Population Of Community-dwelling Older Adults Research Articles

Care recipients' physical frailty is independently associated with subjective burden in informal caregivers in the community setting: a cross-sectional study.

BackgroundPhysical frailty is associated with significant morbidity and mortality in community-dwelling older adults. Burden in informal caregivers of older adults causes significant physical and psychological distress. However, the relationship between these two clinical phenomena has not been extensively studied. This cross-sectional study evaluated the relationship between physical frailty of community-dwelling older adults attending an outpatient geriatric clinic and the subjective burden reported by their informal caregivers.MethodsWe measured the following characteristics of 45 patient-caregiver dyads attending an outpatient geriatric assessment clinic: Physical frailty using the Fried Frail Scale (FFS); self-reported independence in activities of daily living (ADL) using the Katz Index; clinical diagnosis of dementia; and subjective caregiver burden using the short 12-item version of the Zarit Burden Interview (ZBI). Multivariable linear regression was performed with FFS, Katz Index score, gender, age, and diagnosis of dementia as independent variables, and ZBI score as the dependent variable.ResultsOnly physical frailty significantly predicted caregiver burden (β = 8.98 95% confidence interval [CI]: 2.15, 15.82).ConclusionsPhysical frailty is independently associated with caregiver burden in a population of community-dwelling older adults. Despite limitations related to sample size and lack of data about caregiver characteristics, this study suggests that the relationship between physical frailty and caregiver burden merits further study.

Curcumin and cognition: a randomised, placebo-controlled, double-blind study of community-dwelling older adults.

Curcumin therapy in animals has produced positive cognitive and behavioural outcomes; results of human trials, however, have been inconsistent. In this study, we report the results of a 12-month, randomised, placebo-controlled, double-blind study that investigated the ability of a curcumin formulation to prevent cognitive decline in a population of community-dwelling older adults. Individuals (n 96) ingested either placebo or 1500 mg/d BiocurcumaxTM for 12 months. A battery of clinical and cognitive measures was administered at baseline and at the 6-month and 12-month follow-up assessments. A significant time×treatment group interaction was observed for the Montreal Cognitive Assessment (repeated-measures analysis; time×treatment; F=3·85, P<0·05). Subsequent analysis revealed that this association was driven by a decline in function of the placebo group at 6 months that was not observed in the curcumin treatment group. No differences were observed between the groups for all other clinical and cognitive measures. Our findings suggest that further longitudinal assessment is required to investigate changes in cognitive outcome measures, ideally in conjunction with biological markers of neurodegeneration.

Characteristics of Older Adults on Waiting Lists for Meals on Wheels: Identifying Areas for Intervention

The purpose of this study was to characterize the population of seniors on Meals on Wheels' (MOW) waiting lists and identify their rate of depression, anxiety, falls, and fear of falling. Data come from surveys of 626 seniors on waiting lists across the country and the 2013 National Health and Aging Trends Study (NHATS). Results suggest that seniors on waiting lists for MOW were more likely to be widowed, less educated, older, Black, Hispanic, and receive Medicaid than the population of community-dwelling older adults. In addition, 31% of seniors on MOW waiting lists were depressed, compared with 12% of seniors in the national population ( p < .001), and 28% exhibited signs and symptoms of anxiety, compared with 10% of the national population of seniors ( p < .001). Seniors on waiting lists were significantly more likely to have fallen in the last month and be fearful of falling than the national population of seniors ( p < .001). Individuals on MOW waiting lists are a vulnerable and high-risk group. By seeking to better understand clients' needs, appropriate services can be tailored to promote independent living and improve older adults' well-being.

Assessment of physical activity in older Belgian adults: validity and reliability of an adapted interview version of the long International Physical Activity Questionnaire (IPAQ-L).

