Maintaining mobility in late life. II. Smoking, alcohol consumption, physical activity, and body mass index

The effect of changes in lower limb pain on the rate of progression of locomotor disability in middle and old age: evidence from the NorStOP cohort with 6-year follow-up

Locomotor disability (LMD) is common at older ages, and can lead to other significant disability and mortality. Prevalent pain has been shown to be associated with LMD. This article aimed to assess the association between changes in lower limb pain status (ascertained from a manikin) and changes in the level of self-reported LMD in a sample of UK adults age ≥ 50years, over a 6-year period (data collected at 3-year intervals). There was an average increase in the level of LMD over 6 years. Reports of an onset of lower limb pain were associated with a relative increase in LMD, independently of sociodemographic factors and the onset of selected comorbid diseases. A dose-response relationship was observed between the onset of multiple lower limb joint involvement and more frequent or intense pain and larger increases in LMD. Becoming free from lower limb pain was associated with a relative decrease in LMD, but did not return LMD scores to the level of those who had remained pain-free throughout. This is consistent with a cumulative effect on LMD of recurrent episodes of pain. Lower limb pain may be a key target for prevention and rehabilitation to reduce years lived with disability in later life.

Efficacy of a home-based intervention programme on the physical activity level and functional ability of older people using domestic services: a randomised study

OBJECTIVE

Our main objective was to assess whether a home-based program supervised by home helpers (HH) during their normal working hours can prevent excessive sedentariness (mainly maximum walking time and distance) and preserve functional status in elderly people at risk for frailty or disability and using domestic services.

DESIGN

A four-month, open label, randomised trial with two groups called "prevention" and "control".

SETTING

In the homes of study participants.

PARTICIPANTS

The participants were all over 78 years old, lived independently at home, and received the visits of HHs at least once a week.

INTERVENTION

The intervention combined a self-administered exercise program, with 10 g amino-acid supplementation under the supervision of HHs.

MEASUREMENTS

Main outcome measures included physical activity (the PASE questionnaire), functional tests, nutritional and autonomy scores, and compliance (50% or more was considered satisfactory). Non-parametric methods were used for comparisons between the two groups. A linear regression model was fitted to assess the effect of the intervention on the relative variation of outcomes, adjusted for unbalanced baseline co-variables.

RESULTS

One hundred and two persons (prevention n=53, control n=49) with a median age of 85 years were included. Their median Activities of Daily Living and Instrumental Activities of Daily Living (IADL) scores were 6 and 7 respectively. Twenty-three (44%) were good compliers for both interventions. The maximum walking time remained stable while decreasing by 25% in the control group (p=0.0015); and fewer participants had a worsened IADL score in the prevention group (p=0.05). The baseline IADL Score was significantly associated with good compliance to the prevention program (p=0.0011). In good compliers, maximum walking distance and maximum walking time increased by 29.15% (0.0 to 66.7) and 33.3% (-20.0 to 50.0) respectively.

CONCLUSION

This study confirms the feasibility of a prevention program supervised by HHs, and some benefit from the intervention and identifies predictors for better compliance. It will help in the design of prevention trials for elderly people at risk for frailty.

Sedative load among community-dwelling people aged 75 years or older: association with balance and mobility

Drugs with sedative properties are frequently used among older people. Sedative load is a measure of the cumulative effect of taking multiple drugs with sedative properties. The objective of this study was to investigate the association between sedative load and balance and mobility. A random sample of 1000 people 75 years or older was invited to participate. Seven hundred community-dwelling participants (mean age, 81.3 years; 69% women) were included in the present study. Demographic, diagnostic, and drug use data were elicited during nurse interviews in 2004. Balance and mobility were tested by physiotherapists. Sedative load was calculated using a previously published model for each participant by summing the sedative ratings of primary sedatives (rating 2) and drugs with sedation as a prominent adverse effect (rating 1). Analyses of covariance and logistic regression analyses were used to assess the association between sedative load and balance and mobility. Of the 700 participants, 21% (n = 147) had a sedative load of 1-2, and 8% (n = 58) had sedative load of 3 or greater. After adjusting for covariates, exposure to higher sedative load ranges was associated with slower walking speed (P = 0.0003), longer time to perform Timed Up and Go test (P = 0.005), and lower scores on Berg Balance Scale (P = 0.005), but not with self-reported ability to walk 400 m. In conclusion, having a higher sedative load was associated with impaired balance and mobility among community-dwelling older people. Clinicians should remain cognizant of this association and regularly reevaluate drug therapy prescribed to older people.

Lifestyle change and mobility in obese adults with type 2 diabetes

BACKGROUND

Adults with type 2 diabetes mellitus often have limitations in mobility that increase with age. An intensive lifestyle intervention that produces weight loss and improves fitness could slow the loss of mobility in such patients.

METHODS

We randomly assigned 5145 overweight or obese adults between the ages of 45 and 74 years with type 2 diabetes to either an intensive lifestyle intervention or a diabetes support-and-education program; 5016 participants contributed data. We used hidden Markov models to characterize disability states and mixed-effects ordinal logistic regression to estimate the probability of functional decline. The primary outcome was self-reported limitation in mobility, with annual assessments for 4 years.

RESULTS

At year 4, among 2514 adults in the lifestyle-intervention group, 517 (20.6%) had severe disability and 969 (38.5%) had good mobility; the numbers among 2502 participants in the support group were 656 (26.2%) and 798 (31.9%), respectively. The lifestyle-intervention group had a relative reduction of 48% in the risk of loss of mobility, as compared with the support group (odds ratio, 0.52; 95% confidence interval, 0.44 to 0.63; P<0.001). Both weight loss and improved fitness (as assessed on treadmill testing) were significant mediators of this effect (P<0.001 for both variables). Adverse events that were related to the lifestyle intervention included a slightly higher frequency of musculoskeletal symptoms at year 1.

CONCLUSIONS

Weight loss and improved fitness slowed the decline in mobility in overweight adults with type 2 diabetes. (Funded by the Department of Health and Human Services and others; ClinicalTrials.gov number, NCT00017953.).

Impact of obesity, overweight and underweight on life expectancy and lifetime medical expenditures: the Ohsaki Cohort Study

OBJECTIVES

People who are obese have higher demands for medical care than those of the normal weight people. However, in view of their shorter life expectancy, it is unclear whether obese people have higher lifetime medical expenditure. We examined the association between body mass index, life expectancy and lifetime medical expenditure.

DESIGN

Prospective cohort study using individual data from the Ohsaki Cohort Study.

SETTING

Miyagi Prefecture, northeastern Japan.

PARTICIPANTS

The 41 965 participants aged 40-79 years.

PRIMARY AND SECONDARY OUTCOME MEASURES

The life expectancy and lifetime medical expenditure aged from 40 years.

