Obesity influences transitional states of disability in older adults with knee pain

Rejeski WJ, Ip EH, Marsh AP, Zhang Q, Miller ME. Obesity influences transitional states of disability in older adults with knee pain.

Objectives

This study employed relatively new statistical methods to understand how many states are needed to describe disability in older adults with knee pain, describe the relative probability of transitioning between states over time, and examine whether obesity influences the probability of transitioning between states.

Design

Prospective epidemiologic study of older adults with knee pain.

Setting

Community.

Participants

The participants, 245 women and 235 men, were 65 years or older, had chronic knee pain on most days, and had difficulty with at least 1 mobility-related activity caused by knee pain.

Interventions

Not applicable.

Main Outcome Measure

The primary instrument, the Pepper Assessment Tool for Disability, evaluated self-reported difficulty with mobility, basic activities of daily living (ADLs), and instrumental activities of daily living (IADLs).

Results

The Hidden Markov Model yielded 6 states reflecting changes in mobility, ADLs, and IADLs. There is evidence that loss in more demanding mobility-related activities such as stair climbing is an early sign for the onset of disability and that functional deficits in the lower extremities are critical to the early loss of ADLs. Overall the trend is for older adults to experience greater progression than regression and for obesity to be important in understanding severe states of disability.

Conclusions

These data provide a strong rationale for characterizing disability on a continuum and underscore the fluid nature of disability in older adults. As expected, lower-extremity function plays a key role in the disablement process; obesity is also particularly relevant to understanding severe states of disability.     

Relationships between level of disability and receipt of preventive health services

OBJECTIVES: To examine relationships between level of disability and receipt of certain preventive health services, including demographic and systems variables that may explain or confound these relationships. DESIGN: Analysis of recent (1998 and 2000) data from the Behavioral Risk Factor Surveillance System, a nationwide telephone survey. SETTING: States reporting data on disability (13 in 1998, 18 in 2000). PARTICIPANTS: Noninstitutionalized persons living in the community. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Frequency of receipt of recommended preventive health services, including colorectal, cervical, and breast cancer screening, and influenza and pneumococcal vaccination. An ordinal index of disability severity was constructed from questions on activity limitations. RESULTS: In 2000, people with mild and moderate disability received influenza and pneumonia vaccinations somewhat more frequently than people without disabilities, but people with the most severe disabilities least frequently received vaccinations that year. Disabled women received fewer Papanicolaou tests and clinical breast examinations, but significant differences did not occur for mammograms in 2000. Fewer differences as a function of disability level were apparent in 2000 than 1998. Demographic variables affected receipt of most preventive services. Access to routine checkups affected all preventive services independent of disability level in both years. CONCLUSIONS: Severity of disability is related to receipt of certain preventive services but not necessarily in a simple or unidirectional way. Regardless of disability, receipt of a checkup was an important determinant of receipt of preventive health services. For almost all services and groups studied, preventive care remained below targeted goals for Healthy People 2010.     

Increased trunk extension endurance is associated with meaningful improvement in balance among older adults with mobility problems

Suri P, Kiely DK, Leveille SG, Frontera WR, Bean JF. Increased trunk extension endurance is associated with meaningful improvement in balance among older adults with mobility problems.

Objective

To determine whether trunk extension endurance changes with training are associated with clinically meaningful improvements in balance among mobility-limited older adults.

Design

Longitudinal data from a randomized controlled trial.

Setting

Outpatient rehabilitation research center.

Participants

Community-dwelling older adults (N=64; mean age, 75.9y) with mobility limitations as defined by a score of 4 to 10 on the Short Physical Performance Battery.

Interventions

Sixteen weeks of progressive resistance training.

Main Outcome Measures

Outcomes were the Berg Balance Scale (BBS) and the Unipedal Stance Time (UST). Predictors included leg strength, leg power, trunk extension endurance, and the product of heart rate and blood pressure (RPP) at the final stage of an exercise tolerance test. We performed an analysis of data from participants who completed 16 weeks of training by using binary outcomes defined by a clinically meaningful change (CMC) from baseline to completion of the intervention (BBS=4 units; UST=5s). The association of predictor variables with balance outcomes was examined separately and together in multivariate adjusted logistic regression models.

