Progressive versus catastrophic loss of the ability to walk: implications for the prevention of mobility loss

Exploring the association between muscle mass and thyroid function in Chinese community subjects over 45 years old with normal thyroid function: a cross-sectional analysis

Background

Currently, nothing is known about the connection between muscle mass and thyroid hormone levels in middle-aged and elderly Chinese with normal thyroid function. The purpose of this study was to determine the potential association between muscle mass and thyroid function status in middle-aged and elderly Chinese subjects with normal thyroid function.

Methods

A cohort of 1868 participants in China were included in this retrospective study; their mean age was 53.97 years, and their skeletal muscle mass index was 7.44 kg/m2. Of them, 60.97% were men. Thyroid hormone concentrations, standard biochemical indices, and the frequency of chronic illnesses were among the many factors that were evaluated. Bioelectrical impedance analysis (BIA) was used to assess the patients' body composition. The skeletal muscle index (SMI) was calculated using the following formula: SMI = ASM (kg)/height 2 (m2), where ASM stands for appendicular skeletal muscle mass. To identify the correlations between the variables, the Spearman correlation coefficient was used. Binary logistic regression analysis was conducted to investigate the potential linkages between thyroid hormone levels and diminished muscle mass.

Results

In this investigation, a significant correlation was observed between low muscle mass and FT3/FT4 (OR=0.044, 95% CI: 0.004-0.440, P=0.008), as well as FT3 (OR=0.697, 95% CI: 0.508-0.957, P=0.025). Conversely, no discernible correlation trend was detected with TSH (OR=0.972, 95% CI: 0.814-1.160, P=0.753) and FT4 (OR=1.97, 95% CI=0.983-1.224, P=0.1). Following adjustment for various confounding factors, including age, vitamin D levels, triglycerides, HDL-C, LDL-C, total protein, hypertension, diabetes, hyperuricemia, and overweight/obesity, across the entire study population, a positive correlation between SMI and FT3/FT4 was identified. Subsequent gender, age, and weight-stratified analyses revealed consistent correlation trends between SMI and FT3/FT4, with all interactions yielding P-values > 0.05.

Conclusion

Our study has revealed that among middle-aged and elderly Chinese individuals exhibiting normal thyroid function, a reduction in the free T3 to free T4 ratio is associated with a decline in muscle mass.

Association between multimorbidity trajectories and incident disability among mid to older age adults: China Health and Retirement Longitudinal Study

BACKGROUND

Although multimorbidity is a risk factor for disability, the relationship between the accumulative patterns of multimorbidity and disability remains poorly understood. The objective of this study was to identify the latent groups of multimorbidity trajectories among mid to older age adults and to examine their associations with incident disability.

METHODS

We included 5,548 participants aged ≥ 45 years who participated in the China Health and Retirement Longitudinal Study from 2011 to 2018 and had no multimorbidity (≥ 2 chronic conditions) at baseline. The group-based multi-trajectory modeling was used to identify distinct trajectory groups of multimorbidity based on the latent dimensions underlying 13 chronic conditions. The association between multimorbidity trajectories and incident disability was analyzed using the generalized estimating equation model adjusting for potential confounders.

RESULTS

Of the 5,548 participants included in the current analysis, 2,407 (43.39%) developed multimorbidity during the follow-up. Among participants with new-onset multimorbidity, four trajectory groups were identified according to the combination of newly diagnosed diseases: "Cardiometabolic" (N = 821, 34.11%), "Digestive-arthritic" (N = 753, 31.28%), "Cardiometabolic/Brain" (N = 618, 25.68%), and "Respiratory" (N = 215, 8.93%). Compared to participants who did not develop multimorbidity, the risk of incident disability was most significantly increased in the "Cardiometabolic/Brain" trajectory group (OR = 2.05, 95% CI: 1.55-2.70), followed by the "Cardiometabolic" (OR = 1.96, 95% CI: 1.52 -2.53) and "Digestive-arthritic" (OR = 1.70, 95% CI: 1.31-2.20) trajectory groups.

CONCLUSIONS

The growing burden of multimorbidity, especially the comorbid of cardiometabolic and brain diseases, may be associated with a significantly increased risk of disability for mid to older age adults. These findings improve our understanding of multimorbidity patterns that affect the independence of living and inform the development of strategies for the primary prevention of disability.

Metformin Enhances B Cell Function and Antibody Responses of Elderly Individuals With Type-2 Diabetes Mellitus

Our previous work has shown that young and elderly patients with Type-2 Diabetes Mellitus (T2DM) treated with Metformin have optimal B cell function and serum antibodies specific for the seasonal influenza vaccine. In this paper, we have evaluated B cell function and the metabolic requirements of B cell antibody responses in elderly T2DM patients (E_T2DM) taking or not Metformin, and compared to those of healthy elderly (E_H) and healthy young (Y_H) individuals. Results show that Metformin significantly increases in vivo B cell function, measured by influenza vaccine-specific serum antibodies, in E_T2DM patients to the levels observed in E_H and more importantly in Y_H individuals. Metformin also decreases the frequencies of pro-inflammatory B cell subsets, as well as intrinsic inflammation and metabolic requirements of peripheral B cells from E_T2DM. This hyper-metabolic phenotype of B cells from E_T2DM is needed to support intrinsic inflammation, measured by the expression of transcripts for markers of the senescence-associated secretory phenotype (SASP), and the secretion of autoimmune antibodies. Importantly, B cell function in E_T2DM patients taking Metformin is not only increased as compared to that in E_T2DM patients not taking Metformin, but is comparable to B cell function measured in Y_H individuals. These results altogether strongly support the anti-aging effects of Metformin on humoral immunity.

Assessing the psychosocial dimensions of frailty among older adults in Singapore: a community-based cross-sectional study

OBJECTIVE

To examine how multiple dimensions of mental and social health, in addition to physical health, were associated with frailty among older adults.

DESIGN

A door-to-door sampling household community-based survey.

SETTING

Thirty-two public housing blocks within a residential town in Singapore's central region.

PARTICIPANTS

497 residents aged 60 years or older from the public housing town.

OUTCOME MEASURES

Physical frailty was assessed using the FRAIL Scale, which stands for fatigue, resistance, ambulation, illnesses and loss of weight. Physical health was assessed by multimorbidity, physical activity and functional ability; mental illness was assessed by the General Health Questionnaire (GHQ); and social domains were assessed by the Lubben Social Network Scale, Community Integration Measure and UCLA (University of California, Los Angeles) Loneliness Scale.

