Physical Activity Intervention for Older Adults with Intellectual Disability: Report on a Pilot Project

ERIC Educational Resources Information Center

Podgorski, Carol Ann; Kessler, Karen; Cacia, Barbara; Peterson, Derick R.; Henderson, C. Michael

2004-01-01

A 12-week pilot project on physical activity was introduced in a day habilitation setting to a group of 12 older adults with intellectual disability and a variety of physical and behavioral conditions. Our purpose was to determine whether (a) this intervention would positively impact physical function in this population, (b) consumers would choose…

The prediction of disability by self-reported physical frailty components of the Tilburg Frailty Indicator (TFI).

PubMed

Gobbens, R J J; van Assen, M A L M; Schalk, M J D

2014-01-01

Disability is an important health outcome for older persons; it is associated with impaired quality of life, future hospitalization, and mortality. Disability also places a high burden on health care professionals and health care systems. Disability is regarded as an adverse outcome of physical frailty. The main objective of this study was to assess the predictive validity of the eight individual self-reported components of the physical frailty subscale of the TFI for activities of daily living (ADL) and instrumental activities of daily living (IADL) disability. This longitudinal study was carried out with a sample of Dutch citizens. At baseline the sample consisted at 429 people aged 65 years and older and a subset of all respondents participated again two and a half years later (N=355, 83% response rate). The respondents completed a web-based questionnaire comprising the TFI and the Groningen Activity Restriction Scale (GARS) for measuring disability. Five components together (unintentional weakness, weakness, poor endurance, slowness, low physical activity), referring to the phenotype of Fried et al., predicted disability, even after controlling for previous disability and other background characteristics. The other three components of the physical frailty subscale of the TFI (poor balance, poor hearing, poor vision) together did not predict disability. Low physical activity predicted both total and ADL disability, and slowness both total and IADL disability. In conclusion, self-report assessment using the physical subscale of the TFI aids the prediction of future ADL and IADL disability in older persons two and a half years later. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

Synergistic effects of cognitive impairment on physical disability in all-cause mortality among men aged 80 years and over: Results from longitudinal older veterans study.

PubMed

Yu, Wan-Chen; Chou, Ming-Yueh; Peng, Li-Ning; Lin, Yu-Te; Liang, Chih-Kuang; Chen, Liang-Kung

2017-01-01

We evaluated effects of the interrelationship between physical disability and cognitive impairment on long-term mortality of men aged 80 years and older living in a retirement community in Taiwan. This prospective cohort study enrolled older men aged 80 and older living in a Veterans Care Home. Those with confirmed diagnosis of dementia were excluded. All participants received comprehensive geriatric assessment, including sociodemographic data, Charlson's Comorbidity Index (CCI), geriatric syndromes, activities of daily living (ADL) using the Barthel index and cognitive function using the Mini-Mental State Examination (MMSE). Subjects were categorized into normal cognitive function, mild cognitive deterioration, and moderate-to-severe cognitive impairment and were further stratified by physical disability status. Kaplan-Meier log-rank test was used for survival analysis. After adjusting for sociodemographic characteristics and geriatric syndromes, Cox proportional hazards model was constructed to examine associations between cognitive function, disability and increased mortality risk. Among 305 male subjects aged 85.1 ± 4.1 years, 89 subjects died during follow-up (mean follow-up: 1.87 ± 0.90 years). Kaplan-Meier unadjusted analysis showed reduced survival probability associated with moderate-to-severe cognitive status and physical disability. Mortality risk increased significantly only for physically disabled subjects with simultaneous mild cognitive deterioration (adjusted HR 1.951, 95% CI 1.036-3.673, p = 0.038) or moderate-to-severe cognitive impairment (aHR 2.722, 95% CI 1.430-5.181, p = 0.002) after adjusting for age, BMI, education levels, smoking status, polypharmacy, visual and hearing impairment, urinary incontinence, fall history, depressive symptoms and CCI. Mortality risk was not increased among physically independent subjects with or without cognitive impairment, and physically disabled subjects with intact cognition. Physical disability is a major risk factor for all-cause mortality among men aged 80 years and older, and risk increased synergistically when cognitive impairment was present. Cognitive impairment alone without physical disability did not increase mortality risk in this population.

Understanding and Reducing Disability in Older Adults Following Critical Illness

PubMed Central

Brummel, N.E.; Balas, M.C.; Morandi, A.; Ferrante, L.E.; Gill, T.M.; Ely, E.W.

2015-01-01

Objective To review how disability can develop in older adults with critical illness and to explore ways to reduce long-term disability following critical illness. Data Sources Review of the literature describing post-critical illness disability in older adults and expert opinion. Results We identified 19 studies evaluating disability outcomes in critically ill patients age 65 years and older. Newly acquired disability in activities of daily living, instrumental activities of daily living and mobility activities was commonplace among older adults who survived a critical illness. Incident dementia and less-severe cognitive impairment was also highly prevalent. Factors related to the acute critical illness, intensive care unit practices such as heavy sedation, physical restraints and immobility as well as aging physiology and coexisting geriatric conditions can combine to result in these poor outcomes. Conclusion Older adults who survive critical illness suffer physical and cognitive declines resulting in disability at greater rates than hospitalized, non-critically ill and community dwelling older adults. Interventions derived from widely available geriatric care models in use outside of the ICU, which address modifiable risk factors including immobility and delirium, are associated with improved functional and cognitive outcomes and can be used to complement ICU-focused models such as the ABCDEs. PMID:25756418

Obesity and Diabetes as Accelerators of Functional Decline; Can Lifestyle Interventions Maintain Functional Status in High Risk Older Adults?

PubMed Central

Anton, Stephen D.; Karabetian, Christy; Naugle, Kelly; Buford, Thomas W.

2013-01-01

Obesity and diabetes are known risk factors for the development of physical disability among older adults. With the number of seniors with these conditions rising worldwide, the prevention and treatment of physical disability in these persons has become a major public health challenge. Sarcopenia, the progressive loss of muscle mass and strength, has been identified as a common pathway associated with the initial onset and progression of physical disability among older adults. A growing body of evidence suggests that metabolic dysregulation associated with obesity and diabetes accelerates the progression of sarcopenia, and subsequently functional decline in older adults. The focus of this brief review is on the contributions of obesity and diabetes in accelerating sarcopenia and functional decline among older adults. We also briefly discuss the underexplored interaction between obesity and diabetes that may further accelerate sarcopenia and place obese older adults with diabetes at particularly high risk of disability. Finally, we review findings from studies that have specifically tested the efficacy of lifestyle-based interventions in maintaining the functional status of older persons with obesity and/or diabetes. PMID:23832077

The relationship between perceived promotion of autonomy/dependence and pain-related disability in older adults with chronic pain: the mediating role of self-reported physical functioning.

PubMed

Matos, Marta; Bernardes, Sónia F; Goubert, Liesbet

2016-08-01

Chronic pain is prevalent among older adults and is usually associated with high levels of functional disability. Social support for the promotion of functional autonomy and dependence has been associated with pain-related disability and self-reported physical functioning. Nevertheless, these relationships need further inquiry. Our aims were to investigate: (1) the relationship between perceived promotion of autonomy/dependence and pain-related disability and (2) the extent to which self-reported physical functioning mediated these relationships. 118 older adults (Mage = 81.0) with musculoskeletal chronic pain completed the Portuguese versions of the revised formal social support for Autonomy and Dependence in Pain Inventory, the pain severity and interference scales of the Brief Pain Inventory, and the physical functioning scale of the Medical Outcomes Study-Short-Form 36 v2. Higher levels of perceived promotion of autonomy were associated with lower pain-related disability; this relationship was partially mediated by self-reported physical functioning (B = -.767, p < .001 decreasing to B' = -.485, p < .01). Higher perceived promotion of dependence was associated with higher pain-related disability; this effect was also partially accounted for by self-reported physical functioning (B = .889, p < .01 decreasing to B' = .597, p < .05). These results highlight the importance of perceived promotion of autonomy and dependence for managing older adults' experience of chronic pain.

Measuring Physical Activity with Pedometers in Older Adults with Intellectual Disability: Reactivity and Number of Days

ERIC Educational Resources Information Center

Hilgenkamp, Thessa; Van Wijck, Ruud; Evenhuis, Heleen

2012-01-01

The minimum number of days of pedometer monitoring needed to estimate valid average weekly step counts and reactivity was investigated for older adults with intellectual disability. Participants (N = 268) with borderline to severe intellectual disability ages 50 years and older were instructed to wear a pedometer for 14 days. The outcome measure…

Effect of structured physical activity on prevention of major mobility disability in older adults: the LIFE study randomized clinical trial.

PubMed

Pahor, Marco; Guralnik, Jack M; Ambrosius, Walter T; Blair, Steven; Bonds, Denise E; Church, Timothy S; Espeland, Mark A; Fielding, Roger A; Gill, Thomas M; Groessl, Erik J; King, Abby C; Kritchevsky, Stephen B; Manini, Todd M; McDermott, Mary M; Miller, Michael E; Newman, Anne B; Rejeski, W Jack; Sink, Kaycee M; Williamson, Jeff D

2014-06-18

In older adults reduced mobility is common and is an independent risk factor for morbidity, hospitalization, disability, and mortality. Limited evidence suggests that physical activity may help prevent mobility disability; however, there are no definitive clinical trials examining whether physical activity prevents or delays mobility disability. To test the hypothesis that a long-term structured physical activity program is more effective than a health education program (also referred to as a successful aging program) in reducing the risk of major mobility disability. The Lifestyle Interventions and Independence for Elders (LIFE) study was a multicenter, randomized trial that enrolled participants between February 2010 and December 2011, who participated for an average of 2.6 years. Follow-up ended in December 2013. Outcome assessors were blinded to the intervention assignment. Participants were recruited from urban, suburban, and rural communities at 8 centers throughout the United States. We randomized a volunteer sample of 1635 sedentary men and women aged 70 to 89 years who had physical limitations, defined as a score on the Short Physical Performance Battery of 9 or below, but were able to walk 400 m. Participants were randomized to a structured, moderate-intensity physical activity program (n = 818) conducted in a center (twice/wk) and at home (3-4 times/wk) that included aerobic, resistance, and flexibility training activities or to a health education program (n = 817) consisting of workshops on topics relevant to older adults and upper extremity stretching exercises. The primary outcome was major mobility disability objectively defined by loss of ability to walk 400 m. Incident major mobility disability occurred in 30.1% (246 participants) of the physical activity group and 35.5% (290 participants) of the health education group (hazard ratio [HR], 0.82 [95% CI, 0.69-0.98], P = .03).Persistent mobility disability was experienced by 120 participants (14.7%) in the physical activity group and 162 participants (19.8%) in the health education group (HR, 0.72 [95% CI, 0.57-0.91]; P = .006). Serious adverse events were reported by 404 participants (49.4%) in the physical activity group and 373 participants (45.7%) in the health education group (risk ratio, 1.08 [95% CI, 0.98-1.20]). A structured, moderate-intensity physical activity program compared with a health education program reduced major mobility disability over 2.6 years among older adults at risk for disability. These findings suggest mobility benefit from such a program in vulnerable older adults. clinicaltrials.gov Identifier: NCT01072500.

Cost effectiveness of the LIFE physical activity intervention for older adults at increased risk for mobility disability

USDA-ARS?s Scientific Manuscript database

BACKGROUND: Losing the ability to walk safely and independently is a major concern for many older adults. The Lifestyle Interventions and Independence for Elders study recently demonstrated that a physical activity (PA) intervention can delay the onset of major mobility disability. Our objective is ...

The "Sarcopenia and Physical fRailty IN older people: multi-componenT Treatment strategies" (SPRINTT) randomized controlled trial: design and methods.

PubMed

Landi, Francesco; Cesari, Matteo; Calvani, Riccardo; Cherubini, Antonio; Di Bari, Mauro; Bejuit, Raphael; Mshid, Jerome; Andrieu, Sandrine; Sinclair, Alan J; Sieber, Cornel C; Vellas, Bruno; Topinkova, Eva; Strandberg, Timo; Rodriguez-Manas, Leocadio; Lattanzio, Fabrizia; Pahor, Marco; Roubenoff, Ronenn; Cruz-Jentoft, Alfonso J; Bernabei, Roberto; Marzetti, Emanuele

2017-02-01

The sustainability of health and social care systems is threatened by a growing population of older persons with heterogeneous needs related to multimorbidity, frailty, and increased risk of functional impairment. Since disability is difficult to reverse in old age and is extremely burdensome for individuals and society, novel strategies should be devised to preserve adequate levels of function and independence in late life. The development of mobility disability, an early event in the disablement process, precedes and predicts more severe forms of inability. Its prevention is, therefore, critical to impede the transition to overt disability. For this reason, the Sarcopenia and Physical fRailty IN older people: multi-componenT Treatment strategies (SPRINTT) project is conducting a randomized controlled trial (RCT) to test a multicomponent intervention (MCI) specifically designed to prevent mobility disability in high-risk older persons. SPRINTT is a phase III, multicenter RCT aimed at comparing the efficacy of a MCI, based on long-term structured physical activity, nutritional counseling/dietary intervention, and an information and communication technology intervention, versus a healthy aging lifestyle education program designed to prevent mobility disability in 1500 older persons with physical frailty and sarcopenia who will be followed for up to 36 months. The primary outcome of the SPRINTT trial is mobility disability, operationalized as the inability to walk for 400 m within 15 min, without sitting, help of another person, or the use of a walker. Secondary outcomes include changes in muscle mass and strength, persistent mobility disability, falls and injurious falls, disability in activities of daily living, nutritional status, cognition, mood, the use of healthcare resources, cost-effectiveness analysis, quality of life, and mortality rate. SPRINTT results are expected to promote significant advancements in the management of frail older persons at high risk of disability from both clinical and regulatory perspectives. The findings are also projected to pave the way for major investments in the field of disability prevention in old age.

Social Resources That Preserve Functional Independence After Memory Loss

DTIC Science & Technology

2016-07-01

Toward a common language for function, disability, and health. Physical therapy 86, 726 (May, 2006). 4. R. D. Tucker-Seeley, S. V. Subramanian, Y...20. Boyle PA, Buchman AS, Wilson RS, et al: Physical activity is asso- ciated with incident disability in community-based older persons. J Am Geriatr ...effects of physical activity on physical functioning, quality of life and depression in older people with dementia. Int J Geriatr Psychiatry. 2011

Translation, Validation, and Reliability of the Dutch Late-Life Function and Disability Instrument Computer Adaptive Test.

PubMed

Arensman, Remco M; Pisters, Martijn F; de Man-van Ginkel, Janneke M; Schuurmans, Marieke J; Jette, Alan M; de Bie, Rob A

2016-09-01

Adequate and user-friendly instruments for assessing physical function and disability in older adults are vital for estimating and predicting health care needs in clinical practice. The Late-Life Function and Disability Instrument Computer Adaptive Test (LLFDI-CAT) is a promising instrument for assessing physical function and disability in gerontology research and clinical practice. The aims of this study were: (1) to translate the LLFDI-CAT to the Dutch language and (2) to investigate its validity and reliability in a sample of older adults who spoke Dutch and dwelled in the community. For the assessment of validity of the LLFDI-CAT, a cross-sectional design was used. To assess reliability, measurement of the LLFDI-CAT was repeated in the same sample. The item bank of the LLFDI-CAT was translated with a forward-backward procedure. A sample of 54 older adults completed the LLFDI-CAT, World Health Organization Disability Assessment Schedule 2.0, RAND 36-Item Short-Form Health Survey physical functioning scale (10 items), and 10-Meter Walk Test. The LLFDI-CAT was repeated in 2 to 8 days (mean=4.5 days). Pearson's r and the intraclass correlation coefficient (ICC) (2,1) were calculated to assess validity, group-level reliability, and participant-level reliability. A correlation of .74 for the LLFDI-CAT function scale and the RAND 36-Item Short-Form Health Survey physical functioning scale (10 items) was found. The correlations of the LLFDI-CAT disability scale with the World Health Organization Disability Assessment Schedule 2.0 and the 10-Meter Walk Test were -.57 and -.53, respectively. The ICC (2,1) of the LLFDI-CAT function scale was .84, with a group-level reliability score of .85. The ICC (2,1) of the LLFDI-CAT disability scale was .76, with a group-level reliability score of .81. The high percentage of women in the study and the exclusion of older adults with recent joint replacement or hospitalization limit the generalizability of the results. The Dutch LLFDI-CAT showed strong validity and high reliability when used to assess physical function and disability in older adults dwelling in the community. © 2016 American Physical Therapy Association.

Antihypertensive use and the effect of a physical activity intervention in the prevention of major mobility disability among older adults: The LIFE study

USDA-ARS?s Scientific Manuscript database

BACKGROUND: This subgroup analysis of the Lifestyle Intervention and Independence for Elders trial evaluates the impact of a long-term physical activity (PA) intervention on rates of major mobility disability (MMD) among older adults according to their antihypertensive medication use. METHODS: Lifes...

Measuring and Predicting Long-Term Outcomes in Older Survivors of Critical Illness

PubMed Central

Baldwin, Matthew R.

2015-01-01

Older adults (age ≥65 years) now initially survive what were previously fatal critical illnesses, but long-term mortality and disability after critical illness remain high. Most studies show that the majority of deaths among older ICU survivors occur during the first 6 to 12 months after hospital discharge. Recent studies of older ICU survivors have created a new standard for longitudinal critical care outcomes studies with a systematic evaluation of pre-critical illness comorbidities and disability and detailed assessments of physical and cognitive function after hospital discharge. These studies show that after controlling for pre-morbid health, older ICU survivors experience large and persistent declines in cognitive and physical function after critical illness. Long-term health-related quality-of-life studies suggest that some older ICU survivors may accommodate to a degree of physical disability and still report good emotional and social well-being, but these studies are subject to survivorship and proxy-response bias. In order to risk-stratify older ICU survivors for long-term (6–12 month) outcomes, we will need a paradigm shift in the timing and type of predictors measured. Emerging literature suggests that the initial acuity of critical illness will be less important, whereas pre-hospitalization estimates of disability and frailty, and, in particular, measures of comorbidity, frailty, and disability near the time of hospital discharge will be essential in creating reliable long-term risk-prediction models. PMID:24923682

Association between muscle power impairment and WHODAS 2.0 in older adults with physical disability in Taiwan.

PubMed

Chang, Kwang-Hwa; Liao, Hua-Fang; Yen, Chia-Fan; Hwang, Ai-Wen; Chi, Wen-Chou; Escorpizo, Reuben; Liou, Tsan-Hon

2015-01-01

To explore the association between muscle power impairment and each World Health Organization Disability Assessment Schedule second edition (WHODAS 2.0) domain score among subjects with physical disability. Subjects (≥ 60 years) with physical disability related to neurological diseases, including 730 subjects with brain disease (BD) and 126 subjects with non-BD, were enrolled from a data bank of persons with disabilities from 1 July 2011 to 29 February 2012. Standardized WHODAS 2.0 scores ranging from 0 (least difficulty) to 100 (greatest difficulty) points were calculated for each domain. More than 50% of subjects with physical disability had the greatest difficulty in household activities and mobility. Muscle power impairment (adjusted odds ratios range among domains, 2.75-376.42, p < 0.001), age (1.38-4.81, p < 0.05), and speech impairment (1.94-5.80, p < 0.05) were associated with BD subjects experiencing the greatest difficulty in most WHODAS 2.0 domains. But a few associated factors were identified for the non-BD group in the study. Although the patterns of difficulty in most daily activities were similar between the BD and non-BD groups, factors associated with the difficulties differed between those two groups. Muscle power impairment, age and speech impairment were important factors associated with difficulties in subjects with BD-related physical disability. Older adults with physical disability often experience difficulties in household activities and mobility. Muscle power impairment is associated with difficulties in daily life in subjects with physical disability related to brain disease. Those subjects with brain disease who had older age, a greater degree of muscle power impairment, and the presence of speech impairment were at higher risk of experiencing difficulties in most daily activities.

Moderating role of marital quality in older adults' depressed affect: beyond the main-effects model.

PubMed

Bookwala, Jamila; Franks, Melissa M

2005-11-01

We examine the role of three indicators of marital quality (marital disagreement, marital happiness, and time spent together) as moderators of the association between physical disability and depressed affect among married older individuals (N=1,044). We found support for the moderating role of marital disagreement wherein the detrimental effect of disability on depressed affect was significantly heightened among older adults with more disagreements with their spouse; a moderating effect was not detected for marital happiness or time spent together. We conclude that, in addition to its main effect on older adults' depressed affect, marital quality (as indicated by marital disagreement) plays a significant stress-moderating role in the physical disability-depressed affect link.

Sex Differences in Concomitant Trajectories of Self-Reported Disability and Measured Physical Capacity in Older Adults

PubMed Central

Allore, Heather G.; Mendes de Leon, Carlos F.; Gahbauer, Evelyne A.; Gill, Thomas M.

2016-01-01

Background: Despite documented age-related declines in self-reported functional status and measured physical capacity, it is unclear whether these functional indicators follow similar trajectories over time or whether the patterns of change differ by sex. Methods: We used longitudinal data from 687 initially nondisabled adults, aged 70 or older, from the Precipitating Events Project, who were evaluated every 18 months for nearly 14 years. Self-reported disability was assessed with a 12-item disability scale. Physical capacity was measured using grip strength and a modified version of Short Physical Performance Battery. Hierarchical linear models estimated the intra-individual trajectory of each functional indicator and differences in trajectories’ intercept and slope by sex. Results: Self-reported disability, grip strength, and Short Physical Performance Battery score declined over 13.5 years following nonlinear trajectories. Women experienced faster accumulation of self-reported disability, but slower declines in measured physical capacity, compared with men. Trajectory intercepts revealed that women had significantly weaker grip strength and reported higher levels of disability compared with men, with no differences in starting Short Physical Performance Battery scores. These findings were robust to adjustments for differences in sociodemographic characteristics, length-of-survival, health risk factors, and chronic-disease status. Conclusions: Despite the female disadvantage in self-reported disability, older women preserve measured physical capacity better than men over time. Self-reported and measured indicators should be viewed as complementary rather than interchangeable assessments of functional status for both clinical and research purposes, especially for sex-specific comparisons. PMID:27071781

Physical, lifestyle, psychological, and social determinants of pain intensity, pain disability, and the number of pain locations in depressed older adults.

PubMed

Hanssen, Denise J C; Naarding, Paul; Collard, Rose M; Comijs, Hannie C; Oude Voshaar, Richard C

2014-10-01

Late-life depression and pain more often co-occur than can be explained by chance. Determinants of pain in late-life depression are unknown, even though knowledge on possible determinants of pain in depression is important for clinical practice. Therefore, the objectives of the present study were 1) to describe pain characteristics of depressed older adults and a nondepressed comparison group, and 2) to explore physical, lifestyle, psychological, and social determinants of acute and chronic pain intensity, disability, and multisite pain in depressed older adults. Data from the Netherlands Study of Depression in Older Persons cohort, consisting of 378 depressed persons, diagnosed according to Diagnostic and Statistical Manual of Mental Disorders, 4th edition criteria, and 132 nondepressed persons aged 60 years and older, were used in a cross-sectional design. Pain characteristics were measured by the Chronic Graded Pain Scale. Multiple linear regression analyses were performed to explore the contribution of physical, lifestyle, psychological, and social determinants to outcomes pain intensity, disability, and the number of pain locations. Depressed older adults more often reported chronic pain and experienced their pain as more intense and disabling compared to nondepressed older adults. Adjusted for demographic, physical, and lifestyle characteristics, multinomial logistic regression analyses showed increased odds ratios (OR) for depression in acute pain (OR 3.010; P=0.005) and chronic pain (OR 4.544, P<0.001). In addition, linear regression analyses showed that acute and chronic pain intensity, disability, and multisite pain were associated with several biopsychosocial determinants, of which anxiety was most pronounced. Further research could focus on the temporal relationship between anxiety, late-life depression, and pain. Copyright © 2014 International Association for the Study of Pain. Published by Elsevier B.V. All rights reserved.

The Lifestyle Interventions and Independence for Elders (LIFE) study, randomized trial of physical activity: Effect on the prevention of major mobility disability

USDA-ARS?s Scientific Manuscript database

In older adults reduced mobility is common and is an independent risk factor for morbidity, hospitalization, disability, and mortality. Limited evidence suggests that physical activity may help prevent mobility disability; however, there are no definitive clinical trials examining if physical activi...

The role of physical activity and diabetes status as a moderator: functional disability among older Mexican Americans.

PubMed

Palmer, Raymond F; Espino, David V; Dergance, Jeannae M; Becho, Johanna; Markides, Kyriakos

2012-11-01

we investigate the temporal association between the rate of change in physical function and the rate of change in disability across four comparison groups: Those with and without diabetes who report >30 min of physical activity per day, and those who report <30 min of physical activity per day. six waves of longitudinal data from the Hispanic Established Population for Epidemiologic Studies of the Elderly were utilised. At baseline, there were a total of 3,050 elder participants aged 65 years old or greater. The longitudinal rates of change in disability and physical function were compared by the diabetes status (ever versus none) and the physical activity status (less than or greater than or equal to 30 min per day). disability and physical function data were analysed using a latent growth curve modelling approach adjusted for relevant demographic/health-related covariates. There were statistically significant longitudinal declines in physical function and disability (P < 0.001) in all groups. Most notable, the physical activity status was an important moderator. Those with >30 min of activity demonstrated better baseline function and less disability as well as better temporal trajectories than those reporting <30 min of physical activity per day. Comparisons between diabetes statuses within the same physical activity groups showed worse disability trajectories among those with diabetes. a longitudinal decline in physical function and disability is moderated most notably by physical activity. The diabetes status further moderates decline in function and disability over time. Increased physical activity appears to be protective of disability in general and may lessen the influence of diabetes-related disability in older Mexican Americans, particularly at the end of life.

Freedom and imperative: mutual care between older spouses with physical disabilities.

PubMed

Torgé, Cristina Joy

2014-05-01

This article explores mutual caregiving between older spouses aging with physical disabilities. Nine older couples, where both partners had lived long lives with physical disabilities, were interviewed as dyads about mutual caregiving. The couples not only had access to different kinds and degrees of formal support but also provided mutual care to each other in a variety of ways. Interview coding using grounded theory led to two overarching categories from which motivation for mutual caregiving could be understood. These categories were Mutual care as freedom and Mutual care as imperative. The results extend understanding about how older couples with disabilities attached meaning to their mutual caregiving, and why mutual care was sometimes preferable, despite the availability of other sources of help and despite practical difficulties of providing this help. These findings suggest that health care professionals need to be sensitive to the dynamics of the couple relationship and carefully explore the couple's preferences for how formal support can best be provided in ways that honor and sustain the integrity of the couple relationship.

Differences in Brain Structure and Function in Older Adults with Self-Reported Disabling and Non-Disabling Chronic Low Back Pain

PubMed Central

Buckalew, Neilly; Haut, Marc W.; Aizenstein, Howard; Morrow, Lisa; Perera, Subashan; Kuwabara, Hiroto; Weiner, Debra K.

2010-01-01

Objective The primary aim of this pilot study was to identify structural and functional brain differences in older adults with self-reported disabling chronic low back pain (CLBP) compared with those who reported non-disabling CLBP. Design Cross-sectional. Participants Sixteen cognitively intact older adults, eight with disabling CLBP and eight with non-disabling. Exclusions were psychiatric or neurological disorders, substance abuse, opioid use, or diabetes mellitus. Methods Participants underwent: structural and functional brain MRI; neuropsychological assessment using the Repeatable Battery for the Assessment of Neuropsychological Status, Trail Making Tests A and B; and physical performance assessment using the Short Physical Performance Battery. Results In the disabled group there was significantly lower white matter (WM) integrity (P < 0.05) of the splenium of the corpus callosum. This group also demonstrated activation of the right medial prefrontal cortex at rest whereas the non-disabled demonstrated activation of the left lateral prefrontal cortex. Combined groups analysis revealed a strong positive correlation (rs = 0.80, P < 0.0002) between WM integrity of the left centrum semiovale with gait-speed. Secondary analysis revealed a strong negative correlation between total months of CLBP and WM integrity of the SCC (rs = −0.59, P < 0.02). Conclusions Brain structure and function is different in older adults with disabling CLBP compared to those with non-disabling CLBP. Deficits in brain morphology combining groups are associated with pain duration and poor physical function. Our findings suggest brain structure and function may play a key role in chronic-pain-related-disability and may be important treatment targets. PMID:20609128

Prevalence of disability among US- and foreign-born Arab Americans: results from the 2000 US Census.

PubMed

Dallo, Florence J; Al Snih, Soham; Ajrouch, Kristine J

2009-01-01

Although the prevalence of disability for various racial and ethnic groups has been documented, little attention has been paid to Arab Americans in the United States. We estimated the age- and sex-adjusted prevalence of disability among older Arab Americans and examined the association between nativity status and self-reported physical and self-care disability before and after controlling for covariates. We used data from the 5% Public Use Microdata Samples of the 2000 US Census. Our sample included 4,225 individuals 65 years of age and older who identified with an Arab ancestry. Of these, 2,280 were foreign-born and 1,945 were US-born. The age- and sex-adjusted prevalence of having a physical disability was 31.2% for foreign- and 23.4% for US-born older Arab Americans, and the age- and sex- adjusted prevalence of having a self-care disability was 13.5% for foreign- and 6.8% for US-born Arab Americans. Iraqis reported the highest estimates for both disabilities (physical, 36.2%; self-care, 19.8%) compared to other Arab ethnic groups. In the crude model, foreign-born Arab Americans were more likely (OR=1.32; 95% CI=1.28, 1.36) to report a physical disability compared to US-born Arab Americans. When adjusting for English language ability in the final model, the odds of having a physical disability for foreign-born Arab Americans was protective compared to US-born Arab Americans (OR=0.92; 95% CI=0.88, 0.96). In the crude model, foreign-born Arab Americans were 1.82 times (95% CI=1.74, 1.90) more likely to report a self-care disability compared to US-born Arab Americans. In the fully adjusted model, this association was slightly attenuated (OR=1.32; 95% CI=1.24, 1.41). These findings indicate English language ability is associated with variations in reporting a physical disability. Future studies should include better measures of acculturation. Arab Americans are heterogeneous and should be disaggregated both by subgroups and from the white category in order to reveal a more accurate health and disease status profile for these groups. These efforts will assist in tailoring more effective interventions in reducing or preventing disability among Arab Americans 65 years of age and older. Copyright 2008 S. Karger AG, Basel.

Aging in a cultural context: cross-national differences in disability and the moderating role of personal control among older adults in the United States and England.

PubMed

Clarke, Philippa; Smith, Jacqui

2011-07-01

We investigate cross-national differences in late-life health outcomes and focus on an intriguing difference in beliefs about personal control found between older adult populations in the U.K. and United States. We examine the moderating role of control beliefs in the relationship between physical function and self-reported difficulty with daily activities. Using national data from the United States (Health and Retirement Study) and England (English Longitudinal Study on Ageing), we examine the prevalence in disability across the two countries and show how it varies according to the sense of control. Poisson regression was used to examine the relationship between objective measures of physical function (gait speed) and disability and the modifying effects of control. Older Americans have a higher sense of personal control than the British, which operates as a psychological resource to reduce disability among older Americans. However, the benefits of control are attenuated as physical impairments become more severe. These results emphasize the importance of carefully considering cross-national differences in the disablement process as a result of cultural variation in underlying psychosocial resources. This paper highlights the role of culture in shaping health across adults aging in different sociopolitical contexts.

Aging in a Cultural Context: Cross-national Differences in Disability and the Moderating Role of Personal Control Among Older Adults in the United States and England

PubMed Central

Smith, Jacqui

2011-01-01

Objectives. We investigate cross-national differences in late-life health outcomes and focus on an intriguing difference in beliefs about personal control found between older adult populations in the U.K. and United States. We examine the moderating role of control beliefs in the relationship between physical function and self-reported difficulty with daily activities. Method. Using national data from the United States (Health and Retirement Study) and England (English Longitudinal Study on Ageing), we examine the prevalence in disability across the two countries and show how it varies according to the sense of control. Poisson regression was used to examine the relationship between objective measures of physical function (gait speed) and disability and the modifying effects of control. Results. Older Americans have a higher sense of personal control than the British, which operates as a psychological resource to reduce disability among older Americans. However, the benefits of control are attenuated as physical impairments become more severe. Discussion. These results emphasize the importance of carefully considering cross-national differences in the disablement process as a result of cultural variation in underlying psychosocial resources. This paper highlights the role of culture in shaping health across adults aging in different sociopolitical contexts. PMID:21666145

Effect of physical activity counseling on disability in older people: a 2-year randomized controlled trial.

PubMed

von Bonsdorff, Mikaela B; Leinonen, Raija; Kujala, Urho M; Heikkinen, Eino; Törmäkangas, Timo; Hirvensalo, Mirja; Rasinaho, Minna; Karhula, Sirkka; Mänty, Minna; Rantanen, Taina

2008-12-01

To study the effect of a physical activity counseling intervention on instrumental activity of daily living (IADL) disability. Primary care-based, single-blind, randomized controlled trial. City of Jyväskylä, central Finland. Six hundred thirty-two people aged 75 to 81 who were able to walk 500 meters without assistance, were at most moderately physically active, had a Mini-Mental State Examination score greater than 21, had no medical contraindications for physical activity, and gave informed consent for participation. A single individualized physical activity counseling session with supportive phone calls from a physiotherapist every 4 months for 2 years and annual lectures on physical activity. Control group received no intervention. The outcome was IADL disability defined as having difficulties in or inability to perform IADL tasks. Analyses were carried out according to baseline IADL disability, mobility limitation, and cognitive status. At the end of the follow-up, IADL disability had increased in both groups (P<.001) and was lower in the intervention group, but the group-by-time interaction effect did not reach statistical significance. Subgroup analyses revealed that the intervention prevented incident disability in subjects without disability at baseline (risk ratio=0.68, 95% confidence interval=0.47-0.97) but had no effect on recovery from disability. The physical activity counseling intervention had no effect on older sedentary community-dwelling persons with a wide range of IADL disability, although it prevented incident IADL disability. The results warrant further investigation to explore the benefits of a primary care-based physical activity counseling program on decreasing and postponing IADL disability.

Functional Impairment Severity Is Associated with Health Status among Older Persons with Intellectual Disability and Cerebral Palsy

ERIC Educational Resources Information Center

Henderson, C. M.; Rosasco, M.; Robinson, L. M.; Meccarello, J.; Janicki, M. P.; Turk, M. A.; Davidson, P. W.

2009-01-01

Background: Studies have noted high rates of specific health disorders in adults with cerebral palsy (CP). However, it remains unclear how growing older with a lifelong neuromotor physical disability confers risk for health outcomes in adults who have both intellectual disability (ID) and CP. Aim: To assess the relationship between health status…

Moving towards an understanding of disability in older US stroke survivors

PubMed Central

Brenner, Allison B.; Burke, James F.; Skolarus, Lesli E.

2017-01-01

Objectives We test a comprehensive model of disability in older stroke survivors, and determine the relative contribution of neighborhood, economic, psychological and medical factors to disability. Methods The sample consisted of 728 stroke survivors from the National Health and Aging Trends Study (NHATS), who were 65 years and older living in community settings or residential care. Confirmatory factor analysis and structural equation modeling were used to test relationships between neighborhood, socioeconomic, psychological and medical factors and disability. Results Economic and medical context were associated with disability directly and indirectly through physical impairment. Neighborhood context was associated with disability, but was only marginally statistically significant (p=0.05). The effect of economic and neighborhood factors was small compared to that of medical factors. Discussion Neighborhood and economic factors account for a portion of the variance in disability among older stroke survivors beyond that of medical factors. PMID:27605555

Reliability and Validity of the Floor Transfer Test as a Measure of Readiness for Independent Living Among Older Adults.

PubMed

Ardali, Gunay; Brody, Lori T; States, Rebecca A; Godwin, Ellen M

2017-10-20

The ability to get up from the floor after a fall is a basic skill required for functional independence. Consequently, the inability to safely get down and up from the floor or to perform a floor transfer (FT) may indicate decreased mobility and/or increased frailty. A reliable and valid test of FT ability is a critical part of the clinical decision-making process. The FT test is a simple, performance-based test that can be administered quickly and easily to determine a patient's ability to safely and successfully get down and up from the floor using any movement strategy and without time restriction. The primary purpose of this cross-sectional study was to determine the intrarater reliability and validity of the FT test as a practical alternative to several widely used yet time-consuming measures of physical disability, frailty, and functional mobility. A total of 61 community-dwelling older adults (65-96 years of age) participated in the study divided into 2 separate subsamples: 15 of them in the intrarater reliability part, while the other 46 in the concurrent validity one. In both subsamples, the participants were stratified on the basis of the self-reported levels of FT ability as independent, assisted, and dependent. Intrarater reliability was assessed in 2 separate occasions and scores were analyzed by intraclass correlation coefficient and κ statistics. Concurrent validity of the FT test was assessed against the self-reported FT ability questionnaire, Physical Functioning Scale, Phenotype of Physical Frailty, and the Short Physical Performance Battery. Known-groups validity was tested by determining whether the FT test distinguished between (1) community-dwelling older adults with physical disabilities versus those who without physical disabilities; and (2) community-dwelling older adults who were functionally dependent versus those who were independent. Participants were also categorized on the basis of FT test outcome as independent, assisted, or dependent. The Spearman correlation coefficients were calculated to examine the strength of the relationships between the FT test and physical status measures. The Kruskal-Wallis test was used to determine whether the FT test significantly discriminated between groups as categorized by the Physical Functioning Scale and Short Physical Performance Battery, and to examine the significance level of the sociodemographic data across the 3 FT test outcome groups. The intrarater reliabilities of the measures were good (0.73-1.00). There were statistically positive and strong correlations between the FT test and all physical status measures (ρ ranged from 0.86 to 0.93, P < .001). Older adults who passed the FT test were collectively categorized as those without physical disabilities and functionally independent, whereas older adults who failed the FT test were categorized as those with physical disabilities and functionally dependent (P < .001). The FT test is a reliable and valid measure for screening for physical disability, frailty, and functional mobility. It can determine which older adults have physical disabilities and/or functional dependence and hence may be useful in assessing readiness for independent living. Inclusion of the FT test at initial evaluation may reveal the presence of these conditions and address the safety of older adults in the community.

Physical and Mental Health of Transgender Older Adults: An At-Risk and Underserved Population

PubMed Central

Fredriksen-Goldsen, Karen I.

2014-01-01

Purpose: This study is one of the first to examine the physical and mental health of transgender older adults and to identify modifiable factors that account for health risks in this underserved population. Design and Methods: Utilizing data from a cross-sectional survey of lesbian, gay, bisexual, and transgender older adults aged 50 and older (N = 2,560), we assessed direct and indirect effects of gender identity on 4 health outcomes (physical health, disability, depressive symptomatology, and perceived stress) based on a resilience conceptual framework. Results: Transgender older adults were at significantly higher risk of poor physical health, disability, depressive symptomatology, and perceived stress compared with nontransgender participants. We found significant indirect effects of gender identity on the health outcomes via fear of accessing health services, lack of physical activity, internalized stigma, victimization, and lack of social support; other mediators included obesity for physical health and disability, identity concealment for perceived stress, and community belonging for depressive symptomatology and perceived stress. Further analyses revealed that risk factors (victimization and stigma) explained the highest proportion of the total effect of gender identity on health outcomes. Implications: The study identifies important modifiable factors (stigma, victimization, health-related behaviors, and social support) associated with health among transgender older adults. Reducing stigma and victimization and including gender identity in nondiscrimination and hate crime statutes are important steps to reduce health risks. Attention to bolstering individual and community-level social support must be considered when developing tailored interventions to address transgender older adults’ distinct health and aging needs. PMID:23535500

Shakespeare on old age and disability.

PubMed

Covey, H

2000-01-01

The plays of William Shakespeare were reviewed for references to disabilities, aging and disability, and older characters with disabilities. Shakespeare's references draw from traditional cultural notions about older people with disabilities. These traditional notions include people with physical disabilities being evil, the entertainment value of disabilty, and those who were mentally ill being wild and animal-like. He viewed the aging process as disabling and old age as a time when individuals lost some abilities to function, particularly when it came to mental capacity and physical mobility. His writings show that he used disability as a literary tool to add dimension to characters and set them apart. Contemporary literature continues to share some of Shakespeare's view on aging and disability but also departs from them in important ways. For example, contemporary treatment of disabilities and aging places more emphasis on the human side of the affects of aging and disabilities. Disabilities and aging are not cast in the same negative terms as Shakespeare used.

Differential Impact of Involuntary Job Loss on Physical Disability Among Older Workers Does Predisposition Matter?

PubMed Central

Gallo, William T.; Brand, Jennie E.; Teng, Hsun-Mei; Leo-Summers, Linda; Byers, Amy L.

2009-01-01

Older workers' share of involuntary job losses in the United States has grown fairly consistently in recent decades, prompting greater interest in the health consequences of involuntary unemployment among individuals nearing retirement. In this study, the authors applied the multifactorial model of geriatric health to investigate whether late-career involuntary job loss was associated with subsequent physical disability and whether the effect of involuntary job loss on physical disability varied by predisposition. Using data from the first four waves (1992 to 1998) of the Health and Retirement Survey, the authors measured predisposition with individual risk factors for functional disability and indices of aggregate risk. The results of gender-specific models fit with generalized estimating equations revealed that unmarried women and those with low predisplacement incomes had heightened risk for subsequent functional disability. No differential effects of job loss were found for men. PMID:19924265

Does Age Affect the Relationship Between Pain and Disability? A Descriptive Study in Individuals Suffering From Chronic Low Back Pain.

PubMed

Houde, Francis; Cabana, François; Léonard, Guillaume

2016-01-01

Previous studies have revealed a weak to moderate relationship between pain and disability in individuals suffering from low back pain (LBP). However, to our knowledge, no studies have evaluated if this relationship is different between young and older adults. The objective of this descriptive, cross-sectional study was to determine whether the relationship between LBP intensity and physical disability is different between young and older adults. Pain intensity (measured with a visual analog scale) and physical disability scores (measured with the Oswestry Disability Index) were collected from the medical files of 164 patients with LBP. Separate Pearson correlation coefficients were calculated between these 2 variables for young (mean age 40 ± 6 years, n = 82) and older (62 ± 9 years, n = 82) individuals and a Fisher r-to-z transformation was used to test for group differences in the strength of the relationship. Linear regression analyses were also performed to determine whether the slope of the association was different between the 2 groups. A significant and positive association was found between pain intensity and disability for both young and older individuals. However, the correlation was stronger in the young group (r = 0.66; P < .01) than in the older group (r = 0.44; P < .01) (Fisher Z = 2.03; P < .05). The linear regression model also revealed that the slope of the relationship was steeper in the young group (P < .05). Although both young and older individuals showed a significant association between pain intensity and disability, the relationship between these 2 variables was more tenuous in older individuals than in young patients. Future research is essential to identify the factors underlying this age-related difference.

Do Inactive Older Adults who Increase Physical Activity Experience Less Disability: Evidence from the Osteoarthritis Initiative

PubMed Central

Song, Jing; Gilbert, Abigail L.; Chang, Rowland W.; Pellegrini, Christine A.; Ehrlich-Jones, Linda S.; Lee, Jungwha; Pinto, Daniel; Semanik, Pamela A.; Sharma, Leena; Kwoh, C. Kent; Jackson, Rebecca D.; Dunlop, Dorothy D.

2016-01-01

Background Physical inactivity is a leading risk factor for developing disability. Although randomized clinical trials have demonstrated improving physical activity can reduce this risk in older adults with arthritis, these studies did not specifically evaluate inactive adults. Objectives To evaluate the relationship of changes in physical activity with disability changes among initially inactive adults with or at high risk of knee OA from Osteoarthritis Initiative. Methods Inactive persons were identified at baseline based on the U.S. Department of Health and Human Services classification (no [zero] 10-minute session of moderate-to-vigorous activity over one week) from objective accelerometer monitoring. Two years later physical activity change status was classified as: (1) met Federal physical activity guidelines (≥150 moderate-to-vigorous minutes/week acquired in bouts ≥10 minutes), (2) insufficiently increased activity (some but <150 moderate-to-vigorous bout minutes/week) or (3) remained inactive. Disability at baseline and two years was assessed by Late Life Disability Instrument (LLDI) limitation and frequency scores. Multiple regression evaluated the relationship of physical activity change status with baseline-to-2 year changes in disability scores adjusting for socioeconomics, health factors, and baseline disability score. Results Increased physical activity showed a graded relationship with improved disability scores in LLDI limitation (P<0.001) and frequency scores (P=0.027). While increasing moderate-to-vigorous activity to guideline levels showed the greatest reduction, even insufficiently increased physical activity was related to reduced disability. Conclusions Findings support advice to increase moderate-to-vigorous physical activity to reduce disability among inactive adults with or at high risk for knee osteoarthritis, even when guidelines are not met. PMID:28002153

Concurrent and convergent validity of the mobility- and multidimensional-hierarchical disability categorization models with physical performance in community older adults.

PubMed

Hu, Ming-Hsia; Yeh, Chih-Jun; Chen, Tou-Rong; Wang, Ching-Yi

2014-01-01

A valid, time-efficient and easy-to-use instrument is important for busy clinical settings, large scale surveys, or community screening use. The purpose of this study was to validate the mobility hierarchical disability categorization model (an abbreviated model) by investigating its concurrent validity with the multidimensional hierarchical disability categorization model (a comprehensive model) and triangulating both models with physical performance measures in older adults. 604 community-dwelling older adults of at least 60 years in age volunteered to participate. Self-reported function on mobility, instrumental activities of daily living (IADL) and activities of daily living (ADL) domains were recorded and then the disability status determined based on both the multidimensional hierarchical categorization model and the mobility hierarchical categorization model. The physical performance measures, consisting of grip strength and usual and fastest gait speeds (UGS, FGS), were collected on the same day. Both categorization models showed high correlation (γs = 0.92, p < 0.001) and agreement (kappa = 0.61, p < 0.0001). Physical performance measures demonstrated significant different group means among the disability subgroups based on both categorization models. The results of multiple regression analysis indicated that both models individually explain similar amount of variance on all physical performances, with adjustments for age, sex, and number of comorbidities. Our results found that the mobility hierarchical disability categorization model is a valid and time efficient tool for large survey or screening use.

Health Outcomes of Midlife and Older Latina and Black American Mothers of Children with Developmental Disabilities

ERIC Educational Resources Information Center

Magana, Sandra; Smith, Matthew J.

2006-01-01

The impact of caring for a child with a developmental disability on the physical and mental health of Latina and Black American women was examined. We used the National Health Interview Survey to compare the health of older mothers who were co-residing with a child who had a developmental disability to the health of same age mothers without…

Self-reported stigma and its association with socio-demographic factors and physical disability in people with intellectual disabilities: results from a cross-sectional study in England.

PubMed

Ali, Afia; King, Michael; Strydom, Andre; Hassiotis, Angela

2016-03-01

The aim of this study was to investigate whether socio-demographic variables and physical disability (e.g. sensory impairment and mobility problems) were associated with self-reported stigma in people with intellectual disabilities (ID), and to examine whether age, sex and ethnicity modified the relationship between severity of intellectual disability and self-reported stigma. 229 participants with mild or moderate intellectual disabilities were recruited from 12 centres/sites in England from community intellectual disability services, day centres, supported housing schemes, voluntary organisations and invitation letters. Information on physical disability and socio-demographic variables were obtained using a structured data collection form. Self-reported stigma was measured using a validated questionnaire. Age was associated with self-reported stigma, with older adults reporting more stigmatising experiences. Participants with moderate intellectual disabilities were more likely to report being treated differently such as being made fun of and being treated like children. Physical disability such as sensory, mobility and speech problems were not associated with self-reported stigma. Gender modified the relationship between severity of ID and self-reported stigma as participants who were male and had moderate ID were more likely to report stigma compared to females with moderate ID. Categorical age also modified the relationship between severity of ID and self-reported stigma as older participants who had moderate ID were more likely to report stigma compared to younger people with moderate ID. Older adults and those with moderate ID are potentially at higher risk of being targets of public stigma or are more likely to report stigma. Interventions to help individuals cope with stigma could be targeted to this group.

The Joint Associations of Sedentary Time and Physical Activity With Mobility Disability in Older People: The NIH-AARP Diet and Health Study.

PubMed

DiPietro, Loretta; Jin, Yichen; Talegawkar, Sameera; Matthews, Charles E

2018-03-14

The purpose of this study was to determine the joint associations of sedentary time and physical activity with mobility disability in older age. We analyzed prospective data from 134,269 participants in the National Institutes of Health (NIH)-American Association of Retired Persons (NIH-AARP) Diet and Health Study between 1995-1996 and 2004-2005. Total sitting time (h/d), TV viewing time (h/d) and light- and moderate-to-vigorous-intensity physical activity (h/wk) were self-reported at baseline, and mobility disability at follow-up was defined as being "unable to walk" or having an "easy usual walking pace (<2 mph)." Multivariable logistic regression determined the independent and joint associations of sedentary time and total physical activity with the odds of disability. Among the most active participants (>7 h/wk), sitting <6 h/d was not related to excess disability at follow-up, and those in the most active group reporting the highest level of sitting time (≥7 h/d) still had a significantly lower odds (odds ratios = 1.11; 95% confidence interval = 1.02, 1.20) compared with those reporting the lowest level of sitting (<3 h/d) in the least active group (≤3 h/wk; odds ratios = 2.07; 95% confidence interval = 1.92, 2.23). Greater TV time was significantly related to increased disability within all levels of physical activity. Reduction of sedentary time, combined with increased physical activity may be necessary to maintain function in older age.

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

PubMed

Fielding, Roger A; Rejeski, W Jack; Blair, Steven; Church, Tim; Espeland, Mark A; Gill, Thomas M; Guralnik, Jack M; Hsu, Fang-Chi; Katula, Jeffrey; King, Abby C; Kritchevsky, Stephen B; McDermott, Mary M; Miller, Michael E; Nayfield, Susan; Newman, Anne B; Williamson, Jeff D; Bonds, Denise; Romashkan, Sergei; Hadley, Evan; Pahor, Marco

2011-11-01

As the number of older adults in the United States rises, maintaining functional independence among older Americans has emerged as a major clinical and public health priority. Older people who lose mobility are less likely to remain in the community; demonstrate higher rates of morbidity, mortality, and hospitalizations; and experience a poorer quality of life. Several studies have shown that regular physical activity improves functional limitations and intermediate functional outcomes, but definitive evidence showing that major mobility disability can be prevented is lacking. A Phase 3 randomized controlled trial is needed to fill this evidence gap. The Lifestyle Interventions and Independence for Elders (LIFE) Study is a Phase 3 multicenter randomized controlled trial designed to compare a supervised moderate-intensity physical activity program with a successful aging health education program in 1,600 sedentary older persons followed for an average of 2.7 years. LIFE's primary outcome is major mobility disability, defined as the inability to walk 400 m. Secondary outcomes include cognitive function, serious fall injuries, persistent mobility disability, the combined outcome of major mobility disability or death, disability in activities of daily living, and cost-effectiveness. Results of this study are expected to have important public health implications for the large and growing population of older sedentary men and women.

Association Between Circulating Osteogenic Progenitor Cells and Disability and Frailty in Older Persons: The Nepean Osteoporosis and Frailty Study.

PubMed

Gunawardene, Piumali; Bermeo, Sandra; Vidal, Christopher; Al-Saedi, Ahmed; Chung, Philip; Boersma, Derek; Phu, Steven; Pokorski, Izabella; Suriyaarachchi, Pushpa; Demontiero, Oddom; Duque, Gustavo

2016-09-01

Circulating osteogenic progenitor (COP) cells are considered as surrogates of the mesenchymal repository in the body. In this study, we hypothesized that COP cells decrease with age and that lower levels of COP cells are associated with greater frailty and disability in older persons. Using well-established clinical criteria, we quantified physical performance and disability and stratified frailty in a random sample of community-dwelling individuals enrolled in the Nepean Osteoporosis and Frailty (NOF) Study (mean age 82.8; N = 77; 70% female; 27 nonfrail, 23 prefrail, and 27 frail). Percentage of COP cells was quantified by flow cytometry. Logistic regression models estimated the relationship between the percentage of COP cells and prevalent disability, poor physical performance, and frailty. We found that aging is associated with a significant decrease in COP cells (p < .001). Lower percentages of COP cells were associated with disability and poor physical performance (p < .001). Older adults with COP cells in the lower quartile were more likely to be frail (odds ratio 2.65, 95% confidence interval 2.72-3.15, p < .001). In conclusion, COP cells in the circulation decrease with age. Lower percentages of COP cells in late life are associated with prevalent frailty and disability. Further longitudinal studies are needed to understand COP cells as a risk stratifier, biomarker, or therapeutic target and to predict disability in frail older persons. © The Author 2015. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

The physical and mental health of lesbian, gay male, and bisexual (LGB) older adults: the role of key health indicators and risk and protective factors.

PubMed

Fredriksen-Goldsen, Karen I; Emlet, Charles A; Kim, Hyun-Jun; Muraco, Anna; Erosheva, Elena A; Goldsen, Jayn; Hoy-Ellis, Charles P

2013-08-01

Based on resilience theory, this paper investigates the influence of key health indicators and risk and protective factors on health outcomes (including general health, disability, and depression) among lesbian, gay male, and bisexual (LGB) older adults. A cross-sectional survey was conducted with LGB older adults, aged 50 and older (N = 2,439). Logistic regressions were conducted to examine the contributions of key health indicators (access to health care and health behaviors), risk factors (lifetime victimization, internalized stigma, and sexual identity concealment), and protective factors (social support and social network size) to health outcomes, when controlling for background characteristics. The findings revealed that lifetime victimization, financial barriers to health care, obesity, and limited physical activity independently and significantly accounted for poor general health, disability, and depression among LGB older adults. Internalized stigma was also a significant predictor of disability and depression. Social support and social network size served as protective factors, decreasing the odds of poor general health, disability, and depression. Some distinct differences by gender and sexual orientation were also observed. High levels of poor general health, disability, and depression among LGB older adults are of major concern. These findings highlight the important role of key risk and protective factors, which significantly influences health outcomes among LGB older adults. Tailored interventions must be developed to address the distinct health issues facing this historically disadvantaged population.

Prevalence and correlates of physical disability and functional limitation among community dwelling older people in rural Malaysia, a middle income country

PubMed Central

2010-01-01

Background The prevalence and correlates of physical disability and functional limitation among older people have been studied in many developed countries but not in a middle income country such as Malaysia. The present study investigated the epidemiology of physical disability and functional limitation among older people in Malaysia and compares findings to other countries. Methods A population-based cross sectional study was conducted in Alor Gajah, Malacca. Seven hundred and sixty five older people aged 60 years and above underwent tests of functional limitation (Tinetti Performance Oriented Mobility Assessment Tool). Data were also collected for self reported activities of daily living (ADL) using the Barthel Index (ten items). To compare prevalence with other studies, ADL disability was also defined using six basic ADL's (eating, bathing, dressing, transferring, toileting and walking) and five basic ADL's (eating, bathing, dressing, transferring and toileting). Results Ten, six and five basic ADL disability was reported by 24.7% (95% CI 21.6-27.9), 14.4% (95% CI 11.9-17.2) and 10.6% (95% CI 8.5-13.1), respectively. Functional limitation was found in 19.5% (95% CI 16.8-22.5) of participants. Variables independently associated with 10 item ADL disability physical disability, were advanced age (≥ 75 years: prevalence ratio (PR) 7.9; 95% CI 4.8-12.9), presence of diabetes (PR 1.8; 95% CI 1.4-2.3), stroke (PR 1.5; 95% CI 1.1-2.2), depressive symptomology (PR 1.3; 95% CI 1.1-1.8) and visual impairment (blind: PR 2.0; 95% CI 1.1-3.6). Advancing age (≥ 75 years: PR 3.0; 95% CI 1.7-5.2) being female (PR 2.7; 95% CI 1.2-6.1), presence of arthritis (PR 1.6; 95% CI 1.2-2.1) and depressive symptomology (PR 2.0; 95% CI 1.5-2.7) were significantly associated with functional limitation. Conclusions The prevalence of physical disability and functional limitation among older Malaysians appears to be much higher than in developed countries but is comparable to developing countries. Associations with socio-demographic and other health related variables were consistent with other studies. PMID:20716377

Paths to leisure physical activity among adults with intellectual disabilities: self-efficacy and social support.

PubMed

Peterson, Jana J; Lowe, John B; Peterson, N Andrew; Nothwehr, Faryle K; Janz, Kathleen F; Lobas, Jeffrey G

2008-01-01

This study tested a path model that included perceptions of social support and self-efficacy for leisure physical activity and leisure physical activity participation among adults with intellectual disabilities. A cross-sectional design was used. Data was collected via oral interview. Community-based group, supported-living settings in one Midwestern state. A total of 152 adults with mild to moderate intellectual disabilities, which provided a 39% response rate. Self-efficacy and social support (from family, residential staff and peers with disabilities) for leisure physical activity were assessed using self-reported scales. Leisure physical activity participation was measured with a self-reported checklist of the frequency of leisure physical activity participation. Path analysis was conducted for the entire sample and was repeated for younger and older age groups. The hypothesized model fit the data from each group. Social support and self-efficacy predicted physical activity participation, and self-efficacy served as a mediator between social support and physical activity. Significant sources of social support differed between groups; among younger participants, social support from family predicted physical activity, whereas, for the older group, social support from staff and peers predicted physical activity. Self-efficacy and social support for leisure physical activity are related to leisure physical activity participation among adults with intellectual disabilities who are receiving supported-living services. The results provide information to guide health promotion programs for this group.

Patient-Reported Outcomes Associated With Use of Physical Therapist Services by Older Adults With a New Visit for Back Pain

PubMed Central

Sherman, Karen J.; Heagerty, Patrick J.; Mock, Charles; Jarvik, Jeffrey G.

2015-01-01

Background Among older adults, it is not clear how different types or amounts of physical therapy may be associated with improvements in back pain and function. Objective The study objective was to investigate the association between types or amounts of physical therapist services and 1-year outcomes among older adults with back pain. Design This was a prospective cohort study. Methods A total of 3,771 older adults who were enrolled in a cohort study and who had a new primary care visit for back pain participated. Physical therapy use was ascertained from electronic health records. The following patient-reported outcomes were collected over 12 months: back-related disability (Roland-Morris Disability Questionnaire) and back and leg pain intensity (11-point numerical rating scale). Marginal structural models were used to estimate average effects of different amounts of physical therapy use on disability and pain for all types of physical therapy and for active, passive, and manual physical therapy. Results A total of 1,285 participants (34.1%) received some physical therapy. There was no statistically significant gradient in relationships between physical therapy use and back-related disability score. The use of passive or manual therapy was not consistently associated with pain outcomes. Higher amounts of active physical therapy were associated with decreased back and leg pain and increased odds of clinically meaningful improvements in back and leg pain relative to results obtained with no active physical therapy. Limitations The fact that few participants had high amounts of physical therapy use limited precision and the ability to test for nonlinear relationships for the amount of use. Conclusions Higher amounts of active physical therapy were most consistently related to the greatest improvements in pain intensity; however, as with all observational studies, the results must be interpreted with caution. PMID:25278334

An Examination of the Disablement Process Among Older American Indians: The Native Elder Care Study.

PubMed

Schure, Marc B; Goins, R Turner

2016-10-01

Older American Indians disproportionately suffer from poorer physical and mental health and have greater disability compared to their racial and ethnic counterparts. The purpose of this study was to examine the disablement process among older American Indians. Data analyzed were from the Native Elder Care Study, which included in-person interviews with 505 community-dwelling American Indians aged ≥55 years. We used structural equation modeling to examine the contributive direct and indirect effects of health, demographic, and psychosocial risk factors on disability. Pathology had direct and indirect effects through social support and depressive symptoms on chronic pain intensity. Pathology also had direct and indirect effects on disability. Chronic pain intensity was a significant mediator between pathology and functional limitations. With contributive effects of older age and female sex, greater functional limitations were associated with increased disability. Our results support the theorized main pathway of the Disablement Process Model with our sample of older American Indians. Our findings support the importance of taking into account intra and extraindividual factors in assessing the prevalence and incidence of disability for older American Indians. © The Author 2015. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Fatigue in a Representative Population of Older Persons and Its Association With Functional Impairment, Functional Limitation, and Disability

PubMed Central

Nayfield, Susan G.; Patel, Kushang V.; Eldadah, Basil; Cesari, Matteo; Ferrucci, Luigi; Ceresini, Graziano; Guralnik, Jack M.

2009-01-01

Background Older persons often complain of fatigue, but the functional consequences of this symptom are unclear. The aim of the present study was to evaluate fatigue and its association with measures of physical function and disability in a representative sample of the older population. Methods Cross-sectional data from a population-based sample of 1,055 Italian men and women aged 65 and older were analyzed. Fatigue was defined according to two questions evaluating whether participants felt that “everything was an effort” and/or they “could not get going” on three or more days in the past week. Objective measures of physical function were handgrip strength, the Short Physical Performance Battery (SPPB), and 400-m walking speed. Disability was defined as the inability to complete the 400-m walk test and self-reported difficulty in activities of daily living (ADL) and instrumental activities of daily living (IADL). Results The prevalence of fatigue was higher in women (29%) than in men (15%). In age-adjusted analyses, fatigued men and women had weaker handgrip strength, lower SPPB score, slower walking speed, and higher mobility, ADL, and IADL disability than nonfatigued persons. Further adjustment for health behaviors, diseases, inflammatory markers, and thyroid function generally reduced the relationship between fatigue and functional outcomes, but fatigue remained significantly associated with SPPB score, walking speed, and mobility and IADL disability. Conclusions Older persons who report fatigue had significantly poorer functional status than those who did not report this symptom. The causal link between fatigue and these outcomes should be further investigated. PMID:19176328

Prevalence and socio-demographic characteristics of disability in older adults in China: Findings from China Comprehensive Geriatric Assessment Study.

PubMed

Ma, Lina; Li, Zhenzhen; Tang, Zhe; Sun, Fei; Diao, Lijun; Li, Jian; He, Yao; Dong, Birong; Li, Yun

2017-11-01

Disability affects older adults' quality of life. This study aimed to examine the socio-demographic characteristics of disability in older adults in China. Data was obtained from the China Comprehensive Geriatric Assessment Study (CCGAS). The sample comprised 6864 people aged 60 years and above from seven provinces in China. A door-to-door survey was conducted by formally trained interviewers using a unified questionnaire. Disability was assessed with physical health assessment comprising activities of daily living (ADL), and independent activities of daily living (IADL). For the purpose of this study, we analyzed only disability and some socio-demographic dimensions. The rates were standardized based on China's Sixth National Census population distribution. The disability rate in older adults was 7.0%. The disability rate was significantly higher in women than men, significantly higher in rural areas than urban areas, and higher in northern China than southern China. Urban disability rates ranged from 5.7% to 1.2%. The differences were statistically significant, with Beijing having the highest and Shanghai the lowest disability rates. Disability increased with age. In China, the disability rate in older adults is 7.0%, and increases with age. The disability rate is significantly higher in women, rural area, and northern China. This is the first study to report the epidemiology of disability in older adults in China in recent years and indicates the need for further epidemiological data on disability in China to facilitate long-term care and care policy formulation. Copyright © 2017 Elsevier B.V. All rights reserved.

A structured physical activity and fitness programme for older adults with intellectual disabilities: results of a cluster-randomised clinical trial.

PubMed

van Schijndel-Speet, M; Evenhuis, H M; van Wijck, R; van Montfort, K C A G M; Echteld, M A

2017-01-01

The physical activity level of older adults with intellectual disabilities (ID) is extremely low, and their fitness levels are far beneath accepted norms for older people with normal intelligence and comparable with frail older people. A physical activity programme, including an education programme, was developed for older adults with ID using behaviour change techniques. The programme aimed at improving or maintaining adequate levels of physical activity (primary outcome measure) and motor fitness, cardio respiratory fitness, morphologic and metabolic fitness, activities of daily living, cognitive functioning and depressive symptoms (secondary outcome measures). The programme's efficacy was evaluated in a cluster-randomised clinical trial among people aged 43 years and over with mild-moderate levels of ID. Five day-activity centres were randomised to the participation group. In these centres, 81 older adults participated in groups of 8 to 10 in the programme, three times a week during 8 months. The programme was executed by physical activity instructors and staff of day-activity centres. Five other day-activity centres were randomised to the control group; 70 older adults in these centres received care as usual. The generalised linear model with mixed effects was used to test the programme's effectiveness. Significant effects were found on physical activity, muscle strength, systolic and diastolic blood pressure, serum cholesterol level and cognitive functioning, in favour of the programme's participants. No significant improvements were found on balance, serum glucose, weight, waist circumference, walking speed, mobility, depression or instrumental activities of daily living. The physical activity and fitness programme has established small but significant effects in this sample, but generalising the findings to other settings is difficult due to significant participant dropout. Implementation of evidence-based physical activity programmes among older adults with ID is recommended. Further research is needed to investigate the effectiveness of physical activity on daily life functioning and the development on chronic diseases in the long run. © 2016 MENCAP and International Association of the Scientific Study of Intellectual and Developmental Disabilities and John Wiley & Sons Ltd.

Physical Activity Among Persons Aging with Mobility Disabilities: Shaping a Research Agenda

PubMed Central

Rosenberg, Dori E.; Bombardier, Charles H.; Hoffman, Jeanne M.; Belza, Basia

2011-01-01

With the aging of the baby boomer population and their accompanying burden of disease, future disability rates are expected to increase. This paper summarizes the state of the evidence regarding physical activity and aging for individuals with mobility disability and proposes a healthy aging research agenda for this population. Using a previously published framework, we present evidence in order to compile research recommendations in four areas focusing on older adults with mobility disability: (1) prevalence of physical activity, (2) health benefits of physical activity, (3) correlates of physical activity participation, and, (4) promising physical activity intervention strategies. Overall, findings show a dearth of research examining physical activity health benefits, correlates (demographic, psychological, social, and built environment), and interventions among persons aging with mobility disability. Further research is warranted. PMID:21748010

Disparities in Health and Disability Among Older Adults in Same-Sex Cohabiting Relationships

PubMed Central

Gonzales, Gilbert; Henning-Smith, Carrie

2014-01-01

Objectives The present study compared indicators of impaired health and disability between older adults in same-sex cohabiting relationships and their peers in opposite-sex cohabiting relationships. Methods Data were obtained on men (n=698) and women (n=630) aged 50 years and older and in self-reported same-sex relationships from the National Health Interview Survey. Multiple regression analyses were conducted to estimate differences in physical health, mental health and disability status. Results Compared to their peers in married opposite-sex relationships, older men in same-sex relationships exhibited greater odds of psychological distress, and older women in same-sex relationships experienced elevated odds of poor/fair health, needing help with ADLs and IADLs, functional limitations, and psychological distress. Discussion This study adds to the limited information on health and disability among older lesbian, gay and bisexual adults. As this population grows, gerontologists must develop a better understanding of the unique issues and challenges facing them and their families. PMID:25253727

Social participation modifies the effect of a structured physical activity program on major mobility disability among older adults: results from the LIFE study

USDA-ARS?s Scientific Manuscript database

Objectives: To investigate whether baseline social participation modifies the effect of a long-term structured physical activity (PA) program on major mobility disability (MMD). Methods: 1,635 sedentary adults (70-89 years) with physical limitations were randomized to either a structured PA or healt...

Physical Fitness in Older People with ID--Concept and Measuring Instruments: A Review

ERIC Educational Resources Information Center

Hilgenkamp, Thessa I. M.; van Wijck, Ruud; Evenhuis, Heleen M.

2010-01-01

A certain level of physical fitness is a prerequisite for independent functioning and self-care, but the level of physical fitness declines with ageing. This applies to older adult with intellectual disabilities too, but very little is known about their actual level of physical fitness. This lack of knowledge is partly caused by a lack of suitable…

Sarcopenia, Frailty, and Diabetes in Older Adults

PubMed Central

2016-01-01

Populations are aging and the prevalence of diabetes mellitus is increasing tremendously. The number of older people with diabetes is increasing unexpectedly. Aging and diabetes are both risk factors for functional disability. Thus, increasing numbers of frail or disabled older patients with diabetes will increase both direct and indirect health-related costs. Diabetes has been reported as an important risk factor of developing physical disability in older adults. Older people with diabetes have lower muscle mass and weaker muscle strength. In addition, muscle quality is poorer in diabetic patients. Sarcopenia and frailty have a common soil and may share a similar pathway for multiple pathologic processes in older people. Sarcopenia is thought to be an intermediate step in the development of frailty in patients with diabetes. Thus, early detection of sarcopenia and frailty in older adults with diabetes should be routine clinical practice to prevent frailty or to intervene earlier in frail patients. PMID:27098509

Physical Function and Health Status in Aging Puerto Rican Adults: The Boston Puerto Rican Health Study

PubMed Central

Castaneda-Sceppa, Carmen; Price, Lori Lyn; Noel, Sabrina E.; Midle, Jennifer Bassett; Falcon, Luis M.; Tucker, Katherine L.

2015-01-01

Objectives This article describes physical function in Puerto Rican older adults and examines associations between health status and physical function. It also assesses relationships between physical function and disability. Method This study uses a cross-sectional study of Puerto Ricans 45 to 75 years in Boston (N = 1,357). Measures included performance-based physical function (handgrip strength, walking speed, balance, chair stands, foot tapping), health conditions (obesity, diabetes, depressive symptomatology, history of heart disease, heart attack, stroke, and arthritis), and self-reported disability (activities of daily living, instrumental activities of daily living). Results Older women (60-75 years) had the poorest physical function. Poor physical function was associated with obesity, diabetes, depression, history of heart attack, stroke, and arthritis, after adjusting for age, sex, education, income, and lifestyle (p < .05). Physical function and disability were correlated (p < .01). Discussion Health status among Puerto Ricans appears to contribute to poor physical function. Targeted interventions to improve strength, endurance, and balance are needed to combat physical frailty and its consequences in this population. PMID:20495158

Prevalence and determinants of disability among adults in Malaysia: results from the National Health and Morbidity Survey (NHMS) 2015.

PubMed

Ahmad, Noor Ani; Mohamad Kasim, Noraida; Mahmud, Nur Azna; Mohd Yusof, Yusniza; Othman, Salimah; Chan, Ying Ying; Abd Razak, Mohamad Aznuddin; Yusof, Muslimah; Omar, Maisarah; Abdul Aziz, Fazly Azry; Jamaluddin, Rasidah; Ibrahim Wong, Norazizah; Aris, Tahir

2017-09-29

Reliable national data on disability which is internationally comparable is needed in Malaysia. This study aims to examine the prevalence of disability among adults in Malaysia and its determinants, particularly the socioeconomic factors and comorbidities. This study was based on the disability module, which is part of the National Health and Morbidity Survey 2015. This survey was implemented using a multi-stage stratified sampling design. A locally validated Washington Group questionnaire was used to collect data on disability. Based on the definition of having at least one domain scored "a lot of difficulty or unable to do at all" or at least "some difficulty" scored in two domains, the prevalence of disability among adults in Malaysia was 11.8% (95% CI: 11.15, 12.53). Logistic regression analysis performed showed that population at risk of having disability in Malaysia were those of older people, ethnic minority, low level of education, single, obese, physically inactive and having mental health problems. Among older people, disability was significantly higher among those with no formal education, having mental health problems and physically inactive. The prevalence of disability among adults in Malaysia is comparable to WHO estimates and most developing countries. Planning for healthcare services should consider at-risk population, particularly older people and those from disadvantaged background to ensure equity healthcare.

Residential area characteristics and disabilities among Dutch community-dwelling older adults.

PubMed

Etman, Astrid; Kamphuis, Carlijn B M; Pierik, Frank H; Burdorf, Alex; Van Lenthe, Frank J

2016-11-15

Living longer independently may be facilitated by an attractive and safe residential area, which stimulates physical activity. We studied the association between area characteristics and disabilities and whether this association is mediated by transport-related physical activity (TPA). Longitudinal data of 271 Dutch community-dwelling adults aged 65 years and older participating in the Elderly And their Neighbourhood (ELANE) study in 2011-2013 were used. Associations between objectively measured aesthetics (range 0-22), functional features (range 0-14), safety (range 0-16), and destinations (range 0-15) within road network buffers surrounding participants' residences, and self-reported disabilities in instrumental activities of daily living (range 0-8; measured twice over a 9 months period) were investigated by using longitudinal tobit regression analyses. Furthermore, it was investigated whether self-reported TPA mediated associations between area characteristics and disabilities. A one unit increase in aesthetics within the 400 m buffer was associated with 0.86 less disabilities (95% CI -1.47 to -0.25; p < 0.05), but other area characteristics were not related to disabilities. An increase in area aesthetics was associated with more TPA, and more minutes of TPA were associated with less disabilities. TPA however, only partly mediated the associated between area aesthetics and disabilities. Improving aesthetic features in the close by area around older persons' residences may help to prevent disability.

Effect of structured physical activity on overall burden and transitions between states of major mobility disability in older persons: secondary analysis of a randomized trial

USDA-ARS?s Scientific Manuscript database

Background: The total time a patient is disabled likely has a greater influence on his or her quality of life than the initial occurrence of disability alone. Objective: To compare the effect of a long-term, structured physical activity program with that of a health education intervention on the pro...

Association of total daily physical activity with disability in community-dwelling older persons: a prospective cohort study

PubMed Central

2012-01-01

Background Based on findings primarily using self-report measures, physical activity has been recommended to reduce disability in old age. Collecting objective measures of total daily physical activity in community-dwelling older adults is uncommon, but might enhance the understanding of the relationship of physical activity and disability. We examined whether greater total daily physical activity was associated with less report of disability in the elderly. Methods Data were from the Rush Memory and Aging Project, a longitudinal prospective cohort study of common, age-related, chronic conditions. Total daily physical activity was measured in community-dwelling participants with an average age of 82 using actigraphy for approximately 9 days. Disability was measured via self-reported basic activities of daily living (ADL). The odds ratio and 95% Confidence Interval (CI) were determined for the baseline association of total daily physical activity and ADL disability using a logistic regression model adjusted for age, education level, gender and self-report physical activity. In participants without initial report of ADL disability, the hazard ratio and 95% CI were determined for the relationship of baseline total daily physical activity and the development of ADL disability using a discrete time Cox proportional hazard model adjusted for demographics and self-report physical activity. Results In 870 participants, the mean total daily physical activity was 2. 9 × 105 counts/day (range in 105 counts/day = 0.16, 13. 6) and the mean hours/week of self-reported physical activity was 3.2 (SD = 3.6). At baseline, 718 (82.5%) participants reported being independent in all ADLs. At baseline, total daily physical activity was protective against disability (OR per 105 counts/day difference = 0.55; 95% CI = 0.47, 0.65). Of the participants without baseline disability, 584 were followed for 3.4 years on average. Each 105 counts/day additional total daily physical activity was associated with reduced hazard of developing disability by 25% (HR = 0.75, 95% CI = 0.66, 0.84). The results were unchanged after controlling for important covariates including cognition, depressive symptoms, and chronic health conditions. Conclusions Greater total daily physical activity is independently associated with less disability even after controlling for self-reported physical activity. PMID:23072476

Relationships between Personal Assistance and Productivity among Japanese Adults with Severe Physical Disabilities.

ERIC Educational Resources Information Center

Nosek, Margaret A.

1991-01-01

Examined relationship between personal assistance and level of productivity, using sample of 30 Japanese adults with severe physical disabilities. Found that married individuals who used nonfamily, paid assistants were among most satisfied; and married, older, and less educated individuals were among most productive. (Author/NB)

Mobility stress test approach to predicting frailty, disability, and mortality in high-functioning older adults.

PubMed

Verghese, Joe; Holtzer, Roee; Lipton, Richard B; Wang, Cuiling

2012-10-01

To examine the validity of the Walking While Talking Test (WWT), a mobility stress test, to predict frailty, disability, and death in high-functioning older adults. Prospective cohort study. Community sample. Six hundred thirty-one community-residing adults aged 70 and older participating in the Einstein Aging Study (mean follow-up 32 months). High-functioning status at baseline was defined as absence of disability and dementia and normal walking speeds. Hazard ratios (HRs) for frailty, disability, and all-cause mortality. Frailty was defined as presence of three out of the following five attributes: weight loss, weakness, exhaustion, low physical activity, and slow gait. The predictive validity of the WWT was also compared with that of the Short Physical Performance Battery (SPPB) for study outcomes. Two hundred eighteen participants developed frailty, 88 developed disability, and 49 died. Each 10-cm/s decrease in WWT speed was associated with greater risk of frailty (HR = 1.12, 95% confidence interval (CI) = 1.06-1.18), disability (HR = 1.13, 95% CI = 1.03-1.23), and mortality (HR = 1.13, 95% CI = 1.01-1.27). Most associations remained robust even after accounting for potential confounders and gait speed. Comparisons of HRs and model fit suggest that the WWT may better predict frailty whereas SPPB may better predict disability. Mobility stress tests such as the WWT are robust predictors of risk of frailty, disability, and mortality in high-functioning older adults. © 2012, Copyright the Authors Journal compilation © 2012, The American Geriatrics Society.

Self-reported hearing, vision and quality of life: Older people in New Zealand.

PubMed

Zhang, Shiran; Moyes, Simon; McLean, Chris; Searchfield, Grant; Welch, David; Jacobs, Robert; Kerse, Ngaire

2016-06-01

To establish associations between sensory-related disability and quality of life (QOL). A total of 3817 people aged 75 years and older, including 173 Māori aged 61 years and older, were surveyed. Measures included: sociodemographic and health factors; World Health Organization quality of life (WHOQOL)-BREF for QOL; and self-rated hearing- and vision-related disability. Hearing disability was reported by 866 (51%) men and 736 (36%) women. A total of 974 (26% of all, 61% of hearing disabled) used hearing aids. A total of 513 (30%) men and 618 (30%) women reported vision disability. Vision and hearing disability were both independently associated with lower QOL, with hearing difficulty affecting physical and social domains more, and the environmental domain least. Vision difficulty impacted the environmental domain most and the social domain least. QOL impact was higher for those with both hearing and visual disability (631, 17%). Hearing and vision disability are associated with poorer QOL. © 2012 The Authors. Australasian Journal on Ageing © 2012 ACOTA.

Outdoor Built Environment Barriers and Facilitators to Activity among Midlife and Older Adults with Mobility Disabilities

ERIC Educational Resources Information Center

Rosenberg, Dori E.; Huang, Deborah L.; Simonovich, Shannon D.; Belza, Basia

2013-01-01

Purpose: To gain better understanding of how the built environment impacts neighborhood-based physical activity among midlife and older adults with mobility disabilities. Design and methods: We conducted in-depth interviews with 35 adults over age 50, which used an assistive device and lived in King County, Washington, U.S. In addition,…

Differences in Self-Reported Physical Limitation Among Older Women and Men in Ismailia, Egypt

PubMed Central

2012-01-01

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. PMID:22929399

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

PubMed

Khadr, Zeinab; Yount, Kathryn

2012-09-01

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

Effects of exercise on mobility limitation in obese and non-obese older adults

USDA-ARS?s Scientific Manuscript database

Background: Coupled with an aging society, the rising obesity prevalence is likely to increase the future rates of physical disability. We set out to determine whether the effects of a physical activity intervention aimed to improve mobility function in older adults is modified by obesity. Method...

Prevalence of Metabolic Syndrome and Its Association with Physical Capacity, Disability, and Self-Rated Health among Lifestyle Interventions and Independence for Elders (LIFE) Study Participants

PubMed Central

Botoseneanu, Anda; Ambrosius, Walter T.; Beavers, Daniel P.; de Rekeneire, Nathalie; Anton, Stephen; Church, Timothy; Folta, Sara C.; Goodpaster, Bret H.; King, Abby C.; Nicklas, Barbara J.; Spring, Bonnie; Wang, Xuewen; Gill, Thomas M.

2014-01-01

Objectives To evaluate the prevalence of metabolic syndrome (MetS) and its association with physical capacity, disability, and self-rated health among older adults at high risk for mobility disability, including those with and without diabetes. Design Cross-sectional analysis. Setting Lifestyle Interventions and Independence for Elders (LIFE) Study. Participants 1,535 community-dwelling sedentary adults aged 70–89 years old at high risk for mobility disability [short physical performance battery (SPPB) score ≤ 9; mean (SD) = 7.4 (1.6)]. Measurements MetS was defined according to the 2009 multi-agency harmonized criteria; outcomes were physical capacity (400m walk time, grip strength, and SPPB score), disability (composite 19-item score), and self-rated health (5-point scale ranging from “excellent” to “poor”). Results The prevalence of MetS was 49.8% in the overall sample, and 83.2% and 38.1% among diabetics and non-diabetics, respectively. MetS was associated with greater grip strength [mean difference (kilograms) Δ = 1.2, p = .01] in the overall sample and among participants without diabetes, and with poorer self-rated health (Δ = 0.1, p < .001) in the overall sample only. No significant differences were found in the 400m walk time, SPPB score, and disability score between participants with and without MetS, in either the overall sample or diabetes subgroups. Conclusion Metabolic dysfunction is highly prevalent among older adults at risk for mobility disability, yet consistent associations were not observed between MetS and walking speed, lower extremity function, and self-reported disability after adjusting for known and potential confounders. Longitudinal studies are needed to investigate whether MetS accelerates declines in functional status in high-risk older adults and to inform clinical and public health interventions aimed at preventing or delaying disability in this group. PMID:25645664

Effects of exercise on mobility in obese and nonobese older adults.

