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Fan L, Zhao J, Hu Y, Zhang J, Wang X, Wang F, Wu M, Lin T. Predicting physical functioning status in older adults: insights from wrist accelerometer sensors and derived digital biomarkers of physical activity. J Am Med Inform Assoc 2024:ocae224. [PMID: 39178361 DOI: 10.1093/jamia/ocae224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2024] [Revised: 07/23/2024] [Accepted: 08/13/2024] [Indexed: 08/25/2024] Open
Abstract
OBJECTIVE Conventional physical activity (PA) metrics derived from wearable sensors may not capture the cumulative, transitions from sedentary to active, and multidimensional patterns of PA, limiting the ability to predict physical function impairment (PFI) in older adults. This study aims to identify unique temporal patterns and develop novel digital biomarkers from wrist accelerometer data for predicting PFI and its subtypes using explainable artificial intelligence techniques. MATERIALS AND METHODS Wrist accelerometer streaming data from 747 participants in the National Health and Aging Trends Study (NHATS) were used to calculate 231 PA features through time-series analysis techniques-Tsfresh. Predictive models for PFI and its subtypes (walking, balance, and extremity strength) were developed using 6 machine learning (ML) algorithms with hyperparameter optimization. The SHapley Additive exPlanations method was employed to interpret the ML models and rank the importance of input features. RESULTS Temporal analysis revealed peak PA differences between PFI and healthy controls from 9:00 to 11:00 am. The best-performing model (Gradient boosting Tree) achieved an area under the curve score of 85.93%, accuracy of 81.52%, sensitivity of 77.03%, and specificity of 87.50% when combining wrist accelerometer streaming data (WAPAS) features with demographic data. DISCUSSION The novel digital biomarkers, including change quantiles, Fourier transform (FFT) coefficients, and Aggregated (AGG) Linear Trend, outperformed traditional PA metrics in predicting PFI. These findings highlight the importance of capturing the multidimensional nature of PA patterns for PFI. CONCLUSION This study investigates the potential of wrist accelerometer digital biomarkers in predicting PFI and its subtypes in older adults. Integrated PFI monitoring systems with digital biomarkers would improve the current state of remote PFI surveillance.
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Affiliation(s)
- Lingjie Fan
- College of Computer Science, Sichuan University, Chengdu, Sichuan 610000, China
| | - Junhan Zhao
- Department of Biomedical Informatics, Harvard Medical School, Boston, MA 02114, United States
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA 02114, United States
- Center for Engineering in Medicine and Surgery, Department of Surgery, Massachusetts General Hospital, Boston, MA 02114, United States
| | - Yao Hu
- School of Communication and Information Engineering, Chongqing University of Posts and Telecommunications, Chongqing 400000, China
| | - Junjie Zhang
- College of Computer Science, Sichuan University, Chengdu, Sichuan 610000, China
| | - Xiyue Wang
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA 94305, United States
| | - Fengyi Wang
- Department of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan 610000, China
| | - Mengyi Wu
- School of Communication and Information Engineering, Chongqing University of Posts and Telecommunications, Chongqing 400000, China
| | - Tao Lin
- College of Computer Science, Sichuan University, Chengdu, Sichuan 610000, China
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Stolz E, Schultz A, Mayerl H, Roller-Wirnsberger R, Andrew C. Revisiting unstable disability and the fluctuations of frailty: a measurement burst approach. Age Ageing 2024; 53:afae170. [PMID: 39113468 PMCID: PMC11306319 DOI: 10.1093/ageing/afae170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Revised: 06/19/2024] [Indexed: 08/11/2024] Open
Abstract
BACKGROUND It has been hypothesised that frailty is the root cause of clinically observed but rarely systematically measured unstable disability among older adults. In this study, we measure the extent of short-term disability fluctuations and estimate their association with frailty using intensive longitudinal data. METHODS Repeated measurements of disability were collected under a measurement burst design in the FRequent health Assessment In Later life (FRAIL70+) study. A total of 426 community-dwelling older adults (70+) in Austria were interviewed about difficulties with basic, instrumental and mobility-related activities of daily living biweekly up to a total of 14 times in two measurement bursts (2891 and 2192 observations). Baseline frailty was assessed with both physical frailty (FP) and the frailty index (FI). Disability fluctuations were measured with the intra-individual interquartile range (iIQR) and estimated with a two-step generalised mixed regression procedure. RESULTS Fewer participants were frail at baseline according to FP (11%) than FI (32%). Frail study participants reported not only more severe disability but also had more short-term disability fluctuations (iIQR = 1.0-1.5) compared with their robust counterparts (iIQR = 0). Regression models indicated that baseline frailty was associated with 2-3 times larger short-term disability fluctuations, which were also more prevalent among women, and increased with age and disability severity. CONCLUSION Compared with those who were robust, frail older adults were characterised by not only more severe but also more unstable disability. Short-term disability fluctuations are closely tied to disability severity. Future studies should assess both stressors that may cause disability fluctuations among frail older adults as well as their potential consequences to inform frailty-centred care.
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Affiliation(s)
- Erwin Stolz
- Institute of Social Medicine and Epidemiology, Medical University of Graz, Graz, Austria
| | - Anna Schultz
- Institute of Social Medicine and Epidemiology, Medical University of Graz, Graz, Austria
| | - Hannes Mayerl
- Institute of Social Medicine and Epidemiology, Medical University of Graz, Graz, Austria
| | | | - Clegg Andrew
- Academic Unit for Ageing and Stroke Research, Bradford Institute for Health Research, University of Leeds, Leeds LS2 9JT, UK
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Hays RD, Haas A, Haviland AM, Martino SC, Orr N, Binion J, Elliott MN. Factors associated with self-reports of limitations in activities of daily living among Medicare Fee-for-Service recipients. BMC Geriatr 2024; 24:648. [PMID: 39090545 PMCID: PMC11295787 DOI: 10.1186/s12877-024-05242-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Accepted: 07/24/2024] [Indexed: 08/04/2024] Open
Abstract
BACKGROUND Physical function is an important indicator of physical health and predicts mortality. This study identified characteristics associated with limitations in Medicare recipients' activities of daily living. METHODS 2019 Consumer Assessment of Healthcare Providers and Systems Fee-for-Service Medicare Survey data: 79,725 respondents (34% response rate) who were 65 and older and 53% female; 7% Black, 5% Hispanic, 4% Asian American, Native Hawaiian, or other Pacific Islander, 2% Multiracial, 1% American Indian/Alaskan Native; 35% with high school education or less. Walking, getting in and out of chairs, bathing, dressing, toileting, and eating (scored as having no difficulty versus being able to do with difficulty or unable to do) and a scale of these items were regressed on patient characteristics. RESULTS After adjustment for all characteristics, function limitations were found for those who smoked (effect sizes of significant associations range .04-.13), had chronic health conditions (.02-.33), were 85 years or older (.09-.46), needed assistance completing the survey (.32-1.29), were female (.05-.07), and had low income and assets (.15-.47). CONCLUSIONS These nationally representative U.S. estimates of physical function characteristics are useful for interventions for vulnerable population subgroups.
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Affiliation(s)
- Ron D Hays
- RAND Corporation, 1776 Main Street, Santa Monica, CA, 90407, US
- UCLA Department of Medicine, Division of General Internal Medicine & Health Services Research, Los Angeles, 1100 Glendon Avenue, CA, 90024, US
| | - Ann Haas
- RAND Corporation, 4570 Fifth Ave, Pittsburgh, PA, 15213, US
| | - Amelia M Haviland
- Carnegie Mellon University, Hamburg Hall, 5000 Forbes Ave, Pittsburgh, PA, 15213, US
| | | | - Nate Orr
- RAND Corporation, 1776 Main Street, Santa Monica, CA, 90407, US
| | - Joy Binion
- Centers for Medicare & Medicaid Services, 7500 Security Blvd, Baltimore, MD, 21244, US
| | - Marc N Elliott
- RAND Corporation, 1776 Main Street, Santa Monica, CA, 90407, US.
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Lieberz D, Bishop T, Rohde M, Schmidt A, Schmitz O, Moffett M, Borstad A. Developing Patient-Centered Preventative Care to Reduce Mobility Disability With Aging: Preferences From a Discrete Choice Experiment. J Geriatr Phys Ther 2024; 47:36-42. [PMID: 36827654 DOI: 10.1519/jpt.0000000000000380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/26/2023]
Abstract
BACKGROUND AND PURPOSE Mobility disability is the most prevalent form of disability for older adults in the United States. A physical therapy mobility checkup (MC) under development is a patient-centered preventative physical therapy visit. It includes physical performance testing and education on physical performance as a valuable and modifiable health indicator. The purpose of this study was to identify the proportion of older adults willing to participate in an MC, the age at which they would initiate care, their desired frequency of participation, and the characteristics, or attributes, of the MC they preferred. METHODS In a cross-sectional study conducted at the Minnesota State Fair, adults older than 55 years answered survey questions about preventative health practices and completed a discrete choice experiment (DCE) to determine their preferences for the MC. Attributes studied in the DCE were visit duration, checkup content, education, and possible outcomes of participating in preventative care for mobility. Descriptive statistics characterized demographic information and survey responses. Conjoint choice modeling estimated the main effect for each DCE attribute. RESULTS AND DISCUSSION One hundred sixty-six older adults participated in the study. Seventy-eight percent indicated that they would choose an MC if available. Most participants (66%) believed that MCs should occur before 60 years of age and at least annually (68%). A 30-minute visit duration, which accounted for 84% of attribute importance, was preferred. Balance, the preferred content of the MC, accounted for 12% of the attribute importance. Preferences for educational content and possible outcomes of participation with preventative care aimed at preventing mobility loss were not statistically significant. CONCLUSION Older adults value preventative care for reducing mobility disability. They identified time efficiency and the inclusion of measures to assess balance as priorities for this preventative physical therapy visit.
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Affiliation(s)
- Dalerie Lieberz
- Department of Physical Therapy, The College of St. Scholastica, Duluth, Minnesota
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van der Ploeg T, Gobbens RJJ. Disability transitions in Dutch community-dwelling older people aged 75 years or older. Arch Gerontol Geriatr 2024; 116:105165. [PMID: 37639841 DOI: 10.1016/j.archger.2023.105165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Revised: 08/10/2023] [Accepted: 08/18/2023] [Indexed: 08/31/2023]
Abstract
BACKGROUND Recent world population predictions show that the world population aged >=65 years will increase from 10% in 2022 to 16% in 2050. Population aging is accompanied by an increase in people with disability. It is important to pay special attention to people with disability, as these people are at high risk of adverse outcomes. Our study aimed to investigate the transitions of disability among Dutch community-dwelling older people aged 75 years or older, using a follow-up of nine years. We used socio-demographic factors gender, age, marital status, education, and income, but also lifestyle, diseases, and life events to predict the disability transitions over time. METHODS We used a sample of 484 people that was randomly drawn from the municipality of Roosendaal (the Netherlands), a municipality with 78,000 inhabitants. A subset of people who completed part A of the Tilburg Frailty Indicator (TFI) at baseline and the Groningen Activity Restriction Scale (GARS) questionnaires was used with a nine-year follow-up. Paired Wilcoxon tests were used to compare the consecutive measurements. Socio-demographic factors gender, age, marital status, education, and income, but also lifestyle, diseases, and life events were included to predict the disability transitions over time. For the univariable and multivariable analysis of the measurements over time with the predictor variables, we used generalized estimation equations (GEE). A p-value <0.05 was considered significant. R version 3.4.4 was used for all analyses. RESULTS Of the participants, 65% were younger than 80 years, 50% were married or cohabiting, 87% reported a healthy lifestyle, and 63% had no diseases or chronic disorders. Each year, more participants changed from status not disabled to disabled than vice versa. The GEE analyses showed that lifestyle ('not healthy') and diseases or chronic disorders ('two or more') were significant in the multivariable analysis for the disability score and only diseases or chronic disorders ('two or more') was significant in the multivariable analysis for the dichotomous disability score. CONCLUSIONS The transition of the disability score is strongly influenced by lifestyle and diseases or disorders. This applies to a lesser extent to the dichotomous disability score. There, only diseases or disorders are an important predictor. For health care professionals our study provides starting points for interventions focused on the prevention of worsening disability and for community-dwelling older people >= 75, the most important recommendation is: live healthy!
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Affiliation(s)
- Tjeerd van der Ploeg
- Faculty of Health, Sports and Social Work, Inholland University of Applied Sciences, Amsterdam, The Netherlands.
| | - Robbert J J Gobbens
- Faculty of Health, Sports and Social Work, Inholland University of Applied Sciences, Amsterdam, The Netherlands; Zonnehuisgroep Amstelland, Amstelveen, The Netherlands; Department Family Medicine and Population Health, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium; Tranzo, Tilburg University, Tilburg, The Netherlands
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Bruce DG, Davis WA, Davis TME. Group-Based Trajectory Modelling of Changes in Mobility over Six Years in Type 2 Diabetes: The Fremantle Diabetes Study Phase II. J Clin Med 2023; 12:4528. [PMID: 37445563 DOI: 10.3390/jcm12134528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 06/29/2023] [Accepted: 07/05/2023] [Indexed: 07/15/2023] Open
Abstract
To investigate temporal changes in mobility in community-based people with type 2 diabetes, Fremantle Diabetes Study Phase II (FDS2) data were analysed. The baseline assessment included the Timed Up and Go (TUG) test, which was repeated biennially for up to six years. Group-based trajectory modelling (GBTM) identified TUG trajectory groups in participants with ≥2 tests. Independent associates of group membership were assessed using multinomial regression. Of 1551 potential FDS2 participants, 1116 (72.0%; age 64.9 ± 11.0 years, 45.6% female) were included in the modelling. The best-fitting GBTM model identified two groups with linear, minimally changing trajectories (76.2% and 19.4% of participants; baseline TUG times 8 ± 2 and 12 ± 3 s, respectively), and a third (4.5%; baseline TUG 17 ± 5 s) with a TUG that increased over time then fell at Year 6, reflecting participant attrition. Both slower groups were older, more likely to be female, obese, and had greater diabetes-associated complications and comorbidities. Almost one-quarter of the FDS2 cohort had clinically relevant mobility impairment that persisted or worsened over six years, was multifactorial in origin, and was associated with excess late withdrawals and deaths. The TUG may have important clinical utility in assessing mobility and its consequences in adults with type 2 diabetes.
