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PubMed1998

Functional health and dental service use among older adults.

BACKGROUND: Although socioeconomic barriers to receiving adequate dental care have been well documented, physical frailty as a risk factor for not visiting the dentist has not been fully explored. This study prospectively examines the relationship between functional health and dental service use, taking into account sociodemographic characteristics, general and dental health status, and prior dental utilization behavior. METHODS: Data from a randomized trial of a comprehensive geriatric assessment and prevention program in community-dwelling adults age 75+ years living in Santa Monica, CA, collected between 1988 and 1993, were analyzed. A series of discrete-time proportional hazards models were used to assess the effects of functional status, sociodemographic characteristics, and general health and dental health measures on dental service use. RESULTS: Functional status was negatively associated with dental service use, and the conditional probability of a first visit to the dentist after baseline decreased over time. When additional measures of general health, dental health, and socioeconomic status were introduced, the effect of functional status was mitigated but remained significant. In the most fully specified model, which took dental visitation behavior prior to the beginning of the study into account, the effect of functional limitation remained significant. CONCLUSIONS: Even in this relatively well-educated group of older persons with higher than average dental service use, impaired functional status was associated with lower levels of dental service use over time.

Aged↗

PubMed1999

Peak aerobic power is an important component of physical performance in older women.

BACKGROUND: The purpose of this study was to determine the relationship between peak aerobic power (VO2peak) and performance on a modified Physical Performance Test (modified PPT) in older women. METHODS: One hundred one women aged 75 years and older seeking enrollment in randomized, controlled trials of exercise and/or hormone replacement therapy were recruited from the community-at-large and from congregate living sites. Measures obtained included VO2peak, a modified PPT, and self-reports about performance of activities of daily living. RESULTS: Simple regression analysis demonstrated that VO2peak was associated with total PPT score (r =.53, p <.001), gait speed (r =.44, p <.001), time to arise from a chair five times (r =.43, p = <.001), and time to climb one flight of stairs (r =.36, p =.007). Multiple regression analysis revealed that the relationships between VO2peak and total modified PPT score, gait speed, chair rise time, and time to climb one flight of stairs were independent of age. CONCLUSIONS: Peak aerobic power is a significant independent predictor of performance on a standardized test of physical function in older women and is an important component of physical frailty in this population.

Activities of Daily Living↗

PubMed1999

The relation between psychometric test performance and physical performance in older adults.

BACKGROUND: The relationship between cognitive function and physical disability in nondemented older adults is not well characterized. The purpose of this study was to determine the relationship between performance on psychometric measures and a modified Physical Performance Test (modified PPT) in older men and women. METHODS: One hundred twenty-five men and women aged 75 years and older, who were enrolled in randomized, controlled trials of exercise or hormone replacement therapy, were recruited from the community-at-large and from congregate living sites. Measures obtained included Trailmaking A and B tests, Cancellation Random Figure tests, Weschler Associate Learning and 20-minute Delayed Recall, Verbal Fluency test, a modified PPT, and self-reports about performance of activities of daily living, medication use, and hospitalization in the previous year. RESULTS: Simple regression analysis demonstrated that speed of performance on the Trailmaking B and Cancellation Random Figure tests was significantly associated with total modified PPT score (r = .29, p < .001 and r = .36,p < .001, respectively). A factor analysis of the psychometric test battery demonstrated that two factors, a cognitive speed factor and a memory factor, accounted for 55% of the variance in cognitive test performance. Hierarchical multiple regression analyses demonstrated that age, number of medications, and the cognitive speed factor were independent predictors of total modified PPT score. CONCLUSIONS: Cognitive processing speed is a significant component of physical frailty in this population, although it accounts for a small percentage of variance on a standardized physical performance test.

Activities of Daily Living↗

PubMed2000

Feasibility and measurement properties of the functional reach and the timed up and go tests in the Canadian study of health and aging.

BACKGROUND: Physical performance measures may offer advantages over self-report in the functional assessment of older people. Estimates of the feasibility, reliability, and construct validity of these measures in large, heterogeneous samples are necessary to establish their importance relative to traditional measures of function. METHODS: Analysis of clinical data from Phase 2 of the Canadian Study of Health and Aging, a nation-wide representative survey of elderly people in Canada (N = 2,305). RESULTS: Both physical performance measures proved infeasible in many subjects (29.3% for the Timed Up and Go [TUG], 35.9% for the Functional Reach [FR]). Cognitive impairment was the most important determinant of inability to complete the tests. For those able to complete the tests, cognitively unimpaired subjects could reach farther (median 29 cm) and complete the TUG in less time (median 12 seconds) than those cognitively impaired (25 cm for FR, 15 seconds for the TUG). Test-retest reliability between the screening and clinical administrations of the TUG was .56 for all participants (intra-class correlations), .50 for the cognitively unimpaired, and .56 for the cognitively impaired. Construct validity was substantial, and correlations between performance measures and self-report activities of daily living (ADL) measures ranged from .40 to .70. Compared with a global clinical measure of frailty, correlations were more modest (.38 to .60). CONCLUSIONS: The FR and the TUG were not feasible tools in this study. The TUG showed poor test-retest reliability. Our data support the observation that subsequent studies of measurement instruments typically reveal lower performance than the original reports.