PubMed

Manini, Todd M; Newman, Anne B; Fielding, Roger; Blair, Steven N; Perri, Michael G; Anton, Stephen D; Goodpaster, Bret C; Katula, Jeff A; Rejeski, Walter J; Kritchevsky, Stephen B; Hsu, Fang-Chi; Pahor, Marco; King, Abby C

2010-06-01

Coupled with an aging society, the rising obesity prevalence is likely to increase the future burden of physical disability. We set out to determine whether obesity modified the effects of a physical activity (PA) intervention designed to prevent mobility disability in older adults. Older adults at risk for disability (N = 424, age range: 70-88 years) were randomized to a 12 month PA intervention involving moderate intensity aerobic, strength, balance, and flexibility exercise (150 min per week) or a successful aging (SA) intervention involving weekly educational workshops. Individuals were stratified by obesity using a BMI >or=30 (n = 179). Mobility function was assessed as usual walking speed over 400 m and scores on a short physical performance battery (SPPB), which includes short distance walking, balance tests, and chair rises. Over 12 months of supervised training, the attendance and total amount of walking time was similar between obese and nonobese subjects and no weight change was observed. Nonobese participants in the PA group had significant increases in 400-m walking speed (+1.5%), whereas their counterparts in the SA group declined (-4.3%). In contrast, obese individuals declined regardless of their assigned intervention group (PA: -3.1%; SA: -4.9%). SPPB scores, however, increased following PA in both obese (PA: +13.5%; SA: +2.5%) and nonobese older adults (PA: +18.6%; SA: +6.1%). A moderate intensity PA intervention improves physical function in older adults, but the positive benefits are attenuated with obesity.

Retrospectively assessed physical work environment during working life and risk of sickness absence and labour market exit among older workers

PubMed Central

Sundstrup, Emil; Hansen, Åse Marie; Mortensen, Erik Lykke; Poulsen, Otto Melchior; Clausen, Thomas; Rugulies, Reiner; Møller, Anne; Andersen, Lars L

2018-01-01

Objective To determine the prospective association between retrospectively assessed physical work environment during working life and prospectively assessed sickness absence and labour market exit among older workers. Methods Using Cox regression analyses we estimated the 4-year to 6-year prospective risk of register-based long-term sickness absence (LTSA), disability pension, early retirement and unemployment from exposure to different physical work environmental factors during working life among 5076 older workers (age 49–63 at baseline) from the Copenhagen Aging and Midlife Biobank cohort. Results Very hard physical work throughout working life was a risk factor for LTSA (HR 1.66,95% CI 1.32 to 2.07), disability pension (HR 2.21,95% CI 1.04 to 4.72) and early retirement (HR 1.57,95% CI 1.13 to 2.17). Both short-term (<10 years) and long-term (≥20 years) exposures to lifting or carrying of heavy burdens predicted the risk of LTSA (HRs 1.49–1.56) and disability pension (HRs 2.26–3.29). In contrast, exposure to dust was associated with LTSA and disability pension only following 20 or more exposure years. Conclusions Retrospectively assessed hard physical work during working life and exposure to several factors in the physical work environment, especially heavy lifting, were important for labour market exit and sickness absence. This study underscores the importance of reducing physical work exposures throughout the working life course for preventing sickness absence and premature exit from the labour market. PMID:28819019

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

PubMed

Zeki Al Hazzouri, Adina; Mehio Sibai, Abla; Chaaya, Monique; Mahfoud, Ziyad; Yount, Kathryn M

2011-03-01

To examine the role of health conditions, socioeconomic, and socioenvironmental factors in explaining gender differences in physical disability among older adults. We compared 412 women and 328 men residing in underprivileged communities in Lebanon on their activities of daily living (ADL), instrumental activities of daily living (IADL), and physical tasks (PT). Binary logistic regression analyses adjusting for possible explanatory covariates were conducted sequentially. Women showed higher prevalence rates of ADL, IADL, and PT compared to men. Gender disparities in ADL disability were explained by chronic-disease risk factors and health conditions (OR = 1.46; 95% CI = 0.94-2.25). The odds of disability in IADL and PT remained significantly higher for women compared to men after accounting for all available covariates. These results suggest underlying differences in functional status between women and men, yet, may have been influenced by the sensitivity of the measures to the social context and gendered environment surrounding daily activities.

Obesity and mobility disability in the older adult.

PubMed

Vincent, H K; Vincent, K R; Lamb, K M

2010-08-01

Mobility disability is becoming prevalent in the obese older population (> or = 60 years of age). We included a total of 13 cross-sectional and 15 longitudinal studies based on actual physical assessments of mobility in the obese older population in this review. We systematically examined existing evidence of which adiposity estimate best predicted mobility disability. Cross-sectional studies (82-4000 participants) showed poorer lower extremity mobility with increasing obesity severity in both men and women. All longitudinal studies (1-22 years) except for one, reported relationships between adiposity and declining mobility. While different physical tests made interpretation challenging, a consistent finding was that walking, stair climbing and chair rise ability were compromised with obesity, especially if the body mass index (BMI) exceeded 35 kg m(-2). More studies found that obese women were at an increased risk for mobility impairment than men. Existing evidence suggests that BMI and waist circumference are emerging as the more consistent predictors of the onset or worsening of mobility disability. Limited interventional evidence shows that weight loss is related with increased mobility and lower extremity function. Additional longitudinal studies are warranted that address overall body composition fat and muscle mass or change on future disability.

Factors associated with disability among middle-aged and older African American women with osteoarthritis.

PubMed

Walker, Janiece L; Harrison, Tracie C; Brown, Adama; Thorpe, Roland J; Szanton, Sarah L

2016-07-01

Middle-aged and older African American women experience disproportionate rates of functional limitations and disability from osteoarthritis (OA) compared to other racial ethnic groups; however, little is known about what factors contribute to this disparity within African American women. To examine factors associated with physical function and disability among African American women ages 50-80 with OA using the disablement process model. This descriptive study included 120 African American women with OA from the Southwestern region of the United States. Regression techniques were used to model the correlates of physical function and disability and to test a mediation model. BMI and pain severity were significantly related to functional limitations. Depressive symptoms mediated the relationship between racial discrimination and disability. Biological, intra-individual, and extra-individual factors are related to disablement outcomes in this sample of African American women, which is consistent with theory suggesting the need for treatment coupled with environmental modifications. This study can inform the development of future bio-behavioral interventions. Copyright © 2016 Elsevier Inc. All rights reserved.

Fear of falling predicts incidence of functional disability two years later: A perspective from an international cohort study.

PubMed

Auais, Mohammad; French, Simon; Alvarado, Beatriz; Pirkle, Catherine; Belanger, Emmanuelle; Guralnik, Jack

2017-12-06

To study the extent to which fear of falling (FOF) is associated with the onset of functional disability over a 2-year period in older adults using self-reported and performance-based measures. In 2012, 1,601 participants (aged 65-74) were recruited from four sites: Kingston and Saint-Hyacinthe, Canada; Manizales, Colombia; and Natal, Brazil. They were re-assessed in 2014. We quantified FOF using the Fall Efficacy Scale-International (FES-I; range: 16-64). Functional disability measures were 1) self-reported incident mobility disability, defined as difficulty climbing a flight of stairs or walking 400 meters and 2) incident poor physical performance, defined as a score <9 on the Short Physical Performance Battery. In the Poisson regression analysis, we included only those participants without functional disability at baseline to calculate incident risk ratios in 2014. 1,355 participants completed the 2014 assessment, of which 917 and 1,078 had no mobility disability and poor physical performance at baseline, respectively. In 2014, 131 (14.3%), and 166 (15.4%) participants reported incident mobility disability and poor physical performance, respectively. After adjusting for age, sex, socioeconomic, and health covariates, a one-point increase in FES-I at baseline was associated with a 4% increase in the risk of reporting incident mobility disability (95% CI: 1.02-1.05) and a 3% increase in the risk of developing poor physical performance at follow up in the overall sample (95%CI: 1.01-1.05). FOF is associated with a higher risk of incident mobility disability and poor physical performance in a cohort of older adults. It is increasingly important to study FOF's effect on functional disability and to take necessary measures to prevent the transition to end-stage disability. © The Author(s) 2017. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Gender Roles and Physical Function in Older Adults: Cross-Sectional Analysis of the International Mobility in Aging Study (IMIAS).

PubMed

Ahmed, Tamer; Vafaei, Afshin; Auais, Mohammad; Guralnik, Jack; Zunzunegui, Maria Victoria

2016-01-01

To examine the relationships between physical function and gender-stereotyped traits and whether these relationships are modified by sex or social context. A total of 1995 community-dwelling older adults from the International Mobility in Aging Study (IMIAS) aged 65 to 74 years were recruited in Natal (Brazil), Manizales (Colombia), Tirana (Albania), Kingston (Ontario, Canada), and Saint-Hyacinthe (Quebec, Canada). We performed a cross-sectional analysis. Study outcomes were mobility disability, defined as having difficulty in walking 400 meters without assistance or climbing a flight of stairs without resting, and low physical performance, defined as a score < 8 on the Short Physical Performance Battery. The 12-item Bem Sex Role Inventory (BSRI) was used to classify participants into four gender roles (Masculine, Feminine, Androgynous, and Undifferentiated) using site-specific medians of femininity and masculinity as cut-off points. Poisson regression models were used to estimate prevalence rate ratios (PRR) of mobility disability and poor physical performance according to gender roles. In models adjusted for sex, marital status, education, income, and research site, when comparing to the androgynous role, we found higher prevalence of mobility disability and poor physical performance among participants endorsing the feminine role (PRR = 1.20, 95% confidence interval (CI) 1.03-1.39 and PRR = 1.37, CI 1.01-1.88, respectively) or the undifferentiated role (PRR = 1.23, 95% CI 1.07-1.42 and PRR = 1.58, CI 1.18-2.12, respectively). Participants classified as masculine did not differ from androgynous participants in prevalence rates of mobility disability or low physical performance. None of the multiplicative interactions by sex and research site were significant. Feminine and undifferentiated gender roles are independent risk factors for mobility disability and low physical performance in older adults. Longitudinal research is needed to assess the mediation pathways through which gender-stereotyped traits influence functional limitations and to investigate the longitudinal nature of these relationships.

Midlife Physical Activity and Mobility in Older Age

PubMed Central

Patel, Kushang V.; Coppin, Antonia K.; Manini, Todd M.; Lauretani, Fulvio; Bandinelli, Stefania; Ferrucci, Luigi; Guralnik, Jack M.

2009-01-01

Background Among older adults, loss of mobility represents a critical stage in the disablement process, whereby the risk for disability is significantly increased. Physical activity is a modifiable risk factor that is associated with reduced risk of losing mobility in older adulthood; however, few studies have examined physical activity performed earlier in life in relation to mobility later in life. Methods Data from a population-based study of 1155 adults aged 65 years and older living in the Chianti region of Italy in 1998–2000 were analyzed in 2005 and 2006. Participants retrospectively recalled their physical activity levels in midlife and underwent mobility testing and medical examination. Two objective mobility outcomes were examined as a function of past physical activity: the Short Physical Performance Battery (SPPB) and the ability to walk 400 meters. Results Older Italian adults (mean age 74.8, standard deviation 7.3) who engaged in higher levels of physical activity in midlife were significantly more likely to perform better on the SPPB than individuals who were less physically active in midlife. In addition, failure to complete the 400-meter walk test was significantly less likely among physically active men (Level II) (odds ratio [OR]=0.37, 95% confidence interval [CI]=0.15–0.93) and very active men (Level III) (OR=0.23, 95% CI=0.09–0.63) when compared to men who were less active (Level I) in the past (p for trend, 0.008). These associations remained after adjustment for demographic factors, medical conditions, and physiologic impairments. Conclusions Older adults who reported higher levels of physical activity in midlife had better mobility in old age than less physically active ones. PMID:16905032

Effect of Physical Activity versus Health Education on Physical Function, Grip Strength and Mobility.

PubMed

Santanasto, Adam J; Glynn, Nancy W; Lovato, Laura C; Blair, Steven N; Fielding, Roger A; Gill, Thomas M; Guralnik, Jack M; Hsu, Fang-Chi; King, Abby C; Strotmeyer, Elsa S; Manini, Todd M; Marsh, Anthony P; McDermott, Mary M; Goodpaster, Bret H; Pahor, Marco; Newman, Anne B

2017-07-01

Physical activity (PA) reduces the rate of mobility disability, compared with health education (HE), in at risk older adults. It is important to understand aspects of performance contributing to this benefit. To evaluate intervention effects on tertiary physical performance outcomes. The Lifestyle Interventions and Independence for Elders (LIFE) was a multi-centered, single-blind randomized trial of older adults. Eight field centers throughout the United States. 1635 adults aged 78.9 ± 5.2 years, 67.2% women at risk for mobility disability (Short Physical Performance Battery [SPPB] <10). Moderate PA including walking, resistance and balance training compared with HE consisting of topics relevant to older adults. Grip strength, SPPB score and its components (balance, 4 m gait speed, and chair-stands), as well as 400 m walking speed. Total SPPB score was higher in PA versus HE across all follow-up times (overall P = .04) as was the chair-stand component (overall P < .001). No intervention effects were observed for balance (overall P = .12), 4 m gait speed (overall P = .78), or grip strength (overall P = .62). However, 400 m walking speed was faster in PA versus HE group (overall P =<.001). In separate models, 29% of the rate reduction of major mobility disability in the PA versus HE group was explained by change in SPPB score, while 39% was explained by change in the chair stand component. Lower extremity performance (SPPB) was significantly higher in the PA compared with HE group. Changes in chair-stand score explained a considerable portion of the effect of PA on the reduction of major mobility disability-consistent with the idea that preserving muscle strength/power may be important for the prevention of major mobility disability. © 2017, Copyright the Authors Journal compilation © 2017, The American Geriatrics Society.

Facilitators and barriers to physical activity as perceived by older adults with intellectual disability.

PubMed

van Schijndel-Speet, Marieke; Evenhuis, Heleen M; van Wijck, Ruud; van Empelen, Pepijn; Echteld, Michael A

2014-06-01

Older people with intellectual disability (ID) are characterized by low physical activity (PA) levels. PA is important for reducing health risks and maintaining adequate fitness levels for performing activities of daily living. The aim of this study was to explore preferences of older adults with ID for specific physical activities, and to gain insight into facilitators and barriers to engaging into PA. Fourteen in-depth interviews and four focus groups were undertaken, with a total of 40 older adults with mild and moderate ID included in the analysis. NVivo software was used for analysing the transcribed verbatim interviews. In total, 30 codes for facilitators and barriers were identified. Themes concerning facilitators to PA were enjoyment, support from others, social contact and friendship, reward, familiarity, and routine of activities. Themes concerning barriers to PA were health and physiological factors, lack of self-confidence, lack of skills, lack of support, transportation problems, costs, and lack of appropriate PA options and materials. The results of the present study suggest that older adults with ID may benefit from specific PA programs, adapted to their individual needs and limitations. Results can be used for developing feasible health promotion programs for older adults with ID.

A physical activity intervention to treat the frailty syndrome in older persons-results from the LIFE-P study

USDA-ARS?s Scientific Manuscript database

BACKGROUND: The frailty syndrome is as a well-established condition of risk for disability. Aim of the study is to explore whether a physical activity (PA) intervention can reduce prevalence and severity of frailty in a community-dwelling elders at risk of disability. METHODS: Exploratory analyses ...

Prevalence of Dementia, Emotional State and Physical Performance among Older Adults in the Metropolitan Area of Guadalajara, Jalisco, Mexico

PubMed Central

Velázquez-Brizuela, Irma E.; Ortiz, Genaro G.; Ventura-Castro, Lucia; Árias-Merino, Elva D.; Pacheco-Moisés, Fermín P.; Macías-Islas, Miguel A.

2014-01-01

Background. Dementia affects memory, thinking, language, judgment, and behavior. Depression, is common in older adults with dementia. The concomitance of dementia and depression increases disability with impaired activities of daily living (ADL), increasing the chances of institutionalization and mortality. Methods. Cross-sectional study of a population 60 years and older who live in the State of Jalisco, Mexico. A total of 1142 persons were assessed regarding their cognitive function, emotional state, and physical performance. Door-to-door interview technique was assigned in condition with multistage probability random sampling. Cognitive function, depression and functional disability were assessed by applying standardized Minimental State Examination (Folstein), Geriatric Depression Scale, and the Katz index, respectively. Diagnosis of dementia was performed according to the criteria of the Diagnostic and Statistical Manual of Mental Disorders, the Fourth Edition. Data were analyzed using SPSS software. Results. Prevalence of demency was 9.5% (63.35% women, and 36.7% men). Demency was associated with being woman, being older than 70 years, low level of education, not having the economic benefit of retirement, being single or living without a partner, low level of education, suffering from depression and have functional disability in ADL. Conclusion. Dementia is more common in women and is related to depression and disability. PMID:24795758

Prevalence of Dementia, Emotional State and Physical Performance among Older Adults in the Metropolitan Area of Guadalajara, Jalisco, Mexico.

PubMed

Velázquez-Brizuela, Irma E; Ortiz, Genaro G; Ventura-Castro, Lucia; Arias-Merino, Elva D; Pacheco-Moisés, Fermín P; Macías-Islas, Miguel A

2014-01-01

Background. Dementia affects memory, thinking, language, judgment, and behavior. Depression, is common in older adults with dementia. The concomitance of dementia and depression increases disability with impaired activities of daily living (ADL), increasing the chances of institutionalization and mortality. Methods. Cross-sectional study of a population 60 years and older who live in the State of Jalisco, Mexico. A total of 1142 persons were assessed regarding their cognitive function, emotional state, and physical performance. Door-to-door interview technique was assigned in condition with multistage probability random sampling. Cognitive function, depression and functional disability were assessed by applying standardized Minimental State Examination (Folstein), Geriatric Depression Scale, and the Katz index, respectively. Diagnosis of dementia was performed according to the criteria of the Diagnostic and Statistical Manual of Mental Disorders, the Fourth Edition. Data were analyzed using SPSS software. Results. Prevalence of demency was 9.5% (63.35% women, and 36.7% men). Demency was associated with being woman, being older than 70 years, low level of education, not having the economic benefit of retirement, being single or living without a partner, low level of education, suffering from depression and have functional disability in ADL. Conclusion. Dementia is more common in women and is related to depression and disability.

Short term treatment versus long term management of neck and back disability in older adults utilizing spinal manipulative therapy and supervised exercise: a parallel-group randomized clinical trial evaluating relative effectiveness and harms.

PubMed

Vihstadt, Corrie; Maiers, Michele; Westrom, Kristine; Bronfort, Gert; Evans, Roni; Hartvigsen, Jan; Schulz, Craig

2014-01-01

Back and neck disability are frequent in older adults resulting in loss of function and independence. Exercise therapy and manual therapy, like spinal manipulative therapy (SMT), have evidence of short and intermediate term effectiveness for spinal disability in the general population and growing evidence in older adults. For older populations experiencing chronic spinal conditions, long term management may be more appropriate to maintain improvement and minimize the impact of future exacerbations. Research is limited comparing short courses of treatment to long term management of spinal disability. The primary aim is to compare the relative effectiveness of 12 weeks versus 36 weeks of SMT and supervised rehabilitative exercise (SRE) in older adults with back and neck disability. Randomized, mixed-methods, comparative effectiveness trial conducted at a university-affiliated research clinic in the Minneapolis/St. Paul, Minnesota metropolitan area. Independently ambulatory community dwelling adults ≥ 65 years of age with back and neck disability of minimum 12 weeks duration (n = 200). 12 weeks SMT + SRE or 36 weeks SMT + SRE. Blocked 1:1 allocation; computer generated scheme, concealed in sequentially numbered, opaque, sealed envelopes. Functional outcome examiners are blinded to treatment allocation; physical nature of the treatments prevents blinding of participants and providers to treatment assignment. 36 weeks post-randomization. Self-report questionnaires administered at 2 baseline visits and 4, 12, 24, 36, 52, and 78 weeks post-randomization. Primary outcomes include back and neck disability, measured by the Oswestry Disability Index and Neck Disability Index. Secondary outcomes include pain, general health status, improvement, self-efficacy, kinesiophobia, satisfaction, and medication use. Functional outcome assessment occurs at baseline and week 37 for hand grip strength, short physical performance battery, and accelerometry. Individual qualitative interviews are conducted when treatment ends. Data on expectations, falls, side effects, and adverse events are systematically collected. Linear mixed-model method for repeated measures to test for between-group differences with baseline values as covariates. Treatments that address the management of spinal disability in older adults may have far reaching implications for patient outcomes, clinical guidelines, and healthcare policy. www.ClinicalTrials.gov; Identifier: NCT01057706.

Retrospectively assessed physical work environment during working life and risk of sickness absence and labour market exit among older workers.

PubMed

Sundstrup, Emil; Hansen, Åse Marie; Mortensen, Erik Lykke; Poulsen, Otto Melchior; Clausen, Thomas; Rugulies, Reiner; Møller, Anne; Andersen, Lars L

2018-02-01

To determine the prospective association between retrospectively assessed physical work environment during working life and prospectively assessed sickness absence and labour market exit among older workers. Using Cox regression analyses we estimated the 4-year to 6-year prospective risk of register-based long-term sickness absence (LTSA), disability pension, early retirement and unemployment from exposure to different physical work environmental factors during working life among 5076 older workers (age 49-63 at baseline) from the Copenhagen Aging and Midlife Biobank cohort. Very hard physical work throughout working life was a risk factor for LTSA (HR 1.66,95% CI 1.32 to 2.07), disability pension (HR 2.21,95% CI 1.04 to 4.72) and early retirement (HR 1.57,95% CI 1.13 to 2.17). Both short-term (<10 years) and long-term (≥20 years) exposures to lifting or carrying of heavy burdens predicted the risk of LTSA (HRs 1.49-1.56) and disability pension (HRs 2.26-3.29). In contrast, exposure to dust was associated with LTSA and disability pension only following 20 or more exposure years. Retrospectively assessed hard physical work during working life and exposure to several factors in the physical work environment, especially heavy lifting, were important for labour market exit and sickness absence. This study underscores the importance of reducing physical work exposures throughout the working life course for preventing sickness absence and premature exit from the labour market. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Physical activity and quality of life in older adults: an 18-month panel analysis.

PubMed

Phillips, Siobhan M; Wójcicki, Thomas R; McAuley, Edward

2013-09-01

Although physical activity has been associated with quality of life (QOL), the empirical evidence regarding the mechanisms underlying this relationship is limited. In the present study, we examined the mediating roles played by self-efficacy and health status in the physical activity-QOL relationship from baseline to 18-month follow-up in a sample of community-dwelling older adults. Community-dwelling adults (N = 321, M age = 63.8 years) were recruited to participate in a cross-sectional study and were later contacted to participate in an 18-month follow-up. Individuals completed a battery of questionnaires assessing physical activity, self-efficacy, physical self-worth, disability limitations, and quality of life. A panel analysis within a covariance modeling framework was used to analyze the data. Overall, the model was a good fit to the data (χ(2) = 61.00, df = 29, p < 0.001, standardized root mean residual = 0.05, Comparative Fit Index = 0.97) with changes in physical activity indirectly influencing change in life satisfaction from baseline to 18 months via changes in exercise self-efficacy, physical self-worth, and disability limitations independent of baseline relationships and demographic factors. Specifically, increases in physical activity were associated with increases in exercise self-efficacy which, in turn, was associated with higher physical self-worth and fewer disability limitations which were associated with greater life satisfaction. The findings from this study suggest the relationship between physical activity and global QOL in older adults may be mediated by more proximal modifiable outcomes that can be targeted in physical activity programs and interventions.

Dynapenia and Sarcopenia as a Risk Factor for Disability in a Falls and Fractures Clinic in Older Persons.

PubMed

Benjumea, Angela-María; Curcio, Carmen-Lucía; Duque, Gustavo; Gómez, Fernando

2018-02-15

The role of sarcopenia and dynapenia in disability in older persons from falls and bone health clinics remain unknown. This study aims to compare the association of sarcopenia and dynapenia with physical and instrumental disability in a population of older persons attending a falls and fractures clinic. This is a cross-sectional study in Manizales, Andes Mountains, Colombia. A cohort of 534 subjects (mean age = 74, 75% female) Sarcopenia was measured according to the European Working Group on Sarcopenia in Older People (EWGSOP) including an index of skeletal mass, muscle strength, and gait speed. Dynapenia was defined as a handgrip force ≤ 30 kg for men and ≤ 20 kg for women. Dynapenia and sarcopenia were present in 84.6% and 71.2% respectively. Both were more prevalent in older subjects and women than men. While sarcopenia was associated with body mass index and hypertension, dynapenia was associated with hypothyroidism and visual impairment. After controlling for all covariates, sarcopenia was associated with low IADL and mobility disability. Sarcopenia was associated with mobility, ADL and IADL disability. Dynapenia was not associated with disability in this high - risk population. Systematic assessment of sarcopenia should be implemented in falls and fractures clinics to identify sarcopenia and develop interventions to prevent functional decline among elderly individuals.

The correlates of slow gait and its relation with social network among older adults in Singapore.

PubMed

Shafie, Saleha; Shahwan, Shazana; Abdin, Edimansyah; Vaingankar, Janhavi; Picco, Louisa; Sambasivam, Rajeswari; Zhang, Yunjue; Ng, Li Ling; Chong, Siow Ann; Subramaniam, Mythily

2017-11-01

This study aimed to identify socio-demographic correlates of slow gait speed among Singapore older adult residents and to examine the relationship between slow gait speed and the older adult residents' social network, physical health status, disability and mental health status. Trained interviewers administered the adapted 10/66 research protocol through face-to-face interviews to 2565 respondents aged 60 and over. Information on gait test, socio-demographic characteristics, obesity, social network, physical status and activity, overall health, disability and mental health status were collected. The gait test was completed by 2192 participants. Slow gait was defined as walking speed of 1 standard deviation (SD) below age and gender specific mean gait of the sample. The prevalence of slow gait speed after adjusting for age and gender was 13.7%. Slow gait speed was more prevalent among Indians, respondents with low education, and those who were retired. Those with slow gait speed were significantly associated with lower probability of being unemployed and attending religious activities. They were significantly associated with not being physically active and reported a higher disability score. Older adult residents' socio-demographic factors were found to be associated with gait speed. Those with slow gait speed were not physically active and had less frequent contact with people through religious activities and this might place them at risk of being socially isolated, which can have consequences. Gait speed can be included as a routine assessment tool to identify at-risk groups for interventions which aim to keep the older adults socially engaged and healthy.

Association of arthritis and vitamin D insufficiency with physical disability in Mexican older adults: findings from the Mexican Health and Aging Study.

PubMed

Valderrama-Hinds, Luis M; Al Snih, Soham; Rodriguez, Martin A; Wong, Rebeca

2017-04-01

Arthritis and vitamin D insufficiency are prevalent in older adults and are risk factors for disability. The objective of this study was to examine the effect of co-occurring arthritis and vitamin D deficiency on upper-lower extremity functional limitations and disability in older adults. We examined 1533 participants aged ≥50 years from a subsample of the Mexican Health and Aging Study. Measures included sociodemographics, body mass index, comorbid conditions, falls, physical activity, physical function tests, functional limitations, activities of daily living (ADL), and vitamin D. Participants were categorized into four groups according to arthritis and vitamin D status: no vitamin D insufficiency and no arthritis (58.80%), vitamin D insufficiency only (27.49%), arthritis only (8.47%), and arthritis and vitamin D insufficiency (5.24%). Fourteen percent reported arthritis, and 31.2% had vitamin D insufficiency. The arthritis and vitamin D insufficiency group was associated with upper-lower extremity functional limitations [odds ratio (OR) 1.82, 95% confidence interval (CI) 1.06-3.15, and OR 1.90, 95% CI 1.00-3.62, respectively] and ADL disability (OR 3.00, 95% CI 1.63-5.51) when compared with the no vitamin D insufficiency and no arthritis group (reference group). The arthritis only group was three times more likely to report upper-lower extremity functional limitations and ADL disability. The vitamin D insufficiency only group was not significantly associated with functional limitations nor ADL disability. Arthritis and vitamin D insufficiency increased the risk of ADL disability in this population. However, the effect of arthritis and vitamin D insufficiency on upper-lower extremity functional limitations was not higher than the effect of arthritis only, but higher than the effect on vitamin D insufficiency alone.

Physical activity, body functions and disability among middle-aged and older Spanish adults.

PubMed

Caron, Alexandre; Ayala, Alba; Damián, Javier; Rodriguez-Blazquez, Carmen; Almazán, Javier; Castellote, Juan Manuel; Comin, Madgalena; Forjaz, Maria João; de Pedro, Jesús

2017-07-18

Physical activity (PA) is a health determinant among middle-aged and older adults. In contrast, poor health is expected to have a negative impact on PA. This study sought to assess to what extent specific International Classification of Functioning, Disability and Health (ICF) health components were associated with PA among older adults. We used a sample of 864 persons aged ≥50 years, positively screened for disability or cognition in a cross-sectional community survey in Spain. Weekly energy expenditure during PA was measured with the Yale Physical Activity Survey (YPAS) scale. The associations between body function impairment, health conditions or World Health Organization Disability Assessment Schedule (WHODAS 2.0) disability scores and energy expenditure were quantified using negative-binomial regression, and expressed in terms of adjusted mean ratios (aMRs). Mean energy expenditure was 4542 Kcal/week. A lower weekly energy expenditure was associated with: severe/extreme impairment of mental functions, aMR 0.38, 95% confidence interval, CI (0.21-0.68), and neuromusculoskeletal and movement functions, aMR 0.50 (0.35-0.72); WHODAS 2.0 disability, aMR 0.55 (0.34-0.91); dementia, aMR 0.45 (0.31-0.66); and heart failure, aMR 0.54 (0.34-0.87). In contrast, people with arthritis/osteoarthritis had a higher energy expenditure, aMR 1.27 (1.07-1.51). Our results suggest that there is a strong relationship between selected body function impairments, mainly mental, and PA. Although more research is needed to fully understand causal relationships, strategies to improve PA among the elderly may require targeting mental, neuromusculoskeletal and movement functions, disability determinants (including barriers), and specific approaches for persons with dementia or heart failure.

Disability Rises Gradually for a Cohort of Older Americans

PubMed Central

Brown, Dustin C.; Zajacova, Anna

2017-01-01

Objectives: We study changes in average disability over nearly two decades for a large epidemiological cohort of older Americans. As some people exit by mortality, do average disability levels for the living cohort rise rapidly, rise gradually, stay steady, or decline? Method: Data are from the Study of Asset and Health Dynamics Among the Oldest Old (AHEAD) cohort for 1993–2010. Cohort members are aged 70+ in 1993 (mean = 77.5 years), and the survivors are aged 87+ in 2010 (mean = 90.2 years). Personal care disability (activities of daily living), household management disability (instrumental activities of daily living), and physical limitations are studied. We study average disability for the living cohort over time and the disability histories for decedent and survivor groups. Results: Average disability rises gradually over time for the living cohort. Earlier decedent groups have higher average disability than later ones. Near death, disability rises sharply for all decedent groups. Longer surviving groups have less average disability, and slower disability increases, than shorter surviving groups. All results are repeated for younger cohort members (baseline age = 70–79 years), older ones (baseline age = 80+ years), women, and men. Discussion: As a cohort ages, average disability among living members increases gradually, signaling behavioral, psychological, and biological fitness in very old persons. PMID:26968638

Disability transitions and health expectancies among adults 45 years and older in Malawi: a cohort-based model.

PubMed

Payne, Collin F; Mkandawire, James; Kohler, Hans-Peter

2013-01-01

Falling fertility and increasing life expectancy contribute to a growing elderly population in sub-Saharan Africa (SSA); by 2060, persons aged 45 y and older are projected to be 25% of SSA's population, up from 10% in 2010. Aging in SSA is associated with unique challenges because of poverty and inadequate social supports. However, despite its importance for understanding the consequences of population aging, the evidence about the prevalence of disabilities and functional limitations due to poor physical health among older adults in SSA continues to be very limited. Participants came from 2006, 2008, and 2010 waves of the Malawi Longitudinal Survey of Families and Health, a study of the rural population in Malawi. We investigate how poor physical health results in functional limitations that limit the day-to-day activities of individuals in domains relevant to this subsistence-agriculture context. These disabilities were parameterized based on questions from the SF-12 questionnaire about limitations in daily living activities. We estimated age-specific patterns of functional limitations and the transitions over time between different disability states using a discrete-time hazard model. The estimated transition rates were then used to calculate the first (to our knowledge) microdata-based health expectancies calculated for SSA. The risks of experiencing functional limitations due to poor physical health are high in this population, and the onset of disabilities happens early in life. Our analyses show that 45-y-old women can expect to spend 58% (95% CI, 55%-64%) of their remaining 28 y of life (95% CI, 25.7-33.5) with functional limitations; 45-y-old men can expect to live 41% (95% CI, 35%-46%) of their remaining 25.4 y (95% CI, 23.3-28.8) with such limitations. Disabilities related to functional limitations are shown to have a substantial negative effect on individuals' labor activities, and are negatively related to subjective well-being. Individuals in this population experience a lengthy struggle with disabling conditions in adulthood, with high probabilities of remitting and relapsing between states of functional limitation. Given the strong association of disabilities with work efforts and subjective well-being, this research suggests that current national health policies and international donor-funded health programs in SSA inadequately target the physical health of mature and older adults.

Dietary Intake among U.S. Adults with Disability

ERIC Educational Resources Information Center

An, Ruopeng; Chiu, Chung-Yi

2015-01-01

Purpose: Physical, mental, and financial barriers among individuals with disability may limit their access to fruit and vegetable. In this study, we examined the relationship between disability status and vegetable, fruit, and fruit juice intake among U.S. adults aged 18 years and older using a large nationally representative sample. Methods:…

Socioeconomic differences in the benefits of structured physical activity compared with health education on the prevention of major mobility disability in older adults: the LIFE study.

PubMed

Bann, David; Chen, Haiying; Bonell, Chris; Glynn, Nancy W; Fielding, Roger A; Manini, Todd; King, Abby C; Pahor, Marco; Mihalko, Shannon L; Gill, Thomas M

2016-09-01

Evidence is lacking on whether health-benefiting community-based interventions differ in their effectiveness according to socioeconomic characteristics. We evaluated whether the benefit of a structured physical activity intervention on reducing mobility disability in older adults differs by education or income. The Lifestyle Interventions and Independence for Elders (LIFE) study was a multicentre, randomised trial that compared a structured physical activity programme with a health education programme on the incidence of mobility disability among at-risk community-living older adults (aged 70-89 years; average follow-up of 2.6 years). Education (≤ high school (0-12 years), college (13-17 years) or postgraduate) and annual household income were self-reported (<$24 999, $25 000 to $49 999 and ≥$50 000). The risk of disability (objectively defined as loss of ability to walk 400 m) was compared between the 2 treatment groups using Cox regression, separately by socioeconomic group. Socioeconomic group×intervention interaction terms were tested. The effect of reducing the incidence of mobility disability was larger for those with postgraduate education (0.72, 0.51 to 1.03; N=411) compared with lower education (high school or less (0.93, 0.70 to 1.24; N=536). However, the education group×intervention interaction term was not statistically significant (p=0.54). Findings were in the same direction yet less pronounced when household income was used as the socioeconomic indicator. In the largest and longest running trial of physical activity amongst at-risk older adults, intervention effect sizes were largest among those with higher education or income, yet tests of statistical interactions were non-significant, likely due to inadequate power. NCT01072500. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

Self-Reported Disability: Association With Lower Extremity Performance and Other Determinants in Older Adults Attending Primary Care.

PubMed

Silva, Anabela G; Queirós, Alexandra; Sa-Couto, Pedro; Rocha, Nelson P

2015-12-01

Measurement of function usually involves the use of both performance-based and self-report instruments. However, the relationship between both types of measures is not yet completely understood, in particular for older adults attending primary care. The main objective of the study was to investigate the association between the World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0) and the Short Physical Performance Battery (SPPB) for older adults at primary care. A secondary objective was to determine the influence of sociodemographic and health-related variables on this relationship. This was a cross-sectional study. A total of 504 participants aged 60 years and older from 18 different primary care centers underwent a one-session assessment including: sociodemographic variables, comorbidities, performance, self-reported disability, pain, depressive symptoms, and physical activity. Performance was assessed using the SPPB, and self-reported disability was assessed using the WHODAS 2.0. The correlation between WHODAS 2.0 and SPPB scores was strong (r=.65). Regression analysis showed that the SPPB total score explained 41.7% of the variance in WHODAS 2.0 scores (adjusted R(2)=41.6%). A second model including the SPPB subtests (balance, gait, and sit-to-stand), depressive symptoms, number of pain sites, pain intensity, and level of physical activity explained 61.7% of the variance in WHODAS 2.0 scores (adjusted R(2)=60.4%). No model improvement was found when considering the 6 WHODAS 2.0 individual domains. The cross-sectional nature of the study does not allow inferences on causal relationships. This study's findings confirm that self-report and performance-based measures relate to different aspects of functioning. Further study is needed to determine if primary care interventions targeting lower extremity performance and depressive symptoms improve self-reported disability. © 2015 American Physical Therapy Association.

Stressors, Coping Resources, and Depressive Symptoms among Rural American Indian Older Adults.

PubMed

Roh, Soonhee; Brown-Rice, Kathleen A; Lee, Kyoung Hag; Lee, Yeon-Shim; Lawler, Michael J; Martin, James I

2015-01-01

The purpose of this study was to examine the associations of physical health stressors and coping resources with depressive symptoms among American Indian older adults age 50 years or older. The study used a convenience sample of 227 rural American Indian older adults. A hierarchical multiple regression tested three sets of predictors on depressive symptoms: (a) sociodemographics, (b) physical health stressors (functional disability and chronic medical conditions), and (c) coping resources (social support and spirituality). Most participants reported little difficulty in performing daily activities (e.g., eating, dressing, traveling, and managing money), while presenting over two types of chronic medical conditions. Depressive symptoms were predicted by higher scores on perceived social support and lower scores on functional disability; women and those having no health insurance also had higher levels of depressive symptoms. Findings suggest that social work practitioners should engage family and community support, advocate for access to adequate health care, and attend to women's unique circumstances and needs when working with American Indian older adults.

Gender differences in life expectancy with and without disability among older adults in Ecuador.

PubMed

Egüez-Guevara, Pilar; Andrade, Flávia Cristina Drumond

2015-01-01

Knowledge on disability's impact among older women and men in Ecuador is limited. This paper provides gender-specific estimates of disability prevalence, life expectancy with and without disability, and the factors associated with gender differences in disability at older age in Ecuador (2009-2010). Data from the Health, Well-Being, and Aging Survey (SABE) Ecuador 2009 was used. Participants were 4480 men and women aged 60 and over. Life expectancy with and without disability was calculated using the Sullivan method. Logistic regression analyses were used to explore gender differences in disability prevalence. Two disability measures, indicating limitations in activities of daily living (ADL) and instrumental activities of daily living (IADL), were used. 60-year-old women in Ecuador can expect to live 16.3 years without ADL limitations compared to 16.9 years for men. Life expectancy without IADL limitations was 12.5 years for women and 15.5 years for men. At age 60, women's length of life with ADL and IADL disability was higher (7.9 years for women vs. 4.9 years for men with ADL, and 11.7 years for women vs. 6.3 years for men with IADL). After controlling for socioeconomic characteristics, chronic conditions and lifestyle factors, gender differences in ADL disability were not statistically significant. However, older women were 58% more likely (OR=1.58, 95% CI 1.27, 1.95) to report having IADL limitations than men, even after including control variables. Interventions should tackle chronic disease, physical inactivity, and socioeconomic differences to reduce women's vulnerability to disability in older age. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

Depressive symptoms in older female carers of adults with intellectual disabilities.

PubMed

Chou, Y C; Pu, C-Y; Fu, L-Y; Kröger, T

2010-12-01

This survey study aims to examine the prevalence and factors associated with depressive symptoms among primary older female family carers of adults with intellectual disabilities (ID). In total, 350 female family carers aged 55 and older took part and completed the interview in their homes. The survey package contained standardised scales to assess carer self-reported depressive symptoms, social support, caregiving burden and disease and health, as well as adult and carer sociodemographic information. Multiple linear regressions were used to identify the factors associated with high depressive symptoms in carers. Between 64% and 72% of these carers were classified as having high depressive symptoms. The factors associated with carer self-reported depressive symptoms were carer physical health, social support and caregiving burden; overall, the carer self-reported physical health was a stronger factor associated with depressive symptoms than their physical disease status. The level of the adult with ID's behavioural functioning and the carer age, marital status, employment status, education level and the family income level were not significantly associated with carer depressive symptoms. The factors identified in this study as correlating with self-reported depressive symptoms suggest that researchers and mental health professionals should collaborate to help improve the physical health and social support networks of the most vulnerable older female family carers. This should reduce depressive symptoms directly among this high-risk group. © 2010 The Authors. Journal of Intellectual Disability Research © 2010 Blackwell Publishing Ltd.

Longitudinal and Reciprocal Relationships Between Depression and Disability in Older Women Caregivers and Noncaregivers

PubMed Central

Bacon, Kathryn L.; Heeren, Timothy; Keysor, Julie J.; Stuver, Sherri O.; Cauley, Jane A.; Fredman, Lisa

2016-01-01

Purpose of the Study: Depressive symptoms and disability each increase the risk of the other, yet few studies have examined reciprocal associations between these conditions in a single study, or over periods longer than 3 years. These associations may differ in older caregivers due to chronic stress, health characteristics, or factors related to caregiving. Design and Methods: Structural equation models were used to investigate relationships between depressive symptoms and disability over 3 interviews spanning 6 years among 956 older women (M = 81.5 years) from the Caregiver Study of Osteoporotic Fractures. Results were evaluated separately for 611 noncaregivers and 345 caregivers to a relative or friend. Results: In noncaregivers, more depressive symptoms significantly predicted greater disability, whereas greater disability predicted increased depressive symptoms at the next interview in age-adjusted models. In contrast, there was not a significant relationship between depression and disability in either direction for caregivers. Further adjustment for body mass index and medical condition variables did not change these relationships. Implications: Caregivers did not exhibit longitudinal or reciprocal relationships between depressive symptoms and disability observed in noncaregivers. It is possible that older women caregivers are buffered by better physical condition or social interactions related to caregiving activities. PMID:26035874

Exposure to Traffic-Related Air Pollution in Relation to Progression in Physical Disability among Older Adults

PubMed Central

Weuve, Jennifer; Kaufman, Joel D.; Szpiro, Adam A.; Curl, Cynthia; Puett, Robin C.; Beck, Todd; Evans, Denis A.; Mendes de Leon, Carlos F.

2016-01-01

Background: Physical disability is common though not inevitable in older age and has direct bearing on a person’s ability to perform activities essential for self-care and independent living. Air pollution appears to increase the risk of several chronic diseases that contribute to the progression of disability. Objective: We evaluated long-term exposure to traffic-related air pollution (TRAP) in relation to progression in physical disability. Methods: We conducted our investigation within the Chicago Health and Aging Project. We measured participants’ exposures to TRAP using two surrogates: residential proximity to major roads (1993 onwards) and ambient concentrations of oxides of nitrogen (NOX; 1999 onwards), predicted via a geographic information systems-based spatiotemporal smoothing model (cross-validation R2 = 0.87) that incorporated community-based monitoring and resolved intraurban exposure gradients at a spatial scale of tens of meters. Participants’ lower-extremity physical ability was assessed every 3 years (1993–2012) via tandem stand, chair stand, and timed walking speed. Results: In multivariable-adjusted analyses (n = 5,708), higher long-term NOX exposure was associated with significantly faster progression in disability. Compared with the 5-year decline in physical ability score among participants in the lowest quartile of NOX exposure, decline among those in the highest exposure quartile was 1.14 units greater (95% confidence interval [CI]: –1.86, –0.42), equivalent to 3 additional years of decline among those in the lowest exposure quartile. The association was linear across the continuum of NOX exposure: per 10-ppb increment in exposure, the 5-year decline in physical ability score was 0.87 unit greater (95% CI: –1.35, –0.39). Proximity to a major road was not associated with disability progression (n = 9,994). Conclusions: These data join a growing body of evidence suggesting that TRAP exposures may accelerate aging-related declines in health. Citation: Weuve J, Kaufman JD, Szpiro AA, Curl C, Puett RC, Beck T, Evans DA, Mendes de Leon CF. 2016. Exposure to traffic-related air pollution in relation to progression in physical disability among older adults. Environ Health Perspect 124:1000–1008; http://dx.doi.org/10.1289/ehp.1510089 PMID:27022889

Physical fitness is predictive for a decline in daily functioning in older adults with intellectual disabilities: results of the HA-ID study.

PubMed

Oppewal, Alyt; Hilgenkamp, Thessa I M; van Wijck, Ruud; Schoufour, Josje D; Evenhuis, Heleen M

2014-10-01

A high incidence of limitations in daily functioning is seen in older adults with intellectual disabilities (ID), along with poor physical fitness levels. The aim of this study was to assess the predictive value of physical fitness for daily functioning after 3 years, in 602 older adults with borderline to profound ID (≥ 50 years). At baseline, physical fitness levels and daily functioning (operationalized as basic activities of daily living [ADL] and mobility) were assessed. After 3 years, the measurements of daily functioning were repeated. At follow-up, 12.6% of the participants were completely independent in ADL and 48.5% had no mobility limitations. More than half of the participants (54.8%) declined in their ability to perform ADL and 37.5% declined in their mobility. Manual dexterity, visual reaction time, balance, comfortable and fast gait speed, muscular endurance, and cardiorespiratory fitness were significant predictors for a decline in ADL. For a decline in mobility, manual dexterity, balance, comfortable and fast walking speed, grip strength, muscular endurance, and cardiorespiratory fitness were all significant predictors. This proves the predictive validity of these physical fitness tests for daily functioning and stresses the importance of using physical fitness tests and implementing physical fitness enhancing programs in the care for older adults with ID. Copyright © 2014 Elsevier Ltd. All rights reserved.

Variation by Disability in State Predictors of Medicaid 1915C Waiver Use and Expenditures

ERIC Educational Resources Information Center

Miller, Nancy A.; Kitchener, Martin; Elder, Keith T.; Kang, Yu; Rubin, Andrea; Harrington, Charlene

2005-01-01

Purpose: States are increasingly using the Medicaid 1915c waiver program to provide community-based long-term care. A substantially greater share of long-term-care dollars supports community-based care for individuals with intellectual and developmental disabilities, relative to older and working-age persons with primarily physical disabilities.…

Trajectories of Leisure Activity and Disability in Older Adults Over 11 Years in Taiwan.

PubMed

Yu, Hsiao-Wei; Chiang, Tung-Liang; Chen, Duan-Rung; Tu, Yu-Kang; Chen, Ya-Mei

2018-06-01

We aimed to identify leisure activity (LA) trajectories and examined the association among baseline characteristics, LA trajectories, and the later disability among older Taiwanese adults. Data were from the Taiwan Longitudinal Study on Aging Survey for the years 1996-2007 ( N = 3,186). LA trajectories were identified by using latent class growth curve modeling. Regression analyses were applied to predict the relationships among baseline characteristics, LA trajectories, and disability. Four LA trajectories-consistent high, consistent low, increasing, and decreasing-were identified. Lower depressive symptom was related to consistently active in LAs. Younger age and fewer comorbidities were related to develop an increasing LA trajectory. Participants in the consistent-high or increasing LA trajectories were more likely to be functionally independent, but those in the decreasing LA subgroup were more at risk of developing disability. The findings suggested that long-term changes in LA over time have benefits on physical health in older population.

Old-Age Disability and Wealth among Return Mexican Migrants from the United States

PubMed Central

Wong, Rebeca; Gonzalez-Gonzalez, Cesar

2012-01-01

Objective To examine the old-age consequences of international migration with a focus on disability and wealth from the perspective of the origin country. Methods Analysis sample includes persons aged 60+ from the Mexican Health and Aging Study, a national survey of older-adults in Mexico in 2001. Univariate methods are used to present a comparative profile of return migrants. Multivariate models are estimated for physical disability and wealth. Results Gender differences are profound. Return migrant women are more likely to be disabled while men are wealthier than comparable older adults in Mexico. Discussion Compared to current older adults, younger cohorts of Mexico-U.S. migrants increasingly include women, and more migrants seem likely to remain in the United States rather than return, thus more research will be needed on the old-age conditions of migrants in both countries. PMID:20876848

Does functional disability mediate the pain-depression relationship in older adults with osteoarthritis? A longitudinal study in China.

PubMed

Wang, Qian; Jayasuriya, Rohan; Man, Wing Young Nicola; Fu, Hua

2015-03-01

Older adults with osteoarthritis have been found to be impaired in physical functioning and report higher levels of depression. This study examined the relationships between pain, functional disability, and depression to test the activity restriction model in a cohort of 176 older adults in China. This model states that disability is a mediator for the relationship between pain and depression. Other investigators have found that pain and disability were two independent correlates of depression. In both cross-sectional and longitudinal analyses, the authors found that disability is a mediator, using commonly accepted methods (indirect effect 44%, Sobel Z = 4.07, P < .001; 41%, Sobel Z = 3.45, P < .001, respectively). However, this mediation effect was not seen when the outcome was residualized with the baseline value. When the baseline level of depression is residualized, the effect size of the relationship is reduced, requiring larger sample size to test its effect. © 2012 APJPH.

Childhood Abuse and Current Health Problems among Older Adults: The Mediating Role of Self-Efficacy

PubMed Central

Sachs-Ericsson, Natalie; Medley, Amanda N.; Kendall – Tackett, Kathleen; Taylor, John

2011-01-01

Objectives Child abuse has negative consequences on health functioning and the self-concept. Prior studies have garnered support for these relationships in younger adults; yet few studies have looked at the effects of abuse on health in older adults and the psychosocial variables, specifically self-efficacy, that may influence the abuse-health relationship. Methods Data obtained from the Physical Health and Disability Study were used to explore the impact of child abuse on current medical problems among older adults who were screened on physical disability status (N=1396, Mean age = 67, SD = 10.2). The study was conducted in South Florida and employed a multiethnic sample that is representative of the general population in this area. Results Child abuse was associated with the number of current medical problems and disability. Child abuse was also related to lower self-efficacy, and self-efficacy explained the relationship between abuse and the number of health problems. Conclusions There are far reaching effects of child abuse on older adults' health and self-concept. Health care providers and gerontologists need to be aware that child abuse is a life-long risk factor for increased disability and specific health problems, especially among the elderly. Future research should examine treatments designed to increase self-efficacy, especially among those who experienced child abuse, and observe any positive effects on health functioning. PMID:21922052

The Framingham Disability Study: relationship of various coronary heart disease manifestations to disability in older persons living in the community.

PubMed Central

Pinsky, J L; Jette, A M; Branch, L G; Kannel, W B; Feinleib, M

1990-01-01

The relation between coronary heart disease and disability was examined in 2,576 community-dwelling women and men ages 55-88 years. These Framingham Study participants were originally recruited in 1948-51 for an examination of cardiovascular disease. Twenty-seven years later, remaining members of the cohort were interviewed to ascertain physical abilities, and a score on a disability scale was assigned. Multivariate logistic analyses examined disability in relation to uncomplicated angina pectoris (AP), complicated AP, and coronary heart disease other than AP, controlling for possible confounders. In younger and older women and men, uncomplicated and complicated AP were associated with disability. Coronary heart disease other than AP was associated with disability only in the younger men. Congestive heart failure predicted disability only in the women. These results suggest that onset of AP should be recognized as a critical point in the development of disability and that AP is a better predictor of disability than is myocardial infarction or coronary insufficiency. PMID:2240306

Physical Disability Trajectories in Older Americans with and without Diabetes: The Role of Age, Gender, Race or Ethnicity, and Education

ERIC Educational Resources Information Center

Chiu, Ching-Ju; Wray, Linda A.

2011-01-01

Purpose: This research combined cross-sectional and longitudinal data to characterize age-related trajectories in physical disability for adults with and without diabetes in the United States and to investigate if those patterns differ by age, gender, race or ethnicity, and education. Design and Methods: Data were examined on 20,433 adults aged 51…

Dynapenia and Sarcopenia as a Risk Factor for Disability in a Falls and Fractures Clinic in Older Persons

PubMed Central

Benjumea, Angela-María; Curcio, Carmen-Lucía; Duque, Gustavo; Gómez, Fernando

2018-01-01

BACKGROUND: The role of sarcopenia and dynapenia in disability in older persons from falls and bone health clinics remain unknown. AIM: This study aims to compare the association of sarcopenia and dynapenia with physical and instrumental disability in a population of older persons attending a falls and fractures clinic. METHODS: This is a cross-sectional study in Manizales, Andes Mountains, Colombia. A cohort of 534 subjects (mean age = 74, 75% female) Sarcopenia was measured according to the European Working Group on Sarcopenia in Older People (EWGSOP) including an index of skeletal mass, muscle strength, and gait speed. Dynapenia was defined as a handgrip force ≤ 30 kg for men and ≤ 20 kg for women. RESULTS: Dynapenia and sarcopenia were present in 84.6% and 71.2% respectively. Both were more prevalent in older subjects and women than men. While sarcopenia was associated with body mass index and hypertension, dynapenia was associated with hypothyroidism and visual impairment. After controlling for all covariates, sarcopenia was associated with low IADL and mobility disability. CONCLUSIONS: Sarcopenia was associated with mobility, ADL and IADL disability. Dynapenia was not associated with disability in this high - risk population. Systematic assessment of sarcopenia should be implemented in falls and fractures clinics to identify sarcopenia and develop interventions to prevent functional decline among elderly individuals. PMID:29531601

Patterns of Technology Use Among Older Adults With and Without Disabilities

PubMed Central

Gell, Nancy M.; Rosenberg, Dori E.; Demiris, George; LaCroix, Andrea Z.; Patel, Kushang V.

2015-01-01

Purpose of the Study: The purpose of this study was to describe prevalence of technology use among adults ages 65 and older, particularly for those with disability and activity-limiting symptoms and impairments. Design and Methods: Data from the 2011 National Health and Aging Trends Study, a nationally representative sample of community-dwelling Medicare beneficiaries (N = 7,609), were analyzed. Analysis consisted of technology use (use of e-mail/text messages and the internet) by sociodemographic and health characteristics and prevalence ratios for technology usage by disability status. Results: Forty percent of older adults used e-mail or text messaging and 42.7% used the internet. Higher prevalence of technology use was associated with younger age, male sex, white race, higher education level, and being married (all p values <.001). After adjustment for sociodemographic and health characteristics, technology use decreased significantly with greater limitations in physical capacity and greater disability. Vision impairment and memory limitations were also associated with lower likelihood of technology use. Implications: Technology usage in U.S. older adults varied significantly by sociodemographic and health status. Prevalence of technology use differed by the type of disability and activity-limiting impairments. The internet, e-mail, and text messaging might be viable mediums for health promotion and communication, particularly for younger cohorts of older adults and those with certain types of impairment and less severe disability. PMID:24379019

Association of Physical Activity History With Physical Function and Mortality in Old Age

PubMed Central

Koster, Annemarie; Valkeinen, Heli; Patel, Kushang V.; Bandinelli, Stefania; Guralnik, Jack M.; Ferrucci, Luigi

2016-01-01

Background. We examined whether physical activity in early adulthood, late midlife, and old age as well as cumulative physical activity history are associated with changes in physical functioning and mortality in old age. Methods. Data are from participants aged 65 years or older enrolled in the InCHIANTI study who were followed up from 1998–2000 to 2007–2008 (n = 1,149). At baseline, participants recalled their physical activity levels at ages 20–40, 40–60, and in the previous year, and they were categorized as physically inactive, moderately active, and physically active. Physical performance was assessed with the Short Physical Performance Battery and self-reported mobility disability was evaluated at the 3-, 6- and 9-year follow-up. Mortality follow-up was assessed until the end of 2010. Results. Physical inactivity at baseline was associated with greater decline in Short Physical Performance Battery score (mean 9-year change: −2.72, 95% CI: −3.08, −2.35 vs −0.98, 95% −1.57, −0.39) and greater rate of incident mobility disability (hazard ratio 4.66, 95% CI 1.14–19.07) and mortality (hazard ratio 2.18, 95% CI 1.01–4.70) compared to physically active participants at baseline. Being physically active throughout adulthood was associated with smaller decline in physical performance as well as with lower risk of incident mobility disability and premature death compared with those who had been less active during their adult life. Conclusions. Higher cumulative physical activity over the life course was associated with less decline in physical performance and reduced rate of incident mobility disability and mortality in older ages. PMID:26290538

Correlates of a Recent History of Disabling Low Back Pain in Community-dwelling Older Persons: The Pain in the Elderly (PAINEL) Study.

PubMed

Machado, Luciana A C; Viana, Joana U; da Silva, Sílvia L A; Couto, Flávia G P; Mendes, Liliane P; Ferreira, Paulo H; Ferreira, Manuela L; Dias, João M D; Dias, Rosângela C

2018-06-01

To investigate the correlates of a recent history of disabling low back pain (LBP) in older persons. The Pain in the Elderly (PAINEL) Study was derived from the Frailty among Brazilian Older Adults (FIBRA) Network Study. Data were collected through face-to-face/telephone interviews and clinical examination. A series of logistic regressions assessed associations between a recent history of disabling LBP and sociodemographic, physical/lifestyle, and psychological factors. Of the 378 community-dwelling elders included in the study (age±SD, 75.5±6.1), 9.3% experienced LBP that was bad enough to limit or change their daily activities during the past year. Those reporting a recent history of disabling LBP were more likely to be women and under financial strain, to present poor self-rated health, overweight, multimorbidity, low physical activity level, fatigue, depressive symptomatology/diagnosis and fear beliefs, and to report decreased sleep time, prolonged sitting time, chronic pain (in location other than lower back), and frequently recurring LBP. The multivariate logistic regression analysis indicated that overweight (odds ratio [OR], 29.6; 95% confidence interval [CI], 2.3-391.0), low physical activity level (OR, 4.4; 95% CI, 1.3-15.4), fatigue (OR, 10.3; 95% CI, 2.4-43.4), depression diagnosis (OR, 4.9; 95% CI, 1.3-18.4), and frequently recurring LBP (OR, 4.6; 95% CI, 1.0-20.1) were independently associated with a recent history of disabling LBP. Our study supports the link between disabling LBP and other age-related chronic conditions in a middle-income country with a rapidly aging population.

Psychological wellbeing, physical impairments and rural aging in a developing country setting.

PubMed

Abas, Melanie A; Punpuing, Sureeporn; Jirapramupitak, Tawanchai; Tangchonlatip, Kanchana; Leese, Morven

2009-07-16

There has been very little research on wellbeing, physical impairments and disability in older people in developing countries. A community survey of 1147 older parents, one per household, aged sixty and over in rural Thailand. We used the Burvill scale of physical impairment, the Thai Psychological Wellbeing Scale and the brief WHO Disability Assessment Schedule. We rated received and perceived social support separately from children and from others and rated support to children. We used weighted analyses to take account of the sampling design. Impairments due to arthritis, pain, paralysis, vision, stomach problems or breathing were all associated with lower wellbeing. After adjusting for disability, only impairment due to paralysis was independently associated with lowered wellbeing. The effect of having two or more impairments compared to none was associated with lowered wellbeing after adjusting for demographic factors and social support (adjusted difference -2.37 on the well-being scale with SD = 7.9, p < 0.001) but after adjusting for disability the coefficient fell and was non-significant. The parsimonious model for wellbeing included age, wealth, social support, disability and impairment due to paralysis (the effect of paralysis was -2.97, p = 0.001). In this Thai setting, received support from children and from others and perceived good support from and to children were all independently associated with greater wellbeing whereas actual support to children was associated with lower wellbeing. Low received support from children interacted with paralysis in being especially associated with low wellbeing. In this Thai setting, as found in western settings, most of the association between physical impairments and lower wellbeing is explained by disability. Disability is potentially mediating the association between impairment and low wellbeing. Received support may buffer the impact of some impairments on wellbeing in this setting. Giving actual support to children is associated with less wellbeing unless the support being given to children is perceived as good, perhaps reflecting parental obligation to support adult children in need. Improving community disability services for older people and optimizing received social support will be vital in rural areas in developing countries.

Gender Roles and Physical Function in Older Adults: Cross-Sectional Analysis of the International Mobility in Aging Study (IMIAS)

PubMed Central

Ahmed, Tamer; Vafaei, Afshin; Auais, Mohammad; Guralnik, Jack; Zunzunegui, Maria Victoria

2016-01-01

Objectives To examine the relationships between physical function and gender-stereotyped traits and whether these relationships are modified by sex or social context. Methods A total of 1995 community-dwelling older adults from the International Mobility in Aging Study (IMIAS) aged 65 to 74 years were recruited in Natal (Brazil), Manizales (Colombia), Tirana (Albania), Kingston (Ontario, Canada), and Saint-Hyacinthe (Quebec, Canada). We performed a cross-sectional analysis. Study outcomes were mobility disability, defined as having difficulty in walking 400 meters without assistance or climbing a flight of stairs without resting, and low physical performance, defined as a score < 8 on the Short Physical Performance Battery. The 12-item Bem Sex Role Inventory (BSRI) was used to classify participants into four gender roles (Masculine, Feminine, Androgynous, and Undifferentiated) using site-specific medians of femininity and masculinity as cut-off points. Poisson regression models were used to estimate prevalence rate ratios (PRR) of mobility disability and poor physical performance according to gender roles. Results In models adjusted for sex, marital status, education, income, and research site, when comparing to the androgynous role, we found higher prevalence of mobility disability and poor physical performance among participants endorsing the feminine role (PRR = 1.20, 95% confidence interval (CI) 1.03–1.39 and PRR = 1.37, CI 1.01–1.88, respectively) or the undifferentiated role (PRR = 1.23, 95% CI 1.07–1.42 and PRR = 1.58, CI 1.18–2.12, respectively). Participants classified as masculine did not differ from androgynous participants in prevalence rates of mobility disability or low physical performance. None of the multiplicative interactions by sex and research site were significant. Conclusion Feminine and undifferentiated gender roles are independent risk factors for mobility disability and low physical performance in older adults. Longitudinal research is needed to assess the mediation pathways through which gender-stereotyped traits influence functional limitations and to investigate the longitudinal nature of these relationships. PMID:27258050

Oxandrolone augmentation of resistance training in older women: a randomized trial

USDA-ARS?s Scientific Manuscript database

INTRODUCTION: Sarcopenia is disproportionately present in older women with disability, and optimum treatment is not clear. We conducted a double-blind, randomized, placebo-controlled trial to determine whether oxandrolone administration in elderly women improves body composition or physical function...

Community covariates of malnutrition based mortality among older adults.

PubMed

Lee, Matthew R; Berthelot, Emily R

2010-05-01

The purpose of this study was to identify community level covariates of malnutrition-based mortality among older adults. A community level framework was delineated which explains rates of malnutrition-related mortality among older adults as a function of community levels of socioeconomic disadvantage, disability, and social isolation among members of this group. County level data on malnutrition mortality of people 65 years of age and older for the period 2000-2003 were drawn from the CDC WONDER system databases. County level measures of older adult socioeconomic disadvantage, disability, and social isolation were derived from the 2000 US Census of Population and Housing. Negative binomial regression models adjusting for the size of the population at risk, racial composition, urbanism, and region were estimated to assess the relationships among these indicators. Results from negative binomial regression analysis yielded the following: a standard deviation increase in socioeconomic/physical disadvantage was associated with a 12% increase in the rate of malnutrition mortality among older adults (p < 0.001), whereas a standard deviation increase in social isolation was associated with a 5% increase in malnutrition mortality among older adults (p < 0.05). Community patterns of malnutrition based mortality among older adults are partly a function of levels of socioeconomic and physical disadvantage and social isolation among older adults. 2010 Elsevier Inc. All rights reserved.

Rethinking Hospital-Associated Deconditioning: Proposed Paradigm Shift

PubMed Central

Mangione, Kathleen K.; Stevens-Lapsley, Jennifer E.

2015-01-01

Physical therapists often treat older adults with marked deficits in physical function secondary to an acute hospitalization. These deficits are often collectively defined as hospital-associated deconditioning (HAD). However, there is a paucity of evidence that objectively demonstrates the efficacy of physical therapy for older adults with HAD. Older adults with HAD represent a highly variable and complex population and thus may be difficult to study and develop effective interventions for using our current rehabilitation strategies. This perspective article outlines an innovative framework to operationalize and treat older adults with HAD. This framework may help therapists apply emerging exercise strategies to this population and facilitate additional research to support the total value of physical therapy for older adults in postacute care settings—with value measured not only by improvements in physical performance but perhaps also by reduced rates of disability development, rehospitalization, and institutionalization. PMID:25908526

Short term treatment versus long term management of neck and back disability in older adults utilizing spinal manipulative therapy and supervised exercise: a parallel-group randomized clinical trial evaluating relative effectiveness and harms

PubMed Central

2014-01-01

Background Back and neck disability are frequent in older adults resulting in loss of function and independence. Exercise therapy and manual therapy, like spinal manipulative therapy (SMT), have evidence of short and intermediate term effectiveness for spinal disability in the general population and growing evidence in older adults. For older populations experiencing chronic spinal conditions, long term management may be more appropriate to maintain improvement and minimize the impact of future exacerbations. Research is limited comparing short courses of treatment to long term management of spinal disability. The primary aim is to compare the relative effectiveness of 12 weeks versus 36 weeks of SMT and supervised rehabilitative exercise (SRE) in older adults with back and neck disability. Methods/Design Randomized, mixed-methods, comparative effectiveness trial conducted at a university-affiliated research clinic in the Minneapolis/St. Paul, Minnesota metropolitan area. Participants Independently ambulatory community dwelling adults ≥ 65 years of age with back and neck disability of minimum 12 weeks duration (n = 200). Interventions 12 weeks SMT + SRE or 36 weeks SMT + SRE. Randomization Blocked 1:1 allocation; computer generated scheme, concealed in sequentially numbered, opaque, sealed envelopes. Blinding Functional outcome examiners are blinded to treatment allocation; physical nature of the treatments prevents blinding of participants and providers to treatment assignment. Primary endpoint 36 weeks post-randomization. Data collection Self-report questionnaires administered at 2 baseline visits and 4, 12, 24, 36, 52, and 78 weeks post-randomization. Primary outcomes include back and neck disability, measured by the Oswestry Disability Index and Neck Disability Index. Secondary outcomes include pain, general health status, improvement, self-efficacy, kinesiophobia, satisfaction, and medication use. Functional outcome assessment occurs at baseline and week 37 for hand grip strength, short physical performance battery, and accelerometry. Individual qualitative interviews are conducted when treatment ends. Data on expectations, falls, side effects, and adverse events are systematically collected. Primary analysis Linear mixed-model method for repeated measures to test for between-group differences with baseline values as covariates. Discussion Treatments that address the management of spinal disability in older adults may have far reaching implications for patient outcomes, clinical guidelines, and healthcare policy. Trial registry www.ClinicalTrials.gov; Identifier: NCT01057706. PMID:25478141

Effects of dance on depression, physical function, and disability in underserved adults.

PubMed

Murrock, Carolyn J; Graor, Christine Heifner

2014-07-01

This study documented the feasibility and immediate effects of a dance intervention two times per week for 12 weeks on depression, physical function, and disability in older, underserved adults. The one-group, pretest-posttest study had a convenience sample of 40 participants recruited from a federally subsidized apartment complex located in an economically depressed, inner-city neighborhood. Depression, physical function, and disability were measured at baseline and 12 weeks. Average age was 63 years (SD = 7.9), 92% were female, and 75% were African American. At baseline, participants reported increased depression (M = 20.0, SD = 12.4), decreased physical function (M = 56.6, SD = 10.9), and increased disability limitations (M = 65.7, SD = 14.9). At posttest, paired t tests showed that the dance intervention significantly decreased depression, t = 6.11, p < .001, and disability, t = -2.70, p = .014, and significantly increased physical function, t = -2.74, p = .013. The results indicate that the 12-week dance intervention may be an effective adjunct therapy to improve depression, disability, and physical function in underserved adults.

A randomized, controlled trial of disability prevention in frail older patients screened in primary care: the FRASI study. Design and baseline evaluation.

PubMed

Bandinelli, Stefania; Lauretani, Fulvio; Boscherini, Vittorio; Gandi, Francesca; Pozzi, Martina; Corsi, Anna Maria; Bartali, Benedetta; Lova, Raffaello Molino; Guralnik, Jack M; Ferrucci, Luigi

2006-10-01

We describe the enrollment and intervention phases of FRASI (FRAilty, Screening and Intervention), a randomized controlled trial aimed at preventing ADL disability in frail older persons screened in primary care. Patients, 70-85 years old, non-disabled and noncognitively impaired, were screened for frailty (score < or = 9 on the Short Physical Performance Battery, SPPB) during primary care visits. Of 447 eligible persons, 410 came to the study clinic and 251 were randomized into treatment (n=126) and control groups (n=125). The active group received an intensive medical intervention, and sixteen 90-minute supervised exercise sessions over 8 weeks. The primary outcome was time to ADL disability onset or death in the 12-month period after study enrollment. The two study arms were similar for demographics, cognitive function, physical function and health status. Compared with a population-based sample selected according to FRASI inclusion criteria except SPPB score, FRASI participants had significantly worse health and functional status. Restricting the comparison to persons with SPPB < or = 9, all differences disappeared. The 99 participants (78.6% of 126) who completed the intervention participated in a mean of 15.3+/-1.6 exercise sessions. Screening in primary care for non-disabled, older persons with SPPB < or = 9 yields individuals with substantial morbidity, impairments and functional limitations that can be successfully involved in an intensive medical and exercise intervention. Whether such an intervention effectively prevents new disability remains to be confirmed.

Long Term Trend Analysis of Geographical Disparity in Aging and Disability: Taiwanese Population Approach

ERIC Educational Resources Information Center

Chen, Yong-Chen; Chou, Yu-Ching; Lin, Lan-Ping; Wu, Chia-Ling; Lin, Jin-Ding

2012-01-01

Purposes of the present paper were to describe the overtime change of disability prevalence among the elderly (65 years and older), and to analyze the geographic disparity of the disability prevalence during the year 2000-2010 in Taiwan. Study data mainly come from two public web-access information: (1) The physically and mentally disabled…

The Learning Needs of Older Adults.

ERIC Educational Resources Information Center

Purdie, Nola; Boulton-Lewis, Gillian

2003-01-01

Interviews with 17 older adults about learning needs and barriers resulted in a questionnaire completed by 160 elders. Most important needs were associated with transportation, health, and safety. Physical disabilities were the chief barrier. They felt most confident addressing health, safety, leisure, and transportation needs but not…

Disability Transitions and Health Expectancies among Adults 45 Years and Older in Malawi: A Cohort-Based Model

PubMed Central

Payne, Collin F.; Mkandawire, James; Kohler, Hans-Peter

2013-01-01

Background Falling fertility and increasing life expectancy contribute to a growing elderly population in sub-Saharan Africa (SSA); by 2060, persons aged 45 y and older are projected to be 25% of SSA's population, up from 10% in 2010. Aging in SSA is associated with unique challenges because of poverty and inadequate social supports. However, despite its importance for understanding the consequences of population aging, the evidence about the prevalence of disabilities and functional limitations due to poor physical health among older adults in SSA continues to be very limited. Methods and Findings Participants came from 2006, 2008, and 2010 waves of the Malawi Longitudinal Survey of Families and Health, a study of the rural population in Malawi. We investigate how poor physical health results in functional limitations that limit the day-to-day activities of individuals in domains relevant to this subsistence-agriculture context. These disabilities were parameterized based on questions from the SF-12 questionnaire about limitations in daily living activities. We estimated age-specific patterns of functional limitations and the transitions over time between different disability states using a discrete-time hazard model. The estimated transition rates were then used to calculate the first (to our knowledge) microdata-based health expectancies calculated for SSA. The risks of experiencing functional limitations due to poor physical health are high in this population, and the onset of disabilities happens early in life. Our analyses show that 45-y-old women can expect to spend 58% (95% CI, 55%–64%) of their remaining 28 y of life (95% CI, 25.7–33.5) with functional limitations; 45-y-old men can expect to live 41% (95% CI, 35%–46%) of their remaining 25.4 y (95% CI, 23.3–28.8) with such limitations. Disabilities related to functional limitations are shown to have a substantial negative effect on individuals' labor activities, and are negatively related to subjective well-being. Conclusions Individuals in this population experience a lengthy struggle with disabling conditions in adulthood, with high probabilities of remitting and relapsing between states of functional limitation. Given the strong association of disabilities with work efforts and subjective well-being, this research suggests that current national health policies and international donor-funded health programs in SSA inadequately target the physical health of mature and older adults. Please see later in the article for the Editors' Summary PMID:23667343

Short-term effect of physical activity and obesity on disability in a sample of rural elderly in Mexico.

PubMed

Manrique-Espinoza, Betty; Moreno-Tamayo, Karla; Téllez-Rojo Solís, Martha M; De la Cruz-Góngora, Vanessa Vianey; Gutiérrez-Robledo, Luis Miguel; Salinas-Rodríguez, Aarón

2014-01-01

To estimate the effects of physical activity (PA) and obesity on the cumulative incidence of disability on the basic activities of daily living in the elderly. Longitudinal study. We selected 2477 participants aged 65-74 years from the impact evaluation study of a non-contributory pension program in Mexico. Participants were without disability at baseline. Katz index was used to assess disability both at baseline and follow-up. PA, body mass index, and covariates were measured at baseline. After 14-months of follow-up, the cumulative incidence of disability reached 10.1%. High PA was found to reduce disability risk (OR=0.64; 95%CI [0.43-0.95]), and the association between obesity and disability was marginally significant (OR=1.36; 95%CI [0.96-1.95]). There is a need to perform a functional assessment of older adults in primary care to identify patients with functional dependence , and to promote physical activity to maintain muscle mass and thus reduce the incidence of disability.

Body composition, muscle capacity, and physical function in older adults: an integrated conceptual model.

PubMed

Brady, Anne O; Straight, Chad R; Evans, Ellen M

2014-07-01

The aging process leads to adverse changes in body composition (increases in fat mass and decreases in skeletal muscle mass), declines in physical function (PF), and ultimately increased risk for disability and loss of independence. Specific components of body composition or muscle capacity (strength and power) may be useful in predicting PF; however, findings have been mixed regarding the most salient predictor of PF. The development of a conceptual model potentially aids in understanding the interrelated factors contributing to PF with the factors of interest being physical activity, body composition, and muscle capacity. This article also highlights sex differences in these domains. Finally, factors known to affect PF, such as sleep, depression, fatigue, and self-efficacy, are discussed. Development of a comprehensive conceptual model is needed to better characterize the most salient factors contributing to PF and to subsequently inform the development of interventions to reduce physical disability in older adults.

International Classification of Functioning, Disability and Health core set for physical health of older adults.

PubMed

Ruaro, João A; Ruaro, Marinêz B; Guerra, Ricardo O

2014-01-01

To facilitate a systematic, comprehensive description of functioning and to enable the use of the International Classification of Functioning, Disability and Health (ICF) in clinical practice and research, core sets have been developed. The aim of this study was to propose a version of the ICF core set to classify the physical health of older adults. The proposition of the ICF core set was based on the Delphi technique. The panel of experts included 8 Brazilian researchers (physical therapists, medical doctors, nurses, and physical educators). The communication was wholly electronic. In total, there were 5 rounds of interactivity between the participants to arrive at the final version of the construct. The ICF core set presented 30 categories (14 on body functions, 4 on body structures, 9 on activities or participation, and 3 on environmental factors) and had a Cronbach α of 0.964. The presented core set is a secure, fast, and accurate instrument for assessing the physical health and engagement of older adults. It defines points related to functioning and health that are relevant when evaluating this population, as well as when reevaluating it and monitoring changes.

The Public Health Perspective in Health Promotion and Disability Prevention for Older Adults: The Role of the Centers for Disease Control and Prevention.

ERIC Educational Resources Information Center

Hennessy, Catherine Hagan; Buchner, David M.; Jordan, Joanne M.; Leveille, Suzanne G.; Shefer, Abigail M.; Stevens, Judy A.

2001-01-01

The Centers for Disease Control and Prevention works with public health agencies and other organizations to address chronic disease prevention and risk reduction in older adults. Efforts in the areas of physical activity, osteoarthritis, and chronic illness self-management are described. Other activities include older adult immunization programs…

Activity, Social Network and Well-Being: An Empirical Examination.

ERIC Educational Resources Information Center

Litwin, Howard

2000-01-01

A study of 170 older adults in Israel found that physical disability was a primary predictor of well-being. The social network aspect of activity made a difference in older persons' subjective well-being, rather than the effect of the activity. (Contains 62 references.) (JOW)

Disability intervention model for older adults with arthritis: an integration of theory of symptom management and disablement process model.

PubMed

Shin, So Young

2014-12-01

To evolve a management plan for rheumatoid arthritis, it is necessary to understand the patient's symptom experience and disablement process. This paper aims to introduce and critique two models as a conceptual foundation from which to construct a new model for arthritis care. A Disability Intervention Model for Older Adults with Arthritis includes three interrelated concepts of symptom experience, symptom management strategies, and symptom outcomes that correspond to the Theory of Symptom Management. These main concepts influence or are influenced by contextual factors that are situated within the domains of person, environment, and health/illness. It accepts the bidirectional, complex, dynamic interactions among all components within the model representing the comprehensive aspects of the disablement process and its interventions in older adults with rheumatoid arthritis. In spite of some limitations such as confusion or complexity within the model, the Disability Intervention Model for Older Adults with Arthritis has strengths in that it encompasses the majority of the concepts of the two models, attempts to compensate for the limitations of the two models, and aims to understand the impact of rheumatoid arthritis on a patient's physical, cognitive, and emotional health status, socioeconomic status, and well-being. Therefore, it can be utilized as a guiding theoretical framework for arthritis care and research to improve the functional status of older adults with rheumatoid arthritis. Copyright © 2014. Published by Elsevier B.V.

Patterns of technology use among older adults with and without disabilities.

PubMed

Gell, Nancy M; Rosenberg, Dori E; Demiris, George; LaCroix, Andrea Z; Patel, Kushang V

2015-06-01

The purpose of this study was to describe prevalence of technology use among adults ages 65 and older, particularly for those with disability and activity-limiting symptoms and impairments. Data from the 2011 National Health and Aging Trends Study, a nationally representative sample of community-dwelling Medicare beneficiaries (N = 7,609), were analyzed. Analysis consisted of technology use (use of e-mail/text messages and the internet) by sociodemographic and health characteristics and prevalence ratios for technology usage by disability status. Forty percent of older adults used e-mail or text messaging and 42.7% used the internet. Higher prevalence of technology use was associated with younger age, male sex, white race, higher education level, and being married (all p values <.001). After adjustment for sociodemographic and health characteristics, technology use decreased significantly with greater limitations in physical capacity and greater disability. Vision impairment and memory limitations were also associated with lower likelihood of technology use. Technology usage in U.S. older adults varied significantly by sociodemographic and health status. Prevalence of technology use differed by the type of disability and activity-limiting impairments. The internet, e-mail, and text messaging might be viable mediums for health promotion and communication, particularly for younger cohorts of older adults and those with certain types of impairment and less severe disability. © The Author 2013. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Activity restriction induced by fear of falling and objective and subjective measures of physical function: a prospective cohort study.

PubMed

Deshpande, Nandini; Metter, E Jeffrey; Lauretani, Fulvio; Bandinelli, Stefania; Guralnik, Jack; Ferrucci, Luigi

2008-04-01

To examine whether activity restriction specifically induced by fear of falling (FF) contributes to greater risk of disability and decline in physical function. Prospective cohort study. Population-based older cohort. Six hundred seventy-three community-living elderly (> or = 65) participants in the Invecchiare in Chianti Study who reported FF. FF, fear-induced activity restriction, cognition, depressive symptoms, comorbidities, smoking history, and demographic factors were assessed at baseline. Disability in activities of daily living (ADLs) and instrumental activities of daily living (IADLs) and performance on the Short Performance Physical Battery (SPPB) were evaluated at baseline and at the 3-year follow-up. One-quarter (25.5%) of participants did not report any activity restriction, 59.6% reported moderate activity restriction (restriction or avoidance of < 3 activities), and 14.9% reported severe activity restriction (restriction or avoidance of > or = 3 activities). The severe restriction group reported significantly higher IADL disability and worse SPPB scores than the no restriction and moderate restriction groups. Severe activity restriction was a significant independent predictor of worsening ADL disability and accelerated decline in lower extremity performance on SPPB over the 3-year follow-up. Severe and moderate activity restriction were independent predictors of worsening IADL disability. Results were consistent even after adjusting for multiple potential confounders. In an elderly population, activity restriction associated with FF is an independent predictor of decline in physical function. Future intervention studies in geriatric preventive care should directly address risk factors associated with FF and activity restriction to substantiate long-term effects on physical abilities and autonomy of older persons.

