Disability In Older Women Research Articles

Specific Neurodynamic Exercises on Pain and Disability in Old Women with Chronic Mechanical Neck Pain: A Randomized Controlled Trial.

Neurodynamic exercise is a specific type of exercise used as a neural treatment that focuses on restoring altered homeostasis in the neuroimmune system by mobilising the nervous system and other structures. A prospective, randomized clinical trial was performed to evaluate the effect of neurodynamic exercises on disability and neck pain in elderly women over four weeks. Participants were randomized into two groups: a neurodynamic (NM) group (n = 28) and a non-specific exercise (NSE) group (n = 28). Inclusion criteria were women over 65 years of age who subjectively admitted to having mechanical neck pain for more than six months. Results showed that specific neurodynamic exercises can improve pain and disability in older women with chronic mechanical neck pain. Improvements were observed in all variables (p < 0.05). Significant between-group differences in favour of the NM group were only found for neck pressure pain thresholds and both tibialis anterior muscles. Larger effect sizes were obtained in favour of the NM group, especially for pain, disability, neck extension and inclination and pressure pain thresholds. Neurodynamic exercises have been shown to be more clinically relevant in disability and neck pain in older women.

Effects of a tailored mat-Pilates exercise program for older adults on pain, functioning, and balance in women with chronic non-specific low back pain: a randomized controlled trial.

Mat-Pilates exercise is effective for chronic non-specific low back pain (NSLBP), but its application in older women is understudied. To examine the effects of a 10-week mat-Pilates program on pain, disability, and balance in older women with chronic NSLBP. Sixty-three women (≥ 65years) with chronic NSLBP were randomly assigned to intervention (IG) or control (CG) groups. IG received individualized mat-Pilates sessions (45min, twice weekly), while CG followed a home-based general exercise program. Primary outcomes included visual analog scale (VAS) for pain, Roland-Morris Disability Questionnaire (RMDQ), timed up-and-go (TUG), and Berg Balance Scale (BBS) at baseline, 10weeks, and 6months post-intervention. Repeated measures multivariate analysis of covariance (MANCOVA) was used, adjusted for exercise adherence and analgesic use. IG significantly improved in VAS and RMDQ scores at 10weeks and 6 months (p > 0.05). No significant differences were observed in TUG and BBS scores at any measurement point. No between-group differences were found in analgesic use or adherence to exercise during the 6-month follow-up. A 10-week mat-Pilates program reduced pain and improved disability in older women with chronic NSLBP, effects which persisted at 6 months. However, no impact on balance, analgesic use, or exercise adherence was observed. NCT04752579/February 12, 2021.

Three-Month vs. One-Year Detraining Effects after Multicomponent Exercise Program in Hypertensive Older Women.

Background: Chronic diseases are the leading causes of death and disability in older women. Physical exercise training programs promote beneficial effects for health and quality of life. However, exercise interruption periods may be detrimental for the hemodynamic and lipidic profiles of hypertensive older women with dyslipidemia. Methods: Nineteen hypertensive older women with dyslipidemia (exercise group: 67.5 ± 5.4 years, 1.53 ± 3.42 m, 71.84 ± 7.45 kg) performed a supervised multicomponent exercise training program (METP) during nine months, followed by a one-year detraining period (DT), while fourteen hypertensive older women (control group: 66.4 ± 5.2 years, 1.56 ± 3.10 m, 69.38 ± 5.24 kg) with dyslipidemia kept their continued daily routine without exercise. For both groups, hemodynamic and lipidic profiles and functional capacities (FCs) were assessed four times: before and after the METP and after 3 and 12 months of DT (no exercise was carried out). Results: The METP improved hemodynamic and lipidic profiles (p < 0.05), while three months of DT decreased all (p < 0.05) parameters, with the exception of diastolic blood pressure (DBP). One year of DT significantly (p < 0.01) decreased systolic blood pressure (7.85%), DBP (2.29%), resting heart rate (7.95%), blood glucose (19.14%), total cholesterol (10.27%), triglycerides (6.92%) and FC—agility (4.24%), lower- (−12.75%) and upper-body strength (−12.17%), cardiorespiratory capacity (−4.81%) and lower- (−16.16%) and upper-body flexibility (−11.11%). Conclusion: Nine months of the exercise program significantly improved the hemodynamic and lipid profiles as well as the functional capacities of hypertensive older women with dyslipidemia. Although a detraining period is detrimental to these benefits, it seems that the first three months are more prominent in these alterations.

