Disability In Community-dwelling Older Adults Research Articles

Sleep Duration and Excessive Daytime Sleepiness Are Associated With Incidence of Disability in Community-Dwelling Older Adults

ObjectiveAlthough sleep disturbances are associated with disability among older adults, no longitudinal study has examined the impact of sleep assessed based on both sleep quality and quantity on incident disability. This study examined whether sleep duration and excessive daytime sleepiness were associated with incidence of disability in community-dwelling older adults. MethodsA total of 4756 older adults (53.3% women, mean age 71.9 years) met the entry criteria for this study. We measured monthly incident disability, defined as the onset of being certified for personal support or care as required by Japanese public long-term care insurance during the preceding 24 months. Sleep duration, excessive daytime sleepiness (EDS), and demographic factors were assessed at baseline. Cox's proportional hazard regression analysis estimated hazard ratios (HRs) and 95% confidence intervals (CIs) of incidence of disability according to the 3 categories of sleep duration (short: ≤6.0 hours, mid: 6.1 to 8.9 hours, long: ≥9.0 hours), and we used mid duration sleepers as the reference group. ResultsLong sleep duration (HR 1.43, 95% CI 1.04–1.97) and presence of EDS (HR 1.41, 95% CI 1.01–1.98) were associated with higher rates of incident disability. Furthermore, a combination of sleep duration and EDS was associated with a higher rate of incident disability than the mid and no EDS group (HR 2.25, 95% CI 1.36–3.70). ConclusionLong sleep duration and EDS affected the incident of disability; thus, older adults with both sleep patterns may require an intervention to alter their sleep habit.

Back Stiffness Is Associated with Physical Health and Low Back Pain-Related Disability in Community-Dwelling Older Adults.

Back stiffness is a common complaint among older adults with low back pain. Nonetheless, self-reported back stiffness has received little exploration in this patient population. The purpose of this study was to examine the associations of self-reported low back stiffness with physical health and low back pain-related disability among older adults with low back pain. Cross-sectional analysis. Data included in this study were obtained from the Retirement Community Back Pain Study, a population-based survey of older adults. Participants completed the Medical Outcomes Survey Short-Form 36 and the modified Oswestry Low Back Pain Questionnaire. Physical health, derived from the Short Form-36, was represented by the physical component summary score. Back stiffness was rated on a 0-10 scale, where 0 indicated "no back stiffness." Covariates-that is, intensity and duration of low back pain, age, sex, weight, education level, and comorbidities-explained 27% of the variance in physical health ( P < 0.0001) and 38% of the variance in low back pain-related disability ( P = 0.0002). Self-reported stiffness explained an additional 6% of the variance in physical health ( P < 0.0001) and 10% of the variance in low back pain-related disability ( P < 0.0001). Back stiffness in older, community-dwelling adults with low back pain may help explain physical health and low back pain-related disability, above and beyond demographics and pain. Future longitudinal research is needed to evaluate low back stiffness as a predictor of physical health and disability. Ultimately, assessment and treatment of back stiffness in older adults with low back pain may improve patient outcomes.

Performance-Based Impairment Measures as Predictors of Early-Stage Activity Limitations in Community-Dwelling Older Adults.

The objective of the current investigation was to explore performance-based predictors of decline in the performance quality of everyday tasks as a first step for early identification, screening, and referral to minimize disability in community-dwelling older adults. This was a secondary analysis of data from 256 community-based older women. Mobility, activities of daily living (ADLs), and instrumental activities of daily living (IADLs) were measured using the Performance Assessment of Self-Care Skills (PASS). Logistic regression models explored cognitive and motor predictors of performance quality while controlling for demographics and diagnoses. Functional reach ( p = .049) and cognition ( p = .012) were predictive of mobility quality, whereas balance ( p = .007) and the Keitel Function ( p = .005) were predictive of ADL quality. Manipulation and cognitive measures were predictive of cognitive and physical IADL quality. Cognitive and physical screens are both important to identify older adults at risk for disability.

Impact of physical frailty on disability in community-dwelling older adults: a prospective cohort study

ObjectiveTo examine the relationship between physical frailty and risk of disability, and to identify the component(s) of frailty with the most impact on disability in community-dwelling older adults.DesignProspective cohort study.SettingA...