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Affiliation(s)
- David G Bruce
- Medical School, The University of Western Australia, Fremantle Hospital, Alma Street, Fremantle, WA 6160, Australia
| | - Wendy A Davis
- Medical School, The University of Western Australia, Fremantle Hospital, Alma Street, Fremantle, WA 6160, Australia
| | - Timothy M E Davis
- Medical School, The University of Western Australia, Fremantle Hospital, Alma Street, Fremantle, WA 6160, Australia
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Beltz S, Gloystein S, Litschko T, Laag S, van den Berg N. Multivariate analysis of independent determinants of ADL/IADL and quality of life in the elderly. BMC Geriatr 2022; 22:894. [PMID: 36418975 PMCID: PMC9682836 DOI: 10.1186/s12877-022-03621-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 11/14/2022] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND This study evaluated the determinants of disability and quality of life in elderly people who participated at the multi-centred RubiN project (Regional ununterbrochen betreut im Netz) in Germany. METHODS Baseline data of the subjects aged 70 years and older of the RubiN project were used and only subjects with complete data sets were considered for the ensuing analysis (complete case analysis (CCA)). Disability was examined using the concepts of ADL (activities of daily living) and IADL (instrumental activities of daily living). Subjects exhibiting one or more deficiencies in ADL respectively IADL were considered as ADL respectively IADL disabled. Quality of life was assessed using the WHOQOL-BREF and the WHOQOL-OLD. Applying multivariate analysis, sociodemographic factors, psychosocial characteristics as well as the functional, nutritional and cognitive status were explored as potential determinants of disability and quality of life in the elderly. RESULTS One thousand three hundred seventy-five subjects from the RubiN project exhibited data completeness regarding baseline data. ADL and IADL disability were both associated with the respective other construct of disability, sex, a reduced cognitive and functional status as well as domains of the WHOQOL-BREF. Furthermore, ADL disability was related to social participation, while IADL disability was linked to age, education and social support. Sex, ADL and IADL disability, income, social support and social participation as well as the functional status were predictors of the domain 'Physical Health' (WHOQOL-BREF). The facet 'Social Participation' (WHOQOL-OLD) was affected by both ADL and IADL disability, income, social participation, the nutritional and also the functional status. CONCLUSIONS Several potential determinants of disability and quality of life were identified and confirmed in this study. Attention should be drawn to prevention schemes as many of these determinants appear to be at least partly modifiable.
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Affiliation(s)
- Sebastian Beltz
- grid.5603.0Institute for Community Medicine, Section Epidemiology of Health Care and Community Health, University Medicine Greifswald, Greifswald, Germany
| | - Simone Gloystein
- grid.5603.0Institute for Community Medicine, Section Epidemiology of Health Care and Community Health, University Medicine Greifswald, Greifswald, Germany
| | - Thomas Litschko
- grid.5603.0Institute for Community Medicine, Section Epidemiology of Health Care and Community Health, University Medicine Greifswald, Greifswald, Germany
| | - Sonja Laag
- Department for Product Strategy/Development, BARMER Health Insurance, Wuppertal, Germany
| | - Neeltje van den Berg
- grid.5603.0Institute for Community Medicine, Section Epidemiology of Health Care and Community Health, University Medicine Greifswald, Greifswald, Germany
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The association between multimorbidity and mobility disability-free life expectancy in adults aged 85 years and over: A modelling study in the Newcastle 85+ cohort. PLoS Med 2022; 19:e1004130. [PMID: 36374907 PMCID: PMC9662726 DOI: 10.1371/journal.pmed.1004130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 10/20/2022] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Mobility disability is predictive of further functional decline and can itself compromise older people's capacity (and preference) to live independently. The world's population is also ageing, and multimorbidity is the norm in those aged ≥85. What is unclear in this age group, is the influence of multimorbidity on (a) transitions in mobility disability and (b) mobility disability-free life expectancy (mobDFLE). METHODS AND FINDINGS Using multistate modelling in an inception cohort of 714 85-year-olds followed over a 10-year period (aged 85 in 2006 to 95 in 2016), we investigated the association between increasing numbers of long-term conditions and (1) mobility disability incidence, (2) recovery from mobility disability and (3) death, and then explored how this shaped the remaining life expectancy free from mobility disability at age 85. Models were adjusted for age, sex, disease group count, BMI and education. We defined mobility disability based on participants' self-reported ability to get around the house, go up and down stairs/steps, and walk at least 400 yards; participants were defined as having mobility disability if, for one or more these activities, they had any difficulty with them or could not perform them. Data were drawn from the Newcastle 85+ Study: a longitudinal population-based cohort study that recruited community-dwelling and institutionalised individuals from Newcastle upon Tyne and North Tyneside general practices. We observed that each additional disease was associated with a 16% increased risk of incident mobility disability (hazard ratio (HR) 1.16, 95% confidence interval (CI): 1.07 to 1.25, p < 0.001), a 26% decrease in the chance of recovery from this state (HR 0.74, 95% CI: 0.63 to 0.86, p < 0.001), and a 12% increased risk of death with mobility disability (HR: 1.12, 95% CI: 1.07- to .17, p < 0.001). This translated to reductions in mobDFLE with increasing numbers of long-term conditions. However, residual and unmeasured confounding cannot be excluded from these analyses, and there may have been unobserved transitions to/from mobility disability between interviews and prior to death. CONCLUSIONS We suggest 2 implications from this work. (1) Our findings support calls for a greater focus on the prevention of multimorbidity as populations age. (2) As more time spent with mobility disability could potentially lead to greater care needs, maintaining independence with increasing age should also be a key focus for health/social care and reablement services.
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Self-reported symptom causes of mobility difficulty contributing to fear of falling in older adults. Aging Clin Exp Res 2022; 34:3089-3095. [PMID: 36121639 DOI: 10.1007/s40520-022-02253-2] [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: 05/19/2022] [Accepted: 09/08/2022] [Indexed: 11/01/2022]
Abstract
BACKGROUND Self-reported symptom causes of mobility difficulty that contribute to fear of falling (FOF) in older adults has not been fully explored as an area for intervention. AIMS Identify the prevalence of self-reported symptoms causing mobility difficulties and to examine the difference in FOF by symptom category. METHODS Conduct a secondary data analysis of a population-based cohort of community-dwelling older adults, ≥ 70 years, enrolled in the MOBILIZE Boston study. The analysis included 242 older adults reported difficulty walking ¼ mile (0.4 km) and/or climbing one flight of stairs. Participants identified the main symptom cause of the mobility difficulty from a list of 32 symptoms, grouped into five categories. FOF was measured using the Tinetti Falls Efficacy Scale. RESULTS Pain was the primary symptom causing mobility difficulty (38%), followed by endurance (21%), weakness (13%), balance (9%), and other (3%). Although a greater proportion of participants who identified balance as the primary symptom category had significantly higher FOF compared to others, there was a greater number overall who reported pain as their main symptom who also had FOF. Therefore, pain contributed to a higher relative burden of FOF in the population than did balance symptoms. DISCUSSION Various symptoms affect mobility and are associated with FOF, a known fall risk factor. Many older adults identify pain as the main cause of their mobility difficulty and report FOF. CONCLUSIONS Improving pain symptoms for older adults may improve mobility and reduce fear of falling, potentially averting further decline in mobility and independence.
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Dapp U, Vinyard D, Golgert S, Krumpoch S, Freiberger E. Reference values of gait characteristics in community-dwelling older persons with different physical functional levels. BMC Geriatr 2022; 22:713. [PMID: 36038832 PMCID: PMC9422159 DOI: 10.1186/s12877-022-03373-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Accepted: 08/05/2022] [Indexed: 11/24/2022] Open
Abstract
Background Mobility is one major component of healthy ageing of older persons. It includes gait speed, nowadays valued as the sixth vital sign of ageing. Quantitative gait analysis can support clinical diagnostics, monitor progression of diseases and provide information about the efficacy of interventions. Fast gait speed is an additional marker in the area of functional ability. Our aim was to contribute reference values of gait parameters of older persons based on their functional ability. Methods We visualised and combined three different established frameworks that assess gait characteristics into a new framework based approach that comprises eight gait parameters: gait speed, stride length, walk ratio, single and double support time, step width, step width CV (coefficient of variance), stride length CV. Gait parameters were stratified by two instruments that indicate levels of functional ability: First, the LUCAS Functional Ability Index (FAI), a self-administered screening tool easy to apply to a public-health orientated approach and second the Short Physical Performance Battery (SPPB), an established performance test widely used in comprehensive geriatric assessments (CGA). Gait parameters of older community-dwelling persons were measured with an objective Gait system (GAITRite) across differing functional ability ranging from robust to transient (postrobust and prefrail) to frail physical status. Results Of 642 community-dwelling participants (age 78.5 ± 4.8; n = 233 male, n = 409 female) categorisations by SPPB were 27.1% for robust (11–12 points), 44.2% for transient (8–10 points), 28.7% for frail (0–7 points), and 16.2, 50.3, 33.5% for robust, transient, frail by LUCAS FAI. Overall, our results showed that distinction by functional level only uncovers a wide spectrum of functional decline for all investigated gait parameters. Stratification by functional ability (biological age) revealed a greater range of differentiation than chronological age. Conclusions Gait parameters, carefully selected by literature, showed clinically meaningful differences between the functional featuring a gradient declining from robust over transient to frail in most gait parameters. We found discriminative power of stratifications by SPPB to be the highest, closely followed by LUCAS FAI, age groups and dichotomous age making the application of the LUCAS FAI more cost and time effective than conducting SPPB. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-022-03373-0.
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Affiliation(s)
- Ulrike Dapp
- Scientific Department at the University of Hamburg, Albertinen-Haus Geriatrics Center, Sellhopsweg 18-22, 22459, Hamburg, Germany.
| | - Dominic Vinyard
- Scientific Department at the University of Hamburg, Albertinen-Haus Geriatrics Center, Sellhopsweg 18-22, 22459, Hamburg, Germany
| | - Stefan Golgert
- Scientific Department at the University of Hamburg, Albertinen-Haus Geriatrics Center, Sellhopsweg 18-22, 22459, Hamburg, Germany
| | - Sebastian Krumpoch
- Institute for Biomedicine of Aging (IBA), Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Kobergerstr. 60, 90408, Nürnberg, Germany
| | - Ellen Freiberger
- Institute for Biomedicine of Aging (IBA), Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Kobergerstr. 60, 90408, Nürnberg, Germany.
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Freiberger E, Fabbietti P, Corsonello A, Lattanzio F, Artzi-Medvedik R, Kob R, Melzer I, Britting S. Transient versus stable nature of fear of falling over 24 months in community-older persons with falls- data of the EU SCOPE project on Kidney function. BMC Geriatr 2022; 22:698. [PMID: 35999522 PMCID: PMC9396801 DOI: 10.1186/s12877-022-03357-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 08/01/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Fear of falling (FoF) is an important risk factor for falls among older people. The objectives of our investigations were: a.) to present characteristics of older community-dwelling (CD) fallers with persistent or transient FoF (P-FoF or T-FoF) over 12 months, and b.) to investigate clinical predictors of P-FoF and T-FoF and c.) to explore differences between P-FoF and T-FoF. METHODS Our series consisted of 389 older people reporting a fall or injurious fall at baseline and during 24 months follow-up participating in a multicenter prospective study. T-FoF was defined as participants reported "not at all" at baseline and "somewhat/fairly/very concerned" at follow-up, or "not at all" at follow-up, and "somewhat/fairly/very concerned" at baseline, and P-FoF was defined as participants answered "somewhat/fairly/very concerned" in both assessments at baseline and at follow-up. The association between risk factors and T-FoF or P-FoF was investigated by logistic regression analysis. RESULTS The mean age of fallers in our sample was 79.0 years (SD 6.0), and 54.2% were females. Out of 389 older adults with a fall history at baseline, 83 participants (21.3%) did not report any FoF over time, P-FoF and T-FoF were observed in 42.7% and 35.9% of participants, respectively. After adjusting for potential confounders (e.g. age, gender), osteoporosis (OR = 2.04, 95%CI = 1.03-4.05) and impaired physical performance (OR = 2.38, 95%CI = 1.12-5.03) were significant predictors of T-FoF vs No-FoF. Osteoporosis (OR = 2.68, 95%CI = 1.31-5.48), depressive symptoms (OR = 3.54, 95%CI = 1.23-10.1) and living alone (OR = 2.44, 95%CI = 1.17-5.06) were significantly associated with P-FoF vs No-FoF. When comparing T-FoF and P-FoF, female gender (OR = 1.95, 95%CI = 1.16-3.27), BMI (OR = 1.08, 95%CI = 1.02-1.14), overall comorbidity (OR = 1.07, 95%CI = 1.02-1.13) and depression (OR = 2.55, 95%CI = 1.33-4.88) were significant predictors of P-FoF. CONCLUSIONS T-FoF and P-FoF may be predicted by different sets of risk factors among older fallers. Thus, fallers should be screened for FoF especially when carrying specific risk factors, including female gender, osteoporosis, depression, living alone, impaired physical performance, BMI, comorbidity. These findings may be helpful in designing tailored intervention to blunt the risks related to consequence of FoF among older people experiencing falls. TRIAL REGISTRATION The SCOPE study was registered prospectively at clinicaltrials.gov (NCT02691546; 25/02/2016).
