Health‐related quality of life of patients with juvenile dermatomyositis: Results from the paediatric rheumatology international trials organisation multinational quality of life cohort study

Objective

To investigate the health‐related quality of life (HRQOL) change over time, as measured by the Child Health Questionnaire (CHQ), and its determinants in patients with active juvenile dermatomyositis (DM).

Methods

We assessed patients with juvenile DM at both baseline and 6 months of followup, and healthy children age ≤18 years. Potential determinants of poor HRQOL included demographic data, physician's and parent's global assessments, muscle strength, functional ability as measured by the Childhood Health Assessment Questionnaire (C‐HAQ), global disease activity assessments, and laboratory markers.

Results

A total of 272 children with juvenile DM and 2,288 healthy children were enrolled from 37 countries. The mean ± SD CHQ physical and psychosocial summary scores were significantly lower in children with juvenile DM (33.7 ± 11.7 versus 54.6 ± 4.1) than in healthy children (45.1 ± 9.0 versus 52 ± 7.2), with physical well‐being domains being the most impaired. HRQOL improved over time in responders to treatment and remained unchanged or worsened in nonresponders. Both physical and psychosocial summary scores decreased with increasing levels of disease activity, muscle strength, and parent's evaluation of the child's overall well‐being. A C‐HAQ score >1.6 (odds ratio [OR] 5.06, 95% confidence interval [95% CI] 2.03–12.59), child's overall well‐being score >6.2 (OR 5.24, 95% CI 2.27–12.10), and to a lesser extent muscle strength and alanine aminotransferase level were the strongest determinants of poor physical well‐being at baseline. Baseline disability and longer disease duration were the major determinants for poor physical well‐being at followup.

Conclusion

We found that patients with juvenile DM have a significant impairment in their HRQOL compared with healthy peers, particularly in the physical domain. Physical well‐being was mostly affected by the level of functional impairment.     

Alternative items for identifying hierarchical levels of physical disability by using physical performance tests in women aged 75 years and older

Aim: To identify individuals at hierarchical levels of physical disability by using physical performance tests and to determine threshold values for the discriminating of levels of physical disability in women aged 75 years or older. Methods: A cross‐sectional observational study was conducted on 306 community‐dwelling women aged 75 years or order (range, 75–99 years). Physical disability was categorized into no disability, mobility disability and activities of daily living (ADL) disability, by evaluating selected ADL and mobility‐related functional tasks. Physical function tests comprised nine items (such as strength, balance, mobility and walking ability). To assess the observed threshold values, receiver–operator curves were prepared for all the scales. Results: The results revealed significant differences among all the pairwise group comparisons in all the performance tests, except in the one‐legged stance, tandem stance and tandem walk tests. The individuals with ADL disability were unable to perform the one‐legged stance (28.9%), tandem stance (32.5%), functional reach (19.3%), tandem walk (61.4%), alternate step (53.0%) and 5‐chair sit‐to‐stand (31.3%) tests. The observed thresholds for discriminating between the no disability and mobility disability groups and between the mobility disability and ADL disability groups were as follows: timed Up & Go test, 8.5 s and 12.7 s; usual gait speed, 1.05 m/s and 0.79 m/s; and grip strength, 19.5 kg and 16.3 kg, respectively. Conclusion: Tests for balance and lower extremity strength can be used together to identify or monitor the characteristics of the hierarchical levels of physical disability in women aged 75 years or older. Geriatr Gerontol Int 2010; 10: 302–310.     

Association of foot symptoms with self-reported and performance-based measures of physical function: The Johnston County osteoarthritis project

Objective

To examine associations of foot symptoms with self‐reported and performance‐based measures of physical function in a large, biracial, community‐based sample of individuals ages ≥45 years.