Activities of Daily Living↗

PubMed2000

Genes and longevity: lessons from studies of centenarians.

In population studies of aging, the data on genetic markers are often collected for individuals from different age groups. The idea of such studies is to identify "longevity" or "frailty" genes by comparing the frequencies of genotypes in the oldest and in the younger groups of individuals. In this paper we discuss a new approach to the analysis of such data. This approach, based on the maximum likelihood method, combines data on genetic markers with survival information obtained from standard demographic life tables. This method allows us to evaluate survival characteristics for individuals carrying respective candidate genes. It can also be used in the estimation of the effects of allele-area and allele-allele interaction, either in the presence or absence of hidden heterogeneity. We apply this method to the analysis of Italian data on genetic markers for five autosomal loci and mitochondrial genomes. Then we discuss basic assumptions used in this analysis and directions of further research.

Aged↗

PubMed2001

Relationship between muscle strength and the time taken to complete a standardized walk-turn-walk test.

We examined the effects of age and gender on the relationship between knee strength and walking time during a walk-turn-walk test in 176 male and 168 female generally healthy participants of the Baltimore Longitudinal Study of Aging who were aged 21-89 years. Subjects were timed as they walked 50 ft (15.24 m), turned around, and walked back to the starting point, both at a comfortable pace and as fast as possible. Isokinetic concentric knee extensor strength was measured at 30 degrees /s by using a Kin-Com dynamometer. Both comfortable and fast gait times increased with increasing age for both women and men, starting in middle age. An interaction was found between gender and age showing that older women are slower than older men at both paces. Gait time decreased linearly with increasing knee extensor strength, plateauing at higher strength levels (>130 N m for comfortable gait, and 190 N m for fast gait). Most women occupied the linear part of the curve below the plateau. Adjustment for body size, age, physical activity, and particularly number of steps to complete the task removed the relationship between strength and gait time for the comfortable gait. Women took longer to complete the walk-turn-walk test than men at older ages, were on the linear part of the strength-gait time relationship, and used more steps to complete the task, all of which may contribute to their greater likelihood of frailty in later years.

Adult↗

PubMed2003

Sarcopenia: causes, consequences, and preventions.

With the onset of advancing age, muscle tissue is gradually lost, resulting in diminished mass and strength, a condition referred to as sarcopenia. The sequela of sarcopenia often contributes to frailty, decreased independence, and subsequently increased health care costs. The following was adapted from an introduction to the conference "Sarcopenia, Age-Related Muscle Loss-Causes, Consequences, and Prevention," sponsored by the Kronos Longevity Research Institute in June 2002. This brief review will introduce potential mechanisms that may contribute to sarcopenia, although no one mechanism has yet, and may not completely, define this process. The only agreed-upon intervention from these proceedings was regular physical exercise, stressing weight-training for elderly men and women. However, even those individuals who maintain their fitness through exercise do not appear to be immune to sarcopenia.

Aging↗

PubMed2003

Oral testosterone supplementation increases muscle and decreases fat mass in healthy elderly males with low-normal gonadal status.

BACKGROUND: Loss of muscle mass (sarcopenia) leads to frailty in older men. The decline in testosterone over the life span may contribute to this muscle loss. We studied the ability of oral testosterone to prevent muscle loss in older men over a 12-month period. METHODS: A standard dose (80 mg twice daily) of testosterone undecanoate or placebo was administered for 1 year to 76 healthy men aged 60 years or older. All men had a free testosterone index of 0.3-0.5, which represents a value below the normal lower limit for young men (19-30 years), but remains within the overall normal male range. Measurements of body composition, muscle strength, hormones, and safety parameters were obtained at 0, 6, and 12 months. RESULTS: Lean body mass increased (p =.0001) and fat mass decreased (p =.02) in the testosterone as compared with the placebo-treated group. There were no significant effects on muscle strength. There was a significant increase in hematocrit (0.02%) in the testosterone-treated group (p =.03). Plasma triglycerides, total cholesterol, and low-density lipoprotein cholesterol levels were similar in both groups, but there was a decrease in high-density lipoprotein cholesterol (-0.1 mmol/L) at 12 months in the testosterone group as compared to the placebo group (p = 0.026). There were no differences in prostate-specific antigen or systolic or diastolic blood pressure between the groups. CONCLUSION: Oral testosterone administration to older relatively hypogonadal men results in an increase in muscle mass and a decrease in body fat.

