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Timsina SR, Tanomkiat W, Geater SL, Ina N. Exploring previously used thresholds for computed tomography-defined low skeletal muscle mass in predicting functional limitations among lung cancer patients. Thorac Cancer 2024; 15:1287-1295. [PMID: 38666456 PMCID: PMC11147667 DOI: 10.1111/1759-7714.15313] [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: 03/17/2024] [Revised: 04/08/2024] [Accepted: 04/10/2024] [Indexed: 06/05/2024] Open
Abstract
BACKGROUND Various cutoffs have been used to diagnose computed tomography (CT)-defined low skeletal muscle mass; however, the impact of this variability on predicting physical functional limitations (PFL) remains unclear. In the present study we aimed to evaluate the diagnostic test metrics for predicting PFLs using a fixed cutoff value from previous reports and sought to create a prediction score that incorporated the skeletal muscle index (SMI) and other clinical factors. METHODS In this cross-sectional study including 237 patients with lung cancer, the SMI was assessed using CT-determined skeletal muscle area at the third lumbar vertebra. Physical function was assessed using the short physical performance battery (SPPB) test, with PFL defined as an SPPB score ≤9. We analyzed the diagnostic metrics of the five previous cutoffs for CT-defined low skeletal muscle mass in predicting PFL. RESULTS The mean age of participants was 66.0 ± 10.4 years. Out of 237 patients, 158 (66.7%) had PFLs. A significant difference was observed in SMI between individuals with and without PFLs (35.7 cm2/m2 ± 7.8 vs. 39.5 cm2/m2 ± 8.4, p < 0.001). Diagnostic metrics of previous cutoffs in predicting PFL showed suboptimal sensitivity (63.29%-91.77%), specificity (11.39%-50.63%), and area under the receiver operating characteristic curve (AUC) values (0.516-0.592). Age and the SMI were significant predictors of PFL; therefore, a score for predicting PFL (age - SMI + 21) was constructed, which achieved an AUC value of 0.748. CONCLUSION Fixed cutoffs for CT-defined low skeletal muscle mass may inadequately predict PFLs, potentially overlooking declining physical functions in patients with lung cancer.
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Affiliation(s)
- Shiva Raj Timsina
- Department of Radiology, Faculty of MedicinePrince of Songkla UniversitySongklaThailand
| | - Wiwatana Tanomkiat
- Department of Radiology, Faculty of MedicinePrince of Songkla UniversitySongklaThailand
| | - Sarayut L. Geater
- Unit of Respiratory and Respiratory Critical Care Medicine, Department of Medicine, Faculty of MedicinePrince of Songkla UniversitySongklaThailand
| | - Natee Ina
- Department of Radiology, Faculty of MedicinePrince of Songkla UniversitySongklaThailand
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Mavronasou A, Asimakos A, Vasilopoulos A, Katsaounou P, Kortianou EA. Remote administration of the short physical performance battery, the 1-minute sit to stand, and the Chester step test in post-COVID-19 patients after hospitalization: establishing inter-reliability and agreement with the face-to-face assessment. Disabil Rehabil 2023:1-11. [PMID: 38156771 DOI: 10.1080/09638288.2023.2297928] [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: 01/23/2023] [Accepted: 12/16/2023] [Indexed: 01/03/2024]
Abstract
PURPOSE To assess the inter-reliability of the Short Physical Performance Battery (SPPB), the 1-min Sit to Stand test (1-MSTS), and the Chester Step Test (CST) via remote assessment in post-COVID-19 patients after hospitalization. METHODS Twenty-five post-COVID-19 patients randomly performed the functional tests via remote assessment using a software platform at home and via face-to-face assessment at the rehabilitation center 24-72 h apart. One day before the remote assessment, all participants had a 1-h guidance session regarding the platform use, safety instructions, and home equipment preparation. RESULTS Participants completed all tests for both assessment procedures without experience of adverse events. The mean age was 53 (SD = 10) years old, and the median days of hospitalization were 23 (IQR = 10-33). The inter-reliability was moderate for the total score in the SPPB: Cohen's kappa = 0.545 (95% CI: 0.234 to 0.838), excellent for the number of repetitions in the 1-MSTS: ICC = 0.977 (95% CI: 0.948 to 0.990) and good for the total number of steps in the CST: ICC = 0.871 (95% CI: 0.698 to 0.944). CONCLUSION Remote functional assessments for SPPB, 1-MSTS, and CST indicated moderate to excellent inter-reliability in post-COVID-19 patients after hospitalization.
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Affiliation(s)
- Aspasia Mavronasou
- Clinical Exercise Physiology & Rehabilitation Research Laboratory, Physiotherapy Department, School of Health Sciences, University of Thessaly, Volos, Greece
| | - Andreas Asimakos
- First Department of Critical Care Medicine and Pulmonary Services, Evangelismos Hospital, Athens, Greece
| | - Aristeidis Vasilopoulos
- Health Assessment and Quality of Life Research Laboratory, Physiotherapy Department, School of Health Sciences, University of Thessaly, Volos, Greece
| | - Paraskevi Katsaounou
- Pulmonary & Respiratory Failure Department, First ICU, Evangelismos Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Eleni A Kortianou
- Clinical Exercise Physiology & Rehabilitation Research Laboratory, Physiotherapy Department, School of Health Sciences, University of Thessaly, Volos, Greece
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Park WT, Shon OJ, Kim GB. Multidisciplinary approach to sarcopenia: a narrative review. JOURNAL OF YEUNGNAM MEDICAL SCIENCE 2023; 40:352-363. [PMID: 37674374 PMCID: PMC10626311 DOI: 10.12701/jyms.2023.00724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Revised: 08/03/2023] [Accepted: 08/10/2023] [Indexed: 09/08/2023]
Abstract
Sarcopenia is a condition in which muscle mass and strength are decreased and muscle function is impaired. It is an indicator of frailty and loss of independence in older adults. It is also associated with increased physical disability, which increases the risk of falls. As a multifactorial disease, sarcopenia is caused by a combination of factors including aging, hormonal changes, nutritional deficiencies, and physical inactivity. Understanding the underlying pathophysiology of sarcopenia and identifying its different causes is critical to developing effective prevention and treatment strategies. This review summarizes the pathophysiology, consequences, diagnostic methods, and multidisciplinary approaches to sarcopenia.
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Affiliation(s)
- Wook Tae Park
- Department of Orthopedic Surgery, Yeungnam University College of Medicine, Daegu, Korea
| | - Oog-Jin Shon
- Department of Orthopedic Surgery, Yeungnam University College of Medicine, Daegu, Korea
| | - Gi Beom Kim
- Department of Orthopedic Surgery, Yeungnam University College of Medicine, Daegu, Korea
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Moran R. Patient-stimulated fall prevention screening in primary care: analysis of provider coding changes. BMC PRIMARY CARE 2023; 24:186. [PMID: 37710193 PMCID: PMC10503052 DOI: 10.1186/s12875-023-02154-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 09/06/2023] [Indexed: 09/16/2023]
Abstract
BACKGROUND The Centers for Disease Control and Prevention (CDC) has developed an evidenced based clinical screening tool, Stopping Elderly Accidents, Deaths & Injuries (STEADI) but penetration into routine clinical practice has been slow. To increase screening for falls and fall risk in an internal medicine primary care practice, a patient-centered screening program was integrated into a busy academic clinic. METHODS Over a three month period, Patients were invited to self-screen via a large poster in the waiting room, and complete a STEADI Staying Independent questionnaire, and discuss findings with their healthcare provider. Fall Prevention Booklets were made readily available in clinic exam rooms. Questionnaires and fall prevention booklets, were uniquely numbered, and Epic Slicer-Dicer reports were utilized to evaluate falls screening-related ICD-10 codes determined a priori. Generalized linear modeling calculated difference-in-difference compared with other clinics without this program for rates of coding for fall-related diagnosis codes. RESULTS In three months, 255 questionnaires were taken; only 5 (2%) were returned for later review. 110 booklets were disseminated from clinic exam rooms. The absolute difference-in-difference in ICD-10 coding was 0.7% compared to other clinics in the same practice, and year before. Generalized linear modeling showed a 4.7% increased impact in screening-related ICD-10 codes, which was statistically significant (P = < .0001) without reported disruption to clinical workflows. CONCLUSION There are indicators that patient-centered selective screening at a busy academic practice may have resulted in an increase in falls-related ICD-10 coding. Clinical integration of this program was well received.
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Affiliation(s)
- Ryan Moran
- San Diego Department of Medicine, Department of Family Medicine, University of California, 8899 University Center Lane, St 4000, La Jolla, CA, 92037, USA.
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5
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van der Putten GJ, de Baat C. An Overview of Systemic Health Factors Related to Rapid Oral Health Deterioration among Older People. J Clin Med 2023; 12:4306. [PMID: 37445340 DOI: 10.3390/jcm12134306] [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: 04/24/2023] [Revised: 06/12/2023] [Accepted: 06/19/2023] [Indexed: 07/15/2023] Open
Abstract
The oral health of older individuals can be negatively impacted by various systemic health factors, leading to rapid oral health deterioration. This paper aims to present an overview of the published evidence on systemic health factors that contribute to rapid oral health deterioration in older individuals, and to explore the implications of these factors for both general healthcare and oral healthcare provision. Older people are at risk of experiencing adverse reactions to medications due to multimorbidity, polypharmacy, and changes in pharmacokinetics and pharmacodynamics. Hyposalivation, a significant side effect of some medications, can be induced by both the type and number of medications used. Frailty, disability, sarcopenia, care dependency, and limited access to professional oral healthcare can also compromise the oral health of older people. To prevent rapid oral health deterioration, a comprehensive approach is required that involves effective communication between oral healthcare providers, other healthcare providers, and informal caregivers. Oral healthcare providers have a responsibility to advocate for the importance of maintaining adequate oral health and to raise awareness of the serious consequences of weakened oral health. By doing so, we can prevent weakened oral health from becoming a geriatric syndrome.
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Affiliation(s)
- Gert-Jan van der Putten
- Orpea Dagelijks Leven, 7327 AA Apeldoorn, The Netherlands
- Department of Dentistry, Radboud University Nijmegen Medical Centre, 6525 GA Nijmegen, The Netherlands
| | - Cees de Baat
- Fresh Unieke Mondzorg, 2411 NT Bodegraven, The Netherlands
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6
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Liao H, Li S, Han D, Zhang M, Zhao J, Wu Y, Ma Y, Yan C, Wang J. Associations between social support and poverty among older adults. BMC Geriatr 2023; 23:384. [PMID: 37353734 PMCID: PMC10288788 DOI: 10.1186/s12877-023-04079-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Accepted: 05/30/2023] [Indexed: 06/25/2023] Open
Abstract
BACKGROUND With population aging becoming a pressing global concern, social support is more meaningful for older adults. In particular, financial supports, such as health insurance and financial assistance derived from family, all play great role in assistance affairs. Research shows social support possibly has an impact on poverty, but the association between formal and informal supports is unclear. We are aimed at verifying the association between distinct social supports and exploring whether this association would affect poverty alleviation for older adults. METHODS A total of 2,683 individuals aged 60 years or older who have medical expenses were included in a survey conducted by the China Health and Retirement Longitudinal Study in 2018. A chi-square analysis and an independent samples T test all were used to explore the differences of social supports among old people with different economic condition. A binary logistic regression was aimed at analyzing the association between social supports and poverty for older adults. The structural equation model was established to evaluate the association between formal support and informal support and the mechanism(s) of social supports affecting poverty. RESULTS The overall average rate of reimbursement for outpatient care was 0.20 with standard deviation 0.22, and the average reimbursement rate of inpatient care for the poor older adults is nearly 5% lower than the average of the non-poor older adults. We found that having private health insurance and higher reimbursement rate of inpatient care were associated with lower likelihood of living in poverty for older adults. Formal support would directly affect poverty, but its impact on poverty through informal support is insignificant even if formal support is negatively associated with informal support. CONCLUSION A dilemma in reducing the economic burden of disease and receiving family assistance for older adults was revealed, and a more complete health security and higher level of medical expenses compensation would be beneficial to prevent poverty. Optimizing the primary healthcare and increasing the percentage of insurance compensation, policies that focus on the specific cultural values and strengthening the role of supplementary insurance are advantaged for alleviating poverty among older adults.
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Affiliation(s)
- Hui Liao
- Department of Health Management, School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei China
| | - Sangsang Li
- Department of Health Management, School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei China
| | - Dan Han
- Department of Health Management, School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei China
| | - Mei Zhang
- Department of Health Management, School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei China
| | - Jie Zhao
- Department of Health Management, School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei China
| | - Yunyi Wu
- Department of Health Management, School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei China
| | - Ying Ma
- Department of Health Management, School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei China
| | - Chaoyang Yan
- Department of Health Management, School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei China
| | - Jing Wang
- Department of Health Management, School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei China
- The Key Research Institute of Humanities and Social Science of Hubei Province, Huazhong University of Science and Technology, Wuhan, Hubei China
- Institute for Poverty Reduction and Development, Huazhong University of Science and Technology, Wuhan, Hubei China
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7
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Joseph J, Pajewski NM, Dolor RJ, Ann Sellers M, Perdue LH, Peeples SR, Henrie AM, Woolard N, Jones WS, Benziger CP, Orkaby AR, Mixon AS, VanWormer JJ, Shapiro MD, Kistler CE, Polonsky TS, Chatterjee R, Chamberlain AM, Forman DE, Knowlton KU, Gill TM, Newby LK, Hammill BG, Cicek MS, Williams NA, Decker JE, Ou J, Rubinstein J, Choudhary G, Gazmuri RJ, Schmader KE, Roumie CL, Vaughan CP, Effron MB, Cooper-DeHoff RM, Supiano MA, Shah RC, Whittle JC, Hernandez AF, Ambrosius WT, Williamson JD, Alexander KP. Pragmatic evaluation of events and benefits of lipid lowering in older adults (PREVENTABLE): Trial design and rationale. J Am Geriatr Soc 2023; 71:1701-1713. [PMID: 37082807 PMCID: PMC10258159 DOI: 10.1111/jgs.18312] [Citation(s) in RCA: 19] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 01/17/2023] [Accepted: 01/29/2023] [Indexed: 04/22/2023]
Abstract
Whether initiation of statins could increase survival free of dementia and disability in adults aged ≥75 years is unknown. PREVENTABLE, a double-blind, placebo-controlled randomized pragmatic clinical trial, will compare high-intensity statin therapy (atorvastatin 40 mg) with placebo in 20,000 community-dwelling adults aged ≥75 years without cardiovascular disease, disability, or dementia at baseline. Exclusion criteria include statin use in the prior year or for >5 years and inability to take a statin. Potential participants are identified using computable phenotypes derived from the electronic health record and local referrals from the community. Participants will undergo baseline cognitive testing, with physical testing and a blinded lipid panel if feasible. Cognitive testing and disability screening will be conducted annually. Multiple data sources will be queried for cardiovascular events, dementia, and disability; survival is site-reported and supplemented by a National Death Index search. The primary outcome is survival free of new dementia or persisting disability. Co-secondary outcomes are a composite of cardiovascular death, hospitalization for unstable angina or myocardial infarction, heart failure, stroke, or coronary revascularization; and a composite of mild cognitive impairment or dementia. Ancillary studies will offer mechanistic insights into the effects of statins on key outcomes. Biorepository samples are obtained and stored for future study. These results will inform the benefit of statins for increasing survival free of dementia and disability among older adults. This is a pioneering pragmatic study testing important questions with low participant burden to align with the needs of the growing population of older adults.
