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Background. This cohort of 'late middle-aged' African Americans has an excess of disability. We aimed to determine associations of circulating cytokine receptors (sTNFRI, sTNFR2, and sIL-6R) and C-reactive protein (CRP) with disability, physical function, and body composition. Methods. Stratified sampling of two socioeconomically diverse strata of St Louis, Missouri, occurred in 2000-2001. Inclusion criteria were self-reported black or African American race, born 1936-1950 inclusive, and Mini-Mental State Examination score of 16 or greater. In-home evaluations of handgrip strength, lean body mass percentage (LBM%), physical performance, upper and lower body functional limitations (UBFLs and LBFLs), and basic and instrumental activities of daily living (BADLs and 1ADLs) were collected. Of the 998 participants, 368 had blood sampled at baseline. Serum was stored and assayed in 2006. Results. Absolute risks were LBFLs of 2 or more, 46%; UBFLs of 1 or more, 23.5%; BADLs of 2 or more, 20.6%; and IADLs of 2 or more, 22.5%. Independent of age, sex, and underlying comorbid conditions, higher CRP and sTNFR were associated with poorer physical performance ([beta] = -1.462, p < .001 and [beta] = -0.618, p = .003), UBFLs (odds ratio [OR] 2.26, 95% confidence interval [CI] 1.1-4.64 and OR 1.39, 95% CI 0.96-2.02), LBFLs (OR 2.30, 95% CI 1.19-4.45 and OR 1.91, 95% CI 1.26-2.91), BADLs (OR 2.79, 95% CI 1.03-5.96 and OR 1.66, 95% CI 1.11-2.46), and IADLs (OR 2.13, 95% CI 1.03-4.41 and OR 1.43, 95% CI 0.99-2.08). Higher CRP ([beta] = -3.251, p Conclusions. Higher CRP and sTNFR are independently associated with disability and physical dysfunction. Higher sIL-6R, CRP, and lower adiponectin associate with lower LBM%. Key Words: Cytokine receptors--Aging--Disability. doi: 10.1093/gerona/glp148

Objective. We examined global declines in health-related quality of life (HRQoL) for a period of 3 years among the 998 participants in the African American Health (AAH) project. Methods. The AAH is a population-based sample from two areas of metropolitan St. Louis. Global declines were defined as clinically important differences (CIDs) on four or more of the eight Short Form 36-Item scales. Individual CIDs were defined as drops of 0.5 SD or more from the baseline score. Multivariable logistic regression was used to identify antecedents of global decline. Results. Fourteen percent (n=117) of the 846 AAH subjects in the analysis demonstrated global declines in HRQoL. Five statistically significant risk factors were identified, including sampling strata (inner-city vs. suburban residence; adjusted odds ratio [AOR] = 2.06), cancer (AOR = 3.56), chronic obstructive pulmonary disease (AOR = 2.19), clinically relevant levels of depressive symptoms (AOR = 1.96). and incident (postbaseline) health conditions (1 [AOR = 1.7l] and [greater than or equal to] 2 [AOR = 3.09] vs. none). Conclusion. Although these risk factors are for the most part nonmalleable, they can serve as markers of impending global HRQoL declines among late-middle-aged African Americans. Key Words: African Americans--Epidemiology--Health-related quality of life--Prospective cohort study.

Background. Poor muscle size and function (sarcopenia) have an important rote in the age-associated disability process. However, no commonly accepted index of sarcopenia exists for use in epidemiological studies. Methods. A cohort of 998 community-dwelling African Americans 49-65 years' old at baseline was used to construct the short portable sarcopenia measure (SPSM). SPSM was conceptualized as a measure of sarcopenia that combines estimates of muscle quantity and function into a single scale, is based on component items that can be obtained easily in the field, represents muscle status at a single time point that can be used without sex-specific adjustments, and can be used to follow change in muscle status over time with each person as his or her own control. We used exploratory factor analysis (EFA) to identify a unidimensional scale based on timed chair rises, lean mass, and grip strength divided by height. We used these three items and their EFA factor weights to construct SPSM (mean 9.0, median 9, range 0 [worst] to 18 [best] at baseline). Construct validity of the new measure, over a period of 36 months was examined. Results. SPSM required 8.5 pounds of equipment and 12.4 minutes to complete. It showed good score distribution and convergent, discriminant, and predictive validity with measures of muscle function, body composition, physical performance, psychological factors, and functional limitation cross-sectionally and with muscle function and body composition longitudinally. Extensive sensitivity analyses confirmed SPSM's robustness. Conclusions. SPSM is a brief, portable, and valid measure of sarcopenia for use in epidemiological research. Similar studies in other populations are needed. Key Words: Aging--Muscles--African Americans--Disability.

