ADL Disability Research Articles

Predictability of a modified Mini- Nutritional- Assessment version on six-month and one-year mortality in hospitalized geriatric patients: a comparative analysis

Recently we introduced a modified Mini Nutritional Assessment (MNA) Short Form (MNA-SF) and Long Form (MNA-SF) with operationalization of the ‘mobility’ and ‘neuropsychological problems’ items of the MNA using scores on Barthel Index mobility item and Mini Mental State Examination and Geriatric Depression Scale scores. We have now evaluated the abilities of this modified MNA-SF and MNA-LF to predict mortality in comparison with the standard MNA-SF and MNA-LF and the Nutritional Risk Screening 2002 (NRS 2002) and the Malnutrition Universal Screening Tool (MUST). A prospective analysis was performed in 240 hospitalised geriatric patients aged ≥ 65 years. Malnutrition and/or malnutrition risk were assessed using the modified MNA-SF and MNA-LF, the standard MNA-SF and MNA-LF, and the NRS 2002 and MUST. The modified MNA-SF and MNA-LF and the standard MNA-SF and MNA-LF assessments (all p < 0.05), but not NRS 2002 or MUST (all p ≥ 0.05), predicted six-month and/or one-year mortality. Prediction of six-month and/or one-year mortality by the modified MNA-SF was comparable with predictions by the standard MNA-SF and MNA-LF (all p ≥ 0.05). The modified MNA-LF showed better prediction of six-month and one-year mortality than the standard MNA-SF and MNA-LF (all p < 0.05). The modified MNA-LF (all adjusted p < 0.05), but none of the other instruments (all adjusted p ≥ 0.05), predicted six-month and one-year mortality independently of age, sex, frailty, comorbidity and ADL disability burden. The modified MNA-SF and MNA-LF emerged as potentially valuable tools for predicting mortality in patients hospitalised on geriatric wards.

Is preoperative frailty a risk factor for poor outcomes after total joint replacements for osteoarthritis?

Purpose: Frailty is a novel potentially modifiable risk factor for poor outcomes after surgical procedures. The objective of this study is to determine whether pre-operative frailty is associated with clinical outcomes 1-year after total hip or total knee replacement (TKR and THR) for osteoarthritis. Methods: Osteoarthritis patients ≥65yo scheduled for elective primary TKR or THR were recruited from a musculoskeletal specialty hospital. Frailty was measured using validated criteria comprised of specific frailty elements, including Katz Index of Independence in Activities of Daily Living (Katz ADL). Hip/Knee Injury and Osteoarthritis Outcome Score (HOOS/KOOS) were administered pre-operatively and at 1-year. Regression models were created by considering all variables which were significant at the 0.05 level in univariate models, and then performing backward selection to retain variables with 0.05 significance. Age and gender were forced in to all models. Results: 797 subjects enrolled, 325 THR/474 TKR. Median age 72 years (range 65-94), 98% Caucasian, 63.2% female, 7.0% were frail. 524 cases have submitted 1-year data, (94.4% of eligible). Frail subjects had significantly lower preoperative scores in all HOOS domains and in 3/5 KOOS domains. In a multivariable model the number of frailty elements pre-operatively was a significant predictor of OARSI-OMERACT responder status 1-year after joint replacement (OR = 1.48 all TJR; OR = 1.64 THR only; OR = 1.43 TKR only; all p-<0.05). In contrast, overall pre-operative frailty did not predict OARSI-OMERACT responder status. In the multivariable model pre-operative Katz ADL predicted 1-year HOOS Function in Daily living (β -10.9 +/- 2.6SD, p<0.001) and HOOS Function Sports and Rec. (β -17.0 +/- 5.1SD, p<0.001). The number of pre-operative frailty elements also predicted HOOS Function Sports and Rec. (β -4.20 +/- 1.9SD, p=0.02). In the univariate analysis, number of frailty elements significantly predicted severe adverse events in both TJR (OR = 1.34) and TKR (OR = 1.33) but this was no longer significant in the multivariable model. Overall frailty was not a significant predictor of adverse events in either univariate or multivariate analyses. Conclusions: Frail patients had significantly worse preoperative HOOS and KOOS scores. An increase in the number of frailty elements significantly increased the odds of being an OMERACT-OARSI responder at 1-year (OR = 1.43-1.64). Worse Katz ADL scores, an element of frailty, predicted worse HOOS function at 1-year. Frailty was not associated with serious adverse events, but a much larger cohort would be required to have adequate power to reliably assess this outcome. Monitoring the development of frailty or ADL disability may help inform optimal timing of TJR in OA patients contemplating this elective procedure.