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Affiliation(s)
| | | | - Rowena J. Dolor
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC
| | - Mary Ann Sellers
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC
| | | | | | - Adam M. Henrie
- Cooperative Studies Program Clinical Research Pharmacy Coordinating Center, Office of Research and Development, Department of Veterans Affairs, Albuquerque, NM
| | - Nancy Woolard
- Wake Forest University School of Medicine, Winston-Salem, NC
| | - W. Schuyler Jones
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC
| | | | - Ariela R. Orkaby
- New England Geriatric Research, Education, and Clinical Center (GRECC), VA Boston Healthcare System, and Division of Aging, Brigham & Women’s Hospital, Harvard Medical School, Boston, MA
| | - Amanda S. Mixon
- Vanderbilt University Medical Center and Geriatric Research Education and Clinical Center (GRECC), VA Tennessee Valley Healthcare System, Nashville, TN
| | | | | | - Christine E. Kistler
- Department of Family Medicine, School of Medicine, University of North Carolina at Chapel Hill, NC
| | | | - Ranee Chatterjee
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC
| | | | - Daniel E. Forman
- Department of Medicine, Sections of Geriatrics and Cardiology, University of Pittsburgh; Pittsburgh GRECC, VA Pittsburgh Healthcare System, Pittsburgh, PA
| | | | | | - L. Kristin Newby
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC
| | - Bradley G. Hammill
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC
| | | | | | - Jake E. Decker
- Section of Primary Care Medicine, Medical College of Wisconsin, Milwaukee, WI
| | - Jiafu Ou
- Cardiology Division, John Cochran VA Medical Center and Cardiology Division, Washington University School of Medicine, St. Louis, MO
| | - Jack Rubinstein
- Division of Cardiology, Cincinnati VAMC and Division of Cardiovascular Diseases, Department of Internal Medicine, College of Medicine, University of Cincinnati, Cincinnati, OH
| | - Gaurav Choudhary
- Providence VA Medical Center, and Lifespan Cardiovascular Institute, and Alpert Medical School of Brown University, Providence RI
| | - Raúl J. Gazmuri
- Captain James A. Lovell Federal Health Care Center and Rosalind Franklin University of Medicine and Science, Chicago, IL
| | | | - Christianne L. Roumie
- Vanderbilt University Medical Center and Geriatric Research Education and Clinical Center (GRECC), VA Tennessee Valley Healthcare System, Nashville, TN
| | - Camille P. Vaughan
- Birmingham/Atlanta Geriatric Research Education and Clinical Center (GRECC), Department of Veterans Affairs, and Division of Geriatrics & Gerontology, Department of Medicine, Emory University, Atlanta, GA
| | - Mark B. Effron
- John Ochsner Heart and Vascular Institute, The University of Queensland Ochsner Clinical School, New Orleans, LA
| | | | | | - Raj C. Shah
- Family & Preventive Medicine and the Rush Alzheimer’s Disease Center, Rush University, Chicago, IL
| | | | - Adrian F. Hernandez
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC
| | | | | | - Karen P. Alexander
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC
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Ceruti S, Glotta A, Biggiogero M, Marzano M, Bona G, Previsdomini M, Saporito A, Capdevila X. Long-Term Evolution of Activities of Daily Life (ADLs) in Critically Ill COVID-19 Patients, a Case Series. Healthcare (Basel) 2023; 11:healthcare11050650. [PMID: 36900655 PMCID: PMC10001119 DOI: 10.3390/healthcare11050650] [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: 12/30/2022] [Revised: 02/16/2023] [Accepted: 02/19/2023] [Indexed: 02/25/2023] Open
Abstract
BACKGROUND The most common long-term symptoms of critically ill COVID-19 patients are fatigue, dyspnea and mental confusion. Adequate monitoring of long-term morbidity, mainly analyzing the activities of daily life (ADLs), allows better patient management after hospital discharge. The aim was to report long-term ADL evolution in critically ill COVID-19 patients admitted to a COVID-19 center in Lugano (Switzerland). METHODS A retrospective analysis on consecutive patients discharged alive from ICU with COVID-19 ARDS was performed based on a follow-up one year after hospital discharge; ADLs were assessed through the Barthel index (BI) and the Karnofsky Performance Status (KPS) scale. The primary objective was to assess differences in ADLs at hospital discharge (acute ADLs) and one-year follow-up (chronic ADLs). The secondary objective was to explore any correlations between ADLs and multiple measures at admission and during the ICU stay. RESULTS A total of 38 consecutive patients were admitted to the ICU; a t-test analysis between acute and chronic ADLs through BI showed a significant improvement at one year post discharge (t = -5.211, p < 0.0001); similarly, every single task of BI showed the same results (p < 0.0001 for each task of BI). The mean KPS was 86.47 (SD 20.9) at hospital discharge and 99.6 at 1 year post discharge (p = 0.02). Thirteen (34%) patients deceased during the first 28 days in the ICU; no patient died after hospital discharge. CONCLUSIONS Based on BI and KPS, patients reached complete functional recovery of ADLs one year after critical COVID-19.
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Affiliation(s)
- Samuele Ceruti
- Department of Critical Care, Clinica Luganese Moncucco, 6900 Lugano, Switzerland
- Correspondence: ; Tel.: +41-079/440-73-92
| | - Andrea Glotta
- Department of Critical Care, Clinica Luganese Moncucco, 6900 Lugano, Switzerland
| | - Maira Biggiogero
- Clinical Research Unit, Clinica Luganese Moncucco, 6900 Lugano, Switzerland
| | - Martino Marzano
- Department of Internal Medicine, Clinica Luganese Moncucco, 6900 Lugano, Switzerland
| | - Giovanni Bona
- Clinical Research Unit, Clinica Luganese Moncucco, 6900 Lugano, Switzerland
| | - Marco Previsdomini
- Department of Intensive Care Medicine, Ente Ospedaliero Cantonale, 6500 Bellinzona, Switzerland
| | - Andrea Saporito
- Service of Anesthesiology, Ente Ospedaliero Cantonale, 6500 Bellinzona, Switzerland
| | - Xavier Capdevila
- Department of Anesthesia and Intensive Care, Centre Hospitalier Universitaire de Montpellier, 34000 Montpellier, France
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Shimada H, Doi T, Tsutsumimoto K, Makino K, Harada K, Tomida K, Arai H. Predictive Validity of Different Walking Measures to Identify the Incident Long-Term Care Needs in Older Adults. J Nutr Health Aging 2023; 27:759-766. [PMID: 37754216 DOI: 10.1007/s12603-023-1978-x] [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: 04/21/2023] [Accepted: 07/26/2023] [Indexed: 09/28/2023]
Abstract
OBJECTIVES A comfortable walking speed is a suitable measurement of functional status in older adults. In addition to assessing their comfortable walking speed, two complex walking tests were administered to a cohort of older people, assuming that these tests would be a more sensitive predictor of the incident long-term care needs than comfortable walking speed. DESIGN A prospective observational study was conducted to collect data. SETTING AND PARTICIPANTS Among the initial 5,563 community-dwelling independent older adults (aged ≥ 65 years), 935 were excluded and the data of 4,628 (mean age, 73.9 ± 5.5 years, 65-94 years; 2,052 men, 2,576 women) older adults were finally analyzed. METHODS Three walking tasks were administered: comfortable, complicated balance, and Go-stop walking. Complicated balance walking was measured under comfortable walking conditions, with participants having to walk with their hands crossed at the shoulder joint at 90°. For the Go-stop walking test, the time taken to walk 2 meters was measured using a stopwatch. For two years following baseline assessments, participants received monthly follow-ups for incident certification of the need for care under the long-term care insurance (LTCI) system. RESULTS Low performance in comfortable, complicated balance, and Go-stop walking were 29.8%, 37.7%, and 35.1%, respectively. During the 24-month follow-up period, 246 participants (5.3%) required LTCI certification. The Youden Index was used to determine the cut-points of the incident long-term care needs in the comfortable, complicated balance, and Go-stop walking conditions, which were 1.055 m/s, 0.936 m/s, and 3.205 seconds, respectively. Participants classified as exhibiting low performance included 1,381 (29.8%) under comfortable walking, 1,746 (37.7%) under complicated balance walking, and 1,623 (35.1%) under the Go-stop walking tests. The C-indices of the comfortable, complicated balance, and Go-stop walking tests were 0.72 (95% confidence interval (CI) 0.69-0.76), 0.71 (95% CI 0.67-0.74), and 0.65 (95% CI 0.61-0.69), respectively. Cox proportional hazards regression model revealed significant relationships between the incident long-term care needs and the comfortable (hazard ratio (HR) 2.14, 95% CI 1.62-2.84), complicated balance (1.81, 1.36-2.41), and Go-stop (1.46, 1.12-1.91) walking conditions. CONCLUSIONS AND IMPLICATIONS The findings suggest that slow walking speed has a considerably greater impact on the incident long-term care needs in older adults. However, the complex walking task did not improve the predictive performance. Comfortable walking speed tests, which can easily be measured to predict the future incident long-term care needs, are effective tools in community health promotion and primary care.
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Affiliation(s)
- H Shimada
- Hiroyuki Shimada, Department of Preventive Gerontology, Centre for Gerontology and Social Science, Research Institute, National Centre for Geriatrics and Gerontology 7-430 Morioka-cho, Obu, Aichi 474-8511, Japan, Tel: +81-562-44-5651 (ext. 5611) E-mail:
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10
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Zhang C, Zhang X, Zhang H, Zeng P, Yin P, Li Z, Zhao Y, Yao Y. Psychometric properties of the Barthel Index for evaluating physical function among Chinese oldest‐old. JCSM CLINICAL REPORTS 2022. [DOI: 10.1002/crt2.47] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Chi Zhang
- The Key Laboratory of Geriatrics, Beijing Institute of Geriatrics, Institute of Geriatric Medicine Chinese Academy of Medical Sciences, Beijing Hospital, National Center of Gerontology of National Health Commission Beijing China
| | - Xuxi Zhang
- Center for Healthy Aging and Development Studies, National School of Development Peking University Beijing China
| | - Hao Zhang
- Department of healthcare policy and research Weill Cornell Medicine New York NY USA
| | - Ping Zeng
- The Key Laboratory of Geriatrics, Beijing Institute of Geriatrics, Institute of Geriatric Medicine Chinese Academy of Medical Sciences, Beijing Hospital, National Center of Gerontology of National Health Commission Beijing China
| | - Pengbin Yin
- Department of Orthopedics The Fourth Medical Centre, Chinese PLA General Hospital Beijing China
- National Clinical Research Center for Orthopedics Sports Medicine & Rehabilitation Beijing China
| | - Zhongquan Li
- School of Social and Behavioral Sciences Nanjing University Nanjing China
| | - Yali Zhao
- Central Laboratory Hainan Hospital of Chinese PLA General Hospital Sanya China
| | - Yao Yao
- Center for Healthy Aging and Development Studies, National School of Development Peking University Beijing China
- China Center for Health Development Studies Peking University Beijing China
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11
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Guidarelli C, Lipps C, Stoyles S, Dieckmann NF, Winters-Stone KM. Remote administration of physical performance tests among persons with and without a cancer history: Establishing reliability and agreement with in-person assessment. J Geriatr Oncol 2022; 13:691-697. [PMID: 35177378 DOI: 10.1016/j.jgo.2022.02.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 01/07/2022] [Accepted: 02/03/2022] [Indexed: 12/14/2022]
Abstract
OBJECTIVES To assess the reliability of using videoconference technology to remotely administer the Short Physical Performance Battery (SPPB), including the 5-time sit-to-stand (5XSTS) and usual 4-m walk (4mWT), and the Timed Up and Go (TUG) tests and agreement with in-person administration among adults with and without cancer. METHODS Participants from two ongoing clinical exercise trials in cancer survivors, one that included partners without cancer, comprised the available sample (n = 176; mean age 62.5 ± 11.5 years.). Remote tests were administered on two separate days by either the same or a different assessor to determine intra-rater and inter-rater reliability, respectively. We also compared tests conducted remotely and in-person using the same assessor and the same participant. Intraclass correlation coefficients (ICC) and 95% confidence intervals (95% CI) were used for all comparisons, except for the SPPB score, which used Cohen's kappa and Krippendorf's alpha for intra- and inter-rater reliability, respectively. RESULTS Remote assessment of the TUG test had excellent intra-rater reliability (0.98, 95% CI 0.93-0.99), inter-rater reliability (ICC = 0.96, 95% CI 0.90-0.99), and good agreement with in-person tests (ICC = 0.88, 95% CI 0.74-0.94). The 5XSTS and 4mWT showed excellent (ICC = 0.92, 95% CI 0.84-0.96) and good (ICC = 0.87, 95% CI 0.71-0.94) intra-rater reliability, respectively, but somewhat lower inter-rater reliability (5XSTS: ICC = 0.65, 95% CI 0.34-0.83 and 4mWT: ICC = 0.62, 95% CI 0.30-0.81). Remote 5XSTS had moderate agreement (ICC = 0.72, 95% CI 0.62-0.80) and 4mWT had poor agreement (ICC = 0.48, 95% CI -0.07-0.76) with in-person tests. CONCLUSIONS Remote assessment of common physical function tests in older adults, including those who have cancer, is feasible and highly reliable when using the same assessor. TUG may be the most methodologically robust measure for remote assessment because it is also highly reliable when using different assessors and correlates strongly with in-person testing. Adapting administration of objective measures of physical function for the remote environment could significantly expand the reach of research and clinical practice to assess populations at risk of functional decline.
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Affiliation(s)
- Carolyn Guidarelli
- Division of Oncological Sciences, Knight Cancer Institute, Oregon Health & Science University, Portland, OR, USA
| | - Colin Lipps
- Division of Oncological Sciences, Knight Cancer Institute, Oregon Health & Science University, Portland, OR, USA
| | - Sydnee Stoyles
- School of Nursing, Oregon Health & Science University, Portland, OR, USA
| | - Nathan F Dieckmann
- School of Nursing, Oregon Health & Science University, Portland, OR, USA; Department of Psychiatry, School of Medicine, Oregon Health & Science University, Portland, OR, USA
| | - Kerri M Winters-Stone
- Division of Oncological Sciences, Knight Cancer Institute, Oregon Health & Science University, Portland, OR, USA; School of Nursing, Oregon Health & Science University, Portland, OR, USA.
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12
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Liao H, Yan C, Ma Y, Wang J. Association Between Dynamic Trends of Functional Disability and Poverty Among People Aged 45 and Over. Front Public Health 2022; 9:742385. [PMID: 35111709 PMCID: PMC8801517 DOI: 10.3389/fpubh.2021.742385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Accepted: 12/15/2021] [Indexed: 11/23/2022] Open
Abstract
Background The disability problem has become prominent with the acceleration of the global aging process. Individual disability is associated with economic conditions and contributes to family poverty. As disability will change over a long period of time and may even show distinct dynamic trends, we aimed to focus on activities of daily living (ADL) and classify functional disability trends. Moreover, we aimed to highlight and analyze the association between functional disability trends and economic conditions and explore the influencing factors. Materials and Methods A total of 11,222 individuals who were 45 years old or older were included in four surveys conducted by the China Health and Retirement Longitudinal Study in 2011, 2013, 2015, and 2018. Samples were analyzed after excluding those with missing key variables. The latent class growth model was used to classify the ADL trends. Two binary logistic regressions were established to observe the association between the ADL trends and follow-up economic conditions or catastrophic health expenditure trends. Results ADL trends of older adults were classified into improving (25.4%), stabilizing (57.0%), and weakening ADL (17.6%). ADL trend was associated with follow-up poverty (p = 0.002) and catastrophic health expenditure trends (p < 0.001). Compared with the improving ADL trend, the stabilizing ADL may have a negative influence on individuals' economic conditions (OR = 1.175, 95%CI = 1.060–1.303). However, a stabilizing ADL trend was less likely to bring about catastrophic health expenditures (OR = 0.746, 95%CI = 0.678–0.820) compared with an improving ADL trend. Conclusion The improvement of functional disability would make the medical expense burden heavier but would still be beneficial for the prevention of poverty. A significant association was found between socioeconomic factors and poverty. Preventing the older adults from developing disability and illness, improving the compensation level of medical insurance, and optimizing the long-term care insurance and the primary healthcare system can potentially contribute to the prevention of poverty. Meanwhile, focusing on people who are poor at early stages, women, middle-aged, low-educated, and in rural areas is important.
