Correlates of improvement in walking ability in older persons in the United States

"Taking a Turn for the Better": Does Self-reported Recovery From Walking Limitation Improve Disability and Mortality Outcomes?

Objectives

Recovery from self-reported walking limitation may be a turning point in an individual's health trajectory and may lead to better physical and mental health in the future. This research examines whether recovery from walking limitation is associated with onset of mobility disability, activities of daily living (ADLs) disability, or mortality among a national sample of older Americans.

Data and Methods

Using Waves 4 through 11 (1998-2012) of the Health and Retirement Study (HRS), discrete-time event history models (N = 12,579 person-intervals) with multiple competing events were estimated using multinomial logistic regression. The risk group was defined as respondents with walking limitation, but free of disability. A lagged measure of recovery was created using 2 adjacent waves, and disability and mortality outcomes were assessed in the subsequent wave (i.e., 2 years later).

Results

Recovery from walking limitation (i.e., difficulty walking one or several blocks) was associated with lower odds of mobility disability (i.e., difficulty walking across the room) onset, ADL with mobility disability onset, ADL without mobility disability onset, and mortality. Recovery from walking limitation was not only predictive of mobility-related outcomes, but also nonmobility-related ADLs and mortality-suggesting that the predictive capacity of recovery extends to multiple physical health outcomes.

Discussion

This research suggests that self-reported recovery from walking limitation may be a turning point in the disabling process and signals a meaningful change in an older adult's functional health trajectory.

Change in motor function and adverse health outcomes in older African-Americans

OBJECTIVE

We tested whether declining motor function accelerates with age in older African-Americans.

METHODS

Eleven motor performances were assessed annually in 513 older African-Americans.

RESULTS

During follow-up of 5 years, linear mixed-effect models showed that motor function declined by about 0.03 units/year (Estimate, -0.026, p<0.001); about 4% more rapidly for each additional year of age at baseline. A proportional hazard model showed that both baseline motor function level and its rate of change were independent predictors of death and incident disability (all p's<0.001). These models showed that the additional annual amount of motor decline in 85 year old persons at baseline versus 65 year old persons was associated with a 1.5-fold higher rate of death and a 3-fold higher rate of developing Katz disability.

CONCLUSIONS

The rate of declining motor function accelerates with increasing age and its rate of decline predicts adverse health outcomes in older African-Americans.

Relationship of meeting physical activity guidelines with health-related utility

OBJECTIVE

Health-related utility measures overall health status and quality of life and is commonly incorporated into cost-effectiveness analyses. This study investigates whether attainment of federal physical activity guidelines translates into better health-related utility in adults with or at risk for knee osteoarthritis (OA).

METHODS

Cross-sectional data from 1,908 adults with or at risk for knee OA participating in the accelerometer ancillary study of the Osteoarthritis Initiative were assessed. Physical activity was measured using 7 days of accelerometer monitoring and was classified as 1) meeting guidelines (≥150 bouted moderate-to-vigorous [MV] minutes per week); 2) insufficiently active (≥1 MV bout[s] per week but below guidelines); or 3) inactive (zero MV bouts per week). A Short Form 6D health-related utility score was derived from patient-reported health status. Relationship of physical activity levels to median health-related utility adjusted for socioeconomic and health factors was tested using quantile regression.

RESULTS

Only 13% of participants met physical activity guidelines, and 45% were inactive. Relative to the inactive group, median health-related utility scores were significantly greater for the meeting guidelines group (0.063; 95% confidence interval [95% CI] 0.055, 0.071) and the insufficiently active group (0.059; 95% CI 0.054, 0.064). These differences showed a statistically significant linear trend and strong cross-sectional relationship with physical activity level even after adjusting for socioeconomic and health factors.

CONCLUSION

We found a significant positive relationship between physical activity level and health-related utility. Interventions that encourage adults, including persons with knee OA, to increase physical activity even if recommended levels are not attained may improve their quality of life.

Social network and mobility improvement among older Europeans: the ambiguous role of family ties

This study examined the social network correlates of improvement in lower extremity mobility among respondents aged 65 and older from the longitudinal sample of the Survey of Health, Ageing and Retirement in Europe. The study focused on those who self-reported having difficulties with four lower extremity functions: (1) walking 100 m; (2) rising from a seated position; (3) climbing flights of steps; and (4) stooping, kneeling, or crouching. Multivariate logistic regression analyses revealed that social networks were variously associated with improvement in lower extremity function at the two-year follow-up. The findings suggest that under certain circumstances, a lack of social support in late life may actually promote mobility improvement. The research also shows that family networks are not always facilitative of mobility improvement. This is in contrast to previously published social network research positing that supportive relationships help foster health and buffer stressors in late life. Family caregivers and social services should keep this in mind when devising treatment plans upon discharge from the hospital and implementing care management plans for frail older persons in the community.

