Severity of upper and lower extremity functional limitation: scale development and validation with self-report and performance-based measures of physical function. WHAS Research Group. Women's Health and Aging Study

Spousal collaboration mediates the relation between self-rated health and depressive symptoms of Chinese older couples: an actor-partner interdependence approach

BACKGROUND

Dyadic coping resources have been considered a potential explanatory mechanism of spousal interdependence in health, but the mediation of spousal collaboration for the relationship between self-rated health and depressive symptoms has yet to be examined. This study aimed to investigate the within- (actor effect) and between-partner effects of self-rated health on depressive symptoms in community-dwelling older couples facing physical functioning limitations and to examine the role of spousal collaboration in mediating the actor and cross-partner effects of self-rated health on depressive symptoms.

METHOD

Data from 185 community-dwelling older Chinese married couples were analyzed using the actor-partner interdependence mediation model (APIMeM). Couples were interviewed through trained research assistants using the 5-item common dyadic coping subscale of the Dyadic Coping Inventory (DCI), the Visual Analog Scale (VAS) of the QoL questionnaire EQ-5D and the Patient Health Questionnaire-9 (PHQ-9).

RESULTS

Husbands' self-rated health had an actor effect on their own depressive symptoms and a partner effect on their wives' depressive symptoms. Wives' self-rated health had an actor effect on their own depressive symptoms. The actor effects between self-rated health and depressive symptoms were partially mediated by their own perception of spousal collaboration. Furthermore, husbands' self-rated health not only affects wives' depressive symptoms directly but also indirectly by influencing wives' perceptions of spousal collaboration.

DISCUSSION

The findings from this study underscored the importance of viewing couples' coping processes from a dyadic and gender-specific perspective, since more (perceived) collaborative efforts have beneficial effects on both partners' mental health outcomes.

Prevalence and incidence of mobility limitation in Chinese older adults: evidence from the China health and retirement longitudinal study

BACKGROUND

Mobility limitation, a manifestation of impaired intrinsic capacity, is the first obvious sign of functional decline. However, few studies have been conducted on the prevalence and incidence of mobility limitation. This study aimed to estimate the prevalence and incidence of mobility limitation in Chinese older adults (over 60 years old) and evaluate its impact on mortality.

METHODS

The study used two waves of data from China Health and Retirement Longitudinal Study (CHARLS) in 2011 and 2013. The prevalence and incidence of mobility limitation were assessed using the methods recommended by the World Health Organization in the integrated care for older people guidelines, using the five-time sit-to-stand test as a screening and then the Short Physical Performance Battery assessment for diagnosis. Multivariable logistic regression was used to analyze the association between mobility limitation and death.

RESULTS

Of the 5507 participants with complete baseline data, 1486 had limited mobility, and 4021 had intact mobility at baseline; 4093 participants completed follow-up assessment 2 years later, and 189 died between the baseline and follow-up assessments. Of the 2828 participants with intact mobility at baseline who completed the follow-up mobility assessment, 408 developed mobility limitation. The standardized prevalence was 30.4% (95% CI = 28.8-32.1 %). The standardized incidence of mobility limitation in 2 years was 18.1% (95% CI = 15.8-20.4 %). A total of 189 patients died during the follow-up period. After adjusting for sociodemographic factors and chronic diseases, mobility limitation was associated with an increased risk of death (odds ratio = 1.84, 95% CI = 1.33-2.55, P < .001).

CONCLUSIONS

The standardized prevalence of mobility limitation in Chinese older adults living in the community was 30.4%, and the standardized incidence was 18.1%. Mobility limitation significantly predicts 2-year death in older adults. This suggests that early screening, assessment of intrinsic capacity (particularly locomotion domain) as well as tailored interventions to tackle mobility limitation in older adults might reduce mortality.

Agreement between standard and self-reported assessments of physical frailty syndrome and its components in a registry of community-dwelling older adults

BACKGROUND

The ability to identify frail older adults using a self-reported version of the physical frailty phenotype (PFP) that has been validated with the standard PFP could facilitate physical frailty detection in clinical settings.

METHODS

We collected data from volunteers (N = 182), ages 65 years and older, in an aging research registry in Baltimore, Maryland. Measurements included: standard PFP (walking speed, grip strength, weight loss, activity, exhaustion); and self-reported questions about walking and handgrip strength. We compared objectively-measured gait speed and grip strength to self-reported questions using Cohen's Kappa and diagnostic accuracy tests. We used these measures to compare the standard PFP with self-reported versions of the PFP, focusing on a dichotomized identification of frail versus pre- or non-frail participants.

RESULTS

Self-reported slowness had fair-to-moderate agreement (Kappa(k) = 0.34-0.56) with measured slowness; self-reported and objective weakness had slight-to-borderline-fair agreement (k = 0.10-0.21). Combining three self-reported slowness questions had highest sensitivity (81%) and negative predictive value (NPV; 91%). For weakness, three questions combined had highest sensitivity (72%), while all combinations had comparable NPV. Follow-up questions on level of difficulty led to minimal changes in agreement and decreased sensitivity. Substituting subjective for objective measures in our PFP model dichotomized by frail versus non/pre-frail, we found substantial (k = 0.76-0.78) agreement between standard and self-reported PFPs. We found highest sensitivity (86.4%) and NPV (98.7%) when comparing the dichotomized standard PFP to a self-reported version combining all slowness and weakness questions. Substitutions in a three-level model (frail, vs pre-frail, vs. non-frail) resulted in fair-to-moderate agreement (k = 0.33-0.50) with the standard PFP.

CONCLUSIONS

Our results show potential utility as well as challenges of using certain self-reported questions in a modified frailty phenotype. A self-reported PFP with high agreement to the standard phenotype could be a valuable frailty screening assessment in clinical settings.

Distinctions Between Self-Report and Performance-Based Measures of Physical Function in Older Patients Prior to Chemotherapy

BACKGROUND

The maintenance of physical function (PF) is an extremely important outcome for elderly people.

OBJECTIVE

The aims of this study were to identify differences in the subjective and objective measures of PF between younger older adults (YOAs, 60-69 years of age) and older adults (OA, ≥70 years of age), to compare the PF scores with age-matched samples from the general population, and to evaluate for associations between the subjective and objective measures of PF.

METHODS

Patients (n = 139) were assessed using subjective (ie, European Organization for Research and Treatment of Cancer Core Quality-of-Life Questionnaire) and objective (ie, Short Physical Performance Battery [SPPB]) measures prior to chemotherapy (CTX). Data were analyzed using parametric and nonparametric tests.

RESULTS

No differences were found between the 2 age groups in any of the subjective or objective measures of PF. Compared with the age-matched general population, both YOAs and OAs had significantly lower scores in both measures of PF. Large effect sizes were found for differences in European Organization for Research and Treatment of Cancer Core Quality-of-Life Questionnaire role function, SPPB balance, and SPPB total scores between the YOA group and the age-matched general population samples. Correlations between the subjective and objective measures were low.

CONCLUSIONS

Older patients with cancer have lower PF than their age-matched general population prior to CTX. Longitudinal studies are warranted to evaluate for changes in PF during and following CTX.

IMPLICATIONS FOR PRACTICE

Nurses need to perform routine assessments of PF in older oncology patients prior to CTX. Our findings suggest that SPPB gait speed may be a useful screening measure for PF in older patients.

Effects of peri-traumatic stress experienced during Hurricane Sandy on functional limitation trajectories for older men and women

BACKGROUND AND METHODS

Although the short-term effects of disasters on the physical health of mid-life and older people have been documented, little is understood about the long-term effects that disasters have on the physical health of these people. Based on the environmental docility hypothesis and research regarding gender effects on functional limitations and disaster, our analyses examined the effects of peri-traumatic stress experienced during Hurricane Sandy using longitudinal data from 5688 people aged 50 and older collected over six waves (2006-2019).

