of movement, ROM, asymmetry, and trunk stability. It identifies novel attributes (leg velocity and trunk extensor muscle endurance) relevant to mobility and highlights that impairment profiles vary by the level of mobility assessed. These findings will inform the design of more thorough and potentially more effective disability prevention strategies.
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Affiliation(s)
| | | | - Nicole Holt
- Spaulding Rehabilitation Hospital, Boston, MA
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The association of menopause status with physical function: the Study of Women's Health Across the Nation. Menopause 2013; 19:1186-92. [PMID: 22760087 DOI: 10.1097/gme.0b013e3182565740] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE The aim of this study was to determine whether postmenopause status is associated with self-reported limitations in physical function. METHODS The Study of Women's Health Across the Nation is a multisite, multiethnic, longitudinal study of midlife women. Women aged 45 to 57 years (N = 2,566) completed the physical function scale of the Medical Outcomes Study Short-Form 36 on visit 4 (2000-2001). Scores created a three-category variable of physical function limitations: none (86-100), moderate (51-85), and substantial (0-50). In the Study of Women's Health Across the Nation, menopause status is a five-category list variable based on menstrual bleeding patterns and gynecological surgery. Premenopausal and perimenopausal women using hormones (n = 284) or missing physical function scores (n = 46) were excluded. Multinomial logistic regression was used to relate physical function and menopause status after adjustment for age, ethnicity, site, education, body mass index (BMI), and self-reported diabetes, hypertension, arthritis, depressive symptoms, smoking, and hormone use among postmenopausal women. RESULTS Of 2,236 women, 8% were premenopausal, 51% were early perimenopausal, 12% were late perimenopausal, 24% were naturally postmenopausal, and 5% were surgically postmenopausal. In the full model, substantial limitations in physical function were higher in postmenopausal women, whether naturally postmenopausal (odds ratio, 3.82; 95% CI, 1.46-10.0) or surgically postmenopausal (odds ratio, 3.54; 95% CI, 1.15-10.84), than in premenopausal women. These associations were attenuated by higher BMI and depressive symptoms but remained significant. Moderate limitations in physical function were not significantly related to menopause status. CONCLUSIONS Women experiencing surgical or naturally occurring postmenopause report greater limitations in physical function compared with premenopausal women, independent of age and only partly explained by higher BMI and depressive symptoms. This suggests that physiological changes in menopause could contribute directly to limitations in physical function.
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Holt NE, Percac-Lima S, Kurlinski LA, Thomas JC, Landry PM, Campbell B, Latham N, Ni P, Jette A, Leveille SG, Bean JF. The Boston Rehabilitative Impairment Study of the Elderly: a description of methods. Arch Phys Med Rehabil 2012; 94:347-55. [PMID: 22989700 DOI: 10.1016/j.apmr.2012.08.217] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2012] [Accepted: 08/30/2012] [Indexed: 11/17/2022]
Abstract
OBJECTIVES To describe the methods of a longitudinal cohort study among older adults with preclinical disability. The study aims to address the lack of evidence guiding mobility rehabilitation for older adults by identifying those impairments and impairment combinations that are most responsible for mobility decline and disability progression over 2 years of follow-up. DESIGN Longitudinal cohort study. SETTING Metropolitan-based health care system. PARTICIPANTS Community-dwelling primary care patients aged ≥65 years (N=430), with self-reported modification of mobility tasks because of underlying health conditions. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Late Life Function and Disability Instrument (LLFDI) (primary outcome); Short Physical Performance Battery and 400-m walk test (secondary outcomes). RESULTS Among 7403 primary care patients identified as being potentially eligible for participation, 430 were enrolled. Participants have a mean age of 76.5 years, are 68% women, and have on average 4.2 chronic conditions. Mean LLFDI scores are 55.5 for Function and 68.9 and 52.3 for the Disability Limitation and Frequency domains, respectively. CONCLUSIONS Completion of our study aims will inform development of primary care-based rehabilitative strategies to prevent disability. Additionally, data generated in this investigation can also serve as a vital resource for ancillary studies addressing important questions in rehabilitative science relevant to geriatric care.
