Predicting participation restriction in community-dwelling older men: the Concord Health and Ageing in Men Project

Impact of a history of cardiovascular disease and physical activity habits on the incidence of functional disability

We examined the impact of a history of coronary artery disease (CAD) or cerebrovascular disease (CVD) and physical activity habits on functional disability among community-dwelling Japanese adults. This population-based retrospective cohort study included 10,661 people aged 39-98 years in Japan (5054, men). Median follow-up was 3.7 years. During the study period, 209 functional disabilities occurred in the overall study population. In multivariable analysis, a history of CVD (hazard ratio [HR] 1.57 [95% CI: 1.00-2.45]) and no physical activity habit (HR 1.74 [1.27-2.39]) presented increased risks for functional disability. HRs for functional disability among patients with a CVD history with and without a physical activity habit were 1.68 (0.75-3.74) and 2.65 (1.49-4.71), respectively, compared with individuals without a history of CVD with a physical activity habit. Similar results were observed for CAD. We found no significant difference in the incidence of functional disability between the group with a history of CAD or CVD and physical activity habits and the group with no history of CAD or CVD and without physical activity habits. Physical activity habits had a favorable influence on avoiding functional disability regardless of a history of CAD or CVD. Future prospective studies are needed to clarify these associations.

Longitudinal associations between mental health and social environment in older adults: a multilevel growth modeling

OBJECTIVES

This study aimed to assess longitudinal relationships between social environment indicators (social connectedness, social engagement, social contribution) and mental health indicators (depression and anxiety) among community-dwelling adults age 55 years and older.

METHODS

Data were drawn from 3-waves of the national longitudinal survey of Midlife Development in the United States (MIDUS) (N = 2,020; age range = 55-94 years). We developed multilevel growth models to ascertain the relationships of interest, controlling for sociodemographic and physical health factors.

RESULTS

Over the 20-year period of study, lower levels of emotional social support, social integration and social contribution significantly predicted depression and anxiety, whereas social network and social engagement were not significant predictors of these mental health outcomes in older adults. The models also indicated a moderation effect of the number of chronic conditions on the slopes of depression and anxiety.

DISCUSSION

Considering our findings, interventions to enhance social contribution and social connectedness could be effective to help older adults maintain positive mental health, as well as programs that facilitate older adults' connections with their families, communities and health care providers. These interventions must also account for multiple chronic conditions since functional limitations drive declining integration in the community and participation in social activities.

Association of social disengagement with health status and all-cause mortality among community-dwelling older adults: evidence from the Otassha study

This study examined the impact of disengagement on health status and mortality among community-dwelling older adults in Japan. Disengagement from society was operationally defined as dropping out of a longitudinal survey. A follow-up mail survey was conducted, in 2014, among respondents (n = 3696) of the baseline mail survey. Step-by-step follow-up surveys (FLs), including simplified mail, postcard, and home-visit surveys, were sent to participants who did not respond. Disengagement levels were defined according to the response to the FLs as zero (mail survey), low (simplified mail survey), middle (postcard survey), high (home-visit survey), and highest (non-responders to the home-visit survey). After adjusting for health status at baseline, the proportion of respondents self-rated as "not healthy" during FLs was significantly higher in the high-level than in the zero-level group. The proportion of respondents reporting a "once a week or less" frequency of going outdoors during FLs was significantly higher in the low-, middle-, and high-level groups than in the zero-level group. Mortality rates were significantly higher in the high and highest levels than in the zero-level group. Higher disengagement levels increased the risk of lower health status and mortality, suggesting an urgent need to prevent societal disengagement among older adults.

Social Network Moderates the Association between Frequency of Social Participation and Physical Function among Community-dwelling Older Adults

OBJECTIVE

Social participation is an essential component of active aging. Physical dysfunction is restriction of social participation, but it is inconclusive that improvement of physical function contributes to promote social participation. Therefore, understanding the other factor that moderates the association between physical dysfunction and social participation is important, and social network (i.e., ties with family and friends) may be a key factor. The aims of this study were to investigate the association between physical function and frequency of social participation, with social network as a moderator, and to examine the gender differences on the relationships.

