Associations Between Informal Caregiving and Physical Functioning: A Longitudinal Analysis of Dutch Older Adults

Physical activity can prevent or delay the onset of physical functional limitations in older adults. There are limited data that evidence-based physical activity interventions can be successfully translated into community programs and result in similar benefits for physical functioning. The purpose of this study is to measure the effects of the Active Living Every Day program on physical functioning and physical functional limitations in a diverse sample of older adults. As a part of the Active for Life initiative, the Council on Aging of Southwestern Ohio implemented Active Living Every Day (ALED), a group-based lifestyle behavior change program designed to increase physical activity. Performance-based physical functioning tests (30-s Chair Stand Test, eight Foot Up-and-Go Test, Chair Sit-and-Reach Test, 30-Foot Walk Test) were administered to participants at baseline and posttest. Baseline to post-program changes in physical functioning and impairment status were examined with repeated measures analysis of covariance. Interactions tested whether change over time differed according to race/ethnicity, body mass index (BMI), and baseline impairment status. Participants significantly increased their performance in all four physical functioning tests. The percentage of participants classified as "impaired" according to normative data significantly decreased over time. Physical functioning improved regardless of BMI, race/ethnicity, or baseline impairment status. ALED is an example of an evidenced-based physical activity program that can be successfully translated into community programs and result in significant and clinically meaningful improvements in performance-based measures of physical functioning.

Three out of 10 older adults are admitted in US hospitals where they are at risk for a decline in physical function. Identifying factors related to sleep and recovery of physical function is key to facilitating independence after discharge. This study examined the association between sleep and functional recovery following an acute hospitalisation in community-dwelling older adults. Participants aged 65+ years (n = 52) were recruited during hospitalisation at the UTMB hospital in Galveston, Texas. Prior to discharge (baseline) and at 4-weeks post-discharge (follow-up), participants completed sleep questionnaires, including PROMIS Sleep-Related Impairment and Sleep Disturbance, as well as physical function testing and questionnaires, Short Physical Performance Battery (SPPB) and PROMIS Physical Function. A subset of participants (n = 24) wore an actigraphy device for 4 weeks post-discharge to record sleep continuity. Separate multivariate regression models were conducted to determine whether baseline sleep predicted physical functioning at follow-up as well as if pre-post hospital changes in sleep predicted pre-post changes in physical functioning. Baseline PROMIS Sleep-Related Impairment was inversely associated with SPPB Balance (p = 0.023), SPPB Chair Stand (p = 0.0406), SPPB Total (p = 0.01), and PROMIS Physical Function (p = 0.008). Change in PROMIS Sleep-Related Impairment between baseline and follow-up was inversely associated with change in SPPB Total (p = 0.03), SPPB Balance (p = 0.0102), and PROMIS Physical Function (p = 0.012). Additionally, change in PROMIS Sleep Disturbance was inversely correlated with change in PROMIS Physical Function (p = 0.04). These results showed that self-reported sleep disturbances and daytime sleep-related impairments during and after hospitalisation predicted physical functioning at 4-weeks post-discharge. Trail Registration: clinicaltrials.gov as NCT02990533.

