Community-living Adults Research Articles

Associations of Socioeconomic Status and Processed Food Intake With Serum Phosphorus Concentration in Community-Living Adults: The Multi-Ethnic Study of Atherosclerosis (MESA)

Higher serum phosphorus concentrations are associated with cardiovascular disease events and mortality. Low socioeconomic status is linked with higher serum phosphorus concentration, but the reasons are unclear. Poor individuals disproportionately consume inexpensive processed foods commonly enriched with phosphorus-based food preservatives. Accordingly, we hypothesized that excess intake of these foods accounts for a relationship between lower socioeconomic status and higher serum phosphorus concentration. Cross-sectional analysis. We examined a random cohort of 2,664 participants with available phosphorus measurements in the Multi-Ethnic Study of Atherosclerosis, a community-based sample of individuals free of clinically apparent cardiovascular disease from across the United States. Socioeconomic status, the intake of foods commonly enriched with phosphorus-based food additives (processed meats, sodas), and frequency of fast-food consumption. Fasting morning serum phosphorus concentrations. In unadjusted analyses, lower income and lower educational achievement categories were associated with modestly higher serum phosphorus concentration (by 0.02 to 0.10 mg/dL, P < .05 for all). These associations were attenuated in models adjusted for demographic and clinical factors, almost entirely due to adjustment for female gender. In multivariable-adjusted analyses, there were no statistically significant associations of processed meat intake or frequency of fast-food consumption with serum phosphorus. In contrast, each serving per day higher soda intake was associated with 0.02 mg/dL lower serum phosphorus concentration (95% confidence interval, -0.04, -0.01). Greater intake of foods commonly enriched with phosphorus additives was not associated with higher serum phosphorus concentration in a community-living sample with largely preserved kidney function. These results suggest that excess intake of processed and fast foods may not impact fasting serum phosphorus concentrations among individuals without kidney disease.

Factors associated with maximal walking speed among older community-living adults

The relative contribution of different domains on walking speed is largely unknown. This study investigated the central factors associated with maximal walking speed among older people. Cross-sectional analyses of baseline data from the SCAMOB study (ISRCTN 07330512) involving 605 community-living ambulatory adults aged 75-81 years. Maximal walking speed, leg extensor power, standing balance and body mass index were measured at the research center. Physical activity, smoking, use of alcohol, chronic diseases and depressive symptoms were self-reported by standard questionnaires. The mean maximal walking speed was 1.4 m/s (range 0.3-2.9). In linear regression analysis, age, gender and body mass index explained 11% of the variation in maximal walking speed. Adding leg extensor power and standing balance into the model increased the variation explained to 38%. Further adjusting for physical activity, smoking status and use of alcohol increased the variation explained by an additional 7%. A minor further increase in variability explained was gained by adding chronic diseases and depressive symptoms to the model. In the final model, the single most important factors associated with walking speed were leg extensor power, standing balance and physical activity, and these associations were similar in men and women and in different body mass index categories. Lower extremity impairment and physical inactivity were the central factors associated with slow walking speed among older people, probably because these factors capture the influences of health changes and other life-style factors, potentially leading to walking limitations.

Associations between perception of wellness and health‐related quality of life, comorbidities, modifiable lifestyle factors and demographics in older Australians

The associations between perceived wellness and health-related quality of life, comorbidities and modifiable lifestyle factors in older adults were explored. Self-administered questionnaires including the Perceived Wellness Survey and the 36-Item Short Form of the Medical Outcomes Study version two were distributed to 328 community-living adults aged 65 years and over. Results showed positive associations between perception of wellness and health-related quality of life. General health (r(249) = 0.66, P < 0.01), vitality (r(249) = 0.59, P < 0.01) and mental health (r(249) = 0.52, P < 0.01) had the strongest association with perceived wellness; and social functioning (r(249) = 0.3, P < 0.01) and pain (r(249) = 0.36, P < 0.01) the lowest. Perceived wellness was influenced by hearing, mobility, memory, chronic disease, exercise, gambling and single status. The study identified that perceived wellness in older adults is a multidimensional construct.

