Exploring effective items of physical function in slow walking speed and self-reported mobility limitation in community-dwelling older adults

Correlation between Power Elbow Flexion and Physical Performance Test: A Potential Predictor for Assessing Physical Performance in Older Adults

BACKGROUND

With the increasing number of older adults and their declining motor and cognitive function, it is crucial to find alternative methods for assessing physical functionality. The Short Physical Performance Battery (SPPB), the Time Up and Go (TUG) test, the 4 Meter Walk Test and the Barthel Index (BI) have been used to evaluate mobility and fragility and predict falls. But some of these functional test tasks could be difficult to perform for frail older adults or bedridden patients that cannot ambulate. This study aimed to evaluate the relationship between these functional tests and the power elbow flexion (PEF test).

MATERIAL AND METHODS

A correlation study was designed with 41 older adults over 65 years of age. The upper limb muscle power was measured using a linear encoder (VITRUBE VBT) with the flexion of the elbow.

RESULTS

Strong correlations were found between the PEF test and the 4mWT (rho = 0.715, p = 0.001) and TUG (rho= -0.768, p = 0.001), indicating that the greater the upper limb muscle power is, the greater physical performance will be. Moderate correlations were also found between the PEF and Barthel Index (rho = 0.495, p = 0.001) and SPPB (rho = 0.650, p < 0.001).

CONCLUSIONS

There is a strong correlation between PEF and the functional tests, proving that older adults that have greater upper limb muscle power have better physical performance. Upper limb muscle power and PEF could be an interesting tool for the assessment of physical performance in bedridden older adults.

Comparison of four screening methods for sarcopenia among community-dwelling older adults: A diagnostic accuracy study

This study aimed to compare the diagnostic values of SARC-F (strength, assistance with walking, rising from a chair, climbing stairs, and falls), SARC-Calf (SARC-F combined with calf circumference), CC (calf circumference), and the Yubi-wakka (finger-ring) test for screening for sarcopenia in community-dwelling older adults. The Asian Working Group for Sarcopenia (AWGS) 2019 criteria were used as a standard reference. A total of 209 participants were enrolled, and 40.7% were identified as sarcopenia. The sensitivity, specificity, and AUC were respectively 54.1%, 70.2%, and 0.687 for SARC-F; 76.5%, 73.4% and 0.832 for SARC-calf, 86.7%, 82.4%, and 0.906 for CC in men, and 85.5%, 63.3%, and 0.877 for CC in women. Relative to the "bigger," a significant association between sarcopenia and the Yubi-wakka test ("just fits" OR: 4.1, 95% CI: 1.57-10.98; "small" OR: 27.5, 95% CI: 10.14-74.55) was observed. The overall accuracy of CC was better than SARC-Calf for sarcopenia screening.

Quantifying Physical Resilience in Ageing Using Measurement Instruments: A Scoping Review

Purpose: The capacity to recover motor function with pathology or age-related decline is termed physical resilience. It is unknown what outcome domains are captured with existing measurement instruments. Thus, this scoping review aimed to identify measurement instruments for physical resilience, identify research gaps, and make recommendations for future research. Methods: Articles were included from the search when their subject matter included the term resilience in relation to the physical health of older adults. Data on physical resilience measurement instruments were extracted using the outcome domains: body function or structure, activity and participation, and societal impact. Results: The majority of the 33 included articles involved older adults with fractures, cardiac conditions, and cancer. Many measurement instruments quantified body function or structure, and some instruments captured activity and participation, and societal impact of physical resilience. Measurement instruments were pooled into 4 categories: psychological, physiological, motor function, and psychosocial scales. No studies combined all areas of measurement. Conclusions: A potential gap of a measurement instrument capturing social aspects of physical resilience was identified. Comprehensive measurement could identify which outcome domains could be targeted to foster resilience. This knowledge might be useful across many health disciplines and contribute to therapeutic decision-making and rehabilitation strategies.

Comparing SARC-CalF With SARC-F for Screening Sarcopenia in Adults With Type 2 Diabetes Mellitus

Background

The prevalence of sarcopenia is high in older people with type 2 diabetes mellitus (T2DM) and is now considered a critical problem in the healthcare sector. However, the preferred screening tool for identifying sarcopenia remains unknown. Thus, the aim of this study was to ensure that the diagnostic values of the SARC-F (strength, assisting with walking, rising from a chair, climbing stairs, and falling) and SARC-CalF (SARC and calf circumference) scales were compared with five reference diagnostic criteria for sarcopenia.