Gender differences in four-year incidence of self-reported and performance-based functional disability: The International Mobility in Aging Study

ObjectivesTo examine differences in incidence of functional disability between older women and men. Methods2002 participants (65–74 years) were recruited in 2012 from Canada, Brazil, Colombia, and Albania, and re-assessed in 2016. Three measures of functional disability were used (1) Difficulty in any of five mobility-related Activities of Daily Living (ADL disability); (2) Self-reported difficulty climbing a flight of stairs or walking 400 m (mobility disability); and (3) Poor physical performance. We estimated the adjusted gender-specific incidence risk ratios (IRR) for each outcome in 2016. ResultsIn 2016, 1506 participants (52% women) were re-examined, 80% of the surviving cohort. Among those not disabled in 2012, seventy-four (12.9%) men developed ADL disability, while 105 (19.2%) developed mobility disability, and 97 (16.1%) developed poor physical performance. For women, numbers were higher 120 (21.4%) developed ADL disability, 117 (26.5%) developed mobility disability, and 140 (23.0%) developed poor physical performance. Compared to men, women had a higher adjusted incidence of self-reported ADL disability (IRR 1.4; 95% CI 1.04–1.88) and mobility disability (IRR 1.4; 95% CI 1.06–1.77), but not of poor physical performance (IRR 1.03; 95% CI 0.88–1.32). ConclusionsAlthough women have a higher self-reported incidence of ADL and mobility disability than men, there was no significant difference in poor physical performance. Reasons for this discrepancy between self-reported and performance-based measures require further investigation. Understanding gender differences in functional disabilities can provide the basis for interventions to prevent mobility loss and minimize any gender gap.

The Effect of Multidomain Lifestyle Intervention on Daily Functioning in Older People

To investigate the effect of a 2-year multidomain lifestyle intervention on daily functioning of older people. A 2-year randomized controlled trial (ClinicalTrials.gov, NCT01041989). Finnish Geriatric Intervention Study to Prevent Cognitive Impairment and Disability. A total of 1260 older adults, with a mean age of 69 years at the baseline, who were at risk of cognitive decline. A multidomain intervention, including simultaneous physical activity intervention, nutritional counseling, vascular risk monitoring and management, and cognitive training and social activity. The ability to perform daily activities (activities of daily living [ADLs] and instrumental ADLs) and physical performance (Short Physical Performance Battery). The mean baseline ADL score was 18.1 (SD = 2.6) points; the scale ranges from 17 (no difficulties) to 85 (total ADL dependence). During the 2-year intervention, the ADL disability score slightly increased in the control group, while in the intervention group, it remained relatively stable. Based on the latent growth curve model, the difference in the change between the intervention and control groups was -0.95 (95% confidence interval [CI] = -1.61 to -0.28) after 1 year and -1.20 (95% CI = -2.02 to -0.38) after 2 years. In terms of physical performance, the intervention group had a slightly higher probability of improvement (from score 3 to score 4; P = .041) and a lower probability of decline (from score 3 to scores 0-2; P = .043) for chair rise compared to the control group. A 2-year lifestyle intervention was able to maintain the daily functioning of the at-risk older population. The clinical significance of these results in this fairly well-functioning population remains uncertain, but the study results hold promise that healthy eating, exercise, and cognitive and social activity may have favorable effects on functional independence in older people.

Clinical characteristics of bullous pemphigoid in elderly patients with type 2 diabetes mellitus: The association with the use of dipeptidyl peptidase-4 inhibitors

