Association of clinical outcome assessments of mobility capacity and incident disability in community-dwelling older adults - a systematic review and meta-analysis

Reference centiles for intrinsic capacity to monitor clinical health outcomes in real-world primary care cohorts

Intrinsic capacity (IC) refers to physical and mental capacities that determine healthy aging. IC is the central element of the World Health Organization care pathway 'Integrated Care for Older People' (ICOPE). However, the operationalization of a composite IC measurement in clinical settings remains to be defined. We used screening data from ICOPE implementation in a real-life population of 27,706 adults 60 years or older that were users of primary care services to elaborate and cross-validate IC scores and centile values for men and women. Here, we show that IC centiles were cross-sectionally associated with comorbidity, frailty and limitations in both activities of daily living and instrumental activities of daily living. External validation using populations from high-income (French INSPIRE-T cohort) and upper-middle-income (ICOPE Brazil) countries validated the associations between IC centiles and clinical outcomes. The IC centiles developed using ICOPE screening data constitute a standardized parameter to monitor individual and population IC through a clinically friendly approach.

Effects of Functional Training on Physical Function, Cardiorespiratory Fitness, and Quality of Life in Older Women: A 6-Week Randomized Controlled Trial

Background: Functional training is increasingly recognized for its potential to improve physical function and quality of life (QoL) in older adults. This randomized controlled trial examined the effects of a six-week functional training program on physical function, cardiorespiratory fitness, and QoL in older women. Methods: Fifty older women (mean age: 63.5 ± 3.7 years) were randomly assigned to a functional training group (n = 25) or a control group (n = 25). The intervention group participated in a six-week functional training program (six sessions per week), while the control group maintained usual daily activities. Outcomes included dynamic balance (TUG test), flexibility, muscle strength, walking speed, cardiorespiratory fitness (two-minute step test), and QoL. Results: Functional training significantly improved dynamic balance, lower body flexibility, lower body strength, walking speed, and aerobic endurance (p < .05 for all). QoL significantly increased in the functional training group across all domains, as well as overall scores (p < .05). However, the control group experienced declines in some measures. Conclusion: Functional training is a safe and effective intervention for improving physical function, cardiorespiratory fitness, and QoL in older women. The significant enhancements in physical and mental health highlight its value in promoting independence and well-being in aging populations. Future studies should explore its long-term benefits and scalability.

Evidence-based exercise recommendations to improve functional mobility in older adults - A study protocol for living systematic review and meta-analysis

Background and objectives

This is a protocol for a living systematic review and meta-analysis.This review will assess the effects of state-of-the-art exercise interventions designed to promote functional mobility. Therefore, after identifying all potential interventions, we will use the F.I.T.T. principles (frequency, intensity, time, type) as well as the physical and health status of the participants as moderators to analyse the mechanisms for the positive benefits of exercise interventions.The main research questions are:Which exercise types are most beneficial for improving functional mobility in various populations of older adults?Which physical exercise characteristics in terms of frequency, intensity, time and duration will achieve the greatest benefit in terms of the defined outcomes, i.e, the functional mobility of older adults?

Methods

The systematic literature research according to PRISMA guidelines will search databases like MEDLINE, APA Psych-Info and Web of Science.Inclusion criteria are: healthy older people ≥ 50 years, randomized-controlled trials including exercise intervention and a walking or mobility assessments (eg., TUG, SPPB) as an outcome measure. A preliminary search revealed more than 33,000 hits that will be screened by pairs of independent reviewers. The results will be summarized according to the effects regarding functional mobility and potential dose-response relations via respective meta-analysis.

Conclusion

The systematic review will comprise the knowledge of the existing literature with regards to the effects of the physical activity interventions compared to an active or inactive control group.We will summarize the effects with respect to the F.I.T.T.. They provide a foundation for structuring an optimal exercise training program. If possible, we will also compare interventions from the different categories (eg. cardiovascular, resistance, motor-coordinative, multicomponent or mind-body exercise) as a network analysis and report the influence of moderator variables. Based on the results evidence-based guidelines following GRADE for physical exercise interventions to improve functional mobility in older adults will be provided.

Association between walking pace and heart failure: A Mendelian randomization analysis

BACKGROUND AND AIM

The relationship between walking pace and heart failure (HF) has been recognized, yet the directionality and underlying mediating risk factors remain unclear.

