降压治疗后续效应对老老年高血压患者认知功能的影响

目的探讨降压治疗后续效应对老老年高血压患者认知功能的影响。方法老老年高血压患者194例,5年降压治疗期间治疗组(105例)单用吲达帕胺或合用培哚普利降压治疗,对照组(89例)单用吲达帕胺安慰剂或合用培哚普利安慰剂。主试验结束后进行2年开放治疗,患者自主服药,不对其进行干预,定期随访。开放治疗始末采用简易精神状态检查量表(MMSE)对两组患者的认知功能进行评价。结果开放治疗期间治疗组死亡18例(16.67%),对照组14例(15.73%),两组病死率相比,P>0.05。开放治疗起始,治疗组MMSE总分、定向力、即刻记忆力、注意力和计算力、语言能力评分均高于对照组(P均<0.01);开放治疗末,两组MMSE总分、定向力、即刻记忆力、注意力和计算力、记忆力、语言能力评分均低于开放治疗始(P均<0.01)。治疗组MMSE总分、定向力、即刻记忆力、注意力和计算力评分变化率低于对照组(P均<0.01)。结论对老老年高血压患者进行降压治疗,其后续效应可以延缓患者认知功能的下降。     

Correlates of gait speed in a sample of physically active elderly

ObjectivesGait speed (GS) is an important predictor of disability, falls, institutionalization and death among elderly people. Our aim was to assess which factors are associated with higher GS in a sample of physically active elderly.Subjects and methodsA cross-sectional study was performed in a sample of 43 self-sufficient and active elderly (12 men and 31 women) aged 65–82 years. Anthropometric features (weight and height), mobility (Tinetti test), physical and mental health (Short Form 12 - SF12 questionnaire), physical activity (Physical Activity Scale for Elderly - PASE questionnaire), strength and power of lower limbs (Myotest Pro accelerometer) and GS were measured. A multivariable linear regression model was built in order to identify which variables were associated with higher GS.ResultsThe final multivariable linear regression model included gender, fall in the previous year, hypertension, age, BMI and Mental Health score. Furthermore, it explained nearly 2/3 of the variability in GS (R² = 0.64). Male sex, hypertension and a higher Mental Health score were associated with higher GS, whereas fall in the previous year and higher values of both age and BMI were associated with lower GS. A further model which included an interaction between sex and BMI (R² = 0.68) revealed that the negative association between GS and BMI was found among women but not among men.ConclusionsIn addition to the well-known associations between GS and demographic and anthropometric characteristics, we reported a positive association between mental health and GS among generally healthy and physically active community-dwelling elderly.     

The relationship between physical performance and cardiac function in an elderly Russian cohort

This study aims to determine the cardiac dysfunction prevalence, to investigate the relationship between the Short Physical Performance Battery (SPPB) test and structural and functional echocardiographic parameters and to determine whether SPPB scores and cardiac dysfunction are independent mortality predictors in an elderly Russian population. A random sample of 284 community-dwelling adults aged 65 and older were selected from a population-based register and divided into two age groups (65–74 and ≥75). The SPPB test, echocardiography and all-cause mortality were measured. The prevalence of cardiac dysfunction was 12% in the 65–74 group and 23% in the ≥75 group. The multivariate models could explain 15% and 23% of the SPPB score total variance for the 65–74 and ≥75 age groups, respectively. In the younger age group, the mean follow-up time was 2.6 ± 0.46 years, and the adjusted hazard ratio (HR) for risk of mortality from cardiac dysfunction was 4.9. In the older age group, the mean follow-up time was 2.4 ± 0.61 years, and both cardiac dysfunction and poor physical performance were found to be independent predictors of mortality (adjusted HR = 3.4 and adjusted HR = 4.2, respectively). The cardiac dysfunction prevalence in this elderly Russian population was found to be comparable to, or even lower than, reported prevalences for Western countries. Furthermore, the observed correlations between echocardiographic abnormalities and SPPB scores were limited. Cardiac dysfunction was shown to be a strong mortality predictor in both age groups, and poor physical performance was identified as an independent mortality predictor in the oldest subjects.     

Comparison of biomechanics platform measures of balance and videotaped measures of gait with a clinical mobility scale in elderly women

Performance on the clinical mobility index developed by Tinetti (9) was compared with biomechanics platform measures of sway and videotaped measures of gait in a sample of 43 community-dwelling aged women. Area measures of sway, but not velocity, were associated with performance on the mobility index. When standing on one leg with eyes open, the correlation coefficients for radial area per second with the mobility indices ranged from -0.59 to -0.64 (p less than .001). Knee range of motion and stride length correlated with performance on the mobility index. Knee range of motion correlation coefficients ranged from 0.47 to 0.54 (p less than .001), whereas the range was 0.62 to 0.68 (p less than .001) for stride length. These data demonstrate that biomechanics platform measures of sway and videotaped measures of gait are associated with subject performance on a clinical mobility index and may themselves also be predictive of persons susceptible to falling.     