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Affiliation(s)
- Ellen Freiberger
- Department of Internal Medicine-Geriatrics, Institute for Biomedicine of Aging (IBA), Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany.
| | - Paolo Fabbietti
- Italian National Research Center On Aging (IRCCS INRCA), Ancona, Fermo and Cosenza, Italy
| | - Andrea Corsonello
- Italian National Research Center On Aging (IRCCS INRCA), Ancona, Fermo and Cosenza, Italy
| | - Fabrizia Lattanzio
- Italian National Research Center On Aging (IRCCS INRCA), Ancona, Fermo and Cosenza, Italy
| | - Rada Artzi-Medvedik
- Department of Nursing, Recanati School for Community Health Professions at the Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.,Maccabi Health Services, Israel; and Department of Nursing, Recanati School for Community Health Professions at the Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Robert Kob
- Department of Internal Medicine-Geriatrics, Institute for Biomedicine of Aging (IBA), Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Itshak Melzer
- Department of Physical Therapy, Recanati School for Community Health Professions at the Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | | | - Sabine Britting
- Department of Internal Medicine-Geriatrics, Institute for Biomedicine of Aging (IBA), Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
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12
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Zhou J, Wei MY, Zhang J, Liu H, Wu C. Association of multimorbidity patterns with incident disability and recovery of independence among middle-aged and older adults. Age Ageing 2022; 51:afac177. [PMID: 35930720 DOI: 10.1093/ageing/afac177] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2022] [Revised: 05/17/2022] [Indexed: 01/25/2023] Open
Abstract
OBJECTIVE to identify multimorbidity patterns among middle-aged and older adults in China and examine how these patterns are associated with incident disability and recovery of independence. METHODS data were from The China Health and Retirement Longitudinal Study. We included 14,613 persons aged ≥45 years. Latent class analysis (LCA) was conducted to identify multimorbidity patterns with clinical meaningfulness. Multinomial logistic models were used to determine the adjusted association between multimorbidity patterns and incident disability and recovery of independence. RESULTS we identified four multimorbidity patterns: 'low morbidity' (67.91% of the sample), 'pulmonary-digestive-rheumatic' (17.28%), 'cardiovascular-metabolic-neuro' (10.77%) and 'high morbidity' (4.04%). Compared to the 'low morbidity' group, 'high morbidity' (OR = 2.63, 95% CI = 1.97-3.51), 'pulmonary-digestive-rheumatic' (OR = 1.89, 95% CI = 1.63-2.21) and 'cardiovascular-metabolic-neuro' pattern (OR = 1.61, 95% CI = 1.31-1.97) had higher odds of incident disability in adjusted multinomial logistic models. The 'cardiovascular-metabolic-neuro' (OR = 0.60, 95% CI = 0.44-0.81), 'high morbidity' (OR = 0.68, 95% CI = 0.47-0.98) and 'pulmonary-digestive-rheumatic' group (OR = 0.75, 95% CI = 0.60-0.95) had lower odds of recovery from disability than the 'low morbidity' group. Among people without disability, the 'cardiovascular-endocrine-neuro' pattern was associated with the highest 2-year mortality (OR = 2.42, 95% CI = 1.56-3.72). CONCLUSIONS multimorbidity is complex and heterogeneous, but our study demonstrates that clinically meaningful patterns can be obtained using LCA. We highlight four multimorbidity patterns with differential effects on incident disability and recovery from disability. These studies suggest that targeted prevention and treatment approaches are needed for people with multimorbidity.
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Affiliation(s)
- Jiayi Zhou
- School of Public Health, LKS Faculty of Medicine, University of Hong Kong, Hong Kong 999077, China
- Global Health Research Center, Duke Kunshan University, Kunshan 215316, China
| | - Melissa Y Wei
- Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine, University of California, Los Angeles, CA 90095, USA
| | - Jingyi Zhang
- College of Arts and Sciences, Hanover, NH 02747, USA
| | - Hua Liu
- Department of Neurosurgery, The Affiliated Kunshan Hospital of Jiangsu University, Suzhou, China
| | - Chenkai Wu
- Global Health Research Center, Duke Kunshan University, Kunshan 215316, China
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13
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Lee S, Kim M, Lee Y, Kim J, Jang HC, Cho B, Choi KM, Roh E, Son SJ, Lee JH, Park YS, Lee SG, Kim BJ, Kim H, Won CW. The effect of sex and physical frailty on incident disability after 2 years among community-dwelling older adults: KFACS study. BMC Geriatr 2022; 22:588. [PMID: 35840889 PMCID: PMC9288076 DOI: 10.1186/s12877-022-03263-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2022] [Accepted: 06/30/2022] [Indexed: 11/30/2022] Open
Abstract
Background This study investigated the impact of physical frailty on the development of disabilities in mobility, activities of daily living (ADL), and instrumental activities of daily living (IADL) according to sex among community-dwelling Korean older adults. Methods We used data of 2,905 older adults aged 70-84 years from the Korean Frailty and Aging Cohort Study (KFACS) at baseline (2016-2017) and Wave 2 (2018-2019). Fried’s physical frailty phenotype was used to identify frailty. Results After adjustment, frailty showed a higher impact for women than men on developing mobility disability (odds ratio [OR]=14.00, 95% confidence interval [CI]=4.8–40.78 vs. OR=9.89, 95% CI=4.28–22.86) and IADL disability after two years (OR=7.22, 95% CI=2.67–19.56 vs. OR=3.19, 95% CI=1.17–8.70). Pre-frailty led to mobility disability for women and men (OR=2.77, 95% CI=1.93–3.98 vs. OR=2.49, 95% CI=1.66–3.72, respectively), and IADL disability only for women (OR=3.01, 95% CI=1.28–7.09). Among the IADL components, both men and women who were prefrail or frail showed increased disability in ‘using transportation’. Among men, pre-frailty was significantly associated with disability in “going out” and “shopping”. In women, frailty was significantly associated with disability in “doing laundry,” “performing household chores,” “shopping,” and “managing money”. Conclusions Physical frailty increased disability over 2 years for women more than men. Physical frailty increased disability in outdoor activity-related IADL components in men and household work-related IADL components in women. This study highlights the need for gender-specific policies and preventative programs for frailty, particularly restorative interventions that focus on women who are physically frail. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-022-03263-5.
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Affiliation(s)
- Seoyoon Lee
- Elderly Frailty Research Center, Department of Family Medicine, College of Medicine, Kyung Hee University, Seoul, Republic of Korea.,Interdisciplinary Graduate Program in Social Welfare Policy, Yonsei University, Seoul, Republic of Korea
| | - Miji Kim
- Department of Biomedical Science and Technology, College of Medicine, East-West Medical Research Institute, Kyung Hee University, Seoul, Republic of Korea.
| | - Yunhwan Lee
- Department of Preventive Medicine and Public Health, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Jinhee Kim
- Department of Preventive Medicine and Public Health, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Hak Chul Jang
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University, College of Medicine, Seongnam, Korea
| | - Belong Cho
- Department of Family Medicine, Center for Health Promotion and Optimal Aging, Seoul National University College of Medicine & Hospital, Seoul, Republic of Korea
| | - Kyung Mook Choi
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Korea University, Seoul, Republic of Korea
| | - Eun Roh
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Hallym University Sacred Heart Hospital, Anyang, 14068, Republic of Korea
| | - Sang Joon Son
- Department of Psychiatry, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Jin-Hee Lee
- Catholic institute of U-healthcare, The Catholic University of Korea, Seoul, Republic of Korea
| | - Yong Soon Park
- Department of Family Medicine, Hallym University Chuncheon Sacred Heart Hospital, Chuncheon, Republic of Korea
| | - Sam-Gyu Lee
- Department of Physical & Rehabilitation Medicine, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Bong Jo Kim
- Department of Psychiatry, College of Medicine, Gyeongsang National University, Jinju, Republic of Korea
| | - Hyeonju Kim
- Department of Family Medicine, Jeju National University College of Medicine, Jeju, Republic of Korea
| | - Chang Won Won
- Elderly Frailty Research Center, Department of Family Medicine, College of Medicine, Kyung Hee University, Seoul, Republic of Korea. .,Department of Family Medicine, Kyung Hee University Medical Center, Seoul, Republic of Korea.
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14
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The Use of Urban Parks by Older Adults in the Context of Perceived Security. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19074184. [PMID: 35409867 PMCID: PMC8998194 DOI: 10.3390/ijerph19074184] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Revised: 03/30/2022] [Accepted: 03/30/2022] [Indexed: 01/01/2023]
Abstract
The perception of urban greenery is determined by many aspects, including the personal security of different groups of city dwellers. The objective of this study was to investigate if there are differences between the sense of security of older adults and other groups of urban park users, and which factors play an important role in the evaluation of personal security and thus determine the use (or not) of parks. A survey questionnaire was administrated to a sample of randomly selected park users in Poland (n = 394), including seniors (s = 69). The results show statistically significant differences in security perception between respondents under the age of 60 and those over the age of 60 in the case of all questioned factors. At the same time, all of them are important for a sense of security in older adults. This knowledge is crucial for designing more inclusive and age-friendly urban parks, which should meet the needs and expectations of older adults and encourage them to engage in more activity.
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15
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Kim DJ, Massa MS, Clarke R, Scarlett S, O'Halloran AM, Kenny RA, Bennett D. Variability and agreement of frailty measures and risk of falls, hospital admissions and mortality in TILDA. Sci Rep 2022; 12:4878. [PMID: 35318402 PMCID: PMC8940970 DOI: 10.1038/s41598-022-08959-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Accepted: 03/07/2022] [Indexed: 11/18/2022] Open
Abstract
Little is known about the within-person variability of different frailty instruments, their agreement over time, and whether use of repeat assessments could improve the strength of associations with adverse health outcomes. Repeat measurements recorded in 2010–2011 (Wave 1) and 2012 (Wave 2) from The Irish Longitudinal Study on Ageing (TILDA) were used to classify individuals with frailty using the frailty phenotype (FP) and frailty index (FI). Within-person variability and agreement of frailty classifications were assessed using ANOVA and kappa (K) statistics, respectively. Associations of each frailty measure (wave 1, wave 2, or mean of both waves) with risk of falls, hospitalisations and all-cause mortality were assessed using logistic regression. Among 7455 individuals (mean age 64.7 [SD 9.9] years), within-person SD was 0.664 units (95% CI 0.654–0.671) for FP and 2 health deficits (SD 0.050 [0.048–0.051]) for FI. Agreement of frailty was modest for both measures, but higher for FI (K 0.600 [0.584–0.615]) than FP (K 0.370 [0.348–0.401]). The odds ratios (ORs) for all-cause mortality were higher for frailty assessed using the mean of two versus single measurements for FI (ORs for mortality 3.5 [2.6–4.9] vs. 2.7 [1.9–3.4], respectively) and FP (ORs for mortality 6.9 [4.6–10.3] vs. 4.0 [2.8–5.635], respectively). Frailty scores based on single measurements had substantial within-person variability, but the agreement in classification of frailty was higher for FI than FP. Frailty assessed using the mean of two or more measurements recorded at separate visits was more strongly associated with adverse health outcomes than those recorded at a single visit.
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Affiliation(s)
- Dani J Kim
- Clinical Trial Service Unit and Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, Big Data Institute, Old Road Campus, Oxford, OX3 7LF, UK
| | - M Sofia Massa
- Clinical Trial Service Unit and Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, Big Data Institute, Old Road Campus, Oxford, OX3 7LF, UK
| | - Robert Clarke
- Clinical Trial Service Unit and Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, Big Data Institute, Old Road Campus, Oxford, OX3 7LF, UK.
| | - Siobhan Scarlett
- The Irish Longitudinal Study on Ageing, Medical Gerontology, Trinity College, Dublin, Ireland
| | - Aisling M O'Halloran
- The Irish Longitudinal Study on Ageing, Medical Gerontology, Trinity College, Dublin, Ireland
| | - Rose Anne Kenny
- The Irish Longitudinal Study on Ageing, Medical Gerontology, Trinity College, Dublin, Ireland
| | - Derrick Bennett
- Clinical Trial Service Unit and Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, Big Data Institute, Old Road Campus, Oxford, OX3 7LF, UK.,The National Institute of Health (NIHR) Oxford Biomedical Research Centre (BRC), Oxford, UK
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16
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Lieberz D, Borgeson H, Dobson S, Ewings L, Johnson K, Klaysmat K, Schultz A, Tasson R, Borstad AL. A Physical Therapy Mobility Checkup for Older Adults: Feasibility and Participant Preferences From a Discrete Choice Experiment. J Patient Cent Res Rev 2022; 9:24-34. [PMID: 35111880 PMCID: PMC8772607 DOI: 10.17294/2330-0698.1874] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/11/2024] Open
Abstract
PURPOSE Physical performance measures, like walking speed, identify and predict preclinical mobility disability but are rarely used in routine medical care. A preventive model of care called Mobility Checkup is being designed to reduce mobility disability in older adults. This study had two purposes: 1) determine feasibility and outcomes of the Mobility Checkup, and 2) identify preferences of older adults regarding this model of care using a discrete choice experiment. METHODS Adults over 55 years of age were recruited from the community. In the study's first phase, participants completed a Mobility Checkup, with feasibility evaluated using 6 criteria. In the second phase, a new sample of older adults (>55 years old) were educated about the Mobility Checkup and then completed a discrete choice experiment to determine their preferences regarding 4 attributes of this care model: cost, visit duration, desired education topic, and style of educational graphic. RESULTS Each study phase was completed by 31 participants. Of the 6 feasibility criteria, 5 were met. Visit duration exceeded the 60-minute criteria for 13 of the 31 participants. Still, 91% of participants were very satisfied with the Mobility Checkup. Ability to transition positions identified preclinical mobility disability most frequently. A 30-minute visit with no out-of-pocket cost was deemed preferred. CONCLUSIONS Older adults value knowing what physical performance measurements predict about their general health. Transitions should be evaluated as part of a Mobility Checkup for older adults. Clearly conveyed cost of health care service is important to older adult consumers.
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Affiliation(s)
- Dalerie Lieberz
- Department of Physical Therapy, The College of St. Scholastica, Duluth, MN
| | | | | | - Lindsey Ewings
- Department of Physical Therapy, The College of St. Scholastica, Duluth, MN
| | | | - Kori Klaysmat
- Department of Physical Therapy, The College of St. Scholastica, Duluth, MN
| | - Abby Schultz
- Department of Physical Therapy, The College of St. Scholastica, Duluth, MN
| | - Rachel Tasson
- Department of Physical Therapy, The College of St. Scholastica, Duluth, MN
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Smith J, Ylitalo KR. Physical activity recommendation by health care providers to adults with and without functional limitations. Prev Med 2021; 153:106730. [PMID: 34284001 PMCID: PMC8595525 DOI: 10.1016/j.ypmed.2021.106730] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 06/22/2021] [Accepted: 07/14/2021] [Indexed: 11/25/2022]
Abstract
Adults with functional limitations are more likely to be physically inactive than those without functional limitations, despite evidence that regular physical activity (PA) slows the progression of functional decline. The health care setting provides an opportunity to communicate with patients about positive behavior changes, including increased PA, but there is little information about provider recommendation for PA to adults with functional limitations. This study investigated health care provider recommendation to increase PA among adults with and without functional limitations. Adults (≥18 years) who participated in the 2016 National Health Interview Survey and reported ≥1 primary care encounter within the previous 12 months were included (unweighted n = 23,540; weighted N = 170,004,764). Receipt of PA recommendation and physical functioning limitations were self-reported. Statistical analyses were weighted to account for complex survey sampling design. One-third (35.88%) of adults received a PA recommendation and 19.71% reported functional limitations. Adults who received a PA recommendation were more likely to have a functional limitation than those who did not (28.64% vs. 14.70%; p < 0.001), even after adjusting for covariates and current activity level (aOR = 1.48; 95% CI:1.33,1.65). PA recommendation for those with functional limitations appeared to increase during middle age and peak for adults aged 65-75 years (57.01%) but declined substantially for adults ≥75 years. Only one-third of adults in the United States received PA recommendations. Health care providers recommended PA to approximately half of adults with functional limitations. Continued efforts to leverage health care encounters for behavior change should be explored, particularly for middle aged and older adults.
