Adiposity Markers as Predictors of 11-Year Decline in Maximal Walking Speed in Late Midlife

Background: Obesity is linked to poorer physical functioning in older adults, but impact of excess adiposity on loss of functional capacity in late midlife is unclear. This study examined associations between adiposity markers and 11-year change in maximal walking speed, a sensitive indicator of physical functioning, among adults aged 55 to 69 years. Method: Maximal walking speed over 6.1 m was assessed in 2000 and 2011 among Finnish men (n = 409) and women (n = 498) from the prospective Health 2000 Survey. Body mass index (BMI) and waist circumference were assessed in 2000. Generalized estimating equation models estimated changes in maximal walking speed by BMI and waist circumference, stratified by sex. Results: BMI greater than 30 kg/m(2) was associated with accelerated decline in maximal walking speed particularly in women. Associations with waist circumference were nonsignificant. Conclusion: Late midlife obesity may speed up the decline in functional capacity as measured by maximal walking speed, especially in women

Associations of social engagement, and loneliness with the progression and reversal of frailty: longitudinal investigations of two prospective cohorts from the UK and the USA.

BACKGROUND: Social connections may impact the dynamic trajectory of frailty. METHODS: Using data from the British Regional Heart Study (BRHS) in the UK (n = 715), and the US Health, Aging and Body Composition (Health ABC) Study (n = 1256), we conducted multinominal regression analyses to examine the association of baseline and change in social engagement and loneliness with progression to pre-frailty and frailty, as well as their association with reversal to pre-frailty and robust status among older adults. RESULTS: A higher level of social engagement at baseline (BRHS: relative risk ratio (RRR) 0.69 [95%CI 0.55-0.85]; Health ABC: 0.56 [0.45-0.70]), as well as increase in social engagement (BRHS: 0.73, [0.59-0.90]; Health ABC: 0.51 [0.41-0.63]), were associated with a lower risk of developing frailty. In BRHS, a higher level of loneliness at baseline (1.42 [1.10-1.83]) and an increase in loneliness (1.50 [1.18-1.90]), increased the risk of developing frailty. For reversal of frailty, higher social engagement at baseline (Health ABC: 1.63 [1.08-2.47]) and an increase in social engagement (BRHS:1.74[1.18-2.50]; Health ABC: 1.79[1.17-.274]) were beneficial. CONCLUSION: Social connections maybe potentially important and modifiable factors in both preventing and reversing progression of frailty in older adults

Construct validation of a non-exercise measure of cardiorespiratory fitness in older adults

<p>Abstract</p> <p>Background</p> <p>Cardiorespiratory fitness (CRF) is associated with a decreased risk of all-cause mortality but is rarely assessed in medical settings due to burdens of time, cost, risk, and resources. The purpose of this study was to test the construct validity of a regression equation developed by Jurca and colleagues (2005) to estimate CRF without exercise testing in community dwelling older adults.</p> <p>Methods</p> <p>Participants (n = 172) aged 60 to 80 years with no contraindications to submaximal or maximal exercise testing completed a maximal graded exercise test (GXT) and the submaximal Rockport 1-mile walk test on separate occasions. Data included in the regression equation (age, sex, body mass index, resting heart rate, and physical activity) were obtained via measurement or self-report. Participants also reported presence of cardiovascular conditions.</p> <p>Results</p> <p>The multiple R for the regression equation was .72, <it>p < .001 </it>and CRF estimated from this equation was significantly correlated with the MET value from the GXT (<it>r </it>= 0.66) and with CRF estimated from submaximal field testing (<it>r </it>= 0.67). All three CRF indices were significantly and inversely associated with reporting more cardiovascular conditions.</p> <p>Conclusions</p> <p>This research provides preliminary evidence that a non-exercise estimate of CRF is at least as valid as field test estimates of CRF and represents a low-risk, low-cost, and expedient method for estimating fitness in older adults.</p

The feasibility of using pedometers and brief advice to increase activity in sedentary older women:a pilot study