Onset and progression of chronic disease and disability in a large cohort of older Australian women

ObjectiveTo estimate the probability of onset and progression of disease and disability, length of life with or without disease and/or disability, and incidence of mortality, and to identify factors associated with transitioning to disease and/or disability over time. Study designA prospective cohort study. Data were provided by 12,432 participants (born 1921–26) of the Australian Longitudinal Study of Women's Health linked with National Death Index data from 1996 (age: 70–75) to 2016 (age: 90–95). Main outcome measuresA five-state Markov model was fitted to estimate the transition probability, length of life with or without disease and/or disability, and the association between baseline characteristics and disease/disability/mortality risk. ResultsOver two-thirds of women had died by age 90–95, and only 3.8% of these had died with no chronic disease and disability. Those reporting chronic disease were more likely to have experienced disability (Transition Rate Ratio: 2•72, 95%CI= 2•52–2•93) than those who died without disability. At age 70–75, the expected life without chronic disease and disability was 7•68 (95%CI: 7•52–7•80) years, life with chronic disease but no disability was 4•39 (95%CI=4•23–4•49) years, and life with disability was 3.76 (95%CI=3•66–3•92) years. The factors difficulties managing on available income (HR=1•18, 95%CI=1•02–1•38), did not complete secondary school (HR=1•19, 95%CI=1•03–1•37), and overweight/obese (HR=1•36, 95%CI=1•20–1•55) were associated with an increased risk of disability. ConclusionsOur findings provide important insights on the onset and progression of disease and disability in older women, underscoring the importance of addressing mid-/early old-life risk factors, managing chronic conditions, and delaying disability onset and progression through targeted intervention programs.

Older people's experiences of dignity and support with eating during hospital stays: analytical framework, policies and outcomes

AbstractThere is growing recognition of the importance of dignity and support with eating as markers of high-quality and older-person-centred hospital services. We use data on these markers from the national Adult Inpatient Survey for England to build up statistical evidence on older people's experiences. We find that poor and inconsistent experiences of being treated with dignity and respect, and of receiving support with eating, affect a substantial proportion of inpatients across the vast majority of acute hospital trusts. There has been remarkably little change over time, although small improvements provide some grounds for optimism relating to policy developments in the period following the Francis Inquiry. Amongst people over 65, the prevalence of inconsistent and poor experiences of dignity and support with eating was higher amongst the ‘oldest of the old’ (inpatients aged over 80), individuals who experience a long-standing limiting illness or disability, and women. The highest rates of prevalence were observed amongst disabled women over 80. Perceptions of inadequate nursing quantity and quality, and lack of choice of food, stand out from logistic regression analysis as having consistent, large associations with lack of support with eating. These factors provide potential policy levers since they are within the control of hospitals to a certain extent. In drawing lessons from our analysis for inspection, regulation and monitoring, we highlight the importance of inequalities analysis – including systematic disaggregation and separate identification of at risk sub-groups (e.g. older disabled women) – rather than relying on a ‘population average approach’.

Predicting Chronic Disease, Disability and Mortality in a Large Cohort of Older Australian Women: A Markov Multi-State Modelling Approach

