Comparisons Between Older Men and Women in the Trajectory and Burden of Disability Over the Course of Nearly 14 Years

ObjectivesAcross the life span, women live longer than men but experience higher rates of disability. To more completely evaluate these gender differences, the current study set out to compare the trajectories and burden of disability over an extended period between older men and women.DesignProspective, longitudinal study with 13.5 years of follow-up.SettingGreater New Haven, Connecticut.ParticipantsParticipants were 754 persons, aged 70 years or older, who were initially community-living and nondisabled in their basic activities of daily living.MeasurementsDisability in 13 basic, instrumental, and mobility activities was assessed during monthly interviews, whereas demographic and clinical covariates were measured during comprehensive assessments every 18 months.ResultsFive distinct trajectories were identified over successive 18-month intervals: independent, mild disability, mild to moderate disability, moderate disability, and severe disability. Women were more likely than men to experience the moderate and severe disability trajectories, but were less likely to transition from the independent trajectory to a worse disability trajectory during the subsequent 18-month interval. Women were also less likely to die after each of the five trajectories, and these differences were at least marginally significant for all but the independent trajectory. Over the entire duration of follow-up, women suffered from a greater burden of disability than men, but these differences were greatly attenuated after adjustment for the baseline levels of disability.ConclusionsGender differences in disability over an extended period can be explained, at least in part, by the higher mortality experienced by older men and the higher initial levels of disability among older women. These results suggest the need to take a life-course approach to better understand gender differences in disability.     

Gender equality in global health leadership: Cross-sectional survey of global health graduates

ABSTRACT

Women comprise two-thirds of the global-health (GH) workforce but are underrepresented in leadership. GH departments are platforms to advance gender equality in GH leadership. Using a survey of graduates from one GH department, we compared women’s and men’s post-training career agency and GH employment and assessed whether gender gaps in training accounted for gender gaps in career outcomes. Master-of-Public-Health (MPH) and mid-career-fellow alumni since 2010 received a 31-question online survey. Forty-four per cent of MPH alum and 24% of fellows responded. Using logistic regression, we tested gender gaps in training satisfaction, career agency, and GH employment, unadjusted and adjusted for training received. Women (N?=?293) reported lower satisfaction with training (M7.6 vs 8.2) and career agency (leadership ability: M6.3 vs 7.4) than men (N?=?60). Women more often than men acquired methods-related skills (95% vs 78%), employment recommendations (42% vs 18%), and group membership. Men more often than women acquired leadership training (43% vs 23%), award recommendations (53% vs 17%), and conference support (65% vs 35%). Women and men had similar odds of GH employment. Accounting for confounders and gender-gaps in training eliminated gender gaps in five of six career-agency outcomes. Panel studies of women’s and men’s career trajectories in GH are needed.     

Physical activity growth curves relate to adiposity in adolescents

PurposeFindings from prospective studies on associations between physical activity and adiposity among youth are inconsistent. Our aim was to describe physical activity trajectories during secondary school and examine the association with change in adiposity in youth.MethodsPhysical activity was measured in 20 survey cycles from 1999 to 2005; anthropometrics were measured in survey cycles 1, 12, and 19. Individual growth curves modeling moderate-to-vigorous physical activity (MVPA) and vigorous physical activity (VPA) were estimated. Estimates of initial level and rate of decline in MVPA and VPA bouts per week were included as potential predictors of body fat% and body mass index using age- and sex-specific linear regression.ResultsComplete data were available for 840 and 760 adolescents aged 12–13 years at baseline, followed from survey cycles 1–12 and 12–19, respectively. Among girls, yearly declines of one MVPA and one VPA bout per week during earlier adolescence were associated with increases of 0.19 (95% confidence interval [CI], 0.02–0.36) and 0.47 (95% CI, 0.015–0.92) units of body fat%, respectively. In boys, a yearly decline of one MVPA bout per week was associated with an increase of 0.38 (95% CI, 0.05–0.70) units of body fat% during later adolescence.ConclusionsObesity prevention programs should include strategies to prevent declines in physical activity.     