12087 Background: Aging is a nebulous concept with several definitions, but they all generally include physical and cognitive decline in function as a key component. We hypothesized that following cancer diagnosis, patients decline in physical and cognitive function would correspond with accelerated and/or accentuated aging trajectories. The magnitude of the functional changes could inform strategies to minimize impact of cancer diagnosis on trajectory of aging. Methods: We analyzed 32,935 participants >50 years enrolled between 1995-2018 in the Health and Retirement Study (HRS), a population-based, biennial longitudinal health interview survey of older adults in the United States. We assessed the changes in physical and cognitive function among cancer patients controlling for their pre-cancer trajectories and comparing it with aged population with no cancer diagnosis as control. The primary outcomes were change in physical function (Activities of Daily Living (ADL) and Instrumental Activities of Daily Living (IADL): range 0–11) and global cognitive function (Telephone Interview for Cognitive Status (TICS): range 0–27). The secondary outcome was change in self-rated health (SRH: range 1-5). We estimated the effect of acute change based on the immediate post-cancer outcome measurements compared to the trajectories before cancer; and the long-term effect as the per-year change in outcome decline post cancer compared to aging of cancer-free respondents adjusting covariates by linear mixed models. Results: 5,101 developed incident cancer: 1,514 in the 50-64 age group, 1,901 in the 65-74 age group, and 1,686 in the 75+ age group. 27,834 participants were cancer-free throughout. Cancer was associated with acute declines in physical function (0.06 [0.01– 0.10] and 0.25 [0.14– 0.36] points), cognitive function (0.22 [0.04–0.39] and 0.24 [0.01– 0.46] points), and SRH (0.19 [0.14–0.23] and 0.22 [0.12–0.33] points) for age of onset groups 50- and 75+ respectively. Moreover, participants with cancer demonstrated accelerated decline in physical function (0.02 [0.01–0.03], and 0.06 [0.05–0.07] points per year faster for 50-74 and 75+ age-of-onset groups respectively) compared to cancer-free participants, but not in cognitive and SRH. Lung, colorectal & breast cancer were associated with the highest acute and accelerated decline in functions, while prostate cancer was associated with moderate and insignificant decline. Conclusions: Using 24 years of nationally representative longitudinal data, this study provides, for the first time, evidence for the heterogeneous aging trajectories of cancer patients across varying age-of-onset and cancer types. Our results supported an accelerated aging trajectory of physical function with increased acceleration with increasing age-of-onset compared to the non-cancer population. It also provides evidence for accentuated aging trajectories of cognitive function and self-rated health.

Poor oral health could be associated with changes in musculoskeletal health over time. This aim of this study was to investigate the longitudinal relationship between oral health and decline in physical function in later life. We did a prospective analysis of two cohorts of older adults (aged 70 years or older) including men from the British Regional Heart Study (BRHS; n=612), and men and women from the Health, Aging and Body Composition (Health ABC) Study (n=1572), followed up for about 8 years. Data were available for clinical or self-reported oral health measures, muscle (grip) strength, and physical performance (chair stand and gait speed). ANCOVA models were used to assess the association between oral health and follow-up physical function scores. Multivariate logistic regression models were used to examine the associations between oral health and decline in physical function over the follow-up period. In the BRHS, changes in oral health and physical function were also assessed. All models were adjusted for relevant sociodemographic, behavioural, and health-related factors. In the BRHS, complete tooth loss and difficulty eating were associated with weaker grip strength at follow-up, and periodontal status was associated with decline in gait speed. In the Health ABC Study, complete tooth loss, poor self-rated oral health, and the presence of one oral health problem were associated with slower gait speed at follow-up. In both studies, dry mouth was associated with declines in physical function. In the BRHS, deterioration of dentition (tooth loss) over the follow-up period was associated with decline in chair stand speed (adjusted odds ratio 2·34 [95% CI 1·20-4·46]), as was deterioration in difficulty eating (2·41 [1·04-5·60]). Oral health problems are associated with poorer physical function and greater decline in physical function in older adults, and could be an indicator of individuals at risk of reduced physical capacity and subsequent frailty and disability in later life. The Dunhill Medical Trust and the US National Institutes of Health-National Institute of Dental and Craniofacial Research.

Previous studies have shown a relationship between physical and social aspects of the neighborhood environment (e.g., built environment, safety) and physical function in older adults. However, these associations are unclear in older Asian adults because longitudinal studies are lacking. This study examined the effects of neighborhood physical and social environment on longitudinal changes in physical function among Japanese older adults. We analyzed 299 Japanese community-dwelling adults aged ≥65 years. Neighborhood environment was assessed using the International Physical Activity Questionnaire Environment Module. Physical function was assessed using handgrip strength, knee extension muscle strength, 5-m walking time, and a timed up-and-go test (TUG) in baseline and follow-up surveys. Changes in physical function over one year were calculated and classified into decline or maintenance groups based on minimal detectable changes. Multiple logistic regression analysis showed that even after adjusting for confounding factors, good access to recreational facilities affected the maintenance of 5-m walking time (odds ratio [OR] = 2.31, 95% confidence interval [CI]: 1.02–5.21) and good crime safety affected the maintenance of TUG (OR = 1.87, 95%CI: 1.06–3.33). Therefore, it is important to assess both physical and social environmental neighborhood resources in predicting decline in physical function among Japanese older adults.