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Affiliation(s)
- Hui Liao
- Department of Health Management, School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Chaoyang Yan
- Department of Health Management, School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Ying Ma
- Department of Health Management, School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jing Wang
- Department of Health Management, School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- The Key Research Institute of Humanities and Social Science of Hubei Province, Huazhong University of Science and Technology, Wuhan, China
- Institute for Poverty Reduction and Development, Huazhong University of Science and Technology, Wuhan, China
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13
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Cawthon PM, Blackwell T, Cummings SR, Orwoll ES, Duchowny KA, Kado DM, Stone KL, Ensrud KE, Cauley JA, Evans WJ. Muscle Mass Assessed by the D3-Creatine Dilution Method and Incident Self-reported Disability and Mortality in a Prospective Observational Study of Community-Dwelling Older Men. J Gerontol A Biol Sci Med Sci 2021; 76:123-130. [PMID: 32442245 DOI: 10.1093/gerona/glaa111] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2019] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Whether low muscle mass is a risk factor for disability and mortality is unclear. Associations between approximations of muscle mass (including lean mass from dual-energy x-ray absorptiometry [DXA]), and these outcomes are inconsistent. METHODS Muscle mass measured by deuterated creatine (D3Cr) dilution and appendicular lean mass (ALM, by DXA) were assessed at the Year 14 Visit (2014-2016) of the prospective Osteoporotic Fractures in Men study (N = 1,425, age 77-101 years). Disability in activities of daily living (ADLs), instrumental ADLs, and mobility tasks was self-reported at the Year 14 visit and 2.2 years later; deaths were centrally adjudicated over 3.3 years. Relative risks and 95% confidence intervals (CI) were estimated per standard deviation decrement with negative binomial, logistic regression, or proportional hazards models. RESULTS In age- and clinical center-adjusted models, the relative risks per decrement in D3Cr muscle mass/wgt was 1.9 (95% CI: 1.2, 3.1) for incident self-reported ADL disability; 1.5 (95% CI: 1.3, 1.9) for instrumental ADL disability; and 1.8 (95% CI: 1.5, 2.2) for mobility disability. In age-, clinical center-, and weight-adjusted models, the relative risks per decrement in D3Cr muscle mass was 1.8 (95% CI: 1.5, 2.2) for all-cause mortality. In contrast, lower DXA ALM was not associated with any outcome. Associations of D3Cr muscle mass with these outcomes were slightly attenuated after adjustment for confounding factors and the potentially mediating effects of strength and physical performance. CONCLUSIONS Low muscle mass as measured by D3Cr dilution is a novel risk factor for clinically meaningful outcomes in older men.
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Affiliation(s)
- Peggy M Cawthon
- Research Institute, California Pacific Medical Center, San Francisco.,Department of Epidemiology and Biostatistics, University of California, San Francisco
| | - Terri Blackwell
- Research Institute, California Pacific Medical Center, San Francisco
| | - Steven R Cummings
- Research Institute, California Pacific Medical Center, San Francisco.,Department of Epidemiology and Biostatistics, University of California, San Francisco
| | - Eric S Orwoll
- Department of Medicine, Oregon Health and Science University, Portland
| | - Kate A Duchowny
- Department of Epidemiology and Biostatistics, University of California, San Francisco
| | - Deborah M Kado
- Department of Family Medicine and Public Health, University of California, San Diego.,Department of Internal Medicine, University of California, San Diego
| | - Katie L Stone
- Research Institute, California Pacific Medical Center, San Francisco
| | - Kristine E Ensrud
- Center for Chronic Disease Outcomes Research, Minneapolis VA Health Care System, Minnesota.,Division of Epidemiology and Community Health, University of Minnesota, Minneapolis
| | - Jane A Cauley
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pennsylvania
| | - William J Evans
- Department of Nutrition Sciences, University of California, Berkeley.,Department of Medicine, Duke University, Durham, North Carolina
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14
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Shimada H, Doi T, Lee S, Tsutsumimoto K, Bae S, Makino K, Nakakubo S, Arai H. Identification of Disability Risk in Addition to Slow Walking Speed in Older Adults. Gerontology 2021; 68:625-634. [PMID: 34261066 DOI: 10.1159/000516966] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 05/01/2021] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION A cutoff speed of 1.0 m/s for walking at a comfortable pace is critical for predicting future functional decline. However, some older adults with walking speeds below the cutoff point maintain an independent living. We aimed to identify specific predictors of disability development in older adults with slow walking speeds in contrast to those with a normal walking speed. METHODS This prospective cohort study on 12,046 community-dwelling independent Japanese older adults (mean age, 73.6 ± 5.4 years) was conducted between 2011 and 2015. Participants were classified into slow walking speed (comfortable walking speed slower than 1.0 m/s) and normal walking speed (speed of 1.0 m/s or faster) groups and followed up to assess disability incidence for 24 months after baseline assessments. Cox proportional hazards regression models were used to identify predictors of disability development in the slow and normal walking groups. RESULTS Overall, 26.8% of participants had a slow walking speed. At follow-up, 17.3% and 5.1% of participants in the slow and normal walking groups, respectively, developed disability (p < 0.01). Cox regression models revealed that age (hazard ratio 1.07, 95% confidence interval 1.05-1.09), walking speed (0.12, 0.07-0.22), grip strength (0.97, 0.95-0.99), Parkinson's disease (4.65, 2.59-8.33), word list memory-immediate recognition score (0.90, 0.85-0.97), word list memory-delayed recall score (0.94, 0.89-1.00), Symbol Digit Substitution Test (SDST) score (0.98, 0.96-0.99), and 15-item Geriatric Depression Scale (GDS) score (1.04, 1.01-1.07) were significantly associated with disability incidence in the slow walking group. In the normal walking group, age, grip strength, depression, diabetes, cognition, GDS score, and reduced participation in outdoor activity were significantly associated with disability incidence; however, there was no significant association with walking speed. CONCLUSIONS Decreased walking speeds have considerably greater impact on disability development in older adults with a slow walking speed than in those with a normal walking speed. Health-care providers should explore modifiable factors for reducing walking speed; they should also encourage improvement of risk factors such as muscle weakness and depression to reduce disability risk in older adults with slow walking speeds.
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Affiliation(s)
- Hiroyuki Shimada
- Department of Preventive Gerontology, Centre for Gerontology and Social Science, National Centre for Geriatrics and Gerontology, Obu, Japan
| | - Takehiko Doi
- Department of Preventive Gerontology, Centre for Gerontology and Social Science, National Centre for Geriatrics and Gerontology, Obu, Japan
| | - Sangyoon Lee
- Department of Preventive Gerontology, Centre for Gerontology and Social Science, National Centre for Geriatrics and Gerontology, Obu, Japan
| | - Kota Tsutsumimoto
- Department of Preventive Gerontology, Centre for Gerontology and Social Science, National Centre for Geriatrics and Gerontology, Obu, Japan
| | - Seongryu Bae
- Department of Preventive Gerontology, Centre for Gerontology and Social Science, National Centre for Geriatrics and Gerontology, Obu, Japan
| | - Keitaro Makino
- Department of Preventive Gerontology, Centre for Gerontology and Social Science, National Centre for Geriatrics and Gerontology, Obu, Japan
| | - Sho Nakakubo
- Department of Preventive Gerontology, Centre for Gerontology and Social Science, National Centre for Geriatrics and Gerontology, Obu, Japan
| | - Hidenori Arai
- Centre for Gerontology and Social Science, National Centre for Geriatrics and Gerontology, Obu, Japan
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15
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Trevissón-Redondo B, López-López D, Pérez-Boal E, Marqués-Sánchez P, Liébana-Presa C, Navarro-Flores E, Jiménez-Fernández R, Corral-Liria I, Losa-Iglesias M, Becerro-de-Bengoa-Vallejo R. Use of the Barthel Index to Assess Activities of Daily Living before and after SARS-COVID 19 Infection of Institutionalized Nursing Home Patients. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:7258. [PMID: 34299709 PMCID: PMC8304574 DOI: 10.3390/ijerph18147258] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 06/29/2021] [Accepted: 07/05/2021] [Indexed: 01/08/2023]
Abstract
The objective of the present study was to evaluate the activities of daily living (ADLs) using the Barthel Index before and after infection with the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and also to determine whether or not the results varied according to gender. The ADLs of 68 cohabiting geriatric patients, 34 men and 34 women, in two nursing homes were measured before and after SARS-CoV-2 (Coronavirus 2019 (COVID-19)) infection. COVID-19 infection was found to affect the performance of ADLs in institutionalized elderly in nursing homes, especially in the more elderly subjects, regardless of sex. The COVID-19 pandemic, in addition to having claimed many victims, especially in the elderly population, has led to a reduction in the abilities of these people to perform their ADLs and caused considerable worsening of their quality of life even after recovering from the disease.
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Affiliation(s)
- Bibiana Trevissón-Redondo
- SALBIS Research Group, Faculty of Health Sciences, Universidad de León, 24071 León, Spain; (B.T.-R.); (P.M.-S.); (C.L.-P.)
| | - Daniel López-López
- Research, Health and Podiatry Unit, Department of Health Sciences, Faculty of Nursing and Podiatry, Universidade da Coruña, 15403 Ferrol, Spain;
| | | | - Pilar Marqués-Sánchez
- SALBIS Research Group, Faculty of Health Sciences, Universidad de León, 24071 León, Spain; (B.T.-R.); (P.M.-S.); (C.L.-P.)
| | - Cristina Liébana-Presa
- SALBIS Research Group, Faculty of Health Sciences, Universidad de León, 24071 León, Spain; (B.T.-R.); (P.M.-S.); (C.L.-P.)
| | - Emmanuel Navarro-Flores
- Frailty Research Organizaded Group (FROG), Department of Nursing, Faculty of Nursing and Podiatry, University of Valencia, 46010 Valencia, Spain;
| | - Raquel Jiménez-Fernández
- Faculty of Health Sciences, Universidad Rey Juan Carlos, 28933 Madrid, Spain; (R.J.-F.); (I.C.-L.)
| | - Inmaculada Corral-Liria
- Faculty of Health Sciences, Universidad Rey Juan Carlos, 28933 Madrid, Spain; (R.J.-F.); (I.C.-L.)
| | - Marta Losa-Iglesias
- Faculty of Health Sciences, Universidad Rey Juan Carlos, 28933 Madrid, Spain; (R.J.-F.); (I.C.-L.)
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16
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Examination of the measurement equivalence of the Functional Assessment in Acute Care MCAT (FAMCAT) mobility item bank using differential item functioning analyses. Arch Phys Med Rehabil 2021; 103:S84-S107.e38. [PMID: 34146534 DOI: 10.1016/j.apmr.2021.03.044] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Revised: 03/20/2021] [Accepted: 03/25/2021] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To assess differential item functioning (DIF) in an item pool measuring the mobility of hospitalized patients across educational, age, and gender groups. DESIGN Measurement evaluation cohort study. Content experts generated DIF hypotheses to guide the interpretation. The graded response item response theory (IRT) model was used. Primary DIF tests were Wald statistics; sensitivity analyses were conducted using the IRT ordinal logistic regression procedure. Magnitude and impact were evaluated by examining group differences in expected item and scale score functions. SETTING Hospital-based rehabilitation PARTICIPANTS: 2216 hospitalized patients MAIN OUTCOME MEASURES: 111 self-reported mobility items RESULTS: Two linking items among those used to set the metric across forms evidenced DIF for gender and age: 'difficulty climbing stairs step-over-step without a handrail (alternating feet)' and 'difficulty climbing 3 to 5 steps without a handrail'. Conditional on the mobility state, the items were more difficult for women and older people (aged 65 and over). An additional 18 items were identified with DIF. Items with both high DIF magnitude and hypotheses related to age were difficulty: 'crossing road at a 4-lane traffic light with curbs'; 'jumping/landing on one leg'; 'strenuous activities'; 'descending 3-5 steps with no handrail'. Although DIF of higher magnitude was observed for several items, the scale-level impact was relatively small and the exposure rate for the most problematic items was low (0.35, 0.27 and 0.20). CONCLUSIONS This was the first study to evaluate measurement equivalence of the hospital-based rehabilitation mobility item bank. Although 20 items evidenced high magnitude DIF, five related to stairs, the scale-level impact was minimal; however, it is recommended that such items be avoided in the development of short-form measures. No items with salient DIF were removed from calibrations, supporting the use of the item bank across groups differing in education, age, and gender. The bank may thus be useful to assist clinical assessment and decision-making regarding risk for specific mobility restrictions at discharge as well as identifying mobility-related functions targeted for post- discharge interventions. Additionally, with the goal of avoiding long and burdensome assessments for patients and clinical staff; these results could be informative for those using the item bank to construct short forms.
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17
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González-Bautista E, de Souto Barreto P, Andrieu S, Rolland Y, Vellas B. Screening for intrinsic capacity impairments as markers of increased risk of frailty and disability in the context of integrated care for older people: Secondary analysis of MAPT. Maturitas 2021; 150:1-6. [PMID: 34274071 DOI: 10.1016/j.maturitas.2021.05.011] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 04/29/2021] [Accepted: 05/31/2021] [Indexed: 01/01/2023]
Abstract
AIM This longitudinal secondary analysis of the Multidomain Alzheimer Preventive Trial (MAPT) aimed to test whether the Integrated Care for Older People (ICOPE) Step 1 screening tool is able to identify people at risk of developing frailty and disability in basic (ADL) and instrumental (IADL) activities of daily living among community-dwelling older adults. PARTICIPANTS AND SETTING Seven hundred and fifty-nine (n = 759) non-demented participants of the MAPT aged 70-89 years were assessed in memory clinics in France between 2008 and 2013. METHODS We measured six intrinsic capacity (IC) impairments, adapted from the ICOPE screening tool. We used Cox models to estimate the adjusted hazard ratios of incident frailty and IADL/ADL disability. Incident frailty was defined by Fried's phenotype, and incident disability was measured according to Lawton and Katz for IADLs and ADLs. RESULTS Limited mobility (HR= 2.97, 95%CI= 1.85-4.76), depressive symptoms (HR= 2.07, 95%CI= 1.03-4.19), and visual impairment (HR= 1.70, 95%CI 1.01-2.86) were associated with a higher incidence of frailty over 5 years. Each additional IC condition demonstrated a positive association with a higher risk of incident frailty, IADL, ADL disability, with risk increased by 47%, 27%, and 23% over 5 years, respectively. CONCLUSION Screening for IC impairments identifies older adults at higher risk of incident frailty and incident IADL/ADL disability. It is relevant to screen for these impairments together because the risk of frailty and disability increases with each additional one. ClinicalTrials.gov identifier: NCT00672685.
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Affiliation(s)
- Emmanuel González-Bautista
- Gerontopole of Toulouse, Institute of Aging, Toulouse University Hospital (CHU Toulouse), Toulouse, France; UPS/Inserm UMR1027, University of Toulouse III, Toulouse, France.
| | - Philipe de Souto Barreto
- Gerontopole of Toulouse, Institute of Aging, Toulouse University Hospital (CHU Toulouse), Toulouse, France; UPS/Inserm UMR1027, University of Toulouse III, Toulouse, France.
| | - Sandrine Andrieu
- Gerontopole of Toulouse, Institute of Aging, Toulouse University Hospital (CHU Toulouse), Toulouse, France; UPS/Inserm UMR1027, University of Toulouse III, Toulouse, France.
| | - Yves Rolland
- Gerontopole of Toulouse, Institute of Aging, Toulouse University Hospital (CHU Toulouse), Toulouse, France; UPS/Inserm UMR1027, University of Toulouse III, Toulouse, France.
| | - Bruno Vellas
- Gerontopole of Toulouse, Institute of Aging, Toulouse University Hospital (CHU Toulouse), Toulouse, France; UPS/Inserm UMR1027, University of Toulouse III, Toulouse, France.
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18
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Muramatsu N, Yin L, Berbaum ML, Marquez DX, Walton SM, Caceres M, Cruz Madrid KY, Zanoni JP. Protocol for a randomized controlled trial of low-intensity physical activity for frail older adults: Promoting seniors' health with home care aides (Pro-Home). Contemp Clin Trials 2021; 104:106362. [PMID: 33737196 PMCID: PMC8180508 DOI: 10.1016/j.cct.2021.106362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Revised: 03/10/2021] [Accepted: 03/12/2021] [Indexed: 10/21/2022]
Abstract
Regular participation in physical activity benefits older adults physically and mentally. However, the availability and assessment of physical activity programs that are safe and appropriate for homebound older adults at risk for nursing home admission are limited. Here we describe the protocol for a randomized controlled trial that examines the effectiveness of a gentle physical activity program. Delivered by home care aides who regularly help hard-to-reach older home care clients with housekeeping and routine personal care services in the home, this program is implemented in a real-world context of caregiver-client dyads in a Medicaid-funded home care program. The trial uses a two-group repeated measures design (baseline, Month 4, and Month 8) with 300 pairs of eligible home care clients and their home care aides. The results from this trial could provide evidence and guidelines for a new model of home care, which would facilitate the working together of older home care clients and their home care aides to maintain or improve the functional status of nursing home-eligible older adults.