RESULTS

We found that functional limitations follow three trajectories, with people in each group having a significant linear increase over time and all but the highest functioning people also having a significant quadratic effect, indicating that the linear increase peaked post-Hurricane and then slowed in later waves.

CONCLUSION

Consistent with the environmental docility hypothesis, peri-traumatic stress had its greatest impact on people with more functional limitations before the hurricane. Men experiencing peri-traumatic stress during Hurricane Sandy were more likely to experience an increase in functional limitations than women. These findings, which identify people most likely to experience long-term health effects following a disaster, can be used to inform health policies before, during, and after disaster strikes.

Impact of Upper and Lower Body Functional Ability on Affect in Older Couples

Objective: We explore how upper and lower body functional ability of older adults and their partners relate to affect in later life. Methods: Data regarding own and partner's upper and lower body functional abilities were reported by 1767 married/partnered persons aged 57-83. Using multilevel modeling to account for nesting within couples, we examined the impact of a respondent's own functional abilities, their perception of their partner's abilities, and the interaction of respondent's and perceived partner's abilities on respondent's positive and negative affect. Results: Higher upper and lower body ability of both respondents and partners were associated with higher positive and lower negative affect. Moderating effects demonstrated a protective role of respondents' ability on affect when their partners experienced lower ability. Discussion: There is a potential compensatory relationship between older couples adapting to functional changes; it is important to support the functional abilities of both partners in couples to maximize psychological well-being.

Snap-fit assembly and upper limb functional limitations in automotive production workers: a nested case-control study

OBJECTIVES

The use of snap-fits in car-part assembling has developed into an industrial standard. Cross-sectional evidence indicates, however, that this assembling process might adversely affect workers' upper limb function. The objective of this study was to analyze incident cases of upper limb functional limitations (ULFL) in relation to exposure to snap-fit assembly.

METHODS

We performed a nested case-control study within a population of 5139 blue-collar automotive production workers. Cases with ULFL detected during follow-up were matched with controls based on employment duration and investigated on their exposure to snap-fit assembly. By conditional logistic regression, we modeled the risk for ULFL according to person-years of exposure to snap-fit assembly, adjusted for gender and baseline BMI.

RESULTS

Overall, 64 ULFL cases were detected during a follow-up of 20610.8 person-years (3.1 cases per 1000 person-years). Cases, matched with an average of 4 controls, had significantly longer exposure duration to snap-fit assembly compared with controls (M = 1.15 person-years, SD = 1.68 person-years vs. M = 0.41 person-years, SD = 1.25 person-years). One person-year of exposure to snap-fit assembly was associated with an approximate 20% risk increase of developing ULFLs (OR 1.23, 95% CI 1.08-1.39).

CONCLUSIONS

We confirm an association between accumulated exposure to snap-fits in car-part assembling and upper limb musculoskeletal disorders. Company physicians should thus be vigilant to symptoms of musculoskeletal disorders of the upper limbs in snap-fit assembly and support the development of threshold values for snap-fit insertion forces.

Disseminating the Otago Exercise Program in the United States: Perceived and Actual Physical Performance Improvements From Participants

The Otago Exercise Program (OEP) is an evidence-based fall prevention program disseminated internationally. Little is known about the implementation or effectiveness of the OEP in the United States. The purposes were to (a) identify characteristics of older adults enrolled in OEP, and (b) examine perceived and actual functional performance changes after participation in 8 weeks of the program. Baseline and 8-week functional and self-report data were collected on 210 older adults from 2013 to 2015. Linear mixed models and general estimating equations logistic regression models adjusted for socio-demographic factors were performed to assess changes. At 8 weeks, scores dramatically improved on self-report and physical performance tests: Timed Up-and-Go ( p < .001), 30-Second Chair Rise ( p < .001), and Four-Stage Balance ( p < .001). Findings support that participation in the U.S. OEP as part of a plan of care can result in significant improvements in objective functional mobility, balance measures, and self-reported ability.

Association between Race, Household Income and Grip Strength in Middle- and Older-Aged Adults

BACKGROUND

Poor grip strength is an indicator of frailty and a precursor to functional limitations. Although poor grip strength is more prevalent in older disabled African American women, little is known about the association between race and poverty-related disparities and grip strength in middle-aged men and women.

METHODS

We examined the cross-sectional relationship between race, socioeconomic status as assessed by household income, and hand grip strength in men and women in the Healthy Aging in Neighborhoods of Diversity across the Life Span study. General linear models examined grip strength (maximum of two trials on both sides) by race and household income adjusted for age, weight, height, hand pain, education, insurance status, family income, and two or more chronic conditions.

RESULTS

Of 2,091 adults, 422(45.4%) were male, 509(54.8%) were African American, and 320 (34.5%) were living in households with incomes below 125% of the federal poverty level (low SES). In adjusted models, African American women had greater grip strength than White women independent of SES (low income household: 29.3 vs 26.9 kg and high income household: 30.5 vs. 28.3kg; P<.05 for both); whereas in men, only African Americans in the high income household group had better grip strength than Whites (46.3 vs. 43.2; P<.05).

CONCLUSIONS

The relationship between grip strength, race and SES as assessed by household income varied in this cohort. Efforts to develop grip strength norms and cut points that indicate frailty and sarcopenia may need to be race- and income-specific.

Measuring Physical Capacity

OBJECTIVE

The objective of this study was to develop and assess a composite measure of physical capacity using self-report and physical performance items.

METHOD

Item response theory (IRT) is used to evaluate measurement properties of self-report and performance items and to develop a composite measure for 7,609 participants in the National Health and Aging Trends Study.

RESULTS

Self-reports distinguish differences at the lower end of physical capacity but not at mid-to-high levels. Performance-based measures discriminate across a fuller spectrum. An IRT-based composite score, drawing on both, provides increased measurement precision across the physical capacity spectrum and detects age group differences if either self-report or performance does so-suggesting it is better suited for studying age-related changes than either measure alone.

DISCUSSION

Self-report and performance measures have different strengths on the physical capacity spectrum. IRT provides a means of combining these different measurement approaches for analyses of physical capacity across a broad range of functioning in later life.

Snap-fits and upper limb functional limitations in German automotive workers

BACKGROUND

The use of snap-fit fasteners in automotive assembly has increased in the last 10 years. Their impact on musculoskeletal function of the upper limbs in assembly workers is not well described.

AIMS

To investigate the association between snap-fit assembly and upper limb functional limitations (ULFLs) in workers after a large-scale expansion of snap-fit assembly by a German automotive company.

METHODS

Cross-sectional data on blue-collar production workers' exposure to snap-fit assembly and ULFLs were collected from medical check-ups and company registers. The association between duration of snap-fit assembly and ULFLs, and the dose-response relationship between the two were analysed using logistic regression, adjusted for body mass index, gender and employment duration before snap-fit exposure.

RESULTS

The study group included 10722 workers. Within the company, 8.4, 6.9 and 10.3% were exposed to snap-fit 1-12, 13-24 and ≥25 months, respectively. After adjusting for confounders, snap-fit exposure for 1-12 months [odds ratio (OR) = 1.59, 95% confidence interval (CI) 0.88-2.88] and 13-24 months (OR = 1.48, 95% CI 0.76-2.88) was not statistically significantly associated with ULFLs compared with an unexposed group. However, exposure to ≥25 months of snap-fit assembly was statistically significant associated with ULFLs showing >2-fold risk (OR = 2.44, 95% CI 1.52-3.92). No clear dose-response relationship was found.

CONCLUSIONS

Our study suggests a negative long-term impact from snap-fit assembly on workers' upper limb function. Company physicians should be vigilant for signs of upper limb musculoskeletal disorders among workers exposed to snap-fit assembly.