Identification and prediction of physical activity trajectories in women treated for breast cancer

PurposeIn this study, we aimed to identify trajectories of physical activity in a cohort of women over a 1-year period after treatment for breast cancer. We also examined factors that could predict trajectory group membership.MethodsWe collected data from 199 women using questionnaires at baseline (mean = 3.46 months after treatment), and 3, 6, 9, and 12 months thereafter.ResultsBased on semiparametric group-based modeling, there were five trajectories: consistently inactive, decreasing levels, inactive with increasing levels, somewhat active, and consistently sufficiently active. Based on logistic regression analysis, women who reported higher levels of depressive symptoms and fatigue were less likely to remain consistently sufficiently active, and women who reported higher levels of cancer worry were more likely to remain consistently sufficiently active. Age, stage of cancer, time since treatment, number of treatment types received, and number of physical symptoms did not predict trajectory group membership.ConclusionsWomen do not have uniform physical activity trajectories after treatment for breast cancer. Identification subgroups of women who do not remain consistently sufficiently active, and factors that predict these trajectories, can aid in the development of targeted behavior change interventions.     

The Clinical Potential of Frailty Indicators on Identifying Recurrent Fallers in the Community: The Mr. Os and Ms. OS Cohort Study in Hong Kong

ObjectivesTo compare the clinical value of 3 frailty indicators in a screening pathway for identifying older men and women who are at risk of falls.DesignA prospective cohort study.Setting and participantsFour thousand Chinese adults (2000 men) aged ≥65 years were recruited from the community in Hong Kong.MethodsThe Cardiovascular Health Study Criteria, the FRAIL scale, and the Study for Osteoporosis and Fracture Criteria (SOF) were included for evaluation. Fall history was used as a comparative predictor. Recurrent falls during the second year after baseline was the primary outcome. The area under the receiver operating characteristic curve (AUC) was used to evaluate the ability of the frailty indicators and fall history to predict recurrent falls. Independent predictors identified in logistic regression were put in the Classification and Regression Tree (CART) analysis to evaluate their performance in screening high-risk fallers.ResultsFall history predicts recurrent falls in both men and women (AUC: men = 0.681; women = 0.645) better than all frailty indicators (AUC ≤ 0.641). After adjusting for fall history, only FRAIL (AUC = 0.676) and SOF (AUC = 0.673) remained as significant predictors for women whereas no frailty indicator remained significant in men.FRAIL could classify older women into 2 groups with distinct chances of being a recurrent faller in people with no fall history (3.8% vs 7.5%), a single fall history (9.5% vs 37.5%), and history of recurrent falls (16.0% vs 30.8%). SOF has limited ability in identifying recurrent fallers in the group of older adults with a single fall history (no fall history: 3.9% vs 8.6%; single fall history: 10.2% vs 10.9%; history of recurrent falls: 16.5% vs 20.6%).Conclusions and implicationsSOF and FRAIL could provide some additional prediction value to fall history in older women but not men. FRAIL could be clinically useful in identifying older women at risk of recurrent falls, especially in those with a single fall history.     

Social Isolation and Loneliness as Risk Factors for Grip Strength Decline Among Older Women and Men in China

ObjectiveThe purpose of this study was to examine the relationships of social isolation and loneliness, both individually and simultaneously, on changes in grip strength among Chinese older adults and whether these relations vary by gender.DesignA 4-year prospective observational study.Setting and ParticipantsThis study used data from the China Health and Retirement Longitudinal Study (CHARLS). Analyses were conducted with data from 2 waves (2011 and 2015) and were restricted to those respondents aged 50 and older [n = 7025, mean age (SD) = 61.46 (7.59); male, 48.4%].MethodsSocial isolation, loneliness, and grip strength were measured at baseline. Follow-up measures of grip strength were obtained 4 years later. Multiple linear regression was used to evaluate the associations among baseline isolation, loneliness, and decline of grip strength between 2 waves after adjustment for age, gender, education, body mass index, chronic diseases, smoking and drinking status, activities of daily living (ADL) and instrumental ADL disabilities, and depressive symptoms.ResultsFor women, baseline loneliness (β = 0.04, P = .035) rather than isolation (β = 0.03, P = .110) significantly predicted grip strength decline after 4 years when other confounding variables were taken into account. For men, baseline isolation (β = 0.05, P = .005) rather than loneliness (β = 0.01, P = .570) significantly predicted grip strength decline. No synergistic effect of isolation and loneliness on grip strength was found for either women or men.Conclusions and ImplicationsIn this prospective study, gender differences were found for the associations of social isolation and loneliness with grip strength decline. Our results suggest that older women and men may benefit from different social enhancement strategies for prevention of physical function decline.     