Results

Trunk extension endurance in seconds (1.04 [1.00–1.09]) was independently associated with CMC on the BBS. Trunk extension endurance (1.02 [1.00–1.03]) was independently associated with CMC on the UST. Other physical attributes were not associated with meaningful change in balance.

Conclusions

Improvements in trunk extension endurance were independently associated with CMCs in balance in older adults. Leg strength, leg power, and RPP were not associated with CMC in balance. Poor trunk extension endurance may be a rehabilitative impairment worthy of further study as a modifiable factor linked to balance among older adults.     

Participation survey/mobility: psychometric properties of a measure of participation for people with mobility impairments and limitations

OBJECTIVE: To describe the development and psychometric properties of a self-report survey of participation by people with mobility limitations, the Participation Survey/Mobility (PARTS/M). DESIGN: The information obtained during interviews and focus groups was used to develop items for the PARTS/M. Demographics and measures of disability, health, and functioning were collected. The PARTS/M was administered twice. SETTING: Primarily in the midwestern United States. PARTICIPANTS: Purposeful sample of 604 people with mobility limitations having a diagnosis of spinal cord injury, multiple sclerosis, cerebral palsy, stroke, or postpoliomyelitis. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURE: PARTS/M is composed of 20 major life activities that are placed in 6 domains used in the activity/participation component of the International Classification of Functioning, Disability and Health: self-care; mobility; domestic life; interpersonal interactions and relationships; major life areas; and community, social, and civic life. For each activity, questions were asked about components of participation including frequency, health-related limitations, importance, choice, satisfaction, use of assistive technology, and use of personal assistance. RESULTS: PARTS/M domains and components of participation had good internal consistency and stability. Composite participation scores were developed for participation components and domains. CONCLUSIONS: PARTS/M is a reliable measure of some aspects of participation in major life activities for people with mobility impairments and limitations living in community settings.     

Leg extension power asymmetry and mobility limitation in healthy older women

OBJECTIVE: To investigate the association of asymmetry in leg extension power (LEP) with walking and standing balance. DESIGN: Cross-sectional analysis. SETTING: Research laboratory. PARTICIPANTS: Healthy female twins (N=419), ages 63 to 75 years. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: The LEP difference between the stronger and the weaker leg, measured with the Nottingham power rig, was calculated. Ten-meter maximal walking velocity was assessed in a laboratory corridor on a wide (170 cm) and narrow (35 cm) track, and the ability to maintain tandem stance for 20 seconds was recorded. RESULTS: The mean LEP difference +/- standard deviation between the legs was 15%+/-9% (P<.001). Those with large LEP difference had lower walking velocity and poorer standing balance than those with small LEP difference, in particular when the LEP of the stronger leg was below the median. CONCLUSIONS: Even in healthy older women, substantial LEP asymmetry between the lower limbs was present, encumbering walking and standing balance. Lower-limb muscle power asymmetry warrants further study in order to develop well-targeted strategies for preventing mobility limitation in older people.     

Intrasession reliability of force platform parameters in community-dwelling older adults

Bauer C, Gröger I, Rupprecht R, Gaßmann KG. Intrasession reliability of force platform parameters in community-dwelling older adults.

Objective

To investigate the intrasession reliability of center of pressure (COP) parameters calculated from force platform measurements.

Design

A cross-sectional study.

Setting

Gait and balance laboratory.

Participants

Community-dwelling healthy older adults (N=63) above the age of 62 years (mean age, 78.74y).

Interventions

Not applicable.

Main Outcome Measures

COP was estimated from a force platform, and the following parameters were calculated: (1) the total length of the COP displacement, (2) area of sway, (3) length of the COP displacement in the sagittal plane, and (4) length of the COP displacement in the frontal plane. Intraclass correlation coefficients (ICCs) were calculated by using 3 successive trials with 4 different test conditions. The test conditions were (1) normative standing with eyes open, (2) normative standing with eyes closed, (3) narrow stance with eyes open, and (4) narrow stance with eyes closed.