Bullous pemphigoid (BP) is an autoimmune skin disorder characterized by the production of autoantibodies. Several recent reports have described the occurrence of BP in diabetic patients treated with dipeptidyl peptidase-4 (DPP-4) inhibitors. However, the clinical features of BP in diabetic patients, particularly in those treated with DPP-4 inhibitors, have not yet been examined. The aim of this study was to clarify clinical characteristics of BP in elderly type 2 diabetic patients. We found cases of BP in 15 elderly type 2 diabetic patients (11 men, 4 women) and 20 non-diabetic patients (8 men, 12 women) from September, 2012 to September, 2016. These patients had all been treated with corticosteroid therapy. We investigated the participants' basic clinical characteristics and the course of BP treatment. The differences in variables between the two groups were analyzed using Wilcoxon's test and the chi-square test. The mean age of type 2 diabetes patients with BP was 81.1±5.5 years. The mean HbA1c was 7.3±1.6%. A total of 87% of diabetic patients had been treated with DPP-4 inhibitors for 11.7 months prior to the BP onset. The diabetic patients had a lower prevalence of neurogenerative disease, severe ADL disabilities, and dementia than the non-diabetic patients. Furthermore, the diabetic patients with BP tended to be younger and more frequently male than those without diabetes. After stopping the DPP-4 inhibitors, the skin lesions were successfully treated with systemic corticosteroid therapy, and glycemic control was achieved using intensive insulin therapy. DPP-4 inhibitors were used in all cases where the aniti-BP180NC16a antibody showed negative conversion. BP in patients with type 2 diabetes had different clinical features from that in non-diabetic patients, suggesting an association between BP and the use of DPP-4 inhibitors.

Disability Incidence and Functional Decline among Older Adults with Major Chronic Diseases

Background: More than 80% of elderly Americans have at least one chronic disease. While past studies have shown that the pattern of functional loss follows a distinct progression that may differ by gender and institutional settings, little is known about whether such patterns differ in relation to chronic health condition. The aim of this study is to investigate the pattern of functional loss among older adults with major chronic illnesses, and to compare their onset, ordering and general pattern of incident ADL disability with those of persons without such conditions. Methods: We use a nationally representative sample of persons aged 80+ from the 1998-2016 Asset and Health Dynamics of the Oldest Old survey. The group with major noncommunicable diseases (including cardiovascular disease, cancer, chronic respiratory disease, and diabetes) comprises 3,514,052 subjects, while the comparison group comprises 1,073,263 subjects. Self-reports of having difficulty with six distinct ADLs are used to estimate disability incidence rate. Nonparametric statistical methods are used to derive median onset ages and ADL loss sequence separately for each group. Results: Older adults with major chronic diseases have higher rates of incident disability across all ADL items, and those who are have disabilities face a higher mortality risk. For the full sample, the estimated median onset ages of ADL disabilities range from 91.5 to 95.6. Disability occurs earlier for chronically ill persons (onset ages 91.1-95.0) than for those in the comparison group (onset ages 93.5-98.1). The pattern of functional loss is, however, largely similar between groups. The loss sequence for both subpopulations are characterized by an early-loss cluster and a late-loss cluster. Results also show that disability progression for those with major chronic diseases is compressed within a shorter timeframe, and that timing gaps between adjacent disabilities are smaller. Conclusions: Older Americans with major noncommunicable diseases face an earlier and steeper slope of functional decline. Chronic care delivery programs should adapt to dynamic changes in older patients’ functional status. Health interventions to help patients delay disability onset and optimize functional autonomy within emerging models of chronic care should especially target early-loss activities such as bathing, dressing, and walking.

The Long-Term Impact of Functional Disability on Hospitalization Spending in Singapore.

Singapore is one of the fastest-aging populations due to increased life expectancy and lowered fertility. Lifestyle changes increase the burden of chronic diseases and disability. These have important implications for social protection systems. The goal of this paper is to model future functional disability and healthcare expenditures based on current trends. To project the health, disability and hospitalization spending of future elders, we adapted the Future Elderly Model (FEM) to Singapore. The FEM is a dynamic Markov microsimulation model developed in the US. Our main source of population data was the Singapore Chinese Health Study (SCHS) consisting of 63,000 respondents followed up over three waves from 1993 to 2010. The FEM model enables us to investigate the effects of disability compounded over the lifecycle and hospitalization spending, while adjusting for competing risk of multi-comorbidities. Results indicate that by 2050, 1 in 6 elders in Singapore will have at least one ADL disability and 1 in 3 elders will have at least one IADL disability, an increase from 1 in 12 elders and 1 in 5 elders respectively in 2014. The highest prevalence of functional disability will be in those aged 85 years and above. Lifetime hospitalization spending of elders aged 55 and above is US$24,400 (30.2%) higher among people with functional disability compared to those without disability. Policies that successfully tackle diabetes and promote healthy living may reduce or delay the onset of disability, leading to potential saving. In addition, further technological improvements may reduce the financial burden of disability.