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Affiliation(s)
- Jordan Smith
- Department of Public Health, Robbins College of Health and Human Sciences, Baylor University, Waco, TX, USA
| | - Kelly R Ylitalo
- Department of Public Health, Robbins College of Health and Human Sciences, Baylor University, Waco, TX, USA.
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18
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When Movement Moves: Study Protocol for a Multi-Method Pre/Post Evaluation Study of Two Programmes; the Danish Team Twin and Cycling Without Age. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph181910008. [PMID: 34639309 PMCID: PMC8508096 DOI: 10.3390/ijerph181910008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Revised: 09/17/2021] [Accepted: 09/19/2021] [Indexed: 11/17/2022]
Abstract
Physical activity (PA) can improve physical, mental, and social health, leading to quality of life (QoL). However, some are unable to participate independently due to age-related impairments or disabilities. This study protocol presents the design, methods, outcomes, strengths and limitations of the study “When Movement Moves” (WMM). WMM investigates whether indirect PA in a social context, where persons are unable to participate independently, can result in outcomes similar to those of independent PA, by evaluating the effects of disabled’s, elderly, volunteers’, relatives’ and nursing staff’s participation in either the running programme (Team Twin) or cycling programme (Cycling Without Age). Both programmes seek to enhance QoL through indirect PA in a social context, making PA possible for elderly and disabled persons through PA conducted by abled-bodied volunteers. WMM is a multi-method 12–16-week pre/post evaluation with quality of life, physical, mental and social health as main outcomes. Pre/post measurements consist of questionnaires, clinical examinations, and physical and cognitive appraisal. Throughout, interviews and participant observations will be conducted. Combined results will provide essential knowledge on the effects and experiences of indirect PA. Explorative data will pave the way for further research. Findings may inform policies, guidelines and health promotion among the elderly and disabled.
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19
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Speiser JL, Callahan KE, Ip EH, Miller ME, Tooze JA, Kritchevsky SB, Houston DK. Predicting Future Mobility Limitation in Older Adults: A Machine Learning Analysis of Health ABC Study Data. J Gerontol A Biol Sci Med Sci 2021; 77:1072-1078. [PMID: 34529794 DOI: 10.1093/gerona/glab269] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Mobility limitation in older adults is common and associated with poor health outcomes and loss of independence. Identification of at-risk individuals remains challenging because of time-consuming clinical assessments and limitations of statistical models for dynamic outcomes over time. Therefore, we aimed to develop machine learning models for predicting future mobility limitation in older adults using repeated measures data. METHODS We used annual assessments over nine years of follow-up from the Health, Aging, and Body Composition study to model mobility limitation, defined as self-report of any difficulty walking a quarter mile or climbing 10 steps. We considered 46 predictors, including demographics, lifestyle, chronic conditions and physical function. With a split sample approach, we developed mixed models (generalized linear and Binary Mixed Model forest) using: 1) all 46 predictors, 2) a variable selection algorithm, and 3) the top five most important predictors. Age was included in all models. Performance was evaluated using area under the receiver operating curve (AUC) in two internal validation datasets. RESULTS AUC ranged from 0.80-0.84 for the models. The most important predictors of mobility limitation were ease of getting up from a chair, gait speed, self-reported health status, body mass index and depression. CONCLUSIONS Machine learning models using repeated measures had good performance for identifying older adults at-risk of developing mobility limitation. Future studies should evaluate the utility and efficiency of the prediction models as a tool in clinical settings for identifying at-risk older adults who may benefit from interventions aimed to prevent or delay mobility limitation.
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Affiliation(s)
- Jaime Lynn Speiser
- Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, NC
| | - Kathryn E Callahan
- Department of Internal Medicine, Section on Gerontology and Geriatric Medicine, Wake Forest School of Medicine, Winston-Salem, NC
| | - Edward H Ip
- Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, NC
| | - Michael E Miller
- Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, NC
| | - Janet A Tooze
- Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, NC
| | - Stephen B Kritchevsky
- Department of Internal Medicine, Section on Gerontology and Geriatric Medicine, Wake Forest School of Medicine, Winston-Salem, NC
| | - Denise K Houston
- Department of Internal Medicine, Section on Gerontology and Geriatric Medicine, Wake Forest School of Medicine, Winston-Salem, NC
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Kahraman T, Çekok FK, Üğüt BO, Keskinoğlu P, Genç A. One-Year Change in the Physical Functioning of Older People According to the International Classification of Functioning Domains. J Geriatr Phys Ther 2021; 44:E9-E17. [PMID: 30883529 DOI: 10.1519/jpt.0000000000000234] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND AND PURPOSE It is important to determine physical functioning declines in older people according to the International Classification of Functioning, Disability and Health (ICF) framework, given its advantages. This study was performed to investigate 1-year changes in the physical functioning of older people using the ICF framework. METHODS Eighty older people were enrolled and completed baseline measures in this longitudinal, single-group study while 33 of these participants were reassessed at 1 year. Reliable and valid methods commonly used in geriatric rehabilitation settings for determining physical functioning were applied to evaluate ICF domains including Body Functions, Activities (capacity), and Activities and Participation (performance). Body Functions were assessed by measuring lower extremity muscle strength and exercise tolerance test performance. The Activities (capacity) measures included walking, balance, mobility, sit-to-stand, and upper extremity functional performance. The Activities and Participation (performance) domain included the Falls Efficacy Scale-International, Modified Barthel Index, and Rapid Assessment of Physical Activity scale. RESULTS There were significant decreases in muscle strength in both hip abductors and knee extensors (P < .001, d > 0.80) at 1 year versus baseline, but there were no significant changes in exercise tolerance test parameters (P > .05, d = 0.44-0.71), with the exception of diastolic blood pressure (P = .019, d = 0.90). Significant deterioration was observed in all Activities (capacity) measures (P < .05, d > 0.80). No significant changes were observed in the Falls Efficacy Scale-International (P = .051, d = 0.72), Modified Barthel Index (P = .107, d = 0.59), or Rapid Assessment of Physical Activity-Flexibility and Strength subscale (P = .763, d = 0.11). CONCLUSIONS Significant declines were seen in lower extremity muscle strength, walking capacity, speed, mobility, sit-to-stand performance, upper extremity function, and balance performance at 1 year. On the contrary, no significant changes were observed in the levels of participation in activities of daily living, activities related to balance, or physical activity. According to the ICF framework, during 1 year, our sample of older people showed declines in the Body Functions and Activities (capacity) domains, but the Activities and Participation (performance) domain remained stable.
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Affiliation(s)
- Turhan Kahraman
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Izmir Katip Celebi University, Izmir, Turkey
| | | | - Birön Onur Üğüt
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Izmir Katip Celebi University, Izmir, Turkey
- Institute of Health Sciences, Dokuz Eylül University, Izmir, Turkey
| | - Pembe Keskinoğlu
- Department of Biostatistics and Medical Informatics, Dokuz Eylül University, Izmir, Turkey
| | - Arzu Genç
- School of Physical Therapy and Rehabilitation, Dokuz Eylül University, Izmir, Turkey
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21
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Pruchno R, Wilson-Genderson M, Heid AR, Cartwright FP. Effects of peri-traumatic stress experienced during Hurricane Sandy on functional limitation trajectories for older men and women. Soc Sci Med 2021; 281:114097. [PMID: 34120083 PMCID: PMC8276253 DOI: 10.1016/j.socscimed.2021.114097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 03/13/2021] [Accepted: 05/31/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND AND METHODS Although the short-term effects of disasters on the physical health of mid-life and older people have been documented, little is understood about the long-term effects that disasters have on the physical health of these people. Based on the environmental docility hypothesis and research regarding gender effects on functional limitations and disaster, our analyses examined the effects of peri-traumatic stress experienced during Hurricane Sandy using longitudinal data from 5688 people aged 50 and older collected over six waves (2006-2019). RESULTS We found that functional limitations follow three trajectories, with people in each group having a significant linear increase over time and all but the highest functioning people also having a significant quadratic effect, indicating that the linear increase peaked post-Hurricane and then slowed in later waves. CONCLUSION Consistent with the environmental docility hypothesis, peri-traumatic stress had its greatest impact on people with more functional limitations before the hurricane. Men experiencing peri-traumatic stress during Hurricane Sandy were more likely to experience an increase in functional limitations than women. These findings, which identify people most likely to experience long-term health effects following a disaster, can be used to inform health policies before, during, and after disaster strikes.
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Affiliation(s)
- Rachel Pruchno
- New Jersey Institute for Successful Aging, Rowan University School of Osteopathic Medicine, Stratford, NJ, USA.
| | | | | | - Francine P Cartwright
- New Jersey Institute for Successful Aging, Rowan University School of Osteopathic Medicine, Stratford, NJ, USA.
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22
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Associations of accelerometer-determined sedentary behavior and physical activity with physical performance outcomes by race/ethnicity in older women. Prev Med Rep 2021; 23:101408. [PMID: 34123715 PMCID: PMC8173313 DOI: 10.1016/j.pmedr.2021.101408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 03/16/2021] [Accepted: 05/08/2021] [Indexed: 01/28/2023] Open
Abstract
To determine the cross-sectional associations of accelerometer-measured time spent in physical activity intensity categories (sedentary, low and high light intensity, or moderate to vigorous intensity physical activity (MVPA) with physical performance outcomes [stair climb ascent, 40 foot walk test, and short physical performance battery (SPPB)] in older women and examine differences by race/ethnicity. Data were from 1,256 Study of Women's Health Across the Nation (SWAN) participants [aged 64.9 (2.7) years at Visit 15 (2015-16); 54.1% non-White]. Three sets of adjusted multivariable linear or logistic regression models were built to test the study objectives using the backward elimination approach to identify relevant covariates. In the full analytic sample, a 10 min increment in MVPA was related to faster performance on the stair climb [β = -0.023 (95% CI: -0.04, -0.005) seconds] and 40 foot walk test [β = -0.066 (95% CI: -0.133, -0.038) seconds], and a 9% lower odds [OR: 0.91; 95% CI: 0.87, 0.96; p = 0.004] of limitations based on the SPPB. Statistically significant differences by race/ethnicity were found for the stair climb ascent time as MVPA was associated with better performance for White, Chinese, and Japanese participants while high light intensity physical activity, but not MVPA, was deemed beneficial in Black women. Findings from the isotemporal substitution models were consistent. Findings further support the importance of MVPA on physical performance outcomes in older women. Further research is needed to examine the complex associations between physical (in)activity and physical performance outcomes by race/ethnicity to provide more targeted recommendations.
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23
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Coman RL, Caponecchia CD, Gopaldasani V. Impact of Public Seating Design on Mobility and Independence of Older Adults. Exp Aging Res 2021; 47:262-272. [PMID: 33560937 DOI: 10.1080/0361073x.2021.1884445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Background:Mobility and independence of older adults are influenced by age-related capabilities and limitations, as well as environmental factors such as non-optimum design of public seating (e.g., inappropriate seat height, angle, and compressibility as well as armrests). This study was the first part of a multi-stage investigation of the impact of public seating on older adults. Method:One hundred and six older adults (aged 65 and over) completed an online survey regarding difficulties experienced with standing up from public seating (e.g. frequency; location; type of seating; effects). Results:A majority (59.4%) reported experiencing problems, with seat height the most common issue. Shopping malls, cafes and restaurants, doctor's offices, outdoor locations, and public toilets were the most common locations. Effects included inconvenience, embarrassment, discomfort, pain, and needing help from another person to stand. Discussion:Further research is needed to explore the locations and features of seating that can contribute to this problem.
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Affiliation(s)
- Robyn L Coman
- School of Health and Society, Faculty of Arts, Social Sciences & Humanities, University of Wollongong, Wollongong, Australia
| | - Carlo D Caponecchia
- School of Aviation, Faculty of Science, University of New South Wales, Sydney, Australia
| | - Vinod Gopaldasani
- School of Health and Society, Faculty of Arts, Social Sciences & Humanities, University of Wollongong, Wollongong, Australia
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24
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Cornman JC, Glei DA, Weinstein M. Change in Mobility: Consistency of Estimates and Predictors Across Studies of Older Adults. J Gerontol B Psychol Sci Soc Sci 2021; 76:209-218. [PMID: 31362309 DOI: 10.1093/geronb/gbz091] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Indexed: 01/11/2023] Open
Abstract
OBJECTIVES This study compares estimates and determinants of within-individual changes in mobility across surveys of older U.S. adults. METHODS Data come from the Health and Retirement Study (HRS) and the Midlife in the United States (MIDUS) study. Measures of mobility comprise self-reported level of difficulty with walking several blocks, going up several flights of stairs, lifting and carrying 10 pounds, and stooping. Predictors include sociodemographic characteristics and indicators of health and health behaviors. We pool the datasets and estimate weighted lagged dependent variable logistic regression models for each activity, assessing cross-study differences using interaction terms between a survey indicator and relevant variables. RESULTS Estimates of declines in mobility differ substantially across surveys for walking, lifting and carrying, and stooping, but there are no between-survey differences in the probability of (not) recovering from a limitation. With the exception of age, determinants of change are similar between studies. For lifting/carrying and stooping, the age-related increase in developing limitations is less steep at younger ages for HRS respondents than MIDUS respondents, but steeper at older ages. DISCUSSION To compare estimates of mobility change across surveys, mobility measures would need to be harmonized. Determinants of mobility change, however, are more comparable.
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Affiliation(s)
| | - Dana A Glei
- Center for Population and Health, Georgetown University, Washington, D.C
| | - Maxine Weinstein
- Center for Population and Health, Georgetown University, Washington, D.C
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25
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Bell M, Schein RM, Straatmann J, Dicianno BE, Schmeler MR. Functional Mobility Outcomes in Telehealth and In-Person Assessments for Wheeled Mobility Devices. Int J Telerehabil 2020; 12:27-34. [PMID: 33520092 PMCID: PMC7757644 DOI: 10.5195/ijt.2020.6335] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
The purpose of this study was to compare telehealth and in-person service delivery models for wheeled mobility devices in terms of functional outcomes. We hypothesized that clinically significant improvements in functional mobility measured by the Functional Mobility Assessment (FMA) will occur in individuals receiving both telehealth and in-person clinic evaluations. A total of 27 Veterans receiving telehealth visits were compared to 27 individuals seen in clinic, selected from a database, matching for age, gender, and primary diagnosis. All mean individual item and total FMA scores in both groups increased from Time 1 to Time 2. Within the telehealth group, all changes in individual item and total FMA scores were statistically significant, with changes in 8 of 10 items meeting threshold for clinical significance (change >1.85 points). Within the clinic group, changes in 7 of 10 individual items and total FMA scores were statistically significant, and these same 7 items met threshold for clinical significance. Change scores for individual item and total FMA scores did not differ significantly between the two groups. A larger and clinically significant change in transfer score was seen in the telehealth group, suggesting telehealth visits may confer an advantage in being able to assess and address transfer issues in the home.
