Decline In Functional Capacity Research Articles

Midlife Occupational Physical Activity and Risk of Disability Later in Life: National Health and Aging Trends Study.

To determine whether midlife occupational physical activity (PA) is associated with disability in older adults and to test disease as a mediating variable. Cross-sectional study. National Health and Aging Trends Study. Individuals aged 65 and older (N = 7,307). Participants were classified as to occupational PA levels by linking information from the Occupational Information Network database using standard occupation codes. Disability outcomes and covariates were obtained through in-person interviews. Logistic regression models were used to examine the association between occupational PA and disability. Structural equation modeling (SEM) was fitted to examine the mediating effect of disease. Occupations with high physically demands were associated with greater decline in functional capacity later in life. Individuals with occupations with high and very high PA were less likely to be able to perform activities of daily living than those with occupations with low PA. SEM showed that occupational PA has a very strong direct effect on disability (P < .001) and has an indirect effect on disability through disease (P = .003). The population attributable fraction for high occupational PA was 11%. Higher midlife occupational PA levels were significantly associated with poorer ability to perform activities of daily living in older age. Performing the optimal level of occupational PA may be instrumental in reducing disability later in life.

Depression in pulmonary arterial hypertension: An undertreated comorbidity.

Pulmonary arterial hypertension (PAH) is a debilitating condition leading to progressive decline in functional capacity. As a result, PAH can lead to psychological impairment that can impact the overall disease status. The medical community has developed several screening questionnaires in order to assess depression in their patients allowing physicians to be at the forefront of recognizing clinical depression. There is a suggestion that depression symptomatology is more prevalent in the PAH population. The aim of this article is to review the current thought process about diagnosis and management of depression in PAH patients.

Development of anti-ageing natural products based on biodiversity of the Greek flora by employing environmentally friendly technologies and anti-ageing biological research

Ageing is a complex process driven by diverse molecular pathways and biochemical events. It has been defined as the time-dependent decline of functional capacity and stress resistance and affects most of tissues and organs of the body. The aim of this study is the development of anti-ageing natural products by employing state-of-the art environmentally friendly technologies and anti-ageing biological research. Specifically, a high number of plants (600) from Greek flora was selected and extracted by using “green technologies” (SFE, ASE and MWE). The extracts were investigated for their chemical profile and for their in vitro antioxidant activity (DPPH· and ABTS assays). Subsequently, the most promising extracts were applied to human diploid skin fibroblast cells and their antioxidant capacity was recorded by using the DCFH-DA assay. Based on these results 25 plant extracts were selected for further investigation. Assays were mainly based on normal human cells and refer to targets known to contribute cell protection from age-related damage. Specifically, they were tested for their efficacy against UV protection, as well as for their ability to modulate the proteasome and/or the autophagy-lysosome pathways functionality. “Multi-functional” extracts that apart from exerting antioxidant activity, are also activating main cellular pathways were identified. Plants affording the most bioactive extracts were cultivated, in order to protect the Greek biodiversity, while their chemical profile and biological activity was afresh confirmed. Among others, Rosa damascena R. and Sideritis scardica L. preparations showed the ability to reduce the ROS levels (to 24% and 51% compare to the control, respectively), while at a non-toxic concentration induced the activation of the proteasome LLVY/β5 peptidase activity. Finally, the results of the aforementioned biological research revealed these extracts as promising anti-ageing agents for potential usage as cosmeceuticals.

Primary care - The unrecognized member of the intensive care team.