Incidence of Disability in Frail Older Persons With or Without Slow Walking Speed

ObjectiveTo identify the differences of incidence of disability between frail older persons with and without slow walking speed. DesignProspective cohort study. SettingJapanese community. ParticipantsA total of l4,081 older adults aged ≥65 years living in the community, participated in a baseline assessment and were followed for incidence of disability for 29.5 months. MeasurementsCare-needs certification in the national long-term care insurance system of Japan, physical frailty (slow walking speed, muscle weakness, exhaustion, low activity, weight loss), adjusted for several potential confounders such as demographic characteristics; Kaplan-Meier survival curves for incident disability by physical frailty with and without slow walking speed. ResultsDuring the follow-up period, 198 participants (4.9%) were certified as requiring long-term care insurance in accordance with incident disability. Participants who had prefrailty without slow walking speed (hazard ratio 1.86, 95% confidence interval 1.19–2.92), prefrailty with slow walking speed (3.62, 2.19–5.96), frailty without slow walking speed (4.33, 2.00–9.39), and frailty with slow walking speed (4.68, 2.72–8.05) at the baseline assessment had an increased risk of incident disability compared with nonfrail participants. In stratified analyses, frail older men and frail participants with low cognitive performance had the highest risk of incidence of disability. ConclusionThe presence of frailty or even prefrailty when older adults showed slow walking speed increased the risk of future disability in community-dwelling older adults.

Trends in ADL and IADL Disability in Community-Dwelling Older Adults in Shanghai, China, 1998-2008

We investigated trends in activities of daily living (ADL) and instrumental activities of daily living (IADL) disability from 1998 to 2008 among elder adults in Shanghai, China. Our data came from 4 waves of the Shanghai Longitudinal Survey of Elderly Life and Opinion (1998, 2003, 2005, and 2008). ADL and IADL disabilities were recorded dichotomously (difficulty vs. no difficulty). The major independent variable was survey year. Covariates included demographics, socioeconomic conditions, family and social support, and other health conditions. Nested random-effect models were applied to estimate trends over time, referenced to 1998. In comparison with the baseline year (1998), older adults in 2008 had lower odds of being ADL disabled, though the effect was no longer statistically significant when other health conditions were taken into account. Elders in 2003, 2005, and 2008 were 20%-26%, 17%-38%, and 53%-64% less likely to be IADL disabled than those in 1998, respectively, depending on the set of covariates included in the model. Shanghai elders experienced substantial improvements in both ADL and IADL disability prevalence over the past decade. The trend toward improvement in IADL function is more consistent and substantial than that of ADL function.

Low 25-Hydroxyvitamin D Predicts the Onset of Mobility Limitation and Disability in Community-Dwelling Older Adults: The Health ABC Study

Although low 25-hydroxyvitamin D (25(OH)D) is prevalent among older adults and is associated with poor physical function, longitudinal studies examining vitamin D status and physical function are lacking. We examined the association between 25(OH)D, parathyroid hormone (PTH), and the onset of mobility limitation and disability over 6 years of follow-up in community-dwelling, initially well-functioning older adults participating in the Health, Aging and Body Composition study (n = 2,099). Serum 25(OH)D and PTH were measured at the 12-month follow-up visit (1998-1999). Mobility limitation and disability (any/severe difficulty walking 1/4 mile or climbing 10 steps) was assessed semiannually over 6 years of follow-up. The association between 25(OH)D, PTH, and mobility limitation and disability was examined using Cox proportional hazard regression models adjusted for demographics, season, behavioral characteristics, and chronic conditions. At baseline, 28.9% of the participants had 25(OH)D <50 nmol/L and 36.1% had 25(OH)D of 50 to <75 nmol/L. Participants with 25(OH)D <50 and 50 to <75 nmol/L were at greater risk of developing mobility limitation (HR (95% CI): 1.29 (1.04-1.61) and 1.27 (1.05-1.53), respectively) and mobility disability (HR (95% CI): 1.93 (1.32-2.81) and 1.30 (0.92-1.83), respectively) over 6 years of follow-up compared with participants with 25(OH)D ≥75 nmol/L. Elevated PTH, however, was not significantly associated with developing mobility limitation or disability. Low 25(OH)D was associated with an increased risk of mobility limitation and disability in community-dwelling, initially well-functioning black and white older adults. Prevention or treatment of low 25(OH)D may provide a pathway for reducing the burden of mobility disability in older adults.

Serum 25-hydroxyvitamin D and physical function in older adults: the Cardiovascular Health Study All Stars.

