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PubMed2005

Description and prediction of physical functional disability in psoriatic arthritis: a longitudinal analysis using a Markov model approach.

OBJECTIVE: To describe the longitudinal course of physical functioning in patients with psoriatic arthritis. METHODS: Between June 1993 and June 2003, 341 patients attending the University of Toronto Psoriatic Arthritis Clinic completed 2 or more Health Assessment Questionnaires (HAQs). At the time of administration of each HAQ, patients were assigned to 1 of 3 physical functional disability states, based on their HAQ score. A Markov model that allowed for transitions to and from these 3 disability states was used to characterize the longitudinal course of physical functioning, as well as to identify factors for both progression and regression of disability. RESULTS: Despite patient variability in the course of physical functioning, the following 3 longitudinal patterns were observed: 1) a stable state of disability throughout the entire study period, with 28%, 12%, and 6% of patients experiencing no, moderate, or severe disability, respectively; 2) a steady improvement or deterioration in disability over time (this pattern was observed in 27% of patients); and 3) a fluctuating state of disability, occurring in 27% of the patients. Sex, age, disease duration, number of actively inflamed joints, and number of deformed joints predicted transitions between disability states. CONCLUSION: Although 28% of patients appeared resistant to becoming disabled over the duration of this study, the remaining patients were observed either to experience enduring disability or to move between disability states.

Arthritis, Psoriatic↗

PubMed2006

Population impact of arthritis on disability in older adults.

OBJECTIVE: Disability threatens the independence of older adults and has large economic and societal costs. This article examines the population impact of arthritis on disability incidence among older Americans. METHODS: The present study used longitudinal data (1998-2000) from the Health and Retirement Study, a national probability sample of elderly Americans. Disability was defined by the inability to perform basic activities of daily living (ADL). A total of 7,758 participants ages > or =65 years with no ADL disability at baseline were included in the analyses. Multiple logistic regression was used to measure the impact of baseline arthritis (self reported) on incidence of subsequent ADL disability after controlling for baseline differences in demographics, health factors, health behaviors, and medical access. RESULTS: Older adults who had baseline arthritis had a substantially higher incidence of ADL disability compared with those without arthritis (9.3% versus 4.5%). The strong relationship of arthritis and ADL disability was partially explained by demographic, health, behavioral, and medical access factors. However, even after adjusting for all other risk factors, arthritis remained as an independent and significant predictor for developing ADL disability (adjusted odds ratio 1.5, 95% confidence interval 1.2-1.8). Almost 1 in every 4 new cases of ADL disability was due to arthritis (adjusted population attributable fraction: 23.7%). CONCLUSION: The high frequency of incident ADL disability attributable to arthritis points to the importance of intervention programs that address the entire spectrum of health and functional problems in persons with arthritis to prevent disability.

Activities of Daily Living↗

PubMed1996

Disability and health: perceptions of a sample of elderly people.

The background to this work was the expected increase in the proportion of elderly people in the population, giving rise to a greater demand for services at a time of scarcity of healthcare resources. The aims of the study were to investigate disability and health in a sample of elderly people living at home in the community. We wished to obtain detailed information about physical disability and health then to explore individual perceptions of health and disability and, finally, to examine relationships between the objective assessments and individual, subjective perceptions. The results reported here represent only part of the work of a larger study which also investigated the use of health and social services in this sample of elderly people. In-depth interviews were undertaken with a random stratified population sample of 200 elderly people living at home. Analysis of interview data showed that, by use of a multidimensional scale of disability, just over one-third of the sample could be classified as 'disabled'. The mobility status of the sample was, in general, good with only small numbers spending most of their time in a wheelchair. The total sample scored highly on activities of daily living, though those classified as disabled were significantly less independent. The mean number of reported health conditions was less than might have been expected in an elderly population. One-third of the subjects in the sample showed discrepancies between their own assessment of their disability and objective assessments. These discrepancies could partly be explained by a combination of individuals' assessment of their own abilities and their beliefs about factors influencing disability. Measures of disability, or activity associated with daily living, were related to perceptions of health, whereas the number of current health problems was not. The factors which determined perceptions of health or disability were: walking unaided and general levels of activity. Health was perceived in terms of what one could do rather than the presence of current diseases or conditions. The results suggested that when planning treatment for elderly people, physiotherapists and others should consider individual variability in perceptions of disability and health, as well as objective assessments. The importance of locomotion in the value systems of elderly people emphasises the high profile of physiotherapy in the care of elderly people.

