Disability in adults with hip and knee arthroplasty: a French national community based survey

OBJECTIVES: To compare levels of disability of people with and without hip and knee arthroplasty in a random national sample. METHODS: In 1999 a screening questionnaire to classify people into groups of increasing probabilities of disability was sent to 417 500 people; response rate 86%. The study population was obtained by a stratified randomisation, with a high sampling rate for the most severely disabled group and a minimum sampling rate for people without daily living restrictions. A computer assisted interview to assess levels of disability, dependence, and handicap was given to 21 760 people; response rate 78%. A weighting factor was applied to obtain estimates representative of the French population. The presence of chronic conditions, impairments, and disability was ascertained from the subjects' reports. RESULTS: The hip and knee arthroplasty group comprised 815 subjects in the sample, indicating an estimated 691 000 subjects (95% confidence interval (CI) 597 000 to 785 000) in the French non-institutionalised population. The prevalence of arthroplasty is estimated at 1.2%. After adjustments for confounding factors, activity limitations were greater among subjects with arthroplasty for the following activities: climbing stairs (odds ratio (OR)=4.0, 95% CI 2.8 to 5.8); walking distance (OR=3.4, 95% CI 2.5 to 4.6 for a walking distance less than 500 m); bending forward (OR=3.2, 95% CI 2.2 to 4.7); cutting toenails (OR=2.8, 95% CI 1.9 to 3.9); carrying (OR=2.6, 95% CI= 1.8 to 3.8); shopping (OR=2.1, 95% CI 1.5 to 2.9). CONCLUSIONS: This study would be useful to policy-makers considering population strategies for managing disabling arthritis.     

Effect of co-morbidity on the association of high body mass index with walking limitation among men and women aged 55 years and older

BACKGROUND AND AIMS: Obesity among older persons is rapidly increasing, thus affecting their mobility negatively. The aim of this study was to examine the association of high body mass index (BMI) with walking limitation, and the effect of obesity-related diseases on this association. METHODS: In a representative sample of the Finnish population of 55 years and older (2055 women and 1337 men), maximal walking speed, chronic diseases, and BMI were ascertained in a health examination. Walking limitation was defined as maximal walking speed of less than 1.2 m/s or difficulty in walking 500 meters. To analyze the effects of chronic conditions, smoking, marital status, and education on BMI class differences in walking limitation, covariates were sequentially adjusted in logistic regression analyses. RESULTS: In women, an increasing gradient in the age-adjusted risk of walking limitation was observed with higher BMI: overweight (OR 1.47, 95% CI 1.10-1.96), obese (OR 2.77, 95% CI 2.01-3.82), and severely obese (OR 5.80, 95% CI 3.52-9.54). In men, the risk was significantly increased among the obese (OR 1.63, 95% CI 1.04-2.55) and severely obese (OR 4.33, 95% CI 2.20- 8.53). After adjustment of multiple covariates, the association remained significant among the obese (OR 1.99, 95% CI 1.38-2.86) and severely obese women (OR 3.64, 95% CI 2.12-6.26), as well as severely obese men (OR 2.78, 95% CI 1.30-5.95). Knee osteoarthritis in women and diabetes in men contributed most to the excess risk of walking limitation among obese persons, 18 and 32% respectively. CONCLUSIONS: Obesity increases the risk of walking limitation, independent of obesity-related diseases, smoking, marital status, and education, especially in older women. The results of this study emphasize the importance of maintaining normal body weight, in order to prevent obesity-related health risks and loss of functioning in older age.     

At the tipping point: predicting severe mobility difficulty in vulnerable older women

OBJECTIVES: To identify clinical measures that aid detection of impending severe mobility difficulty in older women. DESIGN: Cross‐sectional and longitudinal cohort study. SETTING: Urban community in Baltimore, Maryland. PARTICIPANTS: One thousand two community‐dwelling, moderate to severely disabled women aged 65 and older in the Women's Health and Aging Study I. MEASUREMENTS: Self‐report and performance measures representing six domains necessary for mobility: central and peripheral nervous systems, muscles, bones and joints, perception, and energy. Severe mobility difficulty was defined as usual gait of 0.5 m/s or less, any reported difficulty walking across a small room, or dependence on a walking aid during a 4‐m walking test. RESULTS: Four hundred sixty‐seven out of 984 (47%) had severe mobility difficulty at baseline, and 104/474 (22%) developed it within 12 months. Baseline mobility difficulty was correlated with poor vision, knee pain, feelings of helplessness, inability to stand with feet side by side for 10 seconds, difficulty keeping balance while dressing or walking, inability to rise from a chair five times, and cognitive impairment. Of these, knee pain (odds ratio (OR)=1.74, 95% confidence interval (CI)=1.05–2.89), helplessness (OR=1.87, 95% CI=1.10–3.24), poor vision (OR=2.03, 95% CI=1.06–3.89), inability to rise from a chair five times (OR=2.50, 95% CI=1.15–5.41), and cognitive impairment (OR=4.75, 95% CI=1.67–13.48) predicted incident severe mobility difficulty within 12 months, independent of age. CONCLUSION: Five simple measures may aid identification of disabled older women at high risk of severe mobility difficulty. Further studies should determine generalizability to men and higher‐functioning individuals.     