BackgroundAdequate monitoring of older adults’ physical activity (PA) is essential to develop effective health promotion programs. The present study examined criterion validity and test-retest reliability of the long International Physical Activity Questionnaire (IPAQ-L), adapted for Belgian, community-dwelling older adults (65y and older).MethodsParticipants (n = 434) completed the last seven days version of IPAQ-L, modified for the Belgian population of community-dwelling older adults. This elderly-adapted version of IPAQ-L combined vigorous and moderate activities, and questions on gait speed and recreational cycling were added. Furthermore, participants wore an ActiGraph GT3X(+) accelerometer for at least five days. Criterion validity was determined by comparing self-reported weekly minutes of moderate-to-vigorous physical activity (MVPA) and weekly minutes of total PA with accelerometer data, defined by two different cut points (Freedson vs. Copeland). To examine test-retest reliability, a subsample of 29 participants completed IPAQ-L for a second time within a ten day interval.ResultsIPAQ-L showed moderate criterion validity for measuring weekly minutes of MVPA and total PA (Spearman’s ρ range 0.33–0.40). However, plots on agreement between self-reported and accelerometer PA showed a systematic over-reporting of IPAQ-L for MVPA. In contrast, plots indicated that IPAQ-L under-estimated levels of total PA, however, this under-estimation of total PA was substantially lower than the observed over-reporting of MVPA. Test-retest reliability was moderate-to-good for work-related PA, domestic PA, MVPA and total PA (ICC range 0.52–0.81), but poorer for transportation and recreational PA (ICC 0.44 and 0.43, respectively).ConclusionsCriterion validity results suggest that IPAQ-L is more valid to measure older adults’ weekly minutes of total PA than weekly MVPA minutes. Moreover, results might imply that content validity of IPAQ-L can be improved if specific light-intensity PA items are incorporated into IPAQ-L. Test-retest reliability of IPAQ-L was moderate to good, except for weekly minutes of transportation and recreational PA, probably due to week-to-week variability of these behaviors.Electronic supplementary materialThe online version of this article (doi:10.1186/s12889-015-1785-3) contains supplementary material, which is available to authorized users.

Factors associated with lower gait speed among the elderly living in a developing country: a cross-sectional population-based study.

BackgroundAmong community-dwelling older adults, mean values for gait speed vary substantially depending not only on the population studied, but also on the methodology used. Despite the large number of studies published in developed countries, there are few population-based studies in developing countries with socioeconomic inequality and different health conditions, and this is the first study with a representative sample of population. To explore this, the association of lower gait speed with sociodemographic, anthropometric factors, mental status and physical health was incorporated participants’ weight (main weight) in the analysis of population of community-dwelling older adults living in a developing country.MethodsThis was a cross-sectional population based on a sample of 1112 older adults aged 60 years and over from Health, Wellbeing and Aging Study cohort 2010. Usual gait speed (s) to walk 3 meters was stratified by sex and height into quartiles. Multiple regression analysis was performed to investigate the independent effect of each factor associated with a slower usual gait speed.ResultsThe average walking speed of the elderly was 0.81 m/s – 0.78 m/s among women and 0.86 m/s among men. In the final model, the factors associated with lower gait speed were age (OR = 3.56), literacy (OR = 3.20), difficulty in one or more IADL (OR = 2.74), presence of cardiovascular disease (OR = 2.15) and sedentarism. When we consider the 50% slower, we can add the variables handgrip strength, and the presence of COPD.ConclusionsGait speed is a clinical marker and an important measure of functional capacity among the elderly. Our findings suggest that lower walking speed is associated with age, education, but especially with modifiable factors such as impairment of IADL, physical inactivity and cardiovascular disease. These results reinforce how important it is for the elderly to remain active and healthy.

Abstract 15730: Ankle-Brachial Index and Physical Function in Community-Based Older Adults: The Atherosclerosis Risk in Communities (ARIC) Study

Background: Lower extremity peripheral artery disease (PAD), commonly defined by an ankle-brachial index (ABI) &lt;0.9, increases mortality risk and also reduces physical function. All prior studies of the impact of PAD on objectively measured physical function have been in restricted populations with known PAD or physical inactivity, leaving uncertainty regarding its impact in the community. Methods: We studied 5,351 ARIC participants (age 71-90 years during 2011-2013) who underwent the assessment of ABI and the Short Physical Performance Battery (SPPB, 0-12 scale), a summary measure of physical function based on three domains (4-meter walk velocity, timed chair stands, and standing balance). Logistic regression models examined the association of ABI with poor physical function (SPPB score &lt;6), adjusting for potential confounders including a history of other cardiovascular diseases. Results: There were 463 participants (8.2%) with ABI &lt;0.9 and 506 participants (9.0%) with ABI ≥1.3, a potential manifestation of PAD reflecting noncompressible pedal arteries. Both ABI &lt;0.9 and ≥1.3 were significantly and independently associated with higher odds of having poor physical function compared to those with a normal ABI (1.1-1.2). The 469 participants (8.8%) with a “borderline” low ABI (0.9-1.0) also demonstrated significantly poor physical function. Low ABI was significantly associated with poor performance in every SPPB domain, whereas none were statistically significant for high ABI. The results were largely consistent among those without a history of stroke or heart failure. Conclusion: In our population of community-dwelling older adults, ~25% had low, borderline low, or high ABI suggestive of PAD and demonstrated poorer physical function compared to those with normal ABI. Since physical function is a key element for independent living in older adults and several therapeutic options for PAD exist, our findings may have broad and important implications.