Older adults with disability in extreme poverty in Peru: How is their access to health care?

BackgroundDisability rates increase with age. In 2012, Peruvian older adults (≥ 65 years) represented 9% of the population. Additionally, older population reported disabilities at about 5 times the rate of Peruvians between 36 and 64 years old, and 30% of older population lived in poverty. Peruvian seniors living in extreme poverty experience disabilities and the extent of their access to healthcare is unknown.ObjectiveThis study assesses associations between disability and access to healthcare among Peruvians older individuals living in extreme poverty.MethodsSecondary analysis of a national representative population based survey that utilizes information from Peru’s 2012 survey Health and Wellbeing in Older Adults (ESBAM), which includes older adults living in extreme poverty. We define disability in terms of the Activities of Daily Living (ADL disability) framework. Healthcare access was assessed as having any of Peru’s available health insurance schemes combined with preventive health services (vision assessment, influenza vaccination, blood pressure assessment, diabetes screening, and cholesterol assessment). Poisson robust regression models were used to evaluate the associations among relevant variables. Prevalence Ratios and 95% confidence intervals (95%CI) were reported.ResultsData from 3869 individuals (65 to 80 years old), of whom 1760 (45.5%) were females, were analyzed. The prevalence of ADL disability was 17.3% (95%CI: 16.0%-18.4%). In addition, more than 60% had never received any of the preventive measures evaluated, except for the blood pressure assessment. In the adjusted model, people with ADL disability had 63% less probability of having extensive insurance, compared to those without disability (p<0.05).ConclusionsThis study shows that this Peruvian older population living in extreme poverty has limited access to healthcare services. Although there was no consistent association between ADL disability and the healthcare access, there is an urgent need to reduce the inequitable access to healthcare of this poor Peruvian older population.

Age and sex differences in the association between access to medical care and health outcomes among older Chinese

BackgroundWhether the association between access to medical care and health outcomes differs by age and gender among older adults in China is unclear. We aimed to investigate the associations between self-reported inadequate access to care and multiple health outcomes among older men and women in mainland China.MethodsBased on four latest waves available so far from a national longitudinal study in mainland China in 2005–2014, we used multilevel random-effect logistic models to estimate the contemporaneous relationships between inadequate access to care and disabilities in instrumental activities of daily living (IADL) and cognitive impairment in men and women at ages 65–74, 75–84, 85–94, and 95+, separately. We also used multilevel hazard models to investigate the relationships between reported access to care and mortality in 2005–2014. Nested models were used to adjust for survey design, sociodemographic background, enrollment in health insurance, and health behaviors.ResultsApproximately 6.5% of older adults in China reported inadequate access to care in the period of 2005–2014; and the percentages increased with age and were higher among women at older ages (≥75 years). Overall, older adults with self-reported inadequate access to care had greater odds of IADL and ADL disabilities and cognitive impairment than those with adequate access to healthcare. The elevated odds ratios (ORs) in men were higher in middle-old (75–84) and old-old (85–94) age groups compared to other age groups; whereas the elevated ORs in women were higher in young-old (65–74) and middle-old (75–84) age groups. The relationship between access to care and the health outcomes was generally weakest at the oldest-old ages (95+). Inadequate access to care was also linked with higher mortality risk, primarily in adults aged 75–84, and it was somewhat more pronounced in women than in men.ConclusionsIncreased odds of physical disability and cognitive impairment and increased risk of mortality are linked with inadequate access to care. The associations were generally stronger in women than in men and varied across age groups. The findings of the present study have important implications for further improving access to health care and improving health outcomes of older adults in China.

ASSOCIATIONS OF ADL AND IADL DISABILITY WITH QUALITY OF LIFE IN DUTCH OLDER PEOPLE

ASSOCIATIONS OF ADL AND IADL DISABILITY WITH QUALITY OF LIFE IN DUTCH OLDER PEOPLE

FUNCTIONAL RESILIENCE IN A SOCIAL CONTEXT: GENDER DIFFERENCES IN SOCIAL PROTECTION

Assistance with ADL disabilities reduces risk for depression and mortality, but prior research suggests that the social context in which help is provided may matter. Using data from the National Social Life, Health and Aging Project, we examine how the social relationships of men and women with ADL/IADL limitations affect depressive symptoms and mortality five years later. For disabled women, proportion of kin in the network, but not source of help, is associated with increased mortality (OR=3.55, 95% CI:1.59–7.93). For disabled men, source of help, but not proportion kin, is associated with increased mortality, such that married men reliant on a non-spousal other are at greater risk than men reliant on their spouse (OR=3.42, 95% CI:1.01–11.54). Among married dependent women, strain in the spousal relationship is positively associated and having a child negatively associated with depressive symptoms at follow-up. Functional resilience appears optimized when broader social resources are harnessed.