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Affiliation(s)
- Mitchell Bell
- Department of Rehabilitation Science and Technology, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Richard M. Schein
- Department of Rehabilitation Science and Technology, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Joseph Straatmann
- Department of Rehabilitation Science and Technology, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Brad E. Dicianno
- Human Engineering Research Laboratories, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania, USA
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Mark R. Schmeler
- Department of Rehabilitation Science and Technology, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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26
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Moskowitz S, Russ DW, Clark LA, Wages NP, Grooms DR, Woods AJ, Suhr J, Simon JE, O'Shea A, Criss CR, Fadda P, Clark BC. Is impaired dopaminergic function associated with mobility capacity in older adults? GeroScience 2020; 43:1383-1404. [PMID: 33236263 DOI: 10.1007/s11357-020-00303-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 11/18/2020] [Indexed: 01/14/2023] Open
Abstract
The capacity to move is essential for independence and declines with age. Slow movement speed, in particular, is strongly associated with negative health outcomes. Prior research on mobility (herein defined as movement slowness) and aging has largely focused on musculoskeletal mechanisms and processes. More recent work has provided growing evidence for a significant role of the nervous system in contributing to reduced mobility in older adults. In this article, we report four pieces of complementary evidence from behavioral, genetic, and neuroimaging experiments that, we believe, provide theoretical support for the assertion that the basal ganglia and its dopaminergic function are responsible, in part, for age-related reductions in mobility. We report four a posteriori findings from an existing dataset: (1) slower central activation of ballistic force development is associated with worse mobility among older adults; (2) older adults with the Val/Met intermediate catecholamine-O-methyl-transferase (COMT) genotype involved in dopamine degradation exhibit greater mobility than their homozygous counterparts; (3) there are moderate relationships between performance times from a series of lower and upper extremity tasks supporting the notion that movement speed in older adults is a trait-like attribute; and (4) there is a relationship of functional connectivity within the medial orbofrontal (mOFC) cortico-striatal network and measures of mobility, suggesting that a potential neural mechanism for impaired mobility with aging is the deterioration of the integrity of key regions within the mOFC cortico-striatal network. These findings align with recent basic and clinical science work suggesting that the basal ganglia and its dopaminergic function are mechanistically linked to age-related reductions in mobility capacity.
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Affiliation(s)
- Simon Moskowitz
- Ohio Musculoskeletal and Neurological Institute (OMNI), Ohio University, 250 Irvine Hall, Athens, OH, 45701, USA
| | - David W Russ
- Ohio Musculoskeletal and Neurological Institute (OMNI), Ohio University, 250 Irvine Hall, Athens, OH, 45701, USA.,School of Rehabilitation and Communication Sciences, Ohio University, Athens, OH, USA.,School of Physical Therapy & Rehabilitation Sciences, University of South Florida Morsani College of Medicine, Tampa, FL, USA
| | - Leatha A Clark
- Ohio Musculoskeletal and Neurological Institute (OMNI), Ohio University, 250 Irvine Hall, Athens, OH, 45701, USA.,Department of Biomedical Sciences at Ohio University, Athens, OH, USA.,Department of Family Medicine at Ohio University, Athens, OH, USA
| | - Nathan P Wages
- Ohio Musculoskeletal and Neurological Institute (OMNI), Ohio University, 250 Irvine Hall, Athens, OH, 45701, USA.,Department of Biomedical Sciences at Ohio University, Athens, OH, USA
| | - Dustin R Grooms
- Ohio Musculoskeletal and Neurological Institute (OMNI), Ohio University, 250 Irvine Hall, Athens, OH, 45701, USA.,School of Applied Health and Wellness, Ohio University, Athens, OH, USA
| | - Adam J Woods
- Center for Cognitive Aging and Memory, Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, USA
| | - Julie Suhr
- Ohio Musculoskeletal and Neurological Institute (OMNI), Ohio University, 250 Irvine Hall, Athens, OH, 45701, USA.,Department of Psychology, Ohio University, Athens, OH, USA
| | - Janet E Simon
- Ohio Musculoskeletal and Neurological Institute (OMNI), Ohio University, 250 Irvine Hall, Athens, OH, 45701, USA.,School of Applied Health and Wellness, Ohio University, Athens, OH, USA
| | - Andrew O'Shea
- Center for Cognitive Aging and Memory, Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, USA
| | - Cody R Criss
- Ohio Musculoskeletal and Neurological Institute (OMNI), Ohio University, 250 Irvine Hall, Athens, OH, 45701, USA
| | - Paolo Fadda
- Genomics Shared Resource-Comprehensive Cancer Center, The Ohio State University, Athens, OH, USA
| | - Brian C Clark
- Ohio Musculoskeletal and Neurological Institute (OMNI), Ohio University, 250 Irvine Hall, Athens, OH, 45701, USA. .,Department of Biomedical Sciences at Ohio University, Athens, OH, USA. .,Division of Geriatric Medicine at Ohio University, Athens, OH, USA.
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27
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Freiberger E, Sieber CC, Kob R. Mobility in Older Community-Dwelling Persons: A Narrative Review. Front Physiol 2020; 11:881. [PMID: 33041836 PMCID: PMC7522521 DOI: 10.3389/fphys.2020.00881] [Citation(s) in RCA: 52] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Accepted: 06/29/2020] [Indexed: 12/21/2022] Open
Abstract
Due to the demographic changes and the increasing awareness of the role of physical function, mobility in older age is becoming an important topic. Mobility limitations have been reported as increasingly prevalent in older persons affecting about 35% of persons aged 70 and the majority of persons over 85 years. Mobility limitations have been associated with increased fall risk, hospitalization, a decreased quality of life, and even mortality. As concepts of mobility are multifactorial and complex, in this narrative review, definitions, physical factors, and their age-related changes associated with mobility will be presented. Also, areas of cognitive decline and their impact on mobility, as well as neuromuscular factors related to mobility will be addressed. Another section will relate psychological factors such as Fall-related psychological concerns and sedentary behavior to mobility. Assessment of mobility as well as effective exercise interventions are only shortly addressed. In the last part, gaps and future work on mobility in older persons are discussed.
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Affiliation(s)
- Ellen Freiberger
- Institute for Biomedicine of Aging, Friedrich-Alexander-Universität Erlangen-Nürnberg, Nürnberg, Germany
| | - Cornel Christian Sieber
- Institute for Biomedicine of Aging, Friedrich-Alexander-Universität Erlangen-Nürnberg, Nürnberg, Germany
| | - Robert Kob
- Institute for Biomedicine of Aging, Friedrich-Alexander-Universität Erlangen-Nürnberg, Nürnberg, Germany
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28
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Wages NP, Simon JE, Clark LA, Amano S, Russ DW, Manini TM, Clark BC. Relative contribution of muscle strength, lean mass, and lower extremity motor function in explaining between-person variance in mobility in older adults. BMC Geriatr 2020; 20:255. [PMID: 32723298 PMCID: PMC7385889 DOI: 10.1186/s12877-020-01656-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Accepted: 07/15/2020] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Approximately 35% of individuals > 70 years have mobility limitations. Historically, it was posited lean mass and muscle strength were major contributors to mobility limitations, but recent findings indicate lean mass and muscle strength only moderately explain mobility limitations. One likely reason is that lean mass and muscle strength do not necessarily incorporate measures globally reflective of motor function (defined as the ability to learn, or to demonstrate, the skillful and efficient assumption, maintenance, modification, and control of voluntary postures and movement patterns). In this study we determined the relative contribution of lean mass, muscle strength, and the four square step test, as an index of lower extremity motor function, in explaining between-participant variance in mobility tasks. METHODS In community-dwelling older adults (N = 89; 67% women; mean 74.9 ± 6.7 years), we quantified grip and leg extension strength, total and regional lean mass, and time to complete the four square step test. Mobility was assessed via 6-min walk gait speed, stair climb power, 5x-chair rise time, and time to complete a complex functional task. Multifactorial linear regression modeling was used to determine the relative contribution (via semi-partial r2) for indices of lean mass, indices of muscle strength, and the four square step test. RESULTS When aggregated by sex, the four square step test explained 17-34% of the variance for all mobility tasks (p < 0.01). Muscle strength explained ~ 12% and ~ 7% of the variance in 6-min walk gait speed and 5x-chair rise time, respectively (p < 0.02). Lean mass explained 32% and ~ 4% of the variance in stair climb power and complex functional task time, respectively (p < 0.02). When disaggregated by sex, lean mass was a stronger predictor of mobility in men. CONCLUSION The four square step test is uniquely associated with multiple measures of mobility in older adults, suggesting lower extremity motor function is an important factor for mobility performance. TRIAL REGISTRATION NCT02505529 -2015/07/22.
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Affiliation(s)
- Nathan P Wages
- Ohio Musculoskeletal and Neurological Institute (OMNI), Ohio University, 250 Irvine Hall, 1, Athens, OH, 43147, USA
- Department of Biomedical Sciences, Ohio University, 250 Irvine Hall, Athens, OH, 43147, USA
| | - Janet E Simon
- Ohio Musculoskeletal and Neurological Institute (OMNI), Ohio University, 250 Irvine Hall, 1, Athens, OH, 43147, USA
- School of Applied Health Sciences and Wellness, Ohio University, Athens, OH, USA
| | - Leatha A Clark
- Ohio Musculoskeletal and Neurological Institute (OMNI), Ohio University, 250 Irvine Hall, 1, Athens, OH, 43147, USA
- Department of Biomedical Sciences, Ohio University, 250 Irvine Hall, Athens, OH, 43147, USA
- Department of Family Medicine, Ohio University, Athens, OH, USA
| | - Shinichi Amano
- Ohio Musculoskeletal and Neurological Institute (OMNI), Ohio University, 250 Irvine Hall, 1, Athens, OH, 43147, USA
- Xenoma Inc., Ota-Ku, Tokyo, Japan
| | - David W Russ
- University of South Florida Morsani College of Medicine, School of Physical Therapy & Rehabilitation Sciences, Tampa, FL, USA
| | - Todd M Manini
- Department of Aging and Geriatric Research, University of Florida, Gainesville, FL, USA
| | - Brian C Clark
- Ohio Musculoskeletal and Neurological Institute (OMNI), Ohio University, 250 Irvine Hall, 1, Athens, OH, 43147, USA.
- Department of Biomedical Sciences, Ohio University, 250 Irvine Hall, Athens, OH, 43147, USA.
- Division of Geriatric Medicine, Ohio University, 250 Irvine Hall, Athens, OH, 43147, USA.
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29
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Understanding Health Deterioration and the Dynamic Relationship between Physical Ability and Cognition among a Cohort of Danish Nonagenarians. J Aging Res 2020; 2020:4704305. [PMID: 32655951 PMCID: PMC7323846 DOI: 10.1155/2020/4704305] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Accepted: 04/15/2020] [Indexed: 11/18/2022] Open
Abstract
This study aims to determine how demographics, socioeconomic characteristics, and lifestyle affect physical and cognitive health transitions among nonagenarians, whether these transitions follow the same patterns, and how each dimension affects the transitions of the other. We applied a multistate model for panel data to 2262 individuals over a 2-year follow-up period from the 1905 Danish Cohort survey. Within two years from baseline, the transition probability from good to bad physical health-ability to stand up from a chair-was higher than dying directly (29% vs. 25%), while this was not observed for cognition (24% vs. 27%) evaluated with Mini-Mental State Examination-a score lower than 24 indicates poor cognitive health. Probability of dying either from bad physical or cognitive health condition was 50%. Health transitions were associated with sex, education, living alone, body mass index, and physical activity. Physical and cognitive indicators were associated with deterioration of cognitive and physical status, respectively, and with survivorship from a bad health condition. We conclude that physical and cognitive health deteriorated differently among nonagenarians, even if they were related to similar sociodemographic and lifestyle characteristics and resulted dynamically related with each other.
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Martin J, Barker K. The Hierarchical Assessment of Balance and Mobility (HABAM): a useful tool to estimate length of hospital stay following hip and knee replacement. INTERNATIONAL JOURNAL OF THERAPY AND REHABILITATION 2020. [DOI: 10.12968/ijtr.2019.0003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background/Aims The Hierarchical Assessment of Balance and Mobility is a measure of balance and mobility that can detect recovery of physical function, and can be used to identify patients at risk of delayed discharge. The aim of this study was to investigate the use of Hierarchical Assessment of Balance and Mobility scores as a predictor of length of hospital stay in patients following hip and knee replacement. Methods Hierarchical Assessment of Balance and Mobility scores were collected on 191 patients following primary total joint replacement. Regression and receiver operating characteristic curve analyses were conducted to assess the relationship between Hierarchical Assessment of Balance and Mobility and length of stay. Results Hierarchical Assessment of Balance and Mobility scores of <31 on the first post-operative day predicted longer than mean length of stay (4 days) with sensitivity and specificity of 79% and 83%. Receiver operating characteristic curve analyses showed that a Hierarchical Assessment of Balance and Mobility score of 50 was the optimal cut-off point for discharge. Conclusions Hierarchical Assessment of Balance and Mobility offers a practical way to quantify and objectively track patients' physical function, and can help identify patients at risk of an increased length of stay on post-operative day one.