Background: Many older people, particularly women, spend a substantial proportion of later life with chronic disease and/or disability. This study aimed to estimate the transition probability, length of life with or without disease and/or disability, and identify factors associated with transitioning to declining health states over time. Methods: Data were provided by 12,432 participants (born: 1921-26) of the Australian Longitudinal Study of Women’s Health linked with National Death Index data from 1996 (age: 70-75) to 2016 (age: 90-95). A five-state Markov model was fitted to estimate the transition probability, length of life with or without disease and/or disability, and the association between baseline characteristics and disease/disability/mortality risk. Findings: Over two-thirds of women died by age 90-95, with only 326 (3.8%) of these dying with no reported chronic disease and disability. Those reporting chronic disease were more likely to experience disability (Transition Rate Ratio: 2·72, 95%CI= 2·52-2·93) than die without disability. At age 70-75, the predicted length of life without disease and disability: 7·68 (CI: 7·52-7·80) years, life with chronic disease but no disability: 4·39 (CI=4·23-4·49) years, and life with disability: 3.76 (CI=3·66-3·92) years. Difficulties managing on available income (HR=1·18, 95%CI=1·02-1·38), did not completed secondary school (HR=1·19, 95%CI=1·03-1·37), and overweight/obese (HR=1·36, 95%CI=1·20-1·55) were associated with an increased risk of disability. Interpretation: Our findings provide important insights on the onset and progression of disease and disability in older women, underscoring the importance of addressing mid-/early old-life risk factors, managing chronic conditions, and delaying disability onset and progression through targeted intervention programs. Funding Information: Australian Research Council. Declaration of Interests: The authors have no conflicts. Ethics Approval Statement: The ethical approval was obtained from the Human Resources Ethics Committee of The University of Newcastle.

Physical activity is associated with functional capacity of older women with osteosarcopenic obesity: 24-month prospective study.

Physical activity (PA) could be effective in the prevention of functional disability in older women, especially for those with body composition abnormalities. The aim this study was to analyze the association of total PA and in different domains with physical function and functional capacity in older women with or without osteosarcopenic obesity (OSO), as well as to assess the risk of functional disability in osteosarcopenic obesity older women insufficiently active. The study included 152 Brazilian older women, aged 60 years and older. Body composition was measured by dual energy X-ray absorptiometry (DXA) and physical function by physical tests. Functional capacity and PA were self-reported. In older women without OSO, the practice of leisure-time exercise (β:-0.23; 95%CI -0.40 to -0.06) and total PA (β:-0.40; 95%CI -0.57 to -0.23) is inversely associated with dependence in ADL. In older women with OSO, the practice of leisure-time exercise was inversely associated with physical function (β:0.88; 95%CI 0.31-1.46) and functional capacity (β:-1.05; 95%CI 1.64 to -0.45), while total PA (β:-1.03; 95%CI -1.93 to -0.13) was inversely associated with functional capacity, independent of control variables. In addition, older women with OSO who remained insufficiently active in leisure-time exercise (HR:2.28; 95%CI 1.04-4.99) and locomotion (HR:2.62; 95%CI 1.28-5.36) domains presented risk for functional disability. PA is inversely associated with physical function and functional capacity in older women with or without OSO, and older women with OSO who are insufficiently active in leisure-time exercise and locomotion domains presented a higher risk for functional disability.

Exercise type and activities of daily living disability in older women: An 8-year population-based cohort study.

Exercise may reduce the risk of disability for activities of daily living (ADL), but the degree of associations between specific exercise types and such a risk remains unclear. This study aimed to examine the longitudinal associations between exercise types and the incidence of ADL disability in older women. This 8-year population-based prospective cohort study enrolled 1003 community-dwelling older Japanese women without ADL disability in the baseline surveys. In the baseline surveys, all participants were asked whether or not they participated in any of 16 exercise types through a face-to-face interview. ADL were assessed using a modified form of the Katz index that comprised five ADL tasks. ADL disability was defined as dependence in at least one ADL task during the 8-year follow-up period. Binary logistic regression analyses were applied to obtain adjusted odds ratios (ORs) and 95% confident intervals (CIs) for the incidence of ADL disability based on participation or non-participation in each exercise type. Activities of daily living disability was noted in 130 participants (13.0%) over the 8-year follow-up period. After adjustment for confounders and other exercise types, participation in dancing, compared to non-participation, was associated with a significantly lower OR (0.27; 95% CI: 0.09-0.75) for incident ADL disability. There were no significant associations between other exercise types and incident ADL disability. Dancing was significantly and independently associated with a lower incidence of ADL disability. Thus, dancing may solely contribute to a reduced risk of ADL disability in older women.

