Temporal trends in self-reported functional limitations and physical disability among the community-dwelling elderly population: the Framingham heart study

Objectives. We sought to determine change in the prevalence of functional limitations and physical disability among the community-dwelling elderly population across 3 decades.Methods. We studied original participants of the Framingham Heart Study, aged 79 to 88 years, at examination 15 (1977–1979; 177 women, 103 men), examination 20 (1988–1990; 159 women, 98 men) and examination 25 (1997–1999; 174 women, 119 men). Self-reported functional limitation was defined using the Nagi scale, and physical disability was defined using the Rosow-Breslau and Katz scales.Results. Functional limitations declined across examinations from 74.6% to 60.5% to 37.9% (P < .001) among women and from 54.2% to 37.8% to 27.8% (P<.001) among men. Physical disability declined from 74.5% to 48.5% to 34.6% (P < .001) among women and 42.3% to 33.3% to 22.8% (P = .009) among men. Among women, improvements in functional limitations (P = .05) were greater from examination 20 to 25, whereas for physical disability (P=.02), improvements were greater from examination 15 to 20. Improvements in function were constant across the 3 examinations in men.Conclusions. Among community-dwelling elders, the prevalence of functional limitations and physical disability declined significantly in both women and men from the 1970s to the 1990s. This may in part be due to improvements in technological devices used to maintain independence. Further work is needed to identify the underlining causes of the decline so preventative measures can be established that promote independence for the elderly population.National surveys and epidemiological studies have reported a significant decline in self-reported functional limitations and physical disability among older adults.1^–7 Despite consensus among reports, uncertainty exists with regard to the magnitude, rate, and specific characteristics of the disability decline.5^,6^,8 Variations in study samples, evolving measures of functional limitation and disability, and differences in study questions and responses contribute to the inconsistencies in disability trends.5^,6 Furthermore, disparities exist in the improvement in function, with marked variations according to age, gender, race, and socioeconomic and educational attainment.1^,9^,10 Compared with men, women report greater difficulty with physical function and less recovery from disability.1 Surveys have reported that declines in functional limitations occurred only among women11 or were larger among women than among men,12 whereas others note that disability declines were about the same among women and men.3^,13 Thus, it remains unclear if the disability gaps between men and women have narrowed or remained stable over time.4The causes for the improved disability trends are not well understood. One possible explanation is the “compression of morbidity” hypothesis, whereby disease and disability are postponed until the end of the lifespan.14^,15 However, the consequences of an increase in life expectancy in the United States in relation to the overall health of older adults continue to be debated. Other divergent paradigms have been proposed to describe the possible health-related consequences of living longer, including a rise in chronic disease and disability16 and a dynamic equilibrium whereby declines in mortality result in increases in chronic disease with lesser severity and disability.17^,18We obtained self-reported information on functional limitations and physical disability among surviving members of the original cohort of the Framingham Heart Study in late life (aged 79–88 years) who attended research examinations over 3 points in time from the 1970s to the 1990s. We hypothesized that the prevalence of functional limitations and physical disability would decline over time among elders, with a greater decline among women than among men. Our study cohort is particularly well suited for this investigation, because the Framingham Disability Study19 introduced questionnaires to measure self-reported functional limitations and physical disability beginning in 1976 that were repeated on successive examinations. Moreover, this cohort has been well characterized for over 50 years, with documentation of validated medical conditions and measurement of risk factors.     

Body mass index and disability in adulthood: a 20-year panel study

OBJECTIVES: This study examined whether body mass index (BMI) or change in BMI raises the risk of disability in adulthood. METHODS: The relation between BMI and upper- and lower-body disability was examined among adult subjects from a national longitudinal survey (n = 6833). Tobit regression models were used to examine the effect of BMI on disability 10 and 20 years later. RESULTS: Obesity (BMI > or = 30) at baseline or becoming obese during the study was associated with higher levels of upper- and, especially, lower-body disability. In persons who began the study with a BMI of 30 or more and became normal weight, disability was not reduced. Underweight persons (BMI < 18.5) also manifested higher disability in most instances. CONCLUSIONS: Disability risk was higher for obese persons, but overweight was not consistently associated with higher disability.     

Midlife adults with functional limitations: Comparison of adults with early- and late-onset arthritis-related disability

Background

Arthritis is the most common cause of disability among U.S. adults.

