SEARCH · PubMed Health

Results for “Frailty”

Explore indexed PubMed citations for clinical trials, systematic reviews and public health research. Read source abstracts and follow each citation to its original PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 883 records · Page 49Linked to original sources

PubMed1997

Self-report benefits of Tai Chi practice by older adults.

Older persons who are willing to begin exercise programs are often not willing to continue them. At the Atlanta FICSIT (Frailty and Injuries: Cooperative Studies of Intervention Techniques) site, individuals aged 70+ were randomized to Tai Chi (TC), individualized balance training (BT), and exercise control education (ED) groups for 15 weeks. In a follow-up assessment 4 months post-intervention, 130 subjects responded to exit interview questions asking about perceived benefits of participation. Both TC and BT subjects reported increased confidence in balance and movement, but only TC subjects reported that their daily activities and their overall life had been affected; many of these subjects had changed their normal physical activity to incorporate ongoing TC practice. The data suggest that when mental as well as physical control is perceived to be enhanced, with a generalized sense of improvement in overall well-being, older persons' motivation to continue exercising also increases.

Activities of Daily Living↗

PubMed1999

Correlates of open- and locked-facility placement in a population of decisionally impaired adults.

OBJECTIVES: This study compares characteristics of public conservatees placed in locked facilities with those in less restrictive settings. Given the principle of the least restrictive alternative, the study seeks to identify factors, including the role of aging and advanced age, associated with restrictive placement within conservatorship. METHODS: Management Information Systems data on 1,534 adult conservatees in Los Angeles County in July, 1993, are examined in cross-section. Models exploring individual and environmental characteristics of conservatees and linear, curvilinear, and multiplicative aging effects are tested on the probability that adults are placed in locked facilities versus all other placement types. RESULTS: Locked facility placement is associated with being female, receiving SSI, a diagnosis of dementia, and being identified as a danger to oneself and to others. Locked-facility placement is associated with increasing age until age 60, when the effect becomes inversely related; the multiplicative effect of older age and impaired functioning is also inversely related. DISCUSSION: The curvilinear nature of age and the interaction effect of Age x Functioning implies that increasing frailty in older adults makes locked facility-placement less likely. Further research is needed on whether alternative placement types, such as special care units with secured perimeters, can further reduce the need for locked facilities.

Adolescent↗

PubMed2002

Self-gain and self-loss among African American and white caregivers.

OBJECTIVES: This study compared the effects of a traditional ideology of care and role conflict on the intrinsic rewards (self-gain) and consequences (self-loss) of caregiving among African Americans and Whites. METHODS: Using a cross-sectional telephone survey of caregivers in North Carolina (n = 481), the authors performed a structural equation groups analysis to assess the equality of an a priori caregiving model for African Americans (n = 257) and Whites (n = 224). RESULTS: Despite a stronger preference for family care among African Americans, traditional caregiving ideology was associated with more self-gain among Whites only; there was no relationship between preference for family care and self-loss for either group. Furthermore, role conflict was unrelated to self-gain but was related to more self-loss for both groups. Three additional relationships differed between African Americans and Whites: age and self-gain, gender and self-gain, and care recipient depression and role conflict. However, 12 proposed relationships were statistically significant and equivalent for African Americans and Whites. DISCUSSION: The findings suggest that contextual elements that influence preference for family care and role conflict are almost identical for African Americans and Whites. Caregiver demographics are associated with caregiving ideology, whereas care recipient frailty is related to role conflict. However, there are differences between African American and White caregivers, which primarily stem from the role of age, gender, and preference for family care with self-gain.

Black or African American↗

PubMed2002

Reciprocity in parent-child relations over the adult life course.