METHODS

We conducted a cross-sectional study among 287 community-dwelling older adults. We asked how often they participated in social groups in a week to measure frequency of social participation. Physical function and social network were measured by using the modified version of Short Physical Performance Battery for community-dwelling older adults and the abbreviated Lubben Social Network Scale, respectively. To investigate the association, we performed a linear regression analysis.

RESULTS

After adjustment, a linear regression analysis showed interactions between physical function and social network on frequent social participation (β: -0.20, 95% confidence interval [CI]: -0.40 to -0.01). Furthermore, the same association was observed only in women (adjusted β: -0.33, 95% CI: -0.65 to -0.02).

CONCLUSION

Our results suggested that social network moderates the association between physical function and social participation, and observed gender differences on the relationships. The findings of this study indicated the importance of multidimensional assessment and measures for improving social participation, not only physical function but also social network.

Disability among Older People: Analysis of Data from Disability Surveys in Six Low- and Middle-Income Countries

This analysis of surveys from six low- and middle-income countries (LMICs) aimed to (i) estimate the prevalence of disability among older adults and (ii) compare experiences and participation in key life areas among older people with and without disabilities which may show vulnerability during the COVID-19 pandemic. Data were analysed from district-level or national surveys in Cameroon, Guatemala, Haiti, India, Nepal and the Maldives, which across the six databases totalled 3499 participants aged 60 years and above including 691 people with disabilities. Disability was common among adults 60+, ranging from 9.7% (8.0–11.8) in Nepal to 39.2% in India (95% CI 34.1–44.5%). Mobility was the most commonly reported functional difficulty. In each setting, older people with disabilities were significantly less likely to be working and reported greater participation restrictions and environmental barriers in key life areas compared to people in the same age categories without disabilities (p < 0.05). Disability is common in this population, and older people with disabilities may have greater difficulties participating in COVID-19 responses and have high economic vulnerabilities. It is imperative to prioritise the needs of older people with disabilities in the COVID-19 pandemic, including ensuring accessibility of both health services and the community in general.

Using Serial Trichotomization with Neuropsychological Measures to Inform Clinical Decisions on Fitness-to-Drive among Older Adults with Cognitive Impairment

Decisions related to driving safety and when to cease driving are complex and costly. There is an interest in developing an off-road driving test utilizing neuropsychological tests that could help assess fitness-to-drive. Serial trichotomization has demonstrated potential as it yields 100% sensitivity and specificity in retrospective test samples. The purpose of this study was to test serial trichotomization using four common neuropsychological tests (Trail Making Test Part A and B, Clock Drawing Test, and Modified Mini-Mental State Examination). Test scores from 105 patients who were seen in a memory clinic were abstracted. After applying the model, participants were classified as unfit, fit, or requiring further testing, 38.1%, 25.8%, and 36.1%, respectively. This study provides further evidence that trichotomization can facilitate the assessment of fitness-to-drive.

Social participation and loneliness among older adults in Yazd, Iran

Social participation among older people is associated with more practice of physical activities, improvement of cognitive skills and less feeling of loneliness. The primary purpose of this cross-sectional study was to examine the social participation and sense of loneliness among older adults in Yazd, an Iranian city that is known for its traditional values and religious people. The non-probability sample consisted of 200 elderly people. Data collection tool was a questionnaire, which was completed by a trained interviewer through face-to-face interview. The mean scores of social participation and loneliness feeling among participants were 17.29 ± 5.62 (8-40) and 38.02 ± 7.91 (16-80), respectively. From the participants, 79.8% had not participated in educational cultural and activities. Mostly reported barriers to social participation included transportation-related issues (57%), diseases and health problems (43.5%) and personal or family responsibility (36%). The best predictors of loneliness were demographic characteristics, followed by the total number of diseases/problems and the total number of barriers to social participation. Social participation itself was not a statistically significant predictor of loneliness. Theoretical and practical implications were discussed.

