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Cystatin C and measures of physical function in elderly adults: the Health, Aging, and Body Composition (HABC) Study.

Most studies of the relation between kidney function and physical function have been conducted in persons with advanced kidney disease and have used creatinine-based measures of kidney function. Cystatin C concentration is a measure of kidney function that is independent of muscle mass, unlike creatinine. Using baseline data on 3,043 elderly adults from the Health, Aging, and Body Composition Study (Blacks and Whites recruited from Pittsburgh, Pennsylvania, and Memphis, Tennessee, in 1997-1998), the authors examined the cross-sectional association between cystatin C level and performance on several tests of physical function. After adjustment for demographic and lifestyle variables, chronic health conditions, and inflammation, each standard-deviation (0.34 mg/liter) increase in cystatin C concentration was associated with 1.32 odds (95% confidence interval (CI): 1.20, 1.46) of not completing a 400-m walk, a 10.9-second (95% CI: 8.1, 13.8) slower 400-m walk time, a 0.11-point (95% CI: 0.09, 0.13) reduction in lower extremity performance score, a 1.12-kg (95% CI: 0.83, 1.40) lower grip strength, and a 4.7-nm (95% CI: 3.5, 5.9) lower knee extension strength. In contrast, when kidney function was measured by estimated glomerular filtration rate, the association of kidney function with physical function was only evident below 60 ml/minute/1.73 m2. In these older adults, mild decrements in kidney function, as measured by cystatin C concentration, were associated with poorer physical function.

Aged↗

Physics and applications of microfluidics in biology.

Fluid flow at the microscale exhibits unique phenomena that can be leveraged to fabricate devices and components capable of performing functions useful for biological studies. The physics of importance to microfluidics are reviewed. Common methods of fabricating microfluidic devices and systems are described. Components, including valves, mixers, and pumps, capable of controlling fluid flow by utilizing the physics of the microscale are presented. Techniques for sensing flow characteristics are described and examples of devices and systems that perform bioanalysis are presented. The focus of this review is microscale phenomena and the use of the physics of the scale to create devices and systems that provide functionality useful to the life sciences.

Biosensing Techniques↗

Proxy reporting in five areas of functional status. Comparison with self-reports and observations of performance.

Proxy ratings of functional status were compared with subject self-reports in five domains relevant to the study of older persons and with observations of subject performance in two areas (physical and instrumental functioning). Data were derived from 233 proxy-subject pairs evaluated in a prospective study of hip fracture patients aged 65 years or more in Baltimore, Maryland (1990-1991). Agreement between proxy and subject reports was highest for a summary measure of instrumental functioning and lowest for a measure of depression. Proxies tended to report more disability than did subjects, although bias varied by function. Patterns of agreement for proxy reports versus observations of performance compared with patterns for proxy reports versus subject reports were lower for measures of instrumental functioning, and bias was generally more extreme for instrumental and physical functioning measures. The authors conclude that agreement and bias differ by functional domain, by the way summary measures are created and scored, and by the criterion against which proxy reports are compared.

Activities of Daily Living↗

Muscle power of the ankle flexors predicts functional performance in community-dwelling older women.

OBJECTIVES: To test the hypothesis that peak power of the ankle flexors is related to physical functioning in older women with functional limitations. DESIGN: A cross-sectional study. SETTING: University-based human physiology laboratory. PARTICIPANTS: Thirty-four older women (75.4 +/- 5.1 years, 67.8 +/- 11.3 kg, body mass index 27.4 +/- 4.5) with self-reported functional limitations. MEASUREMENTS: Plantarflexion (PF) and dorsiflexion (DF) peak power and isometric strength with physical performance (stair climb time, repeated chair rise time, maximal and habitual gait velocity) were determined. An isokinetic dynamometer was used to measure isometric strength, isokinetic peak torque and power of PF and DF at five angular velocities (30 degrees, 60 degrees, 90 degrees, 120 degrees, and 180 degrees.sec-1), and isometric strength. RESULTS: Peak torque for both PF and DF declined with increasing velocity of movement (PF: P <.0001; DF: P <.0001), whereas peak power increased with increasing velocity up to 120 degrees.sec-1. The strongest univariate associations were found between chair rise time and DF peak power (r = 0.50; P <.002), stair climb time and DF peak power (r = 0.49; P <.003), habitual gait velocity and PF isometric strength (r = 0.53; P <.001), and maximal gait and PF isometric strength (r = 0.47; P <.005). Multivariate regression analysis revealed that DF and PF peak power along with the physical functioning and general health scores from the Medical Outcomes Study Short Form were independent predictors of chair and stair climb performance. CONCLUSION: These data suggest that ankle muscle power together with self-reported measures of health and physical functioning are essential components of functional mobility in older women with functional limitations.