OBJECTIVES: This research assessed how parents' transfers of sentiment, time, and financial assets to their adolescent/young adult children affect the children's propensity in middle age to provide social support to their aging parents. We tested whether the mechanism of long-term intergenerational exchange is better modeled as a return on investment, an insurance policy triggered by the longevity or physical frailty of parents, or the result of altruistic (or other nonreciprocal) motivations on the part of adult children. METHODS: Models were examined with 6 waves of data from the University of Southern California Longitudinal Study of Generations. The sample consisted of 501 children who participated in the 1971 survey and who had at least 1 parent surviving in 1985. Growth curve modeling was applied to predict average levels and rates of change in social support provided to mothers and fathers between 1985 and 1997 as a function of early parental transfers of affection, association, and tangible resources to their children. RESULTS: Children who spent more time in shared activities with their mothers and fathers in 1971 provided more support to them on average. Receiving greater financial support from parents in 1971 raised the marginal rate at which support provided by children increased over time. Maternal health operated synergistically with early affection to produce greater levels of support. Both levels and rates of increase in support from children were positive, even for children who received no early transfers from their parents. DISCUSSION: The results offer some support for investment, insurance, and altruistic models of intergenerational exchange. Sharing time in activities provides a direct return to the parent that is characteristic of an investment strategy, whereas financial transfers provide a time-contingent return that is characteristic of an insurance mechanism. That affection triggers greater support to more functionally impaired mothers suggests that emotionally investing in children as a health insurance mechanism may be based on the greater moral equity accorded to mothers. The motivation of adult children to provide social support to their older parents is partially rooted in earlier family experiences and guided by an implicit social contract that ensures long-term reciprocity.

Adolescent↗

PubMed2004

Negotiating care: ties between aging mothers and their caregiving daughters.

OBJECTIVE: Using a feminist social constructionist perspective, we illuminate how aging mothers and their caregiving daughters negotiate issues of connection, autonomy, and conflict. METHODS: We conducted a qualitative analysis of videotaped interactions between 31 White mother-daughter pairs. RESULT: We found that the mothers and daughters mostly (a) were attentive and responsive, (b) preserved mothers' autonomy, and (c) minimized open conflict and tension. Subtle behavioral cues visible on the videotapes also exposed underlying emotional tension in these relationships. These cues alerted us to important variation in relationship quality among the pairs. Three patterns of relating emerged: (a) symmetrically connected, (b) asymmetrically connected, and (c) symmetrically constrained. DISCUSSION: Our exploratory study suggests that a balance between autonomy and connection is fundamental to the success of these mother-daughter caregiving relationships. Not only is it important for frail mothers to be responsive to their caregiving daughter's needs, but also it is important for daughters to support the autonomy and independence of their mothers. Our study also highlights the importance of attentiveness in these relationships. Even when mothers, because of illness and frailty, were less capable of attending to their daughters' lives, daughters in connected pairs interacted with their mothers in attentive ways. In constrained pairs, neither intergenerational partner was attentive.

Adult Children↗

PubMed2005

Further evidence for the importance of subclinical functional limitation and subclinical disability assessment in gerontology and geriatrics.

OBJECTIVE: The objectives of this work were to determine the prevalence of self-reported subclinical status for functional limitation and disability at baseline and assess their independent effects on the onset of functional limitation and disability 1-2 years later. METHODS: Nine hundred ninety-eight African American men and women 49-65 years old in St. Louis, MO, received comprehensive in-home evaluations at baseline and two annual telephone follow-ups. Outcome measures included walking a half-mile, climbing steps, stooping-crouching-kneeling, lifting or carrying 10 lbs., and doing heavy housework. RESULT: The baseline prevalence of subclinical status was 26.4% for walking a half-mile, 26.8% for climbing steps, 39.0% for stooping-crouching-kneeling, 29.1% for lifting or carrying 10 lbs., and 22.7% for doing heavy housework. The adjusted odds ratios for the task-specific subclinical status measure at baseline on developing difficulty 1-2 years later were 1.68 (p < .05) for walking a half-mile, 4.46 (p < .001) for climbing steps, 2.48 (p < .001) for stooping-crouching-kneeling, 2.51 (p < .001) for lifting or carrying 10 lbs., and 2.22 (p < .001) for doing heavy housework. Performance tests (tandem stand, chair stands, and preferred gait speed) did not have consistent independent effects on the onset of functional limitation or disability. CONCLUSION: The subclinical status measures were the main predictors of the onset of difficulty in all tasks and functions 1-2 years later. Interventions to reduce frailty should focus on self-reported subclinical status as an early warning system.