NATURAL HISTORY OF FRAILTY AND COGNITIVE IMPAIRMENT: LONGITUDINAL EVIDENCE FROM THREE POPULATION STUDIES

Physical frailty and cognitive impairment are associated and often coexist in older adults. What is unknown is: (1) whether there are sentinel patterns in the temporal development of physical frailty and cognitive impairment; (2) whether these patterns reflect different etiologies; and (3) whether health of older adults is deferentially impacted depending on their order and rate of occurrence. To begin to address these questions, the studies present longitudinal evidence from three prospective epidemiological cohorts: the National Health and Aging Trends Study (NHAT; n=7,439), the Women’s Health and Aging Study II (WHAS; n=436), and the Yale Precipitating Events Project (PEP; n=754). Talk 1 discusses temporal orders in the development of frailty and cognitive impairment in the NHATS, and their relationship with multimorbidity and onset of dementia. Talk 2 uses data from WHAS to examine the role of dysregulation across multiple physiological systems involving stress response and energy metabolism in the onset of cognitive impairment and frailty. Talk 3 assesses the associations of frailty and cognitive impairment separately versus jointly with cumulative 5-year incidence of ADL disability in NHATS, while accounting for competing risk of mortality. Talk 4 analyzed patterns of joint trajectories of cognition and frailty and their associations with patient-reported health outcomes in PEP. Taken together, findings from these studies provide preliminary evidence supporting the hypothesis that cognitive impairment and physical frailty result in part from distinct physiological processes; and the varying patterns of symptom emergence may signal different etiologic pathways, which would require different interventions.

Chronic multisite pain: evaluation of a new geriatric syndrome.

Chronic musculoskeletal pain is highly prevalent in the older adults, and individuals with musculoskeletal pain frequently report pain in two or more sites. To determine the prevalence and characteristics of multisite pain in relation to other geriatric syndromes and to evaluate whether multisite pain may represent a distinct geriatric syndrome. The MOBILIZE Boston Study is a population-based cohort study of older adults that enrolled 749 participants aged 70 and older. Persistent pain in the back and major joint areas was assessed using a joint pain questionnaire. Assessment of other geriatric syndromes included urinary incontinence, fall history, ADL disability, and frailty. A number of risk factors for geriatric syndromes were assessed. The prevalence of multisite pain was 40% in this population of older adults. Many participants had more than one geriatric syndrome, indicating substantial overlap in the prevalence of these conditions. Nearly half (48%) of participants with urinary incontinence or falls, 61% with ADL disability, and 49% of those with frailty also had multisite pain. Shared risk factors for established geriatric conditions were similarly distributed among the elderly population who had multisite pain. Demographic and health characteristics associated with multisite pain and other geriatric syndromes, included gender (female), depression, number of comorbid conditions, and mobility limitations. Although prior studies have explored risk factors for chronic multisite pain, these findings reveal that multisite pain, often unexplained, bears many similarities to established geriatric syndromes. Multisite pain warrants further consideration as a unique geriatric syndrome.

Dietary Patterns and Self-reported Incident Disability in Older Adults.

