Morbidity and Physical Functioning in Old Age: Differences According to Living Area

Olfaction and Physical Functioning in Older Adults: A Longitudinal Study

BACKGROUND

Poor olfaction is associated with worse functional performance in older adults, but longitudinal evidence is lacking. We investigated poor olfaction in relation to longitudinal changes in physical functioning among community-dwelling older adults.

METHODS

The analysis included 2,319 participants from the Health, Aging and Body Composition Study (aged 71-82 years, 47·9% men, and 37·3% blacks) who completed the Brief Smell Identification Test in 1999-2000. Olfaction was defined as good (test score 11-12), moderate (9-10), or poor (0-8). Physical functioning was assessed up to four times over 8 years, using the Short Physical Performance Battery (SPPB) and the Health ABC Physical Performance Battery (HABCPPB). We conducted joint model analyses and reported the differences in annual declines across olfaction groups.

RESULTS

During the follow-up, compared to those with good olfaction, older adults with poor olfaction had greater annual declines in both the SPPB score (-0.137, 95%CI: -0.186, -0.088) and all its subscales: standing balance (-0.068, 95%CI:-0.091, -0.044), chair stand (-0.046, 95%CI: -0.070, -0.022), and gait speed (-0.022, 95%CI: -0.042, -0.001). A similar observation was made for the HABCPPB score (difference in annual decline: -0.032, 95%CI:-0.042, -0.021). These findings are robust and cannot be explained by measured confounding from demographics, lifestyle factors, chronic diseases, nor by potential biases due to death and loss of follow-up. Similar associations were observed across subgroups of sex, race, and self-reported general health status.

CONCLUSION

This study provides the first epidemiological evidence that poor olfaction predicts a faster decline in physical functioning. Future studies should investigate potential mechanisms.

Application of EASY-Care Standard 2010 instrument in a population-based survey in transitional Kosovo

BACKGROUND

The aim of this study was to assess the health needs and priorities of older people in Kosovo, the newest state in Europe striving for a functional democracy after the breakdown of former Yugoslavia and the following war in the region.

METHODS

A cross-sectional study was conducted in Kosovo in 2011 including a nationwide representative sample of 1890 individuals aged ≥65 years (949 men, mean age: 73 ± 6 years; 941 women, mean age: 74 ± 7 years; overall response rate: 84%). All individuals were administered the full version of EASY-Care Standard 2010 instrument, inquiring about the need for support in activities of daily living ('independence'), the 'risk of breakdown in care' (leading to emergency admission to hospital) and the 'risk of falls'.

RESULTS

The degree of 'independence' was lower, whereas the 'risk of breakdown in care' and the 'risk of falls' were significantly higher in: older women; the oldest individuals (≥85 years); rural residents; participants living alone; those perceiving themselves as poor; participants who could not access medical care; those who perceived their general health status as poor; and older people who reported at least one chronic condition.

CONCLUSIONS

This is one of the very few reports from Southeast European region informing about the health needs and priorities of older people in a large and representative population-based sample of older men and women. The poor health status of older people, especially evident in the socio-demographic disadvantaged categories, should raise the awareness of policymakers and decision-makers for appropriate health and social care of elderly in Kosovo and in other European countries.

Dimensions and predictors of disability-A baseline study of patients entering somatic rehabilitation in secondary care

PURPOSE

The purpose of this study was to investigate disability among patients who were accepted for admission to a Norwegian rehabilitation center and to identify predictors of disability.

MATERIALS AND METHODS

In a cross-sectional study including 967 adult participants, the World Health Organization Disability Assessment Schedule version 2.0 36-item version was used for assessing overall and domain-specific disability as outcome variables. Patients completed the Hospital Anxiety and Depression Scale (HADS), EuroQoL EQ-5D-5L and questions about multi-morbidity, smoking and perceived physical fitness. Additionally, the main health condition, sociodemographic and environmental variables obtained from referrals and public registers were used as predictor variables. Descriptive statistics and linear regression analyses were performed.

RESULTS

The mean (standard error) overall disability score was 30.0 (0.5), domain scores ranged from 11.9 to 44.7. Neurological diseases, multi-morbidity, low education, impaired physical fitness, pain, and higher HADS depressive score increased the overall disability score. A low HADS depressive score predicted a lower disability score in all domains.