Activities of Daily Living↗

PubMed2005

Continuity and change in the social stratification of aging and health over the life course: evidence from a nationally representative longitudinal study from 1986 to 2001/2002 (Americans' Changing Lives Study).

OBJECTIVES: This article overviews previously published and ongoing research from the Americans' Changing Lives (ACL) Study, a longitudinal study of a nationally representative sample of 3,617 adults aged 25 years and older when first interviewed in 1986, focusing on socioeconomic disparities in the way health changes with age during middle and later life, especially in terms of compression of morbidity/functional limitations. METHODS: A variety of descriptive and multivariate regression and growth curve analyses are done on the ACL sample, now surveyed over four waves spanning 15.5 years between 1986 and 2001/2002 with continuing mortality ascertainment via the National Death Index, death certificate searches, and informant reports. RESULTS: Both cross-sectional and longitudinal analyses indicate that socioeconomic disparities in health are small in early adulthood, increase through middle and early old age, and then lessen again in later old age. In other terms, compression of morbidity/functional limitations into the later stages of the life course is realized to a much greater degree among the better educated compared with the less educated. Cross-sectional evidence suggests that this reflects differential exposure to or experience of a wide range of psychosocial, environmental, and biomedical risk factors for health (and perhaps their differential impact at different ages and life stages), as well as variations in biological robustness and frailty and also perhaps in the strength of social welfare supports for health at different life stages. Longitudinal analyses reveal several new insights: (a) The flow of causality is much greater from socioeconomic position to health than vice versa; (b) education plays a greater role relative to income in the onset of functional limitations, whereas income has much stronger effects on their progression or course; and (c) educational disparities in the onset and hence of compression of functional limitations over the life course have increased strikingly in later middle and early old age (ages 55-84 years) since 1986. DISCUSSION: The results indicate that understanding and alleviating social disparities in health are both theoretically and methodologically quintessential problems of life course analysis and research.

Adult↗

PubMed2006

Satisfaction with present life predicts survival in octogenarians.

We examined the effect of life satisfaction on survival over 10 years among 80-year-old and older same-sex twins of whom 320 individuals responded to the Life Satisfaction Index Z questionnaire in connection with the OCTO-Twin study. We treated participants as individuals in semiparametric Cox regression mixed-effects models (frailty) by adjusting the similarity of mortality risk within twin pairs by modeling it as a random variable. An exploratory factor analysis yielded three factors: Zest and Mood represented satisfaction with present life and Congruence represented satisfaction with past life. Those in the lowest quartile of factors of satisfaction with present life had an almost twofold risk for mortality compared with those in the highest quartile, even after adjustment for multiple confounders. Satisfaction with past life satisfaction showed no association with mortality.

Aged, 80 and over↗

PubMed1993

Altered sensory function and balance in older persons.

The effects of three different visual inputs (eyes open, eyes closed, and inaccurate) while standing on an unstable surface (respectively, UEO, UEC, UI) were compared in a group of healthy elderly community dwellers (N = 239; mean age 76) and young (N = 34; mean age 34) adults. Subjects with medical factors known to affect balance were excluded. Body sway and loss of balance measured dynamic force platform (EquiTest, NeuroCom International). Visual and somatosensory inputs were rendered inaccurate through tilting of the standing surface and/or the visual surround proportional to the subject's angle of sway (sway-referencing). The elderly group had significantly more difficulty balancing during UEC and UI, and a larger proportion lost their balance during UI. These findings are compared to those of other dynamic posturography studies in which sensory inputs were controlled. Issues of age, frailty, screening, and test protocol are addressed in order to account for differences in results among studies.