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Affiliation(s)
- Naoko Muramatsu
- Division of Community Health Sciences, School of Public Health, University of Illinois Chicago, USA; Institute for Health Research and Policy, University of Illinois Chicago, USA.
| | - Lijuan Yin
- Institute for Health Research and Policy, University of Illinois Chicago, USA
| | - Michael L Berbaum
- Institute for Health Research and Policy, University of Illinois Chicago, USA
| | - David X Marquez
- Department of Kinesiology and Nutrition, University of Illinois Chicago, USA
| | - Surrey M Walton
- Department of Pharmacy Systems Outcomes and Policy, College of Pharmacy, University of Illinois Chicago, USA
| | - Maria Caceres
- Institute for Health Research and Policy, University of Illinois Chicago, USA
| | - Katya Y Cruz Madrid
- Division of Academic Internal Medicine and Geriatrics, University of Illinois Chicago, USA; Jesse Brown VA Medical Center, Chicago, Illinois, USA
| | - Joseph P Zanoni
- Division of Environmental and Occupational Health Sciences, School of Public Health, University of Illinois Chicago, USA
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19
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Lee SY, Choo PL, Pang BWJ, Lau LK, Jabbar KA, Seah WT, Chen KK, Ng TP, Wee SL. SPPB reference values and performance in assessing sarcopenia in community-dwelling Singaporeans - Yishun study. BMC Geriatr 2021; 21:213. [PMID: 33781211 PMCID: PMC8008740 DOI: 10.1186/s12877-021-02147-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Accepted: 03/08/2021] [Indexed: 01/05/2023] Open
Abstract
Background The Short Physical Performance Battery (SPPB) is an established test of physical performance. We provide reference values for SPPB and determine SPPB performance and cut-offs in assessing sarcopenia for Asian community-dwelling older adults. Methods Five hundred thirty-eight (57.8% women) community-dwelling adults aged 21–90 years were recruited. SPPB and its subtest scores and timings (8 ft. gait speed (GS), five-times repeated chair sit-to-stand (STS) and balance) were determined. Appendicular lean mass divided by height-squared, muscle strength (handgrip) and physical performance (6 m GS, STS and SPPB) were assessed to define sarcopenia for various Asian criteria. Area under the ROC curve (AUC) was used to assess performance of SPPB and subtests in discriminating sarcopenia in adults aged ≥60 years. Optimal SPPB and GS subtest cut-offs for each sarcopenia criterion were determined by maximizing sensitivity and specificity. Results The mean SPPB score was 11.6(SD 1.1) in men and 11.5(SD1.2) in women. Majority of participants(≥50%) aged 21–80 years achieved the maximum SPPB score. SPPB total and subtest scores generally decreased with age (all p < 0.001), but did not differ between sex. Among older adults (≥60 years), SPPB and GS subtest had varied performance in assessing sarcopenia (AUC 0.54–0.64 and 0.51–0.72, respectively), and moderate-to-excellent performance in assessing severe sarcopenia (AUC 0.69–0.98 and 0.75–0.95, respectively), depending on sarcopenia definitions. The optimal cut-offs for discriminating sarcopenia in both sexes were SPPB ≤11points and GS subtest ≤1.0 m/s. The most common optimal cut-offs for discriminating severe sarcopenia according to various definitions were SPPB ≤11points in both sexes, and GS ≤0.9 m/s in men and ≤ 1.0 m/s in women. Conclusions Population-specific normative SPPB values are important for use in diagnostic criteria and to interpret results of studies evaluating and establishing appropriate treatment goals. Performance on the SPPB should be reported in terms of the total sum score and registered time to complete the repeated-chair STS and 8-ft walk tests. The performance of GS subtest was comparable to SPPB and could be a useful, simple and accessible screening tool for discriminating severe sarcopenia in community-dwelling older adults. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-021-02147-4.
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Affiliation(s)
- Shuen Yee Lee
- Faculty of Health and Social Sciences, Singapore Institute of Technology, Singapore, Singapore
| | - Pei Ling Choo
- Faculty of Health and Social Sciences, Singapore Institute of Technology, Singapore, Singapore.,School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
| | | | - Lay Khoon Lau
- Geriatric Education and Research Institute (GERI), Singapore, Singapore
| | | | - Wei Ting Seah
- Geriatric Education and Research Institute (GERI), Singapore, Singapore
| | | | - Tze Pin Ng
- Geriatric Education and Research Institute (GERI), Singapore, Singapore.,Department of Psychological Medicine, National University of Singapore, Singapore, Singapore
| | - Shiou-Liang Wee
- Faculty of Health and Social Sciences, Singapore Institute of Technology, Singapore, Singapore. .,Geriatric Education and Research Institute (GERI), Singapore, Singapore.
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20
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Callahan KE, Willard J, Foley KL, Miller ME, Houston DK, Kritchevsky SB, Williamson JD, Applegate WB, Girma F, Whitehead SE, Rejeski WJ. Promoting Active Aging: Lessons Learned in an Implementation Pilot in Primary Care. J Am Geriatr Soc 2020; 69:373-380. [PMID: 33006763 DOI: 10.1111/jgs.16838] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 08/11/2020] [Accepted: 08/28/2020] [Indexed: 01/26/2023]
Abstract
BACKGROUND Physical activity (PA) preserves mobility, but few practices screen older adults for mobility impairment or counsel on PA. DESIGN "Promoting Active Aging" (PAA) was a mixed-methods randomized-controlled pilot, to test the feasibility and acceptability of a video-based PA counseling tool and implementation into practice of two mobility assessment tools. SETTING Three primary care practices affiliated with Wake Forest Baptist Health. PARTICIPANTS Adults aged 65 years and older who presented for primary care follow-up and were willing and able to answer self-report questions and walk 4 meters (n = 59). INTERVENTION Video-based PA counseling intervention versus control video, "Healthy Eating." MEASUREMENTS Potential participants completed mobility assessments: self-report (Mobility Assessment Tool-short form (MAT-sf)) and performance based (4-meter walk test). We assessed PAA's implementation-feasibility, acceptability, and value-via interviews and surveys. Effectiveness was measured via participant attendance at a PA information session. RESULTS Of 92 patients approached, 89 (96.7%) agreed to mobility assessment. Eighty-nine completed MAT-sf, and 97.8% (87/89) completed 4-meter walk test. Sixty-seven (75%) met eligibility criteria, and 59 (88%) consented to be randomized either to the PA counseling intervention (Video-PA) or to active control (Video-C). Most participants viewed the walk test positively (51/59; 86.4%). Staff reported that completion of patient surveys, MAT-sf, and videos required significant staff time and support (median = 26 minutes for all), resulting in low acceptability of MAT-sf and the videos. Attendance at a PA information session did not differ by randomization group (Video-PA = 11/29 (37.9%); Video-C = 12/30 (40%); 95% confidence interval for difference in proportion = -0.29 to 0.25). CONCLUSIONS Mobility assessment, particularly a 4-meter walk test, was feasible in primary care. Tablet-based assessment (MAT-sf) and video counseling tools, selected to reduce staff effort, instead required significant time to implement. Future work to promote PA should identify effective ways to facilitate adoption of PA in sedentary older adults that do not burden staff.
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Affiliation(s)
- Kathryn E Callahan
- Section on Gerontology and Geriatric Medicine, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina.,Sticht Center for Healthy Aging and Alzheimer's Prevention, Wake Forest School of Medicine, Winston-Salem, North Carolina.,Center for Healthcare Innovation, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - James Willard
- Center for Healthcare Innovation, Wake Forest School of Medicine, Winston-Salem, North Carolina.,Division of Public Health Sciences, Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Kristie L Foley
- Center for Healthcare Innovation, Wake Forest School of Medicine, Winston-Salem, North Carolina.,Division of Public Health Sciences, Department of Implementation Science, Wake Forest School of Medicine, Winston-Salem, North Carolina.,Wake Forest School of Medicine, Wake Forest Translational Science Institute, Winston-Salem, North Carolina.,Cancer Prevention and Control Program, Wake Forest Comprehensive Cancer Center, Winston-Salem, North Carolina
| | - Michael E Miller
- Sticht Center for Healthy Aging and Alzheimer's Prevention, Wake Forest School of Medicine, Winston-Salem, North Carolina.,Division of Public Health Sciences, Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Denise K Houston
- Section on Gerontology and Geriatric Medicine, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina.,Sticht Center for Healthy Aging and Alzheimer's Prevention, Wake Forest School of Medicine, Winston-Salem, North Carolina.,Division of Public Health Sciences, Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Stephen B Kritchevsky
- Section on Gerontology and Geriatric Medicine, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina.,Sticht Center for Healthy Aging and Alzheimer's Prevention, Wake Forest School of Medicine, Winston-Salem, North Carolina.,Wake Forest School of Medicine, Wake Forest Translational Science Institute, Winston-Salem, North Carolina.,Division of Public Health Sciences, Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Jeff D Williamson
- Section on Gerontology and Geriatric Medicine, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina.,Sticht Center for Healthy Aging and Alzheimer's Prevention, Wake Forest School of Medicine, Winston-Salem, North Carolina.,Center for Healthcare Innovation, Wake Forest School of Medicine, Winston-Salem, North Carolina.,Division of Public Health Sciences, Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - William B Applegate
- Section on Gerontology and Geriatric Medicine, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina.,Sticht Center for Healthy Aging and Alzheimer's Prevention, Wake Forest School of Medicine, Winston-Salem, North Carolina.,Division of Public Health Sciences, Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Feben Girma
- Department of General Internal Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Sarah E Whitehead
- Paris View Family Practice, Bon Secours St. Francis Health System, Greenville, South Carolina
| | - W Jack Rejeski
- Sticht Center for Healthy Aging and Alzheimer's Prevention, Wake Forest School of Medicine, Winston-Salem, North Carolina.,Department of Health and Exercise Science, Wake Forest University, Winston-Salem, North Carolina.,Department of Psychology, Wake Forest University, Winston-Salem, North Carolina
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21
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Barry LC, Coman E, Wakefield D, Trestman RL, Conwell Y, Steffens DC. Functional disability, depression, and suicidal ideation in older prisoners. J Affect Disord 2020; 266:366-373. [PMID: 32056900 PMCID: PMC7103559 DOI: 10.1016/j.jad.2020.01.156] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Revised: 01/09/2020] [Accepted: 01/26/2020] [Indexed: 01/05/2023]
Abstract
BACKGROUND The population of older prisoners (age ≥50), a group with high suicide rates, is growing. We sought to explore the associations among functional disability, depression, and suicidal ideation (SI) among older prisoners, focusing on the mediating role of depression. METHODS Study participants were 220 sentenced male inmates age ≥50 who were incarcerated in 8 prisons. Face-to-face interviews were conducted following consent. Functional disability was assessed objectively, using the Short Physical Performance Battery (SPPB), and via self-report by asking participants their level of difficulty climbing stairs and completing activities necessary for daily living in prison (PADLS) such as standing in line for medications. The PHQ-9 and the Geriatric Suicide Ideation Scale assessed depressive symptoms and SI, respectively. Data were analyzed using linear regression models and causal mediation models. RESULTS Participants were racially diverse and ranged from age 50 to 79 years. Whereas each functional disability measure was significantly associated with depressive symptoms, difficulty climbing stairs and PADL disability, but not SPPB score, were independently associated with SI. Depressive symptoms mediated the relationship between functional disability, assessed both objectively and via self-report, and SI. LIMITATIONS Cross-sectional study design; possible under-sampling of participants with depressive symptoms and SI. CONCLUSIONS Our findings have implications for suicide prevention in older prisoners. As this population continues to grow, prevention efforts should target those with depression, including but not limited to those with functional disability. Furthermore, assessing functional disability may offer a means of identifying those who should be screened for depression and suicidal ideation.
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Affiliation(s)
- Lisa C Barry
- University of Connecticut School of Medicine, Department of Psychiatry, Farmington, CT 06030-5215, US; University of Connecticut Health Center, UConn Center on Aging, Farmington, CT 06030-5215, US.
| | - Emil Coman
- University of Connecticut Health Center, Health Disparities Institute, Farmington, CT 06030-7030, US
| | - Dorothy Wakefield
- University of Connecticut Health Center, UConn Center on Aging, Farmington, CT 06030-5215, US
| | - Robert L Trestman
- Virginia Tech Carilion School of Medicine, Department of Psychiatry, Roanoke, VA 24016, US
| | - Yeates Conwell
- Yeates Conwell, MD, University of Rochester School of Medicine, Rochester, NY 14627, US
| | - David C Steffens
- University of Connecticut School of Medicine, Department of Psychiatry, Farmington, CT 06030-5215, US
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22
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Ikegami ÉM, Souza LA, Tavares DMDS, Rodrigues LR. Functional capacity and physical performance of community-dwelling elderly: a longitudinal study. CIENCIA & SAUDE COLETIVA 2020; 25:1083-1090. [PMID: 32159676 DOI: 10.1590/1413-81232020253.18512018] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Accepted: 07/23/2018] [Indexed: 11/22/2022] Open
Abstract
This study aimed to verify the occurrence of changes in the functional capacity and physical performance of community-dwelling elderly and its determining factors over a two-year period. This is a quantitative, observational and longitudinal household survey conducted in 2014 and 2016, with the participation of 380 elderly from Uberaba, Minas Gerais. The following instruments were used: The Mini-Mental State Examination and questionnaires with sociodemographic/economic, clinical and life habits data. The functional capacity was evaluated through the Katz Index and Lawton-Brody's scale. Physical performance was verified through the Short Physical Performance Battery. A descriptive, bivariate and linear multiple regression analysis was conducted, with a significance level of α < 0.05. The results showed reduced functional capacity for the instrumental activities of daily living and physical performance in a two-year period. The determining factors for both outcomes were age group, occupational activity, and physical activity. Schooling was a specific factor only for the instrumental activities of daily living, and gender and the number of medicines used, for physical performance.
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Affiliation(s)
- Érica Midori Ikegami
- Centro de Graduação em Enfermagem, Universidade Federal do Triângulo Mineiro. Praça Manoel Terra 330, Centro. 38015-050, Uberaba, MG, Brasil.
| | - Lara Andrade Souza
- Centro de Graduação em Enfermagem, Universidade Federal do Triângulo Mineiro. Praça Manoel Terra 330, Centro. 38015-050, Uberaba, MG, Brasil.
| | - Darlene Mara Dos Santos Tavares
- Centro de Graduação em Enfermagem, Universidade Federal do Triângulo Mineiro. Praça Manoel Terra 330, Centro. 38015-050, Uberaba, MG, Brasil.
| | - Leiner Resende Rodrigues
- Centro de Graduação em Enfermagem, Universidade Federal do Triângulo Mineiro. Praça Manoel Terra 330, Centro. 38015-050, Uberaba, MG, Brasil.
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23
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Operationalizing the Disablement Process for Research on Older Adults: A Critical Review. Can J Aging 2020; 39:600-613. [PMID: 32000871 DOI: 10.1017/s0714980819000758] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Self-care disability is difficulty with or dependence on others to perform activities of daily living, such as eating and dressing. Disablement is worsening self-care disability measured over time. The disablement process model (DPM) is often used to conceptualize gerontology research on self-care disability and disablement; however, no summary of variables that align with person-level DPM constructs exists. This review summarizes the results of 88 studies to identify the nature and role of variables associated with disability and disablement in older adults according to the person-level constructs (e.g., demographic characteristics, chronic pathologies) in the DPM. It also examines the evidence for cross-sectional applications of the DPM and identifies common limitations in extant literature to address in future research. Researchers can apply these results to guide theory-driven disability and disablement research using routinely collected health data from older adults.