Background. The Short Physical Performance Battery (SPPB) is a well-established measure of lower body physical functioning in older persons but has not been adequately examined in African Americans or younger persons. Moreover, factors associated with changes in SPPB over time have not been reported. Methods. A representative sample of 998 African Americans (49-65 years old at baseline) living in St. Louis, Missouri were followed for 36 months to examine the predictive validity of SPPB in this population and identify factors associated with changes in SPPB. SPPB was calibrated to this population, ranged from 0 (worst) to 12 (best), and required imputation for about 50% of scores. Adverse outcomes of baseline SPPB included death, nursing home placement, hospitalization, physician visits, incident basic and instrumental activity of daily living disabilities, and functional limitations. Changes in SPPB over 36 months were modeled. Results. Adjusted for appropriate covariates, weighted appropriately, and using propensity scores to address potential selection bias, baseline SPPB scores were associated with all adverse outcomes except physician visits, and were marginally associated with hospitalization. Declines in SPPB scores were associated with low falls efficacy (b = - 1.311), perceived income adequacy (-0.121), older age (-0.073 per year), poor vision (-0.754), diabetes mellitus (-0.565), refusal to report household income (1.48), ever had Medicaid insurance (-0.610), obesity (-0.437), hospitalization in the prior year (-0.521), and kidney disease (-.956). Conclusions. The effect of baseline SPPB on adverse outcomes in this late middle-age African American population confirms reports involving older, primarily white participants. Alleviating deterioration in lower body physical functioning guided by the associated covariates may avoid or delay multiple age-associated adverse outcomes. Key Words: Aging--Lower body physical functioning--Disability--African Americans--Mortality--Nursing home placement.

Background. We examined 4-year lower extremity disability trajectories. Methods. Nine hundred ninety-eight African American men and women 49-65 years old were evaluated at baseline and at four annual follow-ups. Lower extremity disability was the number of difficulties with nine standard activities of daily living (ADL), instrumental ADLs (IADL), and lower body function items. Mixed-effect models were used. Results. The 9-item lower extremity disability measure had factorial validity and high reliability ([alpha] > 0.88). The mean baseline lower extremity disability score was 2.43, and at the subsequent follow-ups it was 2.23, 2.35, 2.60, and 2.70. The mixed-effect model included significant random intercept and aging effects. Fixed factors with the largest effect sizes (all p [less than or equal to] .001) were physical performance (-0.238 lower extremity disabilities per point on the Short Physical Performance Battery [SPPB]), fear of falling (1.094), poor or fair self-rated health (0.735), self-reported arthritis (0.659), clinically relevant levels of depression symptoms (0.641), body mass index (0.047 per kg/[m.sup.2] unit), aging (0.082 per year), and asthma (0.558). Conclusions. To improve lower extremity disability trajectories among African Americans, interventions should focus on improving SPPB scores. In addition, fear of falling, poor or fair self-rated health, and clinically relevant levels of depression symptoms should be considered potential intervention candidates warranting further evaluation.

Objectives. The purpose of this study was to estimate educational differences in the prevalence and mortality consequence of physical vulnerability among older adults in the United States. Methods. Data came from the 1998 and 2000 waves of the Health and Retirement Study, a nationally representative cross-sectional and prospective cohort study of community-based adults aged 65 and older. We created a physical vulnerability score from age, gender, and self-reported disability measures and measured socioeconomic status via educational attainment. Mortality data came from the National Death Index. Results. In the 1998 cohort, high physical vulnerability was more than 3 times more prevalent in individuals with less than 12 years of education compared to those with 16 or more years of education. Although less educated older adults had a higher probability of death overall, evidence of educational differences in the mortality consequence of high physical vulnerability was limited. In 2000, 2.16 million older adults had high physical vulnerability, and more than one half (53%) of these adults had less than 12 years of education. Discussion. In persons 65 years of age or older, educational differences are more apparent in the prevalence of physical vulnerability than in the mortality consequence of that vulnerability.