Aged↗

PubMed1993

The etiology and reversibility of muscle dysfunction in the aged.

Muscle weakness in the elderly is prevalent and morbid, closely linked to the frailty, functional decline, immobility, falls, and injuries in this population. The marked decrease in skeletal muscle strength and size with aging is a multifactorial syndrome which may be attributable in part to: (a) biological changes of aging itself; (b) the accumulation of acute and chronic diseases; (c) the assumption of a sedentary life style, and (d) selective or generalized nutritional inadequacies. Inactivity and undernutrition are potentially at least partially reversible with appropriate interventions, and therefore the delineation of the attributable risk of these two factors to the muscle weakness of aging is a critical research goal. Similarly, identification of appropriate modalities of physical activity and nutrition which have positive effects on muscle physiology in the aged is the focus of major investigations currently.

Aged↗

PubMed2001

The ageism survey: first findings.

PURPOSE: To develop an instrument that can be used to answer three questions: What is the prevalence of ageism in various societies? Which types of ageism are more prevalent? Which subgroups of older people report more ageism? METHODS: A survey instrument was developed listing 20 types of ageism. This instrument was tested on a convenience sample of 84 persons older than age 60. RESULTS: The instrument appears to have satisfactory reliability and validity. The survey found that the experience of ageism was widespread and frequent among these respondents. The majority reported several incidents of ageism and over half of the incidents were reported to have occurred "more than once." The most frequent types were persons showing disrespect for older people, followed by persons showing assumptions about ailments or frailty caused by age. IMPLICATIONS: Researchers now have a reliable and valid instrument for measuring the prevalence of ageism in various societies and of various types of ageism experienced by various groups of older persons. This may aid in reducing the prevalence of ageism in our society.

Age Factors↗

PubMed2002

Patterns and health effects of caring for people with dementia: the impact of changing cognitive and residential status.

PURPOSE: To link changes over 5 years in the health, vital and residential status of very elderly people to changes in their family caregivers' health. DESIGN AND METHODS: Canadian population-based, longitudinal study including community and institutional residents. From interviews and clinical examinations, 948 people (mean age = 86 years) were classified as demented, frail, or healthy at two points in time. Caregivers reported on the care they provided and their health outcomes. RESULTS: Diagnostic and residential groups of care recipients differed significantly in their level of activity of daily living/instrumental activity of daily living disability (range = 0.2 problems for the healthy group, 10-12 in the dementia groups) and in the amount of assistance received; caregiver burden scores were higher for people with dementia in the community than for those in institutions (p <.001). However, these differences did not translate directly into contrasts in caregiver health. Caregivers of healthy elders reported fewer health problems than did caregivers for people with dementia or frailty, but the latter groups did not differ significantly. Death of the care recipient and admission to institutional care did not have a consistent impact on caregiver health. IMPLICATIONS: The relationship between caregiver load and health outcomes is complex and dynamic; treatments that slow the progression of dementia will not necessarily relieve caregiver strain.

Activities of Daily Living↗

PubMed2003

Stagnation in mortality decline among elders in the Netherlands.

PURPOSE: This study assesses whether the stagnation of old-age (80+) mortality decline observed in The Netherlands in the 1980s continued in the 1990s and determines which factors contributed to this stagnation. Emphasis is on the role of smoking. DESIGN AND METHODS: Poisson regression analysis with linear splines was applied to total and cause-specific mortality data by age, year of death (1950-1999), and sex. An age-period-cohort analysis was carried out to determine whether the trends followed period or cohort patterns. ICD revisions were bridged by use of a concordance table. RESULTS: A sudden reversal in old-age mortality decline occurred around 1980, leading to a stagnation of the decline and even increases in mortality thereafter. Smoking-related cancers, chronic obstructive pulmonary disease, and diseases specifically related to old age contributed to this stagnation. Trends in smoking-related cancers and chronic obstructive pulmonary disease showed a cohort pattern--especially for men. When these smoking-related diseases were excluded, the trends in old-age mortality in The Netherlands showed an increasing stagnation for both sexes. IMPLICATIONS: Smoking behavior can only partly explain the stagnation of mortality. Other factors such as increased frailty and changes in medical and social services for elderly people probably played a more decisive role in the recent stagnation.