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24
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Nguyen C, Leanos S, Natsuaki MN, Rebok GW, Wu R. Adaptation for Growth Via Learning New Skills as a Means to Long-Term Functional Independence in Older Adulthood: Insights From Emerging Adulthood. THE GERONTOLOGIST 2020; 60:4-11. [PMID: 30321326 DOI: 10.1093/geront/gny128] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Indexed: 11/14/2022] Open
Abstract
Maintenance of functional independence, or the ability to perform daily tasks independently, is a hallmark of successful aging. Healthy older adults are considered functionally independent if they pass a short survey consisting of relatively simple daily activities, including grocery shopping and managing finances. We argue that aging research often has overlooked an important factor for long-term functional independence in a dynamic environment: adaptation for growth via learning new skills. Previous research has focused primarily on compensation and mitigating decline rather than growth. Given that adaptation for growth is at the core of intelligence, resilience, and neuroplasticity, we suggest that functional independence research with older adults could integrate adaptation for growth into the construct, following research on adolescent autonomy and emerging adulthood. After briefly reviewing research on functional independence and compensation in older adulthood, we offer suggestions to push forward gerontological research linking adaptation for growth and functional independence.
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Affiliation(s)
- Courtney Nguyen
- Department of Psychology, University of California, Riverside
| | - Shirley Leanos
- Department of Psychology, University of California, Riverside
| | | | - George W Rebok
- Department of Mental Health, Bloomberg School of Public Health and Johns Hopkins Center on Aging and Health, Johns Hopkins University, Baltimore, Maryland
| | - Rachel Wu
- Department of Psychology, University of California, Riverside
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25
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Operationalization of Concepts of Health and Disability. INTERNATIONAL HANDBOOK OF HEALTH EXPECTANCIES 2020. [DOI: 10.1007/978-3-030-37668-0_1] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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26
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Gaertner B, Busch MA, Scheidt-Nave C, Fuchs J. Limitations in activities of daily living in old age in Germany and the EU - Results from the European Health Interview Survey (EHIS) 2. JOURNAL OF HEALTH MONITORING 2019; 4:48-56. [PMID: 35146257 PMCID: PMC8734179 DOI: 10.25646/6226.2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Accepted: 10/25/2019] [Indexed: 12/02/2022]
Abstract
The health status of older people in Germany can be compared with the health of older people in other European Union (EU) Member States using data on the distribution of limitations in activities of daily living. This concept covers basic limitations in activities of daily living (ADL) such as eating, as well as limitations in instrumental activities of daily living (iADL) such as shopping and managing finances. The second wave of the European Health Interview Survey (EHIS 2) collected data on five ADLs and seven iADLs for people aged 65 or above. An ADL or iADL limitation was defined if a participant reported at least a lot of difficulty in at least one ADL or iADL, respectively. On average, 8.4% of the EU population reported an ADL limitation, with 25.2% reporting an iADL limitation. However, prevalences vary widely between EU Member States and are lower in Germany than the EU average (ADL limitation 6.3%, iADL limitation 14.0%). In general, women, people aged 75 or above, and lower education groups have a higher prevalence of ADL and iADL limitations.
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Affiliation(s)
- Beate Gaertner
- Robert Koch Institute, Berlin Department of Epidemiology and Health Monitoring
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27
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Hopman-Rock M, van Hirtum H, de Vreede P, Freiberger E. Activities of daily living in older community-dwelling persons: a systematic review of psychometric properties of instruments. Aging Clin Exp Res 2019; 31:917-925. [PMID: 30191453 PMCID: PMC6589141 DOI: 10.1007/s40520-018-1034-6] [Citation(s) in RCA: 67] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Accepted: 08/29/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Activities of daily living (ADL) are often used as predictors of health and function in older persons. This systematic review is part of a series initiated by the European Network for Action on Ageing and Physical Activity (EUNAAPA). AIM To assess psychometric properties of ADL instruments for use in older populations. METHODS Electronic databases (Medline, EMBASE, AMED, Psycinfo, CINAHL) were searched, using MeSH terms and relevant keywords. Studies, published in English, were included if they evaluated one or more psychometric properties of ADL instruments in community-dwelling older persons aged 60 years and older. Combination scales with IADL were excluded. This systematic review adhered to a pre-specified protocol regarding reliability, validity, and responsiveness. RESULTS In total, 140 articles describing more than 50 different ADL instruments were included. Ten instruments which were applied in minimally three different articles of good quality (clear descriptions and adequate design according to the protocol), were evaluated for reliability, validity and responsiveness; each received a summary score. The four instruments with the highest scores were the Functional Autonomy Measurement System (SMAF), 5-items Katz list (although content and wording are often inconsistent across studies), Functional Independence and Difficulty Scale (FIDS) and the Barthel Index. DISCUSSION Critical reflection is essential to avoid unnecessary modifications and use of instruments that have not been documented to be valid or reliable. CONCLUSION Based on this systematic review, we recommend the SMAF, 5-item Katz, FIDS and Barthel index as ADL measures for research and care practice in older populations.
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Affiliation(s)
- Marijke Hopman-Rock
- Research center Body@Work TNO (Netherlands Organization for Applied Scientific Research) and VU University Medical Center, Van der Boechhorststraat 7, 1081 BT, Leiden/Amsterdam, The Netherlands.
| | - Helmi van Hirtum
- Research center Body@Work TNO (Netherlands Organization for Applied Scientific Research) and VU University Medical Center, Van der Boechhorststraat 7, 1081 BT, Leiden/Amsterdam, The Netherlands
- Sint Antonius Hospital, Koekoekslaan 1, 3435 CM, Nieuwegein, The Netherlands
| | - Paul de Vreede
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
- Concreet Onderzoeken and Toepassen, Hofzicht 2, 2641 LT, Pijnacker, The Netherlands
| | - Ellen Freiberger
- Institute for Biomedicine of Aging, Friedrich-Alexander University Erlangen-Nürnberg, Kobergerstr. 60, 90408, Nuremberg, Germany.
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28
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Kamitani T, Yamamoto Y, Fukuma S, Ikenoue T, Kimachi M, Shimizu S, Yamamoto S, Otani K, Sekiguchi M, Onishi Y, Takegami M, Ono R, Yamazaki S, Konno S, Kikuchi S, Fukuhara S. Association Between the Discrepancy in Self-Reported and Performance-Based Physical Functioning Levels and Risk of Future Falls Among Community-Dwelling Older Adults: The Locomotive Syndrome and Health Outcomes in Aizu Cohort Study (LOHAS). J Am Med Dir Assoc 2018; 20:195-200.e1. [PMID: 30409491 DOI: 10.1016/j.jamda.2018.09.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Revised: 08/17/2018] [Accepted: 09/10/2018] [Indexed: 11/16/2022]
Abstract
OBJECTIVES A discrepancy in self-reported and performance-based physical functioning levels is often observed among older adults. We investigated the association of discrepancy in self-reported and performance-based physical functioning levels with risk of future falls among community-dwelling older adults. DESIGN Prospective cohort study. SETTING Two communities in Fukushima Prefecture, Japan. PARTICIPANTS 1379 older adults who took part in the yearly health checkup in both 2009 and 2010. MEASURES The performance-based and self-reported physical functioning levels were evaluated by the Timed Up and Go test and the Short-Form 12 Health Survey (Japanese version) physical functioning subscale, respectively. We divided the participants into 4 groups based on the combinations of low or high performance-based and self-reported physical functioning groups, which were classified by age- and sex-specific reference values. The main outcome was the occurrence of any falls within the 1-year follow-up period, assessed using a self-reported questionnaire. RESULTS A total of 22% of the participants reported the occurrence of a fall during the follow-up period. In multivariable logistic regression analysis, the adjusted odds ratios of the high self-reported and low performance-based, low self-reported and high performance-based, and low self-reported and low performance-based physical functioning groups were 1.10 (95% confidence interval [CI], 0.67-1.82), 1.76 (95% CI, 1.17-2.66), and 1.80 (95% CI, 1.11-2.90), respectively, compared with the high self-reported and high performance-based physical functioning group. CONCLUSIONS Our findings suggest that the discrepancy as high performance-based but low self-reported physical functioning level is associated with an increased risk of future falls in older adults aged 65-89 years. Clinicians should carefully assess older adults whose subjective perception of their physical functioning capacity is lower than those in similar age and sex groups, even if their actual physical functioning appears to be objectively high.
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Affiliation(s)
- Tsukasa Kamitani
- Department of Healthcare Epidemiology, School of Public Health in the Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Yosuke Yamamoto
- Department of Healthcare Epidemiology, School of Public Health in the Graduate School of Medicine, Kyoto University, Kyoto, Japan.
| | - Shingo Fukuma
- Human Health Science, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Tatsuyoshi Ikenoue
- Human Health Science, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Miho Kimachi
- Department of Healthcare Epidemiology, School of Public Health in the Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Sayaka Shimizu
- Department of Healthcare Epidemiology, School of Public Health in the Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Shungo Yamamoto
- Department of Healthcare Epidemiology, School of Public Health in the Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Koji Otani
- Department of Orthopedic Surgery, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Miho Sekiguchi
- Department of Orthopedic Surgery, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Yoshihiro Onishi
- Institute for Health Outcomes and Process Evaluation Research (iHope International), Kyoto, Japan
| | - Misa Takegami
- Department of Preventive Medicine and Epidemiologic Informatics, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Rei Ono
- Department of Community Health Sciences, Kobe University Graduate School of Health Sciences, Kobe, Japan
| | - Shin Yamazaki
- Center for Environmental Health Sciences, National Institute for Environmental Studies, Tsukuba, Japan
| | - Shinichi Konno
- Department of Orthopedic Surgery, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Shinichi Kikuchi
- Department of Orthopedic Surgery, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Shunichi Fukuhara
- Department of Healthcare Epidemiology, School of Public Health in the Graduate School of Medicine, Kyoto University, Kyoto, Japan; Center for Innovative Research for Communities and Clinical Excellence (CIRC(2)LE), Fukushima Medical University, Fukushima, Japan
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29
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Winters-Stone KM, Medysky ME, Savin MA. Patient-reported and objectively measured physical function in older breast cancer survivors and cancer-free controls. J Geriatr Oncol 2018; 10:311-316. [PMID: 30344000 DOI: 10.1016/j.jgo.2018.10.006] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Revised: 09/28/2018] [Accepted: 10/10/2018] [Indexed: 01/16/2023]
Abstract
OBJECTIVES Older breast cancer survivors (BCS) consistently report more functional limitations than women without cancer, but whether or not these differences remain when using objective measures of physical functioning and the correlates of these measures is unknown. METHODS Cross-sectional study comparing older (≥60 years old) BCS (n = 84) to similarly aged women without cancer (n = 40). Patient-reported physical function was assessed by the SF-36 physical function (SF-36PF) subscale and the Late Life Function & Disability Instrument (LLFDI). Objective measures included the short Physical Performance Battery (sPPB), usual walk speed (m/s), chair stand time (sec) and, grip strength (kg). Potential predictors included age, comorbidities, symptom severity, fatigue and skeletal muscle index (SMI; kg/m2). RESULTS Patient-reported physical function was significantly lower in BCS than controls using SF-36PF (47.3 ± 0.1 vs. 52.9 ± 4.0, p < 0.001) and LLFDI (68.2 ± 10.5 vs. 75.0 ± 8.9, p = 0.001). BCS had significantly lower sPPB scores (10.7 ± 0.1 vs. 11.7 ± 0.5, p < 0.001), longer chair stand times (12.6 ± 3.7 vs. 10.1 ± 1.4 s, p < 0.001), and lower handgrip strength (22.3 ± 5.0 vs. 24.3 ± 4.4 kg, p = 0.03) than controls, but similar walk speed (1.1+0.2 vs. 1.1+0.1 m/s, p = 0.75). Within BCS, age, comorbidities, SMI, symptom severity and fatigue explained 17.3%-33.1% of the variance across physical function measures. Fatigue was the variable most consistently associated with patient-reported physical functioning and age and comorbidities were the variables most consistently associated with objectively measured physical functioning. CONCLUSION Older BCS should be screened for functional limitations using simple standardized objective tests and interventions that focus on improving strength and reducing fatigue should be tested.
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Affiliation(s)
- Kerri M Winters-Stone
- Knight Cancer Institute, Oregon Health and Science University, 2720 SW Moody Ave, Mailcode KCRB-CPC, Portland, OR 97201, USA; School of Nursing, Oregon Health and Science University, 3455 SW, US Veterans Rd, Portland, OR, USA.
| | - Mary E Medysky
- School of Nursing, Oregon Health and Science University, 3455 SW, US Veterans Rd, Portland, OR, USA
| | - Michael A Savin
- Knight Cancer Institute, Oregon Health and Science University, 2720 SW Moody Ave, Mailcode KCRB-CPC, Portland, OR 97201, USA
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30
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Nielsen LM, Maribo T, Kirkegaard H, Petersen KS, Oestergaard LG. Development of a complex intervention aimed at reducing the risk of readmission of elderly patients discharged from the emergency department using the intervention mapping protocol. BMC Health Serv Res 2018; 18:588. [PMID: 30055597 PMCID: PMC6064169 DOI: 10.1186/s12913-018-3391-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2017] [Accepted: 07/15/2018] [Indexed: 11/10/2022] Open
Abstract
Background Limitations in performing daily activities and a incoherent discharge are risk factors for readmission of elderly patients after discharge from the emergency department. This paper describes the development and design of a complex intervention whose aim was to reduce the risk of readmission of elderly patients discharged from the emergency department. Methods The intervention was described using the Intervention Mapping approach. In step 1, a needs assessment was conducted to analyse causes of readmission. In steps 2 and 3, expected improvements in terms of intervention outcomes, performance objectives and change objectives were specified and linked to selected theory- and evidence-based methods. In step 4, the specific intervention components were developed; and in step 5, an implementation plan was described. Finally, in step 6, a plan for evaluating the effectiveness of the intervention was described. The intervention was informed by input from a literature search, informal interviews and an expert steering group. Results A three-phased theory- and evidence-based intervention was developed. The intervention consisted of 1) assessment of performance of daily activities, 2) defining a rehabilitation plan and 3) a follow-up home visit the day after discharge with focus on enhancing the patients’ performance of daily activities. Conclusion The intervention mapping protocol was found to be a useful method to describe and systemize this theory- and evidence-based intervention. Electronic supplementary material The online version of this article (10.1186/s12913-018-3391-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Louise Moeldrup Nielsen
- Department of Physiotherapy and Occupational Therapy, Aarhus University Hospital, Aarhus, Denmark. .,Department of Occupational Therapy, VIA University College, Aarhus, Denmark.
| | - Thomas Maribo
- Department of Public Health, Aarhus University, Aarhus, Denmark.,DEFACTUM, Central Denmark Region , Aarhus, Denmark
| | - Hans Kirkegaard
- Research Center for Emergency Medicine, Aarhus University Hospital, Aarhus, Denmark
| | | | - Lisa Gregersen Oestergaard
- Department of Physiotherapy and Occupational Therapy, Aarhus University Hospital, Aarhus, Denmark.,Department of Public Health, Aarhus University, Aarhus, Denmark.,Centre of Research in Rehabilitation (CORIR) Department of Clinical Medicin, Aarhus University and Aarhus University Hospital, Aarhus, Denmark
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Muramatsu N, Yin L, Berbaum ML, Marquez DX, Jurivich DA, Zanoni JP, Cruz Madrid KY, Walton SM. Promoting Seniors' Health With Home Care Aides: A Pilot. THE GERONTOLOGIST 2018; 58:779-788. [PMID: 28633502 PMCID: PMC6044396 DOI: 10.1093/geront/gnx101] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2017] [Indexed: 11/13/2022] Open
Abstract
Purpose Regular physical activity (PA) benefits older adults. However, frail older adults lack opportunities to be physically active. This pilot study aimed to test and enhance the feasibility of a PA program delivered by home care aides (HCAs) for community-dwelling older adults in a Medicaid-funded home care setting and to generate preliminary efficacy and cost data. Design and Methods HCAs were trained to deliver a brief motivational enhancement and three chair-bound movements to motivate their older clients to do PA daily and to help maintain their independence in the community. Mixed methods were used to evaluate clients' function and health before and after the 4-month intervention. Results Clients' daily activity function and health outcomes (physical fitness, self-rated health, pain interference, and fear of falling) improved significantly. The program was well-received by clients (N = 54) and their HCAs (N = 46) as indicated by high retention rates among client participants (93%) and remarks provided by clients. Implications Building PA into the everyday care of older adults and the routine work of HCAs is feasible. The intervention has the potential for further implementation and dissemination.