RESULTS

Compared with robust (59.5%) and prefrail (32.6%) older adults, frail adults (7.9%) reported higher morbidity, lower functional ability and physical activity, higher scores on GHQ, and lower scores on all three social health scales. In multiple regression models, frailty was significantly associated with age 81-90 years (adjusted OR=2.22, 95% CI 1.23 to 3.99), having 2-3 (adjusted OR=1.56, 95% CI 1.02 to 2.38) or >3 (adjusted OR=1.83, 95% CI 1.05 to 3.18) chronic diseases, reduced ability to perform daily tasks without assistance (adjusted OR=0.41, 95% CI 0.23 to 0.73), having fallen in the past 6 months (adjusted OR=2.18, 95% CI 1.18 to 4.06), social dysfunction in GHQ (adjusted OR=1.24, 95% CI 1.08 to 1.43) and loneliness (adjusted OR=1.26, 95% CI 1.06 to 1.50). Physical activity did not remain significantly associated with frailty when mental and social health-related factors were entered in the regression.

CONCLUSION

Community intervention for frailty prevention and management needs to include mental health promotion and social engagement to increase its impact on older adults.

Prognostic Factors in Elderly Patients With Guillain-Barré Syndrome: Does Age Matter?

Introduction

Twenty to 40% of Guillain Barré syndrome (GBS) patients will not be able to walk independently despite effective treatment. Older patients carry additional risks for worse outcomes.

Methods

A single center, ambispective cohort study was performed. Only subjects ≥18 years with a 3-month follow-up were included. Elderly patients were considered as a whole if ≥ 60 years. Demographics, CSF and nerve conduction studies were compared. A binomial logistic regression and Kaplan-Meier analyses were carried out to estimate good prognosis (Hugues ≤2) at 3-month follow-up.

Results

From 130 patients recruited, 27.6% were elderly adults. They had a more severe disease, higher mEGOS and more cranial nerve involvement. Age ≥70 years, invasive mechanical ventilation and axonal subtype, portrayed an unfavorable 3-month outcome. Further analysis demonstrated an earlier recovery in independent walk at 3 months for patients <70 years.

Conclusions

Elderly patients with GBS have a more severe disease at admission and encounter worse prognosis at 3-month follow-up, especially those above 70 years.

Impact of mobility restrictions on active aging; cross-sectional associations and longitudinal changes parallel to COVID-19 restrictions

BACKGROUND

Meaningful activities can be done in or around home, but opportunities for participation and active aging decrease when moving in smaller areas. Active aging refers to having an active approach to life in line with one's goals, ability and opportunities. In adults over 75 years with different baseline neighborhood mobility levels, we studied active aging scores two years prior to and amid COVID-19, when governments restricted mobility of residents to slow the COVID-19 outbreak.

METHODS

AGNES cohort data were collected in 2017-2018 and spring 2020. Individuals were queried about their will, ability, and opportunity, and extent of doing 17 activities, and subsequently, item, composite and sub-scores of active aging were computed. Neighborhood mobility was assessed as frequency of moving in or beyond own neighborhood (limited, regular, daily=reference). Associations were studied using Generalized Linear Models (cross-sectionally, n = 1007) and General Estimating Equations (prospectively, n = 774).

RESULTS

Participants with limited baseline neighborhood mobility had lower active aging scores than those with daily mobility, but the decline over time was similar. Some item scores on opportunity to act and extent of doing, e.g. for making one's day more interesting and advancing matters of faith or worldview, were better retained amid COVID-19 by those with limited mobility, attenuating group differences.

CONCLUSIONS

Active aging scores were somewhat compromised in individuals with limited neighborhood mobility, but opportunities for and engagement in several activities seemed to be better retained amid COVID-19 than for those with daily mobility. Thus, active aging may be possible despite mobility restriction.

Risk Factors for Mobility Decline in Community-Dwelling Older Adults: A Systematic Literature Review

Mobility is essential to maintaining independence for older adults. This systematic review aimed to summarize evidence about self-reported risk factors for self-reported mobility decline; and to provide an overview of published prognostic models for self-reported mobility decline among community-dwelling older adults. Databases were searched from inception to June 2, 2020. Studies were screened by two independent reviewers who extracted data and assessed study quality. Sixty-one studies (45,187 participants) were included, providing information on 107 risk factors. High-quality evidence and moderate/large effect sizes for the association with mobility decline were found for older age beyond 75 years, the presence of widespread pain, and mobility modifications. Moderate-high quality evidence and small effect sizes were found for a further 21 factors. Three model development studies demonstrated acceptable model performance, limited by high risk of bias. These findings should be considered in intervention development, and in developing a prediction instrument for practical application.

Outdoor Mobility and Use of Adaptive or Maladaptive Walking Modifications Among Older People

BACKGROUND

In old age, decline in functioning may cause changes in walking ability. Our aim was to study whether older people who report adaptive, maladaptive, or no walking modifications differ in outdoor mobility.

METHODS

Community-dwelling people aged 75-90 years (N = 848) were interviewed at baseline, of whom 761 participated in the 2-year follow-up. Walking modifications were assessed by asking the participants whether they had modified their way of walking 2 km due to their health. Based on the responses, three categories were formed: no walking modifications (reference), adaptive (eg, walking more slowly, using an aid), and maladaptive walking modifications (reduced frequency of walking, or having given up walking 2 km). Differences between these categories in life-space mobility, autonomy in participation outdoors, and unmet physical activity need were analyzed using generalized estimation equation models.

RESULTS

Participants with maladaptive walking modifications (n = 238) reported the most restricted life-space mobility (β = -9.6, SE = 2.5, p < .001) and autonomy in participation outdoors (β = 1.7, SE = 0.6, p = .004) and the highest prevalence of unmet physical activity need (odds ratio = 4.3, 95% confidence interval = 1.1-16.5) at baseline and showed a decline in these variables over time. Those with no walking modifications (n = 285) at baseline exhibited the best values in all outdoor mobility variables and no change over time. Although at baseline those with adaptive walking modifications (n = 325) resembled those with no modifications, their outdoor mobility declined over time.

CONCLUSION

Adopting adaptive modifications may postpone decline in outdoor mobility, whereas the use of maladaptive modifications has unfavorable consequences for outdoor mobility.

Thyroid hormone signaling is associated with physical performance, muscle mass, and strength in a cohort of oldest-old: results from the Mugello study

Thyroid hormones (THs) play a crucial role in the homeostasis of muscle function, such as myogenesis and energy metabolism, suggesting that the thyroid may be also involved in the entropic processes of muscle aging. The aim of the present study is to evaluate the effect of TH signaling on physical performance, muscle mass, and strength in a cohort of community-dwelling oldest-old subjects (> 90 years). The study population was selected in a rural area of central Italy (Mugello, Tuscany), and the design was cross-sectional. Four hundred seventy-five subjects (130 males and 345 females) were enrolled, representing about 65% of all the nonagenarians living in the Mugello area. After adjusting for multiple confounding factors (sex, age, diabetes, and levothyroxine administration), the lowest quartile of FT3/FT4 ratio distribution showed lower physical performance compared to the other quartiles (β ± SE: − 0.49 ± 0.12; p < 0.001), whereas the highest quartile of FT3/FT4 ratio was associated with higher skeletal muscle index (β ± SE: 1.11 ± 0.42; p = 0.009). In addition, the lowest quartile of FT4 showed a statistically significant higher handgrip strength (β ± SE: 1.78 ± 0.68; p = 0.009) compared to all other quartiles. This study demonstrates that nonagenarians with higher FT3/FT4 ratios had better preserved muscle function, therefore successfully overcoming the imbalance of homeostatic and entropic processes involved in muscle aging. However, we could not establish a cause-effect relationship due to the cross-sectional design of the study.