Low Skeletal Muscle Mass and Risk of Functional Decline in Elderly Community-Dwelling Women: The Prospective EPIDOS Study

ObjectivesTo assess relationships between low skeletal muscle mass (SMM) and functional decline in community-dwelling elderly women.DesignSecondary analysis of data from EPIDOS, a French prospective observational multicenter cohort study of osteoporosis epidemiology.SettingOne center in France between 1992 and 1994.ParticipantsWomen aged 75 years or older without disability and with available baseline SMM measurements.MeasurementsSMM was assessed using dual-energy X-ray absorptiometry and functional decline was defined as loss of at least one Instrumental Activity of Daily Living component. Associations linking low SMM to functional decline were estimated using the Cox proportional hazards model.ResultsOf 975 women followed for 4 years, 452 (46.4%) experienced functional decline. Factors independently associated with functional decline were decreased SMM (adjusted hazard ratio [aHR] per SD decrease, 1.12; 95% confidence interval [95% CI], 1.01–1.24), older age (aHR per SD increase, 1.28; 95% CI, 1.17–1.39), one or more comorbidities (aHR, 1.65; 95%CI, 1.05–2.59), and impaired chair-stand test (aHR, 1.35; 95% CI, 1.01–1.82). The second SMM quartile was associated with functional decline (aHR, 1.39; 95% CI, 1.06–1.84) and the lowest quartile showed a nearly significant association (aHR, 1.29; 95% CI, 0.98–1.72). Factors negatively associated with functional decline were living alone (aHR, 0.76; 95% CI, 0.59–0.96), higher handgrip strength (aHR per SD increase, 0.88; 95% CI, 0.78–0.88), and walking speed (aHR per SD increase, 0.86; 95% CI, 0.77–0.96).ConclusionLow SMM was independently associated with functional decline within 4 years after adjustment for age, muscle strength, physical performance, and comorbidities in community-dwelling elderly women.     

中国50岁及以上人群衰弱轨迹的研究

目的 识别中国≥50岁人群的衰弱轨迹，并探索相关影响因素。方法 采用WHO“全球老龄化与成人健康研究”（SAGE）中国项目第一至第三轮纵向数据，由32种变量计算衰弱指数得分，并在此基础上在组基轨迹模型中采用删失正态模型确定随时间变化的衰弱轨迹模式，采用多项式logistic回归模型研究社会经济地位和行为影响因素对衰弱轨迹的影响。结果 共纳入4 303名≥50岁且拥有3轮完整数据的调查对象进入分析，本研究识别出3条衰弱轨迹：低水平稳定轨迹（LT）、中度增加轨迹（MT）和高度增加轨迹（HT），分别占所有调查对象的75.9%，19.1%和5.0%。多项式logistic回归分析的结果显示，与LT组相比，HT组更倾向是女性（OR=1.88，95%CI：1.22~2.92）和农村居民（OR=1.87，95%CI：1.29~2.70）。在家庭人均财富方面，OR值有一个明显的梯度，较低的家庭财富更有可能归为HT组。结论 本研究识别出了3种我国≥50岁人群衰弱轨迹的进展模式，并强调了干预措施应尽可能地以那些衰弱进展快速的脆弱人群为目标。     

Physical and occupational therapy utilization and associated factors among adults with cerebral palsy: Longitudinal modelling to capture distinct utilization groups

