Age-related differences in lower extremity tissue compartments and associations with physical function in older adults

The lower extremities are important to performing physical activities of daily life. This study investigated lower extremity tissue composition, i.e. muscle and fat volumes, in young and older adults and the relative importance of individual tissue compartments to the physical function of older adults. A total of 43 older (age 78.3 ± 5.6 years) and 20 younger (age 23.8 ± 3.9 years) healthy men and women participated in the study. Older participants were further classified as either high- (HF) or low-functioning (LF) according to the Short Physical Performance Battery (SPPB). Magnetic resonance images were used to determine the volumes of skeletal muscle, subcutaneous fat (SAT), and intermuscular fat (IMAT) in the thigh (femoral) and calf (tibiofibular) regions. After adjusting for the sex of participants, younger participants had more femoral muscle mass than older adults (p < 0.001 for between group differences) as well as less femoral IMAT (p = 0.008) and tibiofibular IMAT (p < 0.001). Femoral muscle was the only tissue compartment demonstrating a significant difference between the two older groups, with HF participants having 31% more femoral muscle mass than LF participants (mean difference = 103.0 ± 34.0 cm³; p = 0.011). In subsequent multiple regression models including tissue compartments and demographic confounders, femoral muscle was the primary compartment associated with both SPPB score (r² = 0.264, p = 0.001) and 4-meter gait speed (r² = 0.187, p = 0.007). These data suggest that aging affects all lower extremity compartments, but femoral muscle mass is the major compartment associated with physical function in older adults.     

The Association Between Social Engagement,Mild Cognitive Impairment,and Falls Among Older Primary Care Patients

ObjectivesTo examine associations between mild cognitive impairment (MCI) and falls among primary care patients, and to investigate whether social engagement (SE) modifies these associations.DesignCross sectional analysis using baseline data from an observational cohort study.SettingPrimary care.ParticipantsCommunity-dwelling older adults (N=430) at risk of mobility decline with a mean age of 76.6 years (range 65-96y).Main Outcome MeasuresThe number of falls in the past year was reported at the baseline interview. MCI was identified using a cutoff of 1.5 SD below the age-adjusted mean on at least 2 of the standardized cognitive performance tests. SE (eg, keeping in touch with friends and family, volunteering, participating social activities…) was assessed with the Late Life Function and Disability Instrument, and required a score above the median value 49.5 out of 100.ResultsMCI was present among 42% of participants and 42% reported at least 1 fall in the preceding year. Using generalized estimating equations, MCI was associated with a 77% greater rate of falls (P<.05). There was a statistically significant interaction between SE and MCI on the rate of falls (P<.01), such that at a high level of SE, MCI was not statistically associated with falls (P=.83). In participants with lower levels of SE, MCI is associated with 1.3 times greater rate of falls (P<.01).ConclusionsWhile MCI is associated with a greater risk for falls, higher levels of SE may play a protective role.     

A Cost-Effectiveness Analysis of a Randomized Control Trial of a Tailored,Multifactorial Program to Prevent Falls Among the Community-Dwelling Elderly

Objective

To perform a cost-effectiveness analysis of a multifactorial, tailored intervention to reduce falls among a heterogeneous group of high-risk elderly people.

Baseline Lower Extremity Strength and Subsequent Decline in Functional Performance at 6‐Year Follow‐Up in Persons with Lower Extremity Peripheral Arterial Disease

OBJECTIVES: To evaluate associations between baseline lower extremity strength and decline in functional performance over 6 years of follow‐up in men and women with lower extremity peripheral arterial disease (PAD). DESIGN: Prospective observational study. SETTING: Three Chicago‐area hospitals. PARTICIPANTS: Three hundred seventy‐four men and women with PAD. MEASUREMENTS: Baseline isometric hip extension, hip flexion, knee flexion, and knee extension strength were measured using a musculoskeletal fitness evaluation chair. Usual and fastest‐paced 4‐m walking speed, 6‐minute walk, and Short Physical Performance Battery (SPPB) were assessed at baseline and annually thereafter. Analyses were adjusted for age, sex, race, ankle–brachial index (ABI), comorbidities, and other confounders. RESULTS: In women with PAD, weaker baseline hip and knee flexion strength were associated with faster average annual decline in usual‐pace 4‐m walking speed (P trend <.001 and .02, respectively) and SPPB (P trend=.02 and .01, respectively). In women, weaker hip extension strength was associated with faster decline in usual‐pace 4‐m walking speed and SPPB (P trend=.01 and <.01, respectively). There were no significant associations between baseline strength and decline in 6‐minute walk in women. There were no significant associations between any baseline strength measure and functional decline in men. CONCLUSION: Weaker baseline leg strength is associated with faster functional decline in nonendurance measures of functional performance in women with PAD but not in men with PAD.     

Age-Related Variations of Muscle Mass,Strength, and Physical Performance in Community-Dwellers: Results From the Milan EXPO Survey

Objectives

Declining muscle mass and function are hallmarks of the aging process. The preservation of muscle trophism may protect against various negative health outcomes. Age- and sex-specific curves of muscle mass, strength, and function, using data from a large sample of community-dwelling people, are necessary.

Interaction Between Frailty and Access Site in Older Adults Undergoing Transcatheter Aortic Valve Replacement

Objectives

The authors sought to determine whether frail older adults undergoing nonfemoral transcatheter aortic valve replacement (TAVR) procedures had a higher risk of 30-day and 12-month mortality.

The influence of lower-extremity function in elderly individuals’ quality of life (QOL): An analysis of the correlation between SPPB and EQ-5D

Background

If an association between a decline in physical performance and subjective QOL is confirmed, the SPPB could be used as a predictor for declining QOL in older people.

Objective

This study aimed to elucidate the association between the short physical performance battery (SPPB) and QOL (EQ-5D) to determine the utility of the SPPB as a predictor of declining QOL.

Methods

The SPPB and the EQ-5D test were performed with a random sample of participants nested in the Korean Longitudinal Study of Aging (KLoSA) panel. Comparisons of the adjusted mean scores on the EQ-5D index between normal and abnormal SPPB groups were performed. We selected the quartiles of the EQ-5D index variables for the analysis. The association between the EQ-5D index and SPPB abnormality was examined using multinomial logistic regression analysis. Additionally, the associations between gait speed and chair stand time and the EQ-5D index were examined using the same analysis.

Results

Four hundred and twenty-two subjects were included in the analysis. The adjusted means for the EQ-5D index were significantly lower when the SPPB score was abnormal (p = 0.022 for men, p = 0.047 for women). An abnormal SPPB score was significantly associated with the lowest quartile of EQ-5D index score (adjusted OR 3.54 in the lowest quartile for men; adjusted OR 2.50 and 3.37 in the lowest and second quartiles for women). Gait speed was significantly associated with the EQ-5D index for participants of both sexes, but standup time was associated with the EQ-5D index only for men.

Conclusions

An abnormal SPPB score was associated with lower QOL. Thus, the SPPB has the potential to be used as an early predictor of declining QOL in clinical settings and epidemiological studies.