Activities of Daily Living↗

[Protective effects of the regulators of energy metabolism and essentiale in case of nitrite intoxication].

The objective of this investigation was to assess immuno-, hepato- and actoprotective activity of mildronate and the impact of riboxin, elcar and essentiale on this drug in Wistar rats receiving the injections of sodium nitrite. The parameters characterizing non-specific resistance, immunological reactivity, the membranes state, detoxicating hepatic activity and physical performance. Mildronate administration increased functional activity of immune cells, hepatocytes and myocytes (but not up to normal limit) that had been reduced by sodium nitrite. The combination of mildronate and riboxine normalized phagocytic and metabolic activity of polymorphonuclear leucocytes, induced humoral immune response and delayed-onset hyperresponsiveness and normalized the ability of the intoxicated rats to perform submaximal physical activity. The combined administration of mildronate and essentiale normalized immune reactions, hepatic metabolism and physical performance of the rats poisoned by sodium nitrite. The combination of mildronate and riboxin or essentiale decreased the severity of damaged oxidation potential of the red blood cells of the intoxicated rats and prevented the development of erythrocytic immunosuppressive properties.

Animals↗

Constant hierarchic patterns of physical functioning across seven populations in five countries.

This research was aimed at identifying critical steps in the decline in physical function that often parallels aging. Six basic and nine instrumental activities of daily living (ADLs) were classified into four domains of disability characterized by specific underlying physical impairment. The hierarchical order of this classification was verified in two random samples representative of the older home-dwelling population. The concordance level of disability and results of performance-based measures of physical function were also tested. Finally, the cross-cultural reliability of the model was verified in seven population-based samples of older persons living in five European countries. In older persons the disabling process follows a general pattern of progression based on a typical sequence of impairments.

Activities of Daily Living↗

The Performance Status Scale for Head and Neck Cancer Patients and the Functional Assessment of Cancer Therapy-Head and Neck Scale. A study of utility and validity.

BACKGROUND: The goal of this investigation was to examine the relationship between, and application of, two disease specific quality of life (QL) measures currently being employed for head and neck cancer patients: the Functional Assessment of Cancer Therapy-Head and Neck Scale (FACT-H&N) and the Performance Status Scale for Head and Neck Cancer Patients (PSS-HN). METHODS: The FACT-H&N and PSS-HN were administered to 151 head and neck cancer patients with a range of disease sites, treatment status (on vs. off treatment), and treatment modalities (surgery, radiation, and chemotherapy). RESULTS: FACT-H&N subscale and total scores and PSS-HN subscale scores proved sensitive to patients groups (showed significant and clinically meaningful differences) on the basis of treatment status (on vs. off treatment) and global performance status (Karnofsky scores). The pattern of correlations between FACT-H&N and PSS-HN subscales supported the scales' construct (convergent vs. divergent) validity. The strongest and most significant associations were observed between PSS-HN Normalcy of Diet and Eating in Public, and the head and neck subscale (HNS) of FACT-H&N, both of which were designed to measure the unique problems of head and neck cancer patients. More modest associations were observed between subscales measuring physical and functional areas of performance, social functioning, and emotional well-being. CONCLUSIONS: The FACT-HNS was found to be reliable and valid when applied to head and neck cancer patients. It clearly adds information to that collected by the parent (core) instrument. The PSS-HN also provides unique information, independent of that provided by the Karnofsky or the FACT-H&N. This study supported the multidimensional nature of QL for head and neck cancer patients, and thus the importance of assessing disease specific concerns in addition to general health status when assessing functional and QL outcome.

Adolescent↗

Comparative effects of two physical activity programs on measured and perceived physical functioning and other health-related quality of life outcomes in older adults.