Association of Back Pain with All-Cause and Cause-Specific Mortality Among Older Women: a Cohort Study.

The impact of back pain on disability in older women is well-understood, but the influence of back pain on mortality is unclear. To examine whether back pain was associated with all-cause and cause-specific mortality in older women and mediation of this association by disability. Prospective cohort study. The Study of Osteoporotic Fractures. Women aged 65 or older. Our primary outcome, time to death, was assessed using all-cause and cause-specific adjusted Cox models. We used a four-category back pain exposure (no back pain, non-persistent, infrequent persistent, or frequent persistent back pain) that combined back pain frequency and persistence across baseline (1986-1988) and first follow-up (1989-1990) interviews. Disability measures (limitations of instrumental activities of daily living [IADL], slow chair stand time, and slow walking speed) from 1991 were considered a priori potential mediators. Of 8321 women (mean age 71.5, SD = 5.1), 4975 (56%) died over a median follow-up of 14.1years. A higher proportion of women with frequent persistent back pain died (65.8%) than those with no back pain (53.5%). In the fully adjusted model, women with frequent persistent back pain had higher hazard of all-cause (hazard ratio [HR] = 1.24 [95% CI, 1.11-1.39]), cardiovascular (HR = 1.34 [CI, 1.12-1.62]), and cancer (HR = 1.33, [CI 1.03-1.71]) mortality. No association with mortality was observed for other back pain categories. In mediation analyses, IADL limitations explained 47% of the effect of persistent frequent back pain on all-cause mortality, slow chair stand time, and walking speed, explained 27% and 24% (all significant, p < 0.001), respectively. Only white women were included. Frequent persistent back pain was associated with increased mortality in older women. Much of this association was mediated by disability.

Appendicular Muscle Mass is Lower in Late‐ Compared to Early‐perimenopausal Women

OBJECTIVEThe age‐related decline in skeletal muscle mass (i.e. sarcopenia) and bone mineral density (BMD; i.e. low bone mass, osteoporosis) contribute to physical disability in older women. Although menopause‐related loss of BMD is well documented, whether menopause influences muscle mass and sarcopenia is unclear. We determined the extent to which appendicular lean mass (ALM) and BMD differ across the stages of menopause in healthy women.METHODS145 women (aged 30–70 years) classified as premenopausal (Pre; regular menstrual cycles; n=30, 38±6yrs; mean ± SD), early perimenopausal (Eperi; &gt; 2 cycles with cycle length changes of ≥7 days; n=31, 50±3yrs), late perimenopausal (Lperi; ≥2 but &lt;12 months of amenorrhea; n=30, 50±4yrs), early postmenopausal (Epost; ≤5 yrs since menopause; n=26, 55±3yrs), or late postmenopausal (Lpost; &gt;5 yrs since menopause; n=28, 62±4yrs) were enrolled. Dual‐energy x‐ray absorptiometry (DEXA) was used to assess ALM (kg/m2), BMD, total body lean mass, and fat mass.RESULTSALM was lower (p&lt;0.05) in Lperi and Lpost compared to Eperi with no significant differences between other groups (Pre, 6.6±0.6; Eperi, 6.8±0.8; Lperi, 6.1±0.8; Epost, 6.5±1.1; and Lpost, 6.2±0.9 kg/m2). The prevalence of sarcopenia (ALM ≤5.67 kg/m2) was 7, 3, 30, 27, and 32% in Pre, Eperi, Lperi, Epost, and Lpost, respectively. BMD tends to be lower (p=0.05, both) in Lperi and Epost compared to Eperi, and was lower (p&lt;0.05) in Lpost compared to Eperi (Pre, 1.108±0.100; Eperi, 1.164±0.104; Lperi, 1.092±0.100; Epost, 1.088±0.107; and Lpost, 1.045±0.113 gm/cm2). There was a consistent increase in total fat mass and decrease in total lean mass from Pre to each subsequent stage (both, p&lt;0.05 for Pre vs. Lpost).CONCLUSIONIn addition to the menopause‐related decline in bone mass, the menopause transition appears to be a vulnerable period for the loss of skeletal muscle mass that may begin during the late perimenopausal transition. Potential mechanisms underlying menopause‐related loss of muscle mass such as estrogen receptor signaling and protein metabolism should be explored in future studies.Support or Funding InformationNIH R01AG049762, R01AG027678, R56HL114073, P30DK048520, P50HD073063, NCATS Colorado CTSA UL1TR001082, and Eastern Colorado VA GRECCThis abstract is from the Experimental Biology 2018 Meeting. There is no full text article associated with this abstract published in The FASEB Journal.

