Upper extremity weakness: A novel risk factor for non-cardiovascular mortality among community-dwelling older adults

Performance of the Physical Functioning Activities of Daily Living Scale in the 2020 Medicare Health Outcomes Survey

OBJECTIVE

Assessing functional limitations for adults at high risk of frailty yields valuable information for identifying those in need of therapy. We evaluate a self-report measure used to assess physical function among Medicare recipients in the United States.

DESIGN

Secondary analysis of the 2020 Medicare Health Outcomes Survey.

SETTING

A random sample of adult enrollees of 510 managed care plans.

PARTICIPANTS

287,476 adults (37% completion rate): 58% women; 16% were <65 years old (entitled via disability), 50% 65-74, and 34% 75 or older; 77% White, 14% Black, and 8% another race; 19% had

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURE

We evaluate item distributions, dimensionality, monotonicity of response options, reliability, and validity of the 8-item Physical Functioning Activities of Daily Living (PFADL) scale.

RESULTS

Most reported they could do 6 basic activities of daily living without difficulty. More limitations were reported for the other 2 PFADL items: 32% were not limited at all in climbing several flights of stairs and 40% in moderate activities. Product-moment correlations among the 8 items ranged from r=0.19 between the easiest-to-do (eating) and most difficult-to-do (climbing several flights of stairs) items to r=0.73 between bathing and dressing. The coefficient alpha and omega for the 8-item scale were both 0.86. Item slopes ranged from 2.6 (climbing several flights of stairs and eating) to 4.8 (dressing). Item characteristic curves revealed that response options were most likely to be selected in the appropriate order along the physical functioning continuum. The PFADL had at least 0.80 reliability between about -3 SDs below the mean to the mean. It was negatively correlated with comorbid condition count, disability days, problems with balance or walking, falling, and obesity.

CONCLUSIONS

The PFADL is useful for assessing average or below physical function in Medicare recipients.

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Key Words

• Aged
• Functional status
• Medicare
• Rehabilitation
• Self-assessment

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MESH Headings

• Adult
• Humans
• Female
• Aged
• United States
• Male
• Activities of Daily Living
• Reproducibility of Results
• Medicare
• Surveys and Questionnaires
• Outcome Assessment, Health Care
• Disability Evaluation

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Grants

• P30 AG021684 NIA NIH HHS

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Affiliation(s)

Ron D Hays UCLA Division of General Internal Medicine, Department of Medicine, Los Angeles, CA.
Marc N Elliott RAND Corporation, Santa Monica, CA

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Retrospective multicenter (TRON group) study of humeral shaft fragility fractures: Analysis of mortality rates and risk factors

AIMS

This study aimed to show the mortality rate following humeral shaft fragility fractures (HSFF) in the elderly. The secondary aim was to examine the predictors associated with mortality in elderly patients who have sustained HSFF.

METHODS

From 2011 to 2020, all elderly patients aged 65 years and older with HSFF managed at our nine hospitals were retrospectively identified from our TRON database. Patient demographics and surgical characteristics were extracted from medical records and radiographs, and multivariable Cox regression analysis was used to identify factors affecting mortality.

RESULTS

In total, 153 patients who sustained HSFF were included. The mortality rate for HSFF in the elderly was 15.7% at 1 year and 24.6% at 2 years. Multivariable Cox regression analysis showed significant differences in survival for the following variables: older age (p < 0.001), underweight (p = 0.022), severely ill (p = 0.025), mobility limited to indoors (p = 0.003), dominant-side injury (p = 0.027), and nonoperative treatment (p = 0.013).

CONCLUSION

The outcome following HSFF in the elderly population appears to be relatively grim. The prognosis of elderly patients with HSFF is closely related to their medical history. In the elderly patients with HSFF, operative treatment should be positively considered while taking into account their medical status.