RESULTS

In spite of their shorter life expectancy, obese participants might require higher medical expenditure than normal weight participants. In men aged 40 years, multiadjusted life expectancy for those who were obese participants was 41.4 years (95% CI 38.28 to 44.70), which was 1.7 years non-significantly shorter than that for normal weight participants (p=0.3184). Multiadjusted lifetime medical expenditure for obese participants was £112 858.9 (94 954.1-131 840.9), being 14.7% non-significantly higher than that for normal weight participants (p=0.1141). In women aged 40 years, multiadjusted life expectancy for those who were obese participants was 49.2 years (46.14-52.59), which was 3.1 years non-significantly shorter than for normal weight participants (p=0.0724), and multiadjusted lifetime medical expenditure was £137 765.9 (123 672.9-152 970.2), being 21.6% significantly higher (p=0.0005).

CONCLUSIONS

According to the point estimate, lifetime medical expenditure might appear to be higher for obese participants, despite their short life expectancy. With weight control, more people would enjoy their longevity with lower demands for medical care.

Evolução da aptidão física e capacidade funcional de mulheres ativas acima de 50 anos de idade de acordo com a idade cronológica, na cidade de Santos

O objetivo deste estudo foi comparar a evolução da aptidão física, capacidade funcional e densidade mineral óssea de mulheres fisicamente ativas durante um ano. Métodos: A amostra consistiu de 78 mulheres de 50 a 79 anos de idade (c: 62,4 ± 7,1 anos), participantes de um programa de exercícios aeróbicos, duas vezes por semana, 50 minutos por sessão durante 3,4 anos e divididas em três grupos: A: 5059 (n: 38); B: 6069 (n: 28); C: 7079 (n:12). Os resultados foram comparados usando ANOVA Two Way com "post-hoc" Bonferroni e delta percentual (*p<0,01). Resultados: A velocidade de levantar da cadeira evidenciou diferença significativa nos três grupos de -14,3% a -45,5%, na de andar, houve melhora significativa nos grupos A e B (-12,1% a -13,9%), na máxima de andar (-15,4% a -18,5%), a flexão de cotovelo em todos os grupos (18,9% a 24,1%) e a impulsão vertical (22,5% a 43,9%) nos grupos B e C; o levantar da cadeira em 30 segundos de 25,2% a 30,8% nos grupos A e B, o teste da flexibilidade no grupo A, que variou de 16,2% a 33,3% e a marcha estacionária nos três grupos de 16,4% a 30,0%; a densitometria óssea evidenciou ganho significativo de massa óssea de 3,1% a 10,2%. Conclusões: Os resultados sugerem um efeito favorável da atividade física regular.

Effects of an exercise programme for chronically ill and mobility-restricted elderly with structured support by the general practitioner's practice (HOMEfit) - study protocol of a randomised controlled trial

BACKGROUND

Exercise programmes can be administered successfully as therapeutic agents to patients with a number of chronic diseases and help to improve physical functioning in older adults. Usually, such programmes target either healthy and mobile community-dwelling seniors or elderly individuals living in nursing institutions or special residences. Chronically ill or mobility-restricted individuals, however, are difficult to reach when they live in their own homes.A pilot study has shown good feasibility of a home-based exercise programme that is delivered to this target group through cooperation between general practitioners and exercise therapists. A logical next step involves evaluation of the effects of the programme.

METHODS/DESIGN

The study is designed as a randomised controlled trial. We plan to recruit 210 patients (≥ 70 years) in about 15 general practices.The experimental intervention (duration 12 weeks)-a multidimensional home-based exercise programme-is delivered to the participant by an exercise therapist in counselling sessions at the general practitioner's practice and on the telephone. It is based on methods and strategies for facilitating behaviour change according to the Health Action Process Approach (HAPA). The control intervention-baseline physical activities-differs from the experimental intervention with regard to content of the counselling sessions as well as to content and frequency of the promoted activities.Primary outcome is functional lower body strength measured by the "chair-rise" test. Secondary outcomes are: physical function (battery of motor tests), physical activity (step count), health-related quality of life (SF-8), fall-related self-efficacy (FES-I), and exercise self-efficacy (SSA-Scale).The hypothesis that there will be differences between the two groups (experimental/control) with respect to post-interventional chair-rise time will be tested using an ANCOVA with chair-rise time at baseline, treatment group, and study centre effects as explanatory variables. Analysis of the data will be undertaken using the principle of intention-to-treat.

TRIAL REGISTRATION

Current Controlled Trials ISRCTN17727272.

Challenges in examining area effects across the life course on physical capability in mid-life: findings from the 1946 British Birth Cohort

A major limitation of past work linking area socioeconomic conditions to health in mid-life has been the reliance on single point in time measurement of area. Using the MRC National Survey of Health and Development, this study for the first time linked place of residence at three major life periods of childhood (1950), young adulthood (1972), and mid-life (1999) to area-socioeconomic data from the nearest census years. Using objective measures of physical capability as the outcome, the purpose of this study was to highlight four methodological challenges of attrition bias, secular changes in socio-economic measures, historical data availability, and changing reporting units over time. In general, standing balance and chair rise time showed clear cross-sectional associations with residing in areas with high deprivation. However, it was the process of overcoming the methodological challenges, which led to the conclusion that in this example percent low social class occupations was the most appropriate measure to use when extending cross-sectional analysis of standing balance and chair rise to life course investigation.

Gender and life course occupational social class differences in trajectories of functional limitations in midlife: findings from the 1946 British birth cohort

BACKGROUND

Older women and those of lower socioeconomic position (SEP) consistently constitute a larger portion of the disabled population than older men or those of higher SEP, yet no studies have examined when in the life course these differences emerge.

METHODS

Prevalence of self-reported limitations in the upper body (gripping or reaching) and lower body (walking or stair climbing) at 43 and 53 years were utilized from 1,530 men and 1,518 women from the British 1946 birth cohort. Generalized linear models with a binomial distribution were used to examine the effects of gender, childhood and adult SEP, and the differences in the SEP effects by gender on the prevalence of limitations at age 43 years and changes in prevalence from 43 to 53 years.

RESULTS

For both genders, the prevalence of upper and lower body limitations were reported at 3%-5% at age 43 years. However, by age 53 years, women's upper body limitations had increased to 28% and lower body limitations to 21%, whereas men's limitations had only increased to 12% and 11%, respectively. Men and women whose father's occupation was manual or whose adult head of household occupation was manual had higher prevalence of both limitations compared with those with non-manual backgrounds. These differences widened with age, especially in women. The effect of adult SEP on the prevalence of limitations was stronger than that of childhood SEP and was partly mediated by educational attainment.

CONCLUSION

Our findings provide the first evidence that prevention of disability in old age should begin early in midlife, especially for women from manual occupation households.