The Association Between Comorbidity, Frailty, and Outdoor Mobility Loss Among Community-Dwelling Individuals 60 Years of Age and Above in Moscow

To determine the prognostic value of frailty and comorbidity for outdoor mobility loss and mortality in the elderly. The retrospective study was conducted among outpatients aged ≥60 years. Patients with ≥3 chronic illnesses were treated by doctors who had undergone a 72-hour geriatric training. The outdoor low-mobility group comprised patients who failed to visit a doctor because of decreased outdoor mobility during the 3-year follow-up period. The outdoor high-mobility group comprised participants with no outdoor mobility loss. 5678 patients with a mean age of 71.0 ± 0.1 years were included in the study. The risk of outdoor mobility loss rose by 4% per year with men developing it 30% more than women. The effect of frailty was of particular importance because it increased the risk of developing outdoor mobility loss by 70%. Comorbidity was not associated with a higher risk of outdoor mobility loss, but the investigators did not take into account all possible illnesses, or the severity of disease. The loss of outdoor mobility was associated with increase in mortality. Early detection of frailty can help predict outdoor mobility loss and could reduce mortality among older people.

The mediating effect of pain on the association between multimorbidity and disability and impaired physical performance among community-dwelling older adults in southern China

AIM

To investigate the association between multimorbidity and disability and impaired physical performance, and to further evaluate the mediating effect of physical pain in this association.

METHODS

1321 community-dwelling older adults, who were over 60 years old in southern China, were regarded as participants in this cross-sectional study. Subjects completed a multi-instrument questionnaire including essential characteristics and physical function assessments. Physical function was assessed by activities of daily living (ADL), instrumental activities of daily living (IADL), index of mobility scale (NAGI), index of basic physical activities scale (RB), and short physical performance battery (SPPB). Multimorbidity was defined as the simultaneous presence of two or more chronic conditions. Multivariable regression and mediation analyses were conducted and gender differences were explored.

RESULTS

The prevalence of multimorbidity was 44.6% in our study. In gender stratification analysis, multimorbidity was significantly associated with ADL disability (OR = 2.16), IADL disability (OR = 1.97), NAGI disability (OR = 2.84), RB disability (OR = 2.65) and lower SPPB score (β = - 0.83) in women. The rate of pain increased with the number of chronic diseases and the multimorbidity patients with higher pain prevalence. Moreover, the presence of pain was also significantly associated with disability and impaired physical performance. Mediation analysis illustrated that pain was accounted for 16.5% to 22.1% of the adverse effects of multimorbidity on disability and impaired physical performance in women.

CONCLUSIONS

Multimorbidity was significantly associated with disability and impaired physical performance, and pain might be a mediating factor for adverse effects of multimorbidity on disability and impaired physical performance in women.

A Scoping Review of Physical Performance Outcome Measures Used in Exercise Interventions for Older Adults With Alzheimer Disease and Related Dementias

BACKGROUND AND PURPOSE

There is growing evidence that exercise interventions can mitigate functional decline and reduce fall risk in older adults with Alzheimer disease and related dementias (ADRD). Although physical performance outcome measures have been successfully used in older adults without cognitive impairment, additional research is needed regarding their use with individuals who have ADRD, and who may have difficulty following instructions regarding performance of these measures. The purpose of this scoping review was to identify commonly used physical performance outcome measures, for exercise interventions, that are responsive and reliable in older adults with ADRD. Ultimately, we aimed to provide recommendations regarding the use of outcome measures for individuals with ADRD across several domains of physical performance.

METHODS

A scoping review was conducted to broadly assess physical performance outcome measures used in exercise interventions for older adults with ADRD. Exercise intervention studies that included at least 1 measure of physical performance were included. All physical performance outcome measures were abstracted, coded, and categorized into 5 domains of physical performance: fitness, functional mobility, gait, balance, and strength. Criteria for recommendations were based on (1) the frequency of use, (2) responsiveness, and (3) reliability. Frequency was determined by the number of studies that used the outcome measure per physical performance domain. Responsiveness was assessed via calculated effect size of the outcome measures across studies within physical performance domains. Reliability was evaluated via published studies of psychometric properties.

RESULTS AND DISCUSSION

A total of 20 physical performance outcome measures were extracted from 48 articles that met study inclusion criteria. The most frequently used outcome measures were the 6-minute walk test, Timed Up and Go, repeated chair stand tests, short-distance gait speed, the Berg Balance Scale, and isometric strength measures. These outcome measures demonstrated a small, medium, or large effect in at least 50% of the exercise intervention studies. Good to excellent reliability was reported in samples of older adults with mild to moderate dementia. Fitness, functional mobility, gait, balance, and strength represent important domains of physical performance for older adults. The 6-minute walk test, Timed Up and Go, repeated chair stand tests, short-distance gait speed, Berg Balance Scale, and isometric strength are recommended as commonly used and reliable physical performance outcome measures for exercise interventions in older adults with mild to moderate ADRD. Further research is needed on optimal measures for individuals with severe ADRD.

CONCLUSIONS

The results of this review will aid clinicians and researchers in selecting reliable measures to evaluate physical performance outcomes in response to exercise interventions in older adults with ADRD.

Effects of an individually targeted multicomponent counseling and home-based rehabilitation program on physical activity and mobility in community-dwelling older people after discharge from hospital: a randomized controlled trial

OBJECTIVES

The aim of this study is to evaluate the effects of multicomponent rehabilitation on physical activity, sedentary behavior, and mobility in older people recently discharged from hospital.

DESIGN

Randomized controlled trial.

SETTING

Home and community.

PARTICIPANTS

Community-dwelling people aged ⩾60 years recovering from a lower limb or back musculoskeletal injury, surgery, or disorder were recruited from local health center hospitals and randomly assigned into an intervention (n = 59) or a control (standard care, n = 58) group.

INTERVENTION

The six-month intervention consisted of a motivational interview, goal attainment process, guidance for safe walking, a progressive home exercise program, physical activity counseling, and standard care.

MEASUREMENTS

Physical activity and sedentary time were assessed using an accelerometer and a single question. Mobility was evaluated with the Short Physical Performance Battery, self-reported use of a walking aid, and ability to negotiate stairs and walk outdoors. Intervention effects were analyzed with generalized estimating equations.