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Affiliation(s)
- Jack Martin
- Physiotherapy Research Unit, Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Foundation Trust, Oxford
| | - Karen Barker
- Physiotherapy Research Unit, Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Foundation Trust, Oxford
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31
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Sezgin D, Liew A, O'Donovan MR, O'Caoimh R. Pre-frailty as a multi-dimensional construct: A systematic review of definitions in the scientific literature. Geriatr Nurs 2020; 41:139-146. [DOI: 10.1016/j.gerinurse.2019.08.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Revised: 08/08/2019] [Accepted: 08/12/2019] [Indexed: 12/12/2022]
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32
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Riwniak C, Simon JE, Wages NP, Clark LA, Manini TM, Russ DW, Clark BC. Comparison of a Multi-Component Physical Function Battery to Usual Walking Speed for Assessing Lower Extremity Function and Mobility Limitation in Older Adults. J Nutr Health Aging 2020; 24:906-913. [PMID: 33009544 PMCID: PMC9731178 DOI: 10.1007/s12603-020-1432-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OBJECTIVES To compare a composite measure of physical function that comprises locomotor and non-locomotor tests (i.e., the Mobility Battery Assessment (MBA)) with traditional measures of mobility (4-m usual gait speed (UGS), six-minute walk (6MW) gait speed, and short physical performance battery (SPPB) score) for assessing lower extremity function and discriminating community dwelling older adults with and without mobility limitations. DESIGN Cross-sectional, observational study. SETTING Laboratory-based. PARTICIPANTS 89 community-dwelling older adults (74.9±6.7). MEASUREMENTS Using principal component analysis we derived an MBA score for 89 community-dwelling older adults, and quantified 4-m UGS, 6MW gait speed, and SPPB score. The MBA score was based on five lab-based tests. We also quantified self-reported lower extremity function/mobility using the Neuro-QOL Lower Extremity Function-Mobility instrument. Based on this data a continuous score was derived and subjects were classified as "mobility limited" or "non-mobility limited". Correlations between the mobility measures and the Neuro-QOL score were calculated, and ROC curves were constructed to determine the AUC for the mobility measures ability to predict mobility limitations. RESULTS The MBA had the largest AUC (0.92) for discriminating mobility limitations and exhibited the strongest correlation (0.73) with the Neuro-QOL Lower Extremity Function-Mobility Scale. The worst performing predictors were the 4-meter UGS and stair climb power both with an AUC of 0.8 for discriminating mobility limitations, and a low correlation with Neuro-QOL Lower Extremity Function Scale of 0.39 and 0.46, respectively. CONCLUSION The MBA score moderately improves the magnitude of correlation and discrimination of mobility limitation in older adults than singular, standard tests of mobility.
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Affiliation(s)
- C Riwniak
- Brian C. Clark, Ph.D., Ohio Musculoskeletal and Neurological Institute, Ohio University, 250 Irvine Hall, Athens, OH 45701, 740-593-2354, ,
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Bone Mass and Strength and Fall-Related Fractures in Older Age. J Osteoporos 2019; 2019:5134690. [PMID: 31583071 PMCID: PMC6754934 DOI: 10.1155/2019/5134690] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Revised: 08/14/2019] [Accepted: 08/22/2019] [Indexed: 01/08/2023] Open
Abstract
INTRODUCTION Low bone mineral density is a risk factor for fractures. The aim of this follow-up study was to assess the association of various bone properties with fall-related fractures. MATERIALS AND METHODS 187 healthy women aged 55 to 83 years at baseline who were either physically active or inactive were followed for 20 years. They were divided into two groups by whether or not they sustained fall-related fractures: fracture group (F) and nonfracture group (NF). At baseline, several bone properties were measured with DXA and pQCT, and their physical performance was also assessed. RESULTS During the follow-up, 120 women had no fall-related fractures, while 67 (38%) sustained at least one fall with fracture. NF group had about 4 to 11% greater BMD at the femoral neck and distal radius; the mean differences (95% CI) were 4.5 (0.3 to 8.6) % and 11.1 (6.3 to 16.1) %, respectively. NF group also had stronger bone structure at the tibia, the mean difference in BMC at the distal tibia was 6.0 (2.2 to 9.7) %, and at the tibial shaft 3.6 (0.4 to 6.8) %. However, there was no mean difference in physical performance. CONCLUSIONS Low bone properties contribute to the risk of fracture if a person falls. Therefore, in the prevention of fragility fractures, it is essential to focus on improving bone mass, density, and strength during the lifetime. Reduction of falls by improving physical performance, balance, mobility, and muscle power is equally important.
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Volders E, Bolman CAW, de Groot RHM, Lechner L. The effect of Active Plus, a computer-tailored physical activity intervention, on cognitive functioning of elderly people with chronic illness(es) - study protocol for a randomized controlled trial. BMC Public Health 2019; 19:1197. [PMID: 31470829 PMCID: PMC6717346 DOI: 10.1186/s12889-019-7517-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Accepted: 08/19/2019] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Physical activity not only is beneficial to a person's health, but can also have a positive influence on cognitive functioning. However, elderly people with chronic illness(es) often do not meet the physical activity guidelines. Physical activity programs for the elderly exist, but these are often expensive and not easily accessible to the elderly with chronic illness(es). In addition, the beneficial effects of these physical activity programs on cognitive functioning have never been specifically tested in this target group. Hence, this randomized controlled trial aims to test whether Active Plus, a proven effective physical activity intervention, is able to improve the cognitive functioning of elderly people with chronic illness(es) or to slow down cognitive decline. In addition, it studies what kind of activity, intensity, duration and frequency of physical activity most strongly influence cognitive functioning. METHODS A randomized controlled trial is performed, comparing the Active Plus intervention group to a waiting list control group. In total 540 older adults (≥65 years) with at least one chronic illness that limits mobility are recruited from 7 municipalities. Comparable neighborhoods within a municipality are randomly allocated to the intervention or control group. Baseline and follow-up measurements after 6 and 12 months assess cognitive functioning and physical activity behavior, measured both objectively with an accelerometer and subjectively with a self-report questionnaire. Multilevel analyses are conducted to assess effects on cognitive functioning, including analyses on moderation effects for physical activity type, frequency, duration and intensity. DISCUSSION To our knowledge this is the first study to investigate effectiveness of a physical activity program on cognitive functioning in elderly people suffering from a broad range of chronic illnesses. If proven effective Active Plus would be a very cost effective intervention not only to increase physical activity, but also to improve cognitive functioning or slow down cognitive decline. Up till now clear evidence is lacking on the kind of physical activity, intensity, duration and frequency needed to achieve cognitive benefits. By measuring both with accelerometers and self-report questionnaires we hope to gain insight in these processes. TRIAL REGISTRATION Nederlands Trial Register NL6005 ; Date of Registration 21-03-2017.
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Affiliation(s)
- Esmee Volders
- Faculty of Psychology and Educational Sciences, Open University of the Netherlands, 6419 AT Heerlen, The Netherlands
| | - Catherine A. W. Bolman
- Faculty of Psychology and Educational Sciences, Open University of the Netherlands, 6419 AT Heerlen, The Netherlands
| | - Renate H. M. de Groot
- Welten Institute – Research Centre for Learning, Teaching and Technology, Open University of the Netherlands, 6419 AT Heerlen, The Netherlands
- Nutrition and Translational Research in Metabolism (School NUTRIM), Maastricht University, 6200 MD Maastricht, The Netherlands
| | - Lilian Lechner
- Faculty of Psychology and Educational Sciences, Open University of the Netherlands, 6419 AT Heerlen, The Netherlands
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Clark BC, Woods AJ, Clark LA, Criss CR, Shadmehr R, Grooms DR. The Aging Brain & the Dorsal Basal Ganglia: Implications for Age-Related Limitations of Mobility. ADVANCES IN GERIATRIC MEDICINE AND RESEARCH 2019; 1:e190008. [PMID: 31497780 PMCID: PMC6731027 DOI: 10.20900/agmr20190008] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
The capacity to move is essential for independence and declines with age. Limitations in mobility impact ~35% of adults over 70 and the majority of adults over 85. These limitations are highly associated with disability, dependency, and survival. More than 25-years ago the term "sarcopenia" was coined to highlight the age-related loss of muscle mass and strength with the assumption being that sarcopenia led to limitations in mobility. However, contrary to expectations, recent findings clearly indicate these variables only modestly explain limitations in mobility. One likely reason the current sarcopenia variables of muscle mass and strength do not discriminate, or predict, mobility limitations well is because they are heavily influenced by musculoskeletal mechanisms and do not incorporate measures reflective of the central neural control of mobility. Unfortunately, the precise central neural changes associated with aging that lead to decreased mobility are poorly understood. This knowledge gap has hampered the development of effective interventions for mobility limitations and the subsequent reduction of major functional disability for older adults. Here, we discuss the potential role of the motor control circuit of the dorsal basal ganglia as well as dopaminergic function in age-related reductions in mobility.
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Affiliation(s)
- Brian C. Clark
- Ohio Musculoskeletal and Neurological Institute (OMNI), Ohio University, Athens, OH 45701, USA
- Department of Biomedical Sciences, Ohio University, Athens, OH 45701, USA
- Division of Geriatric Medicine, Ohio University, Athens, OH 45701, USA
| | - Adam J. Woods
- Center for Cognitive Aging and Memory, Department of Clinical and Health Psychology, University of Florida, Gainesville, FL 32610, USA
| | - Leatha A. Clark
- Ohio Musculoskeletal and Neurological Institute (OMNI), Ohio University, Athens, OH 45701, USA
- Department of Biomedical Sciences, Ohio University, Athens, OH 45701, USA
| | - Cody R. Criss
- Ohio Musculoskeletal and Neurological Institute (OMNI), Ohio University, Athens, OH 45701, USA
- Heritage Fellow, Translational Biomedical Science Program, Ohio University, Athens, OH 45701, USA
| | - Reza Shadmehr
- Laboratory for Computational Motor Control, Department of Biomedical Engineering, Johns Hopkins School of Medicine, Baltimore, MA 21218, USA
| | - Dustin R. Grooms
- Ohio Musculoskeletal and Neurological Institute (OMNI), Ohio University, Athens, OH 45701, USA
- Division of Athletic Training, School of Applied Health Sciences and Wellness, College of Health Sciences and Professions, Ohio University, Athens, OH 45701, USA
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36
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Fancourt D, Steptoe A. Comparison of physical and social risk-reducing factors for the development of disability in older adults: a population-based cohort study. J Epidemiol Community Health 2019; 73:906-912. [PMID: 31243046 PMCID: PMC6817696 DOI: 10.1136/jech-2019-212372] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Revised: 06/05/2019] [Accepted: 06/12/2019] [Indexed: 12/25/2022]
Abstract
BACKGROUND Considerations of modifiable risk factors for the development of disability in older age have traditionally focused on physical activity. However, there is increasing evidence that psychological, social, and cognitive factors also help to maintain functional independence. This study compared the protective associations between physical and social activities and disability onset. METHODS We analysed data from 5434 adults aged 50+ years tracked biennially from 2004/2005 to 2016/2017, measuring self-reported difficulty in carrying out any basic activities of daily living (ADLs) or instrumental ADLs. Exposures included mild, moderate and vigorous physical activity, frequency of socialising with friends/family, cultural engagement (eg, going to the theatre/museums/concerts), and participation in community groups. RESULTS Over the 12-year follow-up, 1945 adults developed disability. Using Cox proportional hazards regression models adjusted for all identified demographic and health-related variables, vigorous exercise or activity once a month or more (HR 0.82, 95% CI 0.71 to 0.96), moderate exercise or activity more than once a week (HR 0.81, 95% CI 0.67 to 0.97) or cultural engagement once or twice a year or more (HR 0.84, 95% CI 0.73 to 0.97) were associated with a lower hazard of developing disability. Other exposures did not show independent protective associations. Results were robust to sensitivity analyses considering reverse causality and exploring the potential confounding role of time-invariant factors, such as socioeconomic status. CONCLUSION These results suggest the importance of either developing multimodal interventions to protect against disability and promote healthy ageing or promoting greater physical and social engagement with existing community activities among older adults.
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Affiliation(s)
- Daisy Fancourt
- Department of Behavioural Science and Health, University College London Research Department of Epidemiology and Public Health, London, UK
| | - Andrew Steptoe
- Department of Behavioural Science and Health, University College London Research Department of Epidemiology and Public Health, London, UK
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Prognostication during Critical Illness: Moving the Field Forward. Ann Am Thorac Soc 2019; 14:1510-1511. [PMID: 28961035 DOI: 10.1513/annalsats.201706-496ed] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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38
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Panza F, Lozupone M, Solfrizzi V, Sardone R, Dibello V, Di Lena L, D'Urso F, Stallone R, Petruzzi M, Giannelli G, Quaranta N, Bellomo A, Greco A, Daniele A, Seripa D, Logroscino G. Different Cognitive Frailty Models and Health- and Cognitive-related Outcomes in Older Age: From Epidemiology to Prevention. J Alzheimers Dis 2019; 62:993-1012. [PMID: 29562543 PMCID: PMC5870024 DOI: 10.3233/jad-170963] [Citation(s) in RCA: 194] [Impact Index Per Article: 38.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Frailty, a critical intermediate status of the aging process that is at increased risk for negative health-related events, includes physical, cognitive, and psychosocial domains or phenotypes. Cognitive frailty is a condition recently defined by operationalized criteria describing coexisting physical frailty and mild cognitive impairment (MCI), with two proposed subtypes: potentially reversible cognitive frailty (physical frailty/MCI) and reversible cognitive frailty (physical frailty/pre-MCI subjective cognitive decline). In the present article, we reviewed the framework for the definition, different models, and the current epidemiology of cognitive frailty, also describing neurobiological mechanisms, and exploring the possible prevention of the cognitive frailty progression. Several studies suggested a relevant heterogeneity with prevalence estimates ranging 1.0–22.0% (10.7–22.0% in clinical-based settings and 1.0–4.4% in population-based settings). Cross-sectional and longitudinal population-based studies showed that different cognitive frailty models may be associated with increased risk of functional disability, worsened quality of life, hospitalization, mortality, incidence of dementia, vascular dementia, and neurocognitive disorders. The operationalization of clinical constructs based on cognitive impairment related to physical causes (physical frailty, motor function decline, or other physical factors) appears to be interesting for dementia secondary prevention given the increased risk for progression to dementia of these clinical entities. Multidomain interventions have the potential to be effective in preventing cognitive frailty. In the near future, we need to establish more reliable clinical and research criteria, using different operational definitions for frailty and cognitive impairment, and useful clinical, biological, and imaging markers to implement intervention programs targeted to improve frailty, so preventing also late-life cognitive disorders.