Methods

Data from 2,589 Johnston County participants (evaluated in 1999–2004) were used in cross‐sectional analyses. The presence of foot symptoms was defined as pain, aching, or stiffness of at least one foot on most days. Physical function was assessed by the total Stanford Health Assessment Questionnaire (HAQ) score (0, >0 but <1, and ≥1), timed 5 repeated chair stands (completion time <12 seconds, ≥12 seconds, and unable), and 8‐foot walk time (<3.35 seconds and ≥3.35 seconds). Separate multivariable logistic regression models examined associations between foot symptoms and physical function measures, controlling for age, race, sex, body mass index, radiographic knee osteoarthritis, radiographic hip osteoarthritis, knee symptoms, hip symptoms, and depressive symptoms. Interaction terms between each of the 3 physical function measures and each demographic and clinical characteristic were examined.

Results

The prevalence of foot symptoms was 37%. Participants with foot symptoms were more likely than those without symptoms to have higher HAQ scores (adjusted odds ratio [OR] 1.79, 95% confidence interval [95% CI] 1.50–2.12). Among obese participants, those with foot symptoms had longer chair stand (adjusted OR 1.38, 95% CI 1.04–1.87) and 8‐foot walk times (adjusted OR 1.61, 95% CI 1.21–2.15) than those without symptoms.

Conclusion

Foot symptoms were independently and significantly associated with 2 of 3 measures of poorer physical function. Interventions for foot symptoms may be important for helping patients prevent or deal with an existing decline in physical function.     

Correlates of Urinary Incontinence in Community‐Dwelling Older Latinos

The prevalence of urinary incontinence (UI) has varied in the literature and is reflective of the definition and sampling methodologies used, as well as the age, ethnicity, and sex being studied. The aim of the current study was to measure the prevalence and correlates of UI in a sample of 572 older Latinos participating in Caminemos, a trial of a behavioral intervention to increase walking. Participants completed an in‐person survey and physical performance measures. UI was measured using the International Consultation on Incontinence item: “How often do you leak urine?” Potential correlates of UI included sociodemographic variables, body mass index, smoking, physical activity, medical comorbidity, physical performance, activity of daily living (ADL) impairment, use of assistive ambulatory devices, health‐related quality of life (HRQoL), and depressive symptoms. The prevalence of UI in this sample was 26.9%. Women were more likely to report UI, as were those who were less physically active; used assistive ambulatory devices; and had depressive symptoms, greater medical comorbidity, worse physical performance, greater ADL impairment, worse cognitive function, and lower HRQoL. Multivariate logistic regression revealed that medical comorbidity was independently associated with higher rates of UI (odds ratio (OR)=1.66, 95% confidence interval (CI)=1.30–2.12), whereas better cognitive function (OR=0.73, 95% CI=0.57–0.93) and higher weighted physical activity scores (OR=0.77, 95% CI=0.60–0.98) were independently associated with lower rates of UI. UI is highly prevalent but not ubiquitous among community‐residing older Latinos, suggesting that UI is not an inevitable consequence of aging. Future studies should examine whether interventions that decrease comorbidity and cognitive decline and increase physical activity improve continence status.     

Performance Measures Predict Onset of Activity of Daily Living Difficulty in Community‐Dwelling Older Adults

OBJECTIVES: To assess the predictive value of five performance‐based measures for the onset of difficulty in activities of daily living (ADLs). DESIGN: A prospective cohort study; home visits every 6 months for 18 months. SETTING: Community‐based. PARTICIPANTS: Community‐dwelling older adults, n=110, (mean age 80.3±7.0; range 67–98) who reported no difficulty in basic ADLs. MEASUREMENTS: The Short Physical Performance Battery (SPPB), gait speed, Berg Balance Scale (BBS), grip strength, and Timed Up and Go Test (TUG) were evaluated at baseline. Seven ADL items were assessed at baseline and 6, 12, and 18 months. The onset of ADL disability was self‐report of difficulty in any of the seven ADL items. Logistic regression models were fitted for each of the physical performance measures to predict onset of ADL difficulty at 6, 12, and 18 months. RESULTS: After controlling for age, comorbid conditions, and sex, the BBS was the most consistent and best predictor for the onset of ADL difficulty over an 18‐month period (6 months, c‐statistic=0.725, (95% confidence interval (CI)=0.60–0.85; 12 months, c‐statistic=0.840 95% CI=0.75, 0.93; 18 months, c‐statistic=0.821, 95% CI=0.71, 0.93). The SPPB showed excellent predictive value for the onset of difficulty at 12 months. Ninety‐five, 89, and 75 older adults completed the 6, 12, and 18‐month follow‐up visits, respectively. CONCLUSION: BBS, followed by SPPB, TUG, gait speed, and grip strength, were predictive of the onset of ADL difficulty over an 18‐month period in community‐dwelling older adults. Screening nondisabled older adults with simple performance tests could allow clinicians to identify those at risk for ADL difficulty and may help to detect early functional decline.     