RESULTS

Daily physical activity was 127 ± 78 minutes/day and 121 ± 70 at baseline and 167 ± 81 and 164 ± 72 at six months in the intervention and control group, respectively; mean difference of 3.4 minutes (95% confidence interval (CI) = -20.3 to 27.1). In addition, no significant between-group differences were shown in physical performance.

CONCLUSION

The rehabilitation program was not superior to standard care for increasing physical activity or improving physical performance. Mobility-limited older people who had recently returned home from hospital would have needed a longer and more frequently monitored comprehensive geriatric intervention.

Validity of Instrumented 360° Turn Test in Older Adults with Cognitive Impairment

AIMS

To examine concurrent and construct validity of inertial sensor 360°turn measures in relation with motion capture and mobility assessments in cognitively impaired older adults.

METHODS

Data was collected in 31 participants, mean age 85.2 (SD 5.2), during clockwise (CW) and counter clockwise (CCW) 360° turns using (1) APDM body-worn inertial sensors and (2) Qualisys 8-camera laboratory-based motion capture.

RESULTS

Absolute agreement between inertial sensor and motion capture measures was excellent for turn duration and turn peak velocity (ICC = 0.96-0.98). Strong to moderate correlations were present between inertial sensor turn measures and performance on the Timed Up and Go, Short Physical Performance Battery and 90-s Balance Test. ROC curve analysis of CCW 360° turn duration and turn peak velocity distinguished higher risk versus lower risk for mobility disability.

CONCLUSIONS

Inertial sensor 360° turn measures demonstrated concurrent and construct validity in relation to motion capture and mobility assessments.

Quality of life among older people with a disability: the role of purpose in life and capabilities

Purpose: Purpose in life and capabilities are two significant individual elements that enhance quality of life among older people. Capabilities refers to the extent to which older people are free to make choices that are important to them. At present, it is not known how purpose in life interacts with capabilities to influence quality of life for those living with a disability. This study examined the extent to which purpose in life and capabilities interacts with health status to affect quality of life, particularly for older people with a disability.Methods: Self-report data from participants in a longitudinal cohort study of older New Zealanders were analyzed. Responses from 452 older people with a disability were compared with 3299 age- and gender-matched older people without a disability on indicators related to health and aging. The associations were tested using hierarchical regression. Mediational impact of purpose in life and capabilities were tested via path analysis.Results: Mental health, physical health, purpose in life, and capabilities accounted for a significant amount of variance in quality of life for older people with a disability. Purpose in life and capabilities were significant unique mediators for older people with a disability.Conclusions: Purpose in life may help older people with a disability to deal with early onset stressors or changes in mental and physical health to maintain overall quality of life. The role of capabilities suggests that the social environment and access to resources and choices are important in ensuring that older people aging with or into a disability achieve quality of life in a socially just environment.Implications for rehabilitationsPurpose in life and capability are unique mediators of the relationship between health status and quality of life.Purpose in life may act as an effective buffering mechanism to deal with disability in later life while capability can empower older people with a disability to achieve quality of life in a just environment.The notion of successful aging with disability should be re-defined as using psychological, social support, and healthcare resources to live a life consistent with personal values in the context of disabilityRather than emphasizing structural factors and physical functioning in activity participation, older people with disability should be supported to decide and pursue their own preferences.Rehabilitation professionals can work flexibly with older people with disability to maximize their resilience, dignity, autonomy and choice, and positive connection to others.

Frailty Questionnaire Is Not a Strong Prognostic Factor for Functional Outcomes in Hip or Knee Arthroplasty Patients

Introduction

Up to 33% and 25% of patients with end-stage hip and knee osteoarthritis (OA) are considered frail by the Groningen Frailty Indicator (GFI). This study aims to assess whether frail patients have lower functional gains after arthroplasty and to assess GFI as a tool to discriminate between good and adverse change score.

Materials and Methods

Patients with end-stage hip/knee OA scheduled for arthroplasty were recruited from the Longitudinal Leiden Orthopaedics Outcomes of Osteo-Arthritis Study. Functional outcome was measured as change score on the Hip Osteoarthritis Outcome Score/Knee Osteoarthritis Outcome Score (HOOS/KOOS), by subtracting preoperative score from 1-year postsurgery score and then dichotomized based on a cutoff of 20 points. For each HOOS/KOOS subscale, 3 models were estimated: GFI univariate (model 1), GFI and baseline score (model 2), and baseline score univariate (model 3). A receiver operating characteristic analysis was performed to assess the discriminative ability of each model.

Results

Eight hundred five patients with end-stage hip OA (31.4% frail) and 640 patients with end-stage knee OA (25.4% frail) were included. Frail patients were older, had a higher body mass index, had more comorbidities, and lived more often alone. Persons considered frail by GFI had significant lower baseline score; however, except for "function in sports and recreation" and "quality of life," change scores were similar in frail and nonfrail persons. The discriminatory value of GFI was negligible for all HOOS/KOOS subscales. Baseline score, however, was adequate to discriminate between total knee arthroplasty patients with more or less than twice the minimally clinically important difference on KOOS symptoms subscale (area under the curve = 0.802).

Discussion/Conclusion

Although frail patients with OA have lower functioning scores at baseline, the change scores on HOOS/KOOS subscales are similar for both frail and nonfrail patients. Exploring other heath assessements may improve patient-specific outcome prediction.

Association Between Early Rehabilitation and Mobility Status in Elderly Inpatients with Heart Failure: A Nationwide Retrospective Cohort Study

OBJECTIVE

We set out to examine the effectiveness of early rehabilitation for maintaining mobility status during hospitalization in elderly patients with heart failure.

METHODS

Using the Japanese Diagnosis Procedure Combination inpatient database, we retrospectively examined the eligibility of 527,440 consecutive patients aged ≥60 years who were diagnosed with heart failure with New York Heart Association class ≥ II at admission between July 2010 and March 2014. Of the 146,735 eligible subjects, 39,357 underwent early rehabilitation and 107,378 underwent non-early rehabilitation. Early rehabilitation was defined as rehabilitation starting within 3 days after admission. A multivariable logistic regression analysis and an instrumental variable analysis were carried out to examine the association of early rehabilitation with changes in mobility status during hospitalization.

RESULTS

The proportion of heart failure patients with maintained or improved mobility status during hospitalization was higher in the early rehabilitation group. Multivariable logistic regression analysis revealed that the early rehabilitation group had a significantly higher proportion with maintained or improved mobility status (odds ratio, 1.32; 95% confidence interval, 1.21-1.43; P<0.001). The instrumental variable analysis showed that early rehabilitation was associated with an increased proportion of patients with maintained or improved mobility status (risk difference, 0.8%; 95% confidence interval, 0.4%-1.1%; P<0.001).

CONCLUSIONS

The present study suggests that early rehabilitation is associated with an increase in the proportion of patients with maintained or improved mobility status compared with non-early rehabilitation in elderly inpatients with heart failure.