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Affiliation(s)
- Francesco Panza
- Department of Medical Sciences, Geriatric Unit and Laboratory of Gerontology and Geriatrics, IRCCS "Casa Sollievo della Sofferenza", San Giovanni Rotondo, Foggia, Italy.,Department of Basic Medicine, Neurodegenerative Disease Unit, Neuroscience, and Sense Organs, University of Bari Aldo Moro, Bari, Italy.,Department of Clinical Research in Neurology, University of Bari Aldo Moro, "Pia Fondazione Cardinale G. Panico", Tricase, Lecce, Italy
| | - Madia Lozupone
- Department of Basic Medicine, Neurodegenerative Disease Unit, Neuroscience, and Sense Organs, University of Bari Aldo Moro, Bari, Italy
| | - Vincenzo Solfrizzi
- Geriatric Medicine-Memory Unit and Rare Disease Centre, University of Bari "Aldo Moro", Bari, Italy
| | - Rodolfo Sardone
- National Institute of Gastroenterology "Saverio de Bellis", Research Hospital, Castellana Grotte Bari, Italy
| | - Vittorio Dibello
- Interdisciplinary Department of Medicine (DIM), Section of Dentistry, University of Bari Aldo Moro, Bari, Italy
| | - Luca Di Lena
- National Institute of Gastroenterology "Saverio de Bellis", Research Hospital, Castellana Grotte Bari, Italy
| | - Francesca D'Urso
- Department of Clinical and Experimental Medicine, Psychiatric Unit, University of Foggia, Foggia, Italy
| | - Roberta Stallone
- Department of Basic Medicine, Neurodegenerative Disease Unit, Neuroscience, and Sense Organs, University of Bari Aldo Moro, Bari, Italy
| | - Massimo Petruzzi
- Interdisciplinary Department of Medicine (DIM), Section of Dentistry, University of Bari Aldo Moro, Bari, Italy
| | - Gianluigi Giannelli
- National Institute of Gastroenterology "Saverio de Bellis", Research Hospital, Castellana Grotte Bari, Italy
| | | | - Antonello Bellomo
- Department of Clinical and Experimental Medicine, Psychiatric Unit, University of Foggia, Foggia, Italy
| | - Antonio Greco
- Department of Medical Sciences, Geriatric Unit and Laboratory of Gerontology and Geriatrics, IRCCS "Casa Sollievo della Sofferenza", San Giovanni Rotondo, Foggia, Italy
| | - Antonio Daniele
- Institute of Neurology, Catholic University of Sacred Heart, Rome, Italy
| | - Davide Seripa
- Department of Medical Sciences, Geriatric Unit and Laboratory of Gerontology and Geriatrics, IRCCS "Casa Sollievo della Sofferenza", San Giovanni Rotondo, Foggia, Italy
| | - Giancarlo Logroscino
- Department of Basic Medicine, Neurodegenerative Disease Unit, Neuroscience, and Sense Organs, University of Bari Aldo Moro, Bari, Italy.,Department of Clinical Research in Neurology, University of Bari Aldo Moro, "Pia Fondazione Cardinale G. Panico", Tricase, Lecce, Italy
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39
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Roshanravan B, Patel KV. Assessment of physical functioning in the clinical care of the patient with advanced kidney disease. Semin Dial 2019; 32:351-360. [PMID: 31044471 DOI: 10.1111/sdi.12813] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Maintenance of independent living is the top health priority among patients with advanced chronic kidney disease (CKD). Mobility limitation is often the first sign of functional limitation leading to loss of independence. Regular assessments of physical capacity can help provide kidney health providers identify patients at risk of frailty and other adverse health-related outcomes that contribute to the loss of functional independence. These physical capacities can be measured with commonly used self-reported measures of physical function or by objective physical performance testing. The current review describes commonly used assessments of self-reported physical function and physical performance. First, we describe the disablement process and how these assessments can be performed with commonly used quality of life instruments measuring self-reported physical function or objective physical performance tests. Second, we identify the determinants and correlates of self-reported physical function and physical performance and their contribution to the frailty phenotype. Third, we describe the association of physical capacities with clinical outcomes. We conclude with on possible approach to identifying and intervening on persons with CKD at high risk of functional decline.
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Affiliation(s)
- Baback Roshanravan
- Department of Medicine, Division of Nephrology, University of California Davis, Davis, California
| | - Kushang V Patel
- Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, Washington
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40
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Chen H, Rejeski WJ, Gill TM, Guralnik J, King AC, Newman A, Blair SN, Conroy D, Liu C, Manini TM, Pahor M, Ambrosius WT, Miller ME. A Comparison of Self-report Indices of Major Mobility Disability to Failure on the 400-m Walk Test: The LIFE Study. J Gerontol A Biol Sci Med Sci 2019; 73:513-518. [PMID: 28958023 DOI: 10.1093/gerona/glx153] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2017] [Accepted: 08/05/2017] [Indexed: 11/14/2022] Open
Abstract
Background The objective assessment of major mobility disability (objective MMD) by a 400-m walk test (400 MWT) is important but not always practical. Previous research on the relationship between self-reported MMD (SR MMD) and objective MMD is sparse and limited to cross-sectional data. Methods We evaluated agreement between SR MMD and objective MMD using longitudinal data from the Lifestyle Interventions for Elders (LIFE) study. The SR MMD indices were defined based on having a lot of difficulty or inability to walk a quarter of a mile (SR-1/4MILE), walk several blocks (SR-BLOCKS), and climb one flight of stairs (SR-STAIRS). Results Using objective MMD as the gold standard, SR-1/4MILE and SR-BLOCKS had relatively low sensitivity (around 0.4) and high specificity (around 0.9) for prevalence. Their overall sensitivity and specificity for cumulative incident objective MMD were approximately 0.6 and 0.8, respectively. While the annual probability of staying MMD free was similar for objective MMD, SR-1/4MILE, and SR-BLOCKS (90% for all), the probability of recovering from SR MMD was higher (50%) than that of objective MMD (22%). The development of objective MMD (439 events), SR-1/4MILE (356 events), and SR-BLOCKS (379 events) had a similar trajectory over time with substantially overlapping survival curves. SR-STAIRS generally did not agree well with objective MMD. Incorporating SR-STAIRS with either SR-1/4MILE or SR-BLOCKS did not significantly improve the agreement between SR MMD and objective MMD. Conclusions Simple SR-1/4MILE and SR-BLOCKS are reasonable candidates to define MMD if the primary outcome of interest is incident MMD.
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Affiliation(s)
- Haiying Chen
- Department of Biostatistical Sciences, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - W Jack Rejeski
- Department of Health and Exercise Science, Wake Forest University, Winston-Salem, North Carolina
| | - Thomas M Gill
- Department of Internal Medicine/Geriatrics, Yale University, New Haven, Connecticut
| | - Jack Guralnik
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore
| | - Abby C King
- Health Research & Policy Department and Department of Medicine (Stanford Prevention Research Center), Stanford University School of Medicine, California
| | - Anne Newman
- Department of Epidemiology, University of Pittsburgh, Pennsylvania
| | - Steven N Blair
- Arnold School of Public Health, University of South Carolina, Columbia
| | - David Conroy
- Department of Preventive Medicine, Northwestern University, Chicago, Illinois
| | - Christine Liu
- Nutrition, Exercise Physiology, and Sarcopenia Laboratory, Jean Mayer Human Nutrition Research Center in Aging, Tufts University, Boston, Massachusetts.,Section of Geriatrics, Boston University School of Medicine, Massachusetts
| | - Todd M Manini
- Department of Aging and Geriatric Research, University of Florida, Gainesville
| | - Marco Pahor
- Department of Aging and Geriatric Research, University of Florida, Gainesville
| | - Walter T Ambrosius
- Department of Biostatistical Sciences, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Michael E Miller
- Department of Biostatistical Sciences, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina
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Melgaard D, Rodrigo-Domingo M, Mørch MM, Byrgesen SM. DEMMI Scores, Length of Stay, and 30-Day Readmission of Acute Geriatric Patients in Denmark: A Cross-Sectional Observational Study with Longitudinal Follow-Up. Geriatrics (Basel) 2019; 4:E8. [PMID: 31023976 PMCID: PMC6473830 DOI: 10.3390/geriatrics4010008] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Revised: 12/28/2018] [Accepted: 12/31/2018] [Indexed: 01/12/2023] Open
Abstract
The aims of this study are to describe the mobility of acute geriatric patients, the length of stay, and to characterise patients who were readmitted within 30 days based on the De Morton Mobility Index (DEMMI). A cross-sectional observational study with longitudinal follow-up was conducted in the period from 1 March 2016 to 31 August 2016. Inclusion criteria were acute geriatric patients hospitalised for a minimum of 24 h. Of the 418 patients hospitalised during the study period, 246 (59%) participated in this study (44% male, median age 83 years [70; 94]). For patients in an acute geriatric department, the median DEMMI score was 41 and the mean score was 39.95. Patients with a DEMMI score ≤40 show a significantly lower Barthel 100 index, lower 30 s. sit-to-stand scores and were significantly more likely to be bedridden or, amongst those not bedridden, to use a mobility aid. Lower DEMMI scores were associated with longer admissions. DEMMI seems to have the ability to predict discharge within one week. There was no significant association between a lower DEMMI score and higher risk for 30-day readmission. Further research is needed to determine whether the DEMMI is suitable for identifying the patient's need for further rehabilitation following the discharge.
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Affiliation(s)
- Dorte Melgaard
- Physio- and Occupational Therapy Department, North Denmark Regional Hospital, DK-9800 Hjørring, Denmark.
- Center for Clinical Research, North Denmark Regional Hospital, DK-9800 Hjørring, Denmark.
| | - Maria Rodrigo-Domingo
- Unit of Epidemiology and Biostatistics, Aalborg University Hospital, DK-9000 Aalborg, Denmark.
- Aalborg University Hospital, Psychiatry, DK-9000 Aalborg, Denmark.
| | - Marianne M Mørch
- Geriatric Department, North Denmark Regional Hospital, DK-9800 Hjørring, Denmark.
| | - Stephanie M Byrgesen
- Physio- and Occupational Therapy Department, North Denmark Regional Hospital, DK-9800 Hjørring, Denmark.
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van Deurzen I, Vanhoutte B. A Longitudinal Study of Allostatic Load in Later Life: The Role of Sex, Birth Cohorts, and Risk Accumulation. Res Aging 2018; 41:419-442. [DOI: 10.1177/0164027518813839] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Are challenging life courses associated with more wear and tear on the biological level? This study investigates this question from a life-course perspective by examining the influence of life-course risk accumulation on allostatic load (AL), considering the role of sex and birth cohorts. Using biomarker data collected over three waves (2004, 2008, and 2012) of the English Longitudinal Study of Ageing ( N = 3,824) in a growth curve framework, AL trajectories over a period of 8 years are investigated. Our results illustrate that AL increases substantially in later life. Men have higher AL than women, but increases are similar for both sexes. Older cohorts have both higher levels and a steeper increase of AL over time. Higher risk accumulation over the life course goes hand in hand with higher AL levels and steeper trajectories, contributing to the body of evidence on cumulative (dis)advantage processes in later life.
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Affiliation(s)
| | - Bram Vanhoutte
- Sociology, University of Manchester, Manchester, United Kingdom
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43
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Hara M, Kitamura T, Murakawa Y, Shimba K, Yamaguchi S, Tamaki M. Safety and Feasibility of Dual-task Rehabilitation Program for Body Trunk Balance Using Virtual Reality and Three-dimensional Tracking Technologies. Prog Rehabil Med 2018; 3:20180016. [PMID: 32789241 DOI: 10.2490/prm.20180016] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Accepted: 10/15/2018] [Indexed: 01/27/2023] Open
Abstract
Objective The ability to walk is one of the most important basic functional activities of daily living, and the number of patients with walking disability who need rehabilitation is increasing worldwide. The purpose of this first-in-man study was to evaluate the safety and feasibility of an off-label, tailor-made, dual-task rehabilitation program for body trunk balance using the mediVR01 system (mediVR, Inc. Osaka, Japan), which incorporates virtual reality (VR) and three-dimensional tracking technologies. Methods We prospectively enrolled 31 healthy volunteers to take part in the trial (Trial Registration UMIN000029659). After an assessment of body trunk balance, a tailor-made, dual-task, rehabilitation training program lasting 10-15 min was provided. The primary endpoint was the postprocedural number of simulator sickness questionnaire (SSQ) symptoms. The secondary endpoints were adverse events and satisfaction with the program. Results The median age of participants was 68 years, with 67.7% being elderly (>65 years) and 54.8% being male. The number of SSQ symptoms immediately after the rehabilitation programs significantly increased from 0 (interquartile range 0-0) to 0 (0-1.5) (P=0.009), with a significant difference between the young and elderly participants (P-interaction<0.001). The most frequent symptom was sweating (22.6%), followed by fatigue (19.4%). All participants successfully completed the rehabilitation programs without significant adverse events such as fall or injuries. Moreover, all participants considered the VR rehabilitation programs to be enjoyable, and 93.5% of participants reported a sense of achievement. Group attendance was associated with higher levels of satisfaction (P=0.049). Conclusion The tailor-made, dual-task rehabilitation training programs for body trunk balance using VR and three-dimensional tracking technologies were safe and feasible even for elderly participants.
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Affiliation(s)
- Masahiko Hara
- Center for Community-based Healthcare Research and Education, Shimane University, Izumo, Japan.,Department of Medical Device Development, mediVR, Inc., Osaka, Japan
| | - Tetsuhisa Kitamura
- Division of Environmental Medicine and Population Sciences, Department of Social and Environmental Medicine, Osaka University Graduate School of Medicine, Suita, Japan
| | - Yuichiro Murakawa
- Division of Stroke Rehabilitation, National Cerebral and Cardiovascular Center Hospital, Suita, Japan
| | - Kyosuke Shimba
- Department of Medical Device Development, mediVR, Inc., Osaka, Japan
| | - Shimpei Yamaguchi
- Department of Medical Device Development, mediVR, Inc., Osaka, Japan
| | - Masatake Tamaki
- Department of Medical Device Development, mediVR, Inc., Osaka, Japan
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Latham K. "Taking a Turn for the Better": Does Self-reported Recovery From Walking Limitation Improve Disability and Mortality Outcomes? J Gerontol B Psychol Sci Soc Sci 2018; 73:1278-1291. [PMID: 27577051 DOI: 10.1093/geronb/gbw113] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2016] [Accepted: 08/10/2016] [Indexed: 11/12/2022] Open
Abstract
Objectives Recovery from self-reported walking limitation may be a turning point in an individual's health trajectory and may lead to better physical and mental health in the future. This research examines whether recovery from walking limitation is associated with onset of mobility disability, activities of daily living (ADLs) disability, or mortality among a national sample of older Americans. Data and Methods Using Waves 4 through 11 (1998-2012) of the Health and Retirement Study (HRS), discrete-time event history models (N = 12,579 person-intervals) with multiple competing events were estimated using multinomial logistic regression. The risk group was defined as respondents with walking limitation, but free of disability. A lagged measure of recovery was created using 2 adjacent waves, and disability and mortality outcomes were assessed in the subsequent wave (i.e., 2 years later). Results Recovery from walking limitation (i.e., difficulty walking one or several blocks) was associated with lower odds of mobility disability (i.e., difficulty walking across the room) onset, ADL with mobility disability onset, ADL without mobility disability onset, and mortality. Recovery from walking limitation was not only predictive of mobility-related outcomes, but also nonmobility-related ADLs and mortality-suggesting that the predictive capacity of recovery extends to multiple physical health outcomes. Discussion This research suggests that self-reported recovery from walking limitation may be a turning point in the disabling process and signals a meaningful change in an older adult's functional health trajectory.