住院老年患者日常生活能力受损的相关因素分析

目的分析住院老年患者日常生活能力(ADL)受损相关因素,为老年人群提供合理的医疗照护服务。方法对2016年10月至2017年3月宜宾市第二人民医院老年医学科住院期间的100例老年患者进行老年综合评估,分析ADL受损与慢性疾病、居家照护、老年综合评估间的关系。应用SPSS 22.0软件进行统计学分析。根据数据类型,单因素相关分析连续变量采用Spearman相关分析,二分类变量采用χ2检验,多因素相关分析采用logistic回归法。结果纳入的100例老年患者中,ADL受损共37人,ADL(5.22±1.36)分。ADL受损单因素相关分析显示ADL与年龄、握力、微型营养评定法简版(MNA-SF)、简易精神状态量表(MMSE)、跌倒病史相关(P0.05),多因素相关分析显示ADL与年龄、居家陪护、握力、跌倒病史相关(P0.05);ADL受损程度与性别、MMSE独立相关(P0.05),与其他各组分不能明确有无相关关系。结论针对ADL受损的老人,可以通过锻炼握力、预防跌倒、加强营养、预防痴呆等预防功能状态的下降。     

Cross‐sectional and longitudinal associations of functional and health status with institutional care use: Results from the Survey of Health and Living Status of the Elderly in Taiwan

Aim: This study evaluated the cross‐sectional and longitudinal associations of functional and health status with institutional care, and examined determinants of institutional care use over time. Methods: Data of this study were obtained from the Survey of Health and Living Status of the Elderly in Taiwan (SHLSET), which was launched in 1989 and involved a nationally representative sample of nearly‐old and old Taiwanese. The baseline data in this present study were collected in 1999, and followed in 2003 and 2007. Results: Participants with institutional care use had a higher activities of daily living (ADL) score, more self‐reported diseases and poorer self‐reported health status than participants without institutional care use (all P < 0.05). Cross‐sectional analysis showed that a higher ADL score, having heart diseases and having a stroke were positively associated with institutional care use (P < 0.05); whereas the number of self‐reported diseases and poor self‐reported health status were not associated with institutional care use. Longitudinal analysis showed that increased ADL scores and the number of self‐reported diseases over 4‐ and 8 years were associated with an increased likelihood of subsequent institutional care use (all P < 0.05). Worsening health status over 4 years was associated with an increased likelihood of subsequent institutional care use, but this association did not exist over 8 years. Conclusions: Only ADL and ADL deterioration over time are cross‐sectionally and longitudinally associated with increased institutional care use. Declining functional status is a major determinant of institutional care use for Taiwanese aged over 53 years. Geriatr Gerontol Int 2013; 13: 597–606.     

Variation in sources of clinician-rated and self-rated instrumental activities of daily living disability

BACKGROUND: It is unclear how well self-reports and clinician ratings of performance in the instrumental activities of daily living (IADLs; household maintenance tasks) correspond and why they may differ. METHODS: We assessed clinician-rated IADL performance using an occupational therapy protocol, the Assessment of Motor and Process Skills (AMPS). AMPS and self-rated IADL disability were compared in two groups of nondemented elderly persons without ADL limitation: a group with functional limitation only (self-reported difficulty in some area of upper or lower body function, n = 139) and a group that reported functional limitation plus IADL disability (difficulty in at least one IADL task, n = 49). Occupational therapists were blind to self-reports, and all assessments were conducted in respondent homes. RESULTS: Self-rated IADL disability was significantly associated with the AMPS motor skill score (r = -.34, p <.001), but the motor skill score was only moderately sensitive (61%) and specific (67%) in identifying self-rated disability. In adjusted logistic regression models, clinician-rated performance and self-rated IADL disability shared some physical predictors, but only clinician-rated performance was related to cognitive status. AMPS process skill scores did not relate to self-rated IADL disability or physical or cognitive status. CONCLUSIONS: In this sample of older adults without dementia or ADL disability, clinician ratings of IADL motor skill and self-rated IADL disability were correlated. Physical deficits appear to be more salient in self-ratings than is cognitive ability, because cognitive ability (in particular, verbal fluency) was associated only with clinician-rated IADL performance.     