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Bledowski P, Mossakowska M, Chudek J, Grodzicki T, Milewicz A, Szybalska A, Wieczorowska-Tobis K, Wiecek A, Bartoszek A, Dabrowski A, Zdrojewski T. Medical, psychological and socioeconomic aspects of aging in Poland. Exp Gerontol 2011; 46:1003-9. [PMID: 21979452 DOI: 10.1016/j.exger.2011.09.006] [Citation(s) in RCA: 77] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2010] [Revised: 09/09/2011] [Accepted: 09/16/2011] [Indexed: 10/17/2022]
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Hung WW, Ross JS, Boockvar KS, Siu AL. Recent trends in chronic disease, impairment and disability among older adults in the United States. BMC Geriatr 2011; 11:47. [PMID: 21851629 PMCID: PMC3170191 DOI: 10.1186/1471-2318-11-47] [Citation(s) in RCA: 203] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2011] [Accepted: 08/18/2011] [Indexed: 11/20/2022] Open
Abstract
Background To examine concurrent prevalence trends of chronic disease, impairment and disability among older adults. Methods We analyzed the 1998, 2004 and 2008 waves of the Health and Retirement Study, a nationally representative survey of older adults in the United States, and included 31,568 community dwelling adults aged 65 and over. Measurements include: prevalence of chronic diseases including hypertension, heart disease, stroke, diabetes, cancer, chronic lung disease and arthritis; prevalence of impairments, including impairments of cognition, vision, hearing, mobility, and urinary incontinence; prevalence of disability, including activities of daily living (ADLs) and instrumental activities of daily living (IADLs). Results The proportion of older adults reporting no chronic disease decreased from 13.1% (95% Confidence Interval [CI], 12.4%-13.8%) in 1998 to 7.8% (95% CI, 7.2%-8.4%) in 2008, whereas the proportion reporting 1 or more chronic diseases increased from 86.9% (95% CI, 86.2%-89.6%) in 1998 to 92.2% (95% CI, 91.6%-92.8%) in 2008. In addition, the proportion reporting 4 or more diseases increased from 11.7% (95% CI, 11.0%-12.4%) in 1998 to 17.4% (95% CI, 16.6%-18.2%) in 2008. The proportion of older adults reporting no impairments was 47.3% (95% CI, 46.3%-48.4%) in 1998 and 44.4% (95% CI, 43.3%-45.5%) in 2008, whereas the proportion of respondents reporting 3 or more was 7.2% (95% CI, 6.7%-7.7%) in 1998 and 7.3% (95% CI, 6.8%-7.9%) in 2008. The proportion of older adults reporting any ADL or IADL disability was 26.3% (95% CI, 25.4%-27.2%) in 1998 and 25.4% (95% CI, 24.5%-26.3%) in 2008. Conclusions Multiple chronic disease is increasingly prevalent among older U.S. adults, whereas the prevalence of impairment and disability, while substantial, remain stable.
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Affiliation(s)
- William W Hung
- Department of Geriatrics and Palliative Medicine, Mount Sinai School of Medicine, New York, NY, USA.
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Louie GH, Ward MM. Sex disparities in self-reported physical functioning: true differences, reporting bias, or incomplete adjustment for confounding? J Am Geriatr Soc 2010; 58:1117-22. [PMID: 20487076 PMCID: PMC2924945 DOI: 10.1111/j.1532-5415.2010.02858.x] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
OBJECTIVES To determine whether sex disparities in self-reported physical functioning remain after adjusting for potential confounding factors and to assess associations for possible reporting bias. DESIGN Cross-sectional survey. SETTING U.S. population of noninstitutionalized older adults. PARTICIPANTS Women and men aged 60 and older (N=5,396) who participated in the Third National Health and Nutrition Examination Survey. MEASUREMENTS Degree of self-reported limitation in 11 physical functions. RESULTS In unadjusted models, women reported more limitations than men in 10 of 11 tasks. In multivariate ordinal logistic regression models that included adjustment for age, race or ethnicity, education level, comorbidities, smoking, hemoglobin, serum albumin, knee pain, body mass index, skeletal muscle index, and physical performance tests, women reported more limitations only in lifting or carrying 10 pounds (adjusted odds ratio=2.03, 95% confidence interval=1.45-2.84). There was no evidence of systematic reporting differences between men and women for limitations in lifting or carrying 10 pounds relative to the degree of limitation predicted by the model. CONCLUSION Older women have similar degrees of self-reported limitation in physical functioning as older men of the same age, health, and physical abilities.