Benzodiazepine use and physical disability in community-dwelling older adults

OBJECTIVES: To determine whether benzodiazepine use is associated with incident disability in mobility and activities of daily living (ADLs) in older individuals. DESIGN: A prospective cohort study. SETTING: Four sites of the Established Populations for Epidemiologic Studies of the Elderly. PARTICIPANTS: This study included 9,093 subjects (aged > or =65) who were not disabled in mobility or ADLs at baseline. MEASUREMENTS: Mobility disability was defined as inability to walk half a mile or climb one flight of stairs. ADL disability was defined as inability to perform one or more basic ADLs (bathing, eating, dressing, transferring from a bed to a chair, using the toilet, or walking across a small room). Trained interviewers assessed outcomes annually. RESULTS: At baseline, 5.5% of subjects reported benzodiazepine use. In multivariable models, benzodiazepine users were 1.23 times as likely as nonusers (95% confidence interval (CI) = 1.09-1.39) to develop mobility disability and 1.28 times as likely (95% CI = 1.09-1.52) to develop ADL disability. Risk for incident mobility was increased with short- (hazard ratio (HR) = 1.27, 95% CI = 1.08-1.50) and long-acting benzodiazepines (HR = 1.20, 95% CI = 1.03-1.39) and no use. Risk for ADL disability was greater with short- (HR = 1.58, 95% CI = 1.25-2.01) but not long-acting (HR = 1.11, 95% CI = 0.89-1.39) agents than for no use. CONCLUSION: Older adults taking benzodiazepines have a greater risk for incident mobility and ADL disability. Use of short-acting agents does not appear to confer any safety benefits over long-acting agents.     

Carotenoids as protection against disability in older persons

The purpose was to examine the relationship of total plasma carotenoids, an indicator of fruit and vegetable intake, with walking speed and severe walking disability in older adults. Nine hundred twenty-eight men and women aged 65 to 102 years from the Invecchiare in Chianti (Aging in the Chianti Area [InCHIANTI]) study, a population-based cohort in Tuscany, Italy, were studied. Plasma carotenoids were measured at enrollment (1998-2000), and walking speed over 4 meters and 400 meters distance were assessed at enrollment and 6 years later (2004-2006). At enrollment, 85 of 928 (9.2%) participants had severe walking disability (defined as being unable to walk or having a walking speed at the 4-meter walking test < 0.4 m/sec). After adjusting for potential confounders, participants with high total plasma carotenoids were significantly less likely to have prevalent severe walking disability (odds ration [OR] 0.59, 95% confidence interval [CI] 0.38-0.90, p = 0.01) and had higher walking speed over 4 meters (beta = 0.024, standard error [SE] = 0.011, p = 0.03) and over 400 meters (beta = 0.019, SE = 0.010, p = 0.04). Of 621 participants without severe walking disability at enrollment who were seen 6 years later, 68 (11.0%) developed severe walking disability. After adjusting for potential confounders, higher total plasma carotenoids were associated with a significantly lower risk of developing severe walking disability (OR 0.51, 95% CI 0.30-0.86, p = 0.01) and were associated with a less steep decline in 4-meter walking speed over a 6-year follow-up (n = 579; beta = 0.026, SE = 0.012, p = 0.03) and with lower incidence rates of being unable to successfully complete the 400-meter walking test at the 6-year follow-up visit (beta = -0.054, SE = 0.03, p = 0.04). High plasma carotenoids concentrations may be protective against the decline in walking speed and the development of severe walking disability in older adults.     