Physical fitness is predictive for a decline in the ability to perform instrumental activities of daily living in older adults with intellectual disabilities: Results of the HA-ID study.

PubMed

Oppewal, Alyt; Hilgenkamp, Thessa I M; van Wijck, Ruud; Schoufour, Josje D; Evenhuis, Heleen M

2015-01-01

The ability to perform instrumental activities of daily living (IADL) is important for one's level of independence. A high incidence of limitations in IADL is seen in older adults with intellectual disabilities (ID), which is an important determinant for the amount of support one needs. The aim of this study was to assess the predictive value of physical fitness for the ability to perform IADL, over a 3-year follow-up period, in 601 older adults with ID. At baseline, an extensive physical fitness assessment was performed. In addition, professional caregivers completed the Lawton IADL scale, both at baseline and at follow-up. The average ability to perform IADL declined significantly over the 3-year follow-up period. A decline in the ability to perform IADL was seen in 44.3% of the participants. The percentage of participants being completely independent in IADL declined from 2.7% to 1.3%. Manual dexterity, balance, comfortable and fast gait speed, muscular endurance, and cardiorespiratory fitness were significant predictors for a decline in IADL after correcting for baseline IADL and personal characteristics (age, gender, level of ID, and Down syndrome). This can be interpreted as representing the predictive validity of the physical tests for a decline in IADL. This study shows that even though older adults with ID experience dependency on others due to cognitive limitations, physical fitness also is an important aspect for IADL, which stresses the importance of using physical fitness tests and physical fitness enhancing programs in the care for older adults with ID. Copyright © 2015 Elsevier Ltd. All rights reserved.

Frailty and sarcopenia - newly emerging and high impact complications of diabetes.

PubMed

Sinclair, Alan J; Abdelhafiz, Ahmed H; Rodríguez-Mañas, Leocadio

2017-09-01

Diabetes increases the risk of physical dysfunction and disability. Diabetes-related complications and coexisting morbidities partially explain the deterioration in physical function. The decline in muscle mass, strength and function associated with diabetes leads to sarcopenia, frailty and eventually disability. Frailty acts as a mediator in the pathogenesis of disability in older people with diabetes and its measurement in routine daily practice is recommended. Frailty is a dynamic process which progresses from a robust condition to a pre-frail stage then frailty and eventually disability. Therefore, a multimodal intervention which includes adequate nutrition, exercise training, good glycaemic control and the use of appropriate hypoglycemic medications may help delay or prevent the progression to disability. Copyright © 2017 Elsevier Inc. All rights reserved.

Relationship Between Ideal Cardiovascular Health and Disability in Older Adults: The Chilean National Health Survey (2009-10).

PubMed

García-Hermoso, Antonio; Ramírez-Vélez, Robinson; Ramirez-Campillo, Rodrigo; Izquierdo, Mikel

2017-12-01

This study aimed to examine the relationship between disability and the American Heart Association metric of ideal cardiovascular health (CVH) in older adults from the 2009-10 Chilean National Health Survey. Data from 460 older adults were analyzed. All subjects were interviewed using the standardized World Health Survey, which includes 16 health-related questions and assesses the domains of mobility, self-care, pain and discomfort, cognition, interpersonal activities, vision, sleep and energy, and affect. A person who responds with a difficulty rating of severe, extreme, or unable to do in at least one of these eight functioning domains is considered to have a disability. Ideal CVH was defined as meeting the ideal levels of four behaviors (smoking, body mass index, physical activity, diet adherence) and three factors (total cholesterol, fasting glucose, blood pressure). Logistic regression analysis suggested that ideal physical activity reduces the odds of disability (odds ratio (OR) = 0.55, 95% confidence interval (CI) = 0.36-0.85). Moreover, participants with intermediate (3-4 metrics) (OR = 0.63, 95% CI = 0.41-0.97) and ideal (5-7 metrics) (OR = 0.51, 95% CI = 0.24-0.97) CVH profiles had lower odds of disability independent of history of vascular events and arthritis disease than those with a poor profile (0-2 metrics). In conclusion, despite the cross-sectional design, this study suggests the importance of promoting ideal CVH because of their relationship with disability. © 2017, Copyright the Authors Journal compilation © 2017, The American Geriatrics Society.

Aging Well Among Women Veterans Compared With Non-Veterans in the Women’s Health Initiative

PubMed Central

LaCroix, Andrea Z.; Rillamas-Sun, Eileen; Woods, Nancy F.; Weitlauf, Julie; Zaslavsky, Oleg; Shih, Regina; LaMonte, Michael J.; Bird, Chloe; Yano, Elizabeth M.; LeBoff, Meryl; Washington, Donna; Reiber, Gayle

2016-01-01

Abstract Purpose of the Study: To examine whether Veteran status influences (a) women’s survival to age 80 years without disease and disability and (b) indicators of successful, effective, and optimal aging at ages 80 years and older. Design and Methods: The Women’s Health Initiative (WHI) enrolled 161,808 postmenopausal women aged 50–79 years from 1993 to 1998. We compared successful aging indicators collected in 2011–2012 via mailed questionnaire among 33,565 women (921 Veterans) who reached the age of 80 years and older, according to Veteran status. A second analysis focused on women with intact mobility at baseline who could have reached age 80 years by December 2013. Multinominal logistic models examined Veteran status in relation to survival to age 80 years without major disease or mobility disability versus having prevalent or incident disease, having mobility disability, or dying prior to age 80 years. Results: Women Veterans aged 80 years and older reported significantly lower perceived health, physical function, life satisfaction, social support, quality of life, and purpose in life scale scores compared with non-Veterans. The largest difference was in physical function scores (53.0 for Veterans vs 59.5 for non-Veterans; p < .001). Women Veterans were significantly more likely to die prior to age 80 years than non-Veteran WHI participants (multivariate adjusted odds ratio = 1.20; 95% confidence interval, 1.04–1.38). In both Veteran and non-Veteran women, healthy survival was associated with not smoking, higher physical activity, healthy body weight, and fewer depressive symptoms. Implications: Intervening upon smoking, low physical activity, obesity, and depressive symptoms has potential to improve chances for healthy survival in older women including Veterans. PMID:26768388

B.A.I.L.A. - A Latin dance randomized controlled trial for older Spanish-speaking Latinos: Rationale, design, and methods

PubMed Central

Marquez, David X.; Wilbur, JoEllen; Hughes, Susan; Berbaum, Michael L.; Wilson, Robert; Buchner, David M.; McAuley, Edward

2014-01-01

Physical activity (PA) has documented health benefits, but older Latinos are less likely to engage in leisure time PA than older non-Latino whites. Dance holds promise as a culturally appropriate form of PA that challenges individuals physically and cognitively. This paper describes a randomized controlled trial that will test the efficacy of BAILAMOS©, a 4-month Latin dance program followed by a 4-month maintenance program, for improving lifestyle PA and health outcomes. Older adults (n = 332), aged 55+, Latino/Hispanic, Spanish speaking, with low PA levels, and at risk for disability will be randomized to one of two programs, a dance program or health education control group. BAILAMOS© is a 4-month program that meets two times per week for one hour per session. Dance sessions focus on instruction, including four styles of dance, and couples dancing. Bi-monthly “Fiestas de Baile” (dance parties) are also included, in which participants dance and practice what they have learned.. Monthly 1-hour discussion sessions utilize a Social Cognitive framework and focus on knowledge, social support, and self-efficacy to increase lifestyle PA. The health education control group will meet one time per week for two hours per session. Primary outcomes including PA changes and secondary outcomes including self-efficacy, physical function, cognitive function, and disability will be assessed at baseline, 4, and 8 months. It is hypothesized that PA, self-efficacy, physical function, cognitive function, and functional limitations and disability scores will be significantly better in the BAILAMOS© group at 4 and 8 months compared to the control group. PMID:24969395

The impact of comorbidity of mental and physical conditions on role disability in the US adult household population.

PubMed

Merikangas, Kathleen R; Ames, Minnie; Cui, Lihong; Stang, Paul E; Ustun, T Bedirhan; Von Korff, Michael; Kessler, Ronald C

2007-10-01

There is limited information that accounts for comorbidity on the impact of role disability associated with a wide range of mental and physical disorders in population-based samples. To estimate the comparative effects of common mental and physical conditions on role disability in the general population using a novel method that accounts for comorbidity. Direct interviews about physical and mental conditions during the past year. The National Comorbidity Survey Replication, a nationally representative series of face-to-face interviews. A nationally representative sample of adults living in households (N = 5962 respondents, 18 years and older). Disability in major life roles was assessed with the World Health Organization Disability Assessment Schedule. Simulations that allow for complex interactions among conditions were used to estimate the conditions' effects on disability days, when respondents were completely unable to carry out their usual daily activities because of problems with mental or physical health, in the past 12 months. An estimated 53.4% of US adults have 1 or more of the mental or physical conditions assessed in the survey. These respondents report an average 32.1 more role-disability days in the past year than demographically matched controls, equivalent to nearly 3.6 billion days of role disability in the population. Musculoskeletal disorders and major depression had the greatest effects on disability days. Mental conditions accounted for more than half as many disability days as all physical conditions at the population level. Associations of specific conditions with disability decreased substantially after controlling for comorbidity, suggesting that prior studies, which generally did not control for comorbidity, overestimated disease-specific effects. The staggering amount of health-related disability associated with mental and physical conditions should be considered in establishing priorities for the allocation of health care and research resources.

Short-term change in physical function and disability: the Women's Health and Aging Study.

PubMed

Mendes de Leon, Carlos F; Guralnik, Jack M; Bandeen-Roche, Karen

2002-11-01

Although measures of physical function are predictive of future disability, little is known about the short-term impact of changes in physical function on disability. Data from 93 of the 102 women who participated in the Weekly Substudy of the Women's Health and Aging Study (WHAS) were used to explore the association of changes in physical function with disability. The WHAS Substudy included 24 weekly assessments of three standard performance tests and self-reported disability in activities of daily living (ADLs) and basic mobility. Using random-effects models, we found small but significant (ps <.01) changes in ADL and mobility disability during weekly follow-up. Baseline performance scores were significantly associated with both ADL and mobility disability (ps <.001), accounting for 27% and 36% of the between-person variability in each type of disability, respectively. After adjustment for baseline scores, change in performance scores was significantly associated with ADL disability (beta = 0.08, p <.01) and mobility disability (beta = 0.12, p <.001), but accounted only for a small proportion (<10%) of the variability in the rate of change in disability outcomes. There was no evidence for an additional effect on either type of disability because of having a single episode of a higher or lower than usual performance score, or because of periods of at least 4 consecutive higher or lower than usual performance test scores. Basic physical functions account for a substantial proportion of the heterogeneity in ADL and mobility disability among older disabled women, but have a relatively small impact on short-term changes in either type of disability. Effective prevention of disability may require attention to a wider array of risk factors than just limitations in basic physical functions.

Incident physical disability in people with lower extremity peripheral arterial disease: the role of cardiovascular disease.

PubMed

Brach, Jennifer S; Solomon, Cam; Naydeck, Barbara L; Sutton-Tyrrell, Kim; Enright, Paul L; Jenny, Nancy Swords; Chaves, Paulo M; Newman, Anne B

2008-06-01

To evaluate the risk of incident physical disability and the decline in gait speed over a 6-year follow-up associated with a low ankle-arm index (AAI) in older adults. Observational cohort study. Forsyth County, North Carolina; Sacramento County, California; Washington County, Maryland; and Allegheny County, Pennsylvania. Four thousand seven hundred five older adults, 58% women and 17.6% black, participating in the Cardiovascular Health Study. AAI was measured in 1992/93 (baseline). Self-reported mobility, activity of daily living (ADL), and instrumental activity of daily living (IADL) disability and gait speed were recorded at baseline and at 1-year intervals over 6 years of follow-up. Mobility disability was defined as any difficulty walking half a mile and ADL and IADL disability was defined as any difficulty with 11 specific ADL and IADL tasks. Individuals with mobility, ADL, or IADL disability at baseline were excluded from the respective incident disability analyses. Lower baseline AAI values were associated with increased risk of mobility disability and ADL/IADL disability. Clinical cardiovascular disease (CVD), diabetes mellitus, and interim CVD events partially explained these associations for mobility disability and clinical CVD and diabetes mellitus partially explained these associations for ADL and IADL disability. Individuals with an AAI less than 0.9 had on average a mean decrease in gait speed of 0.02 m/s per year, or a decline of 0.12 m/s over the 6-year follow-up. Prevalent CVD partly explained this decrease but interim CVD events did not further attenuate it. Low AAI serves as marker of future disability risk. Reduction of disability risk in patients with a low AAI should consider cardiovascular comorbidity and the prevention of additional disabling CVD events.

The predictive power of physical function assessed by questionnaire and physical performance measures for subsequent disability.

PubMed

Hoshi, Masayuki; Hozawa, Atsushi; Kuriyama, Shinichi; Nakaya, Naoki; Ohmori-Matsuda, Kaori; Sone, Toshimasa; Kakizaki, Masako; Niu, Kaijun; Fujita, Kazuki; Ueki, Shouzoh; Haga, Hiroshi; Nagatomi, Ryoichi; Tsuji, Ichiro

2012-08-01

To compare the predictive power of physical function assessed by questionnaire and physical performance measures for subsequent disability in community-dwelling elderly persons. Prospective cohort study. Participants were 813 aged 70 years and older, elderly Japanese residing in the community, included in the Tsurugaya Project, who were not disabled at the baseline in 2003. Physical function was assessed by the questionnaire of "Motor Fitness Scale". Physical performance measures consisted of maximum walking velocity, timed up and go test (TUG), leg extension power, and functional reach test. The area under the curve (AUC) of the receiver operating characteristic curve for disability was used to compare screening accuracy between Motor Fitness Scale and physical performance measures. Incident disability, defined as certification for long-term care insurance, was used as the endpoint. We observed 135 cases of incident disability during follow-up. The third or fourth quartile for each measure was associated with a significantly increased risk of disability in comparison with the highest quartile. The AUC was 0.70, 0.72, 0.70, 0.68, 0.69 and 0.74, for Motor Fitness Scale, maxi- mum walking velocity, TUG, leg extension power, functional reach test, and total performance score, respectively. The predictive power of physical function assessed by the Motor Fitness Scale was equivalent to that assessed by physical performance measures. Since Motor Fitness Scale can evaluate physical function safely and simply in comparison with physical performance tests, it would be a practical tool for screening persons at high risk of disability.

Family Caregiver Factors Associated with Unmet Needs for Care of Older Adults.

PubMed

Beach, Scott R; Schulz, Richard

2017-03-01

To examine caregiver factors associated with unmet needs for care of older adults. Population-based surveys of caregivers and older adult care recipients in the United States in 2011. 2011 National Health and Aging Trends Study and National Study of Caregiving. Family caregivers (n = 1,996) of community-dwelling older adults with disabilities (n = 1,366). Disabled care recipient reports of unmet needs for care in the past month with activities of daily living (ADLs; e.g., wet or soiled clothing), mobility (e.g., have to stay inside), or instrumental activities of daily living (IADLs; e.g., medication errors). Caregiver reported sociodemographic characteristics, caregiving intensity and tasks performed, health, and psychosocial effects. Of the care recipients, 44.3% reported at least one unmet need for care in the past month (38.2% ADL related, 14.6% IADL related). Younger caregivers, caregiving sons, caregivers not living with care recipients, and having supplemental paid caregivers were associated with more unmet needs. Caregivers with recipients reporting two or more unmet needs were more likely to spend more than 100 hours per month caregiving, help with skin care and wounds, report caregiving as emotionally and physically difficult, and report restricted participation in valued activities (all P < .001). Unmet ADL needs are prevalent among older adults with family caregivers. Caregivers experiencing high levels of burden, stress, and negative physical and psychosocial impacts may provide substandard or poor care to older adults, which may be a risk factor for neglect. Clinicians caring for disabled older adults should assess their unmet needs and the capacity of caregivers to address them. © 2016, Copyright the Authors Journal compilation © 2016, The American Geriatrics Society.

A Portrait of Older Californians With Disabilities Who Rely on Public Services to Remain Independent

PubMed Central

KIETZMAN, KATHRYN G.; WALLACE, STEVEN P.; DURAZO, EVA M.; TORRES, JACQUELINE M.; CHOI, ANNE SOON; BENJAMIN, A. E.; MENDEZ-LUCK, CAROLYN

2013-01-01

Low-income older adults with disabilities in California depend on a variety of public programs to help them remain in their own homes. The availability of those services has been in flux since 2009 because of cuts caused by the recession. This article reports on a qualitative study of 33 California seniors who depend on fragile arrangements of paid and unpaid assistance. Thematic analyses of in-depth interviews conducted with these older adults and their caregivers indicate that the disability needs of these individuals are often unstable, with both physical and mental health status sometimes changing day to day. Most have nowhere else to turn for help if their public services are cut. All share the common goal of staying at home and maintaining their independence. Public services serve as a crucial link in the support networks of these individuals. PMID:23216515

Independence at risk: older Californians with disabilities struggle to remain at home as public supports shrink.

PubMed

Kietzman, Kathryn G; Durazo, Eva M; Torres, Jacqueline M; Choi, Anne Soon; Wallace, Steven P

2011-12-01

This policy brief presents findings from a yearlong study that closely followed a small but typical set of older Californians with disabilities who depend on fragile arrangements of paid public programs and unpaid help to live safely and independently at home. Many of these older adults have physical and mental health needs that can rise or fall with little warning; most are struggling with increasing disability as they age. In spite of these challenges, most display resilience and fortitude, and all share a common determination to maintain their independence at almost any cost. Declines in health status and other personal circumstances among aging Californians have been exacerbated by recent reductions in public support, and will be made even worse by significant additional cuts that are pending. Policy recommendations include consolidating long-term care programs and enhancing support for caregivers.

A New Adaptive Home-based Exercise Technology among Older Adults Living in Nursing Home: A Pilot Study on Feasibility, Acceptability and Physical Performance.

PubMed

Valiani, V; Lauzé, M; Martel, D; Pahor, M; Manini, T M; Anton, S; Aubertin-Leheudre, M

2017-01-01

To explore the feasibility and acceptability of a new home-based exercise technology among older adults and to evaluate its efficacy on physical performance measures. Longitudinal clinical trial. Oak Hammock at the University of Florida, a nursing home located in Gainesville, Florida. Twelve pre-disabled older adults (≥75 years) living in a nursing home with a Short Physical Performance Battery (SPPB) score between 6 and 9 and no diagnosis of dementia. Thirty minutes of light intensity exercise (aerobic, strength and balance) two times per week for four weeks using a home-based physical activity technology called Jintronix. Feasibility and acceptability were assessed through a 9-item self-administered questionnaire and by exploring the percentage of quality of movements and time performing exercise which was calculated automatically by Jintronix technology. Physical performance measures were assessed through the SPPB score at baseline, after 4 weeks of intervention and after 3 months from the completion of the intervention. Twelve older adults (80.5±4.2 years old) performed light intensity exercise with Jintronix for a total of 51.9±7.9 minutes per week. Participants reached 87% score of quality of movements in strength and balance exercises, a global appreciation score of 91.7% and a global difficulty score of 36%. Compared to baseline, there was a significant improvement in SPPB score at the end of the intervention and at 3 months following the completion of the exercise program (0.67±0.98 and 1.08±0.99 respectively, p-value <0.05). Jintronix technology is feasible and acceptable among pre-disabled older adults without dementia living in nursing home and is beneficial in improving their physical performance.

Depression and disability: comparisons with common physical conditions in the Ibadan study of aging.

PubMed

Gureje, Oye; Ademola, Adedotun; Olley, Benjamin O

2008-11-01

To compare the effects of depression and chronic physical conditions on disability in elderly persons. Yoruba-speaking areas of Nigeria. Interviews. PATICIPANTS: Community-dwelling persons aged 65 and older. Face-to-face interviews were conducted with a representative sample of community-dwelling persons aged 65 and older (N=2,152) in the Yoruba-speaking areas of Nigeria (representing approximately 22% of the national population). Major depressive disorder (MDD) was assessed using the World Health Organization Composite International Diagnostic Interview. Chronic pain and medical disorders were assessed using self-report. Disorder-specific disability was evaluated using the Sheehan Disability Scale (SDS). MDD was highly comorbid with each of the medical conditions (odds ratio range 1.3-2.0). A higher proportion of persons with MDD (47.2%) were rated severely disabled globally than those with arthritis (20.6%), chronic spinal pain (24.2%), or high blood pressure (25.0%). Subjects with MDD were also more likely to be severely disabled in three of the four domains of the SDS. In pair-wise comparisons, persons with MDD had significantly higher levels of disability than those with any of the disorders, with differences in mean scores ranging between -3.74 and -27.50. To reduce the public health burden of depression, its prevention and treatment require more clinical and research attention than currently given by developing countries.

Criterion-Referenced Values of Grip Strength and Usual Gait Speed Using Instrumental Activities of Daily Living Disability as the Criterion.

PubMed

Lee, Meng-Chih; Hsu, Chih-Cheng; Tsai, Yi-Fen; Chen, Ching-Yu; Lin, Cheng-Chieh; Wang, Ching-Yi

Current evidence suggests that grip strength and usual gait speed (UGS) are important predictors of instrumental activities of daily living (IADL) disability. Knowing the optimum cut points of these tests for discriminating people with and without IADL disability could help clinicians or researchers to better interpret the test results and make medical decisions. The purpose of this study was to determine the cutoff values of grip strength and UGS for best discriminating community-dwelling older adults with and without IADL disability, separately for men and women, and to investigate their association with IADL disability. We conducted secondary data analysis on a national dataset collected in the Sarcopenia and Translational Aging Research in Taiwan (START). The data used in this study consisted of health data of 2420 community-dwelling older adults 65 years and older with no history of stroke and with complete data. IADL disability was defined as at least 1 IADL item scored as "need help" or "unable to perform." Receiver operating characteristics analysis was used to estimate the optimum grip strength and UGS cut points for best discriminating older adults with/without IADL disability. The association between each physical performance (grip strength and UGS) and IADL disability was assessed with odds ratios (ORs). With IADL disability as the criterion, the optimal cutoff values of grip strength were 28.7 kg for men and 16.0 kg for women, and those for UGS were 0.76 m/s for men and 0.66 m/s for women. The grip strength test showed satisfactory discriminant validity (area under the curve > 0.7) in men and a strong association with IADL disability (OR > 4). Our cut points using IADL disability as the criterion were close to those indicating frailty or sarcopenia. Our reported cutoffs can serve as criterion-referenced values, along with those previously determined using different indicators, and provide important landmarks on the performance continua of older adults' grip strength and UGS. These landmarks could be useful in interpreting test results, monitoring changes in performance, and identifying individuals requiring timely intervention. For identifying older adults at risk of IADL disability, grip strength is superior to UGS.

Serum Micronutrient Concentrations and Decline in Physical Function Among Older Persons

PubMed Central

Bartali, Benedetta; Frongillo, Edward A.; Guralnik, Jack M.; Stipanuk, Martha H.; Allore, Heather G.; Cherubini, Antonio; Bandinelli, Stefania; Ferrucci, Luigi; Gill, Thomas M.

2009-01-01

Context Maintaining independence of older persons is a public health priority, and identifying the factors that contribute to decline in physical function is needed to prevent or postpone the disablement process. The potential deleterious effect of poor nutrition on decline in physical function in older persons is unclear. Objective To determine whether a low serum concentration of micronutrients is associated with subsequent decline in physical function among older men and women living in the community. Design, Setting, and Participants Longitudinal study of 698 community-living persons 65 years or older who were randomly selected from a population registry in Tuscany, Italy. Participants completed the baseline examination from November 1, 1998, through May 28, 2000, and the 3-year follow-up assessments from November 1, 2001, through March 30, 2003. Main Outcome Measure Decline in physical function was defined as a loss of at least 1 point in the Short Physical Performance Battery during the 3-year follow-up. Odds ratios (ORs) were calculated for the lowest quartile of each nutrient using the other 3 quartiles combined as the reference group. Two additional and complementary analytical approaches were used to confirm the validity of the results. Results The mean decline in the Short Physical Performance Battery score was 1.1 point. In a logistic regression analysis that was adjusted for potential confounders, only a low concentration of vitamin E (<1.1 μg/mL [<24.9 μmol/L]) was significantly associated with subsequent decline in physical function (OR, 1.62; 95% confidence interval, 1.11-2.36; P=.01 for association of lowest α-tocopherol quartile with at least a 1-point decline in physical function). In a general linear model, the concentration of vitamin E at baseline, when analyzed as a continuous measure, was significantly associated with the Short Physical Performance Battery score at follow-up after adjustment for potential confounders and Short Physical Performance Battery score at baseline (β=.023; P=.01). In a classification and regression tree analysis, age older than 81 years and vitamin E (in participants aged 70-80 years) were identified as the strongest determinants of decline in physical function (physical decline in 84% and 60%, respectively; misclassification error rate, 0.33). Conclusions These results provide empirical evidence that a low serum concentration of vitamin E is associated with subsequent decline in physical function among community-living older adults. Clinical trials may be warranted to determine whether an optimal concentration of vitamin E reduces functional decline and the onset of disability in older persons. PMID:18212315

A comparison of correlates of self-rated health and functional disability of older persons in the Far East: Japan and Korea.

PubMed

Lee, Yunhwan; Shinkai, Shoji

2003-01-01

Self-rated health and physical functioning are recognized as important indicators of health in older persons. Rarely, however, there have been studies done which examine cross-cultural differences in the health of older people using these measures, especially among non-Western countries. The objective of this study was to examine patterns of association of self-rated health and functional disability of Japanese and Korean elderly people living in the community, using nationwide surveys of persons aged 60 years or over. There were striking similarities in the general pattern of associations with covariates. In the multivariate analysis, age, work status, comorbidity, depressive symptoms, life satisfaction, hospitalization, and functional disability were strongly associated with self-rated health in both populations. For functional disability, older age, female, low social contact, depressive symptoms, poor life satisfaction, and poor self-rated health were found to be significantly associated. Some differences in the structure of associations with self-rated health, however, were noted. Women tended to assess their health more favorably than men in Korea, but in the Japanese elderly gender differences disappeared when other variables were taken into account. Health-related variables tended to be more closely associated with functional disability in the Japanese sample. An overall similarity, however, in the pattern of associations of these measures supports their utility in assessing and comparing the health of older populations in this region.

Activity Restriction Induced by Fear of Falling and Objective and Subjective Measures of Physical Function: A Prospective Cohort Study

PubMed Central

Deshpande, Nandini; Metter, E. Jeffrey; Lauretani, Fulvio; Bandinelli, Stefania; Guralnik, Jack; Ferrucci, Luigi

2009-01-01

Objectives To examine whether activity restriction specifically induced by fear of falling (FF) contributes to greater risk of disability and decline in physical function. Design Prospective cohort study. Setting Population-based older cohort. Participants Six hundred seventy-three community-living elderly (≥65) participants in the Invecchiare in Chianti Study who reported FF. Measurements FF, fear-induced activity restriction, cognition, depressive symptoms, comorbidities, smoking history, and demographic factors were assessed at baseline. Disability in activities of daily living (ADLs) and instrumental activities of daily living (IADLs) and performance on the Short Performance Physical Battery (SPPB) were evaluated at baseline and at the 3-year follow-up. Results One-quarter (25.5%) of participants did not report any activity restriction, 59.6% reported moderate activity restriction (restriction or avoidance of <3 activities), and 14.9% reported severe activity restriction (restriction or avoidance of ≥3 activities). The severe restriction group reported significantly higher IADL disability and worse SPPB scores than the no restriction and moderate restriction groups. Severe activity restriction was a significant independent predictor of worsening ADL disability and accelerated decline in lower extremity performance on SPPB over the 3-year follow-up. Severe and moderate activity restriction were independent predictors of worsening IADL disability. Results were consistent even after adjusting for multiple potential confounders. Conclusion In an elderly population, activity restriction associated with FF is an independent predictor of decline in physical function. Future intervention studies in geriatric preventive care should directly address risk factors associated with FF and activity restriction to substantiate long-term effects on physical abilities and autonomy of older persons. PMID:18312314

Best-Practice Physical Activity Programs for Older Adults: Findings From the National Impact Study

PubMed Central

Seymour, Rachel B.; Campbell, Richard T.; Whitelaw, Nancy; Bazzarre, Terry

2009-01-01

Objectives. We assessed the impact of existing best-practice physical activity programs for older adults on physical activity participation and health-related outcomes. Methods. We used a multisite, randomized trial with 544 older adults (mean age 66 years) and measures at baseline, 5, and 10 months to test the impact of a multiple-component physical activity program compared with results for a control group that did not participate in such a program. Results. For adults who participated in a multiple-component physical activity program, we found statistically significant benefits at 5 and 10 months with regard to self-efficacy for exercise adherence over time (P < .001), adherence in the face of barriers (P = .01), increased upper- and lower-body strength (P = .02, P = .01), and exercise participation (P = .01). Conclusions. Best-practice community-based physical activity programs can measurably improve aspects of functioning that are risk factors for disability among older adults. US public policy should encourage these inexpensive health promotion programs. PMID:19059858

Prevalence and Influencing Factors of Metabolic Syndrome Among Persons with Physical Disabilities.

PubMed

Jeong, Jeonghee; Yu, Jungok

2018-03-01

Metabolic syndrome is an important cluster of coronary heart disease risk factors. However, it remains unclear to what extent metabolic syndrome is associated with demographic and potentially modifiable lifestyle factors among Korean persons with physical disabilities. This study aimed to determine the prevalence and influencing factors of metabolic syndrome among persons with physical disabilities using the Korean National Health Insurance Service-National Sample Cohort. The Adult Treatment Panel III criteria were used to define metabolic syndrome influencing factors and prevalence, which were evaluated in a representative sample from the 2013 Korean National Health Insurance Service-National Sample Cohort database. Characteristics were compared based on frequency using the χ 2 test. The associations between metabolic syndrome and its risk factors were estimated using logistic multivariable regression analysis. Metabolic syndrome was detected in 31.5% of the surveyed persons with physical disabilities. Female sex, age of ≥65 years, smoking, greater alcohol consumption, physical inactivity, higher body mass index, and a family history of diabetes were associated with increased risks of metabolic syndrome. The major risk factors for metabolic syndrome among persons with physical disabilities were obesity and older age. Performing physical activity was associated with a lower risk of metabolic syndrome. Therefore, we recommend using a continuous obesity management program and physical activity to prevent metabolic syndrome among persons with physical disabilities. Copyright © 2018. Published by Elsevier B.V.

Inflammation and Oxidative Stress as Biomarkers of Premature Aging in Persons with Intellectual Disability

ERIC Educational Resources Information Center

Carmeli, Eli; Imam, Bita; Bachar, Asad; Merrick, Joav

2012-01-01

The decline in cognitive ability and physical performance in older adults with intellectual disabilities (ID) is accompanied by less participation in social activities and a sedentary lifestyle; however the pathogenesis is not clear yet. It was recently suggested that chronic disease, adverse drug reactions, and aging create a cascade of events…

Why and when social support predicts older adults' pain-related disability: a longitudinal study.

PubMed

Matos, Marta; Bernardes, Sónia F; Goubert, Liesbet

2017-10-01

Pain-related social support has been shown to be directly associated with pain-related disability, depending on whether it promotes functional autonomy or dependence. However, previous studies mostly relied on cross-sectional methods, precluding conclusions on the temporal relationship between pain-related social support and disability. Also, research on the behavioral and psychological processes that account for such a relationship is scarce. Therefore, this study aimed at investigating the following longitudinally: (1) direct effects of social support for functional autonomy/dependence on pain-related disability, (2) mediating role of physical functioning, pain-related self-efficacy, and fear, and (3) whether pain duration and pain intensity moderate such mediating processes. A total of 168 older adults (Mage = 78.3; SDage = 8.7) participated in a 3-month prospective design, with 3 moments of measurement, with a 6-week lag between them. Participants completed the Formal Social Support for Autonomy and Dependence in Pain Inventory, the Brief Pain Inventory, the 36-SF Health Survey, behavioral tasks from the Senior Fitness Test, the Pain Self-Efficacy Questionnaire, and the Tampa Scale for Kinesiophobia. Moderated mediation analyses showed that formal social support for functional dependence (T1) predicted an increase in pain-related disability (T3), that was mediated by self-reported physical functioning (T2) and by pain-related self-efficacy (T2) at short to moderate pain duration and at low to moderate pain intensity, but not at higher levels. Findings emphasized that social support for functional dependence is a risk factor for pain-related disability and uncovered the "why" and "when" of this relationship. Implications for the design of social support interventions aiming at promoting older adults' healthy aging despite chronic pain are drawn.

Prevalence of sarcopenia and associated factors in the healthy older adults of the Peruvian Andes.

PubMed

Tramontano, Alessandra; Veronese, Nicola; Sergi, Giuseppe; Manzato, Enzo; Rodriguez-Hurtado, Diana; Maggi, Stefania; Trevisan, Caterina; De Zaiacomo, Francesca; Giantin, Valter

To assess the prevalence of sarcopenia and associated factors in a population of older people living in a rural area of the Peruvian Andes. The study concerned 222 people aged ≥65 years. Sarcopenia was diagnosed on the basis of skeletal muscle mass, measured using bioimpedance analysis, and gait speed, measured with the 4-m walking test, as recommended by the International Working Group on sarcopenia. Self-reported physical activity, the Short Physical Performance Battery, and the Six-Minute Walking Test also contributed information on participants' physical performance status. Disabilities were investigated by assessing participants' self-reported difficulties in performing one or more basic or instrumental activities of daily living. The prevalence of sarcopenia was 17.6%. Compared with participants without sarcopenia, individuals who were found sarcopenic were significantly older, female and were less frequently farmers, had fewer children, had a worse nutritional status, a significantly lower physical performance, and higher levels of disability in the instrumental activities of daily living. After adjusting for potential confounders, age, female sex, a low body mass index, a self-reported low physical activity level, a worse Six-Minute Walking Test scores, and a low number of children were significantly associated with sarcopenia. The prevalence of sarcopenia seems to be quite high among community-dwelling older subjects in the Peruvian Andes. Age, female sex, a low body mass index, little physical activity, a poor Six-Minute Walking Test scores, and a low number of children could be associated with this condition. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Angiotensin-converting enzyme inhibitor use by older adults is associated with greater functional responses to exercise.

PubMed

Buford, Thomas W; Manini, Todd M; Hsu, Fang-Chi; Cesari, Matteo; Anton, Stephen D; Nayfield, Susan; Stafford, Randall S; Church, Timothy S; Pahor, Marco; Carter, Christy S

2012-07-01

To assess the association between angiotensin converting enzyme inhibitors (ACEis) and improvements in the physical function of older adults in response to chronic exercise training. Secondary analysis of the Lifestyle Interventions and Independence for Elders Pilot (LIFE-P) study, a multisite randomized clinical trial to evaluate the effects of chronic exercise on the physical function of older adults at risk for mobility disability. Four academic research centers within the United States. Four hundred twenty-four individuals aged 70 to 89 with mild to moderate functional impairments categorized for this analysis as ACEi users, users of other antihypertensive drugs, or antihypertensive nonusers. A 12-month intervention of structured physical activity (PA) or health education promoting successful aging (SA). Change in walking speed during a 400-m test and performance on a battery of short-duration mobility tasks (Short Physical Performance Battery (SPPB)). Physical activity significantly improved the adjusted walking speed of ACEi users (P < .001) but did not of nonusers. PA improved the adjusted SPPB score of ACEi users (P < .001) and of persons who used other antihypertensive drugs (P = .005) but not of antihypertensive nonusers (P = .91).The percentage of ACEi users deriving clinically significant benefit from exercise training for walking speed (30%) and SPPB score (48%) was dramatically higher than for nonusers (14% and 12%, respectively). For older adults at risk for disability, exercise-derived improvements in physical function were greater for ACEi users than users of other antihypertensive drugs and antihypertensive nonusers. © 2012, Copyright the Authors Journal compilation © 2012, The American Geriatrics Society.

Angiotensin-Converting Enzyme Inhibitor Use by Older Adults Is Associated with Greater Functional Responses to Exercise

PubMed Central

Buford, Thomas W.; Manini, Todd M.; Hsu, Fang-Chi; Cesari, Matteo; Anton, Stephen D.; Nayfield, Susan; Stafford, Randall S.; Church, Timothy S.; Pahor, Marco; Carter, Christy S.

2013-01-01

OBJECTIVES To assess the association between angiotensin converting enzyme inhibitors (ACEis) and improvements in the physical function of older adults in response to chronic exercise training. DESIGN Secondary analysis of the Lifestyle Interventions and Independence for Elders Pilot (LIFE-P) study, a multisite randomized clinical trial to evaluate the effects of chronic exercise on the physical function of older adults at risk for mobility disability. SETTING Four academic research centers within the United States. PARTICIPANTS Four hundred twenty-four individuals aged 70 to 89 with mild to moderate functional impairments categorized for this analysis as ACEi users, users of other antihypertensive drugs, or antihypertensive nonusers. INTERVENTION A 12-month intervention of structured physical activity (PA) or health education promoting successful aging (SA). MEASUREMENTS Change in walking speed during a 400-m test and performance on a battery of short-duration mobility tasks (Short Physical Performance Battery (SPPB)). RESULTS Physical activity significantly improved the adjusted walking speed of ACEi users (P < .001) but did not of nonusers. PA improved the adjusted SPPB score of ACEi users (P < .001) and of persons who used other antihypertensive drugs (P = .005) but not of antihypertensive nonusers (P = .91). The percentage of ACEi users deriving clinically significant benefit from exercise training for walking speed (30%) and SPPB score (48%) was dramatically higher than for nonusers (14% and 12%, respectively). CONCLUSION For older adults at risk for disability, exercise-derived improvements in physical function were greater for ACEi users than users of other antihypertensive drugs and antihypertensive nonusers. PMID:22726232

Beyond equality: Providing equitable care for persons with disabilities

PubMed Central

Wakeham, Scott; Heung, Sally; Lee, Janet; Sadowski, Cheryl A.

2017-01-01

Background: Almost 14% of Canadians have a disability, and older adults are most commonly affected. People living with disabilities have challenges accessing health care services, including medications and other services provided in pharmacies. Methods: A literature review was conducted regarding disability and pharmacy services. Resources regarding accessibility were also incorporated. Results: A number of organizations provide guidance on caring for those with disabilities. A primary concern for these vulnerable individuals relates to being invisible or overlooked by the health care system. There are also the stresses of physical, communication and attitudinal barriers. Pharmacists may be unaware of these barriers and may actually be contributing to them. To understand their patients’ accessibility needs, pharmacists can consider physical and nonphysical barriers and engage in education, advocacy and communications training to improve their patient-centred care for individuals with disabilities. Discussion and Conclusion: Pharmacists can improve the care of individuals with disabilities by learning more about accessibility. Within the community pharmacy environment, there are physical and nonphysical interventions that pharmacists can implement to ensure that patient-centred care is prioritized. PMID:29163726

Seventeen-year time trend in poor self-rated health in older adults: changing contributions of chronic diseases and disability.

PubMed

Galenkamp, Henrike; Braam, Arjan W; Huisman, Martijn; Deeg, Dorly J H

2013-06-01

Studies on trends in the self-rated health (SRH) of older people have shown conflicting results, which might partly be explained by changing associations between SRH and indicators of other health dimensions over time. Therefore, this study investigates 17-year time trends in older adults' poor SRH, in the context of trends in chronic diseases and disability, between 1992 and 2009. Data originate from six measurement waves of the Longitudinal Aging Study Amsterdam (N = 4009, ages 60-85 years). SRH was assessed with the question 'How is your health in general?' The presence of lung disease, cardiac disease, peripheral arterial disease, diabetes mellitus, stroke, arthritis and cancer was assessed by self-report. Two severity levels of disability were assessed with six questions on physical functioning. Generalized Estimating Equations (GEE) analysis was applied to assess statistical significance in each time trend. There was a stable trend in the prevalence of poor SRH and severe disability, while the mean number of chronic diseases (1.3-1.8) and the prevalence of mild disability (20.5-32.1%) increased between 1992 and 2009. The association between poor SRH and chronic diseases became weaker, whereas the association between poor SRH and severe disability became stronger over time. Most unfavourable trends were observed in the older old and the lower educated. Our results suggest that the seeming stability of poor SRH hides underlying increases in chronic diseases and disability: over time, people may attach importance to different aspects of health when rating their overall health.

Association among measures of mobility-related disability and self-perceived fatigue among older people: a population-based study

PubMed Central

Soares, Wuber J. S.; Lima, Camila A.; Bilton, Tereza L.; Ferrioli, Eduardo; Dias, Rosângela C.; Perracini, Monica R.

2015-01-01

Objective: To investigate the relationship between self-perceived fatigue with different physical functioning tests and functional performance scales used for evaluating mobility-related disability among community-dwelling older persons. Method: This is a cross-sectional, population-based study. The sample was composed of older persons with 65 years of age or more living in Cuiabá, MT, and Barueri, SP, Brazil. The data for this study is from the FIBRA Network Study. The presence of self-perceived fatigue was assessed using self-reports based on the Center for Epidemiologic Studies-Depression Scale. The Lawton instrumental activities of daily living scale (IADL) and the advanced activities of daily living scale (AADL) were used to assess performance and participation restriction. The following physical functioning tests were used: five-step test (FST), the Short Physical Performance Battery (SPPB), and usual gait speed (UGS). Three models of logistic regression analysis were conducted, and a significance level of α<0.05 was adopted. Results: The sample was composed of 776 older adults with a mean age (SD) of 71.9 (5.9) years, of whom the majority were women (74%). The prevalence of self-perceived fatigue within the participants was 20%. After adjusting for covariates, SPPB, UGS, IADL, and AADL remained associated with self-perceived fatigue in the final multivariate regression model. Conclusion: Our results suggest that there is an association between self-perceived fatigue and lower extremity function, usual gait speed and activity limitation and participation restriction in older adults. Further cohort studies are needed to investigate which physical performance measure may be able to predict the negative impact of fatigue in older adults. PMID:26039035

Socioeconomic inequalities in health after age 50: Are health risk behaviors to blame?

PubMed Central

Shaw, Benjamin A.; McGeever, Kelly; Grubert, Elizabeth; Agahi, Neda; Fors, Stefan

2013-01-01

Recent studies indicate that socioeconomic inequalities in health extend into the elderly population, even within the most highly developed welfare states. One potential explanation for socioeconomic inequalities in health focuses on the role of health behaviors, but little is known about the degree to which health behaviors account for health inequalities among older adults, in particular. Using data from the Health and Retirement Study (N=19,245), this study examined the degree to which four behavioral risk factors – smoking, obesity, physical inactivity, and heavy drinking – are associated with socioeconomic position among adults aged 51 and older, and whether these behaviors mediate socioeconomic differences in mortality, and the onset of disability among those who were disability-free at baseline, over a 10-year period from 1998–2008. Results indicate that the odds of both smoking and physical inactivity are higher among persons with lower wealth, with similar stratification in obesity, but primarily among women. The odds of heavy drinking decrease at lower levels of wealth. Significant socioeconomic inequalities in mortality and disability onset are apparent among older men and women; however, the role that health behaviors play in accounting for these inequalities differs by age and gender. For example, these health behaviors account for between 23–45% of the mortality disparities among men and middle aged women, but only about 5% of the disparities found among women over 65 years. Meanwhile, these health behaviors appear to account for about 33% of the disparities in disability onset found among women survivors, and about 9–14% among men survivors. These findings suggest that within the U.S. elderly population, behavioral risks such as smoking and physical inactivity contribute moderately to maintaining socioeconomic inequalities in health. As such, promoting healthier lifestyles among the socioeconomically disadvantaged older adults should help to reduce later life health inequalities. PMID:24560224

Older Adults with Intellectual Disabilities: Targets for Increasing Victimization, a Call for a Preemptive Screening Policy

ERIC Educational Resources Information Center

Strasser, Sheryl; O'Quin, Karen; Price, Thomas; Leyda, Elizabeth

2012-01-01

The aging population is a rapidly growing demographic in the United States. Isolation, limited autonomy, and declining physical and mental health render many older adults vulnerable to abuse, neglect, and exploitation. As the population grows, so does the need for Adult Protective Services (APS). This article highlights an ultrasensitive subgroup…

[The "Short Physical Performance Battery" in the Czech Republic -  the pilot and validation study in older persons].

PubMed

Berková, M; Topinková, E; Mádlová, P; Klán, J; Vlachová, M; Běláček, J

2013-04-01

Population ageing increases number of seniors with decline of physical capabilities and functional deficits. Targeted interventions to maintain or increase physical performance are most effective before the development of full frailty, in so-called "prefrail" period. One of the assessment tools for evaluation of the physical performance and/ or frailty in older persons is the "Short Physical Performance Battery" -  SPPB. The aim of the study was to introduce the assessment battery to clinical practice in the CR and to evaluate its selected psychometric properties. Original English SPPB was translated into Czech language and back translated to ensure linguistic accuracy. SPPB was applied in the selected sample of older persons and validated against other performance tools for cognition, self- care and nutrition status used in CR and selected psychometric properties evaluated. We examined 145 older persons (108 women, i.e. 74.48 % and 37 men, i.e. 25.52 %) mean age 80.38 years (54- 101 years, SD ± 8,47). We found good physical performance in 35 (24.1 %) older persons (SPPB 10- 12 points), 21 (14.5 %) were identified as prefrail (SPPB 7- 9 points) and 89 (61.4 %) as frail in high risk of future disability or already disabled (SPPB 6 points). We found statistically significant correlation of global SPPB score with nutritional status (MNA- Short Form), activities of daily living performance (ADL) and cognitive performance (MMSE) -  (Spearman correlation ρ = 0.51; 0.53 and 0.38 respectively). The Cronbachs a for SPPB variables scored 0.821, which is consistent with good internal consistency of SPPB battery. When evaluating 3 age groups [ 75 years (n = 41), 76- 85 (n = 62) and 86- 101 years (n = 42)] the most significant correlations were found between SPPB and MNA, ADL and MMSE in the young elderly (ρ = 0.74, 0.79 and 0.64 respectively) and they diminished with increasing age. We confirmed significant correlations between SPPB and self care activities, cognitive performance and nutritional status and good internal consistency of the battery. SPPB test is simple, easy to perform, with low time and cost requirements. It could be recommended for clinical practice in both community and hospitalized older patients to evaluate their overall physical performance and identify persons at risk of frailty and disability who may profit from targeted interventions.

Efficacy of percutaneous electrical nerve stimulation for the treatment of chronic low back pain in older adults.

PubMed

Weiner, Debra K; Rudy, Thomas E; Glick, Ronald M; Boston, J Robert; Lieber, Susan J; Morrow, Lisa A; Taylor, Stephen

2003-05-01

To determine the efficacy of a complementary analgesic modality, percutaneous electrical nerve stimulation (PENS), for the treatment of chronic low back pain (CLBP) in community-dwelling older adults. Randomized, controlled clinical trial. University of Pittsburgh Pain Evaluation and Treatment Institute. Thirty-four English speaking, community-dwelling adults aged 65 and older with CLBP of at least moderate intensity experienced every day or almost every day. Subjects were randomized to receive twice-weekly PENS and physical therapy (PT) or sham PENS and physical therapy for 6 weeks. At baseline, immediately after the 6-week intervention period, and 3 months later, the primary outcome measures pain intensity and pain-related disability were assessed. The secondary outcome measures physical performance (timed chair rise, functional reach, gait speed, static and isoinertial lifting), psychosocial factors (mood, sleep, and life control), and cognitive function (measures of attention, concentration, and mental flexibility) were also collected. Subjects randomized to PENS plus PT displayed significant reductions in pain intensity measures from pre- to posttreatment (P <.001), but the sham PENS plus PT group did not (P =.94). These pain reduction effects were maintained at 3-month follow-up. Similarly, significant reductions in pain-related disability were observed at posttreatment (P =.002) for the PENS plus PT group and were maintained at follow-up, but the sham PENS plus PT group did not show reductions in pain-related disability (P =.81). Of the secondary outcome measures, psychosocial function, timed chair rise, and isoinertial lifting endurance also improved significantly at posttreatment for the PENS plus PT group, and their improvement was sustained at 3-month follow-up, but the sham PENS plus PT did not display significant changes on these measures after treatment. This preliminary study suggests that PENS may be a promising treatment modality for community-dwelling older adults with CLBP, as demonstrated by reduction in pain intensity and self-reported disability, and improvement in mood, life control, and physical performance. Larger studies with longer duration of follow-up are needed to validate these findings and support the use of PENS in clinical practice.

Recruitment Techniques among Understudied Populations and Their Implications for Physical Activity Promotion

ERIC Educational Resources Information Center

Kosma, Maria; Cardinal, Bradley; McCubbin, Jeffrey A.

2004-01-01

The inclusion of a representative sample of understudied populations (e.g., women, minorities, older adults, youth, and people with disabilities) in physical activity promotion studies is a public health priority. Given the limited empirical evidence of effective recruitment strategies and limitations in research methodology for both over…

Association of sarcopenia with depressive symptoms and functional status among ambulatory community-dwelling elderly.

PubMed

Kilavuz, Asli; Meseri, Reci; Savas, Sumru; Simsek, Hatice; Sahin, Sevnaz; Bicakli, Derya Hopanci; Sarac, Fulden; Uyar, Mehmet; Akcicek, Fehmi

Sarcopenia, functional disability, and depression are common problems in the elderly. Sarcopenia is associated with physical disability, functional impairment, depression, cardiometabolic diseases, and even mortality. This study aims to determine the association of sarcopenia with depression and functional status among ambulatory community-dwelling elderly aged 65 years and older. The sample of this cross-sectional study consisted of 28,323 people, aged 65 years and older, living in Bornova, Izmir. Multi-stage sample selection was performed to reach 1007 individuals. However, 966 elderly people could be reached, and 861 elderly people who can walk were included in the study. The data were collected by the interviewers at home through face-to-face interview. The mean age was 72.2 ± 5.8 (65-100) years. The prevalence of functional disability, depressive symptoms, and sarcopenia were 21.7%, 25.2%, and 4.6%, respectively. In multivariate analysis depression was associated with sarcopenia, being illiterate and divorced, perception of the economic situation as poor/moderate, increased number of chronic diseases, and having at least one physical disability. IADL associated functional disability with sarcopenia, being illiterate/literate and female, increased age and number of medications, and the BMI. Sarcopenia in ambulatory community-dwelling elderly is significantly associated with depressive symptoms and functional disability. Elderly people at high risk of sarcopenia should be screened for functional disability and depression. Appropriate interventions should also be implemented. Copyright © 2018 Elsevier B.V. All rights reserved.

Growing old with fibromyalgia: factors that predict physical function.

PubMed

Torma, Linda M; Houck, Gail M; Wagnild, Gail M; Messecar, Deborah; Jones, Kim Dupree

2013-01-01

Fibromyalgia, a persistent, widespread pain condition, significantly limits physical function, threatening an older adult's health and ability to live independently. The aim of the study was to identify predictors of physical function in older adults living with fibromyalgia and to examine the influence of resilience on the relationship between fibromyalgia pain and physical function. This was a descriptive correlational, cross-sectional design using mailed questionnaires to analyze relationships between health-related variables and physical function in a convenience sample of community-dwelling older adults diagnosed with fibromyalgia (n = 224; age M = 62.1 years, SD = 6.75 years). Multiple regression was used to identify a priori predictors of physical function; hierarchical multiple regression was used to examine resilience as a moderator of pain and physical function. The sample was predominantly women, Caucasian, married, well educated, had moderate levels of income and tangible social support, and had low levels of physical function. Three-fourths were overweight or obese. Despite impaired physical function (Late Life Function and Disability Index, M = 51.5/100, SD = 9) and moderate levels of pain (Numeric Rating Scale, M = 5.47/10, SD = 2.6), resilience was moderately high (Resilience Scale, M = 137/175, SD = 20). An eight-variable disablement-based model accounted for 48% of variance in physical function: age, income, education, depressive symptoms, body mass index, and physical activity accounted for 31%; pain added 14%; and resilience contributed an additional 3%. Resilience was not a moderator of fibromyalgia pain and physical function; resilience did contribute uniquely to physical function variance. Resilience, a novel variable in fibromyalgia research, was a unique predictor of physical function. Further research is needed to learn more about the relationships between resilience, fibromyalgia impact, and the aging process.

Multiple Hormonal Dysregulation as Determinant of Low Physical Performance and Mobility in Older Persons

PubMed Central

Maggio, Marcello; Lauretani, Fulvio; De Vita, Francesca; Basaria, Shehzad; Lippi, Giuseppe; Buttò, Valeria; Luci, Michele; Cattabiani, Chiara; Ceresini, Graziano; Verzicco, Ignazio; Ferrucci, Luigi; Ceda, Gian Paolo

2015-01-01

Mobility-disability is a common condition in older individuals. Many factors, including the age-related hormonal dysregulation, may concur to the development of disability in the elderly. In fact, during the aging process it is observed an imbalance between anabolic hormones that decrease (testosterone, dehydroepiandrosterone sulphate (DHEAS), estradiol, insulin like growth factor-1 (IGF-1) and Vitamin D) and catabolic hormones (cortisol, thyroid hormones) that increase. We start this review focusing on the mechanisms by which anabolic and catabolic hormones may affect physical performance and mobility. To address the role of the hormonal dysregulation to mobility-disability, we start to discuss the contribution of the single hormonal derangement. The studies used in this review were selected according to the period of time of publication, ranging from 2002 to 2013, and the age of the participants (≥65 years). We devoted particular attention to the effects of anabolic hormones (DHEAS, testosterone, estradiol, Vitamin D and IGF-1) on both skeletal muscle mass and strength, as well as other objective indicators of physical performance. We also analyzed the reasons beyond the inconclusive data coming from RCTs using sex hormones, thyroid hormones, and vitamin D (dosage, duration of treatment, baseline hormonal values and reached hormonal levels). We finally hypothesized that the parallel decline of anabolic hormones has a higher impact than a single hormonal derangement on adverse mobility outcomes in older population. Given the multifactorial origin of low mobility, we underlined the need of future synergistic optional treatments (micronutrients and exercise) to improve the effectiveness of hormonal treatment and to safely ameliorate the anabolic hormonal status and mobility in older individuals. PMID:24050169

Multiple hormonal dysregulation as determinant of low physical performance and mobility in older persons.

PubMed

Maggio, Marcello; Lauretani, Fulvio; De Vita, Francesca; Basaria, Shehzad; Lippi, Giuseppe; Butto, Valeria; Luci, Michele; Cattabiani, Chiara; Ceresini, Graziano; Verzicco, Ignazio; Ferrucci, Luigi; Ceda, Gian Paolo

2014-01-01

Mobility-disability is a common condition in older individuals. Many factors, including the age-related hormonal dysregulation, may concur to the development of disability in the elderly. In fact, during the aging process it is observed an imbalance between anabolic hormones that decrease (testosterone, dehydroepiandrosterone sulphate (DHEAS), estradiol, insulin like growth factor-1 (IGF-1) and Vitamin D) and catabolic hormones (cortisol, thyroid hormones) that increase. We start this review focusing on the mechanisms by which anabolic and catabolic hormones may affect physical performance and mobility. To address the role of the hormonal dysregulation to mobility-disability, we start to discuss the contribution of the single hormonal derangement. The studies used in this review were selected according to the period of time of publication, ranging from 2002 to 2013, and the age of the participants (≥65 years). We devoted particular attention to the effects of anabolic hormones (DHEAS, testosterone, estradiol, Vitamin D and IGF-1) on both skeletal muscle mass and strength, as well as other objective indicators of physical performance. We also analyzed the reasons beyond the inconclusive data coming from RCTs using sex hormones, thyroid hormones, and vitamin D (dosage, duration of treatment, baseline hormonal values and reached hormonal levels). We finally hypothesized that the parallel decline of anabolic hormones has a higher impact than a single hormonal derangement on adverse mobility outcomes in older population. Given the multifactorial origin of low mobility, we underlined the need of future synergistic optional treatments (micronutrients and exercise) to improve the effectiveness of hormonal treatment and to safely ameliorate the anabolic hormonal status and mobility in older individuals.

The Impact of Comorbidity of Mental and Physical Conditions on Role Disability in the US Adult Household Population

PubMed Central

Merikangas, Kathleen R.; Ames, Minnie; Cui, Lihong; Stang, Paul E.; Ustun, T. Bedirhan; Von Korff, Michael; Kessler, Ronald C.

2007-01-01

Context There is limited information that accounts for comorbidity on the impact of role disability associated with a wide range of mental and physical disorders in population-based samples. Objective To estimate the comparative effects of common mental and physical conditions on role disability in the general population using a novel method that accounts for comorbidity. Design Direct interviews about physical and mental conditions during the past year. Setting The National Comorbidity Survey Replication, a nationally representative series of face-to-face interviews. Patients A nationally representative sample of adults living in households (N=5962 respondents, 18 years and older). Main Outcome Measure Disability in major life roles was assessed with the World Health Organization Disability Assessment Schedule. Simulations that allow for complex interactions among conditions were used to estimate the conditions’ effects on disability days, when respondents were completely unable to carry out their usual daily activities because of problems with mental or physical health, in the past 12 months. Results An estimated 53.4 % of US adults have 1 or more of the mental or physical conditions assessed in the survey. These respondents report an average 32.1 more role-disability days in the past year than demographically matched controls, equivalent to nearly 3.6 billion days of role disability in the population. Musculoskeletal disorders and major depression had the greatest effects on disability days. Mental conditions accounted for more than half as many disability days as all physical conditions at the population level. Associations of specific conditions with disability decreased substantially after controlling for comorbidity, suggesting that prior studies, which generally did not control for comorbidity, overestimated disease-specific effects. Conclusion The staggering amount of health-related disability associated with mental and physical conditions should be considered in establishing priorities for the allocation of health care and research resources. PMID:17909130

PROCESS OF PHYSICAL DISABILITY AMONG OLDER ADULTS―CONTRIBUTION OF FRAILTY IN THE SUPER-AGED SOCIETY

PubMed Central

KUZUYA, MASAFUMI

2012-01-01

ABSTRACT One of the critical issues that Japan, well known for the world’s highest proportion of older adults, a super-aged society, is currently confronting is how to prevent physical disability in old age. This issue is particularly important not only from a medical perspective such as functional prognoses but also from a socio-economic angle in view of reducing the rapid rise in the cost of medical and long-term care insurance services. Functional decline in old age results not only from acute diseases but also from frailty. Such a common and important syndrome that is increasingly prevalent with advancing age can be the cause. The present article intends to review what is known about frailty, including its definition, epidemiology, and pathophysiology, and to examine potential areas of future research. PMID:22515109

Education and disability trends of older Americans, 2000-2014.

PubMed

Tsai, Yuping

2017-09-01

Trends in disability among older Americans has declined since the 1980s. The study examines whether the trend continues to decline and whether educational disparities exist in the prevalence of functional limitations. I used the 2000-2014 National Health Interview Survey and included adults aged ≥65 years. Functional limitations was measured by three outcomes: the need for help with activities of daily living (ADLs) or instrumental activities of daily living (IADLs) and physical function limitations. I used a set of logistic models to estimate the average annual change rate of functional limitations. I examined whether the annual rate of change differed by education, age group and sex. During 2000-2014, the annual increase rate of ADL limitations was 1.7% (P < 0.001) and was 2.0% (P < 0.001) for physical function limitations; IADL limitation did not change significantly. All subgroups experienced an increase in ADL and physical function limitations except for adults with a more than high school education. The lower-educated group had a higher proportion and a higher annual rate of increase in all outcomes. Increasing trends in chronic conditions may contribute to the increasing trend in functional limitations. The study highlighted a large educational disparity in late-life disability among older Americans. Published by Oxford University Press on behalf of Faculty of Public Health 2016. This work is written by (a) US Government employee(s) and is in the public domain in the US.

Effects of a home-based physical rehabilitation program on physical disability after hip fracture: a randomized controlled trial.

PubMed

Edgren, Johanna; Salpakoski, Anu; Sihvonen, Sanna E; Portegijs, Erja; Kallinen, Mauri; Arkela, Marja; Jäntti, Pirkko; Vanhatalo, Jukka; Pekkonen, Mika; Rantanen, Taina; Heinonen, Ari; Sipilä, Sarianna

2015-04-01

Fewer than half of the patients with hip fracture will regain the prefracture level of physical functioning. This secondary analysis of a randomized controlled trial investigated the effects of a multicomponent home-based rehabilitation program (ProMo) on physical disability after hip fracture. Randomized, controlled, parallel-group trial. Rehabilitation in participants' homes; measurements in university-based laboratory and local hospital. Population-based clinical sample of community-dwelling people older than 60 years (n = 81) operated for hip fracture were randomized into intervention and control groups. The year-long intervention aimed at restoring mobility. It included evaluation and modification of environmental hazards, guidance for safe walking, pain management, home exercise, physical activity counseling, and standard care. Physical disability was assessed by a questionnaire at baseline, and 3, 6, and 12 months thereafter. Sum scores were computed for basic (ADLs) and instrumental activities of daily living (IADLs). A higher score indicated more difficulty. GEE models were constructed to analyze the effect of the intervention. In the intention-to-treat analysis, no intervention effect was observed for sum scores. For the single disability items, borderline significant positive effects were observed for preparing food and handling medication (interaction P = .061 and P = .061, respectively). In the per-protocol analysis, the mean differences between groups were -0.4 points (SE 0.5), -1.7 (0.7), and -1.2 (0.7) at 3, 6, and 12 months for ADLs and -1.0 (1.2), -3.2 (1.5), and -2.5 (1.4) for IADLs, correspondingly. The current analyses suggest that home-based rehabilitation may reduce disability among older people after hip fracture. The present results need to be confirmed in a study with larger sample size. Potentially a more task-oriented rehabilitation approach might gain more benefits. Current Controlled Trials (ISRCTN53680197). Copyright © 2015 AMDA – The Society for Post-Acute and Long-Term Care Medicine. Published by Elsevier Inc. All rights reserved.

Functional and Mental Health Outcomes of the Joint Effects of Spousal Health: The Potential Threats of "Concordant Frailty".

PubMed

Lu, Wan-Hsuan; Chiou, Shu-Ti; Chen, Liang-Kung; Hsiao, Fei-Yuan

2016-04-01

Existing studies have indicated that caring for a person with disabilities in a family could result in strong adverse impacts on the health of his or her spouse. However, little is known about the potential joint burden and interactive patterns in a family when both spouses are in poor health. The objective of this study was to evaluate the impacts of self and spousal health statuses on the physical and mental health outcomes of older people in Taiwan. Retrospective observational study. The Social Environment and Biomarkers of Aging Study (SEBAS), Taiwan. Data of 1123 study participants from the SEBAS were retrieved for analysis and all participants were divided into 4 groups based on their self-rated and spousal health status: good self-good spousal health (GG), good self-poor spousal health (GP), poor self-good spousal health (PG), and poor self-poor spousal health (PP). Multinomial logistic regression models were used to evaluate the associations of the different health statuses of couples to disabilities of physical function, daily activity disabilities (activities of daily living, or ADLs, and instrumental activities of daily living, or IADLs) and depressive symptoms. Subgroup analyses were conducted for middle-aged (aged 53 to 64) and older (aged 65 and older) adults to examine whether the impacts of spousal health statuses on the physical and mental health outcomes increased with age. The adjusted multinomial logistic regressions showed that people in the PP group were at the highest risk for difficulties in physical function, daily activities, and depressive symptoms. This association was more significant in the elderly population than the middle-aged group. Elderly PP couples were associated with a 7-fold increase in risk of acquiring a disability of physical function (adjusted odds ratio [aOR] 7.5, 95% confidence interval [CI] 2.4-23.6, P < .01), an 8-fold increase in risk of an IADL disability (aOR 8.5, 95% CI 4.1-17.5, P < .01), a 47-fold increase in risk of an ADL disability (aOR 47.3, 95% CI 5.8-387.7, P < .01), and a 10-fold increase in risk of depressive symptoms (aOR 10.6, 95% CI 4.8-23.4, P < .01), compared with the elderly GG groups. This is the first study to demonstrate that when both people in a couple have poor health status, it is a significant risk factor regarding difficulties in physical activities, daily activity disabilities, and depressive symptoms. This effect was particularly stronger in elderly couples compared with middle-aged couples. Copyright © 2016 AMDA – The Society for Post-Acute and Long-Term Care Medicine. Published by Elsevier Inc. All rights reserved.

Sedentary and Physical Activity Patterns in Adults with Intellectual Disability.

PubMed

Oviedo, Guillermo R; Travier, Noémie; Guerra-Balic, Myriam

2017-09-07

Little is known about the patterns of sedentary time (ST) and physical activity (PA) levels throughout the week among adults and older adults with Intellectual Disability (ID). We analyzed ST and PA patterns of adults and older adults with ID. Forty-two adults and 42 older adults with mild to severe ID participated in this study. Height and weight were obtained to calculate Body Mass Index (BMI). Body fat and fat-free mass percentages were also obtained. Patterns of PA levels and ST were assessed with GT3X Actigraph accelerometers. Adults performed higher amounts of total PA and moderate to vigorous PA than older adults during the week, on weekdays and in center time (all p > 0.05). No differences between males and females were found for either PA levels or ST. Only 10.7% of the participants met the global recommendations on PA for health. The participants of the current study showed low PA levels and a high prevalence of ST. Interestingly, when comparing age and/or sex groups, no differences were observed for ST. Our findings provide novel and valuable information to be considered in future interventions aiming to increase PA levels and reduce ST.

Sedentary and Physical Activity Patterns in Adults with Intellectual Disability

PubMed Central

Oviedo, Guillermo R.; Travier, Noémie; Guerra-Balic, Myriam

2017-01-01

Little is known about the patterns of sedentary time (ST) and physical activity (PA) levels throughout the week among adults and older adults with Intellectual Disability (ID). We analyzed ST and PA patterns of adults and older adults with ID. Forty-two adults and 42 older adults with mild to severe ID participated in this study. Height and weight were obtained to calculate Body Mass Index (BMI). Body fat and fat-free mass percentages were also obtained. Patterns of PA levels and ST were assessed with GT3X Actigraph accelerometers. Adults performed higher amounts of total PA and moderate to vigorous PA than older adults during the week, on weekdays and in center time (all p > 0.05). No differences between males and females were found for either PA levels or ST. Only 10.7% of the participants met the global recommendations on PA for health. The participants of the current study showed low PA levels and a high prevalence of ST. Interestingly, when comparing age and/or sex groups, no differences were observed for ST. Our findings provide novel and valuable information to be considered in future interventions aiming to increase PA levels and reduce ST. PMID:28880236

Exercise and Sarcopenia.

PubMed

Phu, Steven; Boersma, Derek; Duque, Gustavo

2015-01-01

Sarcopenia is a major component of the frailty syndrome and is also a strong predictor of disability, morbidity, and mortality in older persons. Without any available pharmacological intervention to sarcopenia, non-pharmacological interventions are the only option to prevent these poor outcomes in sarcopenic patients. Among those interventions, physical activity with or without protein supplementation has demonstrated to be effective in improving muscle mass and function and in preventing disability and frailty in older persons. Additionally, to the beneficial effect of physical activity on metabolic and cardiovascular diseases, a regular exercise program (3 times/wk) that includes resistance and endurance exercise training would have a major positive effect on sarcopenic muscle through improving muscle mass, strength, and function. In this review, we looked at the effect of exercise on sarcopenic frail older persons from the biological aspects of the response of the muscle to exercise to some practical aspects of exercise prescription in this high-risk population. We conclude that, although challenging, older persons should be encouraged to participate in this type of programs, which would improve not only their function and independence but also their quality of life. Copyright © 2015 The International Society for Clinical Densitometry. Published by Elsevier Inc. All rights reserved.

Physical activity guidelines for older adults.

PubMed

Elsawy, Bassem; Higgins, Kim E

2010-01-01

Few older adults in the United States achieve the minimum recommended amount of physical activity. Lack of physical activity contributes to many chronic diseases that occur in older adults, including heart disease, stroke, diabetes mellitus, lung disease, Alzheimer disease, hypertension, and cancer. Lack of physical activity, combined with poor dietary habits, has also contributed to increased obesity in older persons. Regular exercise and increased aerobic fitness are associated with a decrease in all-cause mortality and morbidity, and are proven to reduce disease and disability, and improve quality of life in older persons. In 2008, The U.S. Department of Health and Human Services released guidelines to provide information and guidance on the amount of physical activity recommended to maintain health and fitness. For substantial health benefits, the guidelines recommend that most older adults participate in at least 150 minutes of moderate-intensity aerobic activity, 75 minutes of vigorous-intensity aerobic activity, or an equivalent combination of each per week. Older adults should also engage in strengthening activities that involve all major muscle groups at least two days a week. Those at risk of falling should add exercises that help maintain or improve balance. Generally healthy adults without chronic health conditions do not need to consult with a physician before starting an exercise regimen. (c) 2010 American Academy of Family Physicians.

Physical activity among older people with sight loss: a qualitative research study to inform policy and practice.

PubMed

Phoenix, C; Griffin, M; Smith, B

2015-02-01

To investigate the ways in which participation in physical activity is prevented or facilitated among older people with acquired sight loss later in life. Qualitative research. Interviews were conducted with 48 visually impaired adults age 60+ years, recruited from a range of settings including local sight loss organisations and via talking newspaper advertisements. Visual impairment was defined by self-report. Data was analysed using a thematic analysis. This research represents a first step toward the development of empirically based practical suggestions for decision-makers and health professionals in terms of supporting - when required - visually impaired older adults participation in physical activity. Six themes were identified that captured why physical activity was prevented or facilitated: disabling environments; organisational opportunities; transport; lack of information; confidence, fear and personal safety; and exercise as medicine. Recommendations for policy change need to be focused at the societal level. This includes developing more accessible and inclusive environments and providing meaningful information about physical activity to older adults with a visual impairment, and visual impairment in older age to physical activity providers. Copyright © 2015 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.

Social Frailty and Functional Disability: Findings From the Singapore Longitudinal Ageing Studies.

PubMed

Teo, Nigel; Gao, Qi; Nyunt, Ma Shwe Zin; Wee, Shiou Liang; Ng, Tze-Pin

2017-07-01

To examine the association between the social frailty (SF) phenotype and functional disability, independently of the physical frailty (PF) phenotype, and compare the abilities of the PF, SF, and combined social and physical (PSF) indexes for predicting functional disability. Cross-sectional and longitudinal analyses of a population-based cohort (Singapore Longitudinal Ageing Study, SLAS-1) of 2406 community-dwelling older adults with 3 years of follow-up (N = 1254 and N = 1557 for instrumental activity of daily living (IADL) disability and severe disability (≥3 basic ADL) respectively). Seven-item social frailty index (living arrangements, education, socioeconomic status, and social network and support, 0 = nil SF, 1 = low, 2-7 = high), PF phenotype (Fried criteria), and instrumental activities of daily living (IADLs) disability and severe disability (≥3 basic ADLs). Compared to nil SF, low and high SF were significantly associated with 1.3 to 2.4 fold increased prevalence and incidence of IADL disability, and 6.3 fold increase in severe disability. Frail individuals with and without SF stood out with 5-11 fold increased prevalence and incidence of IADL disability and 21-25 fold increased prevalence and incidence of severe disability, compared to robust individuals without SF. A combined PSF index more accurately identified individuals with increased risk of functional disability (ROC = 64%) and severe disability (ROC = 81%) than either the SF or the PF indexes alone (55% to 68%). The SF index alone or in combination with the PF index has clinical relevance and utility for identifying and stratifying older people at risk of disability. The mental frailty construct is closely related to SF and should be further investigated in future studies. Copyright © 2017 AMDA – The Society for Post-Acute and Long-Term Care Medicine. Published by Elsevier Inc. All rights reserved.

American College of Sports Medicine position stand. Exercise and physical activity for older adults.

PubMed

Chodzko-Zajko, Wojtek J; Proctor, David N; Fiatarone Singh, Maria A; Minson, Christopher T; Nigg, Claudio R; Salem, George J; Skinner, James S

2009-07-01

The purpose of this Position Stand is to provide an overview of issues critical to understanding the importance of exercise and physical activity in older adult populations. The Position Stand is divided into three sections: Section 1 briefly reviews the structural and functional changes that characterize normal human aging, Section 2 considers the extent to which exercise and physical activity can influence the aging process, and Section 3 summarizes the benefits of both long-term exercise and physical activity and shorter-duration exercise programs on health and functional capacity. Although no amount of physical activity can stop the biological aging process, there is evidence that regular exercise can minimize the physiological effects of an otherwise sedentary lifestyle and increase active life expectancy by limiting the development and progression of chronic disease and disabling conditions. There is also emerging evidence for significant psychological and cognitive benefits accruing from regular exercise participation by older adults. Ideally, exercise prescription for older adults should include aerobic exercise, muscle strengthening exercises, and flexibility exercises. The evidence reviewed in this Position Stand is generally consistent with prior American College of Sports Medicine statements on the types and amounts of physical activity recommended for older adults as well as the recently published 2008 Physical Activity Guidelines for Americans. All older adults should engage in regular physical activity and avoid an inactive lifestyle.

Do older adults with chronic low back pain differ from younger adults in regards to baseline characteristics and prognosis?

PubMed

Manogharan, S; Kongsted, A; Ferreira, M L; Hancock, M J

2017-05-01

Low back pain (LBP) in older adults is poorly understood because the vast majority of the LBP research has focused on the working aged population. The aim of this study was to compare older adults consulting with chronic LBP to middle aged and young adults consulting with chronic LBP, in terms of their baseline characteristics, and pain and disability outcomes over 1 year. Data were systematically collected as part of routine care in a secondary care spine clinic. At initial presentation patients answered a self-report questionnaire and underwent a physical examination. Patients older than 65 were classified as older adults and compared to middle aged (45-65 years old) and younger adults (17-44 years old) for 10 baseline characteristics. Pain intensity and disability were collected at 6 and 12 month follow-ups and compared between age groups. A total of 14,479 participants were included in the study. Of these 3087 (21%) patients were older adults, 6071 (42%) were middle aged and 5321 (37%) were young adults. At presentation older adults were statistically different to the middle aged and younger adults for most characteristics measured (e.g. less intense back pain, more leg pain and more depression); however, the differences were small. The change in pain and disability over 12 months did not differ between age groups. This study found small baseline differences in older people with chronic LBP compared to middle aged and younger adults. There were no associations between age groups and the clinical course. Small baseline differences exist in older people with chronic low back pain compared to middle aged and younger adults referred to secondary care for chronic low back pain. Older adults present with slightly less intense low back pain but slightly more intense leg pain. Changes in pain intensity and disability over a 12 month period were similar across all age groups. © 2017 European Pain Federation - EFIC®.

Living with disability: patterns of health problems and symptom mediation of health consequences.

PubMed

Patterson, Brandon J; Doucette, William R; Lindgren, Scott D; Chrischilles, Elizabeth A

2012-07-01

People with disability experience a range of symptoms that may serve as an important linkage between disability and other health consequences. The aims of this study were to describe and compare symptom experiences of people with and without disability using a population-based sample and to test direct relationships between disability and health status and indirect effects of disability mediated through symptom experience. A Midwestern sample of 12,249 adults aged 40 and older responded to a cross-sectional survey. Data collected included symptom prevalence and frequencies for 21 commonly reported symptoms, self-perceived health status and physical functioning, number of medications, and demographic variables. Two mediation analyses were conducted using cumulative symptom frequency as the mediator between disability status and both self-rated health and physical functioning. Adults with disability reported significantly greater prevalence and frequencies for all 21 symptoms, with pain and fatigue being the most common. The indirect effect through cumulative symptom frequency explained roughly half of the total effect of disability on general health status, and about one third of the total effect of disability on physical functioning. This study found evidence supporting the diverse and significant symptom experience of people living with disability, especially for symptoms of pain and fatigue. Moreover, symptom experience was found to partially mediate the effects of disability on self-reported general health status and physical functioning. This provides support for symptoms serving as an important link to health outcomes in patients with disability. Copyright © 2012 Elsevier Inc. All rights reserved.

Exercise and fall prevention self-management to reduce mobility-related disability and falls after fall-related lower limb fracture in older people: protocol for the RESTORE (Recovery Exercises and STepping On afteR fracturE) randomised controlled trial.

PubMed

Sherrington, Catherine; Fairhall, Nicola; Kirkham, Catherine; Clemson, Lindy; Howard, Kirsten; Vogler, Constance; Close, Jacqueline C T; Moseley, Anne M; Cameron, Ian D; Mak, Jenson; Sonnabend, David; Lord, Stephen R

2016-02-02

Lasting disability and further falls are common and costly problems in older people following fall-related lower limb and pelvic fractures. Exercise interventions can improve mobility after fracture and reduce falls in older people, however the optimal approach to rehabilitation after fall-related lower limb and pelvic fracture is unclear. This randomised controlled trial aims to evaluate the effects of an exercise and fall prevention self-management intervention on mobility-related disability and falls in older people following fall-related lower limb or pelvic fracture. Cost-effectiveness of the intervention will also be investigated. A randomised controlled trial with concealed allocation, assessor blinding for physical performance tests and intention-to-treat analysis will be conducted. Three hundred and fifty people aged 60 years and over with a fall-related lower limb or pelvic fracture, who are living at home or in a low care residential aged care facility and have completed active rehabilitation, will be recruited. Participants will be randomised to receive a 12-month intervention or usual care. The intervention group will receive ten home visits from a physiotherapist to prescribe an individualised exercise program with motivational interviewing, plus fall prevention education through individualised advice from the physiotherapist or attendance at the group based "Stepping On" program (seven two-hour group sessions). Participants will be followed for a 12-month period. Primary outcome measures will be mobility-related disability and falls. Secondary outcomes will include measures of balance and mobility, falls risk, physical activity, walking aid use, frailty, pain, nutrition, falls efficacy, mood, positive and negative affect, quality of life, assistance required, hospital readmission, and health-system and community-service contact. This study will determine the effect and cost-effectiveness of this exercise self management intervention on mobility-related disability and falls in older people who have recently sustained a fall-related lower limb or pelvic fracture. The results will have implications for the design and implementation of interventions for older people with fall related lower limb fractures. The findings of this study will be disseminated in peer-reviewed journals and through professional and scientific conferences. Australian New Zealand Clinical Trials Registry: ACTRN12610000805077.

Collection Development "Universal Design": Design for Everyone

ERIC Educational Resources Information Center

Felix, Lisa

2008-01-01

As the first wave of baby boomers hit their "golden years," there is a growing demand for housing that meets their changing physical needs. The older and disabled population face a lot of physical challenges in a traditional home. Before homeowners can modify their houses, they must first understand the key design terminology involved.…

The impact of sarcopenia on a physical activity intervention: the Lifestyle Interventions and Independence for Elders Pilot Study (LIFE-P)

USDA-ARS?s Scientific Manuscript database

To determine if sarcopenia modulates the response to a physical activity intervention in functionally limited older adults. Design: secondary analysis of a randomized controlled trial. Setting: three academic centers. Participants: elders aged 70 to 89 years at risk for mobility disability who under...

Relation of physical activity time to incident disability in community dwelling adults with or at risk of knee arthritis: prospective cohort study.

PubMed

Dunlop, Dorothy D; Song, Jing; Semanik, Pamela A; Sharma, Leena; Bathon, Joan M; Eaton, Charles B; Hochberg, Marc C; Jackson, Rebecca D; Kwoh, C Kent; Mysiw, W Jerry; Nevitt, Michael C; Chang, Rowland W

2014-04-29

To investigate whether objectively measured time spent in light intensity physical activity is related to incident disability and to disability progression. Prospective multisite cohort study from September 2008 to December 2012. Baltimore, Maryland; Columbus, Ohio; Pittsburgh, Pennsylvania; and Pawtucket, Rhode Island, USA. Disability onset cohort of 1680 community dwelling adults aged 49 years or older with knee osteoarthritis or risk factors for knee osteoarthritis; the disability progression cohort included 1814 adults. Physical activity was measured by accelerometer monitoring. Disability was ascertained from limitations in instrumental and basic activities of daily living at baseline and two years. The primary outcome was incident disability. The secondary outcome was progression of disability defined by a more severe level (no limitations, limitations to instrumental activities only, 1-2 basic activities, or ≥3 basic activities) at two years compared with baseline. Greater time spent in light intensity activities had a significant inverse association with incident disability. Less incident disability and less disability progression were each significantly related to increasing quartile categories of daily time spent in light intensity physical activities (hazard ratios for disability onset 1.00, 0.62, 0.47, and 0.58, P for trend=0.007; hazard ratios for progression 1.00, 0.59, 0.50, and 0.53, P for trend=0.003) with control for socioeconomic factors (age, sex, race/ethnicity, education, income) and health factors (comorbidities, depressive symptoms, obesity, smoking, lower extremity pain and function, and knee assessments: osteoarthritis severity, pain, symptoms, prior injury). This finding was independent of time spent in moderate-vigorous activities. These prospective data showed an association between greater daily time spent in light intensity physical activities and reduced risk of onset and progression of disability in adults with osteoarthritis of the knee or risk factors for knee osteoarthritis. An increase in daily physical activity time may reduce the risk of disability, even if the intensity of that additional activity is not increased.

