Search

A study was conducted to evaluate the change in disability following hospitalization after intervening events in older individuals and the association between physical frailty with transitions. Results indicated that in the case of physically frail elderly people intervening illnesses or events greatly increased the chances of worsening of disabilities.

Objective. We evaluated the longitudinal association between self-rated health (SRH) and timed gait, an indicator of lower extremity dysfunction, in a community-based sample of older persons. Methods. Participants (N = 754) were evaluated at 18-month intervals for 72 months. SRH was categorized as Excellent/Very Good/Good and Fair/Poor. Participants were asked to walk a 10-foot course 'as last as it feels safe and comfortable,' turn around, and walk back, with timed gait defined as normal ([less than or equal to] 10 s) or slow (>10 s). Generalized multinomial logit models, adjusted for demographic features, biomedical and psychosocial factors, and activities of daily living, evaluated the association between SRH and the likelihood of 6 possible transitions (from normal or slow timed gait to normal timed gait, slow timed gait, or death) over time. We also ran a repeated measures linear mixed model with change in timed gait as the outcome. Results. Compared with participants reporting Excellent/Very Good/Good SRH, those reporting Fair/Poor SRH were more likely to transition from normal to slow timed gait or to death. SRH was not associated with transitions from slow timed gait to normal timed gait or to death. In addition, time to complete the gait task increased (i.e., slowed) over time among participants reporting Fair/Poor SRH compared with those reporting Excellent/Very Good/ Good SRH. Discussion. Among older persons, SRH is associated with the development of lower extremity dysfunction but not with recovery from lower extremity dysfunction. This relationship may indicate an intermediate step in the pathway from SRH to mortality. Key Words: Gait--Longitudinal study--Objective measures--Older people--Self-rated health. doi: 10.1093/geronb/gbp115.

Several longitudinal studies are conducted to explain the disabilities that are caused in older people at the end of their lives. The various different patterns and trajectories of disability exhibited by different people are also discussed.

Background. To advance the field of disability assessment, additional developmental work is needed. The objective of this study was to determine the potential value of participant recall when evaluating disability over discrete periods of lime. Methods. We studied 491 residents of greater New Haven, Connecticut, who were 76 years old or older. Participants completed a comprehensive assessment that included several new questions on disability in four essential activities of daily living (bathing, dressing, transferring, and walking). Participants were also assessed for disability in the same activities during monthly telephone interviews before and after the comprehensive assessment. Chronic disability was defined as a new disability that was present for at least three consecutive months. Results. We found that up to half of the incident disability episodes, which would otherwise have been missed, can be ascertained if participants are asked to recall whether they have had disability 'at any time' since the prior assessment; that these disability episodes, which are ascertained by participant recall, confer high risk for the subsequent development of chronic disability, with an adjusted hazard ratio of 2.5 (95% confidence interval, 1.1-5.8); and that participant recall for the absence of disability becomes increasingly inaccurate as the duration of the assessment interval increases, with 2.2%, 6.0%, 6.9%, and 9.1% of participants having inaccurate recall at 1, 3, 6, and 12 months, respectively. Conclusions. Our results demonstrate both the promise and limitations of participant recall and suggest that additional strategies are needed to more completely and accurately ascertain the occurrence of disability among older persons. Key Words: Disability evaluation--Activities of daily living--Cohort studies.

The impact of the serum micronutrient concentrations on the declining physical function among older men and women is discussed. The results prove that low serum vitamin E concentration leads to a fall in the physical function of older people.

Background. Clinical trials to assess interventions for mobility disability are critically needed; however, data for efficiently designing such trials are lacking. Methods. Results are described from a pilot clinical trial in which 424 volunteers aged 70-89 years were randomly assigned to one of two interventions--physical activity or a healthy aging education program--and followed for a planned minimum of 12 months. We evaluated the longitudinal distributions of four standardized outcomes to contrast how they may serve as primary outcomes of future clinical trials: ability to walk 400 meters, ability to walk 4 meters in [less than or equal to] 10 seconds, a physical performance battery, and a questionnaire focused on physical function. Results. Changes in all four outcomes were interrelated over time. The ability to walk 400 meters as a dichotomous outcome provided the smallest sample size projections (i.e., appeared to be the most efficient outcome). It loaded most heavily on the underlying latent variable in structural equation modeling with a weight of 80%. A 4-year trial based on the outcome of the 400-meter walk is projected to require N= 962-2234 to detect an intervention effect of 30%-20% with 90% power. Conclusions. Future clinical trials of interventions designed to influence mobility disability may have greater efficiency if they adopt the ability to complete a 400-meter walk as their primary outcome.

Background. Peak expiratory flow ('peak flow') predicts important outcomes in older persons. Nevertheless, its clinical application is uncertain because prior strategies for reporting peak flow may not be valid. We thus determined the frequency distribution of peak flow by the conventional strategy of percent predicted (%predicted) and by an alternative method termed standardized residual (SR) percentile, and evaluated how these two metrics relate to health status in older persons. Methods. Participants included 754 community-dwelling persons aged [greater than or equal to] 70 years. Data included chronic conditions, frailty indicators, and peak flow. Results. Mean age was 78.4 years, with 63.7% reporting a smoking history, 17.4% chronic lung disease, and 77.1% having one or more frailty indicators. Peak flow [greater than or equal to] 8 %predicted was recorded in 67.5% of participants, whereas peak flow [greater than or equal to] 80th SR percentile was only noted in 15.9%. A graded relationship was observed between peak flow and health status, but % 0-100 %predicted), whereas SR percentile conferred health risk only at severely reduced peak flows (< 50th SR percentile). Conclusions. Peak flow expressed as SR percentile attains a frequency distribution more consistent with the characteristics of our elderly cohort, and establishes health risk at more appropriate levels of reduced peak flow. These findings establish the need for longitudinal studies based on SR percentile to further evaluate the use of peak flow as a risk assessment tool in older persons and to deter as SR percentile, rather than as %predicted.