The Lifestyle Interventions and Independence for Elders Study: design and methods

BACKGROUND

As the number of older adults in the United States rises, maintaining functional independence among older Americans has emerged as a major clinical and public health priority. Older people who lose mobility are less likely to remain in the community; demonstrate higher rates of morbidity, mortality, and hospitalizations; and experience a poorer quality of life. Several studies have shown that regular physical activity improves functional limitations and intermediate functional outcomes, but definitive evidence showing that major mobility disability can be prevented is lacking. A Phase 3 randomized controlled trial is needed to fill this evidence gap.

METHODS

The Lifestyle Interventions and Independence for Elders (LIFE) Study is a Phase 3 multicenter randomized controlled trial designed to compare a supervised moderate-intensity physical activity program with a successful aging health education program in 1,600 sedentary older persons followed for an average of 2.7 years.

RESULTS

LIFE's primary outcome is major mobility disability, defined as the inability to walk 400 m. Secondary outcomes include cognitive function, serious fall injuries, persistent mobility disability, the combined outcome of major mobility disability or death, disability in activities of daily living, and cost-effectiveness.

CONCLUSIONS

Results of this study are expected to have important public health implications for the large and growing population of older sedentary men and women.

Social inequality in onset of mobility limitations in midlife: a longitudinal study in Denmark

The aim of this longitudinal study was to investigate if social inequality in onset of mobility limitations is present in early midlife, and to examine whether common determinants of disability account for social status differences in onset of mobility limitations in midlife. 3,586 40-and 50-year-old Danish men and women enrolled in The Danish Longitudinal Study on Work, Unemployment and Health constituted the study population. Data were collected by mailed questionnaires in 2000 and 2006. Limitations in running 100 m and in climbing two flights of stairs represented two aspects of mobility limitations. Occupational social class was applied as a measure of socioeconomic position. Among individuals reporting no limitations in 2000 social gradients in onset of mobility limitations emerged in 2006. Having a low social class at age 40 and 50 respectively was associated with higher onset of mobility limitations 6 years later, and this association was overall only partly explained by common determinants of disability: smoking, alcohol consumption, physical activity, body mass index, and chronic diseases. These results indicate that the development of mobility limitations might begin earlier in lower compared to higher social strata, and that social status differences in mobility limitations might emerge already in the forties.

Perceived neighborhood environment and walking for specific purposes among elderly Japanese

BACKGROUND

Recent research has revealed the importance of neighborhood environment as a determinant of physical activity. However, evidence among elderly adults is limited. This study examined the association between perceived neighborhood environment and walking for specific purposes among Japanese elderly adults.

METHODS

This population-based, cross-sectional study enrolled 1921 participants (age: 65-74 years, men: 51.9%). Neighborhood environment (International Physical Activity Questionnaire Environmental Module) and walking for specific purposes (ie, transportation or recreation) were assessed by self-report. Multilevel logistic regression analyses with individuals at level 1 and neighborhoods at level 2 were conducted to examine the association between environment and walking, after adjustment for potential confounders.

RESULTS

Access to exercise facilities, social environment, and aesthetics were associated with total neighborhood walking. Odds ratios (95% CI) were 1.23 (1.00-1.51), 1.39 (1.14-1.71), and 1.48 (1.21-1.81), respectively. Regarding walking for specific purposes, social environment and aesthetics were consistent correlates of both transportation walking and recreational walking. Environmental correlates differed by specific types of walking and by sex. Transportation walking significantly correlated with a greater variety of environmental attributes. Sex differences were observed, especially for transportation walking. Bicycle lanes, crime safety, traffic safety, aesthetics, and household motor vehicles were significant correlates among men, while access to shops, access to exercise facilities, and social environment were important among women.

CONCLUSIONS

Specific environment-walking associations differed by walking purpose and sex among elderly adults. Social environment and aesthetics were consistent correlates of both transportation walking and recreational walking. Improving these environmental features might be effective in promoting physical activity among elderly Japanese.

Impact of obesity on functioning among women with systemic lupus erythematosus

OBJECTIVE

Obesity is associated with high rates of disability in the general population. The nature of the relationship between obesity and disability in systemic lupus erythematosus (SLE), a condition with a high background rate of disability, is unknown.

METHODS

Data were from 2 interviews, 4 years apart, of a longitudinal cohort of individuals with SLE (n = 716 women). Body mass index (BMI) was calculated from self-reported height and weight; obesity was classified by usual (BMI ≥30) and revised (BMI ≥26.8) definitions. Three measures of functioning were examined: the Short Form 36 (SF-36) Health Survey physical function (PF) subscale, Valued Life Activities (VLA) Disability Questionnaire, and employment. Multivariate analyses controlled for demographics, SLE duration and disease activity, glucocorticoid use, depression, and comorbidities. Prospective analyses also controlled for baseline function.

RESULTS

At a BMI of ≥30, 27.8% of the subjects were obese; at a BMI of ≥26.8, 40.6% of the subjects were obese. Regardless of obesity definition, obese women exhibited poorer baseline function, with decrements ranging from 20-33% depending on the functional measure and obesity definition. With a BMI of ≥26.8, the adjusted SF-36 PF scores were 4.3 points lower for obese women (P < 0.0001), VLA difficulty was 0.09 higher (P = 0.01), and odds of employment were 80% of nonobese women (odds ratio 0.8, 95% confidence interval 0.5-1.1). At the 4-year followup, women who were obese at baseline had poorer function and experienced greater functional declines.

CONCLUSION

Obesity was associated with clinically significant negative effects on function, both concurrently and prospectively. This negative impact occurred at a lower BMI than is often considered problematic clinically. Because of the high rate of SLE-related disability, addressing preventable risk factors such as obesity may improve long-term SLE outcomes.

Muscle strength and sedative load in community-dwelling people aged 75 years and older: a population-based study

BACKGROUND

Use of psychotropic and sedative drugs has been associated with impaired muscle strength. Muscle weakness predicts important outcomes for older people including functional disability and mortality. The objective of this study was to investigate if the use of drugs with sedative properties is associated with poorer muscle strength.

METHODS

Seven-hundred community-dwelling participants, aged 75 years and older, enrolled in the population-based Geriatric Multidisciplinary Strategy for the Good Care of the Elderly (GeMS) study in 2004 were included in the present analyses. Data on demographics, diagnostics, and drug use were collected during standardized interviews, conducted by trained nurses and verified through medical records. Physiotherapists conducted objective tests of handgrip strength, knee extension strength, and the five repeated chair stands test. Sedative load was calculated using a previously published model for each participant.

RESULTS

Twenty-one percent of the participants (n = 147) had a sedative load of 1-2 and 8% (n = 58) had a sedative load 3 or more. After adjusting for covariates, participants with sedative load more than 0 had poorer performance on grip strength (p = .009), knee extension strength (p = .02), and five chair stands (p = .003) than nonusers of drugs with sedative properties. Increasing sedative load was associated with poorer grip strength.