Determinants of socioeconomic differences in change in physical and mental functioning

ObjectiveTo investigate changes and predictors of change in physical and mental function over a 3-year period after rehabilitation.DesignProspective cohort.ParticipantsPatients, across diseases, living in western Norway, accepted for somatic spesialized interprofessional rehabilitation (n = 984).MethodsPhysical and mental function were assessed at admittance (baseline), and after 1 and 3 years using the Medical Outcome Study Short Form 36 (SF-36). Associations between changes in SF-36 component summary scores and sense of coherence, pain, disease group (musculoskeletal, neoplasm, cardiovascular, neurological, other), exercise habits and demographic variables were analysed using linear mixed modelling.ResultsIn the total group, mean (standard deviation) physical component summary scores improved by 2.9 (8.4) and 3.4 (9.3) points at 1 and 3 years, respectively. Mental component summary scores improved by 2.1 (9.7) and 1.6 (10.8) points. Improvement in physical component summary was significantly greater for patients with higher sense of coherence (b = 0.09, p = 0.001) and for the neoplasm disease group (b = 2.13, p = 0.046). Improvement in mental component summary was significantly greater for patients with low sense of coherence (b = –0.13, p = < 0.001) and higher level of education (b = 3.02, p = 0.0302). Interaction with age (physical component summary: b = 0.22, p = 0.039/mental component summary b = 0.51, p = 0.006) indicated larger effect at 1 year than at 3 years.ConclusionPhysical and mental function improved in the total study group over the 3-year period. Sense of coherence at baseline was associated with improved physical and mental function, suggesting that coping resources are important in rehabilitation.LAY ABSTRACTRehabilitation aims to improve function among people with disabilities. This study investigated how physical and mental function change in a 3-year period after rehabilitation, and the factors related to these changes. In a cohort of 984 rehabilitation patients, physical and mental function were measured before rehabilitation (baseline) and at 1 and 3 years after rehabilitation. Both physical and mental function improved over a period of 3 years, with the greatest improvement from baseline to 1 year. Improved function at 1 year remained relatively stable over time. Participants with higher coping resources at baseline, measured by sense of coherence, had the greatest improvement in physical function, and less improvement in mental function. Participants’ disease group influenced change in physical function. Participants with a higher level of education demonstrated greater improvement in mental function. These results imply that coping resources should be addressed as an important part of rehabilitation.

The impact of acute skeletal muscle loss after gastrointestinal cancer surgery on physical function.