Activities of Daily Living↗

PubMed2004

Predicting the course of relapsing-remitting MS using longitudinal disability curves.

BACKGROUND AND OBJECTIVE: Multiple sclerosis (MS) is a chronic, progressive disease of the central nervous system that generally occurs in adults under the age of 40 years and ultimately leads to severe neurological disability. Following the progression of MS by monitoring changes in disability levels can facilitate treatment decisions taken by physicians. The aim of this review is to present longitudinal disability curves enabling the assessment of disease progression in patients with relapsing-remitting (RR)MS. METHODS: Patients with a definite diagnosis of MS and an RR disease course were identified using the Multiple Sclerosis Center computerised database. Patients were stratified into major percentile groups based on their Expanded Disability Status Scale (EDSS) score 1 year after disease onset. Model disability curves for each percentile were constructed using mean consecutive EDSS scores for 10 years after disease onset. Model curves were generated by smoothing (parametric and non-parametric regression) and curve approximation (linear regression and moving averages). The predictive ability of model curves was validated by superimposing data from a separate group of patients with RRMS. RESULTS: Disability curves were constructed using data from 1001 patients. A significant difference between the initial percentile assignment and disability progression was indicated by the log-rank test (p < 0.001). Kaplan-Meier and life table analyses demonstrated the validity of the model in predicting disease progression. The probability of experiencing more severe disability than predicted (i. e. deviating from the initial percentile to a higher percentile over time) ranged from 6.5 % (50th percentile) to 15.4 % (75th percentile), while the probability of experiencing less severe disability than predicted (i. e. deviating from the initially assigned percentile to a lower percentile over time) ranged from 6.9% (50th percentile) to 1.6 % (75th percentile). Both suggest reasonable predictive validity. CONCLUSION: In MS, longitudinal disability curves can help to assess individual patient disability, map the effects of immunomodulatory treatments over time, and generally build on the overall clinical impression of disease progression. Such models can act as a tool to aid and support the clinical decision-making process. This review is based on the study published in Multiple Sclerosis (2003) 9:486-491.

Disability Evaluation↗

PubMed2004

Relationships between level of disability and receipt of preventive health services.

OBJECTIVES: To examine relationships between level of disability and receipt of certain preventive health services, including demographic and systems variables that may explain or confound these relationships. DESIGN: Analysis of recent (1998 and 2000) data from the Behavioral Risk Factor Surveillance System, a nationwide telephone survey. SETTING: States reporting data on disability (13 in 1998, 18 in 2000). PARTICIPANTS: Noninstitutionalized persons living in the community. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Frequency of receipt of recommended preventive health services, including colorectal, cervical, and breast cancer screening, and influenza and pneumococcal vaccination. An ordinal index of disability severity was constructed from questions on activity limitations. RESULTS: In 2000, people with mild and moderate disability received influenza and pneumonia vaccinations somewhat more frequently than people without disabilities, but people with the most severe disabilities least frequently received vaccinations that year. Disabled women received fewer Papanicolaou tests and clinical breast examinations, but significant differences did not occur for mammograms in 2000. Fewer differences as a function of disability level were apparent in 2000 than 1998. Demographic variables affected receipt of most preventive services. Access to routine checkups affected all preventive services independent of disability level in both years. CONCLUSIONS: Severity of disability is related to receipt of certain preventive services but not necessarily in a simple or unidirectional way. Regardless of disability, receipt of a checkup was an important determinant of receipt of preventive health services. For almost all services and groups studied, preventive care remained below targeted goals for Healthy People 2010.

