Abstract
SummaryThis cohort study conducted in Japan showed that severe age-related kyphosis was visually detected. The visual assessment of kyphosis was associated with declines in ADL, suggesting that we can easily identify people at high risk to develop future ADL reduction in the community setting.PurposeAge-related kyphosis is related with declines in activities of daily living (ADL). Its conventional diagnosis has been made by orthopedic surgeons and trained examiners using specialized equipment such as X-rays. We investigated whether visual classification of kyphosis by laypersons accurately predicted future ADL decline.MethodsThis study was part of the Kurabuchi Study, a cohort study of community-dwelling elderly Japanese. Between 2009 and 2010, three layperson raters used reference illustrations to classify 532 participants without ADL decline at study baseline into four categories. Other examiners used conventional methods to assess kyphosis in the same participants: curve ruler, Spinal Mouse, and the block method. ADL decline was defined as the development of dependence according to the Katz Index, admission to a nursing home, or certification of long-term care need.ResultsThirty-five of the participants (6.6%) were classified with the most severe degree of kyphosis at baseline by visual assessment. Interrater agreement was high (Kappa = 0.73) for the most severe group. During 4.5 years of follow-up, 106 participants (19.9%) showed ADL decline. On the basis of visual assessment, the adjusted risk ratio for ADL decline among the participants with the most severe kyphosis was 2.6 (95% CI: 1.4–4.6). Assessments of kyphosis made with the Spinal Mouse also accurately predicted ADL decline.ConclusionsVisual assessment of kyphosis predicted future declines in ADL in this study. Since our method requires no special tools or training, it may be useful for identifying those at high risk of ADL decline.
Highlights
Scientific advances have led to longer lifespans and aging societies
[3], pain [4], and vision and hearing impairments [5] have been reported as useful predictors of declines in activities of daily living (ADL) in the elderly, and we have previously reported that measurement of age-related kyphosis with a combination of the block method and kyphosis index [6], and with the Spinal Mouse [7] can predict future ADL decline
We showed in a previous study that there is no difference in the risk ratio (RR) for ADL decline with measurements between 0 and 2 blocks [6], so we classified the results into four categories: 0–2 blocks, 3 blocks, 4 blocks, or ≥ 5 blocks
Summary
Scientific advances have led to longer lifespans and aging societies. According to United Nations data, more than 40% of the populations of several Asian and European countries will be over the age of 60 by 2050; among these countries, Japan has the highest aging rate [1]. It is desirable to keep the elderly members of these aging societies as physically independent as possible by identifying those at risk of developing dependency and taking appropriate measures to prevent it [2]. As the number of healthy elderly people increases, it becomes more difficult to predict functional deterioration only on the basis of age. To identify those who would benefit from preventive intervention, effective predictive measures are needed.
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