Neuroticism, extraversion, and motor function in community-dwelling older persons

OBJECTIVE

Personality traits are associated with adverse health outcomes in old age, but their association with motor function is unclear. We tested the hypothesis that neuroticism and extraversion are associated with motor decline in older persons.

DESIGN

Prospective, observational cohort study.

SETTING

Retirement communities across metropolitan Chicago.

PARTICIPANTS

Nine hundred eighty-three older persons without dementia.

MEASUREMENTS

At baseline, neuroticism and extraversion were assessed and annual assessment of 18 motor measures were summarized in a composite measure.

RESULTS

Average follow-up was 5 years. Separate linear mixed-effects models controlling for age, sex, and education showed that baseline levels of neuroticism and extraversion were associated with the rate of motor decline. For each 7-point (∼1 SD) higher neuroticism score at baseline, the average annual rate of motor decline was more than 20% faster. This amount of motor decline was associated with a 10% increased risk of death compared to a participant with an average neuroticism score. Each 6-point (∼1 SD) lower extraversion score at baseline was associated with an 8% faster rate of motor decline. This amount of motor decline was associated with about a 9% increased risk of death compared to a participant with an average extraversion score. Neuroticism and extraversion were relatively independently associated with motor decline. These associations were unchanged when controlling for depressive symptoms and current health status but were partially attenuated when controlling for late-life cognitive and social activities.

CONCLUSIONS

Higher levels of neuroticism and lower levels of extraversion are associated with more rapid motor decline in old age.

Multidimensional health-transition patterns among a middle-aged and older population

AIM

Previous studies on health transition have focused on single-dimension outcomes and minimally evaluated heterogeneity. This study aimed to explore heterogeneous and multidimensional health-transition patterns on comorbidity, frailty and disability while examining the factors predicting different patterns of health transition.

METHODS

This study drew on data from a nationwide and longitudinally-followed sample of 5131 Taiwanese aged 50 years and older who were interviewed in 1996, 1999, 2003 and 2007. Latent class analysis (LCA) and multinomial logistic regression were applied to identify health-transition patterns and their predictors.

RESULTS

We identified six health-transition classes by applying LCA, including "persistently healthy", "well-managed comorbidity", "originally comorbid and gradually deteriorating to disability", "deteriorating gradually and died in late stage of the follow-up period", "deteriorating and died in middle stage of the follow-up period", and "originally comorbid and died in early stage of the follow-up period". Using the "well-managed comorbidity" class as the reference group, men had higher probabilities of being in the categories of dying in the follow-up period, but a lower risk of deteriorating to disability. Younger baseline age, higher education, having social engagement and non-smoking were predictors of "persistently healthy" and were associated with a lower risk of deteriorating to disability and death. Having a spouse and health examinations were associated with a lower risk of death, and also a lower probability of "persistently healthy".

CONCLUSIONS

Heterogeneous and multidimensional health-transition patterns exist in middle-aged and older populations. Several factors might have an effect on health-transition patterns.

Correlates of the incidence of disability and mortality among older adult Brazilians with and without diabetes mellitus and stroke

Background

The combined effect of diabetes and stroke on disability and mortality remains largely unexplored in Brazil and Latin America. Previous studies have been based primarily on data from developed countries. This study addresses the empirical gap by evaluating the combined impact of diabetes and stroke on disability and mortality in Brazil.

Methods

The sample was drawn from two waves of the Survey on Health and Well-being of the Elderly, which followed 2,143 older adults in São Paulo, Brazil, from 2000 to 2006. Disability was assessed via measures of activities of daily living (ADL) limitations, severe ADL limitations, and receiving assistance to perform these activities. Logistic and multinomial regression models controlling for sociodemographic and health conditions were used to address the influence of diabetes and stroke on disability and mortality.

Results

By itself, the presence of diabetes did not increase the risk of disability or the need for assistance; however, diabetes was related to increased risks when assessed in combination with stroke. After controlling for demographic, social and health conditions, individuals who had experienced stroke but not diabetes were 3.4 times more likely to have ADL limitations than those with neither condition (95% CI 2.26-5.04). This elevated risk more than doubled for those suffering from a combination of diabetes and stroke (OR 7.34, 95% CI 3.73-14.46). Similar effects from the combination of diabetes and stroke were observed for severe ADL limitations (OR 19.75, 95% CI 9.81- 39.76) and receiving ADL assistance (OR 16.57, 95% CI 8.39-32.73). Over time, older adults who had experienced a stroke were at higher risk of remaining disabled (RRR 4.28, 95% CI 1.53,11.95) and of mortality (RRR 3.42, 95% CI 1.65,7.09). However, risks were even higher for those who had experienced both diabetes and stroke. Diabetes was associated with higher mortality.