Persons with Disabilities↗

PubMed2005

Disability in schizophrenia: clinical correlates and prediction over 1-year follow-up.

Schizophrenia may cause disability leading to restrictions on many domains of daily life such as hygiene, self-management, vocational and leisure activities, and family and social relationships. The aim of this study was to assess the level of disability with the Brief Disability Questionnaire (BDQ), developed by the World Health Organization, and to identify the clinical correlates and predictors of disability during a 1-year follow-up period in 382 patients with schizophrenia. All patients were assessed at the beginning of the study, and 168 (44%) of them were re-evaluated after 1 year. Total disability scores of the patients with schizophrenia were significantly decreased at follow-up. Female patients seemed to be more disabled than males. Disability showed a positive correlation with the total, positive symptoms and negative symptoms scores on the Brief Psychiatric Rating Scale, as well as scores on the UKU Side Effects Rating Scale. Patients with the disorganized subtype of schizophrenia and residual symptoms were more disabled than patients with other subtype diagnoses. Negative symptoms and duration of untreated psychosis were significant predictors of disability after 1 year. Early-onset schizophrenia had a twofold increased risk for developing disability. Disability in schizophrenia is a clinical phenomenon closely linked to negative symptoms and poor outcome.

Adult↗

PubMedDate not supplied

Health service use and outcomes among disabled Medicaid pregnant women.

PURPOSE: We investigated differences in health service use and pregnancy outcomes among women enrolled in Medicaid under eligibility categories for the blind and disabled and those enrolled under other eligibility categories. METHODS: We used Medicaid enrollment and claims data to create episodes of pregnancy- and delivery-related care for women with and without disabilities who had Medicaid-covered deliveries in Florida, Georgia, and New Jersey during 1995 and Texas during 1997. We linked birth certificate information on prenatal care and birth outcomes to the files for Georgia and Texas. We then computed the unadjusted and adjusted odds ratios for the receipt of selected routine prenatal and illness-related services and the occurrence of selected pregnancy outcomes among women with disabilities relative to women without disabilities. FINDINGS: In all states, women with disabilities were more likely than women without disabilities to have had continuous Medicaid coverage from preconception through the postnatal period. Women with disabilities were equally or less likely to have received adequate prenatal care compared to women without disabilities in the two study states with these data. They were also more likely to have had emergency room visits, hospital admissions during pregnancy, cesarean deliveries, and readmissions within 3 months of delivery in all study states. We also found women with disabilities to have been more likely to deliver preterm and low birthweight infants. CONCLUSION: Our results suggest that opportunities exist to improve access to prenatal care among women with disabilities enrolled in Medicaid under blind and disabled eligibility categories who become pregnant.

Adult↗

PubMed1997

Prevalence of abuse of women with physical disabilities.

OBJECTIVE: Emotional, physical, and sexual abuse of women with physical disabilities is a problem largely unrecognized by rehabilitation service providers. This article documents the prevalence of abuse of women with physical disabilities compared to women without physical disabilities. DESIGN: Case-comparison study using written survey. Data were analyzed using chi 2 analyses and the Mann-Whitney U Wilcoxon rank sum W tests. SETTING: General community. PARTICIPANTS: A sample of 860 women, 439 with physical disabilities and 421 without physical disabilities, was compiled from women responding to a national sexuality survey. MAIN OUTCOME MEASURES: The women were asked if they had ever experienced emotional, physical, or sexual abuse. If they answered yes, they were asked to identify the perpetrator(s) of the abuse and when the abuse began and ended. RESULTS: Sixty-two percent of both groups of women had experienced some type of abuse at some point in their lives. Of women who had experienced abuse, half of each group had experienced physical or sexual abuse. Husbands or live-in partners were the most common perpetrators of emotional or physical abuse for both groups. Male strangers were the most common perpetrators of sexual abuse for both groups. Women with physical disabilities also were more likely to be abused by their attendants and by health care providers. Thirteen percent of women with physical disabilities described experiencing physical or sexual abuse in the past year. CONCLUSIONS: Women with physical disabilities appear to be at risk for emotional, physical, and sexual abuse to the same extent as women without physical disabilities. Prevalence of abuse by husbands or live-in partners in this study is similar to estimates of lifetime occurrence of domestic violence for women living in the United States. Women with physical disabilities are more at risk for abuse by attendants or health care providers. They are also more likely to experience a longer duration of abuse than women without physical disabilities.