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Affiliation(s)
- Naoko Muramatsu
- School of Public Health, University of Illinois at Chicago
- Institute for Health Research and Policy, University of Illinois at Chicago
| | - Lijuan Yin
- School of Public Health, University of Illinois at Chicago
- Institute for Health Research and Policy, University of Illinois at Chicago
| | - Michael L Berbaum
- Institute for Health Research and Policy, University of Illinois at Chicago
| | - David X Marquez
- Institute for Health Research and Policy, University of Illinois at Chicago
- Department of Kinesiology and Nutrition, University of Illinois at Chicago
| | - Donald A Jurivich
- Section of Geriatrics, School of Medicine and Health Sciences, University of North Dakota, Grand Forks
| | | | - Katya Y Cruz Madrid
- Division of Academic Internal Medicine and Geriatrics, University of Illinois at Chicago and Jesse Brown VA Health Care System
| | - Surrey M Walton
- Institute for Health Research and Policy, University of Illinois at Chicago
- College of Pharmacy, University of Illinois at Chicago
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Granic A, Mossop H, Engstrom G, Davies K, Dodds R, Galvin J, Ouslander JG, Tappen R, Sayer AA. Factors Associated With Physical Performance Measures in a Multiethnic Cohort of Older Adults. Gerontol Geriatr Med 2018; 4:2333721418778623. [PMID: 29977978 PMCID: PMC6024280 DOI: 10.1177/2333721418778623] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Revised: 03/23/2018] [Accepted: 04/26/2018] [Indexed: 12/29/2022] Open
Abstract
Objective: To explore the association between ethnicity, sociodemographic, health, and lifestyle factors, and physical performance (PP) in ethnically diverse community-dwelling older adults from one geographic area. Method: We used multivariable linear regression to identify factors associated with upper (grip strength [GS], arm curls [AC]) and lower (chair stands [CS]) body strength and mobility (gait speed [GSp]) in 577 older adults (mean age 74 ± 8; 104 African American, 142 Afro-Caribbean, 123 Hispanic, and 208 European American) from South Florida. Results: Worse mental health was negatively associated with CS in African Americans and AC in Hispanics. Older age and higher body mass index (BMI) was associated with slower GSp in all except in Hispanics. Higher physical activity was associated with higher upper body strength in Hispanics and better mobility in African Americans and Afro-Caribbeans, but not in European Americans. Conclusion: Studies with large multiethnic cohorts are needed to further our understanding of ethnic differences in PP, which will help in tailoring interventions and recognizing unmet needs for health and social services.
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Affiliation(s)
| | | | | | | | - Richard Dodds
- Newcastle University, Newcastle upon Tyne, UK.,University of Southampton, UK
| | | | | | - Ruth Tappen
- Florida Atlantic University, Boca Raton, USA
| | - Avan A Sayer
- Newcastle University, Newcastle upon Tyne, UK.,University of Southampton, UK
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Verweij L, van de Korput E, Daams JG, Ter Riet G, Peters RJG, Engelbert RHH, Scholte Op Reimer WJM, Buurman BM. Effects of Postacute Multidisciplinary Rehabilitation Including Exercise in Out-of-Hospital Settings in the Aged: Systematic Review and Meta-analysis. Arch Phys Med Rehabil 2018; 100:530-550. [PMID: 29902471 DOI: 10.1016/j.apmr.2018.05.010] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Revised: 05/02/2018] [Accepted: 05/04/2018] [Indexed: 10/14/2022]
Abstract
OBJECTIVE Many older individuals receive rehabilitation in an out-of-hospital setting (OOHS) after acute hospitalization; however, its effect on mobility and unplanned hospital readmission is unclear. Therefore, a systematic review and meta-analysis were conducted on this topic. DATA SOURCES Medline OVID, Embase OVID, and CINAHL were searched from their inception until February 22, 2018. STUDY SELECTION OOHS (ie, skilled nursing facilities, outpatient clinics, or community-based at home) randomized trials studying the effect of multidisciplinary rehabilitation were selected, including those assessing exercise in older patients (mean age ≥65y) after discharge from hospital after an acute illness. DATA EXTRACTION Two reviewers independently selected the studies, performed independent data extraction, and assessed the risk of bias. Outcomes were pooled using fixed- or random-effect models as appropriate. The main outcomes were mobility at and unplanned hospital readmission within 3 months of discharge. DATA SYNTHESIS A total of 15 studies (1255 patients) were included in the systematic review and 12 were included in the meta-analysis (7 assessing mobility using the 6-minute walk distance [6MWD] test and 7 assessing unplanned hospital readmission). Based on the 6MWD, patients receiving rehabilitation walked an average of 23 m more than controls (95% confidence interval [CI]=: -1.34 to 48.32; I2: 51%). Rehabilitation did not lower the 3-month risk of unplanned hospital readmission (risk ratio: 0.93; 95% CI: 0.73-1.19; I2: 34%). The risk of bias was present, mainly due to the nonblinded outcome assessment in 3 studies, and 7 studies scored this unclearly. CONCLUSION OOHS-based multidisciplinary rehabilitation leads to improved mobility in older patients 3 months after they are discharged from hospital following an acute illness and is not associated with a lower risk of unplanned hospital readmission within 3 months of discharge. However, the wide 95% CIs indicate that the evidence is not robust.
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Affiliation(s)
- Lotte Verweij
- ACHIEVE, Center of Applied Research, Amsterdam University of Applied Sciences, Amsterdam, the Netherlands; Department of Internal Medicine, Section of Geriatric Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands; Department of Cardiology and Geriatric Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands.
| | - Eva van de Korput
- Department of Internal Medicine, Section of Geriatric Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Joost G Daams
- Research Support, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Gerben Ter Riet
- Department of General Practice, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Ron J G Peters
- Department of Cardiology and Geriatric Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Raoul H H Engelbert
- ACHIEVE, Center of Applied Research, Amsterdam University of Applied Sciences, Amsterdam, the Netherlands; Department of Rehabilitation, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Wilma J M Scholte Op Reimer
- ACHIEVE, Center of Applied Research, Amsterdam University of Applied Sciences, Amsterdam, the Netherlands; Department of Cardiology and Geriatric Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Bianca M Buurman
- ACHIEVE, Center of Applied Research, Amsterdam University of Applied Sciences, Amsterdam, the Netherlands; Department of Internal Medicine, Section of Geriatric Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
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MacEwan JP, Gill TM, Johnson K, Doctor J, Sullivan J, Shim J, Goldman DP. Measuring Sarcopenia Severity in Older Adults and the Value of Effective Interventions. J Nutr Health Aging 2018; 22:1253-1258. [PMID: 30498834 PMCID: PMC6302764 DOI: 10.1007/s12603-018-1104-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Accepted: 04/30/2018] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Little is known about the severity and long-term health and economic consequences of sarcopenia. We developed a sarcopenia index to measure severity in older Americans and estimated the long-term societal benefits generated by effective interventions to mitigate severity. DESIGN Using a micro-simulation model, we quantified the potential societal value generated in the US in 2010-2040 by reductions in sarcopenia severity in older adults. All analyses were performed in Stata and SAS. SETTING AND PARTICIPANTS Secondary data from the National Health and Nutrition Examination Survey (NHANES) (N = 1634) and Health and Retirement Study (HRS) (N = 952) were used to develop a sarcopenia severity index in older adults. MEASUREMENTS Multi-trait multi-method and factor analyses were used to validate and calibrate the sarcopenia severity index, which was modeled as a function of gait speed, walking without an assistive device, and moderate physical activity. RESULTS In representative elderly populations, reducing sarcopenia severity by improving gait speed by 0.1 m/s in those with gait speed under 0.8 m/s generated a cumulative benefit of $65B by 2040 (2015 dollars). Improving walking ability in those with walking difficulty generated cumulative social benefit of $787B by 2040. CONCLUSIONS Reducing sarcopenia severity would generate significant health and economic benefits to society-almost $800B in the most optimistic scenarios.
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Affiliation(s)
- J P MacEwan
- Joanna P. MacEwan, Precision Health Economics, 11100 Santa Monica Blvd. Suite 500, Los Angeles, CA 90025, Phone: 310-984-7718,
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Kabayama M, Mikami H, Kamide K. Multidimensional factors associated with the loss of independence: A population-based longitudinal study. Geriatr Gerontol Int 2017; 18:448-455. [PMID: 29235230 DOI: 10.1111/ggi.13209] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 09/22/2017] [Accepted: 09/28/2017] [Indexed: 11/29/2022]
Abstract
AIM To clarify the factors associated with loss of independence multidimensionally over a 3-year period among community-dwelling older adults. METHODS The survey was exclusively carried out by the local government for people aged >65 years who were independent at baseline living in H-City, a mid-sized urban city in Japan. The participants completed a self-administered postal questionnaire, and we obtained data regarding their loss of independence from administrative records 3 years later. RESULTS A total of 22 328 participants completed the follow up (baseline mean age 71.6 years). At follow up, 998 (4.3%) participants were categorized as dependent, with 606 requiring partial support in toileting, bathing and so on (mild loss of independence), and 392 requiring complete support (severe loss). Factors independently associated with mild loss of independence after 3 years for both men and women were advanced age, low physical function, low nutritional status, low cognitive function and high depression risk. In contrast, factors independently associated with severe loss of independence were advanced age, low physical function and high depression risk in men, and advanced age, and low physical and cognitive function in women. CONCLUSIONS We clarified the variety of factors associated with loss of independence according to its severity, and the strength of those independent associations was different in the whole city longitudinal study. The present study's findings have important clinical implications for the development of better preventive medicine to establish a society of healthy longevity. Geriatr Gerontol Int 2018; 18: 448-455.
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Affiliation(s)
- Mai Kabayama
- Department of Health Promotion Sciences, Division of Health Sciences, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Hiroshi Mikami
- Osaka Pharmacology Clinical Research Hospital, Osaka, Japan
| | - Kei Kamide
- Department of Health Promotion Sciences, Division of Health Sciences, Osaka University Graduate School of Medicine, Osaka, Japan
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Gill TM, Williams CS. Evaluating Distinctions in the Assessment of Late-Life Disability. J Gerontol A Biol Sci Med Sci 2017; 72:1538-1546. [PMID: 28329106 DOI: 10.1093/gerona/glx022] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Accepted: 01/24/2017] [Indexed: 11/14/2022] Open
Abstract
Background By including categories for accommodations and reduced frequency, to supplement earlier classifications of difficulty and dependence, a new 5-category functional scale has the potential to distinguish finer gradations in disability but the hierarchical nature and advantages of this scale over alternative scales are uncertain. Methods Using data from the National Health and Aging Trends Study (N = 7,609), we conducted a series of: cross-sectional analyses that focused on the hierarchical consistency of responses in the 5-category scale; and longitudinal analyses that focused on predictive accuracy for mortality and functional dependence, comparing the 5-category scale with three simpler scales, having only three or four categories. Results Although there was considerable variability across the seven functional activities, the prevalence of inconsistencies in the hierarchy of the 5-category scale (eg, reports difficulty but no accommodations) was relatively high. In addition, the predictive accuracy of the 5-category scale for mortality and functional dependence was only modestly better than that of the two 3-category scales and was comparable to that of the 4-category scale. Finally, when evaluated as summative disability scores, there was little difference in predictive accuracy between the 5-category scale and three alternative scales. Conclusions Despite inconsistencies in its hierarchy, the 5-category scale is more effective in stratifying risk for mortality and functional dependence than the two 3-category scales but not the 4-category scale. When assessing changes over time, however, the addition of questions on accommodations and reduced frequency to those on difficulty and dependence, to form a summative disability score, offers little benefit and increases the burden of the assessment.
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Affiliation(s)
- Thomas M Gill
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Christianna S Williams
- Cecil G. Sheps Center for Health Services Research, University of North Carolina, Chapel Hill
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Abstract
The objectives of this study, presented as part of a plenary session at WW7 in Hyderabad, India were to review (i) the epidemiology and current clinical issues of HIV infection with regard to HIV and older populations and (ii) models for increased morbidity and mortality in older HIV-positive individuals with implications for clinical care. HIV infection for those in treatment has become a complex chronic disease in which end-organ injury and resulting morbidity, functional decline, and mortality do not have a single etiology but reflect cumulative loss of organ system reserve from multiple interacting sources leading to functional decline, organ system failure, and death. Emerging guidelines and recommendations suggest a need for increased awareness and treatment of the multifaceted needs of the aging HIV-infected patient.
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Affiliation(s)
- M John
- Department of Medicine, University of California at San Francisco, San Francisco, CA, USA
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38
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Bernabeu-Mora R, Giménez-Giménez LM, Montilla-Herrador J, García-Guillamón G, García-Vidal JA, Medina-Mirapeix F. Determinants of each domain of the Short Physical Performance Battery in COPD. Int J Chron Obstruct Pulmon Dis 2017; 12:2539-2544. [PMID: 28883721 PMCID: PMC5574685 DOI: 10.2147/copd.s138402] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND The Short Physical Performance Battery (SPPB) is an assessment tool with good prognostic value in COPD. It includes the following: standing balance, 4 m gait speed test (4MGS), and the timed five-repetition sit-to-stand test (5STS). The specific differences in determinants between these three tasks have not been adequately characterized in COPD patients. We aimed to identify health-related, functional, and psychological determinants of each SPPB test. METHODS We conducted a cross-sectional analysis of 137 patients with stable COPD. Patients performed the SPPB, quadriceps muscle strength (QMS), exercise tolerance test (6-min walk test [6MWT]), and pulmonary function; and health-related and psychological factors, physical activity, the COPD assessment test (CAT), body mass index, age, and depression were assessed. RESULTS Separate multivariable regression models predicting the 4MGS, 5STS, and balance test results described 31%, 39.1%, and 12.1% of the variance for each test, respectively. QMS was negatively associated with all three tests. The 6MWT was negatively associated with the 4MGS and 5STS. Depression and age were positively associated with 4MGS scores, whereas CAT and age were positively associated with 5STS scores. CONCLUSION The three SPPB tests did not provide equivalent information regarding a COPD patient's status. The 5STS was associated with health status factors, while the 4MGS was associated with psychological factors.
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Omega-3 fatty acid levels in red blood cell membranes and physical decline over 3 years: longitudinal data from the MAPT study. GeroScience 2017; 39:429-437. [PMID: 28831714 DOI: 10.1007/s11357-017-9990-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Accepted: 08/10/2017] [Indexed: 10/19/2022] Open
Abstract
Studies have shown that omega-3 polyunsaturated fatty acids (PUFAs) are associated with brain, cardiovascular, and immune function, as well as physical performance and bone health in older adults. So far, few studies have investigated the associations between PUFA status and performance-based tests of physical function. The objective of this study was to investigate the associations between the omega-3 PUFA levels (eicosapentaenoic acid (EPA), docosahexaenoic acid (DHA)) in red blood cell (RBC) membranes and physical performance, in a sample of community-dwelling older adults. This is a longitudinal observational study using data from the Multidomain Alzheimer's Disease Trial (MAPT), a randomized, placebo-controlled trial. Four hundred participants from MAPT placebo group with available PUFA data were included. Omega-3 PUFA levels in RBC membranes were measured at baseline, and their percentage of total RBC membrane fatty acid content was calculated. We dichotomized the standardized omega-3 PUFA levels in RBC membranes as low (lowest quartile) vs. high (three upper quartiles). Gait speed (in m/s) and short physical performance battery (SPPB) score (range from 0 to 12, higher is better) were used to assess physical performance at baseline and after 6, 12, 24, and 36 months. Participants were 75.2 (± 4.3) years old and 68% were female. Bivariate analyses found that the characteristic of the participants in the lowest quartile of omega-3 PUFA levels (Q1) and those in the three upper quartiles (Q2-Q4) was not different at baseline; only those in Q1 were slightly older. In an unadjusted model, the difference in gait speed after 3 years of follow-up was significant (- 0.09 ± 0.03 m/s; p = 0.008) between participants in Q1 and those in Q2-Q4. In a model adjusted for age, gender, educational level, cognitive function, depressive status, body mass index, physical activity, grip strength, and their time interaction, this difference remained clinically relevant (- 0.07 ± 0.04 m/s; p = 0.075). No difference between the two groups was found for the SPPB score development over 3 years. Older adults with subjective memory complaints and in the lower quartile of omega-3 have a faster decline on gait speed compared to people in the three upper quartiles. Other longitudinal studies are needed to explore this association and to examine mechanisms.