Disability in older adults is associated with low quality of life and higher mortality. Diet may be a potentially important public health strategy for disability prevention in aging. We examined the relations of the Mediterranean, Dietary Approaches to Stop Hypertension (DASH), and Mediterranean-DASH Intervention for Neurodegenerative Delay (MIND) diets to functional disability in the Rush Memory and Aging Project. A total of 809 participants (mean age = 80.7 ± 7.2 years, 74% female) without functional disability at baseline were followed for an average of 5.3 years. Standardized measures for self-reported disability including, activities of daily living ADL), instrumental ADL, and mobility disability were assessed annually. The diet scores were computed based on a validated food frequency questionnaire administered at baseline. In Cox proportional hazards models adjusted for age, sex, education, smoking, physical activity, and total calories, the second (hazard ratio = 0.75, 95% CI: 0.60-0.95) and third tertiles (hazard ratio = 0.67, 95% CI: 0.53-0.86) of MIND diet scores had lower rates of ADL disability compared to the lowest tertile (p for trend = .001), whereas only the third tertiles of the Mediterranean (hazard ratio = 0.73, 95% CI: 0.57-0.94) and DASH (hazard ratio = 0.75, 95% CI: 0.59-0.95) diets were significantly associated with ADL disability. Instrumental ADL disability was inversely and linearly associated with the MIND diet score only (p for trend = .04). Mobility disability was associated with the MIND (p for trend = .02), Mediterranean (p for trend = .05) and DASH (p for trend = .02) diet scores. These findings are encouraging that diet may be an effective strategy for the prevention of functional disability in older adults.

Domains and determinants of a person-centered index of aging well in Canada: a mixed-methods study.

The objectives of this study were to explore the perspectives of older adults about the most important domains of aging well and to identify the social determinants of a person-centered index capturing these domains. We conducted a mixed-methods study of 40 semi-structured interviews and epidemiological data from 670 older adults participating in the International Mobility in Aging Study (IMIAS) in Saint-Hyacinthe and Kingston. A composite index capturing the domains of aging well was constructed on the basis of findings from qualitative content analysis. Bivariate and multivariate regressions were carried out to examine the determinants of aging well, including economic determinants, health behaviours, health services, and the social environment. The qualitative results confirm the importance of symptomatic health conditions and psychosocial components. The index was computed as a continuous score (0 to 100) containing health components (ADL disability, mobility disability, pain, self-rated health, and cognitive function), and psychosocial components (mood, productive activities, social relations, life satisfaction, and self-mastery). Mean scores were 81 among Canadian older adults, and 83 and 79 for men and women respectively. Being male, having sufficient income, doing leisure physical activity, and feeling safe in one's neighbourhood were all significantly associated with a higher score on the aging well index. The composite index highlights important aspects of health and psychosocial well-being that could be augmented according to older adults themselves. Modifiable social determinants of aging well could guide social and health policies to maximize well-being in this population.

Wednesday, September 26, 2018 7:35 AM–9:00 AM ePosters: P140. Registry outcomes of cement augmentation for osteoporotic vertebral compression fractures

BACKGROUND CONTEXT The BenchMarket Medical Vertebral Compression Fracture registry (BMM VCF Registry) is a stakeholder collaborative. BMM (authorized registry vendor), Noridian Healthcare Solutions (NHS, Medicare vendor, payer) and clinicians collaborated to gather outcomes evidence for cement augmentation treatments (CA) of patients with acute, painful, osteoporotic vertebral compression fractures (OVCFs). The VCF Registry was designed to provide an easy to use data collection platform, for clinicians performing CA procedures, in order to support their submissions of required clinical and outcomes data. Noridian used the data submissions for claims purposes. PURPOSE The BMM VCF Registry was designed to provide outcomes evidence to inform the payer's “coverage with evidence development” decision to authorize reimbursement for CA treatments. VCF Registry outcomes are also used for internal quality improvement and educational purposes. STUDY DESIGN/SETTING Prospective observational registry data were collected from community hospitals, ambulatory care and tertiary care centers. PATIENT SAMPLE Prospective observational registry data (patient characteristics, diagnosis, process of care, patient reported outcomes (PROs) for pain (NRS) and function (RM) were collected for 1,000 patients suffering acute, painful OVCFs. Thoracolumbar OVCFs (T4-L5) were included in this study. OUTCOME MEASURES Patient reported outcomes were collected at baseline, 1 month, 3 months and 6 months. Primary outcomes were pain (Numeric Rated Pain Scale, NRS 0–10, 0=no pain, 10=worst pain) and function (Rolland Morris Disability Questionnaire, RM 1–24, 1=minimal ADL Disability, 24=maximal disability). All treated patients were tracked for primary (PROs – pain and function) and secondary outcome variables, at the same time points (baseline, 1 month, 3 months and 6 months). Secondary outcomes were patient characteristics, steroids, diagnosis, cement leakage, new neurologic deficit, adverse events, readmit, new VCF, death. METHODS All patients in this study received CA treatments of acute, painful OVCFs. The type of CA treatment (balloon kyphoplasty, vertebroplasty, cavity creation) was at the discretion of the clinician. RESULTS The BMM VCF Registry delivered validated outcomes data to support Noridian's “coverage with evidence development” decision. Registry outcomes confirmed “real-world” evidence of significant pain relief (delta NRS −6) and function improvements (delta RM −10) for CA treated patients, at all time points. The BMM VCF Registry benefited clinicians by providing streamlined authorizations, facilitated required data submissions and avoided authorization denials while facilitating reimbursements. CONCLUSIONS Cement augmentation treatments of patients with acute painful OVCFs reliably results in significant benefit, pain relief and improved function for this vulnerable, elderly population. Vertebral Compression Fracture Registry data are used for clinical internal quality improvement, outcomes reporting and referral or health system education.