ASSESSMENT TYPEThe Short Physical Performance Battery (SPPB) is an objective measurement instrument of balance, lower extremity strength, and functional capacity in older adults (>65 years of age). It was developed by the National Institute on Aging (NIA). Three domains, which include balance, usual or self-selected gait speed, and lower limb strength, are assessed by a three-stage balance test (feet side-by-side, semitandem, and tandem positions), a 3-m or 4-m gait speed test (time spent to walk the course), and a repetitive chair stand test (five times chair sit-to-stand test), respectively (1,2). A 0- to 12-point scale is used to score the sum of the three assessments with higher point values corresponding with greater levels of physical function and lower disability, whereas lower point values correspond with lower levels of physical function and higher disability, respectively (1,2). BENEFITS OF THE ASSESSMENT The SPPB is a standardized and clinically relevant assessment of functional performance, balance, and lower extremity strength in older adults (3–6). This test requires minimal equipment and can be performed by health-fitness professionals that work with elderly clients in field, community, or clinical settings. The SPPB has demonstrated sensitivity and responsiveness to exercise-based interventions over time (4–7) and can be completed in approximately 10 to 15 minutes. Results from the SPPB can help health-fitness professionals formulate physical activity and exercise program interventions to improve physical function in their older adult clients. Because it has demonstrated good sensitivity to changes in physical condition and performance over time, it can help guide program design and monitor improvements in fitness and lower limb function upon reassessment. Figure 1 depicts the three assessments from the SPPB.Figure 1: The three assessments from the SPPB.INTRODUCTION The SPPB was originally developed to assess lower extremity function in more than 5,000 persons 71 years and older (1). Results from the SPPB can help practitioners validly characterize older persons across a broad spectrum of lower extremity function (1,2). It is a powerful predictor of disability, institutionalization, and mortality (1,2,8). The SPPB has been subsequently used to identify mobility limitations and disability potential in persons with peripheral artery disease (5,9) and chronic obstructive pulmonary disease (10). This assessment also can be used to determine the need for and the responses to physical activity interventions in persons with sarcopenia (7) and as a predictor of the inability of older adults to walk 400 m (approximately two blocks which is considered another valid measure of disability) (11). It has been determined to be responsive and sensitive to changes in physical function over time (4,6). In addition, Ishiyama and colleagues (12) determined that an SPPB score of 9.5 was the cut point for the presence of sarcopenia in a cohort of elderly in-patient cardiac rehabilitation patients. The purpose of this Do It Right column is to describe the administration, scoring, and interpretation of the SPPB. To hear a summary of this column from author Peter Ronai, see Supplemental Digital Content 1, Video 1 (introduction), http://links.lww.com/FIT/A127. The NIA (13) has made educational materials regarding the SPPB available for use without permission or royalty fees. This site will allow you to download a training video that includes comprehensive instructions on the administration of the battery, safety tips, a scoring sheet, and background information on publications that support the methodology. A smart phone app also is available. It can be accessed at https://sppbguide.com/. EQUIPMENT Required equipment includes a standard height armless chair, stopwatch, adhesive tape, a 4-m rope or chain, measuring tape, SPPB scoring forms and directions, and a flat, well-lit floor or corridor long enough to accommodate a 4-m walking course and at least half a meter distance before and after the starting and finish lines, respectively. Alternatively, a 3-m course with a half meter zone before and after the starting and finish lines can be used if the testing area is smaller. PRIMARY PHYSICAL DOMAINS ASSESSED The SPPB assesses balance, gait speed, and lower extremity strength and function to predict mobility disability, morbidity, and mortality in older adults (1,2,8,11). TESTING PROCEDURE The SPPB is divided into three primary assessments, which include standing balance (in three separate foot placement patterns), comfortable gait speed over either a 3-m or a 4-m course and a timed five-repetition chair stand assessment (1,2). Clients should be medically cleared before participating in the SPPB. Standardized procedures and instructions for administering, scoring, and interpreting results of and from each portion of the SPPB from the NIA are available for free by downloading a video from their web site at https://sppbguide.com/ and should be followed in a script-like manner with all clients (1,13). STANDING BALANCE The client should be able to stand unassisted without the use of a cane or walker, but you may help them to get up initially. Clients are asked to hold three increasingly difficult standing positions for 10 seconds each. The positions include side-by-side (standing with feet parallel and touching), semitandem (standing with feet parallel with the heel of 1 foot touching the base of the big toe of the other foot), and tandem (standing with 1 foot directly in front of the other, with the heel of the front foot touching the tips of the toes on the opposite foot) and should be administered in this order. The following section describes verbal client directions and administration and safety procedures for each of the three standing balance subtests. Parallel Stance “I want you to try to stand with your feet together, side-by-side, for about 10 seconds. You may use your arms, bend your knees, or move your body to maintain your balance, but try not to move your feet. Try to hold this position until I tell you to stop.” Stand next to the client to help them into the side-by-side position. Supply just enough support to the participant’s arm to prevent loss of balance. When the participant has his/her feet together, ask, “Are you ready?” Then let go and begin timing as you say, “Ready, begin.” Stop the stopwatch and say “Stop” after 10 seconds or when the participant steps out of position or grabs your arm. Semitandem Stance “Now I will show you the second movement” (demonstrate this test for the client). “Now I want you to try to stand with the side of the heel of one foot touching the big toe of the other foot for about 10 seconds. You may put either foot in front, whichever is more comfortable for you. You may use your arms, bend your knees, or move your body to maintain your balance, but try not to move your feet. Try to hold this position until I tell you to stop.” Stand next to the participant to help them get into the semitandem position and supply just enough support to the participant’s arm to prevent loss of balance. When the client has their feet together, ask, “Are you ready?” If the client indicates that he/she is ready, let go and begin timing as you say, “Ready, begin.” Stop the stopwatch and say “Stop” after 10 seconds or when the participant either steps out of position or grabs your arm. If clients cannot hold the position for 10 seconds, record the time, bypass the tandem stance test position, and administer the gait speed test next. Tandem Stance “Now I will show you the third movement” (demonstrate this test for the client). “Now I want you to try to stand with the heel of one foot in front of and touching the toes of the other foot for about 10 seconds. You may put either foot in front, whichever is more comfortable for you. You may use your arms, bend your knees, or move your body to maintain your balance, but try not to move your feet. Try to hold this position until I tell you to stop.” Stand next to the participant to help him/her into the tandem position and supply just enough support to the client’s arm to prevent loss of balance. When the client has their feet together, ask, “Are you ready?” If the client indicates that he/she is ready, let go and begin timing as you say, “Ready, begin.” Stop the stopwatch and say “Stop” after 10 seconds or when the participant steps out of position or grabs your arm. Participants received a score of “1” if they can hold the side-by-side stand for 10 seconds but cannot hold the semitandem stand for 10 seconds. Participants receive a score of “2” if they can hold the semitandem stand for 10 seconds but cannot hold the tandem stand for more than 2 