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Background: In older adults, impaired control of standing balance in the lateral direction is associated with the increased risk of falling. Assessing the factors that contribute to impaired standing balance control may identify areas to address to reduce falls risk.Aim: To investigate the contributions of physiological factors to standing lateral balance control.Methods: Two hundred twenty-two participants from the Pittsburgh site of the Health, Aging and Body Composition Study had lateral balance control assessed using a clinical sensory integration balance test (standing on level and foam surface with eyes open and closed) and a lateral center of pressure tracking test using visual feedback. The center of pressure was recorded from a force platform. Multiple linear regression models examined contributors of lateral control of balance performance, including concurrently measured tests of lower extremity sensation, knee extensor strength, executive function, and clinical balance tests. Models were adjusted for age, body mass index, and sex.Results: Larger lateral sway during the sensory integration test performed on foam was associated with longer repeated chair stands time. During the lateral center of pressure tracking task, the error in tracking increased at higher frequencies; greater error was associated with worse executive function. The relationship between sway performance and physical and cognitive function differed between women and men.Discussion: Contributors to control of lateral balance were task-dependent. Lateral standing performance on an unstable surface may be more dependent upon general lower extremity strength, whereas visual tracking performance may be more dependent upon cognitive factors.Conclusions: Lateral balance control in ambulatory older adults is associated with deficits in strength and executive function. [ABSTRACT FROM AUTHOR]

Objectives: This study aimed to assess the independent associations of serum levels of vitamin B12 and plasma concentrations of homocysteine with gait speed decline. Design, Setting, Participants: This study utilized longitudinal analysis of participants 50 years or older from The Baltimore Longitudinal Study of Aging, N=774. Measurements: Gait speed (m/s) was assessed using the 6-meter usual pace test. Vitamin B12 and homocysteine concentrations were collected using standard clinical protocols. Linear mixed effects regression was stratified by baseline age category (50-69, 70-79, and ≥80 years old). Results: Mean follow-up time for the total study sample was 5.4 ± 2.0 years. No association between vitamin B12 and gait speed decline over the follow-up time for any age group was found. Elevated homocysteine concentrations were associated with decline in gait speed after adjustment for covariates (50-69: β= -0.005, p=.057; 70-79: β= -0.013, p<.001, ≥80: β= -0.007, p=.054). Conclusion: Homocysteine and vitamin B12 are inversely related, yet only homocysteine was associated with gait speed decline in this population of healthy older adults. Given these results, future research should be directed towards investigating the relationship in populations with greater variation in vitamin B12 concentrations and other mechanisms influencing homocysteine concentrations. [ABSTRACT FROM AUTHOR]