Assessment of Nutritional Risk in Community-Dwelling Older Adults (65 to 75 Years) in Kolkata, India

This study was conducted to profile nutritional risk factors in a population of community-dwelling older adults in Kolkata, India. We applied the short version of the Mini Nutritional Assessment–Short Form (MNA-SF) questionnaire among 500 participants (65 to 75 years)—263 males and 237 females. The prevalence of undernutrition was 8.8% in females and 4.9% in males; a risk of undernutrition was found in 24.5% females and 17.5% males. All those with undernutrition or at-risk were studied further using the full version of the MNA. Data regarding education, occupation, socioeconomic status, and food intake pattern were also collected. Females had a significantly lower (P < 0.01) education level than males; 73.4% males were financially independent, whereas 72.7% females were financially dependent on others. Moderate appetite loss was commonly found (64.9%), and in 24.3% of the participants appetite loss was severe. Digestive and chewing problems were present in 32.4% and 21.6% of study participants, respectively. The rate of psychological stress and/or acute disease 3 months prior to study was 47%, and 62.2% of the study population were taking 3 or more medicines per day. Weight loss of greater than 3 kg and of 1 to 3 kg during past 3 months of the study period was observed in 27% and 32.5% of the population, respectively. Undernourished individuals were also found to consume fewer protein-rich foods. We hypothesize that low education levels and lack of financial independence were the strongest underlying causes of high undernutrition in this population, particularly, among females.

Costs Associated With Recruitment and Interviewing of Study Participants in a Diverse Population of Community-Dwelling Older Adults

America's racial and ethnic composition is changing so rapidly that minority groups are expected to constitute almost half of the U.S. population by 2060. Special efforts are needed to effectively recruit and retain members of racial and ethnic minority groups in health-related research studies, but the information available on time and costs associated with their recruitment is limited. The aim of this study was to describe and compare the time and monetary costs associated with recruiting and interviewing a diverse sample of older adults living in south Florida. Men and women aged 60 years and older from four ethnic groups-African American, Afro-Caribbean, Hispanic American, and European American-were recruited to participate in a longitudinal study of healthy aging. Costs for study activities (including recruitment, scheduling sessions, interviewing, file scoring, log updating, blood specimen analysis and storage, data analysis, and monetary compensation to participants) were determined after 100 weeks of data collection. Altogether, 483 participants completed the study in the first 100 weeks. The total cost for each participant ranged from $265 to $576. Each successful enrollment required an average of 1.83 hours for recruitment and scheduling of the interviews. The time to interview African American and Afro-Caribbeans was greater than the time needed to interview Hispanic American and European American participants. To develop more accurate budgets for recruitment of minority individuals into research studies and to use the limited resources in an effective way, careful planning and ongoing monitoring of costs are essential.

Identification of Environmental Supports for Healthy Eating in Older Adults

Many environmental settings and influences can affect food choices and eating behaviors in the growing population of community-dwelling older adults. Using the Social Ecological model, an expert panel participated in online discussions and an Analytic Hierarchy Process survey to identify the most important and changeable environmental settings and enabling factors that promote healthy eating in older adults. Food stores were rated most important when considering accessibility and affordability. Congregate nutrition sites were important for social support along with supporting access and affordability of healthful foods and living accommodations. Senior housing, health care, and religious settings also contributed to the goal of promoting healthful eating in aging adults. Restaurants were rated of lower importance. Based on these results, it is recommended that community food policies include the nutritional needs of older adults by addressing food accessibility and affordability, social support, and living accommodations, with a focus on congregate nutrition sites, food stores, senior housing, health care, and religious organizations.