CONCLUSIONS

Use of drugs with sedative properties was associated with impaired muscle strength. Although we adjusted for diagnoses affecting physical function, the possibility of confounding by indication cannot be entirely excluded. Given that muscle strength is predictive of functional disability and mortality, further attention should be directed toward conducting regular reviews of drug therapy and reducing use of sedative drugs.

Optimal cutoff values for high-risk waist circumference in older adults based on related health outcomes

The authors aimed to explore optimal cutoffs for high-risk waist circumference (WC) in older adults to assess the health risks of obesity. Prospective data from 4,996 measurements in 2,232 participants aged ≥70 years were collected during 5 triennial measurement cycles (1992/1993-2005/2006) of a population-based cohort study, the Longitudinal Aging Study Amsterdam (Amsterdam, the Netherlands). Cross-sectional associations of WC with pain, mobility limitations, incontinence, knee osteoarthritis, cardiovascular disease, and diabetes were studied. Generalized estimating equations models were fitted with restricted cubic spline functions in order to carefully study the shapes of the associations. Model fits for applying different cutoffs to categorize WC in the association with all outcomes were tested using the quasi-likelihood under the Independence Criterion (QIC). On the basis of the spline regression curves, potential WC cutoffs of approximately 109 cm in men and 98 cm in women were proposed. Based on the model fit, cutoffs between 100 cm and 106 cm were equally applicable in men but should not be higher. In women, the QIC confirmed an optimal cutoff of 99 cm.

Cognitive impairment and low physical activity are the components of frailty more strongly associated with disability

OBJECTIVE

To determine the association of the five frailty criteria from the Cardiovascular Health Study, as well as cognitive impairment, with prevalent disability for the instrumental (IADL) and basic activities of daily living (ADL).

DESIGN

Cross-sectional study of 475 community-dwelling subjects aged 70 and older, participating in the Mexican Study of Nutritional and Psychosocial Markers of Frailty.

MEASUREMENTS

Six probable frailty criteria were considered: weight loss, poor endurance, low physical activity, slowness, weakness, and cognitive impairment. The association of each component of frailty for IADL and ADL disability as main outcomes was determined constructing multivariate logistic regression analyses. Final models were adjusted by socio-demographic factors and the presence of the other five frailty components as covariates.

RESULTS

Mean age of participants was 78.1 (SD=6.2). The unadjusted results showed that each of the components of frailty, except weight loss, was associated with both IADL and ADL disability. However, after adjustment, only low physical activity [Odds ratio (OR) =3.27; 95% CI=1.56 to 6.85] and cognitive impairment (OR=2.06; 95% CI=1.04 to 4.06) remain independently associated with IADL disability. Regarding ADL disability, only a lower physical activity (OR=7.72; 95% CI=1.28 to 46.46) was associated with this outcome, whereas cognitive impairment was marginally associated but was not statistically significant (OR=5.45; 95% CI=0.91 to 32.57).

CONCLUSIONS

Cognitive impairment and low physical activity are the main contributing factors of frailty phenotype to disability. Better understanding the independent contribution of each frailty subdimension to the different adverse-health outcomes may help to provide a more adequate management of frail elderly.

Alcohol intake and bone status in elderly Japanese men: baseline data from the Fujiwara-kyo osteoporosis risk in men (FORMEN) study

There are no data concerning a relationship between alcohol and bone status from a large-scale community-based study of elderly Japanese men. The baseline survey for the Fujiwara-kyo Osteoporosis Risk in Men Study was performed in 2174 male participants during the period from 2007 to 2008 in Nara Prefecture, Japan. Among them 1665 fitted the following inclusion criteria: (a) age ≥65years, (b) no diseases or drug therapy that could affect bone mineral density (BMD). We analyzed 1421 men with complete information about alcohol intake. We found that alcohol intake and BMD were positively correlated after adjustment for age, body mass index, natto intake, milk intake, smoking, physical activity, education, marital status, and hypertension. Adjusted total hip BMD of men with alcohol intake >39g/day was 0.90g/cm(2) and that of abstainers was 0.85g/cm(2). With regard to bone turnover markers, alcohol intake was inversely associated with serum levels of osteocalcin and tartrate-resistant acid phosphatase isoenzyme 5b. A two-piece linear regression model revealed a positive relationship between alcohol intake and crude mean BMD for the total hip in those with alcohol intake of less than 55g/day. In contrast, alcohol intake and BMD in those with an alcohol intake of 55g/day or more was inversely correlated. The present large-scale study of elderly Japanese men revealed that although an alcohol intake of <55g/day was positively correlated to BMD, alcohol intake of ≥55g/day was inversely correlated to BMD.

Association of body mass index with self-report and performance-based measures of balance and mobility

BACKGROUND

The incidence of obesity is increasing in older adults, with associated worsening in the burden of disability. Little is known about the impact of body mass index (BMI) on self-report and performance-based balance and mobility measures in older adults.

OBJECTIVE

The purposes of this study were (1) to examine the association of BMI with measures of balance and mobility and (2) to explore potential explanatory factors.

DESIGN

This was a cross-sectional, observational study.

METHODS

Older adults (mean age=77.6 years) who participated in an ongoing observational study (N=120) were classified as normal weight (BMI=18.5-24.9 kg/m(2)), overweight (BMI=25.0-29.9 kg/m(2)), moderately obese (BMI=30.0-34.9 kg/m(2)), or severely obese (BMI ≥ 35 kg/m(2)). Body mass index data were missing for one individual; thus, data for 119 participants were included in the analysis. Mobility and balance were assessed using self-report and performance-based measures and were compared among weight groups using analysis of variance and chi-square analysis for categorical data. Multiple linear regression analysis was used to examine the association among BMI, mobility, and balance after controlling for potential confounding variables.

RESULTS

Compared with participants who were of normal weight or overweight, those with moderate or severe obesity were less likely to report their mobility as very good or excellent (52%, 55%, 39%, and 6%, respectively); however, there was no difference in self-report of balance among weight groups. Participants with severe obesity (n=17) had the lowest levels of mobility on the performance-based measures, followed by those who were moderately obese (n=31), overweight (n=42), and of normal weight (n=29). There were no differences on performance-based balance measures among weight groups. After controlling for age, sex, minority status, physical activity level, education level, and comorbid conditions, BMI still significantly contributed to mobility (β=-.02, adjusted R(2)=.41).

CONCLUSIONS

Although older adults with severe obesity were most impaired, those with less severe obesity also demonstrated significant decrements in mobility.

Correlates of mobility limitation in African Americans

BACKGROUND

This study identified demographic and health-related characteristics that were related to mobility limitation in a sample of community-dwelling African Americans.

METHODS

The sample consisted of 602 community-dwelling African-American men and women ages 48-92 years at study inception. Participants who reported being limited "a lot" or "a little" in climbing one flight of stairs or walking several blocks were considered to have mobility limitation. Logistic regression was conducted to estimate the independent effect of each demographic and health-related characteristic on odds of mobility limitation.