To examine the association between 25-hydroxyvitamin D (25(OH)D) and physical function in adults of advanced age. Cross-sectional and longitudinal analysis of physical function over 3years of follow-up in the Cardiovascular Health Study All Stars. Forsyth County, North Carolina; Sacramento County, California; Washington County, Maryland; and Allegheny County, Pennsylvania. Community-dwelling adults aged 77 to 100 (N=988). Serum 25-hydroxyvitamin D 25(OH)D), Short Physical Performance Battery (SPPB), and grip and knee extensor strength assessed at baseline. Mobility disability (difficulty walking half a mile or up 10 steps) and activities of daily living (ADLs) disability were assessed at baseline and every 6months over 3years of follow-up. Almost one-third (30.8%) of participants were deficient in 25(OH)D (<20ng/mL). SPPB scores were lower in those with deficient 25(OH)D (mean (standard error) 6.53(0.24)) than in those with sufficient 25(OH)D (≥30ng/mL) (7.15(0.25)) after adjusting for sociodemographic characteristics, season, health behaviors, and chronic conditions (P=.006). Grip strength adjusted for body size was also lower in those with deficient 25(OH)D than in those with sufficient 25(OH)D (24.7(0.6)kg vs 26.0(0.6)kg, P=.02). Participants with deficient 25(OH)D were more likely to have prevalent mobility (OR=1.44, 95% confidence interval (CI))=0.96-2.14) and ADL disability (OR=1.51, 95% CI=1.01-2.25) at baseline than those with sufficient 25(OH)D. Furthermore, participants with deficient 25(OH)D were at greater risk of incident mobility disability over 3years of follow-up (hazard ratio=1.56, 95% CI=1.06-2.30). Vitamin D deficiency was common and was associated with poorer physical performance, lower muscle strength, and prevalent mobility and ADL disability in community-dwelling older adults. Moreover, vitamin D deficiency predicted incident mobility disability.

Nutritional, Physical and Mental Health Correlates of Physical Disability in Community-Dwelling Older Adults

Nutritional, Physical and Mental Health Correlates of Physical Disability in Community-Dwelling Older Adults

Functional Outcomes of Anemia in Older Adults

Observational studies have consistently documented independent, strong associations of anemia--even if not severe--with major adverse functional outcomes in older adults. In this chapter, recent epidemiologic evidence linking mild anemia with decline in physical and cognitive function, frailty, and disability in community-dwelling older adults is reviewed. Altogether, these biologically plausible associations provide empirical, though not conclusive, support for the notion of mild anemia as a cause of adverse functional outcomes in older adults. Randomized clinical trial data assessing the impact of anemia correction on functional outcomes are lacking at this time.

Gait Variability and the Risk of Incident Mobility Disability in Community-Dwelling Older Adults

Gait speed is a strong predictor of incident walking disability. The objective was to determine if gait variability adds to the prediction of incident mobility disability independent of gait speed. Participants included 379 older adults (mean age = 79 years; 78% Caucasian, and 40% men) in the Cardiovascular Health Study at the Pittsburgh site. All could ambulate independently and reported no difficulty walking a half mile. Gait characteristics were determined from a 4-meter computerized walkway. For each gait parameter, variability was defined as the standard deviation from the individual steps from two passes. Incident walking disability was obtained by phone interview every 6 months for 54 months and was defined as new difficulty walking a half mile or inability to walk a half mile. Of the 379 participants, 222 (58.6%) developed incident mobility disability. In unadjusted Cox proportional hazards models gait speed, mean step length, mean stance time, and stance time variability were associated with incident mobility disability. After adjusting for gait speed, demographics, chronic conditions, prescription medications, health status, and physical activity level, only stance time variability remained an important indicator of disability. In the adjusted model, an increase in stance time variability of 0.01 seconds was associated with a 13% higher incidence of mobility disability (hazard ratio 1.13, 95% confidence interval, 1.01-1.27). Stance time variability is an independent predictor of future mobility disability. Future efforts are needed to determine whether interventions that decrease stance time variability will also delay mobility disability.

Relationships Among Impairments in Lower-Extremity Strength and Power, Functional Limitations, and Disability in Older Adults

During the aging process, older adults may experience a loss of strength and power, which then may lead to functional limitations and disability. The purpose of this study was to examine how impairments in lower-extremity strength and power are related to functional limitations and disability in community-dwelling older adults. Thirty older adults (age [X+/-SD], 77.3+/-7.0 years; 25 women and 5 men) with mild to moderate functional limitations participated in this study. Lower-extremity strength, peak power, power at a low relative intensity, and power at a high relative intensity were measured with a pneumatic resistance leg press. Functional limitations and disability were assessed with the Short Physical Performance Battery (SPPB), the Six-Minute Walk Test (SMWT), and the Late Life Function and Disability Instrument (LLFDI). All measures of strength and power were related to functional limitations. Peak power demonstrated the strongest relationships with SMWT, the SPPB gait speed subscale, and the LLFDI functional limitation component. Power at a high relative intensity demonstrated the strongest relationships to the SPPB total score and the SPPB sit-to-stand subscale score. All measures of strength and power were indirectly related to the LLFDI disability component. Older adults should focus on increasing and maintaining lower-extremity strength and power across a range of intensities in order to decrease functional limitations and disability.