Everyday life in older men living alone - a complex view needing a biopsychosocial perspective

Purpose: To explore how older men living alone, describe their everyday activities and their abilities as well as how they could be helped in everyday life.Materials and methods: Qualitative semi-structured interviews were analysed with inductive content analysis. Eight men aged 65+ years were included. They were all living alone, albeit with home help services. They were able to walk and had sufficient cognitive ability.Results: The analysis resulted in one theme "A driving force of managing activities and overcome hindering factors requires a broad spectrum of prerequisites for participating in everyday life" with the following four categories: Importance of everyday activities; individual prerequisites enabling everyday activities; body and mind inhibit, and react to the decreased, abilities; and importance of the environment.Conclusions: The results generate a complex view of older men's everyday life. It is important for older men's independence that health care and rehabilitation staff adopt a comprehensive view and work from a biopsychosocial (BPS) perspective. Implications for rehabilitationTo be an older man living alone might mean a decreased health and good health is a strong predictor for increased abilities in everyday activities. The living situation of older men living alone is not well studied and needs to be explored to a greater extend, especially from their own perspective.An interaction of biological, psychological, and social factors was expressed as important for older men's everyday life, in accordance with the biopsychosocial (BPS) model.The expressed importance of participation as well as performing both physical and social activities reflects the need of individualised goals in rehabilitation according to the behavioural medicine approach.It is of outmost importance that health care and rehabilitation staff in contact with this group has a comprehensive view and works from a biopsychosocial (BPS) perspective, for maintenance of the older men's independence in everyday life.

Selection of Activity Items for Development of the Activity Card Sort-Japan Version

The Activity Card Sort (ACS) can both record the clients' participation and any changes, which is a useful tool for practitioners to establish tailored occupation-focused goals. However, there is a limitation to apply the ACS to Japanese older adults as it consists of culturally relevant activities in the United States. The aim of this study was to select activity items reflecting Japanese older adults' lifestyles and opinions to develop the Activity Card Sort-Japan Version (ACS-JPN). In the item selection process, a two-round questionnaire survey was conducted for community-dwelling Japanese older adults (Round 1: n = 177, M age = 69.9 years; Round 2: n = 178, M age = 74.9 years). Seventy-two activity items were finally included in the ACS-JPN and were classified into four domains. The ACS-JPN has some unique features compared with other ACS versions. This study only selected activity items. Further work on psychometric properties is needed.

The role of environmental factors for the onset of restricted mobility outside the home among older adults with osteoarthritis: a prospective cohort study

OBJECTIVES

The study examines how environmental factors contribute to the onset of restricted mobility outside the home among older adults with osteoarthritis.

METHODS

This is a prospective cohort study of adults aged 50 years and older with osteoarthritis (n=1802). Logistic regression tested the association between the onset of restricted mobility outside the home and health, sociodemographic and perceived environmental barriers (hills and steep slopes, inaccessible public buildings, poor pavement condition, lack of access to public parks or sport facilities, heavy traffic or speeding cars and poor weather). The potential moderating role of environmental barriers on the association between health factors and onset was examined using interaction terms and stratified analysis.

RESULTS

Of 1802 participants, 13.5% (n=243) reported the onset of restricted mobility outside the home at 3-year follow-up. Walking disability, anxiety, depression, cognitive impairment and obesity and all environmental barriers were associated with onset after adjustment for confounders. Environmental barriers had an added contribution to the effect of the health conditions on onset of restricted mobility, which was attenuated when adjusted for confounders. The added contribution remained only for walking disability and the presence of hills and steep slopes; in the presence of both, the association with onset of restricted mobility was stronger (OR 7.66, 95% CI 4.64 to 12.64) than in the presence of walking disability (3.60, 2.43 to 5.32) or the presence of hills and steep slopes alone (4.55, 2.89 to 7.16).