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Affiliation(s)
- Grant H Louie
- Intramural Research Program, National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Bethesda, Maryland 20892, USA
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Suri P, Kiely DK, Leveille SG, Frontera WR, Bean JF. Trunk muscle attributes are associated with balance and mobility in older adults: a pilot study. PM R 2010; 1:916-24. [PMID: 19854420 DOI: 10.1016/j.pmrj.2009.09.009] [Citation(s) in RCA: 66] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2009] [Revised: 09/08/2009] [Accepted: 09/17/2009] [Indexed: 12/25/2022]
Abstract
OBJECTIVE To determine whether trunk muscle attributes are associated with balance and mobility performance among mobility-limited older adults. DESIGN Cross-sectional analysis of data from a randomized clinical trial. SETTING Outpatient rehabilitation research center. PARTICIPANTS Community-dwelling older adults (N = 70; mean age 75.9 years) with mobility limitations as defined by the Short Physical Performance Battery (SPPB). METHODS Independent variables included physiologic measures of trunk extension strength, trunk flexion strength, trunk extension endurance, trunk extension endurance, and leg press strength. All measures were well tolerated by the study subjects without the occurrence of any associated injuries or adverse events. The association of each physiologic measure with each outcome was examined by the use of separate multivariate models to calculate the partial variance (R(2)) of each trunk and extremity measure. MAIN OUTCOME MEASUREMENTS Balance measured by the Berg Balance Scale and Unipedal Stance Test and mobility performance as measured by the SPPB. RESULTS Trunk extension endurance (partial R(2) = .14, P = .02), and leg press strength (partial R(2) = .14, P = .003) accounted for the greatest amount of the variance in SPPB performance. Trunk extension endurance (partial R(2) = .17, P = .007), accounted for the greatest amount of the variance in BBS performance. Trunk extension strength (R(2) = .09, P = .03), accounted for the greatest amount of the variance in UST performance. The variance explained by trunk extension endurance equaled or exceeded the variance explained by limb strength across all three performance outcomes. CONCLUSIONS Trunk endurance and strength can be safely measured in mobility-limited older adults and are associated with both balance and mobility performance. Trunk endurance and trunk strength are physiologic attributes worthy of targeting in the rehabilitative care of mobility-limited older adults.
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Affiliation(s)
- Pradeep Suri
- Department of PM&R, Harvard Medical School, Boston, MA, USA.
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Sociocultural Care, Service Context, and IADL Dependence Among Very Old European Women. TOPICS IN GERIATRIC REHABILITATION 2010. [DOI: 10.1097/tgr.0b013e3181cd68c1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Nikolova R, Demers L, Béland F, Giroux F. Transitions in the functional status of disabled community-living older adults over a 3-year follow-up period. Arch Gerontol Geriatr 2009; 52:12-7. [PMID: 19945757 DOI: 10.1016/j.archger.2009.11.003] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2009] [Revised: 10/22/2009] [Accepted: 11/03/2009] [Indexed: 10/20/2022]
Abstract
The purpose of this study was to investigate transitions over time in the functional status of disabled community-living elderly. The study explored clinical and socio-demographic predictors of functional status decline. Data from the SIPA 3-year longitudinal study were analyzed (n=1164). Three categories of functional status were defined: no important disability, significant IADL disability and significant ADL disability. At baseline, results show that the prevalence rates were 26.9%, 58.6% and 14.5% for the three categories of functional status. After 12 months, about 50-60% of participants had remained in the same status, while some 10-15% of those with baseline significant disability had improved. The patterns of transitions between 12 and 36 months of follow-up were slightly different. The results indicated more deterioration (13-38%) and less improvement (6-9%). After controlling for baseline functional status, the best predictors for functional decline at 36 months were prior disability, functional limitations, cognitive impairment and comorbidity burden. We found that older adults' functional status may decline or improve even if the participants are disabled. Disabled conditions play a crucial role in the development of future disability and preventive actions need to be implemented.
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Affiliation(s)
- Rossitza Nikolova
- Research Center, Montreal Geriatric University Institute, 4565 Queen Mary, Montreal, (Quebec), H3W 1W5 Canada.