A concordance of self-reported and performance-based assessments of mobility as a mortality predictor for older Mexican Americans

AIM

To assess the efficacy in mortality prediction of a concordance of performance-based (timed 10-foot walk; performance-oriented mobility assessment [POMA]) and self-rated (reported ability to walk across a small room with no help from people or devices; activities of daily living [ADL]) assessments of mobility for Mexican Americans aged 75 years and older.

METHODS

A longitudinal study of 2069 participants aged 75 years and older from the Hispanic Established Population for the Epidemiological Study of the Elderly wave 5 (June 2004 to January 2006) and wave 6 (February 2007 to February 2008) was carried out. Sociodemographic variables, performance-based (timed 10-foot walk) and self-rated assessments (reported ability to walk across a small room without the help of any people or devices) of mobility, and mortality data were obtained.

RESULTS

The ADL/POMA concordance assessment showed a prevalence of the "positively concordant" group (completed the walk and reported being able to walk, ADL and POMA both positive), followed by the "pessimist," "optimist," and "negatively concordant" groups at 80.09%, 10.50%, 3.78% and 5.63%, respectively. Logistic regression analyses showed that "negatively concordant" was a critical mortality predictor (OR 4.80; 95% CI 2.59-8.90) followed by "pessimist" (OR 1.94; 95% CI 1.12-3.36) as compared with the reference group, "positively concordant."

CONCLUSION

The ADL/POMA concordance is an effective predictor of mortality for older Mexican Americans in the Hispanic Established Population for the Epidemiological Study of the Elderly. Geriatr Gerontol Int 2017; 17: 433-439.

Visual impairment and incident mobility limitations: the health, aging and body composition study

OBJECTIVES

To examine the association between multiple measures of visual impairment (VI) and incident mobility limitations in older adults.

DESIGN

Prospective observational cohort study.

SETTING

Memphis, Tennessee, and Pittsburgh, Pennsylvania.

PARTICIPANTS

Health, Aging and Body Composition study participants aged 70 to 79 without mobility limitations at the Year 3 visit (N = 1,862).

MEASUREMENTS

Vision was measured at the Year 3 visit, and VI was defined as distance visual acuity (VA) worse than 20/40, contrast sensitivity (CS) less than 1.55 log Contrast, and stereoacuity (SA) greater than 85 arcsec. Incident persistent walking and stair climbing limitation was defined as two consecutive 6-month reports of any difficulty walking one-quarter of a mile or walking up 10 steps after 1, 3, and 5 years of follow-up.

RESULTS

At Year 3 (baseline for these analyses), 7.4% had impaired VA, 27.2% had impaired CS, and 29.2% had impaired SA. At all follow-up times, the incidence of walking and stair climbing limitations was higher in participants with VA, CS, or SA impairment. After 5 years, impaired CS and SA were independently associated with greater risk of walking limitation (hazard ratio (HR)CS = 1.3, 95% confidence interval (CI) = 1.1-1.7; HRSA = 1.3, 95% CI = 1.1-1.6) and stair climbing limitation (HRCS = 1.4, 95% CI = 1.1-1.8; HRSA = 1.3, 95% CI=1.1-1.7). Having impaired CS and SA was associated with greater risk of mobility limitations (HRwalking limitations = 2.0, 95% CI = 1.6-2.5; HRstair limitation = 2.1, 95% CI = 1.6-2.8).

CONCLUSION

Multiple aspects of VI may contribute to mobility limitations in older adults. Addressing more than one component of vision may be needed to reduce the effect of vision impairment on functional decline.

Association of serum bicarbonate with incident functional limitation in older adults

BACKGROUND AND OBJECTIVES

Cross-sectional studies have found that low serum bicarbonate is associated with slower gait speed. Whether bicarbonate levels independently predict the development of functional limitation has not been previously studied. Whether bicarbonate was associated with incident persistent lower extremity functional limitation and whether the relationship differed in individuals with and without CKD were assessed in participants in the Health, Aging, and Body Composition study, a prospective study of well functioning older individuals

DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS

Functional limitation was defined as difficulty in walking 0.25 miles or up 10 stairs on two consecutive reports 6 months apart in the same activity (stairs or walking). Kidney function was measured using eGFR by the Chronic Kidney Disease Epidemiology Collaboration creatinine equation, and CKD was defined as an eGFR<60 ml/min per 1.73 m(2). Serum bicarbonate was measured using arterialized venous blood gas. Cox proportional hazards analysis was used to assess the association of bicarbonate (<23, 23-25.9, and ≥26 mEq/L) with functional limitation. Mixed model linear regression was performed to assess the association of serum bicarbonate on change in gait speed over time.

RESULTS

Of 1544 participants, 412 participants developed incident persistent functional limitation events over a median 4.4 years (interquartile range, 3.1 to 4.5). Compared with ≥26 mEq/L, lower serum bicarbonate was associated with functional limitation. After adjustment for demographics, CKD, diabetes, body mass index, smoking, diuretic use, and gait speed, lower serum bicarbonate was significantly associated with functional limitation (hazard ratio, 1.35; 95% confidence interval, 1.08 to 1.68 and hazard ratio, 1.58; 95% confidence interval, 1.12 to 2.22 for bicarbonate levels from 23 to 25.9 and <23, respectively). There was not a significant interaction of bicarbonate with CKD. In addition, bicarbonate was not significantly associated with change in gait speed.

CONCLUSIONS

Lower serum bicarbonate was associated with greater risk of incident, persistent functional limitation. This association was present in individuals with and without CKD.

What do older people understand by mobility-related difficulties?

Despite the centrality of the difficulty concept in the study of disability, there has been little research on its significance from the point of view of people with functional limitations. The main objective of this study was to describe what older people understand when asked about difficulty in undertaking mobility activities. As a secondary objective, we considered whether there are any differences depending on the type of activities, according to the International Classification of Functioning (ICF) mobility domains.

METHODS

Seventeen community-dwelling men and women aged 70 years old or over were interviewed by means of a questionnaire containing 55 items covering the ICF mobility domains. The participants responded to the items while thinking aloud, saying what led them to give a specific answer about their level of difficulty. Inductive content analysis was conducted and categories, subthemes and themes were identified.

RESULTS

Causes of difficulty (pathologies, impairments, symptoms) and accommodations (task modifications and use of aids) were the two themes identified; and their importance (and that of the subthemes included) varied across the types of activity. All the participants said that they had no difficulty in at least one task, despite mentioning changes in the way they performed them.

CONCLUSIONS

Older people's opinions were consistent with theoretical models of disability and with the standard practice of measuring functional limitations by asking about the degree of difficulty; however, the design of these measures needs to be improved in order to detect perceptions of no difficulty in the presence of task modification.

Exploring the Relationships Among Performance-Based Functional Ability, Self-Rated Disability, Perceived Instrumental Support, and Depression

Data from the Women’s Health and Aging Study were used to test a model of factors explaining depressive symptomology. The primary purpose of the study was to explore the association between performance-based measures of functional ability and depression and to examine the role of self-rated physical difficulties and perceived instrumental support in mediating the relationship between performance-based functioning and depression. The inclusion of performance-based measures allows for the testing of functional ability as a clinical precursor to disability and depression: a critical, but rarely examined, association in the disablement process. Structural equation modeling supported the overall fit of the model and found an indirect relationship between performance-based functioning and depression, with perceived physical difficulties serving as a significant mediator. Our results highlight the complementary nature of performance-based and self-rated measures and the importance of including perception of self-rated physical difficulties when examining depression in older persons.

A Rasch-validated version of the upper extremity functional index for interval-level measurement of upper extremity function

BACKGROUND

The original 20-item Upper Extremity Functional Index (UEFI) has not undergone Rasch validation.

OBJECTIVE

The purpose of this study was to determine whether Rasch analysis supports the UEFI as a measure of a single construct (ie, upper extremity function) and whether a Rasch-validated UEFI has adequate reproducibility for individual-level patient evaluation.

DESIGN

This was a secondary analysis of data from a repeated-measures study designed to evaluate the measurement properties of the UEFI over a 3-week period.