Methods

This was a cross-sectional study. Patients diagnosed with diabetes were treated at the First Affiliated Hospital of Wenzhou Medical University. Appendicular skeletal muscle mass, muscle strength, and physical performance were assessed using dual-energy X-ray absorptiometry, handgrip strength, and gait speed assessment. Five diagnostic criteria for sarcopenia (Asian Working Group for Sarcopenia, International Working Group on Sarcopenia, Foundation for the National Institutes of Health, Sarcopenia Project, Society on Sarcopenia Cachexia and Wasting Disorders, and European Working Group on Sarcopenia in Older People criteria) were utilized. Sensitivity and specificity analyses were performed on the SARC-CalF and SARC-F scales. The diagnostic precision of both instruments was determined using the receiver-operating characteristic (ROC) curves and area under the ROC curves (AUC).

Results

This study included 689 subjects (459 men and 230 women) with a mean age of 58.1 ± 13.2 years. In accordance with the five reference diagnostic parameters, the prevalence of sarcopenia was between 4.5 and 19.2%. In addition, the range of sensitivity of SARC-F and SARC-CalF ranged from 61.4 to 67.4 and 82.6 to 91.8%, respectively. Concurrently, the specificity ranged from 63.1 to 67.3 and 51.5 to 61.2%, respectively. Overall, AUC values for SARC-CalF were higher than those for SARC-F, regardless of the diagnostic standard, sex, or age.

Conclusion

The results of this study suggest that SARC-CalF significantly enhances the sensitivity and overall diagnosis of SARC-F. SARC-CalF appears to be an optimal screening tool for sarcopenia in adults with T2DM.

Standardized gait speed ratio in elderly patients with heart failure

Aims

Although aging is strongly associated with both heart failure and a decline in gait speed, a definition of slowness incorporating an age‐related decline has yet to be developed. We aimed to define an event‐driven cut‐off for the relative decline in gait speed against age‐adjusted reference values derived from the general population and evaluate its prognostic implications.

Methods and results

Standardized gait speed (SGS) was defined as the median gait speed stratified by age, sex, and height in 3777 elderly (age ≥ 65 years) individuals without a history of cardiovascular diseases (Tokyo Metropolitan Institute of Gerontology‐Longitudinal Interdisciplinary Study on Aging: general population cohort). The mortality event‐driven optimal cut‐off of the SGS ratio (actual gait speed divided by the respective SGS) was defined using FRAGILE‐HF cohort data and externally validated using Kitasato cohort data, comprising 1301 and 1247 hospitalized elderly patients with heart failure, respectively. Using FRAGILE‐HF data, the optimal SGS ratio cut‐off was determined as 0.527. In the Kitasato cohort, SGS ratio < 0.527 was associated with a higher 1 year [hazard ratio (HR): 1.70, 95% confidence interval (CI): 1.07–2.72, P = 0.024] and long‐term (HR: 1.46, 95% CI: 1.05–2.02, P = 0.024) mortality rate, independent of pre‐existing covariates.

Conclusions

Gait speed was significantly declined in patients with heart failure, even after taking age and sex‐related decline into account. A SGS ratio of 0.527 is a validated cut‐off for slowness independently associated with mortality in patients with heart failure age ≥65.

The clinical correlates of the chair sit to stand performance in people with multiple sclerosis