RESULTS

African Americans who reported two or more medical conditions had higher odds of mobility limitation (women: odds ratio = 3.52; 95% confidence interval: 1.89-6.53 and men: odds ratio = 2.53; 95% confidence interval: 1.10-5.85) than those who reported one or fewer medical conditions. African Americans with major depressive symptoms had higher odds of mobility limitation (women: odds ratio = 2.98; 95% confidence interval: 1.55-5.71 and men: odds ratio = 3.19; 95% confidence interval: 1.33-7.65) than those without major depressive symptoms.

CONCLUSIONS

These results highlight the importance of creating interventions particularly focused on chronic disease prevention and management for African American men and women during midlife to attempt to delay the onset or impede the progression of mobility problems that will likely become exacerbated in late life and severely affect the quality of life.

Central versus lower body obesity distribution and the association with lower limb physical function and disability

OBJECTIVE

To determine whether fat distribution in obese adults is significantly associated with decreased function and increased disability.

DESIGN

Cross-sectional epidemiologic analysis.

SETTING

Multicenter, community-based study.

PARTICIPANTS

Multicenter Osteoarthritis Study participants included adults ages 50-79 years at high risk of developing or already possessing knee osteoarthritis. A total of 549 men and 892 women from the Multicenter Osteoarthritis Study who had a body mass index ≥ 30 kg/m² and who underwent dual energy x-ray absorptiometry (DEXA) scans were included in these analyses. Exclusion criteria included bilateral knee replacements, cancer, or other rheumatologic disease.

METHODS

Body fat distribution was determined using baseline DEXA scan data. A ratio of abdominal fat in grams compared with lower limb fat in grams (trunk:lower limb fat ratio) was calculated. Participants were divided into quartiles of trunk:lower limb fat ratio, with highest and lowest quartiles representing central and lower body obesity, respectively. Backward elimination linear regression models stratified by gender were used to analyze statistical differences in function and disability between central and lower body obesity groups.

MAIN OUTCOME MEASURES

Lower limb physical function measures included 20-meter walk time, chair stand time, and peak knee flexion and extension strength. Disability was assessed using the Late Life Function and Disability Index.

RESULTS

Trunk:lower limb fat ratio was not significantly associated with physical function or disability in women or men (P value .167-.972). Total percent body fat (standardized β = -0.1533 and -0.1970 in men and women, respectively) was a better predictor of disability when compared with trunk:lower limb fat ratio (standardized β = 0.0309 and 0.0072).

CONCLUSIONS

Although fat distribution patterns may affect clinical outcomes in other areas, lower limb physical function and disability do not appear to be significantly influenced by the distribution of fat in obese older adults with, or at risk for, knee osteoarthritis. These data do not support differential treatment of functional limitations based on fat distribution.

Smoking history and physical performance in midlife: results from the British 1946 birth cohort

BACKGROUND

The adverse effects of smoking on individual medical conditions are well known; however, the cumulative effect of smoking on physical performance is not well characterized, particularly in midlife.

METHODS

In the British 1946 Birth Cohort Study, cigarette pack-years were examined with standing balance, chair rising, grip strength, and an overall composite index. Pack-years were calculated from data collected at ages 20, 25, 31, 36, 43, and 53 years, whereas physical performance, cognitive function, anthropometry, and spirometry were assessed at age 53 years in 2,394 men and women. Regression and cubic splines were used to assess the relationship between pack-years and physical performance.

RESULTS

Greater pack-years smoked were associated with lower overall physical performance and lower performance in standing balance and chair rising; however, there was no association with grip strength. For every 10 pack-years smoked, the overall physical performance index decreased by 0.11 SD (95% confidence interval: 0.07-0.15, p < .001), standing balance time decreased by 0.09 SD (0.05-0.13), and the reciprocal of chair rise time decreased by 0.11 SD (0.07-0.16). Adjustment for education, social class, lung function, cognitive function, and medical conditions attenuated the effect, but pack-years remained significantly associated with standing balance and chair rising time.

CONCLUSIONS

Lifetime cigarette pack-years are strongly related to physical performance in the fifth decade of life, suggesting that smokers will enter older adulthood with decreased physiological reserve. As smoking prevalence remains high in many developed countries and is rapidly growing in developing countries, these findings underscore the need for effective smoking cessation and prevention programs.

Gender differences in physical disability among older adults in underprivileged communities in Lebanon

OBJECTIVE

To examine the role of health conditions, socioeconomic, and socioenvironmental factors in explaining gender differences in physical disability among older adults.

METHOD

We compared 412 women and 328 men residing in underprivileged communities in Lebanon on their activities of daily living (ADL), instrumental activities of daily living (IADL), and physical tasks (PT). Binary logistic regression analyses adjusting for possible explanatory covariates were conducted sequentially.

RESULTS

Women showed higher prevalence rates of ADL, IADL, and PT compared to men. Gender disparities in ADL disability were explained by chronic-disease risk factors and health conditions (OR = 1.46; 95% CI = 0.94-2.25). The odds of disability in IADL and PT remained significantly higher for women compared to men after accounting for all available covariates.

DISCUSSION

These results suggest underlying differences in functional status between women and men, yet, may have been influenced by the sensitivity of the measures to the social context and gendered environment surrounding daily activities.

Effectiveness of a lifestyle physical activity versus a structured exercise intervention in older adults

Two groups of sedentary older adults, participating in either a lifestyle physical activity intervention (LIFE, n = 60) or a structured exercise intervention (STRU, n = 60), were compared with a control group (CO, n = 66) in terms of physical fitness and cardiovascular risk factors. Participants in LIFE were stimulated to integrate physical activity into their daily routines and received an individualized home-based program. Participants in STRU completed 5 supervised training sessions every 2 wk in a fitness center. Both interventions lasted 11 months and focused on endurance, strength, flexibility, and postural/balance exercises. The results revealed that the interventions were equally effective in improving functional performance. STRU was more effective than LIFE in improving cardiorespiratory and muscular fitness. Limited effects emerged on cardiovascular risk, with STRU improving in total cholesterol and HDL. Consequently, interventions aiming at reducing cardiovascular risks among sedentary elderly should focus on long-term changes in physical activity behavior.

Habitual physical activity levels are associated with performance in measures of physical function and mobility in older men

OBJECTIVES

To determine whether objectively measured physical activity levels are associated with physical function and mobility in older men.

DESIGN

Cross-sectional.

SETTING

Academic research center.

PARTICIPANTS

Eighty-two community-dwelling men aged 65 and older with self-reported mobility limitations were divided into a low-activity and a high-activity group based on the median average daily physical activity counts of the whole sample.

MEASUREMENTS

Physical activity according to triaxial accelerometers; physical function and mobility according to the Short Physical Performance Battery (SPPB), gait speed, stair climb time, and a lift-and-lower task; aerobic capacity according to maximum oxygen consumption (VO(2) max); and leg press and chest press maximal strength and peak power.