METHODS

Patients (n=239) with musculoskeletal upper extremity disorders were recruited from 17 physical therapy clinics across 4 Canadian provinces. Rasch analysis of the UEFI measurement properties was performed. If the UEFI did not fit the Rasch model, misfitting patients were deleted, items with poor response structure were corrected, and misfitting items and redundant items were deleted. The impact of differential item functioning on the ability estimate of patients was investigated.

RESULTS

A 15-item modified UEFI was derived to achieve fit to the Rasch model where the total score was supported as a measure of upper extremity function only. The resultant UEFI-15 interval-level scale (0-100, worst to best state) demonstrated excellent internal consistency (person separation index=0.94) and test-retest reliability (intraclass correlation coefficient [2,1]=.95). The minimal detectable change at the 90% confidence interval was 8.1.

LIMITATIONS

Patients who were ambidextrous or bilaterally affected were excluded to allow for the analysis of differential item functioning due to limb involvement and arm dominance.

CONCLUSION

Rasch analysis did not support the validity of the 20-item UEFI. However, the UEFI-15 was a valid and reliable interval-level measure of a single dimension: upper extremity function. Rasch analysis supports using the UEFI-15 in physical therapist practice to quantify upper extremity function in patients with musculoskeletal disorders of the upper extremity.

Differences in self-reported physical limitation among older women and men in Ismailia, Egypt

OBJECTIVES

This study explores the reasons for gender differences in self-reported physical limitation among older adults in Ismailia, Egypt.

METHOD

435 women and 448 men, 50 years and older in Ismailia, Egypt, participated in a social survey and tests of physical performance. Ordered logit models were estimated to compare unadjusted gender differences in reported disability with these differences adjusted sequentially for (a) age and objective measures of physical performance, (b) self-reported morbidities and health care use, and (c) social and economic attributes.

RESULTS

Compared with men, women more often reported higher levels of limitation in activities of daily living (ADLs), upper-extremity range of motion (ROM), and lower-extremity gross mobility (GM). Adjusting for age and objective measures of physical performance, women and men had similar odds of self-reporting difficulty with ADLs. With sequential adjustments for the remaining variables, women maintained significantly higher odds of self-reported difficulty with upper-extremity ROM and lower-extremity GM.

DISCUSSION

Cross-culturally, gender differences in self-reported disability may arise from objective and subjective perceptions of disability. Collectively, these results and those from prior studies in Bangladesh and the United States suggest that gender gaps in self-reported physical limitation may be associated with the degree of gender equality in society.

Frailty and its prediction of disability and health care utilization: the added value of interviews and physical measures following a self-report questionnaire

AIMS

To establish whether the prediction of the adverse outcomes disability and six indicators of health care utilization one and two years later by the three frailty domains (physical, psychological, social) of the Tilburg Frailty Indicator (TFI) is improved by adding interview and physical measures of frailty.

MATERIALS AND METHODS

A representative sample of 245 Dutch community-dwelling persons aged 75 years and older (response rate 53%) participated in 2008, one year later in 2009 (n=179, 73%) and again two years later in 2010 (n=141, 58%). Frailty was assessed with the TFI, an easy to administer self-report measure. Disability was measured using the Groningen Activity Restriction Scale (GARS). Indicators of health care utilization were: visit to a general practitioner (gp), contacts with health care professionals (hcps), hospital admission, receiving personal care, receiving nursing care, and receiving informal care.

RESULTS

After controlling for background characteristics, the TFI predicted disability and the indicators of health care utilization. Interviews and physical measures of frailty improved the prediction of disability. The Hospital Anxiety and Depression Scale (HADS-A) improved the prediction of contacts with hcps, but the interview and physical measures of frailty did not improve the predictions of the other indicators of health care utilization.

CONCLUSIONS

Assessment by the self-report TFI is sufficient for predicting six indicators of health care utilization, but for predicting disability the use of both the TFI and the Timed Up & Go (TUG) test is recommended. It is advisable assessing all three frailty domains when examining frailty and its prediction of adverse outcomes.

[Reliability of the VIDA questionnaire for assessing instrumental activities of daily living (iADL) in the elderly]

OBJECTIVE

To analyse the inter- and intra-examiner reliability of the VIDA questionnaire, and their concordance with the "timed get up and go" test in people aged ≥75 years.

DESIGN

Descriptive study of a diagnostic test.

LOCATION

Primary Health Care. SUBJECTS-INTERVENTION: Application of 71 pairs of VIDA questionnaire, by one (38) or two professionals (33), in people aged ≥75 years with no significant sensory or physical-psychic impairment. Stratified sample based on ADL (Barthel index) to obtain a variety of responses that would ensure a range of scores of the questionnaire.

MAIN MEASUREMENTS

Overall score of VIDA questionnaire, "get up and go" test (functional), Pfeiffer questionnaire (cognitive), and risk factors of frailty (comorbidity, falls, recent hospitalisation, sensory disturbance, social impairment, polypharmacy).

RESULTS

Mean age 81.3 years±4.8, with a 65.5% moderate-severe change in Barthel index. The mean score of the questionnaire was 31.3±7.9, with a rank of 11 to 38 (maximum). There were no differences according to gender (P=0.78). Inter-examiner reliability (n 33): Intraclass Correlation Coefficient (ICC) 0.94, 95% Confidence Interval (CI) 0.88-0.97, P<0.0001. Intra-examiner reliability (n 38): ICC 0.96, CI 0.93-0.98, P<0.0001. Correlation coefficient (rho of Spearman) with the "get up and go" test (n 67) 0.61 (moderate), P<0.0001. Lower score if there are ≥ 2 frailty factors (P=0.015).

CONCLUSIONS

VIDA questionnaire is a very reliable tool, with no gender bias. It demonstrates an association with other functionality measures and with frailty factors in the elderly.

Correlates of mobility limitation in African Americans

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Race, socioeconomic resources, and late-life mobility and decline: findings from the Health, Aging, and Body Composition study

BACKGROUND

This study examines the relationship between race and mobility over 5 years in initially well-functioning older adults and evaluates how a broad set of socioeconomic status indicators affect this relationship.

METHODS

Data were from 2,969 black and white participants aged 70-79 from the Health, Aging, and Body Composition study. Mobility parameters included self-reported capacity to walk a quarter mile and climb 10 steps and usual gait speed. Incident mobility limitation was defined as reported difficulty walking a quarter mile or climbing 10 steps at two consecutive semiannual assessments. Gait speed decline was defined as a 4% reduction in speed per year.

RESULTS

At baseline, even though all participants were free of mobility limitation, blacks had slower walking speed than their white counterparts, which was not explained by poverty, education, reading level, or income adequacy. After 5 years, accounting for age, site, and baseline mobility, blacks were more likely to develop mobility limitation than whites. Adjusting for prevalent conditions at baseline eliminated this difference in women; controlling for education eliminated this difference in men. No differences in gait speed decline were identified.

CONCLUSIONS

Higher rates of mobility loss observed in older blacks relative to older whites appear to be a function of both poorer initial mobility status and existing health conditions particularly for women. Education may also play a role especially for men.

How pleiotropic genetics of the musculoskeletal system can inform genomics and phenomics of aging

Genetic study can provide insight into the biologic mechanisms underlying inter-individual differences in susceptibility to (or resistance to) organisms' aging. Recent advances in molecular genetics and genetic epidemiology provide the necessary tools to perform a study of the genetic sources of biological aging. However, to be successful, the genetic study of a complex condition requires a heritable phenotype to be developed and validated. Genome-wide association studies offer an unbiased approach to identify new candidate genes for human diseases. It is hypothesized that convergent results from multiple aging-related traits will point out the genes responsible for the general aging of the organism. This perspective focuses on the musculoskeletal aging as an example of an approach to identify a downstream common pathway that summarizes aging processes. Since the musculoskeletal traits are linked to the state of many vital functions, disability, and ultimately survival rates, we postulate that there is significance in studying musculoskeletal aging. Construction of an integrated phenotype of aging can be achieved based on shared genetics among multiple musculoskeletal biomarkers. Valid biomarkers from other systems of the organism should be similarly explored. The new composite aging score needs to be validated by determining whether it predicts all-cause mortality, incidences of major chronic diseases, and disability late in life. Comprehensive databases on biomarkers of musculoskeletal aging in multiple large cohort studies, along with information on various health outcomes, are needed to validate the proposed measure of biological aging.