seconds. Participants receive a score of “3” if they can hold the semitandem stand for 10 seconds and the tandem stand for more than 2 to 9 seconds. Participants receive a score of “4” if they hold the tandem stand for a full 10 seconds (1,2,9). Figure 2 depicts the parallel, semitandem, and tandem positions during the standing balance test component of the SPPB. See Supplemental Digital Content 2, Video 2, http://links.lww.com/FIT/A128, for demonstrations of the three stages of the standing balance assessment.Figure 2: Parallel, semitandem, and tandem stand positions during the standing balance test.GAIT SPEED First Gait Speed Test For the first gait speed test, have the client standing with you at one end of the walking course (typically marked with adhesive tape). State to the client, “Now I am going to observe how you normally walk. If you use a cane or other walking aid and you feel you need it to walk a short distance, then you may use it. This is our walking course. I want you to walk to the other end of the course at your usual speed, just as if you were walking down the street to go to the store” (demonstrate the walking test for the client). “Walk all the way past the other end of the tape before you stop. I will walk with you. Do you feel this would be safe?” Have the participant stand with both feet touching the starting line. “When I want you to start, I will say, ‘Ready, begin.’” After the client acknowledges the instruction and indicates they are ready, say, “Ready, begin.” Press the start/stop button to start the stopwatch as the participant begins walking. Walk behind and to the side of the participant (out of their visual field) and do not set the pace for them. If necessary, safety spotting can be applied from this position. Stop timing when one of the participant’s feet is completely across the end line. Repeat a second time and record the best time of two trials (1). Second Gait Speed Test Have the client reposition themselves at the other end of the walking course, standing with both feet touching the starting line. State to the client, “Now I want you to repeat the walk. Remember to walk at your usual pace, and go all the way past the other end of the course. When I want you to start, I will say, ‘Ready, begin.’” Once the client acknowledges this instruction, the health-fitness professional will say, “Ready, begin.” Once the client’s foot starts to move across the tape mark, press the start/stop button on the stopwatch. At this point, you will repeat the procedures for the first gait speed and stop timing once the client is completely across the end line. Figure 3 depicts the gait speed test at the start, middle, and finish. See Supplemental Digital Content 3, Video 3, http://links.lww.com/FIT/A129, for a demonstration of the Gait Speed Test.Figure 3: The gait speed test.CHAIR STAND TEST Single Chair Stand Say to the client, “Let’s do the last movement test. Do you think it would be safe for you to try to stand up from a chair without using your arms? The next test measures the strength in your legs.” (Demonstrate and explain the test procedure to the client.). “First, fold your arms across your chest and sit so that your feet are on the floor; then please stand up keeping your arms folded across your chest” (record whether the client can perform one repetition with arms crossed). If participant cannot rise without using arms, say, “Okay, try to stand up using your arms.” This is the end of their test. Record result and go to the scoring page. If the client is able to perform the single chair stand safely and properly, proceed to the repeated chair stand test. Repeated Chair Stands Say to the client, “Do you think it would be safe for you to try to stand up from a chair five times without using your arms?” (Demonstrate and explain the test to the client). Say, “Please stand up straight as quickly as you can five times, without stopping in between. After standing up each time, sit down and then stand up again. Keep your arms folded across your chest. I’ll be timing you with a stopwatch.” When the client is properly seated, say, “Ready, stand” and begin timing. Count out loud as the participant rises each time a repetition is completed and their legs are fully straightened up to five times. Stop the stopwatch when the client has straightened up completely for the fifth repetition. In addition, stop the stopwatch if the client becomes tired or short of breath during the test, uses their arms, after 1 minute, if the client has not completed five chair stands, or at your discretion if you are concerned about the client’s safety. *If the client appears fatigued before completing the five chair rises, confirm this by asking them, “Can you continue?” Continue timing the client if they say “Yes” and stop and reset the watch if they say “No.” Practitioners should stand in front of the client (without impeding their movement) in case safety spotting becomes necessary. Figure 4 depicts the repeated chair stand test. See Supplemental Digital Content 4, Video 4, http://links.lww.com/FIT/A130, for a demonstration of the repetitive chair stand test.Figure 4: The repetitive chair stand test.SPOTTING AND SAFETY TIPS To enhance safety, the administration scripts mentioned in the previous section should be read verbatim in a standardized manner to each client, and each client should be asked if they have any questions and whether or not they feel safe attempting a task after reading each direction. Spotting should be provided by being close enough to stabilize each client by their arms without helping them perform any of the tasks. It is especially important to be out of the client’s visual field during the gait speed test to avoid pacing their walking speed. SCORING AND INTERPRETATION Each assessment item within the SPPB should be scored and interpreted with the standardized instructions developed by Jack Guralnick, M.D., Ph.D. for the NIA (1,13). Please refer to https://sppbguide.com/, which provides administration, scoring, and interpretation instructions and directions for each item within the SPPB from the NIA. Typically, scores ≥10 out of 12 points correspond with higher levels of balance, lower body strength, mobility, and physical function (1). Lower scores indicate more severe mobility, strength, and functional limitations as well as higher rates of morbidity and all-cause mortality (14) and indicate a need for more targeted interventions (1). Perera and colleagues (4) have suggested using 0.5- and 1.0-point score differential during reassessment as small and meaningful changes occur respectively in the SPPB over time. A decrease of one point may indicate that an older adult client has had a meaningful decline in mobility and physical function (4). Ishiyama and colleagues (12) have suggested using 0.3 to 0.8 points and 0.4 to 1.5 points as small but meaningful and substantial changes in SPPB performance respectfully. ADDITIONAL INFORMATION The SPPB can be administered before establishing physical activity and exercise program interventions for improving balance, mobility, strength, and physical function and as an instrument to monitor progress and program outcomes. In addition, exercise program development can be guided by both the composite and the individual item scores obtained during the administration of the SPPB. SUMMARY The SPPB is an effective, time-efficient assessment of balance, lower extremity strength, and function that health-fitness professionals can administer in clients classified as older adults (>65 years of age). It is sensitive to changes in physical function over time, can be conducted in a field setting, requires minimal equipment and space, and can be used to help design physical activity interventions for improving physical performance in older adults. According to Perera and colleagues (4), “like vital signs such as body weight or BP, performance measures may offer a powerful mechanism to understand and act on the health care needs of older adults.” NOTE TO READERS In the video, 1) the practitioner walks next to the client but should be slightly behind and out of the peripheral vision of the client to ensure safety while avoiding pacing the client. 2) The participant sets his feet before the exercise physiologist’s demonstration for both the side-by-side and semitandem balance tests. The client should not set their feet until the exercise physiologist positions themselves behind the client and is ready to start the timer. 3) During the repeat sit-to-stand test, the client’s feet come off the floor. The client’s feet should remain on the floor during the test. If the client’s feet do not reach the floor, they can shift forward on the seat so that their feet are on the floor.