Chronic medical conditions as predictors of functional disability in an older population in Taiwan

Objective: As there is little understanding of disability processes in Taiwanese elders, the present study aimed to identify medical predictors of the incidence of activities of daily living (ADL) disability. Method: A total of 903 subjects were studied over a 4‐year period (1994–1998). The measurement instrument was the Chinese‐version Multidimensional Functional Assessment Questionnaire (CMFAQ). Only the subjects free of ADL disability at baseline were included in separate logistic regression models to predict disability in physical and instrumental ADL. Results: The hypothesised associations between chronic conditions and future functional disability were cross‐nationally confirmed. Arthritis, diabetes and hypertension were significantly predictive of the onset of physical ADL (PADL) disability; diabetes was the only medical predictor of instrumental ADL (IADL) disability. Age and educational level were significant predictors of PADL and IADL. Conclusions: Prevention programs for chronic disease need to pay more attention not only to the disabled population, but also to secondary prevention among those elders who have higher medical risk of developing disability.     

Habitual Physical Activity Levels Are Associated with Performance in Measures of Physical Function and Mobility in Older Men

OBJECTIVES: To determine whether objectively measured physical activity levels are associated with physical function and mobility in older men. DESIGN: Cross‐sectional. SETTING: Academic research center. PARTICIPANTS: Eighty‐two community‐dwelling men aged 65 and older with self‐reported mobility limitations were divided into a low‐activity and a high‐activity group based on the median average daily physical activity counts of the whole sample. MEASUREMENTS: Physical activity according to triaxial accelerometers; physical function and mobility according to the Short Physical Performance Battery (SPPB), gait speed, stair climb time, and a lift‐and‐lower task; aerobic capacity according to maximum oxygen consumption (VO₂max); and leg press and chest press maximal strength and peak power. RESULTS: Older men with higher physical activity levels had a 1.4‐point higher mean SPPB score and a 0.35‐m/s faster walking speed than those with lower physical activity levels. They also climbed a standard flight of stairs 1.85 seconds faster and completed 60% more shelves in a lift‐and‐lower task (all P<.01); muscle strength and power measures were not significantly different between the low‐ and high‐activity groups. Correlation analyses and multiple linear regression models showed that physical activity is positively associated with all physical function and mobility measures, leg press strength, and VO₂max. CONCLUSION: Older men with higher physical activity levels demonstrate better physical function and mobility than their less‐active peers. Moreover, physical activity levels are predictive of performance in measures of physical function and mobility in older men. Future work is needed to determine whether modifications in physical activity levels can improve or preserve physical performance in later life.     

Physical function, physical activity and recent falls. Results from the "Invecchiamento e Longevità nel Sirente (ilSIRENTE)" Study

BACKGROUND AND AIMS: A fall is a common and traumatic event in the life of older persons. This study aims: 1) to explore the relationship between recent falls and measures of physical function in elders, and 2) to examine the role played by habitual physical activity in the relationship between recent falls and physical function. METHODS: We used baseline data from 361 community-dwelling persons aged > or = 80 years (mean age 85.9 yrs) enrolled in the "Invecchiamento e Longevità nel Sirente (ilSIRENTE)" study. Physical performance was assessed using the Short Physical Performance Battery (SPPB) and usual gait speed. Muscle strength was measured by hand grip strength. Functional status was assessed by the Basic (ADL) and Instrumental Activities of Daily Living (IADL) scales. Self-reported recent falls over the previous three months were recorded. Analyses of covariance were performed to evaluate the relationship between recent fall events and physical function measures. RESULTS: Fifty participants (13.9%) reported at least one recent fall. Physically active participants had fewer falls and significantly higher physical function compared with sedentary subjects, regardless of recent falls. Significant interactions for physical activity were found in the relationships of usual gait speed and SPPB with recent fall history (p for interaction terms <0.01). A difference in usual gait speed and SPPB according to history of recent falls was found only in physically active subjects. CONCLUSIONS: Physical performance measures are negatively associated with recent falls in physically active, but not sedentary, participants. Physical activity is associated with better physical function, independently of recent fall history.     