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Berlau DJ, Corrada MM, Kawas C. The prevalence of disability in the oldest-old is high and continues to increase with age: findings from The 90+ Study. Int J Geriatr Psychiatry 2009; 24:1217-25. [PMID: 19259982 PMCID: PMC2783224 DOI: 10.1002/gps.2248] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
OBJECTIVES To examine the prevalence and type of disability in the oldest-old (90+), the fastest growing age group in the United States. METHODS The current study included functional data on 697 participants from The 90+ Study, a population-based longitudinal study of aging and dementia in people aged 90 and older. Data were obtained by participant's informants via a written questionnaire. The prevalence of disability was calculated for two definitions using activities of daily living (ADLs). ADL difficulty was defined as difficulty with one or more ADLs whereas ADL dependency was defined as needing help on one or more ADLs. RESULTS ADL difficulty was present in 71% in 90-94 year olds, 89% in 95-99 year olds, and 97% in centenarians. ADL dependency was present in 44% of 90-94 year olds, 66% of 95-99 year olds, and 92% of centenarians. The ADL most commonly causing difficulty was walking (70%) whereas the ADL most commonly causing dependency was bathing (51%). Age, gender, and institutionalization were significantly associated with both ADL difficulty and ADL dependency. CONCLUSIONS Similar to studies in younger individuals, the current study suggests that the prevalence of disability continues to increase rapidly in people aged 90 and older. With the rapid growth in the number of people in this age group, disability in the oldest-old has major public health implications.
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Affiliation(s)
- Daniel J. Berlau
- Institute for Brain Aging and Dementia, University of California, Irvine
| | - María M. Corrada
- Institute for Brain Aging and Dementia, University of California, Irvine,Department of Neurology, University of California, Irvine
| | - Claudia Kawas
- Institute for Brain Aging and Dementia, University of California, Irvine,Department of Neurology, University of California, Irvine,Department of Neurobiology & Behavior, University of California, Irvine
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Impact of Sociocultural Care and Service Context on Instrumental Activities of Daily Living Dependence Among Very Old European Women. TOPICS IN GERIATRIC REHABILITATION 2009. [DOI: 10.1097/tgr.0b013e3181b02df9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Manton KG. Recent declines in chronic disability in the elderly U.S. population: risk factors and future dynamics. Annu Rev Public Health 2008; 29:91-113. [PMID: 18031222 DOI: 10.1146/annurev.publhealth.29.020907.090812] [Citation(s) in RCA: 141] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
As U.S. life expectancy has increased, questions arise as to how the quality of health and functioning in the elderly population has changed. Data from the 1982-2004 National Long-Term Care Survey (NLTCS) suggested that chronic disability prevalence above age 65 declined at an increasing rate with a 2.2% per annum rate of decline from 1999 to 2004 ( 71 ). Inflation-adjusted per capita Medicare expenditure rates in nondisabled persons also declined, 0.9% per annum from 1982 to 2004, which suggests that declines in disability were driven by improving health -- not by increases in per capita health expenditures. Declines in disability prevalence were found in other U.S. national health surveys. Analyses of U.S. Civil War veterans suggest recent disability declines were continuations of declines in both chronic disease and disability occurring over the past century due to improved nutrition, sanitation, and education. Concerns exist about whether disability declines will continue because of recent increases in obesity prevalence.
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Murabito JM, Pencina MJ, Zhu L, Kelly-Hayes M, Shrader P, D'Agostino RB. Temporal trends in self-reported functional limitations and physical disability among the community-dwelling elderly population: the Framingham heart study. Am J Public Health 2008; 98:1256-62. [PMID: 18511716 DOI: 10.2105/ajph.2007.128132] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We sought to determine change in the prevalence of functional limitations and physical disability among the community-dwelling elderly population across 3 decades. METHODS We studied original participants of the Framingham Heart Study, aged 79 to 88 years, at examination 15 (1977-1979; 177 women, 103 men), examination 20 (1988-1990; 159 women, 98 men) and examination 25 (1997-1999; 174 women, 119 men). Self-reported functional limitation was defined using the Nagi scale, and physical disability was defined using the Rosow-Breslau and Katz scales. RESULTS Functional limitations declined across examinations from 74.6% to 60.5% to 37.9% (P < .001) among women and from 54.2% to 37.8% to 27.8% (P<.001) among men. Physical disability declined from 74.5% to 48.5% to 34.6% (P < .001) among women and 42.3% to 33.3% to 22.8% (P = .009) among men. Among women, improvements in functional limitations (P = .05) were greater from examination 20 to 25, whereas for physical disability (P=.02), improvements were greater from examination 15 to 20. Improvements in function were constant across the 3 examinations in men. CONCLUSIONS Among community-dwelling elders, the prevalence of functional limitations and physical disability declined significantly in both women and men from the 1970s to the 1990s. This may in part be due to improvements in technological devices used to maintain independence. Further work is needed to identify the underlining causes of the decline so preventative measures can be established that promote independence for the elderly population.