BACKGROUND: Although inactivity is an important contributor to impaired functioning and disability with age, little is known concerning how improvements in physical functioning and well-being in older adults vary with the type of physical activity undertaken. METHODS: One hundred three adults age 65 years and older, recruited via population-based methods, were randomized to 12 months of community-based, moderate-intensity endurance and strengthening exercises (Fit & Firm) or stretching and flexibility exercises (Stretch & Flex). A combination of class- and home-based exercise formats was used. Measured and self-rated physical performance along with perceived functioning and well-being were assessed pre- and postintervention. RESULTS: Fit & Firm subjects showed greater 12-month improvements in both measured and self-rated endurance and strength compared to Stretch & Flex subjects. Stretch & Flex subjects reported greater improvements in bodily pain, and Stretch & Flex men evidenced greater improvements in flexibility relative to Fit & Firm subjects. Although overall exercise adherence was high in both exercise conditions (approximately 80%), subjects in both conditions showed better adherence to the home- versus class-based portions of their exercise prescriptions. CONCLUSIONS: Community-based programs focusing on moderate-intensity endurance and strengthening exercises or flexibility exercises can be delivered through a combination of formats that result in improvement in important functional and well-being outcomes. This represents one of the first studies to report significant improvements in an important quality of life outcome-bodily pain-with a regular regimen of stretching and flexibility exercises in a community-based sample of older adults.

Activities of Daily Living↗

Functional capacity evaluations in persons with spinal disorders: predicting poor outcomes on the Functional Assessment Screening Test (FAST).

This study determines how performance on the simple, low exertion Functional Assessment Screening Test (FAST) relates to performance on more extensive physical and psychological testing. One hundred eighty-eight persons with chronic back disability and 17 spine healthy volunteers underwent the FAST (three 2-min static tests [kneeling, stooping, and squatting] and two 5-min tests [repetitive stooping and repetitive twisting while standing]), the Progressive Isoinertial Lifting Evaluation (PILE), trunk extension endurance, submaximal bicycle ergometry, and psychological profiles. All FAST components were completed by 88% of spine healthy subjects, but only by 19.7% (n = 37) of the back patients. Internal consistency for overall test performance was 0.82 (alpha coefficient). Back pain noncompleters had poorer performance on the PILE and trunk extension endurance despite similar cardiovascular fitness and perceived exertion during testing. They had more dysfunctional coping mechanisms, pain avoidance, depression, and self-reported disability. Since performance on nonstrenuous testing is so poor, and psychosocial variables relate strongly to test performance, extensive Functional Capacity Evaluations may not be necessary or valid in assessing the physical performance of this population of chronic back pain patients.

Activities of Daily Living↗

Enzyme activities in hepatic venous blood under strenuous physical exercise.

In order to study the influence of physical exercise on liver function, experiments were performed in healthy volunteers subjected to controlled major physical effort. Blood samples obtained by catheterization of hepatic vein during exercise were analyzed for activities of LD (thermostabile and thermolabile isoenzymes), AlAT, SDH, ICD, AP and CPK, and these activities were compared with corresponding values in arterial blood samples taken simultaneously. Hepatic blood flow and oxygen saturation of hepatic venous blood were measured. Physical exercise resulted both in diminished hepatic blood flow and a fall in hepatic venous oxygen saturation. These changes were accompanied by release of liver specific enzymes, indicating that exhausting exercise may induce an "increased hepatocyte membrane permeability" in man.

Adult↗

Lower limb function as predictor of falls and loss of mobility with social repercussions one year after discharge among elderly inpatients.

BACKGROUND AND AIMS: Poor mobility of the lower limbs in community-dwelling elderly people is a predictor of functional decline in terms of disability, falls, nursing home admission, and death. However, its predictive value has not been studied in acute care hospital settings. The aims of this observational, prospective study were: 1) to assess the prognostic value of lower limb function; and 2) to compare the predictive value of three performance tests in elderly inpatients. METHODS: We studied 144 patients aged 70 or older (60 men and 84 women, mean age 78.7 +/- 5.6 years), admitted consecutively to a general internal medicine ward. Before discharge, patients underwent multidimensional assessment, including static and dynamic equilibrium and gait, by the Performance-Oriented Mobility Assessment (POMA), Short Physical Performance Battery (SPPB), and Functional Reach (FR). One-year outcomes were falls, loss of mobility with social repercussions (inability to leave home, or need for nursing home care) and death. RESULTS: In univariate analysis, poor results on any of the three tests were associated with an increased risk of falls, loss of mobility with social repercussions, and death. In multivariate analysis, age, two or more falls, and a low POMA score were predictive of future falls, whereas dependency in instrumental activities of daily living and a low SPPB score were predictive of loss of mobility with social repercussions. No multivariate model was superior to univariate ones in predicting death. No associations were found between other medical or geriatric characteristics and outcomes. CONCLUSIONS: Lower limb mobility tests performed in an acute care hospital setting are predictive of future falls, inability to leave home, and/or need for nursing home care.