Does physical activity moderate the association between depressive symptoms and disability in older adults?

Depressive symptoms and disability are closely associated and known to have reciprocal relationships. This study examines whether physical activity moderates the association between depressive symptoms and disability in community-dwelling older adults. Baseline and 1-year follow-up data of 645 persons aged 65 years or older from the Suwon Longitudinal Aging Study were analyzed. A 15-item Geriatric Depression Scale, Physical Functioning scale, and physical performance tests were used to assess the individual's depressive symptoms and functional disability. Physical activity was defined as the recommended level of exercise based on its frequency and intensity. Multiple regression analysis with generalized estimating equations was conducted to examine the physical activity's role as an effect modifier in the association between depressive symptoms and disability. Physical activity was a significant effect modifier in the 'depressive symptoms-disability' association, controlling for sociodemographic characteristics and health-related covariates. Moderate-intensity activity was as effective as vigorous activity in moderating the relationship. The moderating effect was notable among those displaying severe depressive symptoms and functional disability. Over time the strength of the association between depressive symptoms and disability tended to diminish for those engaging in physical activity. The association between depressive symptoms and disability is moderated by physical activity in older persons. The findings suggest that healthcare professionals need to promote moderate amount of physical activity as a potential intervention tool in attenuating the depression-disability connection in later life, especially among those with high levels of physical and mental impairments.

VALUES OF STANCE TIME VARIABILITY RELATED TO MOBILITY DISABILITY.

Purpose/Hypothesis: Greater stance time variability (STV) is related to incident mobility disability independent of gait speed. We wished to confirm this association and determine the magnitude of STV that potentially discriminates mobility disability in a sample of older adults diverse in gait speed and in a sub-sample with normal gait speed. Subjects: This crosssectional study included 544 older adults (mean age=79.4; 39% men; 23% black) of the Cardiovascular Health Study from the Pittsburgh site. Materials/Methods: Stance time, in milliseconds (ms), was determined from 2 passes on a 4-meter computerized walkway at self-selected walking speed, and STV was defined as the standard deviation (SD) from approximately 12 individual steps. Mobility disability was defined as self-reported difficulty walking a half mile. A t-test was used to compare STV between individuals with and without mobility disability. Receiver operating characteristic (ROC) curves were plotted to determine an optimal cutoff value for stance time variability, and the area under the ROC curve was computed. Analyses were repeated in a subset with gait speed ≥ 1.0 meters/second. Results: Individuals without mobility disability (n= 419; mean STV=35.5 ms; SD=17.6 ms) were less variable in stance time than individuals with mobility disability (n=125; mean STV=51.2 ms; SD=31.1; p< 0.001). A STV≥36.5 ms has 66% sensitivity and 63% specificity for identifying mobility disability. Area under the ROC curve was 0.696. In those who walk faster than 1.0 meters/second, STV≥30.5 ms has 60% sensitivity and 62% specificity for identifying mobility disability. Area under the ROC curve was 0.618. Conclusions: Greater STV is associated with mobility disability in community-dwelling older adults. Clinical Relevance: A value of STV≥36.5 ms, is a potentially useful clinical indicator of mobility disability in older adults. In those with near normal walking speed (gait speed ≥ 1.0 meters/second) a lower threshold value of STV (≥30.5 ms) may be more appropriate for identifying disability.

Function and disability in late life: comparison of the Late-Life Function and Disability Instrument to the Short-Form-36 and the London Handicap Scale

Purpose: We evaluated the Late-Life Function and Disability Instrument's (LLFDI) concurrent validity, comprehensiveness and precision by comparing it with the Short-Form-36 physical functioning (PF-10) and the London Handicap Scale (LHS).Methods: We administered the LLFDI, PF-10 and LHS to 75 community-dwelling adults (> 60 years of age). We used Pearson correlation coefficients to examine concurrent validity and Rasch analysis to compare the item hierarchies, content ranges and precision of the PF-10 and LLFDI function domains, and the LHS and the LLFDI disability domains.Results: LLFDI Function (lower extremity scales) and PF-10 scores were highly correlated (r = 0.74 − 0.86, p > 0.001); moderate correlations were found between the LHS and the LLFDI Disability limitation (r = 0.66, p < 0.0001) and Disability frequency (r = 0.47, p < 0.001) scores. The LLFDI had a wider range of content coverage, less ceiling effects and better relative precision across the spectrum of function and disability than the PF-10 and the LHS. The LHS had slightly more content range and precision in the lower end of the disability scale than the LLFDI.Conclusions: The LLFDI is a more comprehensive and precise instrument compared to the PF-10 and LHS for assessing function and disability in community-dwelling older adults.