36-Item Short Form Survey (SF-36) Versus Gait Speed As Predictor of Preclinical Mobility Disability in Older Women: The Women's Health Initiative.

To compare the value of clinically measured gait speed with that of the self-reported Medical Outcomes Study 36-item Short-Form Survey Physical Function Index (SF-36 PF) in predicting future preclinical mobility disability (PCMD) in older women. Prospective cohort study. Forty clinical centers in the United States. Women aged 65 to 79 enrolled in the Women's Health Initiative Clinical Trials with gait speed and SF-36 assessed at baseline (1993-1998) and follow-up Years 1, 3, and 6 (N = 3,587). Women were categorized as nondecliners or decliners based on changes (from baseline to Year 1) in gait speed and SF-36 PF scores. Logistic regression models were used to estimate incident PCMD (gait speed <1.0 m/s) at Years 3 and 6. Area under the receiver operating characteristic curve (AUC) was used to compare the predictive value of SF-36 PF with that of measured gait speed. Slower baseline gait speed and lower SF-36 PF scores were associated with higher adjusted odds of PCMD at Years 3 and 6 (all P < .001). For gait speed, decliners were 2.59 times as likely to have developed PCMD as nondecliners by Year 3 and 2.35 times as likely by Year 6. Likewise, for SF-36, decliners were 1.42 times as likely to have developed PCMD by Year 3 and 1.49 times as likely by Year 6. Baseline gait speed (AUC = 0.713) was nonsignificantly better than SF-36 (AUC = 0.705) at predicting PCMD over 6 years (P = .21); including measures at a second time point significantly improved model discrimination for predicting PCMD (all P < .001). Gait speed identified PCMD risk in older women better than the SF-36 PF did, although the results may be limited given that gait speed served as a predictor and to define the PCMD outcome. Nonetheless, monitoring trajectories of change in mobility are better predictors of future mobility disability than single measures.

The influence of physical activity and sedentary behavior on living to age 85 years without disease and disability in older women

The influence of physical activity and sedentary behavior on living to age 85 years without disease and disability in older women

The Influence of Physical Activity and Sedentary Behavior on Living to Age 85 Years Without Disease and Disability in Older Women.

Whether physical activity (PA) and sedentary behavior influence the odds of women living to age 85 years without chronic disease or disability is not well described. Participants of the Women's Health Initiative (n = 49,612) were categorized based on health status by age 85 years: (i) lived without developing major chronic disease or mobility disability ("healthy"); (ii) lived and developed mobility disability with or without disease; (iii) lived and developed major chronic disease, but not mobility disability; and (iv) died before their 85th birth year. Multinomial logistic regression models that adjusted for covariates such as age, race/ethnicity, and body size estimated associations of self-reported PA and sitting time on developing major disease or mobility disability or dying before age 85 relative to being healthy. Mean ± SD baseline age was 70.2 ± 3.6 years. Distributions were: 22% healthy, 23% had mobility disability, 26% had major disease, and 29% died. Relative to those with high total PA, the adjusted odds ratios (OR) (confidence intervals [CI]) for mobility disability was 1.6 (1.4-1.7), 1.2 (1.1-1.3), and 1.1 (1.0-1.2) for women with no, low, and moderate total PA, respectively (p-trend < .001). The corresponding covariate-adjusted OR (CI) for mortality was 1.7 (1.5-1.8), 1.2 (1.1-1.3), and 1.0 (1.0-1.1) (p-trend < .001). Total PA was not associated with developing chronic disease before age 85 years. Sitting ≥10 relative to <5 hours per day increased the odds of mobility disability (1.1, CI: 1.0-1.3) and mortality (1.2, CI: 1.0-1.3) prior to age 85 years (p < .001). Increasing PA to recommended levels and reducing sitting time are modifiable behaviors that may improve healthy aging in older women.