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Affiliation(s)
- Joanne M Murabito
- National Heart, Lung, and Blood Institute's Framingham Heart Study, Framingham, MA, USA.
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Tomey KM, Sowers MR, Crandall C, Johnston J, Jannausch M, Yosef M. Dietary intake related to prevalent functional limitations in midlife women. Am J Epidemiol 2008; 167:935-43. [PMID: 18250080 DOI: 10.1093/aje/kwm397] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Physical functioning measures are considered integrated markers of the aging process. This prospective investigation examined relations between dietary intake of women at midlife in 1996-1997 and prevalence of physical functioning limitations 4 years later, defined by the Medical Outcomes Study Short-Form 36. The sample included 2,160 multiethnic women, aged 42-52 years, from six geographic areas participating in the Study of Women's Health Across the Nation (SWAN). Associations between measures of diet quality and number of fruit and vegetable servings and prevalent physical functional limitations (no, moderate, or substantial limitations) were tested by logistic regression. The prevalence of moderate and substantial functional limitations was 31% and 10%, respectively. Women in the highest quartile of cholesterol intake had 40% greater odds (odds ratio = 1.4, 95% confidence interval: 1.1, 1.8) of being more limited versus those in the lowest quartile. Women in the highest quartile of fat and saturated fat intakes were 50% and 60% more likely to be more limited, with respective odds ratios of 1.5 and 1.6 (95% confidence intervals: 1.2, 2.0 and 1.2, 2.1) versus those in the lowest quartiles. Lower fruit, vegetable, and fiber intakes were related to reporting greater functional limitations. Modifying dietary practices could be important in minimizing physical limitations.
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Affiliation(s)
- Kristin M Tomey
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI, USA
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Abstract
OBJECTIVE To assess whether losses in physical functioning are related to the natural menopause, hysterectomy, or calendar time during midlife, after adjustment for body size and smoking. METHODS A longitudinal assessment of physical functioning was conducted from 2000/01 through 2005/06 in a population-based sample of 544 women at midlife enrolled in the Michigan Bone Health and Metabolism Study. Longitudinal mixed models were used to relate menopausal status to measures of physical functioning. Perception of physical functioning was assessed with the Medical Outcomes Study Short-Form 36 questionnaire. Eight performance-based measures of physical functioning were also included. RESULTS Women with hysterectomy (with or without estrogen from ovarian conservation or exogenous replacement) had reduced levels of functioning and greater rates of change in the 2-lb lift (P<.005), sit-to-stand (P<.01), timed stair climb (P<.01), timed walk (P<.01), velocity (P<.05), and perception of physical functioning (P<.01) compared with premenopausal and perimenopausal women after adjustment for time since baseline, body size, and smoking. Diminished functioning in postmenopausal women was observed in hand grip (P<.005), 2-lb lift (P<.05), sit-to-stand (P<.05), velocity (P<.05), and perceived physical functioning (P<.05). Based on regression analyses, there was greater loss in women with hysterectomy compared with natural menopause. Level of functioning among postmenopausal women with exogenous hormone replacement was similar to premenopausal women on eight of nine physical functioning measures. CONCLUSION Hysterectomy, even with availability of an estrogen source, seems to be a "risk" state for diminishing physical function at midlife, and this may initiate a vulnerable stage for future compromised quality of life. LEVEL OF EVIDENCE II.
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Ciol MA, Shumway-Cook A, Hoffman JM, Yorkston KM, Dudgeon BJ, Chan L. Minority disparities in disability between Medicare beneficiaries. J Am Geriatr Soc 2008; 56:444-53. [PMID: 18179505 DOI: 10.1111/j.1532-5415.2007.01570.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To examine racial and ethnic disparities in mobility limitation, activities of daily living (ADLs), and instrumental activities of daily living (IADLs) in older adults enrolled in Medicare. DESIGN Longitudinal national survey. PARTICIPANTS Community-dwelling respondents in the Medicare Current Beneficiaries Survey from 1992 to 2004 (10,180-16,788 respondents per year). MEASUREMENTS Disability-related outcomes included mobility limitation, difficulty in six ADLs and six IADLs. Explanatory variables included age, sex, racial or ethnic group, living situation, and income level. RESULTS From 1992 to 2004, proportions of Medicare beneficiaries with mobility limitations were stable across racial and ethnic groups, improving slightly for ADLs and IADLs. Blacks reported more limitations in all three disability-related measures. In a longitudinal analysis, the probability of developing mobility limitation was consistently higher for blacks, followed by white Hispanics, white non-Hispanics, and Asians, after adjusting for age, sex, socioeconomic status, and living situation. For ADL and IADL difficulties, the number of reported difficulties increased with age for all ethnic and racial groups. At approximately age 75, Asians and white Hispanics reported difficulties with much higher numbers of ADLs and IADLs than the other groups. CONCLUSION Across all ethnic and racial groups, self-reported disability has declined in the past decade, but even after adjusting for age, sex, socioeconomic status, and living situation, racial and ethnic disparities in disability outcomes persist. Race and ethnicity may influence the reporting of disability, potentially affecting measures of prevalence. Further research is needed to understand whether these differences are a result of perceptions related to disablement or true differences in disability between racial and ethnic groups.