Physical performance is associated with executive functioning in older african american women

An older adult's ability to perform physical tasks is predictive of disability onset and is associated with declines in cognition. Risk factors for physical performance declines among African Americans, a group with the highest rates of disability, remain understudied. This study sought to identify demographic, health, and cognitive factors associated with lower-extremity physical performance in a sample of 106 African American women ages 56 to 91. After controlling for global cognitive functioning (Mini Mental State Exam), physical performance was associated with executive functioning (Stroop Color/Word), but not visuospatial construction (WASI Block Design) or processing speed (Trail Making Test, Part A). Executive functioning remained associated with physical performance after entry of demographic variables, exercise, depression, disease burden, and body mass index (BMI). Age, and BMI were also significant in this model. Executive functioning, age and BMI are associated with lower-extremity physical performance among older African American women.

Do worsening knee radiographs mean greater chances of severe functional limitation?

OBJECTIVE

Development of functional limitation is thought to be unrelated to changes in severity of radiographic osteoarthritis (OA) of the knee. We evaluated the relationship of change in radiographic OA to the incidence of severe functional limitation.

METHODS

Participants of the Multicenter Osteoarthritis Study, a cohort study of persons with or at high risk of knee OA, were evaluated at 0 and 30 months. Subjects were classified as having no, incident, stable, or worsening radiographic OA. Incidence of severe functional limitation was defined by Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) physical function scores (≥36.1/68) and walking speed (≤1.0 meter/second) at 30 months. The relationship of the change in radiographic OA to the incidence of severe functional limitation was evaluated by calculating risk ratios adjusted for potential confounders.

RESULTS

Of the 2,210 subjects included (mean age 62 years, mean body mass index 30 kg/m², 60% women), 53% had no, 6% had incident, 14% had stable, and 27% had worsening radiographic OA. Persons with incident radiographic OA had 1.9 and 1.8 times the risk by WOMAC physical function score and walking speed, respectively, to have incident severe functional limitation compared with those with no radiographic OA over 30 months. Compared with those with stable radiographic OA, persons with worsening radiographic OA had 2.2 and 2.3 times the risk of incident severe functional limitation, respectively.

CONCLUSION

Changes in structural disease are associated with the development of severe functional limitations in persons with or even at high risk of knee OA.

Disability and self-rated health among older women and men in rural Guatemala: the role of obesity and chronic conditions

Unprecedented population aging in poorer settings is coinciding with the rapid spread of obesity and other chronic conditions. These conditions predict disability and poor self-rated health and often are more prevalent in women than men. Thus, gender gaps in obesity and other chronic conditions may account for older women's greater disability and worse self-rated health in poor, rural populations, where aging, obesity, and chronic conditions are rapidly emerging. In a survey of 604 adults 50 years and older in rural Guatemala, we assessed whether gender gaps in obesity and other chronic conditions accounted for gender gaps in disability and self-rated health. Obesity strongly predicted gross mobility (GM) disability, and the number of chronic conditions strongly predicted all outcomes, especially in women. Controlling for gender gaps in body-mass index (BMI) and especially the number of chronic conditions eliminated gender gaps in GM disability, and controlling for gender gaps in the number of chronic conditions eliminated gender gaps in self-rated health. We recommend conducting longitudinal cohort studies to explore interventions that may mitigate adult obesity and chronic conditions among poor, rural older adults. Such interventions also may reduce gender gaps in later-life disability and self-rated health.

Performance-based or self-report measures of physical function: which should be used in clinical trials of hip fracture patients?

OBJECTIVES

To assess the validity, sensitivity to change, and responsiveness of 3 self-report and 4 performance-based measures of physical function: activity measure for postacute care (AM-PAC) Physical Mobility and Personal Care scales, the Medical Outcomes Study 36-Item Short Form Health Survey Physical Function scale (SF-36 PF), the Physical Functional Performance test (PFP-10), the Short Physical Performance Battery (SPPB), a 4-meter gait speed, and the six-minute walk test (6MWT).

DESIGN

A prospective observational study of patients after a hip fracture. Assessments were performed at baseline and 12 weeks postenrollment.

SETTING

Inpatient and outpatient rehabilitation facilities in Norway, the United Kingdom, Sweden, Israel, Germany, the United States, Denmark, and Spain.

PARTICIPANTS

A sample of study participants (N=108) who had a hip fracture.

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURES

Assessments of validity (known-groups, concurrent, construct, and predictive), sensitivity to change (effect size, standardized response mean [SRM], SE of measure, minimal detectable change (MDC), and responsiveness (optimal operating cut-points and area under the curve) between baseline and 12-week follow-up.

RESULTS

All physical function measures achieved comparably acceptable levels of validity. Odds ratios in predicting patient Global Assessment of Improvement at 12 weeks were as follows: AM-PAC Physical Mobility scale, 5.3; AM-PAC Personal Care scale, 3.6; SF-36 PF, 4.3; SPPB, 2.0; PFP-10, 2.5; gait speed, 1.9; and 6MWT, 2.4. Effect sizes and SRM exceeded 1 SD for all 7 measures. Percent of patients who exceeded the MDC(90) at week 12 were as follows: AM-PAC Physical Mobility scale, 90%; AM-PAC Personal Care scale, 74%; SF-36 PF, 66%; SPPB, 36%; PFP-10, 75%; gait speed, 69%; and 6MWT, 75%. When evaluating responsiveness using the area under receiver operating curves for each measure, all measures had acceptable responsiveness, and no pattern emerged of superior responsiveness depending on the type of measure used.

CONCLUSIONS

Findings reveal that the validity, sensitivity, and responsiveness of self-report measures of physical function are comparable to performance-based measures in a sample of patients followed after fracturing a hip. From a psychometric perspective, either type of functional measure would be suitable for use in clinical trials where improvement in function is an endpoint of interest. The selection of the most appropriate type of functional measure as the primary endpoint for a clinical trial will depend on other factors, such as the measure's feasibility or the strength of the association between the hypothesized mechanism of action of the study intervention and a functional outcome measure.

Caregiving, mortality, and mobility decline: the Health, Aging, and Body Composition (Health ABC) Study

BACKGROUND

Although caregivers report more stress than noncaregivers, few studies have found greater health decline in older caregivers. We hypothesized that caregivers may be more physically active than noncaregivers, which may protect them from health decline.

METHODS

The sample included 3075 healthy adults from the Health, Aging, and Body Composition (Health ABC) Study. They were aged 70 to 79 years in April 1997 to June 1998 and resided in Memphis, Tennessee, or Pittsburgh, Pennsylvania. Caregivers (680 [22.1%]) were participants who provided regular care or assistance for a child or a disabled or sick adult. Outcomes included all-cause mortality and incident mobility limitation (defined as difficulty walking one-quarter mile or climbing 10 steps on 2 consecutive semiannual contacts) during 8 years. Total physical activity included daily routine, exercise, and caregiving activity.

RESULTS

Overall, 20.6% of caregivers died and 50.9% developed mobility limitations vs 22.0% and 48.9% of noncaregivers, respectively. Associations differed by race and sex. Mortality and mobility limitation rates were 1.5 times higher in white caregivers (eg, among white female caregivers, adjusted hazard ratio for mortality, 1.6; 95% confidence interval, 1.0-2.5) but not for black female caregivers vs noncaregivers (adjusted hazard ratio for mortality, 0.9; 95% confidence interval, 0.5-1.4). Physical activity mediated these associations in most race-sex groups. High-intensity caregivers (ie, caregiving > or =24 hours per week) had elevated rates of decline when adjusted for physical activity but lower rates when not adjusted for activity.

