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Short-term consistency in self-reported physical functioning among elderly women: the Women's Health and Aging Study.

The assessment of physical functioning and disability is integral to population-based and clinical research carried out among elderly people. Typically, functional status is measured through self-reported responses to questions of the form "Do you have difficulty [doing a specific task]?" Knowledge of the reliability and validity of these self-report measures is key to the interpretation of many research efforts, but data on these measurement parameters are sparse. This paper addresses this deficiency through analyses of data from the Weekly Substudy of the Women's Health and Aging Study, a cohort of Baltimore-area women aged > or =65 years with moderate to severe physical disability. Self-reported data on 20 activities, obtained weekly over a 6-month period in 1993 or 1994, were analyzed to investigate how time intervals between assessments and a subject's age and baseline level of disability influenced the consistency of self-reports of disability at both the population level and the individual level. The prevalence of self-reported difficulty increased with baseline disability and, to a lesser extent, with age group. Consistency for all items was very high over short time intervals, but it decreased substantially with increasing intervals between responses (although associations between responses remained significant at 24 weeks). Consistency did not vary with age or baseline disability. Graphic techniques and statistical methods for use with repeated binary data are also illustrated.

Activities of Daily Living↗

Whose education counts? The added impact of adult-child education on physical functioning of older taiwanese.

OBJECTIVES: Research has implicated education as an important predictor of physical functioning in old age. Older adults in Taiwan tend to experience tight familial integration and high rates of adult-child coresidency-much more so than is typical in Western cultures-which might imply additional influences stemming from the education of children. This could arise in a number of ways; for instance, through the sharing of health-related information between child and parent, the quality of caregiving efforts, monetary assistance for medical and other services, or other psychosocial avenues. Despite this probable association, such hypotheses have rarely been tested. In this study, a nationally representative survey of older Taiwanese was used to examine these concurrent effects. METHODS: Outcome variables include the existence of any functional limitations (dichotomously measured) and the severity of functional disorders (ordinally measured). Dichotomous and ordinal logistic models were used. RESULTS: Results suggest that, after adjusting for age, sex, and other factors, both child and respondent education associate with the existence of limitations, but the child's education is more important than the parent's when predicting severity of limitations. DISCUSSION: This implies that models ignoring social network characteristics in determining health outcomes of older adults may be misspecified, at least in some non-Western societies, and calls for further testing in other societies as well.

Aged↗

ICF based comparison of disease specific instruments measuring physical functional ability in ankylosing spondylitis.

OBJECTIVES: To link validated and widely used instruments measuring physical functional ability in ankylosing spondylitis to the International Classification of Functioning, Disability, and Health (ICF) and to compare their contents, based on the results of the linking process. METHODS: The Bath Ankylosing Spondylitis Functional Index (BASFI), the Dougados Functional Index (DFI), the Health Assessment Questionnaire modified for the spondylarthropathies (HAQ-S), and the Revised Leeds Disability Questionnaire (RLDQ) were linked to the ICF separately by two trained health professionals according to 10 linkage rules. RESULTS: All concepts contained in the items of the selected instruments could be successfully linked to the ICF except for "illness" included in the HAQ-S. Altogether 55 different ICF categories were linked. Seven belonged to "body functions", 43 to "activities and participation", and five to "environmental factors". The component "body structure" was not contained in any of the four instruments. Only two ICF categories were common to all selected questionnaires, but there was a high level of concordance on the concepts represented in them. However, especially in terms of "activities and participation", the emphasised aspects differed. CONCLUSIONS: The ICF provides an excellent common framework for the comparison of disease specific instruments for ankylosing spondylitis. For a future revision of the ICF, a specification of major limitations in patients with ankylosing spondylitis is suggested.

Activities of Daily Living↗

Relation between use of angiotensin-converting enzyme inhibitors and muscle strength and physical function in older women: an observational study.