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Affiliation(s)
- Marcia A Ciol
- Department of Rehabilitation Medicine, University of Washington School of Medicine, Seattle, Washington 98195, USA.
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Bean JF, Kiely DK, LaRose S, Alian J, Frontera WR. Is stair climb power a clinically relevant measure of leg power impairments in at-risk older adults? Arch Phys Med Rehabil 2007; 88:604-9. [PMID: 17466729 DOI: 10.1016/j.apmr.2007.02.004] [Citation(s) in RCA: 177] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To test the clinical relevance of the stair climb power test (SCPT) as a measure of leg power impairments in mobility-limited older adults. DESIGN Cross-sectional analysis of baseline data from participants within a randomized controlled trial. SETTING Rehabilitation research gym. PARTICIPANTS Community-dwelling older adults (N=138; mean age, 75.4 y) with mobility limitations as defined by the Short Physical Performance Battery (SPPB). INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Leg power measures included the SCPT and double leg press power measured at 40% (DLP40) and 70% (DLP70) of the 1 repetition maximum. Mobility performance tests included the SPPB and its 3 components: gait speed, chair stand time, and standing balance. RESULTS Stair climb power per kilogram (SCP/kg) had correlations of moderate strength (r=.47, r=.52) with DLP40/kg and DLP70/kg, respectively. All 3 leg power measures correlated with each of the mobility performance measures with the exception of DLP40/kg (r=.11, P=.27) and DLP70/kg (r=.11, P=.18) with standing balance. Magnitudes of association, as described by the Pearson correlation coefficient, did not differ substantively among the separate power measures as they related to SPPB performance overall. Separate adjusted multivariate models evaluating the relationship between leg power and SPPB performance were all statistically significant and described equivalent amounts of the total variance (R(2)) in SPPB performance (SCP/kg, R(2)=.30; DLP40, R(2)=.32; DLP70, R(2)=.31). Analyses of the components of the SPPB show that the SCPT had stronger associations than the other leg power impairment measures with models predicting chair stand (SCP/kg, R(2)=.25; DLP40, R(2)=.12; DLP70, R(2)=.13), whereas both types of leg press power testing had stronger associations with models predicting gait speed (SCP/kg, R(2)=.16; DLP40, R(2)=.34; DLP70, R(2)=.34). Stair climb power was the only power measure that was a significant component of models predicting standing balance (SCP/kg R(2)=.20). CONCLUSIONS The SCPT is a clinically relevant measure of leg power impairments. It is associated with more complex modes of testing leg power impairments and is meaningfully associated with mobility performance, making it suitable for clinical settings in which impairment-mobility relationships are of interest.
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Affiliation(s)
- Jonathan F Bean
- Department of PM&R, Harvard Medical School, Boston, MA, USA.
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Abstract
The majority of deaths in the United States occur in the geriatric population. These older adults often develop multiple chronic medical problems and endure complicated medical courses with a variety of disease trajectories. Palliative care physicians need to be skilled in addressing the needs of these frail elders with life-limiting illness as they approach the end of life. Although geriatrics and palliative medicine share much in common, including an emphasis on optimizing quality of life and function, geriatric palliative care is distinct in its focus on the geriatric syndromes and on the provision of care in a variety of long-term care settings. Expertise in the diagnosis and management of the geriatric syndromes and in the complexities of long-term care settings is essential to providing high-quality palliative care to the elderly patient. This paper is a practical review of common geriatric syndromes, including dementia, delirium, urinary incontinence, and falls, with an emphasis on how they may be encountered in the palliative care setting. It also highlights important issues regarding the provision of palliative care in different long-term care settings.