BackgroundAdults with cerebral palsy (CP) experience functional declines. Clinical rehabilitation may preserve function for this population.ObjectiveTo identify longitudinal physical/occupational therapy use and associated factors among adults with CP, to inform health promotion strategies.MethodsA retrospective cohort study including adults ≥ 18 years of age with CP was performed using a random 20% Medicare fee-for-service dataset. Participants with continuous medicare enrolment from 01/01/2016-12/31/2018 were included: 2016 was the one-year baseline period; 2017–2018 was the two-year follow-up. Therapy included an indication of physical, occupational, or other forms of therapy. Two-year therapy use patterns were identified using group-based trajectory modeling. Multivariable multinomial logistic regression models identified associations between baseline characteristics with trajectory groups.ResultsOf 17,441, 7231 (41.5%) adults with CP had therapy use across the three-year period, and six longitudinal therapy trajectories were identified: the majority (42.5%) were low-consistent users, 13.4% moderate-consistent users, 4.4% high-consistent users, and the remaining variable users. Associations between baseline characteristics (e.g., age, sex, comorbidities) with trajectory groups varied. For example, using the low-consistent users as the reference, Black versus White were 49% less likely, Northeast versus South residency were 7.52-fold more likely, and co-occurring neurologic conditions versus CP only were up to 118% more likely to be high-consistent users (all, P < 0.05). Bone fragility and some chronic comorbidities were associated with moderate consistent users.ConclusionsThe majority of adults with CP were not using physical/occupational therapy. Of those that did, there were unique longitudinal trajectories which associated differently with demographics and comorbidities.     

Gender Differences in Cardiovascular Risk Factors in Incident Diabetes

BackgroundCardiovascular disease is a major cause of morbidity and mortality for women and men with diabetes. Previous cross-sectional studies of prevalent diabetes have found that women are less likely to meet American Diabetes Association (ADA) and American Heart Association guidelines for control of cardiovascular risk factors (hemoglobin A1c, low-density lipoprotein [LDL] cholesterol, and blood pressure), but have not studied the critical period immediately after diagnosis.MethodsTo assess gender differences in cardiovascular risk factors at the time of diabetes diagnosis (baseline) and 1 year later (follow-up), we conducted a retrospective cohort study of 6,547 individuals with incident diabetes in an integrated care delivery system. We assessed mean cardiovascular risk factor values by gender and adjusted odds ratios of attaining ADA goals.FindingsCompared with men, at baseline women had lower hemoglobin A1c (7.9% vs. 8.2%; p < .001), higher LDL cholesterol (118.9 vs. 111.5 mg/dL; p < .001), higher systolic blood pressure (131.9 vs. 130.5 mmHg; p < .001), and lower diastolic blood pressure (79.1 vs. 79.7 mmHg; p = .006). At follow-up, the hemoglobin A1c gender gap had closed (6.9% vs. 6.9%; p = .39), and the gender gaps had decreased for blood pressure (129.8/77.0 vs. 128.9/77.6; p = .009) and LDL cholesterol (104.0 vs. 98.2 mg/dL; p < .001). These associations varied by age. Adjusted odds ratios showed similar relationships.ConclusionsIn this cohort of individuals with incident diabetes, men and women had important differences in risk factor control at the time of diabetes diagnosis. These differences varied by age and decreased over time.     

Physical activity trajectories and cognitive function: A national cohort study

ObjectiveTo examine the prospective associations between physical activity trajectories, measured from repeated assessments over time, and cognitive function.MethodA total of 2972 participants aged 45 years old and over (median age: 56.0 [interquartile range - IQR 50.0–62.0], 50.8% males]) from the Chinese Health and Retirement Longitudinal Study (CHARLS) study were included. First, our study used the growth mixture modeling to identify physical activity trajectories from the first three surveys of the CHARLS. Second, we performed regression analysis to explore the associations of the trajectories with 3-year cognitive function.ResultsWe identified four physical activity trajectories, characterized by persistently low (N = 1880), initially low then increasing (154), initially moderate then decreasing (584), and initially high then decreasing (354). After 3-year follow-up, compared to individuals with persistently low trajectory, those with initially moderate then decreasing (β = −0.74, 95% CI = (−1.38, −1.10), p = 0.024) and initially high then decreasing (β = −1.12, 95% CI = (−1.91, −0.33), p = 0.005) were significantly associated with cognitive decline. The effects of the decline in physical activity on cognitive function varied by sex. Females’ cognitive function (β = −1.79, 95% CI = (−2.82, −0.77) was more likely to be influenced by decreasing physical activity, but this association was not significant in males. We did not find the significant effect of initially low then increasing trajectory on cognitive function.ConclusionsFast decline in physical activity is related to a higher risk of cognitive decline, especially in females.     