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Validity of the German Version of the Continuous-Scale Physical Functional Performance 10 Test. J Aging Res 2017; 2017:9575214. [PMID: 28775900 PMCID: PMC5523344 DOI: 10.1155/2017/9575214] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Accepted: 06/01/2017] [Indexed: 11/18/2022] Open
Abstract
Background The Continuous-Scale Physical Functional Performance 10 Test (CS-PFP 10) quantitatively assesses physical functional performance in older adults who have a broad range of physical functional ability. This study assessed the validity and reliability of the CS-PFP 10 German version. Methods Forward-translations and backtranslations as well as cultural adaptions of the test were conducted. Participants were German-speaking Swiss community-dwelling adults aged 64 and older. Concurrent validity was assessed using Pearson correlation coefficients between CS-PFP 10 and gait velocity, Timed Up and Go Test, hand grip strength, SF-36 physical function domain, and Freiburger Physical Activity Questionnaire. Internal consistency was calculated by Cronbach's alpha. Results Backtranslation and cultural adaptions were accepted by the CS-PFP 10 developer. CS-PFP 10 total score and subscores (upper body strength, upper body flexibility, lower body strength, balance and coordination, and endurance) correlated significantly with all measures of physical function tested. Internal consistency was high (Cronbach's alpha 0.95–0.98). Conclusion The CS-PFP 10 German version is valid and reliable for measuring physical functional performance in German-speaking Swiss community-dwelling older adults. Quantifying physical function is essential for clinical practice and research and provides meaningful insight into physical functional performance of older adults. This trial is registered with ClinicalTrials.gov NCT01539200.
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Clarke P, Hirsch JA, Melendez R, Winters M, Sims Gould J, Ashe M, Furst S, McKay H. Snow and Rain Modify Neighbourhood Walkability for Older Adults. Can J Aging 2017; 36:159-169. [PMID: 28390449 PMCID: PMC5423849 DOI: 10.1017/s071498081700006x] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
The literature has documented a positive relationship between walkable built environments and outdoor mobility in older adults. Yet, surprisingly absent is any consideration of how weather conditions modify the impact of neighbourhood walkability. Using archived weather data linked to survey data collected from a sample of older adults in Vancouver, Canada, we found that car-dependent neighbourhoods (featuring longer block lengths, fewer intersections, and greater distance to amenities) became inaccessible in snow. Even older adults who lived in very walkable neighbourhoods walked to 25 per cent fewer destinations in snow. It is crucial to consider the impact of weather in the relationship between neighbourhood walkability and older adult mobility.
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Affiliation(s)
- Philippa Clarke
- Institute for Social Research,Department of Epidemiology,University of Michigan
| | - Jana A Hirsch
- Carolina Population Center,University of North Carolina at Chapel Hill
| | | | | | - Joanie Sims Gould
- Centre for Hip Health and Mobility and Department of Family Practice,University of British Columbia
| | - Maureen Ashe
- Centre for Hip Health and Mobility and Department of Family Practice,University of British Columbia
| | - Sarah Furst
- Centre for Hip Health and Mobility,University of British Columbia
| | - Heather McKay
- Centre for Hip Health and Mobility and Department of Family Practice,University of British Columbia
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Saito T, Matsui N, Watanabe S. Predictive validity of the functional independence and difficulty scale in community-dwelling Japanese older adults. J Phys Ther Sci 2017; 29:914-920. [PMID: 28603371 PMCID: PMC5462698 DOI: 10.1589/jpts.29.914] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2017] [Accepted: 02/20/2017] [Indexed: 11/24/2022] Open
Abstract
[Purpose] The newly developed Functional Independence and Difficulty Scale is a tool for
assessing the performance of basic activities of daily living in terms of both
independence and difficulty. The aim of this study was to examine the predictive validity
of the scale for decline of instrumental activities of daily living ability and multiple
falls during a 24-month follow-up period. [Subjects and Methods] One-hundred forty older
adults (median age 74.0, 60% women) completed baseline data collection and a follow-up
postal survey. At baseline, background variables, the Functional Independence and
Difficulty Scale, and instrumental activities of daily living ability assessed by the five
sub-items of Tokyo Metropolitan Institute of Gerontology Index of Competence were
recorded. At follow-up, data on instrumental activities of daily living ability and falls
in the previous 12 months were obtained. [Results] Of the 140 participants, 15 (10.7%)
declined in instrumental activities of daily living ability and 14 (10.0%) experienced
multiple falls. The Functional Independence and Difficulty Scale at baseline independently
predicted decline of instrumental activities of daily living ability and multiple falls.
[Conclusion] The Functional Independence and Difficulty Scale predicts subsequent decline
of instrumental activities of daily living ability and multiple falls.
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Affiliation(s)
| | - Nobuko Matsui
- Department of Physical Therapy, Tokyo College of Allied Medicine, Japan
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Saito T, Izawa KP, Matsui N, Arai K, Ando M, Morimoto K, Fujita N, Takahashi Y, Kawazoe M, Watanabe S. Comparison of the measurement properties of the Functional Independence and Difficulty Scale with the Barthel Index in community-dwelling elderly people in Japan. Aging Clin Exp Res 2017; 29:273-281. [PMID: 26988689 DOI: 10.1007/s40520-016-0558-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2015] [Accepted: 03/02/2016] [Indexed: 11/28/2022]
Abstract
BACKGROUND The new Functional Independence and Difficulty Scale (FIDS) is a tool for assessing the performance of basic activities of daily living (BADL). Because many BADL measures already exist, it is important to know whether FIDS can offer added benefit over the existing measures. AIMS This study compared measurement properties between the FIDS and a representative BADL assessment tool, the Barthel Index (BI). METHODS Recruitment of the participants was done on the basis of convenience sampling. Participants were community-dwelling elderly Japanese subjects (n = 314; age ≥65 years) divided into a healthy elderly group [n = 225; subjects not using long-term care insurance (LTCI) services] and frail elderly group (n = 89; subjects using LTCI services). For each group, ceiling effect (percent participation with the maximum score) was calculated, and it was compared between the two scales. Associations between the FIDS, BI and Medical Outcomes Study Short Form 8 Health Survey (SF-8) were evaluated by Spearman correlation coefficient and partial correlations. Partial correlations coefficients to SF-8 were compared between the two scales. RESULTS FIDS showed a relatively small ceiling effect compared to the BI. Compared to the BI, FIDS showed a significant positive partial correlation with the broader aspect of the SF-8 subscales, but the strength of correlation between FIDS and SF-8 was weak to negligible. CONCLUSIONS The FIDS might be less affected by ceiling effect than the BI. Additional studies using a sufficient number of probability samples are needed to clarify whether FIDS has any benefit over BI in terms of correlations with the SF-8.
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Affiliation(s)
- Takashi Saito
- Doctoral Course of Gerontology, Graduate School of Gerontology, J. F. Oberlin University, 3758 Tokiwa-machi, Machida-shi, Tokyo, 194-0294, Japan.
| | - Kazuhiro P Izawa
- Graduate School of Health Sciences, Kobe University, Kobe, Japan
| | - Nobuko Matsui
- Department of Physical Therapy, Tokyo College of Allied Medicine, Tokyo, Japan
| | - Kenji Arai
- Department of Rehabilitation, Visiting Nursing and Rehabilitation Network, Kanagawa, Japan
| | - Makoto Ando
- Department of Rehabilitation, Visiting Nursing and Rehabilitation Network, Kanagawa, Japan
| | - Kazuhiro Morimoto
- Department of Rehabilitation, Visiting Nursing and Rehabilitation Network, Kanagawa, Japan
| | - Naoki Fujita
- Department of Rehabilitation, Visiting Nursing and Rehabilitation Network, Kanagawa, Japan
| | - Yuki Takahashi
- Department of Rehabilitation, Visiting Nursing and Rehabilitation Network, Kanagawa, Japan
| | - Moe Kawazoe
- Department of Rehabilitation, Visiting Nursing and Rehabilitation Network, Kanagawa, Japan
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Suijker JJ, van Rijn M, Ter Riet G, Moll van Charante EP, de Rooij SE, Buurman BM. Minimal Important Change and Minimal Detectable Change in Activities of Daily Living in Community-Living Older People. J Nutr Health Aging 2017; 21:165-172. [PMID: 28112771 DOI: 10.1007/s12603-016-0797-8] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
OBJECTIVE To estimate the minimal important change (MIC) and the minimal detectable change (MDC) of the Katz-activities of daily living (ADL) index score and the Lawton instrumental activities of daily living (IADL) scale. DESIGN Data from a cluster-randomized clinical trial and a cohort study. SETTING General practices in the Netherlands. PARTICIPANTS 3184 trial participants and 51 participants of the cohort study with a mean age of 80.1 (SD 6.4) years. MEASUREMENTS At baseline and after 6 months, the Katz-ADL index score (0-6 points), the Lawton IADL scale (0-7 points), and self-perceived decline in (I)ADL were assessed using a self-reporting questionnaire. MIC was assessed using anchor-based methods: the (relative) mean change score; and using distributional methods: the effect size (ES), the standard error of measurement (SEM), and 0.5 SD. The MDC was estimated using SEM, based on a test-retest study (2-week interval) and on the anchor-based method. RESULTS Anchor-based MICs of the Katz-ADL index score were 0.47 points, while distributional MICs ranged from 0.18 to 0.47 points. Similarly, anchor-based MICs of the Lawton IADL scale were between 0.31 and 0.54 points and distributional MICs ranged from 0.31 to 0.77 points. The MDC varies by sample size. For the MIC to exceed the MDC at least 482 patients are needed. CONCLUSION The MIC of both the Katz-ADL index and the Lawton IADL scale lie around half a point. The certainty of this conclusion is reduced by the variation across calculational methods.
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Affiliation(s)
- J J Suijker
- Jacqueline J Suijker, MD, Academic Medical Center, Department of General Practice and Public Health, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands.
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Nielsen LM, Kirkegaard H, Østergaard LG, Bovbjerg K, Breinholt K, Maribo T. Comparison of self-reported and performance-based measures of functional ability in elderly patients in an emergency department: implications for selection of clinical outcome measures. BMC Geriatr 2016; 16:199. [PMID: 27899065 PMCID: PMC5129645 DOI: 10.1186/s12877-016-0376-1] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2016] [Accepted: 11/23/2016] [Indexed: 11/10/2022] Open
Abstract
Background Assessment of functional ability in elderly patients is often based on self-reported rather than performance-based measures. This study aims to compare self-reported and performance-based measures of functional ability in a population of elderly patients at an emergency department (ED). Methods Participants were 61 patients aged 65 years and above admitted to an ED. The self-reported measure used was the Barthel-20; the performance-based measures were Timed Up and Go (TUG); 30s-Chair Stand Test (30s-CST) and Assessment of Motor and Process Skills (AMPS) with the two scales; motor and process. Correlation analyses were conducted to examine the relationships between the self-reported and performance-based measures of functional ability. Results The correlation between the Barthel-20 and the TUG was moderate (r = −0.64). The correlation between the Barthel-20 and the AMPS motor was also moderate (r = 0.53). The correlation between the Barthel-20 and the 30s-CST was fair (r = 0.45). The correlation between Barthel-20 and the AMPS process was non-significant. The results were affected by high ceiling effect (Barthel-20). Conclusion Self-reported and performance-based measures seem to assess different aspects of functional ability. Thus, the two methods provide different information, and this highlight the importance of supplementing self-reported measures with performance-based measures when assessing functional ability in elderly patients. Electronic supplementary material The online version of this article (doi:10.1186/s12877-016-0376-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Louise M Nielsen
- Department of Physiotherapy and Occupational Therapy, Aarhus University Hospital, Aarhus C, Denmark. .,School of Occupational Therapy at VIA University College, Aarhus N, Denmark.
| | - Hans Kirkegaard
- Research Center for Emergency Medicine, Aarhus University Hospital, Aarhus C, Denmark
| | - Lisa G Østergaard
- Department of Physiotherapy and Occupational Therapy, Aarhus University Hospital, Aarhus C, Denmark
| | - Karina Bovbjerg
- Department of Physiotherapy and Occupational Therapy, Aarhus University Hospital, Aarhus C, Denmark
| | - Kasper Breinholt
- Department of Physiotherapy and Occupational Therapy, Aarhus University Hospital, Aarhus C, Denmark
| | - Thomas Maribo
- MarselisborgCentret, DEFACTUM, Central Denmark Region, Department of Public Health, Aarhus University, Aarhus C, Denmark
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The relative and absolute reliability of the Functional Independence and Difficulty Scale in community-dwelling frail elderly Japanese people using long-term care insurance services. Aging Clin Exp Res 2016; 29:549-556. [PMID: 27149862 DOI: 10.1007/s40520-016-0577-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Accepted: 04/20/2016] [Indexed: 01/21/2023]
Abstract
BACKGROUND The newly developed Functional Independence and Difficulty Scale is a tool for assessing the performance of basic activities of daily living in terms of both independence and difficulty. The reliability of this new scale has not been assessed. AIMS The aim of this study was to examine the relative reliability and absolute reliability of the newly developed scale in community-dwelling frail elderly people in Japan. METHODS Participants were 47 community-dwelling elderly subjects (22 for assessing test-retest reliability and 25 for assessing inter-rater reliability). As relative reliability indices, intra-class correlation coefficients were used. From an absolute reliability perspective, we conducted Bland-Altman analysis and calculated the limit of agreement or minimal detectable change to determine the acceptable range of error. RESULTS Intra-class correlation coefficients for test-retest and inter-rater reliability were 0.90 (P < 0.001) and 0.97 (P < 0.001), respectively. The limit of agreement for test-retest reliability was -5.2 to 1.8, representing an increase of over six points for improvement and a decrease of over two points for decline of basic activities of daily living ability. The minimal detectable change for inter-rater reliability was 3.7, indicating that a three-point difference might be existed between difference raters. The results of this study demonstrated that the FIDS appeared to be a reliable instrument for use in Japanese community-dwelling frail elderly people. CONCLUSIONS While further research using a large and more diverse sample of participants is needed, our findings support the use of FIDS in clinical practice or clinical research targeting frail elderly Japanese people.
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Maggio M, Ceda GP, Ticinesi A, De Vita F, Gelmini G, Costantino C, Meschi T, Kressig RW, Cesari M, Fabi M, Lauretani F. Instrumental and Non-Instrumental Evaluation of 4-Meter Walking Speed in Older Individuals. PLoS One 2016; 11:e0153583. [PMID: 27077744 PMCID: PMC4831727 DOI: 10.1371/journal.pone.0153583] [Citation(s) in RCA: 78] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2015] [Accepted: 03/31/2016] [Indexed: 01/12/2023] Open
Abstract
Background Manual measurement of 4-meter gait speed by a stopwatch is the gold standard test for functional assessment in older adults. However, the accuracy of this technique may be biased by several factors, including intra- and inter-operator variability. Instrumental techniques of measurement using accelerometers may have a higher accuracy. Studies addressing the concordance between these two techniques are missing. The aim of the present community-based observational study was to compare manual and instrumental measurements of 4-meter gait speed in older individuals and to assess their relationship with other indicators of physical performance. Methods One-hundred seventy-two (69 men, 103 women) non-disabled community-dwellers aged ≥65 years were enrolled. They underwent a comprehensive geriatric assessment including physical function by Short Physical Performance Battery (SPPB), hand grip strength, and 6-minute walking test (6MWT). Timed usual walking speed on a 4-meter course was assessed by using both a stopwatch (4-meter manual measurement, 4-MM) and a tri-axial accelerometer (4-meter automatic measurement, 4-MA). Correlations between these performance measures were evaluated separately in men and women by partial correlation coefficients. Results In both genders, 4-MA was associated with 4-MM (men r = 0.62, p<0.001; women r = 0.73, p<0.001), handgrip strength (men r = 0.40, p = 0.005; women r = 0.29, p = 0.001) and 6MWT (men r = 0.50, p = 0.0004; women r = 0.22, p = 0.048). 4-MM was associated with handgrip strength and 6MWT in both men and women. Considering gait speed <0.6 m/s as diagnostic of dismobility syndrome, the two methods of assessment disagreed, with a different categorization of subjects, in 19% of men and 23% of women. The use of accelerometer resulted in 29 (13 M, 16 F) additional diagnoses of dismobility, compared with the 4-MM. Conclusions In an older population, the concordance of gait speeds manually or instrumentally assessed is not optimal. The results suggest that manual measures might lead to misclassification of a substantial number of subjects. However, longitudinal studies using standardized and validated procedures aimed at the comparison of different techniques are needed before recommending the use of accelerometers in comprehensive geriatric assessment.