Results

The ICCs for the tests with eyes closed (.710-.946) were higher than those for tests with eyes open (.841-.945). The highest value was obtained for the vector sum of the COP during anteroposterior movement in narrow stance with eyes closed (.946). The value .710 was the lowest of all parameters and was an outlier for the narrow stance with eyes closed test, which was otherwise very reliable.

Conclusions

Eight of 16 calculated ICCs showed excellent reliability (>.90). They can be recommended for further use in clinical trials. Tests with closed eyes were more reliable than tests with eyes open. We recommend using eyes closed test conditions when assessing static balance control. For these tests, all the calculated ICCs were over .90, except for measurements of sway area.     

Dynamic gait stability, clinical correlates, and prognosis of falls among community-dwelling older adults

Bhatt T, Espy D, Yang F, Pai Y-C. Dynamic gait stability, clinical correlates, and prognosis of falls among community-dwelling older adults.

Objective

To establish an accurate measure for prognostic assessment of fall risk in community-dwelling older adults, this study examined the prediction accuracy of a dynamic gait stability measure and common clinical tests for slip-related falls among these adults.

Design

Participants were tested for their fall-risk likelihood on a slip-test.

Setting

Biomechanics research laboratory.

Participants

Community-dwelling older adults (N=119; ≥65y).

Interventions

Not applicable.

Main Outcome Measures

Participants performed a battery of clinical tests, including Berg Balance Scale, Timed Up & Go (TUG) test, static posturography, isometric muscle strength, and bone density. They were then exposed to an unannounced slip during gait. The dynamic stability during unperturbed gait was measured based on the center of mass position and velocity relative to the limits of stability against backward falling. Accuracy of each measure was examined for prediction of slip outcome (fall or recovery).

Results

On the slip, 59 participants fell, 56 recovered their balance, and 4 were harness-assisted. Dynamic stability predicted fall outcome with 69% accuracy. Except for TUG and bone density, no other measure could differentiate fallers from nonfallers; TUG predicted 56% of fall outcomes.

Conclusions

Reproduction of actual falls provides a new benchmark for evaluating the prognostic power of different performance-based assessment tools. The TUG was able to better predict fall outcome than other clinical measures; however, the new dynamic gait stability measure was more sensitive than TUG in its prediction of falls. Ultrasound bone scan could be used to screen older adults for fall risk.     

The feasibility of measuring frailty to predict disability and mortality in older medical intensive care unit survivors

Purpose

To determine whether frailty can be measured within 4 days prior to hospital discharge in older intensive care unit (ICU) survivors of respiratory failure and whether it is associated with post-discharge disability and mortality.

Materials and Methods

We performed a single-center prospective cohort study of 22 medical ICU survivors age 65 years or older who had received noninvasive or invasive mechanical ventilation for at least 24 hours. Frailty was defined as a score of ≥ 3 using Fried’s 5-point scale. We measured disability with the Katz Activities of Daily Living. We estimated unadjusted associations between Fried’s frailty score and incident disability at 1-month and 6-month mortality using Cox proportional hazard models.

Results

The mean (SD) age was 77 (9) years, mean Acute Physiology and Chronic Health Evaluation II score was 27 (9.7), mean frailty score was 3.4 (1.3), and 18 (82%) were frail. Nine subjects (41%) died within 6 months, and all were frail. Each 1-point increase in frailty score was associated with a 90% increased rate of incident disability at 1-month (rate ratio: 1.9, 95% CI 0.7-4.9) and a threefold increase in 6-month mortality (rate ratio: 3.0, 95% CI 1.4-6.3).

Conclusions

Frailty can be measured in older ICU survivors near hospital discharge and is associated with 6-month mortality in unadjusted analysis. Larger studies to determine if frailty independently predicts outcomes are warranted.     