The ABC Scale and Fall Risk: A Systematic Review

ABSTRACTObjective: The aim of this systematic review was to assess the ability of the Activities-specific Balance Confidence (ABC) scale to predict the fall risk in older community-living adults. Methods: A systematic literature review was conducted from February 1, 2010, to October 8, 2010, through Pubmed, CINAHL and MEDLINE. Appraisal of full-text English articles, which were published from January 1996 to October 2010, provided the framework for this analysis. Results: On the basis of our inclusion/exclusion criteria, three studies qualified for inclusion in this review. Two of the three selected studies indicated a significant association between ABC scores and falls. The third study concluded that the ABC scale was unable to distinguish fallers from nonfallers. Conclusion: Despite the abundance of studies, which include the ABC scale, there is insufficient research that specifically examines the relationship between balance confidence scores with actual falls in community-dwelling older adults. In this population of adults, who live in the community and are aged at least 60 years, there is limited support for the hypothesis that the ABC scale can predict the fall risk.

Vitamin D and Risk of Cognitive Decline in Elderly Persons

The findings of a report published in 2007 suggested that over 40% of older, community-living adults in the United States and Europe were vitamin D deficient. There is clinical evidence for a relationship between low serum 25-hydroxyvitamin D (25[OH]D) levels and cognitive dysfunction with aging. Although data in several small clinical studies showing such an association were equivocal, 3 of 4 large population-based cross-sectional studies reported a relationship between levels of serum 25(OH)D and cognitive dysfunction in the elderly. No prior prospective population-based studies have investigated the possible association between vitamin D status and incident dementia or cognitive decline. This prospective population-based study was designed to determine whether low serum levels of 25(OH)D were associated with an increased risk of substantial cognitive decline in an elderly population. Data were obtained from a sample of elderly individuals enrolled in the InCHIANTI study, a large, prospective cohort study conducted in Italy to identify risk factors for late-life disability. The study participants were 858 adults aged 65 years or older who had completed 1 or more follow-up cognitive assessment between 1998 and 2006, with follow-up every 3 years. Cognitive decline was assessed using 2 tests of cognitive function: the Mini-Mental State Examination (MMSE) and the Trail-Making Tests A and B; both were administered at baseline, with follow-up at 3 and 6 years. Substantial cognitive decline was defined with MMSE as a decrease in score of 3 or more points, and with Trails A and Trails B as scoring in the worst 10% of cognitive decline or having the testing discontinued. In multivariate logistic regression fully adjusted models, the relative risk (RR) of substantial cognitive decline on the MMSE among participants who were severely 25(OH)D deficient was 60% greater compared with those who were 25(OH)D sufficient (RR, 1.60; 95% confidence interval [CI], 1.19–2.00; Pvalue for linear trend < 0.02). In fully adjusted random-effects models, the MMSE score declined by an additional 0.3 points per year more among severely 25(OH)D deficient participants compared with those who were 25(OH)D sufficient. With the Trails B, severely vitamin D deficient participants were 31% more likely of having a substantial decline in cognitive performance scores compared to those with sufficient levels of vitamin D; the RR was 1.31, with a 95% CI of 1.03–1.51 (Pvalue for linear trend < 0.04). No significant association was found between 25(OH)D levels and cognitive performance on Trails A. These findings are the first to show in a prospective study that low levels of vitamin D are associated with increased risk of substantial cognitive decline in an elderly population. The data suggest that tests of cognitive function may be useful in future prospective trials of vitamin D supplementation in the elderly.