I have been working at National University Hospital Singapore for a year now on a busy intensive care unit (ICU), much like others in the UK in which I’ve worked. This week there is someone pre-liver transplant, someone for consideration of ECMO (extracorporeal membrane oxygenation) and the usual gamut of critical care staples – severe pneumonias, pancreatitis and acute renal failure. My senior resident is stuck in the emergency department intubating a sick patient, while 80-odd patients wait for a hospital bed to appear for their admission. I’m considering sending someone home from ICU, as there hasn’t and won’t be an in-patient bed for her in the near future. The department has diverse interests in teaching, research and clinical service, and camaraderie is evident among the consultant body. In patient mix and system pressures, this could be the UK. Other aspects are very different – the physiotherapists have mobilized a ventilated patient outside (32 and sunny, as opposed to a British January), there is no sign of a desultory sandwich for lunch (instead a buffet meal prior to the medical grand round) and my juniors have been through an aspirational trans-thoracic echocardiogram program, ensuring that I have regular excellent bedside assessments for my sick patients. All in all, it’s a great place to be an intensive care physician. Singapore has been consistently cited as a model of healthcare economics, with 4% of gross domestic product invested in healthcare. Secondary care is recognized to be world class, and there is a voracious interest in continued advancement, tying in international experience with local research addressing certain aspects of disease unique to their racial mix. However, I am acutely aware of the absence of organized general practice in this system. Primary care remains fractured. There are 18 polyclinics (subsidized) and 1400 private primary healthcare clinics in Singapore. As a result of shared financial responsibility (fees can be subsidized up to 80% depending on means testing), patients shop around for what they perceive to be the best primary care doctors, with long-term plans difficult to develop. Costs of drugs interfere with compliance. Defaulting to follow-up seems to be the norm, either due to costs or as a result of difficulties with integrating personal health needs into everyday life. Leading causes of morbidity are the major non-communicable diseases: cancer, coronary heart disease, diabetes and hypertension. Long-term management of such chronic diseases is taxing even for the best systems. The lack of continuum of healthcare provision leads to a high level of preventable end organ damage. Ischaemic heart disease and chronic renal failure are common secondary to hypertension or diabetes. My remark regarding the relative youth of long-term dialysis patients with triple-vessel disease was met with the international medical language of one-upmanship – ‘‘40? Do you know how many 30 year-olds I see?’’ Teaching on the airway management of severe asthma had to be modified – near fatal asthma with community arrests is common. Sadly the majority that make it to our unit recover with beta agonists and steroids – there is no need for high-level care, merely compliance and access to healthcare. This preponderance of established chronic disease impacts on critical care both directly and indirectly. In the acutely unstable patient, hypertensive heart disease contributes to mortality, acute renal failure (pre-disposed to by chronic organ failure) has a high mortality rate, and chronic lung disease may lead to prolonged ventilator weaning. ICU survival is only the first stage: chronic disease states are associated with a decline in functional capacity and a higher level of institutionalization. Many in critical care focus on survival and subsequent functional disability. Yet, it seems increasingly clear that without good long-term chronic disease management – for which the general practice team is essential – critical care will see an increasing number of patients with preventable chronic organ failure, at a younger age. Not only will they be younger but also from areas of social deprivation – those who already

Energy and protein intakes and their association with a decline in functional capacity among diabetic older adults from the NuAge cohort.

Diabetic older adults (OA) are at greater risk of muscle strength (MS) loss and functional capacity (FC) decline than non-diabetics. Protein and energy intakes are important determinants of muscle mass and MS maintenance and indirectly affect FC. The study sought to determine whether low protein and energy intakes were associated with FC decline and whether this association was mediated by MS in diabetic OA over a 3-year follow-up, in secondary analyses of the Quebec Longitudinal Study on Nutrition and Successful Aging. In 172 diabetic OA (62 % men, mean age=75years), FC decline was defined as the change between SMAF (Système de Mesure de l'Autonomie Fonctionnelle) scores at baseline (T1) and 3years later (T4). Baseline adequate protein and energy intakes were set at ≥1g/kg BW and ≥30kcal/kg BW, respectively. Sex-stratified linear regressions were controlled for confounding variables. Mean body weight (BW) was 85.42±13.8 in men and 79.7±11.5 in women (p≤.001). Adequate protein intake in women was associated with lesser FC decline (mean±SE) (2.11±0.81 vs. 4.91±0.72; p=.029), while adequate energy intake was not associated with FC decline either in men or in women. In women, 1g protein/kg BW helped maintain MS, hence minimizing FC decline. These results demonstrate that protein intake is important in maintaining FC in diabetic OA, albeit with sex differences. This study provides further evidence that protein requirements may be greater than the 0.8g/kg BW currently recommended for OA. Future research in larger samples over longer follow-up is needed to confirm these results.