Effects of dehydroepiandrosterone supplementation on cognitive function and activities of daily living in older women with mild to moderate cognitive impairment

Aim: There is little evidence that dehydroepiandrosterone (DHEA) has beneficial effects on physical and psychological functions in older women. We investigated the effect of DHEA supplementation on cognitive function and ADL in older women with cognitive impairment. Methods: A total of 27 women aged 65–90 years (mean ± standard deviation, 83 ± 6) with mild to moderate cognitive impairment (Mini‐Mental State Examination, MMSE; 10–28/30 points), receiving long‐term care at a facility in Japan were enrolled. Twelve women were assigned to receive DHEA 25 mg/day p.o. for 6 months. The control group (n = 15) matched for age and cognitive function was followed without hormone replacement. Cognitive function was assessed by MMSE and Hasegawa Dementia Scale‐Revised (HDS‐R), and basic activities of daily living (ADL) by Barthel Index at baseline, 3 and 6 months. Plasma hormone levels including testosterone, DHEA, DHEA‐sulfate and estradiol were also followed up. Results: After 6 months, DHEA treatment significantly increased plasma testosterone, DHEA and DHEA‐sulfate levels by 2–3‐fold but not estradiol level compared to baseline. DHEA administration increased cognitive scores and maintained basic ADL score, while cognition and basic ADL deteriorated in the control group (6‐month change in DHEA group vs control group; MMSE, +0.6 ± 3.2 vs ?2.1 ± 2.2, P < 0.05; HDS‐R, +2.8 ± 2.8 vs ?0.3 ± 4.1, P < 0.05; Barthel Index, +3.7 ± 7.1 vs ?2.7 ± 4.6, P = 0.05). Among the cognitive domains, DHEA treatment improved verbal fluency (P < 0.05). Conclusion: DHEA supplementation in older women with cognitive impairment may have beneficial effects on cognitive function and ADL. Geriatr Gerontol Int 2010; 10: 280–287.     

Identification of high-risk individuals for the development of disability in activities of daily living. A ten-year follow-up study

Independence in activities of daily living (ADL) is important in an aging population. ADL disability is a multifactorial problem, therefore a multifactorial approach is needed in the prediction of ADL disability. Our objective is to identify predictors for the development of ADL disability over a course of ten years in middle-aged and older persons. In a prospective cohort study, 478 middle-aged and older persons (61.2 years, range 40–78 years) without ADL disability at baseline were included. ADL disability was measured using the Katz-questionnaire. We included the following candidate predictors: number of chronic diseases, MMSE, Short Physical Performance Battery, leg strength, handgrip strength, physical activity, cholesterol/HDL ratio, BMI, pulse wave velocity, the degree of urbanization, age, gender and socioeconomic status. Associations between candidate predictors and ADL disability were examined using Poisson regression analysis. Performance of the prediction model was assessed with calibration and discrimination measures. The number of chronic diseases, muscle strength, age, gender and socioeconomic status were predictors of ADL disability at ten-year follow-up. The model showed a good calibration and discrimination (c-statistic: 0.83) between persons who will and will not develop ADL disability. In conclusion, the present study showed that using a multifactorial prediction model – based on easily and readily available measurements – individuals who are at high risk of developing ADL disability could be identified. The prediction model could be used as a screening tool to identify which persons most likely benefit from preventive strategies and interventions.     