Gait speed correlates in a multiracial population of community-dwelling older adults living in Brazil: a cross-sectional population-based study

BackgroundGait speed is a strong predictor of a wide range of adverse health outcomes in older adults. Mean values for gait speed in community-dwelling older adults vary substantially depending on population characteristics, suggesting that social, biological, or health factors might explain why certain groups tend to self-select their gait speed in different patterns. The vast majority of studies reported in the literature present data from North American and European populations. There are few population-based studies from other regions with a different ethnicity and/or social and health conditions. To address this, the present study identified the mean usual and fast gait speeds in a representative multiracial population of community-dwelling older adults living in a developing country, and explored their association with sociodemographic, mental and physical health characteristics.MethodsThis was a cross-sectional population-based study of a sample of 137 men and 248 women, aged 65 years and over. Usual gait speed and fast gait speed were measured on a 4.6 m path. Participants were classified into slow, intermediate, and faster groups by cluster analysis. Logistic regression analysis was used to estimate the independent effect of each factor on the odds of presenting with a slower usual and slower fast gait speeds.ResultsParticipants had a mean (SD) usual gait speed of 1.11 (0.27) m/s and a mean fast gait speed of 1.39 (0.34) m/s. We did not observe an independent association between gait speed and race/ethnicity, educational level, or income. The main contributors to present a slower usual gait speed were low physical activity level, stroke, diabetes, urinary incontinence, high concern about falling, and old age. A slower fast gait speed was associated with old age, low physical activity, urinary incontinence and high concern about falling.ConclusionA multiracial population of older adults living in a developing country showed a similar mean gait speed to that observed in previously studied populations. The results suggest that low physical activity, urinary incontinence and high concern about falling should not be neglected and may help identify those who might benefit from early intervention.

The Five Times Sit to Stand Test in Senior Athletes

The Five Times Sit to Stand Test (FTSST) has been established as a valid and reliable functional measure for older adults. Norms have been clearly defined for community-dwelling older adults and can be useful in the identification of mobility decline and prediction of future disability. However, because of the high rates of inactivity in the population of community-dwelling older adults, it seems inappropriate to compare high-functioning older adults, for example, senior athletes, to these norms. With trends showing increased senior athlete participation, new norms may be necessary to appropriately evaluate this population of older adults. The purpose of this study was to (1) compare results of the FTSST in senior athletes older than 60 years to norms for community-dwelling adults of the same age (2) determine the effects of age, gender, and sport intensity on FTSST performance in senior athletes, and (3) establish norms appropriate for this population of interest. The FTSST was performed on 276 (104 men, 172 women) senior athletes age 50 to 91 years (mean age = 64.9, SD = 15) reporting an average of 4 hours of cardiovascular training and 1 hour of strength training each week. All were actively engaged in national or state senior game competitions. All participants were able to complete the test. One hundred ninety-four participants between 60 and 89 years of age showed significantly faster times than currently reported norms. Performance was negatively associated with age, but did not differ significantly between genders. Participants in more physically demanding sports did show the best FTSST times, although athletes engaged in more leisure sports still outperformed norms for community-dwelling seniors. Senior athletes show significantly greater FTSST speed than norms derived from community-dwelling older adults. New normative guidelines are presented to assist the screening of these athletes on this functional performance measure.

Potentially inappropriate medication use: the Beers’ Criteria used among older adults with depressive symptoms

The ageing population means prescribing for chronic illnesses in older people is expected to rise. Comorbidities and compromised organ function may complicate prescribing and increase medication-related risks. Comorbid depression in older people is highly prevalent and complicates medication prescribing decisions. To determine the prevalence of potentially inappropriate medication use in a community-dwelling population of older adults with depressive symptoms. The medications of 191 community-dwelling older people selected because of depressive symptoms for a randomised trial were reviewed and assessed using the modified version of the Beers' Criteria. The association between inappropriate medication use and various population characteristics was assessed using Chi-square statistics and logistic regression analyses. The mean age was 81 (±4.3) years and 59% were women. The median number of medications used was 6 (range 1-21 medications). The most commonly prescribed potentially inappropriate medications were amitriptyline, dextropropoxyphene, quinine and benzodiazepines. Almost half (49%) of the participants were prescribed at least one potentially inappropriate medication; 29% were considered to suffer significant depressive symptoms (Geriatric Depression Scale ≥5) and no differences were found in the number of inappropriate medications used between those with and without significant depressive symptoms (Chi-square 0.005 p=0.54). Potentially inappropriate medication use, as per the modified Beers' Criteria, is very common among community-dwelling older people with depressive symptoms. However, the utility of the Beers' Criteria is lessened by lack of clinical correlation. Ongoing research to examine outcomes related to apparent inappropriate medication use is needed.

Clinician's Commentary on LaPier

Clinician's Commentary on LaPier

Normative Fitness Performance Scores of Community-Dwelling Older Adults in Spain

A cross-sectional descriptive study was designed to obtain normative age-specific fitness scores for the general population of community-dwelling older adults in Spain. In total, 6,449 participants (5,610 women and 839 men) age 60-99 yr who lived in the region of Extremadura were recruited. Compared with the cohorts of similar studies in other countries, this cohort had more physically inactive elderly participants and participants with a higher body-fat percentage. All test results declined as age increased. Sex differences in the age-related decline in fat and body mass were observed. Women scored better in the flexibility tests, and men performed better in the other tests. These data may be highly useful for the age-specific assessment of the fitness performance of older adults and the design of programs that promote functional ability in older adults.