Diet and Activity Assessments and Interventions Using Technology in Older Adults

This paper reports on the findings and recommendations specific to older adults from the "Tech Summit: Innovative Tools for Assessing Diet and Physical Activity for Health Promotion" forum organized by the North American branch of the International Life Sciences Institute. The summit aimed to investigate current and emerging challenges related to improving energy balance behavior assessment and intervention via technology. The current manuscript focuses on how novel technologies are applied in older adult populations and enumerated the barriers and facilitators to using technology within this population. Given the multiple applications for technology in this population, including the ability to monitor health events and behaviors in real time, technology presents an innovative method to aid with the changes associated with aging. Although older adults are often perceived as lacking interest in and ability to adopt technologies, recent studies show they are comfortable adopting technology and user uptake is high with proper training and guided facilitation. Finally, the conclusions suggest recommendations for future research, including the need for larger trials with clinical outcomes and more research using end-user design that includes older adults as technology partners who are part of the design process.

THEME INFORMATION

This article is part of a theme issue entitled Innovative Tools for Assessing Diet and Physical Activity for Health Promotion, which is sponsored by the North American branch of the International Life Sciences Institute.

Integrating Health Promotion Into Physical Therapy Practice to Improve Brain Health and Prevent Alzheimer Disease

BACKGROUND AND PURPOSE

Alzheimer disease is the most common cause of dementia, and brain pathology appears years before symptoms are evident. Primary prevention through health promotion can incorporate lifestyle improvement across the lifespan. Risk factor assessment and identifying markers of disease might also trigger preventive measures needed for high-risk individuals and groups.

SUMMARY OF KEY POINTS

Many potential risk factors are modifiable through exercise, and may be responsive to early intervention strategies to reduce the downward slope toward disability. Through the use of common clinical tests to identify cognitive and noncognitive functional markers of disease, detection and intervention can occur at earlier stages, including preclinical stages of disease. Physical activity and exercise interventions to address modifiable risk factors and impairments can play a pivotal role in the prevention and delay of functional decline, ultimately reducing the incidence of dementia. This article discusses prevention, prediction, plasticity, and participation in the context of preserving brain health and preventing Alzheimer disease and related dementias in aging adults.

RECOMMENDATIONS FOR CLINICAL PRACTICE

Rehabilitation professionals have opportunities to slow disease progression through research, practice, and education initiatives. From a clinical perspective, interventions that target brain health through lifestyle changes and exercise interventions show promise for preventing stroke and associated neurovascular diseases in addition to dementia. Physical therapists are well positioned to integrate primary health promotion into practice for the prevention of dementia and other neurological conditions in older adults.

"Life Goes On." Everyday Tasks, Coping Self-Efficacy, and Independence: Exploring Older Adults' Recovery From Hip Fracture

Older adults face many challenges in the first few months after hip fracture. Rehabilitation holds promise to assist the recovery process. Therefore, we used semistructured interviews to explore older adults' and allied health professionals' acceptance of a rehabilitation intervention for hip fracture, and we described perceptions of the early recovery period (<4 months). Interviews were recorded and transcribed verbatim; three authors independently read the transcripts multiple times and together developed themes guided by Interpretive Description. Older adults described the intervention as acceptable and provided valuable feedback for its future implementation. Older adults also provided reflections on their experience of fracture recovery. Themes that emerged included physical limitations and loss of independence, the long recovery time, and coping with additional complications of living with multimorbidity. To overcome challenges, older adults identified the need for social support and physical activity, balanced by their own personal outlook.

Frailty in end-stage hip or knee osteoarthritis: validation of the Groningen Frailty Indicator (GFI) questionnaire

Frailty is highly prevalent in the elderly, increasing the risk of poor health outcomes. The Groningen Frailty Indicator (GFI) is a 15-item validated questionnaire for the elderly. Its value in patients with end-stage hip or knee osteoarthritis (OA) has not yet been determined. This study assesses the validity of the GFI in this patient group. End-stage hip or knee OA patients completed the GFI (range 0-15, ≥ 4 = frail) before arthroplasty surgery. Convergent validity was determined by Spearman-rank correlation between the SF-12 physical (PCS) and mental (MCS) component scores and the physical and mental GFI-domains, respectively. Discriminant validity was assessed by means of overall GFI-score and the pain-domain of the Hip/Knee Osteoarthritis Outcome Score (HOOS/KOOS). Altogether 3275 patients were included of whom 2957 (90.3%) completed the GFI. Mean GFI-scores were 2.78 (2.41) and 2.28 (1.99) in hip and knee OA-patients, respectively, with 570 (35.9%) of hip and 344 (24.1%) of knee patients considered frail. The convergent validity was moderate to strong (physical domain R = - 0.4, mental domain R = - 0.6) and discriminant validity low (R HOOS/KOOS-pain domain = - 0.2), confirming the validity of the GFI-questionnaire in this population. With 90% of participants completing the GFI, it is a feasible and valid questionnaire to assess frailty in end-stage hip and knee OA-patients. One-third (33.3%) of the patients undergoing hip arthroplasty and a quarter (24.1%) of those undergoing knee arthroplasty are frail. Whether this is associated with worse outcomes and can thus be used as a pre-operative predictor needs to be explored.

Hierarchy and Speed of Loss in Physical Functioning: A Comparison Across Older U.S. and English Men and Women

BACKGROUND

We aimed to identify the hierarchy of rates of decline in 16 physical functioning measures in U.S. and English samples, using a systematic and integrative coordinated data analysis approach.

METHODS

The U.S. sample consisted of 13,612 Health and Retirement Study participants, and the English sample consisted of 5,301 English Longitudinal Study of Ageing participants. Functional loss was ascertained using self-reported difficulties performing 6 activities of daily living and 10 mobility tasks. The variables were standardized, rates of decline were computed, and mean rates of decline were ranked. Mann-Whitney U tests were performed to compare rates of decline between studies.

RESULTS

In both studies, the rates of decline followed a similar pattern; difficulty with eating was the activity that showed the slowest decline and climbing several flights of stairs and stooping, kneeling, or crouching the fastest declines. There were statistical differences in the speed of decline in all 16 measures between countries. American women had steeper declines in 10 of the measures than English women. Similar differences were found between American and English men.

CONCLUSIONS

Reporting difficulties climbing several flights of stairs without resting, and stooping, kneeling, or crouching are the first indicators of functional loss reported in both populations.