Background. This article examines the effect of self-reported, baseline subclinical status (i.e., independent but adaptive performance) for functional limitation and disability on adverse health outcomes. Methods. Nine hundred ninety-eight African-American men and women aged 49-455 years received in-home evaluations at baseline, and 853 were re-evaluated 3 years later. Baseline subclinical status was ascertained for five lower body tasks and seven activities of daily living (ADLs)/ instmmental ADLs (IADLs). Outcomes included difficulty with lower body limitations, ADLs/IADLs, physical performance, physician visits, hospitalization, nursing home placement, and mortality. Results. The baseline proportion of subclinical status evidence for the five lower body items was 0.33 (standard deviation [SD] = 0.20), and for the seven ADLs/IADLs was 0.20 (SD = 0.30). Significant independent effects of subclinical status for lower body limitations were observed on physician visits and hospitalization. Significant independent effects of subclinical status for ADLs/IADLs were observed on ADLs/IADLs and physician visits. Conclusions. Subclinical status for functional limitation and disability independently predicts several subsequent adverse health outcomes, although the effects of the latter (ADLs/IADLs) are stronger. Interventions to reduce frailty should focus on self-reported subclinical status as an early warning system.

Purpose: The purpose of this study is to cross-sectionally and longitudinally identify risk factors for falls, fear of falling, and falls efficacy in late-middle-aged African Americans. Design and Methods: We performed in-home assessments on a probability sample of 998 African Americans and conducted two annual follow-up interviews. Multiple logistic regression modeled the associations with falls (any fall or injurious fall) during 2 years prior to the baseline interview, and baseline fear of falling and falls efficacy with 2-year prospective risks for falling and fear of falling. Results: The most consistent association for all outcomes was depressive symptoms. Age was associated with increased risk of prior and prospective falls. Lower-body functional limitations were associated with prior falls, baseline fear of falling, and low falls efficacy, whereas low ability with one-leg stands prospectively predicted fear of falling. The greatest prospective risk for incident falls was having had a prior fall (odds ratio = 2.51), and the greatest prospective risk for fear of falling was having been afraid of falling at baseline (odds ratio = 8.14). Implications: Falls, fear of falling, and low falls efficacy are important issues for late-middle-aged as well as older persons. Interventions should focus on younger adults and attend especially to lower-body function and depressive symptoms as well as building self-efficacy for safe exercise, dealing with falls risks, and managing falls themselves. Key Words: Balance, Strength, Mobility, Functional status, Quality of life

Objectives. Subclinical status for functional limitation and disability help explain pathways to difficulties with functional limitation and disability, but data on their measurement stability are minimal. We evaluated the reproducibility of measuring subclinical status in a random subset of 92 community-dwelling St. Louis African Americans aged 49 to 65 years old. Methods. We examined test-retest reliability of subclinical status using Fried's measurement method of changing either the frequency or method of task performance for five functional limitations, three basic activities of daily living (ADLs), and four instrumental ADLs, as well as summary scales reflecting these three constructs. We also performed sensitivity analyses of test-retest interval and alternative definitional approaches (using only method, only frequency, or both). Results. Weighted kappas for individual tasks across three performance levels (high functioning, subclinical status, and task difficulty) indicated moderate agreement for one task and substantial agreement for 11 tasks. Intraclass correlation coefficients for the three scales demonstrated outstanding agreement. The most reproducible definition of subclinical status involved the either/or method. Discussion. Excellent test-retest reproducibility was demonstrated in this population-based sample of late middle-aged African Americans using Fried's method of measuring subclinical status.

Socioeconomic status (SES) has powerful and complex impacts on health, and understanding the relationship between SES and health is essential for long-term improvements in the health of populations. In addition, in the United States, the impact of SES on health is inextricably intertwined with racial and ethnicity status and the historical development and maintenance of health disparities. Most of the literature documenting this relationship has focused on individual-level socioeconomic factors. There are sound theoretical reasons and some empirical support to suggest that socioeconomic resources at both individual and neighborhood levels have strong influences on health outcomes such as disease, disability, and mortality. However, these relationships have been inadequately examined to date. In this article, the term 'ecological SES' will be used to denote SES at geographic group levels. As the United States attempts to achieve the goals of the Department of Health and Human Services' Healthy People 2010 program, understanding ecological SES and its impacts on health will be crucial. We review the theory, some of the empirical evidence, and likely future for the measurement and use of a broader approach to SES and offer a specific research paradigm for examining these issues. We focus in particular on one racial--ethnic group that experiences health disparity, that is, African Americans. We use our ongoing project investigating physical frailty in urban African Americans to illustrate the importance of a multilevel approach to understanding the impacts of socioeconomic resources on health and the potential implications for efforts to prevent or reverse frailty.