METHODS AND RESULTS

This study utilized bidirectional two-sample Mendelian randomization (MR) with genome-wide association studies (GWAS) summary statistics to assess the causal relationships between walking pace and HF. Additionally, we employed a two-step Multivariable Mendelian Randomization (MVMR) to explore potential mediating factors. We further validated our findings by conducting two-sample MR with another available GWAS summary data on heart failure. Results indicated that genetically predicted increases in walking pace were associated with a reduced risk of HF (odds ratio (OR), 0.589, 95% confidence interval (CI): 0.417-0.832). Among the considered mediators, the waist-to-hip ratio (WHR) accounts for the largest proportion of the effect (45.7%, 95% CI: 13.2%, 78.2%). This is followed by type 2 diabetes at 24.4% (95% CI: 6.7%, 42.0%) and triglycerides at 18.6% (95% CI: 4.5%, 32.7%). Furthermore, our findings reveal that genetically predicted HF risk (OR, 0.975, 95% CI: 0.960-0.991) is associated with a slower walking pace. Validated findings were consistent with the main results.

CONCLUSIONS

In conclusion, MR analysis demonstrates that a slow walking pace is a reliable indicator of an elevated risk of HF, and the causal relationship is bidirectional. Interventions focusing on waist-to-hip ratio, type 2 diabetes, and triglycerides may provide valuable strategies for HF prevention in individuals with a slow walking pace.

The impact of social isolation on functional disability in older people: A multi-cohort study

OBJECTIVES

We assessed the relationship between social isolation and functional disability in older people.

DESIGN

Comparison of longitudinal cohort studies.

SETTING AND PARTICIPANTS

Harmonised longitudinal datasets from the United States, England, European countries, Japan, Korea, China and Hong Kong.

METHODS

Social isolation was operationalised as a composite score with five domains, such as marital status, living alone, and social contact with others. Functional disability was defined as whether the cohort participant had any difficulty in activities of daily living (ADL). In each dataset, we used robust Poisson regression models to obtain the relative risks (RRs) and the corresponding 95 % confidence intervals (CI). We combined the RRs to synthesize a pooled estimate using meta-analysis with random-effects models.

RESULTS

Overall, the social isolation composite score was not associated with ADL disability (pooled RR = 1.05, 95 % CI [0.97-1.14], n = 40,119). Subgroup analysis suggested social isolation composite score was associated with ADL disability in Asian regions (pooled RR = 1.09, 95 % CI [1.02, 1.16], but not in Western regions (pooled RR = 1.01, 95 % CI [0.96, 1.07]). The relationships between different domains of social isolation and ADL disability were heterogeneous, except that no participation in any social clubs or religious groups was consistently associated with ADL disability (pooled RR = 1.12, 95 % CI [1.04, 1.21]).

CONCLUSION

Targeting social isolation may prevent decline in functional abilities in older adults, providing an avenue to active and healthy ageing. Nonetheless, interventions tackling social isolation should tailor to the unique cultural and social underpinnings. A limitation of the study is that reverse causality could not be ruled out definitively.

Functional Mobility and Balance Confidence Measures Are Associated with Disability among Community-Dwelling Older Adults

Background and Objectives: Our objectives were to examine the association between balance confidence, functional mobility measures, and the presence of disability in older adults in Saudi Arabia and to identify the optimal cutoff scores for these measures that predict disability. Materials and Methods: A cross-sectional study was conducted among 324 community-dwelling older adults (65 ± 7 years, 59% women). Disability was assessed using the Arabic version of the basic activities of daily living (ADLs) scale. Balance confidence was evaluated using the Arabic version of the Activities -Specific Balance Confidence (ABC) scale, and functional mobility was assessed using the 30-Second Chair Stand Test (30s-CST). Results: The prevalence of disability was 33.6% among the participants. Logistic regression revealed a 6% increase in disability odds for each one-unit decrease in the 30s-CST (OR: 0.94) and a 3% increase per one-point decrease in the ABC score (OR: 0.97). The optimal cutoff scores were ≤5 repetitions for the 30s-CST (sensitivity: 74.4%; specificity: 51.4%; AUC: 0.64) and ≤40 for the ABC scale (sensitivity: 80.8%; specificity: 61.4%; AUC: 0.75). Conclusions: Impaired balance and functional mobility are significantly associated with disability among older adults. The 30s-CST and the ABC scale can be used as effective screening tools, but the cross-sectional design of the current study limits its generalizability. Longitudinal research is needed to validate these findings.

Real-life intrinsic capacity screening data from the ICOPE-Care program

The Integrated Care for Older People (ICOPE) program is a healthcare pathway that uses a screening test for intrinsic capacity (IC) as its entry point. However, real-life data informing on how IC domains cluster and change over time, as well as their clinical utility, are lacking. Using primary healthcare screening data from more than 20,000 French adults 60 years of age or older, this study identified four clusters of IC impairment: 'Low impairment' (most prevalent), 'Cognition+Locomotion+Hearing+Vision', 'All IC impaired' and 'Psychology+Vitality+Vision'. Compared to individuals with 'Low impairment', those in the other clusters had higher likelihood of having frailty and limitations in both activities of daily living (ADL) and instrumental activities of daily living (IADL), with the strongest associations being observed for 'All IC impaired'. This study found that ICOPE screening might be a useful tool for patient risk stratification in clinical practice, with a higher number of IC domains impaired at screening indicating a higher probability of functional decline.