Elderly families of South of Brazil in the Health Strategy.

to characterize families and health status of the elderly in the Family Health Strategy and to verify the association of family composition with sociodemographic characteristics and health of the elderly. population-based study with 215 families and 266 elderly, linked to the Family Health Strategy from a city of Rio Grande do Sul state. there was predominance of nuclear family composition, considered as the main source of informal support, families of female elderly (62.6%) and cardiovascular complication. The nuclear structure was significantly associated with female gender (PR = 0.77; p = 0.025) and smoking (PR = 1.35; p = 0.009). the results reinforce the need to maintain a network of formal and informal support to the elderly and their families to preserve the independence or to postpone the decline in functional capacity.

Prevalence of disability and associated factors in the elderly

The aim of this study was to estimate the prevalence and factors associated with functional disability in the elderly. The cross-sectional design was used with a sample of 624 individuals, between 60 and 96 years of age. In the assessment of the elderly interviews and physical performance tests were used. In the inferential data analysis, the Poisson regression was used, p≤0.05. The prevalence of disability was 17.6% for Basic Activities of Daily Living and 46.3% for Instrumental Activities of Daily Living. Functional disability for Basic Activities of Daily Living was associated with increasing age, alcohol consumption, depressive symptoms and frailty; the Instrumental Activities of Daily Living were associated with increasing age, illiteracy, multigenerational family arrangement, hospitalization and fragility. The variables that remained in the explanatory model for the decline of functional capacity should be emphasized in proposals for public policies to promote the health of the elderly.

In-Hospital Mobility and Associated Factors

Background and Purpose: Immobility during hospitalization can lead to deleterious consequences and substantial decline in functional capacity, and even a rise in mortality rate has been reported. Determining and understanding varying levels of mobility, barriers to mobility, and associated factors during hospitalization will help in the development of successful health care interventions. Study D esign: An institution-based cross sectional study design was used to determine various levels of mobility (LOM) and to identify their associated factors and barriers in a single academic center in Ethiopia. Methods: A 400 bed university teaching hospital and referral center for different health centers in and around Gondar was the study set-up. Four hundred twenty three adult patients of various wards admitted for different conditions were recruited by stratified sampling and assessed for inhospital LOM using a previously validated scale. Results: Four hundred twenty three subjects were included in this study (n=423, mean age 37±14,

Aging of skeletal muscle fibers.

Aging has become an important topic for scientific research because life expectancy and the number of men and women in older age groups have increased dramatically in the last century. This is true in most countries of the world including the Republic of Korea and the United States. From a rehabilitation perspective, the most important associated issue is a progressive decline in functional capacity and independence. Sarcopenia is partly responsible for this decline. Many changes underlying the loss of muscle mass and force-generating capacity of skeletal muscle can be understood at the cellular and molecular levels. Muscle size and architecture are both altered with advanced adult age. Further, changes in myofibers include impairments in several physiological domains including muscle fiber activation, excitation-contraction coupling, actin-myosin cross-bridge interaction, energy production, and repair and regeneration. A thorough understanding of these alterations can lead to the design of improved preventative and rehabilitative interventions, such as personalized exercise training programs.

Decline in functional capacity is unaffected by diet quality alone or in combination with physical activity among generally healthy older adults with T2D from the NuAge cohort