RESULTS

Older men with higher physical activity levels had a 1.4-point higher mean SPPB score and a 0.35-m/s faster walking speed than those with lower physical activity levels. They also climbed a standard flight of stairs 1.85 seconds faster and completed 60% more shelves in a lift-and-lower task (all P<.01); muscle strength and power measures were not significantly different between the low- and high-activity groups. Correlation analyses and multiple linear regression models showed that physical activity is positively associated with all physical function and mobility measures, leg press strength, and VO(2) max.

CONCLUSION

Older men with higher physical activity levels demonstrate better physical function and mobility than their less-active peers. Moreover, physical activity levels are predictive of performance in measures of physical function and mobility in older men. Future work is needed to determine whether modifications in physical activity levels can improve or preserve physical performance in later life.

Exercise and the Onset of Disability in Later Life

Objective: This study was to examine whether overall physical activity levels, and different types of earlier sporting activities, are associated with the onset of locomotor disability in early older age. Method: A longitudinal analysis of a general population cohort of British men and women born in the early 1930s was conducted. Results: Measures of overall activity levels at age 58 did not show a relationship with locomotor disability 5-6 years later. Swimming was the only sporting activity to show any strong evidence of a protective association with later locomotor disability. Discussion: The promotion of swimming in adulthood could play a role in the prevention of locomotor disability and aid people’s ability to follow active living health promotion guidelines in late mid-life and early old-age.

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.

Physical activity and mortality risk in the Japanese elderly: a cohort study

BACKGROUND

Physical activity recommendations for older adults with poor health needs to be understood.

PURPOSE

This study aims to examine the association between the frequency of physical activity and mortality among a sample of elderly subjects, most of whom were under treatment for pre-existing disease.

METHODS

Data on the frequency of leisure-time physical activity, walking for transportation, and non-exercise physical activity were obtained from a population-based cohort study in Shizuoka, Japan. Of the randomly selected 22,200 residents aged 65-84 years, 10,385 subjects were followed from 1999 to 2006 and analyzed. Hazard ratios (HRs) and 95% CIs were obtained for all-cause; cardiovascular disease (CVD); and cancer mortality, after adjusting for covariates such as pre-existing disease(s). A subgroup analysis that was restricted to subjects under treatment for pre-existing disease(s) at baseline was further conducted. Data were collected between 1999 and 2006, and all analyses were conducted in 2008 and 2009.

RESULTS

Every physical activity was associated with a reduced risk of all-cause and CVD mortality, among not only the total sample but even those under treatment. The HRs for CVD mortality among participants with 5 or more days of non-exercise physical activity per week for the total sample and those with pre-existing disease(s) were 0.38 (95% CI=0.22, 0.55) and 0.35 (95% CI=0.24, 0.52), respectively, compared with no non-exercise physical activity. The association between physical activity and cancer mortality was not clear.

CONCLUSIONS

This study suggests a protective effect of physical activity on all-cause and CVD mortality among Japanese elderly people with pre-existing disease.

Exploring cut-off values for large waist circumference in older adults: a new methodological approach

BACKGROUND

There is an ongoing debate about the applicability of current criteria for large waist circumference (WC) in older adults.

OBJECTIVES

Our aim was to explore cut-off values for large WC in adults aged 70 years and older, using previously used and new methods.

DESIGN

Prospective cohort study.

PARTICIPANTS

Data of 1049 participants of the Longitudinal Aging Study Amsterdam (LASA) (1995-1996), aged 70-88y, were used.

MEASUREMENTS

Measured BMI and WC, and self-reported mobility limitations.

RESULTS

Linear regression analyses showed that the values of WC corresponding to BMI of 25kg/m2 and 30kg/m2 were higher than the current cut-offs. Cut-offs found in men were 97 and 110cm, whereas 88 and 98cm represented the cut-offs in women. Areas under the Receiver Operating Characteristic (ROC) curves showed that the accuracy to predict mobility limitations improved when the higher cut-offs were applied. Spline regression curves showed that the relationship of WC with mobility limitations was U-shaped in men, while in women, the risk for mobility limitations increased gradually with increasing WC. However, at the level of current cut-off values for WC the odds for mobility limitations were not increased.

CONCLUSION

Based on results of extensive analyses, this study suggests that the cut-offs for large WC should be higher when applied to older adults. The association of WC with other negative health outcomes needs to be investigated to establish the final cut-points.

A review of the effects of growth hormone changes on symptoms of frailty in the elderly with chronic kidney disease

The incidence and prevalence of chronic kidney disease (CKD) is increasing worldwide, especially in the elderly. Recently, functional impairment and frailty have been recognized as factors affecting the quality of life, and outcomes in elderly patients with CKD and therapeutic interventions to improve function and reduce frailty are therefore being considered. Growth hormone (GH) levels decrease with age and GH actions are impaired in CKD patients. GH stimulates protein synthesis, bone, and glucose metabolism, and affects body composition by reducing body fat and increasing lean body mass. An increase in lean body mass may reduce frailty and thus avoid functional impairment. Thus, providing GH to elderly CKD patients could potentially improve outcomes and quality of life by lowering the risk of frailty and associated functional impairment. There are few studies assessing the long-term effects of GH administration on symptoms of frailty in elderly patients with CKD. In this review we will try to shed some light on the trials assessing the administration of GH to elderly subjects and to patients with CKD and focus on the possible role GH administration may play to improve frailty and quality of life in those patients.

Relative strength as a determinant of mobility in elders 67-84 years of age. a nuage study: nutrition as a determinant of successful aging

This cross-sectional study proposes two relative strength indexes in order to evaluate the risks of lower mobility in healthy older adults: 1) handgrip strength on body mass index and 2) quadriceps strength on body weight. Nine hundred and four men and women aged between 67-84 years old were tested for body composition, muscle strength and mobility function. Individuals in the lowest and middle tertiles of relative handgrip strength were respectively 2.2 (1.3-3.7) and 4.4 (2.6-7.6) more likely to have a lower mobility score. As for relative quadriceps strength, odd ratios for lowest and middle tertiles were respectively 2.8 (1.6-4.9) and 6.9 (3.9-12.1). Relative strength indexes, either using handgrip strength or quadriceps strength, are convenient to use in large scale studies and clinical practice.

Effect of the Japanese preventive-care version of the Minimum Data Set--Home Care on the health-related behaviors of community-dwelling, frail older adults and skills of preventive-care managers: a quasi-experimental study conducted in Japan

AIM

To determine whether the Japanese preventive-care version of the Minimum Data Set-Home Care improves the health-related behaviors of older adults and the skills of preventive-care managers.

METHODS

Municipal preventive-care managers were instructed on the use of the Japanese preventive-care version of the Minimum Data Set--Home Care and asked to employ it in their interactions with clients during the intervention period (intervention group). The health-related behaviors of older adults (maintenance of self-care and consumption of a balanced diet) were assessed by self-rating methods. The skills of the preventive-care managers were assessed by considering the number of and variations in the needs of the clients, as reflected in the care plans formulated by the managers.