Accidental Falls↗

Sleep and quality of life in stable heart failure.

BACKGROUND: Functional performance and mental health are significant quality of life concerns for heart failure (HF) patients. Poor sleep also appears to be common. We examined the extent to which sleep was associated with functional performance and mental health among persons who had stable systolic HF. METHODS AND RESULTS: Sixty-one patients with stable systolic HF wore wrist actigraphs to record nocturnal sleep and daily activity for 3 days while living at home, performed 6-minute walks (6MWT), and completed the Pittsburgh Sleep Quality Index and the Medical Outcomes Study SF-36 questionnaire. Self-reported sleep quality and actigraph-recorded wake time and wake bout time explained 9% to 20% of the variance in the functional performance variables (daytime activity level, 6MWT, self-reported physical function), and mental health, after controlling for age, gender, comorbidity, and New York Heart Association class. Time in bed was negatively associated with functional performance. There were no statistically significant relationships between sleep duration and functional performance. CONCLUSIONS: Self-reported sleep quality and sleep continuity (sleep that is undisturbed by nocturnal awakenings) are associated with functional performance and mental health in stable systolic HF patients. Effective treatment of sleep problems may contribute to improvement in quality of life.

Adult↗

The efficacy of ginseng. A systematic review of randomised clinical trials.

OBJECTIVE: Ginseng is one of the most popular herbal remedies, and a number of health claims are made for it. This systematic review provides an evaluation of the current evidence for or against the efficacy of ginseng root extract. METHODS: Searches of the computerised literature databases Medline, Embase, Biosis, CISCOM and the Cochrane Library were performed to retrieve double-blind, randomised, placebo-controlled trials of ginseng root extract for any indication. Manufacturers and experts were contacted to provide additional information. There were no restrictions regarding the language of publication. The outcome and methodological quality of all trials were independently assessed by two reviewers. RESULTS: Sixteen trials met the inclusion criteria and were reviewed. These trials related to physical performance, psychomotor performance and cognitive function, immunomodulation, diabetes mellitus and herpes simplex type-II infections. The evidence found for ginseng root extract is compelling for none of these indications. CONCLUSION: Based on these data, it is concluded that the efficacy of ginseng root extract is not established beyond reasonable doubt for any of these indications. The widespread use of ginseng as a herbal remedy warrants more rigorous investigations to assess its efficacy and safety.

Adjuvants, Immunologic↗

Home-based multicomponent rehabilitation program for older persons after hip fracture: a randomized trial.

OBJECTIVE: To determine whether a home-based systematic multicomponent rehabilitation strategy leads to improved outcomes relative to usual care. DESIGN: A randomized controlled trial with 12 months of follow-up. SETTING: General community; 27 home care agencies. PARTICIPANTS: Three hundred four nondemented persons at least 65 years of age who underwent surgical repair of a hip fracture at two hospitals in New Haven, CT, and returned home within 100 days. INTERVENTION: Systematic multicomponent rehabilitation strategy addressing both modifiable physical impairments (physical therapy) and activities of daily living (ADL) disabilities (functional therapy) versus usual care. MAIN OUTCOME MEASURES: A battery of self-report and performance-based measures of physical and social function. RESULTS: There was no significant difference in the proportion of participants in the two groups who recovered to prefracture levels in self-care ADL at 6 months (71% vs 75%) or 12 months (74% in both groups) or in home management ADL at 6 months (35% vs 44%) or 12 months (44% vs 48%). There also was no difference between the two groups in social activity levels, two timed mobility tasks, balance, or lower extremity strength at either 6 or 12 months. Compared with participants who received usual care, those in the multicomponent rehabilitation program showed slightly greater upper extremity strength at 6 months (p = .04) and a marginally better gait performance (p = .08). CONCLUSIONS: The systematic multicomponent rehabilitation program was no more effective in promoting recovery than usual home-based rehabilitation. Compared with previous cohorts, however, participants randomized to usual care in our study received more rehabilitative and home care services and experienced a higher rate of recovery. This finding is important given the current pressures to reduce home services. The challenge is to determine the composition and duration of rehabilitation and home services that will ensure optimal functional recovery most efficiently in older persons after hip fracture.