BACKGROUND: Angiotensin-converting enzyme (ACE) inhibitors prevent decline in physical function in patients with congestive heart failure (CHF). We aimed to see whether ACE inhibitors also prevent reduction in physical performance and in muscle strength in older women who do not have CHF. METHODS: We assessed 3-year rates of decline in both knee extensor muscle strength and walking speed in 641 women with hypertension who had participated in the Women's Health and Aging Study. Women were stratified into four groups according to type and duration of antihypertensive drug treatment. 61 had used ACE inhibitors continuously, 133 intermittently, 146 never, and 301 had used other hypertensive drugs either continuously or intermittently. FINDINGS: Participants who had taken ACE inhibitors continuously had a lower mean 3-year decline in muscle strength of -1.0 kg (SE 1.1) compared with -3.7 (0.5) kg in continuous/intermittent users of other antihypertensive drugs (p=0.016) and with -3.9 kg in those who had never used antihypertensives (p=0.026). Muscle strength fell by 3.0 kg in 3 years in both continuous and intermittent users of ACE inhibitors (p=0.096). Mean 3-year decline in walking speed in continuous ACE inhibitor users was -1.7 cm/s compared with -13.6 cm/s in intermittent users of ACE inhibitors (p=0.015), -15.7 cm/s in continuous/intermittent users of other antihypertensive drugs (p=0.002), and -17.9 cm/s in never users of antihypertensive drugs (p=0.001). INTERPRETATION: ACE inhibitor treatment may halt or slow decline in muscle strength in elderly women with hypertension and without CHF.

Aged↗

The physical, functional, and developmental outcome of pediatric burn survivors from 1 to 12 months postinjury.

Fifty-one children with an average age of 27 months and who had sustained a burn injury were tested at 1, 6, and 12 months postinjury to determine their physical, functional, and developmental outcomes. Most parents were either African-American or Hispanic, lived on public assistance, and had a high school education or less. Most children had normal range of motion and were appropriate for their age in self-care skills. On the basis of the Home Screening Questionnaire, 48% of the children came from suspect home environments. Developmental delays were noted in language acquisition that persisted over the first year postburn. Although the outcomes of these burn injuries were good in physical and functional areas, the developmental findings raised concerns. The results alert clinicians to screen for potential developmental problems during the burned child's recovery phase and to include appropriate developmental activities and parental guidance in the treatment plan.

Activities of Daily Living↗

Measures of physical function and emotional well being for young adults with arthritis.

We investigated whether it is necessary to adapt measures of functional status as used with adults with rheumatoid arthritis when measuring physical function in young adults between 16 and 30 years of age with arthritis, and which aspects of emotional well being are important outcomes in young adults with arthritis. A questionnaire as filled in by 196 young adults with arthritis and 117 healthy peers of same age and sex. Functional status was measured with the 17 item Young Adults Disability Inventory (YADI), which includes the 8 item Modified Health Assessment Questionnaire (M-HAQ). Four aspects of emotional well being were assessed: depression, anxiety, loneliness, and self-esteem. The mean score of the patients on the YADI was significantly higher than that on the M-HAQ. YADI scores correlated significantly higher with a measure of disease symptoms than the scores on the M-HAQ with disease symptoms. Anxiety was not strongly correlated with functional status, disease symptoms, or self-reported Thompson joint score. Depression, loneliness, and self-esteem were moderately correlated with functional status and disease symptoms and weakly correlated with the Thompson score. There were no significant difference in emotional well being between patients and their healthy peers. Patients with severe symptoms were significantly more depressed than their healthy peers. It seems that the YADI is more appropriate measure of functional status in young adults with arthritis than the M-HAQ. Depression seems to be an important emotional outcome for young adults with arthritis. Anxiety does not seem to be a severely affected area of emotional well being.

Activities of Daily Living↗

Reported and measured physical functioning in older inner-city diabetic African Americans.

BACKGROUND: The impact of diabetes on disability and physical functioning in older African Americans and potential causes of the excessive disability associated with diabetes in other studies have been inadequately investigated. METHODS: A population-based survey was performed comparing 116 self-reported diabetic inner-city African Americans aged 70 years and older to 522 nondiabetic persons from the same population. A subsample (n = 168) received a physical examination focused on body habitus, upper and lower body strength, balance, and timed physical performance tasks. Blood tests were obtained from 173 subjects. RESULTS: Diabetic individuals reported worse general health (p = .01), instrumental activities of daily living (p = .02), and modified versions of the Rosow-Breslau scale (p<.001) and the Stanford Health Assessment Questionnaire (p = .002). Diabetic persons also reported more falls (0.59 per person vs. 0.20, p = .019) and injurious falls (12% vs. 6%, p = .025). There were minimal differences in the strength, balance, and timed performance measures (analyzed separately by gender). In multivariable analyses, impairments in visual function and pain and light touch perception appeared to explain some of the association between diabetic status and poor general health, disability, and falls, with lesser contribution from the number of medical problems, number of medications, and glycemic control. CONCLUSIONS: Older inner-city diabetic blacks demonstrated worse general health, excess disability, and more falls compared to controls, although deficits in strength, balance, and timed performance could not be demonstrated. The cause of decreased functional status in diabetic elders deserves additional investigation, focusing especially on sensory function, glycemic control, and contribution from specific medical problems and medications.