Cognitive status and physical function in older african americans

OBJECTIVES: To investigate the relationship between global cognition, three specific domains of cognition, and lower extremity function in community‐dwelling elderly African Americans (AAs) from two community settings. DESIGN: Cross‐sectional study. SETTING: Community. PARTICIPANTS: Ninety‐six AA men and women aged 60 and older from two community settings, enrolled in the Boosting Minority Involvement (BMI) study, a community‐based cohort study designed to increase research participation of older low‐income AAs. MEASUREMENTS: Physical performance was assessed using Short Physical Performance Battery score, which is composed of three timed tests: a 4‐m walking task, static balance assessment, and a chair stand test. The Bushke Memory Impairment Screen (MIS) and Mini‐Mental State Examination were used to assess global memory and global cognition, respectively. For domain‐specific performance, three z‐score composite scores (attention, verbal memory, and executive function) were developed using the Computer‐based Assessment of Mild Cognitive Impairment. RESULTS: All domains of cognition were significant predictors of lower extremity function except for verbal memory. Executive function and MIS were the best predictors of lower extremity function in adjusted models. Participants with poor executive function were more than four times as likely to have poorer lower extremity function (odds ratio=4.96, 95% confidence interval=1.07–23.0). CONCLUSION: Global memory and executive function were the best predictors of lower extremity function in a sample of community‐dwelling AA adults. Deficits in lower extremity function may depend on multifaceted higher executive function control processes.     

Cardiac structure and function and dependency in the oldest old

OBJECTIVES: To examine the association between cardiac function and activities of daily living (ADLs) in an age‐homogenous, community‐dwelling population born in 1920 and 1921. DESIGN: Cross‐sectional analysis of a prospective cohort study. SETTING: Community‐dwelling elderly population. PARTICIPANTS: Participants were recruited from the Jerusalem Longitudinal Cohort Study, which has followed an age‐homogenous cohort of Jerusalem residents born in 1920 and 1921. Four hundred eighty‐nine of the participants (228 male, 261 female) from the most recent set of data collection in 2005 and 2006 underwent echocardiography at their place of residence in addition to structured interviews and physical examination. MEASUREMENTS: A home‐based comprehensive assessment was performed to assess health and functional status, including performance of ADLs. Dependence was defined as needing assistance with one or more basic ADLs. Standard echocardiographic assessment of cardiac structure and function, including ejection fraction (EF) and diastolic function as assessed using early diastolic mitral annular tissue velocity measurements obtained using tissue Doppler, was performed. RESULTS: Of the participants with limitation in at least one ADL, significantly more had low EF (<55%) than the group that was independent (52.6 % vs 39.1%; P=.01). In addition, participants with dependence in ADL had higher left ventricular mass index (LVMI) (129.3 vs 119.7 g/m²) and left atrial volume index (LAVI) (41.3 vs 36.7 mL/m²). There were no differences between the groups in percentage of participants with impaired diastolic function or average ratio of early diastolic transmitral flow velocity to early diastolic mitral annular tissue velocity (11.5 vs 11.8; P=.64). CONCLUSION: In this age‐homogenous cohort of the oldest old, high LVMI and LAVI and indices of systolic but not diastolic function as assessed according to Doppler were associated with limitations in ADLs.     

Urinary incontinence and its association with death, nursing home admission, and functional decline