Objective: This study aimed to evaluate the motor and non-motor factors associated with sit-to-stand performance in people with Multiple Sclerosis (PwMS). Design: Observational cross-sectional study. Subjects: A total of 88 individuals with MS participated in this study. Main Measures: Standing performance was measured using the five-times-sit-to-stand test (FTSTS). The Berg Balance Scale to assess balance, the 10-Meter Walking Test (10-MWT) was used to assess walking speed; the Patient Determined Disease Steps (PDDS) was used to assess disability level. Furthermore, Brief International Cognitive Assessment for MS (BICAMS) was used to assess cognitive status, Hospital Anxiety and Depression scale (HADS) to assess depression and anxiety, and the Modified Fatigue Impact scale (MFIS) to evaluate fatigue. Spearman correlation coefficient was used to determine the relationship between all these variables and the FTSTS. Furthermore, multiple linear regression was conducted to determine predictive factors of the FTSTS. Results: FTSTS score was correlated significantly with BBS, PDDS, BICAMS, 10-MWT and MFIS (r ranged from 0.3 to 0.52; P < .05). However, there was no significant correlation observed between the FTSTS and HADS-depression or HADS-anxiety. Considering the multiple regression analysis, the following factors were significantly predictive of the FTSTS: 10-MWT, MFIS and the BICAMS-z score (R²: 0.433, P < .0001). Conclusion: The study concludes that sit to stand is multifactorial and is potentially associated with walking speed, cognitive function and fatigue. These factors should be considered by healthcare professionals in interpreting the sit-to-stand performance of PwMS and in designing rehabilitation interventions.

Comparison of Three Screening Methods for Sarcopenia in Community-Dwelling Older Persons

OBJECTIVE

The 2019 Asian Working Group on Sarcopenia in Older People (AWGS 2019) recommends using either calf circumference or the strength, assistance in walking, rising from a chair, climbing stairs, and falls (SARC-F) or SARC-F combined with calf circumference (SARC-CalF) questionnaires for sarcopenia screening. The aim of this study was to compare the ability and applicability of calf circumference, SARC-F, and SARC-CalF for screening sarcopenia among community-dwelling older adults.

DESIGN

Cross-sectional study.

SETTING AND PARTICIPANTS

A total of 1050 community-dwelling older people were enrolled.

METHODS

Sarcopenia was diagnosed according to the AWGS 2019 criteria: bioimpedance analysis for appendicular skeletal muscle index, hand grip, and 6-m gait speed test. Participants also completed the SARC-F questionnaire and calf circumference measurement. The screening tools' performances were evaluated through receiver operating characteristic (ROC) curves, area under the ROC curves (AUC), and sensitivity/specificity analyses.

RESULTS

Sarcopenia was identified in 263 (25.0%) participants by the AWGS 2019 criteria. Calf circumference had a sensitivity of 81.4% and a specificity of 77.0%. Sensitivity and specificity of SARC-F for screening sarcopenia were 17.9% and 93.7%, respectively. SARC-CalF improved the sensitivity of SARC-F (47.5%) while keeping similar specificity (92.0%). The AUCs of calf circumference, SARC-F, and SARC-CalF were 0.79 [95% confidence interval (CI), 0.77-0.82], 0.56 (95% CI, 0.52-0.59), and 0.70 (95% CI, 0.67-0.73), respectively. The differences across ROC curves were statistically significant among 3 screening tools (P < .001).

CONCLUSIONS AND IMPLICATIONS

The overall screening ability of calf circumference was better than that of SARC-F and SARC-CalF for sarcopenia in community-dwelling older persons despite gender, age, and cognitive function. SARC-F and SARC-CalF have high specificity but are susceptible to the preceding factors.

Gait Speed and Dynamic Stability Decline Accelerates Only in Late Life: A Cross-sectional Study in Community-Dwelling Older Adults

BACKGROUND AND PURPOSE

Incidence of falls increases with age whereas gait speed declines. The purposes of this study were to examine (1) whether gait speed and center-of-mass (COM) velocity declined steadily across ages in a linear fashion among community-dwelling older adults, and (2) whether such decline corresponded to the similar decline in dynamic stability, which is governed by the control of their COM position and COM velocity relative to base of support (BOS).

METHODS

A total of 184 community-dwelling older adults (≥65 years) participated in the cross-sectional study. The participants were categorized into 5 age groups (65-69, 70-74, 75-79, 80-84, and 85+ years) and were asked to walk on the 7-m walkway at their preferred walking speed. Their speed, gait pattern, relative COM position, and relative COM velocity were measured.