Health status indicators among community-dwelling elders with arthritis: the Bambuí health and aging study

OBJECTIVE: To investigate the association of arthritis with health status indicators among elders living in Bambuí, Brazil. METHODS: A cross-sectional study was conducted among 1606 elders using baseline data from the Bambuí Health and Aging Study, a population based cohort study of older adults. Arthritis was self-reported and defined as a physician diagnosis of arthritis or rheumatism, and/or chronic hand and knee symptoms. Health status indicators, defined a priori as the main independent variables, were self-rated health, psychological distress (based on the General Health Questionnaire), report of sleep complaints, disability in activities of daily living (ADL), "2-week" disability, mobility disability, and 2 composite indexes of mental health problems and physical disability problems. Logistic regression compared health status indicators among elders reporting arthritis (N = 833) and non-arthritis subjects. RESULTS: After controlling for sociodemographics and chronic conditions, all measures were found to be associated with arthritis: sleep complaints (OR 1.81, 95% CI 1.43-1.92), fair (OR 2.17, 95% CI 1.62-2.90) and poor self-rated health (OR 3.48, 95% CI 2.46-4.94), ADL disability (OR 1.73, 95% CI 1.02-2.87), mobility disability (OR 2.65, 95% CI 2.06-3.41), 2-week disability (OR 1.86, 95% CI 1.35-2.57), 2 mental health problems (OR 2.25, 95% CI 1.67-3.04), and one (OR 2.46, 95% CI 1.91-3.16) and 2 physical disability problems (OR 4.19, 95% CI 2.02-8.59). CONCLUSION: Considering the paucity of similar studies addressing the impact of arthritis in developing nations, these findings may be applied to similar communities and support better planning of resource allocations to minimize the effects of arthritis among the elderly.     

Predictors of activity limitation and dependence on walking aids after primary total hip arthroplasty

OBJECTIVES: To study function outcomes and their predictors after primary total hip arthroplasty (THA). DESIGN: Prospective cohort study. SETTING: Mayo Clinic. PARTICIPANTS: All patients who underwent primary THA at the Mayo Clinic between 1993 and 2005 and were alive at the time of follow‐up. MEASUREMENTS: Whether sex, age, body mass index (BMI), comorbidity, anxiety, and depression predict moderate to severe activity limitation (limitation in ≥3 activities) and complete dependence on waling aids 2 and 5 years after primary THA was examined. Multivariable logistic regression adjusted for operative diagnosis, American Society of Anesthesiologists score, implant type, and distance from medical center. RESULTS: At 2 years, 30.3% of participants reported moderate to severe activity limitation; at 5 years, 35% of participants reported moderate to severe activity limitation. Significant predictors of moderate to severe activity limitations at 2‐year follow‐up were female sex (odds ratio (OR)=1.2, 95% confidence interval (CI)=1.1–1.4), aged 71 to 80 (OR=2.0, 95% CI=1.6–2.5), aged 80 and older (OR=4.5, 95% CI=3.4–6.0), depression (OR=2.1, 95% CI=1.6–2.7), and BMI greater than 30.0. At 5‐year follow‐up, significant predictors were aged 71 to 80 (OR=1.7, 95% CI=1.3–2.2), older than 80 (OR=4.3, 95% CI=2.8–6.6), depression (OR=2.3, 95% CI=1.6–3.4), and BMI greater than 30.0.Significant predictors of complete dependence on walking aids at 2 years were female sex (OR=2.0, 95% CI=1.4–2.7), aged 71 to 80 (OR=2.4, 95% CI=1.4–4.2), older than 80 (OR=11.4, 95% CI=6.0–21.9), higher Deyo‐Charlson score (OR=1.5, 95% CI=(1.1–1.2) for 5‐point increase, depression (OR=2.0, 95% CI=1.2–3.4), and BMI greater than 35.0. Each of these factors also significantly predicted complete dependence on walking at 5‐year follow‐up, with similar odds ratios, except that BMI of 30.0 to 34.9 was not significantly associated. CONCLUSION: Higher BMI, depression, older age, and female sex predict activity limitation and complete dependence on walking aids 2 and 5 years after primary THA.     