The power of ageism on physical function of older persons: reversibility of age-related gait changes

OBJECTIVE: To test the hypothesis that age-associated changes in physical function, particularly walking performance, are influenced by ageism and that the activation of positive sterotypes of aging can partially reverse these changes. DESIGN: Randomized intervention study. SETTING: General community. PARTICIPANTS: Forty-seven community-dwelling men and women (63-82 years old) who walked independently and described themselves as healthy. INTERVENTION: Thirty-minute exposure to the subconscious reinforcement of either a positive or negative stereotype of aging while subjects played a computer game. MEASUREMENTS: Pre- and postintervention measures of gait speed and percent swing time (the time spent with one foot in the air during walking). Health and psychosocial status were also evaluated. RESULTS: Significant increases in walking speed (9%+/-2%; P < .001) and percent swing time (percent change: 1.1%+/-0.4%; P = .023) were observed in subjects who received reinforcement of positive stereotypes of aging. Gait speed and swing time did not change in those who received reinforcement of negative stereotypes of aging. The observed improvements in gait were related to the positive intervention, but were not related to age, gender, health status, or psychosocial status. CONCLUSIONS: Stereotypes of aging apparently have a powerful impact on the gait of older persons. Interventions designed to enhance perceptions of old age may prove beneficial in helping to improve gait and functional independence among older persons. In the future, positive changes in society's view of aging may also help to reduce and prevent age-related declines in function and the associated deleterious consequences.     

Four-meter gait speed predicts daily physical activity in patients with chronic respiratory diseases

BackgroundPhysical activity measures are valuable for assessing the progression of chronic respiratory diseases. The 4-m gait speed (4MGS) test is an established functional assessment in the elderly. However, the relationship between the 4MGS and daily activity in patients with chronic respiratory diseases has not been fully understood. The present study aimed to investigate whether the 4MGS predicted daily activity, including physical activity level (PAL), in patients with chronic respiratory diseases.MethodsWe enrolled 57 patients with chronic respiratory diseases, including interstitial lung disease and chronic obstructive pulmonary disease, and evaluated the correlations between the 4MGS and various clinical parameters, including respiratory function, the 6-min walk test (6MWT), and daily activities, by using an accelerometer. Linear regression analysis was performed to identify significant predictors of daily activity.ResultsThe 4MGS was significantly correlated with daily step counts and PAL, as well as the 6 min walk distance (r = 0.477, p < 0.001; r = 0.433, p = 0.001; and r = 0.593, p < 0.001, respectively). In the multivariate linear regression analysis, the 4MGS, % predicted forced expiratory volume in 1 s, and body mass index were independent predictors of PAL. Receiver operating characteristic analysis revealed that a 4MGS <1.07 m/s was the optimal cutoff for predicting an inactive PAL (area under the curve, 0.728; 95% confidence interval, 0.589–0.866). Patients with a slower 4MGS had significantly reduced daily activity than did those with a preserved 4MGS, despite similar modified Medical Research Council dyspnea scale measures and respiratory parameters, such as oxygenation profiles.ConclusionsThe 4MGS test is a simple screening test and a useful predictor of worsening daily activity in patients with chronic respiratory diseases.     

Associations of calf skeletal muscle characteristics and peripheral nerve function with self-perceived physical functioning and walking ability in persons with peripheral artery disease

We determined whether more adverse calf muscle characteristics and poorer peripheral nerve function were associated with impairments in self-perceived physical functioning and walking ability in persons with lower extremity peripheral artery disease (PAD). Participants included 462 persons with PAD; measures included the ankle-brachial index (ABI), medical history, electrophysiologic characteristics of nerves, and computed tomography of calf muscle. Self-perceived physical functioning and walking ability were assessed using the 36-Item Short Form Health Survey (SF-36) and the Walking Impairment Questionnaire (WIQ). Results were adjusted for age, sex, race, ABI, body mass index, comorbidities, and other confounders. Lower calf muscle area was associated with a poorer SF-36 physical function (PF) score (overall p-trend < 0.001, 33.76 PF score for the lowest quartile versus 59.74 for the highest, pairwise p < 0.001) and a poorer WIQ walking distance score (p-trend = 0.001, 29.71 WIQ score for the lowest quartile versus 48.43 for the highest, pairwise p < 0.001). Higher calf muscle percent fat was associated with a poorer SF-36 PF score (p-trend < 0.001, 53.76 PF score for the lowest quartile versus 40.28 for the highest, pairwise p = 0.009). Slower peroneal nerve conduction velocity was associated with a poorer WIQ speed score ( p-trend = 0.023, 30.49 WIQ score for the lowest quartile versus 40.48 for the highest, pairwise p = 0.031). In summary, adverse calf muscle characteristics and poorer peripheral nerve function are associated significantly and independently with impairments in self-perceived physical functioning and walking ability in PAD persons.     