Biomarkers of frailty

Several biomarkers have been proposed to identify frailty, a multisystemic age-related syndrome. However, the complex pathophysiology and the absence of a consensus on a comprehensive and universal definition make it challenging to pinpoint a singular biomarker or set of biomarkers that conclusively characterize frailty. This review delves into the main laboratory biomarkers, placing special emphasis on those associated with various pathways closely tied to the frailty condition, such as inflammation, oxidative stress, mitochondrial dysfunction, metabolic and endocrine alterations and microRNA. Additionally, we provide a summary of different clinical biomarkers encompassing different tools that have been proposed to assess frailty. We further address various imaging biomarkers such as Dual Energy X-ray Absorptiometry, Bioelectrical Impedance analysis, Computed Tomography and Magnetic Resonance Imaging, Ultrasound and D3 Creatine dilution. Intervention to treat frailty, including non-pharmacological ones, especially those involving physical exercise and nutrition, and pharmacological interventions, that include those targeting specific mechanisms such as myostatin inhibitors, insulin sensitizer metformin and with special relevance for hormonal treatments are mentioned. We further address the levels of different biomarkers in monitoring the potential positive effects of some of these interventions. Despite the availability of numerous biomarkers, their performance and usefulness in the clinical arena are far from being satisfactory. Considering the multicausality of frailty, there is an increasing need to assess the role of sets of biomarkers and the combination between laboratory, clinical and image biomarkers, in terms of sensitivity, specificity and predictive values for the diagnosis and prognosis of the different outcomes of frailty to improve detection and monitoring of older people with frailty or at risk of developing it, being this a need in the everyday clinical practice.

Association of cancer diagnosis with disability status among older survivors of colorectal cancer: a population-based retrospective cohort study

Background

Older cancer survivors likely experience physical function limitations due to cancer and its treatments, leading to disability and early mortality. Existing studies have focused on factors associated with surgical complications and mortality risk rather than factors associated with the development of poor disability status (DS), a proxy measure of poor performance status, in cancer survivors. We aimed to identify factors associated with the development of poor DS among older survivors of colorectal cancer (CRC) and compare poor DS rates to an age-sex-matched, non-cancer cohort.

Methods

This retrospective cohort study utilized administrative data from the Texas Cancer Registry Medicare-linked database. The study cohort consisted of 13,229 survivors of CRC diagnosed between 2005 and 2013 and an age-sex-matched, non-cancer cohort of 13,225 beneficiaries. The primary outcome was poor DS, determined by Davidoff's method, using predictors from 12 months of Medicare claims after cancer diagnosis. Multivariable Cox proportional hazards regression was used to identify risk factors associated with the development of poor DS.

Results

Among the survivors of CRC, 97% were 65 years or older. After a 9-year follow-up, 54% of survivors of CRC developed poor DS. Significant factors associated with future poor DS included: age at diagnosis (hazard ratio [HR] = 3.50 for >80 years old), female sex (HR = 1.50), race/ethnicity (HR = 1.34 for Hispanic and 1.21 for Black), stage at diagnosis (HR = 2.26 for distant metastasis), comorbidity index (HR = 2.18 for >1), and radiation therapy (HR = 1.21). Having cancer (HR = 1.07) was significantly associated with developing poor DS in the pooled cohorts; age and race/ethnicity were also significant factors.

Conclusions

Our findings suggest that a CRC diagnosis is independently associated with a small increase in the risk of developing poor DS after accounting for other known factors. The study identified risk factors for developing poor DS in CRC survivors, including Hispanic and Black race/ethnicity, age, sex, histologic stage, and comorbidities. These findings underscore the importance of consistent physical function assessments, particularly among subsets of older survivors of CRC who are at higher risk of disability, to prevent developing poor DS.

Mortality and disability risk among older adults unable to complete grip strength and physical performance tests: a population-based cohort study from China

BACKGROUND

The link between low grip strength, diminished physical performance, and adverse health outcomes in older adults has been well-established. However, the impact of older adults who cannot complete these tests on disability and mortality rates remains unexplored without longitudinal study.

METHODS

We collected data from the China Health and Retirement Longitudinal Study (CHARLS). Participants aged 60-101 were enrolled at baseline. We analyzed the prevalence of populations unable to complete handgrip strength (HGS), gait speed (GS), and five times chair stand test (FTCST). Completing risk models were used to estimate the risk of mortality and disability over seven years.