Frailty: emergence and consequences in women aged 65 and older in the Women's Health Initiative Observational Study

OBJECTIVES: To define frailty using simple indicators; to identify risk factors for frailty as targets for prevention; and to investigate the predictive validity of this frailty classification for death, hospitalization, hip fracture, and activity of daily living (ADL) disability. DESIGN: Prospective study, the Women's Health Initiative Observational Study. SETTING: Forty U.S. clinical centers. PARTICIPANTS: Forty thousand six hundred fifty-seven women aged 65 to 79 at baseline. MEASUREMENTS: Components of frailty included self-reported muscle weakness/impaired walking, exhaustion, low physical activity, and unintended weight loss between baseline and 3 years of follow-up. Death, hip fractures, ADL disability, and hospitalizations were ascertained during an average of 5.9 years of follow-up. RESULTS: Baseline frailty was classified in 16.3% of participants, and incident frailty at 3-years was 14.8%. Older age, chronic conditions, smoking, and depressive symptom score were positively associated with incident frailty, whereas income, moderate alcohol use, living alone, and self-reported health were inversely associated. Being underweight, overweight, or obese all carried significantly higher risk of frailty than normal weight. Baseline frailty independently predicted risk of death (hazard ratio (HR)=1.71, 95% confidence interval (CI)=1.48-1.97), hip fracture (HR=1.57, 95% CI=1.11-2.20), ADL disability (odds ratio (OR)=3.15, 95% CI=2.47-4.02), and hospitalizations (OR=1.95, 95% CI=1.72-2.22) after adjustment for demographic characteristics, health behaviors, disability, and comorbid conditions. CONCLUSION: These results support the robustness of the concept of frailty as a geriatric syndrome that predicts several poor outcomes in older women. Underweight, obesity, smoking, and depressive symptoms are strongly associated with the development of frailty and represent important targets for prevention.     

Weight change and lower body disability in older Mexican Americans

OBJECTIVES: To examine the association between 2-year weight change and onset of lower body disability over time in older Mexican Americans. DESIGN: Data were from the Hispanic Established Population for the Epidemiological Study of the Elderly (1993-2001). Weight change was examined by comparing baseline weight to weight at 2-year follow-up. Incidence of lower body disability was studied from the end of this period through an additional 5 years. SETTING: Five southwestern states: Texas, New Mexico, Colorado, Arizona, and California. PARTICIPANTS: One thousand seven hundred thirty-seven noninstitutionalized Mexican-American men and women aged 65 and older who reported no limitation in activities of daily living (ADLs) and were able to perform the walk test at 2-year follow-up. MEASUREMENTS: In-home interviews assessed sociodemographic factors, self-reported physician diagnoses of medical conditions (arthritis, diabetes mellitus, heart attack, stroke, hip fracture, and cancer), self-reported ADLs, depressive symptoms, and number of hospitalizations. Cognitive function, handgrip muscle strength, and body mass index (BMI) were obtained. The outcomes were any limitation of lower body ADL (walking across a small room, bathing, transferring from a bed to a chair, and using the toilet) and limitation on the walk test over subsequent 5-year follow-up period. General Estimation Equation (GEE) was used to estimate lower body disability over time. RESULTS: Weight change of 5% or more occurred in 42.3% of the participants; 21.7% lost weight, 20.6% gained weight, and 57.7% had stable weight. Using GEE analysis, with stable weight as the reference, weight loss of 5% or more was associated with greater risk of any lower body ADL limitation (odds ratio (OR)=1.43, 95% confidence interval (CI)=1.06-1.95) and walking limitation (OR=1.35, 95% CI=1.03-1.76) after controlling for sociodemographic variables and BMI at baseline. Weight gain of 5% or more was associated with greater risk of any lower body ADL limitation (OR=1.39, 95% CI=1.02-1.89), after controlling for sociodemographic variables and BMI at baseline. When medical conditions, handgrip muscle strength, high depressive symptomatology, cognitive function, and hospitalization were added to the equation, the relationship between 2-year weight change (>5% loss or >5% gain) and lower body disability decreased. CONCLUSION: Health conditions and muscle strength partially mediate the association between weight loss or gain and future loss of ability to walk and independently perform ADLs.     

Hip pain onset in relation to cumulative workplace and leisure time mechanical load: a population based case-control study