Background: People over the age of 70 carry the greatest burden of chronic disease, disability and health care use. Participation in physical activity is crucial for health, and walking accounts for much of the physical activity undertaken by sedentary individuals. Pedometers are a useful motivational tool to encourage increased walking and they are cheap and easy to use. The aim of this pilot study was to evaluate the feasibility of the use of pedometers plus a theory-based intervention to assist sedentary older women to accumulate increasing amounts of physical activity, mainly through walking. Methods: Female participants over the age of 70 were recruited from primary care and randomised to receive either pedometer plus a theory-based intervention or a theory-based intervention alone. The theory-based intervention consisted of motivational techniques, goal-setting, barrier identification and self-monitoring with pedometers and daily diaries. The pedometer group were further randomised to one of three target groups: a 10%, 15% or 20% monthly increase in step count to assess the achievability and acceptability of a range of targets. The primary outcome was change in daily activity levels measured by accelerometry. Secondary outcome measures were lower limb function, health related quality of life, anxiety and depression. Results: 54 participants were recruited into the study, with an average age of 76. There were 9 drop outs, 45 completing the study. All participants in the pedometer group found the pedometers easy to use and there was good compliance with diary keeping (96% in the pedometer group and 83% in the theory-based intervention alone group). There was a strong correlation (0.78) between accelerometry and pedometer step counts i.e. indicating that walking was the main physical activity amongst participants. There was a greater increase in activity (accelerometry) amongst those in the 20% target pedometer group compared to the other groups, although not reaching statistical significance (p = 0.192). Conclusion: We have demonstrated that it is feasible to use pedometers and provide theory-based advice to community dwelling sedentary older women to increase physical activity levels and a larger study is planned to investigate this further.Publisher PDFPeer reviewe

Validity and reliability of the Arabic version of Activities of Daily Living (ADL)

Background. The Activity of Daily Living (ADL) is an instrument that screens elderly respondents for physical functioning and assesses whether they are dependent or independent in their daily activities. This study demonstrates a translation procedure and obtains the reliability and validity of a translated, Arabic ADL. Methods. The ADL was translated to Arabic through a forward translation method followed by a committee-consensual approach. The ADL and the Arabic Mini-Mental State Examination (AMMSE) were administered to an opportunistic sample of 354 Lebanese elderly living in nursing homes who did not have dementia. Results. Reliability split half measures, sensitivity, and negative predictive values were high across all dimensions of the ADL with the exception of feeding. There were non-significant differences on the scored ADL between the three age groups: young age, middle age and older old. In addition, a non-significant difference was found on the scored ADL between the high and low AMMSE scores. Conclusion. Overall, the translated ADL was consistent and valid measure for assessing daily activities in elderly nursing home residents. As it is quick and easy to use, the ADL in Arabic could help caregivers and doctors to prescribe appropriate physical exercise for elderly Arabic speaking patients

Tibiofemoral osteoarthritis affects quality of life and function in elderly Koreans, with women more adversely affected than men

<p>Abstract</p> <p>Background</p> <p>The prevalence of knee osteoarthritis(OA) in East Asia is as common for men and even higher for women than that reported in the Caucasian population. Since both population aging and economic growth have taken place at a much faster pace in Asian countries, such as South Korea, one would expect knee OA to become a major public health problem. However, few studies have examined the influence of knee OA on the quality of life (QoL) and physical function in Asia. The aim of this cross-sectional study is to investigate the influence of knee osteoarthritis (OA) on the quality of life (QoL), function and lower extremity physical performance and the gender difference in its influence in elderly community residents in Korea.</p> <p>Methods</p> <p>Participants were from the population-based Hallym Aging Study (HAS). The mean age of the 504 study subjects was 70.2 years and 274 (54%) were women. Demographic information was obtained by questionnaire, and radiographic evaluations consisted of weight-bearing semi-flexed knee radiographs. Self-reported QoL and function were assessed using Western Ontario and McMaster Universities Osteoarthritis (WOMAC) Index and Short Form 12-item (SF-12). Performance-based lower extremity function was assessed using the tests consisting of standing balance, usual walk and chair stands. The odds ratios(ORs) for belonging to the worst quartile of WOMAC and physical performance test were calculated by logistic regression analysis in radiographic knee OA compared to non-OA after adjustment of confounders. Scores for SF-12 items were analyzed using general linear models and means adjusted for age, BMI and OA severity were compared.</p> <p>Results</p> <p>Subjects with radiographic knee OA had significantly increased OR for belonging to the worst WOMAC quartile(for pain, 2.13,95% confidence interval[CI], 1.33-3.40, for stiffness, 2.94,95% CI,1.78-4.86, and for function, 2.97, 95% CI,1.83-4.81) and significantly worse SF-12 scores compared to non-OA after adjustment of age, BMI and sex. Women had worse WOMAC and SF-12 scores compared to men, regardless of the presence of radiographic knee OA after adjustment of age, BMI and OA severity. OA subjects had significantly worse performance score for usual walk and chair stands compared to non-OA subjects, but the ORs were no more significant after adjustment of sex.</p> <p>Conclusions</p> <p>Knee OA negatively affects the QoL and physical function in both genders, but women are more adversely affected than men.</p