Nutrition, Frailty, Cognitive Frailty and Prevention of Disabilities with Aging.

PubMed

Guyonnet, Sophie; Secher, Marion; Vellas, Bruno

2015-01-01

Older adults can be categorized into three subgroups to better design and develop personalized interventions: the disabled (those needing assistance in the accomplishment of basic activities of daily living), the 'frail' (those presenting limitations and impairments in the absence of disability) and the 'robust' (those without frailty or disability). However, despite evidence linking frailty with a poor outcome, frailty is not implemented clinically in most countries. Since many people are not identified as frail, their treatment is frequently inappropriate in health care settings. Assessing the frail and prefrail older adults can no longer be delayed, we should rather act preventively before the irreversible disabling cascade is in place. Clinical characteristics of frailty such as weakness, low energy, slow walking speed, low physical activity and weight loss underline the links between nutrition and frailty. Physical frailty is also associated with cognitive frailty. We need to better understand cognitive frailty, a syndrome which must be differentiated from Alzheimer's disease. At the Gérontopôle frailty clinics, we have found that almost 40% of the patients referred to our center by their primary care physicians to evaluate frailty had significant weight loss in the past 3 months, 83.9% of patients presented slow gait speed, 53.8% a sedentary lifestyle and 57.7% poor muscle strength. Moreover, 43% had a Mini-Nutritional Assessment less than 23.5 and 9% less than 17, which reflects protein-energy undernutrition. More than 60% had some cognitive impairment associated with physical frailty. © 2015 Nestec Ltd., Vevey/S. Karger AG, Basel.

Disability, participation, and subjective wellbeing among older couples

PubMed Central

Freedman, Vicki A.; Stafford, Frank; Schwarz, Norbert; Conrad, Frederick; Cornman, Jennifer C.

2012-01-01

This paper investigates the link between disability and subjective wellbeing, using data from the 2009 Disability and Use of Time supplement to the Panel Study of Income Dynamics, the longest running national panel study in the United States. Disability is construed broadly to include both the presence of any physical, cognitive, or sensory impairment or activity limitation and also the severity of underlying impairments. Subjective wellbeing is measured using two distinct approaches: reports of life satisfaction and of moment-to-moment wellbeing—both positive and negative—on the previous day. The latter, collected through 24-h time diaries, also offers for the first time the ability to explore the role of participation in particular kinds of activities linking disability to subjective wellbeing. The analytic sample included married persons ages 60 and older and their spouses (n = 751 married individuals) who completed 1498 diaries. Several new findings emerged: no matter what the measure of wellbeing, older married adults with disability report worse subjective wellbeing than those without, and neither different demographic and socioeconomic profiles nor differences in participation fully account for these disparities. Influences of disability on global life satisfaction and episodic reports of happiness were relatively small and of comparable size. However, notably sizeable differences were identified in the cumulative number of pleasant minutes experienced yesterday by disability status - on the order of 71 fewer minutes on average for those with a disability of average severity. Differences appear to be more strongly linked to somatic symptoms of pain and feeling tired than to differential intensity of experiencing happiness, sadness, frustration, or worry. We also found limited support for the notion that participation partially mediates the relationship between disability and global, but not episodic, subjective wellbeing. PMID:22226156

Sarcopenia according to the european working group on sarcopenia in older people (EWGSOP) versus Dynapenia as a risk factor for disability in the elderly.

PubMed

da Silva Alexandre, T; de Oliveira Duarte, Y A; Ferreira Santos, J L; Wong, R; Lebrão, M L

2014-05-01

Sarcopenia, defined as low muscle mass (LMM), and dynapenia have been associated with adverse outcomes in elderly. Contrast the association of sarcopenia versus dynapenia with incidence of disability. A four-year prospective study (2006-2010). São Paulo, Brazil. 478 individuals aged 60 and older from the Saúde, Bem-Estar e Envelhecimento (SABE) study who were non-disabled at baseline. Sarcopenia, measured according to the European Working Group on Sarcopenia in Older People (EWGSOP), includes: LMM assessed by skeletal muscle mass index ≤8.90kg/m2 (men) and ≤6.37kg/m2 (women); low muscle strength (LMS) assessed by handgrip strength <30kg (men) and <20kg (women); and low physical performance (LPP) assessed by gait speed ≤0.8m/s. Diagnosis of sarcopenia required LMM plus LMS or LPP. Dynapenia was defined as handgrip strength <30kg (men) and <20kg (women). Covariates included socio-demographic and behavioral variables, medical conditions, hospitalization, depressive symptoms, cognition, perception of vision, hearing and body mass index. Disability in mobility or instrumental activities of daily living (IADL) or disability in activities of daily living (ADL) and IADL. The incidence density of mobility or IADL disability was 43.4/1000 person/year and 22.6/1000 person/year for IADL and ADL disability. There was no significant difference in incidence density according sarcopenia or dynapenia status. After controlling for all covariates, sarcopenia was associated with mobility or IADL disability (relative risk ratio = 2.23, 95%Confidence Interval: 1.03-4.85). Dynapenia was not associated with disability. Sarcopenia according to the EWGSOP definition can be used in clinical practice as a screening tool for early functional decline (mobility or IADL disability).

Device-Measured Physical Activity As a Predictor of Disability in Mobility-Limited Older Adults.

PubMed

Mankowski, Robert T; Anton, Stephen D; Axtell, Robert; Chen, Shyh-Huei; Fielding, Roger A; Glynn, Nancy W; Hsu, Fang-Chi; King, Abby C; Layne, Andrew S; Leeuwenburgh, Christiaan; Manini, Todd M; Marsh, Anthony P; Pahor, Marco; Tudor-Locke, Catrine; Conroy, David E; Buford, Thomas W

2017-10-01

To examine associations between objectively measured physical activity (PA) and incidence of major mobility disability (MMD) and persistent MMD (PMMD) in older adults in the Lifestyle Interventions and Independence for Elders (LIFE) Study. Prospective cohort of individuals aged 65 and older undergoing structured PA intervention or health education. The LIFE Study was a multicenter (eight sites) randomized controlled trial designed to compare the efficacy of a long-term structured PA intervention with that of a health education (HE) program in reducing the incidence of MMD in mobility-limited older adults. LIFE Study participants (n = 1,590) had a mean age±standard deviation of 78.9 ± 5.2, low levels of PA, and measured mobility-relevant functional impairment at baseline. Activity data were collected using hip-worn 7-day accelerometers at baseline and 6, 12, and 24 months after randomization to test for associations with incident MMD and PMMD (≥2 consecutive instances of MMD). At baseline, every 30 minutes spent being sedentary (<100 accelerometry counts per minute) was associated with higher rate of subsequent MMD (10%) and PMMD (11%) events. Every 500 steps taken was associated with lower rate of MMD (15%) and PMMD (18%). Similar associations were observed when fitting accelerometry-based PA as a time-dependent variable. Accelerometry-based PA levels were strongly associated with MMD and PMMD events in older adults with limited mobility. These results support the importance of daily PA and lower amounts of sedentary time levels in this population and suggest that accelerometry may be a useful tool for assessing risk of mobility disability. © 2017, Copyright the Authors Journal compilation © 2017, The American Geriatrics Society.

Collaborative Evaluation of the Healthy Habits Program: An Effective Community Intervention to Improve Mobility and Cognition of Chinese Older Adults Living in the U.S.

PubMed

Hau, C; Reid, K F; Wong, K F; Chin, R J; Botto, T J; Eliasziw, M; Bermudez, O I; Fielding, R A

2016-04-01

There is a growing demand to reduce ethnic health disparities. The Healthy Habits Program (HHP) was implemented to provide a community-based physical activity and education intervention for Chinese older adults living in Boston, Massachusetts. This study evaluated the HHP by assessing outcomes that are critical for maintaining independence of older persons. Quantitative evaluation was performed on 50 Chinese older adults enrolled in the HHP. The community members were trained in data collection and management. Cognition (Mini Mental State Examination (MMSE), Trail Making Test and Complex Walking Task), mobility (Short Physical Performance Battery (SPPB) and maximal gait speed), depressive symptoms (Patient Health Questionnaire-9), perceived disability (World Health Organization Disability Assessment 2.0), nutritional status (Mini Nutrition Assessment®), and strength (grip and leg strength) were assessed at baseline and at 6 months. All tests were translated into Chinese. Of the 50 participants (mean age 68.4 years; 68% female), 78% achieved the goal of performing exercise ≥3 times/week. After 6 months, clinically meaningful improvements were observed in mobility (mean SPPB score changed from 10.3 to 11.1 points; p=0.01) and cognition (mean MMSE score changed from 26.0 to 27.8 points; p=0.001). There were also statistically significant improvements in executive function, depressive symptoms and perceived disability (p<0.05). Culturally sensitive community interventions, such as the HHP, are effective for improving mobility and cognition of Chinese older adults. This reveals the potential of promoting successful aging in minority populations through community settings, and should be advocated to reduce ethnic health disparities in the U.S.

Is Kyphosis Related to Mobility, Balance and Disability?

PubMed Central

Eum, Regina; Leveille, Suzanne G.; Kiely, Dan K.; Kiel, Douglas P.; Samelson, Elizabeth J.; Bean, Jonathan F.

2013-01-01

Objective To determine the association of increased kyphosis with declines in mobility, balance and disability among community-living older adults. Design 18-month follow-up visit data from 2006–2009 for 620 participants from the population-based MOBILIZE Boston Study of older adults was used. Cross-sectional multivariable regression analyses were performed to assess the relationship between kyphosis (measured using the kyphosis index (KI)) and measures of mobility performance (Short Physical Performance Battery (SPPB)), balance (Berg Balance Score (BBS)) and disability (self-reported difficulty walking a quarter-mile or climbing a flight of stairs). We then evaluated men and women separately. Adjustment variables included demographic factors (age, gender, race, education), body-mass index, self-rated health, comorbidities (heart disease, diabetes, stroke, depressive symptoms), back pain, knee pain and falls self-efficacy. Results After full adjustment, greater KI was associated with lower SPPB scores (adj. β = −0.08, p = 0.01), but not BBS (adj. β = −0.09, p = 0.23) or self-reported disability (adj. β = 1.00, 95% CI, 0.93 –1.06). In gender-specific analyses, KI was only associated with SPPB in women. Conclusions Greater kyphosis is associated with poorer mobility performance, but not balance or self-reported disability. This association with SPPB was only observed among women. Mechanisms by which increased kyphosis influence physical performance should be explored prospectively. PMID:23636086

Does the built environment moderate the relationship between having a disability and lower levels of physical activity? A systematic review.

PubMed

Eisenberg, Yochai; Vanderbom, Kerri A; Vasudevan, Vijay

2017-02-01

The relationship between the built environment and physical activity has been well documented. However, little is known about how the built environment affects physical activity among people with disabilities, who have disproportionately higher rates of physical inactivity and obesity. This study is the first systematic review to examine the role of the built environment as a moderator of the relationship between having a disability (physical, sensory or cognitive) and lower levels of physical activity. After conducting an extensive search of the literature published between 1990 and 2015, 2039 articles were screened, 126 were evaluated by abstract and 66 by full text for eligibility in the review. Data were abstracted using a predefined coding guide and synthesized from both qualitative and quantitative studies to examine evidence of moderation. Nine quantitative and six qualitative articles met the inclusion criteria. Results showed that most research to date has been on older adults with physical disabilities. People with disabilities described how aspects of the built environment affect neighborhood walking, suggesting a positive moderating role of features related to safety and aesthetic qualities, such as benches, lighting and stop light timing. There were mixed results among studies that examined the relationship quantitatively. Most of the studies were not designed to appropriately examine moderation. Future research should utilize valid and reliable built environment measures that are more specific to disability and should include people with and without disabilities to allow for testing of moderation of the built environment. Copyright © 2016 Elsevier Inc. All rights reserved.

Gender differences in the impact of mental disorders and chronic physical conditions on health-related quality of life among non-demented primary care elderly patients.

PubMed

Baladón, Luisa; Rubio-Valera, Maria; Serrano-Blanco, Antoni; Palao, Diego J; Fernández, Ana

2016-06-01

This paper aims to estimate the comorbidity of mental disorders and chronic physical conditions and to describe the impact of these conditions on health-related quality of life (HRQoL) in a sample of older primary care (PC) attendees by gender. Cross-sectional survey, conducted in 77 PC centres in Catalonia (Spain) on 1192 patients over 65 years old. Using face-to-face interviews, we assessed HRQoL (SF-12), mental disorders (SCID and MINI structured clinical interviews), chronic physical conditions (checklist), and disability (Sheehan disability scale). We used multivariate quantile regressions to model which factors were associated with the physical component summary-short form 12 and mental component summary-short form 12. The most frequent comorbidity in both men and women was mood disorder with chronic pain and arthrosis. Mental disorders mainly affected 'mental' QoL, while physical disorders affected 'physical' QoL. Mental disorders had a greater impact on HRQoL than chronic physical conditions, with mood and adjustment disorders being the most disabling conditions. There were some gender differences in the impact of mental and chronic physical conditions on HRQoL. Anxiety disorders and pain had an impact on HRQoL but only in women. Respiratory diseases had an effect on the MCS in women, but only affected the PCS in men. Mood and adjustment disorders had the greatest impact on HRQoL. The impact profile of mental and chronic physical conditions differs between genders. Our results reinforce the need for screening for mental disorders (mainly depression) in older patients in PC.

Associations between physical examination and self-reported physical function in older community-dwelling adults with knee pain.

PubMed

Wood, Laurence; Peat, George; Thomas, Elaine; Hay, Elaine M; Sim, Julius

2008-01-01

Knee pain is a common disabling condition for which older people seek primary care. Clinicians depend on the history and physical examination to direct treatment. The purpose of this study was to examine the associations between simple physical examination tests and self-reported physical functional limitations. A population sample of 819 older adults underwent a standardized physical examination consisting of 24 tests. Associations between the tests and self-reported physical functional limitations (Western Ontario and McMaster Universities Osteoarthritis Index physical functioning subscale [WOMAC-PF] scores) were explored. Five of the tests showed correlations with WOMAC-PF scores, corresponding to an intermediate effect (r>or=.30). These were tenderness on palpation of the infrapatellar area, timed single-leg standing balance, maximal isometric quadriceps femoris muscle strength (force-generating capacity), reproduction of symptoms on patellofemoral compression, and degree of knee flexion. Each of these tests was able to account for between 7% and 13% of the variance in WOMAC-PF scores, after controlling for age, sex, and body mass index. Three of these tests are indicative of impairments that may be modifiable by exercise interventions. Self-reported physical functional limitations among older people with knee pain are associated with potentially modifiable physical impairments that can be identified by simple physical examination tests.

Harm avoidance and disability in old age.

PubMed

Wilson, Robert S; Buchman, Aron S; Arnold, Steven E; Shah, Raj C; Tang, Yuxiao; Bennett, David A

2006-01-01

The relation of personality to disability in old age is not well understood. The authors examined the relation of harm avoidance, a trait indicating a tendency to worry, fear uncertainty, be shy, and tire easily, to disability in a group of 474 older persons without dementia. Participants completed the 35-item Harm Avoidance scale. Disability was assessed with the Rosow-Breslau scale, a self-report measure of physical mobility. Performance-based tests of lower limb functions were also administered from which composite measures of gait, balance, and strength were derived. In a logistic regression model controlled for age, sex, education, and lower limb function, persons with high levels of harm avoidance were nearly three times as likely to report mobility limitations as persons with low levels, and these effects largely reflected fatigability and fear of uncertainty. The association of harm avoidance with disability was not explained or modified by frailty, physical activity, depressive symptoms, neuroticism, extraversion, or cognition. The results suggest that harm avoidance is associated with disability in old age.

Self-efficacy: Implications for Physical Activity, Function, and Functional Limitations in Older Adults.

PubMed

McAuley, Edward; Szabo, Amanda; Gothe, Neha; Olson, Erin A

2011-07-01

Attenuating the physical decline and increases in disability associated with the aging process is an important public health priority. Evidence suggests that regular physical activity participation improves functional performance, such as walking, standing balance, flexibility, and getting up out of a chair, and also plays an important role in the disablement process by providing a protective effect against functional limitations. Whether these effects are direct or indirect has yet to be reliably established. In this review, the authors take the perspective that such relationships are indirect and operate through self-efficacy expectations. They first provide an introduction to social cognitive theory followed by an overview of self-efficacy's reciprocal relationship with physical activity. They then consider the literature that documents the effects of physical activity on functional performance and functional limitations in older adults and the extent to which self-efficacy might mediate these relationships. Furthermore, they also present evidence that suggests that self-efficacy plays a pivotal role in a model in which the protective effects conferred by physical activity on functional limitations operate through functional performance. The article concludes with a brief section making recommendations for the development of strategies within physical activity and rehabilitative programs for maximizing the major sources of efficacy information.

Self-efficacy: Implications for Physical Activity, Function, and Functional Limitations in Older Adults

PubMed Central

McAuley, Edward; Szabo, Amanda; Gothe, Neha; Olson, Erin A.

2013-01-01

Attenuating the physical decline and increases in disability associated with the aging process is an important public health priority. Evidence suggests that regular physical activity participation improves functional performance, such as walking, standing balance, flexibility, and getting up out of a chair, and also plays an important role in the disablement process by providing a protective effect against functional limitations. Whether these effects are direct or indirect has yet to be reliably established. In this review, the authors take the perspective that such relationships are indirect and operate through self-efficacy expectations. They first provide an introduction to social cognitive theory followed by an overview of self-efficacy's reciprocal relationship with physical activity. They then consider the literature that documents the effects of physical activity on functional performance and functional limitations in older adults and the extent to which self-efficacy might mediate these relationships. Furthermore, they also present evidence that suggests that self-efficacy plays a pivotal role in a model in which the protective effects conferred by physical activity on functional limitations operate through functional performance. The article concludes with a brief section making recommendations for the development of strategies within physical activity and rehabilitative programs for maximizing the major sources of efficacy information. PMID:24353482

Does Protecting Older Workers From Discrimination Make It Harder to Get Hired? Evidence From Disability Discrimination Laws.

PubMed

Neumark, David; Song, Joanne; Button, Patrick

2017-01-01

We explore the effects of disability discrimination laws on hiring of older workers. A concern with antidiscrimination laws is that they may reduce hiring by raising the cost of terminations and-in the specific case of disability discrimination laws-raising the cost of employment because of the need to accommodate disabled workers. Moreover, disability discrimination laws can affect nondisabled older workers because they are fairly likely to develop work-related disabilities, but are generally not protected by these laws. Using state variation in disability discrimination protections, we find little or no evidence that stronger disability discrimination laws lower the hiring of nondisabled older workers. We similarly find no evidence of adverse effects of disability discrimination laws on hiring of disabled older workers.

Rehabilitation of Older Persons Disabled by Cancer, Stroke, and Heart Disease.

ERIC Educational Resources Information Center

Finnerty-Fried, Pamela; And Others

1986-01-01

Rehabilitation of older persons disabled by cancer, stroke, or heart disease is discussed. Aspects of each disability are described, and the importance of timely and appropriate intervention with older persons is emphasized. Barriers generally faced by older disabled persons are briefly outlined. (Author)

Drug burden index to define the burden of medicines in older adults with intellectual disabilities: An observational cross-sectional study.

PubMed

O'Connell, Juliette; Burke, Éilish; Mulryan, Niamh; O'Dwyer, Claire; Donegan, Clare; McCallion, Philip; McCarron, Mary; Henman, Martin C; O'Dwyer, Máire

2018-03-01

The drug burden index (DBI) is a dose-related measure of anticholinergic and sedative drug exposure. This cross-sectional study described DBI in older adults with intellectual disabilities (ID) and the most frequently reported therapeutic classes contributing to DBI and examined associations between higher DBI scores and potential adverse effects as well as physical function. This study analysed data from Wave 2 (2013/2014) of the Intellectual Disability Supplement to the Irish Longitudinal Study on Ageing (IDS-TILDA), a representative study on the ageing of people with ID in Ireland. Self- and objectively-reported data were collected on medication use and physical health, including health conditions. The Barthel index was the physical function measure. The study examined 677 individuals with ID, of whom 644 (95.1%) reported taking medication and 78.6% (n = 532) were exposed to medication with anticholinergic and/or sedative activity. 54.2% (n = 367) were exposed to high DBI score (≥1). Adjusted multivariate regression analysis revealed no significant association between DBI score and daytime dozing, constipation or falls. After adjusting for confounders (sex, age, level of ID, comorbidities, behaviours that challenge, history of falls), DBI was associated with significantly higher dependence in the Barthel index (P = 0.002). This is the first time DBI has been described in older adults with ID. Scores were much higher than those observed in the general population and higher scores were associated with higher dependence in Barthel index activities of daily living. © 2017 The British Pharmacological Society.

Promotion Considerations for Exercise and Physical Activity in Mentally Impaired, Diseased, and Disabled Older Adults.

ERIC Educational Resources Information Center

Frizzell, Linda Bane

This paper reports evidence indicating that adapted exercise has a preventive effect on the incidence and progression of chronic diseases which are often related to the aging process. Exercise is known to preserve many physiological responses in the healthy elderly, yet those with physical impairments are often discouraged from exercising because…

Assistive technologies to overcome sarcopenia in ageing.

PubMed

Scott, Rachel A; Callisaya, Michele L; Duque, Gustavo; Ebeling, Peter R; Scott, David

2018-06-01

Sarcopenia is an age-related decline in skeletal muscle mass and function that results in disability and loss of independence. It affects up to 30% of older adults. Exercise (particularly progressive resistance training) and nutrition are key strategies in preventing and reversing declines in muscle mass, strength and power during ageing, but many sarcopenic older adults fail to meet recommended levels of both physical activity and dietary nutrient intake. Assistive technology (AT) describes devices or systems used to maintain or improve physical functioning. These may help sarcopenic older adults to maintain independence, and also to achieve adequate physical activity and nutrition. There is a paucity of research exploring the use of AT in sarcopenic patients, but there is evidence that AT, including walking aids, may reduce functional decline in other populations with disability. Newer technologies, such as interactive and virtual reality games, as well as wearable devices and smartphone applications, smart homes, 3D printed foods, exoskeletons and robotics, and neuromuscular electrical stimulation also hold promise for improving engagement in physical activity and nutrition behaviours to prevent further functional declines. While AT may be beneficial for sarcopenic patients, clinicians should be aware of its potential limitations. In particular, there are high rates of patient abandonment of AT, which may be minimised by appropriate training and monitoring of use. Clinicians should preferentially prescribe AT devices which promote physical activity. Further research is required in sarcopenic populations to identify strategies for effective use of current and emerging AT devices. Copyright © 2018 Elsevier B.V. All rights reserved.

Determinants of Dropout and Nonadherence in a Dementia Prevention Randomized Controlled Trial: The Prevention of Dementia by Intensive Vascular Care Trial.

PubMed

Beishuizen, Cathrien R L; Coley, Nicola; Moll van Charante, Eric P; van Gool, Willem A; Richard, Edo; Andrieu, Sandrine

2017-07-01

To explore and compare sociodemographic, clinical, and neuropsychiatric determinants of dropout and nonadherence in older people participating in an open-label cluster-randomized controlled trial-the Prevention of Dementia by Intensive Vascular care (preDIVA) trial-over 6 years. Secondary analysis. One hundred sixteen general practices in the Netherlands. Community-dwelling individuals aged 70 to 78 (N = 2,994). Nurse-led multidomain intervention targeting cardiovascular risk factors to prevent dementia. The associations between participant baseline sociodemographic (age, sex, education), clinical (medical history, disability, cardiovascular risk), neuropsychiatric (depressive symptoms (Geriatric Depression Scale-15), and cognitive (Mini-Mental State Examination)) characteristics and dropout from the trial and nonadherence to the trial intervention were explored using multilevel logistic regression models. Older age, poorer cognitive function, more symptoms of depression, and greater disability were the most important determinants of dropout of older people. The presence of cardiovascular risk factors was not associated with dropout but was associated with nonadherence. Being overweight was a risk factor for nonadherence, whereas people with high blood pressure or a low level of physical exercise adhered better to the intervention. The association between poorer cognitive function and symptoms of depression and dropout was stronger in the control group than in the intervention group, and vice versa for increased disability. In a large dementia prevention trial with 6-year follow-up, dropout was associated with older age, poorer cognitive function, symptoms of depression, and disability at baseline. These findings can help to guide the design of future dementia prevention trials in older adults. The associations found between cardiovascular risk factors and nonadherence need to be confirmed in other older populations receiving cardiovascular prevention interventions. © 2017, Copyright the Authors Journal compilation © 2017, The American Geriatrics Society.

The mobility gap between older men and women: the embodiment of gender.

PubMed

Zunzunegui, M V; Alvarado, B E; Guerra, R; Gómez, J F; Ylli, A; Guralnik, J M

2015-01-01

To present the study design and baseline results of the longitudinal International Mobility in Aging Study (IMIAS) on gender differences in physical performance and mobility disability prevalence in five diverse societies. Data are from surveys on random samples of people aged 65-74 years at Canadian (Kingston, Ontario; Saint-Hyacinthe, Quebec), Mediterranean (Tirana, Albania) and Latin American sites (Natal, Brazil; Manizales, Colombia) (N=1995). Mobility disability was defined as reporting difficulty in walking 400m or climbing stairs. Activities of daily living (ADL) disability was based on any self-reported difficulty in five mobility-related ADLs. The short physical performance battery (SPPB) was used to assess physical performance. Poisson regression models were fitted to estimate prevalence ratios. Age-adjusted prevalence of low SPPB, mobility disability and ADL disability were higher in women than in men in all sites except for Kingston. After adjustment for education and income, gender differences in SPPB and ADL disability attenuated or disappeared in Saint-Hyacinthe and Manizales but remained large in Tirana and Natal and mobility disability remained more frequent in women than in men at all sites except Kingston. After further adjustment by chronic conditions and depressive symptoms, gender differences in mobility remained large at all sites except Kingston but only in Tirana did women have significantly poorer physical performance than men. Results provide evidence for gender as a risk factor to explain poorer physical function in women and suggest that moving toward gender equality could attenuate the gender gap in physical function in old age. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

Suicide in older adults: current perspectives

PubMed Central

Conejero, Ismael; Olié, Emilie; Courtet, Philippe; Calati, Raffaella

2018-01-01

Suicidal behavior in older adults (65 years old and over) is a major public health issue in many countries. Suicide rates increase during the life course and are as high as 48.7/100,000 among older white men in the USA. Specific health conditions and stress factors increase the complexity of the explanatory model for suicide in older adults. A PubMed literature search was performed to identify most recent and representative studies on suicide risk factors in older adults. The aim of our narrative review was to provide a critical evaluation of recent findings concerning specific risk factors for suicidal thoughts and behaviors among older people: psychiatric and neurocognitive disorders, social exclusion, bereavement, cognitive impairment, decision making and cognitive inhibition, physical illnesses, and physical and psychological pain. We also aimed to approach the problem of euthanasia or physician-assisted suicide in older adults. Our main findings emphasize the need to integrate specific stress factors, such as feelings of social disconnectedness, neurocognitive impairment or decision making, as well as chronic physical illnesses and disability in suicide models and in suicide prevention programs in older adults. Furthermore, the chronic care model should be adapted for the treatment of older people with long-term conditions in order to improve the treatment of depressive disorders and the prevention of suicidal thoughts and acts. PMID:29719381

Water-loss dehydration and aging.

PubMed

Hooper, Lee; Bunn, Diane; Jimoh, Florence O; Fairweather-Tait, Susan J

2014-01-01

This review defines water-loss and salt-loss dehydration. For older people serum osmolality appears the most appropriate gold standard for diagnosis of water-loss dehydration, but clear signs of early dehydration have not been developed. In older adults, lower muscle mass, reduced kidney function, physical and cognitive disabilities, blunted thirst, and polypharmacy all increase dehydration risk. Cross-sectional studies suggest a water-loss dehydration prevalence of 20-30% in this population. Water-loss dehydration is associated with higher mortality, morbidity and disability in older people, but evidence is still needed that this relationship is causal. There are a variety of ways we may be able to help older people reduce their risk of dehydration by recognising that they are not drinking enough, and being helped to drink more. Strategies to increase fluid intake in residential care homes include identifying and overcoming individual and institutional barriers to drinking, such as being worried about not reaching the toilet in time, physical inability to make or to reach drinks, and reduced social drinking and drinking pleasure. Research needs are discussed, some of which will be addressed by the FP7-funded NU-AGE (New dietary strategies addressing the specific needs of elderly population for a healthy ageing in Europe) trial. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

Caring for disabled older adults with musculoskeletal conditions: A transactional model of caregiver burden, coping strategies, and depressive symptoms.

PubMed

Lu, Nan; Liu, Jinyu; Wang, Fei; Lou, Vivian W Q

This study investigated the mediating role of coping strategies in the relationship between caregiver burden and depressive symptoms among family caregivers caring for disabled older adults with musculoskeletal (MSK) conditions. The cross-sectional data were from a quota sampling of 494 pairs of disabled older adults and their primary family caregivers in Shanghai, China. The disabled older adults had MSK conditions and limitations in activities of daily living. The mean ages of the older adults and their caregivers were 83.9 and 62.6 years. Path analysis was conducted to test the proposed hypotheses. Caregivers of adults with MSK conditions were more likely to use active coping to handle time dependence (β [SD]=0.182 [0.055]) and physical burden (β [SD]=0.226 [0.071]) and to use avoidant coping to handle developmental burden (β [SD]=0.414 [0.061]). Both coping strategies were used to handle social burden(active: β [SD]=0.179 [0.078]; avoidant: β [SD]=0.241 [0.073]). Experiencing emotional burden reduced the likelihood of using both coping strategies (active: β [SD]=-0.266 [0.066]; avoidant: β [SD]=-0.373 [0.062]). Active coping had a protective impact on depressive symptoms (β [SD]=-0.228 [0.050]), whereas avoidant coping had an adverse impact on depressive symptoms (β [SD]=0.232 [0.053]). The findings confirm the mediating effects of coping strategies in the relationship between caregiver burden and depressive symptoms. Copyright © 2016. Published by Elsevier Ireland Ltd.

Retrospectively assessed psychosocial working conditions as predictors of prospectively assessed sickness absence and disability pension among older workers.

PubMed

Sundstrup, Emil; Hansen, Åse Marie; Mortensen, Erik Lykke; Poulsen, Otto Melchior; Clausen, Thomas; Rugulies, Reiner; Møller, Anne; Andersen, Lars L

2018-01-17

The aim was to explore the association between retrospectively assessed psychosocial working conditions during working life and prospectively assessed risk of sickness absence and disability pension among older workers. The prospective risk of register-based long-term sickness absence (LTSA) and disability pension was estimated from exposure to 12 different psychosocial work characteristics during working life among 5076 older workers from the CAMB cohort (Copenhagen Aging and Midlife Biobank). Analyses were censored for competing events and adjusted for age, gender, physical work environment, lifestyle, education, and prior LTSA. LTSA was predicted by high levels of cognitive demands (HR 1.31 (95% CI 1.10-1.56)), high levels of emotional demands (HR 1.26 (95% CI 1.07-1.48)), low levels of influence at work (HR 1.30 (95% CI 1.03-1.64)), and high levels of role conflicts (HR 1.34 (95% CI 1.09-1.65)). Disability pension was predicted by low levels of influence at work (HR 2.73 (95% CI 1.49-5.00)) and low levels of recognition from management (HR 2.04 (95% CI 1.14-3.67)). This exploratory study found that retrospectively assessed high cognitive demands, high and medium emotional demands, low influence at work, low recognition from management, medium role clarity, and high role conflicts predicted LTSA and/or disability pension.

Trends in late-life disability in Taiwan: The roles of education, environment, and technology

PubMed Central

Martin, Linda G.; Zimmer, Zachary; Hurng, Baai-Shyun

2011-01-01

This analysis offers the first strong evidence of trends in late-life disability in an emerging economy. Consistent measures of limitations in seeing, hearing, physical functions, instrumental activities of daily living (IADLs), and activities of daily living (ADLs) were available for three to six survey waves, depending on the outcome, from 1989 to 2007 for the population of Taiwan aged 65 and older. Limitations in seeing, hearing, and IADLs declined substantially, but trends were mixed for physical functions and flat for ADLs. The remarkable reduction in difficulty phoning, an IADL, may reflect changes in telecommunications infrastructure and highlights the roles of environment and technology in disability outcomes. Trends for urban residents were more advantageous than those for rural residents for seeing and hearing, but less so for physical functions and IADLs. Were it not for the substantial increase in educational attainment, trends in all outcomes would have been less favorable. PMID:21923619

Dose of physical activity, physical functioning and disability risk in mobility-limited older adults: Results from the LIFE study randomized trial

PubMed Central

Guralnik, Jack M.; King, Abby C.; Pahor, Marco; McDermott, Mary M.; Tudor-Locke, Catrine; Manini, Todd M.; Glynn, Nancy W.; Marsh, Anthony P.; Axtell, Robert S.; Hsu, Fang-Chi; Rejeski, W. Jack

2017-01-01

Understanding the minimal dose of physical activity required to achieve improvement in physical functioning and reductions in disability risk is necessary to inform public health recommendations. To examine the effect of physical activity dose on changes in physical functioning and the onset of major mobility disability in The Lifestyle Interventions and Independence for Elders (LIFE) Study. We conducted a multicenter single masked randomized controlled trial that enrolled participants in 2010 and 2011 and followed them for an average of 2.6 years. 1,635 sedentary men and women aged 70–89 years who had functional limitations were randomized to a structured moderate intensity walking, resistance, and flexibility physical activity program or a health education program. Physical activity dose was assessed by 7-day accelerometry and self-report at baseline and 24 months. Outcomes included the 400 m walk gait speed, the Short Physical Performance Battery (SPPB), assessed at baseline, 6, 12, and 24 months, and onset of major mobility disability (objectively defined by loss of ability to walk 400 m in 15 min). When the physical activity arm or the entire sample were stratified by change in physical activity from baseline to 24 months, there was a dose-dependent increase in the change in gait speed and SPPB from baseline at 6, 12, and 24 months. In addition, the magnitude of change in physical activity over 24 months was related to the reduction in the onset of major mobility disability (overall P < 0.001) (highest versus the lowest quartile of physical activity change HR 0.23 ((95% CI:0.10–0.52) P = 0.001) in the physical activity arm. We observed a dose-dependent effect of objectively monitored physical activity on physical functioning and onset of major mobility disability. Relatively small increases (> 48 minutes per week) in regular physical activity participation had significant and clinically meaningful effects on these outcomes. Trial registration: ClinicalsTrials.gov NCT00116194 PMID:28820909

Dose of physical activity, physical functioning and disability risk in mobility-limited older adults: Results from the LIFE study randomized trial.

PubMed

Fielding, Roger A; Guralnik, Jack M; King, Abby C; Pahor, Marco; McDermott, Mary M; Tudor-Locke, Catrine; Manini, Todd M; Glynn, Nancy W; Marsh, Anthony P; Axtell, Robert S; Hsu, Fang-Chi; Rejeski, W Jack

2017-01-01

Understanding the minimal dose of physical activity required to achieve improvement in physical functioning and reductions in disability risk is necessary to inform public health recommendations. To examine the effect of physical activity dose on changes in physical functioning and the onset of major mobility disability in The Lifestyle Interventions and Independence for Elders (LIFE) Study. We conducted a multicenter single masked randomized controlled trial that enrolled participants in 2010 and 2011 and followed them for an average of 2.6 years. 1,635 sedentary men and women aged 70-89 years who had functional limitations were randomized to a structured moderate intensity walking, resistance, and flexibility physical activity program or a health education program. Physical activity dose was assessed by 7-day accelerometry and self-report at baseline and 24 months. Outcomes included the 400 m walk gait speed, the Short Physical Performance Battery (SPPB), assessed at baseline, 6, 12, and 24 months, and onset of major mobility disability (objectively defined by loss of ability to walk 400 m in 15 min). When the physical activity arm or the entire sample were stratified by change in physical activity from baseline to 24 months, there was a dose-dependent increase in the change in gait speed and SPPB from baseline at 6, 12, and 24 months. In addition, the magnitude of change in physical activity over 24 months was related to the reduction in the onset of major mobility disability (overall P < 0.001) (highest versus the lowest quartile of physical activity change HR 0.23 ((95% CI:0.10-0.52) P = 0.001) in the physical activity arm. We observed a dose-dependent effect of objectively monitored physical activity on physical functioning and onset of major mobility disability. Relatively small increases (> 48 minutes per week) in regular physical activity participation had significant and clinically meaningful effects on these outcomes. ClinicalsTrials.gov NCT00116194.

Impact of Exercise to Improve Gait Efficiency on Activity and Participation in Older Adults With Mobility Limitations: A Randomized Controlled Trial

PubMed Central

Perera, Subashan; Brach, Jennifer S.; Wert, David; Studenski, Stephanie A.

2011-01-01

Background Definitive evidence that exercise interventions that improve gait also reduce disability is lacking. A task-oriented, motor sequence learning exercise intervention has been shown to reduce the energy cost of walking and improve gait speed, but whether the intervention also improves activity and participation has not been demonstrated. Objective The objective of this study was to compare the impact of a task-oriented, motor sequence learning exercise (TO) intervention and the impact of an impairment-oriented, multicomponent exercise (IO) intervention on activity and participation outcomes in older adults with mobility limitations. The mediating effects of a change in the energy cost of walking on changes in activity and participation also were determined. Design This study was a single-blind, randomized controlled trial. Setting The study was conducted in an ambulatory clinical research training center. Participants The study participants were 47 older adults (mean age=77.2 years, SD=5.5) with slow and variable gait. Intervention The intervention was a 12-week, physical therapist–guided program of TO or IO. Measurements Measures of activity (gait speed over an instrumented walkway; daily physical activity measured with an accelerometer; confidence in walking determined with the Gait Efficacy Scale; and physical function determined with the total, basic lower-extremity, and advanced lower-extremity components of the Late-Life Function and Disability Instrument [Late-Life FDI]) and participation (disability limitation dimension and instrumental role [home and community task performance] domain components of the Late-Life FDI) were recorded before and after the intervention. The energy cost of walking was determined from the rate of oxygen consumption during self-paced treadmill walking at the physiological steady state standardized by walking speed. An adjusted comparison of activity and participation outcomes in the treatment arms was made by use of an analysis of covariance model, with baseline and change in energy cost of walking added to the model to test for mediation. Tests were used to determine the significance of the mediating effects. Results Activity improved in TO but not in IO for confidence in walking (Gait Efficacy Scale; mean adjusted difference=9.8 [SD=3.5]) and physical function (Late-Life FDI basic lower-extremity component; mean adjusted difference=3.5 [SD=1.7]). Improvements in TO were marginally greater than those in IO for gait speed, physical activity, and total physical function. Participation improved marginally more in TO than in IO for disability limitations and instrumental role. Limitations The older adults were randomized to the intervention group, but differences in baseline measures had to be accounted for in the analyses. Conclusions A TO intervention that improved gait also led to improvements in some activity and participation outcomes in older adults with mobility limitations. PMID:22003158

Social marketing strategies for reaching older people with disabilities: findings from a survey of centers for independent living participants.

PubMed

Moone, Rajean Paul; Lightfoot, Elizabeth

2009-01-01

Centers for independent living (CILs) provide critical supports, services, and advocacy for assisting people with disabilities in living independently. As there is a rapidly increasing population of older people with disabilities, many CILs are now considering how to actively engage older adults in their organizations. This study utilized a survey of older people with disabilities to help identify social marketing techniques that community organizations like CILs can use to effectively reach older people with disabilities. Utilizing the components of the social marketing mix in designing outreach efforts, including a critical examination of product, place, price, participants, and partnering, CILs and other community agencies can better reach older adults with disabilities.

Feelings of uselessness and 3-year mortality in an Italian community older people: the role of the functional status.

PubMed

Curzio, Olivia; Bernacca, Emilia; Bianchi, Bruno; Rossi, Giuseppe

2017-09-01

Sense of self-worth influences the health status of the elderly and may be associated with mortality. The aim of the study was to investigate whether the association between subjective feelings of uselessness and mortality was confounded or modified by functional limitation in non-institutionalized older people. Participants were community-dwelling older people, aged 70 years and older, who lived in neighbourhoods of Massa and Carrara municipalities in northern Tuscany, Italy. At baseline, 2335 non-institutionalized older people were assessed with a short self-administered questionnaire; the analysis included 2132 older persons for whom vital statistical data were available after a 3-year follow-up. The feeling of uselessness was associated with an increased mortality at the 3-year follow-up, but only in older people who reported disability problems (adjusted hazard ratio = 1.97, 95% confidence interval = 1.48-2.63, P < 0.0001). People who reported disability problems and a feeling of uselessness may be vulnerable to an increased risk for poor health outcomes in later life. This study outlined the importance of enquiring about feelings of uselessness, which is a relational variable that is linked to both psychological and physical health status, especially in older people who need help in daily activities. © 2017 Japanese Psychogeriatric Society.

Comparative study of four physical performance measures as predictors of death, incident disability, and falls in unselected older persons: the insufficienza Cardiaca negli Anziani Residenti a Dicomano Study.

PubMed

Minneci, Cristina; Mello, Anna Maria; Mossello, Enrico; Baldasseroni, Samuele; Macchi, Loredana; Cipolletti, Stefano; Marchionni, Niccolò; Di Bari, Mauro

2015-01-01

To compare the ability of the Short Physical Performance Battery (SPPB), 4-m walk test (4mWT), 6-minute walk test (6MWT), and handgrip strength to predict mortality, incident disability, worsening mobility, and falls in older community dwellers. Cohort study. Population-based. Individuals aged 65 and older n = 561) without prevalent basic activity of daily living (ADL) disability participating. Separate logistic regression models were developed to predict incident ADL disability, worsening mobility, and falls in 3 years, and Cox regression models were used to assess 7-year risk of death as a function of the four tests, adjusting for covariates. Performance tests were reciprocally correlated at baseline. After 3 years, 33 (7.3%) of 453 participants reexamined were disabled in ADLs, 87 (20%) had worsening mobility, and 99 (22%) reported falls. Of the 561 baseline participants, 141 (25%) died over the 7 years. All measures predicted incident ADL disability, with adjusted odds ratios (ORs) per unit increase of 0.85 (95% confidence interval (CI) = 0.77-0.93) for handgrip strength, 0.08 (95% CI = 0.02-0.36) for 4mWT, 0.74 (95% CI = 0.61-0.89) for SPPB, and 0.993 (95% CI = 0.988-0.997) for 6MWT. Handgrip strength (OR = 0.88, 95% CI = 0.83-0.93), 4mWT (OR = 0.33, 95% CI = 0.11-0.94), and SPPB (OR = 0.81, 95%CI = 0.71-0.93) predicted worsening mobility. No measure predicted falls; only SPPB (hazard ratio (HR) = 0.92, 95% CI = 0.85-0.997) and 6MWT (HR = 0.997, 95% CI = 0.995-0.999) predicted death. Performance measures are independent predictors of relevant health outcomes, with the exception of falls. Because SPPB is easily applied and is the only measure predicting incident ADL disability, worsening mobility, and death, it is preferable to the other tests. © 2015, Copyright the Authors Journal compilation © 2015, The American Geriatrics Society.

Relation of physical activity time to incident disability in community dwelling adults with or at risk of knee arthritis: prospective cohort study

PubMed Central

Song, Jing; Semanik, Pamela A; Sharma, Leena; Bathon, Joan M; Eaton, Charles B; Hochberg, Marc C; Jackson, Rebecca D; Kwoh, C Kent; Mysiw, W Jerry; Nevitt, Michael C; Chang, Rowland W

2014-01-01

Objective To investigate whether objectively measured time spent in light intensity physical activity is related to incident disability and to disability progression. Design Prospective multisite cohort study from September 2008 to December 2012. Setting Baltimore, Maryland; Columbus, Ohio; Pittsburgh, Pennsylvania; and Pawtucket, Rhode Island, USA. Participants Disability onset cohort of 1680 community dwelling adults aged 49 years or older with knee osteoarthritis or risk factors for knee osteoarthritis; the disability progression cohort included 1814 adults. Main outcome measures Physical activity was measured by accelerometer monitoring. Disability was ascertained from limitations in instrumental and basic activities of daily living at baseline and two years. The primary outcome was incident disability. The secondary outcome was progression of disability defined by a more severe level (no limitations, limitations to instrumental activities only, 1-2 basic activities, or ≥3 basic activities) at two years compared with baseline. Results Greater time spent in light intensity activities had a significant inverse association with incident disability. Less incident disability and less disability progression were each significantly related to increasing quartile categories of daily time spent in light intensity physical activities (hazard ratios for disability onset 1.00, 0.62, 0.47, and 0.58, P for trend=0.007; hazard ratios for progression 1.00, 0.59, 0.50, and 0.53, P for trend=0.003) with control for socioeconomic factors (age, sex, race/ethnicity, education, income) and health factors (comorbidities, depressive symptoms, obesity, smoking, lower extremity pain and function, and knee assessments: osteoarthritis severity, pain, symptoms, prior injury). This finding was independent of time spent in moderate-vigorous activities. Conclusion These prospective data showed an association between greater daily time spent in light intensity physical activities and reduced risk of onset and progression of disability in adults with osteoarthritis of the knee or risk factors for knee osteoarthritis. An increase in daily physical activity time may reduce the risk of disability, even if the intensity of that additional activity is not increased. PMID:24782514

Walking smoothness is associated with self-reported function after accounting for gait speed.

PubMed

Lowry, Kristin A; Vanswearingen, Jessie M; Perera, Subashan; Studenski, Stephanie A; Brach, Jennifer S

2013-10-01

Gait speed has shown to be an indicator of functional status in older adults; however, there may be aspects of physical function not represented by speed but by the quality of movement. The purpose of this study was to determine the relations between walking smoothness, an indicator of the quality of movement based on trunk accelerations, and physical function. Thirty older adults (mean age, 77.7±5.1 years) participated. Usual gait speed was measured using an instrumented walkway. Walking smoothness was quantified by harmonic ratios derived from anteroposterior, vertical, and mediolateral trunk accelerations recorded during overground walking. Self-reported physical function was recorded using the function subscales of the Late-Life Function and Disability Instrument. Anteroposterior smoothness was positively associated with all function components of the Late-Life Function and Disability Instrument, whereas mediolateral smoothness exhibited negative associations. Adjusting for gait speed, anteroposterior smoothness remained associated with the overall and lower extremity function subscales, whereas mediolateral smoothness remained associated with only the advanced lower extremity subscale. These findings indicate that walking smoothness, particularly the smoothness of forward progression, represents aspects of the motor control of walking important for physical function not represented by gait speed alone.

Scoping review report: obesity in older adults.

PubMed

Decaria, J E; Sharp, C; Petrella, R J

2012-09-01

Obesity is associated with an increased risk for early death, heart disease and stroke, disability and several other comorbidities. Although there is concern about the potential burden on health-care services with the aging demographic and the increasing trend of obesity prevalence in older adults, evidence on which to base management strategies is conflicting for various reasons. The analytic framework for this review is based on a scoping review methodology, and was conducted to examine what is known about the diagnosis, treatment and management of obesity in older adults. A total of 492 relevant research articles were identified using PubMed, Scirus, EBSCO, Clinicaltrials.gov, Cochrane Reviews and Google Scholar. The findings of this review indicate that the current WHO (World Health Organization)-recommended body mass index, waist circumference and waist-to-hip ratio obesity thresholds for the general adult population may not be appropriate for older adults. Alternatively, weight change or physical fitness may be more useful measures of mortality and health risk in obese older adults. Furthermore, although obesity in older adults is associated with several disorders that increase functional disability, epidemiological evidence suggests that obesity is protective against mortality in seniors. Consequently, the trend toward increasing prevalence of obesity in older adults will lead to an increase in unhealthy life years and health-care costs. The findings from this review also suggest that treatment strategies for obese older adults should focus on maintaining body weight and improving physical fitness and function rather than weight loss, and that a combination of aerobic and resistance exercise appears to be the most effective strategy. In conclusion, this review demonstrates the need for more research to clarify the definition of obesity in older adults, to establish criteria for evaluating when to treat older adults for obesity, and to develop effective treatment strategies focused on functional outcomes in obese older adults.

Hierarchy of higher-level physical functions: a longitudinal investigation on a nationally representative population of community-dwelling middle-aged and elderly persons.

PubMed

Yeh, Chih-Jung; Wang, Ching-Yi; Tang, Pei-Fang; Lee, Meng-Chih; Lin, Hui-Sheng; Chen, Hui-Ya

2012-01-01

Understanding the hierarchy of higher-level physical functions to infer disability level (mild, moderate or severe) is essential for the precise targeting of preventive interventions and has been examined previously in a cross-sectional study. Based on longitudinal data, this study evaluated the hierarchy of higher-level physical functions. Data from a cohort of 2729 community-dwelling persons aged over 50 with no initial disability were drawn from the "Survey of Health and Living Status of the Elderly in Taiwan" from 1996 through 2007. The three-level hierarchy of eight chosen activities was examined by the median ages to disability onset with survival analyses and by Cox regressions, which examined the effects of sex and age on the development of this hierarchy. The progression of incident disability was as follows: mild level-running, carrying weight, and squatting; moderate level-climbing stairs, walking, and standing; and severe level-grasping and raising arms up. Women and older persons were at greater risk of developing more severe levels of disability. Another Cox regression with one index activity from each hierarchical level revealed similar results. The three-level hierarchy of higher-level physical functions has been validated longitudinally, suggesting rich research and clinical implications.

A preliminary report on the medical profile of disabled persons living in Zhabei District, Shanghai, Mainland China.

PubMed

Chen, Gang; Tan, B-K; Sun, Xiaoxiao; Meng, Xingqiong; Jiwa, Moyez

2011-01-01

The prevalence of chronic diseases and their risk factors in different general populations are well documented, but little is known about disabled populations in China. The purpose of this study is to report available data on the medical profile of disabled persons living in Zhabei District, Shanghai, Mainland China. It also aimed to explore the association between any medical conditions, types and severity of disabilities and socio-demographic factors. Nine hundred and sixty-one disabled persons underwent physical medical examination to identify predisposing conditions for chronic diseases (hypertension and elevated glucose, lipids and triglyceride levels) and to diagnose two common chronic diseases - heart disease and diabetes. Logistic regression was used to assess the influence of age, gender, disability type, disability severity, education level, employment status, socio-economic status or marital status on chronic diseases and predisposing factors. The mean age of the participants was 53 (±12.5) years. The most prevalent types of disability were physical disability (44.9%), visual impairment (28.8%) and intellectual disability (12.5%). Hyperlipidemia was most prevalent (17.1%), followed by hypertension (15.3%), heart disease (7.2%) and diabetes (6.0%). These conditions were not associated with the type or the severity of disability in this sample. Males were more likely to have hypertension (OR=1.75; 95% CI: 1.05, 2.93) and elevated triglycerides (OR=1.84; 95% CI: 1.05, 3.20). The unemployed (OR=4.80, 95% CI: 1.45, 15.76) and older participants (OR=1.04, 95% CI: 1.02, 1.07) were more likely to have elevated blood glucose levels. Divorced individuals were more likely to be diagnosed with heart disease (OR=3.72; 95% CI: 1.37, 10.09) and those with better socio-economic backgrounds (OR=3.09; 95% CI: 1.05, 9.15) and the older disabled (OR=1.08, 95% CI: 1.04, 1.12) were more likely to have diabetes. This preliminary study found that abnormal clinical findings were not related to the type or the severity of disability. Most abnormal findings were, however, related to increasing age, consistent with previous findings in the general Chinese population.

Using population-based data to examine preventive services by disability type among dually eligible (Medicare/Medicaid) adults.

PubMed

Reichard, Amanda; Fox, Michael H

2013-04-01

Individuals dually eligible for Medicaid and Medicare constitute a small percentage of these program's populations but account for a disproportionately large percent of their total costs. While much work has examined high expenditures, little is known about their health and details of their health care utilization. Utilize an important public health surveillance tool to better understand preventive service use among the dual eligible population. This study involved descriptive and regression analyses of dual eligibles in the Medical Expenditure Panel Survey data from pooled alternate years 2000-2008. We classified the sample into 4 mutually exclusive groups: cognitive limitations, physical disabilities, double diagnosis (cognitive limitations and physical disability), or neither cognitive limitations nor physical disability. For most groups, age was significantly associated with preventive services, though direction varies. Older age was linked to greater receipt of flu shots while younger age was associated with greater receipt of Pap tests, mammograms and dental services. Black women in all groups (except cognitive limitations) had an increased likelihood of receiving a Pap test and a mammogram. A subset of dual eligibles drives the majority of expenditures. People with physical disabilities, regardless of whether they also have a cognitive limitation, are among the highest costing and sickest of our non-institutionalized dual eligible population. Efforts to understand and address the challenges faced by women with physical disabilities in accessing Pap tests or mammograms may be helpful in improving the overall health status for this disability group, but also for all dual eligibles. Published by Elsevier Inc.

Cost-effectiveness of the LIFE Physical Activity Intervention for Older Adults at Increased Risk for Mobility Disability

PubMed Central

Kaplan, Robert M.; Castro Sweet, Cynthia M.; Church, Timothy; Espeland, Mark A.; Gill, Thomas M.; Glynn, Nancy W.; King, Abby C.; Kritchevsky, Stephen; Manini, Todd; McDermott, Mary M.; Reid, Kieran F.; Rushing, Julia; Pahor, Marco

2016-01-01

Background: Losing the ability to walk safely and independently is a major concern for many older adults. The Lifestyle Interventions and Independence for Elders study recently demonstrated that a physical activity (PA) intervention can delay the onset of major mobility disability. Our objective is to examine the resources required to deliver the PA intervention and calculate the incremental cost-effectiveness compared with a health education intervention. Methods: The Lifestyle Interventions and Independence for Elders study enrolled 1,635 older adults at risk for mobility disability. They were recruited at eight field centers and randomly assigned to either PA or health education. The PA program consisted of 50-minute center-based exercise 2× weekly, augmented with home-based activity to achieve a goal of 150min/wk of PA. Health education consisted of weekly workshops for 26 weeks, and monthly sessions thereafter. Analyses were conducted from a health system perspective, with a 2.6-year time horizon. Results: The average cost per participant over 2.6 years was US$3,302 and US$1,001 for the PA and health education interventions, respectively. PA participants accrued 0.047 per person more Quality-Adjusted Life-Years (QALYs) than health education participants. PA interventions costs were slightly higher than other recent PA interventions. The incremental cost-effectiveness ratios were US$42,376/major mobility disability prevented and US$49,167/QALY. Sensitivity analyses indicated that results were relatively robust to varied assumptions. Conclusions: The PA intervention costs and QALYs gained are comparable to those found in other studies. The ICERS are less than many commonly recommended medical treatments. Implementing the intervention in non-research settings may reduce costs further. PMID:26888433

Predictors of mortality among elderly people living in a south Indian urban community; a 10/66 Dementia Research Group prospective population-based cohort study.

PubMed

Jotheeswaran, A T; Williams, Joseph D; Prince, Martin J

2010-06-23

Eighty percent of deaths occur in low and middle income countries (LMIC), where chronic diseases are the leading cause. Most of these deaths are of older people, but there is little information on the extent, pattern and predictors of their mortality. We studied these among people aged 65 years and over living in urban catchment areas in Chennai, south India. In a prospective population cohort study, 1005 participants were followed-up after three years. Baseline assessment included sociodemographic and socioeconomic characteristics, health behaviours, physical, mental and cognitive disorders, disability and subjective global health. At follow-up, 257 (25.6%) were not traced. Baseline characteristics were similar to the 748 whose vital status was ascertained; 154 (20.6%) had died. The mortality rate was 92.5/1,000 per annum for men and 51.0/1,000 per annum for women. Adjusting for age and sex, mortality was associated with older age, male sex, having no friends, physical inactivity, smaller arm circumference, dementia, depression, poor self-rated health and disability. A parsimonious model included, in order of aetiologic force, male sex, smaller arm circumference, age, disability, and dementia. The total population attributable risk fraction was 0.90. A balanced approach to prevention of chronic disease deaths requires some attention to proximal risk factors in older people. Smoking and obesity seem much less relevant than in younger people. Undernutrition is preventable. While dementia makes the largest contribution to disability and dependency, comorbidity is the rule, and more attention should be given to the chronic care needs of those affected, and their carers.

Factors related to hysterectomy in women with physical and mobility disabilities.

PubMed

Lin, Lan-Ping; Hsieh, Molly; Chen, Si-Fan; Wu, Chia-Ling; Hsu, Shang-Wei; Lin, Jin-Ding

2012-01-01

This paper aims to identify self-report data for hysterectomy prevalence and to explore its correlated factors among women with physical and mobility disabilities in Taiwan. This paper was part of a larger study, "Survey on Preventive Health Utilizations of People with Physical and Mobility Disability in Taiwan", which is a cross-sectional survey conducted in 2009. We recruited 502 women aged ≧15 years who were officially registered as having physical and mobility disabilities. The results show that 11.3% of women with physical and mobility disabilities accepted hysterectomy surgery and that hysterectomy prevalence was increasing by age: 7% (45-49 years), 9.7% (50-54 years), 26.3% (55-59 years), 31% (60-64 years) and 17.6% (≧65 years). Multilevel logistic regression analyses revealed that being ≧50 years or older (OR=4.65, 95% CI=1.79-12.064), having had cervical cancer (OR=17.2, 95% CI=3.5-84.47) and not having a Pap smear test within the last 3 years (OR=2.79, 95% CI=1.194-6.561) were more likely to accept a hysterectomy operation than their counterparts. This study suggests that future studies should analyze hospital data and assesses long-term changes to understand an area's hysterectomy profile and correlated factors for these types of vulnerable populations. Copyright © 2012 Elsevier Ltd. All rights reserved.

Handgrip Strength Cutoff Points to Identify Mobility Limitation in Community-dwelling Older People and Associated Factors.

PubMed

Vasconcelos, K S de Souza; Dias, J M Domingues; Bastone, A de Carvalho; Vieira, R Alvarenga; Andrade, A C de Souza; Perracini, M Rodrigues; Guerra, R Oliveira; Dias, R Corrêa

2016-03-01

Sarcopenia is defined as a progressive and generalized loss of skeletal muscle mass and strength. The specific threshold of muscle weakness that leads to mobility limitations has not been identified. To determine the best cutoff point of handgrip strength for identifying mobility limitation and to investigate the factors associated with muscle weakness and mobility limitation in community-dwelling older people. Transversal study. Cities of Belo Horizonte, Barueri and Santa Cruz in Brazil. 1374 community-dwelling older people from the Frailty study in Brazilian older people (FIBRA Study). Outcomes included muscle weakness determined according to gender-specific handgrip strength cutoff points generated by Receiver Operating Characteristic curves, mobility limitation defined as a gait speed ≤ 0.8 m/s; and a combination of both muscle weakness and mobility limitation. Associated factors included socio-demographic variables, lifestyle, anthropometrics, health conditions, use of health services and disability. The cutoff points of handgrip strength with the best balancing between sensitivity and specificity for mobility limitation were 25.8 kgf for men (sensitivity 69%, specificity 73%) and 17.4 kgf (sensitivity 60%, specificity 66%) for women. Age and disability in instrumental activities of daily living were associated with all outcomes. Women had greater odds of mobility limitation than men. Physical inactivity, body fat, diabetes, depression, sleeping disturbances, number of medications and occurrence of falls remained as significant associated factors in the final model. Handgrip strength can be a useful tool to identify mobility limitation in clinical practice. Interventions to prevent or minimize impacts of sarcopenia should stimulate physical activity and improvement of body composition in addition to the management of chronic diseases and disabilities.

Characterizing disability at the Iganga-Mayuge Demographic Surveillance System (IM-DSS), Uganda.

PubMed

Bachani, Abdulgafoor M; Galiwango, Edward; Kadobera, Daniel; Bentley, Jacob A; Bishai, David; Wegener, Stephen; Zia, Nukhba; Hyder, Adnan A

2016-01-01

There is a need to better measure disability as an outcome to understand the magnitude of the problem and its impact on health and socio-economic status. The aim of this study was to characterize the physical disabilities present at the Iganga-Mayuge Demographic Surveillance Site (IM-DSS) in Uganda. WHODAS 2.0 was used to examine the consequences of disability on activity limitations and participation in society. One thousand five hundred and fourteen individuals over the age of 18 at the IM-DSS with previously identified physical disabilities were included. Total and domain scores were calculated, and regression analyses examined differences by age, sex, education, occupation and SES. The mean total score was 40.72. Domain 2 - getting around, had the highest mean score (57.21), followed by household activities (55.18). Domains 5.2 (work/school activities) and 6 (participation in society) also had relatively high mean scores - 47.71 and 49.44, respectively. This study serves as an indication of what the major limitations are among individuals in rural Uganda with physical disabilities. In general, individuals with disabilities had the most trouble on getting around, life activities and participation in society. This can guide public health planners and policy-makers on priorities to ameliorate the impact of disabilities in this population. This study found that in general, individuals with disabilities had the most trouble on getting around, life activities and participation in society. This can guide public health planners and policy-makers on rehabilitation priorities to ameliorate the impact of disabilities in this population. Efforts can be made to develop and implement rehabilitation programs that cater to the needs of vulnerable populations including females and older individuals. Programs that focus on education and employment for physically disabled individuals ought to be given priority. These could include legislative changes, and modification of the physical environment, among others.

Influences of Resistance Training on Physical Function in Older, Obese Men and Women With Sarcopenia.

PubMed

Stoever, Katja; Heber, Anke; Eichberg, Sabine; Brixius, Klara

Sarcopenic obesity is associated with disability, gait problems, and falls. Activities of daily living such as walking and climbing stairs are physically difficult or impossible for the individual with severe obesity. These aspects also limit participation in recreational activities or exercise programs. However, good muscle function is crucial to maintain functional independence. The objective of this study was to investigate the influence of resistance training on physical function in older, obese persons with sarcopenia. The study was conducted in a pre-test/post-test design with 2 intervention groups. The participants were physically inactive and obese older adults (≥65 years, BMI ≥ 30 kg/m), without severe diseases. They were divided into a group with sarcopenia (SAR, n = 28) and a group with no or presarcopenia (NSAR, n = 20). The intervention consisted of progressive resistance training, undertaken twice a week for 16 weeks, increasing to 80% to 85% of maximum strength with 3 sets of 8 to 12 repetitions. Sarcopenia was assessed using the Short Physical Performance Battery (SPPB), hand-grip strength, and skeletal muscle mass index (SMI). In addition, the modified Physical Performance Test (PPT) and the Functional Reach Test were used for determining physical function. After training, participants in the SAR group were able to significantly increase their performance in hand-grip strength (by 9%), gait speed (by 5%), SPPB score (by 13%), and modified PPT score (by 11%). In SPPB and modified PPT, they could reach the values of the NSAR group's baseline performance. The NSAR group participants were also able to improve their already good performance at baseline in the 2 tests of physical function after training (SPPB score by 10%, modified PPT score by 7%). However, the participants of both groups could not increase the results of the SMI and the Functional Reach Test. The participants of both groups improved their physical performance in several parameters after training. The results also showed that older, obese adults with sarcopenia benefitted from resistance training. The increase in muscle function can support them having a life with functional independence, and this can help reduce the risk of disability and falls.

Definition of frailty in older men according to questionnaire data (RAND-36/SF-36): The Helsinki Businessmen Study.

PubMed

Sirola, J; Pitkala, K H; Tilvis, R S; Miettinen, T A; Strandberg, T E

2011-11-01

To explore the association of frailty according to questionnaire data (modified Fried criteria) with important endpoints in older men. Prospective cohort study (the Helsinki Businessmen Study) in Finland. In 1974, clinically healthy men (born 1919-1934, n=1815) of similar socioeconomic status were identified. After a 26-year follow-up in 2000 (mean age 73 years), disease prevalence, mobility-disability, and frailty status (80.9% of survivors, n=1125) were appraised using a postal questionnaire including RAND-36. Four criteria were used for definition: 1) >5% weight loss from midlife, or body mass index (BMI) <21 kg/m2; 2) reported physical inactivity; 3) low vitality (RAND-36); 4) physical weakness (RAND-36). Responders with 3-4, 1-2, and zero criteria were classified as frail (n=108), prefrail (n=567), and nonfrail (n=450), respectively. Eight-year mortality was assessed from registers, and in 2007, survivors were re-assessed with questionnaires. Nonfrail as referent and adjusted for age, BMI and smoking, both prefrail (HR 2.26; 95% CI, 1.57-3.26), and frail status (4.09; 95% CI, 2.60-6.44) were significant predictors of mortality. Nonfrailty predicted better survival independently of the frailty components, diseases, and disability, and also predicted faster walking speed and less disability 7 years later. Frailty, and also prefrailty, as defined using questionnaire data (RAND-36) independently predicted important endpoints in older men.

Actigraphy features for predicting mobility disability in older adults

USDA-ARS?s Scientific Manuscript database

Actigraphy has attracted much attention for assessing physical activity in the past decade. Many algorithms have been developed to automate the analysis process, but none has targeted a general model to discover related features for detecting or predicting mobility function, or more specifically, mo...

How many steps/day are enough? For older adults and special populations

PubMed Central

2011-01-01

Older adults and special populations (living with disability and/or chronic illness that may limit mobility and/or physical endurance) can benefit from practicing a more physically active lifestyle, typically by increasing ambulatory activity. Step counting devices (accelerometers and pedometers) offer an opportunity to monitor daily ambulatory activity; however, an appropriate translation of public health guidelines in terms of steps/day is unknown. Therefore this review was conducted to translate public health recommendations in terms of steps/day. Normative data indicates that 1) healthy older adults average 2,000-9,000 steps/day, and 2) special populations average 1,200-8,800 steps/day. Pedometer-based interventions in older adults and special populations elicit a weighted increase of approximately 775 steps/day (or an effect size of 0.26) and 2,215 steps/day (or an effect size of 0.67), respectively. There is no evidence to inform a moderate intensity cadence (i.e., steps/minute) in older adults at this time. However, using the adult cadence of 100 steps/minute to demark the lower end of an absolutely-defined moderate intensity (i.e., 3 METs), and multiplying this by 30 minutes produces a reasonable heuristic (i.e., guiding) value of 3,000 steps. However, this cadence may be unattainable in some frail/diseased populations. Regardless, to truly translate public health guidelines, these steps should be taken over and above activities performed in the course of daily living, be of at least moderate intensity accumulated in minimally 10 minute bouts, and add up to at least 150 minutes over the week. Considering a daily background of 5,000 steps/day (which may actually be too high for some older adults and/or special populations), a computed translation approximates 8,000 steps on days that include a target of achieving 30 minutes of moderate-to-vigorous physical activity (MVPA), and approximately 7,100 steps/day if averaged over a week. Measured directly and including these background activities, the evidence suggests that 30 minutes of daily MVPA accumulated in addition to habitual daily activities in healthy older adults is equivalent to taking approximately 7,000-10,000 steps/day. Those living with disability and/or chronic illness (that limits mobility and or/physical endurance) display lower levels of background daily activity, and this will affect whole-day estimates of recommended physical activity. PMID:21798044

The smart house for older persons and persons with physical disabilities: structure, technology arrangements, and perspectives.

PubMed

Stefanov, Dimitar H; Bien, Zeungnam; Bang, Won-Chul

2004-06-01

Smart houses are considered a good alternative for the independent life of older persons and persons with disabilities. Numerous intelligent devices, embedded into the home environment, can provide the resident with both movement assistance and 24-h health monitoring. Modern home-installed systems tend to be not only physically versatile in functionality but also emotionally human-friendly, i.e., they may be able to perform their functions without disturbing the user and without causing him/her any pain, inconvenience, or movement restriction, instead possibly providing him/her with comfort and pleasure. Through an extensive survey, this paper analyzes the building blocks of smart houses, with particular attention paid to the health monitoring subsystem as an important component, by addressing the basic requirements of various sensors implemented from both research and clinical perspectives. The paper will then discuss some important issues of the future development of an intelligent residential space with a human-friendly health monitoring functional system.

Living with a Chronic Disabling Illness and Then Some: Data from the 1998 Ice Storm

ERIC Educational Resources Information Center

Gignac, Monique A. M.; Cott, Cheryl A.; Badley, Elizabeth M.

2003-01-01

This study examined the impact of the 1998 Canadian ice storm on the physical and psychological health of older adults (age greater than 55 years) living with a chronic physical illness, namely osteoarthritis and/or osteoporosis. Although disasters are relatively rare, they are a useful means of examining the impact of a single stressor on a group…

Staff-Averse Challenging Behaviour in Older Adults with Intellectual Disabilities

ERIC Educational Resources Information Center

Hartley, Sigan L.; MacLean, William E.

2007-01-01

Background: People with intellectual disabilities are increasingly reaching older adulthood. Little is known about age-related change in the prevalence of challenging behaviours among older adults with intellectual disabilities. Materials and method: The frequency and severity of staff-averse challenging behaviours of 132 older adults with…

Dynapenic-obesity and physical function in older adults.

PubMed

Bouchard, Danielle R; Janssen, Ian

2010-01-01

Dynapenia (low muscle strength) and obesity are associated with an impaired physical function. It was hypothesized that older individuals with both conditions (dynapenic-obesity) would have a more impaired physical function than individuals with dynapenia or obesity alone. This cross-sectional study included 2,039 men and women aged 55 years and older from the 1999-2002 National Health and Nutrition Examination Survey. Fat mass was measured by dual-energy x-ray absorptiometry and leg strength by dynamometer. Based on fat mass and leg strength tertiles, four independent groups were identified: non-dynapenic and non-obese, obese alone, dynapenic alone, and dynapenic-obese. An objective physical function measure was obtained from a 20-foot walking speed test, whereas subjective physical function measures were obtained from five self-reported questions. Within both sexes, the dynapenic-obese group had a slower walking speed than the non-dynapenic and non-obese and obese-alone groups (p

Analysis of moment structures for assessing relationships among perceived chewing ability, dentition status, muscle strength, and balance in community-dwelling older adults.

PubMed

Moriya, Shingo; Notani, Kenji; Murata, Ayumi; Inoue, Nobuo; Miura, Hiroko

2014-12-01

The aim of this study was to assess relationships among perceived chewing ability, dentition status, muscle strength and balance in community-dwelling older adults using analysis of moment structures (Amos). Physical performance parameters such as muscle strength and balance can predict the future onset of disabilities in activities of daily living among older adults. In this context, elucidation of the relationships among oral conditions and physical performance parameters is necessary. Data on occlusal contact patterns of natural teeth (OPNT), self-assessed masticatory ability (mastication), body mass index (BMI), handgrip strength (HG) and one-leg standing time with eyes open (OLST) were collected from 501 independently living adults aged 65-74 years. The relationships among these parameters were analysed using Spearman's rank correlation coefficients and Amos. Subjects of both genders showed significant correlations among OPNT, mastication, HG and OLST, evaluated using Spearman's rank correlation coefficients. For each Amos model, the goodness-of-fit statistic indicated a good level of fit. In both men and women, OPNT was significantly related to mastication, and mastication was related to HG but not to OLST. OPNT was related to neither HG nor OLST in women and was related to OLST but not HG in men. The findings observed in this study present a possible importance of dental status and perceived chewing ability for the onset of disability by influencing physical performance in community-dwelling older adults. © 2012 The Gerodontology Society and John Wiley & Sons A/S.

The Cluster-Randomized BRIGHT Trial: Proactive Case Finding for Community-Dwelling Older Adults

PubMed Central

Kerse, Ngaire; McLean, Chris; Moyes, Simon A.; Peri, Kathy; Ng, Terence; Wilkinson-Meyers, Laura; Brown, Paul; Latham, Nancy; Connolly, Martin

2014-01-01

PURPOSE People are now living longer, but disability may affect the quality of those additional years of life. We undertook a trial to assess whether case finding reduces disability among older primary care patients. METHODS We conducted a cluster-randomized trial of the Brief Risk Identification Geriatric Health Tool (BRIGHT) among 60 primary care practices in New Zealand, assigning them to an intervention or control group. Intervention practices sent a BRIGHT screening tool to older adults every birthday; those with a score of 3 or higher were referred to regional geriatric services for assessment and, if needed, service provision. Control practices provided usual care. Main outcomes, assessed in blinded fashion, were residential care placement and hospitalization, and secondary outcomes were disability, assessed with Nottingham Extended Activities of Daily Living Scale (NEADL), and quality of life, assessed with the World Health Organization Quality of Life scale, abbreviated version (WHOQOL-BREF). RESULTS All 8,308 community-dwelling patients aged 75 years and older were approached; 3,893 (47%) participated, of whom 3,010 (77%) completed the trial. Their mean age was 80.3 (SD 4.5) years, and 55% were women. Overall, 88% of the intervention group returned a BRIGHT tool; 549 patients were referred. After 36 months, patients in the intervention group were more likely than those in the control group to have been placed in residential care: 8.4% vs 6.2% (hazard ratio = 1.32; 95% CI, 1.04–1.68; P = .02). Intervention patients had smaller declines in mean scores for physical health-related quality of life (1.6 vs 2.9 points, P = .007) and psychological health-related quality of life (1.1 vs 2.4 points, P = .005). Hospitalization, disability, and use of services did not differ between groups, however. CONCLUSIONS Our case-finding strategy was effective in increasing identification of older adults with disability, but there was little evidence of improved outcomes. Further research could trial stronger primary care integration strategies. PMID:25384813

Diagnostic indicators of anxiety and depression in older dizzy patients in primary care.

PubMed

Maarsingh, Otto R; Dros, Jacquelien; van der Windt, Daniëlle A; ter Riet, Gerben; Schellevis, François G; van Weert, Henk C; van der Horst, Henriëtte E

2011-06-01

Dizzy patients with both psychological and physical symptoms tend to have high levels of disability and are at risk of remaining symptomatic and disabled. The objective of this study was to develop a prediction model for the presence of anxiety and/or depression in older dizzy patients in primary care. We performed a cross-sectional study among 415 older patients consulting their primary care physician for persistent dizziness. Participants underwent a standardized, comprehensive evaluation and completed self-administered questionnaires regarding anxiety and depression (PRIME-MD Patient Health Questionnaire [PHQ]) and dizziness-related disability (Dizziness Handicap Inventory). To determine the diagnostic indicators of anxiety and/or depression, we used multiple logistic regression analysis with ''presence of Panic Disorder, Other Anxiety Disorder, or Major Depressive Disorder'' as dependent variable. Potential diagnostic indicators included dizziness-related disability, patient characteristics (age, sex, history of anxiety, and history of depression), and dizziness characteristics (description of dizziness, provoking circumstances, associated symptoms, onset, frequency, duration, and avoidance of activities because of dizziness). According to the PHQ, an anxiety and/or depressive disorder was present in 90 patients (22%), of whom 35 reported no medical history of anxiety or depression, nor current pharmacological treatment for these disorders. In the final model, dizziness-related disability, a history of depression, and accompanying fear were associated with an increased odd of anxiety and/or depression, whereas tinnitus and rotational dizziness were associated with a decreased odd of anxiety and/or depression. The model showed good calibration (Hosmer-Lemeshow P value of .46) and discrimination (adjusted area under the receiver operating characteristic curve [AUC] after bootstrapping of .82). Primary care physicians should consider the existence of anxiety and depression in older patients presenting with dizziness. After external validation, our model may contribute to better recognition and hence better management of anxiety and depression in older patients with dizziness in primary care.

Short- and long-term effects of a six-week clinical Pilates program in addition to physical therapy on postmenopausal women with chronic low back pain: a randomized controlled trial.

PubMed

Cruz-Díaz, David; Martínez-Amat, Antonio; Osuna-Pérez, M C; De la Torre-Cruz, M J; Hita-Contreras, Fidel

2016-01-01

To determine the short- and long-term effectiveness of the application of Clinical Pilates in addition to physical therapy versus a physical therapy treatment alone in a population of postmenopausal women with chronic low back pain (CLBP). A single-blind randomized controlled trial with repeated measures and a follow-up period. One hundred and one patients were randomly allocated to a Pilates + physical therapy (PPT) group or to a physical therapy (PT) only group for six weeks. Pain and disability were measured by visual analog scale (VAS) and the Oswestry disability index respectively preintervention, after 6 weeks of treatment and after 1-year follow-up. There were significant differences between groups in pain and disability after 6 weeks of treatment, with better results in the PPT group with an effect size of d = 3.14 and d = 2.33 for pain and disability. After 1-year follow-up, only PPT group showed better results compared with baseline with an effect size of d = 2.49 and d = 4.98 for pain and disability. The results suggest that using Clinical Pilates in addition to physical therapy provides improved results on pain management and functional status for postmenopausal woman with CLBP and that its benefits still linger after one year. Chronic Low Back Pain could benefit from the Pilates practice in postmenopausal women. Improvement in pain and disability derived from CLBP seem to be maintained over time due to Pilates practice. Pilates constitutes a safe tool to be applied in older population with CLBP due to its ability to be adapted to every performance and physical level.

Knowledge Gaps in Cardiovascular Care of Older Adults: A Scientific Statement from the American Heart Association, American College of Cardiology, and American Geriatrics Society: Executive Summary.

PubMed

Rich, Michael W; Chyun, Deborah A; Skolnick, Adam H; Alexander, Karen P; Forman, Daniel E; Kitzman, Dalane W; Maurer, Mathew S; McClurken, James B; Resnick, Barbara M; Shen, Win K; Tirschwell, David L

2016-11-01

The incidence and prevalence of most cardiovascular disorders increase with age, and cardiovascular disease (CVD) is the leading cause of death and major disability in adults aged 75 and older. Despite the effect of CVD on quality of life, morbidity, and mortality in older adults, individuals aged 75 and older have been markedly underrepresented in most major cardiovascular trials, and virtually all trials have excluded older adults with complex comorbidities, significant physical or cognitive disabilities, frailty, or residence in nursing homes and assisted living facilities. As a result, current guidelines are unable to provide evidence-based recommendations for diagnosis and treatment of older adults typical of those encountered in routine clinical practice. The objectives of this scientific statement are to summarize current guideline recommendations as they apply to older adults, identify critical gaps in knowledge that preclude informed evidence-based decision-making, and recommend future research to close existing knowledge gaps. To achieve these objectives, a detailed review was conducted of current American College of Cardiology/American Heart Association (ACC/AHA) and American Stroke Association (ASA) guidelines to identify content and recommendations that explicitly targeted older adults. A pervasive lack of evidence to guide clinical decision-making in older adults with CVD was found, as well as a paucity of data on the effect of diagnostic and therapeutic interventions on outcomes that are particularly important to older adults, such as quality of life, physical function, and maintenance of independence. Accordingly, there is a critical need for a multitude of large population-based studies and clinical trials that include a broad spectrum of older adults representative of those seen in clinical practice and that incorporate relevant outcomes important to older adults in the study design. The results of these studies will provide the foundation for future evidence-based guidelines applicable to older adults and enhance person-centered care of older individuals with CVD in the United States and around the world. © 2016, Copyright the Authors Journal compilation © 2016, The American Geriatrics Society.

Therapeutic home adaptations for older adults with disabilities.

PubMed

Unwin, Brian K; Andrews, Christopher M; Andrews, Patrick M; Hanson, Janice L

2009-11-01

Family physicians commonly care for older patients with disabilities. Many of these patients need help maintaining a therapeutic home environment to preserve their comfort and independence. Patients often have little time to decide how to address the limitations of newly-acquired disabilities. Physicians can provide patients with general recommendations in home modification after careful history and assessment. Universal design features, such as one-story living, no-step entries, and wide hallways and doors, are key adaptations for patients with physical disabilities. Home adaptations for patients with dementia include general safety measures such as grab bars and door alarms, and securing potentially hazardous items, such as cleaning supplies and medications. Improved lighting and color contrast, enlarged print materials, and vision aids can assist patients with limited vision. Patients with hearing impairments may benefit from interventions that provide supplemental visual and vibratory cues and alarms. Although funding sources are available, home modification is often a nonreimbursed expense. However, sufficient home modifications may allow the patient and caregivers to safely remain in the home without transitioning to a long-term care facility.

The effect of an outdoor activities' intervention delivered by older volunteers on the quality of life of older people with severe mobility limitations: a randomized controlled trial.