Activities of Daily Living↗

[Impact of common reasons for consultation on the feeling of vitality and the physical performance of the over-65s].

OBJECTIVES: To measure two functional dimensions (vitality and physical function) involved in the quality of life of the over-65s and to find what relationship they maintain with the commonest reasons for consultation. DESIGN: Cross-sectional, descriptive study. SETTING: Primary care. PARTICIPANTS: Randomised sample of 179 patients over 65 from 14 primary care clinics in Navarra. METHODS: SF-36 quality-of-life questionnaire and most common reasons for consultation. Personal and family details and ongoing drug prescription were also recorded. RESULTS: The most common reasons for consultation were insomnia (31.8%), arthrosis (48%), and urinary symptoms (16.2%). The greatest differences in the SF-36 scales occurred in patients with insomnia. In the multiple regression models, inverse associations were found for each of the reasons for consultation with the vitality and physical function dimensions. Vitality was associated with urinary symptoms, with an adjusted beta coefficient of -11.2 points (95% CI, -18.6 to -3.7). Insomnia was associated with significant decline in vitality and physical function, with beta of -7.7 points (95% CI, -13.9 to -1.5) and -10.3 points (95% CI, -19.1 to -1.6), respectively. Arthrosis symptoms behaved in a similar way. CONCLUSIONS: The most common pathologies or symptoms causing primary care consultations in the over-65s affect significantly the quality-of-life dimensions relating to the pursuit of normal daily life.

Age Factors↗

Consistency of performance on the functional capacity assessment: static strength and dynamic endurance.

OBJECTIVE: To explore the degree of consistency in a subject's performance in physical strength and endurance. DESIGN: Thirty healthy men, aged 19 to 26 yr, were recruited to participate in protocols to assess static strength and dynamic endurance tests on their upper limbs with the Baltimore Therapeutic Equipment Primus. Retests were conducted 7 days after the initial test. RESULTS: The intraclass correlation coefficients were 0.71 to 0.97 and 0.32 to 0.90 for static and dynamic endurance strengths, respectively. These results indicated that the consistency of the subjects' performance across occasions was high for testing static strength, although it was more varied for testing endurance strength. CONCLUSIONS: Higher consistency was observed among subjects in the assessment of static strength than dynamic endurance strength. The range of motion traveled by the limb, speed of performance, and ergonomic design of attachments seemed to confound the subjects' performance on the instrument. Stringent assessment protocols, ergonomically designed hardware, and clear instructions and practice trials before the formal testing were essential to maximize the subjects' consistency of performance. The results of this study were applicable and generalized to other performance-based instruments for physical and functional capacity evaluation and work simulators.

Activities of Daily Living↗

The Timed Test of Money Counting: a short physical performance test for manual dexterity and cognitive capacity.

The competent handling of money is an essential basis for living independently. Seventy-eight consecutively admitted patients to a geriatric hospital underwent the Timed Test of Money Counting (TTMC) which measures patients' ability to open a purse, take out all the money and count it. Further assessment included Mini-Mental State Examination (MMSE), Barthel Index of ADL, Self-maintaining and Instrumental Activities of Daily Living (IADL), grip strength and Williams' Board Test. The TTMC was reliable (inter-rater and intra-rater) and showed construct and concurrent validity with other measures of physical function. Unlike many other physical performance tests the TTMC is quickly performed and requires no special equipment or training.

Activities of Daily Living↗

Factors affecting contrasting results between self-reported and performance-based levels of physical limitation.

We have examined the role of socio-demographic variables, cognitive and affective functioning, and personality in discrepancies between performance-based and self-report measures within three domains of physical limitations: motor functioning, hearing and vision. Data are drawn from a community-based sample of 624 persons of 57 years of age and older. The strength of the association between self-reported and performance-based levels of physical limitations is moderate. Socio-demographic variables and levels of cognitive functioning explained some of the discrepancies between self-reported and performance-based vision. Within the domains of motor functioning and hearing, discrepancies were substantially influenced by affective functioning and personality. The discrepancies may reflect bias in perception or true variation in the effect of limitations on daily functioning. Both self-report and performance-based measures seem to complement each other in providing useful information about physical limitations.

Activities of Daily Living↗