PARTICIPANTS: J. Bennett (UCSF, San Francisco, CA), A. Stewart (University of California San Francisco, San Francisco, CA), M, Danielson. S, Kritchevsky, A. Newman, S. Rubin, E. Simonsick (UCSF, San Francisco, CA). Correlates of Poor Lower Extremity Performance in Well-Functioning Black and White Older Adults. We analyzed baseline data from black and white older adults in the Health, Aging, and Body Composition (Health ABC) study to identify poor performers on tests of lower extremity function. Risk factors associated with poor lower extremity performance were assessed overall and separately by race. Of 3028 adults aged 70-79 years reporting no difficulty walking ? mile, walking up 10 steps or performing basic ADL, 938 (31%) had functional limitations revealed by low scores on performance tests. Proportionately more blacks (41%) than whites (24%) had poor lower extremity performance. Older age and female sex were associated with poor performance in both races. Having less than a high school education, physical inactivity, and obesity were associated with poor performance overall, with a higher proportion of blacks falling into these groups. Our findings suggest that performance tests of lower extremity function can identify functional limitations in persons who report no functional difficulties. The possibility that these individuals are unaware of their impending mobility difficulties, perhaps due to low activity levels, argues for inclusion of objective performance tests of function in both research studies and clinical settings. C. Rosano, E. Simonsick, T. Harris, J. Brach, S. Rubin, S. Kritchevsky, M. Visser, K. Yaffe, A. Newman (University of Pittsburgh, Pittsburgh, PA). Association Between Motor and Cognitive Performance in Well-Functioning Elderly. In everyday activities, motor performance requires cognitive abilities such as attention, memory and planning. We hypothesized that impaired motor function may indicate cognitive decline and examined the association between motor and cognitive function in well-functioning men and women aged 70-79 participating in Health ABC. Cognitive tests [Teng modified Mini-Mental State Exam (3MS) and Digit Symbol Substitution Test (DSST)] and motor function data (chair stands, gait speed, standing balance, and summary score) were available for 2892 participants (mean age: 73.6+2.9). Regression analyses showed a strong association between motor function and 3MS and DSST scores independent of demographics, chronic disease, wt, and exercise (Fig1: 3MS: B:0.6; DSST: B:l.81 p B. Penninx (Wake Forest University School of Medicine, Winston-Salem, NC), S. Kritchevsky (University of Pittsburgh, Pittsburgh, PA), R. Tracy (Wake Forest University School of Medicine, Winston-Salem, NC), A. Newman, M. Visser, T. Harris (University of Pittsburgh, Pittsburgh, PA), M. Pahor (Wake Forest University School of Medicine, Winston-Salem, NC). Inflammation and Incident Lower Extremity Limitation in Older Persons. We examined the effect of inflammation on incident lower extremity limitations in 3,044 well-functioning persons, 70 to 79 years, participating in Health ABC. Plasma levels of interleukin (IL)-6, tumor necrosis factor (TNF)-a and C-reactive protein (CRP) and various cytokine soluble receptors were measured. The onset of lower extremity limitations (difficulty walking ? mile or climbing 10 steps) was assessed semiannually over 30 months. A total of 816 persons (26.8%) developed incident limitations. After adjustment for confounders (incl. baseline and incident CVD), the relative risk (RR, 95% CI) of incident limitations for the upper vs. lower tertile was 1.7 (1.4-2.1) for IL-6, 1.6 (1.3-1.9) for TNF-a and 1.4 (1.2-1.7) for CRP. The limitation RR was 1.3 (1.1-1.5) if 1 marker was high (upper tertile), 1.5 (1.3-1.9) if2 markers were high, and 2.1 (1.6-2.7) if all 3 markers were high. Data in a subset (n=500) showed that high levels of the soluble receptors II-2sR (upper vs. lower tertile: RR=I.8 (1.2-2.7) and sTNF-R1 (RR=I.5 (1.0-2.3)), but not IL-6sR and sTNF-R2 increased the limitation risk. These findings suggest that inflammation may increase the incidence of lower extremity limitations, especially when levels of multiple inflammation markers are elevated. E. Simonsick (National Institute on Aging/IRP, Baltimore, MD), A. Newman, M. Visser (University of Pittsburgh, Pittsburgh, PA), B. (3oodpaster (IRP/NIA, Baltimore, MD), S. Kritchevsky. S. Rubin (University of Pittsburgh, Pittsburgh, PA), M, Nevitt, T. Harris (IRP/NIA, Baltimore, MD). Prognostic Significance of Endurance Walking Capacity for Incident Functional Limitation in 70 Year-Olds. As many older adults 'take it easy,' they may be unaware of cardiovascular and functional impairments. To identify impending limitations, we examined performance on a test of walking endurance, the Long Distance Corridor Walk (LDCW), as a predictor of incident persistent functional limitation (PFL; 2 consecutive semi-annual reports of difficulty walking ? mile or up 10 steps) within 2.5 years in 3,075 Health ABC participants. 395 (13%) were excluded from testing due to abnormal ECG, BP or HR or recent cardiac symptoms or procedures, 356 (12%) stopped the LDCW due to symptoms or HR>135 bpm, and 325 (11%) took > 6:30 to walk 400m 'as quickly as possible.' In each group 51-55% developed PFL in contrast to 32% overall and 9% of those (n--750) who took < 5:00 to walk 400m. Independent of age, race, site, education, ht, wt, exercise, and smoking, relative risk (RR, 95% CI) of PFL in those unable versus able to complete the LDCW was 3.06 (2.05-4.56) for men and 2.71 (1.98-3.70) for women (p < .0001). The RR of PFL for each 30-second interval over 5:00 for 400m was 1.76 (1.57-1.99) in men and 1.52 (1.33-1.75 in women (p < .0001). Objective assessment of walking endurance identified a majority of 70 year-olds at high risk of PFL independent of other risk factors and evidence of CVD. Whether identified a majority of 70 year-olds at high risk of PFL independent of other risk factors and evidence of CVD. Whether identification of impaired walking endurance can help prevent or delay mobility loss remains to be demonstrated. Self-described well-functioning older adults are not uniformly healthy or at low risk of impending health events and mobility limitations. Inactivity, low exertion and reduced mental challenge, leave many elders unaware of impaired capacities. Using cross-sectional and longitudinal data from the Health, Aging and Body Composition (Health ABC) study, a prospective investigation of disablement in a biracial cohort of 3.075 ment and women aged 70-79 at two sites--Pittsburgh and Memphis, with no reported difficulty walking ? mile, walking up 10 steps, or performing ADL, this symposium examines the value of performance-based assessment of physical function and biological parameters, inflammatory markers in particular, for aiding discovery of hidden risks, i.e., identifying insidious disease processes and physical and cognitive impairments at less severe and potentially modifiable stages.