Severe developmental disability and the transition to adulthood

BackgroundDevelopmental disabilities are serious and long-lasting. There are few studies of developmental disability in the transition to adulthood, when the programs that provided support in childhood may no longer be available.ObjectiveWe studied associations of long-lasting developmental disabilities with health, behaviors, and well-being in adulthood.MethodsWe used the Panel Study of Income Dynamics (1968–2017), its Child Development Supplement (CDS, 1997, 2002, 2007), and its Transition into Adulthood Supplement (TAS, every-other year, 2005–2017) (n = 2702) following a national sample from childhood through age 28, defining serious developmental disabilities using diagnoses and reports from parents, teachers, schools, children, and young adults. We tested differences in proportions using Chi-square tests, estimated differences in least squares means, and used logistic regression to compare results for those with and without developmental disabilities. We adjusted results for age, sex, race, immigrant status, family income, region, metropolitan statistical area, educational attainment, and employment status, accounting for sampling weights and survey design.ResultsAt ages 18–21, 8.2% had serious developmental disability (95% confidence interval, CI 6.6–9.8). They were more likely to report: no high school graduation (19.3% vs. 4.3%), being assaulted physically (32.1% vs. 20.4%) or sexually (14.4% vs. 6.6%), serious criminal arrests (25.7% vs. 13.2%), smoking (30.8% vs. 12.8%), sedentariness (5.8% vs. 1.1%), obesity (39.2% vs. 23.4%), diabetes (9.1% vs. 2.1%), and work disability (18.7% vs. 4.3%) (all p < 0.01) compared to peers without developmental disability.ConclusionsResults indicate opportunities to promote education, self-direction, safety, and well-being for people transitioning to adulthood with serious developmental disabilities.     

The relationship of functional limitations to disability and the moderating effects of psychological attributes in community-dwelling older persons

This paper examines the moderating effects of three psychological attributes (neuroticism, self-efficacy expectancies and mastery) on the association between functional limitations (motor and cognitive limitation, vision and hearing loss) and disability ((instrumental) activities of daily living, role function and social function) in a sample of 624 community-dwelling older persons. In contrast to our hypothesis, we did not find any evidence for interaction effects. This means that low levels of psychological resources do not exacerbate the effect of functional limitation on disability in community-dwelling older persons. We found significant unique contributions of the psychological attributes to disability. Even when all three psychological attributes were taken into account, neuroticism and mastery had unique effects on social and role function, and self-efficacy expectancies had unique effects on (instrumental) activities of daily living. We conclude that the effects of functional limitation and psychological attributes on disability can be considered as additive. Older persons with less psychological resources are particularly at risk in developing disability.     

Socioeconomic position in childhood and in adulthood and functional limitations in midlife: Data from a nationally-representative survey of French men and women

Research shows that lifetime socioeconomic circumstances are associated with adult health. Yet most studies to date have focused on mortality and additional data on morbidity outcomes are needed. Additionally, most research in this area has been conducted in Northern European countries or in the United States, and less is known about the extent of socioeconomic inequalities in health in other industrialized countries with different health and labour market characteristics. In this study, we examined the relationship between the socioeconomic trajectory from childhood to adulthood and functional limitations in midlife in France. We used data from a nationally-representative sample of French men and women conducted in 2002-2003 (the Life History survey). Participants (n = 4798) were 35-64 years of age at the time of the survey. standardized morbidity ratios (SMRs) associated with different lifelong trajectories were estimated using indirect age standardization. Overall, the socioeconomic trajectory from childhood to adulthood was associated with functional limitations in midlife in both men and women. The experience of lifelong socioeconomic disadvantage was associated with SMRs of 1.44, p < 0.0001 in men and 1.21, p = 0.0207 in women. In men, the prevalence of functional limitations was low among those who experienced upward intergenerational mobility and high among those who experienced a downward trajectory during the course of their professional career. Additionally, the prevalence of functional limitations was elevated among men and women who experienced unemployment. These findings indicate that in French men and women, lifetime socioeconomic circumstances are associated with functional limitations in midlife. Understanding the mechanisms that underlie these health disparities will require additional studies of specific health outcomes.     