OBJECTIVES: To determine whether urinary incontinence (UI) is an independent predictor of death, nursing home admission, decline in activities of daily living (ADLs), or decline in instrumental activities of daily living (IADLs). DESIGN: A population-based prospective cohort study from 1993 to 1995. SETTING: Community-dwelling within the United States. PARTICIPANTS: Six thousand five hundred six of the 7,447 subjects aged 70 and older in the Asset and Health Dynamics Among the Oldest Old study who had complete information on continence status and did not require a proxy interview at baseline. MEASUREMENTS: The predictor was UI, and the outcomes were death, nursing home admission, ADL decline, and IADL decline. Potential confounders considered were comorbid conditions, baseline function, sensory impairment, cognition, depressive symptoms, body mass index, smoking and alcohol, demographics, and socioeconomic status. RESULTS: The prevalence of UI was 14.8% (18.5% in women; 8.5% in men). At 2-year follow-up, subjects incontinent at baseline were more likely to have died (10.9% vs 8.7%; unadjusted odds ratio (OR)=1.29, 95% confidence interval (CI)=1.02-1.64), be admitted to a nursing home (4.4% vs 2.6%, OR=1.77; 95% CI=1.18-2.63), and to have declined in ADL function (13.6% vs 8.1%; OR=1.78, 95% CI=1.36-2.33) and IADL function (21.2% vs 13.8%; OR 1.69, 95% CI 1.39-2.05). However, after adjusting for confounders, UI was not an independent predictor of death (adjusted OR (AOR)= 0.90, 95% CI=0.67-1.21), nursing home admission (AOR=1.33, 95% CI=0.86-2.04), or ADL decline (AOR=1.24, 95% CI=0.92-1.68). Incontinence remained a predictor of IADL decline (AOR=1.31; 95% CI=1.05-1.63), although adjustment markedly reduced the strength of this association. CONCLUSION: Higher levels of baseline illness severity and functional impairment appear to mediate the relationship between UI and adverse outcomes. The results suggest that, although UI appears to be a marker of frailty in community-dwelling elderly, it is not a strong independent risk factor for death, nursing home admission, or functional decline.     

Exercise program for nursing home residents with Alzheimer's disease: a 1-year randomized, controlled trial

OBJECTIVES: To investigate the effectiveness of an exercise program in improving ability to perform activities of daily living (ADLs), physical performance, and nutritional status and decreasing behavioral disturbance and depression in patients with Alzheimer's disease (AD). DESIGN: Randomized, controlled trial. SETTING: Five nursing homes. PARTICIPANTS: One hundred thirty-four ambulatory patients with mild to severe AD. INTERVENTION: Collective exercise program (1 hour, twice weekly of walk, strength, balance, and flexibility training) or routine medical care for 12 months. MEASUREMENTS: ADLs were assessed using the Katz Index of ADLs. Physical performance was evaluated using 6-meter walking speed, the get-up-and-go test, and the one-leg-balance test. Behavioral disturbance, depression, and nutritional status were evaluated using the Neuropsychiatric Inventory, the Montgomery and Asberg Depression Rating Scale, and the Mini-Nutritional Assessment. For each outcome measure, the mean change from baseline to 12 months was calculated using intention-to-treat analysis. RESULTS: ADL mean change from baseline score for exercise program patients showed a slower decline than in patients receiving routine medical care (12-month mean treatment differences: ADL=0.39, P=.02). A significant difference between the groups in favor of the exercise program was observed for 6-meter walking speed at 12 months. No effect was observed for behavioral disturbance, depression, or nutritional assessment scores. In the intervention group, adherence to the program sessions in exploratory analysis predicted change in ability to perform ADLs. No adverse effects of exercise occurred. CONCLUSION: A simple exercise program, 1 hour twice a week, led to significantly slower decline in ADL score in patients with AD living in a nursing home than routine medical care.     

Predictors of recovery in activities of daily living among disabled older persons living in the community