Adolescent↗

PubMed1998

Disability and psychiatric disorders in an urban community: measurement, prevalence and outcomes.

BACKGROUND: The purpose of this analysis was to examine: (1) the prevalence of psychiatric disorders among disabled people, using seven different measures of disability; (2) variation in disability between and within psychiatric diagnostic categories; and (3) relationship of diagnosis and disability to health service utilization. METHOD: Data were drawn from Phase I and Phase II of the Eastern Baltimore Mental Health Survey, part of the Epidemiologic Catchment Area Program (ECA) conducted in 1980-1 to survey mental morbidity within the adult population. A total of 810 individuals received both a household interview and a standardized clinical psychiatric evaluation. Estimated prevalence rates were computed using appropriate survey sampling weights. RESULTS: Prevalence of disability ranged from 2.5 to 19.5%, varying with specific disability measure. Among those classified as disabled by any of the measures examined, 56 to 92% had a psychiatric disorder and serious chronic medical conditions were present in the majority of these cases (54 to 78%). Disability was expressed differently among the various diagnostic groups. Diagnostic category and disability were significant independent predictors of medical service utilization and receipt of disability payments. CONCLUSIONS: The majority of disabled adults living in the community have diagnosable psychiatric disorders, with the majority of these individuals suffering from significant chronic medical conditions as well, thus making co-morbidity the norm.

Activities of Daily Living↗

PubMed2004

Adult obesity and the burden of disability throughout life.

OBJECTIVE: To analyze the prevalence of disability throughout life and life expectancy free of disability, associated with obesity at ages 30 to 49 years. RESEARCH METHODS AND PROCEDURES: We used 46 and 20 years of mortality follow-up, respectively, for 3521 Original and 3013 Offspring Framingham Heart Study participants 30 to 49 years and classified as normal weight, overweight, or obese at baseline. Disability measures were available between 36 and 46 years of follow-up for 1352 Original participants and at 20 years of follow-up for 2268 Offspring participants. We measured the odds of disability in the Original cohort after 46 years follow-up, and we estimated life expectancy with and without disability from age 50. Two disability measures were used, one representing limitations with mobility only and the second representing limitations with activities of daily living (ADL). RESULTS: Obesity at ages 30 to 49 years was associated with a 2.01-fold increase in the odds of ADL limitations 46 years later. Nonsmoking adults who were obese between 30 and 49 years lived 5.70 (95% confidence interval, 4.11 to 7.35) (men) and 5.02 (95% confidence interval, 3.36 to 6.61) (women) fewer years free of ADL limitations from age 50 than their normal-weight counterparts. There was no significant difference in the total number of years lived with disability throughout life between those obese or normal weight, due to both higher disability prevalence and higher mortality in the obese population. DISCUSSION: Obesity in adulthood is associated with an increased risk of disability throughout life and a reduction in the length of time spent free of disability, but no substantial change in the length of time spent with disability.

Adult↗

PubMed1999

Conceptualizing disability in nursing: some evidence from students and their teachers.