Adipose Tissue↗

PubMed2004

First autopsy study of an Okinawan centenarian: absence of many age-related diseases.

Consistent with the compression-of-morbidity hypothesis, several studies have reported that a significant proportion of centenarians delay or escape age-related diseases. Of those who live with such diseases for a long time, many appear to do so with better functional status than do younger persons who do not achieve extreme old age. The authors describe the first autopsy in an Okinawan-Japanese centenarian who escaped many age-related illnesses and delayed frailty toward the end of her very long life. Her late-life morbidity pattern is contrasted with that of white centenarians.

Aged↗

PubMed2004

The deleterious effects of bed rest among community-living older persons.

BACKGROUND: Older persons often "take to bed" while they are ill or injured, but relatively little is known about the functional consequences of bed rest among community-living older persons. In this prospective cohort study, the association between episodes of bed rest and functional decline was evaluated during an 18-month period. METHODS: Participants included 680 nondisabled, community-living persons aged 70 years or older. They were separated into 2 groups according to the presence or absence of physical frailty, which was defined based on slow gait speed. Episodes of bed rest were ascertained each month in a telephone interview for a median of 18 months. The completion rate was 99.1%. Functional decline was defined as a worsening in scores between the baseline and 18-month follow-up assessments in 1 or more of the following measures: instrumental activities of daily living, mobility, physical activity, and social activity. RESULTS: Among the 404 (59.4%) participants who had at least 1 episode of bed rest, the mean number of months with bed rest was 2.8 (standard deviation, 2.4). After adjustments were made for several potential confounders, the number of months with bed rest was significantly associated with decline in each of the functional measures. Significant associations were also observed for each of the functional outcomes among participants who were not physically frail, but they were observed only for instrumental activities of daily living disability among participants who were physically frail. CONCLUSIONS: These findings indicate that episodes of bed rest among community-living older persons are associated with decline in several important indicators of function.

Activities of Daily Living↗

PubMed2005

Grip strength, postural control, and functional leg power in a representative cohort of British men and women: associations with physical activity, health status, and socioeconomic conditions.

BACKGROUND: Understanding the health, behavioral, and social factors that influence physical performance in midlife may provide clues to the origins of frailty in old age and the future health of elderly populations. The authors evaluated muscle strength, postural control, and chair rise performance in a large representative prospective cohort of 53-year-old British men and women in relation to functional limitations, body size, health and activity, and socioeconomic conditions. METHODS: Nurses interviewed 2984 men and women in their own homes in England, Scotland, and Wales and conducted physical examinations in 2956 of them. Objective measures were height, weight, and three physical performance tests: handgrip strength, one-legged standing balance time, and time to complete 10 chair rises. Functional limitations (difficulties walking, stair climbing, gripping, and falls), health status, physical activity, and social class were obtained using a structured questionnaire. RESULTS: Those with the worst scores on the physical performance tests had higher rates of functional limitations for both upper and lower limbs. Women had much weaker handgrip strength, somewhat poorer balance time, and only slightly poorer chair rise time compared with men. In women, health problems and low levels of physical activity contributed to poor physical performance on all three measures. In men, physical activity was the predominant influence. Heavier weight and poorer socioeconomic conditions contributed to poorer balance and chair rise times. CONCLUSIONS: In this representative middle-aged group, physical performance levels varied widely, and women were seriously disadvantaged compared with men. In general, physical performance was worse for men and women living in poorer socioeconomic conditions with greater body weight, poorer health status, and inactive lifestyles. These findings support recommendations for controlling excess body weight, effective health interventions, and the maintenance of active lifestyles during aging.

Cohort Studies↗

PubMed2005

Fear of falling and related activity restriction among middle-aged African Americans.