Functional mobility and postural control in essential tremor

OBJECTIVE: To evaluate functional mobility and postural control in participants with essential tremor (ET). DESIGN: Cross-sectional cohort study. SETTING: Motor performance research laboratory. PARTICIPANTS: Sixteen participants with ET including head tremor (age, 59.4+/-12.0 y), 14 participants with ET and no head tremor (age, 57.1+/-15.9 y), and 28 healthy controls (age, 58.4+/-12.4 y). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: We assessed the Timed Up & Go, time to ascend and descend stairs, Dynamic Gait Index, and Berg Balance Scale (BBS). Participants completed the Activities-specific Balance Confidence Scale and the Human Activity Profile. We assessed postural control using center-of-pressure measures from force platform recordings of quiet standing in 5 conditions. RESULTS: Participants with ET including head tremor performed worse than controls on all functional mobility performance and self-report measures (P<.05) except the BBS and stair descent time. Mean performance of ET participants without head tremor was intermediate between the other 2 groups. Sway speed measures of postural control showed similar patterns, but no significant group differences in post hoc analysis. There were no statistically significant or clinically important correlations between measures of tremor status and functional mobility status. CONCLUSIONS: Participants with ET show reduced functional mobility, especially those with head tremor.     

Stair negotiation time in community-dwelling older adults: normative values and association with functional decline

Oh-Park M, Wang C, Verghese J. Stair negotiation time in community-dwelling older adults: normative values and association with functional decline.

Objectives

To establish reference values for stair ascent and descent times in community-dwelling, ambulatory older adults, and to examine their predictive validity for functional decline.

Design

Longitudinal cohort study. Mean follow-up time was 1.8 years (maximum, 3.2y; total, 857.9 person-years).

Setting

Community sample.

Participants

Adults 70 years and older (N=513; mean age, 80.8±5.1y) without disability or dementia.

Interventions

Not applicable.

Main Outcome Measures

Time to ascend and descend 3 steps measured at baseline. A 14-point disability scale assessed functional status at baseline and at follow-up interviews every 2 to 3 months. Functional decline was defined as an increase in the disability score by 1 point during the follow-up period.

Results

The mean±SD stair ascent and descent times for 3 steps were 2.78±1.49 and 2.83±1.61 seconds, respectively. The proportion of self-reported and objective difficulty was higher with longer stair ascent and descent times (P<.001 for trend for both stair ascent and descent). Of the 472 participants with at least 1 follow-up interview, 315 developed functional decline, with a 12-month cumulative incidence of 56.6% (95% confidence interval [CI], 52.1%–61.3%). The stair negotiation time was a significant predictor of functional decline after adjusting for covariates including gait velocity (adjusted hazard ratio [aHR] per 1-s increase: aHR=1.12 [95% CI, 1.04–1.21] for stair ascent time; aHR=1.15 [95% CI, 1.07–1.24] for stair descent time). Stair descent time was a significant predictor of functional decline among relatively high functioning older adults reporting no difficulty in stair negotiation (P=.001).

Conclusions

The stair ascent and descent times are simple, quick, and valid clinical measures for assessing the risk of functional decline in community-dwelling older adults including high-functioning individuals.     

Non malignant daily pain and risk of disability among older adults in home care in Europe

Aim of the present observational study was to evaluate the association between daily pain and incident disability in elderly subjects living in the community. We used data from the AgeD in HOme Care (AD-HOC) project, a 1 year longitudinal study enrolling subjects aged 65 or older receiving home care in 11 European countries. Daily pain was defined as any type of pain or discomfort in any part of the body manifested every day in the seven days before the baseline assessment. Disability performing activities of daily living (ADLs) was defined as the need of assistance in 1 or more of the following ADL: eating, dressing, transferring, mobility in bed, personal hygiene and toileting. Mean age of 1520 subjects participating the study was 82.1 (standard deviation 6.9) years, and 1178 (77.5%) were women and 695 (45.7%) reported daily pain at the baseline assessment. Overall, 123/825 participants (19.0%) with daily pain and 132/695 (14.9%) without daily pain reported incident disability during the 1 year follow up of the study. After adjustment for potential confounders, participants with daily pain had a significantly higher risk of developing disability, compared with other participants (hazard ratio 1.36; 95% CI: 1.05-1.78). The risk of disability increased with pain severity and with number of painful sites. In conclusion among old subjects living in the community, daily pain is associated with an increased risk of disability.     

Clinimetric properties of the de Morton Mobility Index in healthy, community-dwelling older adults

Davenport SJ, de Morton NA. Clinimetric properties of the de Morton Mobility Index in healthy, community-dwelling older adults.