A Rapid Review of the Detrimental Impact of Loneliness and Social Isolation in Caregivers of Older Adults

Purpose Physical activity (PA) is distinct from physical capacity (PC), even though they correlate strongly in old age. Physical capacity defines the boundaries for PA, while activities in daily life typically remain submaximal. Older people who approach their capacity in terms of intensity and duration of daily activities might be better protected from future declines in physical function compared to those who do not (i.e., “use it or lose it”), although prospective research is lacking to support this hypothesis. Therefore, this study compared changes in physical function over a four-year follow-up between community-dwelling older adults categorized based on their baseline PC and PA. Methods This study is a longitudinal 4-year follow-up study in older adults aged 75-85 years at baseline (N = 311, 60% women). Baseline PC was measured by a 10-meter maximal walking speed, and PA was continuously monitored for 3-7 days using a thigh-worn accelerometer. PA intensity was examined using Mean Amplitude Deviation (MAD) and 5-second epochs. Baseline values of PA and PC were categorized distributionally (low &amp; high) into lowPC-lowPA, lowPC-highPA, highPC-lowPA, and highPC-highPA profiles. Physical function was evaluated using the Short Physical Performance Battery (SPPB) at baseline and at the four-year follow-up, with total score and 5 x Sit-To-Stand (5xSTS) test time as the primary outcomes. Paired samples t-test and generalized estimating equations were used for analyses. Results During the follow-up, the SPPB total score and the 5xSTS test decreased for all profiles (p&amp;lt;.05), except for the highPC-highPA profile (p=.055, p=.182, respectively). When comparing highPC-highPA to other profiles, a greater decrease in SPPB total score were observed in all other profiles (highPC-lowPA B -.62 (SE .22), p=.006; lowPC-highPA -.70 (.35), p=.045; lowPC-lowPA -1.86 (.28), p&amp;lt;.001) and in 5xSTS time for the lowPA profiles (highPC-lowPA 1.32 (.49), p=.004; lowPC-lowPA 1.92 (.67), p=.007). Conclusions The findings suggest that engaging in PA close to one’s PC may help to protect against decline in physical functioning among older adults, especially among those with relatively high PC. Therefore, older adults should be encouraged to participate in physically challenging activities that could potentially improve their capacity.