Handgrip strength is associated with, but poorly predicts, disability in older women with acute low back pain: A 12-month follow-up study

BackgroundOlder women with low back pain (LBP) constitute a special subpopulation at risk of severe and permanent disability. It is important to identify factors limiting functionality in this population in order to reduce costs and improve both prevention and intervention. Handgrip strength (HGS) is a biomarker of aging associated with several adverse health outcomes, but long-term associations with disability in older patients with LBP are not known. ObjectiveTo examine whether HGS predicts disability in older women with acute low back pain (LBP). MethodsLongitudinal analyses were conducted with a sample of 135 older women from the international multicenter study Back Complaints in the Elders (BACE-Brazil). Women aged 60 years and over with a new episode of acute LBP were included. HGS was assessed with Jamar® dynamometer, and disability was assessed using the Roland Morris questionnaire and gait speed test. Variables were assessed at baseline and at 12-month follow-up. Linear regression models explored associations between HGS and disability measures. ResultsSignificant association was found between HGS at baseline and gait speed at 12-month follow-up (r=−0.24; p=0.004). A multivariable-adjusted model showed that this association was independent of age, body mass index, and pain intensity (adjusted R2=0.13; p<0.001). A final prediction model showed an incremental difference of only 2.1% in gait speed after inclusion of HGS as an independent variable. No association was found between HGS and score on the Roland Morris questionnaire. ConclusionCaution is needed regarding the use of HGS as a predictive measure of disability in older women with acute LBP. Changes in gait speed were very small and unlikely to be of clinical relevance.

The Relationship Between Urinary Incontinence, Mobility Limitations, and Disability in Older Women.

To describe current understanding and the relationship between urinary incontinence (UI), mobility limitations, and disability in older women with pelvic floor disorders. UI is a prevalent pelvic floor disorder in older women and is considered to be one of the most common geriatric problems. There is no clear classification of UI as a disease versus UI as a geriatric syndrome in the current literature. Since the disability is also prevalent in older women, an evaluation of the relationship between UI and disability, may improve ourunderstanding of UI as a disease or a geriatric syndrome. This relationship may be classified through different pathways. Some evidence suggests that mobility disabilities and UI in older women may have bidirectional pathophysiologic mechanisms through generalized muscle dysfunction. Expanding research on the mechanisms of UI, mobility limitations, and disability in older women as well as their associations will enhance our insight into clinical, pharmacological, environmental, behavioral, and rehabilitative interventions. It will also lead to improved measures for prevention and treatment UI in older women. Thus, understanding UI, mobility limitations, and disability can have substantial implications for both clinical work and research in this area.

A Comparison of Upper Body Strength and Body Composition Between Elderly from Costa Rica and Kansas

