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Objectives To determine whether midlife occupational physical activity (PA) is associated with disability in older adults and to test disease as a mediating variable. Design Cross-sectional study. Setting National Health and Aging Trends Study. Participants Individuals aged 65 and older (N = 7,307). Measurements Participants were classified as to occupational PA levels by linking information from the Occupational Information Network database using standard occupation codes. Disability outcomes and covariates were obtained through in-person interviews. Logistic regression models were used to examine the association between occupational PA and disability. Structural equation modeling (SEM) was fitted to examine the mediating effect of disease. Results Occupations with high physically demands were associated with greater decline in functional capacity later in life. Individuals with occupations with high and very high PA were less likely to be able to perform activities of daily living than those with occupations with low PA. SEM showed that occupational PA has a very strong direct effect on disability (P < .001) and has an indirect effect on disability through disease (P = .003). The population attributable fraction for high occupational PA was 11%. Conclusion Higher midlife occupational PA levels were significantly associated with poorer ability to perform activities of daily living in older age. Performing the optimal level of occupational PA may be instrumental in reducing disability later in life.

Objectives: To determine how the number of geriatric syndromes is associated with incident disability in community-based populations of older adults. Design: Longitudinal analysis from the Women's Health Initiative Observational Study (WHI-OS). Setting: Community. Participants: Twenty-nine thousand five hundred forty-four women aged 65 and older enrolled in the WHI-OS and free of disability in activities of daily living (ADLs) at baseline. Measurements: Geriatric syndromes (high depressive symptoms, dizziness, falls, hearing or visual impairment, osteoporosis, polypharmacy, syncope, sleep disturbance, and urinary incontinence) were self-reported at baseline and 3-year follow-up. Disability was defined as dependence in any ADL and was assessed at baseline and follow-up. Chronic diseases were measured according to a modified Charlson Index. Results: Geriatric syndromes were common in this population of women; 76.3% had at least one syndrome at baseline. Greater number of geriatric syndromes at baseline was significantly associated with greater risk of incident ADL disability at follow-up (P ? .001). Adjusted risk ratios were 1.21 (95% confidence interval (CI) = 0.78�1.87) for a single syndrome and 6.64 (95% CI = 4.15�10.62) for five or more syndromes compared with no syndromes. These results were only slightly attenuated after adjustment for number of chronic diseases or pain. Conclusion: Geriatric syndromes are significantly associated with onset of disability in older women; this association is not simply a result of chronic disease or pain. A better understanding of how these conditions contribute to disablement is needed. Geriatric syndrome assessment should be considered along with chronic disease management in the prevention of disability in older women

Author(s): Beasley, Jeannette M; LaCroix, Andrea Z; Neuhouser, Marian L; Huang, Ying; Tinker, Lesley; Woods, Nancy; Michael, Yvonne; Curb, J David; Prentice, Ross L | Abstract: ObjectivesTo evaluate the association between protein intake and incident frailty.DesignProspective cohort study.SettingSubset of the Women's Health Initiative Observational Study conducted at 40 clinical centers.ParticipantsTwenty-four thousand four hundred seventeen women aged 65 to 79 who were free of frailty at baseline with plausible self-reported energy intakes (600-5,000 kcal/day) according to the Food Frequency Questionnaire (FFQ).MeasurementsBaseline protein intake was estimated from the FFQ. Calibrated estimates of energy and protein intake were corrected for measurement error using regression calibration equations estimated from objective measures of total energy expenditure (doubly labeled water) and dietary protein (24-hour urinary nitrogen). After 3 years of follow-up, frailty was defined as having at least three of the following components: low physical function (measured using the Rand-36 questionnaire), exhaustion, low physical activity, and unintended weight loss. Multinomial logistic regression models estimated associations for uncalibrated and calibrated protein intake.ResultsOf the 24,417 eligible women, 3,298 (13.5%) developed frailty over 3 years. After adjustment for confounders, a 20% increase in uncalibrated protein intake (%kcal) was associated with a 12% (95% confidence interval (CI)=8-16%) lower risk of frailty, and a 20% increase in calibrated protein intake was associated with a 32% (95% CI=23-50%) lower risk of frailty.ConclusionHigher protein consumption, as a fraction of energy, is associated with a strong, independent, dose-responsive lower risk of incident frailty in older women. Using uncalibrated measures underestimated the strength of the association. Incorporating more protein into the diet may be an intervention target for frailty prevention.

OBJECTIVES: To describe the association between frailty and health status, the progression of frailty, and the relationship between frailty and mortality in older men. DESIGN: Cross-sectional and prospective cohort study. SETTING: Six U.S. clinical centers. PARTICIPANTS: Five thousand nine hundred ninety-three community-dwelling men aged 65 and older. MEASUREMENTS: Frailty was defined as three or more of the following: sarcopenia (low appendicular skeletal mass adjusted for height and body fat), weakness (grip strength), self-reported exhaustion, low activity level, and slow walking speed. Prefrail men met one or two criteria; robust men had none. Follow-up averaged 4.7 years. RESULTS: At baseline, 240 subjects (4.0%) were frail, 2,395 (40.0%) were prefrail, and 3,358 were robust (56.0%). Frail men were less healthy in most measures of self-reported health than prefrail or robust men. Frailty was somewhat more common in African Americans (6.6%) and Asians (5.8%) than Caucasians (3.8%). At the second visit, men who were frail at baseline tended to remain frail (24.2%) or die (37.1%) or were unable to complete the follow-up visit (26.2%); robust men tended to remain robust (54.4%). Frail men were approximately twice as likely to die as robust men (multivariate hazard ratio (MHR)=2.05, 95% confidence interval (CI)=1.55–2.72). Mortality risk for frail men was greater in all weight categories than for nonfrail men but was highest for normal-weight frail men (MHR=2.39, 95% CI=1.51–3.79, P for interaction=.01). The relationship between frailty and mortality was somewhat stronger in younger men than older men (P for interaction=.01). CONCLUSION: Frailty in older men is associated with poorer health and a greater risk of mortality.