OBJECTIVE: In an unselected community sample of adults, to assess the role and importance of exposure to mechanical factors both at work and leisure in the aetiology of hip pain. METHOD: A population based prevalence case-control study. Cases and controls were identified from a population survey of 3847 subjects registered with two general practices in Cheshire, United Kingdom. All subjects received a postal questionnaire which inquired about hip pain during the past month. An occupational history was obtained, including exposure to each of seven physical demands. Information was also obtained on history of participation in eight common sporting activities. RESULTS: 88% of those invited to participate returned a completed questionnaire. The 352 subjects with hip pain were designated as cases, and the remaining 3002 subjects as controls. In people ever employed, hip pain was significantly associated with high cumulative workplace exposure (before onset) of walking long distances over rough ground, lifting/moving heavy weights, sitting for prolonged periods, walking long distances, frequent jumping between different levels, and standing for prolonged periods. Odds ratios (ORs) in the higher exposure categories ranged from 1.46 to 2.65. Cumulative exposure to three sporting activities was significantly associated with hip pain: track and field sports, jogging, and walking, with odds ratios varying between 1.57 to 1.94. On multivariate analysis three factors were independent predictors of hip pain onset: cumulative exposure of sitting for prolonged periods (higher exposure v not exposed: OR=1.82, 95% confidence interval (CI) 1.13 to 2.92), lifting weights >50 lb (23 kg) (OR=1.74, 95% CI 1.06 to 2.86) (both relating to the workplace), and walking as a leisure activity (OR=1.97, 95% CI 1.32 to 2.94). The population attributable risk associated with each of these activities was 21%, 13%, and 16%, respectively CONCLUSIONS: Cumulative exposure to some workplace and sporting "mechanical" risk factors for hip osteoarthritis (OA) appear to be related to hip pain in general-some (but not all) have previously been related to hip OA. Because these are common workplace or leisure time activities their attributable risk is high.     

Preclinical disability as a risk factor for falls in community-dwelling older adults

BACKGROUND: Falls are common and serious problems in older adults. The goal of this study was to examine whether preclinical disability predicts incident falls in a European population of community-dwelling older adults. METHODS: Secondary data analysis was performed on a population-based longitudinal study of 1644 community-dwelling older adults living in London, U.K.; Hamburg, Germany; Solothurn, Switzerland. Data were collected at baseline and 1-year follow-up using a self-administered multidimensional health risk appraisal questionnaire, including validated questions on falls, mobility disability status (high function, preclinical disability, task difficulty), and demographic and health-related characteristics. Associations were evaluated using bivariate and multivariate logistic regression analyses. RESULTS: Overall incidence of falls was 24%, and increased by worsening mobility disability status: high function (17%), preclinical disability (32%), task difficulty (40%), test-of-trend p <.003. In multivariate analysis adjusting for other fall risk factors, preclinical disability (odds ratio [OR] = 1.7, 95% confidence interval [CI], 1.1-2.5), task difficulty (OR = 1.7, 95% CI, 1.1-2.6) and history of falls (OR = 4.7, 95% CI, 3.5-6.3) were the strongest significant predictors of falls. In stratified multivariate analyses, preclinical disability equally predicted falls in participants with (OR = 1.7, 95% CI, 1.0-3.0) and without history of falls (OR = 1.8, 95% CI, 1.1-3.0). CONCLUSIONS: This study provides longitudinal evidence that self-reported preclinical disability predicts incident falls at 1-year follow-up independent of other self-reported fall risk factors. Multidimensional geriatric assessment that includes preclinical disability may provide a unique early warning system as well as potential targets for intervention.     

Association of urgency symptoms with self-rated health, mood and functioning in an older population

BACKGROUND AND AIMS: Lower urinary tract symptoms (LUTS) with comorbidities are common in old age. The aim here was to investigate the associations of urgency symptoms with self-rated health, mood and functioning in a random older population adjusted for comorbid conditions. METHODS: A population-based cross-sectional survey was made involving 343 people (159 men and 184 women) aged 70 years and over. LUTS were categorized as symptoms with or without urgency. Perceived inconvenience from LUTS, self-rated health, mood, social activity and activities of daily living (ADL), instrumental activities of daily living (IADL) and mobility disability were the outcome measures. Ageand gender-adjusted and multivariate logistic regression models were constructed in order to examine the associations of urgency and non-urgency symptoms with the outcomes. The covariates were age, gender, and self-reported cardiovascular, musculoskeletal, neurological and other chronic diseases. RESULTS: Perceived inconvenience from urgency symptoms was more frequent than that from non-urgency symptoms (64% vs 20%, p<0.001). In the age- and gender-adjusted logistic regression models, LUTS with urgency were associated with poor self-rated health (OR [odds ratio] 2.35; 95% CI [confidence interval] 1.06-5.20), depressive mood (OR 7.29; 95% CI 2.91-18.30), ADL (OR 2.33; 95% CI 1.10-4.92), IADL (OR 2.16; 95% CI 1.19-3.92) and mobility disability (OR 2.44; 95% CI 1.37-4.36). LUTS without urgency were associated with depressive mood (OR 5.02; 95% CI 1.97-12.82) and mobility disability (OR 1.97; 95% CI 1.10-3.53). In the multivariate analyses in which comorbid conditions were added to the model, the associations of non-urgency and urgency symptoms persisted only with depressive mood (OR 4.00; 95% CI 1.52-10.53 and OR 6.16; 95% CI 2.39-15.84, respectively). CONCLUSION: Urgency symptoms are associated with poor self-rated health, depressive mood and disability in older people. There is an independent association between both urgency and non-urgency LUTS and depressive mood. A careful assessment of the mental state of older individuals with LUTS is warranted.     