An increased lifespan and body adiposity as people age are considered risks factors for all-cause mortality. Handgrip strength is a considered a powerful predictor of cause-specific and total mortality in older disabled women and to cardiometabolic risk in aging populations. Ethnic-specific heterogeneity of risk factors calls for comparative studies to better understand competent prevention and management, which might be one of the essential steps toward elimination of ethnic disparities for several diseases. PURPOSE: To compare the upper body strength and body composition in elderly from Costa Rica (CR) and Kansas (KS). METHODS: Older adults from CR (men = 26, women = 52, mean age = 68.91 ± 4.79 yr.) and KS (men = 35, women = 65, mean age = 72.84 ± 5.59 yr.), underwent handgrip strength and body composition measurements (dual-energy X-ray absorptiometry). RESULTS: Men (31.24 ± 7.02 %) had lower %BF than women (41.28 ± 5.87 %; p ≤ 0.001). Women (15.0 ± 1.7 kg/m2) had lower lean tissue mass index than men (18.0 ± 1.7 kg/m2; p ≤ 0.001). Women (6.2 ± 0.8 kg/m2) had lower appendicular lean soft tissue index than men (8.1 ± 1.0 kg/m2; p ≤ 0.001). KS participants (1.16 ± 0.11 g/cm2) had higher total bone mineral density than CR participants (1.08 ± 0.11 g/cm2; p ≤ 0.001), and men (1.21 ± 0.11 g/cm2) had higher total bone mineral density than women (1.08 ± 0.09 g/cm2; p ≤ 0.001). Significant correlations (p ≤ 0.003 for all) were obtained between handgrip strength and body height (r = 0.72), body weight (r = 0.56), arms bone mineral density (r = 0.67), total bone mineral density (r = 0.56), lean arms mass (r = 0.78), total lean mass (r = 0.81), body fat% (r = -0.48), body fat mass index (r = -0.22), lean tissue mass index (r = 0.59), and appendicular lean soft tissue index (r = 0.69). CONCLUSIONS: Differences in body composition and handgrip strength were found in older adults from CR and KS. Ethnic-specific heterogeneity on biologic factors and physical-related performance allows for culturally diverse prevention programs for the elderly.

Perioperative Management of Older Women in Urogynecologic Surgery

Preoperative measurements of frailty and mobility predict surgical outcomes in older patients better than measurements of medical comorbidities or American Society of Anesthesiologists (ASA) status alone. The purpose of this review is to summarize updated evidence for optimal preoperative assessment, perioperative management, and postoperative care for elective gynecologic surgery in older women. Two joint best-practice guideline statements from the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) and the American Geriatrics Society (AGS) focus on preoperative (2012) and perioperative care (2016) of the geriatric patient. Preoperative identification of frailty, cognitive impairment, and functional disability in older women may be an important way to improve outcomes. Preoperative identification has the potential to allow surgeons to better counsel patients about unique postoperative risks, tailor the aggressiveness of the surgical approach, and facilitate shared decision-making. Finally, preoperative identification can help identify patients who need extra support at hospital discharge with transitions of care. Future research is necessary to assess the impact of preoperative geriatric screening for frailty, cognitive impairment, and mobility disorders with treatment success and postoperative outcomes in older women undergoing surgical correction of pelvic floor disorders (PFDs) and other elective gynecologic procedures.

Comparações entre índices de adiposidade corporal e pontos de corte na predição de incapacidade funcional em mulheres idosas

DOI: http://dx.doi.org/10.5007/1980-0037.2016v18n4p381 The aim of this study was to compare body adiposity indexes and to identify cutoff values in the prediction of disability in older women. Eighty-seven voluntees (67.27±6.45 years) underwent body composition assessment using dual-energy X-ray absorptiometry (DXA) and had five anthropometric indexes measured (Waist Circumference, WC; Waist-to-Height Ratio, WHtR; Body Mass Index, BMI; Body Adiposity Index, BAI; and conicity index). Functionality was assessed from three Senior Fitness Test Battery protocols: 30-second chair stand, 8-foot up-and-go, and 6-minute walk. Pearson’s correlation was conducted to identify the relationship between body adiposity indexes and functionality results. Cutoff values to predict disability were obtained from ROC curves and odds ratio were calculated for the same outcome. Disability prevalence was 36.8%. Scores in the 30-second chair stand, 8-foot up-and-go, and 6-minute walk tests showed stronger associations with WC (r=-0.345; p&lt;0.01), WHtR (r=-0.417; p&lt;0.01) and BAI (r=0.296; p&lt;0.01), respectively. The cutoff values identified were 89.5cm, 39.2%, 26.93kg/m2, 34.6%, 0.51cm and 1.23 for WC, DXA-derived body fat percentage, BMI, BAI, WHtR and conicity index, respectively. WC showed greater odds ratio for disability outcome (odds ratio: 3.16; CI: 1.3–7.8). WC showed strong relationship with functional tests and its cutoff values exhibited predicting skill for disability in older women.