BackgroundBoth diet quality (DQ) and physical activity (PA) have been shown to play a role in the prevention of functional capacity (FC) decline. Because older adults (OA) with T2D are at a higher risk of FC decline compared to their non-diabetic counterparts, our aim was to determine if DQ alone, or combined with PA is associated with FC decline in OA with T2D over a 3-year follow-up in a secondary analysis of the NuAge cohort. MethodsIn 159 OA with T2D (mean age=75 years), FC change was calculated as the difference in FC scores at T1 and T4 measured by the SMAF (Système de Mesure de l’Autonomie Fonctionnelle). Baseline DQ was calculated from three non-consecutive 24-h dietary recalls collected at T1 using the validated Canadian Healthy Eating Index (C-HEI). PA change was calculated from Physical Activity Scale for the Elderly (PASE) as T4−T1. Associations were evaluated between FC decline and four combinations of variables: C-HEI score < or ≥70 with PASE change < or > median and analyzed by GLM while controlling for covariates. ResultsNeither DQ alone nor DQ combined with PA change were associated with FC decline over follow-up. ConclusionsThe absence of effect may be explained by characteristics of this healthy sample of OA with T2D who showed relatively good adherence to dietary recommendations (mean C-HEI=70) and were highly functional shown by minimal, clinically non-significant FC decline over 3 years. More research is needed to confirm the role of DQ in preventing FC decline in a larger diabetic sample showing clinically significant FC decline.

What is the evidence for changes in cognition and functioning over the lifespan in patients with schizophrenia?

Cognitive deficits in schizophrenia are important predictors of impairment in most functional domains and are a critical therapeutic target. These deficits appear at or before the onset of illness, are stable across time in most patients, and can be improved by cognitive remediation treatments. Recent evidence, however, suggests that cognitive function does not necessarily follow a pattern of age-related decline. Several studies evaluated this pattern of decline in schizophrenia patients compared to both natural aging and degenerative conditions such as Alzheimer's disease. Age-related differences were not comparable to either normal aging or Alzheimer's disease. Older patients with an extensive history of illness and protracted institutionalization have shown a greater progressive decline. These deficits were also observed in older patients who were no longer institutionalized, with these patients demonstrating decline in functional capacity across time compared to healthy controls and patients with no lengthy institutional stay. There were 2 clear conclusions from this body of data. First, there appear to be 2 separate periods of deterioration in schizophrenia patients. These patients appear to decline the most at 2 key time points; the first occurs some time prior to the first psychotic episode and the second begins at approximately 65 years of age. The second important conclusion is that these 2 important periods of time may be the time point at which an aggressive intervention may have the greatest impact.

Effectiveness of muscle strengthening and description of protocols for preventing falls in the elderly: a systematic review.

BackgroundFalls are a geriatric syndrome that is considered a significant public health problem in terms of morbidity and mortality because they lead to a decline in functional capacity and an impaired quality of life in the elderly. Lower limb muscle strengthening seems to be an effective intervention for preventing falls; however, there is no consensus regarding the best method for increasing lower limb muscle strength.ObjectivesTo analyze the effectiveness of lower limb muscle strengthening and to investigate and describe the protocols used for preventing falls in elderly subjects.MethodWe performed a systematic review of randomized and controlled clinical trials published between 2002 and 2012 in the databases PubMed, EMBASE, Scopus, Web of Science, and PEDro that cited some type of lower limb muscle strengthening protocol and that evaluated the incidence of falls as the primary outcome exclusively in elderly subjects. Twelve studies met the inclusion criteria. Qualitative analysis was performed by independent reviewers applying the PEDro scale.ResultsThe data obtained from the selected studies showed lower fall rates in the intervention groups compared to controls. Six studies described the lower limb muscle strengthening protocol in detail. High methodological quality was found in 6 studies (PEDro score ≥7/10 points).ConclusionsThe methodological quality of the studies in this area appears to leave little doubt regarding the effectiveness of lower limb strengthening exercises for preventing falls in elderly subjects, however the interventions in these studies were poorly reported.