RESULTS

The clients' self-care levels were higher in the intervention group than in the control group (P < 0.05). A greater number of needs, as reflected in the care plans, were noted in the intervention group than in the control group (P < 0.05), and the variation in the assessed needs was greater in the former than in the latter.

CONCLUSION

This study suggests that the Japanese preventive-care version of the Minimum Data Set--Home Care may improve the skills of preventive-care managers, and consequently, the health-related behaviors of frail older clients.

Day-to-Day Variability of Physical Activity of Older Adults Living in the Community

The purpose of the study was to investigate whether a 24-hr recording period is sufficient to describe physical activity (PA) of 1 week for intraindividual comparison in older adults. Furthermore, the authors analyzed whether physical performance can be used as a surrogate marker of PA. PA was captured on 7 consecutive days by a body-fixed sensor in 44 community-dwelling older adults (80.75 ± 4.05 yr). Mean times of walking and of “time on feet” of the group were 10.2 hr (± 3.5) and 35.1 hr (± 9.43), respectively. Intraindividual variabilities of walking and of time on feet were 31.9% ± 10.79% and 19.4% ± 8.76%, respectively. Accumulated time of variables of PA showed no differences between weekdays, with variabilities of 3.8% and 1.8% for walking and time on feet, respectively. Association between Short Physical Performance Battery and PA was limited (walkingr= .397, time on feetr= .41).

Secular trends in body weight in older men born between 1877 and 1941: the Baltimore Longitudinal Study of Aging

BACKGROUND

The prevalence of overweight and obesity has increased in all age groups, including older adults. However, it is not known whether higher body weight is maintained in the very old and in the years prior to death. The present study examines whether there are secular trends in body weight in old age among three birth cohorts.

METHODS

The study population includes 1,364 Caucasian men born between 1877 and 1941 from the Baltimore Longitudinal Study of Aging who were followed until death. Four hundred and seventy-seven men had body weight measured during the last 5 years prior to death. Body weight was measured biannually with the last visit occurring between 1959 and 2008. Differences in body weight at the last visit and body weight trajectories across birth cohorts were examined with linear regression and linear mixed-effect regression models.

RESULTS

Men born between 1920 and 1941 had significantly higher body weight over the entire follow-up time compared with men born between 1900 and 1919 (p < .001) and 1877 and 1899 (p = .001), and the difference was also significant between the two earlier birth cohorts (p < .001). A significant increasing trend in body weight across birth cohorts was also observed in the few years prior to death.

CONCLUSIONS

In generally healthy men, there is a significant secular increase in body weight over the adult life span and in the few years prior to death. This study confirms that the obesity epidemic also extends into late life in the current elderly population.

Regional muscle and whole-body composition factors related to mobility in older individuals: a review

PURPOSE

To describe previously reported locomotor muscle and whole-body composition factors related to mobility in older individuals.

METHODS

A narrative review of the literature, including a combination of search terms related to muscle and whole-body composition factors and to mobility in older individuals, was carried out. Statistical measures of association and risk were consolidated to summarize the common effects between studies.

RESULTS

Fifty-three studies were reviewed. Muscle and whole-body factors accounted for a substantial amount of the variability in walking speed, with coefficients of determination ranging from 0.30 to 0.47. Muscle power consistently accounted for a greater percentage of the variance in mobility than did strength. Risks associated with high fat mass presented a minimum odds ratio (OR) of 0.70 and a maximum OR of 4.07, while the minimum and maximum ORs associated with low lean mass were 0.87 and 2.30 respectively. Whole-body and regional fat deposits accounted for significant amounts of the variance in mobility.

CONCLUSION

Muscle power accounts for a greater amount of the variance in the level of mobility in older individuals than does muscle strength. Whole-body fat accounts for a greater amount of the variance in level of mobility than does whole-body lean tissue. Fat stored within muscle also appears to increase the risk of a mobility limitation in older individuals.

The obesity epidemic: implications for recruitment and retention of defence force personnel

The primary purpose of fitness and body composition standards in the military has always been to select individuals best suited to the physical demands of military service. Obesity has reached epidemic proportions globally, and may have adverse consequences for the military: a worsening prevalence of obesity in young civilian adults could hinder the recruitment and maintenance of military manpower. This review explores the impact of obesity on suitability for employment in defence force careers and any potential impact on long-term occupational health. Studies containing data on obesity and the military were identified from an electronic database. Thirty-eight papers were identified and 17 were included in this review. There is a limited body of evidence available to ascertain whether or not obese individuals are suitable for employment in the military. There are a number of key issues that need to be addressed before a definitive conclusion can be drawn. These include the future health of obese personnel recruited into the military and subsequent implications for health services, costs to the organization and military readiness, and the ability of an obese person to be an active member of the military workforce. Future research should be targeted towards these areas in order to determine the implications of obesity for recruitment and retention of defence force personnel.

Joint association of obesity and metabolic syndrome with incident mobility limitation in older men and women--results from the Health, Aging, and Body Composition Study

BACKGROUND

Although both obesity and the metabolic syndrome (MetS) are known risk factors for decline in physical function, the joint association of obesity and metabolic alterations with risk of incident mobility limitation is unknown.

METHODS

Data are from 2,984 women and men aged 70-79 years participating in the Health, Aging, and Body Composition Study without mobility limitation at baseline. Obesity was defined as body mass index greater than or equal to 30 kg/m(2) and the MetS as meeting greater than or equal to 3 of the ATP III criteria. Mobility limitation was defined as any difficulty walking one-quarter mile or climbing 10 steps during two consecutive semiannual assessments for more than 6.5 years.

RESULTS

Incidence of mobility limitation was 55% in women and 44% in men. In women, adjusted risk of developing mobility limitation was progressively greater in nonobese participants with the MetS (hazard ratio [HR] = 1.49, 95% confidence interval [CI] = 1.24-1.80), obese participants without the MetS (HR = 1.95, 95% CI = 1.51-2.53), and obese participants with the MetS (HR = 2.16, 95% CI = 1.78-2.63) relative to the nonobese without the MetS. In men, the corresponding adjusted HRs (95% CI) were 1.07 (0.87-1.32), 1.64 (1.19-2.25), and 1.41 (1.12-1.78). Elevated inflammatory markers partly explained the association between obesity, the MetS, and mobility limitation, particularly in nonobese and obese participants with the MetS.

CONCLUSIONS

Obesity itself, independent of its metabolic consequences, is a risk factor for mobility limitation among obese older adults. In addition, having the MetS increases the risk of functional decline in older nonobese women but not in men.

Moderate alcohol intake and risk of functional decline: the Health, Aging, and Body Composition study

OBJECTIVES

To investigate the prospective relationship between alcohol consumption and incident mobility limitation.