Accidental Falls↗

Recovery of physical function after limb injuries in independent older people living at home.

OBJECTIVES: to describe changes in physical functioning after fall-related injuries to the limbs in independently living older people. DESIGN: prospective cohort study, including a pre-injury assessment and post-injury assessments at 8 weeks and 5 and 12 months. SETTING: the study is part of the larger, population-based prospective and longitudinal Groningen Longitudinal Aging Study on the determinants of health-related quality of life of people aged 57 and over, who are living independently in the north of the Netherlands. SUBJECTS: 171 patients who sustained injuries at various sites on the limbs and who had completed all four assessments (66% of the eligible population). Patients were grouped according to injury site. OUTCOME MEASURE: self-reported grades of difficulties with performing basic and instrumental activities of daily living as measured by the Groningen Activity Restriction Scale. RESULTS: 1 year after the injury, pre-injury (mean) levels of functioning were not regained in any of the groups studied. However, only those with fractures of the wrist or hip experienced a substantial decrease in ability to perform basic and instrumental activities of daily living between baseline and the final assessment. Furthermore, of the 44 subjects with wrist fractures, seven (15.9%) needed help with at least one relevant activity at baseline and 18 (40.9%) at 12 months. Of the 34 subjects with hip fractures, four (11.8%) needed help with at least one activity at baseline and 18 (52.9%) at 12 months. Practically no changes were found in any of the groups after 5 months post-injury. CONCLUSIONS: not only hip fractures, but also wrist fractures may reduce older people's chances of remaining independent. Prospects of further recovery are minimal 5-6 months after the injury.

Activities of Daily Living↗

Effect on physical functioning of care in adult foster homes and nursing homes.

This study tested the effects on physical functioning of substituting adult foster care (AFC) for nursing home care. Secondary data from Oregon's Medicaid agency were used to compare change in ADL functioning of 1,032 nursing home and 279 AFC residents. Maximum likelihood estimation was used to analyze selection of long-term care setting and change in functioning. One-third of surviving AFC residents would have been better off in a nursing home, whereas almost all nursing home residents were placed appropriately. Further research on outcomes that clients value most along with efforts to support functioning are needed.

Activities of Daily Living↗

How does low back pain impact physical function in independent, well-functioning older adults? Evidence from the Health ABC Cohort and implications for the future.

OBJECTIVE: To determine the relationships between low back pain (LBP) frequency and intensity and self-reported and performance-based physical function in a large cohort of well-functioning older adults. DESIGN: Cross-sectional survey and examination. SETTING: Community-based cohort of the Health, Aging, and Body Composition (Health ABC) study. PARTICIPANTS: Participants were 2,766 community-dwelling adults, aged 70-79; 42% were African American, 52% were men. OUTCOME MEASURES: 1) Back pain-location, frequency, intensity; 2) Hip and/or knee pain; 3) Body mass index (BMI); 4) Self-reported difficulty doing functional tasks; 5) Lower extremity function, using the battery from the Established Populations for Epidemiologic Studies in the Elderly (EPESE); 6) Self-rated health; 7) Comorbidity; 8) Depressive symptoms, using the Center for Epidemiological Studies-Depression (CES-D) scale. RESULTS: LBP was common (36%), and its frequency/intensity was significantly associated with other pain and comorbidities. In gender-specific models, LBP frequency/intensity was not significantly associated with EPESE performance score after adjusting for age, race, BMI, CES-D score, knee pain, hip pain, and other comorbidities. LBP frequency/intensity, however, was significantly associated with self-reported difficulty with most functional tasks after adjusting for important confounders. CONCLUSIONS: Among well-functioning community-dwelling older adults, LBP frequency/intensity was associated with perceived difficulty in performing important functional tasks, but not with observed physical performance. The demonstrated dose-response relationship between pain frequency/intensity and self-reported task performance difficulty underscores the importance of clinical efforts to treat pain without necessarily eradicating it. Additional work is needed to determine whether back pain is associated with a risk for progressive functional decline and loss of independence in older adults and whether therapeutic interventions can ameliorate decline and, therefore, preserve independence.

Activities of Daily Living↗

Expansion of a physical function item bank and development of an abbreviated form for clinical research.