Age Distribution↗

PubMed2006

Informal caregivers and the risk of nursing home admission among individuals enrolled in the program of all-inclusive care for the elderly.

PURPOSE: We sought to determine whether participants in the Program of All-Inclusive Care for the Elderly (PACE) with an informal caregiver have a higher or lower risk of nursing home admission than those without caregivers. DESIGN AND METHODS: We performed a secondary data analysis of 3,189 participants aged 55 years or older who were enrolled in 11 PACE programs during the period from June 1, 1990 through June 30, 1998. Cox proportional hazard models determined whether having any caregiver, as well as specific caregiver characteristics, such as either living separately from the enrollee, being over the age of 75 years, providing personal care, not reducing or quitting work to provide care, or not being a spouse, predicted time to nursing home admission. RESULTS: Fewer than half of the participants (49.4%) lived with a caregiver, and 12.4% had no caregiver. Individuals who lived with their caregiver were frailer than either those who lived separately or those without a caregiver. We measured frailty in terms of functional and cognitive status, incontinence, and multiple behavioral disturbances. The presence of a caregiver did not change the risk for institutionalization. None of the caregiver characteristics were associated with a higher risk of nursing home admission. IMPLICATIONS: Unlike individuals in the general population, participants in PACE who lack an informal caregiver are not at higher risk of institutionalization. Further research is required to ascertain whether PACE's comprehensive formal services compensate for the lack of informal caregiving in limiting the risk for institutionalization.

Aged↗

PubMed2006

The relative benefits and cost of medicaid home- and community-based services in Florida.

PURPOSE: We compared inpatient days, nursing home days, and total Medicaid claims for five Medicaid-funded home- and community-based services (HCBS) programs for in-home and assisted living services in Florida. DESIGN AND METHODS: We studied a single cohort of Medicaid enrollees in Florida aged 60 and older, who were enrolled for the first time in any of five Medicaid HCBS programs and who had at least one assessment (N=6,014). In this 3-year longitudinal study, we used a two-stage probit regression and ordinary least squares regression in order to test the independent effects of explanatory variables on outcomes and cost. RESULTS: After controlling for differences in frailty, chronic health conditions, presence of dementia, and available caregiver, we found that Medicaid HCBS programs had a differential effect on hospital and nursing home utilization and cost. IMPLICATIONS: Medicaid HCBS programs serve very impaired populations at a wide range of costs to Medicaid. The rates for Medicaid HCBS programs could be adjusted upward or downward in order to better reflect the level of need in each program. At the same time, providers could use titration techniques based on the relative costs of these needs in order to budget for the costs of meeting the needs of particular elders.

Aged↗

PubMed2006

An evaluation of the Health Promoting Health Service Framework: the implementation of a settings based approach within the NHS in Scotland.