PubMed

Rantanen, Taina; Äyräväinen, Irma; Eronen, Johanna; Lyyra, Tiinamari; Törmäkangas, Timo; Vaarama, Marja; Rantakokko, Merja

2015-04-01

Older community-living disabled people often have unmet activity needs and participation restrictions potentially reducing their quality of life (QoL). We examined the effects of an individualized out-of-home activity intervention delivered by volunteers on QoL among community-living older people, who have difficulty accessing the outdoors independently. Volunteering, Access to Outdoor Activities and Wellbeing in Older People (VOW; ISRCTN56847832) was a two-arm randomized single-blinded, controlled effectiveness trial (RCT) in Jyväskylä, Finland. The inclusion criteria were: age 65 or over, severe mobility limitation, able to communicate, and agree to participate in a RCT. Each intervention group member was assigned a trained volunteer with whom out-of-home activities were done once a week for 3 months (e.g., running errands or recreational activities). The primary outcome was the environmental subscore of QoL assessed with WHOQOL-BREF. Secondary outcomes were the overall QoL, physical capacity, psychological well-being, and social relationships assessed with WHOQOL_BREF and lower-extremity performance assessed with Short Physical Performance Battery (SPPB). 121 people aged 67-92 years (mean age 81.9 years, SD 5.9, 90 % women) were randomized. No treatment effect on the environmental QoL subscore was observed, but for physical capacity subscore a significant treatment effect was observed (General Linear Model, Group by Time p = 0.001). No effects were observed for the other QoL subscores or for SPPB score. This study suggests that individualized out-of-home activity intervention delivered by volunteers may influence the QoL of old severely mobility-limited community-living people in a positive way. Further studies are needed to better understand how to improve QoL of older disabled community-living people and potentially buffer them against more severe care needs and institutionalization.

A community-based physical activity intervention to prevent mobility-related disability for retired older people (REtirement in ACTion (REACT)): study protocol for a randomised controlled trial.

PubMed

Stathi, Afroditi; Withall, Janet; Greaves, Colin J; Thompson, Janice L; Taylor, Gordon; Medina-Lara, Antonieta; Green, Colin; Bilzon, James; Gray, Selena; Johansen-Berg, Heidi; Sexton, Claire E; Western, Max J; de Koning, Jolanthe L; Bollen, Jessica C; Moorlock, Sarah J; Demnitz, Naiara; Seager, Poppy; Guralnik, Jack M; Jack Rejeski, W; Fox, Ken R

2018-04-17

The REtirement in ACTion (REACT) study is a multi-centre, pragmatic, two-arm, parallel-group randomised controlled trial (RCT) with an internal pilot phase. It aims to test the effectiveness and cost-effectiveness of a community, group-based physical activity intervention for reducing, or reversing, the progression of functional limitations in older people who are at high risk of mobility-related disability. A sample of 768 sedentary, community-dwelling, older people aged 65 years and over with functional limitations, but who are still ambulatory (scores between 4 and 9 out of 12 in the Short Physical Performance Battery test (SPPB)) will be randomised to receive either the REACT intervention, delivered over a period of 12 months by trained facilitators, or a minimal control intervention. The REACT study incorporates comprehensive process and economic evaluation and a nested sub-study which will test the hypothesis that the REACT intervention will slow the rate of brain atrophy and of decline in cognitive function assessed using magnetic resonance imaging (MRI). Outcome data will be collected at baseline, 6, 12 and 24 months for the main study, with MRI sub-study data collected at baseline, 6 and 12 months. The primary outcome analysis (SPPB score at 24 months) will be undertaken blinded to group allocation. Primary comparative analyses will be on an intention-to-treat (ITT) basis with due emphasis placed on confidence intervals. REACT represents the first large-scale, pragmatic, community-based trial in the UK to target the non-disabled but high-risk segment of the older population with an intervention to reduce mobility-related disability. A programme that can successfully engage this population in sufficient activity to improve strength, aerobic capacity, coordination and balance would have a major impact on sustaining health and independence. REACT is also the first study of its kind to conduct a full economic and comprehensive process evaluation alongside the RCT. If effective and cost-effective, the REACT intervention has strong potential to be implemented widely in the UK and elsewhere. ISRCTN, ID: ISRCTN45627165 . Retrospectively registered on 13 June 2016. Trial sponsor: University of Bath. Protocol Version 1.5.

Physical Activity, Functional Ability, and Obesity in Older Adults: A Gender Difference.

PubMed

Gretebeck, Kimberlee A; Sabatini, LeAnn M; Black, David R; Gretebeck, Randall J

2017-09-01

Disability, institutionalization, and loss of independence may be directly caused or exacerbated by physical inactivity and obesity. The purpose of the current cross-sectional survey was to explore the impact of gender and obesity on functional ability tasks, physical activity, and psychosocial factors in older adults. Participants comprised 964 University retirees (55% female, mean age = 75.3 years, SD = 6.7 years) with a mean body mass index (BMI) of 26.1 kg/m 2 (SD = 4.7 kg/m 2 ). Results revealed significant gender and BMI interaction effects. Women were less active than men and obese women were most functionally impaired, particularly in activities that target lower extremity function, regardless of weight status. These findings suggest that physical activity interventions for older adults should focus on exercises that improve functional ability and are tailored to meet individual needs while considering weight and gender. Type, intensity, frequency, and duration of exercises should be individualized to limit injuries and improve functional ability and physical activity adherence. [Journal of Gerontological Nursing, 43(9), 38-46.]. Copyright 2017, SLACK Incorporated.

Part-time work among older workers with disabilities in Europe.

PubMed

Pagán, R

2009-05-01

To analyse the use of part-time work among older workers with disabilities compared with their non-disabled counterparts within a European context. Cross-sectional. Data were drawn from the 2004 Survey of Health, Ageing and Retirement in Europe. The key advantage of this dataset is that it provides a harmonized cross-national dimension, and contains information for European individuals aged 50 years or over on a wide range of health indicators, disability, socio-economic situation, social relations, etc. Older people with disabilities (aged 50-64 years) are more likely to have a part-time job compared with their non-disabled counterparts. Although there is an important employment gap between the two groups, many older workers with disabilities use part-time work to achieve a better balance between their health status and working life. The econometric analysis corroborated that being disabled has a positive effect on the probability of working on a part-time basis, although this effect varies by country. Policy makers must encourage part-time employment as a means of increasing employment opportunities for older workers with disabilities, and support gradual retirement opportunities with flexible and reduced working hours. It is crucial to change attitudes towards older people with disabilities in order to increase their labour participation and reduce their levels of poverty and marginalization.

Preparedness for natural disasters among older US adults: a nationwide survey.

PubMed

Al-Rousan, Tala M; Rubenstein, Linda M; Wallace, Robert B

2015-10-01

We sought to determine natural disaster preparedness levels among older US adults and assess factors that may adversely affect health and safety during such incidents. We sampled adults aged 50 years or older (n = 1304) from the 2010 interview survey of the Health and Retirement Study. The survey gathered data on general demographic characteristics, disability status or functional limitations, and preparedness-related factors and behaviors. We calculated a general disaster preparedness score by using individual indicators to assess overall preparedness. Participant (n = 1304) mean age was 70 years (SD = 9.3). Only 34.3% reported participating in an educational program or reading materials about disaster preparation. Nearly 15% reported using electrically powered medical devices that might be at risk in a power outage. The preparedness score indicated that increasing age, physical disability, and lower educational attainment and income were independently and significantly associated with worse overall preparedness. Despite both greater vulnerability to disasters and continuous growth in the number of older US adults, many of the substantial problems discovered are remediable and require attention in the clinical, public health, and emergency management sectors of society.

[Preparedness for natural disasters among older US adults: a nationwide survery].

PubMed

Al-rousan, Tala M; Rubenstein, Linda M; Wallace, Robert B

2014-12-01

We sought to determine natural disaster preparedness levels among older US adults and assess factors that may adversely affect health and safety during such incidents. We sampled adults aged 50 years or older (n = 1 304) from the 2010 interview survey of the Health and Retirement Study. The survey gathered data on general demographic characteristics, disability status or functional limitations, and preparedness-related factors and behaviors. We calculated a general disaster preparedness score by using individual indicators to assess overall preparedness. Participant (n = 1 304) mean age was 70 years (SD = 9.3). Only 34.3% reported participating in an educational program or reading materials about disaster preparation. Nearly 15% reported using electrically powered medical devices that might be at risk in a power outage. The preparedness score indicated that increasing age, physical disability, and lower educational attainment and income were independently and significantly associated with worse overall preparedness. Despite both greater vulnerability to disasters and continuous growth in the number of older US adults, many of the substantial problems discovered are remediable and require attention in the clinical, public health, and emergency management sectors of society.

Social Connections for Older People with Intellectual Disability in Ireland: Results from Wave One of IDS-TILDA.

PubMed

McCausland, Darren; McCallion, Philip; Cleary, Eimear; McCarron, Mary

2016-01-01

The literature on influences of community versus congregated settings raises questions about how social inclusion can be optimised for people with intellectual disability. This study examines social contacts for older people with intellectual disability in Ireland, examining differences in social connection for adults with intellectual disability and other adults. Data were drawn from the IDS-TILDA study in Ireland. A nationally representative sample (n = 753) included adults aged 40 years and older, with additional comparison with general population participants. Predictors of social contacts were explored. Residence, level of intellectual disability and age were significant factors determining social contact. People in institutional residences, older respondents and those with severe/profound intellectual disability had the lowest levels of contact; older adults with intellectual disability had much lower rates than general population counterparts. Community-dwelling people with intellectual disability have greater social contact than those living in institutions, but levels are below those for other adults in Ireland. © 2015 John Wiley & Sons Ltd.

Public Health Options for Improving Cardiovascular Health Among Older Americans

PubMed Central

Keenan, Nora L.; Clayton, Paula F.; Pandey, Dilip K.; Hong, Yuling

2012-01-01

Life expectancy at birth has increased from 74 years in 1980 to 78 years in 2006. Older adults (aged 65 years and older) are living longer with cardiovascular conditions, which are leading causes of death and disability and thus an important public health concern. We describe several major issues, including the impact of comorbidities, the role of cognitive health, prevention and intervention approaches, and opportunities for collaboration to strengthen the public health system. Prevention can be effective at any age, including for older adults. Public health models focusing on policy, systems, and environmental change approaches have the goal of providing social and physical environments and promoting healthy choices. PMID:22698028

Disparity between Physical Capacity and Participation in Seniors with Chronic Disease

PubMed Central

Ashe, Maureen C.; Eng, Janice J.; Miller, William C.; Soon, Judith A.

2011-01-01

Consistently low rates of physical activity are reported for older adults and there is even lower participation if a chronic disease is present. Purpose To explore the predictors of physical capacity and participation in older community-dwelling individuals living with multiple chronic diseases. Methods This was a descriptive cross-sectional investigation of physical capacity (physiological potential) and physical activity participation (recorded engagement in physical activity). Multiple regression and odds ratios were used to investigate determinants of physical capacity (6 Minute Walk Test) and physical activity participation (Physical Activity Scale for Individuals with Physical Disabilities Questionnaire; pedometer steps/day). Results 200 community dwelling ambulatory participants living with 2 or more chronic disease were assessed. Sixty-five percent (65%) were women and the mean age was 74 ± 6 years (range 65–90 years). Mobility (Timed Up and Go) was a consistent determinant across all 3 primary outcomes. For the Six Minute Walk Test, determinants included mobility, BMI, grip strength, number of medications, leg strength, balance and Chronic Disease Management Self Efficacy Scale (r2=0.58; P=.000). The determinants for the self-reported participation measure (Physical Activity Scale for Individuals with Physical Disabilities Questionnaire) was mobility (r2=0.04; P=.007). For the mean daily pedometer steps, the determinants included mobility, body mass index (BMI), age and Chronic Disease Management Self-Efficacy Scale (r2=0.27; P=.000). There were higher risks for inactivity associated with impairments compared with the presence of a chronic disease. In addition, over 1/3 of participants had sufficient physical capacity, but did not meet minimal recommendations of physical activity. Conclusion This study suggests that it is easier to predict an individual’s physical capacity than their actual physical participation. PMID:17596782

Exploring the relationships among performance-based functional ability, self-rated disability, perceived instrumental support, and depression: a structural equation model analysis.

PubMed

Weil, Joyce; Hutchinson, Susan R; Traxler, Karen

2014-11-01

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. © The Author(s) 2014.

Living with companion animals after stroke: experiences of older people in community and primary care nursing.

PubMed

Johansson, Maria; Ahlström, Gerd; Jönsson, Ann-Cathrin

2014-12-01

Older people often have companion animals, and the significance of animals in human lives should be considered by nurses-particularly in relation to older people's health, which can be affected by diseases. The incidence of stroke increases with age and disabilities as a result of stroke are common. This study aimed to explore older people's experiences of living with companion animals after stroke, and their life situation with the animals in relation to the physical, psychological and social aspects of recovery after stroke. The study was performed using individual interviews approximately 2 years after stroke with 17 participants (10 women and 7 men) aged 62-88 years. An overarching theme arising from the content analysis was contribution to a meaningful life. This theme was generated from four categories: motivation for physical and psychosocial recovery after stroke; someone to care for who cares for you; animals as family members; and providers of safety and protection. The main conclusion was that companion animals are experienced as physical and psychosocial contributors to recovery and a meaningful life after stroke.

Is vision function related to physical functional ability in older adults?

PubMed

West, Catherine G; Gildengorin, Ginny; Haegerstrom-Portnoy, Gunilla; Schneck, Marilyn E; Lott, Lori; Brabyn, John A

2002-01-01

To assess the relationship between a broad range of vision functions and measures of physical performance in older adults. Cross-sectional study. Population-based cohort of community-dwelling older adults, subset of an on-going longitudinal study. Seven hundred eighty-two adults aged 55 and older (65% of living eligible subjects) had subjective health measures and objective physical performance evaluated in 1989/91 and again in 1993/95 and a battery of vision functions tested in 1993/95. Comprehensive battery of vision tests (visual acuity, contrast sensitivity, effects of illumination level, contrast and glare on acuity, visual fields with and without attentional load, color vision, temporal sensitivity, and the impact of dimming light on walking ability) and physical function measures (self-reported mobility limitations and observed measures of walking, rising from a chair and tandem balance). The failure rate for all vision functions and physical performance measures increased exponentially with age. Standard high-contrast visual acuity and standard visual fields showed the lowest failure rates. Nonstandard vision tests showed much higher failure rates. Poor performance on many individual vision functions was significantly associated with particular individual measures of physical performance. Using constructed combination vision variables, significant associations were found between spatial vision, field integrity, binocularity and/or adaptation, and each of the functional outcomes. Vision functions other than standard visual acuity may affect day-to-day functioning of older adults. Additional studies of these other aspects of vision and how they can be treated or rehabilitated are needed to determine whether these aspects play a role in strategies for reducing disability in older adults.

Opportunities for Action: Traditionally Marginalized Populations and the Economic Crisis

ERIC Educational Resources Information Center

Tate, Kevin A.; Kathleen M. Fallon; Casquarelli, Elaine J.; Marks, Laura Reid

2014-01-01

This study investigated the career and work life challenges faced by traditionally marginalized populations (e.g., women; historically oppressed racial/ethnic groups; people who identify as lesbian, gay, transgender, bisexual and/or queer; immigrants; individuals with mental or physical disabilities; older individuals; and those of lower…

Fitness for Those with Disabilities and Older Adults | NIH MedlinePlus the Magazine

MedlinePlus

... no exception. According to the National Institute on Aging, being physically active can help you continue to do the things ... Out More Go4Life from the National Institute on Aging: ... Tips to Help You Get Active: www.niddk.nih/gov/health-information/health-topics/ ...

The natural history and risk factors of musculoskeletal conditions resulting in disability among US Army personnel

PubMed Central

Lincoln, Andrew E.; Smith, Gordon S.; Amoroso, Paul J.; Bell, Nicole S.

2007-01-01

We describe the natural history of 13 musculoskeletal conditions requiring hospitalization and identify demographic, behavioral, psychosocial, occupational, and clinical characteristics most strongly associated with disability discharge from the Army. Subjects included 15,268 active-duty personnel hospitalized for a common musculoskeletal condition between the years 1989–1996 who were retrospectively followed through 1997. Back conditions had the greatest 5-year cumulative risk of disability (21%, 19%, and 17% for intervertebral disc displacement, intervertebral disc degeneration, and nonspecific low back pain, respectively). Cox proportional hazards models identified the following risk factors for disability among males: lower pay grade, musculoskeletal diagnosis, shorter length of service, older age, occupational category, lower job satisfaction, recurrent musculoskeletal hospitalizations, more cigarette smoking, greater work stress, and heavier physical demands. Among females, fewer covariates reached statistical significance, although lower education level was significant in more than one model. Modifiable risk factors related to work (job satisfaction, work stress, physical demands, occupation) and health behaviors (smoking) suggest possible targets for intervention. PMID:12441574

Locus of control and utilization of social support among mothers of young children with physical disabilities.

PubMed

Rimmerman, A; Stanger, V

1992-01-01

Sixty mothers of young children with physical disabilities were studied with respect to the effect of the mothers' locus of control on the utilization of social support. The initial findings failed to support the thesis that mothers with an 'internally' focused locus of control would demonstrate greater utilization of their support system, both in terms of descriptive and functional measures. A secondary analysis showed that the mothers' age, the children's level of functioning, and the existence of additional members of the family with a disability served as intervening variables. Only among older mothers, who perceived their children's functioning as severe, was there significant association between the locus of control ('internal') and greater use of their social support system. 'Internal' mothers who had no additional extended family members with a disability reported higher levels of functional social support, as compared to 'external' mothers. Findings are interpreted with respect to social support theory and its implications to applied research.

Knowledge Gaps in Cardiovascular Care of the Older Adult Population: A Scientific Statement From the American Heart Association, American College of Cardiology, and American Geriatrics Society.

PubMed

Rich, Michael W; Chyun, Deborah A; Skolnick, Adam H; Alexander, Karen P; Forman, Daniel E; Kitzman, Dalane W; Maurer, Mathew S; McClurken, James B; Resnick, Barbara M; Shen, Win K; Tirschwell, David L

2016-05-24

The incidence and prevalence of most cardiovascular disorders increase with age, and cardiovascular disease is the leading cause of death and major disability in adults ≥75 years of age; however, despite the large impact of cardiovascular disease on quality of life, morbidity, and mortality in older adults, patients aged ≥75 years have been markedly underrepresented in most major cardiovascular trials, and virtually all trials have excluded older patients with complex comorbidities, significant physical or cognitive disabilities, frailty, or residence in a nursing home or assisted living facility. As a result, current guidelines are unable to provide evidence-based recommendations for diagnosis and treatment of older patients typical of those encountered in routine clinical practice. The objectives of this scientific statement are to summarize current guideline recommendations as they apply to older adults, identify critical gaps in knowledge that preclude informed evidence-based decision making, and recommend future research to close existing knowledge gaps. To achieve these objectives, we conducted a detailed review of current American College of Cardiology/American Heart Association and American Stroke Association guidelines to identify content and recommendations that explicitly targeted older patients. We found that there is a pervasive lack of evidence to guide clinical decision making in older patients with cardiovascular disease, as well as a paucity of data on the impact of diagnostic and therapeutic interventions on key outcomes that are particularly important to older patients, such as quality of life, physical function, and maintenance of independence. Accordingly, there is a critical need for a multitude of large population-based studies and clinical trials that include a broad spectrum of older patients representative of those seen in clinical practice and that incorporate relevant outcomes important to older patients in the study design. The results of these studies will provide the foundation for future evidence-based guidelines applicable to older patients, thereby enhancing patient-centered evidence-based care of older people with cardiovascular disease in the United States and around the world. © 2016 by the American Heart Association, Inc., the American College of Cardiology Foundation, and the American Geriatrics Society.

Factors relating to high psychological distress in Indigenous Australians and their contribution to Indigenous-non-Indigenous disparities.

PubMed

McNamara, Bridgette J; Banks, Emily; Gubhaju, Lina; Joshy, Grace; Williamson, Anna; Raphael, Beverley; Eades, Sandra

2018-04-01

To explore factors associated with high psychological distress among Aboriginal and non-Aboriginal Australians and their contribution to the elevated distress prevalence among Aboriginal people. Questionnaire data from 1,631 Aboriginal and 233,405 non-Aboriginal 45 and Up Study (NSW, Australia) participants aged ≥45 years were used to calculate adjusted prevalence ratios for high psychological distress (Kessler-10 score ≥22) for socio-demographic, health and disability-related factors, and to quantify contributions to differences in distress prevalence. While high-distress prevalence was increased around three-fold in Aboriginal versus non-Aboriginal participants, distress-related risk factors were similar. Morbidity and physical disability had the strongest associations; high distress affected 43.8% of Aboriginal and 20.9% of non-Aboriginal participants with severe physical limitations and 9.5% and 3.9% of those without limitations, respectively. Differences in distress prevalence between Aboriginal and non-Aboriginal participants were essentially attributable to differences in SES, morbidity, disability/functional limitations and social support (fully-adjusted PR 1.19 [95% 1.08, 1.30]); physical morbidity and disability explained the bulk. The markedly elevated prevalence of high distress among older Aboriginal Australians appears largely attributable to greater physical morbidity and disability. Implications for public health: Addressing upstream determinants of physical morbidity and improved integration of social and emotional wellbeing care into primary care and chronic disease management are essential. © 2018 The Authors.

Prevalence, characteristics, and acute care utilization of disabled older adults with an absence of help for activities of daily living: Findings from a nationally representative survey.

PubMed

Wang, Hui-Hsuan; Shyu, Yea-Ing Lotus; Chang, Hsing-Yi; Bai, Yuh-Bin; Stanaway, Fiona; Lin, Jen-Der; Li, Chia-Lin

2016-01-01

The aim of this study was to investigate the prevalence, characteristics, and acute care utilization of community dwelling disabled older adults with an absence of help for activities of daily living (ADL). We analyzed cross-sectional data from a nationally representative sample of people aged 65 years and over (n=2904) participating in the 2009 National Health Interview Survey in Taiwan. Disability was defined as self-reporting a lot of difficulty or complete inability to carry out one or more ADL tasks. Participants with disability were asked whether they received help in the form of personal assistance or assistive devices to complete ADL tasks, with a yes response indicating the presence of help and a no response indicating the absence of help. Hospitalization and emergency department visits was assessed as a dichotomous variable (any or none), respectively. An absence of available help for ADL disability was reported in 16.6% of disabled older adults. Disabled older adults reporting an absence of help were more likely to be female. After adjustment for other factors, compared to older adults without disability, older adults with disability not receiving help for ADL tasks were highly related to hospitalization (OR=4.57; 95%CI=[1.51-13.82]) and emergency department visits (OR=3.52; 95%CI=[1.15-10.76]) during the past year, respectively. We found that there is high prevalence of absence of help to perform ADL tasks in older adults with disability, and that this absence of help for ADL disability is associated with a greater burden of acute care utilization than those without disability. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Prevalence of Disability in Patients With Musculoskeletal Pain and Rheumatic Diseases in a Population From Cuenca, Ecuador.

PubMed

Guevara-Pacheco, Sergio Vicente; Feican-Alvarado, Astrid; Delgado-Pauta, Jorge; Lliguisaca-Segarra, Angelita; Pelaez-Ballestas, Ingris

2017-09-01

The aim of this study was to determine the prevalence of disability in patients with musculoskeletal pain and rheumatic diseases in Cuenca, Ecuador. We performed a cross-sectional analytical study with randomized sampling in 4877 subjects, from urban and rural areas. COPCORD (Community Oriented Program for Control of Rheumatic Diseases)-validated questionnaire was administered house-to-house to identify subjects with nontraumatic musculoskeletal pain and rheumatic diseases. The subjects were assessed by rheumatologists for diagnostic accuracy, and the Health Assessment Questionnaire Disability Index was administered to assess functional capacity. A logistic regression analysis was conducted to determine the association of rheumatic diseases with functional disability. Functional disability was found in 221 subjects (73.1% women), with mean age 62 (SD, 18.2) years, residing in rural areas (201 [66.5%]), with education of 6.9 (SD, 5.3) years, and of low income (77 [47.2%]). The value of HAQ-DI was a mean of 0.2 (0-2.9). The real prevalence of physical disability was 9.5%. Moderate and severe disability predominated in activities such as kneeling (4.9% and 3.3%), squatting (4.8% and 2.7%), and leaning to pick up objects (3.7% and 0.9%), respectively. Rheumatic diseases associated with physical disabilities were knee osteoarthritis (95 [31.4%]) and hand osteoarthritis (69 [22.8%]), mechanical low-back pain (43 [14.2%]), fibromyalgia (27 [9.5%]), and rheumatoid arthritis (11 [3.6%]; P < 0.001). Physical disability was associated with older age, female sex, rural residence, lower education, and lower income. Moderate and severe disability predominated in the dimensions of kneeling, squatting, and picking up objects. Rheumatic diseases associated with disability were hand and knee osteoarthritis, back pain, fibromyalgia, and rheumatoid arthritis.

Lifetime Exposure to Family Violence: Implications for the Health Status of Older African American Women

PubMed Central

Sprauve-Holmes, Nancy E; Gaughan, John; Kaslow, Nadine J.

2009-01-01

Abstract Background Family violence among older women encompasses intimate partner violence (IPV) and elder maltreatment, both linked to poor health status. Little is known about the association between family violence and the health status of older innercity African American women. Methods One hundred fifty-eight African American women, aged ≥50, were interviewed in the ambulatory clinics of a large public hospital. Lifetime family violence exposure as an adult was measured by the Family Violence against Older Women (FVOW) scale; physical and mental health status were measured by the physical and mental component summary scores of the Short Form 8® scale. Results Mean participant age was 61.5 years (SD 7.1). Participants with FVOW scores in the top quartile were considered to have high lifetime family violence exposure. Participants with higher family violence exposure and those younger, unemployed, or disabled reported worse physical and mental health status. Lower income and not having Medicare were associated with worse physical and mental health status, respectively. Using stepwise linear regression techniques, only employment status and high family violence exposure were associated with worse physical (F = 7.16, p = 0.0011) and mental health (f = 7.09, p = 0.0012) status. Women with high FVOW scores reported physical and mental component summary scores that were 4.18 and 4.6 points lower, respectively, than those of women with lower FVOW scores. Conclusions Among older, innercity, African American women, lack of employment and high levels of family violence exposure as an adult are associated with worse physical and mental health status. Clinicians caring for older African American women need to be cognizant of the role both current and prior violence exposure may play in their patients' current health status. PMID:19183088

Lifetime exposure to family violence: implications for the health status of older African American women.

PubMed

Paranjape, Anuradha; Sprauve-Holmes, Nancy E; Gaughan, John; Kaslow, Nadine J

2009-02-01

Family violence among older women encompasses intimate partner violence (IPV) and elder maltreatment, both linked to poor health status. Little is known about the association between family violence and the health status of older innercity African American women. One hundred fifty-eight African American women, aged >/=50, were interviewed in the ambulatory clinics of a large public hospital. Lifetime family violence exposure as an adult was measured by the Family Violence against Older Women (FVOW) scale; physical and mental health status were measured by the physical and mental component summary scores of the Short Form 8 scale. Mean participant age was 61.5 years (SD 7.1). Participants with FVOW scores in the top quartile were considered to have high lifetime family violence exposure. Participants with higher family violence exposure and those younger, unemployed, or disabled reported worse physical and mental health status. Lower income and not having Medicare were associated with worse physical and mental health status, respectively. Using stepwise linear regression techniques, only employment status and high family violence exposure were associated with worse physical (F = 7.16, p = 0.0011) and mental health (f = 7.09, p = 0.0012) status. Women with high FVOW scores reported physical and mental component summary scores that were 4.18 and 4.6 points lower, respectively, than those of women with lower FVOW scores. Among older, innercity, African American women, lack of employment and high levels of family violence exposure as an adult are associated with worse physical and mental health status. Clinicians caring for older African American women need to be cognizant of the role both current and prior violence exposure may play in their patients' current health status.

Gender differences in functional disability and self-care among seniors in Bangladesh.

PubMed

Tareque, Md Ismail; Tiedt, Andrew D; Islam, Towfiqua Mahfuza; Begum, Sharifa; Saito, Yasuhiko

2017-08-08

Disability among older adults is a public health concern. To date there are no in-depth and comprehensive analyses on older adults' disabilities in Bangladesh. This study investigated gender differences in the prevalence of disability and the socio-demographic factors associated with disability among older adults in Bangladesh. This research used a sample of 4176 elderly males and females aged 60 years and over from a nationally representative data set- Bangladesh's 2010 Household Income and Expenditure Survey. The study used both household level and individual level data and applied a wealth index, which was constructed based on household assets using principal component analysis. The Washington Group's short set of questions on disability were used to measure disability. Chi-square tests and ordinal logistic regression models were fit. Forty-two percent of older had some form of functional disability, including 5% of elderly with severe/extreme functional disability. Seven percent of older adults had a self-care disability, including 3% of elderly with a severe/extreme form of self-care disability. Elderly females suffered from all the studied disabilities, including functional and self-care disabilities in higher percentages, and had higher odds ratios of having both functional disability and self-care disability compared to elderly males. The study also identified some significant factors affecting functional disability and self-care disability, namely age, having a chronic condition, wealth status and place of residence, including divisional differences. Programs aimed at reducing functional disability among seniors, particularly elderly females, should be granted the highest priority in Bangladesh.

Diabetes in South African older adults: prevalence and impact on quality of life and functional disability - as assessed using SAGE Wave 1 data.

PubMed

Werfalli, Mahmoud; Kassanjee, Reshma; Kalula, Sebastiana; Kowal, Paul; Phaswana-Mafuya, Nancy; Levitt, Naomi S

2018-01-01

Diabetes is a chronic disease with severe late complications. It is known to impact the quality of life and cause disability, which may affect an individual's capacity to manage and maintain longer-term health and well-being. To examine the prevalence of self-report diabetes, and association between diabetes and each of health-related quality of life and disability amongst South Africa's older adults. To study both the direct relationship between diabetes and these two measures, as well as moderation effects, i.e. whether associations between other factors and these measures of well-being differed between individuals with diabetes and those without. Secondary analyses of data on participants aged 50 years and older from the Study on global AGEing and adult health (SAGE) in South Africa Wave 1 (2007-2008) were conducted. Prevalence of self-reported diabetes was assessed. Multivariable regressions describe the relationships between each of quality of life (WHOQoL) and disability (WHODAS), and diabetes, while controlling for selected socio-demographic characteristics, health risk behaviours and co-morbid conditions. In the regression models, we also investigated whether diabetes moderates the relationships between these additional factors and WHOQoL/WHODAS. Self-reported diabetes prevalence was 9.2% (95% CI: 7.8,10.9) and increased with age. Having diabetes was associated with poorer WHOQoL scores (additive effect: -4.2; 95% CI: -9.2,0.9; p-value <0.001) and greater disability (multiplicative effect: 2.1; 95% CI: 1.5,2.9; p-value <0.001). Lower quality of life and greater disability were both related to not being in a relationship, lower education, less wealth, lower physical activity and a larger number of chronic conditions. Diabetes is associated with lower quality of life and greater disability amongst older South Africans. Attention needs to be given to enhancing the capacity of health systems to meet the changing needs of ageing populations with diabetes in SA as well as facilitating social support networks in communities.

Diabetes in South African older adults: prevalence and impact on quality of life and functional disability – as assessed using SAGE Wave 1 data

PubMed Central

Kassanjee, Reshma; Kalula, Sebastiana; Phaswana-Mafuya, Nancy; Levitt, Naomi S.

2018-01-01

ABSTRACT Background: Diabetes is a chronic disease with severe late complications. It is known to impact the quality of life and cause disability, which may affect an individual’s capacity to manage and maintain longer-term health and well-being. Objectives: To examine the prevalence of self-report diabetes, and association between diabetes and each of health-related quality of life and disability amongst South Africa’s older adults. To study both the direct relationship between diabetes and these two measures, as well as moderation effects, i.e. whether associations between other factors and these measures of well-being differed between individuals with diabetes and those without. Methods: Secondary analyses of data on participants aged 50 years and older from the Study on global AGEing and adult health (SAGE) in South Africa Wave 1 (2007–2008) were conducted. Prevalence of self-reported diabetes was assessed. Multivariable regressions describe the relationships between each of quality of life (WHOQoL) and disability (WHODAS), and diabetes, while controlling for selected socio-demographic characteristics, health risk behaviours and co-morbid conditions. In the regression models, we also investigated whether diabetes moderates the relationships between these additional factors and WHOQoL/WHODAS. Results: Self-reported diabetes prevalence was 9.2% (95% CI: 7.8,10.9) and increased with age. Having diabetes was associated with poorer WHOQoL scores (additive effect: −4.2; 95% CI: −9.2,0.9; p-value <0.001) and greater disability (multiplicative effect: 2.1; 95% CI: 1.5,2.9; p-value <0.001). Lower quality of life and greater disability were both related to not being in a relationship, lower education, less wealth, lower physical activity and a larger number of chronic conditions. Conclusions: Diabetes is associated with lower quality of life and greater disability amongst older South Africans. Attention needs to be given to enhancing the capacity of health systems to meet the changing needs of ageing populations with diabetes in SA as well as facilitating social support networks in communities. PMID:29699475

Prescription Errors in Older Individuals with an Intellectual Disability: Prevalence and Risk Factors in the Healthy Ageing and Intellectual Disability Study

ERIC Educational Resources Information Center

Zaal, Rianne J.; van der Kaaij, Annemieke D. M.; Evenhuis, Heleen M.; van den Bemt, Patricia M. L. A.

2013-01-01

Prescribing pharmacotherapy for older individuals with an intellectual disability (ID) is a complex process, possibly leading to an increased risk of prescription errors. The objectives of this study were (1) to determine the prevalence of older individuals with an intellectual disability with at least one prescription error and (2) to identify…

Environmental barriers in mainstream schools.

PubMed

Hemmingsson, H; Borell, L

2002-01-01

Research on students with disabilities in mainstream schools often focuses on the students' personal abilities rather than on the establishment itself. To promote inclusive education, the environmental prerequisite for participation has to be explored also. The aim of this study was to identify the barriers to participation in Swedish mainstream schools, from the personal perspective of students with physical disabilities. The study also investigated how gender, diagnosis, level of mobility, academic years and availability of an assistant were related to student-environment fit. A total of 34 students with physical disabilities, aged between 10 and 19 years, participated in the study. The students were assessed by 'The school-setting interview'. Results show that two-thirds of the students experienced barriers to participation in both the physical and the social environment. A majority of the barriers originated from the way in which school activities were organized and carried out in schools. Failure to provide adequate environmental adjustments resulted in restricted participation or exclusion from some of the activities in class. Older students experienced significantly more barriers than younger ones because the school organization was less favourable. The results suggest that the way in which activities are organized in school is the area in need of most improvements to promote participation of students with physical disabilities.

Female disability disadvantage: a global perspective on sex differences in physical function and disability.

PubMed

Wheaton, Felicia V; Crimmins, Eileen M

2016-07-01

The objectives were to determine whether women always fare more poorly in terms of physical function and disability across countries that vary widely in terms of their level of development, epidemiologic context and level of gender equality. Sex differences in self-reported and objective measures of disability and physical function were compared among older adults aged 55-85 in the United States of America, Taiwan, Korea, Mexico, China, Indonesia and among the Tsimane of Bolivia using population-based studies collected between 2001 and 2011. Data were analysed using logistic and ordinary least-squares regression. Confidence intervals were examined to see whether the effect of being female differed significantly between countries. In all countries, women had consistently worse physical functioning (both self-reported and objectively measured). Women also tended to report more difficulty with activities of daily living (ADL), although differences were not always significant. In general, sex differences across measures were less pronounced in China. In Korea, women had significantly lower grip strength, but sex differences in ADL difficulty were non-significant or even reversed. Education and marital status helped explain sex differences. Overall, there was striking similarity in the magnitude and direction of sex differences across countries despite considerable differences in context, although modest variations in the effect of sex were observed.

Physical frailty and sarcopenia (PF&S): a point of view from the industry.

PubMed

Del Signore, Susanna; Roubenoff, Ronenn

2017-02-01

We have observed over the last 15 years a wide debate both in the medical scientific community and in the public health arena on the definition and operationalization of frailty, typically a geriatric condition, and in particular of physical frailty linked to sarcopenia. Because physical frailty in its initial phase can still be reversed, fighting sarcopenia in elderly persons has the potential to slow or halt progressive decline towards disability and dependency. Quite recently, regulators focused attention on frailty as an indicator of biological age to be measured to characterize elderly patients before their inclusion in clinical trials. A European guidance regarding most adapted evaluation instruments of frailty is currently under public consultation. Does the regulatory initiative imply we should now consider frailty, and particularly physical frailty, primarily as an important risk factor for adverse events and poor response, or mainly as a clinical tool helping the physician to opt for one therapeutic pathway or another? Or is physical frailty above all a specific geriatric condition deserving an effective and innovative therapeutic approach with the objective to curb the incidence of its most common result, e.g., mobility disability? Pharmaceutical industry developers consider both faces of the coin very relevant. We agree with regulators that better characterization of subpopulations, not only in elderly patients, can improve the benefit risk ratio of medicines. At the same time, we believe it is in the public health interest to develop novel drugs indicated for specific geriatric conditions, like osteoporosis in the 1990s and sarcopenia today. We consider it an important therapeutic goal to effectively delay mobility disability and to extend the active, independent, and healthy life years of aging people. The "Sarcopenia and Physical fRailty IN older people: multi-componenT Treatment strategies" (SPRINTT) collaborative project under IMI is paving the way for adapted methodologies to study the change of physical frailty and sarcopenia in at-risk older persons and to adequately characterize the population that needs to be treated.

Exploring the Housing Needs of Older People in Standard and Sheltered Social Housing

PubMed Central

Fox, Siobhan; Kenny, Lorna; Day, Mary Rose; O’Connell, Cathal; Finnerty, Joe; Timmons, Suzanne

2017-01-01

Objective: Our home can have a major impact on our physical and mental health; this is particularly true for older people who may spend more time at home. Older people in social (i.e., public) housing are particularly vulnerable. Housing options for older people in social housing include standard design dwellings or specially designed “sheltered housing.” The most suitable housing model should be identified, with older people consulted in this process. Method: Survey of older people (aged ≥60) living in standard or sheltered social housing. Data were analyzed using descriptive and inferential statistics in SPSS Version 22. Results: Overall, 380 surveys were returned (response rate = 47.2%). All older people had similar housing needs. Those in sheltered housing were more satisfied with the physical home design and reported more positive outcomes. Older people in standard housing were less likely to have necessary adaptations to facilitate aging-in-place. Discussion: Older people in standard housing reported more disability/illnesses, are worried about the future, and felt less safe at home. However, few wanted to move, and very few viewed sheltered housing as an alternative, suggesting limited knowledge about their housing options. Future social housing designs should be flexible, that is, adaptable to the needs of the tenants over time. PMID:28491914

Nutrient intake and use of dietary supplements among US adults with disabilities.

PubMed

An, Ruopeng; Chiu, Chung-Yi; Andrade, Flavia

2015-04-01

Physical, mental, social, and financial hurdles in adults with disabilities may limit their access to adequate nutrition. To examine the impact of dietary supplement use on daily total nutrient intake levels among US adults 20 years and older with disabilities. Study sample came from 2007-2008 and 2009-2010 waves of the National Health and Nutrition Examination Survey, a nationally representative repeated cross-sectional survey. Disability was classified into 5 categories using standardized indices. Nutrient intakes from foods and dietary supplements were calculated from 2 nonconsecutive 24-hour dietary recalls. Two-sample proportion tests and multiple logistic regressions were used to examine the adherence rates to the recommended daily nutrient intake levels between dietary supplement users and nonusers in each disability category. The association between sociodemographic characteristics and dietary supplement use was assessed using multiple logistic regressions, accounting for complex survey design. A substantial proportion of the US adult population with disabilities failed to meet dietary guidelines, with insufficient intakes of multiple nutrients. Over half of the US adults with disabilities used dietary supplements. Dietary supplement use was associated with higher adherence rates for vitamin A, vitamin B1, vitamin B2, vitamin B6, vitamin B12, vitamin C, vitamin D, vitamin E, calcium, copper, iron, magnesium, and zinc intake among adults with disabilities. Women, non-Hispanic Whites, older age, higher education, and higher household income were found to predict dietary supplement use. Proper use of dietary supplements under the guidance of health care providers may improve the nutritional status among adults with disabilities. Copyright © 2015 Elsevier Inc. All rights reserved.

Characteristics of individuals receiving disability benefits in the Netherlands and predictors of leaving the disability benefit scheme: a retrospective cohort study with five-year follow-up.

PubMed

Louwerse, Ilse; Huysmans, Maaike A; van Rijssen, H Jolanda; van der Beek, Allard J; Anema, Johannes R

2018-01-18

Today, work disability is one of the greatest social and labour market challenges for policy makers in most OECD countries, where on average, about 6% of the working-age population relies on disability benefits. Understanding of factors associated with long-term work disability may be helpful to identify groups of individuals at risk for disability benefit entitlement or continuing eligibility, and to develop effective interventions for these groups. The purpose of this study is to provide insight into the main diagnoses of workers who qualify for disability benefits and how these diagnoses differ in age, gender and education. Using a five-year follow-up, we examined the duration of disability benefits and how durations differ among individuals with various characteristics. We performed a cohort study of 31,733 individuals receiving disability benefits from the Dutch Social Security Institute (SSI) with a five-year follow-up. Data were collected from SSI databases. Information about disorders was assessed by an insurance physician upon benefit application. These data were used to test for significant relationships among socio-demographics, main diagnoses and comorbidity, and disability benefit entitlement and continuing eligibility. Mental disorders were the most frequent diagnosis for individuals claiming work disability. Diagnoses differed among age groups and education categories. Mental disorders were the main diagnosis for work disability for younger and more highly educated individuals, and physical disorders (generally musculoskeletal, cardiovascular and cancer) were the main diagnosis for older and less educated individuals. In 82% of the claims, the duration of disability benefit was five years or more after approval. Outflow was lowest for individuals with (multiple) mental disorders and those with comorbidity of mental and physical disorders, and highest for individuals with (multiple) physical disorders. The main diagnosis for persons entitled to disability benefits was mental health problems, especially for young women. In a five-year follow-up, claim duration for disability benefits was long lasting for most claimants.

Prevalence and experiences of intimate partner violence against women with disabilities in Bangladesh: results of an explanatory sequential mixed-method study.

PubMed

Hasan, Tanvir; Muhaddes, Tisa; Camellia, Suborna; Selim, Nasima; Rashid, Sabina Faiz

2014-11-01

This study was aimed to estimate the prevalence of intimate partner violence (IPV) in a sample of 226 women with disabilities living in four different districts of Bangladesh. It also explored the physical and psychological suffering of women experiencing violence and their various coping strategies. A cross-sectional survey was carried out with 226 women with disabilities to measure the prevalence of IPV, and 16 in-depth interviews were conducted to document in detail the experiences of violence encountered by the abused women. Among the 226 women interviewed in the survey, about 84% reported ever having experienced at least one act of emotional abuse, physical, or sexual violence from their partner during their lifetime. Women who were older (aged above 32 years), separated, and members of economic/savings group were more likely to report ever having experienced any IPV than women with disabilities who were younger (aged 32 years and less), married, and not members of economic/savings group. Most of the women experiencing violence reported sufferings from physical and psychological problems. Of all the women who experienced violence, less than half (45%) reported seeking support to minimize or avoid violence experiences. However, seeking support from informal network such as family and relatives was commonly reported by many (81.4%) of them. Study findings suggest that women with disabilities who possess poor socio-economic status coupled with economic dependency on husbands' income and wide-spread social stigma against disability make them vulnerable to IPV. Future interventions to address IPV against women with disabilities should include building community knowledge of disability and IPV, countering the pervasive social stigma against disabilities, and improving the socio-economic conditions of women with disabilities through education and employment. © The Author(s) 2014.

Thought Suppression is Associated with Psychological Distress in Homebound Older Adults

PubMed Central

Petkus, Andrew J.; Gum, Amber; Wetherell, Julie Loebach

2014-01-01

Background Engaging in thought suppression as a coping mechanism has been associated with higher rates of anxiety and depressive disorders in younger adults. Homebound older adults are a population of elders experiencing poor health and high levels of depression and anxiety. It is unclear the extent to which psychological factors, such as thought suppression, are associated with distress, given that their health and disability status may be more salient. The aim of this study was to investigate thought suppression in relation to anxiety and depressive symptoms in homebound older adults. Methods Participants (N = 142) were clients of home-based case management services delivered by aging service agencies in Florida. Participants were administered a research interview that included the White Bear Suppression Inventory, Structured Clinical Interview for DSM-IV Diagnosis (SCID), Brief Symptom Inventory-18 (BSI-18), and Modified Mini-Mental Status Examination (3MS). Case managers provided standard assessments containing functional and health status of the participant. Results After controlling for physical health and cognitive functioning, thought suppression was significantly associated with higher likelihood of clinically significant somatic, depressive, and anxiety symptoms on the BSI-18. Thought suppression was also associated with meeting criteria for a SCID depressive or adjustment disorder. Engaging in thought suppression was associated with worse mental health in this sample of homebound older adults even after taking into account physical health, disability, and cognitive functioning. Conclusions These findings suggest the need to develop and test interventions that may address thought suppression as a coping mechanism. PMID:22170756

Caregivers of older persons with multiple sclerosis: determinants of health-related quality of life.

PubMed

Buhse, Marijean; Della Ratta, Carol; Galiczewski, Janet; Eckardt, Patricia

2015-04-01

This study was conducted to determine which factors (clinical and demographic) are associated with mental and physical health-related quality of life (HRQOL) for caregivers of older persons with multiple sclerosis (MS). The Andersen's Healthcare Utilization Model guided this study. Knowledge of identified predictors of HRQOL may prompt nurses who care for persons with MS to address these issues and provide supportive care. A cross-sectional descriptive design was used to examine the relationship between patient with MS and caregiver clinical and demographic factors with caregiver physical and mental HRQOL. Patients with MS aged 60 years or older and their caregivers from four MS centers on Long Island, New York, self-selected into this study (n = 102). A caregiver survey was administered that collected demographic information and included validated questionnaires measuring HRQOL, caregiver burden, and caregiver perception of risk for neuropsychological impairment of patients with MS. Patient surveys collected demographic information and validated questionnaires measuring cognition, depression, and disability. Multivariate linear regression was used to examine patient and caregiver variables to explain caregiver physical and mental HRQOL. The caregivers in this study were older (mean age = 61 years) with existing comorbidities. We found that caregiver mental HRQOL was negatively associated with patient depression and, surprisingly, positively associated with caregiver burden and caregiver comorbidity of heart disease. Caregiver physical HRQOL was negatively associated with caregiver comorbidities of arthritis and diabetes and lower household income. The challenges older caregivers face when caring for older persons with MS have been shown to affect their mental and physical QOL. Nurses who care for older patients with MS will increasingly rely on older caregivers to provide patient-centered interventions. This descriptive study, based on the Anderson theoretical model, provides insight on factors impacting older caregivers' HRQOL. Further research is necessary to elucidate the types of interventions that support them as they care for older patients with MS.

Making Physical Activity Accessible to Older Adults with Memory Loss: A Feasibility Study

ERIC Educational Resources Information Center

Logsdon, Rebecca G.; McCurry, Susan M.; Pike, Kenneth C.; Teri, Linda

2009-01-01

Purpose: For individuals with mild cognitive impairment (MCI), memory loss may prevent successful engagement in exercise, a key factor in preventing additional disability. The Resources and Activities for Life Long Independence (RALLI) program uses behavioral principles to make exercise more accessible for these individuals. Exercises are broken…

Reading and the Aged: A Statement of the Problem.

ERIC Educational Resources Information Center

Kingston, Albert J., Jr.

A review of studies concerning the reading habits of people 65 years old or older shows that females spend more time reading then do males; senior citizens do not suddenly develop new or extensive reading habits; they prefer light romance with no sex, biographies, westerns, and mysteries; intellectual and physical disabilities are not major…

Relation of pulse pressure to long-distance gait speed in community-dwelling older adults: Findings from the LIFE-P study

USDA-ARS?s Scientific Manuscript database

Reduced long-distance gait speed, a measure of physical function, is associated with falls, late-life disability, hospitalization/institutionalization and cardiovascular morbidity and mortality. Aging is also accompanied by a widening of pulse pressure (PP) that contributes to ventricular-vascular ...

Dissemination and Implementation of Function Focused Care for Assisted Living

ERIC Educational Resources Information Center

Resnick, Barbara; Galik, Elizabeth; Vigne, Erin; Carew, Allison Payne

2016-01-01

Assisted living (AL) settings are residential settings that provide housing and supportive services for older and disabled adults. Although individuals in AL are less functionally impaired than those in nursing home settings, they engage in limited amounts of physical activity and experience more rapid functional decline than their peers in…

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

PubMed

Gobbens, Robbert J J; van Assen, Marcel A L M

2012-01-01

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. 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. 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. 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. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

The Brazilian Back Complaints in the Elders (Brazilian BACE) study: characteristics of Brazilian older adults with a new episode of low back pain.

PubMed

Jesus-Moraleida, Fabianna Resende De; Ferreira, Paulo Henrique; Ferreira, Manuela Loureiro; Silva, Juscelio Pereira Da; Assis, Marcella Guimarães; Pereira, Leani Souza Máximo

Low back pain (LBP) is little explored in the aging population especially when considering age-relevant and culturally dependent outcomes. We aimed to describe socio-demographic and clinical characteristics of Brazilian older people with a new episode of LBP presenting to primary care. We sourced baseline information on socio-demographic, pain-related and clinical characteristics from 602 older adults from the Brazilian Back Complaints in the Elders (Brazilian BACE) study. We analyzed differences in pain, disability, functional capacity and psychosocial factors between sub-groups based on age (i.e. participants aged 55-74 or ≥75 years), education (i.e. those with four years or less of schooling or those with more than four years of schooling) and income (i.e. participants who reported earning two or less minimal wages or three and more). Participants presented severe LBP (7.18/10, SD: 2.59). Younger participants were slightly more disabled (mean difference 1.29 points, 95% confidence interval [CI]: 0.03/5.56), reporting poorer physical health, and less fall-related self-efficacy (mean difference of 2.41, 95% CI 0.35/4.46). Those less educated, and those with income equal or less than two minimum wages had more disability, pain catastrophizing and worse functional capacity. This was the first study showing that Brazilian older adults with LBP present high levels of functional disability and psychological distress, especially those with low socioeconomic status. Copyright © 2017 Associação Brasileira de Pesquisa e Pós-Graduação em Fisioterapia. Publicado por Elsevier Editora Ltda. All rights reserved.

[Validation of an instrument for measuring the effects of oral health on the quality of life of older adults in Mexico].

PubMed

Castrejón-Pérez, Roberto Carlos; Borges-Yáñez, S Aída; Irigoyen-Camacho, María Esther

2010-05-01

Translate, culturally adapt, and validate a new Spanish version of the Oral Health Impact Profile (OHIP) for older persons in Mexico City, Mexico. A validation study of the new version of OHIP-Mx-49 was carried out through interviews and clinical examinations of people aged 60 or older in the southern area of Mexico City. The following variables were analyzed: sociodemographic (age, sex, marital status, level of schooling, and whether the subject lived alone), clinical (current number of teeth, coronal and root caries, dental hygiene, and the use of removable prostheses and dentures), and self-perception (of the need for dental and general health care). The OHIP-Mx-49 value was calculated as the sum of the scores in seven dimensions: functional limitation, pain, psychological discomfort, physical disability, psychological disability, social disability, and handicap. The internal consistency (Cronbach's alpha coefficient), replicability (intraclass correlation coefficient), and convergent and discriminant validity (Mann-Whitney and Kruskal-Wallis tests) were assessed. Of the 131 people interviewed (average age: 73.8 +/- 8.3 years), 77.9% were women. High internal consistency values were obtained for the OHIP-Mx-49 (0.96) and the dimensions (0.79-0.86), and replicability in the instrument (0.877) and all the dimensions except social disability (0.176). The average OHIP-Mx-49 score was 37.1 +/- 35.3; higher scores were observed in people with 1-9 teeth (P = 0.02), people who did not have coronal caries (P = 0.02), and people who perceived a need for dental care (P = 0.01). The OHIP-Mx-49 is a reliable and valid instrument that can be used with older Mexicans.

"She was truly an angel": Women with disabilities' satisfaction with hospital-based sexual assault and domestic violence services.

PubMed

Du Mont, Janice; Macdonald, Sheila; White, Meghan; Turner, Linda

2013-01-01

Little is known about the characteristics of women with disabilities who have experienced abuse and their satisfaction with care received from specialized healthcare providers working in hospital-based violence services. To address this gap, we surveyed clients presenting to 30 sexual assault/domestic violence treatment centers (SA/DVTCs) in Ontario. Of the 920 women aged 12 years or older who completed a survey, 194 (21%) reported having a disability. Bivariate analyses revealed that women with a disability who experienced abuse were more likely than those without a disability to be older, separated, widowed or divorced, and unemployed; to live alone or to be homeless or living in a shelter; and to report less support from family and friends or colleagues. Women with disabilities were less likely to have been assaulted by acquaintances known for < 24 hours, to be students, and to have been accompanied to the SA/DVTC by another person. Women with disabilities were also more likely than those without disabilities to sustain physical injuries in the assault. Despite these significant differences, almost all women with disabilities rated the care received as excellent or good (97%) and reported that they received the care needed (98%); were able to choose the preferred care (95%); felt safe during the visit (96%); and were treated sensitively (97%), respectfully (96%), and in a nonjudgmental manner (96%). Furthermore, 96% stated that they would recommend the services to others. Women with disabilities were overwhelmingly satisfied with SA/DVTC services. However, given their distinct vulnerabilities and increased risk of being injured, attending health providers should receive training relevant to working with this population.

The effects of 16-week group exercise program on physical function and mental health of elderly Korean women in long-term assisted living facility.

PubMed

Sung, Kiwol

2009-01-01

The purpose of this study was to compare the effects of 16-week group exercise program on the physical function (ie, strength, flexibility, and balance) and mental health (ie, self-esteem and depression) of older elderlyl women (>or=75 years old) compared with younger elderly women (<75 years old). Exercise is crucial in maintaining older women's health and well-being. However, because most elders have at least one chronic disease, their physical function declines, so their dependence on others for instrumental daily living activities often increases. Older women typically have multiple barriers to participation in physical activities including higher disability rates. Of the total of 40 older women (older than 65 years) enrolled, 21 were older elders and 16 were younger elders. Lower body strength (using 30-second chair test), flexibility (sit-and-reach test), and static balance (ability to balance on one leg with open and closed eyes) were assessed. Self-esteem (using Rosenberg's Self-esteem Questionnaire) and depressive symptoms (using Yesavage's Geriatric Depression Scale) were assessed. Two-way analysis of variance was used to examine the differences between the 2 age groups. The intervention program was effective in improving body strength, flexibility, static balance, and self-esteem, regardless of age. Furthermore, older elders receiving the intervention program demonstrated greater improvement in self-esteem than younger elders did, although there were intervention effects in both age groups. Elderly women can realize benefits from a group exercise program that can improve their functional ability and self-esteem, both important to cardiovascular health.

Prevalence and associated factors of problem behaviours among older adults with intellectual disabilities in Ireland.

PubMed

O'Dwyer, Claire; McCallion, Philip; Burke, Éilish; Carroll, Rachael; O'Dwyer, Máire; McCarron, Mary

2018-06-05

A growing number of adults with intellectual disabilities (ID) are reaching old age, however, little is known about epidemiology of problem behaviours (PBs) in this population. The aim was to identify the prevalence and associated factors of PBs among older adults with ID in Ireland. Data was generated from Wave 2 of the Intellectual Disability Supplement to the Irish Longitudinal Study on Ageing (IDS-TILDA), a nationally representative sample of adults with ID aged ≥40. Data on PBs was available for 683 (98.3%) of individuals. Over half (53%; n = 362) reported displaying any PB (verbal aggression, physical aggression, destruction, self-injury, or "other" PB). Multivariate analyses indicated PBs were independently associated with moderate or severe/profound ID, living in a community group home or residential centre, experiencing a greater number of life events in the last year, taking psychotropic medication, and reporting a doctor's diagnosis of a psychiatric problem. A considerable number of older adults with ID in Ireland display PBs, which may hinder their opportunities to engage in community based activities and form meaningful social connections. High rates of psychotropic medication and doctor's diagnosis of psychiatric conditions and their associations with PBs were highlighted. Future research should examine mechanisms underlying these linkages. Copyright © 2018 Elsevier Ltd. All rights reserved.

Outdoor built environment barriers and facilitators to activity among midlife and older adults with mobility disabilities.

PubMed

Rosenberg, Dori E; Huang, Deborah L; Simonovich, Shannon D; Belza, Basia

2013-04-01

To gain better understanding of how the built environment impacts neighborhood-based physical activity among midlife and older adults with mobility disabilities. We conducted in-depth interviews with 35 adults over age 50, which used an assistive device and lived in King County, Washington, U.S. In addition, participants wore global positioning systems (GPS) devices for 3 days prior to the interview. The GPS maps were used as prompts during the interviews. Open coding of the 35 interviews using latent content analysis resulted in key themes and subthemes that achieved consensus between coders. Two investigators independently coded the text of each interview. Participants were on average of 67 years of age (range: 50-86) and predominantly used canes (57%), walkers (57%), or wheelchairs (46%). Key themes pertained to curb ramp availability and condition, sidewalk availability and condition, hills, aesthetics, lighting, ramp availability, weather, presence and features of crosswalks, availability of resting places and shelter on streets, paved or smooth walking paths, safety, and traffic on roads. A variety of built environment barriers and facilitators to neighborhood-based activity exist for midlife and older adults with mobility disabilities. Preparing our neighborhood environments for an aging population that uses assistive devices will be important to foster independence and health.

Comorbidity among older American Indians: the native elder care study.

PubMed

Goins, R Turner; Pilkerton, Courtney S

2010-12-01

Comorbidity is a growing challenge and the older adult population is most at risk of developing comorbid conditions. Comorbidity is associated with increased risk of mortality, increased hospitalizations, increased doctor visits, increased prescription medications, nursing home placement, poorer mental health, and physical disability. American Indians experience some of the highest rates of chronic conditions, but to date there have been only two published studies on the subject of comorbidity in this population. With a community-based sample of 505 American Indians aged 55 years or older, this study identified the most prevalent chronic conditions, described comorbidity, and identified socio-demographic, functional limitations, and psychosocial correlates of comorbidity. Results indicated that older American Indians experience higher rates of hypertension, diabetes, back pain, and vision loss compared to national statistics of older adults. Two-thirds of the sample experienced some degree of comorbidity according to the scale used. Older age, poorer physical functioning, more depressive symptomatology, and lower personal mastery were all correlates of higher comorbidity scores. Despite medical advances increasing life expectancy, morbidity and mortality statistics suggest that the health of older American Indians lags behind the majority population. These findings highlight the importance of supporting chronic care and management services for the older American Indian population.

Muscle strength and physical performance as predictors of mortality, hospitalization, and disability in the oldest old.

PubMed

Legrand, Delphine; Vaes, Bert; Matheï, Catharina; Adriaensen, Wim; Van Pottelbergh, Gijs; Degryse, Jean-Marie

2014-06-01

To evaluate the predictive value of muscle strength and physical performance in the oldest old for all-cause mortality; hospitalization; and the onset of disability, defined as a decline in activities of daily living (ADLs), independent of muscle mass, inflammatory markers, and comorbidities. A prospective, observational, population-based follow-up study. Three well-circumscribed areas of Belgium. Five hundred sixty participants aged 80 and older were followed for 33.5 months (interquartile range 31.1-35.6 months). Grip strength, Short Physical Performance Battery (SPPB) score, and muscle mass were measured at baseline; ADLs at baseline and after 20 months; and all-cause mortality and time to first hospitalization from inclusion onward. Kaplan-Meier curves and Cox proportional hazards models were calculated for all-cause mortality and hospitalization. Logistic regression analysis was used to determine predictors of decline in ADLs. Kaplan-Meier curves showed significantly higher all-cause mortality and hospitalization in subjects in the lowest tertile of grip strength and SPPB score. The adjusted Cox proportional hazards model showed that participants with high grip strength or a high SPPB score had a lower risk of mortality and hospitalization, independent of muscle mass, inflammatory markers, and comorbidity. A relationship was found between SPPB score and decline in ADLs, independent of muscle mass, inflammation, and comorbidity. In people aged 80 and older, physical performance is a strong predictor of mortality, hospitalization, and disability, and muscle strength is a strong predictor of mortality and hospitalization. All of these relationships were independent of muscle mass, inflammatory markers, and comorbidity. © 2014, Copyright the Authors Journal compilation © 2014, The American Geriatrics Society.

Hypoglycemia in Older People - A Less Well Recognized Risk Factor for Frailty

PubMed Central

Abdelhafiz, Ahmed H; Rodríguez-Mañas, Leocadio; Morley, John E.; Sinclair, Alan J

2015-01-01

Recurrent hypoglycemia is common in older people with diabetes and is likely to be less recognized and under reported by patients and health care professionals. Hypoglycemia in this age group is associated with significant morbidities leading to both physical and cognitive dysfunction. Repeated hospital admissions due to frequent hypoglycemia are also associated with further deterioration in patients’ general health. This negative impact of hypoglycemia is likely to eventually lead to frailty, disability and poor outcomes. It appears that the relationship between hypoglycemia and frailty is bidirectional and mediated through a series of influences including under nutrition. Therefore, attention should be paid to the management of under nutrition in the general elderly population by improving energy intake and maintaining muscle mass. Increasing physical activity and having a more conservative approach to glycemic targets in frail older people with diabetes may be worthwhile. PMID:25821643

Watching sport on television, physical activity, and risk of obesity in older adults.

PubMed

Hamer, Mark; Weiler, Richard; Stamatakis, Emmanuel

2014-01-08

Television (TV) viewing has been associated with obesity although the effects of specific TV content on health and other behaviours remains unknown. We examined the association between watching sport on TV, physical activity levels, and risk of obesity. We studied 6,733 (aged 64.9 ± 9.2 yrs) men and women from the English Longitudinal Study of Ageing, a prospective study of community dwelling older adults. Data were collected on self reported TV time and content, and physical activity. Nurses measured height and weight for the calculation of body mass index. On average, participants reported viewing TV for 5.3 ± 4.1 hours per day and 30.3% of the sample watched sport on TV at least twice a week. There was no association between watching sport and physical activity levels. Participants that watched sports every day were at higher risk of obesity [odds ratio = 1.39, 95% CI, 1.15, 1.68) after adjustment for age, sex, smoking, alcohol, physical activity, total TV time, disability, and self-rated health. Watching elite athletes may have no role in the promotion of physical activity in older adults, which has implications for staging large sporting events with physical activity legacy promises.

White matter hyperintensity burden and disability in older adults: is chronic pain a contributor?

PubMed

Buckalew, Neilly; Haut, Marc W; Aizenstein, Howard; Rosano, Caterina; Edelman, Kathryn Dunfee; Perera, Subashan; Marrow, Lisa; Tadic, Stasa; Venkatraman, Vijay; Weiner, Debra

2013-06-01

To primarily explore differences in global and regional white matter hyperintensities (WMH) in older adults with self-reported disabling and nondisabling chronic low back pain (CLBP) and to examine the association of WMH with gait speed in all participants with CLBP. To secondarily compare WMH of the participants with CLBP with the pain-free controls. A cross-sectional, case-control study. University of Pittsburgh. Twenty-four community-dwelling older adults: 8 with self-reported disabling CLBP, 8 with nondisabling CLBP, and 8 were pain-free. Exclusions were psychiatric or neurologic disorders (either central or peripheral), substance abuse, opioid use, or diabetes mellitus. All participants underwent structural brain magnetic resonance imaging, and all participants with CLBP underwent the 4-m walk test. All the participants were assessed for both global and regional WMH by using an automated localization and segmentation method, and gait speed of participants with CLBP. The disabled group demonstrated statistically significant regional WMH in a number of left hemispheric tracts: anterior thalamic radiation (P = .0391), lower cingulate (P = .0336), inferior longitudinal fasciculus (P = .0367), superior longitudinal fasciculus (P = .0011), and the superior longitudinal fasciculus branch to the temporal lobe (P = .0072). Also, there was a statistically significant negative association (rs = -0.57; P = .0225) between the left lower cingulate WMH and the gait speed in all the participants with CLBP. There was a statistical difference in global WMH burden (P = .0014) and nearly all regional tracts (both left and right hemispheres) when comparing CLBP with pain-free participants. Our findings suggest that WMH is associated with, and hence, may be accelerated by chronic pain manifesting as perceived disability, given the self-reported disabled CLBP patients had the greatest burden, and the pain free the least, and manifesting as measurable disability, given increasing WMH was associated with decreasing gait speed in all chronic pain participants. Copyright © 2013 American Academy of Physical Medicine and Rehabilitation. Published by Elsevier Inc. All rights reserved.

Evaluation of successful aging among older people in China: Results from China health and retirement longitudinal study.

PubMed

Liu, Huaqing; Byles, Julie E; Xu, Xiaoyue; Zhang, Min; Wu, Xuesen; Hall, John J

2017-08-01

China faces a "time-bomb" of the aging population. Successful aging has long been a goal in the field of gerontology. The present study aimed to evaluate successful aging among Chinese older adults. Data on a total of 7102 people in the China Health and Retirement Study aged ≥60 years were analyzed in the present study. Successful aging is defined by the model of Rowe and Kahn including the following five indicators: "no major diseases," "no disability," "high cognitive functioning," "high physical functioning" and "active engagement with life." Using logistic regression analysis, crude and adjusted odds ratios with 95% confidence intervals were calculated to evaluate the relationship between sociodemographic parameters and successful aging. The prevalence of successful aging was 13.2% among Chinese older people. The percentage of older people with the five indicators, "no major diseases," "no disability," "high cognitive functioning," "high physical functioning," and "active engagement with life" was 41.7%, 92.1%, 54.2%, 70.2% and 46.0%, respectively. Multiple logistic regression showed people who had received education of high/vocational school or above had significantly greater odds of successful aging compared with those with less than primary school education (P < 0.05). The effect of education to college level or above on cognitive functioning was 2.51-fold higher in women than men (P = 0.006). Older people from a non-agricultural Hukou had 1.85-fold higher odds of successful aging than those from an agricultural Hukou. Older people living in the central, northeast or western regions had lower odds of successful aging relative to those living in the east coast region (0.72, 0.72 and 0.56, respectively). The prevalence of successful aging is low among Chinese older people, and is affected by sociodemographic factors, such as education, Hukou and regions. Geriatr Gerontol Int 2017; 17: 1183-1190. © 2016 Japan Geriatrics Society.

Independent and inverse association of healthcare utilisation with physical activity in older adults with multiple chronic conditions.

PubMed

Liu-Ambrose, T Y L; Ashe, M C; Marra, C

2010-11-01

In this study, whether physical activity is independently associated with direct healthcare costs in community-dwelling older adults with multiple chronic conditions was examined. Cross-sectional analysis. Research laboratory. 299 community-dwelling men and women volunteers aged 65 years and older with chronic conditions. None. Primary dependent variable was direct healthcare costs incurred in the previous 3 months. Participants completed the Health Resource Utilisation (HRU) questionnaire. To estimate HRU, direct costs in the previous 3 months were calculated using the three-party payer perspective of the British Columbia Ministry of Health, deemed representative of the Canadian healthcare system costs. For medications, the Retail Pharmacy Dispensed prescription cost tables were used. Primary independent variables were (1) self-report current level of physical activity as assessed by the Physical Activity Scale for Individuals with Physical Disabilities (PASIPD) and (2) general balance and mobility as assessed by the National Institute on Aging Balance Scale. The mean number of chronic conditions per participant was six. Current level of physical activity was independently and inversely associated with HRU. Age, sex, number of chronic conditions, global cognitive function, body mass index, and general balance and mobility together accounted for 24.3% of the total variance. Adding the PASIPD score resulted in an R2 change of 3.3% and significantly improved the model. The total variance accounted by the final model was 27.6%. Physical activity promotion may reduce healthcare costs in older adults with chronic conditions.

Preparedness for Natural Disasters Among Older US Adults: A Nationwide Survey

PubMed Central

Rubenstein, Linda M.; Wallace, Robert B.

2014-01-01

Objectives. We sought to determine natural disaster preparedness levels among older US adults and assess factors that may adversely affect health and safety during such incidents. Methods. We sampled adults aged 50 years or older (n = 1304) from the 2010 interview survey of the Health and Retirement Study. The survey gathered data on general demographic characteristics, disability status or functional limitations, and preparedness-related factors and behaviors. We calculated a general disaster preparedness score by using individual indicators to assess overall preparedness. Results. Participant (n = 1304) mean age was 70 years (SD = 9.3). Only 34.3% reported participating in an educational program or reading materials about disaster preparation. Nearly 15% reported using electrically powered medical devices that might be at risk in a power outage. The preparedness score indicated that increasing age, physical disability, and lower educational attainment and income were independently and significantly associated with worse overall preparedness. Conclusions. Despite both greater vulnerability to disasters and continuous growth in the number of older US adults, many of the substantial problems discovered are remediable and require attention in the clinical, public health, and emergency management sectors of society. PMID:24432877

Preparedness for Natural Disasters Among Older US Adults: A Nationwide Survey

PubMed Central

Rubenstein, Linda M.; Wallace, Robert B.

2015-01-01

Objectives. We sought to determine natural disaster preparedness levels among older US adults and assess factors that may adversely affect health and safety during such incidents. Methods. We sampled adults aged 50 years or older (n = 1304) from the 2010 interview survey of the Health and Retirement Study. The survey gathered data on general demographic characteristics, disability status or functional limitations, and preparedness-related factors and behaviors. We calculated a general disaster preparedness score by using individual indicators to assess overall preparedness. Results. Participant (n = 1304) mean age was 70 years (SD = 9.3). Only 34.3% reported participating in an educational program or reading materials about disaster preparation. Nearly 15% reported using electrically powered medical devices that might be at risk in a power outage. The preparedness score indicated that increasing age, physical disability, and lower educational attainment and income were independently and significantly associated with worse overall preparedness. Conclusions. Despite both greater vulnerability to disasters and continuous growth in the number of older US adults, many of the substantial problems discovered are remediable and require attention in the clinical, public health, and emergency management sectors of society. PMID:26313052

When Do Older Adults Become “Disabled”? Social and Health Antecedents of Perceived Disability in a Panel Study of the Oldest Old*

PubMed Central

KELLEY-MOORE, JESSICA A.; SCHUMACHER, JOHN G.; KAHANA, EVA; KAHANA, BOAZ

2007-01-01

Disability carries negative social meaning, and little is known about when (or if), in the process of health decline, persons identify themselves as “disabled” We examine the social and health criteria that older adults use to subjectively rate their own disability status. Using a panel study of older adults (ages 72+), we estimate ordered probit and growth curve models of perceived disability over time. Total prevalent morbidity, functional limitations, and cognitive impairment are predictors of perceived disability. Cessation of driving and receipt of home health care also influence older adults’ perceptions of their own disability. A dense social network slowed the rate of labeling oneself disabled, while health anxiety accelerated the process over time, independent of health status. When considering perceived disability, the oldest old use multidimensional criteria capturing function, recent changes in health status and social networks, and anxiety about their health. PMID:16821507

Sex-specific relationships of physical activity, body composition, and muscle quality with lower-extremity physical function in older men and women.

PubMed

Straight, Chad R; Brady, Anne O; Evans, Ellen

2015-03-01

This study aims to determine the sex-specific relationships of physical activity, body composition, and muscle quality with lower-extremity physical function in older men and women. Seventy-nine community-dwelling men (n = 39; mean [SD] age, 76.1 [6.2] y; mean [SD] body mass index, 27.3 [3.8] kg/m(2)) and women (n = 40; mean [SD] age, 75.8 [5.5] y; mean [SD] body mass index, 27.0 [3.8] kg/m(2)) were assessed for physical activity via questionnaire, body composition via dual-energy x-ray absorptiometry scanning, leg extension power using the Nottingham power rig, and muscle quality (W/kg; the ratio of leg extension power [W] to lower-body mineral-free lean mass [kg]). A composite measure of physical function was obtained by summing Z scores from the 6-minute walk, 8-ft up-and-go test, and 30-second chair-stand test. As expected, men had significantly greater levels of physical activity, lower adiposity, greater lean mass, higher leg extension power, and greater muscle quality compared with women (all P < 0.05). In linear regression analyses, muscle quality and physical activity were the strongest predictors of lower-extremity physical function in men and independently explained 42% and 29% of the variance, respectively. In women, muscle quality (16%) and percent body fat (12%) were independent predictors after adjustment for covariates. Muscle quality is the strongest predictor of lower-extremity physical function in men and women, but sex impacts the importance of physical activity and adiposity. These findings suggest that older men and women may benefit from different intervention strategies for preventing physical disability and also highlight the importance of weight management for older women to preserve physical function.

Factors associated with the amount of public home care received by elderly and intellectually disabled individuals in a large Norwegian municipality.

PubMed

Døhl, Øystein; Garåsen, Helge; Kalseth, Jorid; Magnussen, Jon

2016-05-01

This study reports an analysis of factors associated with home care use in a setting in which long-term care services are provided within a publicly financed welfare system. We considered two groups of home care recipients: elderly individuals and intellectually disabled individuals. Routinely collected data on users of public home care in the municipality of Trondheim in October 2012, including 2493 people aged 67 years or older and 270 intellectually disabled people, were used. Multivariate regression analysis was used to analyse the relationship between the time spent in direct contact with recipients by public healthcare personnel and perceived individual determinants of home care use (i.e. physical disability, cognitive impairment, diagnoses, age and gender, as well as socioeconomic characteristics). Physical disability and cognitive impairment are routinely registered for long-term care users through a standardised instrument that is used in all Norwegian municipalities. Factor analysis was used to aggregate the individual items into composite variables that were included as need variables. Both physical disability and cognitive impairment were strong predictors of the amount of received care for both elderly and intellectually disabled individuals. Furthermore, we found a negative interaction effect between physical disability and cognitive impairment for elderly home care users. For elderly individuals, we also found significant positive associations between weekly hours of home care and having comorbidity, living alone, living in a service flat and having a safety alarm. The reduction in the amount of care for elderly individuals living with a cohabitant was substantially greater for males than for females. For intellectually disabled individuals, receiving services involuntarily due to severe behavioural problems was a strong predictor of the amount of care received. Our analysis showed that routinely collected data capture important predictors of home care use and thus facilitate both short-term budgeting and long-term planning of home care services. © 2015 John Wiley & Sons Ltd.

Socio-demographic patterns of disability among older adult populations of low-income and middle-income countries: results from World Health Survey.

PubMed

Hosseinpoor, Ahmad Reza; Bergen, Nicole; Kostanjsek, Nenad; Kowal, Paul; Officer, Alana; Chatterji, Somnath

2016-04-01

Our objective was to quantify disability prevalence among older adults of low- and middle-income countries, and measure socio-demographic distribution of disability. World Health Survey data included 53,447 adults aged 50 or older from 43 low- and middle-income countries. Disability was a binary classification, based on a composite score derived from self-reported functional difficulties. Socio-demographic variables included sex, age, marital status, area of residence, education level, and household economic status. A multivariate Poisson regression model with robust variance was used to assess associations between disability and socio-demographic variables. Overall, 33.3 % (95 % CI 32.2-34.4 %) of older adults reported disability. Disability was 1.5 times more common in females, and was positively associated with increasing age. Divorced/separated/widowed respondents reported higher disability rates in all but one study country, and education and wealth levels were inversely associated with disability rates. Urban residence tended to be advantageous over rural. Country-level datasets showed disparate patterns. Effective approaches aimed at disability prevention and improved disability management are warranted, including the inclusion of equity considerations in monitoring and evaluation activities.

Intellectual Ability in Young Adulthood as an Antecedent of Physical Functioning in Older Age

PubMed Central

Poranen-Clark, Taina; von Bonsdorff, Mikaela B.; Törmäkangas, Timo; Lahti, Jari; Wasenius, Niko; Räikkönen, Katri; Osmond, Clive; Salonen, Minna K.; Rantanen, Taina; Kajantie, Eero; Eriksson, Johan G.

2016-01-01

Objectives Low cognitive ability is associated with subsequent functional disability. Whether this association extends across adult life has been little studied. The aim of this study was to examine the association between intellectual ability in young adulthood and physical functioning during a 10-year follow-up in older age. Methods 360 persons of the Helsinki Birth Cohort Study (HBCS) male members, born between 1934- 1944 and residing in Finland in 1971, took part in The Finnish Defence Forces Basic Intellectual Ability Test during the first two weeks of their military service training between 1952- 72. Their physical functioning was assessed twice using the Short Form 36 (SF-36) questionnaire at average ages of 61 and 71 years. A longitudinal path model linking Intellectual Ability Test score to the physical functioning assessments was used to explore the effect of intellectual ability in young adulthood on physical functioning in older age. Results After adjustments for age at measurement, childhood socioeconomic status and adult BMI (kg/m2), better intellectual ability total and arithmetic and verbal reasoning subtest scores in young adulthood predicted better physical functioning at age 61 years (P-values < 0.021). Intellectual ability total and arithmetic and verbal reasoning subtest scores in young adulthood had indirect effects on physical functioning at age 71 years (P-values < 0.022) through better physical functioning at age 61 years. Adjustment for main chronic diseases did not change the results materially. Conclusion Better early life intellectual ability helps in maintaining better physical functioning in older age. PMID:27189726

A behavioral medicine intervention for older women living alone with chronic pain – a feasibility study

PubMed Central

Cederbom, Sara; Rydwik, Elisabeth; Söderlund, Anne; Denison, Eva; Frändin, Kerstin; von Heideken Wågert, Petra

2014-01-01

Background To be an older woman, live alone, have chronic pain, and be dependent on support are all factors that may have an impact on daily life. One way to promote ability in everyday activities in people with pain-related conditions is to use individualized, integrated behavioral medicine in physical therapy interventions. How this kind of intervention works for older women living alone at home, with chronic pain, and dependent on formal care to manage their everyday lives has not been studied. The aim was to explore the feasibility of a study and to evaluate an individually tailored integrated behavioral medicine in physical therapy intervention for the target group of women. Materials and methods The study was a 12-week randomized trial with two-group design. Primary effect outcomes were pain-related disability and morale. Secondary effect outcomes focused on pain-related beliefs, self-efficacy for exercise, concerns of falling, physical activity, and physical performance. Results In total, 23 women agreed to participate in the study and 16 women completed the intervention. The results showed that the behavioral medicine in physical therapy intervention was feasible. No effects were seen on the primary effect outcomes. The experimental intervention seemed to improve the level of physical activity and self-efficacy for exercise. Some of the participants in both groups perceived that they could manage their everyday life in a better way after participation in the study. Conclusion Results from this study are encouraging, but the study procedure and interventions have to be refined and tested in a larger feasibility study to be able to evaluate the effects of these kinds of interventions on pain-related disability, pain-related beliefs, self-efficacy in everyday activities, and morale in the target group. Further research is also needed to refine and evaluate effects from individualized reminder routines, support to collect self-report data, safety procedures for balance training, and training of personnel to enhance self-efficacy. PMID:25170262

A behavioral medicine intervention for older women living alone with chronic pain - a feasibility study.

PubMed

Cederbom, Sara; Rydwik, Elisabeth; Söderlund, Anne; Denison, Eva; Frändin, Kerstin; von Heideken Wågert, Petra

2014-01-01

To be an older woman, live alone, have chronic pain, and be dependent on support are all factors that may have an impact on daily life. One way to promote ability in everyday activities in people with pain-related conditions is to use individualized, integrated behavioral medicine in physical therapy interventions. How this kind of intervention works for older women living alone at home, with chronic pain, and dependent on formal care to manage their everyday lives has not been studied. The aim was to explore the feasibility of a study and to evaluate an individually tailored integrated behavioral medicine in physical therapy intervention for the target group of women. The study was a 12-week randomized trial with two-group design. Primary effect outcomes were pain-related disability and morale. Secondary effect outcomes focused on pain-related beliefs, self-efficacy for exercise, concerns of falling, physical activity, and physical performance. In total, 23 women agreed to participate in the study and 16 women completed the intervention. The results showed that the behavioral medicine in physical therapy intervention was feasible. No effects were seen on the primary effect outcomes. The experimental intervention seemed to improve the level of physical activity and self-efficacy for exercise. Some of the participants in both groups perceived that they could manage their everyday life in a better way after participation in the study. Results from this study are encouraging, but the study procedure and interventions have to be refined and tested in a larger feasibility study to be able to evaluate the effects of these kinds of interventions on pain-related disability, pain-related beliefs, self-efficacy in everyday activities, and morale in the target group. Further research is also needed to refine and evaluate effects from individualized reminder routines, support to collect self-report data, safety procedures for balance training, and training of personnel to enhance self-efficacy.