CONCLUSIONS

A moderate overall disability score was found among patients accepted for admission to a rehabilitation center but "life activities" and "participation in society" had the highest domain scores. This should be taken into account when rehabilitation strategies are developed.

Factors associated with low levels of physical activity among elderly residents in a small urban area in the interior of the Brazilian Amazon

The aim of the present study was to investigate levels of physical activity and risk factors for inactivity in older adults living in an urban area in the interior of the Amazonas state, Brazil. Data were collected between 2013 and 2015 from 274 individuals 60 years of age or older who resided in the interior of the Brazilian Amazon. Sociodemographic, general health, functional capacity and physical performance were associated with self-referred physical activity level. A multivariate analysis, after adjustment, showed that being a man, having a body mass index above 27kg/m², never having lived in riverside communities and having less than three associated chronic diseases were independent risk factors for low levels of physical activity among elderly residing in the interior of the Brazilian Amazon. Few studies have been conducted about the characteristics that are singular to this population. Our results suggest that the physical activity level and, consequently, the aging process of the elderly is influenced by where they have resided throughout their lives. Additionally, the results showed particular risk factors associated with low physical activity level among older adults residing in the interior of the state of Amazonas.

Time trends in prevalence of activities of daily living (ADL) disability and survival: comparing two populations (aged 78+ years) living in a rural area in Sweden

The aim was to study time trends in prevalence of disability in ADL and survival among men and women 78 years and older comparing two cohorts. The study was a time trend study based on two population-based community cohorts, the Nordanstig Project (NP), collected 1995-1998 and the Swedish National Study on Aging and Care in Nordanstig (SNAC-N), collected 2001-2003. The participants were people aged 78 years and older from the NP cohort (N=303) and from the SNAC-N cohort (N=406). All were clinically examined by physicians and nurses using standardized protocols. Disability was defined as a need for assistance in one or more ADL activities. The prevalence of disability and survival were compared using logistic and Cox models. The prevalence of ADL disability was stable for men, while women became more disabled in ADL during the time period, OR 2.36 (1.12-4.94). There was no significant difference in survival time between the cohorts in either ADL disabled persons or non-disabled persons. There was a tendency for increased survival for non-disabled persons in SNAC-N compared with NP, although not significant; this was particularly true for women. In general, women survived longer than men did regardless of whether they were ADL disabled or not. The time trends for ADL disability found in the study show that ADL disability had increased in women but not in men. More studies are needed to identify risk factors for ADL disability with a view to preventing it in time.

One-year outcome of frailty indicators and activities of daily living following the randomised controlled trial: "Continuum of care for frail older people"

Background

The intervention; “Continuum of Care for Frail Older People”, was designed to create an integrated continuum of care from the hospital emergency department through the hospital and back to the older person’s own home. The aim of this study is to evaluate the effects of the intervention on functional ability in terms of activities of daily living (ADL).

Methods

The study is a non-blinded controlled trial with participants randomised to either the intervention group or a control group with follow-ups at three-, six- and 12 months. The intervention involved collaboration between a nurse with geriatric competence at the emergency department, the hospital wards and a multi-professional team for care and rehabilitation of the older people in the municipality with a case manager as the hub. Older people who sought care at the emergency department at Sahlgrenska University Hospital/Mölndal and who were discharged to their own homes in the municipality of Mölndal, Sweden were asked to participate. Inclusion criteria were age 80 and older or 65 to 79 with at least one chronic disease and dependent in at least one ADL. Analyses were made on the basis of the intention-to-treat principle. Outcome measures were ADL independence and eight frailty indicators. These were analysed, using Chi-square and odds ratio (OR).

Results

A total of 161 participated in the study, 76 persons allocated to the control group and 85 to the intervention group were analysed throughout the study. There were no significant differences between the groups with regards to change in frailty compared to baseline at any follow-up. At both the three- and twelve-month follow-ups the intervention group had doubled their odds for improved ADL independence compared to the control (OR 2.37, 95% CI; 1.20 – 4.68) and (2.04, 95% CI; 1.03 – 4.06) respectively. At six months the intervention group had halved their odds for decreased ADL independence (OR 0.52, 95% CI; 0.27 – 0.98) compared to the control group.

Conclusions

The intervention has the potential to reduce dependency in ADLs, a valuable benefit both for the individual and for society.

Trial registration

ClinicalTrials.gov: NCT01260493