Hypoglycemia Common Even With High A1C

Miriam E. Tucker is a senior writer with Elsevier Global Medical News. ORLANDO – Hypoglycemic episodes were common despite high hemoglobin A1c levels among 40 elderly community-living adults with diabetes who underwent continuous glucose monitoring. “Raising A1c goals may not be adequate to prevent hypoglycemia in this vulnerable population,” Medha N. Munshi, MD, said at the annual scientific sessions of the American Diabetes Association. Guidelines from the American Diabetes Association and the American Geriatric Society advise that the usual recommended HbA1c target of less than 6.5%-7.0% might be relaxed for elderly adults who have a history of severe hypoglycemia, limited life expectancy, advanced diabetes complications, or extensive comorbidity (Diabetes Care 2010;33 [suppl 1]). In practice, this has been interpreted as a goal of less than 8%. But no study has ever clearly demonstrated that raising the HbA1c target actually reduces the risk of hypoglycemia, said Dr. Munshi, director of the Joslin Diabetes Center geriatric programs at Beth Israel Deaconess Medical Center, Boston. The current study included patients older than 69 years (mean, 75 years) and with a HbA1cgreater than 8%. The patients took a mean of eight medications per day, with 55%) on insulin alone and another 38% on insulin plus one or more oral agents. Two-thirds had type 2 diabetes, and the rest had type 1. Patients performed four fingerstick glucose measurements per day and kept daily diaries of hypoglycemic symptoms, diet, and physical activity. One or more hypoglycemic events occurred in 26 of the 40 patients. The 26 patients who experienced hypoglycemia (glucose less than 70 mg/dL) did not differ from the 14 without such events in patient characteristics including age, diabetes duration, HbA1c, or insulin treatment. There was also no difference between those who did and did not have hypoglycemia in cognitive dysfunction, depression, falls in the past 6 months, number of medications, hypertension, or vision/hearing problems. Of the 26 with hypoglycemia, 12 had HbA1c levels above 9%. “Even a high A1c doesn't preclude lows. Hemoglobin A1c measures the mean. There are wide fluctuations in this population,” Dr. Munshi noted. Surprisingly, 58% of the study's 102 hypoglycemic episodes occurred among the 16 patients with type 2 diabetes, with a mean duration of nocturnal hypoglycemia nearly twice that of the hypoglycemia in the type 1 patients (2.9 vs. 1.6 hours). “Even the type 2 patients had wide glycemic excursions,” she said. Also of concern, 95 of the 102 episodes (were not recognized by fingerstick testing or by the patients' symptoms. Moreover, there was no significant relationship between severity of hypoglycemia and age, type of diabetes, duration, HbA1c, treatment, or living alone. “I believe that elderly patients with other comorbidities are unable to follow complex insulin regimens appropriately and end up having wide fluctuations in their glucose values. If a treatment regimen is designed with consideration for an elderly patient's self-care abilities, risk of hypoglycemia can be reduced,” Dr. Munshi said in an interview. In nursing home settings, education of nursing staff to adapt insulin regimens to changes in overall health, fluctuating appetite, and physical activity – for example, by holding short-acting insulin if the patient refuses a meal – is probably the best way to avoid large fluctuations, she commented. And when available, CGM can be extremely helpful for elderly patients. “I think CGM can be a great tool for pattern recognition and assessment of risk of hypoglycemia in elderly patients who are on complex insulin regimens without consideration of glycemic control,” Dr. Munshi said. This study was funded by the American Diabetes Association. Dr. Munshi stated that she had no conflicts of interest.

Prevalence of interpersonal violence against community-living adults with disabilities: A literature review.

To review the empirical literature on the prevalence of interpersonal violence (IPV) against people with disabilities. The authors searched for, obtained, and reviewed 6,000 abstracts published between January, 2000 and August, 2010 via searches in PsycINFO and PubMed. Subsequently, 177 potentially applicable full-text articles were independently assessed for inclusion; 22 articles describing 21 individual studies were included in this review. The prevalence of IPV varied depending on the time frame, the definition and type of violence, perpetrator, and disability. Prevalence of any type of IPV among women with disabilities ranged from 26.0%-90.0% for lifetime; 4.9%-29.1% for the past 5 years; and 2.0%-70.0% for the past year. In some studies, when compared to women without disabilities, women with disabilities experienced more lifetime, 5 year, and past year physical and sexual IPV. Prevalence of any IPV in men with disabilities ranged from 28.7%-86.7% for lifetime; 24.9% for the past 5 years; and 36.7% for the past year. IPV occurs at elevated and disproportionate rates among women and men with disabilities, especially when assessed over the course of their lives. Future research that relies on standard definitions of disability and violence, uses accessible measurement, and examines IPV in diverse populations of people with disabilities will strengthen future reviews and better inform research and policy priorities on disability and violence.