CONCLUSION

Older white caregivers have poorer health outcomes than black female caregivers. Physical activity appears to mask the adverse effects of high-intensity caregiving in most race-sex groups.

Association between lower digit symbol substitution test score and slower gait and greater risk of mortality and of developing incident disability in well-functioning older adults

OBJECTIVES

To determine whether, in well-functioning older adults, a lower score on the Digit Symbol Substitution Test (DSST) and slower gait are associated with greater risk of mortality and of developing incident disability independent of other risk factors, including brain structural abnormalities (white matter hyperintensities, brain infarcts, ventricular enlargement) and whether the combination of varying levels of DSST score and gait speed are associated with a greater risk of mortality and disability than low DSST or slow gait alone.

DESIGN

Observational cohort study.

SETTING

Community.

PARTICIPANTS

Three thousand one hundred fifty-six (43% men, 29% black, mean age 70.4) participants in the Cardiovascular Health Study (CHS), free from stroke and physical disability and with a modified Mini-Mental State Examination (3MS) score of 80 or higher.

MEASUREMENTS

Total mortality and incident disability (self-report of any difficulty performing one or more of the six activities of daily living) ascertained over a median follow-up time of 8.4 years.

RESULTS

By the end of follow-up, 704 participants had died and 1,096 had incident disability. In Cox proportional hazards models adjusted for age, sex, race, education, cardiovascular disease, and brain magnetic resonance imaging abnormalities, lower DSST score and slower gait remained significantly associated with greater risk of mortality and of incident disability. Mortality rates were higher in those who had both low DSST score (<27 points) and slow gait (speed <1.0 m/s) than in those who had only low DSST score, only slow gait, or neither (rates per 1,000 person years (p-y): 61.2, 42.8, 20.8, and 16.3, respectively). A similar risk gradient was observed for incident disability (82.0, 57.9, 47.9, and 36.0/1,000 p-y, respectively).

CONCLUSION

In well-functioning older adults, low DSST score and slow gait, alone or in combination, could be risk factors for mortality and for developing disability, independent of other risk factors, including measures of brain integrity.

Estudo de base populacional dos fatores associados à incapacidade funcional entre idosos na Região Metropolitana de Belo Horizonte, Minas Gerais, Brasil

O objetivo deste trabalho foi determinar os fatores associados à incapacidade funcional entre idosos na Região Metropolitana de Belo Horizonte, Minas Gerais, Brasil. O modelo teórico adotado foi baseado em características predisponentes (sócio-demográficas), fatores extra-individuais (apoio social, uso de serviços de saúde) e intra-individuais (condições de saúde). Participaram do estudo 1.786 idosos (> 60 anos) selecionados por meio de amostra probabilística. A variável dependente foi a incapacidade funcional, definida como incapacidade leve ou moderada (alguma dificuldade) e grave (total dependência) para realizar atividades da vida diária. A prevalência da incapacidade foi de 16% (8% leve e 8% grave). Idade e pior auto-avaliação da saúde apresentaram associações positivas e independentes com ambos os níveis de incapacidade. Hipertensão e artrite apresentaram associações com incapacidade leve ou moderada, enquanto diabetes e acidente vascular cerebral apresentaram associações com incapacidade grave. Associação negativa com incapacidade grave foi observada para visita de amigos nos últimos trinta dias. Esses resultados mostram que as condições crônicas associadas à incapacidade na população estudada são passíveis de prevenção e que o apoio social externo à família é menor em idosos com incapacidade grave.

Patients with worse mental health report more physical limitations after adjustment for physical performance

OBJECTIVE

To determine whether mental health scores are associated with self-reported physical limitations after adjustment for physical performance. Patient-reported physical limitations are widely used to assess health status or the impact of disease. However, patients' mental health may influence their reports of their physical limitations.

METHODS

Mental health and physical limitations were measured using the SF-36v2 mental health and physical functioning subscales in a cross-sectional study of 1024 participants. Physical performance was measured using tests of strength, endurance, dexterity, and flexibility. Multivariable linear regression was performed to examine the relationship between self-reported mental health and physical limitations adjusting for age, gender, race/ethnicity, education, body mass index, and measured physical performance.

RESULTS

The score distributions for mental health and physical functioning were similar to that of the United States population in this age range. In unadjusted analyses, every 10-point decline in mental health scores was associated with a 4.8-point decline in physical functioning scores (95% Confidence Interval (CI) = -4.2 to -5.3; p < .001). After adjusting for covariables including measured physical performance, every 10-point decline in mental health scores was associated with a 3.0-point decline in physical functioning scores (95% CI = -2.5 to -3.6; p < .001).

CONCLUSIONS

People with poor mental health scores seem to report more physical limitations than would be expected based on physical performance. When comparing self-reported physical limitations between groups, it is important to consider differences in mental health.

Self-selected walking speed was consistent when recorded while using a cane

OBJECTIVE

To assess whether loss of consistency or systematic measurement error is introduced by allowing older individuals to use a cane during measurement of self-selected walking speed (SSWS).

STUDY DESIGN AND SETTING

Observational study of women aged 65+ (Women's Health and Aging Study I, n=1,002).

RESULTS

Of individuals who use a cane in daily life, 201 (50.76%) did not use an aid during testing. The Coefficient of Variation was low in individuals who reported cane use in daily life but did not use one in testing (10.72%), and did not vary substantially if a cane was used (12.04%). The Intra-Class Correlation Coefficient was high: 0.958 for those who reported cane use in daily life but did not use one during testing and 0.962 for those who used a cane. In both groups, Bland-Altman plots revealed a small systematic difference between the first and second trials. There was no evidence of effect modification of the association between SSWS and mobility disability by cane use during testing.

CONCLUSION

This observational study found neither evidence of poorer consistency nor increased measurement bias in SSWS recorded while using a cane compared to using no assistive device.

Relationship of race and poverty to lower extremity function and decline: findings from the Women's Health and Aging Study

Race- and poverty-related disparities in physical function are well documented, though little is known about effects of race and poverty on functional decline and the progression of disability. We examined cross-sectional and longitudinal relationships between race, poverty and lower extremity function using data from moderately to severely disabled women in the U.S. Women's Health and Aging Study. Severity of lower extremity functional limitation was determined from scaled responses of reported difficulty walking (1/4) mile, walking across a room, climbing stairs, and stooping, crouching or kneeling. Usual walking speed assessed over 4m was our objective measure of function. Of the 996 women who described themselves as black or white, 284 (29%) were black and 367 (37%) were living at or below 100% of the federal poverty level. Independent of demographic and health-related factors, among white women, the poor exhibited consistently worse lower extremity function than the non-poor; this association, however, was not observed in black women. Among the non-poor, black women had slower walking speeds, and reported more limitation in lower extremity function than their non-poor white counterparts, even after adjusting for demographic variables and health-related characteristics. After 3 years, accounting for baseline function, demographic and health-related factors, race and poverty status were unrelated to functional decline. Thus, while race and poverty status were associated with functional deficits in old age, they do not appear to impact the rate of functional decline or progression of disability over 3 years.

The clinically meaningful change in physical performance scores in an elderly cohort

BACKGROUND AND AIMS

The aim of this study was to assess annual changes in the continuous summary physical performance score (CSPPS) and the quartile summary physical performance (QSPPS) score, evaluate how these changes relate to self-reported changes in physical function and to examine clinically meaningful changes in CSPPS and QSPPS.