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Affiliation(s)
- Jennifer Kapo
- University of Pennsylvania, 3615 Chestnut Street, Philadelphia, PA 19104, USA.
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Affiliation(s)
- Karl A Lorenz
- Veterans Administration Greater Los Angeles Healthcare System, Los Angeles, California 90073, USA.
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Pérès K, Helmer C, Letenneur L, Jacqmin-Gadda H, Barberger-Gateau P. Ten-year change in disability prevalence and related factors in two generations of French elderly community dwellers: data from the PAQUID study. Aging Clin Exp Res 2005; 17:229-35. [PMID: 16110737 DOI: 10.1007/bf03324602] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND AIMS Some studies have reported a decline in disability prevalence in older people, but few data were available for Europe, especially for France. Our aim was to study the 10-year evolution of disability prevalence in elderly community dwellers and related factors. METHODS Two generations of subjects aged 75 to 84, participants in the PAQUID (Personnes Agées QUID) cohort were compared. The first generation included 1496 subjects (born between 1903 and 1912) and the second 910 subjects (born between 1913 and 1922). Three domains of disability were assessed: mobility, Activities of Daily Living (ADL) and Instrumental ADL (IADL). Logistic regressions were used to explain the effect of generation on disability, controlling for sociodemographic characteristics, impairment, life-style, medical care, and social support. RESULTS The percentage of subjects fully independent increased from 13.5 to 23.3% (p < 0.001). A large decline in disability prevalence independent of the controlled factors was observed for mobility in both genders [Odds Ratio for the second generation (OR(G2)) = 0.48, 95% CI 0.38-0.60]. When adjusting for age and education, the risk of IADL disability was significantly lower in women in the second generation (ORG2 0.61, 95% CI 0.49-0.77), and the generation effect was strengthened when adjusting for the other covariates, but unchanged in men (ORG2 1.09, 95% CI 0.81-1.48). There was no significant change for ADL. CONCLUSIONS A significant decline in disability prevalence was observed over 10 years, which was not explained by the selected covariates. These aggregate changes differed by gender, education, and the domain of disability considered.
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Affiliation(s)
- Karine Pérès
- INSERM U593, Case 11, Université Victor Segalen Bordeaux 2, 146, rue Léo Saignat, 33076 Bordeaux Cedex, France.
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Freedman VA, Crimmins E, Schoeni RF, Spillman BC, Aykan H, Kramarow E, Land K, Lubitz J, Manton K, Martin LG, Shinberg D, Waidmann T. Resolving inconsistencies in trends in old-age disability: report from a technical working group. Demography 2004; 41:417-41. [PMID: 15461008 DOI: 10.1353/dem.2004.0022] [Citation(s) in RCA: 239] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
In September 2002, a technical working group met to resolve previously published inconsistencies across national surveys in trends in activity limitations among the older population. The 12-person panel prepared estimates from five national data sets and investigated methodological sources of the inconsistencies among the population aged 70 and older from the early 1980s to 2001. Although the evidence was mixed for the 1980s and it is difficult to pinpoint when in the 1990s the decline began, during the mid- and late 1990s, the panel found consistent declines on the order of 1%-2.5% per year for two commonly used measures in the disability literature: difficulty with daily activities and help with daily activities. Mixed evidence was found for a third measure: the use of help or equipment with daily activities. The panel also found agreement across surveys that the proportion of older persons who receive help with bathing has declined at the same time as the proportion who use only equipment (but not personal care) to bathe has increased. In comparing findings across surveys, the panel found that the period, definition of disability, treatment of the institutionalized population, and age standardizing of results were important to consider. The implications of the findings for policy, national survey efforts, and further research are discussed.
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Affiliation(s)
- Vicki A Freedman
- Polisher Research Institute, Madlyn and Leonard Abramson Center for Jewish Life, North Wales, PA 19454, USA.
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Abstract
Health among the older population as measured by most dimensions has improved during the last two decades. Mortality has continued to decline, and disability and functioning loss are less common now than in the past. However, the prevalence of most diseases has increased in the older population as people survive longer with disease, and the reduction in incidence does not counter the effect of increased survival. On the other hand, having a disease appears to be less disabling than in the past.
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Affiliation(s)
- Eileen M Crimmins
- Andrus Gerontology Center, University of Southern California, Los Angeles, California 90089-0191, USA.