Objective  To identify the factors that predict recovery in activities of daily living (ADLs) among disabled older persons living in the community. Design  Prospective cohort study with 2-year follow-up. Setting  General community. Participants  213 men and women 72 years or older, who reported dependence in one or more ADLs. Measurements and Main Results  All participants underwent a comprehensive home assessment and were followed for recovery of ADL function, defined as requiring no personal assistance in any of the ADLs within 2 years. Fifty-nine participants (28%) recovered independent ADL function. Compared with those older than 85 years, participants aged 85 years or younger were more than 8 times as likely to recover their ADL function (relative risk [RR] 8.4; 95% confidence interval [CI] 2.7. 26). Several factors besides age were associated with ADL recovery in bivariate analysis, including disability in only one ADL, self-efficacy score greater than 75, Folstein Mini-Mental State Examination (MMSE) score of 28 or better, high mobility, score in the best third of timed physical performance, fewer than five medications, and good nutritional status. In multivariable analysis, four factors were independently associated with ADL recovery—age 85 years or younger (adjusted RR 4.1; 95% CI 1.3, 13), MMSE score of 28 or better (RR 1.7; 95% CI 1.2, 2.3), high mobility (RR 1.7; 95% CI 1.0, 2.9), and good nutritional status (RR 1.6; 95% CI 1.0, 2.5). Conclusions  Once disabled, few persons older than 85 years recover independent ADL function. Intact cognitive function, high mobility, and good nutritional status each improve the likelihood of ADL recovery and may serve as markers of resilliency in this population. Presented at the annual meeting of the American Geriatric Society, Chicago, Ill., May 4, 1996. Funded in part by the Claude D. Pepper Older Americans Independence Center (P60-AG10469) and by grant R01-AG07449 from the National Institute on Aging, Bethesda, Md., and was conducted while Dr. Gill was a Pfizer/AGS Postdoctoral Fellow. Dr. Gill is currently supported as a Robert Wood Johnson Foundation Generalist Physician Faculty Scholar and as a Paul Beeson Physician Faculty Scholar in Aging Research. Dr. Robison was supported by a Research Training Award in the Epidemiology of Aging from the National Institute on Aging (5T32-AG00153).     

HDL-cholesterol and physical performance: results from the ageing and longevity study in the sirente geographic area (ilSIRENTE Study)

BACKGROUND: High-density lipoprotein (HDL) cholesterol has been hypothesised to be a reliable marker of frailty and poor prognosis among the oldest elderly. We evaluate the relationship of HDL-cholesterol with measures of physical performance, muscle strength, and functional status in older persons aged 80years or older. METHODS: Data are from baseline evaluation of the ageing and longevity study in the Sirente geographic area (ilSIRENTE study) (n = 364). Physical performance was assessed using the physical performance battery score [short physical performance battery (SPPB)], which is based on three-timed tests: 4-m walking-speed, balance, and chair-stand tests. Muscle strength was measured by hand-grip strength. Analyses of covariance were performed to evaluate the relationship of different HDL-cholesterol levels with physical function. RESULTS: In the unadjusted analyses, physical function (as measured by the 4-m walking-speed, theSPPB score, the basic and instrumental activities of daily living scales scores), but not hand-grip strength, improved significantly as HDL-cholesterol tertiles increased. After adjustment for potential confounders, which included age, gender, living alone, alcohol abuse, physical activity, congestive heart failure, diabetes, cerebrovascular diseases, osteoarthritis, albumin, urea, C-reactive protein and LDL cholesterol, the association of HDL-cholesterol tertiles with the 4-m walking-speed and the SPPB score was still consistent. CONCLUSION: The present study suggests that among very old subjects living in the community the higher levels of HDL-cholesterol are associated with better functional performance.     

The relationship between grip strength and muscle mass (MM), inflammatory biomarkers and physical performance in community-dwelling very old persons

The main consequence of the loss of MM and muscle strength is limitations of physical performance and disability in older people. It is unclear whether a decline in functional capacity results from the loss of MM and/or the qualitative impairment of the muscle tissue. The aim of our research was to investigate the relationship between physical performance and grip strength, inflammatory markers and MM in a population of community-dwelling very old persons. This study is a cross-sectional analysis within the BELFRAIL-study, a cohort study of subjects aged 80 years and older (n = 567). MM was assessed by bioelectrical impedance. Interleukin-6 (IL-6) and tumor necrosis factor-α (TNF-α) concentrations were determined on fasting blood samples. Logistic regression analysis was build using a low physical performance level evaluated according to Short Physical Performance Battery (SPPB) (dependent variable) and grip strength, pro-inflammatory status and MM (independent variables) adjusted for age and for the total number of chronic diseases. Low SPPB scores were associated with grip strength scores for women (OR 0.86 (95% CI 0.77–0.96)), and for men (OR 0.89 (95% CI 0.81–0.96)). The relationships between low SPPB and MM or inflammatory profile were not significant. Our results show that low physical performance remains associated with low grip strength even after considering other risk factors for sarcopenia in the oldest old and support the hypothesis that low muscle strength is a better indicator than low MM. The role of an inflammatory component in the age-related loss of muscle strength and function could not be confirmed.