재가노인의 일상활동 어려움, 악력, 일상생활동작이 주관적 건강에 미치는 영향

Purpose: The purpose of the study was to examine the predictive relationships between predictors [(difficulty on daily activities due to arthritis, falls, and pain, grip strength, and activities of daily living (ADLs)], and perceived health in community-living older adults in Korea. Method: A descriptive, cross-sectional survey design was used. Data were obtained from Korean Longitudinal Study of Ageing conducted in 2006. A stratified sample was selected of 5,545 older adults who were over 60 years old for analysis of this study. Descriptive statistics, t-test, Pearson`s correlations, and multiple regressions were used. Result: Mean age was 70.27 years (SD

The effect of diabetes mellitus on age‐associated lean mass loss in 3153 older adults

Diabetes mellitus may be associated with excessive lean mass loss. Other diabetes-related conditions may also play a role. We assessed body composition changes associated with diabetes in older adults with adjustment for diabetes-related co-morbidities. Three thousand, one hundred and fifty-three community-living adults aged ≥ 65 years were examined for lifestyle factors, diabetes-related medical conditions and body composition by dual energy X-ray absorptiometry at baseline and 4 years later. Body composition changes were compared between participants with diabetes and those without diabetes. Multivariate linear regression was used to examine the relationship between appendicular lean mass loss and confounders. Appendicular lean mass loss in men with diabetes was two times that of men without diabetes (-1.5% in 'no diabetes' vs. -3.0% in 'diabetes') and in women with diabetes was 1.8 times that of those without diabetes (-1.9% in 'no diabetes' vs. -3.4% in 'diabetes') over 4 years. Men with diabetes also had higher total body mass loss and higher total body fat loss than men without diabetes. Women with diabetes had higher total body mass loss but total body fat loss was similar. After adjusting for age, body mass index, diabetes-related conditions, lifestyle factors and total body mass loss, diabetes remained an independent predictor of appendicular lean mass loss in both men and women. Diabetes was associated with higher body mass loss and higher appendicular lean mass loss in older adults. In men, diabetes was also associated with total body fat loss.

Diet and Eating Pattern Modifications Used by Community-Living Adults to Manage Their Fecal Incontinence

The study aimed to describe modifications in diet and eating patterns made by community-living people to manage fecal incontinence (FI), and to compare these differences according to sex, age, and FI severity. Subjects were 188 community-living adults (77% female, 92% white, 34% aged 65 years or older) in the upper Midwest who participated in a study about managing FI with dietary fiber. Subjects were interviewed about diet and eating pattern changes that they made to manage FI, and self-reported demographic data. FI severity was recorded daily. Fifty-five percent of participants perceived that some foods worsen their FI (eg, fatty or spicy foods and dairy products). More women than men (40% vs 18%, P = .008) reported avoiding foods to manage FI. A greater percentage of younger than older people believed that fatty/greasy foods (15% vs 4%) and alcohol (14% vs 3%) worsened their FI. Subjects with a higher FI severity score appeared to wait until FI was more severe before restricting caffeine than those with lower severity scores (22.2 ± 9.8 vs 11.69 ± 8.3, P = .034). One-third of subjects consumed foods rich in dietary fiber to prevent FI. Subjects also reported altered eating or cooking patterns, skipping meals, or eating at consistent times to manage FI. Diet modification for managing FI incorporates restriction of some foods, along with adding others foods to the diet. Nursing assessments of self-care practices for FI should include diet and eating pattern changes when developing a plan of care.