Review: Physical disability and the cumulative impact of diabetes in older adults

he already high and increasing prevalence of diabetes among older adults will make ageing-related outcomes like physical disability an increasingly important complication of diabetes. Disability is a key indicator of both overall morbidity and the success of public health efforts to compress the period of morbidity in old age for the overall population. Many cross-sectional and longitudinal studies have now associated diabetes with increased risk of disabilities in mobility and in instrumental and basic activities of living. The explanation for higher disability among persons with diabetes appears to be multifactorial with neuropathy, peripheral arterial disease, coronary heart disease, depression, obesity, visual impairment, and physical inactivity the most prominent factors. These factors are common in persons with diabetes and exert strong effects on risk of disability. Several promising interventions exist, ranging from exercise programmes and identification and treatment of depression, to long-term prevention of disability through better management of glycaemia and risk factors for cardiovascular disease. Preliminary findings from the U.S. Diabetes Surveillance System suggest that, like the general population, prevalence of physical disability may also have declined among persons with diabetes during the last decade. Ultimately, preventing disability will likely depend on a combination of secondary and tertiary prevention along with, ideally, preventing diabetes in the first place.

Patterns of functional decline in very old age: an application of latent transition analysis

BACKGROUND AND AIMS

There is a scarcity of longitudinal studies examining how functional decline develops among very old people. The aim of the current study was to detect and characterize typical patterns of functional decline in a sample of very old people.

METHODS

We utilized longitudinal data from a sample of people aged 80-89 at baseline from Sweden and Germany (N = 847). Three follow-up assessments were completed and 159 participants completed the last assessment 9 years after baseline. Death (45 %) and contact no longer possible (40 %) were main reasons for dropout. We used latent transition analysis (LTA) to estimate the probabilities of latent class membership at each measurement point, as well as the transition probabilities of moving from one class to another.

RESULTS

Three latent classes were revealed, labeled Mobility Problem Stayers, Hearing Problem Advancers and Visual Problem Advancers. The first class had a low probability of additional problems throughout the study period, while the two latter had increased probabilities of additional limitations. In terms of class membership change, Mobility Problem Stayers moved either towards Hearing Problem Advancers or towards Visual Problem Advancers.

DISCUSSION AND CONCLUSIONS

The results suggest that mobility problems are most common when people reach the age of 80+. Further decline is typically characterized by the addition of either visual problems or hearing problems, which are both associated with an increased risk of limitations in upper extremities. These findings warrant further research to analyze the association between the detected typical patterns of functional decline and health-related outcomes.

Horizontal and vertical targeting: a population-based comparison of public eldercare services in urban and rural areas of Sweden

The concepts of target efficiency can be used to assess the extent to which service provision is in line with the needs of the population. Horizontal target efficiency denotes the extent to which those deemed to need a service receive it and vertical target efficiency is the corresponding extent to which those who receive services actually need them. The aim of this study was to assess the target efficiency of the Swedish eldercare system and to establish whether target efficiencies differ in different geographical areas such as large urban, midsize urban and rural areas. Vertical efficiency was measured by studying those people who received eldercare services and was expressed as a percentage of those who received services who were functionally dependent. To measure horizontal target efficiency, data collected at baseline in the longitudinal population study SNAC (Swedish National study on Aging and Care) during the years 2001-2004 were used. The horizontal efficiency was calculated as the percentage of functionally dependent persons who received services. Functional dependency was measured as having difficulty with instrumental activities of daily living (IADL) and/or personal activities of daily living (PADL). Services included long-term municipal eldercare services (LTC). Horizontal target efficiency for the public LTC system was reasonably high in all three geographical areas, when using dependency in PADL as the measure of need (70-90 %), but efficiency was lower when the less restrictive measure of IADL dependency was used (40-50 %). In both cases, the target efficiency was markedly higher in the large urban and the rural areas than in the midsize urban areas. Vertical target efficiency showed the same pattern-it was almost 100 % in all areas for IADL dependency, but only 50-60 % for PADL dependency. Household composition differed in the areas studied as did the way public long-term care was provided to people living alone as compared to those co-habiting.

Obesity and Muscle Weakness as Risk Factors for Mobility Limitation in Community-Dwelling Older Japanese Women: A Two-Year Follow-Up Investigation

OBJECTIVES

To examine the combined association of obesity and low muscle strength with mobility limitation in older adults.

DESIGN, SETTING AND PARTICIPANTS

This two-year follow-up longitudinal study included pooled data from 283 older community-dwelling Japanese women without mobility limitations who were 65 to 87 years of age (mean age 72.2 ± 5.0 years).

MEASUREMENTS

Muscle strength was measured by hand-grip strength (HGS). The participants were categorized by HGS (high muscle strength: HGS ≥19.6 kg, low muscle strength: HGS <19.6 kg) and body mass index (BMI) (obese: BMI ≥25 kg/m2, normal weight: BMI <25 kg/m2). The main outcome was mobility limitation, assessed by a self-reported questionnaire (difficulty walking one-half mile or climbing 10 steps without resting). Multivariate logistic regression analysis was performed to determine the combined effect of HGS and BMI on mobility limitation, adjusting for age, exercise habits, medications, and knee pain.

RESULTS

During the follow-up period, 82 of 283 participants (29.0%) developed mobility limitation. The adjusted odds ratios (95% confidence interval) for the incidence of mobility limitation were 1.53 (0.86-2.73) and 2.05 (1.08-3.91) in the obese and low muscle strength groups, respectively. Obesity combined with low muscle strength exhibited a significant and strong association with mobility limitation (odds ratio: 3.88, 1.08-13.91) compared with participants with normal weight and high muscle strength.

CONCLUSION

Among community-dwelling older Japanese women, obesity alone was not associated with the incidence of mobility limitation, but when combined with low muscle weakness, the risk of developing mobility limitation was 3.9-fold greater than for the reference group.

Longitudinal changes in mobility among nonagenarians: the Vitality 90+ Study

Background

Several studies have focused on predictors of mobility limitations and disabilities. Yet little is known about the pace and patterns of mobility changes among very old people. This study examined changes in functional mobility among individuals aged 90 years and older during a 2-9-year follow-up. In addition, we were interested in the patterns of mobility changes.

Methods

Data were collected through a mailed questionnaire in the years 2001, 2003, 2007 and 2010. The study population (n = 948) consisted of individuals from three cohorts (2001, 2003, 2007) who participated in at least two survey rounds and answered the mobility questions. The length of the follow-up varied from 2–9 years between individuals as well as according to how many times an individual took part in the survey. Multilevel ordinal logistic regression analysis was used to evaluate the effects of time, age, gender, cohort and chronic conditions on changes in mobility.

Results

At the baseline, “younger” old people, men and individuals in the cohorts for 2003 and 2007 had significantly better mobility compared with women, older individuals and individuals in the 2001 cohort. In addition, individuals with fewer chronic conditions had better mobility than those with more diseases. Mobility declined for most of the participants during the follow-up. The difference in the change in mobility over time for gender, age or chronic conditions was not statistically significant. The analyses were performed with a subgroup of participants aged 90–91 years at the baseline, and results did not differ substantially from the results for the entire study sample. However, the effect of chronic conditions on the change in mobility was statistically significant among participants aged 90-91years.

Conclusions

No differences were observed in the rate of mobility decline over time between age or gender. The effect of chronic conditions on the change in mobility was significant only among individuals aged 90–91 years. The prevention efforts are important and should focus even more, also among the oldest-old, on additional modifiable risk factors such as maintaining muscle strength.