This paper reports on part of a larger study which examined the nature and influence of a pre-registration nursing curriculum on the preparation of student nurses to work with disabled people. Following case study methodology it focuses on how 'disability' is conceptualized by teachers and adult branch students involved in a particular curriculum. Definitions and working assumptions concerning disability held by nurses are likely to influence ways in which disabled people are cared for. The experiences of disabled people suggest that their contact with nurses is demeaning and disempowering. Some disabled people support a reconceptualization of 'disability', from a largely medical perspective to one which embraces its social dimensions. The results of thematic analysis of data from 16 semi-structured interviews are reported; these support the need for the social dimensions of disability to be given greater emphasis within nursing. Disability was found to be conceptualized as a form of deviation, a condition of dependency or a notion which defies definition. Language associated with disability was also highlighted as an area of concern. Implications for practice and education are alluded to in the light of increasing recognition of disability as an equality opportunity issue.

Adult↗

PubMed2003

Meaning of life for adolescents with a physical disability in Korea.

BACKGROUND: Korean views and attitudes towards disabled people are generally negative. Because of this, living with life-long disabilities in Korea means pain for oneself and one's family. Also family members think that the disability is detrimental to their social standing and try to hide the disabled person. Koreans believe that having disabilities is the result of the geomantic system of topography, used in choosing auspicious sites for graves and houses, sins committed in a previous existence, the fault of an ancestor, or a wicked ghost. AIM: The objective of the study was to provide an understanding of how adolescents with physical disabilities see meaning in their lives, with the ultimate aim of encouraging these adolescents to find their own values and meanings of life. DESIGN: An inductive and descriptive study to understand the perspective of adolescents with physical disabilities. METHODS: Eighty-eight adolescents with physical disabilities were interviewed in depth and content analysis was used for analyzing the data. FINDINGS: Adolescents with physical disabilities in Korea experience meaning in their lives when society accepts their existential problems and allows them to live a normal life. This normality includes helping others (as a friend or as a volunteer) and creating opportunities to achieve their own goals in life. The main categories in the findings were 'accomplishment', 'social adaptation', 'improvement of the quality of life', 'good deeds', 'sincerity', 'satisfaction', 'having a relationship', 'achievement of self', 'perception of one's own usefulness', 'rehabilitation', and 'gain recognition by others'. CONCLUSION: Adolescents with physical disabilities can understand the meaning of their lives when meaning is framed in the context of being a social issue, and when they are allowed to clarify their own values. Nursing intervention programmes need to be developed to improve the quality of physically disabled adolescents' lives.

Adolescent↗

PubMed2001

Information about migraine disability influences physicians' perceptions of illness severity and treatment needs.

OBJECTIVE: To assess physician-patient communication about headache-related disability and to evaluate the influence of information about disability on physicians' perceptions of illness severity and the treatment needs of migraineurs. BACKGROUND: Evidence suggests that migraine is suboptimally treated in clinical practice, partly due to poor communication between physicians and their patients. METHODS: One hundred five neurologists and primary care physicians with an interest in headache participated in two interactive surveys, one in North America (n=42) and one in Europe (n=63). Each survey focused on the evaluation of four videotaped migraine cases. The first case was evaluated twice, initially after a typical symptom history that centered on diagnosis and then following a fuller history of migraine disability. Additional questions assessed the extent of the collection of migraine disability information in clinical practice. RESULTS: Physicians reported that they recorded symptoms relating to diagnosis (eg, pain location/intensity, associated symptoms) rather than information on headache-related disability. Only about one third of patients volunteered disability information. When made available to them, physicians rated information on disability as one of the most important factors in assessing treatment needs. In particular, when physicians knew the patient's disability history: (1) the proportion of physicians who rated the patient's illness as "severe" increased by 128% in North America, 27% in Europe; (2) the proportion of physicians who recommended immediate treatment increased by 63% in North America, 37% in Europe; and (3) the proportion of patients recommended for a follow-up visit increased by 15% in North America, 18% in Europe. CONCLUSIONS: Physicians and patients often fail to discuss headache-related disability during consultation. This information has a powerful influence on physicians' perceptions of illness severity, treatment choice, and the need for follow-up. Tools to improve communication about headache-related disability, such as the Migraine Disability Assessment questionnaire, may favorably improve migraine management.