Evaluation of the Frails' Fall Efficacy by Comparing Treatments (EFFECT) on reducing fall and fear of fall in moderately frail older adults: study protocol for a randomised control trial

<p>Abstract</p> <p>Background</p> <p>Falls are common in frail older adults and often result in injuries and hospitalisation. The Nintendo^®Wii™ is an easily available exercise modality in the community which has been shown to improve lower limb strength and balance. However, not much is known on the effectiveness of the Nintendo^®Wii™ to improve fall efficacy and reduce falls in a moderately frail older adult. Fall efficacy is the measure of fear of falling in performing various daily activities. Fear contributes to avoidance of activities and functional decline.</p> <p>Methods</p> <p>This randomised active-control trial is a comparison between the Nintendo WiiActive programme against standard gym-based rehabilitation of the older population. Eighty subjects aged above 60, fallers and non-fallers, will be recruited from the hospital outpatient clinic. The primary outcome measure is the Modified Falls Efficacy Scale and the secondary outcome measures are self-reported falls, quadriceps strength, walking agility, dynamic balance and quality of life assessments.</p> <p>Discussions</p> <p>The study is the first randomised control trial using the Nintendo Wii as a rehabilitation modality investigating a change in fall efficacy and self-reported falls. Longitudinally, the study will investigate if the interventions can successfully reduce falls and analyse the cost-effectiveness of the programme.</p> <p>Trial registration</p> <p>Australia and New Zealand Clinical Trials Register (ANZCTR): <a href="http://www.anzctr.org.au/ACTRN12610000576022.aspx">ACTRN12610000576022</a></p

Falls, Depression and Antidepressants in Later Life: A Large Primary Care Appraisal

BACKGROUND: Depression and falls are common and co-exist for older people. Safe management of each of these conditions is important to quality of life. METHODS: A cross-sectional survey was used to examine medication use associated with injurious and non-injurious falls in 21,900 community-dwelling adults, aged 60 years or over from 383 Australian general practices recruited for the DEPS-GP Project. Falls and injury from falls, medication use, depressive symptoms (Primary Health Questionnaire (PHQ-9)), clinical morbidity, suicidal ideation and intent, health status (SF-12 Health Survey), demographic and lifestyle information was reported in a standardised survey. FINDINGS: Respondents were 71.8 years (sd 7.7) of age and 58.4% were women. 24% 11% and 8% reported falls, fall related injury, and sought medical attention respectively. Antidepressant use (odds ratio, OR: 1.46; 95% confidence interval, 95%CI: 1.25, 1.70), questionable depression (5-14 on PHQ OR: 1.32, 95%CI: 1.13, 1.53) and clinically significant symptoms of depression (15 or more on PHQ OR: 1.70, 95%CI: 1.14, 1.50) were independently associated with multiple falls. SSRI use was associated with the highest risk of multiple falls (OR: 1.66, 95%CI: 1.36, 2.02) amongst all psychotropic medications. Similar associations were observed for injurious falls. Over 60% of those with four accumulated risk factors had multiple falls in the previous year (OR: 3.40, 95%CI: 1.79, 6.45); adjusted for other demographic and health factors. INTERPRETATION: Antidepressant use (particularly SSRIs) was strongly associated with falls regardless of presence of depressive symptoms. Strategies to prevent falls should become a routine part of the management of older people with depression