RESULTS

Very close relationship was confirmed between a clinical gait speed measurement and the COM velocity (R = 0.875, P < .05), which enabled us to use the 2 terms interchangeably. Gait speed decline was not noticeable from 65 to 84 years of age (P > .05), but it accelerated after 85 years of age. This decline was most likely influenced by a reduction in both step length (P < .05) and cadence (P < .05). Similarly, dynamic stability against backward loss of balance changed little between 65 and 84 years of age (P > .05). Yet, it declined significantly after 85 years of age (P < .05), primarily affected by the reduction in the COM velocity relative to the BOS, whereby the COM position relative to the BOS remained constant during their walking.

CONCLUSION

Expected steady decline in gait speed and in the control of gait stability cannot be confirmed. Rather, we found that both declined precipitously only after 85 years of age, when the risk of falls is likely to increase correspondingly.

An Optimal Questionnaire Representing Slow Gait Speed(<1m/s) in Community-dwelling Older Adults: The Korean Frailty and Aging Cohort Study (KFACS)

OBJECTIVES

This study was conducted to find an optimal questionnaire to evaluate the slow gait speed seen in community dwelling elderly.

DESIGN

Four questions asking about difficulty in walking were compared against the measured usual gait speed. The questions were: 1) Is it difficult to walk 100 m without help? 2) Is it difficult to walk 300 m without help? 3) Is it difficult to walk around one lap of a 400-meter track without help? 4) Can you cross a crosswalk before the green on the crosswalk light turns red?

PARTICIPANTS

The subjects were 1479 older adults aged 70 to 84 years who had responded to the four questions and completed gait speed measuring in the first baseline year (2016) of the Korean Frailty and Aging Cohort Study.

RESULTS

Of the four questions, "Is it difficult to walk around one lap of track (400 m) without help?" showed the highest kappa coefficient (0.357), sensitivity (0.61), and negative predictive value (0.82).

CONCLUSION

Based on the results of this study, the authors suggest that "Difficulty in walking around one lap of a 400-m track without help" may be the best question to use when evaluating slow gait speed.

Validation of the Korean Version of the SARC-F Questionnaire to Assess Sarcopenia: Korean Frailty and Aging Cohort Study

OBJECTIVES

The SARC-F is a simple sarcopenia screening tool comprising 5 assessment items: strength, assistance walking, rising from a chair, climbing stairs, and falls. The present study aimed to examine the validation of the Korean version of SARC-F for elderly individuals residing in communities.

SETTING AND PARTICIPANTS

From the first year baseline data of Korean Frailty and Aging Cohort Study, a total of 1222 elderly individuals (70 years and older) who met the study's selection criteria were included in the analysis.

MEASUREMENTS

The SARC-F was translated into the Korean language in a culturally responsive way. The total score was calculated by adding the scores on the 5 items. The participants were divided into 2 groups according to the total score (SARC-F <4 vs SARC-F ≥4), and its correlations with various factors including walking speed, hand grip, ability to perform everyday activities, and health-related quality of life, were examined by sex. In addition, the tool's validity was analyzed by comparing it with the European, international, and Asian sarcopenia working group diagnostic criteria for sarcopenia.

RESULTS

The prevalence of sarcopenia according to the SARC-F was 4.2% in among men and 15.3% in women. The sensitivity of the SARC-F was low compared with the European, international, and Asian criteria of sarcopenia [male (M): 11%-60%, female (F): 28%-34%]. However, SARC-F showed a high specificity (M: 96.6%-98%, F: 85%-87.7%) and a high negative predictive value (M: 89.2%-99.3%, F: 88.5%-98.4%). The participants in the SARC-F ≥4 group had poorer grip strength, slower walking speed, poorer physical performance, poorer cognitive function, and a lower quality of life (a high EuroQol-5 dimension score) than the participants in the SARC-F <4 group.

CONCLUSIONS

The Korean language version of SARC-F showed a high specificity and high negative predictive value. As such, the tool is useful for briefly ruling out sarcopenia in a clinical setting. In addition, diagnosis of sarcopenia using the SARC-F was found to be associated with physical performance, cognitive function, and the quality of life.

Can You Ride a Bicycle? The Ability to Ride a Bicycle Prevents Reduced Social Function in Older Adults With Mobility Limitation

Background

The health benefits of bicycling in older adults with mobility limitation (ML) are unclear. We investigated ML and functional capacity of older cyclists by evaluating their instrumental activities of daily living (IADL), intellectual activity, and social function.