Adult↗

PubMed2001

Correlates of attributing new disability to old age. Study of Osteoporotic Fractures Research Group.

OBJECTIVES: To describe women who attribute new disability to old age and to identify demographic, medical, behavioral, and psychosocial characteristics that correlate with attributing new disability to old age. DESIGN: Prospective cohort study with 4-year follow-up. SETTING: Four geographic regions of the United States. PARTICIPANTS: 9704 women aged > or = 67 years participating in the Study of Osteoporotic Fractures. Of these, 657 who reported no disability at baseline but at follow-up reported difficulty carrying out 1 or more of 13 functional activities were eligible for our analysis. MEASUREMENTS: All women reporting difficulty in any functional activity at follow-up were asked "What is the main condition that causes you to have difficulty or prevents you from (doing the activity)?" and were shown a card listing 14 medical conditions as well as the option "old age," from which they could choose only one response. Women attributing difficulty or inability in 1 or more functional activities to old age were classified as attributing new disability to old age. We examined the relationship between attributing new disability to old age and the following characteristics measured at baseline: age, level of education, medical comorbidity, cognitive function, body mass index (BMI), gait speed, grip strength, visual acuity, physical activity level, smoking status, social network level, and depressed mood. RESULTS: Overall, 13.5% of women attributed new disability to old age. Age was a strong independent correlate of attributing new disability to old age: compared with women age 67 to 69, the odds of attributing new disability to old age for women age 70 to 79 was 3.6 times as large (95% confidence interval [CI] = 1.6-8.3), and for women age 80 or over was 5.5 times as large (95% CI = 2.1-14.7). The only other characteristic that remained an independent correlate of attributing new disability to old age was grip strength; for each decile decrease in grip strength, a woman's odds of attributing new disability to old age increased by 9% (odds ratio [OR] = 1.09, 95% CI = 1.01-1.19). CONCLUSIONS: Despite great advances in geriatric medicine, old age is still perceived as a causal agent in functional decline, especially among our oldest patients. Further study is needed to determine whether, how often, and under what circumstances older adults who attribute new disability to old age have medical conditions amenable to interventions that could preserve their functioning and improve their quality of life.

Activities of Daily Living↗

PubMed1985

Therapists with disabilities: theoretical and clinical issues.

Disability as a characteristic of the therapist needs to be addressed for several reasons. First, substantial evidence indicates that people without visible disabilities or physical differences regard persons who diverge from ideals of physical perfection and norms of physical acceptability with a variety of emotions which--at the very least--alter ordinary social interaction. Second, the psychoanalytic literature on therapy with disabled patients and the developmental literature about people with disabilities reinforce the generally negative or ambivalent attitudes about the mental well-being and potential for productivity and intimacy of people with disabilities. As a consequence of both general acculturation and professional training in psychology and psychoanalysis, professionals in charge of admissions have frequently denied competent disabled people the graduate education which is prerequisite to psychoanalytic training and professional employment. Mental health practitioners who make up the training committees of analytic institutes have frequently been reluctant to accept a disabled candidate for psychotherapy or psychoanalytic training. Once trained, many disabled clinicians have faced hurdles in obtaining employment, in advancing within their profession, in being selected as faculty members or supervisors, and even in obtaining referrals from nondisabled colleagues. After briefly describing the literature on attitudes of the nondisabled toward people with physical impairments, we will present the reasons for the reluctance to train disabled people as therapists. We will include material on how disabled people work with their disabilities in the analytic process and will bring in analogies to practitioners who are members of racial or cultural minority groups.

Attitude↗

PubMed2000

Self-reported physical disabilities in children in the Netherlands.