Prevalence and correlates of disability among older Ugandans: evidence from the Uganda National Household Survey

PubMed Central

Wandera, Stephen O.; Ntozi, James; Kwagala, Betty

2014-01-01

Background Nationally representative evidence on the burden and determinants of disability among older people in sub-Saharan Africa in general, and Uganda in particular, is limited. Objective The aim of this study was to estimate the prevalence and investigate the correlates of disability among older people in Uganda. Design We conducted secondary analysis of data from a sample of 2,382 older persons from the Uganda National Household Survey. Disability was operationalized as either: 1) having a lot of difficulty on any one question; 2) being unable to perform on any one question; or, 3) having some difficulty with two of the six domains. We used frequency distributions for description, chi-square tests for initial associations, and multivariable logistic regressions to assess the associations. Results A third of the older population was disabled. Among all older persons, disability was associated with advancement in age (OR=4.91, 95% CI: 3.38–7.13), rural residence (0.56, 0.37–0.85), living alone (1.56, 1.07–2.27), separated or divorced (1.96, 1.31–2.94) or widowed (1.86, 1.32–2.61) marital status, households’ dependence on remittances (1.48, 1.10–1.98), ill health (2.48, 1.95–3.15), and non-communicable diseases (NCDs) (1.81, 0.80–2.33). Gender was not associated with disability among older persons. Conclusions Disability was associated with advancement in age, rural residence, living alone, divorced/separated/widowed marital status, dependence on remittances, ill health, and NCDs. Interventions to improve health and functioning of older people need to focus on addressing social inequalities and on the early preventive interventions and management of NCDs in old age in Uganda. PMID:25413721

Objective assessment of activity in older adults at risk for mobility disability.

PubMed

Marsh, Anthony P; Vance, Rachel M; Frederick, Tera L; Hesselmann, Sarah A; Rejeski, W Jack

2007-06-01

The purpose of this study was to evaluate the validity of three objective measures of physical activity (Accusplit Eagle 120 mechanical pedometer (AE120), NL-2000 electronic pedometer, and IDEEA pattern-recognition device) that varied in their levels of sophistication, among older adults at risk for mobility disability. In addition, we examined the potential influences of gait speed and body mass index (BMI) on step count accuracy. Step counts recorded on the three devices were compared against manual step counts made by two investigators as each participant walked 131 m around an indoor track at their preferred walking speed (N=29; 75.8+/-4.2 yr). Gait speed was determined by dividing total distance walked by time to completion. BMI was calculated from height and body mass measurements. All three devices significantly underestimated steps taken (AE120=22.8+/-53.9 steps; NL-2000=4.0+/-5.8 steps; IDEEA=5.6+/-7.8 steps), but there was no significant difference between devices (P=0.084). Steps counted by the AE120, NL-2000, and IDEEA were significantly correlated with manual step counts (r=0.508, 0.980, and 0.965, respectively; P

The need of operational paradigms for frailty in older persons: the SPRINTT project.

PubMed

Cesari, Matteo; Marzetti, Emanuele; Calvani, Riccardo; Vellas, Bruno; Bernabei, Roberto; Bordes, Philippe; Roubenoff, Ronenn; Landi, Francesco; Cherubini, Antonio

2017-02-01

The exploration of frailty as a pre-disability geriatric condition represents one of the most promising research arenas of modern medicine. Frailty is today indicated as a paradigmatic condition around which the traditional healthcare systems might be re-shaped and optimized in order to address the complexities and peculiarities of elders. Unfortunately, the lack of consensus around a single operational definition has limited the clinical implementation of frailty in clinical practice. In these last years, growing attention (even beyond the traditional boundaries of geriatric medicine) has been given to physical performance measures. These instruments have shown to be predictive of negative health-related events and able to support an accurate estimation of the "biological age" in late life. The strong construct of physical performance measures also makes them particularly suitable for the assessment of the frailty status. Furthermore, the adoption of physical performance measures may help render the frailty condition more organ-specific (i.e., centred on the skeletal muscle quality) and less heterogeneous than currently perceived. The translation of the frailty concept by means of physical performance measures implicitly represents an attempt to go beyond traditional paradigms. In this context, the recently funded "Sarcopenia and Physical fRailty IN older people: multi-componenT Treatment strategies" (SPRINTT) project (largely based on such a novel approach) may indeed fill an important gap in the field and provide key insights for counteracting the disabling cascade in the elderly.

Translation and validation of the Arab version of the Late-Life Function and Disability Instrument: a cross sectional study.

PubMed

Elboim-Gabyzon, Michal; Agmon, Maayan; Azaiza, Faisal; Laufer, Yocheved

2015-04-24

The Late-Life Function and Disability Instrument (LLFDI) provides a comprehensive, reliable, and valid assessment of physical function and disability in community-dwelling adults. There does not appear to be a validated, comprehensive instrument for assessing function and disability in Arabic. The objective of the present study was to translate and culturally adapt the LLFDI to Arabic, and to determine its test-retest reliability and validity. The LLFDI was translated to Arabic through a forward and backward translation process, and approved by a bilingual committee of experts. Sixty-one (26 male and 35 female) Arabic speaking, healthy, older adults, ages 65-88, living in northern Israel participated in the study. To determine test-retest reliability, the questionnaire was administered twice to 41 subjects with a 6 to 8day interval. Construct validity was examined by correlating the LLFDI responses with the 10-item physical function (PF-10) subscales of the General Health Survey (SF-36), with the physical component of SF-36 (SF-36 PCS), and with two performance measures, the Berg Balance Scale (BBS) and Time Up and Go (TUG) test. Additionally, gender and fall related differences in the LLFDI were also examined. Internal consistency (Cronbach's alpha) was good to excellent (0.77 to 0.97). Test-retest agreement was good to very good (function component: 0.86-0.93, disability component: 0.77-0.93). Correlation with the SF-36 PCS and PF-10 was moderate to strong for both LLFDI components (function, r = 0.53-0.65 and r = 0.57-0.63, and LLFDI disability, r = 0.57-0.76 and 0.53-0.73, respectively). Significant, moderate-to-strong correlations between the LLFDI and BBS (r = 0.73-0.87) and a significant, moderate, negative correlation between LLFDI and TUG test (r = -0.59- -0.68) were noted. The standard error of measure was 6-12%, and the smallest real difference was 18-33%. Discriminative validity for both gender and fall status were also demonstrated. The Arabic version of the LLFDI is a highly reliable and valid instrument for assessing function and disability in community dwelling, Arab older adults. The translated instrument has a discriminative ability between genders and between fallers and non-fallers. The translated instrument may be used in clinical settings and for research purposes.

Risk factors for work disability in patients with ankylosing spondylitis.

PubMed

Ward, M M; Kuzis, S

2001-02-01

To identify risk factors for work disability in patients with ankylosing spondylitis (AS). Risk factors for permanent work disability and for receipt of disability payments were assessed using Cox regression models in a retrospective cohort study of 234 patients with AS. Candidate risk factors included age at onset of AS, sex, race, education level, marital status, the presence of comorbid conditions, smoking and drinking history, recreational activity, occupation, and physical activity at work. Risk factors for changes in the type of work performed, decrease in number of hours worked, long sick leave, and the need for help at work were assessed using logistic regression models in a prospective study of the subset of 144 patients who reported working for pay during the study. Candidate risk factors for these aspects of work disability were age, sex, race, education level, levels of functional disability, pain and stiffness, changes in functional disability, pain or stiffness over the preceding 6 months, minutes/week of recreational exercise, back exercises, freedom of movement at work, control over the pace of work, and physical activity at work. In a cohort of 234 patients with a median duration of AS of 21.4 years, 31 patients (13.2%) developed permanent work disability and 57 patients (24.3%) had received disability payments. Older age at onset of AS, less formal education, and having had jobs that were more physically active were significant risk factors for permanent work disability. These factors, along with the presence of a comorbid condition and being female, were also significantly associated with the receipt of disability payments. In a prospective study of 144 patients followed for a median of 4 years, higher levels of functional disability and pain were associated with increased risks of decreased work hours, long sick leaves, and needing help at work, while higher levels of pain were also associated with an increased risk of changing the type of work performed. Women were significantly more likely than men to change their type of work or decrease their work hours. Patients whose jobs were more physically demanding were more likely to change their type of work or need help at work. Patients with AS who have physically demanding jobs are more likely to experience permanent or temporary work disability, or need to change the type of work done or receive help at work, than those with jobs that are less physically demanding.

Sex impacts the relation between body composition and physical function in older adults.

PubMed

Valentine, Rudy J; Misic, Mark M; Rosengren, Karl S; Woods, Jeffrey A; Evans, Ellen M

2009-01-01

To determine the sex-specific relationships between physical activity, aerobic fitness, adiposity (%Fat), mineral-free lean mass (MFLM), and balance and gait performance in older adults. Eighty-five female and 49 male sedentary, healthy, community-dwelling older adults (mean [SD] age, 69.6 [5.4] and 70.3 [4.7] years, respectively) were evaluated on habitual physical activity via questionnaire, aerobic fitness by a maximal oxygen consumption treadmill test, whole and regional body composition by dual-energy x-ray absorptiometry, and lower extremity physical function using gait tasks and computerized dynamic posturography. As expected, men had less body fat, more lean mass, and higher aerobic fitness than did women and tended to perform better on all lower extremity physical function tasks (all P 0.50, all P < 0.05). Body fat was related to gait in women (r = -0.38, P < 0.05) but not in men. Neither fitness nor body composition was related to balance in men, whereas in women, leg MFLM was positively associated (r = 0.27, P < 0.05). Women, but not men, with a greater ratio of body weight to leg MFLM performed worse on gait tasks (P < 0.001). There was an interaction with sex for %Fat on gait (P = 0.05) and for leg MFLM on balance (P < 0.05). In sedentary healthy older adults, the relation between body composition, aerobic fitness, and balance and gait differs between sexes such that women are more strongly affected by alterations in body composition. Lower %Fat and preservation of lower body lean mass have important implications for reducing the risk of physical disability, especially in older women.

Rationale for a preliminary operational definition of physical frailty and sarcopenia in the SPRINTT trial.

PubMed

Cesari, Matteo; Landi, Francesco; Calvani, Riccardo; Cherubini, Antonio; Di Bari, Mauro; Kortebein, Patrick; Del Signore, Susanna; Le Lain, Regis; Vellas, Bruno; Pahor, Marco; Roubenoff, Ronenn; Bernabei, Roberto; Marzetti, Emanuele

2017-02-01

In the present article, the rationale that guided the operationalization of the theoretical concept of physical frailty and sarcopenia (PF&S), the condition of interest for the "Sarcopenia and Physical Frailty in Older People: Multicomponent Treatment Strategies" (SPRINTT) trial, is presented. In particular, the decisions lead to the choice of the adopted instruments, and the reasons for setting the relevant thresholds are explained. In SPRINTT, the concept of physical frailty is translated with a Short Physical Performance Battery score of ≥3 and ≤9. Concurrently, sarcopenia is defined according to the recent definitions of low muscle mass proposed by the Foundation for the National Institutes of Health-Sarcopenia Project. Given the preventive purpose of SPRINTT, older persons with mobility disability (operationalized as incapacity to complete a 400-m walk test within 15 min; primary outcome of the trial) at the baseline are not included within the diagnostic spectrum of PF&S.

Adults' recollections and perceptions of childhood caregiving to a parent with significant physical disability.

PubMed

Iezzoni, Lisa I; Wint, Amy J; Kuhlthau, Karen A; Boudreau, Alexy Arauz

2016-04-01

Caregiving roles of children <18 years of age living with parents with health conditions or disability have been studied extensively abroad, but little U.S. research has examined the caregiving activities and perceptions of children with parents with significant physical disability. To examine children's caregiving activities for their disabled parent, childhood perceptions of these activities, and adult views of this caregiving. We conducted 1-h, semi-structured, open-ended interviews with 20 persons age ≥21 years who as children (age < 18 years) had a parent with significant mobility disability. We used conventional content analysis to identify themes. Interviewees' mean (standard deviation) age was 36.7 (13.8) years; 4 were male. As children, most interviewees assisted their disabled parent with activities of daily living (ADLs) and instrumental ADLs; some children provided more medical supports. Several parents, especially of older interviewees, did not seek their children's care. Interviewees reported both positive and negative childhood attitudes about caregiving. Roughly half recalled as children feeling proud, special, or otherwise positively toward caregiving activities, while about one-third viewed caregiving as just part of their daily reality (i.e., simply needing to be done). Approximately half remembered also feeling resentful, primarily from time demands, insufficient appreciation, and being different from their peers. Interviewees reported gender and cultural factors affecting their caregiving roles and perceptions. Children can provide significant care to parents with physical disability. Understanding better their roles and perceptions could suggest ways to improve these experiences for both child and parent. Copyright © 2016 Elsevier Inc. All rights reserved.

Adults’ Recollections and Perceptions of Childhood Caregiving to a Parent with Significant Physical Disability

PubMed Central

Iezzoni, Lisa I.; Wint, Amy J.; Kuhlthau, Karen A.; Boudreau, Alexy Arauz

2015-01-01

Background Caregiving roles of children < 18 years of age living with parents with health conditions or disability have been studied extensively abroad, but little U.S. research has examined the caregiving activities and perceptions of children with parents with significant physical disability. Objective To examine children’s caregiving activities for their disabled parent, childhood perceptions of these activities, and adult views of this caregiving. Methods We conducted one-hour, semi-structured, open-ended interviews with 20 persons age ≥ 21 years who as children (age < 18 years) had a parent with significant mobility disability. We used conventional content analysis to identify themes. Results Interviewees’ mean (standard deviation) age was 36.7 (13.8) years; 4 were male. As children, most interviewees assisted their disabled parent with activities of daily living (ADLs) and instrumental ADLs; some children provided more medical supports. Several parents, especially of older interviewees, did not seek their children’s care. Interviewees reported both positive and negative childhood attitudes about caregiving. Roughly half recalled as children feeling proud, special, or otherwise positively toward caregiving activities, while about one-third viewed caregiving as just part of their daily reality (i.e., simply needing to be done). Approximately half remembered also feeling resentful, primarily from time demands, insufficient appreciation, and being different from their peers. Interviewees reported gender and cultural factors affecting their caregiving roles and perceptions. Conclusions Children can provide significant care to parents with physical disability. Understanding better their roles and perceptions could suggest ways to improve these experiences for both child and parent. PMID:26712460

Have Disability Transfers Caused the Decline in Older Male Labor Force Participation? A Work-Status Rational Choice Model.

ERIC Educational Resources Information Center

Haveman, Robert H.; Wolfe, Barbara L.

This paper presents a decision-process model for explaining the growth in transfer recipiency (the receipt by working age people of disability income), the choice of work status, and the reduction in labor force participation of older workers. It is hypothesized that the attractiveness of disability income transfer options has led older male…

Older and Younger Family Caregivers of Adults with Intellectual Disability: Factors Associated with Future Plans

ERIC Educational Resources Information Center

Chou, Yueh-Ching; Lee, Yue-Chune; Lin, Li-Chan; Kroger, Teppo; Chang, Ai-Ning

2009-01-01

A structured interview survey was conducted in a major city in Taiwan to explore and compare older and younger family primary caregivers' well being and their future caregiving plans for these adults with intellectual disability. The sample size was 315 caregivers who were 55 years or older and who cared for adults with intellectual disability and…

Intentional weight loss in older adults: useful or wasting disease generating strategy?

PubMed

Darmon, Patrice

2013-05-01

Strategies for weight management in older adults remain controversial as overweight may protect them against mortality whereas weight loss may have harmful effects by promoting sarcopenia and bone loss. It has been suggested that weight management for obese older adults should focus more on maintaining weight and improving physical function than promoting weight loss. This review aims to specify whether intentional weight loss in older adults is a useful or a wasting disease generating strategy. Recent randomized controlled studies have shown that a supervised, moderate caloric restriction coupled with regular exercise (both aerobic and resistance) in obese older adults do not increase mortality risk and may conversely reduce insulin resistance, metabolic complications, and disabilities without exacerbating lean mass and bone mineral density loss. In obese older adults, moderate weight loss may have beneficial effects on comorbidities, functional performances, and quality of life provided that regular physical activity can be associated. An individual approach considering life expectancy, chronic comorbidities, functional status, personal motivation, and social support should be preferred. More research is needed to define the circumstances in which cautious dietary restrictions are reasonably justified in older adults. In any case, in the oldest (≥80 years) as in frail individuals, it seems reasonable to abstain from recommending weight loss.

The role of social capital in the relationship between physical constraint and mental distress in older adults: a latent interaction model.

PubMed

An, Sok; Jang, Yuri

2018-02-01

Building upon the widely known link between physical and mental health, the present study explored the buffering effects of social capital (indicated by social cohesion, social ties, and safety) in the relationship between physical constraint (indicated by chronic conditions and functional disability) and mental distress (indicated by symptoms of depression and anxiety). Using data from 2,264 community-dwelling older adults in the National Social Life, Health, and Aging Project (NSHAP) Wave 2 (M age = 74.51, SD = 6.67), a latent interaction model was tested. The model of mental distress, including both the main effect of physical constraint and social capital and their latent interaction, presented an excellent fit. The latent constructs of physical constraint (β = .54, p < .001) and social capital (β = -.11, p < .01) not only had a direct effect on mental distress, but their interaction was also significant (β = -.26, p < .001). Subgroup analysis showed that the group with a low level of social capital had a heightened vulnerability to mental distress when faced with physical constraint, whereas the group with a high level of social capital demonstrated resilience. Findings call attention to ways to enhance older individuals' social capital in efforts to promote their health and well-being.

Effects of Testosterone Therapy on Muscle Performance and Physical Function in Older Men with Mobility Limitations (The TOM Trial): Design and Methods

PubMed Central

LeBrasseur, Nathan K.; Lajevardi, Newsha; Miciek, Renee; Mazer, Norman; Storer, Thomas W.; Bhasin, Shalender

2010-01-01

The TOM study is the first, single-site, placebo-controlled, randomized clinical trial designed to comprehensively determine the effects of testosterone administration on muscle strength and physical function in older men with mobility limitations. A total of 252 community dwelling individuals aged 65 and older with low testosterone levels and self-reported limitations in mobility and short physical performance battery (SPPB) score between 4 and 9 will be randomized to receive either placebo or testosterone therapy for 6 months. The primary objective is to determine whether testosterone therapy improves maximal voluntary muscle strength as quantified by the one repetition maximum. Secondary outcomes will include measures of physical function (walking, stair climbing and a lifting and lowering task), habitual physical activity and self-reported disability. The effects of testosterone on affect, fatigue and sense of well being will also be assessed. Unique aspects of the TOM Trial include selection of men with self-reported as well as objectively demonstrable functional limitations, community-based screening and recruitment, adjustment of testosterone dose to ensure serum testosterone levels in the target range while maintaining blinding, and inclusion of a range of self-reported and performance-based physical function measures as outcomes. Clinicaltrials.gov identifier: NCT00240981. PMID:18996225

Effects of testosterone therapy on muscle performance and physical function in older men with mobility limitations (The TOM Trial): design and methods.

PubMed

LeBrasseur, Nathan K; Lajevardi, Newsha; Miciek, Renee; Mazer, Norman; Storer, Thomas W; Bhasin, Shalender

2009-03-01

The TOM study is the first, single-site, placebo-controlled, randomized clinical trial designed to comprehensively determine the effects of testosterone administration on muscle strength and physical function in older men with mobility limitations. A total of 252 community dwelling individuals aged 65 and older with low testosterone levels and self-reported limitations in mobility and short physical performance battery (SPPB) scores between 4 and 9 will be randomized to receive either placebo or testosterone therapy for 6 months. The primary objective is to determine whether testosterone therapy improves maximal voluntary muscle strength as quantified by the one repetition maximum. Secondary outcomes will include measures of physical function (walking, stair climbing and a lifting and lowering task), habitual physical activity and self-reported disability. The effects of testosterone on affect, fatigue and sense of well being will also be assessed. Unique aspects of the TOM Trial include selection of men with self-reported as well as objectively demonstrable functional limitations, community-based screening and recruitment, adjustment of testosterone dose to ensure serum testosterone levels in the target range while maintaining blinding, and inclusion of a range of self-reported and performance-based physical function measures as outcomes. Clinicaltrials.gov identifier: NCT00240981.

Knowledge Gaps in Cardiovascular Care of the Older Adult Population: A Scientific Statement From the American Heart Association, American College of Cardiology, and American Geriatrics Society.

PubMed

Rich, Michael W; Chyun, Deborah A; Skolnick, Adam H; Alexander, Karen P; Forman, Daniel E; Kitzman, Dalane W; Maurer, Mathew S; McClurken, James B; Resnick, Barbara M; Shen, Win K; Tirschwell, David L

2016-05-24

The incidence and prevalence of most cardiovascular disorders increase with age, and cardiovascular disease is the leading cause of death and major disability in adults ≥75 years of age; however, despite the large impact of cardiovascular disease on quality of life, morbidity, and mortality in older adults, patients aged ≥75 years have been markedly underrepresented in most major cardiovascular trials, and virtually all trials have excluded older patients with complex comorbidities, significant physical or cognitive disabilities, frailty, or residence in a nursing home or assisted living facility. As a result, current guidelines are unable to provide evidence-based recommendations for diagnosis and treatment of older patients typical of those encountered in routine clinical practice. The objectives of this scientific statement are to summarize current guideline recommendations as they apply to older adults, identify critical gaps in knowledge that preclude informed evidence-based decision making, and recommend future research to close existing knowledge gaps. To achieve these objectives, we conducted a detailed review of current American College of Cardiology/American Heart Association and American Stroke Association guidelines to identify content and recommendations that explicitly targeted older patients. We found that there is a pervasive lack of evidence to guide clinical decision making in older patients with cardiovascular disease, as well as a paucity of data on the impact of diagnostic and therapeutic interventions on key outcomes that are particularly important to older patients, such as quality of life, physical function, and maintenance of independence. Accordingly, there is a critical need for a multitude of large population-based studies and clinical trials that include a broad spectrum of older patients representative of those seen in clinical practice and that incorporate relevant outcomes important to older patients in the study design. The results of these studies will provide the foundation for future evidence-based guidelines applicable to older patients, thereby enhancing patient-centered evidence-based care of older people with cardiovascular disease in the United States and around the world. Copyright © 2016 American Heart Association, Inc., the American College of Cardiology Foundation, and the American Geriatrics Society. Published by Elsevier Inc. All rights reserved.

Association of physical activity with future mental health in older, mid-life and younger women.

PubMed

Griffiths, Amanda; Kouvonen, Anne; Pentti, Jaana; Oksanen, Tuula; Virtanen, Marianna; Salo, Paula; Väänänen, Ari; Kivimäki, Mika; Vahtera, Jussi

2014-10-01

Mental ill-health, particularly depression and anxiety, is a leading and increasing cause of disability worldwide, especially for women. We examined the prospective association between physical activity and symptoms of mental ill-health in younger, mid-life and older working women. Participants were 26 913 women from the ongoing cohort Finnish Public Sector Study with complete data at two phases, excluding those who screened positive for mental ill-health at baseline. Mental health was assessed using the 12-item General Health Questionnaire. Self-reported physical activity was expressed in metabolic equivalent task (MET) hours per week. Logistic regression models were used to analyse associations between physical activity levels and subsequent mental health. There was an inverse dose-response relationship between physical activity and future symptoms of mental ill-health. This association is consistent with a protective effect of physical activity and remained after adjustments for socio-demographic, work-related and lifestyle factors, health and body mass index. Furthermore, those mid-life and older women who reported increased physical activity by more than 2 MET hours per week demonstrated a reduced risk of later mental ill-health in comparison with those who did not increase physical activity. This protective effect of increased physical activity did not hold for younger women. This study adds to the evidence for the protective effect of physical activity for later mental health in women. It also suggests that increasing physical activity levels may be beneficial in terms of mental health among mid-life and older women. The alleviation of menopausal symptoms may partly explain age effects but further research is required. © The Author 2014. Published by Oxford University Press on behalf of the European Public Health Association.

The role of sports clubs in helping older people to stay active and prevent frailty: a longitudinal mediation analysis.

PubMed

Watts, Paul; Webb, Elizabeth; Netuveli, Gopalakrishnan

2017-07-14

Frailty is a common syndrome in older adults characterised by increased vulnerability to adverse health outcomes as a result of decline in functional and physiological measures. Frailty predicts a range of poor health and social outcomes and is associated with increased risk of hospital admission. The health benefits of sport and physical activity and the health risks of inactivity are well known. However, less is known about the role of sports clubs and physical activity in preventing and managing frailty in older adults. The objective of this study is to examine the role of membership of sports clubs in promoting physical activity and reducing levels of frailty in older adults. We used data from waves 1 to 7 of the English Longitudinal Study of Ageing (ELSA). Survey items on physical activity were combined to produce a measure of moderate or vigorous physical activity for each wave. Frailty was measured using an index of accumulated deficits. A total of sixty deficits, including symptoms, disabilities and diseases were recorded through self-report and tests. Direct and indirect relationships between sports club membership, levels of physical activity and frailty were examined using a cross-lagged panel model. We found evidence for an indirect relationship between sports club membership and frailty, mediated by physical activity. This finding was observed when examining time-specific indirect pathways and the total of all indirect pathways across seven waves of survey data (Est = -0.097 [95% CI = -0.124,-0.070], p = <0.001). These analyses provide evidence to suggest that sports clubs may be useful in preventing and managing frailty in older adults, both directly and indirectly through increased physical activity levels. Sports clubs accessible to older people may improve health in this demographic by increasing activity levels and reducing frailty and associated comorbidities. There is a need for investment in these organisations to provide opportunities for older people to achieve the levels of physical activity necessary to prevent health problems associated with inactivity.

Influence of physical and psychosocial work environment throughout life and physical and cognitive capacity in midlife on labor market attachment among older workers: study protocol for a prospective cohort study.

PubMed

Sundstrup, Emil; Hansen, Åse Marie; Mortensen, Erik Lykke; Poulsen, Otto Melchior; Clausen, Thomas; Rugulies, Reiner; Møller, Anne; Andersen, Lars Louis

2016-07-22

As average life span increases, elderly will account for an increasing proportion of the total population in most parts of the world. Thus, initiatives to retain older workers at the labor market are becoming increasingly important. This study will investigate the influence of physical and psychosocial work environment throughout working life and physical and cognitive capacity in midlife on labor market attachment among older workers. Approximately 5000 participants (aged 50-60 years) from the Copenhagen Aging and Midlife Biobank (CAMB) will be followed prospectively in a national register (DREAM), containing information on a week-to-week basis about social transfer payments for about 5 million Danish residents. Using Cox regression, we will model the risk of long-term sickness absence, disability pension, early retirement and unemployment within a 4 to 6 year period from the baseline measurement as a function of the following predictors: 1) physical work demands throughout working life, 2) psychosocial working conditions throughout working life, 3) physical capacity in midlife, 4) cognitive capacity in midlife. Estimates will be adjusted for age, sex, lifestyle, socioeconomic position, chronic disease and long-term sickness absence prior to baseline. The project will generate new knowledge on risk factors for loss of labor market attachment. The results will potentially contribute in identifying factors that could be targeted in future interventions for maintaining a longer and healthier working life among older workers.

Participation needs of older adults having disabilities and receiving home care: met needs mainly concern daily activities, while unmet needs mostly involve social activities.

PubMed

Turcotte, Pier-Luc; Larivière, Nadine; Desrosiers, Johanne; Voyer, Philippe; Champoux, Nathalie; Carbonneau, Hélène; Carrier, Annie; Levasseur, Mélanie

2015-08-01

Participation is a key determinant of successful aging and enables older adults to stay in their homes and be integrated into the community. Assessing participation needs involves identifying restrictions in the accomplishment of daily and social activities. Although meeting participation needs involves older adults, their caregivers and healthcare providers, little is known about their respective viewpoints. This study thus explored the participation needs of older adults having disabilities as perceived by the older adults themselves, their caregivers and healthcare providers. A qualitative multiple case study consisted of conducting 33 semi-structured interviews in eleven triads, each composed of an older adult, his/her caregiver and a healthcare provider recruited in a Health and Social Services Centre (HSSC) in Québec, Canada. Interview transcripts and reviews of clinical records were analyzed using content analysis and descriptive statistics based on thematic saliency analysis methods. Aged 66 to 88 years, five older adults had physical disabilities, five had mild cognitive impairment and one had psychological problems, leading to moderate to severe functional decline. Caregivers and healthcare providers were mainly women, respectively retired spouses and various professionals with four to 32 years of clinical experience. Participation needs reported by each triad included all domains of participation. Needs related to daily activities, such as personal care, nutrition, and housing, were generally met. Regarding social activities, few needs were met by various resources in the community and were generally limited to personal responsibilities, including making decisions and managing budgets, and some community life activities, such as going shopping. Unmet needs were mainly related to social activities, involving leisure, other community life activities and interpersonal relationships, and some daily activities, including fitness and mobility. This study highlights the complexity of older adults' participation needs, involving daily as well as social activities. Properly assessing and addressing these needs is thus necessary to improve older adults' health and well-being. Discrepancies in the various actors' perceptions of participation needs must be further explored. Additional research would help better understand how to optimize the contribution of community organizations and caregivers.

Lower Serum DHEAS levels are associated with a higher degree of physical disability and depressive symptoms in middle-aged to older African American women

PubMed Central

Haren, Matthew T.; Malmstrom, Theodore K.; Banks, William A.; Patrick, Ping; Miller, Douglas K.; Morley, John E.

2007-01-01

Background Changes in androgen levels and associations with chronic disease, physical and neuropsychological function and disability in women over the middle to later years of life are not well understood and have not been extensively studied in African-American women. Aims The present cross-sectional analysis reports such levels and associations in community dwelling, African American women aged 49 – 65 years from St. Louis, Missouri. Methods A home-based physical examination and a health status questionnaire were administered to randomly sampled women. Body composition (DEXA), lower limb and hand-grip muscle strength, physical and neuropsychological function and disability levels were assessed. Blood was drawn and assayed for total testosterone (T), sex hormone-binding globulin (SHBG), dehydroepiandrosterone-sulfate (DHEAS), oestradiol (E2), adiponectin, leptin, triglycerides, glucose, C-reactive protein (CRP) and cytokine receptors (sIL2r, sIL6r, sTNFr1 & sTNFr2). Multiple linear regression modelling was used to identify the best predictors of testosterone, DHEAS and Free Androgen Index (T/SHBG). Results Seventy-four percent of women were menopausal and a quarter of these were taking oestrogen therapy. DHEAS and E2 declined between the ages of 49 and 65 years, whereas total T, SHBG and FAI remained stable. Total T and DHEAS levels were strongly correlated. In this population sample there were no independent associations of either total T or FAI with indicators of functional limitations, disability or clinically relevant depressive symptoms. Unlike total T and FAI, lower DHEAS levels was independently associated with both higher IADL scores (indicating a higher degree of physical disability) and higher CESD scores (indicating a higher degree of clinically relevant depressive symptoms). Conclusion There is an age-related decline in serum DHEAS in African-American women. Lower DHEAS levels appear to be associated with a higher degree of physical disability and depressive symptoms in this population. PMID:17451893

"It Just Consumes Your Life": Quality of Life for Informal Caregivers of Diverse Older Adults With Late-Life Disability.

PubMed

Thai, Julie N; Barnhart, Caroline E; Cagle, John; Smith, Alexander K

2016-08-01

Little is known about the quality of life (QoL) for informal caregivers of disabled older adults aged 65+ with diverse backgrounds. Forty-two caregivers were interviewed in English and Cantonese about their caregiving experiences, their recollections of QoL over time, and the factors influencing their appraisals. Overall, 52% of caregivers experienced a decline in QoL. Factors associated with decreased QoL were less time for self, competing financial demands, and the physical and emotional impact of the patient's illness. Factors associated with no change in QoL were minimal caregiving responsibilities, a sense of filial duty, and QoL being consistently poor over time. Factors associated with improved QoL were perceived rewards in caregiving, receiving institutional help, and increased experience. Chinese caregivers were more likely to cite filial duty as their motivator for continued caregiving than were Caucasian caregivers. In conclusion, informal caregivers take on a huge burden in enabling older adults to age in the community. These caregivers need more support in maintaining their QoL. © The Author(s) 2015.

The Boston Rehabilitative Impairment Study of the Elderly: A description of methods

PubMed Central

Holt, Nicole E.; Percac-Lima, Sanja; Kurlinski, Laura A.; Thomas, Julia C.; Landry, Paige M.; Campbell, Braidie; Latham, Nancy; Ni, Pengsheng; Jette, Alan; Leveille, Suzanne G.; Bean, Jonathan F.

2012-01-01

Objective To describe the methods of a longitudinal cohort study among older adults with preclinical disability. The study aims to address the lack of evidence guiding mobility rehabilitation for older adults by identifying those impairments and impairment combinations that are most responsible for mobility decline and disability progression over 2 years of follow up. Design Longitudinal cohort study Setting Metropolitan based healthcare system in the US Participants Community dwelling primary care patients ≥ 65 years (N=430), with self-reported modification of mobility tasks due to underlying health conditions. Interventions: Not Applicable Main Outcome Measures Late Life Function and Disability Instrument (LLFDI) (primary outcome), Short Physical Performance Battery (SPPB) and 400 meter walk test (secondary outcomes) Results Among 7403 primary care patients identified as being potentially eligible for participation, 430 were enrolled. Participants have a mean age of 76.5 years, are 68% women and have on average 4.2 chronic conditions. Mean LLFDI scores are 55.5 for Function and 68.9 and 52.3 for the Disability Limitation and Frequency domains, respectively. Conclusions Completion of our study aims will inform development of primary care-based rehabilitative strategies to prevent disability. Additionally, data generated in this investigation can also serve as a vital resource for ancillary studies addressing important questions in rehabilitative science relevant to geriatric care. PMID:22989700

Workplace characteristics and work disability onset for men and women.

PubMed

Crimmins, Eileen M; Hayward, Mark D

2004-01-01

This paper investigates the association between job characteristics and work disability among men and women in older working ages in the United States. We examine whether the association persists when controlling for major chronic disease experience. We also address whether job characteristics are ultimately associated with the receipt of disability benefits. Data are from the Health and Retirement Survey and are nationally representative of noninstitutionalized persons 51-61 in 1992. Disability onset is estimated using a hazard modeling approach for those working at wave 1 (N = 5,999). A logistic regression analysis of disability benefits is based on a risk set of 525 persons who become work-disabled before the second interview. Women's disability onset and health problems appear less related to job characteristics than men's. For men, work disability is associated with stressful jobs, lack of job control, and environmentally hazardous conditions but is not associated with physical demands. Participation in disability benefit programs among those with work disability is unrelated to most job characteristics or health conditions. Understanding of the differing process to work disability for men and women and the relationship between work and health by gender is important for current policy development.

Perceived discrimination and physical, cognitive, and emotional health in older adulthood.

PubMed

Sutin, Angelina R; Stephan, Yannick; Carretta, Henry; Terracciano, Antonio

2015-02-01

To examine whether perceived discrimination based on multiple personal characteristics is associated with physical, emotional, and cognitive health concurrently, prospectively, and with change in health over time among older adults. Longitudinal. Health and Retirement Study (HRS). Participants (N = 7,622) who completed the Leave-Behind Questionnaire as part of the 2006 HRS assessment (mean age 67 years); participants (N = 6,450) completed the same health measures again in 2010. Participants rated their everyday experience with discrimination and attributed those experiences to eight personal characteristics: race, ancestry, sex, age, weight, physical disability, appearance, and sexual orientation. At both the 2006 and 2010 assessments, participants completed measures of physical health (subjective health, disease burden), emotional health (life satisfaction, loneliness), and cognitive health (memory, mental status). Discrimination based on age, weight, physical disability, and appearance was associated with poor subjective health, greater disease burden, lower life satisfaction, and greater loneliness at both assessments and with declines in health across the four years. Discrimination based on race, ancestry, sex, and sexual orientation was associated with greater loneliness at both time points, but not with change over time. Discrimination was mostly unrelated to cognitive health. The detrimental effect of discrimination on physical and emotional health is not limited to young adulthood but continues to contribute to health and well-being in old age. These effects were driven primarily by discrimination based on personal characteristics that change over time (e.g., age, weight) rather than discrimination based on more stable characteristics (e.g., race, sex). Copyright © 2015 American Association for Geriatric Psychiatry. Published by Elsevier Inc. All rights reserved.

Disabled Workers' Risk of Hospitalization and Death

PubMed Central

McCoy, John L.; Iams, Howard M.

1994-01-01

Data from the 1982 New Beneficiary Survey (NBS) were matched with 5 years (1984-88) of Social Security and Medicare data to analyze disabled workers' probability of death and inpatient care. Fifteen percent of the disabled workers died within 18-24 months of initial eligibility; 34 percent died within 5 years. Older disabled workers had higher probabilities of death and hospitalization. Males were two times as likely to die as females, but no more likely to be hospitalized. Black persons also had a higher risk of death but no greater risk of hospitalization than other races. Additional health insurance had no influence on survival, but was differentially associated with inpatient care. Married males were more likely to survive. Physical functioning capacity had no influence on survival or hospitalization. Respiratory, circulatory, and digestive disorders increased the probability of hospitalization and mortality. PMID:10172156

Patterns of Somatic Diagnoses in Older People with Intellectual Disability: A Swedish Eleven Year Case-Control Study of Inpatient Data

ERIC Educational Resources Information Center

Sandberg, Magnus; Ahlström, Gerd; Kristensson, Jimmie

2017-01-01

Background: Knowledge about diagnoses patterns in older people with intellectual disabilities is limited. Methods: The case group (n = 7936) comprised people with intellectual disabilities aged 55 years and older. The control group (n = 7936) was age matched and sex matched. Somatic inpatient diagnoses (2002-2012) were collected retrospectively.…

Change in Self-Rated Health and Mortality among Community-Dwelling Disabled Older Women

ERIC Educational Resources Information Center

Han, Beth; Phillips, Caroline; Ferrucci, Luigi; Bandeen-Roche, Karen; Jylha, Marja; Kasper, Judith; Guralnik, Jack M.

2005-01-01

Purpose: Our study assessed whether change in self-rated health is a stronger predictor of mortality than baseline self-rated health and the most recent self-rated health (prior to death or loss to follow-up) among disabled older women. Design and Methods: The Women's Health and Aging Study examined disabled older women at baseline and every 6…

MultiComponent Exercise and theRApeutic lifeStyle (CERgAS) intervention to improve physical performance and maintain independent living among urban poor older people--a cluster randomised controlled trial.

PubMed

Loh, Debbie Ann; Hairi, Noran Naqiah; Choo, Wan Yuen; Mohd Hairi, Farizah; Peramalah, Devi; Kandiben, Shathanapriya; Lee, Pek Ling; Gani, Norlissa; Madzlan, Mohamed Faris; Abd Hamid, Mohd Alif Idham; Akram, Zohaib; Chu, Ai Sean; Bulgiba, Awang; Cumming, Robert G

2015-02-11

The ability of older people to function independently is crucial as physical disability and functional limitation have profound impacts on health. Interventions that either delay the onset of frailty or attenuate its severity potentially have cascading benefits for older people, their families and society. This study aims to develop and evaluate the effectiveness of a multiComponent Exercise and theRApeutic lifeStyle (CERgAS) intervention program targeted at improving physical performance and maintaining independent living as compared to general health education among older people in an urban poor setting in Malaysia. This cluster randomised controlled trial will be a 6-week community-based intervention programme for older people aged 60 years and above from urban poor settings. A minimum of 164 eligible participants will be recruited from 8 clusters (low-cost public subsidised flats) and randomised to the intervention and control arm. This study will be underpinned by the Health Belief Model with an emphasis towards self-efficacy. The intervention will comprise multicomponent group exercise sessions, nutrition education, oral care education and on-going support and counselling. These will be complemented with a kit containing practical tips on exercise, nutrition and oral care after each session. Data will be collected over four time points; at baseline, immediately post-intervention, 3-months and 6-months follow-up. Findings from this trial will potentially provide valuable evidence to improve physical function and maintain independence among older people from low-resource settings. This will inform health policies and identify locally acceptable strategies to promote healthy aging, prevent and delay functional decline among older Malaysian adults. ISRCTN22749696.

Mental health treatment preferences and challenges of living with multimorbidity from the veteran perspective

PubMed Central

DiNapoli, Elizabeth A.; Cinna, Christopher; Whiteman, Karen L.; Fox, Lauren; Appelt, Cathleen J.; Kasckow, John

2017-01-01

Objective To explore middle-aged and older veterans’ current disease-management practices, mental health treatment preferences, and challenges of living with multiple chronic health conditions (i.e., multimorbidity). Methods Semi-structured qualitative interviews and self-report measures were collected from 28 middle-aged and older (50 years of age or older) veterans with multimorbidity. Results Our sample of veterans with multimorbidity was, on average, mildly depressed and anxious with elevated stress and disability. Veterans acknowledged the interaction of physical and emotional symptoms, which caused greater difficulty with health care management and daily functioning. Veterans had many concerns regarding their physical and emotional health conditions, such as continued disease progression and the addition of other emotional and physical health complications. Veterans also identified specific self-care approaches for disease management (e.g., medication, healthy lifestyle practices, and psychological stress management techniques), as well as barriers to engaging in care (e.g., money, transportation, and stigma). Participants preferred a combination of medication, psychotherapy, and healthy lifestyle practices for mental health treatment. The majority of participants (88.5%) agreed that these mental health treatments would be beneficial to integrate into disease management for older veterans with multimorbidity. Lastly, veterans provided an array of recommendations for improving Veteran’s Administration services and reducing mental health stigma. Conclusions These findings provide support for patient-centered approaches and integrated mental and physical health self-management in the Veteran’s Administration for middle-aged and older veterans with multiple chronic conditions. PMID:27442187

[Physical exercise in the frail elderly: an update].

PubMed

Casas Herrero, Álvaro; Cadore, Eduardo L; Martínez Velilla, Nicolás; Izquierdo Redin, Mikel

2015-01-01

Frailty is a state of vulnerability that involves an increased risk of adverse events and disability in older adults. It is a condition with a complex etiology and pathophysiology. Skeletal muscle power decreases earlier than muscle strength with advancing age and is more strongly associated with functional capacity than muscle strength in frail elderly populations. Multicomponent exercise programs, and especially resistance exercise that includes muscle power training, are currently the most relevant interventions to slow down disability and other adverse outcomes, even in the oldest-old. Moreover, these programs are valuable interventions in other frailty domains, such as falls and cognitive decline. Physical exercise, in the frail elderly, should be prescribed with a progressive individualized plan and just like other medical treatments. Copyright © 2014 SEGG. Published by Elsevier Espana. All rights reserved.

[Association between physical fitness parameters and health related quality of life in Chilean community-dwelling older adults].

PubMed

Guede Rojas, Francisco; Chirosa Ríos, Luis Javier; Fuentealba Urra, Sergio; Vergara Ríos, César; Ulloa Díaz, David; Campos Jara, Christian; Barbosa González, Paola; Cuevas Aburto, Jesualdo

2017-01-01

There is no conclusive evidence about the association between physical fitness (PF) and health related quality of life (HRQOL) in older adults. To seek for an association between PF and HRQOL in non-disabled community-dwelling Chilean older adults. One hundred and sixteen subjects participated in the study. PF was assessed using the Senior Fitness Test (SFT) and hand grip strength (HGS). HRQOL was assessed using eight dimensions provided by the SF-12v2 questionnaire. Binary multivariate logistic regression models were carried out considering the potential influence of confounder variables. Non-adjusted models, indicated that subjects with better performance in arm curl test (ACT) were more likely to score higher on vitality dimension (OR > 1) and those with higher HGS were more likely to score higher on physical functioning, bodily pain, vitality and mental health (OR > 1). The adjusted models consistently showed that ACT and HGS predicted a favorable perception of vitality and mental health dimensions respectively (OR > 1). HGS and ACT have a predictive value for certain dimensions of HRQOL.

The Relationship Between Diabetes Mellitus, Geriatric Syndromes, Physical Function, and Gait: A Review of the Literature.

PubMed

Moreira, Bruno de Souza; Sampaio, Rosana Ferreira; Furtado, Sheyla Rossana Cavalcanti; Dias, Rosângela Corrêa; Kirkwood, Renata Noce

2016-01-01

Diabetes mellitus is a common and growing problem worldwide, especially in the elderly population imposing a huge economic burden for individuals and healthcare services. The purpose of this narrative review was to summarize the current state of knowledge about the relationship between diabetes and important geriatric syndromes, physical function measures, and gait variables. Studies pertaining to the topics were identified through on-line search of databases. Seniors with diabetes are more likely to experience falls, depression, and frailty. Furthermore, in older patients, diabetes has been associated with disability, including basic and instrumental activities of daily living, and with poorer performance on objective measures of physical function, such as sit-to-stand test, handgrip strength, Timed Up and Go (TUG) test, and Short Physical Performance Battery (SPPB). Diabetic seniors also have an altered gait pattern characterized by lower velocity and stride length, and higher step width, stance time, double support time, and stride length variability compared to non-diabetic seniors. Little is known about fear of falling in older adults with diabetes. The relationship between these outcomes and diabetes in older people is still outstanding and merits further investigation.

Engineering Improved Balance Confidence in Older Adults With Complex Health Care Needs: Learning From the Muscling Up Against Disability Study.

PubMed

Hetherington, Sharon; Henwood, Tim; Swinton, Paul; Keogh, Justin; Gardiner, Paul; Tuckett, Anthony; Rouse, Kevin

2018-04-05

To investigate the associations of balance confidence with physical and cognitive markers of well-being in older adults receiving government-funded aged care services and whether progressive resistance plus balance training could positively influence change. Intervention study. Community-based older adult-specific exercise clinic. Older adults (N=245) with complex care needs who were receiving government-funded aged care support. Twenty-four weeks of twice weekly progressive resistance plus balance training carried out under the supervision of accredited exercise physiologists. The primary measure was the Activity-specific Balance Confidence Scale. Secondary measures included the Short Physical Performance Battery; fall history gathered as part of the health history questionnaire; hierarchical timed balance tests; Geriatric Anxiety Index; Geriatric Depression Scale; Fatigue, Resistance, Ambulation, Illness, Loss of Weight scale; and EuroQoL-5 dimension 3 level. At baseline, better physical performance (r=.54; P<.01) and quality of life (r=.52; P<.01) predicted better balance confidence. In contrast, at baseline, higher levels of frailty predicted worse balance confidence (r=-.55; P<.01). Change in balance confidence after the exercise intervention was accompanied by improved physical performance (+12%) and reduced frailty (-11%). Baseline balance confidence was identified as the most consistent negative predictor of change scores across the intervention. This study shows that reduced physical performance and quality of life and increased frailty are predictive of worse balance confidence in older adults with aged care needs. However, when a targeted intervention of resistance and balance exercise is implemented that reduces frailty and improves physical performance, balance confidence will also improve. Given the influence of balance confidence on a raft of well-being determinants, including the capacity for positive physical and cognitive change, this study offers important insight to those looking to reduce falls in older adults. Copyright © 2018 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

Motor Function Is Associated With Incident Disability in Older African Americans

PubMed Central

Wilson, Robert S.; Yu, Lei; Boyle, Patricia A.; Bennett, David A.; Barnes, Lisa L.

2016-01-01

Background: Disability in older African American adults is common, but its basis is unclear. We tested the hypothesis that the level of motor function is associated with incident disability in older African Americans after adjusting for cognition. Methods: A prospective observational cohort study of 605 older community-dwelling African American adults without dementia was carried out. Baseline global motor score summarized 11 motor performances, cognition was based on 19 cognitive tests, and self-reported disability was obtained annually. We examined the association of motor function with incident disability (instrumental activities of daily living [IADL], activities of daily living [ADL], and mobility disability) with a series of Cox proportional hazards models which controlled for age, sex, and education. Results: Average follow-up was about 5 years. In proportional hazards models, a 1-SD increase in baseline level of global motor score was associated with about a 50% decrease in the risk of subsequent IADL, ADL, and mobility disability (all p values < .001). These associations were unchanged in analyses controlling for cognition and other covariates. Further, the association of global motor score and incident ADL disability varied with the level of cognition (estimate −5.541, SE 1.634, p < .001), such that higher motor function was more protective at higher levels of cognition. Mobility and dexterity components of global motor score were more strongly associated with incident disability than strength (all p values < .001). Conclusions: Better motor function in older African Americans is associated with a decreased risk of developing disability. Moreover, the association of motor function and disability is stronger in individuals with better cognitive function. PMID:26525087

Gender, childhood and adult socioeconomic inequalities in functional disability among Chinese older adults.

PubMed

Zhong, Yaqin; Wang, Jian; Nicholas, Stephen

2017-09-02

Gender difference and life-course socioeconomic inequalities in functional disability may exist among older adults. However, the association is less well understood among Chinese older population. The objective is to provide empirical evidences on this issue by exploring the association between gender, childhood and adult socioeconomic inequalities in functional disability. Data from the 2013 wave of the China Health and Retirement Longitudinal Study (CHARLS) was utilized. Functional disability was assessed by the activities of daily living (ADL) and instrumental activities of daily living (IADL). Childhood socioeconomic status (SES) was measured by birthplace, father's education and occupation. Adult SES was measured in terms of education and household income. Multivariate logistic regressions were conducted to assess the association between gender, childhood and adult SES and functional disability. Based on a sample of 18,448 older adults aged 45 years old and above, our results showed that the prevalence of ADL and IADL disability was higher among women than men, but gender difference disappeared after adult SES and adult health were controlled. Harsh conditions during childhood were associated with functional disability but in multivariate analyses only father's education was associated with IADL disability (OR for no education = 1.198; 95% CI = 1.062-1.353). Current SES such as higher education and good economic situation are protective factors of functional disability. Childhood and adult SES were both related to functional disability among older adults. Our findings highlight the need for policies and programs aimed at decreasing social inequalities during childhood and early adulthood, which could reduce socioeconomic inequalities in functional disability in later life.

Nutrition, frailty, and sarcopenia.

PubMed

Cruz-Jentoft, Alfonso J; Kiesswetter, Eva; Drey, Michael; Sieber, Cornel C

2017-02-01

Frailty and sarcopenia are important concepts in the quest to prevent physical dependence, as geriatrics are shifting towards identifications of early stages of disability. Definitions of both sarcopenia and frailty are still developing, and both concepts clearly overlap in their physical aspects. Malnutrition (both undernutrition and obesity) plays a key role in the pathogenesis of frailty and sarcopenia. The quality of the diet along the lifespan has a close relation with the incidence of both entities, and nutritional interventions may be able to reduce the incidence or revert either of them. This brief review explores the role of energy and protein intake and other key nutrients on muscle function. Nutrition may be a key element of multimodal interventions for frailty and sarcopenia. The results of the "Sarcopenia and Physical fRailty IN older people: multi-componenT Treatment strategies" (SPRINTT) trial will offer key insights on the effect of such interventions in frail, sarcopenic older individuals.

Association between sarcopenia and higher-level functional capacity in daily living in community-dwelling elderly subjects in Japan.

PubMed

Tanimoto, Yoshimi; Watanabe, Misuzu; Sun, Wei; Sugiura, Yumiko; Tsuda, Yuko; Kimura, Motoshi; Hayashida, Itsushi; Kusabiraki, Toshiyuki; Kono, Koichi

2012-01-01

This study aimed to determine the association between sarcopenia, defined by muscle mass, muscle strength, and physical performance, and higher-level functional capacity in community-dwelling Japanese elderly people. Subjects were 1158 elderly, community-dwelling Japanese people aged 65 or older. We used bioelectrical impedance analysis to measure muscle mass, grip strength to measure muscle strength, and usual walking speed to measure physical performance. Sarcopenia was characterized by low muscle mass, plus low muscle strength or low physical performance. Subjects without low muscle mass, low muscle strength, and low physical performance were classified as "normal." Examination of higher-level functional capacity was performed using the Tokyo Metropolitan Institute of Gerontology Index of Competence (TMIG-IC). The TMIG-IC is a 13-item questionnaire completed by the subject; it contains five questions on self-maintenance and four questions each on intellectual activity and social role. Sarcopenia was identified in 11.3% and 10.7% of men and women, respectively. The percentage of disability for instrumental activities of daily living (IADL) was 39.0% in men with sarcopenia and 30.6% in women with sarcopenia. After adjustment for age, in men, sarcopenia was significantly associated with IADL disability compared with intermediate and normal subjects. In women, sarcopenia was significantly associated with every subscale of the TMIG-IC disability compared with intermediate and normal subjects. This study revealed that sarcopenia, defined by muscle mass, muscle strength, and physical performance, had a significant association with disability in higher-level functional capacity in elderly Japanese subjects. Interventions to prevent sarcopenia may prevent higher-level functional disability among elderly people. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

The effects of a life goal-setting technique in a preventive care program for frail community-dwelling older people: a cluster nonrandomized controlled trial.

PubMed

Yuri, Yoshimi; Takabatake, Shinichi; Nishikawa, Tomoko; Oka, Mari; Fujiwara, Taro

2016-05-12

Frailty among older people is associated with an increased risk of needing care. There have been many reports on preventive care programs for frail older people, but few have shown positive effects on disability prevention. Physical exercise programs for frail older people affect elements such as physical fitness and balance, but are less effective for disability outcomes and are not followed up in the longer term. We developed a life goal-setting technique (LGST). Our objective was to determine the effect of a LGST plus standard preventive care program for community-dwelling frail older people. We used a cluster nonrandomized controlled trial with seven intervention and nine matched control groups, with baseline assessment and follow-up at 3, 6, and 9 months. Participants were 176 frail older people, aged 65 years or over, living in the community in Izumi, Osaka, Japan. All participants attended regular 120 min preventive care exercise classes each week, over 3 months. They also received oral care and nutrition education. The intervention groups alone received life goal-setting support. We assessed outcomes longitudinally, comparing pre-intervention with follow-up. The primary outcome measure was health improvement according to the Japanese Ministry of Health, Labour and Welfare's "Kihon Checklist" for assessment of frailty and quality of life (QOL), analyzed with a two-way ANOVA and post-test comparison. Secondary outcomes included physical functions and assessment of life goals. The improvement on the Kihon Checklist for the intervention group was approximately 60 % from baseline to 9-months follow-up; the control group improved by approximately 40 %. The difference between groups was significant at 3-month (p = 0.043) and 6-month (p = 0.015) follow-ups but not at 9-month (p = 0.098) follow-up. Analysis of QOL yielded a significant time × group interaction effect (p = 0.022). The effect was significant at 3 months in the intervention group, but at no time in the control group. A 3-month exercise program helped to decrease frailty and improve QOL in frail older people, and the addition of LGST increased its effectiveness. The LGST is a feasible and promising intervention for reducing risk of needing care. UMIN000021485 . Registered 15 March 2016.

Aging in Neighborhoods Differing in Walkability and Income: Associations with Physical Activity and Obesity in Older Adults

PubMed Central

King, Abby C.; Sallis, James F.; Frank, Lawrence D.; Saelens, Brian E.; Cain, Kelli; Conway, Terry L.; Chapman, James E.; Ahn, David K.; Kerr, Jacqueline

2011-01-01

While there is a growing literature on the relations between neighborhood design and health factors such as physical activity and obesity, less focus has been placed on older adults, who may be particularly vulnerable to environmental influences. This study evaluates the relations among objectively measured neighborhood design, mobility impairment, and physical activity and body weight in two U.S. regional samples of community dwelling older adults living in neighborhoods differing in walkability and income levels. An observational design involving two time points six months apart was employed between 2005–2008. U.S. Census block groups in Seattle-King County, Washington and Baltimore. Maryland-Washington DC regions were selected via geographic information systems to maximize variability in walkability and income. Participants were 719 adults ages 66 years and older who were able to complete surveys in English and walk at least 10 feet continuously. Measurements included reported walking or bicycling for errands (i.e., transport activity) and other outdoor aerobic activities measured via the CHAMPS questionnaire: accelerometry-based moderate-to-vigorous physical activity; reported body mass index; and reported lower-extremity mobility impairment measured via the Late-Life Function and Disability Instrument. Across regions, time, and neighborhood income, older adults living in more walkable neighborhoods had more transport activity and moderate-to- vigorous physical activity and lower body mass index relative to those living in less walkable neighborhoods. The most mobility-impaired adults living in more walkable neighborhoods reported transport activity levels that were similar to less mobility-impaired adults living in less walkable neighborhoods. The results add to the small literature aimed at understanding how neighborhood design may influence physical activity and related aspects of health linked with day-to-day function and independence as people age. PMID:21975025

Patterns of Circulating Inflammatory Biomarkers in Older Persons with Varying Levels of Physical Performance: A Partial Least Squares-Discriminant Analysis Approach

PubMed Central

Marzetti, Emanuele; Landi, Francesco; Marini, Federico; Cesari, Matteo; Buford, Thomas W.; Manini, Todd M.; Onder, Graziano; Pahor, Marco; Bernabei, Roberto; Leeuwenburgh, Christiaan; Calvani, Riccardo

2014-01-01

Background: Chronic, low-grade inflammation and declining physical function are hallmarks of the aging process. However, previous attempts to correlate individual inflammatory biomarkers with physical performance in older people have produced mixed results. Given the complexity of the inflammatory response, the simultaneous analysis of an array of inflammatory mediators may provide more insights into the relationship between inflammation and age-related physical function decline. This study was designed to explore the association between a panel of inflammatory markers and physical performance in older adults through a multivariate statistical approach. Methods: Community-dwelling older persons were categorized into “normal walkers” (NWs; n = 27) or “slow walkers” (SWs; n = 11) groups using 0.8 m s−1 as the 4-m gait speed cutoff. A panel of 14 circulating inflammatory biomarkers was assayed by multiplex analysis. Partial least squares-discriminant analysis (PLS-DA) was used to identify patterns of inflammatory mediators associated with gait speed categories. Results: The optimal complexity of the PLS-DA model was found to be five latent variables. The proportion of correct classification was 88.9% for NW subjects (74.1% in cross-validation) and 90.9% for SW individuals (81.8% in cross-validation). Discriminant biomarkers in the model were interleukin 8, myeloperoxidase, and tumor necrosis factor alpha (all higher in the SW group), and P-selectin, interferon gamma, and granulocyte–macrophage colony-stimulating factor (all higher in the NW group). Conclusion: Distinct profiles of circulating inflammatory biomarkers characterize older subjects with different levels of physical performance. The dissection of these patterns may provide novel insights into the role played by inflammation in the disabling cascade and possible new targets for interventions. PMID:25593902

Improvements and decline in the physical functioning of Israeli older adults.

PubMed

Spalter, Tal; Brodsky, Jenny; Shnoor, Yitschak

2014-12-01

The current study depicts improvement and decline in functioning among 3 population groups of Israeli older adults: Jews and veteran immigrants, former Soviet Union immigrants, and Arabs. Using longitudinal data from 2005 and 2010 Survey of Health and Retirement (SHARE) in Israel (n = 982), we examined 4 functional changes in late life in mobility, movement, activities of daily living (ADL), and instrumental ADL, as a function of sociodemographic, health, and social variables The findings reveal that physical functioning among older adults can decline as well as improve over time. Older age, higher number of diseases and comorbidity, living with others (not the spouse) compared with living alone, receiving informal help and formal help with homemaking, and declined mental health and cognitive status predict deterioration in physical functioning. Also, Arab older adults are at higher risk of deterioration over time compared with Jewish older adults. Findings imply that noncompatible assistance to older adults may "save them the hassle" of doing things by themselves and thus, weakens a potential functional rehabilitation process. There is a need to guide not only professional personnel but also nonprofessional home care workers and family members on how to encourage and retain older adults' functions as much as possible in order to improve their quality of life. Another implication of investing in rehabilitation is that it might reduce the disability rate among older adults and thus save health expenditures on long-term care at the macrosocial level. © The Author 2013. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Delirium as a Predictor of Physical and Cognitive Function in Individuals Aged 80 and Older After Transcatheter Aortic Valve Implantation or Surgical Aortic Valve Replacement.

PubMed

Eide, Leslie S P; Ranhoff, Anette H; Fridlund, Bengt; Haaverstad, Rune; Hufthammer, Karl Ove; Kuiper, Karel K J; Nordrehaug, Jan E; Norekvål, Tone M

2016-06-01

To determine how development of delirium after surgical aortic valve replacement (SAVR) or transcatheter aortic valve implantation (TAVI) could predict activity of daily living (ADL) and instrumental ADLs (IADL) disability, cognitive function, and self-reported health in individuals aged 80 and older. Prospective cohort study. Tertiary university hospital. Individuals aged 80 and older undergoing elective SAVR or TAVI (N = 136). Delirium was assessed for 5 days using the Confusion Assessment Method. The Barthel Index, Nottingham Extended ADL Scale, and SF-12 were used to determine ADL and IADL ability and self-reported health at baseline and 1- and 6-month follow-up. Cognition was assessed using the Mini-Mental State Examination at baseline and 6-month follow-up. Participants had lower IADL scores 1 month after SAVR than at baseline (baseline 58, 1 month: delirium 42, no delirium 50, P ≤ .02), but scores had returned to baseline levels at 6 months. The Medical Outcomes Study 12-item Short-Form Health Survey (SF-12) Physical Component Summary (PCS) score was higher at 6-month follow-up (48) than at baseline (39), especially in participants who did not develop delirium (P < .001). No differences in other outcomes were found. Regression models suggest that delirium may help predict IADL disability 1 month after baseline (P ≤ .07) but does not predict large differences in ADL disability, cognitive function, or SF-12-scores. Individuals who underwent TAVI and developed delirium had lower ADL (baseline 19, 1-month 16, P < .001) and IADL (baseline 49, 1-month 40, P = .003) scores at 1-month follow-up. SF-12 PCS score (baseline 30) increased from baseline to 1- (35, P = .04) and 6- (35, P = .02) month follow-up in individuals who underwent TAVI and did not develop delirium. Delirium after TAVI predicted greater ADL and IADL disability at 1-month but not at 6-month follow-up. Individuals who develop delirium after SAVR and TAVI have poorer short-term IADL function but do not seem to have long-term reductions in physical, mental, or self-reported health. © 2016 The Authors. The Journal of the American Geriatrics Society published by Wiley Periodicals, Inc. on behalf of The American Geriatrics Society.

What is the relation between fear of falling and physical activity in older adults?

PubMed

Hornyak, Victoria; Brach, Jennifer S; Wert, David M; Hile, Elizabeth; Studenski, Stephanie; Vanswearingen, Jessie M

2013-12-01

To describe the association between fear of falling (FOF) and total daily activity in older adults. Cross-sectional observational study. Ambulatory clinical research training center. Community-dwelling older adults aged ≥64 years (N=78), who were independent in ambulation with or without an assistive device. Not applicable. FOF was defined by self-reported fear ratings using the Survey of Activities and Fear of Falling in the Elderly and self-reported fear status determined by response to the following question: Are you afraid of falling? Physical function was assessed using the Late Life Function and Disability Instrument. Physical activity was recorded using an accelerometer worn on the waist for 7 consecutive days, and mean daily counts of activity per minute were averaged over the 7-day period. Fear ratings were related to total daily activity (r=-.26, P=.02). The relation was not as strong as the relation of function and physical activity (r=.45, P<.001). When stratified by exercise status or functional status, fear was no longer related to total daily activity. Physical function explained 19% of the variance in physical activity, whereas the addition of fear status did not add to the explained variance in physical activity. FOF is related to total daily physical activity; however, FOF was not independently associated with physical activity when accounting for physical function. Some FOF may be reported as a limitation in function. Copyright © 2013 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

Outdoor Built Environment Barriers and Facilitators to Activity among Midlife and Older Adults with Mobility Disabilities

PubMed Central

Rosenberg, Dori E.

2013-01-01

Purpose: To gain better understanding of how the built environment impacts neighborhood-based physical activity among midlife and older adults with mobility disabilities. Design and methods: We conducted in-depth interviews with 35 adults over age 50, which used an assistive device and lived in King County, Washington, U.S. In addition, participants wore Global Positioning Systems (GPS) devices for 3 days prior to the interview. The GPS maps were used as prompts during the interviews. Open coding of the 35 interviews using latent content analysis resulted in key themes and subthemes that achieved consensus between coders. Two investigators independently coded the text of each interview. Results: Participants were on average of 67 years of age (range: 50–86) and predominantly used canes (57%), walkers (57%), or wheelchairs (46%). Key themes pertained to curb ramp availability and condition, sidewalk availability and condition, hills, aesthetics, lighting, ramp availability, weather, presence and features of crosswalks, availability of resting places and shelter on streets, paved or smooth walking paths, safety, and traffic on roads. Implications: A variety of built environment barriers and facilitators to neighborhood-based activity exist for midlife and older adults with mobility disabilities. Preparing our neighborhood environments for an aging population that uses assistive devices will be important to foster independence and health. PMID:23010096

Functional Disability and Social Conflict Increase Risk of Depression in Older Adulthood Among Bolivian Forager-Farmers.

PubMed

Stieglitz, Jonathan; Schniter, Eric; von Rueden, Christopher; Kaplan, Hillard; Gurven, Michael

2015-11-01

To present an explanatory framework for depression in older adulthood in a small-scale society. We propose that depression is a consequence of functional disability, which can reduce subsistence productivity and resource transfers within and across generations. Social conflict can also disrupt resource flows and should be associated with depression. To evaluate depression among Tsimane forager-farmers of Bolivia, we developed a reliable interview based on focus groups and a review of validated depression scales. Older adults (mean ± SD age = 62 ± 9, n = 325) were recruited regardless of their health status. Demographic, economic, and medical data were collected during annual censuses and routine medical exams. Depression is associated with reduced energetic status, greater physical limitations, and reduced subsistence involvement after controlling for potential confounds such as age, sex, number of reported unresolved conflicts, and market involvement. Depression is also associated with greater reported conflict, particularly with non-kin. Tsimane depression is associated with disability, reduced subsistence productivity, and interpersonal conflict, all of which can disrupt resource flows. Depression appears to be a response to conditions regularly experienced over human history, and not simply a by-product of modernity. © The Author 2014. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

20 CFR 404.1583 - How we determine disability for blind persons who are age 55 or older.

Code of Federal Regulations, 2012 CFR

2012-04-01

... 20 Employees' Benefits 2 2012-04-01 2012-04-01 false How we determine disability for blind persons... Blindness § 404.1583 How we determine disability for blind persons who are age 55 or older. We will find... substantial gainful activity, if— (a) You are blind; (b) You are age 55 or older; and (c) You are unable to...

20 CFR 404.1583 - How we determine disability for blind persons who are age 55 or older.

Code of Federal Regulations, 2013 CFR

2013-04-01

... 20 Employees' Benefits 2 2013-04-01 2013-04-01 false How we determine disability for blind persons... Blindness § 404.1583 How we determine disability for blind persons who are age 55 or older. We will find... substantial gainful activity, if— (a) You are blind; (b) You are age 55 or older; and (c) You are unable to...

20 CFR 404.1583 - How we determine disability for blind persons who are age 55 or older.

Code of Federal Regulations, 2014 CFR

2014-04-01

... 20 Employees' Benefits 2 2014-04-01 2014-04-01 false How we determine disability for blind persons... Blindness § 404.1583 How we determine disability for blind persons who are age 55 or older. We will find... substantial gainful activity, if— (a) You are blind; (b) You are age 55 or older; and (c) You are unable to...

20 CFR 404.1583 - How we determine disability for blind persons who are age 55 or older.

Code of Federal Regulations, 2011 CFR

2011-04-01

... 20 Employees' Benefits 2 2011-04-01 2011-04-01 false How we determine disability for blind persons... Blindness § 404.1583 How we determine disability for blind persons who are age 55 or older. We will find... substantial gainful activity, if— (a) You are blind; (b) You are age 55 or older; and (c) You are unable to...

A Home Away from Home: Consumer Information on Board and Care Homes.

ERIC Educational Resources Information Center

Haske, Margaret; Cohen, Rebecca, Ed.

This report provides consumer information on board and care homes, a housing alternative for older persons which serves a broad spectrum of the population, ranging from those needing a modest amount of care and assistance to those who are physically or mentally disabled, but do not need to be institutionalized. The first section of this two-part…

Destinations matter: The association between where older adults live and their travel behavior.

PubMed

Chudyk, Anna M; Winters, Meghan; Moniruzzaman, Md; Ashe, Maureen C; Gould, Joanie Sims; McKay, Heather

2015-03-01

The positive effect of physical activity in the prevention and treatment of many chronic diseases and age-related disabilities, such as mobility-disability, are widely accepted. Mobility is broadly defined as the ability of individuals to move themselves within community environments. These two concepts -physical activity and mobility - are closely linked and together contribute to older adults living healthy, independent lives. Neighborhood destinations may encourage mobility, as older adults typically leave their homes to travel to specific destinations. Thus, neighborhoods with a high prevalence of destinations may provide older adults an attractive opportunity to walk, instead of drive, and thereby obtain incidental physical activity. We know surprisingly little about the specific types of destinations older adults deem relevant and even less about destinations that support the mobility of older adults with low income. Accessible neighborhood destinations may be especially important to older adults with low income as they are more likely to walk as a primary travel mode. Conversely, this population may also be at increased risk of functional impairments that negatively affect their ability to walk. As a means to fill this information gap we aimed to better understand the mobility habits of older adults with low income. Thus, our specific objectives were to: (1) describe the types of destinations older adults with low income most commonly travel to in one week; and (2) determine the association between the prevalence of neighborhood destinations and the number of transportation walking trips these individuals make (average per day). We conducted a cross-sectional study of community-dwelling older adults with low income residing within Metro Vancouver, Canada. We assessed participant travel behavior (frequency, purpose, mode, destination) using seven-day travel diaries and measured the prevalence of neighborhood destinations using the Street Smart Walk Score. We also assessed participants' sociodemographic characteristics and mobility (physical function, car access, confidence walking). We used a negative binomial model to determine the association between Street Smart Walk Score and number of transportation walking trips (average per day). Our sample was comprised of 150 participants (median age 74 years; 51 men) from who we acquired at least one day of travel diary data (range = 1-7 days). Participants made three trips per day (2, 5; median P 25 , P 75 ) and travelled to six different destination types per week (5, 9; median P 25 , P 75 ). Destinations most relevant to older adults were grocery stores, malls, and restaurants/cafés. Each 10-point increase in Street Smart Walk Score was associated with a 20% increase in the number of transportation walking trips (average per day, incidence rate ratio = 1.20, 95% CI = 1.12, 1.29). Our findings provide preliminary evidence regarding destinations that may be most relevant to older adults. They also suggest that the prevalence of these neighborhood destinations may encourage walking. As we approach a new era of healthy city benchmarks, our findings guide policy makers and developers to retrofit and develop communities that support the mobility, health, and independence of older adults.

Destinations matter: The association between where older adults live and their travel behavior

PubMed Central

Chudyk, Anna M.; Winters, Meghan; Moniruzzaman, Md; Ashe, Maureen C.; Gould, Joanie Sims; McKay, Heather

2016-01-01

The positive effect of physical activity in the prevention and treatment of many chronic diseases and age-related disabilities, such as mobility-disability, are widely accepted. Mobility is broadly defined as the ability of individuals to move themselves within community environments. These two concepts –physical activity and mobility – are closely linked and together contribute to older adults living healthy, independent lives. Neighborhood destinations may encourage mobility, as older adults typically leave their homes to travel to specific destinations. Thus, neighborhoods with a high prevalence of destinations may provide older adults an attractive opportunity to walk, instead of drive, and thereby obtain incidental physical activity. We know surprisingly little about the specific types of destinations older adults deem relevant and even less about destinations that support the mobility of older adults with low income. Accessible neighborhood destinations may be especially important to older adults with low income as they are more likely to walk as a primary travel mode. Conversely, this population may also be at increased risk of functional impairments that negatively affect their ability to walk. As a means to fill this information gap we aimed to better understand the mobility habits of older adults with low income. Thus, our specific objectives were to: (1) describe the types of destinations older adults with low income most commonly travel to in one week; and (2) determine the association between the prevalence of neighborhood destinations and the number of transportation walking trips these individuals make (average per day). We conducted a cross-sectional study of community-dwelling older adults with low income residing within Metro Vancouver, Canada. We assessed participant travel behavior (frequency, purpose, mode, destination) using seven-day travel diaries and measured the prevalence of neighborhood destinations using the Street Smart Walk Score. We also assessed participants’ sociodemographic characteristics and mobility (physical function, car access, confidence walking). We used a negative binomial model to determine the association between Street Smart Walk Score and number of transportation walking trips (average per day). Our sample was comprised of 150 participants (median age 74 years; 51 men) from who we acquired at least one day of travel diary data (range = 1–7 days). Participants made three trips per day (2, 5; median P25, P75) and travelled to six different destination types per week (5, 9; median P25, P75). Destinations most relevant to older adults were grocery stores, malls, and restaurants/cafés. Each 10-point increase in Street Smart Walk Score was associated with a 20% increase in the number of transportation walking trips (average per day, incidence rate ratio = 1.20, 95% CI = 1.12, 1.29). Our findings provide preliminary evidence regarding destinations that may be most relevant to older adults. They also suggest that the prevalence of these neighborhood destinations may encourage walking. As we approach a new era of healthy city benchmarks, our findings guide policy makers and developers to retrofit and develop communities that support the mobility, health, and independence of older adults. PMID:27104147

Disabled readers: their intellectual and perceptual capacities at differing ages.

PubMed

Miller, J W; McKenna, M C

1981-04-01

To investigate the multiple relationships between selected measures of intelligence and perception and reading achievement a group of young, poor readers (MCA = 8.4 yr.) and a group of older, poor readers (MCA = 11.2 yr.) were given the Gates-MacGinitie Achievement Test, Peabody Picture Vocabulary Test, Slosson Intelligence Test, Spatial Orientation Memory Test, and Auditory Discrimination Test. The combination of the four predictor variables accounted for a significant amount of the variance in reading vocabulary and comprehension for youngest and older poor readers. Greater variance was accounted for in the reading achievement of younger students than of older students. Perceptual abilities related more strongly for younger students, while intelligence related more strongly for older students. Questions are raised about the validity of using expectancy formulae with younger disabled readers and the "learning disabilities" approach with older disabled readers.

Impact of obesity on disability, function, and physical activity: data from the Osteoarthritis Initiative.

PubMed

Batsis, J A; Zbehlik, A J; Barre, L K; Bynum, J P W; Pidgeon, D; Bartels, S J

2015-01-01

Older adults with obesity are at risk for osteoarthritis (OA) and are predisposed to functional decline and disability. We examined the association between obesity and disability, physical activity, and quality of life at 6 years. Using data from the longitudinal Osteoarthritis Initiative (OAI), we analysed older adults (age ≥ 60 years) with a body mass index (BMI) at baseline ≥ 18.5 kg/m(2) (n = 2378) using standard BMI categories. Outcomes were assessed at the 6-year follow-up and included: the Late-Life Function and Disability Index (LLDI), the 12-item Short Form Health Survey (SF-12), and the Physical Activity Scale for the Elderly (PASE). Linear regression predicted outcomes based on BMI category, adjusting for age, sex, race, education, smoking, cohort status, radiographic knee OA, co-morbidity scores, and baseline scores when available. Follow-up data were available for 1727 (71.9%) participants (mean age 67.9 ± 5.3 years; 61.6% female). At baseline, obese subjects compared to overweight and normal were on a greater number of medications (4.28 vs. 3.63 vs. 3.32), had lower gait speeds (1.22 vs. 1.32 vs. 1.36 m/s), higher Charlson scores (0.59 vs. 0.37 vs. 0.30), and higher Western Ontario and McMaster University OA Index (WOMAC) scores (right: 14.8 vs. 10.3 vs. 7.5; left: 14.4 vs. 9.9 vs. 7.5). SF-12 scores at 6 years were lower in obese patients than in overweight or normal [99.5 (95% CI 98.7-100.4) vs. 101.1 (95% CI 100.4-101.8) vs. 102.8 (95% CI 101.8-103.8)], as were PASE scores [115.1 (95% CI 110.3-119.8) vs. 126.2 (95% CI 122.2-130.2) vs. 131.4 (95% CI 125.8-137.0)]. The LLDI limitation component demonstrated differences in obese compared to overweight or normal [78.6 (95% CI 77.4-79.9) vs. 81.2 (95% CI 80.2-82.3) vs. 82.5 (95% CI 81.1-84.0)]. Obesity was associated with worse physical activity scores, lower quality of life, and higher risk of 6-year disability.

Successful cognitive and emotional aging

PubMed Central

JESTE, DILIP V.; DEPP, COLIN A.; VAHIA, IPSIT V.

2010-01-01

We review the definitions, determinants, and ways of enhancing successful cognitive and emotional aging. Objective definitions of successful aging based on physical health emphasize outcomes including freedom from disability and disease, whereas subjective definitions center on well-being, social connectedness, and adaptation. Most older people do not meet objective criteria for successful aging, while a majority meet the subjective criteria. Older people with severe mental illness are not excluded from successful aging. The determinants of successful aging include complex interactions of lifestyle behaviors and social environment with genes. Depression interferes with nearly all determinants of successful aging. Evidence-based means of enhancing successful aging include calorie restriction, physical exercise, cognitive stimulation, social support, and optimization of stress. Future directions for successful aging research and implications for geriatric psychiatry are discussed. PMID:20671889

Effects of a progressive resistance exercise program with high-speed component on the physical function of older women with sarcopenic obesity: a randomized controlled trial.

PubMed

Vasconcelos, Karina S S; Dias, João M D; Araújo, Marília C; Pinheiro, Ana C; Moreira, Bruno S; Dias, Rosângela C

2016-07-11

Sarcopenic obesity is associated with disability in older people, especially in women. Resistance exercises are recommended for this population, but their efficacy is not clear. To evaluate the effects of a progressive resistance exercise program with high-speed component on the physical function of older women with sarcopenic obesity. Twenty-eight women 65 to 80 years old, with a body mass index ≥30kg/m2 and handgrip strength ≤21kg were randomly allocated to two groups. The experimental group underwent a 10-week resistance exercise program designed to improve strength, power, and endurance of lower-limb muscles, with open chain and closed chain exercises. The control group had their health status monitored through telephone calls. The primary outcomes were lower limb muscle performance measured by knee extensor strength, power and fatigue by isokinetic dynamometry, and mobility measured by the Short Physical Performance Battery and by gait velocity. The secondary outcome was health-related quality of life assessed by the SF-36 Questionnaire. The average rate of adherence was 85%, with few mild adverse effects. There were no significant between-group differences for any of the outcomes. In this study, a progressive resistance exercise program with high-speed component was not effective for improving the physical function of older women with sarcopenic obesity.

Recreational physical activity levels in healthy older women: the importance of fear of falling.

PubMed

Bruce, David G; Devine, Amanda; Prince, Richard L

2002-01-01

To examine whether fear of falling is a probable cause of reduced recreational physical activity levels in healthy older women. Cross-sectional analysis of baseline data from a longitudinal study. One thousand five hundred older, ambulatory women (aged 70-85), selected at random from the electoral roll. Self-reported recreational physical activity levels and fear of falling, demographic variables, anthropometric variables and measures of disability, and physical and cognitive function. The study subjects had low levels of physical and cognitive impairments; 24.1% of the group was obese (body mass index> 30). Twenty-six percent of the women did not participate in recreational physical activity; 39% participated in sufficient activity to gain probable health benefits. Although the women who did not participate in recreational activities were most likely to report fear of falling (45.2%), it was common in the group as a whole (33.9%), including the most active women (27.0%). Independent risk factors for nonparticipation in physical activity were fear of falling (odds ratio (OR)=0.70, 95% confidence interval (CI)=0.54-0.90, P=.006), obesity (OR=0.50, 95% CI=0.38-0.66, P=.001), and slower times on the timed up-and-go test (OR=0.88, 95% CI=0.84-0.92, P=.001). Fear of falling was also independently associated with lower recreational physical activity levels in women who were active (beta=-0.09, P=.003). Subgroup analysis suggested that fear of falls affected activity levels at a predisability stage in women with mildly impaired mobility. Fear of falling is common in healthy, high-functioning older women and is independently associated with reduced levels of participation in recreational physical activity. Fear of falling is an important psychological barrier that may need to be overcome in programs attempting to improve activity levels in older women.

Gonadal Status and physical performance in older men

PubMed Central

Maggio, Marcello; Ceda, Gian Paolo; Lauretani, Fulvio; Bandinelli, Stefania; Metter, E. Jeffrey; Guralnik, Jack M.; Basaria, Shehzad; Cattabiani, Chiara; Luci, Michele; Dall'Aglio, Elisabetta; Vignali, Alessandro; Volpi, Riccardo; Valenti, Giorgio; Ferrucci, Luigi

2011-01-01

Background Male aging is characterized by a progressive decline in serum testosterone levels and physical performance. Low testosterone levels may be implicated in the decline of physical performance and consequent mobility disability that occurs with aging. During the recent years many consensus reports have advocated that one of the potential effects of testosterone supplementation is the improvement in mobility. However, to the best of our knowledge no study has fully investigated the relationship between gonadal status and objective measures of physical performance in older men and their determinants. Methods We evaluated 455 ≥ 65 year old male participants of InCHIANTI study a population based study in two municipalities of Tuscany, Italy with complete data on testosterone levels, hand grip strength, cross-sectional muscle area (CSMA), short physical performance battery (SPPB). Linear models were used to test the relationship between gonadal status and determinants of physical performance. Results According to baseline serum levels of total testosterone, three different groups of older men were created: 1) severely hypogonadal (N= 23),total testosterone levels ≤230 ng /dl; 2) moderately hypogonadal (N=88), total testosterone >230 and <350 ng/dL), and 3) eugonadal (N=344), testosterone levels ≥350 ng/dL. With increased severity of hypogonadal status, participants were significantly older while their BMI was substantially similar. In the age and BMI adjusted analysis, there was a significant difference in hemoglobin levels, hand grip strength and SPPB score (p for trend<0.001) among −3 groups, with severely hypogonadal men having lower values of hemoglobin, muscle strength and physical performance. We found no association between testosterone group assignment and calf muscle mass and 4 meter walking speed. In the multivariate analysis grip strength (p for trend=0.004) and haemoglobin (p for trend <0.0001) but not SPPB and other determinants of physical performance were significantly different between the 3 groups. Conclusions In older men, gonadal status is independently associated with some determinants (hemoglobin and muscle strength) of physical performance. PMID:20937007

Instruments to assess sarcopenia and physical frailty in older people living in a community (care) setting: similarities and discrepancies.