Risk factors for hospital-acquired incontinence in elderly female hip fracture patients

BACKGROUND: The objective of this study was to estimate the incidence of, and identify risk factors for, incontinence in female hip fracture patients. The study was a secondary analysis of data abstracted from medical records in hospitals in Pennsylvania, Texas, New Jersey, and Virginia. METHODS: The study included women aged 60 years and older who were admitted to one of the study hospitals with hip fracture. Measurements included incontinence at discharge as recorded in the medical records, demographic information, cognitive and functional status, and two measures of severity of illness (Charlson Comorbidity Index and Sickness at Admission Scale score). RESULTS: Data from 6516 women were analyzed. Twenty-one percent (n = 1365) became incontinent during hospitalization. After adjusting for confounders (i.e., age, race, malnutrition, comorbidity, and severity of illness), admission from a nursing home or other long-term care facility (odds ratio [OR] 1.68, 95% confidence interval [CI] 1.29-2.19), confusion (OR 3.44, 95% CI 2.79-4.24), use of a wheelchair or device for walking (OR 1.53, 95% CI 1.29-1.83), and prefracture dependence on others for ambulation (OR 2.51, 95% CI 1.64-3.85) significantly increased the odds of developing incontinence during hospitalization. CONCLUSION: Hospital-acquired incontinence affects 21% of female hip fracture patients. Certain easily identifiable patient characteristics place female hip fracture patients at high risk. Interventions to increase staff awareness of this vulnerable population need to be tested to minimize the incidence of hospital-acquired incontinence.     

Risk and predictors of motor-performance decline in a normally functioning population-based sample of elderly subjects: the Italian Longitudinal Study on Aging

OBJECTIVES: To examine risk and predictors of motor-performance (MP) decline targeting subjects performing normally at an initial observation. DESIGN: Cohort study. SETTING: A subsample of the Italian Longitudinal Study on Aging (aged 65-84). PARTICIPANTS: One thousand fifty-two subjects (mean age+/-standard deviation = 71+/-5, 69% men) with normal MP at baseline. MEASUREMENTS: Six tests (standing up from a chair, stepping up, tandem walk, standing on one leg, walking speed, and steps turning 180 degrees ) were used to assess MP at baseline and after 3 years. Baseline characteristics were potential predictors of MP decline. RESULTS: Of the 1,052 subjects performing normally at baseline, 166 (15.8%) had declined in MP at follow-up. Older age, female sex, lower education, symptoms of distal symmetrical neuropathy, cognitive impairment without dementia, parkinsonism, heart failure, anemia, depressive symptoms, worse Mini-Mental State Examination score, and lost activities of daily living and instrumental activities of daily living (IADLs) were significantly associated with MP decline in univariate comparisons. Older age (odds ratio (OR) = 3.84, 95% confidence interval (CI) = 2.14-6.88 comparing age classes > or =80 with 65-69), female sex (OR=1.50, 95% CI = 1.03-2.20), distal symmetric neuropathy (OR = 2.00, 95% CI = 1.03-3.87), depressive symptoms (OR = 1.85, 95% CI = 1.17-2.24), and baseline IADLs (OR = 1.22, 95% CI = 1.08-1.37 for each lost activity) independently predicted MP decline after regression analysis. CONCLUSION: In a population-based cohort of elderly people with normal MP, one-sixth declined in 3 years. Age, sex, distal symmetrical neuropathy, depressive symptoms, and baseline IADLs independently predicted this decline. Distal symmetrical neuropathy is underestimated in the clinical and epidemiological evaluation of motor decline in older people.     