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Affiliation(s)
- Kenzie Latham
- Department of Sociology, Indiana University-Purdue University Indianapolis
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Kruse C, Goemaere S, De Buyser S, Lapauw B, Eiken P, Vestergaard P. Predicting mortality and incident immobility in older Belgian men by characteristics related to sarcopenia and frailty. Osteoporos Int 2018; 29:1437-1445. [PMID: 29569152 DOI: 10.1007/s00198-018-4467-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2017] [Accepted: 02/25/2018] [Indexed: 11/24/2022]
Abstract
UNLABELLED There is an increasing awareness of sarcopenia in older people. We applied machine learning principles to predict mortality and incident immobility in older Belgian men through sarcopenia and frailty characteristics. Mortality could be predicted with good accuracy. Serum 25-hydroxyvitamin D and bone mineral density scores were the most important predictors. INTRODUCTION Machine learning principles were used to predict 5-year mortality and 3-year incident severe immobility in a population of older men by frailty and sarcopenia characteristics. METHODS Using prospective data from 1997 on 264 older Belgian men (n = 152 predictors), 29 statistical models were developed and tuned on 75% of data points then validated on the remaining 25%. The model with the highest test area under the curve (AUC) was chosen as the best. From these, ranked predictor importance was extracted. RESULTS Five-year mortality could be predicted with good accuracy (test AUC of .85 [.73; .97], sensitivity 78%, specificity 89% at a probability cut-off of 22.3%) using a Bayesian generalized linear model. Three-year incident severe immobility could be predicted with fair accuracy (test AUC .74 [.57; .91], sensitivity 67%, specificity 78% at a probability cut-off of 14.2%) using a multivariate adaptive regression splines model. Serum 25-hydroxyvitamin D levels and hip bone mineral density scores were the most important predictors of mortality, while biochemical androgen markers and Short-Form 36 Physical Domain questions were the most important predictors of immobility. Sarcopenia assessed by lean mass estimates was relevant to mortality prediction but not immobility prediction. CONCLUSIONS Using advanced statistical models and a machine learning approach 5-year mortality can be predicted with good accuracy using a Bayesian generalized linear model and 3-year incident severe immobility with fair accuracy using a multivariate adaptive regression splines model.
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Affiliation(s)
- C Kruse
- Steno Diabetes Center North Jutland (SDCN), Aalborg, Denmark.
- Department of Clinical Medicine, Aalborg University Hospital, Aalborg, Denmark.
- Department of Endocrinology, Aalborg University Hospital, Hobrovej 19, 9100, Aalborg, Denmark.
| | - S Goemaere
- Unit for Osteoporosis and Metabolic Bone Diseases, Department of Endocrinology, Ghent University Hospital, Ghent, Belgium
| | - S De Buyser
- Department of Geriatrics, Ghent University Hospital, Ghent, Belgium
| | - B Lapauw
- Unit for Osteoporosis and Metabolic Bone Diseases, Department of Endocrinology, Ghent University Hospital, Ghent, Belgium
| | - P Eiken
- Department of Cardiology, Nephrology, and Endocrinology, Nordsjaellands Hospital, Hilleroed, Denmark
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - P Vestergaard
- Steno Diabetes Center North Jutland (SDCN), Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University Hospital, Aalborg, Denmark
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Auais M, Morin SN, Finch L, Ahmed S, Mayo N. Toward a Meaningful Definition of Recovery After Hip Fracture: Comparing Two Definitions for Community-Dwelling Older Adults. Arch Phys Med Rehabil 2018; 99:1108-1115. [DOI: 10.1016/j.apmr.2018.01.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Revised: 12/30/2017] [Accepted: 01/15/2018] [Indexed: 01/09/2023]
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Yau K, Farragher JF, Kim SJ, Famure O, Jassal SV. A Longitudinal Study Examining the Change in Functional Independence Over Time in Elderly Individuals With a Functioning Kidney Transplant. Can J Kidney Health Dis 2018; 5:2054358118775099. [PMID: 29899998 PMCID: PMC5985553 DOI: 10.1177/2054358118775099] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2017] [Accepted: 02/02/2018] [Indexed: 12/17/2022] Open
Abstract
Background: Functional disability is defined as the need for assistance with self-care
tasks. Objective: To document changes in functional status over time among older prevalent
renal transplant recipients. Design: Single center, prospective, follow-up study. Setting: Single center, tertiary care transplant center. Patients: Patients, with a functioning kidney transplant, aged 65 years or older who
underwent assessment of functional status approximately 12 months
previously. Measurements: Validated tools used included Barthel Index, the Lawton-Brody Scale of
Instrumental Activities of Daily Living, the Timed Up and Go test, the
Veterans Specific Activity Questionnaire, the Mini-Cog, and dynamometer
handgrip strength. Methods: Outpatient assessment by a trained observer. Results: Of the 82 patients previously studied, 64 (78%) patients participated in the
follow-up study (mean age 70.5 ± 4.4 years, 58% male, 55% diabetic). Among
those completing functional status measures, 32 (50%) had functional
disability at baseline. Over the 1-year period, 11 (17%) of these patients
experienced progressive functional decline, 6 (9%) exhibited no change, and
15 (23%) had functional recovery. Eleven patients (17%) initially
independent, developed new-onset disability. One of the strongest predictors
of progressive functional decline was having 1 or more falls in the previous
year. Limitations: Assessments were performed only on 2 occasions separated by approximately 1
year. Conclusions: Fluctuations in disability states are common among older adults living with
renal transplants. Episodes of functional disability may place individuals
at higher risk of persistent and/or progressive disability.
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Affiliation(s)
- Kevin Yau
- Division of Nephrology, University Health Network, Toronto, Ontario, Canada
| | - Janine F Farragher
- Division of Nephrology, University Health Network, Toronto, Ontario, Canada
| | - S Joseph Kim
- Division of Nephrology, University Health Network, Toronto, Ontario, Canada
| | - Olusegun Famure
- Division of Nephrology, University Health Network, Toronto, Ontario, Canada
| | - Sarbjit V Jassal
- Division of Nephrology, University Health Network, Toronto, Ontario, Canada
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Montero-Odasso M, Speechley M, Muir-Hunter SW, Sarquis-Adamson Y, Sposato LA, Hachinski V, Borrie M, Wells J, Black A, Sejdić E, Bherer L, Chertkow H. Motor and Cognitive Trajectories Before Dementia: Results from Gait and Brain Study. J Am Geriatr Soc 2018; 66:1676-1683. [DOI: 10.1111/jgs.15341] [Citation(s) in RCA: 61] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Manuel Montero-Odasso
- Gait and Brain Lab, Parkwood Institute; Lawson Health Research Institute; London Ontario Canada
- Division of Geriatric Medicine, Department of Medicine, Schulich School of Medicine and Dentistry; University of Western Ontario; London Ontario Canada
- Department of Epidemiology and Biostatistics; University of Western Ontario; London Ontario Canada
| | - Mark Speechley
- Gait and Brain Lab, Parkwood Institute; Lawson Health Research Institute; London Ontario Canada
- Department of Epidemiology and Biostatistics; University of Western Ontario; London Ontario Canada
| | - Susan W. Muir-Hunter
- Gait and Brain Lab, Parkwood Institute; Lawson Health Research Institute; London Ontario Canada
- Division of Geriatric Medicine, Department of Medicine, Schulich School of Medicine and Dentistry; University of Western Ontario; London Ontario Canada
| | - Yanina Sarquis-Adamson
- Gait and Brain Lab, Parkwood Institute; Lawson Health Research Institute; London Ontario Canada
| | - Luciano A. Sposato
- Department of Epidemiology and Biostatistics; University of Western Ontario; London Ontario Canada
- Department of Clinical Neurological Sciences; University of Western Ontario; London Ontario Canada
- Department of Anatomy and Cell Biology; University of Western Ontario; London Ontario Canada
- Stroke, Dementia and Heart Disease Laboratory; University of Western Ontario; London Ontario Canada
| | - Vladimir Hachinski
- Department of Clinical Neurological Sciences; University of Western Ontario; London Ontario Canada
| | - Michael Borrie
- Division of Geriatric Medicine, Department of Medicine, Schulich School of Medicine and Dentistry; University of Western Ontario; London Ontario Canada
| | - Jennie Wells
- Division of Geriatric Medicine, Department of Medicine, Schulich School of Medicine and Dentistry; University of Western Ontario; London Ontario Canada
| | - Alanna Black
- Gait and Brain Lab, Parkwood Institute; Lawson Health Research Institute; London Ontario Canada
| | - Ervin Sejdić
- Department of Electrical and Computer Engineering; University of Pittsburgh; Pittsburgh Pennsylvania
| | - Louis Bherer
- Department of Medicine; Université de Montréal and Montreal Heart Institute; Montreal Quebec Canada
| | - Howard Chertkow
- Jewish General Hospital Memory Clinic; McGill University; Montreal Quebec Canada
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Pothier K, de Souto Barreto P, Maltais M, Rolland Y, Vellas B. Shifting from Declines to Improvements: Associations between a Meaningful Walking Speed Change and Cognitive Evolution over Three Years in Older Adults. J Nutr Health Aging 2018; 22:1183-1188. [PMID: 30498824 DOI: 10.1007/s12603-018-1059-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Although the close relationship between mobility and cognitive declines is well-known, literature has very little questioned whether improvement in walking speed over time could be associated with improvements in cognitive functions. The objective of this study was to examine the associations between a clinically meaningful improvement in walking speed and global and specific cognitive changes in older adults. DESIGN Prospective cohort study. SETTING Multidomain Alzheimer Preventive Trial (MAPT) study. PARTICIPANTS Three-hundred participants from the control group of the MAPT study (mean age 74.8 ± 4.2; 57% women). MEASUREMENTS The 4-m usual walking speed, global cognition, memory, executive functions, and processing speed measures were collected at baseline, and at 6, 12, 24 and 36 months. Participants were categorized into three groups according to their walking speed change over the three-year study: 1/ Non-Improvers (participants not presenting an increase ≥0.05m/sec on walking speed; n=138); 2/ Improvers (increase ≥0.05m/sec; n=40); Cyclic (≥0.05m/sec improvement at some time points without maintaining it through the whole period; n=122). RESULTS Adjusted mixed-effect linear regressions revealed that walking speed improvers did not significantly differ from participants who never or temporarily improved their walking speed on all of global and specific cognitive functions over three years. Nevertheless, a sensitivity analysis (excluding participants with a non-clinical walking speed improvement) indicated specific cognitive trajectories per group associated with better episodic memory scores for Improvers compared to non-improvers (β=2.41, 95% CI=.12 - 4.71; p=.039). CONCLUSION This study found that the overtime trajectories of cognitive functions did not differ as a function of clinically meaningful walking speed changes in older adults. Nevertheless, secondary analyses provided new insights on the relationship between walking speed and specific cognitive functions. The novelty of this approach (switching from declines to improvements) should be considered in future large-scale, observational longitudinal studies.
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Affiliation(s)
- K Pothier
- Kristell Pothier, PhD, Institut du Vieillissement, 37 allée Jules Guesde, 31000 Toulouse, France. Email address: , Phone number: +33 5 61 14 56 57
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50
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Duchowny KA, Clarke PJ, Peterson MD. Muscle Weakness and Physical Disability in Older Americans: Longitudinal Findings from the U.S. Health and Retirement Study. J Nutr Health Aging 2018; 22:501-507. [PMID: 29582889 PMCID: PMC6472265 DOI: 10.1007/s12603-017-0951-y] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
IMPORTANCE Muscle weakness is an important indicator of disability, chronic disease and mortality. While we recently proposed sex/race specific grip strength cutpoints for clinical muscle weakness in a diverse, nationally representative sample of older Americans, the extent to which these cutpoints predict physical disability remains unknown. OBJECTIVE To examine whether sex/race specific muscle weakness cutpoints predict physical disability status in a nationally representative sample of Americans age 65+. DESIGN We used data from the 2006-2010 Health and Retirement Study. Fully-adjusted, weighted multinomial logistic regression models were used to quantify the odds of experiencing the onset, progression or persistence of disability in activities of daily living (ADL) among weak versus non-weak individuals over a 2-year period. SETTING General community, nationally representative sample of older Americans. PARTICIPANTS Population-based, community dwelling sample of older American adults aged 65-years+; 57 percent were women, 91% were White and the mean age was 75 years. Main Outcome(s) and Measure(s): The primary outcome of interest was disability dynamics, defined by changes in ADL status across at 2- year period. The primary exposure was clinical muscle weakness as defined by previously identified cutpoints. Hypotheses were formulated before analyses were conducted. RESULTS In this nationally representative sample (n= 8,725), 44% of individuals were classified as weak at baseline. At follow-up, 55% remained independent with no change in their ADL status, 11% had an onset of disability and 4% progressed in their disability status. The odds of experiencing an onset of ADL disability was 54% higher among weak individuals compared those who were not weak at baseline (OR= 1.54, 95% CI= 1.54, 1.5, p<.0001); the odds of experiencing a progression in physical disability status was 2.16 times higher among those who were weak at baseline compared to non-weak individuals (OR= 2.16, 95% CI= 2.15, 2.16, p<.0001). CONCLUSIONS This is the first study to use grip strength weakness cut-points to identify those who may be at greatest risk for experiencing physical disability in later life. Results underscore the importance of using population-specific cutpoints for clinical weakness in order to identify individuals at greatest risk for adverse health outcomes.
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Affiliation(s)
- K A Duchowny
- Kate Duchowny, MPH, University of Michigan School of Public Health, Department of Epidemiology, Center for Social Epidemiology and Population health, 1415 Washington Heights, 3rd Flower Tower, Ann Arbor, Michigan 48109, Phone: (734) 615-9209,
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