Predictors of the antibody response to influenza vaccination in older adults with type 2 diabetes

OBJECTIVE

Type 2 diabetes mellitus (T2DM) is one of the most prevalent chronic inflammatory diseases of the elderly. Its development is related to the alteration of the immune system with aging characterized by immunosenescence and inflamm-aging. In turn, T2DM also alters the immune response. As a consequence, older people with T2DM are more susceptible to influenza and to its complications as compared with healthy controls. Vaccination against influenza has shown poor efficacy in the older population and even less efficacy in patients with diabetes. We studied here the antibody response to vaccination in healthy and diabetic elderly participants.

RESEARCH DESIGN AND METHODS

In 2 groups of elderly participants (healthy N=119 and T2DM N=102), we measured the immunogenicity of influenza vaccine by hemagglutination inhibition assays. We assessed several blood and functional parameters as potential predictors of the vaccine efficacy.

RESULTS

We found no difference between antibody responses in diabetic elderly compared with healthy elderly. Among the biological and functional determinants, the cytomegalovirus (CMV) serostatus played a more prominent role in determining the magnitude of response. We concluded that in addition to age and diabetic status, immunological history such as CMV status should be taken into account. None of the other biological or functional parameters studied could be reliably linked to the vaccine antibody response in older adults who are not frail including those with well-controlled diabetes.

CONCLUSIONS

Our data strongly suggest that influenza vaccine should be administered to elderly patients with T2DM; however, the immune determinants of the antibody response to influenza vaccination should be further investigated.

Self-management interventions for chronic disease: a systematic scoping review

OBJECTIVE

To investigate the contributions of physiotherapy and occupational therapy to self-management interventions and the theoretical models used to support these interventions in chronic disease.

DATA SOURCES

We conducted two literature searches to identify studies that evaluated self-management interventions involving physiotherapists and occupational therapists in MEDLINE, the Cochrane Library, CINAHL, EMBASE, AMED (Allied and Complementary Medicine), SPORTdiscus, and REHABDATA databases.

STUDY SELECTION

Four investigator pairs screened article title and abstract, then full text with inclusion criteria. Selected articles (n = 57) included adults who received a chronic disease self-management intervention, developed or delivered by a physiotherapist and/or an occupational therapist compared with a control group.

DATA EXTRACTION

Four pairs of investigators performed independent reviews of each article and data extraction included: (a) participant characteristics, (b) the self-management intervention, (c) the comparison intervention, (d) outcome measures, construct measured and results.

DATA SYNTHESIS

A total of 47 articles reported the involvement of physiotherapy in self-management compared with 10 occupational therapy articles. The type of chronic condition produced different yields: arthritis n = 21 articles; chronic obstructive pulmonary disease and chronic pain n = 9 articles each. The theoretical frameworks most frequently cited were social cognitive theory and self-efficacy theory. Physical activity was the predominant focus of the self-management interventions. Physiotherapy programmes included disease-specific education, fatigue, posture, and pain management, while occupational therapists concentrated on joint protection, fatigue, and stress management.

CONCLUSIONS

Physiotherapists and occupational therapists make moderate contributions to self-management interventions. Most of these interventions are disease-specific and are most frequently based on the principles of behaviour change theories.

The Impact of Health Problems on Driving Status among Older Adults

OBJECTIVE

This study assesses the impact of health problems on driving status (current driver vs. ex-driver) among older adults to identify which of those health problems have the greatest individual and population impact on driving cessation.

METHODS

Data were from baseline and 5 year follow-up waves of a longitudinal survey of adults age 55 years and older (N=1,279). The impact of several health problems on driving status was assessed using a relative risk ratio and a population attributable risk percent. Analyses controlled for age, gender, and the presence of additional baseline health problems.

RESULTS

Many health conditions were not associated with driving cessation. Functional limitations, cognitive function, and measures of vision were significant predictors of driving cessation. Self-care functional limitations were associated with the highest risk for driving cessation, while visual function was associated with the highest attributable risks.

DISCUSSION

In order to effectively address healthy aging and mobility transitions, it is important to consider the implications of targeting individuals or populations who are most at risk for driving cessation. The risk ratio is relevant for evaluating individuals; the attributable risk is relevant for developing interventions in populations.

Geriatric multidimensional assessment for elderly patients with acute respiratory diseases

The case of an 87-year-old woman who falls at home and is admitted to the Emergency Department of an acute hospital with delirium exemplify a common situation that physicians face in their everyday clinical practice. We describe the typical context of frailty in which acute illnesses frequently present in frail elderly patients and, in particular, the relationship between comorbidity, disability and frailty. We also report the current knowledge about frailty theories and we focus on the "atypical" presentation of many acute illnesses. Major attention is devoted on delirium and on mobility impairment, two of the most common atypical symptoms of elderly frail subjects. Finally we describe the evidence on the comprehensive geriatric assessment, i.e., the method that is required to identify and understand the ultimate needs of elderly complex subjects.

Functional impairment in obesity: a focus on knee and back pain

SUMMARY Cross-sectional and longitudinal evidence strongly indicate that obesity is related to physical impairment and joint pain, particularly in the lumbar spine, sacroiliac and knee joints. What is most disturbing is that obese children under 15 years are now reporting joint pain and cannot perform functional tasks as well as their nonobese counterparts. As the prevalence of obesity rises, so do the rates of musculoskeletal disease and physical dysfunction. Functional tasks that involve supporting or transferring body weight are typically painful and difficult to perform. Of most concern is that some of these tasks are simply impossible depending on the severity of obesity. As a consequence, the individual's quality of life suffers. A BMI of 35 kg/m(2) is emerging as the threshold at which functional impairment rates rise dramatically. To restore functional independence and optimize functional gains over the long term, a combination of treatments for the obese patient with joint pain may be effective. The initial use of physical therapy, pain medications or joint viscosupplementation, coupled with diet, exercise, or bariatric surgery are options for weight loss and reduction of pain symptoms. Irrespective of age, weight loss can reduce or eliminate joint pain. As body weight is reduced, so should the reliance on medication with a concomitant improvement in functional mobility.

Understanding frailty in the geriatric population

Clinicians who work with the frail elderly know what frailty looks like, but until recently, they have had no science-based definition of this condition. Frailty is classified as a medical syndrome, and Fried et al. were among the first to standardize the definition of frailty as a distinct syndrome with biologic underpinnings. Their definition describes a clinical phenotype of decreased reserve and resistance to stressors, with clinical manifestations of a mutually exacerbating cycle of negative energy balance, sarcopenia, diminished strength, and exertion intolerance. Age is no longer considered a defining characteristic, although frailty is still considered primarily a geriatric problem. Approximately two-thirds of affected individuals enter frailty in a slow, progressive way, while one-third become frail cataclysmically. Weakness is a common early sign, and exhaustion and weight loss are often late manifestations. Observing early behavioral changes before frailty develops could provide insight into its development and suggest early interventions. Since frailty is clearly associated with adverse outcomes, a healthy, active lifestyle is the cornerstone of prevention, and many researchers suggest that resistance training can reverse some muscle loss and improve functioning. When the health care team proposes any change in care, including a new medication, it should be prepared to describe how the intervention may affect cognition, memory, energy, or function.