Objective

To investigate the clinimetric properties of the de Morton Mobility Index (DEMMI) in healthy, community-dwelling older adults.

Design

Cohort study.

Setting

Retirement village and Returned and Services League (RSL) club in Melbourne, Australia.

Participants

All participants were 65 years or older, healthy, and living within the community. The validation study included participants recruited from a retirement village (n=61), and the reliability studies included participants recruited from an RSL club and a subset of participants from the retirement village.

Interventions

Not applicable.

Main Outcome Measures

Mobility was assessed using the DEMMI. The percentage of participants who scored the highest and lowest possible score on the DEMMI was calculated to determine whether a floor or ceiling effect occurred. The minimal clinically important difference (MCID) was estimated using a distribution-based method. Reliability was assessed independently and concurrently using the minimal detectable change at 90% confidence (MDC₉₀).

Results

Evidence of convergent and discriminant validity was obtained for the DEMMI by examining correlations with measures of related constructs, the Lower Extremity Functional Scale (r=.69) and Quality of Life Scale scores (r=.28), respectively. Participants who ambulated without a gait aid (82.62±10.63) had significantly higher (P<.0) DEMMI scores than those who ambulated with an aid (64.1±12.40), providing evidence of known groups validity. No floor or ceiling effect was identified. The MCID was 7 points. The MDC₉₀ was 13 (95% CI, 8.76–17.05) points on the 100-point scale.

Conclusion

DEMMI scores in healthy, community-dwelling older adults are both valid and reliable.     

Predicting which older adults will or will not fall using the Fullerton Advanced Balance scale

Hernandez D, Rose DJ. Predicting which older adults will or will not fall using the Fullerton Advanced Balance Scale.

Objective

The purpose of this study was to determine if the Fullerton Advanced Balance (FAB) scale can predict faller status in a group of independently functioning older adults.

Design

A cross-sectional design was used to establish the sensitivity and specificity of the FAB scale to predict faller status based on a retrospective self-reported fall history. For the purpose of this study, a faller was classified as an older adult with a history of 2 or more falls in the previous 12 months.

Setting

Multipurpose senior centers in an urban community.

Participants

A sample of independently functioning older adults (N=192; mean age ± SD, 77±6.5y).

Interventions

Not applicable.

Main Outcome Measures

FAB scale, a retrospective history of falls.

Results

Binary logistic regression analysis indicated that the total FAB scale score could be used to predict faller status (as determined by a retrospective self-reported fall history). In the present sample, the probability of falling increased by 8% with each 1-point decrease in total FAB scale score. Receiver operating characteristic analysis determined that a cut-off score of 25 out of 40 on the FAB scale produced the highest sensitivity (74.6%) and specificity (52.6%) in predicting faller status. Five individual test items on the FAB scale were particularly predictive of faller status and could be combined to form a short version of the scale that may be even more predictive of faller status and require less time to administer.

Conclusions

The FAB scale is a predictive measure of faller status when used with independently functioning older adults. A practitioner can be confident in more than 7 out of 10 cases that an older adult who scores 25 or lower on the FAB scale is at high risk for falls and in need of immediate intervention.     

Functioning and disability analysis by using WHO Disability Assessment Schedule 2.0 in older adults Taiwanese patients with dementia

Background: To analyse the disability status of elderly Taiwanese dementia patients by using the World Health Organisation Disability Assessment Schedule 2.0 (WHODAS 2.0). Methods: We enrolled 12 126 disabled elderly (>65 years) patients with dementia during July 2012–January 2014 from the Taiwan Data Bank of Persons with Disability. Trained interviewers evaluated the standardised scores in the six WHODAS 2.0 domains. Student’s t test was used for comparing WHODAS 2.0 scores of male and female dementia patients with different age groups. Results: The study population comprised 12 126 patients; 7612 were women and 4514 were men. The WHODAS 2.0 scores showed that the dementia patients had global activity limitation and participation restriction in all domains. Dementia-induced disability was prominent in male patients in all of the domains of the WHODAS 2.0. The domains of life activities, getting along with people and cognition were more strongly affected than the other domains. However, women experienced more rapid functional decline than men did as they aged. Conclusion: The data analysed in this large-scale, population-based study revealed crucial information on dementia-induced disability in elderly patients on the basis of the WHODAS 2.0 framework.