CONCLUSION

For older adults with osteoarthritis, environmental barriers are associated and add a contribution to that of morbidities and walking disability on the onset of restricted mobility outside the home. Awareness of environmental barriers is important when aiming to maintain mobility and activities outside the home despite health conditions in older adults.

Leisure-time physical activity and risk of disability incidence: A 12-year prospective cohort study among young elderly of the same age at baseline

Background

To clarify the role of physical activity in preventing disability in Japan, we investigated the association between amount of leisure-time physical activity and incidence of disability among the young elderly.

Methods

In the New Integrated Suburban Seniority Investigation (NISSIN) project conducted from 1996 to 2013, we followed 2888 community-dwelling adults aged 64–65 years with no history of cerebrovascular disease for a median follow-up of 11.6 years. Disabilities were defined as follows based on the classifications of the Japanese long-term care insurance system: 1) support or care levels (support levels 1–2 or care levels 1–5); 2) care levels 2–5; 3) support or care levels with dementia; and 4) care levels 2–5 or death. In addition, we also assessed 5) all-cause mortality.

Results

After controlling for sociodemographic, lifestyle, and medical factors, male participants reporting an activity level of 18.1 metabolic equivalent (MET)-hours/week (the median among those with activities) or more had 52% less risk of being classified as support or care levels with dementia compared with the no activity group (hazard ratio 0.48; 95% confidence interval, 0.25–0.94). No significant association was found among women between amount of leisure-time physical activity and incidence of disability.

Conclusion

We identified an inverse dose–response relationship between the amount of leisure-time physical activity and the risk of disability with dementia in men. Therefore, a higher level of physical activity should be recommended to young elderly men to prevent disability with dementia.

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We examined associations between physical activity and disability incidence.

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We quantified amount of leisure-time physical activity.

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A dose–response relationship was found for the risk of disability with dementia.

Trajectories of social participation in old age: a systematic literature review

Abstract Objective: the present study aimed to identify patterns of social participation in old age and the theories used to explain them. Method: A systematic review was performed using the Medical Literature Analysis and Retrieval System Online (MEDLINE / PUBMED), Scientific Electronic Library Online (Scielo) and Web of Science (ISI Web of Knowledge) databases. The keywords used were: social participation, social engagement, social involvement and social activities; combined with seniors, the elderly, older adults, older people and aging. Research was performed between January and February. Results: thirty-one longitudinal studies on social participation among old and healthy middle-aged adults were included for analysis. In three studies social engagement levels increased, especially at the beginning of old age (up to 75 years). Twenty-one studies presented results that described the reduction of social engagement levels in old age, and five studies found that there was no change in levels of social involvement. The most used theories were: the activity theory, the social disengagement theory, the continuity theory and the theory of socioemotional selectivity. Conclusion: the results point to the need for reflection on what is envisioned and what is practiced in terms of policies and practices aimed at achieving successful aging. Future attempts should include not only incentives to remain active, but a description of factors that influence the social disengagement associated with poor adaptation in old age.

Using Serial Trichotomization With Common Cognitive Tests to Screen for Fitness to Drive

OBJECTIVE

The aim of this study was to illustrate the use of serial trichotomization with five common tests of cognition to achieve greater precision in screening for fitness to drive.

METHOD

We collected data (using the Montreal Cognitive Assessment, Motor-Free Visual Perception Test, Clock-Drawing Test, Trail Making Test Part A and B [Trails B], and an on-road driving test) from 83 people referred for a driving evaluation. We identified cutpoints for 100% sensitivity and specificity for each test; the driving test was the gold standard. Using serial trichotomization, we classified drivers as either "Pass," "Fail," or "Indeterminate."

RESULTS

Trails B had the best sensitivity and specificity (66.3% of participants correctly classified). After applying serial trichotomization, we correctly identified the driving test outcome for 78.3% of participants.

CONCLUSION

A screening strategy using serial trichotomization of multiple test results may reduce uncertainty about fitness to drive.