PubMed

Mijnarends, Donja M; Schols, Jos M G A; Meijers, Judith M M; Tan, Frans E S; Verlaan, Sjors; Luiking, Yvette C; Morley, John E; Halfens, Ruud J G

2015-04-01

Both sarcopenia and physical frailty are geriatric syndromes causing loss of functionality and independence. This study explored the association between sarcopenia and physical frailty and the overlap of their criteria in older people living in different community (care) settings. Moreover, it investigated the concurrent validity of the FRAIL scale to assess physical frailty, by comparison with the widely used Fried criteria. Data were retrieved from the cross-sectional Maastricht Sarcopenia Study (MaSS). The study was undertaken in different community care settings in an urban area (Maastricht) in the south of the Netherlands. Participants were 65 years or older, gave written informed consent, were able to understand Dutch language, and were not wheelchair bound or bedridden. Not applicable. Sarcopenia was identified using the algorithm of the European Working Group on Sarcopenia in Older People. Physical frailty was assessed by the Fried criteria and by the FRAIL scale. Logistic regression was performed to assess the association between sarcopenia and physical frailty measured by the Fried criteria. Spearman correlation was performed to assess the concurrent validity of the FRAIL scale compared with the Fried criteria. Data from 227 participants, mean age 74.9 years, were analyzed. Sarcopenia was identified in 23.3% of the participants, when using the cutoff levels for moderate sarcopenia. Physical frailty was identified in 8.4% (≥3 Fried criteria) and 9.3% (≥3 FRAIL scale criteria) of the study population. Sarcopenia and physical frailty were significantly associated (P = .022). Frail older people were more likely to be sarcopenic than those who were not frail. In older people who were not frail, the risk of having sarcopenia increased with age. Next to poor grip strength (78.9%) and slow gait speed (89.5%), poor performance in other functional tests was common in frail older people. The 2 physical frailty scales were significantly correlated (r = 0.617, P < .001). Sarcopenia and physical frailty were associated and partly overlap, especially on parameters of impaired physical function. Some evidence for concurrent validity between the FRAIL scale and Fried criteria was found. Future research should elicit the value of combining sarcopenia and frailty measures in preventing disability and other negative health outcomes. Copyright © 2015 AMDA – The Society for Post-Acute and Long-Term Care Medicine. Published by Elsevier Inc. All rights reserved.

Quality of Life in Group Homes and Older Persons' Homes

ERIC Educational Resources Information Center

Higgins, Laura; Mansell, Jim

2009-01-01

Older people with intellectual disabilities sometimes live in older people's homes rather than homes for people with intellectual disabilities. Little is known about their quality of life in these homes. A non-equivalent comparison group design was used to compare the quality of life of 59 people in three groups; older people without an…

Resilience and Function in Adults With Physical Disabilities: An Observational Study.

PubMed

Battalio, Samuel L; Silverman, Arielle M; Ehde, Dawn M; Amtmann, Dagmar; Edwards, Karlyn A; Jensen, Mark P

2017-06-01

To determine if resilience is uniquely associated with functional outcomes (satisfaction with social roles, physical functioning, and quality of life) in individuals with physical disabilities, after controlling for measures of psychological health (depression and anxiety) and symptom severity (pain, fatigue, and sleep disturbance); and to examine the potential moderating effect of sex, age, and diagnosis on the hypothesized associations between resilience and function. Cross-sectional survey study. Surveys were mailed (81% response rate) to a community sample of 1949 individuals with multiple sclerosis, muscular dystrophy, postpoliomyelitis syndrome, or spinal cord injury. Participants were recruited through the Internet or print advertisement (28%), a registry of previous research participants who indicated interest in future studies (21%), a departmental registry of individuals interested in research (19%), disability-specific registries (18%), word of mouth (10%), or other sources (3%). Convenience sample of community-dwelling adults aging with physical disabilities (N=1574), with a mean Connor-Davidson Resilience Scale (10 items) score of 29. Not applicable. Patient-Reported Outcomes Measurement Information System measures of Satisfaction with Social Roles and Activities and Physical Functioning, the World Health Organization's brief Older People's Quality of Life Questionnaire, and the Connor-Davidson Resilience Scale (10 items). After controlling for age, age squared, sex, diagnosis, psychological health, and symptom severity, resilience was significantly and positively associated with satisfaction with social roles (β=.17, P<.001) and quality of life (β=.39, P<.001), but not physical function (β=.04, P>.05). For every 1-point increase in scores of resilience, there was an increase of .50 in the quality of life score and .20 in the satisfaction with social roles score. Sex also moderated the association between resilience and satisfaction with social roles (F 1,1453 =4.09, P=.043). The findings extend past research, providing further evidence indicating that resilience plays a unique role in nonphysical functional outcomes among individuals with physical disabilities. Copyright © 2016 American Congress of Rehabilitation Medicine. All rights reserved.

Improved self-confidence was a mechanism of action in two geriatric trials evaluating physical interventions.

PubMed

Peduzzi, Peter; Guo, Zhenchao; Marottoli, Richard A; Gill, Thomas M; Araujo, Katy; Allore, Heather G

2007-01-01

To evaluate the mechanisms of action in two successful geriatric clinical trials that tested multicomponent physical conditioning programs and to determine whether the pathways for overall benefit were through improvement in physical ability and/or self-confidence. PREHAB and DRIVER were conducted by the Yale Pepper Center. PREHAB participants received an individualized program that focused on the impairments present (standardly tailored design); DRIVER participants received the entire intervention (global design). PREHAB enrolled 188 community-living persons, aged 75 years or older, who were physically frail but ambulatory; DRIVER enrolled 178 drivers aged 70 years or older with physical impairments associated with poor driving performance. The primary outcome for PREHAB was a disability score and for DRIVER it was a driving score; potential mediators were measures of physical ability and self-confidence. In PREHAB, pathways for the intervention were established through improvement in physical ability and self-confidence. In DRIVER, there was some evidence for a pathway through improved driving self-confidence but not through physical ability; however, the intervention effect was largely unexplained. Multicomponent physical interventions may operate through psychological mechanisms, and these mechanisms should be anticipated in trial designs so that the component effects can be suitably evaluated.

Effects of intensive strength-power training on sense of coherence among 60-85-year-old people with hip fracture: a randomized controlled trial.

PubMed

Pakkala, Inka; Read, Sanna; Sipilä, Sarianna; Portegijs, Erja; Kallinen, Mauri; Heinonen, Ari; Alen, Markku; Kiviranta, Ilkka; Rantanen, Taina

2012-06-01

Older people with disabilities are at increased risk of psychological health decline. There are no earlier studies on the effects of resistance training on sense of coherence (SOC) among older people with a history of hip fracture. The aim of this study is to test the effects of intensive 12-week strength-power training on SOC among older adults after hip fracture. A clinical sample of 60-85-year-old community-dwelling men and women was studied, 0.5. to 7.0 years after hip fracture. Forty-six had no contraindications for participation and were randomized into training (n=24) and control groups (n=22). The training group participated in a 12-week, individually tailored, strength-power training program, twice a week in a senior gym and supervised by an experienced physiotherapist. SOC was assessed with Antonovsky's short 13-item scale. Data were collected at baseline and after intervention. Intensive 12-week strength-power training had no effect on participants' SOC level. Results indicated no change in SOC after 12-week physical exercise training among participants after hip fracture. Further studies on SOC among older people with disabilities and potential ways of increasing it are needed.

Factors Associated with Disability in Rural Bangladesh: Bangladesh Population-Based Diabetes and Eye Study (BPDES)

PubMed Central

Islam, Fakir M. Amirul; Bhowmik, Jahar L.; Islam, Silvia Z.; Renzaho, Andre M. N.; Hiller, Janet E.

2016-01-01

Background To assess factors associated with disability in a rural district of Bangladesh. Methods Using a population-based systematic sampling technique, data were collected from 3104 adults aged ≥ 30 years from the Banshgram union of Narail district. Data collected included an interviewer administered questionnaire to report physical disabilities including impairment that prevents engagement with paid work, visual, hearing, and mobility as well as mental disabilities. Socio-demographic and anthropometric factors including educational attainment and body mass index, as well as clinical factors such as blood pressure, and fasting blood glucose were also collected. Binary and multinomial logistic regression techniques were used to explore the association of various socio-demographic and clinical factors with disability. Results The mean (SD), minimum and maximum ages of the participants were 51 (12), 30 and 89 years. Of total participants, 65% were female. The prevalence of disability varied from 29.1% for visual impairment (highest) to 16.5% for hearing, 14.7% for movement difficulties and 1.6% (lowest) for any other disability that prevented engagement with paid work. Overall, the prevalence of a single disability was 28.6% and that of two or more disabilities was 14.7%. Older age, gender (female), lower socio-economic status (SES), and hypertension were associated with a higher prevalence of most of the disability components. The prevalence of hearing problems (24.5% vs. 13.3%, p<0.001) and movement difficulties (24.9% vs. 13.0%, p<0.001) was significantly higher among lower-income participants than their higher-income counterparts after controlling for age. Prevalence of visual impairment (54.6% vs. 9.2%, p<0.001), hearing (32.2% vs. 6.7%, p<0.001) and movement difficulties (29.2% vs. 5.5%, p<0.001) were significantly higher in people of aged 60 years or older than those aged 30–34 years. After multivariate adjustment, the prevalence of single disability (prevalence risk ratio [PRR] 1.25, 95% CI: 1.09–1.42, p<0.001), and multiple disabilities (PRR 1.41, 95% CI 1.14–1.73, p<0.001) was higher among females than males. The prevalence of single disability and multiple disabilities was respectively 21% (PRR 1.21, 95% CI: 1.02–1.42, p<0.001) and 88% (PRR 1.88, 95% CI: 1.38–2.54, p<0.001) higher among participants with low educational attainment (primary level or less) than those with at least a secondary level of education. Conclusions In rural Bangladesh, the prevalence of disability is high. Public health programs should target those of low SES, older age, and female participants and aim to provide necessary supports in order to bridge disability-related inequities. PMID:27936096

Factors Associated with Disability in Rural Bangladesh: Bangladesh Population-Based Diabetes and Eye Study (BPDES).

PubMed

Islam, Fakir M Amirul; Bhowmik, Jahar L; Islam, Silvia Z; Renzaho, Andre M N; Hiller, Janet E

2016-01-01

To assess factors associated with disability in a rural district of Bangladesh. Using a population-based systematic sampling technique, data were collected from 3104 adults aged ≥ 30 years from the Banshgram union of Narail district. Data collected included an interviewer administered questionnaire to report physical disabilities including impairment that prevents engagement with paid work, visual, hearing, and mobility as well as mental disabilities. Socio-demographic and anthropometric factors including educational attainment and body mass index, as well as clinical factors such as blood pressure, and fasting blood glucose were also collected. Binary and multinomial logistic regression techniques were used to explore the association of various socio-demographic and clinical factors with disability. The mean (SD), minimum and maximum ages of the participants were 51 (12), 30 and 89 years. Of total participants, 65% were female. The prevalence of disability varied from 29.1% for visual impairment (highest) to 16.5% for hearing, 14.7% for movement difficulties and 1.6% (lowest) for any other disability that prevented engagement with paid work. Overall, the prevalence of a single disability was 28.6% and that of two or more disabilities was 14.7%. Older age, gender (female), lower socio-economic status (SES), and hypertension were associated with a higher prevalence of most of the disability components. The prevalence of hearing problems (24.5% vs. 13.3%, p<0.001) and movement difficulties (24.9% vs. 13.0%, p<0.001) was significantly higher among lower-income participants than their higher-income counterparts after controlling for age. Prevalence of visual impairment (54.6% vs. 9.2%, p<0.001), hearing (32.2% vs. 6.7%, p<0.001) and movement difficulties (29.2% vs. 5.5%, p<0.001) were significantly higher in people of aged 60 years or older than those aged 30-34 years. After multivariate adjustment, the prevalence of single disability (prevalence risk ratio [PRR] 1.25, 95% CI: 1.09-1.42, p<0.001), and multiple disabilities (PRR 1.41, 95% CI 1.14-1.73, p<0.001) was higher among females than males. The prevalence of single disability and multiple disabilities was respectively 21% (PRR 1.21, 95% CI: 1.02-1.42, p<0.001) and 88% (PRR 1.88, 95% CI: 1.38-2.54, p<0.001) higher among participants with low educational attainment (primary level or less) than those with at least a secondary level of education. In rural Bangladesh, the prevalence of disability is high. Public health programs should target those of low SES, older age, and female participants and aim to provide necessary supports in order to bridge disability-related inequities.

Age-related structural alterations in human skeletal muscle fibers and mitochondria are sex specific: relationship to single-fiber function.

PubMed

Callahan, Damien M; Bedrin, Nicholas G; Subramanian, Meenakumari; Berking, James; Ades, Philip A; Toth, Michael J; Miller, Mark S

2014-06-15

Age-related loss of skeletal muscle mass and function is implicated in the development of disease and physical disability. However, little is known about how age affects skeletal muscle structure at the cellular and ultrastructural levels or how such alterations impact function. Thus we examined skeletal muscle structure at the tissue, cellular, and myofibrillar levels in young (21-35 yr) and older (65-75 yr) male and female volunteers, matched for habitual physical activity level. Older adults had smaller whole muscle tissue cross-sectional areas (CSAs) and mass. At the cellular level, older adults had reduced CSAs in myosin heavy chain II (MHC II) fibers, with no differences in MHC I fibers. In MHC II fibers, older men tended to have fewer fibers with large CSAs, while older women showed reduced fiber size across the CSA range. Older adults showed a decrease in intermyofibrillar mitochondrial size; however, the age effect was driven primarily by women (i.e., age by sex interaction effect). Mitochondrial size was inversely and directly related to isometric tension and myosin-actin cross-bridge kinetics, respectively. Notably, there were no intermyofibrillar or subsarcolemmal mitochondrial fractional content or myofilament ultrastructural differences in the activity-matched young and older adults. Collectively, our results indicate age-related reductions in whole muscle size do not vary by sex. However, age-related structural alterations at the cellular and subcellular levels are different between the sexes and may contribute to different functional phenotypes in ways that modulate sex-specific reductions in physical capacity with age. Copyright © 2014 the American Physiological Society.

Depression, functional disability and quality of life among Nigerian older adults: Prevalences and relationships.

PubMed

Akosile, Christopher Olusanjo; Mgbeojedo, Ukamaka Gloria; Maruf, Fatai Adesina; Okoye, Emmanuel Chiebuka; Umeonwuka, Ifeanyi Chuka; Ogunniyi, Adesola

2018-01-01

Ageing is associated with increased morbidity, depression and decline in function. These may consequently impair the quality of life (QoL) of older adults. This study was used to investigate the prevalence of functional disability, depression, and level of quality of life of older adults residing in Uyo metropolis and its environs, Nigeria. This cross sectional survey involved 206 (116 females and 90 males) older adults with mean age of 69.8±6.7. The World Health Organization Quality of Life-OLD, Functional status Questionnaire (FSQ) and Geriatric Depression Scale (GDS) were used to measure quality of life, functional disability and depression respectively. Data was analysed using frequency counts and percentages and Spearman rank-order correlation coefficient, at 0.05 alpha level. 45.5% of participants had depression, and at least 30% had functional disability in at least one domain, but their quality of life was fairly good (>60.0%) across all domains. Significant correlation existed between depression scores and individual quality of life and functional disability domains and between overall QoL and each functional disability domain (p<0.001). Depression and functional disability were quite prevalent among sampled older adults but their QOL was not too severely affected. Since the constructs were interrelated, it seems interventions targeted at depression and functional status may invariably enhance the quality of life of the older adults. Copyright © 2017 Elsevier B.V. All rights reserved.

Prevalence of and factors associated with frailty and disability in older adults from China, Ghana, India, Mexico, Russia and South Africa.

PubMed

Biritwum, R B; Minicuci, N; Yawson, A E; Theou, O; Mensah, G P; Naidoo, N; Wu, F; Guo, Y; Zheng, Y; Jiang, Y; Maximova, T; Kalula, S; Arokiasamy, P; Salinas-Rodríguez, A; Manrique-Espinoza, B; Snodgrass, J J; Sterner, K N; Eick, G; Liebert, M A; Schrock, J; Afshar, S; Thiele, E; Vollmer, S; Harttgen, K; Strulik, H; Byles, J E; Rockwood, K; Mitnitski, A; Chatterji, S; Kowal, P

2016-09-01

The severe burden imposed by frailty and disability in old age is a major challenge for healthcare systems in low- and middle-income countries alike. The current study aimed to provide estimates of the prevalence of frailty and disability in older adult populations and to examine their relationship with socioeconomic factors in six countries. Focusing on adults aged 50+ years, a frailty index was constructed as the proportion of deficits in 40 variables, and disability was assessed using the World Health Organization Disability Assessment Schedule (WHODAS 2.0), as part of the Study on global AGEing and adult health (SAGE) Wave 1 in China, Ghana, India, Mexico, Russia and South Africa. This study included a total of 34,123 respondents. China had the lowest percentages of older adults with frailty (13.1%) and with disability (69.6%), whereas India had the highest percentages (55.5% and 93.3%, respectively). Both frailty and disability increased with age for all countries, and were more frequent in women, although the sex gap varied across countries. Lower levels of both frailty and disability were observed at higher levels of education and wealth. Both education and income were protective factors for frailty and disability in China, India and Russia, whereas only income was protective in Mexico, and only education in South Africa. Age-related frailty and disability are increasing concerns for older adult populations in low- and middle-income countries. The results indicate that lower levels of frailty and disability can be achieved for older people, and the study highlights the need for targeted preventive approaches and support programs. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Clinical relevance of the modified physical performance test versus the short physical performance battery for detecting mobility impairments in older men with peripheral arterial disease.

PubMed

Addison, Odessa; Kundi, Rishi; Ryan, Alice S; Goldberg, Andrew P; Patel, Richa; Lal, Brajesh K; Prior, Steven J

2017-08-23

The study is to compare the Modified Physical Performance Test (MPPT) and Short Physical Performance Battery (SPPB) as metrics of mobility and function in older men with peripheral arterial disease (PAD). A total of 51 men (55-87 years) with PAD underwent functional testing including the SPPB, MPPT, Walking Impairment Questionnaire (WIQ), stair ascent, and 6-min walk distance. Individuals were grouped according to SPPB and MPPT scores as not limited on either, limited only on the MPPT, or limited on both. The MPPT identified a higher proportion of patients as being functionally limited than the SPPB (p < 0.001). Men identified as limited only by the MPPT, and not the SPPB, were subsequently confirmed to have lower function on all measures compared to those not identified as limited by either the SPPB or the MPPT (p < 0.02). These findings suggest the MPPT is an appropriate measure to identify early declines in men with PAD and may identify global disability better than SPPB. Implications for rehabilitation Individuals with peripheral arterial disease have low activity levels and are at risk for a loss of independence and global disability. Early detection of decline in mobility and global function would allow for interventions before large changes in ambulatory ability or a loss of functional independence occur. This study shows the Modified Physical Performance Test may be an appropriate test to identify early decline in function in men with peripheral arterial disease.

Complex interplay between health and successful aging: Role of perceived stress, resilience, and social support

PubMed Central

Moore, Raeanne C.; Eyler, Lisa T.; Mausbach, Brent T.; Zlatar, Zvinka Z.; Thompson, Wesley K.; Peavy, Guerry; Fazeli, Pariya L.; Jeste, Dilip V.

2014-01-01

Psychological and psychosocial resources, including resilience and social support, have traditionally been studied in the context of the stress paradigm and, more recently, in the context of successful aging. This study used moderated mediation analyses to examine the role of perceived stress in the relationships between physical and mental health functioning and self-rated successful aging (SRSA), and whether differences between people in level of resilience and social support changes the role of perceived stress in these relationships. A cross-sectional study of 1,006 older adults (Mean=77 years) completed scales addressing SRSA, physical and mental health functioning, perceived stress, resilience, and social support. Results indicated that the strength of relationships between both physical and mental health functioning and SRSA were reduced after accounting for variation in level of perceived stress. The role of perceived stress in the association between mental health functioning and SRSA was found to be stronger among participants with the highest levels of resilience, and the influence of perceived stress on the degree of relationship between physical health functioning and SRSA was stronger among those with greatest social support. These findings suggest that interventions to reduce perceived stress may help break the link between disability and poor well-being in older adults. The findings further suggest that the impact of such interventions might differ depending on psychological resources (i.e., resilience) for mental health disabilities and external resources (i.e., social support) for those with physical health problems. The complex interplay of these factors should be taken into account in clinical settings. PMID:25217186

Toward social system theory: implications for older people with developmental disabilities and service delivery.

PubMed

Dossa, P A

1990-01-01

The literature refers to older people with developmental disabilities as the "new service population." How and why this population emerged as a special category is discussed conceptually with reference to social systems theory. A brief review of social systems theory and some basic systemic tenets are presented. Systemic tenets are employed in examining the historical development of social gerontology and present trends in the service-delivery system. I show that the systemic variable of the economic model of human development has significantly impacted on the making of older people with developmental disabilities a dependent population. In the conclusion the systems perspective is explored in relation to recognizing the liminal, in-between parts between components. It is argued that such a perception minimizes the dichotomy between older people with developmental disabilities and the non-disabled population, paving the way for a genuine encounter.

Balance training with multi-task exercises improves fall-related self-efficacy, gait, balance performance and physical function in older adults with osteoporosis: a randomized controlled trial.

PubMed

Halvarsson, Alexandra; Franzén, Erika; Ståhle, Agneta

2015-04-01

To evaluate the effects of a balance training program including dual- and multi-task exercises on fall-related self-efficacy, fear of falling, gait and balance performance, and physical function in older adults with osteoporosis with an increased risk of falling and to evaluate whether additional physical activity would further improve the effects. Randomized controlled trial, including three groups: two intervention groups (Training, or Training+Physical activity) and one Control group, with a 12-week follow-up. Stockholm County, Sweden. Ninety-six older adults, aged 66-87, with verified osteoporosis. A specific and progressive balance training program including dual- and multi-task three times/week for 12 weeks, and physical activity for 30 minutes, three times/week. Fall-related self-efficacy (Falls Efficacy Scale-International), fear of falling (single-item question - 'In general, are you afraid of falling?'), gait speed with and without a cognitive dual-task at preferred pace and fast walking (GAITRite®), balance performance tests (one-leg stance, and modified figure of eight), and physical function (Late-Life Function and Disability Instrument). Both intervention groups significantly improved their fall-related self-efficacy as compared to the controls (p ≤ 0.034, 4 points) and improved their balance performance. Significant differences over time and between groups in favour of the intervention groups were found for walking speed with a dual-task (p=0.003), at fast walking speed (p=0.008), and for advanced lower extremity physical function (p=0.034). This balance training program, including dual- and multi-task, improves fall-related self-efficacy, gait speed, balance performance, and physical function in older adults with osteoporosis. © The Author(s) 2014.

Hiring discrimination against people with disabilities under the ADA: characteristics of charging parties.

PubMed

McMahon, Brian T; Roessler, Richard; Rumrill, Philip D; Hurley, Jessica E; West, Steven L; Chan, Fong; Carlson, Linnea

2008-06-01

This article describes findings from a causal comparative study of the characteristics of Charging Parties who filed allegations of Hiring discrimination with the U.S. Equal Employment Opportunity Commission (EEOC) under Title I of the Americans with Disabilities Act (ADA) between 1992 and 2005. Charging Party Characteristics derived from 19,527 closed Hiring allegations are compared and contrasted to 259,680 closed allegations aggregated from six other prevalent forms of discrimination including Discharge and Constructive Discharge, Reasonable Accommodation, Disability Harassment and Intimidation, and Terms and Conditions of Employment. Tests of Proportion distributed as chi-square are used to form comparisons along a variety of factors including age, gender, impairment, and ethnicity. Most allegations of ADA job discrimination fall into the realm of job retention and career advancement as opposed to job acquisition. Hiring allegations, however, tend to be filed by Charging Parties who are disproportionately male, younger or older applicants, white, and coping with physical or sensory disabilities. Prevailing theories about stigma suggest that negative attitudes are more prevalent toward persons with behavioral disabilities. However, this study provides clear evidence that one behavioral manifestation of negative attitudes, Hiring discrimination, is more often directed at persons with physical or sensory impairments. More outreach regarding ADA rights appears indicated for individuals who share the aforementioned characteristics.

Days Out of Role Due to Mental and Physical Conditions: Results from the Singapore Mental Health Study

PubMed Central

Abdin, Edimansyah; Ong, Clarissa; Chong, Siow Ann; Vaingankar, Janhavi Ajit; Subramaniam, Mythily

2016-01-01

Objective The aim of the current study was to evaluate the relative contributions of mental and physical conditions to days out of role among adults aged 18 years and above in Singapore. Methods The Singapore Mental Health Study was a cross-sectional epidemiological survey of a nationally representative sample of residents aged 18 years or older. Diagnosis of mental disorders was established using the Composite International Diagnostic Interview; while chronic physical conditions were established using a checklist. Days out of role were assessed using a WHO Disability Assessment Schedule item. Multivariate regression analyses were used to estimate individual-level and societal-level effects of disorders. Results Overall, 8.7% of respondents reported at least one day out of role, with a mean of 5.8 days. The most disabling conditions at the individual level were cancer (118.9 additional days), cardiovascular diseases (93.5), and bipolar disorder (71.0). At the societal level, cardiovascular diseases contributed the highest population attributable risk proportion (45%), followed by cancer (39.3%), and hypertension (13.5%). Conclusions Mental and physical conditions are linked to significant losses in productivity for society as well as role disability for individuals, underscoring the need to enhance prevention and intervention efforts to increase overall productivity and improve individual functioning. PMID:26840741

Association of sarcopenia with functional decline in community-dwelling elderly subjects in Japan.

PubMed

Tanimoto, Yoshimi; Watanabe, Misuzu; Sun, Wei; Tanimoto, Keiji; Shishikura, Kanako; Sugiura, Yumiko; Kusabiraki, Toshiyuki; Kono, Koichi

2013-10-01

The present study aimed to determine the association of sarcopenia, defined by muscle mass, muscle strength and physical performance, with functional disability from a 2-year cohort study of community-dwelling elderly Japanese people. Participants were 743 community-dwelling elderly Japanese people aged 65 years or older. We used bioelectrical impedance analysis (BIA) to measure muscle mass, grip strength to measure muscle strength, and usual walking speed to measure physical performance in a baseline study. Functional disability was defined using an activities of daily living (ADL) scale and instrumental activities of daily living (IADL) scale at baseline and during follow-up examinations 2 years later. Logistic regression analysis, adjusted for age and body mass index, was used to examine the association between sarcopenia and the occurrence of functional disability. In the present study, 7.8% of men and 10.2% of women were classified as having sarcopenia. Among sarcopenia patients in the baseline study, 36.8% of men and 18.8% of women became dependent in ADL at 2-year follow up. From the logistic regression analysis adjusted by age and body mass index, sarcopenia was significantly associated with the occurrences of physical disability compared with normal subjects in both men and women. Sarcopenia, defined by muscle mass, muscle strength and physical performance, was associated with functional decline over a 2-year period in elderly Japanese. Interventions to prevent sarcopenia are very important to prevent functional decline among elderly individuals. © 2013 Japan Geriatrics Society.

Association of CKD with Disability in the United States

PubMed Central

Plantinga, Laura C.; Johansen, Kirsten; Crews, Deidra C.; Shahinian, Vahakn B.; Robinson, Bruce M.; Saran, Rajiv; Burrows, Nilka Rios; Williams, Desmond E.; Powe, Neil R.

2010-01-01

Background Little is known about disability in early-stage chronic kidney disease (CKD). Study Design Cross-sectional national survey (National Health and Nutrition Examination Survey 1999–2006). Setting and Participants Community-based survey of 16,011 non-institutionalized U.S. civilian adults (≥20 years). Predictor CKD, categorized as: no CKD, stages 1 and 2 [albuminuria and estimated glomerular filtration rate (eGFR) ≥60 ml/min/1.73 m2], and stages 3 and 4 (eGFR 15–59). Outcome Self-reported disability, defined by limitations in working, walking, and cognition; and difficulties in activities of daily living (ADL), instrumental ADL, leisure and social activities, lower extremity mobility, and general physical activity. Measurements Albuminuria and eGFR assessed from urine and blood samples; disability, demographics, access to care, and comorbid conditions assessed by standardized questionnaire. Results Age-adjusted prevalence of reported limitations was generally significantly greater with CKD: e.g., difficulty with ADLs was reported by 17.6%, 24.7%, and 23.9% of older (≥65 years) and 6.8%, 11.9%, and 11.0% of younger (20–64 years) adults with no CKD, stages 1 and 2, and stages 3 and 4, respectively. CKD was also associated with greater reported limitations and difficulty in other activities after age adjustment, including instrumental ADL, leisure and social activities, lower extremity mobility, and general physical activity. Other demographics, socioeconomic status, and access to care generally only slightly attenuated the observed associations, particularly among older individuals; adjustment for cardiovascular disease, arthritis, and cancer attenuated most associations such that statistical significance was no longer achieved. Limitations Inability to establish causality and possible unmeasured confounding. Conclusion CKD is associated with higher prevalence of disability in the United States. Age and other comorbid conditions account for most, but not all, of this association. PMID:21036441

The Value of a Gardening Service for the Frail Elderly and People With a Disability Living in the Community.

PubMed

Same, Anne; Lee, Elinda Ai Lim; McNamara, Beverley; Rosenwax, Lorna

2016-11-01

Little is known about the significance of gardening services for frail elderly people. This study explored the value of a gardening service for frail older people and people with a disability living in the community. Using qualitative and quantitative data collected from pre-gardening ( n = 38) and post-gardening service delivery interviews ( n = 35) and the Housing Enabler, the value of a gardening service was examined. Findings suggest that the service had a positive impact on the independence and emotional well-being of frail aged people and younger people with a functional disability, with little impact on physical health. Results indicate that gardening services should be fundamental to planning for these populations to remain or return to living in the community.

The Value of a Gardening Service for the Frail Elderly and People With a Disability Living in the Community

PubMed Central

Same, Anne; Lee, Elinda Ai Lim; McNamara, Beverley; Rosenwax, Lorna

2016-01-01

Little is known about the significance of gardening services for frail elderly people. This study explored the value of a gardening service for frail older people and people with a disability living in the community. Using qualitative and quantitative data collected from pre-gardening (n = 38) and post-gardening service delivery interviews (n = 35) and the Housing Enabler, the value of a gardening service was examined. Findings suggest that the service had a positive impact on the independence and emotional well-being of frail aged people and younger people with a functional disability, with little impact on physical health. Results indicate that gardening services should be fundamental to planning for these populations to remain or return to living in the community. PMID:27746669

Older American Indians' Perspectives on Health, Arthritis, and Physical Activity: Implications for Adapting Evidence-Based Interventions, Oregon, 2013.

PubMed

Conte, Kathleen P; Schure, Marc B; Goins, R Turner

2016-06-23

Despite the high prevalence of arthritis and physical disability among older American Indians, few evidence-based interventions that improve arthritis self-management via physical activity have been adapted for use in this population. The purpose of this study was to identify beliefs about health, arthritis, and physical activity among older American Indians living in a rural area in Oregon to help select and adapt an arthritis self-management program. In partnership with a tribal health program, we conducted surveys, a focus group, and individual interviews with older American Indians with arthritis. Our sample comprised 6 focus group participants and 18 interviewees. The 24 participants were aged 48 to 82 years, of whom 67% were women. Forms B and C of the Multidimensional Health Locus of Control (MHLC) instrument, modified for arthritis, measured MHLC. The concepts of health, arthritis, and physical activity overlapped in that health was a holistic concept informed by cultural teachings that included living a healthy lifestyle, socializing, and being functionally independent. Arthritis inhibited health and healthy behaviors. Participants identified barriers such as unreliable transportation and recruiting challenges that would make existing interventions challenging to implement in this setting. The Doctor subscale had the highest MHLC (mean = 4.4 [standard deviation (SD), 1.0]), followed by the Internal subscale (3.9 [SD, 1.4]) and the Other People subscale (2.8 [SD, 1.1]). Existing evidence-based programs for arthritis should be adapted to address implementation factors, such as access to transportation, and incorporate cultural values that emphasize holistic wellness and social interconnectedness. Culturally sensitive programs that build on indigenous values and practices to promote active coping strategies for older American Indians with arthritis are needed.

"Brain-muscle loop" in the fragility of older persons: from pathophysiology to new organizing models.

PubMed

Lauretani, Fulvio; Meschi, Tiziana; Ticinesi, Andrea; Maggio, Marcello

2017-12-01

The imperative action of the geriatric medicine is to prevent disability in older persons. Many epidemiological studies have been conducted in the last decades for improving knowledge of the aging process and their interactions with age-related diseases, especially for the identification of the relationship between sarcopenia and loss of mobility. Factors influencing muscle integrity can be classified into six main physiologic subsystems, but the central nervous system certainly plays a crucial role for maintaining muscle integrity in older persons. Recent data show that the reduced muscle strength and not muscle mass could be considered the core of the fragility in predicting changes of gait velocity and mobility and conferring a higher risk of mortality in older persons. Sarcopenia and cognitive decline could, therefore, produce slow gait velocity in older persons, with devastating effect and consequences. Perhaps the most notorious corollary is falling, which is often caused by an underlying gait problem. Injuries caused by accidental falls range from relatively innocent bruises to major fractures or head trauma. Another important consequence is reduced mobility, which leads to loss of independence. This immobility is often compounded by a fear of falling, which further immobilises patients and affects their quality of life and physical performance. When we search the association between brain pathology and muscle function in older persons, we amazingly find that established composite measure of physical frailty is associated with brain pathology. Sarcopenia, which produces muscle dysfunction, slow gait velocity and cognitive decline, could share a strong bidirectional relationship, and this suggests the coexistence of both cognitive and motor dysfunctions in older persons to characterize a new syndrome characterized by slow gait and cognitive complaints, the motoric-cognitive risk syndrome (MRC). In this review, we want to emphasize the relationship between memory complaints with muscle function integrating cognitive and physical evaluation, even with amyloid PET study, to identify older patients at high risk of cognitive and physical decline.

Trajectories of Limitations in Activities of Daily Living among Older Adults in Mexico, 2001–2012

PubMed Central

Wong, Rebeca

2016-01-01

Background Trajectories of disability are an essential component to understand the burden of disability at the societal level. Longitudinal studies, compared to cross-national studies, enable a better analysis of the progression of physical limitations among the elderly. However, information on disability dynamics in developing countries is limited. Objectives This paper examines the changes in activities of daily living (ADLs) in an 11-yr. period in the Mexican elderly population aged 60 or older and identifies how sociodemographic variables alter these trajectories. Methods The data come from the Mexican Health and Aging Study (MHAS), a national sample of adults born in 1951 or earlier, including a baseline survey in 2001 and follow-ups in 2003 and 2012. Results The ADL score increased on average by 0.03 for every year respondents aged after 60. In contrast, the ADL score was reduced by 0.06 for every additional year of education. Conclusions Age, gender, and years of education were confirmed to influence the trajectories of ADL limitations. Understanding the patterns of deterioration of functional limitations will help inform public health policies to better serve the population. PMID:26993585

Trajectories of limitations in activities of daily living among older adults in Mexico, 2001-2012.

PubMed

Díaz-Venegas, Carlos; Wong, Rebeca

2016-07-01

Trajectories of disability are an essential component to understand the burden of disability at the societal level. Longitudinal studies, compared to cross-national studies, enable a better analysis of the progression of physical limitations among the elderly. However, information on disability dynamics in developing countries is limited. This paper examines the changes in activities of daily living (ADLs) in an 11-yr. period in the Mexican elderly population aged 60 or older and identifies how sociodemographic variables alter these trajectories. The data come from the Mexican Health and Aging Study (MHAS), a national sample of adults born in 1951 or earlier, including a baseline survey in 2001 and follow-ups in 2003 and 2012. The ADL score increased on average by 0.03 for every year respondents aged after 60. In contrast, the ADL score was reduced by 0.06 for every additional year of education. Age, gender, and years of education were confirmed to influence the trajectories of ADL limitations. Understanding the patterns of deterioration of functional limitations will help public health policies to better serve the population. Copyright © 2016 Elsevier Inc. All rights reserved.

Mental health treatment preferences and challenges of living with multimorbidity from the veteran perspective.

PubMed

DiNapoli, Elizabeth A; Cinna, Christopher; Whiteman, Karen L; Fox, Lauren; Appelt, Cathleen J; Kasckow, John

2016-10-01

To explore middle-aged and older veterans' current disease-management practices, mental health treatment preferences, and challenges of living with multiple chronic health conditions (i.e., multimorbidity). Semi-structured qualitative interviews and self-report measures were collected from 28 middle-aged and older (50 years of age or older) veterans with multimorbidity. Our sample of veterans with multimorbidity was, on average, mildly depressed and anxious with elevated stress and disability. Veterans acknowledged the interaction of physical and emotional symptoms, which caused greater difficulty with health care management and daily functioning. Veterans had many concerns regarding their physical and emotional health conditions, such as continued disease progression and the addition of other emotional and physical health complications. Veterans also identified specific self-care approaches for disease management (e.g., medication, healthy lifestyle practices, and psychological stress management techniques), as well as barriers to engaging in care (e.g., money, transportation, and stigma). Participants preferred a combination of medication, psychotherapy, and healthy lifestyle practices for mental health treatment. The majority of participants (88.5%) agreed that these mental health treatments would be beneficial to integrate into disease management for older veterans with multimorbidity. Lastly, veterans provided an array of recommendations for improving Veteran's Administration services and reducing mental health stigma. These findings provide support for patient-centered approaches and integrated mental and physical health self-management in the Veteran's Administration for middle-aged and older veterans with multiple chronic conditions. Copyright © 2016 John Wiley & Sons, Ltd. Copyright © 2016 John Wiley & Sons, Ltd.

Targeting functional fitness, hearing and health-related quality of life in older adults with hearing loss: Walk, Talk 'n' Listen, study protocol for a pilot randomized controlled trial.

PubMed

Lambert, Justin; Ghadry-Tavi, Rouzbeh; Knuff, Kate; Jutras, Marc; Siever, Jodi; Mick, Paul; Roque, Carolyn; Jones, Gareth; Little, Jonathan; Miller, Harry; Van Bergen, Colin; Kurtz, Donna; Murphy, Mary Ann; Jones, Charlotte Ann

2017-01-28

Hearing loss (HL) is a disability associated with poorer health-related quality of life including an increased risk for loneliness, isolation, functional fitness declines, falls, hospitalization and premature mortality. The purpose of this pilot trial is to determine the feasibility and acceptability of a novel intervention to reduce loneliness, improve functional fitness, social connectedness, hearing and health-related quality of life in older adults with HL. This 10-week, single-blind, pilot randomized control trial (RCT) will include a convenience sample of ambulatory adults aged 65 years or older with self-reported HL. Following baseline assessments, participants will be randomized to either intervention (exercise, health education, socialization and group auditory rehabilitation (GAR)) or control (GAR only) groups. The intervention group will attend a local YMCA twice a week and the control group once a week. Intervention sessions will include 45 min of strengthening, balance and resistance exercises, 30 min of group walking at a self-selected pace and 60 min of interactive health education or GAR. The control group will attend 60-min GAR sessions. GAR sessions will include education about hearing, hearing technologies, enhancing communication skills, and psychosocial support. Pre-post trial data collection and measures will include: functional fitness (gait speed, 30-s Sit to Stand Test), hearing and health-related quality of life, loneliness, depression, social participation and social support. At trial end, feasibility (recruitment, randomization, retention, acceptability) and GAR will be evaluated. Despite evidence suggesting that HL is associated with declines in functional fitness, there are no studies aimed at addressing functional fitness declines associated with the disability of HL. This pilot trial will provide knowledge about the physical, mental and social impacts on health related to HL as a disability. This will inform the feasibility of a larger RCT and preliminary evidence about the initial effects of a novel, community-based, holistic intervention addressing both the negative psychosocial and functional physical effects of HL among older adults. ClinicalTrials.gov, NCT02662192 . Registered on 14 January 2016.

Group intervention for siblings of children with disabilities: a pilot study in a clinical setting.

PubMed

Granat, Tina; Nordgren, Ingrid; Rein, George; Sonnander, Karin

2012-01-01

To study the effectiveness of a group intervention in a clinical setting designed to increase knowledge of disability and improve sibling relationship among siblings of children with disabilities. A self-selected sample of 54 younger and older siblings with typical development (ages 8-12 years) of children with attention deficit hyperactivity disorder (ADHD) (9), Asperger syndrome (7), autistic disorder (13), physical disability (8) and intellectual disability (17) participated in collateral sibling groups. The Sibling Knowledge Interview (SKI) and Sibling Relationship Questionnaire (SRQ) were administered pre- and post-intervention. SKI scores increased (p < 0.001) from pre- to post-intervention when merged diagnostic groups were compared. Comparisons of SRQ pre- and post-intervention scores across diagnostic sibling groups showed significantly different (p < 0.05) score patterns. The results were encouraging and contribute to further development of interventions meeting the needs of siblings of children with disabilities. In view of the limited empirical research on group interventions for siblings of children with disabilities future work is needed to investigate the effectiveness of such interventions. Particular attention should be given to siblings of children with autism and siblings of children with intellectual disability.

Item-level psychometrics of the ADL instrument of the Korean National Survey on persons with physical disabilities.

PubMed

Hong, Ickpyo; Lee, Mi Jung; Kim, Moon Young; Park, Hae Yean

2017-10-01

The aim of this study is to investigate the psychometrics of the 12 items of an instrument assessing activities of daily living (ADL) using an item response theory model. A total of 648 adults with physical disabilities and having difficulties in ADLs were retrieved from the 2014 Korean National Survey on People with Disabilities. The psychometric testing included factor analysis, internal consistency, precision, and differential item functioning (DIF) across categories including sex, older age, marital status, and physical impairment area. The sample had a mean age of 69.7 years old (SD = 13.7). The majority of the sample had lower extremity impairments (62.0%) and had at least 2.1 chronic conditions. The instrument demonstrated unidimensional construct and good internal consistency (Cronbach's alpha = 0.95). The instrument precisely estimated person measures within a wide range of theta values (-2.22 logits < θ < 0.27 logits) with a reliability of 0.9. Only the changing position item demonstrated misfit (χ 2  = 36.6, df = 17, p = 0.0038), and the dressing item demonstrated DIF on the impairment type (upper extremity/others, McFadden's Pseudo R 2  > 5.0%). Our findings indicate that the dressing item would need to be modified to improve its psychometrics. Overall, the ADL instrument demonstrates good psychometrics, and thus, it may be used as a standardized instrument for measuring disability in rehabilitation contexts. However, the findings are limited to adults with physical disabilities. Future studies should replicate psychometric testing for survey respondents with other disorders and for children.

[Timed up and go right and left unipodal stance results in Chilean older people with different degrees of disability].

PubMed

Mancilla S, Eladio; Valenzuela H, José; Escobar C, Máximo

2015-01-01

The Preventive Health Examination of older people in Chile incorporates the timed up and go (TUG) and right and left unipodal stance test (RUPS and LUPS) as functional assessment methods. To assess if TUG and LUPS discriminate older people with different degrees of disability. TUG, RUPS and LUPS were assessed in 860 participants aged 71.3 ± 6.9 years (591 females) attending a primary health care clinic. The results of the three tests were expressed in seconds. Participants were classified as non-disabled without any risk, non-disabled with risk and in risk of dependence, using the Functional Assessment of Older People of EFAM (the Spanish acronym), previously validated for Chilean older people. In all participants TUG, LUPS and RUPS values were 8.9 ± 3.6, 10 ± 10.6 and 9.7 ± 10.3 seconds (sec) respectively. Among non-disabled participants without risk, the values for TUG, RUPS and LUPS were: 7.9 ± 2.3, 12.7 ± 11.1 and 12.2 ± 10.9 sec respectively. The figures for non-disabled participants with risk were 8.4 ± 2.6, 8.8 ± 9.8 and 8.9 ± 9.8 sec respectively. The figures for participants in risk of dependence were 11.7 ± 5.3, 5.1 ± 7.8 and 4.5 ± 7.1 sec, respectively. In this group of older participants there is an association between the degree of disability and the results of TUG, RUPS and LUPS.

Factors associated with happiness in the elderly persons living in the community.

PubMed

Luchesi, Bruna Moretti; de Oliveira, Nathalia Alves; de Morais, Daiene; de Paula Pessoa, Rebeca Mendes; Pavarini, Sofia Cristina I; Chagas, Marcos Hortes N

2018-01-01

The aim of the present study was to evaluate factors associated with happiness in a sample of Brazilian older adults. A study was conducted with 263 elderly people in the area of coverage of a family health unit located in the state of São Paulo, Brazil. The Subjective Happiness Scale was used to measure happiness, the final score of which determined one of three outcomes: not happy, intermediate, and happy. Disability, sociodemographic characteristics, and psychological, cognitive, and physical factors were considered for the multinomial logistic regression analysis. Statistically significant differences were found among the three groups regarding satisfaction with life, disability, social phobia, anxiety, depression, and frailty (p≤0.05). In the multinomial regression analysis, being "not happy" was significantly associated with satisfaction with life (RRR: 0.53), depression (RRR: 1.46), social phobia (RRR: 1.24), and age (RRR: 1.06). The present findings indicate that psychological factors and age influence the levels of happiness in older adults living in the community. Furthermore, better screening, diagnosis, and treatment of mental health disorders could increase the feeling of happiness among older adults. Copyright © 2017 Elsevier B.V. All rights reserved.

Enabling Self-Determination for Older Workers with Intellectual Disabilities in Supported Employment in Australia

ERIC Educational Resources Information Center

McDermott, Shannon; Edwards, Robyn

2012-01-01

Background: Promoting self-determination is recognized to be an essential element of disability service provision; however, the extent to which older people with intellectual disability working in supported employment are enabled to make intentional decisions about retirement is not well understood. Methods: This research explored the views of…

A Job Fair Demonstration for Senior Citizens and People with Disabilities.

ERIC Educational Resources Information Center

Brown, Patricia L.; Roessler, Richard T.

1991-01-01

Tested job fair project, Better Days, at two sites. Project targeted people with disabilities and older adults. Sixty-two older adults and 81 people with disabilities who attended rated the fairs as "good to excellent" employment resources. Total of 13 companies reported hiring someone as result of contacts made with applicants or…

Service Providers' Perceptions of Active Ageing among Older Adults with Lifelong Intellectual Disabilities

ERIC Educational Resources Information Center

Buys, L.; Aird, R.; Miller, E.

2012-01-01

Background: Considerable attention is currently being directed towards both active ageing and the revising of standards for disability services within Australia and internationally. Yet, to date, no consideration appears to have been given to ways to promote active ageing among older adults with intellectual disabilities (IDs). Methods:…

Retreat and Resilience: Life Experiences of Older Women with Intellectual Disabilities

ERIC Educational Resources Information Center

Leroy, Barbara W.; Walsh, Patricia Noonan; Kulik, Noel; Rooney, Margaret

2004-01-01

Older women with intellectual disabilities remain the least studied and understood members of the disability population, and yet they often live well into late adulthood. In this exploratory study we used extensive interviews to examine the demographics, economic and personal safety nets, health, social roles, and well-being of 29 Irish and…

Social Connections for Older People with Intellectual Disability in Ireland: Results from Wave One of IDS-TILDA

ERIC Educational Resources Information Center

McCausland, Darren; McCallion, Philip; Cleary, Eimear; McCarron, Mary

2016-01-01

Background: The literature on influences of community versus congregated settings raises questions about how social inclusion can be optimised for people with intellectual disability. This study examines social contacts for older people with intellectual disability in Ireland, examining differences in social connection for adults with intellectual…

Healthy mental ageing.

PubMed

Flicker, Leon; Lautenschlager, Nicola T; Almeida, Osvaldo P

2006-09-01

Healthy mental ageing may be defined as the absence of the common disabling mental health problems of older people, especially cognitive decline and depression, accompanied by the perception of a positive quality of life. Older people are particularly prone to negative effects on mental health due to poor physical health. Modifiable aspects of lifestyle have been shown to be associated with healthy mental ageing. These include increased physical activity, intellectual stimulation (including education), avoidance of smoking and various aspects of diet. There is reasonably strong evidence that the treatment of hypertension will decrease the risk of cognitive impairment, and moderate alcohol intake may also have some benefits on cognition. These modifiable lifestyle factors may benefit from deliberate individual and population health promotion strategies to maximize mental health in old age, although to date intervention trials have not been performed to support the evidence obtained from observational studies.

Mindfulness: Reconnecting the Body and Mind in Geriatric Medicine and Gerontology

PubMed Central

Rejeski, W. Jack

2008-01-01

Derived from Buddhism, mindfulness is a unique approach for understanding human suffering and happiness that has attracted rapidly growing interest among health care professionals. In this article I describe current thinking about the concept of mindfulness and elaborate on why and how mindfulness-based interventions have potential within the context of geriatric medicine and gerontology. Upon reviewing definitions and models of the concept, I give attention to the unique role that the body plays in cultivating mindfulness and the advantages that this focus has for older adults because they have aging biological systems and may experience chronic disease, pain, and disability. In the final section I discuss why mindfulness may be particularly useful in promoting physical activity among older adults and how physical activity may be used as a vehicle to promote mindfulness. PMID:18483425

Predictors of basic self-care and intermediate self-care functional disabilities among older adults in Ghana.

PubMed

Amegbor, Prince M; Kuuire, Vincent Z; Robertson, Hamish; Kuffuor, Oscar A

2018-04-12

The number of older adults in Ghana is growing rapidly. Associated with this growth, is the rise in age-related chronic diseases such as cardiovascular and musculoskeletal conditions. However, there is limited knowledge in the Ghanaian context on the effect of chronic diseases on functional disabilities among older adults. In this study, we examine the association between chronic diseases, socioeconomic status, and functional disabilities. Data from 4107 Ghanaian older adults (persons aged 50 years and above) who participated in the World Health Organization's Global Ageing and Adult Health survey (SAGE-Wave 1) were used to fit random effect multivariate logistic and complementary log-log regression. Stroke was significantly associated with difficulty in performing both basic self-care functions and intermediate self-care functions. Hypertension and arthritis, on the other hand, were associated with basic self-care functional disability only. Socioeconomically vulnerable groups such as females, those with less education and low-incomes were more likely to have functional disabilities associated with basic self-care and intermediate self-care activities. In order to reduce functional disabilities among older persons in Ghana, efforts should be aimed at reducing chronic conditions as well as improving socioeconomic status. Copyright © 2018 Elsevier B.V. All rights reserved.

Associations between perceived proximity to neighborhood resources, disability, and social participation among community-dwelling older adults: Results from the VoisiNuAge Study

PubMed Central

Levasseur, Mélanie; Gauvin, Lise; Richard, Lucie; Kestens, Yan; Daniel, Mark; Payette, Hélène

2012-01-01

Objective To examine the associations between perceived proximity to neighborhood resources, disability and social participation, and the potential moderating effect of perceived proximity to neighborhood resources on the association between disability and social participation among community-dwelling older women and men. Design Cross-sectional. Setting Community. Participants Older adults (296 women; 258 men). Interventions Not applicable. Main outcome measures Data on age, education, depressive symptoms, frequency of participation in community activities, perceived proximity to neighborhood resources (services and amenities), and functional autonomy in daily activities (disability) were collected by interviewer-administered questionnaire. Results Greater perceived proximity to resources and lower level of disability were associated with greater social participation for both women (R2=0.10; p<0.001) and men (R2=0.05; p<0.01). The association between disability and social participation did not vary as a function of perceived proximity to neighborhood resources among women (no moderating effect; p=0.15). Among men, however, greater perceived proximity to neighborhood resources enhanced social participation (p=0.01), but only among those with minor or no disability. Conclusions Future studies should investigate why perceived proximity to services and amenities is associated with social participation among older men with minor or no disabilities and with women overall but has no association among men with moderate disabilities. PMID:22133245

Feasibility and outcomes of the Berg Balance Scale in older adults with intellectual disabilities.

PubMed

Oppewal, Alyt; Hilgenkamp, Thessa I M; van Wijck, Ruud; Evenhuis, Heleen M

2013-09-01

High incidence of falls and increased risk of fall-related injuries are seen in individuals with intellectual disabilities (ID). The Berg Balance Scale (BBS) is a reliable instrument for balance assessment in the population of (older) adults with ID. The aims of this study were to assess the balance capacities of a large group of older adults with ID with the BBS and look for gender and age effects, as well as reasons for drop-out on separate items, and to identify feasible subtests for subgroups in which the complete BBS is not feasible. The balance capacities of 1050 older clients with borderline to profound ID of three Dutch care-provider services (mean age 61.6 [sd=8.0]) were assessed with the BBS. The participants who completed all items of the BBS (n=508) were the functionally more able part of the study sample. Results showed that even this functionally more able part had poor balance capacities, with a mean BBS score of 47.2, 95% CI [46.3, 48.0], similar to adults in the general population aged around 20 years older. Balance capacities decreased with increasing age and females had poorer balance capacities than males. Difficulties understanding the task and physical limitations were most often the reasons for drop-out. Feasible subtests were identified for the subgroups with very low cognitive levels and wheelchair users. Low balance capacities of older adults with ID show the need for regular screening and the urge for fall prevention programs for individuals with ID. Copyright © 2013 Elsevier Ltd. All rights reserved.

Problem Solving Therapy and Supportive Therapy in Older Adults with Major Depression and Executive Dysfunction: Effect on Disability

PubMed Central

Alexopoulos, George S.; Raue, Patrick J.; Kiosses, Dimitris N.; Mackin, R. Scott; Kanellopoulos, Dora; McCulloch, Charles; Areán, Patricia A.

2010-01-01

Context Older patients with depression and executive dysfunction represent a population with significant disability and high likelihood of failing pharmacotherapy. Objective To examine whether Problem Solving Therapy (PST) reduces disability more than Supportive Therapy (ST) in older patients with depression and executive dysfunction, and whether this effect is mediated by improvement in depressive symptoms. Design Randomized controlled trail, with participant recruitment from 12/02-11/07 and follow-up for 36 weeks. Setting Weill Cornell and University of California, San Francisco. Participants Adults (>59 years) with major depression and executive dysfunction. Intervention 12 sessions of either PST modified for older depressed adults with executive impairment, or ST. Main Outcome Measure Disability as quantified by the World Health Organization Assessment Schedule II (WHODAS II)-12 item form. Results 653 individuals were referred to this study, 221 of whom met criteria and were randomized to PST or ST. PST and ST led to comparable improvement of disability in the first 6 weeks of treatment, but a more prominent reduction in PST participants at weeks 9 and 12. The difference between PST and ST was greater in patients with greater cognitive impairment and higher number of previous episodes. Reduction in disability paralleled reduction in depressive symptoms. The therapeutic advantage of PST over ST in reducing depression was in part due to greater reduction of disability by PST. While disability increased during the 24 weeks following the end of treatment, the advantage of PST over ST-treated patients was retained. Conclusions This study suggests that PST is more effective than ST in reducing disability in older patients with major depression and executive dysfunction, and its benefits were retained after the end of treatment. The clinical value of this finding is that PST may be a treatment alternative in an older patient population likely to be resistant to pharmacotherapy. PMID:21199963

Close social ties and health in later life: Strengths and vulnerabilities.

PubMed

Rook, Karen S; Charles, Susan T

2017-09-01

The world is aging at an unprecedented rate, with older adults representing the fastest-growing segment of the population in most economically developed and developing countries. This demographic shift leaves much uncharted territory for researchers who study social relationships and health. Social relationships exert powerful influences on physical health in later adulthood, a critical consideration given age-related increases in the prevalence of chronic health conditions and physical disability. A large body of research indicates that older adults report greater satisfaction with their social networks than do younger adults, and that they often take measures to minimize their exposure to negative social encounters. These emotionally satisfying and generally positive social ties afford some health protection against a backdrop of mounting physical limitations and play an important role when juxtaposed with the potentially health-damaging frictions that sometimes emerge in older adults' social relationships. Although most older adults report that they are satisfied with their social ties, some older adults experience frequent conflicts or ambivalent exchanges with members of their social networks, and these experiences detract from their health. In addition, many older adults will experience the loss of one or more close relationships during the course of their lives, with ramifications for their health and, often, for the reorganization of their social lives over time. Understanding how both the strengths and vulnerabilities of close social relationships affect health and well-being in later life is an important goal, particularly in view of the accelerating rate of population aging worldwide. (PsycINFO Database Record (c) 2017 APA, all rights reserved).

Depressive Symptoms in Older Female Carers of Adults with Intellectual Disabilities

ERIC Educational Resources Information Center

Chou, Y. C.; Pu, C-Y.; Fu, L-Y.; Kroger, T.

2010-01-01

Background: This survey study aims to examine the prevalence and factors associated with depressive symptoms among primary older female family carers of adults with intellectual disabilities (ID). Method: In total, 350 female family carers aged 55 and older took part and completed the interview in their homes. The survey package contained…

What is the effect of a combined physical activity and fall prevention intervention enhanced with health coaching and pedometers on older adults' physical activity levels and mobility-related goals? Study protocol for a randomised controlled trial.

PubMed

Tiedemann, Anne; Paul, Serene; Ramsay, Elisabeth; O'Rourke, Sandra D; Chamberlain, Kathryn; Kirkham, Catherine; Merom, Dafna; Fairhall, Nicola; Oliveira, Juliana S; Hassett, Leanne; Sherrington, Catherine

2015-05-09

Physical inactivity and falls in older people are important public health problems. Health conditions that could be ameliorated with physical activity are particularly common in older people. One in three people aged 65 years and over fall at least once annually, often resulting in significant injuries and ongoing disability. These problems need to be urgently addressed as the population proportion of older people is rapidly rising. This trial aims to establish the impact of a combined physical activity and fall prevention intervention compared to an advice brochure on objectively measured physical activity participation and mobility-related goal attainment among people aged 60+. A randomised controlled trial involving 130 consenting community-dwelling older people will be conducted. Participants will be individually randomised to a control group (n = 65) and receive a fall prevention brochure, or to an intervention group (n = 65) and receive the brochure plus physical activity promotion and fall prevention intervention enhanced with health coaching and a pedometer. Primary outcomes will be objectively measured physical activity and mobility-related goal attainment, measured at both six and 12 months post randomisation. Secondary outcomes will include: falls, the proportion of people meeting the physical activity guidelines, quality of life, fear of falling, mood, and mobility limitation. Barriers and enablers to physical activity participation will be measured 6 months after randomisation. General linear models will be used to assess the effect of group allocation on the continuously-scored primary and secondary outcome measures, after adjusting for baseline scores. Between-group differences in goal attainment (primary outcome) will be analysed with ordinal regression. The number of falls per person-year will be analysed using negative binomial regression models to estimate the between-group difference in fall rates after one year (secondary outcome). Modified Poisson regression models will compare groups on dichotomous outcome measures. Analyses will be pre-planned, conducted while masked to group allocation and will use an intention-to-treat approach. This trial will address a key gap in evidence regarding physical activity and fall prevention for older people and will evaluate a program that could be directly implemented within Australian health services. ACTRN12614000016639, 7/01/2014.

Risk factors for a 6-year decline in physical disability and functional limitations among elderly people with type 2 diabetes in the Japanese Elderly Diabetes Intervention Trial.

PubMed

Sakurai, Takashi; Iimuro, Satoshi; Sakamaki, Kentaro; Umegaki, Hiroyuki; Araki, Atsushi; Ohashi, Yasuo; Ito, Hideki

2012-04-01

Type 2 diabetes increases the risk of disability. The purpose of this study was to clarify the explanatory factors for disability in Japanese diabetic elderly. The 6-year decline in physical disability and functional limitations was investigated among 317 elderly people with type 2 diabetes recruited in a large-scale prospective study of the Japanese Elderly Diabetes Intervention Trial. Information about diabetes, blood examinations and complications was obtained, and basic activities of daily living (ADL) and instrumental ADL (IADL) were assessed by total score of the Barthel index and the Tokyo Metropolitan Institute of Gerontology Index of Competence, respectively. After 6 years of follow up, 13.6% of patients had developed a new ADL disability and 38.3% had developed a new functional impairment. In the 65-74 years age group, basic ADL decreased only in males, whereas females became functionally impaired. In the 75-84 years age group, basic and IADL decreased in both males and females. Older age and metabolic syndrome were prognostic for impairment of basic ADL, whereas baseline IADL problems, lower cognitive function, physical inactivity and insulin therapy were significant predictors of a future decline in the IADL. This study identified several factors predicting the future decline of basic ADL and IADL in diabetic elderly patients, and provided a conceptual framework that might help to clarify the pathways leading to disability. Because the specific causes of each functional problem are modifiable, comprehensive treatment and care are needed to allow Japanese diabetic elderly patients to have more favorable living conditions. © 2012 Japan Geriatrics Society.

Interactive Videogame Technologies to Support Independence in the Elderly: A Narrative Review.

PubMed

Marston, Hannah R; Smith, Stuart T

2012-04-01

In recent years the use of videogame technology has increased within the domain of health, in particular to facilitate rehabilitation following a stroke or fall. This review presents an overview of how videogame technologies can be used to address health issues contributing to reduced independence in older adults. Four themes were identified: (1) hardware, (2) software, (3) health issues addressed using videogames, and (4) clinicians' perspectives. Several recommendations have been proposed to build upon the use and integration of videogame technology into rehabilitation and training for older adults. In particular, the use of videogames for health requires an appropriate game classification system for development of games that are appropriate for the physical, cognitive, and social requirements of older adults or those living with a disability.

Relation of depression with health behaviors and social conditions of dependent community-dwelling older persons in the Republic of Chile.

PubMed

Sandoval Garrido, Felipe Alfonso; Tamiya, Nanako; Lloyd-Sherlock, Peter; Noguchi, Haruko

2016-12-01

Depressive symptoms are a leading cause of disability and emotional suffering, particularly in old age. However, evidence on depression and old age in developing countries remains largely ignored. The aim of this study was to examine the relation between health behavior and social conditions with depression among dependent community-dwelling older persons in the Republic of Chile. This is a cross-sectional and inferential study, using nationally representative secondary data. Two models used logistic regression on 640 dependent community-dwelling older persons from all over Chile, who personally answered a depression assessment, excluding those taking antidepressants. The geriatric depression scale (GDS-15) was used as outcome. The first model aims at any kind of depression (GDS 5>). The second aims at severe depression (GDS 10>). As exposure, we used the health behavior and social conditions of the older persons. Socio-demographic and physical conditions were used as adjustment. 44.5% of the older persons presented depressive symptoms. Among them, 11% had severe depression. Logistic regression showed that significant detrimental factors for being depressed in both models were visiting the doctor five times or over because of acute diseases, feeling uncomfortable with their living arrangement, and feeling discriminated. On the other hand, every additional day of physical exercise and living alone had a beneficial and detrimental effect only in model one. Analyses on ways to support older persons living alone and the promotion of physical exercise to avoid depression are needed, along with a deeper understanding of the comfort with their living arrangement. Finally, ways to address the discrimination among older persons should be further explored.

Effects of a progressive resistance exercise program with high-speed component on the physical function of older women with sarcopenic obesity: a randomized controlled trial

PubMed Central

Vasconcelos, Karina S. S.; Dias, João M. D.; Araújo, Marília C.; Pinheiro, Ana C.; Moreira, Bruno S.; Dias, Rosângela C.

2016-01-01

ABSTRACT Background Sarcopenic obesity is associated with disability in older people, especially in women. Resistance exercises are recommended for this population, but their efficacy is not clear. Objective To evaluate the effects of a progressive resistance exercise program with high-speed component on the physical function of older women with sarcopenic obesity. Method Twenty-eight women 65 to 80 years old, with a body mass index ≥30kg/m2 and handgrip strength ≤21kg were randomly allocated to two groups. The experimental group underwent a 10-week resistance exercise program designed to improve strength, power, and endurance of lower-limb muscles, with open chain and closed chain exercises. The control group had their health status monitored through telephone calls. The primary outcomes were lower limb muscle performance measured by knee extensor strength, power and fatigue by isokinetic dynamometry, and mobility measured by the Short Physical Performance Battery and by gait velocity. The secondary outcome was health-related quality of life assessed by the SF-36 Questionnaire. Results The average rate of adherence was 85%, with few mild adverse effects. There were no significant between-group differences for any of the outcomes. Conclusion In this study, a progressive resistance exercise program with high-speed component was not effective for improving the physical function of older women with sarcopenic obesity. PMID:27410162

Multidimensional model of apathy in older adults using partial least squares--path modeling.

PubMed

Raffard, Stéphane; Bortolon, Catherine; Burca, Marianna; Gely-Nargeot, Marie-Christine; Capdevielle, Delphine

2016-06-01

Apathy defined as a mental state characterized by a lack of goal-directed behavior is prevalent and associated with poor functioning in older adults. The main objective of this study was to identify factors contributing to the distinct dimensions of apathy (cognitive, emotional, and behavioral) in older adults without dementia. One hundred and fifty participants (mean age, 80.42) completed self-rated questionnaires assessing apathy, emotional distress, anticipatory pleasure, motivational systems, physical functioning, quality of life, and cognitive functioning. Data were analyzed using partial least squares variance-based structural equation modeling in order to examine factors contributing to the three different dimensions of apathy in our sample. Overall, the different facets of apathy were associated with cognitive functioning, anticipatory pleasure, sensitivity to reward, and physical functioning, but the contribution of these different factors to the three dimensions of apathy differed significantly. More specifically, the impact of anticipatory pleasure and physical functioning was stronger for the cognitive than for emotional apathy. Conversely, the impact of sensibility to reward, although small, was slightly stronger on emotional apathy. Regarding behavioral apathy, again we found similar latent variables except for the cognitive functioning whose impact was not statistically significant. Our results highlight the need to take into account various mechanisms involved in the different facets of apathy in older adults without dementia, including not only cognitive factors but also motivational variables and aspects related to physical disability. Clinical implications are discussed.

Negotiating 'positive' aging in the presence of age-related vision loss (ARVL): The shaping and perpetuation of disability.

PubMed

McGrath, Colleen; Laliberte Rudman, Debbie; Polgar, Jan; Spafford, Marlee M; Trentham, Barry

2016-12-01

While previous research has explored the meaning of positive aging discourses from the perspective of older adults, the perspective of older adults aging with a disability has not been studied. In fact the intersection of aging and disability has been largely underexplored in both social gerontology and disability studies. This critical ethnography engaged ten older adults aging with vision loss in narrative interviews, participant observation sessions, and semi-structured in-depth interviews. The overarching objective was to understand those attributes that older adults with age-related vision loss perceive as being the markers of a 'good old age.' The authors critically examined how these markers, and their disabling effects, are situated in ageist and disablist social assumptions regarding what it means to 'age well'. The participants' descriptions of the markers of a 'good old age' were organized into five main themes: 1) maintaining independence while negotiating help; 2) responding positively to vision loss; 3) remaining active while managing risk; 4) managing expectations to be compliant, complicit, and cooperative and; 5) striving to maintain efficiency. The study findings have provided helpful insights into how the ideas and assumptions that operate in relation to disability and impairment in late life are re-produced among older adults with age-related vision loss and how older adults take on an identity that is consistent with socially embedded norms regarding what it means to 'age well'. Copyright © 2016 Elsevier Inc. All rights reserved.

Social determinants of sex differences in disability among older adults: a multi-country decomposition analysis using the World Health Survey.

PubMed

Hosseinpoor, Ahmad Reza; Williams, Jennifer Stewart; Jann, Ben; Kowal, Paul; Officer, Alana; Posarac, Aleksandra; Chatterji, Somnath

2012-09-08

Women represent a growing proportion of older people and experience increasing disability in their longer lives. Using a universally agreed definition of disability based on the International Classification of Functioning, Disability and Health, this paper examines how, apart from age, social and economic factors contribute to disability differences between older men and women. World Health Survey data were analyzed from 57 countries drawn from all income groups defined by the World Bank. The final sample comprises 63638 respondents aged 50 and older (28568 males and 35070 females). Item Response Theory was applied to derive a measure of disability which ensured cross country comparability. Individuals with scores at or above a threshold score were those who experienced significant difficulty in their everyday lives, irrespective of the underlying etiology. The population was then divided into "disabled" vs. "not disabled". We firstly computed disability prevalence for males and females by socio-demographic factors, secondly used multiple logistic regression to estimate the adjusted effects of each social determinant on disability for males and females, and thirdly used a variant of the Blinder-Oaxaca decomposition technique to partition the measured inequality in disability between males and females into the "explained" part that arises because of differences between males and females in terms of age and social and economic characteristics, and an "unexplained" part attributed to the differential effects of these characteristics. Prevalence of disability among women compared with men aged 50+ years was 40.1% vs. 23.8%. Lower levels of education and economic status are associated with disability in women and men. Approximately 45% of the sex inequality in disability can be attributed to differences in the distribution of socio-demographic factors. Approximately 55% of the inequality results from differences in the effects of the determinants. There is an urgent need for data and methodologies that can identify how social, biological and other factors separately contribute to the health decrements facing men and women as they age. This study highlights the need for action to address social structures and institutional practices that impact unfairly on the health of older men and women.

Disability in older adults with acute low back pain: the study Back Complaints in the Elderly - (Brazil).

PubMed

Aguiar, Alessandra Regina Silva Araujo; Ribeiro-Samora, Giane Amorim; Pereira, Leani Souza Maximo; Godinho, Larissa Birro; Assis, Marcella Guimarães

The increase in the older adult and oldest old population in Brazil is growing. This phenomenon may be accompanied by an increase in musculoskeletal symptoms such as low back pain. This condition is usually associated with disability. To verify the association between pain intensity and disability in older adults with acute low back pain and assess whether these variables differ depending on the age group and marital status. This is a cross-sectional study conducted with 532 older adults with acute low back pain episodes. Pain intensity was assessed through the Numeric Pain Scale and disability through the Late Life Function and Disability Instrument, which shows two dimensions: "frequency" and "limitation" in performing activities. The association between pain and disability was analyzed. For the interaction effect between age groups and marital status, we found that the oldest old living with a partner performed activities of the personal domain less often compared to the oldest old living alone. The oldest old group living with a partner had a lower frequency of performing activities, but did not report feeling limited. The association of pain with disability was minimal (rho<0.20) and thus considered irrelevant. Disability in older adults with acute low back pain was influenced by the interaction between age groups and marital status and is not associated with pain intensity. Copyright © 2017 Associação Brasileira de Pesquisa e Pós-Graduação em Fisioterapia. Publicado por Elsevier Editora Ltda. All rights reserved.

Sex hormones and sarcopenia in older persons.

PubMed

Maggio, Marcello; Lauretani, Fulvio; Ceda, Gian Paolo

2013-01-01

Sarcopenia is a geriatric syndrome characterized by progressive and generalized loss of skeletal muscle mass and strength with a risk of adverse outcomes such as physical disability, poor quality of life, and death. Sarcopenia is a multifactorial process involving the decline of androgens, including dehydroepiandrosterone sulphate (DHEAS) and testosterone. The aim of this review is to highlight the effects of DHEAS and testosterone treatment to counteract sarcopenia, especially in older men. DHEAS and, more importantly, testosterone treatment are associated with increased muscle mass, whereas the effects on muscle function and physical performance are less clear. The results of recent randomized placebo controlled trials with DHEAS in older men and women and testosterone in men with mobility limitation are discussed. The novel current and future scenarios to attenuate the detrimental effects and to optimize the efficacy of sex hormone treatment are also addressed. DHEAS and testosterone are important options in the armamentarium of sarcopenia treatment in older men. Future studies are needed to address new approaches by using selective compounds, targeting the correct form and dosage, tailoring the correct patient to treat, and taking into account the multifactorial origin and the new definition of sarcopenia.

Evaluation of frailty in older adults with cardiovascular disease: incorporating physical performance measures.

PubMed

Gary, Rebecca

2012-01-01

Rapid growth in the numbers of older adults with cardiovascular disease (CVD) is raising awareness and concern of the impact that common geriatric syndromes such as frailty may have on clinical outcomes, health-related quality of life, and rising economic burden associated with healthcare. Increasingly, frailty is recognized to be a highly prevalent and important risk factor that is associated with adverse cardiovascular outcomes. A limitation of previous studies in patients with CVD has been the lack of a consistent definition and measures to evaluate frailty. In this review, building upon the work of Fried and colleagues, a definition of frailty is provided that is applicable for evaluating frailty in older adults with CVD. Simple, well-established performance-based measures widely used in comprehensive geriatric assessment are recommended that can be readily implemented by nurses in most practice settings. The limited studies conducted in older adults with CVD have shown physical performance measures to be highly predictive of clinical outcomes. Implications for practice and areas for future research are described for the growing numbers of elderly cardiac patients who are frail frailty and at risk for disability.

Social Resources and Disordered Living Conditions: Evidence from a National Sample of Community-Residing Older Adults

PubMed Central

Cornwell, Erin York

2015-01-01

For older adults aging in the community, living conditions can promote health, enhance coping, and reduce disablement – but they can also create stress and increase risks of illness, accidents, and decline. While socioeconomic disparities in housing likely contribute to inequalities in interior conditions, I argue that living conditions are also shaped by social resources such as co-residential relationships, social network ties, and social support. In this paper, I examine the distribution of a set of risky or stressful physical and ambient living conditions including structural disrepair, clutter, lack of cleanliness, noise, and odor. Using data from the National Social Life, Health, and Aging Project (NSHAP), I find that low income and African American older adults have more disordered living conditions, as do those with poorer physical and mental health. In addition, older adults who have a co-resident partner, more non-residential network ties, and more sources of instrumental support are exposed to fewer risky or harmful living conditions. This suggests that living conditions are an important, though overlooked, mechanism through which household composition, social networks, and social support affect health and well being in later life. PMID:25651314

Tolerating Uncertainty: Perceptions of the Future for Ageing Parent Carers and Their Adult Children with Intellectual Disabilities

ERIC Educational Resources Information Center

Pryce, Laura; Tweed, Alison; Hilton, Amanda; Priest, Helena M.

2017-01-01

Background: Improved life expectancy means that more adults with intellectual disabilities are now living with ageing parents. This study explored older families' perceptions of the future. Methods: Semi-structured interviews were conducted with nine older parents and three adults with intellectual disabilities and analysed to produce an…

Prevalence of Cardiovascular Risk Factors in Older People with Intellectual Disability

ERIC Educational Resources Information Center

de Winter, Channa F.; Magilsen, Karla W.; van Alfen, J. Claudia; Penning, Corine; Evenhuis, Heleen M.

2009-01-01

The prevalence and correlates of cardiovascular risk factors in older adults with intellectual disability was examined. We conducted a cross-sectional study with 50- to 90-year-old clients (N = 470) of three Dutch intellectual disability care providing organizations and found that healthy behavior was low, with 98.9% of the participants having an…

The Potential for Active Mentoring to Support the Transition into Retirement for Older Adults with a Lifelong Disability

ERIC Educational Resources Information Center

Wilson, Nathan J.; Stancliffe, Roger J.; Bigby, Christine; Balandin, Susan; Craig, Diane

2010-01-01

Older people with a lifelong disability, such as intellectual disability, face significant barriers to enjoying "active ageing" as they transition into retirement. Active ageing involves enhancement of quality of life through optimising the health, participation, and security of individuals and populations (World Health Organization [WHO], 2002).…

Trends in disability and program participation among U.S. veterans.

PubMed

Ben-Shalom, Yonatan; Tennant, Jennifer R; Stapleton, David C

2016-07-01

Disability is increasingly part of the lives of veterans and more research is needed to understand its impact on veterans' participation in disability benefit programs. We examine how recent trends in receipt of service-connected disability compensation from the Department of Veterans Affairs (VA) compare to trends in self-reported disability and participation in Social Security Disability Insurance (DI) and Supplemental Security Income (SSI) among veterans. We use 2002-2013 data from the Current Population Survey to describe trends in receipt of VA disability compensation and to compare between trends in self-reported disability and DI/SSI participation for veterans versus nonveterans. The percentage of veterans reporting they receive VA disability compensation increased substantially from 2002 to 2013 and was especially notable among younger (ages 18-39) and older (ages 50-64) veterans. From 2009 to 2013, self-reported disability increased among the younger and older veterans but not among middle-age veterans and nonveterans, and self-reported cognitive disability increased substantially among young veterans. DI/SSI participation among older veterans increased more than for nonveterans over the period examined. Effective policies are needed to incentivize work among young veterans and to help them obtain both the skills they need to succeed in the labor force and the supports (such as psychiatric health services) they need to do so. Older veterans are facing increasing challenges in the labor market, and further research is needed to determine whether these challenges are primarily related to health, a growing skills gap, or poorly-aligned incentives. Copyright © 2016 Elsevier Inc. All rights reserved.

Association of lower extremity range of motion and muscle strength with physical performance of community-dwelling older women.

PubMed

Jung, Hungu; Yamasaki, Masahiro

2016-12-08

Reduced lower extremity range of motion (ROM) and muscle strength are related to functional disability in older adults who cannot perform one or more activities of daily living (ADL) independently. The purpose of this study was to determine which factors of seven lower extremity ROMs and two muscle strengths play dominant roles in the physical performance of community-dwelling older women. Ninety-five community-dwelling older women (mean age ± SD, 70.7 ± 4.7 years; age range, 65-83 years) were enrolled in this study. Seven lower extremity ROMs (hip flexion, hip extension, knee flexion, internal and external hip rotation, ankle dorsiflexion, and ankle plantar flexion) and two muscle strengths (knee extension and flexion) were measured. Physical performance tests, including functional reach test (FRT), 5 m gait test, four square step test (FSST), timed up and go test (TUGT), and five times sit-to-stand test (FTSST) were performed. Stepwise regression models for each of the physical performance tests revealed that hip extension ROM and knee flexion strength were important explanatory variables for FRT, FSST, and FTSST. Furthermore, ankle plantar flexion ROM and knee extension strength were significant explanatory variables for the 5 m gait test and TUGT. However, ankle dorsiflexion ROM was a significant explanatory variable for FRT alone. The amount of variance on stepwise multiple regression for the five physical performance tests ranged from 25 (FSST) to 47% (TUGT). Hip extension, ankle dorsiflexion, and ankle plantar flexion ROMs, as well as knee extension and flexion strengths may play primary roles in the physical performance of community-dwelling older women. Further studies should assess whether specific intervention programs targeting older women may achieve improvements in lower extremity ROM and muscle strength, and thereby play an important role in the prevention of dependence on daily activities and loss of physical function, particularly focusing on hip extension, ankle dorsiflexion, and ankle plantar flexion ROMs as well as knee extension and flexion strength.

Continuing Education for the Elderly in New Zealand: A Survey of the Opportunities. Working Paper #4.

ERIC Educational Resources Information Center

Battersby, David

One in seven New Zealanders is now 60 or older, and by the turn of the century the figure is expected to be one in five. Based on the admittedly incomplete information that is available, the majority of elderly New Zealanders live in their own homes, do not experience excessive financial hardships, and are not physically or mentally disabled.…

The severity and associated factors of participation restriction among community-dwelling frail older people: an application of the International Classification of Functioning, Disability and Health (WHO-ICF).

PubMed

Liu, Justina Yat Wa

2017-01-31

The International Classification of Functioning, Disability, and Health (WHO-ICF) describes participation restriction as one aspect of disability. Participation restriction refers to health problems that can hinder people's involvement in different life events. It is rational to believe that the prevalence of participation restriction increases among a frail population. However, information about the level of participation restriction among older people, particularly the pre-frail or frail, remains scant. The aim of this study was to identify the prevalence and underlying risk factors associated with participation restriction among community-dwelling frail and pre-frail older people. A cross-section of 299 community-dwelling frail older people with a mean age of 79.5 participated in this study. They had to have been identified as being either pre-frail or frail based on the five common characteristics of the frailty phenotype. Their level of participation restriction was assessed based on the Chinese Reintegration to Nursing Living Index (C-RNLI). All other independent variables were identified and systematically linked to different components in the WHO-ICF framework. Among all participants, 207 (69.2%) were identified as encountering participation restrictions in at least one aspect of their life, with a mean C-RNLI score of 68.3 (SD 19.43). A multivariate regression analysis showed that the participants' status of frailty, self-perceived social status, level of exhibited depressive mood, sleep quality, mobility, level of fear of falling, and physical activity levels had a significant association with participation restriction. When all of the variables, regardless of significance, were included, the factors together explained 67.1% of the variance in the participants' participation restriction. Participation restriction was prevalent among community-dwelling frail older people and was associated with factors across different components in the WHO-ICF. This finding supports the view that participation restriction is multifactorial in nature.