Factors Associated with Functional Capacity Decline Risk over a 6-year Period among Independent Elderly Persons Living in the Community

Factors Associated with Functional Capacity Decline Risk over a 6-year Period among Independent Elderly Persons Living in the Community

Oral health and general health at the early stage of ageing: A review of contemporary studies

In 2012, persons over age 65 reached 24.1% of Japan's population, and this population will continue to grow. The relationship between oral health and general health has been examined in many studies, geriatric dentistry in particular. An increasing need for long-term care for older adults is expected with the ageing of Japan's population. This will result in escalating costs for these services; thus, we are now prompted to identify predictors for eligibility for long-term care funding. Recent studies have revealed that many factors of oral health are associated with general health conditions. Of these, we focused on factors responsible for a decline in functional capacity that could facilitate long-term care certification. In the present review, we examine the relationships between oral conditions and general conditions, i.e. nutrition, physical performance, functional capacity, the need for long-term care, and longevity. Associations between oral and general condition have been established in many cross-sectional studies, and a number of longitudinal studies have shown associations between the need for long-term care, longevity, and some oral health factors including dentition status and masticatory ability. Further studies are required to show influence of oral health at the early stage of ageing on subsequent healthy life expectancy.

Development and preliminary validation of a new scale to assess functional ability of older population in India

Identifying the decline in functional ability and preventing disability is the critical element of the quality of life of an old age. However, the lack of contextual scale to assess the decline in functional capacity is a major issue. Objective of this study is to design the functional ability assessment scale for elderly people in India and test its psychometric properties. Random sample of 659 individuals above 60 years of age from western part of India was recruited. This paper outlines the construction, reliability and validity of a newly developed 14 item scale named as Pune-Functional Ability Assessment Tool (Pune-FAAT). The factors were extracted using the principal component analysis. Two-factor-structure of scale was accepted after applying the K1 rule, scree plot and parallel analysis method. The two factor structure yielded variance of 64.4%. The psychometric properties of the scale were examined using confirmatory factor analysis. The scale has an excellent reliability (Cronbach's α 0.928) and very good test–retest reliability (r=0.884). Each subscale demonstrated good internal consistency (Subscale I – Cronbach's α 0.938 and Subscale II – Cronbach's α 0.762). Excellent convergent validity with Standford's health assessment questionnaire (r=0.959). Discriminant validity was very good as FAAT index showed significant difference in young adults (mean±SD 1.11±0.24) and older adults (mean±SD 1.69±0.70). This new measure is a potentially valuable research tool for investigating older adult's functional ability to perform basic and complex daily activities.

IGF-1, the Cross Road of the Nutritional, Inflammatory and Hormonal Pathways to Frailty

The decline in functional capacity is a heterogeneous phenomenon in the elderly. An accelerated ageing determines a frail status. It results in an increased vulnerability to stressors for decreased physiological reserves. The early identification of a frail status is essential for preventing loss of functional capacity, and its clinical consequences. Frailty and mobility limitation result from an interplay of different pathways including multiple anabolic deficiency, inflammation, oxidative stress, and a poor nutritional status. However, the age-related decline in insulin-like growth factor 1 (IGF-1) bioactivity deserves special attention as it could represent the ideal crossroad of endocrine, inflammatory, and nutritional pathways to frailty. Several minerals, namely magnesium, selenium, and zinc, appear to be important determinants of IGF-1 bioactivity. This review aims to provide an overview of the potential usefulness of nutrients modulating IGF-1 as potential therapeutic targets in the prevention of mobility limitation occurring in frail older subjects.

Effect of Enthesitis on 1505 Brazilian Patients with Spondyloarthritis

To analyze the clinical effect of enthesitis in a large Brazilian cohort of patients with spondyloarthritis (SpA). A common protocol of investigation was prospectively applied to 1505 patients with SpA in 29 centers in Brazil. Clinical and demographic variables and disease indexes were investigated. The Maastricht Ankylosing Spondylitis Enthesitis Score was used to investigate the enthesitis component. Ankylosing spondylitis was the most frequent disease in the group (65.4%). Others were psoriatic arthritis (18.4%), undifferentiated SpA (6.7%), reactive arthritis (3.3%), and enteropathic arthritis (3.2%). At least 1 affected enthesis was observed in 54% of the patients with SpA, with a mean of 2.12 ± 2.98 entheses affected. According to the clinical presentation, enthesitis was significantly more frequent in patients with axial + peripheral joint involvement compared to isolated axial or peripheral involvement (p < 0.001). There was a statistical association between the presence of enthesites and axial symptoms (buttock pain, cervical pain, and hip pain), and peripheral symptoms (lower limb arthritis, number of painful and swollen joints; p < 0.05). Patients with enthesitis also presented higher mean scores of Bath Ankylosing Spondylitis Functional Index (BASFI; p < 0.001), Bath Ankylosing Spondylitis Disease Activity Index (p < 0.001), and Ankylosing Spondylitis Quality of Life (ASQoL; p < 0.001). Multivariate logistic regression showed that BASFI (p < 0.0001; OR 74.839), ASQoL (p = 0.0001; OR 14.645), and Achilles tendonitis (p = 0.0059; OR 7.593) were associated with work incapacity. The clinical presence of enthesitis in this large cohort of patients with SpA was frequent and was associated with a significant increase in disease activity and decline in functional capacity and quality of life.