BACKGROUND: The prevalence of fear of falling and related activity restriction, and their joint distribution with falls and falls efficacy, have been inadequately addressed in population-based studies of middle-aged and African-American groups. METHODS: The African American Health project is a population-based panel study of 998 African Americans born in 1936-1950 from two areas of metropolitan St. Louis (an impoverished inner-city area and a suburban area). Fear of falling, fear-related activity restriction, and 24 frailty-related covariates were assessed during in-home evaluations in 2000-2001. RESULTS: We found that 12.6% of participants reported having fear of falling without activity restriction, 13.2% had fear of falling with activity restriction, and 74.2% had no fear of falling. Neither fear of falling nor fear-related activity restriction varied significantly across three birth cohorts (1946-1950, 1941-1945, and 1936-1940). Lack of overlap of these two phenomena with having a fall in the past 2 years and low falls efficacy was considerable. When examined across three groups (no fear, fear without activity restriction, and fear with activity restriction), a consistent pattern of decreasing health status and social, emotional, and physical functioning was demonstrated. CONCLUSIONS: In this population-based sample of 49- to 65-year-old African Americans, fear of falling and fear-related activity restriction were surprisingly common and not well explained by prior falls or low falls efficacy. These phenomena were already evident by age 49-55. Further study is warranted, including detailed qualitative investigations examining the timing, precursors, and consequences of fear of falling and fear-related activity restriction in minority and majority populations.

Accidental Falls↗

PubMed2005

Identification of risk factors for 15-year mortality among community-dwelling older people using Cox regression and a genetic algorithm.

BACKGROUND: Previous research has identified various risk factors for mortality in older people, but has considered a limited number of the variables available for analysis. The aim of this study was to use a genetic algorithm combined with Cox regression (CoRGA) to examine all the variables to identify risk factors for 15-year mortality. METHODS: Data were obtained from a nationally representative sample of 1,042 community-dwelling people aged 65+. Data on cognitive impairment, physical health, physical activity, psychological well-being, social engagement, and physical capability resulted in 460 independent variables for analysis. Outcome was time from 1985 interview to death or censorship on February 29, 2000. CoRGA was used to selected combinations of 1, 2, 4, 8, 12, and 16 variables as potential risk factors for 15-year mortality. RESULTS: CoRGA selected age in all six models; variables relating to handgrip strength were selected in five models; variables relating to reported chest pain were selected in four models; and pain in joints causing difficulty in carrying bags and self-rated activity compared to peers were both selected in three models. Other variables selected by CoRGA included time since last visited the dentist and optician, use of hypnotic drugs, and number of prescribed drugs being taken. CONCLUSIONS: CoRGA confirmed current risk factors for long-term mortality among older people and identified new risk factors. Age was confirmed as the most important predictor of mortality in older people. Handgrip strength is an important marker of frailty in predicting mortality. Self-rated activity is an important predictor of long-term mortality.

Aged↗

PubMed2005

Relationship between functional loss before hospital admission and mortality in elderly persons with medical illness.

OBJECTIVE: This hospital-based prospective study tests the hypothesis that, in a large group of hospitalized elderly patients, those who report functional decline between pre-illness baseline and hospital admission have a higher risk of death. METHODS: Nine hundred fifty elderly ambulant patients (F = 69.3%; mean age 78.3 +/- 8.5 years) were consecutively admitted to a geriatric ward (Poliambulanza Hospital, Brescia, Italy) during a 15-month period. Number and severity of somatic diseases, Charlson Index score, APACHE II score, level of serum albumin, cognitive status (by Mini-Mental State Examination), and depression score (by Geriatric Depression Scale), were assessed on admission and evaluated as potential prognostic factors. Functional status (by Barthel Index) was assessed by self-report on admission. Preadmission function was also assessed by self-report at the time of admission. Impairment of function due to an acute event is measured as the difference between performances on admission and 2 weeks before the acute event. Six-month survival was the main outcome variable. RESULTS: Factors related to mortality in bivariate analysis were: male sex, age over 80, cancer, congestive heart failure, pulmonary diseases, elevated Charlson Index score, and (independently) dementia (Mini-Mental State Examination < 18), APACHE-Acute Physiology Score , albumin level <3.5 g/dL, and anemia. After controlling for these variables and for Barthel Index score 2 weeks before the acute event, change in function due to the acute disease is independently related to 6-month mortality (minor functional change [<30 Barthel Index Point] relative risk: 1.3, 95% confidence interval, 0.6-3.0 and major functional change [major functional decrement] relative risk: 2.8, 95% confidence interval, 1.3-5.7). CONCLUSIONS: Disease-induced disability may reflect a condition of biological inability to react to acute diseases (i.e., frailty), and should be assessed as a relevant prognostic indicator.

Activities of Daily Living↗

PubMed2006

The influence of intense Tai Chi training on physical performance and hemodynamic outcomes in transitionally frail, older adults.