Apolipoprotein epsilon4 allele and problems with orientation are associated with a persistent decline in cognition in community-dwelling elderly persons

BACKGROUND: A decline in cognitive test scores in elderly persons can signal the beginning of a descent into dementia or may indicate only a short-term cognitive disturbance. It would be clinically useful to distinguish between the two outcomes and to identify characteristics of each. METHODS: Four hundred thirty-seven community-dwelling elderly persons were given the Mini-Mental State Examination (MMSE) annually for an average of 7 years. A low score between baseline and final MMSE was identified. A low score 3 or more points lower than baseline score indicated cognitive decline. This decline was called persistent if the final MMSE score was also at least 3 points lower than baseline MMSE score; otherwise, the decline was considered transient. RESULTS: Twenty participants (4.6%) experienced a persistent cognitive decline, 67 participants (15.3%) experienced a transient cognitive decline. Presence of the apolipoprotein epsilon4 allele was significantly associated with persistent cognitive decline (age-adjusted odd ratio [OR] = 11.46, p < .0001) but not with transient cognitive decline (age-adjusted OR = 1.53, p = .219). Incorrect answers on the orientation part of the MMSE at the time of cognitive decline was associated with persistent decline compared to transient decline (age-adjusted OR = 3.58, p = .058). CONCLUSIONS: Persistent cognitive decline is an infrequent occurrence in community-dwelling elderly persons. Presence of the epsilon4 allele and errors made by the subject on questions of orientation may be useful in determining whether a cognitive decline is likely to be persistent.     

Associations between dietary pattern and lifestyle, anthropometry and other health indicators in the elderly participants of the EPIC-Italy cohort

INTRODUCTION: Epidemiological studies have shown that dietary behaviour is an important aetiological factor in various chronic diseases. We used principal component factor analysis to identify dietary patterns and to examine the associations of these patterns with health-related variables in a sample of elderly (> or =60 years) Italians participating in the European Prospective Investigation into Cancer and Nutrition (EPIC). METHODS AND RESULTS: Exploratory factor analysis was applied to the intake of food groups as estimated by semi-quantitative food questionnaires. Individual participants were assigned factor scores, indicating the extent to which their diet conformed to each of the four dietary patterns identified: prudent (cooked vegetables, pulses, cabbage, seed oil and fish); pasta & meat (pasta, tomato sauce, red meat, processed meat, bread and wine); olive oil & salad (raw vegetables, olive oil, soup and chicken); and sweet & dairy (sugar, cakes, ice cream, coffee and dairy). Highly educated people had high scores on prudent and low scores on pasta & meat. The pasta & meat and prudent patterns were strongly positively associated with body mass index (BMI) and waist-to-hip ratio (WHR) in men and women. Hyperlipidaemic men and women consumed more of the prudent and olive oil & salad patterns and less of the sweet & dairy pattern than those with normal lipids. The olive oil & salad was significantly higher and the pasta & meat and sweet & dairy patterns significantly lower in men and women who had dieted over the previous year, suggesting awareness of the health consequences of these patterns. CONCLUSIONS: Dietary pattern analysis provides a characterization of recurrent dietary behaviour in elderly people, and can be used to provide tangible dietary advice to elderly people.     

Assessing the handwriting process in healthy elderly persons using a computerized system

BACKGROUND AND AIMS: Despite the importance of handwriting in everyday life, virtually no literature can be found documenting the extent and range of everyday handwriting performance and ability among healthy elderly persons. The aim of this pilot study was to examine the kinematic characteristics of the handwriting process of healthy elderly persons and its correlates. METHODS: Fifty-three healthy participants (aged 60 to 94) living in the community, performed five functional writing tasks using a computerized system which documented the handwriting process. RESULTS: In air time (i.e., the time of non-writing while writing) accounted for approximately half to two-thirds of total writing time. Higher age was consistently associated with longer on paper and in air time, as well as with lower speed and lower pressure. CONCLUSIONS: The results of this pilot study indicate that kinematic analysis of handwriting provides important information about the handwriting process among elderly people.     