Methods

On the basis of interviews, 614 community-dwelling older adults (after excluding 63 participants who never cycled) were classified as cyclists with ML, cyclists without ML, non-cyclists with ML (who ceased bicycling due to physical difficulties), or non-cyclists without ML (who ceased bicycling for other reasons). A cyclist was defined as a person who cycled at least a few times per month, and ML was defined as difficulty walking 1 km or climbing stairs without using a handrail. Functional capacity and physical ability were evaluated by standardized tests.

Results

Regular cycling was documented in 399 participants, and 74 of them (18.5%) had ML; among non-cyclists, 49 had ML, and 166 did not. Logistic regression analysis for evaluating the relationship between bicycling and functional capacity revealed that non-cyclists with ML were more likely to have reduced IADL and social function compared to cyclists with ML. However, logistic regression analysis also revealed that the risk of bicycle-related falls was significantly associated with ML among older cyclists.

Conclusions

The ability and opportunity to bicycle may prevent reduced IADL and social function in older adults with ML, although older adults with ML have a higher risk of falls during bicycling. It is important to develop a safe environment for bicycling for older adults.

Self-reported walking speed: a useful marker of physical performance among community-dwelling older people?

BACKGROUND

Walking speed is central to emerging consensus definitions of sarcopenia and frailty as well as being a major predictor of future health outcomes in its own right. However, measurement is not always feasible in clinical settings. We hypothesized that self-reported walking speed might be a good marker of objectively measured walking speed for use in this context.

METHODS

We investigated the relationship between self-reported and measured walking speed and their associations with clinical characteristics and mortality using data from 730 men and 999 women, aged 61 to 73 years, who participated in the Hertfordshire Cohort Study. Walking speed was measured over 3 meters. Participants rated their walking speed as "unable to walk," "very slow," "stroll at an easy pace," "normal speed," "fairly brisk," or "fast."

RESULTS

Self-reported walking speed was strongly associated with measured walking speed among men and women (P < .001). Average walking speeds ranged from 0.78 m/s (95% CI 0.73-0.83) among men with "very slow" self-reported walking speed to 0.98 m/s (95% CI 0.93-1.03) among "fast" walkers (corresponding figures for women were 0.72 m/s [95% CI 0.68-0.75] and 1.01 m/s [95% CI 0.98-1.05]). Self-reported and measured walking speeds were similarly associated with clinical characteristics and mortality; among men and women, slower self-reported and measured walking speeds were associated (P < .05) with increased likelihood of poor physical function, having more systems medicated and with increased mortality risk, with and without adjustment for sociodemographic and lifestyle factors (hazard ratios for mortality per slower band of self-reported walking speed, adjusted for sociodemographic and lifestyle characteristics: men 1.44 [95% CI 1.11-1.87]; women 1.35 [95% CI 1.02-1.81]).

CONCLUSION AND IMPLICATIONS

Self-reported walking speed is a good marker of measured walking speed and could serve as a useful marker of physical performance in consensus definitions of sarcopenia and frailty when direct measurement of walking speed is not feasible.

The Reference Values for the Chair Stand Test in Healthy Japanese Older People: Determination by Meta-analysis

[Purpose] The aim of this study was to determine the reference values for the chair stand test (CST) in healthy older Japanese people. [Methods] Relevant research articles for the 5-repetition chair stand test (CS-5) and the 30-second chair stand test (CS-30) were identified by electronic database and manual searching. Research articles involving healthy Japanese people aged 60 years and older were included in a meta-analysis. Weighted means of the CS-5 and CS-30 were estimated by the random effect model as the reference values for the CST. Further, the effects of age and sex on the reference values were analyzed by a meta-regression analysis. [Results] Seven articles (21 data) and three articles (14 data) were included in the meta-analyses for the CS-5 and CS-30, respectively. The reference value for the CS-5 was estimated as 8.50 sec [95% confidence interval (CI): 7.93–9.07]; age and sex were not associated with this reference value. The reference value for the CS-30 was estimated as 17.26 times [95%CI: 15.98–18.55], and age was significantly associated with this value. [Conclusion] When the CS-5 and CS-30 are used to evaluate elderly Japanese people, the reference values for the CS-5 and CS-30 determined in this study would be useful indices.