BACKGROUND: Few data exist to evaluate whether Tai Chi (TC) training improves physical performance and hemodynamic outcomes more than a wellness education (WE) program does among older fallers transitioning to frailty. METHODS: This 48-week randomized clinical trial was provided at 10 matched pairs of congregate living facilities in the Atlanta metropolitan area to 291 women and 20 men, who were transitionally frail, >or=70 years old, and had fallen at least once within the past year. Pairs of facilities were randomized to either TC exercise (n = 158) or WE (control) interventions (n = 153) over 48 weeks. Physical performance (freely chosen gait speed, reach, chair-rises, 360 degrees turn, picking up an object from the floor, and single limb support) and hemodynamic outcomes (heart rate and blood pressure) were obtained at baseline and after 4, 8, and 12 months. RESULTS: Mean percent change (baseline to 1 year) for gait speed increased similarly in both cohorts (TC: 9.1% and WE: 8.2%; p =.78). However, time to complete three chair-rises decreased 12.3% for TC and increased 13.7% for WE (p =.006). Baseline to 1 year mean percent change decreased among TC and increased within WE cohorts for: body mass index (-2.3% vs 1.8%; p <.0001), systolic blood pressure (-3.4% vs 1.7%; p =.02), and resting heart rate (-5.9% vs 4.6%; p <.0001). CONCLUSIONS: TC significantly improved chair-rise and cardiovascular performance. Because TC training reduced fall occurrences in this cohort, factors influencing functional and cardiovascular improvements may also favorably impact fall events.

Aged↗

PubMed2006

Developmental origins of midlife grip strength: findings from a birth cohort study.

BACKGROUND: There is growing evidence that the prenatal environment has long-term effects on adult grip strength, but little is known about the effects of the postnatal environment. We tested whether prepubertal growth, pubertal growth, or the development of motor and cognitive capabilities was associated with midlife muscle strength independently of other determinants of grip strength. METHODS: Handgrip strength and body size were measured in a representative British sample of 1406 men and 1444 women 53 years old with prospective childhood data. Normal regression models were used to examine the effects of birth weight, postnatal height and weight gain before 7 years and between 7 and 15 years, motor milestones and cognitive ability on grip strength at age 53, taking account of lifetime social class, current physical activity, and health status. RESULTS: Birth weight and prepubertal height gain were associated with midlife grip strength, independently of later weight and height gain and other determinants. Pubertal growth was also independently associated with midlife grip strength; for men weight gain during puberty was beneficial, whereas for women it was height gain. Those participants with earlier infant motor development had better midlife grip strength, which was partly confounded by the growth trajectory. CONCLUSIONS: This study showed that components of prenatal, prepubertal, and pubertal growth have long-term effects on midlife grip strength. To the extent that these associations are modifiable, interventions in childhood that help to build muscle mass and strength, such as increased physical exercise, may have long-term beneficial effects on adult muscle strength and may help to prevent sarcopenia, disability, and frailty in later life.

Adolescent↗

PubMed1996

Opportunity wages and workforce adjustments: understanding the cost of in-home elder care.

Time spent providing informal care represents a real cost to caregivers and potentially affects their decisions about alternative activities, including paid work. This study offers estimates of opportunity wages incurred by informal caregivers and explores the impact of these costs on their decisions to reduce or abandon workforce participation. We consider caregivers at two points in time: 1982 and 1989. Our estimates of caregivers' imputed wages vary more widely and range higher than those reported elsewhere, varying from $0.78 to $27.18 per hour, compared to values in the literature ranging from $4.64 to $10.30. In both years, caregivers with higher imputed wages were significantly more likely to work, with this effect stronger in 1989 as all noneconomic factors became less important. However, accommodation (working fewer hours or foregoing job opportunities) decreased with higher imputed wages in 1982 only. In 1989, elders' frailty became a significant determinant of accommodation.

Aged↗

PubMed1996

Health and social precursors of later life retirement-community migration.

This study uses the developmental migration paradigm developed by Litwak and Longino (1987) as a framework to investigate the health and social determinants of late-life elderly mobility to retirement communities. Data from four waves of the Longitudinal Study of Aging are used to predict the likelihood of moving from the general community to two types of retirement communities--those with group meals and those without group meals. Multinomial logistic regression reveals that the likelihood of migrating to both types of retirement communities increases as disability advances to moderate levels, but declines as disability becomes severe. Migration to retirement communities is also more likely among elderly persons who live alone and among those whose children do not live nearby. The results suggest that retirement community migration in middle and late old age is motivated not only by social and amenity considerations, but also by the need for assisted living arising from physical frailty. Implications for developmental migration theory and long-term care policy are discussed.

Age Factors↗