RESULTS

A total of 3,768 participants were included in the analysis. The percentage of older adults unable to complete the GS and FTCST tests increased notably with age, from 2.68 to 8.90% and 2.60-20.42%, respectively. The proportion of older people unable to perform the HGS was relatively stable, ranging from 1.40 to 3.66%. Compared to older adults who can complete these tests, those who cannot perform FTCST face a significantly higher risk of mortality, with 49.1% higher risk [hazard ratio (HR) = 1.491, 95% CI = 1.156, 1.922; subdistribution hazard ratio (SHR) = 1.491, 95%CI = 1.135,1.958)]. Participants who were unable to complete the GS test had a higher risk of developing ADL disability, regardless of whether they were compared to the lowest-performing group (HR = 1.411, 95%CI = 1.037,1.920; SHR = 1.356, 95%CI = 1.030,1.785) or those who can complete the GS (HR = 1.727, 95%CI = 1.302,2.292; SHR = 1.541, 95%CI = 1.196,1.986). No statistically significant difference in the risk of developing ADL disability among older adults who were unable to complete the HGS test compared with either the poorest performing group (HR = 0.982, 95% CI = 0.578, 1.666; SHR = 1.025, 95% CI = 0.639, 1.642) or those who were able to complete the HGS test (HR = 1.008, 95% CI = 0.601, 1.688; SHR = 0.981, 95% CI = 0.619, 1.553). The risk of all-cause mortality was not significantly different for older adults who were unable to complete the HGS test compared to those with the worst performance (HR = 1.196, 95%CI = 0.709-2.020; SHR = 1.196, 95%CI = 0.674, 2.124) or those who were able to complete the test (HR = 1.462, 95%CI = 0.872-2.450; SHR = 1.462, 95%CI = 0.821,2.605).

CONCLUSION

The risks of adverse events faced by older adults unable to complete the tests vary, indicating the necessity for future research to conduct separate analyses on this high-risk population.

Measuring physical performance in later life: reliability of protocol variations for common performance-based mobility tests

BACKGROUND AND AIMS

Performance-based tests of mobility or physical function such as the Timed Up and Go (TUG), gait speed, chair-rise, and single-leg stance (SLS) are often administered using different protocols in aging populations, however, the reliability of their assessment protocols is not often considered. The purpose of this study was to examine the reliabilities of frequently used assessment protocols for the TUG, gait speed, chair-rise, and SLS in different age groups.

METHODS

We administered the following assessment protocols in an age-stratified (50-64, 65-74, 75+ years) sample of participants (N = 147) from the Canadian Longitudinal Study on Aging (CLSA): TUG fast pace and TUG normal pace: TUG-cognitive counting backwards by ones and counting back by threes, gait speed with 3-m and 4-m course, chair-rise with arms crossed and allowing the use of arms, and SLS using preferred leg or both legs-on two occasions within 1 week. We assessed the relative (intra-class correlation) and absolute reliability (standard error of measurement, SEM and minimal detectable change, MDC) for each protocol variation and provided recommendations based on relative reliability.

RESULTS

For participants aged 50-64 years, our results suggest better reliability for TUG fast-pace compared with normal-pace (ICC and 95% CI 0.70; 0.41-0.85 versus 0.38; 0.12-0.59). The reliability values for 3-m gait speed were potentially higher than for 4-m gait speed (ICC 0.75; 0.67-0.82 versus 0.64; 0.54-0.73) and values for chair-rise suggested better reliability allowing participants to use their arms than with arms crossed (ICC 0.79; 0.66-0.86 versus 0.64; 0.45-0.77) for participants overall. For participants aged 75+ years, ICCs for SLS with the preferred leg showed better reliability than for both legs (ICC = 0.62-0.79 versus 0.30-0.39).

CONCLUSIONS AND DISCUSSION

These reliability data and the recommendations can help guide the selection of the most appropriate performance-based test protocols for measuring mobility in middle-aged and older community-dwelling adults.

Validity and reliability of the Apple Health app on iPhone for measuring gait parameters in children, adults, and seniors

This study assessed the concurrent validity and test-retest-reliability of the Apple Health app on iPhone for measuring gait parameters in different age groups. Twenty-seven children, 28 adults and 28 seniors equipped with an iPhone completed a 6-min walk test (6MWT). Gait speed (GS), step length (SL), and double support time (DST) were extracted from the gait recordings of the Health app. Gait parameters were simultaneously collected with an inertial sensors system (APDM Mobility Lab) to assess concurrent validity. Test-retest reliability was assessed via a second iPhone-instrumented 6MWT 1 week later. Agreement of the Health App with the APDM Mobility Lab was good for GS in all age groups and for SL in adults/seniors, but poor to moderate for DST in all age groups and for SL in children. Consistency between repeated measurements was good to excellent for all gait parameters in adults/seniors, and moderate to good for GS and DST but poor for SL in children. The Health app on iPhone is reliable and valid for measuring GS and SL in adults and seniors. Careful interpretation is required when using the Health app in children and when measuring DST in general, as both have shown limited validity and/or reliability.