PURPOSE: To assess the prevalence of self-reported physical disabilities in school children, through the Child Health Monitoring System. METHODS: In 1992/1993. data were obtained in mainstream education (n = 5484), and in 1994/1995 in special education (n = 2622). The data were weighted to calculate estimates representative of the Dutch population. RESULTS: Physical disabilities were reported in 21% [20.9%; 99% confidence interval 20.0-21.8], and 5% [4.7%; 99% confidence interval 4.3-5.2] had a severe disability. Severe physical disabilities were more frequent in the youngest age group, and certain of these disabilities may be related to normal development. In older children, accidents are an important cause of disabilities. Boys had disabilities more often than girls, especially speech disabilities. Disabilities were more common among children whose parents had a low level of education. Only a minority (14%) of the children with a severe disability, reported to be restricted in the daily pursuits. CONCLUSIONS: Physical disabilities are a common health problem in school children, but they do not usually cause a handicap.

Activities of Daily Living↗

PubMed1998

High body fatness, but not low fat-free mass, predicts disability in older men and women: the Cardiovascular Health Study.

Using data from the Cardiovascular Health Study, we studied the relation between body composition (fat mass and fat-free mass, assessed by bioelectrical impedance) and self-reported, mobility-related disability (difficulty walking or stair climbing) in 2714 women and 2095 men aged 65-100 y. In a cross-sectional analysis at baseline (1989-1990), disability was reported by 26.5% of the women and 16.9% of the men. A positive association was observed between fat mass and disability. The odds ratio for disability in the highest quintile of fat mass was 3.04 (95% CI: 2.18, 4.25) for women and 2.77 (95% CI: 1.82, 4.23) for men compared with those in the lowest quintile. Low fat-free mass was not associated with a higher prevalence of disability. In a longitudinal analysis among persons not reporting disability at baseline, 20.3% of the women and 14.8% of the men reported disability 3 y later. Fat mass at baseline was predictive of disability 3 y later, with odds ratios of 2.83 (95% CI: 1.80, 4.46) for women and 1.72 (95% CI: 1.03, 2.85) for men in the highest quintile of fat. The increased risk was not explained by age, physical activity, chronic disease, or other potential confounders. Low fat-free mass was not predictive of disability. The results showed that high body fatness is an independent predictor of mobility-related disability in older men and women. These findings suggest that high body fatness in old age should be avoided to decrease the risk of disability.

Adipose Tissue↗

PubMed1998

Body fat and skeletal muscle mass in relation to physical disability in very old men and women of the Framingham Heart Study.

BACKGROUND: Low muscle mass has been assumed to be associated with disability, but no studies confirming this association have been published. High body weight and high body mass index, both rough indicators of body fatness, have been shown to increase the risk for disability; however, the specific role of body fatness has not been studied. METHODS: The relations of skeletal muscle mass and percent body fat with self-reported physical disability were studied in 753 men and women aged 72 to 95 years. Cross-sectional data from biennial examination 22 (1992-1993) of the Framingham Heart Study were used. Body composition was assessed by dual-energy x-ray absorptiometry. Disability was scored as any versus none on a 9-item questionnaire. RESULTS: Total body and lower extremity muscle mass were not associated with disability in either men or women. However, a strong positive association between percent body fat and disability was observed. The odds ratio for disability in those in the highest tertile of body fatness was 2.69 (95% confidence interval 1.45-5.00) for women and 3.08 (1.22-7.81) for men compared to those in the lowest tertile. The increased risk could not be explained by age, education, physical activity, smoking, alcohol use, estrogen use (women only), muscle mass, and health status. Analyses restricting disability to mobility items gave similar results. CONCLUSIONS: In contrast to current assumptions, low skeletal muscle mass was not associated with self-reported physical disability. Persons with a high percent body fat had high levels of disability. Because it cannot be ruled out that persons with low skeletal muscle mass dropped out earlier in the study, prospective studies are needed to further assess the relationship between body composition and physical disability.

Absorptiometry, Photon↗