Comparing community and specialty provider‐based recruitment in a randomized clinical trial: Clinical trial in fecal incontinence

Recruitment of participants to clinical trials remains a significant challenge, especially for research addressing topics of a sensitive nature such as fecal incontinence (FI). In the Fiber Study, a randomized controlled trial on symptom management for FI, we successfully enrolled 189 community-living adults through collaborations with specialty-based and community-based settings, each employing methods tailored to the organizational characteristics of their site. Results show that using the two settings increased racial and ethnic diversity of the sample and inclusion of informal caregivers. There were no differential effects on enrollment, final eligibility, or completion of protocol by site. Strategic collaborations with complementary sites can achieve sample recruitment goals for clinical trials on topics that are sensitive or known to be underreported.

Spatial and Temporal Parameters of Self-Selected and Fast Walking Speeds in Healthy Community-Living Adults Aged 72–98 Years

Spatial and Temporal Parameters of Self-Selected and Fast Walking Speeds in Healthy Community-Living Adults Aged 72–98 Years

Mobility Adaptations of Older Adults: A Secondary Analysis

The purpose of this secondary study was to describe the mobility adaptations of community-living older adults. The primary study, designed to understand weakness and aging from the perspective of older adults, revealed that older adults viewed weakness as a progression from inability to an end point of 'giving up,' which prompted the use of adaptation strategies to preserve mobility and to counter a self-identity of being weak. A qualitative descriptive design guided the primary study of 15 community-living older adults, who participated in in-depth interviews. A systematic secondary analysis using Baltes and Baltes' theory of Selective Optimization with Compensation (SOC) showed that older adults used selection, optimization, and compensation adaptations across a range of mobility behaviors. The SOC model offered a framework for profiling older adults' agency and motivations in meeting mobility challenges as they age and provided the basis for targeted interventions to maximize mobility with aging.

Goals of Fecal Incontinence Management Identified by Community-Living Incontinent Adults

The purpose of this study was to identify goals of fecal incontinence (FI) management and their importance to community-living adults if complete continence would not be possible. Participants expressed their goals of FI management in a semistructured interview, selected others from 12 investigator-identified goals, and rated their importance. Five thematic categories emerged from the 114 participant-identified goal statements: Fecal Incontinence/Bowel Pattern, Lifestyle, Emotional Responses, Adverse Effects of Fecal Incontinence, and Self-Care Practices. Participants selected a median of seven investigator-identified goals (range = 2 to 12). Goals selected by the most participants were decreased number of leaks of stool and greater confidence in controlling fecal incontinence. These goals also had the highest importance along with decreased leakage of loose or liquid stool. The type and number of management goals identified by participants offer a toolbox of options from which to focus therapy when cure is not possible and promote patient satisfaction.

Hearing Impairment Affects Older People's Ability to Drive in the Presence of Distracters

To investigate the effects of hearing impairment and distractibility on older people's driving ability, assessed under real-world conditions. Experimental cross-sectional study. University laboratory setting and an on-road driving test. One hundred seven community-living adults aged 62 to 88. Fifty-five percent had normal hearing, 26% had a mild hearing impairment, and 19% had a moderate or greater impairment. Hearing was assessed using objective impairment measures (pure-tone audiometry, speech perception testing) and a self-report measure (Hearing Handicap Inventory for the Elderly). Driving was assessed on a closed road circuit under three conditions: no distracters, auditory distracters, and visual distracters. There was a significant interaction between hearing impairment and distracters, such that people with moderate to severe hearing impairment had significantly poorer driving performance in the presence of distracters than those with normal or mild hearing impairment. Older adults with poor hearing have greater difficulty with driving in the presence of distracters than older adults with good hearing.