What Tools Can We Use to Screen for Fall Risk in Older Patients with Mild Cognitive Impairment? Findings from the MEMENTO Cohort

ObjectivesIdentifying risk factors for falls can improve outcomes in older patients without cognitive decline. Yet this has not been demonstrated in older people with mild cognitive impairment (MCI). We therefore sought to better identify risk factors for falls in this particular group.DesignThe analysis was conducted on the MEMENTO cohort, which is a large, French, prospective cohort.Setting and ParticipantsWe included older people (>65 years old) with MCI (defined from neuropsychological scores) and a Short Physical Performance Battery (SPPB) score at baseline.MethodsFallers were defined as participants having fallen at least once during the study's 2-year follow-up period. We compared clinical, neuropsychological, and biological data at baseline in fallers vs nonfallers. Additional analyses were performed on the following subgroups: women, men, people aged ≥75 years.ResultsOf the 1416 people included in our study, 194 (13.5%) fell at least once. A bivariate analysis showed that fallers were older, predominantly women, less independent in activities of daily living, and more apathetic. Fallers performed less well in executive function, balance, and gait tests. In a multivariable analysis, only age, gender, the number of limitations in instrumental activities of daily living, and living alone were significantly associated with falls. In a multivariable analysis of the subgroup of oldest patients and of the subgroup of men, executive function was significantly worse in fallers than in nonfallers.Conclusion and ImplicationsOur results demonstrate that easily attainable risk factors can be used to identify individuals with MCI with a higher risk of falls and for whom prevention could be beneficial. Future studies are needed to further evaluate the role of mild executive dysfunction in certain subgroups, such as men and oldest patients.     

Functional Trajectories in the Year Before Hospice

PURPOSEWe undertook a study to identify distinct functional trajectories in the year before hospice, to determine how patients with these trajectories differ according to demographic characteristics and hospice diagnosis, and to evaluate the association between these trajectories and subsequent outcomes.METHODSFrom an ongoing cohort study of 754 community-living persons aged 70 years or older, we evaluated data on 213 persons who were subsequently enrolled in hospice from March 1998 to December 2011. Disability in 13 basic, instrumental, and mobility activities was assessed during monthly telephone interviews through June 2012.RESULTSIn the year before hospice, we identified 5 clinically distinct functional trajectories, representing worsening cumulative burden of disability: late decline (10.8%), accelerated (10.8%), moderate (21.1%), progressively severe (24.9%), and persistently severe (32.4%). Participants with a cancer diagnosis (34.7%) had the most favorable functional trajectories (ie, lowest burden of disability), whereas those with neurodegenerative disease (21.1%) had the worst. Median survival in hospice was only 14 days and did not differ significantly by functional trajectory. Compared with participants in the persistently severe trajectory, those in the moderate trajectory had the highest likelihood of surviving and being independent in at least 1 activity in the month after hospice admission (adjusted odds ratio = 5.5; 95% CI, 1.9–35.9).CONCLUSIONSThe course of disability in the year before hospice differs greatly among older persons but is particularly poor among those with neurodegenerative disease. Late admission to hospice (as shown by the short survival), coupled with high levels of severe disability before hospice, highlight potential unmet palliative care needs for many older persons at the end of life.     