The Prevalence of Elder Self-Neglect in a Community-Dwelling Population

To examine the prevalence of self-neglect and its specific behaviors in a community-dwelling population of older adults. A population-based cohort study conducted between 2007 and 2010 rated participant's personal and home environment, particularly with regard to hoarding, personal hygiene, house in need of repair, unsanitary conditions, and inadequate utility. Prevalence estimates were presented across health-related variables of health status, physical function, and cognitive function. There were 4,627 older adults (1,645 men and 2,982 women). Prevalence of self-neglect in older adults increased with lower health status in both men (4.7% in very good/excellent health, 7.9% in good health, and 14.9% in fair/poor health) and women (4.5% in very good/excellent health, 7.9% in good health, and 10.6% in fair/poor health). For those with ≥3 Katz impairments, the prevalence of self-neglect in older adults was 12.8% in men and 13.8% in women. For those with MMSE (Mini-Mental State Examination) ≤20, the prevalence of self-neglect in older adults was 18.8% in men and 13.6% in women. Self-neglect was clearly prevalent among older adults, especially among those with lower health status and physical and cognitive function.

Exercise and social support are associated with psychological distress outcomes in a population of community-dwelling older adults

Exercise reduces the likelihood of psychological distress, but this may be due to incidental socializing. We gathered information on exercise, social support and three aspects of psychological distress from 583 community-dwelling older adults. Exercise and social support from friends were both associated with lower scores of depression, anxiety and perceived stress. For infrequent exercisers, having a low level of social support indicated higher levels of depression, whereas for frequent exercisers, having a low level of social support did not affect depression levels. Both exercise and social support have roles in regulating psychological well-being in older populations and exercisers are less susceptible to effects of low social support on depression.

Abstract 18358: Active Aging and Self-Management of Cardiovascular Medications

The rising population of community-dwelling older adults in the United States (US) independently administers an average of five to seven different medications per day. Problems associated with cardiovascular medication self-management include increasing adverse effects and failed symptom management, both possibly leading to hospitalization. Objectives: The objective of this research was to explore lifestyle patterns and characteristics and their influence upon successful cardiovascular medication management as perceived by adults over age 65. Methods: Guided by naturalistic inquiry, two qualitative exploratory studies were conducted in different US geographical locations. Each study's methodology consisted of qualitative interview sessions with 19 older adults living in community-based settings. Results: Inductive data analysis from the first group of participants revealed the themes of organization in daily living, being active and perceiving oneself as healthy as important in medication self-management. Data analysis from the second study revealed parallel findings, with the inclusion of some potential barriers to successful medication self-management: unorganized or inactive lifestyles. Results from both of these studies indicate that older adults whose lifestyle patterns reflect activity and organization are more likely to be successful with their medication self-management than those whose lifestyle patterns reflect inactivity or unorganization. Participants from both studies provided examples of methods to maintain order and remain active despite physical limitations. Older adults' descriptions of themselves as healthy equated with mobility and activity and descriptions of themselves as unhealthy centered on immobility and weakness. Conclusions: Through their scheduled days, older adults who accomplished the goals of exercise, social interaction, and taking care of self and others to remain independent were more successful in their medication management processes than those who did not exhibit these characteristics. This information is important to cardiovascular health care professionals as they educate and encourage older adults about health promotion activities and self-management of medications.

Growth-Differentiation Factor-15 Is a Robust, Independent Predictor of 11-Year Mortality Risk in Community-Dwelling Older Adults