DESIGN

Cohort study.

SETTING

The Health Aging and Body Composition study, conducted in Memphis, Tennessee, and Pittsburgh, Pennsylvania.

PARTICIPANTS

Three thousand sixty-one adults aged 70 to 79 without mobility disability at baseline.

MEASUREMENTS

Incidence of mobility limitation, defined as self-report at two consecutive semiannual interviews of any difficulty walking one-quarter of a mile or climbing stairs, and incidence of mobility disability, defined as severe difficulty or inability to perform these tasks at two consecutive reports. Alcohol intake, lifestyle-related variables, diseases, and health status indicators were assessed at baseline.

RESULTS

During a follow-up time of 6.5 years, participants consuming moderate levels of alcohol had the lowest incidence of mobility limitation (total: 6.4 per 100 person-years (person-years); men: 6.4 per 100 person-years; women: 7.3 per 100 person-years) and mobility disability (total: 2.7 per 100 person-years; men: 2.5 per 100 person-years; women: 2.9 per 100 person-years). Adjusting for demographic characteristics, moderate alcohol intake was associated with lower risk of mobility limitation (hazard ratio (HR)=0.70, 95% confidence interval (CI)=0.55-0.89) and mobility disability (HR=0.66, 95% CI=0.45-0.95) than never or occasional consumption. Additional adjustment for lifestyle-related variables substantially reduced the strength of the associations (HR=0.85, 95% CI=0.66-1.08 and HR=0.81, 95% CI=0.56-1.18, respectively). Adjustment for diseases and health status indicators did not affect the strength of the associations, suggesting that lifestyle is most important in confounding this relationship.

CONCLUSION

Lifestyle-related characteristics mainly accounted for the association between moderate alcohol intake and lower risk of functional decline over time. These findings do not support a direct causal effect of alcohol intake on physical function.

Work and mental health: the case of older men living in underprivileged communities in Lebanon

This paper examines the association between being in paid work and depression among older adults in three poor urban communities in Beirut, Lebanon. In view of the rapid ageing of Lebanon's population and the growing number of older persons, the deteriorating economic conditions and the lack of pension systems, paid work is an important source of income for older people and deserves special attention. The sample was 328 men aged 65 or more years. Depression was assessed using the 15-item Geriatric Depression Scale. The exposure variable was working for pay at the time of the survey, and the covariates included socio-demographic measures, health characteristics, financial resources and social capital. Around one-third of the men were working, and approximately the same fraction were depressed. Adjusted data showed a protective effect of work on depression (odds ratio 0.50, 95 per cent confidence interval 0.25–0.96). This study is an eye opener on the circumstances of disadvantaged older people in a relatively low-income Eastern Mediterranean Region country, a topic rarely addressed in this area of the world. Old age is viewed as a decline in abilities while in reality many older adults are still able and ready to work. Social policies for older people should promote opportunities to work, not only pension schemes.

Worksite Opportunities for Wellness (WOW): effects on cardiovascular disease risk factors after 1 year

OBJECTIVE

To evaluate the effectiveness of a worksite health promotion program on improving cardiovascular disease risk factors.

METHODS

In St Louis, Missouri from 2005 to 2006, 151 employees (134 F, 17 M, 81% overweight/obese) participated in a cohort-randomized trial comparing assessments + intervention (worksite A) with assessments only (worksite B) for 1 year. All participants received personal health reports containing their assessment results. The intervention was designed to promote physical activity and favorable dietary patterns using pedometers, healthy snack cart, WeightWatchers(R) meetings, group exercise classes, seminars, team competitions, and participation rewards. Outcomes included BMI, body composition, blood pressure, fitness, lipids, and Framingham 10-year coronary heart disease risk.

RESULTS

123 participants, aged 45+/-9 yr, with BMI 32.9+/-8.8 kg/m(2) completed 1 year. Improvements (P< or =0.05) were observed at both worksites for fitness, blood pressure, and total-, HDL-, and LDL-cholesterol. Additional improvements occurred at worksite A in BMI, fat mass, Framingham risk score, and prevalence of the metabolic syndrome; only the changes in BMI and fat mass were different between worksites.

CONCLUSION

A multi-faceted worksite intervention promoted favorable changes in cardiovascular disease risk factors, but many of the improvements were achieved with worksite health assessments and personalized health reports in the absence of an intervention.

Brain regional lesion burden and impaired mobility in the elderly

This study investigated the relationship of brain white matter (WM) lesions affecting specific neural networks with decreased mobility in ninety-nine healthy community-dwelling subjects ≥75 years old prospectively enrolled by age and mobility status. We assessed lesion burden in the genu, body and splenium of corpus callosum; anterior, superior and posterior corona radiata; anterior and posterior limbs of internal capsule; corticospinal tract; and superior longitudinal fasciculus. Burden in the splenium of corpus callosum (SCC) demonstrated the highest correlation particularly with walking speed (r=0.4, p<10(-4)), and in logistic regression it was the best regional predictor of low mobility performance. We also found that independent of mobility, corona radiata has the largest lesion burden with anterior (ACR) and posterior (PCR) aspects being the most frequently affected. The results suggest that compromised inter-hemispheric integration of visuospatial information through the SCC plays an important role in mobility impairment in the elderly. The relatively high lesion susceptibility of ACR and PCR in all subjects may obscure the importance of these lesions in mobility impairment.

Self-report functioning according to the ICF model in elderly patients with rheumatoid arthritis and in population controls using the multidimensional health assessment questionnaire

OBJECTIVE

To assess disability and functioning of elderly patients with rheumatoid arthritis (RA) and population controls by linking the items included in the self-report Multidimensional Health Assessment Questionnaire (MDHAQ) with components of the WHO International Classification of Functioning, Disability and Health (ICF) instrument.

METHODS

In total, 1439 patients with RA (mean age 66 yrs, men 29%) and 957 population controls (65 yrs, men 27%) completed a mailed questionnaire. Functioning was recorded by the Finnish version of MDHAQ. Data included comorbidity, subjective health, education level, employment, exercise habits, self-report joint pain/tenderness, and, for patients, the disease duration.

RESULTS

Patients had lower levels of functioning compared to controls in all ICF domains, with the exception that male patients functioned comparably to male controls in the "general tasks and demands" domain. In patients, disease activity, education, exercise frequency, and comorbidities were expectedly associated with lower functioning in the body structure and function component, while male sex and subjectively perceived health were associated with more favorable functioning. In the activity and participation components, disease activity, exercise frequency, and comorbidities were associated with impaired functioning, while better health on self-report was associated with better functioning.

CONCLUSION

There is an extra burden of disability in elderly patients with RA compared to the reference population. With a large patient and control population sample, our study shows that use of the self-report MDHAQ identifies all 3 main components of the ICF framework, thus covering a wide spectrum of functioning. Elderly patients with RA, in comparison to population controls, encounter more difficulties in daily activities and their social life.