Persistent mobility deficit in the absence of deficits in activities of daily living: a risk factor for mortality

OBJECTIVES: To investigate the extent to which self-reported mobility deficit in the absence of impairment in activities of daily living (ADL) is associated with elevated mortality risk. DESIGN: Prospective cohort study, with annual assessments of mobility and ADL status and ongoing monitoring of vital status. SETTING: Population-based cohort drawn from Medicare enrollees in New York City. PARTICIPANTS: One thousand two hundred ninety-eight older adults reporting functional status at baseline (1992-1994) and 2 years later. MEASUREMENTS: Subjects reported mobility (e.g., walking, climbing stairs, and rising from a chair) and ADL (e.g., bathing, toilet use, dressing, grooming, and feeding) limitations. Two-year functional status trajectories were noted. We used two additional follow-up periods, at 2 and 4 years, to examine the likelihood that older people with mobility deficit may face an increased risk of death without first passing through a state of enduring ADL disability. RESULTS: At 2 years, 12.7% had incident mobility deficit without ADL disability, and 21.3% were persistently disabled in mobility without ADL disability. Relative to subjects free of disability at baseline and follow-up, risk of mortality in the incident mobility deficit group was elevated at 2 and 4 years but did not achieve statistical significance. By contrast, for subjects with persistent mobility impairment who did not report ADL impairment, the mortality risk was significantly elevated both at 2 years (relative risk (RR) = 2.5; 95% confidence interval (CI) = 1.1-5.7)) and 4 years (RR = 2.9; 95% CI = 1.7-4.9)) of follow-up. Mortality was significantly elevated in this group in analyses restricted to respondents with no or only one comorbid condition. CONCLUSION: Continuing, self-reported mobility impairment in the absence of ADL deficit is a risk factor for mortality. Older people with self-reported mobility deficit face an increased risk of mortality without first passing through enduring states of ADL disability.     

Life course, gender and ethnic inequalities in functional disability in a Brazilian urban elderly population

BACKGROUND AND AIMS: To examine life course social, gender and ethnic inequalities in ADL disability in a Brazilian urban elderly population. METHODS: We used the S?o Paulo-SABE study (health, well-being and aging in Latin America and the Caribbean) to assess the associations between ADL disability and gender, ethnicity and life course social conditions (childhood socio-economic and health status, education, lifetime occupation, current perception of income), controlling for current physical and mental health (cognitive impairment and comorbidity). ADL disability was defined as the presence of one or more difficulties with six tasks: bathing, toileting, dressing, walking across the room, eating, and getting out of bed. RESULTS: Results suggest that social inequalities during the life course (hunger and poverty in early life; illiteracy, a low skilled occupation, having been a housewife; insufficient income) tend to result in disability in later life. The prevalence of ADL disability was higher among women (22.4%) than among men (14.8%). Mestizo/ Native elders reported higher prevalence of disability compared with Whites and Blacks/Mulattos. Ethnic inequalities concerning ADL disability were explained by social and health conditions, but the gender gap persisted (OR women vs men= 2.16; 95% CI 1.32-3.55). Despite their higher rate of ADL disability in old age, women appear to be more resilient than men toward poor socio-economic conditions throughout the life course. Chronic conditions were more likely to result in ADL disability among men than women (OR= 1.83; 95% CI 1.41-2.38 in women; OR= 3.42; 95% CI 2.41-4.86 in men). CONCLUSIONS: Decreasing social inequalities during childhood and adulthood will reduce socio-economic inequalities in disability in old age, especially among men.     

Coimpairments: strength and balance as predictors of severe walking disability

BACKGROUND: Little information is available on the joint effects of multiple impairments (coimpairments) on the risk of disability. Our aim was to study the joint effects of strength and balance impairments on severe walking disability. METHODS: The data are from the baseline of the Women's Health and Aging Study (WHAS), a study of moderately to severely disabled women. A total of 1,002 women aged 65 and older participated in the tests, which took place in their homes. Severe walking disability was defined as self-reported inability to walk one-quarter mile and customary walking speed in a 4-meter test of < or =0.4 m/s. Balance was measured as an ability to hold progressively more difficult stands (feet side-by-side, semitandem and tandem stands). Maximal knee extension strength was measured using a hand-held dynamometer. RESULTS: There were 129 women who were severely walking disabled but able to walk at least minimally. In logistic regression analysis, balance and knee extension strength were independent predictors of severe walking disability. To study the combined effects, nine groups were formed on the basis of strength tertiles by balance categories in the entire population. In the best balance category, the crude prevalences of severe walking disability were 1.2%, 4.9%, and 14.3% in the highest to lowest strength tertiles. In the middle balance category, the rates were 2.9%, 10.0%, and 45.4.1%, and in the poorest balance category 4.9%, 22.1%, and 42.6%, correspondingly. The age, body weight, and height-adjusted odds ratios (OR) showed that the risk of severe walking disability in the subgroup with best balance and strength was less than 5% of the risk in the subgroup with poorest balance and strength (OR .034, 95% confidence interval [CI] .007-.166). Correspondingly, in the subgroups with poorest strength and best balance (OR .097, 95% CI .025-.38) or poorest balance and best strength (OR .102, 95% CI .012-.866) the risk was about 10%. The age-specific estimates of prevalence of severe walking disability in women were: 2.0% for ages 65-74 years, 3.4% for ages 75-84 years, and 9.1% for ages 85 years and older. CONCLUSIONS: The burden of coimpairments seems to be greater than the sum of single impairments involved. An effective way to reduce severe disabilities could be prevention of coimpairments.     