• Implications for rehabilitation

• Dementia patients have global functional disability in all domains of WHODAS 2.0 and multidisciplinary team is needed for rehabilitation programme intervention for these patients.

• When considering the rehabilitation resource and strategy, the domains of cognition, activities of daily living and life activities should be focussed.

• When dementia patients aged 65–75 years old, male patients got more restriction of function than female and more medical resource allocation for disabled male patients is recommended.

• With ageing, female dementia patients exhibited more rapid functional decline than male patients did and more budget about rehabilitation for maintain functional and dementia progression is crucial for female patients.

     

Biomechanic modeling of sit-to-stand to upright posture for mobility assessment of persons with chronic stroke

OBJECTIVE: To test the suitability of using biomechanic measures associated with a minimum measured input model (MMIM) approach to assess mobility of people with chronic stroke during the execution of a sit-to-stand (STS) to upright posture motor task. DESIGN: Single group, observational. SETTING: Institutional settings in the United States and Italy. PARTICIPANTS: Twenty-nine subjects with chronic unilateral lower-limb impairments and resultant mobility limitations secondary to stroke. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Manual measurement of lower-limb strength; performance-based tests including repeated chair standing, walking speed, and standing balance; and ground reactions measured with a force platform during STS and upright posture. The ground reactions were fed to a telescopic inverted pendulum model of the musculoskeletal system. Parameters representing the model outputs were compared with performance-based and strength measures to assess, respectively, motor ability and impairment-related changes in subjects' motor strategies. RESULTS: The parameters derived from the model effectively differentiated between motor strategies associated with different performance-based scores, and allowed the identification of relevant difficulties encountered in STS execution. These difficulties could be associated with different strength scores. This was also true for subjects scoring the maximum in both performance-based and strength tests. CONCLUSIONS: The MMIM is a relatively inexpensive and noninvasive approach that enhances mobility assessment of hemiparetic subjects with different motor ability levels. It provides information that correlates well with performance-based and strength scores and, in addition, it allows for subject-specific motor strategy identification.     

Driving strategies used by older adults with macular degeneration: assessing the risks.

Older adults with macular degeneration use multiple driving strategies. A secondary analysis focused on driving strategies was conducted on data from two studies that had explored the experience of visual impairment in older adults diagnosed with macular degeneration. Findings revealed 24 driving strategies. Twelve categories emerged, reflecting two themes: (1) strategies used while performing the task of driving and (2) strategies used to continue driving. By understanding these strategies, nurses can assess the conditions under which these older adults drive and the risks taken. Findings guide nurses to counsel and educate older adults regarding driving.     

Longitudinal invariance and construct validity of the abbreviated late-life function and disability instrument in healthy older adults

Szabo AN, Mullen SP, White SM, Wojcicki TR, Mailey EL, Gothe N, Olson EA, Fanning J, Kramer AF, McAuley E. Longitudinal invariance and construct validity of the abbreviated Late-Life Function and Disability Instrument in healthy older adults.

Objective

To cross-validate the psychometric properties of the abbreviated Late-Life Function and Disability Instrument (LL-FDI), a measure of perceived functional limitations and disability.

Design

Baseline and 12-month follow-up assessments conducted across the course of a 12-month exercise program.

Setting

University research community.

Participants

Older healthy adults (N=179; mean ± SD age, 66.43±5.67y) at baseline; 145 were retained at follow-up.

Interventions

Not applicable.

Main Outcome Measures

LL-FDI and functional performance measures.

Results

Factor analyses confirmed the factor structure of the abbreviated LL-FDI, and all subscales met minimal criteria for temporal invariance. Significant correlations also were found between functional limitations subscales and an array of physical function performance measures, supporting the scale's construct validity.

Conclusions

The abbreviated LL-FDI with some modifications appears to be temporally invariant in community-dwelling older adults. Additionally, moderate relationships between functional limitations and functional performance provide further support for these being conceptually distinct constructs.