Positive health outcomes following health-promoting and disease-preventive interventions for independent very old persons: long-term results of the three-armed RCT Elderly Persons in the Risk Zone

The aim of this study was to analyze the long-term effect of the two health-promoting and disease-preventive interventions, preventive home visits and senior meetings, with respect to morbidity, symptoms, self-rated health and satisfaction with health. The study was a three-armed randomized, single-blind, and controlled trial, with follow-ups at one and two years after interventions. A total of 459 persons aged 80 years or older and still living at home were included in the study. Participants were independent in ADL and without overt cognitive impairment. An intention-to-treat analysis was performed. The result shows that both interventions delayed a progression in morbidity, i.e. an increase in CIRS-G score (OR=0.44 for the PHV and OR=0.61 for senior meetings at one year and OR=0.60 for the PHV and OR=0.52 for the senior meetings at two years) and maintained satisfaction with health (OR=0.49 for PHV and OR=0.57 for senior meetings at one year and OR=0.43 for the PHV and OR=0.28 for senior meetings after two years) for up to two years. The intervention senior meetings prevented a decline in self-rated health for up to one year (OR=0.55). However, no significant differences were seen in postponing progression of symptoms in any of the interventions. This study shows that it is possible to postpone a decline in health outcomes measured as morbidity, self-rated health and satisfaction with health in very old persons at risk of frailty. Success factors might be the multi-dimensional and the multi-professional approach in both interventions.

TRIAL REGISTRATION

NCT0087705.

Interventions to Improve Walking in Older Adults

Interventions to improve walking in older adults have historically been multifactorial (i.e. strengthening, endurance and flexibility programs) focusing on improving the underlying impairments. These impairment-based programs have resulted in only modest improvements in walking. In older adults, walking is slow, less stable, inefficient, and the timing and coordination of stepping with postures and phases of gait is poor. We argue the timing and coordination problems are evidence of the loss of motor skill in walking. Taking a lesson from the sports world and from neurorehabilitation, task-oriented motor learning exercise is an essential component of training to improve motor skill and may be a beneficial approach to improving walking in older adults. In this article we: 1) briefly review the current literature regarding impairment-based interventions for improving mobility, 2) discuss why the results have been only modest, and 3) suggest an alternative approach to intervention (i.e. task oriented motor learning).

Validity and applicability of a video-based animated tool to assess mobility in elderly Latin American populations

AIM

To assess the reliability and the validity of Portuguese- and Spanish-translated versions of the video-based short-form Mobility Assessment Tool in assessing self-reported mobility, and to provide evidence for the applicability of these videos in elderly Latin American populations as a complement to physical performance measures.

METHODS

The sample consisted of 300 elderly participants (150 from Brazil, 150 from Colombia) recruited at neighborhood social centers. Mobility was assessed with the Mobility Assessment Tool, and compared with the Short Physical Performance Battery score and self-reported functional limitations. Reliability was calculated using intraclass correlation coefficients. Multiple linear regression analyses were used to assess associations among mobility assessment tools and health, and sociodemographic variables.

RESULTS

A significant gradient of increasing Mobility Assessment Tool score with better physical function was observed for both self-reported and objective measures, and in each city. Associations between self-reported mobility and health were strong, and significant. Mobility Assessment Tool scores were lower in women at both sites. Intraclass correlation coefficients of the Mobility Assessment Tool were 0.94 (95% confidence interval 0.90-0.97) in Brazil and 0.81 (95% confidence interval 0.66-0.91) in Colombia. Mobility Assessment Tool scores were lower in Manizales than in Natal after adjustment by Short Physical Performance Battery, self-rated health and sex.

CONCLUSIONS

These results provide evidence for high reliability and good validity of the Mobility Assessment Tool in its Spanish and Portuguese versions used in Latin American populations. In addition, the Mobility Assessment Tool can detect mobility differences related to environmental features that cannot be captured by objective performance measures.

A cross-sectional assessment of oxidative DNA damage and muscle strength among elderly people living in the community

OBJECTIVES

The mechanism by which muscle weakness leads to an increased risk of death remains a subject of interest. In this context, the aim of this study is to assess the relationship between urinary 8-hydroxy-2'-deoxyguanosine (8-OHdG) and muscle strength, and other risk factors contributing to poor muscle strength in older persons.

METHODS

This was a cross-sectional study in which a total of 86 participants, both men and women, aged 65 years or above were screened for urinary 8-OHdG, and muscle strength as measured by handgrip strength.

RESULTS

Handgrip strength was lower in participants who had history of acute or chronic disease. Urinary 8-OHdG level was negatively associated with muscle strength, and the association remained after adjusting for confounding factors.

CONCLUSIONS

Urinary 8-OHdG is associated with muscle strength. These findings may be clinically relevant as there is a possibility of controlling oxidative DNA damage by healthy behaviors related to lifestyle.

Stroke-associated differences in rates of activity of daily living loss emerge years before stroke onset

OBJECTIVES

To compare typical age-related changes in activities of daily living (ADLs) independence in stroke-free adults with long-term ADL trajectories before and after stroke.

DESIGN

Prospective, observational study.

SETTING

Community-dwelling Health and Retirement Study (HRS) cohort.

PARTICIPANTS

HRS participants who were stroke free in 1998 and were followed through 2008 (average follow-up 7.9 years) (N = 18,441).

MEASUREMENTS

Strokes were assessed using self- or proxy-report of a doctor's diagnosis and month and year of event. Logistic regression was used to compare within-person changes in odds of self-reported independence in five ADLs in those who remained stroke free throughout follow-up (n = 16,816), those who survived a stroke (n = 1,208), and those who had a stroke and did not survive to participate in another interview (n = 417). Models were adjusted for demographic and socioeconomic covariates.

RESULTS

Even before stroke, those who later developed stroke had significantly lower ADL independence and were experiencing faster independence losses than similar-aged individuals who remained stroke free. Of those who developed a stroke, survivors experienced slower pre-stroke loss of ADL independence than those who died. ADL independence declined at the time of stroke and decline continued afterwards.

CONCLUSION

In adults at risk of stroke, disproportionate ADL limitations emerge well before stroke onset. Excess disability in stroke survivors should not be entirely attributed to effects of acute stroke or quality of acute stroke care. Although there are many possible causal pathways between ADL and stroke, the association may be noncausal. For example, ADL limitations may be a consequence of stroke risk factors (e.g., diabetes mellitus) or early cerebrovascular ischemia.