Conclusions

Findings indicate that a combined history of stroke and diabetes has a great impact on disability prevalence and mortality among older adults in São Paulo, Brazil.

Association of functional status with changes in physical activity: insights from a behavioral intervention for participants with arthritis

OBJECTIVE

To analyze change over 6 months in accelerometer-measured physical activity for participants with arthritis in a physical activity promotion trial. We tested the hypothesis that participants with the highest baseline functional capacity, regardless of their intervention status, experienced the greatest increases in physical activity levels at 6-month follow-up.

DESIGN

At baseline, participants were interviewed in person, completed a 5-minute timed walk, and wore a biaxial accelerometer for 1 week, with a subsequent week of accelerometer wear at 6 months. We present data on the changes in accelerometer-measured physical activity across baseline function quartiles derived from participants' walking speed. Analyses were controlled for sociodemographic, health status, and seasonal covariates as well as exposure to the study's behavioral intervention.

SETTING

A Midwest academic medical center.

PARTICIPANTS

Participants (N=226) with knee osteoarthritis or rheumatoid arthritis currently enrolled in the Improving Motivation for Physical Activity in Persons With Arthritis Clinical Trial.

INTERVENTION

Counseling by physical activity coaches versus control group physician advice to exercise.

MAIN OUTCOME MEASURE

Change in average daily counts between baseline and 6-month follow-up.

RESULTS

Contrary to our hypothesis, and after controlling for other predictors of change, the lowest quartile function participants had the largest mean absolute and relative physical improvement over baseline, regardless of intervention group status.

CONCLUSIONS

Participants at a higher risk of immanent mobility loss may have been more committed to improve lifestyle physical activity, reflecting the wisdom of targeting older adults at risk of mobility loss for physical activity behavior change interventions.

The effects of daily weather on accelerometer-measured physical activity

BACKGROUND

This study analyzes Chicago-area weather effects on objectively measured physical activity over a 3-year period among a cohort of 241 participants in an on-going arthritis physical activity trial.

METHODS

Uniaxial accelerometer counts and interview data were analyzed for up to 6 weekly study waves involving 4823 days of wear. The effects of temperature, rainfall, snowfall and daylight hours were analyzed after controlling for participant characteristics, day of the week, and daily accelerometer wear hours in a mixed effects linear regression model.

RESULTS

Daylight hours, mean daily temperature < 20 or ≥ 75 degrees, and light or heavy rainfall (but not snowfall) were all significantly associated with lower physical activity after controlling for the significant effects of weekends, accelerometer wear hours, age, sex, type of arthritis, employment, Hispanic ethnicity, obesity, and SF36 physical and mental health scores.

CONCLUSIONS

The cumulative effects of weather are reflected in a 38.3% mean monthly difference in daily counts between November and June, reflecting over 3 additional hours of sedentary time. Physical activity promotion programs for older persons with chronic conditions need lifestyle physical activity plans adapted to weather extremes.

Moving to maintain function in knee osteoarthritis: evidence from the osteoarthritis initiative

OBJECTIVES

To investigate the association between baseline physical activity and 1-year functional performance in adults with knee osteoarthritis (OA).

DESIGN

Prospective cohort study of knee OA development and progression with 1-year follow-up.

SETTING

Community.

PARTICIPANTS

Osteoarthritis Initiative public data on adults with knee OA (n=2274; age, 45-79y) who participated in functional performance assessments (timed 20-m walk and chair stand test) at baseline and 1-year follow-up.

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURE

A good 1-year performance outcome (separately defined for walk time and chair stand measures) was improvement from baseline quintile or maintenance in the best quintile.

RESULTS

Almost 2 in 5 persons with radiographic knee OA improved or maintained high performance at 1 year. Physical activity measured by the Physical Activity Scale for the Elderly (PASE) was significantly associated with good walk rate and chair stand outcomes (odds ratio per 40 units PASE [95% confidence interval]=1.13 [1.13, 1.17] and 1.10 [1.05, 1.15], respectively), as were participation in sports/recreational activities (1.45 [1.23, 1.71] and 1.29 [1.09, 1.51], respectively) and lifestyle activities (1.11 [1.06, 1.16] and 1.09 [1.04, 1.14], respectively). An independent protective relationship for these physical activity measures approached significance after adjusting for sociodemographic and health factors. Older adults reported the least baseline physical activity and least frequent good 1-year outcomes.

CONCLUSIONS

These findings support public health recommendations to be physically active in order to preserve function for persons with knee OA. Physical activity messages should specifically target older adults whose low activity levels may jeopardize their ability to maintain functional performance.