Family history of coronary heart disease and pre-clinical carotid artery atherosclerosis in African-Americans and whites: the ARIC study: Atherosclerosis Risk in Communities

The association between family history of coronary heart disease (CHD) and morbidity and mortality due to atherosclerotic sequelae, although well documented in population-based samples of whites, has been little studied in African Americans. Less is known about the relationship between a family history of CHD and pre-clinical atherosclerosis. We report the relation between family history of CHD, summarized in a family risk score (FRS), and asymptomatic atherosclerosis at the extracranial carotid arteries, measured by B-mode ultrasound. The FRS was assessed in relatives of 3,034 African Americans and 9,048 white probands aged 45 to 64 years, in the four community-based cohorts of the ARIC Study. The analyses were restricted to individuals free of clinically manifest CHD. The distribution of CHD FRS by ethnic-gender groups was right skewed, with slightly higher mean values for white than African-American males, and for African-American than white females. In a series of multivariate linear regression models with mean carotid artery intima-media wall thickness (IMT) as the dependent variable, FRS was associated positively with IMT in white and African-American women and white men. In a multiple regression model, approximately one-half of the quantitative statistical relationship of the CHD FRS with IMT in whites was statistically explained by the major risk factors considered as intervening, explanatory variables in this analysis. This association in African-American women was fully explained by the major risk factors. The FRS was not, however, associated with atherosclerosis or major risk factors in African-American males, in the ARIC Study.     

Dairy, fruit, and vegetable intakes and functional limitations and disability in a biracial cohort: the Atherosclerosis Risk in Communities Study

BACKGROUND: Dairy, fruit, and vegetable intakes may be associated with functional limitations and disability through their role in muscle function, osteoporosis, and prevention of the oxidative damage associated with aging and chronic disease. OBJECTIVE: The associations between dairy, fruit, and vegetable intakes and functional limitations and disability were examined in African Americans and whites (baseline age: 45-64 y; n=9404) in the Atherosclerosis Risk in Communities (ARIC) Study. DESIGN: Logistic regression analyses were used to ascertain the associations between usual dairy, fruit, and vegetable intakes obtained at baseline by using a food-frequency questionnaire and lower-extremity function, activities of daily living (ADLs), and instrumental ADLs (IADLs) self-reported approximately 9 y later in models stratified by race and sex. RESULTS: Baseline dairy, fruit, and vegetable intakes tended to be inversely associated with impaired lower-extremity function, ADLs, and IADLs approximately 9 y later, particularly in African American women. For example, in African American women, baseline dairy intakes were inversely associated with impaired ADLs and IADLs [odds ratio (95% CI): 0.60 (0.40, 0.90) and 0.69 (0.48, 0.98), respectively [corrected] in the 3rd versus the [corrected] 1st tertile of intake (P [corrected] for trend<0.05]. Combined baseline intakes of fruit and vegetables were also inversely associated with impaired lower-extremity function, ADLs, and IADLs [odds ratio (95% CI): 0.67 (0.47, 0.95), 0.52 (0.36, 0.76), and 0.64 (0.45, 0.90), respectively; P for trend<0.05]. CONCLUSIONS: Dairy, fruit, and vegetable intakes may be inversely associated with functional limitations and disability. Further research is needed to ascertain the effect of diet on subsequent functional limitations and disability.     

Work organization and atherosclerosis: Findings from the ARIC study

Introduction: The aim of this investigation was to examine the extent to which work organization (i.e., occupational stress) is associated with subclinical carotid atherosclerosis.Methods: For that purpose we used a cross-sectional study of four U.S. community samples conducted between 1987 and 1989. Participants in the study were 10,801 adults aged 45 to 64 years. Subclinical carotid atherosclerosis was assessed by measuring the intima-media thickness (IMT) of the carotid artery wall using B-mode ultrasound. Occupational stress was defined using six indicators: substantive complexity of work, physical demands, job insecurity, skill discretion, decision authority, and physical exertion. Information from U.S. national surveys on occupational stress indicators was linked to the study participants' occupation.Results: We observed negative associations of complexity of work and skill discretion with mean IMT of the carotid artery wall among the four race-gender groups. In addition, physical demands was positively associated with mean IMT among blacks and job insecurity was positively associated with IMT among white women and black men. After adjustment for well-established risk factors, the magnitude of these associations was substantially reduced.Conclusions: Taken in combination with results from recent European studies, our findings suggest that work organization plays a role in the etiology of atherosclerosis.     