State of the Art Review: Physical Activity and Older Adults

Physical activity is an important component of a healthy lifestyle for all adults and especially for older adults. Using information from the updated 2008 Physical Activity Guidelines, 3 dimensions of physical activity are identified for older adults. These include increasing aerobic activity, increasing muscle-strengthening activity, and reducing sedentary or sitting behavior. Although the overall goal of the physical activity recommendations is to prevent chronic diseases and conditions from developing, many older adults are already affected. Therefore, suggested types of physical activity are described for specific diseases and conditions that are designed to mediate the condition or prevent additional disability. Finally, barriers to participation in physical activity specific to older adults are described, and possible solutions offered. Encouraging older adults to continue or even start a physical activity program can result in major health benefits for these individuals.

The association between social participation and lower extremity muscle strength, balance, and gait speed in US adults

Social participation is associated with healthy aging, and although associations have been reported between social participation and demographics, no published studies have examined a relationship between social participation and measures amenable to intervention. The purpose was to explore the association between self-reported social participation and lower extremity strength, balance, and gait speed. A cross-sectional analysis of US adults (n = 2291; n = 1,031 males; mean ± standard deviation age 63.5 ± 0.3 years) from the 2001–2 National Health and Nutrition Examination Survey was conducted. Two questions about self-reported difficulty with social participation were categorized into limited (yes/no). The independent variables included knee extension strength (n = 1537; classified as tertiles of weak, normal, and strong), balance (n = 1813; 3 tests scored as pass/fail), and gait speed (n = 2025; dichotomized as slow [less than 1.0 m/s] and fast [greater than or equal to 1.0 m/s]). Logistic regression, accounting for the complex survey design and adjusting for age, sex, physical activity, and medical conditions, was used to estimate the odds of limitation in social participation with each independent variable. Alpha was decreased to 0.01 due to multiple tests. Slower gait speed was significantly associated with social participation limitation (odds ratio = 3.1; 99% confidence interval: 1.5–6.2). No significant association was found with social participation and lower extremity strength or balance. The odds of having limitation in social participation were 3 times greater in those with slow gait speed. Prospective studies should examine the effect of improved gait speed on levels of social participation.

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Social participation is a component of healthy aging.

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Population-based studies can explore associations amenable to intervention.

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Walking speed and social participation were significantly associated.

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Strength and balance were not associated with social participation.

Leg and Trunk Impairments Predict Participation in Life Roles in Older Adults: Results From Boston RISE

BACKGROUND

The physical impairments that affect participation in life roles among older adults have not been identified. Using the International Classification of Functioning Disability and Health as a conceptual framework, we aimed to determine the leg and trunk impairments that predict participation over 2 years, both directly and indirectly through mediation by changes in activities.

METHODS

We analyzed 2 years of data from the Boston Rehabilitative Impairment Study of the Elderly, a cohort study of 430 primary care patients with self-reported mobility limitation (mean age 77 years; 68% female; average of four chronic conditions). Frequency of and limitations in participation were examined using the Late-Life Disability Instrument. Baseline physical impairments included: leg strength, leg speed of movement, knee range of motion (ROM), ankle ROM, leg strength asymmetry, kyphosis, and trunk extensor endurance. Structural equation modeling with latent growth curve analysis was used to identify the impairments that predicted participation at year 2, mediated by changes in activities. Models were adjusted for baseline participation, age, and gender.

RESULTS

Leg speed and ankle ROM directly influenced participation in life roles during follow-up (βdirect = 1.39-4.53 and 4.70, respectively). Additionally, ankle ROM and trunk extensor endurance contributed indirectly to participation score at follow-up via effects on changes in activities (βindirect = -1.06 to -4.24 and 1.01 to 4.18, respectively).

CONCLUSIONS

Leg speed, ankle ROM, and trunk extensor endurance are key physical impairments predicting participation in life roles in older adults. These results have implications for the development of exercise interventions to enhance participation.