Multimorbidity is common among older adults and strongly associated with physical functioning decline and increased mortality. However, the full spectrum of direct and indirect effects of multimorbidity on physical functioning and survival has not been quantified. We aimed to determine the longitudinal relationship of multimorbidity on physical functioning and quantify the impact of multimorbidity and multimorbidity-attributed changes in physical functioning on mortality risk. The Health and Retirement Study (HRS) is a nationally representative population-based prospective cohort of adults aged 51 or older. In 2000, participants were interviewed about physician-diagnosed chronic conditions, from which their multimorbidity-weighted index (MWI) was computed. Between 2000 and 2011, participants reported their current physical functioning using a modified Short Form-36. With MWI as a time-varying exposure, we jointly modeled its associations with physical functioning and survival. The final sample included 74,037 observations from 18,174 participants. At baseline, participants had a weighted mean MWI of 4.6 ± 4.2 (range 0-36.8). During follow-up, physical functioning declined: -1.72 (95% confidence interval [CI] -1.77, -1.67, p < .001) HRS physical functioning units per point MWI in adjusted models. Over follow-up, 6,362 (34%) participants died. Mortality risk increased 8% (hazard ratio 1.08, 95% CI 1.07-1.08, p < .001) per point MWI in adjusted models. Across all population subgroups, MWI was associated with greater physical functioning decline and mortality risk. Multimorbidity and its associated decline in physical functioning were significantly associated with increased mortality. These associations can be predicted with an easily interpreted and applied multimorbidity index that can better identify and target adults at increased risk for disability and death.

For clinicians managing weight loss in patients with HIV, it would be useful to understand how changes in lean body mass (LBM) effect physical functioning, and whether LBM is more strongly related to physical functioning than total body weight (TBW). To determine the relationship of changes in LBM and changes in total body weight (TBW) to changes in self-reported physical functioning in men and women with HIV infection. Study design was longitudinal analysis of 1474 patient-intervals (each interval was approximately 6 months long) in 486 persons. Patients were participants in Nutrition for Healthy Living, a cohort study of HIV positive persons in Massachusetts and Rhode Island. The main outcome measure was change in self-reported physical functioning. Of the 1,474 intervals, 1,165 were contributed by men and 309 by women. The mean CD4 count for the 1,474 intervals was 383 cells/ micro L. In men, 5 kg changes in LBM and TBW were associated with 2.2 (95% confidence interval, 0.9, 3.4, P= 0.001) and 2.6 (95% confidence interval, 1.3, 3.9, P= 0.0002) point changes in physical functioning (on a 100-point scale), respectively, after adjusting for covariates. The relationships of changes in LBM and TBW to changes in physical functioning were linear. In women, there were no significant relationships between changes in LBM or TBW to changes in physical functioning. In this longitudinal analysis of relatively healthy persons with HIV infection, changes in LBM and TBW were significantly related to changes in physical functioning in men, but the magnitude of the relationship was small. In women, changes in LBM and TBW were not related to changes in physical functioning. Our data suggest that it is not necessary to measure body composition (lean and fat compartments) to understand the impact of changes in weight on physical functioning - it is sufficient to follow total body weight.