Heritability of body mass index in pre-adolescence, young adulthood and late adulthood

Increased body mass index (BMI) is a worldwide health issue. Individual differences in the susceptibility to increased BMI could be related to genes or environment. We performed a systematic review of genetic studies on BMI in pre-adolescence, young adulthood and late adulthood. We searched PubMed and EMBASE with heritability, body mass index, BMI, weight, height, anthropometry and twins as search terms. Studies reporting intra-pair correlations of healthy twin pairs that were raised together were included. This resulted in the inclusion of 8,179 monozygotic (MZ) and 9,977 dizygotic (DZ) twin pairs from twelve published studies in addition to individual participant data for 629 MZ and 594 DZ pairs from four twin registries. Structural equation modelling with intra-pair twin correlations showed that the heritability of BMI remained high over all age categories ranging from 61% (95% CI 54-64%) to 80% (95% CI 76-81%) for male and female subjects combined, while unique environmental influences increased from 14% (95% CI 13-15%) to 40% (95% CI 37-43%) with increasing age. Heritability of BMI remains consistently high over different age categories. Environmental changes over time do not seem to have as big a relative impact on an individual's weight as previously reported, suggesting a mainly genetic influence on variation in BMI over the years.     

Borderline personality and weight divergence in adulthood

Borderline personality disorder (BPD) is an Axis II dysfunction characterized by extremist thinking (i.e., black/white thinking and thinking in absolutes). In keeping with this cognitive style, and based upon our clinical observations, we wondered whether a possible behavioral marker of extremism, weight divergence (i.e., a large difference between lowest and highest weights in adulthood), might be associated with BPD. Among 95 women psychiatric inpatients, we explored lowest adult weight, current weight, and highest adult weight as well as BPD using two self-report measures for the disorder, the borderline personality disorder scale of the Personality Diagnostic Questionnaire-4 (PDQ-4) and the Self-Harm Inventory (SHI). Results indicated statistically significantly correlations between increasing weight divergence and both BPD measures. Further analyses indicated that this relationship was not explained by overall body size or history of binge eating behavior. Findings suggest that, among psychiatric inpatients, weight divergence in adulthood may be a potential indicator of BPD.     

出生体重与成年期体格指标的双生子研究

目的 研究出生体重与成年期体格指标（BMI、腰围）表型的相关性,分解相关性可能的来源。方法 本研究使用中国双生子登记系统基线调查的年龄在25~79岁间的同性别双生子对（共6 623对）,通过问卷调查收集其出生体重、目前身高、体重及腰围。采用双生子对内对照设计的方法探索出生体重与成年期体格指标的相关性,采用结构方程模型分解相关性的来源。结果 在调整多种混杂因素后,同卵双生子对内分析结果显示出生体重每增加1.0 kg,成年后BMI增加0.33 kg/m²,腰围增加0.95 cm。结构方程模型结果显示出生体重与BMI、腰围均存在双生子个体特有环境因素的相关。结论 该研究支持成年期体格指标与出生体重的相关受双生子间特有因素的影响。     

中国人群成年期体重变化现况分析

目的 描述中国慢性病前瞻性研究（CKB）队列人群的成年期体重变化状况及其地区和人群差异。方法 采用自行设计的电子问卷进行面对面基线调查，收集调查对象25岁体重以及社会人口学特征、生活方式等信息，并测量调查对象当前体重。本研究剔除基线自报患有慢性病、重要变量缺失、年龄<35岁或者>70岁的个体，最终纳入360 903名研究对象。成年期体重变化定义为当前体重与25岁时体重的差值。结果 研究对象成年期平均增重4.9 kg。城市地区人群增重高于农村地区，北方地区高于南方地区。10个项目点中，青岛项目点成年期平均增重量最大（9.3 kg），甘肃项目点最低（1.5 kg）。出生年代越早者，25岁BMI较高。成年期增重量在45～50岁组最高。在调整了年龄和地区后，不同文化程度、职业、家庭年收入、体力活动水平、吸烟情况人群的成年期体重变化的分布差异有统计学意义（P<0.001）。25岁时BMI水平越高者，成年期增重量越小；当前BMI水平越高者，成年期增重量越大（趋势P<0.001）。结论 CKB项目10个地区研究人群成年期体重变化存在明显的地区和人群差异。     

Television, physical activity, diet, and body weight status: the ARIC cohort

Objective

This study investigated the construct validity of a computerised self-assessment tool to measure psychological, social and environmental influences of young peoples' physical activity. First, analyses of the measure's factorial validity, invariance across, age, gender culture were conducted. Second, the ability of the derived subscales to discriminate between children representing different levels of self-reported and objectively measured physical activity behaviour was examined.