METHODS

This was a longitudinal study of an elderly cohort of men and women (age>65) reporting at least two domains of disability from 5 centers in the US and Europe. Subjects completed assessments of mobility, ability to perform activities of daily living (ADLs), and the physical component of the SF-36 at both baseline and at 1- year, as well as a self-report of change in function over the year. Timed physical performance tests including walking speed, repeated chair stands and balance were used to calculate QSPPS and CSPPS at baseline and one year.

RESULTS

Regardless of the tool used to evaluate clinical significance (ADL, SF- 36 PF, mobility disability, self-rating of physical performance) or a determination of the small meaningful change estimates based on effect size, it appears that a change of approximately 3 points in the CSPPS or 0.6 points in the QSPPS is clinically meaningful.

CONCLUSION

In this cohort with moderate to severe disability, an annual change of approximately 3 points in CSPPS and 0.6 points in QSPPS are clinically meaningful and these changes are evident at one year.

Transitions to mobility difficulty associated with lower extremity osteoarthritis in high functioning older women: longitudinal data from the Women's Health and Aging Study II

OBJECTIVE

To assess the impact of lower extremity osteoarthritis (OA) on transitions to mobility difficulty, and to assess the influence of pain, excess weight, and quadriceps strength on these transitions.

METHODS

We analyzed longitudinal data acquired from 199 participants in the Women's Health and Aging Study II (ages 70-79 years) who initially reported no lower extremity limitation (e.g., difficulty walking one-quarter mile) or difficulty in activities of daily living (ADL; e.g., transferring). Prevalent lower extremity OA was determined from validated algorithms encompassing multiple data sources. Markov transition models were created to analyze the first transition from no difficulty at baseline to lower extremity limitations, ADL difficulty, or both 18, 36, and 72 months later.

RESULTS

Compared with women without OA (n = 140), a higher proportion of women with lower extremity OA (n = 59) initially reported pain on most days and more severe pain while walking (P < 0.05). Women with OA were also heavier, with a higher proportion being obese or overweight (P < 0.001). Lower extremity OA, higher body mass index, and lower knee extensor strength independently increased the risk of transition to combined lower extremity and ADL difficulty first over 72 months.

CONCLUSION

Lower extremity OA increased the likelihood of developing difficulty in both lower extremity tasks and ADL over 72 months in a cohort of initially high functioning older women. Two modifiable factors, higher relative weight and lower knee extensor strength, substantially impacted these transitions, and therefore warrant increased attention in the management of lower extremity OA.

Random-effect models for ordinal responses: application to self-reported disability among older persons

BACKGROUND

Longitudinal studies with ordinal repeated outcomes are now widespread in epidemiology and clinical research. The statistical analysis of these studies combines two difficulties: the choice of the best ordinal model and taking into account correlations for within-subject responses.

METHODS

Random-effect models are of particular value in this context and we propose here a fitting strategy. The various ordinal models extended to the case of repeated responses are detailed. We explain how the choice of model constrains the random effect structure. Model selection criteria and goodness-of-fit measures are also presented. These issues are dealt with by using an example of self-reported disability in older women assessed annually over a period of seven years.

RESULTS

The proportionality of the odds ratios was validated for the covariables "age" and "gait speed". In contrast the impact of the covariable "pain" differs according to the levels of disability. The restricted partial proportional odds model was found to have a goodness of fit equivalent to the full generalized ordered logit model while the stereotype model appeared to give poorer fit.

CONCLUSIONS

The random-effects models presented in this paper allow taking into account the ordinal nature of the outcome in longitudinal studies. Furthermore the impact of the risk factors can be modeled according to the response levels. This approach can be useful for a better understanding of complex processes of evolution.

Population-based cohorts of the 50s and over: a summary of worldwide previous and ongoing studies for research on health in ageing

As most countries face the ageing of their population, understanding successful and pathologic ageing is a research priority. Longitudinal studies examining the ageing process from middle-age are required to establish causal and valid relationships. This systematic review of the literature aimed at identifying large community-based longitudinal studies either including exclusively elderly people or following people from middle-age (50+ years at enrolment) to death, and resulted in a selection of 72 cohort studies. Design features of selected studies show that most were conducted in North America or Northern Europe, most included both genders, and follow-up period was often less than 10 years. Many cohorts focused on cardiovascular health, cognitive decline or osteoporosis. Usually collected variables comprise of self-reported data on socio-demographics, chronic diseases and functional status, as well as measures of cognition, anthropometrics and physical performances. Biological samples were taken in about 60% of the studies, and a third also undertook genetic analyses. This review summarises information on design and content of large population-based cohorts of older persons, and represents a valuable background from which additional data may be retrieved.

Physical and psychological functioning of daily living in relation to physical activity. A longitudinal study among former elite male athletes and controls

BACKGROUND AND AIMS

Physical exercise plays an important role in the prevention and reduction of disabilities in elderly people. The aim of this study was to determine the role of physical activity in the physical and psychological functioning of daily living in a cohort of former elite male athletes representing different sports, and controls of middle and old age.

METHODS

Subjects were 664 former elite male athletes (mean age 64.4 years) and 500 controls (62.0 years) in middle and old age. Subjects were mailed "Physical activity and health survey" questionnaires in 1985 and 1995. The primary outcomes the physical and psychological functioning of daily living--were assessed in 1995 using items from the Mini-Finland Health Survey. Logistic regression was used for longitudinal as well as cross-sectional analyses to estimate odds ratios (OR) for poor physical and psychological functioning of daily living in relation to recreational physical activity adjusted for age, sport group, life-style, BMI, mood, chronic diseases, personality characteristics, life-events and socio-economic status.

RESULTS

In the longitudinal analysis, low levels of physical activity (lowest MET quintile vs highest quintile) in 1985 (OR 4.91, 95% confidence interval (CI) 2.02-11.9), older age (> or =70 yrs vs under 60 yrs OR 9.93, 95% CI 4.90-20.2), depression (OR 2.03, 95% CI 1.01-4.09) and anxiety in 1995 (OR 2.67, 95% CI 1.34-5.32) increased the risk of poor physical functioning of daily living in 1995, whereas an increase in a physical activity between 1985-1995 (OR 0.89, 95% CI 0.83-0.95) protected against poor physical functioning of daily living. A history of participating in specific types of sports, especially among certain power sports (weight-lifting and track & field throwers) (OR 0.19, 95% CI 0.06-0.60) and team sports (OR 0.34, 95% CI 0.15-0.81) did reveal a significant protective effect against poor psychological functioning of daily living in the longitudinal analysis.

CONCLUSIONS

This study suggests that an increase in physical exercise supports physical daily functionality. A specific history of sports participation promotes psychological well-being at an older age.

Changes in biological markers of health: older Americans in the 1990s

BACKGROUND

Many studies that show improved health in older adults have relied on subjective measures of health. This article assesses changes in the physiological status of older Americans during the 1990s using biological measures of high-risk for morbidity and mortality.

METHODS

Changes in the prevalence of clinically-defined, high risk for 10 biological markers were assessed in respondents age 65 years and older from National Health and Nutrition Examination Surveys (NHANES) III (1988-1994) and IV (1999-2000).

RESULTS

Some changes in prevalence of high-risk values of biological markers indicate improved health among older adults in the 1990s: a 6% reduction in the prevalence of high-risk total cholesterol (p <.001) and a 7% reduction in the prevalence of high-risk homocysteine (p <.001). Other changes indicate worsening health: a 9% increase in the prevalence of high-risk systolic blood pressure (p <.01), a 10% increase in obesity (p <.001), and an 8% increase in the prevalence of high-risk C-reactive protein (p <.001). These changes remained significant after adjusting for age, sex, and education. Results of logistic regressions indicate that changes in the frequency of medication usage, medication efficacy, prevalence of chronic disease, and diet explained some of these changes.