We expanded an existing 33-item physical function (PF) item bank with a sufficient number of items to enable computerized adaptive testing (CAT). Ten items were written to expand the bank and the new item pool was administered to 295 people with cancer. For this analysis of the new pool, seven poorly performing items were identified for further examination. This resulted in a bank with items that define an essentially unidimensional PF construct, cover a wide range of that construct, reliably measure the PF of persons with cancer, and distinguish differences in self-reported functional performance levels. We also developed a 5-item (static) assessment form ("BriefPF") that can be used in clinical research to express scores on the same metric as the overall bank. The BriefPF was compared to the PF-10 from the Medical Outcomes Study SF-36. Both short forms significantly differentiated persons across functional performance levels. While the entire bank was more precise across the PF continuum than either short form, there were differences in the area of the continuum in which each short form was more precise: the BriefPF was more precise than the PF-10 at the lower functional levels and the PF-10 was more precise than the BriefPF at the higher levels. Future research on this bank will include the development of a CAT version, the PF-CAT.

Activities of Daily Living↗

Difficulties in physical functioning reported by middle-aged and elderly women with breast cancer: a case-control comparison.

Levels of physical functioning reported by women aged 55 to 84 with incident breast cancer were compared to those reported by women of the same age without the disease. A total of 422 breast cancer patients, identified through the Metropolitan Detroit Cancer Surveillance System, were interviewed 3 and 12 months after diagnosis. Interviews with 478 controls of the same age, identified through telephone random-digit dialing, were conducted twice during the same time period. At 3 months, patients aged 55-64 and 65-74 reported greater difficulty than controls in completing tasks requiring upper-body strength. Little difference was shown between cases and controls aged 75 to 84. After one year, patients aged 65-74 still reported higher than expected levels of difficulty in light lifting as well as pushing and lifting heavy objects. Among cases aged 55-64, only pushing and lifting heavy objects remained problematic. Estimates of the prevalence of physical difficulty will be useful in planning future breast cancer treatment and rehabilitation services.

Activities of Daily Living↗

Physical function and perceived health: cohort differences and interrelationships in older people.

Differences between seven-year birth cohorts in physical functioning (as measured by independence in activities of daily living) are compared with corresponding inter-cohort differences in perceived health, in people aged 75 years and over. Age-period-cohort models were fitted to two linked cross-sectional surveys undertaken in 1981 (N = 1,203) and 1988 (N = 1,579). The proportion of older people who were dependent in ADLs was lower in succeeding cohorts but, by contrast, the proportion with less than good self-perceived health was higher. These inter-cohort differences in perceived health were particularly marked for the comparison between 1981 and 1988 of men aged 75-81 years in the dependent subpopulation. Furthermore, self-perceived health remained as strong a predictor of mortality in 1988 as in 1981. Self-perceived health may be indexing a higher prevalence of mild chronic conditions in newer cohorts of older people, with implications for primary health care providers.

Activities of Daily Living↗

Comparison between irradiated and thermally pasteurized liquid egg white on functional, physical, and microbiological properties.

A comparative study was undertaken to determine the effect of irradiation and thermal pasteurization on the functional, physical, and microbiological properties of liquid egg white (LEW). The LEW was irradiated or thermally pasteurized then stored at 4 C for 3 mo. Both treatments destroyed the inoculum, Salmonella typhimurium. The microbial growth rate was slower in the irradiated LEW than in the thermally pasteurized treatment. Irradiated samples had 47% lower foam drainage and more stable viscosity than samples that were thermally pasteurized. Volume of angel food cake prepared with irradiated or pasteurized LEW decreased 48 and 57%, respectively, after 90 d. Color did not differ between treatments. Ionizing radiation is an alternative processing method that inhibits microbial growth and helps maintain functionality of LEW.

Animals↗

Effects of ultra-low-dose estrogen therapy on muscle and physical function in older women.

OBJECTIVES: To determine the effects of ultra-low-dose hormone therapy on muscle mass and physical function in community-dwelling women. DESIGN: Double-blind, placebo-controlled trial. SETTING: Clinical research center in Connecticut. PARTICIPANTS: Healthy, community-dwelling women aged 65 and older (n=167). INTERVENTION: Eligible women were randomly assigned to treatment with 0.25 mg 17-beta estradiol or placebo for 36 months. All women (estradiol or placebo) with an intact uterus received micronized progesterone 100 mg/d for 2 weeks every 6 months. All participants received 1,300 mg elemental calcium with 1,000 IU vitamin D per day. MEASUREMENTS: Appendicular skeletal muscle mass (ASM), lean body mass (LBM), and percentage body fat were measured using dual x-ray absorptiometry. Sarcopenia was defined as skeletal muscle mass (ASM/height2) 2 standard deviations or less than young, healthy reference population mean. Physical activity (Physical Activity Scale in the Elderly (PASE)) and performance were measured. Serum estrone, estradiol, and sex hormone-binding globulin were measured. RESULTS: The prevalence of sarcopenia at baseline was 13%. There were no baseline differences between groups except for PASE score and chair rise time, in which the estrogen group had better performance. No changes in ASM, LBM, percentage of body fat, or physical performance were found after 3 years of estrogen therapy. CONCLUSION: Sarcopenia was present in 13% of this group of community-dwelling, postmenopausal older women. Ultra-low-dose estrogen therapy neither improves nor harms ASM. Similarly, no changes in body fat or physical performance were detected.