Methods

Participants were 1875 boys and 2078 girls (total = 3958) aged 9–10 years (n = 1955, mean age = 9.65 ± 0.42) and 15–16 years (n = 2003, mean age = 15.49 ± 0.50) from four European countries in Northern, Southern and Eastern Europe who took part in the European Youth Heart Study (EYHS). Children completed the computerised self-assessment tool with support from the researcher if requested. Self-reported exercise and an objective measure of physical activity (Actigraph model 7164) were used for additional construct validation purposes.

Results

Overall evidence of good fit indicating satisfactory factorial validity and cross-cultural, age and gender invariance for 3 of the 4 measurement models were obtained. The majority of measures were also significantly different for those with high versus low levels of physical activity.

Conclusion

Overall, the computerised questionnaire holds promise for use cross-culturally with male and female children and adolescents to measure perceived personal, social and environmental influences on physical activity. Further development of the measures pertaining to perceived environmental influences seems warranted.     

Intimate partner violence in late adolescence and young adulthood and subsequent cardiovascular risk in adulthood

BackgroundChildhood maltreatment has been linked to adulthood cardiovascular disease (CVD). Little is known about the relationship between intimate partner violence (IPV) in late adolescence and young adulthood and CVD risk later in adulthood.PurposeTo examine whether IPV perpetration and victimization experienced in late adolescence and young adulthood are associated with CVD risk among adults in the United States and whether this relationship differs by sex.MethodsData include 9976 participants (50% female) in the National Longitudinal Study of Adolescent to Adult Health. Physical and sexual IPV were measured at wave 3 (2001/02) with items from the revised Conflict Tactics Scales. Participants'30-year risk of CVD was calculated at wave 4 (2008/09) using a Framingham prediction model. Linear regression models adjusted for confounders and IPV by sex interaction terms were tested to examine the relationship.ResultsThe mean CVD risk score was 13.18% (95% CI: 12.71, 13.64). Aone-standard deviation increase in the victimization score was associated with a 0.28% (95% CI: 0.03, 0.54) increase in CVD risk. Perpetration was similarly positively associated with CVD risk (beta: 0.33, 95% CI: 0.03, 0.62). When measured as a composite, all violence types were associated with increased CVD risk but only prior exposure to both victimization and perpetration reached statistical significance (0.62%, 95% CI: 0.01, 1.22). No differences by sex were detected.ConclusionsEffect sizes are not large, but early detection of increased CVD risk in this relatively young population is notable and worthy of further study to inform the clinical response.     

Functional limitations and disability among elders in the Framingham Study.

BACKGROUND. The measurement of physical disability as an indication of the impact of disease is commonly seen in research. However, these measures often do not clearly differentiate between functional limitations and daily performance of an activity. METHODS. We measured the differences between self-reported disability and observed functional limitations in six activities of daily living tasks among community-dwelling elders. The value of functional limitations vs disability measures in determining risk factors for disablement was ascertained. RESULTS. Systematic differences were found among the 1453 participants. At least 89% of the time when a difference was identified, the subjects ranked disability greater than the functional limitations observed. For those who were cognitively impaired, discrepancies occurred up to 11% of the time. In determining risk factors for disablement, we found that neurological impairments were associated with both functional limitations and disability, while sociocultural factors were associated with disability only. CONCLUSIONS. Our findings suggest that physical functional limitations and disability in the elderly are two distinct concepts and that the measure of choice should be determined by research objectives and the type of population being studied.     

Importance of preventing weight gain in adulthood

In the last 20 years, there has been a dramatic upsurge in the average weight of Australian adults. In this period, on average, Australian women have gained 4.8 kg, whilst Australian men have gained 3.6 kg. Consequently, the prevalence of obesity in men has increased from 8% to 19% and in women from 7% to 21%. This threatens to wipe away many recent health gains, as obesity has been associated with a wide range of chronic and debilitating illnesses, such as diabetes, heart disease, some cancers, sleep apnoea and osteoarthritis. Any weight gain in adulthood is usually as a result of an increase in fat stores, and the risk of ill-health from increasing weight actually begins at quite low BMI. Unfortunately, weight gain can be difficult or slow to reverse in the middle years because of physiological and behavioural changes that occur at this time of life. Adults should focus on preventing or minimizing weight gain over time by retaining physical activity within their daily living and by sensible dietary changes. Even if weight gain does occur with age, a regimen of regular exercise and a diet rich in fruit and vegetables and low in fat will provide some protection against a rapid decline in health.