Trajectories of Depressive Symptoms Over 2 Years Postpartum Among Overweight or Obese Women

BackgroundAlthough depressive symptoms are common postpartum, few studies have followed women beyond 12 months postpartum to investigate changes in the number and severity of these symptoms over time, especially in overweight and obese women. Using two complementary analytical methods, this study aims to identify trajectories of depressive symptoms over 2 years postpartum among overweight or obese mothers, and assess the demographic, socioeconomic, and health covariates for these trajectories.MethodsUsing longitudinal data from two behavioral intervention studies (Kids and Adults Now!-Defeat Obesity [KAN-DO] and Active Mothers Postpartum (AMP); n = 844), we used latent growth modeling to identify the overall trajectory of depressive symptoms and how it was related to key covariates. Next, we used latent class growth analysis to assess the heterogeneity in the depressive symptom trajectories over time, and thereby, identify subgroups of women with distinct trajectories.FindingsThe overall trajectory of depressive symptoms over 2 years postpartum was relatively stable in our sample. However, the presence of three distinct latent class trajectories (stable-low [82.5%], decreasing symptoms [7.3%], and increasing symptoms [10.2%]), identified based on trajectory shape and mean depressive symptom score, supported heterogeneity in depressive symptom trajectories over time. Lower maternal education was related to a higher symptom score, and poorer subjective health status at baseline predicted inclusion in the increasing symptoms trajectory.ConclusionsIn some overweight or obese mothers, postpartum depressive symptoms do not resolve quickly. Practitioners should be aware of this phenomenon and continue to screen for depression for longer periods of time postpartum.     

Physical Exercise Improves Function in Acutely Hospitalized Older Patients: Secondary Analysis of a Randomized Clinical Trial

ObjectivesTo evaluate the effects of an exercise intervention on physical function, maximal muscle strength, and muscle power in very old hospitalized patients.DesignIn a randomized controlled trial, 130 hospitalized patients were allocated to an exercise intervention (n = 65) or a control group (n = 65). The intervention consisted of a multicomponent exercise training program performed during 5-7 consecutive days (2 sessions/d). The usual care group received habitual hospital care, which included physical rehabilitation when needed.Setting and participantsAcute care for elderly unit. Older adults age >75 years.MeasuresPhysical function, assessed with the Short Physical Performance Battery test and the Gait Velocity Test (GVT), were the primary endpoints. The GVT was also administered under dual-task conditions (ie, verbal and arithmetic GVT). The functional tasks were recorded using an inertial sensor unit to determine the movement pattern. The secondary endpoints were maximal muscle strength and muscle power output.ResultsThe exercise intervention program provided significant benefits over usual care. At discharge (primary time point), the exercise group showed a mean increase of 1.7 points in the Short Physical Performance Battery scale (95% confidence interval [CI] 0.98, 2.42) and 0.14 m·s-1 in the GVT (95% CI 0.086, 0.194) over the usual care group. The intervention also improved the verbal (0.151; 95% CI 0.119, 0.184 vs ?0.001; 95% CI –0.025, 0.033 in the control group) and arithmetic GVT (0.115; 95% CI 0.077, 0.153 vs ?0.004; 95% CI –0.044, 0.035). Significant benefits were also observed in the intervention group in movement pattern, as well as in muscle strength and muscle power.Conclusions and implicationsAn individualized multicomponent exercise training program improves physical function, maximal muscle strength, and muscle power in acutely hospitalized older patients. These findings support the importance of physical exercise for avoiding the loss of physical functional capacity that frequently occurs during hospitalization in older adults.     

Patients With Type 2 Diabetes Show a Greater Decline in Muscle Mass,Muscle Strength,and Functional Capacity With Aging