In 1996 the Health Education Board for Scotland (now NHS Health Scotland) began a process of developing a 'settings'-based framework that would inform health promotion work across Scottish health services--the Health Promoting Health Service Framework (HPHS). It took the form of a flexible guidance document, attending to the foundations of integrated and sustainable health promotion practice via specific areas like partnership work, policy development and staff health. The project has subsequently been progressed over an extended period, comprising three phases: an initial development of the resource; piloting of the framework; and a wider assessment of implementation and initial impact. This paper reports on the latter phase. Within the context of various issues pertaining to the evaluation of a 'settings' approach and based on the use of case study methodology in nine HPHS pilot sites, this paper reports on the latter 2 year phase. This involved ongoing concern for understanding intervention processes and a growing interest in intervention outcomes and the paper reports on findings in each of these domains. In relation to outcomes, some positive gains in various indicators were detected though significant problems were experienced in this aspect. More significantly, the work was able to gain insights into what we call 'necessary conditions' of implementation. We theorize a range of 'contextual' factors (e.g. responsiveness to health improvement policy agendas) and project specific 'mechanisms' (e.g. providing skilled support) and present these as a nexus of conditions required for effective implementation of health promotion practice within explanatory models. Most significantly, we stress the relative frailty of any settings implementation strategy based simply on the uncoordinated dissemination of a tool or resource.

Community Networks↗

PubMed2000

Lack of improvement of life expectancy at advanced ages in The Netherlands.

BACKGROUND: Several countries have reported an increase in life expectancy at advanced ages. This paper analyses recent changes in life expectancy at age 60 and 85 in The Netherlands, a low mortality country with reliable mortality data. METHODS: We used data on the population and the number of deaths by age, sex and underlying cause of death for 1970-1994. Life expectancy at age 60 and 85 was estimated using standard life-table techniques. The contribution of different ages and causes of death to the change in life expectancy during the 1970s (1970/74-1980/84) and the 1980s (1980/84-1990/94) were estimated with a decomposition technique developed by Arriaga. RESULTS: Life expectancy at age 60 increased in the 1970s and 1980s, whereas life expectancy at age 85 decreased (men) and stagnated (women) in the 1980s, and has decreased in both sexes since 1985/89. The decomposition by age showed that constant mortality rates in women aged 85-89, and increasing mortality rates at ages 85+ (men) and 90+ (women) have caused this lack of increase in life expectancy. The decomposition by cause of death showed that smaller mortality reductions from other cardiovascular and cerebrovascular diseases, which contributed most to the increase in life expectancy at age 85 in the 1970s, and mortality increases from, amongst others, chronic obstructive pulmonary disease (COPD), mental disorders and diabetes mellitus produced the decrease (men) and plateau (women) in life expectancy at age 85. CONCLUSIONS: Life expectancy at advanced ages stopped increasing during the 1980s in The Netherlands due to mortality increases at ages 85+ (men) and 90+ (women). Cause-specific trends suggest that, in addition to (past) smoking behaviour in men, changes in the distribution of morbidity and frailty in the population might have contributed to this stagnation.

Age Distribution↗

PubMed1997

Functional and metabolic consequences of sarcopenia.

The capacity of older men and women to adapt to regularly performed exercise has been demonstrated by many laboratories. Aerobic exercise results in improvements in functional capacity and reduced risk of developing type II diabetes in the elderly. High intensity resistance training (above 60% of the 1 repetition maximum) causes large increases in strength in the elderly, and resistance training significant increases muscle size. Resistance training also significantly increases energy requirements and insulin action of the elderly. We recently demonstrated that resistance training has a positive effect on multiple risk factors for osteoporotic fractures in previously sedentary post-menopausal women. Because the sedentary lifestyle of individuals in a long-term care facility may exacerbate losses of muscle function, we applied this same training program to frail, institutionalized elderly men and women. In a population of 100 nursing home residents, a randomly assigned high intensity strength training program resulted in significant gains in strength and functional status. In addition, spontaneous activity, measured by activity monitors, increased significantly in those participating in the exercise program; there was no change in the sedentary control group. Before the strength training intervention, the relationship of whole-body potassium and leg strength was relatively weak (r2 = 0.29, P < 0.001), indicating that in very old persons muscle mass is an important but not the only determiner of functional status. Thus exercise may minimize or reverse the syndrome of physical frailty prevalent among very old individuals. Because of their low functional status and high incidence of chronic disease, there is no segment of the population that can benefit more from exercise training than the elderly.

Aged↗