Adiposity Indexes Comparisons And Cut-off Values In The Prediction Of Disability In Older Women

PURPOSE: To compare adiposity indexes and propose its cut-off values in the prediction of disability in older women. METHODS: 87 volunteers (67.27 ± 6.45 years) took part in this cross-sectional study, who underwent functional tests, body composition assessment using DXA, and had 5 anthropometric indexes measured (Waist Circumference - WC, Waist-to-Height Ratio - WHtR, Body Mass Index - BMI, Body Adiposity Index - BAI, and Conicity Index - C index). Senior fitness test battery was performed to evaluate functionality, consisting of 30-s chair stand, 8-foot up-and-go, and 6-minute walk. Disability was determined as at least two from three performance scores below reference values. Pearson´s correlation was conducted to identify relationship between variables. Cut-off values to predict disability were obtained from Receiver´s Operating Characteristic (ROC) curves considering its sensibility and specificity. Area under the ROC curve and confidence intervals were used to compare the predictive ability of each adiposity index. Moreover, odds ratio for each adiposity index were calculated for disability outcome. RESULTS: Disability prevalence was 36.8%. Senior fitness test battery scores showed stronger associations with WC (r=-0.345; p<0.01), WHtR (r=-0.417; p<0.01), and BAI (r=0.296; p<0.01). The cut-off values for each adiposity index were 89.5cm, 39.2%, 26.93kg/m2, 34.6%, 0.51cm, and 1.23, for WC, DXA-derived body fat percentage, BMI, BAI, WHtR, and C index, respectively. Significant greater risks for disability outcome were found for volunteers who had WHtR (7.75; CI: 1.0 - 63.2; p=0.05) or WC (3.16; 1.3 - 7.8; p<0.01) measurements above cut-off values. None of the remaining adiposity measurements predicted disability risks. CONCLUSIONS: Adiposity indexes considering abdominal fat (WC and WHtR) had stronger relationship with functional performance and its cut-off values exhibited predicative skill for disability in older women, in spite of gold standard body composition evaluation using DXA. Easy and low cost implementation of these measurements suggests potential practical applications.

Frailty, Cognitive Impairment, and Functional Disability in Older Women With Female Pelvic Floor Dysfunction

Frailty is common in the elderly. It is characterized by increased vulnerability to stressors such as extreme heat or cold, falls, infection, and surgery. There are no consistent definitions of frailty, and different inclusion and exclusion criteria have been used. A large proportion of elderly develop the frailty syndrome, which is predictive for a constellation of adverse outcomes in community-dwelling individuals, including long-term nursing home stay, injurious falls, and death. It is becoming increasingly clear that frailty is also an important predictor of adverse surgical outcomes in elderly patients undergoing major procedures requiring admission to intensive care units. In addition to routine assessment prior to surgery, both the American College of Surgeons and the American Geriatrics Society have recommended that older patients be evaluated for frailty, cognitive ability, and functional status. Since the onset of female pelvic floor dysfunction (PFD) symptoms in women is age related, a high prevalence of frailty in elderly women seeking treatment for PFD could impact the risks and benefits of different treatment options. The primary aim of this prospective cross-sectional study was to determine the prevalence of frailty, cognitive impairment, and functional disability among older women seeking treatment for PFD. Community-dwelling older women, 65 years or older, were enrolled at the conclusion of their new patient consultation for PFD at a tertiary center between September 2011 and September 2012. Comprehensive geriatric screening was performed as follows: frailty was assessed using the Fried Frailty Index; cognitive screening was performed using the Saint Louis University Mental Status examination, and functional status for activities of daily living (ADLs) was evaluated according to Katz’s classification (Katz ADL score). The Fried Frailty Index score categorized 17% (n/N = 25/150) of women as frail. After adjusting the data for education level, 21.3% of women (n/N = 32/150) screened positive for dementia, and 30.7% (46/150) reported functional difficulty or dependence in performing at least 1 Katz ADL. At the conclusion of the new patient visit with a physician, 46% (64/150) of the women in the study chose surgical options for treatment of their PFD. These findings demonstrate that frailty, cognitive impairment, and functional disability are prevalent among older women seeking treatment for PFD.