BackgroundHyperkyphosis is common in older adults and associated with low physical function and reduced health related quality of life (HrQol). Improved kyphosis has been previously established in kyphosis-targeted interventions in randomized controlled trials in older adults with hyperkyphosis; however, evidence for improved physical function is conflicting. Few studies have investigated change in physical function after a targeted kyphosis intervention in older adults with low physical function. The primary aim in this descriptive study was to explore change in physical function after a progressive high-intensity 3-month targeted kyphosis exercise and posture training intervention in older adults with low physical function and hyperkyphosis. Secondary aims were to explore change in HrQol, spinal strength and spinal curvature, and adherence and safety of the intervention.MethodsIn this secondary analysis of the Specialized Center of Research (SCOR) Kyphosis randomized trial, 101 community dwelling older men and women with hyperkyphosis who completed the intervention were divided into a low function group (LFG) and high function group (HFG). Baseline characteristics were compared between LFG and HFG. Physical function, HrQol, spinal strength and spinal curvature (kyphosis and lordosis) pre/post intervention change scores were explored within and between groups. Adherence and adverse events were examined in the LFG and HFG.ResultsTwenty-six (26%) older adults were LFG, mean Short Phyiscal Performance Battery (SPPB) 9.62 (SD = 1.17) points. At baseline, the LFG was older than HFG (p = 0.005), experienced more pain, (p = 0.060), had worse physical function and HrQol (p ≤ 0.001), and comparable kyphosis (p = 0.640). SPPB changed 0.62 (95% CI: − 0.20 to 1.44) points in the LFG and - 0.04 (95%CI: − 0.28 to 0.19) points in the HFG, p = 0.020. Gait speed changed 0.04 (95% CI: − 0.02 to 0.10) m/s in the LFG. Kyphosis improved equally in both groups. Adherence to the intervention was 83% in the LFG and 79% in the HFG. There were no adverse events in either group.ConclusionsOlder adults with low physical function and hyperkyphosis may improve physical function after a kyphosis targeted intervention. Older adults with low physical function may safely participate in targeted high-intensity kyphosis exercise and posture training. This observation needs to be confirmed in larger adequately powered studies.Trial registrationClinicaltrials.gov identifier: NCT01766674.

Falls and fall-related injuries (FRI) are common and costly occurrences among older adults living in the community, with increased risk for those with physical and cognitive limitations. Caregivers provide support for older adults with physical functioning limitations, which are associated with fall risk. Using the 2004-2012 waves of the Health and Retirement Study, we examined whether receipt of low (0-13 weekly hours) and high levels (≥14 weekly hours) of informal care or any formal care is associated with lower risk of falls and FRIs among community-dwelling older adults. We additionally tested whether serious physical functioning (≥3 activities of daily living) or cognitive limitations moderated this relationship. Caregiving receipt categories were jointly significant in predicting noninjurious falls (P=0.03) but not FRIs (P=0.30). High levels of informal care category (P=0.001) and formal care (P<0.001) had stronger associations with reduced fall risk relative to low levels of informal care. Among individuals with ≥3 activities of daily living, fall risks were reduced by 21% for those receiving high levels of informal care; additionally, FRIs were reduced by 42% and 58% for those receiving high levels of informal care and any formal care. High levels of informal care receipt were also associated with a 54% FRI risk reduction among the cognitively impaired. Fall risk reductions among older adults occurred predominantly among those with significant physical and cognitive limitations. Accordingly, policy efforts involving fall prevention should target populations with increased physical functioning and cognitive limitations. They should also reduce financial barriers to informal and formal caregiving.