Physical frailty and cognitive impairment is associated with diabetes and adversely impact functional status and mortality

ABSTRACTObjectives: We investigated whether there was a higher prevalence of cognitive impairment (CI) and/or physical frailty (PF) in persons with diabetes compared to their non-diabetic counterparts, and the individual and combined impact of CI and PF on functional and mortality outcomes among diabetic older persons.Method: Community-living diabetic and non-diabetic participants (N = 2696) aged 55 and above were assessed on CI (MMSE) and PF (CHS criteria) status. Among 486 diabetic persons, we estimated the odds ratio and 95% confidence intervals (OR, 95% CI) of association of CI and/or PF with prevalent IADL and ADL disability and mortality from 11 years of follow up.Results: Diabetes was associated with significantly higher prevalence of CI and/or PF. Adjusted for sex, age, education, smoking, alcohol intake, physical activity, and BMI, diabetes was associated with higher prevalence of PF alone (OR = 2.24, 1.16–4.34) and PF with CI (OR = 2.01, 1.12–3.60), but not with CI alone (OR = 1.02, 0.73–1.44). In multivariable analyses of 486 diabetic older adults, compared to non-frail (NF) and cognitive normal (CN), CI alone was not significantly associated with IADL (OR = 1.06, 0.53–2.10), but PF alone was associated with considerably higher prevalence of IADL (OR = 6.72, 1.84–24.5). PF with CI was associated with the highest prevalence of IADL (OR = 17.8, 3.66–8.68) and ADL disability (OR = 93.8, 23.6–372.4). Whether singly or in combination, PF and/or CI were associated with worse hazard (HR) ratio for mortality outcomes: CI alone (HR = 2.72, 1.48–5.01), PF alone (HR = 4.30, 1.88–9.82) and CI with PF (HR = 8.41, 3.95–17.9).Conclusion: Cognitive impairment and/or physical frailty are powerful prognostic factors identifying people with diabetes at high risk of mortality.

The Impact of ADL Disability through Social Networks on Depression in Old Age

The Impact of ADL Disability through Social Networks on Depression in Old Age

Cardiovascular Health Is Associated With Disability Among Older Community Dwelling Men and Women.

Objective: The aim of this study was to investigate whether an index of overall cardiovascular health (CVH) is associated with disability in older individuals. Method: Data on 925 participants of the InCHIANTI study (Invecchiare in Chianti, aging in the Chianti area, ≥65 years, 55% women) with median follow-up of 9 years were used. CVH score was assessed by smoking status, physical activity, body mass index, diet quality, blood pressure, plasma cholesterol, and fasting blood glucose. Disability was examined using instrumental activities of daily living (IADL disabilities >0 vs. 0) and activities of daily living (ADL disabilities >0 vs. 0). Generalized estimating equations and Cox models assessed relationships between baseline CVH with disability and worsening over 9 years. Results: A 1-point increase in the CVH score was associated with 23% and 17% of lower odds of ADL (p < .001) and IADL (p < .001) disability and was protective of worsening of disability over 9 years. Cox models demonstrated that a 1-point increase in CVH score was associated with lower hazards of both ADL (hazard ratio [HR] = 0.86, p = .005) and IADL (HR = 0.91, p = .007) disability. Discussion: Among older individuals, better CVH was associated with lower risk of disability and worsening over 9 years.

Disability in underweight persons with or at higher risk for knee osteoarthritis

Disability in underweight persons with or at higher risk for knee osteoarthritis