Serum albumin and muscle measures in a cohort of healthy young and old participants

Consensus on clinically valid diagnostic criteria for sarcopenia requires a systematical assessment of the association of its candidate measures of muscle mass, muscle strength, and physical performance on one side and muscle-related clinical parameters on the other side. In this study, we systematically assessed associations between serum albumin as a muscle-related parameter and muscle measures in 172 healthy young (aged 18–30 years) and 271 old participants (aged 69–81 year) from the European MYOAGE study. Muscle measures included relative muscle mass, i.e., total- and appendicular lean mass (ALM) percentage, absolute muscle mass, i.e., ALM/height² and total lean mass in kilograms, handgrip strength, and walking speed. Muscle measures were standardized and analyzed in multivariate linear regression models, stratified by age. Adjustment models included age, body composition, C-reactive protein and lifestyle factors. In young participants, serum albumin was positively associated with lean mass percentage (p = 0.007) and with ALM percentage (p = 0.001). In old participants, serum albumin was not associated with any of the muscle measures. In conclusion, the association between serum albumin and muscle measures was only found in healthy young participants and the strongest for measures of relative muscle mass.     

A prospective trial of serial gait speed as a measure of rehabilitation in the elderly

Walking speed was measured on admission and then weekly during treatment of 125 subjects admitted to a geriatric rehabilitation ward. Walking speed was strongly related to the ability to stand up from a chair without help. Placement decisions at discharge were made without knowledge of gait speed data so that they could be used as a standard against which to compare walking speed as a valid and practical measure of mobility. It was found that a discharge walking speed of 0.15 m/s best separated immobile subjects who required long-term hospital care from those sufficiently mobile to be discharged home alone or to a rest home (54% versus 0% below cut-off, respectively). Relative walking speed (speed/height) was no better at predicting placement or mortality than walking speed. Uncorrected walking speed therefore remains the preferred clinical measure of velocity. A serial record showing improvement in walking speed proved useful in predicting eventual independent mobility of poorly mobile subjects. Thus walking speed is an objective yet inexpensive method of monitoring gait rehabilitation.     

Association of total daily physical activity with disability in community-dwelling older persons: a prospective cohort study

Background

Based on findings primarily using self-report measures, physical activity has been recommended to reduce disability in old age. Collecting objective measures of total daily physical activity in community-dwelling older adults is uncommon, but might enhance the understanding of the relationship of physical activity and disability. We examined whether greater total daily physical activity was associated with less report of disability in the elderly.

Methods

Data were from the Rush Memory and Aging Project, a longitudinal prospective cohort study of common, age-related, chronic conditions. Total daily physical activity was measured in community-dwelling participants with an average age of 82 using actigraphy for approximately 9 days. Disability was measured via self-reported basic activities of daily living (ADL). The odds ratio and 95% Confidence Interval (CI) were determined for the baseline association of total daily physical activity and ADL disability using a logistic regression model adjusted for age, education level, gender and self-report physical activity. In participants without initial report of ADL disability, the hazard ratio and 95% CI were determined for the relationship of baseline total daily physical activity and the development of ADL disability using a discrete time Cox proportional hazard model adjusted for demographics and self-report physical activity.

Results

In 870 participants, the mean total daily physical activity was 2. 9?×?10⁵ counts/day (range in 10⁵ counts/day = 0.16, 13. 6) and the mean hours/week of self-reported physical activity was 3.2 (SD = 3.6). At baseline, 718 (82.5%) participants reported being independent in all ADLs. At baseline, total daily physical activity was protective against disability (OR per 10⁵ counts/day difference = 0.55; 95% CI = 0.47, 0.65). Of the participants without baseline disability, 584 were followed for 3.4 years on average. Each 10⁵ counts/day additional total daily physical activity was associated with reduced hazard of developing disability by 25% (HR = 0.75, 95% CI = 0.66, 0.84). The results were unchanged after controlling for important covariates including cognition, depressive symptoms, and chronic health conditions.

Conclusions

Greater total daily physical activity is independently associated with less disability even after controlling for self-reported physical activity.     

Total energy expenditure and energy requirements in healthy elderly persons.