Association between objectively measured sleep quality and physical function among community-dwelling oldest old Japanese: A cross-sectional study

AIM

The present study examined the association between objective measures of sleep quality and performance-based measures of physical function in community-dwelling oldest old Japanese.

METHODS

This cross-sectional study included 207 community-dwelling adults aged 80 years or older (92 men, 115 women; age 83.5 ± 2.6 years [range 80-95 years]). Participants wore an accelerometer (ActiGraph GT3X+) on their non-dominant wrist for 24 h per day over seven consecutive nights. Sleep parameters included total sleep time, sleep efficiency and wake after sleep onset during the night for a week. Performance-based physical function measures were handgrip strength, knee extension strength, and usual and maximum walking speeds. Multivariable linear regression was carried out to determine the associations between weekly sleep parameter averages and physical function measures.

RESULTS

Approximately 24% of participants had a total sleep time of less than 6 h a night, and 13% had greater than 8 h a night. Overall, average daily physical activity was 1771.8 ± 520.6 (counts/min/day). In multiple linear regression, sleep efficiency and wake after sleep onset were significantly associated with maximum walking speed (β = 0.277; 95% confidence interval [CI] 0.103 to 0.351 and β = -0.214; 95% CI -0.339 to -0.082, respectively) and usual walking speed (β = 0.200, 95% CI 0.035 to 0.305 and β = -0.174; 95% CI -0.341 to -0.064, respectively), after adjusting for potential confounding factors including daily physical activity. Both sleep qualities were also independently associated with knee extension strength. However, wake after sleep onset was not associated with handgrip strength.

CONCLUSION

Objectively measured sleep quality was associated with physical function in the oldest old. Further research is required to identify the temporality of associations between sleep and physical function.

A multidimensional assessment of physical performance for older Japanese people with community-based long-term care needs

BACKGROUND AND AIMS

A multidimensional assessment representing overall lower- and upper-extremity performance is necessary to identify functional decline among older adults. The aim of this study was to develop and validate a physical performance scale (PPS) using both cross-sectional and observational approaches in older adults with and without community-based long-term care (LTC) needs in Japan.

METHODS

A total of 416 community-living adults aged 75 years and over. The 7 items of the PPS include a range of physiological challenges, such as assessment of upper-extremity strength, lower-extremity strength, balance, and walking ability. Concurrent validity [correlating the PPS with self-reported functional status in activities of daily living (ADLs), instrumental ADLs, and Physical Function subscale of the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36PF)] and discriminative validity were assessed. Sensitivity to changes was evaluated with a 12-week exercise program.

RESULTS

Total PPS score was significantly correlated with self-reported functional status such as ADLs, instrumental ADLs (IADLs), and SF-36PF (r = 0.53-0.62) and demonstrated no floor effect and minimal ceiling effect (8.7 %). The total PPS score showed large areas under the curve (AUC = 0.89; 95 % confidence interval, 0.86-0.92) with regard to discrimination between individuals with and without LTC needs. In observational analysis, total PPS score demonstrated small meaningful change in high-risk individuals requiring care (effect size 0.34).

CONCLUSIONS

The PPS may be a useful tool for identifying functional status decline and improvement in older adults requiring community-based LTC.

Pregnancy as a risk factor for ambulatory limitation in later life

OBJECTIVES

We investigated the relationship between the number of times a woman has been pregnant and walking difficulty in later life.

METHODS

With data from the Hispanic Established Populations for Epidemiologic Studies of the Elderly, a representative population-based cohort of Mexican Americans aged 65 years and older residing in 5 Southwestern states, we measured walking difficulty using 2 items from the performance-oriented mobility assessments: the timed walk and seated chair rise.

RESULTS

We observed significantly higher rates of ambulatory limitation among women with 6 or more pregnancies than among women with 4 or fewer pregnancies: 44.9% and 27.0%, respectively, were unable to perform or performed poorly in the seated chair rise and timed walk. Ordinal logistic regression models show that gravidity predicts level of performance in both mobility tasks and that higher gravidity is associated with worse performance, even after adjustment for both age and chronic disease.

CONCLUSIONS

Gravidity is a risk factor for ambulatory limitation in old age. A life course approach to reproduction in public health research and practice is warranted.