Absorptiometry, Photon↗

Association between daily pain and physical function among old-old adults living in the community: results from the ilSIRENTE study.

Little is known about the impact of pain on physical function among old-old subjects. The aim of the present cross-sectional study was to assess the association of daily pain with muscle strength and physical performance in a population of subjects aged 80 or older living in the community. We used data from baseline evaluation of the ilSIRENTE Study. Muscle strength was measured by hand grip strength. Physical performance was assessed using the physical performance battery score, which is based on three timed tests: 4-m walking speed, balance, and chair stand tests. Daily pain was defined as any type of pain or discomfort in any part of the body manifested every day over the 7 days preceding the assessment. Mean age of 273 participants was 85.1 (SD 4.6) years, 181 (66.3%) were women and 150 (54.9%) reported daily pain. After adjustment for potential confounders, participants with daily pain had lower grip strength and physical performance battery score (indicating worse performance) than other participants (hand grip strength: daily pain 31.5 kg, SE 1.4, no daily pain 35.0, SE 1.1, p = 0.02; physical performance battery score: daily pain 6.5, SE 0.3, no daily pain 7.2, SE 0.3, p = 0.05). Both hand grip strength and physical performance battery score progressively declined as pain severity increased. In conclusion, the present study shows that among old-old subjects living in the community, daily pain is highly prevalent and that this condition is associated with impaired muscle strength and physical performance.

Activities of Daily Living↗

Modifiers of change in physical functioning in older adults with knee pain: the Observational Arthritis Study in Seniors (OASIS).

OBJECTIVE: To ascertain predictors of decline in physical functioning among older adults reporting knee pain. METHODS: The Observational Arthritis Study in Seniors was a longitudinal study of 480 adults over 65 years of age. Measurements of strength, sociodemographic characteristics, disease burden (including radiographic knee osteoarthritis [OA]), self-reported disability, and functional limitations were obtained on participants at baseline and at 15 and 30 months. RESULTS: Radiographic evidence of OA at baseline was moderately associated with an increased decline in both transfer (P = 0.06) and ambulatory-based performance tasks (P = 0.04) but not in self-reported disability. This effect disappeared after accounting for baseline levels of knee pain intensity and knee strength. CONCLUSION: Knee pain intensity and knee strength may mediate the relationship between radiographic evidence of knee OA and change in performance. Although it is not clear whether joint disease precedes or follows a decline in muscular strength, these results may help to identify subpopulations of older persons with knee OA who may benefit from interventions aimed at slowing the progression of disability related to transfer and ambulatory-based tasks.

Activities of Daily Living↗

Weight change and physical function in older women: findings from the Nun Study.

OBJECTIVE: To investigate the association between change in weight and decline in physical function in older women. DESIGN: Longitudinal study of a defined population of Catholic sisters (nuns) whose weight and function were assessed twice, an average of 584 days apart. SETTING: Unique life communities (convents) located throughout the United States. PARTICIPANTS: 475 Catholic sisters who were 75 to 99 years of age (M = 82.1, SD = 4.8) and were independent in at least one Activity of Daily Living (ADL) at the first assessment of weight and function. INTERVENTIONS: None. MEASUREMENTS: At each assessment, weight, ADLs, and cognitive function were evaluated as part of the Nun Study--a longitudinal study of aging and Alzheimer's disease. Annual percent weight change was calculated using weights from the two assessments, as well as the number of days that elapsed between assessments. RESULTS: Mean weight at first assessment was 140 pounds (range 78 to 232, SD = 27). The mean annual percent weight change was 0.1% (range 22% loss to 16% gain, SD = 3.8). Age- and initial weight-adjusted findings indicated that those participants with an annual percent weight loss of 3% or greater had 2.7 to 3.9 times the risk of becoming dependent in each ADL, compared to the sisters with no weight change. The elevated risk persisted in those who were mentally intact or were independent in their eating habits. CONCLUSION: Monitoring of weight may be an easy and inexpensive method of identifying older individuals at increased risk of disability.

Activities of Daily Living↗