Objectives. The objectives of this work were to determine the prevalence of self-reported subclinical status for functional limitation and disability at baseline and assess their independent effects on the onset of functional limitation and disability 1-2 years later. Methods. Nine hundred ninety-eight African American men and women 49-65 years old in St. Louis, MO, received comprehensive in-home evaluations at baseline and two annual telephone follow-ups. Outcome measures included walking a half-mile, climbing steps, stooping-crouching-kneeling, lifting or cawing 10 lbs., and doing heavy housework. Results. The baseline prevalence of subclinical status was 26.4% for walking a half-mile, 26.8% for climbing steps, 39.0% for stooping-crouching-kneeling, 29.1% for lifting or carrying 10 lbs., and 22.7% for doing heavy housework. The adjusted odds ratios for the task-specific subclinical status measure at baseline on developing difficulty 1-2 years later were 1.68 (p < .05) for walking a half-mile, 4.46 (p < .001) for climbing steps, 2.48 (p < .001) for stooping-crouching-kneeling, 2.51 (p < .001) for lifting or carrying 10 lbs., and 2.22 (p < .001) for doing heavy housework. Performance tests (tandem stand, chair stands, and preferred gait speed) did not have consistent independent effects on the onset of functional limitation or disability. Conclusions. The subclinical status measures were the main predictors of the onset of difficulty in all tasks and functions 1-2 years later. Interventions to reduce frailty should focus on self-reported subclinical status as an early warning system.

Background. The prevalence of fear of falling and related activity restriction, and their joint distribution with falls and falls efficacy, have been inadequately addressed in population-based studies of middle aged and African American groups. Methods. The African American Health project is a population-based panel study of 998 African Americans born in 1936-1950 from two areas of metropolitan St. Louis (an impoverished inner-city area and a suburban area). Fear of falling, fear-related activity restriction, and 24 frailty-related covariates were assessed during in-home evaluations in 2000-2001. Results. We found that 12.6% of participants reported having fear of falling without activity restriction, 13.2% had fear of falling with activity restriction, and 74.2% had no tear of falling. Neither fear of falling nor fear-related activity restriction varied significantly across three birth cohorts (1946-1950, 1941-1945, and 1936-1940). Lack of overlap of these two phenomena with having a fall in the past 2 years and low falls efficacy was considerable. When examined across three groups (no fear, fear without activity restriction, and fear with activity restriction), a consistent pattern of decreasing health status and social, emotional, and physical functioning was demonstrated. Conclusions. In this population-based sample of 49- to 65-year-old African Americans, fear of falling and fear-related activity restriction were surprisingly common and not well explained by prior falls or low falls efficacy. These phenomena were already evident by age 49-55. Further study is warranted, including detailed qualitative investigations examining the timing, precursors, and consequences of fear of falling and fear-related activity restriction in minority and majority populations.

Background. Healthy People 2010 seeks to decrease or eliminate the health disparities experienced by disadvantaged minority groups. Methods. African American Health (AAH) is a population-based panel study of community-dwelling African Americans born between 1936 and 1950 from two strata. The first encompasses a poor, inner city area, and the second involves a suburban population with higher socioeconomic status. The authors recruited 998 participants (76% recruitment). Frank disability was assessed for 25 tasks and defined as inability or difficulty performing that task. Subclinical disability was assessed for 12 tasks and defined as no difficulty but a change in either manner or frequency of task performance. Frank disability prevalences were compared with national data for community-dwelling non-Hispanic white persons (NHW) and African American persons in the same age range. Results. Compared with the suburban sample, the inner city group had a higher prevalence of frank disability for all 25 tasks (p < .05 for 16) and subclinical disability for 11 of the 12 tasks (p < .05 for 5). Both strata had more frank disability compared with the national NHW population. The inner city area had higher frank disability proportions than did the national African American sample, whereas the suburban group had similar disability levels. Conclusions. The AAH inner city group experiences more frank disability than other populations of African Americans and NHWs. The increased prevalence of subclinical disability in the inner city group compared with the suburban group suggests that the disparity in frank disability will continue. These findings indicate that African Americans living in poor inner city areas in particular need intensive and targeted clinical and public health efforts.