Eliciting older people's preferences for exercise programs: a best-worst scaling choice experiment.

PubMed

Franco, Marcia R; Howard, Kirsten; Sherrington, Catherine; Ferreira, Paulo H; Rose, John; Gomes, Juliana L; Ferreira, Manuela L

2015-01-01

What relative value do older people with a previous fall or mobility-related disability attach to different attributes of exercise? Prospective, best-worst scaling study. Two hundred and twenty community-dwelling people, aged 60 years or older, who presented with a previous fall or mobility-related disability. Online or face-to-face questionnaire. Utility values for different exercise attributes and levels. The utility levels were calculated by asking participants to select the attribute that they considered to be the best (ie, they were most likely to want to participate in programs with this attribute) and worst (ie, least likely to want to participate). The attributes included were: exercise type; time spent on exercise per day; frequency; transport type; travel time; out-of-pocket costs; reduction in the chance of falling; and improvement in the ability to undertake tasks inside and outside of home. The attributes of exercise programs with the highest utility values were: home-based exercise and no need to use transport, followed by an improvement of 60% in the ability to do daily tasks at home, no costs, and decreasing the chances of falling to 0%. The attributes with the lowest utility were travel time of 30 minutes or more and out-of-pocket costs of AUD50 per session. The type of exercise, travel time and costs are more highly valued by older people than the health benefits. These findings suggest that physical activity engagement strategies need to go beyond education about health benefits and focus on improving accessibility to exercise programs. Exercise that can be undertaken at or close to home without any cost is most likely to be taken up by older people with past falls and/or mobility-related disability. Copyright © 2014 Australian Physiotherapy Association. Published by Elsevier B.V. All rights reserved.

Mild cognitive impairment, from theory to practical intervention: "Camminando e leggendo… ricordo" (Walking and reading… I remember), an action plan. The Treviso Dementia (TREDEM) Registry.

PubMed

Gallucci, Maurizio; Mazzetto, Manuela; Spagnolo, Pierpaolo; Aricò, Maria; Bergamelli, Cristina; Oddo, Maria Grazia; Gallo, Giovanni; Astolfo, Paola; Di Giorgi, Enrico; Vanacore, Nicola

2016-01-01

Dementia is one of the most disabling health conditions in older people. Increasing attention is paid to the preclinical phase of dementia and to the prevention programs to reduce the number of patients in the future. Aims of the current study are: a) to present Mild Cognitive Impairment (MCI) as a heterogeneous risk factor and to expose the relationship between cognitive impairment and lifestyles such as physical activity, Mediterranean diet, reading and socialization; b) to present a model, called "Camminando e leggendo… ricordo" (CLR), as a practical experience of secondary prevention aimed at MCI older people. The CLR model is composed of a program of physical and reading activities in group to promote healthy lifestyles. Here we present a protocol to evaluate the effectiveness of our intervention model. A multidimensional geriatric assessment will be carried out. A questionnaire for the detection of frailty, disability and for the adherence to the Mediterranean diet will be administered. The Psychological General Well-Being Index (PGWBI) will be used to assess the quality of life. CLR is an intervention model for secondary prevention in MCI subjects. It is the description of a practical proposal aimed at improving lifestyles and reducing the risk of dementia.

Impact of fear of falling and fall history on disability incidence among older adults: Prospective cohort study.

PubMed

Makino, Keitaro; Makizako, Hyuma; Doi, Takehiko; Tsutsumimoto, Kota; Hotta, Ryo; Nakakubo, Sho; Suzuki, Takao; Shimada, Hiroyuki

2018-04-01

Fear of falling (FOF) is a major health problem for older adults, present not just in fallers, but also nonfallers. This study examined the impact of FOF and fall history on disability incidence among community-dwelling older adults from a prospective cohort study. A total of 5104 older adults living in community settings participated in baseline assessment and were followed up for about 4 years (median 52 mo, range 49-55 mo). At baseline, participants were assessed the presence of FOF and their fall history, and divided into 4 groups: Fall (-) FOF (-), Fall (+) FOF (-), Fall (-) FOF (+), and Fall (+) FOF (+). Disability incidence was defined as national long-term care insurance certification for personal support or care. During the follow-up period, 429 participants (9.9%) were newly certified as having a disability and needing personal support for long-term care insurance. Fall (-) FOF (+) group and Fall (+) FOF (+) group showed a significantly higher risk of disability incidence than Fall (-) FOF (-) group even after adjusting for covariates (Fall (-) FOF (+): hazard ratio 1.28, 95% confidence interval, 1.01-1.62, Fall (+) FOF (+): hazard ratio 1.44, 95% confidence interval, 1.05-1.98). Fear of falling could be a simple and useful predictor of disability incidence in community-dwelling older adults. Identifying and decreasing fall risk factors may prevent fall-related injuries, but excessive FOF may be associated with increased risk of disability incidence. Copyright © 2017 John Wiley & Sons, Ltd.

Complex interplay between health and successful aging: role of perceived stress, resilience, and social support.

PubMed

Moore, Raeanne C; Eyler, Lisa T; Mausbach, Brent T; Zlatar, Zvinka Z; Thompson, Wesley K; Peavy, Guerry; Fazeli, Pariya L; Jeste, Dilip V

2015-06-01

Psychological and psychosocial resources, including resilience and social support, have traditionally been studied in the context of the stress paradigm and, more recently, in the context of successful aging. This study used moderated mediation analyses to examine the role of perceived stress in the relationships between physical and mental health functioning and self-rated successful aging (SRSA) and whether differences between people in level of resilience and social support changes the role of perceived stress in these relationships. A cross-sectional study of 1,006 older adults (mean age: 77 years) completed scales addressing SRSA, physical and mental health functioning, perceived stress, resilience, and social support. Results indicated that the strength of relationships between both physical and mental health functioning and SRSA were reduced after accounting for variation in level of perceived stress. The role of perceived stress in the association between mental health functioning and SRSA was found to be stronger among participants with the highest levels of resilience, and the influence of perceived stress on the degree of relationship between physical health functioning and SRSA was stronger among those with greatest social support. These findings suggest that interventions to reduce perceived stress may help break the link between disability and poor well-being in older adults. The findings further suggest that the impact of such interventions might differ depending on psychological resources (i.e., resilience) for mental health disabilities and external resources (i.e., social support) for those with physical health problems. The complex interplay of these factors should be taken into account in clinical settings. Copyright © 2015 American Association for Geriatric Psychiatry. All rights reserved.

Physical Function, Hyperuricemia, and Gout in Older Adults.

PubMed

Burke, Bridget Teevan; Köttgen, Anna; Law, Andrew; Windham, Beverly Gwen; Segev, Dorry; Baer, Alan N; Coresh, Josef; McAdams-DeMarco, Mara A

2015-12-01

Gout prevalence is high in older adults and those affected are at risk of physical disability, yet it is unclear whether they have worse physical function. We studied gout, hyperuricemia, and physical function in 5,819 older adults (age ≥65 years) attending the 2011-2013 Atherosclerosis Risk in Communities Study visit, a prospective US population-based cohort. Differences in lower extremity function (Short Physical Performance Battery [SPPB] and 4-meter walking speed) and upper extremity function (grip strength) by gout status and by hyperuricemia prevalence were estimated in adjusted ordinal logistic regression (SPPB) and linear regression (walking speed and grip strength) models. Lower scores or times signify worse function. The prevalence of poor physical performance (first quartile) by gout and hyperuricemia was estimated using adjusted modified Poisson regression. Ten percent of participants reported a history of gout and 21% had hyperuricemia. There was no difference in grip strength by history of gout (P = 0.77). Participants with gout performed worse on the SPPB test; they had 0.77 times (95% confidence interval [95% CI] 0.65, 0.90, P = 0.001) the prevalence odds of a 1-unit increase in SPPB score and were 1.18 times (95% CI 1.07, 1.32, P = 0.002) more likely to have poor SPPB performance. Participants with a history of gout had slower walking speed (mean difference -0.03; 95% CI -0.05, -0.01, P < 0.001) and were 1.19 times (95% CI 1.06, 1.34, P = 0.003) more likely to have poor walking speed. Similarly, SPPB score and walking speed, but not grip strength, were worse in participants with hyperuricemia. Older adults with gout and hyperuricemia are more likely to have worse lower extremity, but not upper extremity, function. © 2015, American College of Rheumatology.

Prevalence of physical conditions and multimorbidity in a cohort of adults with intellectual disabilities with and without Down syndrome: cross-sectional study

PubMed Central

Kinnear, Deborah; Morrison, Jill; Allan, Linda; Henderson, Angela; Smiley, Elita

2018-01-01

Objectives To investigate the prevalence of multimorbidity in adults with intellectual disabilities with and without Down syndrome. Design Large, population-based cross-sectional study. Setting The geographical area of one Health Board, Scotland. Participants All adults (aged 16+ years) known to general practitioners to have intellectual disabilities and adults receiving services provided or paid by intellectual disabilities health or social work services. 1023/1562 potential participants took part (65.5%); 562 (54.9%) men and 461 (45.1%) women, aged 43.9 years (16–83 years). 186 had Down syndrome and 837 did not. Main outcome measures The prevalence of International Statistical Classification of Diseases, 10th revision, physical health conditions and multimorbidity detected at a comprehensive health assessment. Results The mean number of physical health conditions/participant was 11.04, and 98.7% had multimorbidity. The most prevalent conditions are painful and/or disabling and, in some cases, life threatening. The five most prevalent were visual impairment, obesity, epilepsy, constipation and ataxic/gait disorders. The pattern of multimorbidity differs from that seen in the general population and is spread across the entire adult life course. The extent of multimorbidity in the adults with Down syndrome was similar to that of the adults without Down syndrome, while the prevalence of individual conditions differed. Conclusions This robustly designed study with a large population found an extremely high prevalence of multimorbidity in adults with intellectual disabilities across the entire adult life course. This increases complexity of medical management that secondary healthcare services and medical education are not yet geared towards, as these tend to focus on single conditions. This is in addition to complexity due to limitations in communication and understanding. As the physical conditions within their multimorbidity also differ from that seen in the older general population, urgent attention is needed to develop the care pathways and guidelines that are required to inform and so improve their healthcare. PMID:29431619

Circadian Sleep-Wake Rhythm of Older Adults with Intellectual Disabilities

ERIC Educational Resources Information Center

Maaskant, Marijke; van de Wouw, Ellen; van Wijck, Ruud; Evenhuis, Heleen M.; Echteld, Michael A.

2013-01-01

The circadian sleep-wake rhythm changes with aging, resulting in a more fragmented sleep-wake pattern. In individuals with intellectual disabilities (ID), brain structures regulating the sleep-wake rhythm might be affected. The aims of this study were to compare the sleep-wake rhythm of older adults with ID to that of older adults in the general…

Characterisation of User-Defined Health Status in Older Adults with Intellectual Disabilities

ERIC Educational Resources Information Center

Starr, J. M.; Marsden, L.

2008-01-01

Background: Older adults with Intellectual Disabilities (ID) have an excess disease burden that standard health assessments are designed to detect. Older adults with ID have a broader concept of health with dimensions of well being in addition to absence of disease in line with the World Health Organization's health definition. We sought to…

Learning among Older Adults with Lifelong Intellectual Disabilities

ERIC Educational Resources Information Center

Boulton-Lewis, G. M.; Buys, L.; Tedman-Jones, J.

2008-01-01

This article includes a description of conceptions of aging and engagement with learning for 16 older people (52 to 80 years; mean age 62 years) with a lifelong intellectual disability. The sample also included the care workers and family member/friend. The older people had sufficient verbal skills to participate in the interviews. Half the sample…

Development of a Frailty Index for Older People with Intellectual Disabilities: Results from the HA-ID Study

ERIC Educational Resources Information Center

Schoufour, Josje D.; Mitnitski, Arnold; Rockwood, Kenneth; Evenhuis, Heleen M.; Echteld, Michael A.

2013-01-01

Background: Although there is no strict definition of frailty, it is generally accepted as a state of high vulnerability for adverse health outcomes at older age. Associations between frailty and mortality, dependence, and hospitalization have been shown. We measured the frailty level of older people with intellectual disabilities (ID).…

Practices used in Israel by nurses who care during hospitalization for older patients with dementia or who are bedridden.

PubMed

Iecovich, Esther; Rabin, Barbara

2014-03-01

The study's purpose was to examine (a) bedside nurses' care practices when providing care to patients with dementia or those who are physically disabled and (b) the extent to which these actions vary by type of hospital, type of ward, and nurse's characteristics. The sample included 265 nurses in internal medicine and geriatric wards in 2 general hospitals in Israel. The results showed that the most prevalent practices were giving greater attention to these patients, locating them in a room near the nurses' station and asking family members to stay with the patient or to hire paid carers. Use of restraints was more prevalent in patients with dementia than those who were physically disabled. Use of specific practices significantly varied by type of ward and hospital, suggesting that nurses' care practices are more connected with organizational characteristics than other factors.

Development and evaluation of a structured programme for promoting physical activity among seniors with intellectual disabilities: a study protocol for a cluster randomized trial

PubMed Central

2013-01-01

Background Older people with intellectual disabilities have very low physical activity levels. Well designed, theory-driven and evidence-based health promotion programmes for the target population are lacking. This paper describes the design of a cluster-randomised trial for a systematically developed health promotion programme aimed at improving physical activity and increasing fitness among seniors with intellectual disabilities. Methods and design The Intervention Mapping protocol was used for programme development. After defining the programme’s objectives, the following behavioural techniques were selected to achieve them: Tailoring, Education, Modelling, Mirroring, Feedback, Reinforcement and Grading. With professionals and managers of provider services for people with intellectual disabilities, we translated these strategies into a structured day-activity programme, that consisted of a physical activity and an education programme. The programme will be executed in five day-activity centres in groups of eight to ten seniors during eight months, whereas seniors in five other centres receive care as usual. The physical activity level, as measured in number of steps a day, will be used as primary outcome measurement. Secondary outcome measurements include motor fitness, cardio respiratory fitness, morphological and metabolic fitness, ADL, functional deterioration and depressive symptoms. Differences in the primary and secondary outcome measures between participants and controls will be analysed using generalized estimation equations, correcting for day-activity center as cluster. Discussion This paper provides insight into the development and content of a theory-driven intervention aimed at behavioural change in a population with a low intellectual level. Its evaluation design is described. The programme’s applicability to other populations is discussed. Trial registration Trial number: ISRCTN82341588 PMID:23938154

The availability and affordability of long-term care for disabled older people in China: The issues related to inequalities in social security benefits.

PubMed

Lei, Peng; Feng, Zhixin; Wu, Zhuochun

2016-01-01

China is experiencing increasing pressure from issues relating to an ageing population. The rationality of different eligibility criteria of the benefits within the social security system has been widely challenged; however, to date, no previous study has explored its association with the availability and affordability of long-term care (LTC). This study evaluates the availability and affordability of Long-Term Care (LTC) services for disabled older people (aged 65 and above) in China, with special attention to the differences among groups in receipt of specific social security benefits. The data of availability and affordability of LTC services for disabled older people is from a nationally representative sample Chinese Longitudinal Healthy Longevity Survey (CLHLS). Three different social security benefits were identified and their effects on the long-term care services for disabled older people were explored. The overall proportions of disabled older people who have only limited or no available or affordable LTC services were remarkably high, especially for those who have moderate or no social security benefits. Compared to those who are entitled to generous social security benefits, older people who have no social security benefits are 18.45 times more likely to be unable to afford health care expenses. The findings imply that policy makers in China could focus on the LTC needs for the social security and socioeconomically disadvantaged (who have limited or no social security benefits and in low household income) disabled older people which could reduce the gap between them and those who are entitled to generous social security benefits. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Wheelchair users, access and exclusion in South African higher education.

PubMed

Chiwandire, Desire; Vincent, Louise

2017-01-01

South Africa's Constitution guarantees everyone, including persons with disabilities, the right to education. A variety of laws are in place obliging higher education institutions to provide appropriate physical access to education sites for all. In practice, however, many buildings remain inaccessible to people with physical disabilities. To describe what measures South African universities are taking to make their built environments more accessible to students with diverse types of disabilities, and to assess the adequacy of such measures. We conducted semi-structured in-depth face-to-face interviews with disability unit staff members (DUSMs) based at 10 different public universities in South Africa. Challenges with promoting higher education accessibility for wheelchair users include the preservation and heritage justification for failing to modify older buildings, ad hoc approaches to creating accessible environments and failure to address access to toilets, libraries and transport facilities for wheelchair users. South African universities are still not places where all students are equally able to integrate socially. DUSMs know what ought to be done to make campuses more accessible and welcoming to students with disabilities and should be empowered to play a leading role in sensitising non-disabled members of universities, to create greater awareness of, and appreciation for, the multiple ways in which wheelchair user students continue to be excluded from full participation in university life. South African universities need to adopt a systemic approach to inclusion, which fosters an understanding of inclusion as a fundamental right rather than as a luxury.

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

PubMed Central

Hoddinott, John; Stein, Aryeh D.

2013-01-01

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. PMID:20813446

Disentangling the Disabling Process: Insights From the Precipitating Events Project

PubMed Central

Gill, Thomas M.

2014-01-01

Among older persons, disability in activities of daily living is common and highly morbid. The Precipitating Events Project (PEP Study), an ongoing longitudinal study of 754 initially nondisabled, community-living persons, aged 70 or older, was designed to further elucidate the epidemiology of disability, with the goal of informing the development of effective interventions to maintain and restore independent function. Over the past 16 years, participants have completed comprehensive, home-based assessments at 18-month intervals and have been interviewed monthly to reassess their functional status and ascertain intervening events, other health care utilization, and deaths. Findings from the PEP Study have demonstrated that the disabling process for many older persons is characterized by multiple and possibly interrelated disability episodes, even over relatively short periods of time, and that disability often results when an intervening event is superimposed upon a vulnerable host. Given the frequency of assessments, long duration of follow-up, and recent linkage to Medicare data, the PEP Study will continue to be an outstanding platform for disability research in older persons. In addition, as the number of decedents accrues, the PEP Study will increasingly become a valuable resource for investigating symptoms, function, and health care utilization at the end of life. PMID:25035454

Impact of Multimorbidity on Disability and Quality of Life in the Spanish Older Population

PubMed Central

Garin, Noe; Olaya, Beatriz; Moneta, Maria Victoria; Miret, Marta; Lobo, Antonio; Ayuso-Mateos, Jose Luis; Haro, Josep Maria

2014-01-01

Background Population aging is closely related to high prevalence of chronic conditions in developed countries. In this context, health care policies aim to increase life span cost-effectively while maintaining quality of life and functional ability. There is still, however, a need for further understanding of how chronic conditions affect these health aspects. The aim of this paper is to assess the individual and combined impact of chronic physical and mental conditions on quality of life and disability in Spain, and secondly to show gender trends. Methods Cross-sectional data were collected from the COURAGE study. A total of 3,625 participants over 50 years old from Spain were included. Crude and adjusted multiple linear regressions were conducted to detect associations between individual chronic conditions and disability, and between chronic conditions and quality of life. Separate models were used to assess the influence of the number of diseases on the same variables. Additional analogous regressions were performed for males and females. Results All chronic conditions except hypertension were statistically associated with poor results in quality of life and disability. Depression, anxiety and stroke were found to have the greatest impact on outcomes. The number of chronic conditions was associated with substantially lower quality of life [β for 4+ diseases: −18.10 (−20.95,−15.25)] and greater disability [β for 4+ diseases: 27.64 (24.99,30.29]. In general, women suffered from higher rates of multimorbidity and poorer results in quality of life and disability. Conclusions Chronic conditions impact greatly on quality of life and disability in the older Spanish population, especially when co-occurring diseases are added. Multimorbidity considerations should be a priority in the development of future health policies focused on quality of life and disability. Further studies would benefit from an expanded selection of diseases. Policies should also deal with gender idiosyncrasy in certain cases. PMID:25375890

Accelerometer-Derived Pattern of Sedentary and Physical Activity Time in Persons with Mobility Disability: National Health and Nutrition Examination Survey 2003 to 2006.

PubMed

Manns, Patricia; Ezeugwu, Victor; Armijo-Olivo, Susan; Vallance, Jeff; Healy, Genevieve N

2015-07-01

To describe objectively determined sedentary and activity outcomes (volume and pattern) and their associations with cardiometabolic risk biomarkers in individuals with and without mobility disability. Cross-sectional. Population based. Community-dwelling older adults (≥60) living in the United States who were participants in the 2003 to 2004 or 2005 to 2006 National Health and Nutrition Examination Survey. Participants were classified as with or without mobility disability according to responses to self-reported questions about ability to walk, climb stairs, and/or use of ambulatory aids. Accelerometer-derived sedentary and activity variables for volume (time in sedentary (<100 counts per minute (cpm)), very light- (100-759 cpm), light- (760-1,951 cpm), and moderate- to vigorous- (≥1,952 cpm) intensity activity and pattern (number of breaks from sedentary time, duration of sedentary bouts, duration of activity bouts). Survey-weighted regression models, adjusted for age, sex, ethnicity, education, and smoking, were used to examine the associations between pattern of activity and cardiometabolic health risk factors (blood pressure, waist circumference, high-density lipoprotein cholesterol). Of the 2,017 participants, 547 were classified as having a mobility disability. Participants with mobility disability had more sedentary time and less active time than those without. Sedentary bouts were longer and active bouts shorter in those with disability. The total number of sedentary breaks (transitions from sedentary to nonsedentary) differed between groups after adjustment for total sedentary time. Fewer breaks, longer sedentary bouts, and shorter activity bouts were associated with higher average waist circumference regardless of disability status. This study provides rationale for the development and testing of interventions to change the pattern of activity (e.g., include more breaks and longer activity bout durations) in older adults with mobility disability. © 2015, Copyright the Authors Journal compilation © 2015, The American Geriatrics Society.

Aging in neighborhoods differing in walkability and income: associations with physical activity and obesity in older adults.

PubMed

King, Abby C; Sallis, James F; Frank, Lawrence D; Saelens, Brian E; Cain, Kelli; Conway, Terry L; Chapman, James E; Ahn, David K; Kerr, Jacqueline

2011-11-01

While there is a growing literature on the relations between neighborhood design and health factors such as physical activity and obesity, less focus has been placed on older adults, who may be particularly vulnerable to environmental influences. This study evaluates the relations among objectively measured neighborhood design, mobility impairment, and physical activity and body weight in two U.S. regional samples of community dwelling older adults living in neighborhoods differing in walkability and income levels. An observational design involving two time points six months apart was employed between 2005 and 2008. U.S. Census block groups in Seattle-King County, Washington and Baltimore, Maryland-Washington DC regions were selected via geographic information systems to maximize variability in walkability and income. Participants were 719 adults ages 66 years and older who were able to complete surveys in English and walk at least 10 feet continuously. Measurements included reported walking or bicycling for errands (i.e., transport activity) and other outdoor aerobic activities measured via the CHAMPS questionnaire: accelerometry-based moderate-to-vigorous physical activity; reported body mass index; and reported lower extremity mobility impairment measured via the Late-Life Function and Disability Instrument. Across regions, time, and neighborhood income, older adults living in more walkable neighborhoods had more transport activity and moderate-to- vigorous physical activity and lower body mass index relative to those living in less walkable neighborhoods. The most mobility-impaired adults living in more walkable neighborhoods reported transport activity levels that were similar to less mobility-impaired adults living in less walkable neighborhoods. The results add to the small literature aimed at understanding how neighborhood design may influence physical activity and related aspects of health linked with day-to-day function and independence as people age. Copyright © 2011 Elsevier Ltd. All rights reserved.

Cardiovascular Risk Factors (Diabetes, Hypertension, Hypercholesterolemia and Metabolic Syndrome) in Older People with Intellectual Disability: Results of the HA-ID Study

ERIC Educational Resources Information Center

de Winter, C. F.; Bastiaanse, L. P.; Hilgenkamp, T. I. M.; Evenhuis, H. M.; Echteld, M. A.

2012-01-01

Hypertension, diabetes, hypercholesterolemia and the metabolic syndrome are important risk factors for cardiovascular disease (CVD). In older people with intellectual disability (ID), CVD is a substantial morbidity risk. The aims of the present study, which was part of the Healthy Ageing in Intellectual Disability (HA-ID) study, were (1) to…

The Importance of Hearing: A Review of the Literature on Hearing Loss for Older People with Learning Disabilities

ERIC Educational Resources Information Center

Bent, Sarah; McShea, Lynzee; Brennan, Siobhan

2015-01-01

Background: Hearing loss has a significant impact on living well and on communication in all adults, with the numbers affected increasing with age, and adults with learning disabilities being at particular risk. Methods: A review of the literature on hearing loss in older adults with learning disabilities was completed. Results: A significant…

Perceived Effort of Walking: Relationship With Gait, Physical Function and Activity, Fear of Falling, and Confidence in Walking in Older Adults With Mobility Limitations

PubMed Central

Julius, Leslie M.; Brach, Jennifer S.; Wert, David M.

2012-01-01

Background Although clinicians have a number of measures to use to describe walking performance, few, if any, of the measures capture a person's perceived effort in walking. Perceived effort of walking may be a factor in what a person does versus what he or she is able to do. Objective The objective of this study was to examine the relationship of perceived effort of walking with gait, function, activity, fear of falling, and confidence in walking in older adults with mobility limitations. Design This investigation was a cross-sectional, descriptive, relational study. Methods The study took place at a clinical research training center. The participants were 50 older adults (mean age=76.8 years, SD=5.5) with mobility limitations. The measurements used were the Rating of Perceived Exertion (RPE) for walking; gait speed; the Modified Gait Abnormality Rating Scale; energy cost of walking; Late Life Function and Disability Instrument (LLFDI) for total, basic, and advanced lower-extremity function and for disability limitations; activity and restriction subscales of the Survey of Activities and Fear of Falling in the Elderly (SAFFE); activity counts; SAFFE fear subscale; and Gait Efficacy Scale (GES). The relationship of the RPE of walking with gait, function, activity, fear, and confidence was determined by using Spearman rank order coefficients and an analysis of variance (adjusted for age and sex) for mean differences between groups defined by no exertion during walking and some exertion during walking. Results The RPE was related to confidence in walking (GES, R=−.326, P=.021) and activity (activity counts, R=.295, P=.044). The RPE groups (no exertion versus some exertion) differed in LLFDI scores for total (57.9 versus 53.2), basic (68.6 versus 61.4), and advanced (49.1 versus 42.6) lower-extremity function; LLFDI scores for disability limitations (74.9 versus 67.5); SAFFE fear subscale scores (0.346 versus 0.643); and GES scores (80.1 versus 67.8) (all P<.05). Limitations The range of RPE scores for the participants studied was narrow. Thus, the real correlations between RPE and gait, physical function, and psychological aspects of walking may be greater than the relationships reported. Conclusions The perceived effort of walking was associated with physical activity and confidence in walking. Reducing the perceived effort of walking may be an important target of interventions to slow the decline in function of older adults with mobility limitations. PMID:22723433

Perceived effort of walking: relationship with gait, physical function and activity, fear of falling, and confidence in walking in older adults with mobility limitations.

PubMed

Julius, Leslie M; Brach, Jennifer S; Wert, David M; VanSwearingen, Jessie M

2012-10-01

Although clinicians have a number of measures to use to describe walking performance, few, if any, of the measures capture a person's perceived effort in walking. Perceived effort of walking may be a factor in what a person does versus what he or she is able to do. The objective of this study was to examine the relationship of perceived effort of walking with gait, function, activity, fear of falling, and confidence in walking in older adults with mobility limitations. Design This investigation was a cross-sectional, descriptive, relational study. The study took place at a clinical research training center. The participants were 50 older adults (mean age=76.8 years, SD=5.5) with mobility limitations. The measurements used were the Rating of Perceived Exertion (RPE) for walking; gait speed; the Modified Gait Abnormality Rating Scale; energy cost of walking; Late Life Function and Disability Instrument (LLFDI) for total, basic, and advanced lower-extremity function and for disability limitations; activity and restriction subscales of the Survey of Activities and Fear of Falling in the Elderly (SAFFE); activity counts; SAFFE fear subscale; and Gait Efficacy Scale (GES). The relationship of the RPE of walking with gait, function, activity, fear, and confidence was determined by using Spearman rank order coefficients and an analysis of variance (adjusted for age and sex) for mean differences between groups defined by no exertion during walking and some exertion during walking. The RPE was related to confidence in walking (GES, R=-.326, P=.021) and activity (activity counts, R=.295, P=.044). The RPE groups (no exertion versus some exertion) differed in LLFDI scores for total (57.9 versus 53.2), basic (68.6 versus 61.4), and advanced (49.1 versus 42.6) lower-extremity function; LLFDI scores for disability limitations (74.9 versus 67.5); SAFFE fear subscale scores (0.346 versus 0.643); and GES scores (80.1 versus 67.8) (all P<.05). Limitations The range of RPE scores for the participants studied was narrow. Thus, the real correlations between RPE and gait, physical function, and psychological aspects of walking may be greater than the relationships reported. The perceived effort of walking was associated with physical activity and confidence in walking. Reducing the perceived effort of walking may be an important target of interventions to slow the decline in function of older adults with mobility limitations.

Functional Impact of a Minor Thoracic Injury: An Investigation of Age, Delayed Hemothorax, and Rib Fracture Effects.

PubMed

Émond, Marcel; Sirois, Marie-Josée; Guimont, Chantal; Chauny, Jean-Marc; Daoust, Raoul; Bergeron, Éric; Vanier, Laurent; Camden, Stephanie; Le Sage, Natalie

2015-12-01

To investigate whether minor thoracic injuries (MTIs) relate to subsequent functional limitations. Approximately 75% of patients with an MTI are discharged after an emergency department (ED) visit, whereas significant functional limitations can occur in the weeks that follow. A 19 months' prospective cohort study with a 90-day follow-up was conducted at 4 university-affiliated EDs. Patients 16 years and older with an MTI were assessed at initial ED visit, 7, 14, 30, and 90 days after injury. Functional outcome was measured using the SF-12 scale. General linear model were used to assess outcome. A total of 482 patients were included, of whom 127 (26.3%) were 65 or older. Overall, 147 patients (30.5%) presented with at least 1 rib fracture and 59 subjects (12.2%) with delayed hemothorax. At 90 days, 22.8% of patients still had severe or moderate disabilities on global physical health score. Patients with solely delayed hemothorax and no rib fracture had the lowest global physical health score (46.4 vs 61.1, P < 0.01, effect size =  -2.60) than patients with simple MTI. Generally, functional limitations also increase with increments of number of rib fracture detected on radiograph. Outcomes were not different among patients 65 years or older when compared to their younger counterparts. In this prospective study of MTIs, severe to moderate disabilities were present in nearly 1 patient out of 5 at 90 days. The presence of delayed hemothorax and the number of rib fracture were associated with increased functional limitations after a MTI.

Housing conditions and limitations in physical function among older adults.

PubMed

García-Esquinas, Esther; Pérez-Hernández, Bibiana; Guallar-Castillón, Pilar; Banegas, José R; Ayuso-Mateos, José Luis; Rodríguez-Artalejo, Fernando

2016-10-01

Housing conditions are an important social determinant of health. However, to the best of our knowledge, no previous study has systematically assessed the association between housing conditions and physical function limitations in older adults; moreover, whether this association is independent of the socioeconomic status achieved earlier in life is still uncertain. Cross-sectional analysis conducted among 2012 non-institutionalised individuals aged ≥60 years, who participated in the Seniors-ENRICA cohort. Participants reported the following poor housing conditions: living in a walk-up building, lacking heating, or feeling cold frequently. We assessed lower extremity performance with the Short Physical Performance Battery (SPPB), mobility or agility limitations with standardised questions, frailty according to the Fried criteria, and disability in instrumental activities of daily living (IADL) with the Lawton and Brody questionnaire. In analyses adjusting for demographic, behavioural and comorbidity variables, when compared with those living in homes without poor housing conditions, those with ≥2 poor conditions showed worse scores in the SPPB (β -1.06; 95% CI -1.46 to -0.65) and a higher frequency of agility limitation (OR 1.62; 95% CI 1.00 to 2.61) and frailty (OR 8.78; 95% CI 3.00 to 25.60). These associations held after adjustment for educational and occupational levels. Living in a walk-up building was associated with a higher frequency of frailty, while lacking heating was linked to lower scores in the 3 SPPB tests, as well as with an increased frequency of frailty and 4 of its components (exhaustion, slow walking speed, low physical activity and weakness). Feeling cold was linked to increased exhaustion. No association was found between housing conditions and IADL disability. Poor housing conditions, particularly living in a walk-up building and lacking heating, are independently associated with limitations in physical function in older adults. This entails serious inequalities in functional status, which should be firmly addressed. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

Psychometric properties of the Rosenberg Self-esteem Scale among people with arthritis.

PubMed

Sheasby, J E; Barlow, J H; Cullen, L A; Wright, C C

2000-06-01

After 30 years of use the factor structure of the Rosenberg Self-esteem Scale remains the subject of debate. Most studies have focused on school-aged or undergraduate students. There are few psychometric data for older people or for those with disabilities. This study compared the factor structures of the Rosenberg Self-esteem Scale among 117 adults with arthritis and 185 undergraduate students. A two-factor solution provided the best fit for both samples, although the item content of the factors differed slightly. Further investigation is required to assess whether the difference is due to age or the presence of physical disability. Nonetheless, the scale discriminated well between students and adults with arthritis.

Self-Reported Needs among Older Persons with Intellectual Disabilities in an Irish Community-Based Service

ERIC Educational Resources Information Center

McCausland, Darragh; Guerin, Suzanne; Tyrrell, Janette; Donohoe, Clare; O'Donoghue, Isabelle; Dodd, Philip

2010-01-01

Current research indicates that older persons with intellectual disabilities (ID) are a growing population with very specific needs. There are few existing studies that identify and characterise these needs. This study aimed to assess the health and social care needs of a group of older persons with ID in a community-based service in Ireland. The…

The preliminary effect of whole-body vibration intervention on improving the skeletal muscle mass index, physical fitness, and quality of life among older people with sarcopenia.

PubMed

Chang, Shu-Fang; Lin, Pei-Chen; Yang, Rong-Sen; Yang, Rea-Jeng

2018-01-17

Studies have shown that sarcopenia easily leads to difficulty moving, disability, and poor quality of life. However, researches on the use of whole-body vibration for older adults with sarcopenia living in institutions have been lacking. Therefore, the main objective of the present study was to investigate the effect of whole-body vibration intervention on improving the skeletal muscle mass index, physical fitness, and quality of life of older adults with sarcopenia living in institutions. This study adopted a quasi-experimental, single-group, pretest-posttest design. The whole-body vibration intervention was performed over a 3-month period, in which the older adults trained 3 times per week; each training lasted 60 s with a break of 30 s for 10 repetitions. The older adults' skeletal muscle mass index, physical fitness and quality of life before and after the intervention of the whole-body vibration was collected. Concerning the statistical methods adopted, nonparametric method-based tests were employed. According to the results of analysis, after the intervention of the 12-week whole-body vibration, the skeletal muscle mass index (z = - 3.621, p = 0.000), physical fitness on standing on one foot (z = - 2.447, p = 0.014), shoulder-arm flexibility (z = - 3.159, p = 0.002), 8-ft up and go test (z = - 2.692, p = 0.009), hand grip strength (z = - 3.388, p = 0.009), and five repeated sit-to-stand tests (z = - 2.936, p = 0.003), all improved significantly. Furthermore, concerning the quality of life of the older adults in the pretest and posttest, the improvements were statistically significant (z = - 2.533, p = 0.011). The study results showed the effect of whole-body vibration intervention on improving the skeletal muscle mass index, physical fitness, and quality of life of sarcopenic older people living in institutions and could serve as a crucial reference to health care professionals.

Effectiveness of a home-based cognitive behavioral program to manage concerns about falls in community-dwelling, frail older people: results of a randomized controlled trial.

PubMed

Dorresteijn, Tanja A C; Zijlstra, G A Rixt; Ambergen, Antonius W; Delbaere, Kim; Vlaeyen, Johan W S; Kempen, Gertrudis I J M

2016-01-06

Concerns about falls are common among older people. These concerns, also referred to as fear of falling, can have serious physical and psychosocial consequences, such as functional decline, increased risk of falls, activity restriction, and lower social participation. Although cognitive behavioral group programs to reduce concerns about falls are available, no home-based approaches for older people with health problems, who may not be able to attend such group programs are available yet. The aim of this study was to assess the effectiveness of a home-based cognitive behavioral program on concerns about falls, in frail, older people living in the community. In a randomized controlled trial in the Netherlands, 389 people aged 70 years and older, in fair or poor perceived health, who reported at least some concerns about falls and related activity avoidance were allocated to a control (n = 195) or intervention group (n = 194). The intervention was a home-based, cognitive behavioral program consisting of seven sessions including three home visits and four telephone contacts. The program aims to instill adaptive and realistic views about fall risks via cognitive restructuring and to increase activity and safe behavior using goal setting and action planning and was facilitated by community nurses. Control group participants received usual care. Outcomes at 5 and 12 months follow-up were concerns about falls, activity avoidance due to concerns about falls, disability and falls. At 12 months, the intervention group showed significant lower levels of concerns about falls compared to the control group. Furthermore, significant reductions in activity avoidance, disability and indoor falls were identified in the intervention group compared with the control group. Effect sizes were small to medium. No significant difference in total number of falls was noted between the groups. The home-based, cognitive behavioral program significantly reduces concerns about falls, related activity avoidance, disability and indoor falls in community-living, frail older people. The program may prolong independent living and provides an alternative for those people who are not able or willing to attend group programs. ClinicalTrials.gov, NCT01358032. Registered 17 May 2011.

Disability relating to basic and instrumental activities of daily living: a zopulation-based study with elderly in Pelotas, Rio Grande do Sul, Brazil, 2014.

PubMed

Farías-Antúnez, Simone; Lima, Natália Peixoto; Bierhals, Isabel Oliveira; Gomes, Ana Paula; Vieira, Luna Strieder; Tomasi, Elaine

2018-06-11

to estimate the prevalence of disability related to basic and instrumental activities of daily living and its association with socioeconomic, demographic, behavioral and health characteristics in the elderly. population-based cross-sectional study in Pelotas, Brazil, in 2014; Katz and Lawton scales were used to assess the outcomes using Poisson regression. the study included 1.451 elderly individuals; the prevalence of disability for basic and instrumental activities was 36.1% and 34.0%, respectively, and 18.1% in both; higher prevalence of functional disability were observed individuals ≥80 years (PR=3.01; 95%CI 2.17;4.18), not working (PR=2.02; 95%CI 1.13;3.60) and those with multiple morbidities (PR=3.28; 95%CI 1.38;7.79); and lower in individuals with ≥12 years of schooling (PR=0.40; 95%CI 0.24;0.66), and that were physically active (PR=0.42; 95%CI 0.21;0.82). functional disability was associated to individuals older than 80, with less schooling years and affected by multiple morbidities.

Examining the Disability Model From the International Classification of Functioning, Disability, and Health Using a Large Data Set of Community-Dwelling Malaysian Older Adults

PubMed Central

Loke, Seng Cheong; Lim, Wee Shiong; Someya, Yoshiko; Hamid, Tengku A.; Nudin, Siti S. H.

2015-01-01

Objective: This study examines the International Classification of Functioning, Disability, and Health model (ICF) using a data set of 2,563 community-dwelling elderly with disease-independent measures of mobility, physical activity, and social networking, to represent ICF constructs. Method: The relationship between chronic disease and disability (independent and dependent variables) was examined using logistic regression. To demonstrate variability in activity performance with functional impairment, graphing was used. The relationship between functional impairment, activity performance, and social participation was examined graphically and using ANOVA. The impact of cognitive deficits was quantified through stratifying by dementia. Results: Disability is strongly related to chronic disease (Wald 25.5, p < .001), functional impairment with activity performance (F = 34.2, p < .001), and social participation (F= 43.6, p < .001). With good function, there is considerable variability in activity performance (inter-quartile range [IQR] = 2.00), but diminishes with high impairment (IQR = 0.00) especially with cognitive deficits. Discussion: Environment modification benefits those with moderate functional impairment, but not with higher grades of functional loss. PMID:26472747

Prognostic Effect of Changes in Physical Function Over Prior Year on Subsequent Mortality and Long-Term Nursing Home Admission.

PubMed

Gill, Thomas M; Han, Ling; Gahbauer, Evelyne A; Leo-Summers, Linda; Allore, Heather G

2018-05-02

To evaluate the prognostic effect of changes in physical function at different intervals over the prior year on subsequent outcomes after accounting for present function. Prospective longitudinal study. Greater New Haven, Connecticut, from March 1998 to January 2006. Community-living persons aged 71 and older who completed an 18-month comprehensive assessment (N=658). Disability in 13 activities of daily living, instrumental activities of daily living, and mobility activities was assessed at the 18-month comprehensive assessment and at 12, 6, and 3 months before 18 months. Time to death and long-term nursing home admission, defined as 3 months and longer, were ascertained for up to 5 years after 18 months. In the bivariate models, disability at 18 months and change in disability between 18 months and each of the 3 prior time-points (12, 6, 3 months) were significantly associated with time to death. The risk of death, for example, increased by 24% for each 1-point increase in 18-month disability score (on a scale from 0 to 13) and by 22% for each 1-point change in disability score between 18 months and prior 12 months (on a scale from -13 to 13). In a set of multivariable models with and without covariates, the associations were maintained for 18-month disability but not for change in disability between 18 months and each of the 3 prior time-points. The results were comparable for time to long-term nursing home admission except that 2 of the associations were not statistically significant. When evaluating risk of adverse outcomes, such as death and long-term nursing home admission, an assessment of change in physical function at different intervals over the prior year, although a strong bivariate predictor, did not provide useful prognostic information beyond that available from current level of function. © 2018, Copyright the Authors Journal compilation © 2018, The American Geriatrics Society.

What are the major drivers of prevalent disability burden in young Australians?

PubMed

Mathews, Rebecca R S; Hall, Wayne D; Vos, Theo; Patton, George C; Degenhardt, Louisa

2011-03-07

To examine age and sex differences in the leading causes of prevalent disability in young Australians. We analysed data from the 2003 Australian Burden of Disease and Injury Study, which estimated the prevalent disability burden attributable to 170 diseases and injuries, for younger adolescents (10-14 years), older adolescents (15-19 years) and young adults (20-24 years). The broad categories of disease and injury that are the main contributors to prevalent disability and the 10 leading disease and injury causes of prevalent disability, according to sex and age group. Total prevalent disability rates are lowest in younger adolescents and highest in young adults. Mental disorders are the largest "contributor" to disability in young Australians, and anxiety and depressive disorders are the leading single cause. In young males, autism and attention deficit hyperactivity disorder cause similar levels of disability as do anxiety and depression. In young females, eating disorders are the second leading cause of mental disorder disability. Alcohol use disorders and schizophrenia make important contributions to disability in young adult males. Asthma is the most prominent cause of physical disability in all three age groups. There are substantial changes in both the pattern and level of disability burden across the three age groups that we studied. The increase in total prevalent disability that occurs from early adolescence to young adulthood should focus attention on the delivery of accessible and youth friendly health care as well as the effectiveness of transitions from child health services to adult health services.

Depression, disability and somatic diseases among elderly.

PubMed

Verhaak, P F M; Dekker, J H; de Waal, M W M; van Marwijk, H W J; Comijs, H C

2014-01-01

Depression among older adults is associated with both disability and somatic disease. We aimed to further understand this complicated relationship and to study the possible modifying effect of increasing age. Cross sectional survey. Outpatient and inpatient clinics of regional facilities for mental health care and primary care. Elderly people, 60 years and older, 378 persons meeting DSM-IV criteria for a depressive disorder and 132 non-depressed comparisons. Depression diagnoses were assessed with the CIDI version 2.1. Disability was assessed with the WHO Disability Assessment Schedule (WHODAS). Social-demographic information and somatic diseases were assessed by self-report measurements. Disability, in general and on all its subscales, was strongly related to depression. Presence of somatic disease did not contribute independently to variance in depression. The relationship was stronger for people of 60-69 years old than for those older than 70 years. Important aspects of disability that contributed to depression were disability in participation, self-care and social activities. Results are based on cross sectional data. No inferences about causal relationships can be drawn. Disability, especially disability regarding participation, self-care, or social activities is strongly related to late-life depression. Somatic diseases in itself are less of a risk for depression, except that somatic diseases are related to disability. Copyright © 2014 Elsevier B.V. All rights reserved.

Inflammatory markers and physical performance in middle-aged and older people in Indonesia.

PubMed

Sujarwoto, Sujarwoto; Tampubolon, Gindo

2015-07-01

although recent studies have suggested that inflammation may play an important role in the process of ageing and in the development of disabilities, knowledge about the role of inflammation in physical performance decline among middle-aged and older people in the context of developing countries is limited. to examine the association between C-reactive protein (CRP) and the activities of daily living (ADL) among middle-aged (40-54 years old) and older (55-96 years old) people in Indonesia. data from a population-based sample, the Indonesia Family Life Survey (IFLS) 2007, were analysed. The data consist of 1,702 respondents of middle age (40-54 years old) and 2,017 older respondents who had completed information on ADL and CRP. CRP concentrations in Dried Blood Spot (DBS) specimens were measured, using the validated enzyme-linked immunosorbent assay (ELISA) method. Thirteen items of ADL were used to measure physical performance. A three-level linear model was applied to take advantage of the nested structure of data at the individual level within the household and community levels. high levels of CRP were significantly associated with lower ADL for middle-aged and older people (P < 0.001). The model was adjusted for co-morbid conditions, health risk factors, medications, depressive symptoms and sociodemographic characteristics. the significant association between the high level of CRP and lower ADL among older people in Indonesia is in line with earlier studies in the context of developed countries. This study provides an extension in which the significant association was also found in middle-aged people (40-54 years old). © The Author 2015. Published by Oxford University Press on behalf of the British Geriatrics Society. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

A Public Health Approach to Addressing Arthritis in Older Adults: The Most Common Cause of Disability

PubMed Central

Helmick, Charles G.; Brady, Teresa J.

2012-01-01

Arthritis is highly prevalent and is the leading cause of disability among older adults in the United States owing to the aging of the population and increases in the prevalence of risk factors (e.g., obesity). Arthritis will play a large role in the health-related quality of life, functional independence, and disability of older adults in the upcoming decades. We have emphasized the role of the public health system in reducing the impact of this large and growing public health problem, and we have presented priority public health actions. PMID:22390506

Diabetes, peripheral neuropathy, and lower-extremity function.

PubMed

Chiles, Nancy S; Phillips, Caroline L; Volpato, Stefano; Bandinelli, Stefania; Ferrucci, Luigi; Guralnik, Jack M; Patel, Kushang V

2014-01-01

Diabetes among older adults causes many complications, including decreased lower-extremity function and physical disability. Diabetes can cause peripheral nerve dysfunction, which might be one pathway through which diabetes leads to decreased physical function. The study aims were to determine the following: (1) whether diabetes and impaired fasting glucose are associated with objective measures of physical function in older adults, (2) which peripheral nerve function (PNF) tests are associated with diabetes, and (3) whether PNF mediates the diabetes-physical function relationship. This study included 983 participants, age 65 years and older from the InCHIANTI study. Diabetes was diagnosed by clinical guidelines. Physical performance was assessed using the Short Physical Performance Battery (SPPB), scored from 0 to 12 (higher values, better physical function) and usual walking speed (m/s). PNF was assessed via standard surface electroneurographic study of right peroneal nerve conduction velocity, vibration and touch sensitivity. Clinical cutpoints of PNF tests were used to create a neuropathy score from 0 to 5 (higher values, greater neuropathy). Multiple linear regression models were used to test associations. One hundred twenty-six (12.8%) participants had diabetes. Adjusting for age, sex, education, and other confounders, diabetic participants had decreased SPPB (β=-0.99; p<0.01), decreased walking speed (β=-0.1m/s; p<0.01), decreased nerve conduction velocity (β=-1.7m/s; p<0.01), and increased neuropathy (β=0.25; p<0.01) compared to non-diabetic participants. Adjusting for nerve conduction velocity and neuropathy score decreased the effect of diabetes on SPPB by 20%, suggesting partial mediation through decreased PNF. © 2014.

Diabetes, Peripheral Neuropathy, and Lower Extremity Function

PubMed Central

Chiles, Nancy S.; Phillips, Caroline L.; Volpato, Stefano; Bandinelli, Stefania; Ferrucci, Luigi; Guralnik, Jack M.; Patel, Kushang V.

2014-01-01

Objective Diabetes among older adults causes many complications, including decreased lower extremity function and physical disability. Diabetes can cause peripheral nerve dysfunction, which might be one pathway through which diabetes leads to decreased physical function. The study aims were to determine: (1) whether diabetes and impaired fasting glucose are associated with objective measures of physical function in older adults, (2) which peripheral nerve function (PNF) tests are associated with diabetes, and (3) whether PNF mediates the diabetes-physical function relationship. Research Design and Methods This study included 983 participants, age 65 and older from the InCHIANTI Study. Diabetes was diagnosed by clinical guidelines. Physical performance was assessed using the Short Physical Performance Battery (SPPB), scored from 0-12 (higher values, better physical function) and usual walking speed (m/s). PNF was assessed via standard surface electroneurographic study of right peroneal nerve conduction velocity, vibration and touch sensitivity. Clinical cut-points of PNF tests were used to create a neuropathy score from 0-5 (higher values, greater neuropathy). Multiple linear regression models were used to test associations. Results and Conclusion 12.8% (n=126) of participants had diabetes. Adjusting for age, sex, education, and other confounders, diabetic participants had decreased SPPB (β= −0.99; p< 0.01), decreased walking speed (β= −0.1m/s; p< 0.01), decreased nerve conduction velocity (β= −1.7m/s; p< 0.01), and increased neuropathy (β= 0.25; p< 0.01) compared to non-diabetic participants. Adjusting for nerve conduction velocity and neuropathy score decreased the effect of diabetes on SPPB by 20%, suggesting partial mediation through decreased PNF. PMID:24120281

Frail and pre-frail phenotype is associated with pain in older HIV-infected patients.

PubMed

Petit, Nathalie; Enel, Patricia; Ravaux, Isabelle; Darque, Albert; Baumstarck, Karine; Bregigeon, Sylvie; Retornaz, Frédérique

2018-02-01

As HIV-infected patients grow older, some accumulate multiple health problems earlier than the noninfected ones in particular frailty phenotypes. Patients with frailty phenotype are at higher risk of adverse outcomes (worsening mobility, disability, hospitalization, and death within three years).Our study aimed to evaluate prevalence of frailty in elderly HIV-infected patients and to assess whether frailty is associated with HIV and geriatric factors, comorbidities, and precariousness in a French cohort of older HIV infected.This 18-month cross-sectional multicenter study carried in 2013 to 2014 had involved 502 HIV-infected patients aged 50 years and older, cared in 18 HIV-dedicated hospital medical units, located in South of France.Prevalence of frailty was 6.3% and of pre-frailty 57.2%. Low physical activity and weakness were the main frailty markers, respectively 49.4% and 19.9%. In univariate models, precariousness, duration of HIV antiretroviral treatment >15 years, 2 comorbidities or more, risk of depression, activities of daily living disability, and presence of pain were significantly associated with frail and pre-frail phenotype. Multivariate logistic regression analyses showed that only pain was significantly different between frail and pre frail phenotype versus non frail phenotype (odds ratio = 1.2; P = .002).Our study is the first showing a significant association between pain and frailty phenotype in older patients infected by HIV. As frailty phenotype could be potentially reversible, a better understanding of the underlying determinant is warranted. Further studies are needed to confirm these first findings.

Home-Delivered Meals and Nutrition Status Among Older Adults.

PubMed

Sahyoun, Nadine R; Vaudin, Anna

2014-08-01

The trend among older adults in the United States is to "age in place" instead of opting for institutionalization. To maintain older adults with chronic conditions in their homes and to improve health after hospitalization, comprehensive social, health, and nutrition services are essential. Quality of dietary intake is crucial and yet often underestimated. Calorie needs decrease with age while nutrient needs remain the same, even increasing for some nutrients. This poses difficulties for individuals with functional disabilities who are unable to shop and cook due to physical or mental limitations or on a limited budget. The Older American Act home-delivered meal (HDM) program offers at least 1 healthy meal per day, 5 or more days per week, and targets individuals homebound due to illness, disability, or social isolation and those with greatest economic or social need. This review summarizes the available literature on the relationship between HDM and health outcomes. The HDM program is difficult to evaluate because of the multifactorial effect on health status. However, national surveys and smaller studies show that it is well targeted, efficient, and well liked; provides quality food to needy individuals; and helps individuals remain living independently. Studies show that HDMs improve dietary intake, with greater health benefits when more meals reach the neediest individuals. HDMs also decrease institutionalization of older adults and resulting healthcare expenditures. However, funding has not kept up with increased demand for this program. More studies with improved designs may provide more information supporting the program's impact on nutrition status and decreased health expenditures. © 2014 American Society for Parenteral and Enteral Nutrition.

The Environmental Production of Disability for Seniors with Age-Related Vision Loss.

PubMed

McGrath, Colleen; Laliberte Rudman, Debbie; Spafford, Marlee; Trentham, Barry; Polgar, Jan

2017-03-01

To date, attention to the environmental production of disability among older adults with age-related vision loss (ARVL) has been limited. This critical ethnographic study aimed to reveal the ways in which environmental barriers produced and perpetuated disability for 10 older adults with ARVL. A modified version of Carspecken's five-stage approach for critical ethnography was adopted with three methods of data collection used, including a narrative interview, a participant observation session, and a semi-structured, in-depth interview. Findings revealed how disability is shaped for older adults with ARVL when they encounter environmental features that are embedded within an ageist and disablist society. These findings are illustrated via presenting analysis of three commonly discussed activities: shopping, eating, and community mobility. Our discussion suggests that addressing the environmental production of disability requires inclusive social policy, advocacy, and a focus on education in order to develop and sustain age and low-vision-friendly environments.

The Impact of Visual Disability on the Quality of Life of Older Persons in Rural Northeast Thailand

ERIC Educational Resources Information Center

La Grow, Steven; Sudnongbua, Supaporn; Boddy, Julie

2011-01-01

A high rate of self-reported visual disability was found among a sample of persons aged 60 and older in the course of a study that assessed the impact of feelings of abandonment among older persons in a remote rural area in northeast Thailand (Sudnongbua, La Grow, & Boddy, 2010). This study assessed the impact of self-reported visual…

Causes of Mortality in Older People with Intellectual Disability: Results from the HA-ID Study

ERIC Educational Resources Information Center

Oppewal, Alyt; Schoufour, Josje D.; van der Maarl, Hanne J. K.; Evenhuis, Heleen M.; Hilgenkamp, Thessa I. M.; Festen, Dederieke A.

2018-01-01

We aim to provide insight into the cause-specific mortality of older adults with intellectual disability (ID), with and without Down syndrome (DS), and compare this to the general population. Immediate and primary cause of death were collected through medical files of 1,050 older adults with ID, 5 years after the start of the Healthy Ageing and…

Expected values for pedometer-determined physical activity in older populations

PubMed Central

2009-01-01

The purpose of this review is to update expected values for pedometer-determined physical activity in free-living healthy older populations. A search of the literature published since 2001 began with a keyword (pedometer, "step counter," "step activity monitor" or "accelerometer AND steps/day") search of PubMed, Cumulative Index to Nursing & Allied Health Literature (CINAHL), SportDiscus, and PsychInfo. An iterative process was then undertaken to abstract and verify studies of pedometer-determined physical activity (captured in terms of steps taken; distance only was not accepted) in free-living adult populations described as ≥ 50 years of age (studies that included samples which spanned this threshold were not included unless they provided at least some appropriately age-stratified data) and not specifically recruited based on any chronic disease or disability. We identified 28 studies representing at least 1,343 males and 3,098 females ranging in age from 50–94 years. Eighteen (or 64%) of the studies clearly identified using a Yamax pedometer model. Monitoring frames ranged from 3 days to 1 year; the modal length of time was 7 days (17 studies, or 61%). Mean pedometer-determined physical activity ranged from 2,015 steps/day to 8,938 steps/day. In those studies reporting such data, consistent patterns emerged: males generally took more steps/day than similarly aged females, steps/day decreased across study-specific age groupings, and BMI-defined normal weight individuals took more steps/day than overweight/obese older adults. The range of 2,000–9,000 steps/day likely reflects the true variability of physical activity behaviors in older populations. More explicit patterns, for example sex- and age-specific relationships, remain to be informed by future research endeavors. PMID:19706192

The Relationship of Reduced Peripheral Nerve Function and Diabetes With Physical Performance in Older White and Black Adults

PubMed Central

Strotmeyer, Elsa S.; de Rekeneire, Nathalie; Schwartz, Ann V.; Faulkner, Kimberly A.; Resnick, Helaine E.; Goodpaster, Bret H.; Shorr, Ronald I.; Vinik, Aaron I.; Harris, Tamara B.; Newman, Anne B.

2008-01-01

OBJECTIVE—Poor peripheral nerve function is prevalent in diabetes and older populations, and it has great potential to contribute to poor physical performance. RESEARCH DESIGN AND METHODS—Cross-sectional analyses were done for the Health, Aging, and Body Composition (Health ABC) Study participants (n = 2,364; 48% men; 38% black; aged 73–82 years). Sensory and motor peripheral nerve function in legs/feet was assessed by 10- and 1.4-g monofilament perception, vibration detection, and peroneal motor nerve conduction amplitude and velocity. The Health ABC lower-extremity performance battery was a supplemented version of the Established Populations for the Epidemiologic Studies of the Elderly battery (chair stands, standing balance, and 6-m walk), adding increased stand duration, single foot stand, and narrow walk. RESULTS—Diabetic participants had fewer chair stands (0.34 vs. 0.36 stands/s), shorter standing balance time (0.69 vs. 0.75 ratio), slower usual walking speed (1.11 vs. 1.14 m/s), slower narrow walking speed (0.80 vs. 0.90 m/s), and lower performance battery score (6.43 vs. 6.93) (all P < 0.05). Peripheral nerve function was associated with each physical performance measure independently. After addition of peripheral nerve function in fully adjusted models, diabetes remained significantly related to a lower performance battery score and slower narrow walking speed but not to chair stands, standing balance, or usual walking speed. CONCLUSIONS—Poor peripheral nerve function accounts for a portion of worse physical performance in diabetes and may be directly associated with physical performance in older diabetic and nondiabetic adults. The impact of peripheral nerve function on incident disability should be evaluated in older adults. PMID:18535192

Association of Sex Hormones With Sexual Function, Vitality, and Physical Function of Symptomatic Older Men With Low Testosterone Levels at Baseline in the Testosterone Trials

PubMed Central

Cunningham, Glenn R.; Stephens-Shields, Alisa J.; Rosen, Raymond C.; Wang, Christina; Ellenberg, Susan S.; Matsumoto, Alvin M.; Bhasin, Shalender; Molitch, Mark E.; Farrar, John T.; Cella, David; Barrett-Connor, Elizabeth; Cauley, Jane A.; Cifelli, Denise; Crandall, Jill P.; Ensrud, Kristine E.; Fluharty, Laura; Gill, Thomas M.; Lewis, Cora E.; Pahor, Marco; Resnick, Susan M.; Storer, Thomas W.; Swerdloff, Ronald S.; Anton, Stephen; Basaria, Shehzad; Diem, Susan; Tabatabaie, Vafa; Hou, Xiaoling

2015-01-01

Context: The prevalence of sexual dysfunction, low vitality, and poor physical function increases with aging, as does the prevalence of low total and free testosterone (TT and FT) levels. However, the relationship between sex hormones and age-related alterations in older men is not clear. Objective: To test the hypotheses that baseline serum TT, FT, estradiol (E2), and sex hormone-binding globulin (SHBG) levels are independently associated with sexual function, vitality, and physical function in older symptomatic men with low testosterone levels participating in the Testosterone Trials (TTrials). Design: Cross-sectional study of baseline measures in the TTrials. Setting: The study was conducted at 12 sites in the United States. Participants: The 788 TTrials participants were ≥ 65 years and had evidence of sexual dysfunction, diminished vitality, and/or mobility disability, and an average of two TT < 275 ng/dL. Interventions: None. Main Outcome Measures: Question 4 of Psychosocial Daily Questionnaire (PDQ-Q4), the FACIT-Fatigue Scale, and the 6-minute walk test. Results: Baseline serum TT and FT, but not E2 or SHBG levels had small, but statistically significant associations with validated measures of sexual desire, erectile function, and sexual activity. None of these hormones was significantly associated within or across trials with FACIT-Fatigue, PHQ-9 Depression or Physical Function-10 scores, or gait speed. Conclusions: FT and TT levels were consistently, independently, and positively associated, albeit to a small degree, with measures of sexual desire, erectile function, and sexual activity, but not with measures of vitality or physical function in symptomatic older men with low T who qualified for the TTrials. PMID:25548978

Association of sex hormones with sexual function, vitality, and physical function of symptomatic older men with low testosterone levels at baseline in the testosterone trials.

PubMed

Cunningham, Glenn R; Stephens-Shields, Alisa J; Rosen, Raymond C; Wang, Christina; Ellenberg, Susan S; Matsumoto, Alvin M; Bhasin, Shalender; Molitch, Mark E; Farrar, John T; Cella, David; Barrett-Connor, Elizabeth; Cauley, Jane A; Cifelli, Denise; Crandall, Jill P; Ensrud, Kristine E; Fluharty, Laura; Gill, Thomas M; Lewis, Cora E; Pahor, Marco; Resnick, Susan M; Storer, Thomas W; Swerdloff, Ronald S; Anton, Stephen; Basaria, Shehzad; Diem, Susan; Tabatabaie, Vafa; Hou, Xiaoling; Snyder, Peter J

2015-03-01

The prevalence of sexual dysfunction, low vitality, and poor physical function increases with aging, as does the prevalence of low total and free testosterone (TT and FT) levels. However, the relationship between sex hormones and age-related alterations in older men is not clear. To test the hypotheses that baseline serum TT, FT, estradiol (E2), and sex hormone-binding globulin (SHBG) levels are independently associated with sexual function, vitality, and physical function in older symptomatic men with low testosterone levels participating in the Testosterone Trials (TTrials). Cross-sectional study of baseline measures in the TTrials. The study was conducted at 12 sites in the United States. The 788 TTrials participants were ≥ 65 years and had evidence of sexual dysfunction, diminished vitality, and/or mobility disability, and an average of two TT < 275 ng/dL. None. Question 4 of Psychosocial Daily Questionnaire (PDQ-Q4), the FACIT-Fatigue Scale, and the 6-minute walk test. Baseline serum TT and FT, but not E2 or SHBG levels had small, but statistically significant associations with validated measures of sexual desire, erectile function, and sexual activity. None of these hormones was significantly associated within or across trials with FACIT-Fatigue, PHQ-9 Depression or Physical Function-10 scores, or gait speed. FT and TT levels were consistently, independently, and positively associated, albeit to a small degree, with measures of sexual desire, erectile function, and sexual activity, but not with measures of vitality or physical function in symptomatic older men with low T who qualified for the TTrials.

Occupational physical demand and risk of hip fracture in older women.

PubMed

Palumbo, Aimee J; Michael, Yvonne L; Burstyn, Igor; Lee, Brian K; Wallace, Robert

2015-08-01

Hip fractures are leading causes of disability, morbidity and mortality among older women. Since physical activity helps maintain physical functioning and bone mineral density, occupational physical demand may influence fracture risk. This study investigates the association of occupational physical demand with hip fracture incidence among women. The Women's Health Initiative Observational Study is a multiethnic cohort of 93,676 postmenopausal women, 50-79 years of age at enrolment, enrolled from 1994 to 1998 at 40 geographically diverse clinical centres throughout the USA. Outcomes including hip fractures were assessed annually and up to 3 jobs held since age 18 years were reported by each woman. Occupational physical demand levels were assigned for each job through linkage of occupational titles with Standard Occupational Codes and the Occupational Information Network. Average, cumulative and peak physical demand scores both before and after menopause and throughout women's work life were estimated. Women were followed through 2010 for an average of 11.5 years; 1834 hip fractures occurred during this time. We did not observe an overall association of occupational physical demand with subsequent risk of hip fracture after adjusting for age, race/ethnicity, birth region and education. Previous research on occupations and hip fracture risk in women is inconclusive. This study was able to take critical risk periods into account and control for confounding factors in a large cohort of older women to show that overall occupational physical demand neither increases nor decreases risk of hip fracture later in life. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Middle-aged and mobility-limited: prevalence of disability and symptom attributions in a national survey.

PubMed

Gardener, Elizabeth A; Huppert, Felicia A; Guralnik, Jack M; Melzer, David

2006-10-01

Lower limb mobility disabilities are well understood in older people, but the causes in middle age have attracted little attention. To estimate the prevalence of mobility disabilities among noninstitutionalized adults in England and to compare the disabling symptoms reported by middle-aged and older people. Cross-sectional data from the 2002 English Longitudinal Study of Ageing (ELSA). Mobility disability was identified by level of reported difficulty walking a quarter mile. Eleven thousand two hundred sixteen respondents aged 50 years and older living in private households in 2002. The prevalence of difficulty walking a quarter mile increases sharply with age, but even in the middle-aged (50 to 64 years age-group) 18% (95% confidence interval [CI]: 16% to 19%) of men and 19% (95% CI: 17% to 20%) of women reported some degree of difficulty. Of the 16 main symptoms reported as causing mobility disability in middle age, 2 dominated: pain in the leg or the foot (43%; 95% CI: 40% to 46%) and shortness of breath/dyspnea (21%; 95% CI: 18% to 23%). Fatigue or tiredness, and stability problems were cited by only 5% and 6%, respectively. These proportions were slightly different from those in the 65 to 79-year age group: 40%, 23%, 6%, and 8%, respectively. Mobility (walking) disabilities in the middle-aged are relatively common. The symptoms reported as causes in this age group differ little from those reported by older groups, and are dominated by lower limb pain and shortness of breath. More clinical attention paid to disabling symptoms may lead to disability reductions in later life.

[Shoulder disability questionnaires: a systematic review].

PubMed

Fayad, F; Mace, Y; Lefevre-Colau, M M

2005-07-01

To identify all available shoulder disability questionnaires designed to measure physical functioning and to examine those with satisfactory clinimetric quality. 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. 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. Numerous shoulder outcome measure instruments are available. There is no "gold standard" for assessing shoulder function outcome in the general population.

Attitudes of old people towards old age homes in Hong Kong.

PubMed

Kwok, T; Luk, J K; Lau, E; Woo, J

1998-01-01

The attitudes of older people towards old age homes (OAH) in Hong Kong and the factors which influenced their attitudes were investigated. A total of 197 non-institutionalised older subjects were interviewed with a standard questionnaire. A quarter of them admitted to having thought about going into an OAH, though most had never visited one. Half of them would consider an OAH if they lived alone with no family support, while only a few would consider it if they were living with family. If they became disabled and required help from family, a third would consider an OAH. If family support was not available, two-thirds would consider an OAH, while a few opted for social services. If advised to go into an OAH by doctors or family, about a half of the subjects would comply. On stepwise logistic regression, independent predictors of the desire for an OAH were agreeing with OAH placement if it was affordable and if one was living alone with visits from family, admitting to be happy in an OAH, and previous experience with an OAH. We concluded that older people in Hong Kong were not in favour of an OAH unless there were physical disabilities and lack of family support. They were, however, vulnerable to external pressures.

Choosing between staying at home or moving: A systematic review of factors influencing housing decisions among frail older adults.

PubMed

Roy, Noémie; Dubé, Roxanne; Després, Carole; Freitas, Adriana; Légaré, France

2018-01-01

Most older adults wish to stay at home during their late life years, but physical disabilities and cognitive impairment may force them to face a housing decision. However, they lack relevant information to make informed value-based housing decisions. Consequently, we sought to identify the sets of factors influencing the housing decision-making of older adults. We performed a systematic literature search for studies evaluating any factors influencing the housing decisions among older adults over 65 years old without cognitive disabilities. Primary research from any study design reported after 1990 in a peer-reviewed journal, a book chapter or an evaluated doctoral thesis and written in English, French or Spanish were eligible. We extracted the main study characteristics, the participant characteristics and any factors reported as associated with the housing decision. We conducted a qualitative thematic analysis from the perspective of the meaning and experience of home. The search resulted in 660 titles (after duplicate removal) from which 86 studies were kept for analysis. One study out of five reported exclusively on frail older adults (n = 17) and two on adults over 75 years old. Overall, a total of 88 factors were identified, of which 71 seem to have an influence on the housing decision-making of older adults, although the influence of 19 of them remains uncertain due to discrepancies between research methodologies. No conclusion was made regarding 12 additional factors due to lack of evidence. A wealth of factors were found to influence housing decisions among older adults. However, very few of them have been studied extensively. Our results highlight the importance of interdisciplinary teamwork to study the influence of a broader range of factors as a whole. These results will help older adults make the best possible housing decision based on their unique situation and values.

Choosing between staying at home or moving: A systematic review of factors influencing housing decisions among frail older adults

PubMed Central

Roy, Noémie; Dubé, Roxanne; Després, Carole; Freitas, Adriana

2018-01-01

Background Most older adults wish to stay at home during their late life years, but physical disabilities and cognitive impairment may force them to face a housing decision. However, they lack relevant information to make informed value-based housing decisions. Consequently, we sought to identify the sets of factors influencing the housing decision-making of older adults. Methods We performed a systematic literature search for studies evaluating any factors influencing the housing decisions among older adults over 65 years old without cognitive disabilities. Primary research from any study design reported after 1990 in a peer-reviewed journal, a book chapter or an evaluated doctoral thesis and written in English, French or Spanish were eligible. We extracted the main study characteristics, the participant characteristics and any factors reported as associated with the housing decision. We conducted a qualitative thematic analysis from the perspective of the meaning and experience of home. Results The search resulted in 660 titles (after duplicate removal) from which 86 studies were kept for analysis. One study out of five reported exclusively on frail older adults (n = 17) and two on adults over 75 years old. Overall, a total of 88 factors were identified, of which 71 seem to have an influence on the housing decision-making of older adults, although the influence of 19 of them remains uncertain due to discrepancies between research methodologies. No conclusion was made regarding 12 additional factors due to lack of evidence. Conclusion A wealth of factors were found to influence housing decisions among older adults. However, very few of them have been studied extensively. Our results highlight the importance of interdisciplinary teamwork to study the influence of a broader range of factors as a whole. These results will help older adults make the best possible housing decision based on their unique situation and values. PMID:29293511

Physical Activity Predicts Higher Physical Function in Older Adults: The Osteoarthritis Initiative.

PubMed

Batsis, John A; Germain, Cassandra M; Vásquez, Elizabeth; Zbehlik, Alicia J; Bartels, Stephen J

2016-01-01

Physical activity reduces mobility impairments in elders. We examined the association of physical activity on risk of subjective and objective physical function in adults with and at risk for osteoarthritis (OA). Adults aged ≥ 60 years from the longitudinal Osteoarthritis Initiative, a prospective observational study of knee OA, were classified by sex-specific quartiles of Physical Activity Score for the Elderly scores. Using linear mixed models, we assessed 6-year data on self-reported health, gait speed, Late-Life Function and Disability Index (LLFDI) and chair stand. Of 2252 subjects, mean age ranged from 66 to 70 years. Within each quartile, physical component (PCS) of the Short Form-12 and gait speed decreased from baseline to follow-up in both sexes (all P < .001), yet the overall changes across PASE quartiles between these 2 time points were no different (P = .40 and .69, males and females, respectively). Decline in PCS occurred in the younger age group, but rates of change between quartiles over time were no different in any outcomes in either sex. LLFDI scores declined in the 70+ age group. Adjusting for knee extensor strength reduced the strength of association. Higher physical activity is associated with maintained physical function and is mediated by muscle strength, highlighting the importance of encouraging physical activity in older adults with and at risk for OA.

The Relationship Between Balance Measured With a Modified Bathroom Scale and Falls and Disability in Older Adults: A 6-Month Follow-Up Study

PubMed Central

2015-01-01

Background There are indications that older adults who suffer from poor balance have an increased risk for adverse health outcomes, such as falls and disability. Monitoring the development of balance over time enables early detection of balance decline, which can identify older adults who could benefit from interventions aimed at prevention of these adverse outcomes. An innovative and easy-to-use device that can be used by older adults for home-based monitoring of balance is a modified bathroom scale. Objective The objective of this paper is to study the relationship between balance scores obtained with a modified bathroom scale and falls and disability in a sample of older adults. Methods For this 6-month follow-up study, participants were recruited via physiotherapists working in a nursing home, geriatricians, exercise classes, and at an event about health for older adults. Inclusion criteria were being aged 65 years or older, being able to stand on a bathroom scale independently, and able to provide informed consent. A total of 41 nursing home patients and 139 community-dwelling older adults stepped onto the modified bathroom scale three consecutive times at baseline to measure their balance. Their mean balance scores on a scale from 0 to 16 were calculated—higher scores indicated better balance. Questionnaires were used to study falls and disability at baseline and after 6 months of follow-up. The cross-sectional relationship between balance and falls and disability at baseline was studied using t tests and Spearman rank correlations. Univariate and multivariate logistic regression analyses were conducted to study the relationship between balance measured at baseline and falls and disability development after 6 months of follow-up. Results A total of 128 participants with complete datasets—25.8% (33/128) male—and a mean age of 75.33 years (SD 6.26) were included in the analyses of this study. Balance scores of participants who reported at baseline that they had fallen at least once in the past 6 months were lower compared to nonfallers—8.9 and 11.2, respectively (P<.001). The correlation between mean balance score and disability sum-score at baseline was -.51 (P<.001). No significant associations were found between balance at baseline and falls after 6 months of follow-up. Baseline balance scores were significantly associated with the development of disability after 6 months of follow-up in the univariate analysis—odds ratio (OR) 0.86 (95% CI 0.76-0.98)—but not in the multivariate analysis when correcting for age, gender, baseline disability, and falls at follow-up—OR 0.94 (95% CI 0.79-1.11). Conclusions There is a cross-sectional relationship between balance measured by a modified bathroom scale and falls and disability in older adults. Despite this cross-sectional relationship, longitudinal data showed that balance scores have no predictive value for falls and might only have limited predictive value for disability development after 6 months of follow-up. PMID:26018423

Low Hemoglobin Concentrations Are Associated With Sarcopenia, Physical Performance, and Disability in Older Australian Men in Cross-sectional and Longitudinal Analysis: The Concord Health and Ageing in Men Project.

PubMed

Hirani, Vasant; Naganathan, Vasi; Blyth, Fiona; Le Couteur, David G; Seibel, Markus J; Waite, Louise M; Handelsman, David J; Hsu, Ben; Cumming, Robert G

2016-12-01

The objective of this study is to examine associations between Hb levels and sarcopenia, low muscle strength, functional measures, and activities of daily living (ADL) and instrumental ADL (IADL) disabilities in older Australian men. Men aged 70 years and older (2005-2007) from the Concord Health and Ageing in Men Project were assessed at baseline (n = 1,705), 2 years (n = 1,367), and 5 years (n = 958). The main outcome measurements were walking speed, muscle strength, ADL and IADL disabilities, and sarcopenia using the Foundation for the National Institutes of Health criteria (low appendicular lean mass adjusted for body mass index < 0.789 and poor grip strength < 26kg). Analysis was performed using Hb levels as a continuous measure, unadjusted and adjusted by age, income, body mass index, measures of health, estimated glomerular function, inflammatory markers, and medication use. Receiver operating characteristic curve analysis was performed to determine a threshold of Hb for each outcome. In cross-sectional and longitudinal analysis, for every 1g/dL increase in Hb, there was a significant reduction in risk of sarcopenia, slow walking speed, poor grip strength, inability to perform chair stands, and ADL and IADL disabilities in unadjusted, age-adjusted, and multivariate-adjusted analysis. The highest value of the Youden Index for Hb was 14.2g/dL for sarcopenia and grip strength, 14.5g/dL for walking speed, and 14.4g/dL for all other outcomes. Declines in Hb levels over time are associated with poor functional outcomes. The risks and benefits of interventions to increase Hb among older men warrant further investigation to differentiate whether this is an active contributor to age-related debility or a passive biomarker of it. © The Author 2016. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Older adults' perceptions of ageing and their health and functioning: a systematic review of observational studies.

PubMed

Warmoth, Krystal; Tarrant, Mark; Abraham, Charles; Lang, Iain A

2016-07-01

Many older people perceive ageing negatively, describing it in terms of poor or declining health and functioning. These perceptions may be related to older adults' health. The aim of this review was to synthesise existing research on the relationship between older adults' perceptions of ageing and their health and functioning. A systematic search was conducted of five electronic databases (ASSIA, CINAHL, IBSS, MEDLINE and PsycINFO). Citations within identified reports were also searched. Observational studies were included if they included perceptions of ageing and health-related measures involving participants aged 60 years and older. Study selection, data extraction and quality appraisal were conducted using predefined criteria. Twenty-eight reports met the criteria for inclusion. Older adults' perceptions of ageing were assessed with a variety of measures. Perceptions were related to health and functioning across seven health domains: memory and cognitive performance, physical and physiological performance, medical conditions and outcomes, disability, care-seeking, self-rated health, quality of life and death. How ageing is perceived by older adults is related to their health and functioning in multiple domains. However, higher quality and longitudinal studies are needed to further investigate this relationship.

The Virtual Short Physical Performance Battery

PubMed Central

Wrights, Abbie P.; Haakonssen, Eric H.; Dobrosielski, Meredith A.; Chmelo, Elizabeth A.; Barnard, Ryan T.; Pecorella, Anthony; Ip, Edward H.; Rejeski, W. Jack

2015-01-01

Background. Performance-based and self-report instruments of physical function are frequently used and provide complementary information. Identifying older adults with a mismatch between actual and perceived function has utility in clinical settings and in the design of interventions. Using novel, video-animated technology, the objective of this study was to develop a self-report measure that parallels the domains of objective physical function assessed by the Short Physical Performance Battery (SPPB)—the virtual SPPB (vSPPB). Methods. The SPPB, vSPPB, the self-report Pepper Assessment Tool for Disability, the Mobility Assessment Tool-short form, and a 400-m walk test were administered to 110 older adults (mean age = 80.6±5.2 years). One-week test–retest reliability of the vSPPB was examined in 30 participants. Results. The total SPPB (mean [±SD] = 7.7±2.8) and vSPPB (7.7±3.2) scores were virtually identical, yet moderately correlated (r = .601, p < .05). The component scores of the SPPB and vSPPB were also moderately correlated (all p values <.01). The vSPPB (intraclass correlation = .963, p < .05) was reliable; however, individuals with the lowest function overestimated their overall lower extremity function while participants of all functional levels overestimated their ability on chair stands, but accurately perceived their usual gait speed. Conclusion. In spite of the similarity between the SPPB and vSPPB, the moderate strength of the association between the two suggests that they offer unique perspectives on an older adult’s physical function. PMID:25829520

The impact of depression and diabetes mellitus on older workers' functioning.

PubMed

Stynen, D; Jansen, N W H; Kant, I J

2015-12-01

Using the International Classification of Functioning, Disability and Health as a framework, this study investigates the impact of depression and diabetes mellitus on older workers' functioning (problems with concentration, physical functioning, need for recovery and work and social participation restrictions). The study focuses on how these chronic conditions, in their interaction with the work context, affect older workers' functioning, which may be an important precursor of early retirement. Older workers (≥ 45years) with depression (n=127) or diabetes mellitus (n=107) enrolled in the prospective Maastricht Cohort Study (MCS) were followed between October 2008 and October 2012. Linear, logistic and Cox regression analyses were performed to investigate the effect of these health conditions on workers' functioning compared to a reference group of older workers without a chronic condition (n=1612). The interaction with participants' working conditions (psychological job demands, decision latitude and strenuous work) was also analysed. Compared to the reference group, depression and diabetes mellitus were (over time) positively related with need for recovery caseness and restrictions in social participation but not with restrictions in work participation. Depression was positively related with concentration problems and need for recovery, whereas diabetes mellitus was negatively related with physical functioning. Finally, the relationship between functioning and depression and diabetes mellitus depends on working conditions. Older workers with depression or diabetes mellitus are vulnerable to losses in specific domains of functioning. The impact on functioning varies across working conditions, providing insight for disease-tailored preventive measures. Copyright © 2015 Elsevier Inc. All rights reserved.

Patterns of Multimorbidity in an Older Population of Persons with an Intellectual Disability: Results from the Intellectual Disability Supplement to the Irish Longitudinal Study on Aging (IDS-TILDA)

ERIC Educational Resources Information Center

McCarron, Mary; Swinburne, Janet; Burke, Eilish; McGlinchey, Eimear; Carroll, Rachael; McCallion, Philip

2013-01-01

Multimorbidity (2 or more chronic conditions) is being widely studied in older populations and this study explores both the relevance of emerging conceptualizations and the extent to which multimorbidity is a feature of aging in persons with an intellectual disability. Methods: Data was generated from wave one of the intellectual disability…