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This study examined whether inability to perform adaptive locomotor tests predicts self-reported incident mobility disability. InCHIANTI study participants {N= 61 1 ; age, 50-85 yrs) who could walk 7 m at self-selected speed and who had no selfreported mobility disability at baseline were included. The ability to complete four adaptive locomotor tests was assessed: fast walking, walking on a narrow path, crossing obstacles while walking, and talking while walking. Mobility disability was recorded again at 3-yr follow-up. Failure in the fast-walking and narrow-path walking tests predicted approximately 2.5 times likelihood of reporting incident mobility disability (P = 0.009 and P = 0.01 1, respectively). Failure in the obstacle-crossing test predicted approximately two times likelihood of reporting incident mobility disability; however, this result did not reach statistical significance (P= 0.077). Failure in talking while walking did not predict incident mobility disability. Those who failed both the fast-walking and narrow-path walking tests were almost nine times as likely to report incident mobility disability. [ABSTRACT FROM AUTHOR]

Purpose: Fear of falling (FF) is a serious problem in elderly. Available scales quantify FF by generating an aggregate total FF score disregarding the environment in which fear is expressed. This study examined the differences in psychosocial and physical characteristics and global functional capabilities between the elderly who experienced FF exclusively for activities usually performed in community environments and those who reported FF only for home-based activities., Methods: Older participants (age > or = 65, n = 1155) enrolled in the InCHIANTI study completed the evaluation of FF, personal mastery, depression, cognition, social support, lower limb strength, grip strength, balance, timed repeated sit-to-stand performance, visual acuity, and contrast sensitivity. Functional capacity measures included walking speed, ADL and IADL disability, self-reported difficulty climbing steps without support and difficulty walking at least 400m. Only those who reported FF exclusively for activities usually performed in the community environment (n = 232) or in home environment (n = 110) were included in the analysis., Results: Multivariate analysis of variance revealed that those who reported FF exclusively for home-based activities were significantly worse in psychosocial and physical characteristics measured (F(1,339) = 4.27; p < 0.01) and were also less able in all global functional capacity measures (p = 0.04 to < 0.01)., Conclusions: There are significant characteristic and functional differences between the older persons who have FF performing community environment activities and those who express FF in home environment activities. The results strongly indicate the need to classify FF according to the environment or alternatively, to derive an aggregate score by appropriately weighting according to the environment, for valid interpretation of FF.

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 (> or = 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 > 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., 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.

Objectives: To evaluate the independent association between high-density lipoprotein cholesterol (HDL-C) levels and objective measures of lower extremity performance., Design: Cross-sectional cohort study., Setting: Community-based., Participants: Eight hundred thirty-six nondisabled women and men aged 65 and older enrolled in the Invecchiare in Chianti study., Measurements: Lower extremity performance was assessed using 4-m walking speed at fast pace, 400-m walking speed, and knee extension torque. Fasting HDL-C levels were determined using commercial enzymatic tests., Results: The mean age of participants was 73.7 (65-92), and 55.6% were women. After adjusting for potential confounders (sociodemographic factors, smoking, physical activity, body composition, and clinical conditions including cardiovascular and cerebrovascular disease, inflammatory markers, and serum testosterone) HDL-C levels were significantly associated with knee extension torque in men and women and with 4-m and 400-m walking speed in men. Men in the highest tertile of the HDL-C distribution (>55 mg/dL) had, on average, a three times greater probability of belonging to the best tertile of all indexes of lower extremity performance, including 4-m fast walking speed (odds ratio (OR)=2.57, 95%=confidence interval (CI)=1.07-6.17), 400-m walking speed (OR=3.74, 95% CI=1.20-11.7), and knee extension torque (OR=3.63, 95%=CI 1.41-9.33). Path analysis suggested a direct relationship between HDL-C and knee extension torque., Conclusion: In older nondisabled persons, HDL-C levels are highly correlated with knee extension torque and walking speed. Further research should focus on the biological mechanism of this association.

Background: Aging in men is characterized by a progressive decline in levels of anabolic hormones, such as testosterone, insulinlike growth factor 1 (IGF-1), and dehydroepiandrosterone sulfate (DHEA-S). We hypothesized that in older men a parallel age-associated decline in bioavailable testosterone, IGF-1, and DHEA-S secretion is associated with higher mortality independent of potential confounders., Methods: Testosterone, IGF-1, DHEA-S, and demographic features were evaluated in a representative sample of 410 men 65 years and older enrolled in the Aging in the Chianti Area (InCHIANTI) study. A total of 126 men died during the 6-year follow-up. Thresholds for lowest-quartile definitions were 70 ng/dL (to convert to nanomoles per liter, multiply by 0.0347) for bioavailable testosterone, 63.9 ng/mL (to convert to nanomoles per liter, multiply by 0.131) for total IGF-1, and 50 microg/dL (to convert to micromoles per liter, multiply by 0.027) for DHEA-S. Men were divided into 4 groups: no hormone in the lowest quartile (reference) and 1, 2, and 3 hormones in the lowest quartiles. Kaplan-Meier survival and Cox proportional hazards models adjusted for confounders were used in the analysis., Results: Compared with men with levels of all 3 hormones above the lowest quartiles, having 1, 2, and 3 dysregulated hormones was associated with hazard ratios for mortality of 1.47 (95% confidence interval [CI], 0.88-2.44), 1.85 (95% CI, 1.04-3.30), and 2.29 (95% CI, 1.12-4.68), respectively (test for trend, P <.001). In the fully adjusted analysis, only men with 3 anabolic hormone deficiencies had a significant increase in mortality (hazard ratio, 2.44; 95% CI, 1.09-5.46 (test for trend, P <.001)., Conclusions: Age-associated decline in anabolic hormone levels is a strong independent predictor of mortality in older men. Having multiple hormonal deficiencies rather than a deficiency in a single anabolic hormone is a robust biomarker of health status in older persons.