Impaired Depth Perception and Restricted Pitch Head Movement Increase Obstacle Contacts When Dual-Tasking in Older People

Trips are the largest contributor to falls in older people, yet little is known about the underlying physiological mechanisms for safe obstacle negotiation. The aims of the study were to determine (i) the effect of a secondary visual task on obstacle contacts when older people negotiated an obstacle course and (ii) physiological factors associated with obstacle contacts. Thirty community-living adults aged 65 years and older walked along a 14.5-m walkway containing 21 obstacles with and without a secondary task. The secondary task required participants to call out a series of letters presented in front of them at head height and the suit of a playing card framed on the sidewall. Obstacle contacts, secondary task errors, eye peak-to-peak pitch amplitude and head peak-to-peak pitch amplitude (PA-H), and head angle in pitch were measured. Participants also completed assessments of sensorimotor function and balance. Compared with the obstacle-only trials, participants performed the dual-task trials more slowly (p < .001), contacted more obstacles (p = .032), showed greater PA-H (p < .001), and an extended head position (p < .001). Most participants also made secondary task errors. Regression analysis revealed that depth perception was the only significant determinant of obstacle contacts (explaining 20.6% of the variance) in the obstacle-only task and that depth perception and PA-H were independent and significant determinants of obstacle contacts (explaining 42.3% of the variance) in the dual task. The findings demonstrate the importance of depth perception and head movement for safe negotiation of obstacles in older people and suggest that depth perception in particular should form part of fall risk assessments.

Near-Vision Acuity Levels and Performance on Neuropsychological Assessments Used in Occupational Therapy

We investigated how induced blur affects performance on the Trail Making Test and Digit Symbol Test routinely used in occupational therapy cognitive evaluations. The study used a factorial design with both age (young and old adults) and simulated blur levels of near visual acuity (20/50 and 20/100) manipulated between participants. A sample of 124 healthy, community-living adults was used in the final analysis. Significant differences (p<.05) were found in performance for young participants between 20/50 and 20/100 blur level as well as between 20/20 and 20/100 blur level for the Digit Symbol Test. Scores for old participants decreased as a function of blur but were not significant. This study illustrates that cognitive evaluations used throughout the lifespan may require the appropriate visual acuity level to maximize performance. Occupational therapists' understanding of client factors and their effect on performance is fundamental to the client evaluation process.

農村部の検診に心理的健康検査を追加する意義

農村部の検診に心理的健康検査を追加する意義

The On‐Road Difficulties of Older Drivers and Their Relationship with Self‐Reported Motor Vehicle Crashes

To quantify the driving difficulties of older adults using a detailed assessment of driving performance and to link this with self-reported retrospective and prospective crashes. Prospective cohort study. On-road driving assessment. Two hundred sixty-seven community-living adults aged 70 to 88 randomly recruited through the electoral roll. Performance on a standardized measure of driving performance. Lane positioning, approach, and blind spot monitoring were the most common error types, and errors occurred most frequently in situations involving merging and maneuvering. Drivers reporting more retrospective or prospective crashes made significantly more driving errors. Driver instructor interventions during self-navigation (where the instructor had to brake or take control of the steering to avoid an accident) were significantly associated with higher retrospective and prospective crashes; every instructor intervention almost doubled prospective crash risk. These findings suggest that on-road driving assessment provides useful information on older driver difficulties, with the self-directed component providing the most valuable information.

Does the clinical context affect the validity of bathroom recommendations made by home health aides?

Introduction When there is a shortage of occupational therapists, an organizational model that involves home health aides in the process of recommending bathroom equipment could have a positive impact on the physical and psychological health of these workers. Currently, the involvement of home health aides is often limited to clients already receiving their services. The purpose of this study was to compare the criterion validity of recommendations made by home health aides regarding bathroom equipment for community-living adults presenting bathing difficulties under two clinical contexts: new referrals (group 1) and clients already receiving bathing assistance from home health aides (group 2). Methods Community-living adults with bathing difficulties ( n = 96) were visited by an occupational therapist (gold standard) and by one of four home health aides. Both evaluations took place within 10 days and evaluators were blind to the recommendations made by the other. Results Participants in the two groups differed on residential status, medical diagnosis and functional autonomy level. However, there was no significant difference between the groups in the criterion validity of the recommendations made by the home health aides. Conclusions Involvement of home health aides could be considered with a broader group of clients to increase the likelihood of bathrooms being properly adapted to the needs of both client and worker. Relevance to industry This study can support workers and homecare managers in their decision regarding whether to involve home health aides in a new and controversial role.