Background— Growth-differentiation factor-15 (GDF-15) is emerging as a prognostic marker in patients with cardiovascular disease (CVD), but its prognostic value in community-dwelling adults has not been reported. We hypothesized that GDF-15 would add incremental power for prediction of mortality in a population of community-dwelling older adults without known heart disease. Methods and Results— We measured plasma GDF-15, N-terminal pro-B-type natriuretic peptide (NT-proBNP), and C-reactive protein levels in 1391 Rancho Bernardo Study participants, mean age 70 years, with no history of CVD and followed them for a mean of 11 years. In models adjusted for traditional CVD risk factors, GDF-15 was a robust predictor of all-cause, cardiovascular, and noncardiovascular mortality. GDF-15 was a stronger predictor of all-cause mortality than either NT-proBNP or C-reactive protein (hazard ratio [95% confidence interval] per SD log 10 units 1.5 [1.3 to 1.8], P &lt;0.0001 for GDF-15 versus 1.3 [1.2 to 1.5], P &lt;0.0001 for NT-proBNP; C-reactive protein was not a significant predictor). Among biomarkers considered, only GDF-15 predicted noncardiovascular death (hazard ratio 1.6 [1.4 to 2.0], P &lt;0.0001). Growth differentiation factor-15 improved discrimination and modestly but significantly improved reclassification for all-cause and noncardiovascular mortality with borderline improvement for cardiovascular mortality; NT-proBNP significantly improved reclassification for all-cause and for cardiovascular mortality; C-reactive protein did not improve reclassification for any end point tested. Participants in the highest quartile of both GDF-15 and NT-proBNP had an increased risk of death compared with participants with only NT-proBNP elevated (hazard ratio 1.5 [1.1 to 2.0], P =0.01). Conclusions— Growth differentiation factor-15 is a strong predictor of all-cause, cardiovascular, and noncardiovascular mortality in community-dwelling older individuals, adding incremental value to traditional risk factors and to NT-proBNP and C-reactive protein levels.

Ethnic Disparities in Self-Reported Oral Health Status and Access to Care among Older Adults in NYC

There is a growing burden of oral disease among older adults that is most significantly borne by minorities, the poor, and immigrants. Yet, national attention to oral heath disparities has focused almost exclusively on children, resulting in large gaps in our knowledge about the oral health risks of older adults and their access to care. The projected growth of the minority and immigrant elderly population as a proportion of older adults heightens the urgency of exploring and addressing factors associated with oral health-related disparities. In 2008, the New York City Health Indicators Project (HIP) conducted a survey of a representative sample of 1,870 adults over the age of 60 who attended a random selection of 56 senior centers in New York City. The survey included questions related to oral health status. This study used the HIP database to examine differences in self-reported dental status, dental care utilization, and dental insurance, by race/ethnicity, among community-dwelling older adults. Non-Hispanic White respondents reported better dental health, higher dental care utilization, and higher satisfaction with dental care compared to all other racial/ethnic groups. Among minority older adults, Chinese immigrants were more likely to report poor dental health, were less likely to report dental care utilization and dental insurance, and were less satisfied with their dental care compared to all other racial/ethnic groups. Language fluency was significantly related to access to dental care among Chinese immigrants. Among a diverse community-dwelling population of older adults in New York City, we found significant differences by race/ethnicity in factors related to oral health. Greater attention is needed in enhancing the cultural competency of providers, addressing gaps in oral health literacy, and reducing language barriers that impede access to care.

The clinical assessment study of the foot (CASF): study protocol for a prospective observational study of foot pain and foot osteoarthritis in the general population.

BackgroundSymptomatic osteoarthritis (OA) affects approximately 10% of adults aged over 60 years. The foot joint complex is commonly affected by OA, yet there is relatively little research into OA of the foot, compared with other frequently affected sites such as the knee and hand. Existing epidemiological studies of foot OA have focussed predominantly on the first metatarsophalangeal joint at the expense of other joints. This three-year prospective population-based observational cohort study will describe the prevalence of symptomatic radiographic foot OA, relate its occurrence to symptoms, examination findings and life-style-factors, describe the natural history of foot OA, and examine how it presents to, and is diagnosed and managed in primary care.MethodsAll adults aged 50 years and over registered with four general practices in North Staffordshire, UK, will be invited to participate in a postal Health Survey questionnaire. Respondents to the questionnaire who indicate that they have experienced foot pain in the preceding twelve months will be invited to attend a research clinic for a detailed clinical assessment. This assessment will consist of: clinical interview; physical examination; digital photography of both feet and ankles; plain x-rays of both feet, ankles and hands; ultrasound examination of the plantar fascia; anthropometric measurement; and a further self-complete questionnaire. Follow-up will be undertaken in consenting participants by postal questionnaire at 18 months (clinic attenders only) and three years (clinic attenders and survey participants), and also by review of medical records.DiscussionThis three-year prospective epidemiological study will combine survey data, comprehensive clinical, x-ray and ultrasound assessment, and review of primary care records to identify radiographic phenotypes of foot OA in a population of community-dwelling older adults, and describe their impact on symptoms, function and clinical examination findings, and their presentation, diagnosis and management in primary care.