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Affiliation(s)
- Marcello Maggio
- Geriatric Rehabilitation Department, University-Hospital of Parma, Parma, Italy
- Department of Clinical and Experimental Medicine, University of Parma, Italy
- * E-mail:
| | - Gian Paolo Ceda
- Geriatric Rehabilitation Department, University-Hospital of Parma, Parma, Italy
- Department of Clinical and Experimental Medicine, University of Parma, Italy
| | - Andrea Ticinesi
- Geriatric Rehabilitation Department, University-Hospital of Parma, Parma, Italy
- Department of Clinical and Experimental Medicine, University of Parma, Italy
| | - Francesca De Vita
- Geriatric Rehabilitation Department, University-Hospital of Parma, Parma, Italy
- Department of Clinical and Experimental Medicine, University of Parma, Italy
| | - Giovanni Gelmini
- Azienda USL of Parma, Distretto Valli di Taro e Ceno, Parma, Italy
| | - Cosimo Costantino
- Geriatric Rehabilitation Department, University-Hospital of Parma, Parma, Italy
- Department of Clinical and Experimental Medicine, University of Parma, Italy
| | - Tiziana Meschi
- Geriatric Rehabilitation Department, University-Hospital of Parma, Parma, Italy
- Department of Clinical and Experimental Medicine, University of Parma, Italy
| | - Reto W. Kressig
- Memory Clinic, University Center for Medicine of Aging Basel (UAB), Felix-Platter Hospital, University of Basel, Switzerland
| | - Matteo Cesari
- Gérontopôle, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
- Université de Toulouse III Paul Sabatier, Toulouse, France
| | - Massimo Fabi
- General Direction, University-Hospital of Parma, Italy
| | - Fulvio Lauretani
- Geriatric Rehabilitation Department, University-Hospital of Parma, Parma, Italy
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Sánchez-Martínez M, Castell M, González-Montalvo J, De la Cruz J, Banegas J, Otero Á. Transitions in functional status of community dwelling older adults: Impact of physical performance, depression and cognition. Eur Geriatr Med 2016. [DOI: 10.1016/j.eurger.2016.01.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Pérez-Zepeda MU, González-Chavero JG, Salinas-Martinez R, Gutiérrez-Robledo LM. RISK FACTORS FOR SLOW GAIT SPEED: A NESTED CASE-CONTROL SECONDARY ANALYSIS OF THE MEXICAN HEALTH AND AGING STUDY. J Frailty Aging 2016; 4:139-43. [PMID: 26889463 DOI: 10.14283/jfa.2015.63] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Physical performance tests play a major role in the geriatric assessment. In particular, gait speed has shown to be useful for predicting adverse outcomes. However, risk factors for slow gait speed (slowness) are not clearly described. OBJECTIVES To determine risk factors associated with slowness in Mexican older adults. DESIGN A two-step process was adopted for exploring the antecedent risk factors of slow gait speed. First, the cut-off values for gait speed were determined in a representative sample of Mexican older adults. Then, antecedent risk factors of slow gait speed (defined using the identified cut-points) were explored in a nested, cohort case-control study. SETTING PARTICIPANTS One representative sample of a cross-sectional survey for the first step and the Mexican Health and Aging Study (a cohort characterized by a 10-year follow-up). MEASUREMENTS A 4-meter usual gait speed test was conducted. Lowest gender and height-stratified groups were considered as defining slow gait speed. Sociodemographic characteristics, comorbidities, psychological and health-care related variables were explored to find those associated with the subsequent development of slow gait speed. Unadjusted and adjusted logistic regression models were performed. RESULTS In the final model, age, diabetes, hypertension, and history of fractures were associated with the development of slow gait speed. CONCLUSIONS Early identification of subjects at risk of developing slow gait speed may halt the path to disability due to the robust association of this physical performance test with functional decline.
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Affiliation(s)
- M U Pérez-Zepeda
- Clinical and Epidemiologic Research Department at Instituto Nacional de Geriatría, Mexico City, México
| | - J G González-Chavero
- Centro Regional para el Estudio del Adulto Mayor, Departamento de Medicina Interna, Hospital Universitario "Doctor José Eleuterio González", Facultad de Medicina, Universidad Autónoma de Nuevo León, Monterrey, Nuevo León, México
| | - R Salinas-Martinez
- Centro Regional para el Estudio del Adulto Mayor, Departamento de Medicina Interna, Hospital Universitario "Doctor José Eleuterio González", Facultad de Medicina, Universidad Autónoma de Nuevo León, Monterrey, Nuevo León, México
| | - L M Gutiérrez-Robledo
- Clinical and Epidemiologic Research Department at Instituto Nacional de Geriatría, Mexico City, México
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Del Campo N, Payoux P, Djilali A, Delrieu J, Hoogendijk EO, Rolland Y, Cesari M, Weiner MW, Andrieu S, Vellas B. Relationship of regional brain β-amyloid to gait speed. Neurology 2015; 86:36-43. [PMID: 26643548 DOI: 10.1212/wnl.0000000000002235] [Citation(s) in RCA: 103] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2015] [Accepted: 08/31/2015] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To investigate in vivo the relationship of regional brain β-amyloid (Aβ) to gait speed in a group of elderly individuals at high risk for dementia. METHODS Cross-sectional associations between brain Aβ as measured with [18F]florbetapir PET and gait speed were examined in 128 elderly participants. Subjects ranged from healthy to mildly cognitively impaired enrolled in the control arm of the multidomain intervention in the Multidomain Alzheimer Preventive Trial (MAPT). Nearly all participants presented spontaneous memory complaints. Regional [18F]florbetapir (AV45) standardized uptake volume ratios were obtained via semiautomated quantitative analysis using the cerebellum as reference region. Gait speed was measured by timing participants while they walked 4 meters. Associations were explored with linear regression, correcting for age, sex, education, body mass index (BMI), and APOE genotype. RESULTS We found a significant association between Aβ in the posterior and anterior putamen, occipital cortex, precuneus, and anterior cingulate and slow gait speed (all corrected p < 0.05). A multivariate model emphasized the locations of the posterior putamen and the precuneus. Aβ burden explained up to 9% of the variance in gait speed, and significantly improved regression models already containing demographic variables, BMI, and APOE status. CONCLUSIONS The present PET study confirms, in vivo, previous postmortem evidence showing an association between Alzheimer disease (AD) pathology and gait speed, and provides additional evidence on potential regional effects of brain Aβ on motor function. More research is needed to elucidate the neural mechanisms underlying these regional associations, which may involve motor and sensorimotor circuits hitherto largely neglected in the pathophysiology of AD.
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Affiliation(s)
- Natalia Del Campo
- From Gérontopôle, Institute of Ageing (N.d.C., J.D., E.O.H., Y.R., M.C., B.V.), and the Department of Epidemiology and Public Health (S.A.), University Hospital Toulouse, France; the Department of Psychiatry (N.d.C.), University of Cambridge, UK; INSERM U825 (P.P., A.D.) and INSERM UMR 1027 (M.C., S.A., B.V.), University Toulouse III Paul Sabatier, France; Department of Epidemiology & Biostatistics (E.O.H.), EMGO+ Institute for Health and Care Research, VU University Medical Center, Amsterdam, the Netherlands; Center for Imaging of Neurodegenerative Diseases (M.W.W.), Department of Veterans Affairs Medical Center, San Francisco; and the Departments of Radiology (M.W.W.), Medicine (M.W.W.), Psychiatry (M.W.W.), and Neurology (M.W.W.), University of California, San Francisco.
| | - Pierre Payoux
- From Gérontopôle, Institute of Ageing (N.d.C., J.D., E.O.H., Y.R., M.C., B.V.), and the Department of Epidemiology and Public Health (S.A.), University Hospital Toulouse, France; the Department of Psychiatry (N.d.C.), University of Cambridge, UK; INSERM U825 (P.P., A.D.) and INSERM UMR 1027 (M.C., S.A., B.V.), University Toulouse III Paul Sabatier, France; Department of Epidemiology & Biostatistics (E.O.H.), EMGO+ Institute for Health and Care Research, VU University Medical Center, Amsterdam, the Netherlands; Center for Imaging of Neurodegenerative Diseases (M.W.W.), Department of Veterans Affairs Medical Center, San Francisco; and the Departments of Radiology (M.W.W.), Medicine (M.W.W.), Psychiatry (M.W.W.), and Neurology (M.W.W.), University of California, San Francisco
| | - Adel Djilali
- From Gérontopôle, Institute of Ageing (N.d.C., J.D., E.O.H., Y.R., M.C., B.V.), and the Department of Epidemiology and Public Health (S.A.), University Hospital Toulouse, France; the Department of Psychiatry (N.d.C.), University of Cambridge, UK; INSERM U825 (P.P., A.D.) and INSERM UMR 1027 (M.C., S.A., B.V.), University Toulouse III Paul Sabatier, France; Department of Epidemiology & Biostatistics (E.O.H.), EMGO+ Institute for Health and Care Research, VU University Medical Center, Amsterdam, the Netherlands; Center for Imaging of Neurodegenerative Diseases (M.W.W.), Department of Veterans Affairs Medical Center, San Francisco; and the Departments of Radiology (M.W.W.), Medicine (M.W.W.), Psychiatry (M.W.W.), and Neurology (M.W.W.), University of California, San Francisco
| | - Julien Delrieu
- From Gérontopôle, Institute of Ageing (N.d.C., J.D., E.O.H., Y.R., M.C., B.V.), and the Department of Epidemiology and Public Health (S.A.), University Hospital Toulouse, France; the Department of Psychiatry (N.d.C.), University of Cambridge, UK; INSERM U825 (P.P., A.D.) and INSERM UMR 1027 (M.C., S.A., B.V.), University Toulouse III Paul Sabatier, France; Department of Epidemiology & Biostatistics (E.O.H.), EMGO+ Institute for Health and Care Research, VU University Medical Center, Amsterdam, the Netherlands; Center for Imaging of Neurodegenerative Diseases (M.W.W.), Department of Veterans Affairs Medical Center, San Francisco; and the Departments of Radiology (M.W.W.), Medicine (M.W.W.), Psychiatry (M.W.W.), and Neurology (M.W.W.), University of California, San Francisco
| | - Emiel O Hoogendijk
- From Gérontopôle, Institute of Ageing (N.d.C., J.D., E.O.H., Y.R., M.C., B.V.), and the Department of Epidemiology and Public Health (S.A.), University Hospital Toulouse, France; the Department of Psychiatry (N.d.C.), University of Cambridge, UK; INSERM U825 (P.P., A.D.) and INSERM UMR 1027 (M.C., S.A., B.V.), University Toulouse III Paul Sabatier, France; Department of Epidemiology & Biostatistics (E.O.H.), EMGO+ Institute for Health and Care Research, VU University Medical Center, Amsterdam, the Netherlands; Center for Imaging of Neurodegenerative Diseases (M.W.W.), Department of Veterans Affairs Medical Center, San Francisco; and the Departments of Radiology (M.W.W.), Medicine (M.W.W.), Psychiatry (M.W.W.), and Neurology (M.W.W.), University of California, San Francisco
| | - Yves Rolland
- From Gérontopôle, Institute of Ageing (N.d.C., J.D., E.O.H., Y.R., M.C., B.V.), and the Department of Epidemiology and Public Health (S.A.), University Hospital Toulouse, France; the Department of Psychiatry (N.d.C.), University of Cambridge, UK; INSERM U825 (P.P., A.D.) and INSERM UMR 1027 (M.C., S.A., B.V.), University Toulouse III Paul Sabatier, France; Department of Epidemiology & Biostatistics (E.O.H.), EMGO+ Institute for Health and Care Research, VU University Medical Center, Amsterdam, the Netherlands; Center for Imaging of Neurodegenerative Diseases (M.W.W.), Department of Veterans Affairs Medical Center, San Francisco; and the Departments of Radiology (M.W.W.), Medicine (M.W.W.), Psychiatry (M.W.W.), and Neurology (M.W.W.), University of California, San Francisco
| | - Matteo Cesari
- From Gérontopôle, Institute of Ageing (N.d.C., J.D., E.O.H., Y.R., M.C., B.V.), and the Department of Epidemiology and Public Health (S.A.), University Hospital Toulouse, France; the Department of Psychiatry (N.d.C.), University of Cambridge, UK; INSERM U825 (P.P., A.D.) and INSERM UMR 1027 (M.C., S.A., B.V.), University Toulouse III Paul Sabatier, France; Department of Epidemiology & Biostatistics (E.O.H.), EMGO+ Institute for Health and Care Research, VU University Medical Center, Amsterdam, the Netherlands; Center for Imaging of Neurodegenerative Diseases (M.W.W.), Department of Veterans Affairs Medical Center, San Francisco; and the Departments of Radiology (M.W.W.), Medicine (M.W.W.), Psychiatry (M.W.W.), and Neurology (M.W.W.), University of California, San Francisco
| | - Michael W Weiner
- From Gérontopôle, Institute of Ageing (N.d.C., J.D., E.O.H., Y.R., M.C., B.V.), and the Department of Epidemiology and Public Health (S.A.), University Hospital Toulouse, France; the Department of Psychiatry (N.d.C.), University of Cambridge, UK; INSERM U825 (P.P., A.D.) and INSERM UMR 1027 (M.C., S.A., B.V.), University Toulouse III Paul Sabatier, France; Department of Epidemiology & Biostatistics (E.O.H.), EMGO+ Institute for Health and Care Research, VU University Medical Center, Amsterdam, the Netherlands; Center for Imaging of Neurodegenerative Diseases (M.W.W.), Department of Veterans Affairs Medical Center, San Francisco; and the Departments of Radiology (M.W.W.), Medicine (M.W.W.), Psychiatry (M.W.W.), and Neurology (M.W.W.), University of California, San Francisco
| | - Sandrine Andrieu
- From Gérontopôle, Institute of Ageing (N.d.C., J.D., E.O.H., Y.R., M.C., B.V.), and the Department of Epidemiology and Public Health (S.A.), University Hospital Toulouse, France; the Department of Psychiatry (N.d.C.), University of Cambridge, UK; INSERM U825 (P.P., A.D.) and INSERM UMR 1027 (M.C., S.A., B.V.), University Toulouse III Paul Sabatier, France; Department of Epidemiology & Biostatistics (E.O.H.), EMGO+ Institute for Health and Care Research, VU University Medical Center, Amsterdam, the Netherlands; Center for Imaging of Neurodegenerative Diseases (M.W.W.), Department of Veterans Affairs Medical Center, San Francisco; and the Departments of Radiology (M.W.W.), Medicine (M.W.W.), Psychiatry (M.W.W.), and Neurology (M.W.W.), University of California, San Francisco
| | - Bruno Vellas
- From Gérontopôle, Institute of Ageing (N.d.C., J.D., E.O.H., Y.R., M.C., B.V.), and the Department of Epidemiology and Public Health (S.A.), University Hospital Toulouse, France; the Department of Psychiatry (N.d.C.), University of Cambridge, UK; INSERM U825 (P.P., A.D.) and INSERM UMR 1027 (M.C., S.A., B.V.), University Toulouse III Paul Sabatier, France; Department of Epidemiology & Biostatistics (E.O.H.), EMGO+ Institute for Health and Care Research, VU University Medical Center, Amsterdam, the Netherlands; Center for Imaging of Neurodegenerative Diseases (M.W.W.), Department of Veterans Affairs Medical Center, San Francisco; and the Departments of Radiology (M.W.W.), Medicine (M.W.W.), Psychiatry (M.W.W.), and Neurology (M.W.W.), University of California, San Francisco
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