CONCLUSIONS

Changes in the prevalence of high-risk values of biological markers in the 1990s are mixed. Greater use and effectiveness of lipid-lowering medication has contributed to the reduction in percentage of the population with high-risk lipid levels, and folate supplementation accounted for a decline in the percentage with high-risk homocysteine. However, increases in the percentage with high-risk systolic blood pressure occurred despite an increase in the use of antihypertensive medications, in part because of the limited ability of antihypertensive medications to bring blood pressure below high-risk levels.

Development and validation of a performance-based measure of upper extremity functional limitation

BACKGROUND AND AIMS

While the standardized lower extremity physical performance battery (LEPPB) is widely used to measure lower body functional limitation, no corresponding measure has been developed for upper body functional limitation. We combined three standard measures (William's Hand Test, Hand Signature, Functional Reach) to develop an upper extremity physical performance battery (UEPPB) analogous to the LEPPB, and examined its validity.

METHODS

We used baseline data from a community-dwelling cohort of 749 Mexican American and European American elders and combined times to complete the William's Hand Board, Hand Signature, and distance on Functional Reach into a single composite measure, using scoring methods analogous to those for the LEPPB. We summarize concurrent, discriminant, and construct validity evidence for the UEPPB, based on observed associations with established measures of physical functional limitation, disability, and dependence.

RESULTS

All correlations were in the expected direction. Shared variance with self-reported upper and lower extremity functional limitation was 10 and 5%, respectively, and with self-reported ADL disability, ADL dependency, and IADL dependency it was 32, 26, and 31%, respectively. In multivariate models of self-reported and performance-based disability and dependency, the UEPPB and LEPPB made significant, independent contributions and, net of contextual variables (age, sex, ethnic group, education, income) explained 4 to 10% of the variance in disability and dependency.

CONCLUSIONS

The UEPPB is a valid performance-based measure of upper extremity functional limitation and makes an independent contribution beyond LEPPB in explaining disability and dependence.

Disentangling the genetic determinants of human aging: biological age as an alternative to the use of survival measures

The choice of a phenotype is critical for the study of a complex genetically regulated process, such as aging. To date, most of the twin and family studies have focused on broad survival measures, primarily age at death or exceptional longevity. However, on the basis of recent studies of twins and families, biological age has also been shown to have a strong genetic component, with heritability estimates ranging from 27% to 57%. The aim of this review is twofold: first, to summarize growing consensus on reliable methods of biological age assessment, and second, to demonstrate validity of this phenotype for research in the genetics of aging in humans.

Les échelles d'incapacité fonctionnelle de l'épaule : revue systématique

OBJECTIVES

To identify all available shoulder disability questionnaires designed to measure physical functioning and to examine those with satisfactory clinimetric quality.

METHODS

We used the Medline database and the "Guide des outils de mesure de l'évaluation en médecine physique et de réadaptation" textbook to search for questionnaires. Analysis took into account the development methodology, clinimetric quality of the instruments and frequency of their utilization. We classified the instruments according to the International Classification of Functioning, Disability and Health.

RESULTS

Thirty-eight instruments have been developed to measure disease-, shoulder- or upper extremity-specific outcome. Four scales assess upper-extremity disability and 3 others shoulder disability. We found 6 scales evaluating disability and shoulder pain, 7 scales measuring the quality of life in patients with various conditions of the shoulder, 14 scales combining objective and subjective measures, 2 pain scales and 2 unclassified scales. Older instruments developed before the advent of modern measurement development methodology usually combine objective and subjective measures. Recent instruments were designed with appropriate methodology. Most are self-administered questionnaires.

CONCLUSION

Numerous shoulder outcome measure instruments are available. There is no "gold standard" for assessing shoulder function outcome in the general population.

Evaluation of continuous summary physical performance scores (CSPPS) in an elderly cohort

BACKGROUND AND AIMS

Physical performance is an important predictor of quality of life among the elderly. A valid and sensitive measure of physical performance is needed in order to evaluate possible interventions. The aim of this study was to examine the validity and reliability of the Continuous Summary Physical Performance Score (CSPPS) and its relationship to the Quartile Summary Physical Performance Score (QSPPS).

METHODS

This cross-sectional study of an elderly cohort from 5 centers in the US and Europe included men and women (> age 65) reporting at least two domains of disability. Subjects completed assessments of mobility and ability to perform activities of daily living (ADLs), the physical component of the SF-36, and a self-rating of physical performance. Timed physical performance tests were used to calculate the CSPPS and QSPPS.

RESULTS

216 subjects took part (mean age = 81 years). The distribution of CSPPS scores was similar for men and women, with a mean of 59.2 (SD 17.8), median of 64.3, and range from 1.3 to 91. Subjects with older age, higher degree of disability, and lower self-rated physical performance had lower CSPPS scores. The CSPPS had good test-retest reliability (r = 0.92), and CSPPS and QSPPS are highly correlated (r = 0.94, p < 0.001). However, the QSPPS appears to lack the linearity, and the ranges of the CSPPS for each score of the QSPPS overlap substantially.

CONCLUSIONS

In a cohort with moderate to severe disability, the CSPPS appears to be a valid, reproducible measure that can discriminate smaller yet clinically meaningful differences in physical function, as compared with the QSPPS.

American Academy of Disability Evaluating Physicians (AADEP) position paper: complex regional pain syndrome I (RSD): impairment and disability issues

OBJECTIVE

To provide an overview and methodology for the evaluation of impairment and functional residual capacity in complex regional pain syndrome I (CRPS I, RSD). This paper is intended to provide assistance to physicians asked to evaluate impairment- and disability-related issues and is not primarily geared to guide treatment of the CRPS I patient.

METHOD

Conference and literature review by neurology, anesthesiology, pain medicine, physiatry, and disability evaluating physicians followed by description of issues, options, and recommendations based upon the committee's deliberations and the widely used AMA Guides to the Evaluation of Permanent Impairment, fourth and fifth editions. The authors present functional criteria for assessing the severity of CRPS. These criteria were developed by committee consensus opinion based on multidisciplinary clinical experience considering daily functional issues. They can be used in conjunction with CRPS-ADL Classes of Impairment in order to categorize an individual into a specific class for purposes of permanent impairment rating. Future reliability and validity studies of this rating scale are pending future use, acceptance and, hopefully, additional studies.

RESULTS

Evaluators should perform a comprehensive assessment of patients with CRPS I to make an accurate diagnosis and exclude other conditions that could explain the symptoms and signs of the condition. While radiological, laboratory, and other diagnostic studies may be of assistance in making the diagnosis, in the final analysis, this is a clinical diagnosis. Impairment is based on objectively validated limitation in activities of daily living (ADL).

Risk factors for serious fall related injury in elderly women living at home

OBJECTIVES

To study whether balance, function, and other health status indicators can predict serious fall related injury in elderly women living at home.

METHODS

In this prospective study, the authors took a random sample of 307 women aged 75 years and over (mean 80.8 years, response rate 74.5%), living in the community. Serious fall injuries which occurred over a period of during one year were recorded, together with baseline registrations of health, function, and tests of walking and balance.

RESULTS

In all, 155 women (50.5%) fell one or more times. One hundred and fifty six (51%) of the 308 falls resulted in a fall related injury, 74 (24%) in a serious fall related injury, and 40 falls (13%) resulted in fractures. The presence of rheumatic disorders, inability to rise from the floor, arthrosis of the hip, having had more than one fall during the one year follow up period, and an increased tendency to sway in the frontal plane when doing a calculation task were independent and significant predictors for serious fall related injury (fractures included). The independent predictors of fall induced fractures were experiencing more than one fall in the follow up period, cognitive impairment, and receiving care from professional or other.

CONCLUSION

The study suggests that rheumatic disorders and the inability to get up from lying on the floor were the strongest independent risk factors for serious fall related injury. Experiencing more than one fall in the follow up period and cognitive impairment are the strongest independent predictors for fall induced fractures. Age was not a significant predictor of serious fall related injury. Assessment of these markers is feasible in a clinical setting and is a useful way of identifying those who are at risk of serious fall related injuries.