BackgroundThe loss of muscle mass with aging reduces muscle strength, impairs functional capacity, and increases the risk of developing chronic metabolic disease. It has been suggested that the development of type 2 diabetes results in a more rapid decline in muscle mass, strength, and functional capacity.ObjectiveTo investigate the impact of type 2 diabetes on muscle mass, strength, and functional capacity in an older population.MethodsMuscle mass (DXA and muscle biopsies), strength (1-repetition maximum), functional capacity (sit-to-stand test and handgrip strength), and reaction time performance (computer task) were compared between 60 older men with type 2 diabetes (71 ± 1 years) and 32 age-matched normoglycemic controls (70 ± 1 years). Data were analyzed using ANCOVA to adjust for several potential confounders.ResultsLeg lean mass and appendicular skeletal muscle mass were significantly lower in older men with type 2 diabetes (19.1 ± 0.3 and 25.9 ± 0.4 kg, respectively) compared with normoglycemic controls (19.7 ± 0.3 and 26.7 ± 0.5 kg, respectively). Additionally, leg extension strength was significantly lower in the group with type 2 diabetes (84 ± 2 vs 91 ± 2 kg, respectively). In agreement, functional performance was impaired in the men with type 2 diabetes, with longer sit-to-stand time (9.1 ± 0.4 vs 7.8 ± 0.3 seconds) and lower handgrip strength (39.5 ± 5.8 vs 44.6 ± 6.1 kg) when compared with normoglycemic controls. However, muscle fiber size and reaction time performance did not differ between groups.ConclusionOlder patients with type 2 diabetes show an accelerated decline in leg lean mass, muscle strength, and functional capacity when compared with normoglycemic controls. Exercise intervention programs should be individualized to specifically target muscle mass, strength, and functional capacity in the older population with type 2 diabetes.     

The relationship between body mass index and 10-year trajectories of physical functioning in middle-aged and older Russians: Prospective results of the Russian HAPIEE study

Objective

To investigate the associations of overweight and obesity with longitudinal decline in physical functioning (PF) among middle-aged and older Russians.

Design

Prospective cohort study.

Setting

Four rounds of data collection in the Russian Health, Alcohol and Psychosocial factors In Eastern Europe study with up to 10 years of follow-up.

Participants

9,222 men and women aged 45-69 years randomly selected from the population of two districts of Novosibirsk, Russia.

Measurements

PF score (range 0-100) was measured by the Physical Functioning Subscale (PF-10) of the 36-item Short Form Health Survey (SF-36) at baseline and three subsequent occasions. Body mass index (BMI), derived from objectively measured body height and weight at baseline, was classified into normal weight (BMI 18.5-24.9), overweight (BMI 25.0-29.9), obesity class I (BMI 30.0-34.9), and obesity class II+ (BMI≥35.0).

Results

The mean annual decline in the PF score during the follow-up was -1.92 (95% confidence interval -2.17; -1.68) in men and -1.91 (-2.13; -1.68) in women. At baseline, compared with normal weight, obesity classes I and II+ (but not overweight) were associated with significantly lower PF in both sexes. In prospective analyses, the decline in PF was faster in overweight men (difference from normal weight subjects -0.38 [-0.63; -0.14]), class I obese men and women (-0.49 [-0.82; -0.17] and -0.44 [-0.73; -0.15] respectively) and class II+ obese men and women (-1.13 [-1.73; -0.53] and -0.43 [-0.77; -0.09] respectively). Adjustment for physical activity and other covariates did not materially change the results.

Conclusions

PF decreased more rapidly in obese men and women than among those with normal weight. The adverse effect of high BMI on PF trajectories appeared to be more pronounced in men than in women, making more extremely obese Russian men an important target population to prevent/slow down the process of decline in PF.

     

Physical Resilience in Daily Functioning Among Acutely Ill Hospitalized Older Adults: The Hospital-ADL Study

ObjectivesInsight into older adults’ physical resilience is needed to predict functional recovery after hospitalization. We assessed functional trajectories in response to acute illness and subsequent hospitalization and investigated baseline variables and dynamic variables associated with these trajectories.DesignProspective observational cohort study (Hospitalization-Associated Disability and impact on daily Life Study).Setting and ParticipantsThis study included 207 older adults (aged 79.8 ± 6.9 years, 49% female, 57% frail) acutely hospitalized in 6 Dutch hospitals.MethodsFunctional disability was assessed using the 15-item modified activities of daily living index retrospectively 2 weeks before admission, and prospectively from admission up to 3 months after discharge. Baseline variables including frailty, somatic, physical, and psychosocial factors were assessed at admission. Dynamic variables (step count, pain, fatigue, and fear of falling) were continuously or repeatedly assessed during hospitalization. We performed individual spline modeling using random effects. Baseline variables and within-person mean levels and variability in the dynamic variables were assessed as predictors of functional trajectories.ResultsFunctional disability significantly increased before admission and decreased from admission to 3 months post discharge. Frail participants had a significantly higher increase in functional disability before admission compared with nonfrail participants. Lower step count, higher pain scores, and higher within-person variability in fear of falling were significantly associated with higher increase in functional disability before admission. Higher within-person variability in fear of falling was associated with more recovery.Conclusions and ImplicationsOlder adults increase in functional disability before hospitalization and start to recover from admission onward. Frailty and dynamic variables are associated with a higher increase in functional disability after acute illness. Our findings give more insight into older adults’ physical resilience, which may improve the prediction of functional recovery and may improve therapeutic decision-making and rehabilitation strategies to improve functional recovery after acute hospitalization.     