Cognitive impairment after stroke: clinical determinants and its associations with long-term stroke outcomes

OBJECTIVES: To identify factors that were associated with cognitive impairment 3 months after stroke, and to examine the associations of cognitive impairment with stroke outcomes up to 4 years after stroke. DESIGN: Observational study. SETTING: Population-based stroke register. PARTICIPANTS: Six hundred forty-five subjects with first-ever stroke, identified from the register. MEASUREMENTS: Subjects were assessed for cognition using the Mini-Mental State Examination (MMSE) 3 months after stroke. Cognitively impaired subjects (MMSE <24, n = 248 (38%)) were compared with cognitively intact subjects (MMSE 24-30, n = 397) in terms of demographic details, stroke risk factors, laterality of stroke, and initial poststroke impairments. Outcome data collected at 1, 3, and 4 years poststroke included disability assessed by the Barthel Index (BI) and the Frenchay Activity Index, case fatality, and institutionalization. RESULTS: Two hundred forty-eight (38%) of 645 subjects were cognitively impaired 3 months after stroke. Using multivariate analyses, cognitive impairment was associated with age of 75 and older (odds ratio (OR) = 2.5, 95% confidence interval (CI) = 1.5-4.2), ethnicity (Caribbean/African (OR = 1.9, 95% CI = 1.2-3.2) and Asian (OR = 3.4, 95% CI = 1.1-10.2), lower socioeconomic class (OR = 2.1, 95% CI = 1.3-3.3), left hemispheric lesion (OR = 1.6, 95% CI = 1.01-2.4), visual field defect (OR = 2.0, 95% CI = 1.2-3.2), and urinary incontinence (OR = 4.8, 95% CI = 3.1-7.3). Using multivariate analyses, cognitive impairment was associated with death or disability (BI <15) at 4 years after stroke (OR = 2.2, 95% CI = 1.1-4.5). In univariate analyses, it was also associated with higher institutionalization 4 years after stroke (P =.001). CONCLUSIONS: Cognitive impairment is common 3 months after stroke and is independently associated with older age, ethnicity, lower social class, left hemispheric stroke, visual field defect, and urinary incontinence. It is associated with poor long-term outcomes, including survival and disability, up to 4 years after stroke. Because physical and cognitive impairments after stroke have independent prognostic implications, measures that evaluate both functions should be used in future studies of stroke outcome and in care of stroke patients.     

Hyperkyphotic posture and poor physical functional ability in older community-dwelling men and women: the Rancho Bernardo study

BACKGROUND: Physical functional decline is often the determining factor that leads to loss of independence in older persons. Identifying risk factors for physical disability may lead to interventions that may prevent or delay the onset of functional decline. Our study objective was to determine the association between hyperkyphotic posture and physical functional limitations. METHODS: Participants were 1578 older men and women from the Rancho Bernardo Study who had kyphotic posture measured as the distance from the occiput to table (units = 1.7-cm blocks, placed under the participant's head when lying supine on a radiology table). Self-reported difficulty in bending, walking, and climbing was assessed by standard questionnaires. Physical performance was assessed by measuring grip strength and ability to rise from a chair without the use of the arms. RESULTS: Men were more likely to be hyperkyphotic than were women (p <.0001). In multiply adjusted comparisons, there was a graded stepwise increase in difficulty in bending, walking and climbing, measured grip strength, and ability to rise from a chair. For example, the odds ratio (OR) of having to use the arms to stand up from a chair increased from 1.6 (95% confidence interval [CI]: 0.9-3.0) for individuals defined as hyperkyphotic by 1 block to 2.9 (95% CI: 1.7-5.1) for individuals defined as hyperkyphotic by 2 blocks to 3.7 (95% CI: 2.1-6.3) for individuals defined as hyperkyphotic by > or = 3 blocks compared to those who were not hyperkyphotic (p for trend < .0001). CONCLUSIONS: Older persons with hyperkyphotic posture are more likely to have physical functional difficulties.