The relationship between grip strength and muscle mass (MM), inflammatory biomarkers and physical performance in community-dwelling very old persons

The main consequence of the loss of MM and muscle strength is limitations of physical performance and disability in older people. It is unclear whether a decline in functional capacity results from the loss of MM and/or the qualitative impairment of the muscle tissue. The aim of our research was to investigate the relationship between physical performance and grip strength, inflammatory markers and MM in a population of community-dwelling very old persons. This study is a cross-sectional analysis within the BELFRAIL-study, a cohort study of subjects aged 80 years and older (n=567). MM was assessed by bioelectrical impedance. Interleukin-6 (IL-6) and tumor necrosis factor-α (TNF-α) concentrations were determined on fasting blood samples. Logistic regression analysis was build using a low physical performance level evaluated according to Short Physical Performance Battery (SPPB) (dependent variable) and grip strength, pro-inflammatory status and MM (independent variables) adjusted for age and for the total number of chronic diseases. Low SPPB scores were associated with grip strength scores for women (OR 0.86 (95% CI 0.77–0.96)), and for men (OR 0.89 (95% CI 0.81–0.96)). The relationships between low SPPB and MM or inflammatory profile were not significant. Our results show that low physical performance remains associated with low grip strength even after considering other risk factors for sarcopenia in the oldest old and support the hypothesis that low muscle strength is a better indicator than low MM. The role of an inflammatory component in the age-related loss of muscle strength and function could not be confirmed.

Handgrip strength as a predictor of higher-level competence decline among community-dwelling Japanese elderly in an urban area during a 4-year follow-up

This 4-year observational study examined whether handgrip strength can predict functional decline in higher-level competence in a cohort of urban community-dwelling Japanese elderly. Subjects were 406 community-dwelling Japanese, 65 years or older at baseline who scored as “independent in higher-level competence” (11 and over) according to the Tokyo Metropolitan Institute of Gerontology Index of Competence (TMIG-IC). Independent variables were handgrip strength and usual walking speed at baseline survey. Dependent variables were functional status in higher-level competence at 4-year follow-up. Logistic regression analysis, after adjustment for age and body mass index (BMI), revealed that handgrip strength was significantly correlated with decline of higher-level competence in both sexes. Usual walking speed was significantly correlated with decline in higher-level competence only in women. This study revealed that handgrip strength is a predictor for decline in higher-level competence in urban community-dwelling Japanese elderly men and women. Results suggest that handgrip strength may be used to screen for functional capacity decline in community-dwelling elderly.

Late gadolinium enhancement cardiac magnetic resonance imaging in prognostic assessment of hypertrophic cardiomyopathy

A 46-year-old man who was diagnosed with familial hypertrophic cardiomyopathy (HCM) related to a heterozygote MYBPC3 (cardiac myosin-binding protein-C) gene mutation at the age of 18 was admitted with cardiogenic shock. A progressive decline in functional capacity started 2 years earlier while successive cardiac magnetic resonance (CMR) imaging performed in 2006, 2010, and 2012 showed focal and progressive myocardial fibrosis ( Panel 1 A ). At admission, bedside echocardiography showed severe HCM and biventricular dysfunction. Femoro-femoral extracorporeal life support …