To investigate energy requirements in healthy elderly subjects, we assessed the association of total energy expenditure (TEE) with resting metabolic rate (RMR), physical activity, body composition, and energy intake in 13 individuals (aged 56 to 78 years, six women and seven men). Free-living TEE was measured using doubly labeled water, RMR was measured by respiratory gas analysis, and energy expenditure of physical activity (EEPA) was derived from the difference between TEE and RMR, assuming the thermic response to feeding contributes 10% of TEE. Fat mass (FM) and fat-free mass (FFM) were obtained from underwater weighing, VO2max was determined from a bicycle test to exhaustion, energy intake was obtained from a 3-day food diary, and leisure time activity (LTA) was determined by structured interview. TEE was 2,406 +/- 438 kcal/d (range, 1,856 to 3,200 kcal/d, or 1.25 to 2.11 times RMR) and was related to VO2max (r = .79, P = .001), LTA (r = .74, P = .004), FFM (r = .69, P = .009), and FM (r = -.64, P = .018). The association between TEE and VO2max persisted after adjustment for FFM (partial r = .58, P = .036). EEPA was related to LTA (r = .83, P less than .0001) and FM (r = -.58, P = .039). Energy intake underestimated TEE by 31% +/- 18% in women and by 12% +/- 11% in men. Using stepwise regression, TEE was best predicted by VO2max and LTA (total adjusted r2 = .86). We conclude the following: (1) TEE varies greatly within healthy elderly subjects due to variations in physical activity; (2) VO2max has an important role in predicting energy requirements in older individuals; and (3) healthy older individuals underreport energy intake.     

Activity restriction induced by fear of falling and objective and subjective measures of physical function: a prospective cohort study

OBJECTIVES: To examine whether activity restriction specifically induced by fear of falling (FF) contributes to greater risk of disability and decline in physical function. DESIGN: Prospective cohort study. SETTING: Population‐based older cohort. PARTICIPANTS: Six hundred seventy‐three community‐living elderly (≥65) participants in the Invecchiare in Chianti Study who reported FF. MEASUREMENTS: FF, fear‐induced activity restriction, cognition, depressive symptoms, comorbidities, smoking history, and demographic factors were assessed at baseline. Disability in activities of daily living (ADLs) and instrumental activities of daily living (IADLs) and performance on the Short Performance Physical Battery (SPPB) were evaluated at baseline and at the 3‐year follow‐up. RESULTS: One‐quarter (25.5%) of participants did not report any activity restriction, 59.6% reported moderate activity restriction (restriction or avoidance of <3 activities), and 14.9% reported severe activity restriction (restriction or avoidance of ≥3 activities). The severe restriction group reported significantly higher IADL disability and worse SPPB scores than the no restriction and moderate restriction groups. Severe activity restriction was a significant independent predictor of worsening ADL disability and accelerated decline in lower extremity performance on SPPB over the 3‐year follow‐up. Severe and moderate activity restriction were independent predictors of worsening IADL disability. Results were consistent even after adjusting for multiple potential confounders. CONCLUSION: In an elderly population, activity restriction associated with FF is an independent predictor of decline in physical function. Future intervention studies in geriatric preventive care should directly address risk factors associated with FF and activity restriction to substantiate long‐term effects on physical abilities and autonomy of older persons.     

Obesity, physical activity, and mortality in a prospective chinese elderly cohort

BACKGROUND: In older people, it is unclear whether obesity relates to mortality, which calls into question its etiologic role in disease and its public health relevance. This apparent lack of relationship in older people could be an artifactual result of their diverse health states. METHODS: We used Cox regression analysis to determine whether the effect of body mass index (BMI) (calculated as weight in kilograms divided by the square of height in meters) or physical activity on mortality varied with health status in a prospective cohort study of Chinese people 65 years or older enrolled from 1998 to 2000 at all of the 18 Elderly Health Centers of the Hong Kong Government Department of Health. Health status was categorized into 5 morbidity groups using a 12-item index covering illnesses, medications, frailty, and smoking. RESULTS: After a mean follow-up of 4.1 years, there were 3819 deaths in 54 088 subjects (96.5% successful follow-up). The effect of BMI on mortality varied with baseline health status (P<.001). In the healthiest group, obese people (BMI >/=25) had higher mortality (adjusted hazard ratio [HR], 1.54; 95% confidence interval [CI], 1.02-2.33), but in the unhealthiest group they had lower mortality (HR, 0.55; 95% CI, 0.49-0.63) compared with subjects of normal weight. Daily physical activity was associated with lower mortality compared with inactivity in the unhealthiest group (HR, 0.70; 95% CI, 0.61- 0.81) but not in the healthiest group. CONCLUSIONS: In the elderly, the relationship between obesity and mortality varies according to the underlying health status. In those with poor health status, obesity is associated with better outcome, whereas in those with initially good health status, obesity is associated with worse outcome.