Age and Gender Differences in Trends and Impact of Depression on Quality of Life in the United States, 2008 to 2016

BackgroundWe aimed to examine age and gender differences in the relationship between depression and quality of life among United States adults.MethodsMedical Expenditure Panel Survey data for 2008 to 2016 on 227,663 adults were analyzed. The dependent variable, quality of life, included physical component summary scores and mental component summary scores from the Short Form Health Survey. The key independent variable, depression, was measured using the two-item Patient Health Questionnaire. General linear regression models examined the relationship between quality of life and depression. Models were adjusted for individual and environmental characteristics, symptom status, functional and biological status, and health perceptions and were stratified by gender and age.ResultsIn adjusted models, mental component summary scores were significantly lower among those with depression compared with those without depression (β = –0.39; 95% confidence interval [CI], 0.38 to –1.16) and lower among women compared with men (β = –0.10; 95% CI, 0.10 to –1.31). Models stratified by gender and age found women with depression ages 40 to 64 (β = –0.07; 95% CI, 0.07 to –0.20) and 65 or older (β = –0.08; 95% CI, 0.08 to –0.24) had significantly lower physical component summary scores compared with those without depression. Among men with depression, those ages 18 to 39 (β = –0.03; 95% CI, 0.03 to –0.10) and 40 to 64 (β = –0.09, 95% CI, 0.08 to –0.26) had lower physical component summary scores compared with those without depression. Women and men of all ages with depression had significantly lower mental component summary scores compared with those without depression.ConclusionsPublic health interventions and clinical approaches to address depression in women and men should target functional status in men and perceptions of health in women.     

Nursing Home Residents’ Functional Trajectories and Mortality After a Transfer to the Emergency Department

ObjectiveTo describe nursing home residents’ (NHRs) functional trajectories and mortality after a transfer to the emergency department (ED).DesignCase-control observational multicenter study.Setting and ParticipantsIn total, 1037 NHRs presenting to 17 EDs in France over 4 nonconsecutive weeks in 2016.MethodsFinite mixture models were fitted to longitudinal data on activities of daily living (ADL) scores before transfer (time 1), during hospitalization (time 2), and within 1 week after discharge (time 3) to identify groups of NHRs following similar functional evolution. Factors associated with mortality were investigated by Cox regressions.ResultsTrajectory modeling identified 4 distinct trajectories of ADL. The first showed a high and stable (across time 1, time 2, and time 3) functional capacity around 5.2/6 ADL points, with breathlessness as the main condition leading to transfer. The second displayed an initial 37.8% decrease in baseline ADL performance (between time 1 and time 2), followed by a 12.5% recovery of baseline ADL performance (time 2?time 3), with fractures as the main condition. The third displayed a similar initial decrease, followed by a 6.7% recovery. The fourth displayed an initial 70.1% decrease, followed by an 8.5% recover, with more complex geriatric polypathology situations. Functional decline was more likely after being transferred for a cerebrovascular condition or for a fracture, after being discharged from ED to a surgery department, and with a heavier burden of distressing symptoms during transfer. Mortality after ED transfer was more likely in older NHRs, those in a more severe condition, those who were hospitalized more frequently in the past month, and those transferred for cerebrovascular conditions or breathlessness.Conclusions and ImplicationsIdentified trajectories and factors associated with functional decline and mortality should help clinicians decide whether to transfer NHRs to ED. NHRs with high functional ability seem to benefit from ED transfers whereas on-site alternatives should be sought for those with poor functional ability.