Objectives. In this article we explore the measurement properties of the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36) in 49- to 65-year-old African Americans, compare their health-related quality of life (HRQoL) with that of the nation, and evaluate the association of selected covariates with HRQoL. Methods. A probability sample of 998 African Americans in St. Louis received comprehensive in-home assessments. We used an item analysis, exploratory and confirmatory factor analysis, and internal consistency reliability to evaluate the measurement properties of the eight SF-36 scales and their interrelationships. We used a multiple linear regression analysis to characterize the effects of the demographic, socioeconomic status, psychosocial attributes, and biomedical markers. Results. Assessments averaged 2.5 hr. Each SF-36 scale was unidimensional, all items had robust factor loadings, and all but one scale achieved excellent ([alpha] [greater than or equal to] .80) internal consistency reliability levels. The overall factor structure of the SF-36 scales was generally consistent with national norms. Substantial variance was explained by the covariates, mostly attributable to socioeconomic status and the biomedical markers. Conclusions. The SF-36 is a reliable and valid measure of HRQoL for use with African Americans. In this sample, the HRQoL was below national averages. Future social epidemiologic studies should include grip strength, vision, and hearing assessments, which had substantial and consistent associations with the SF-36 scale scores.

Background. The impact of diabetes on disability and physical functioning in older African Americans and potential causes of the excessive disability associated with diabetes in other studies have been inadequately investigated. Methods. A population-based survey was performed comparing 116 self-reported diabetic inner-city African Americans aged 70 years and older to 522 nondiabetic persons from the same population. A subsample (n = 168) received a physical examination focused on body habitus, upper and lower body strength, balance, and timed physical performance tasks. Blood tests were obtained from 173 subjects. Results. Diabetic individuals reported worse general health (p = .01), instrumental activities of daily living (p = .02), and modified versions of the Rosow-Breslau scale (p < .001) and the Stanford Health Assessment Questionnaire (p = .002). Diabetic persons also reported more falls (0.59 per person vs 0.20, p = .019) and injurious falls (12% vs 6%, p = .025). There were minimal differences in the strength, balance, and timed performance measures (analyzed separately by gender). In multivariable analyses, impairments in visual function and pain and light touch perception appeared to explain some of the association between diabetic status and poor general health, disability, and falls, with lesser contribution from the number of medical problems, number of medications, and glycemic control. Conclusions. Older inner-city diabetic blacks demonstrated worse general health, excess disability, and more falls compared to controls, although deficits in strength, balance, and timed performance could not be demonstrated. The cause of decreased functional status in diabetic elders deserves additional investigation, focusing especially on sensory function, glycemic control, and contribution from specific medical problems and medications.

Background: An accurate physical fitness survey could be useful in research and clinical care. Purpose: To estimate the validity and reliability of a Self-Reported Fitness (SRFit) survey; an instrument that estimates muscular fitness, flexibility, cardiovascular endurance, BMI, and body composition (BC) in adults > 40 years of age. Methods: 201 participants completed the SF-36 Physical Function Subscale, International Physical Activity Questionnaire (IPAQ), Older Adults' Desire for Physical Competence Scale (Rejeski), the SRFit survey, and the Rikli and Jones Senior Fitness Test. BC, height and weight were measured. SRFit survey items described BC, BMI, and Senior Fitness Test movements. Correlations between the Senior Fitness Test and the SRFit survey assessed concurrent validity. Cronbach's Alpha measured internal consistency within each SRFit domain. SRFit domain scores were compared with SF-36, IPAQ, and Rejeski survey scores to assess construct validity. Intraclass correlations evaluated test-retest reliability. Results: Correlations between SRFit and the Senior Fitness Test domains ranged from 0.35 to 0.79. Cronbach's Alpha scores were .75 to .85. Correlations between SRFit and other survey scores were -0.23 to 0.72 and in the expected direction. Intraclass correlation coefficients were 0.79 to 0.93. All P-values were 0.001. Conclusion: Initial evaluation supports the SRFit survey's validity and reliability. [ABSTRACT FROM AUTHOR]