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Robine JM, Michel JP. Looking Forward to a General Theory on Population Aging. J Gerontol A Biol Sci Med Sci 2004; 59:M590-7. [PMID: 15215269 DOI: 10.1093/gerona/59.6.m590] [Citation(s) in RCA: 156] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The main theories on population aging based on recent data on human longevity, life expectancy, morbidity changes, disability trends, and mortality decrease are presented and discussed within their own geographic, cultural, socioeconomic, and medical contexts. The complex interactions between all these components do not facilitate trend forecasting of aging population (healthy aging versus disability pandemic). In the context of population aging, four elements were introduced with their implications: 1) an increase in the survival rates of sick persons, which would explain the expansion of morbidity, 2) a control of the progression of chronic diseases, which would explain a subtle equilibrium between the decrease in mortality and the increase in disability, 3) an improvement of the health status and health behaviors of new cohorts of elderly people, which would explain the compression of morbidity, and eventually 4) an emergence of very old and frail populations, which would explain a new expansion of morbidity. Obviously, all these elements coexist today, and future trend scenarios-expansion or compression of disability-depend on their respective weights leading to the need of elaborating "a general theory on population aging." This theory has to be based on a world harmonization of functional decline measurements and a periodic "International Aging Survey" to monitor global aging through a sample of carefully selected countries.
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Affiliation(s)
- Jean-Marie Robine
- Geriatric Department, Geneva University Hospitals, CH 1226, Thônex-Geneva, Switzerland.
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Abstract
The progression of the aging process leads to a decreased margin of homeostatic reserve and a reduced ability to accommodate metabolic challenges, including nutritional stress. Nutritional frailty refers to the disability that occurs in old age owing to rapid, unintentional loss of body weight and loss of lean body mass (sarcopenia). Sarcopenia, a loss of muscle mass and strength, contributes to functional impairment. Weight loss is commonly due to a reduction in food intake; its possible etiology includes a host of physiological and nonphysiological causes. The release of cytokines during chronic disease may also be an important determinant of frailty. In addition to being anorectic, cytokines also contribute to lipolysis, muscle protein breakdown, and nitrogen loss. Whereas the multiple causes of nutritional frailty are not completely understood, clinical interventions for weight loss, sarcopenia, and cytokine alterations have been used with modest success.
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Affiliation(s)
- Connie W Bales
- Geriatric Research, Education and Clinical Center, Durham VA Medical Center and Department of Medicine, Duke University Medical Center, Durham, North Carolina 27710, USA
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Foley DJ, Heimovitz HK, Guralnik JM, Brock DB. Driving life expectancy of persons aged 70 years and older in the United States. Am J Public Health 2002; 92:1284-9. [PMID: 12144985 PMCID: PMC1447231 DOI: 10.2105/ajph.92.8.1284] [Citation(s) in RCA: 153] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We estimated total life expectancy and driving life expectancy of US drivers aged 70 years and older. METHODS Life table methods were applied to 4699 elderly persons who were driving in 1993 and reassessed in a 1995 survey. RESULTS Drivers aged 70 to 74 years had a driving life expectancy of approximately 11 years. A higher risk of mortality among men as a cause of driving cessation offset a higher risk of driving cessation not related to mortality among women that resulted in similar driving life expectancies. CONCLUSIONS Nationwide, many elderly drivers quit driving each year and must seek alternative sources of transportation. Because of differences in life expectancy, women require more years of support for transportation, on average, than men after age 70.
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Affiliation(s)
- Daniel J Foley
- Laboratory of Epidemiology, Demography, and Biometry, National Institute on Aging, Bethesda, MD 20892, USA
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Wiener JM, Tilly J. Population ageing in the United States of America: implications for public programmes. Int J Epidemiol 2002; 31:776-81. [PMID: 12177018 DOI: 10.1093/ije/31.4.776] [Citation(s) in RCA: 171] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Joshua M Wiener
- The Urban Institute, 2100 M Street, NW, Washington, DC 20015, USA.
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Affiliation(s)
- Maria A. Fiatarone Singh
- University of Sydney, Lidcombe, New South Wales, Australia
- Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University, Boston, Massachusetts
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Singh MAF. Exercise comes of age: rationale and recommendations for a geriatric exercise prescription. J Gerontol A Biol Sci Med Sci 2002; 57:M262-82. [PMID: 11983720 DOI: 10.1093/gerona/57.5.m262] [Citation(s) in RCA: 271] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
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