Patients with major depression have elevated levels of inflammatory cytokines, but it is unclear whether depressed mood in older people is associated with inflammation. Data are from 3,024 well-functioning older participants, 70 to 79 years, of the Health, Aging and Body Composition study. Depressed mood was assessed by a CES-D score dl 6, and plasma concentrations of interleukin (IL)-6, tumor necrosis factor (TNF)-[pounds sterling]\ and C-reactive protein (CRP) were measured. The 58 men with depressed mood had higher plasma levels of IL-6 (2.42 vs 1.89 pg/mL, p=.002), TNF-[pounds sterling]\ (3.46 vs 3.26 pg/mL, p=.08) and CRP (1.91 vs 1.47 mg/L, p=.04) than the 1,422 non-depressed men. After adjustment for health and demographics, depressed mood was especially prevalent in men with high (above median) levels for d2 inflammatory markers (RR compared to low levels=3.91, 95% CI=1.35-11.9). Levels of inflammatory markers did not differ for women with and without depressed mood. Older men, but not women, with high levels of inflammatory markers showed higher rates of depressed mood than those with low levels.

What is known and objective There are few studies examining both drug-drug and drug-disease interactions in older adults. Therefore, the objective of this study was to describe the prevalence of potential drug-drug and drug-disease interactions and associated factors in community-dwelling older adults. Methods This cross-sectional study included 3055 adults aged 70-79 without mobility limitations at their baseline visit in the Health Aging and Body Composition Study conducted in the communities of Pittsburgh PA and Memphis TN, USA. The outcome factors were potential drug-drug and drug-disease interactions as per the application of explicit criteria drawn from a number of sources to self-reported prescription and non-prescription medication use. Results Over one-third of participants had at least one type of interaction. Approximately one quarter (25·1%) had evidence of had one or more drug-drug interactions. Nearly 10·7% of the participants had a drug-drug interaction that involved a non-prescription medication. % The most common drug-drug interaction was non-steroidal anti-inflammatory drugs (NSAIDs) affecting antihypertensives. Additionally, 16·0% had a potential drug-disease interaction with 3·7% participants having one involving non-prescription medications. The most common drug-disease interaction was aspirin/NSAID use in those with history of peptic ulcer disease without gastroprotection. Over one-third (34·0%) had at least one type of drug interaction. Each prescription medication increased the odds of having at least one type of drug interaction by 35-40% [drug-drug interaction adjusted odds ratio (AOR) = 1·35, 95% confidence interval (CI) = 1·27-1·42; drug-disease interaction AOR = 1·30; CI = 1·21-1·40; and both AOR = 1·45; CI = 1·34-1·57]. A prior hospitalization increased the odds of having at least one type of drug interaction by 49-84% compared with those not hospitalized (drug-drug interaction AOR = 1·49, 95% CI = 1·11-2·01; drug-disease interaction AOR = 1·69, CI = 1·15-2·49; and both AOR = 1·84, CI = 1·20-2·84). What is new and conclusion Drug interactions are common among community-dwelling older adults and are associated with the number of medications and hospitalization in the previous year. Longitudinal studies are needed to evaluate the impact of drug interactions on health-related outcomes. [ABSTRACT FROM AUTHOR]

Because older workers will represent a greater and increasing proportion of the American workforce over the next decades, understanding the health of these older workers will be critical. This study examines cardio-respiratory fitness and strength in two sets of full-time workers aged 50-60 years participating in the Baltimore Longitudinal Study on Aging. In 289 men, 30% had a summed handgrip strength