Introduction. Although testosterone and its association with disease progression and mortality is a widely studied topic, no studies have evaluated mortality risks related to testosterone levels in an older African-American population. The mechanisms for known racial differences in mortality risk for certain cancers and cardiovascular risk factors are largely unknown. Elucidating a mortality risk associated with testosterone levels may give insight into the elevated risk for certain diseases in African-Americans. Methods and results. Study data were derived from a cohort 622 African-Americans (age 80.05 ±± 6.4, range 68--102) from Saint Louis, Missouri that includes 190 males (age 79.38 ±± 6.2, range 70--102). The eligible sample for this report includes 56 of the 190 males (age 78.89 ±± 6.9, range 70--102) who donated blood at baseline in 1992--1994 and subsequently tested for total testosterone and bioavailable testosterone. Covariates for adjusted analyses were lower body functional limitations, physician visits and comorbidities, also collected at baseline. Males' mean bioavailable testosterone levels (ng/dl) were 33.33 ±± 24.4 ( n above 70 ng/dl == 5) and mean total testosterone levels (ng/dl) were 246.63 ±± 118.7 ( n above 300 ng/dl == 20). Vital status was determined through 2002; 41 males (73%%) were deceased and 15 were alive. Mortality did not differ among males with testosterone levels <300 versus 300++ ( p == 0.42) or with bioavailable testosterone levels <70 versus > 70 ( p == 0.34). Total testosterone levels did not predict mortality when adjusted for age (Adjusted Hazard Ratio [[AHR]] == 0.998; 95%% confidence interval [[CI]] 0.995--1.001; p == 0.28) or adjusted for age and other covariates (AHR == 0.099; 95%% CI 0.996, 1.002; p == 0.35). Bioavailable testosterone levels did not predict mortality when adjusted for age (AHR == 0.992; 95%% CI .977--1.007; p == 0.30) or when adjusted for age and other covariates (AHR 0.991; 95%% CI .976--1.006; p == 0.261). Conclusion. In older African-American males, total and bioavailable testosterone levels, with and without adjustment for covariates, are not independently associated with mortality risk. [ABSTRACT FROM AUTHOR]

The authors investigated the association between observed neighborhood conditions and lower-body functional limitations (LBFLs) using data from 563 subjects of the African-American Health Study. This population-based cohort received in-home evaluations. Five items involving LBFL were obtained at baseline (2000–2001) and 3 years later. Subjects were considered to have LBFL if they reported difficulty on at least two of the five tasks. The external appearance of the block the respondent lived on was rated during sample enumeration by use of five items (rated excellent, good, fair, or poor). Of 563 subjects with 0–1 LBFL at baseline, 15% and 14% lived in neighborhoods with 4–5 and 2–3 fair/poor conditions, respectively. Logistic regression adjusting for propensity scores showed that persons who lived in neighborhoods with 4–5 versus 0–1 fair/poor condition were 3.07 times (95% confidence interval: 1.58, 5.94) more likely to develop two or more LBFLs. The odds ratio was 2.24 (95% confidence interval: 1.07, 4.70) when living in neighborhoods with 2–3 conditions versus 0–1 fair/poor condition. Odds ratios for individual neighborhood characteristics varied from 3.45 (fair/poor street conditions) to 2.01 (fair/poor noise level). Sensitivity analyses showed the robustness of the findings. Poor neighborhood conditions appear to be an independent contributor to the risk of incident LBFLs in middle-aged African Americans. [ABSTRACT FROM AUTHOR]

Objective: We evaluate the test-retest stability of physical performance and physiologic assessments used in epidemiologic research. Method: Eighty subjects aged 50 to 65 were randomly selected from a probability sample of African Americans for test-retest assessments 5 to 45 days after baseline. Physical performance assessments included grip strength, chair stands, gait speed, and four standing-balance measures. Physiologic assessments included systolic and diastolic blood pressure, height, weight, body fat, and peak expiratory flow. Results: Intraclass correlations coefficients (ICCs) were .81 for grip strength, .72 for chair stands, .56 for gait speed, .60 for one-leg stand, .52 for semitandem stand, .58 for tandem stand with eyes closed, and .27 for tandem stand with eyes open. Except for blood pressure (ICCs of .51 and .55 for systolic and diastolic), the physiologic assessments had ICCs > .89. Discussion: Additional interviewer training may improve the reproducibility of the tandem stand with eyes open. [ABSTRACT FROM AUTHOR]