Functional Decline In Older Adults Research Articles

High eosinophil counts predict decline in FEV1: results from the CanCOLD study.

The aim of this study was to examine the association between blood eosinophil levels and the decline in lung function in individuals aged >40 years from the general population. The study evaluated the eosinophil counts from thawed blood in 1120 participants (mean age 65 years) from the prospective population-based Canadian Cohort of Obstructive Lung Disease (CanCOLD) study. Participants answered interviewer-administered respiratory questionnaires and performed pre-/post-bronchodilator spirometric tests at 18-month intervals; computed tomography (CT) imaging was performed at baseline. Statistical analyses to describe the relationship between eosinophil levels and decline in forced expiratory volume in 1 s (FEV1) were performed using random mixed-effects regression models with adjustments for demographics, smoking, baseline FEV1, ever-asthma and history of exacerbations in the previous 12 months. CT measurements were compared between eosinophil subgroups using ANOVA. Participants who had a peripheral eosinophil count of ≥300 cells·µL-1 (n=273) had a greater decline in FEV1 compared with those with eosinophil counts of <150 cells·µL-1 (n=430; p=0.003) (reference group) and 150-<300 cells·µL-1 (n=417; p=0.003). The absolute change in FEV1 was -32.99 mL·year-1 for participants with eosinophil counts <150 cells·µL-1; -38.78 mL·year-1 for those with 150-<300 cells·µL-1 and -67.30 mL·year-1 for participants with ≥300 cells·µL-1. In COPD, higher eosinophil count was associated with quantitative CT measurements reflecting both small and large airway abnormalities. A blood eosinophil count of ≥300 cells·µL-1 is an independent risk factor for accelerated lung function decline in older adults and is related to undetected structural airway abnormalities.

Visit‐to‐visit blood pressure variability is associated with functional decline in older adults: The S.AGES cohort

AbstractBackgroundVisit‐to‐visit blood pressure variability (BPV) has been increasingly recognized as a predictor of cardiovascular events, all‐cause mortality and more recently of cognitive decline and dementia. All these associations may be mediated by vascular damage which is a determinant of functional decline in older adults. We aimed to investigate the impact of visit‐to‐visit systolic, diastolic, mean arterial pressure and pulse pressure variability on functional decline in non‐institutionalized patients aged ≥ 65 years.Method3042 subjects from the S.AGES (elderly subjects) cohort underwent clinical examinations every 6 months during 3 years. Systolic, diastolic, mean arterial pressure and pulse pressure variability were evaluated using standard deviation, coefficient of variation, average real variability, successive variation, variation independent of mean and residual standard deviation. Functional decline was assessed using the Activities of Daily Living (ADL) and Instrumental Activities of Daily Living (IADL) scales and defined over time as any help required to perform at least one task. Cox proportional hazards models were used for the analyses.ResultAmong the 3042 subjects, 527 (17.3%) had functional decline (ADL) over time. After adjustment for demographics, systolic blood pressure, antihypertensive drugs, coronary artery disease, diabetes mellitus, chronic heart failure, atrial fibrillation, transient ischemic attack or stroke, smoking, dyslipidemia and Mini Mental State Examination at baseline, higher systolic blood pressure variability was associated with greater risk of functional decline (ADL) (adjusted HR per 1‐SD increase of coefficient of variation = 1.12, 95% CI [1.03‐1.22], p&lt;0.01). Similar results were observed for diastolic blood pressure variability (adjusted HR = 1.11, 95% CI [1.01‐1.22], p=0.03) and mean arterial pressure variability (adjusted HR = 1.15, 95% CI 1.05‐1.25, p&lt;0.01). Higher pulse pressure variability was no longer significantly associated with functional decline after adjustment for age (p=0.6). Similar patterns were found with all indicators of variability and loss of autonomy defined using IADL.ConclusionHigher blood pressure variability could be a novel risk factor for functional decline and controlling blood pressure instability a promising interventional target in preserving autonomy in older adults.

Supporting caregivers to increase confidence can delay functional decline in older adults

AbstractBackgroundInformal caregivers of Alzheimer’s disease and other dementia (ADOD) have higher burden compared to caregivers of other illnesses, and caregivers’ well‐being affects their care recipients (CR). We hypothesized that with tangible support for caregivers' challenges related to daily activities, CR’s functional levels in the intervention group will be maintained while that in the control group will be declined.MethodThis randomized controlled trial involved a 3‐month intervention taking place in Caregiver's homes. Participants (21 intervention and 15 control) were caregivers of community‐dwelling older adults with ADOD who are members of the Programs of All‐inclusive Care for the Elderly (PACE). Challenges were described by caregivers, and solutions were derived from literature reviews, experiences and brain storming among geriatric occupational theorists, and delivered after a discussion with caregivers. Outcome measures were CR’s Activities of Daily Living (ADLs) and Instrumental ADLs, and caregivers’ burden, depression, physical fatigue, and confidence to continue care. T‐tests compared these group differences at baseline and 3 months due to much lower cognition of CR in the intervention group. All scores for the intervention group was much worse than those of the control group.ResultThe intervention group improved in confidence, depression, and physical fatigue, in contrast to the control group’s decline in all these measures. At baseline, CR’s functional levels of the intervention groups were much lower than those of the control group, and both groups declined further over 3 months. However, the decline of care recipients of the control group was much larger: 2.8 times for ADLs and 5.3 times for IADLs more than the intervention group.ConclusionEffective tangible support including working with caregivers to organize life and make schedules, training for transfer of CRs, use of a gait belt, and effective a communication method, and reviewing educational material with them improved their confidence, resulting in delaying CR's function decline. Even with CR's very low cognition, this type of support was effective to improve informal caregivers' confidence for continued care; therefore, we have to find a way to translate exiting knowledge of ADOD care to a practical support system.

Long-Term Functional Decline in Older Adults That Survived 6 Months after Major Surgery

Long-Term Functional Decline in Older Adults That Survived 6 Months after Major Surgery

Kynurenines link chronic inflammation to functional decline and physical frailty.

Chronic inflammation is associated with physical frailty and functional decline in older adults; however, the molecular mechanisms of this linkage are not understood. A mouse model of chronic inflammation showed reduced motor function and partial denervation at the neuromuscular junction. Metabolomic profiling of these mice and further validation in frail human subjects showed significant dysregulation in the tryptophan degradation pathway, including decreased tryptophan and serotonin, and increased levels of some neurotoxic kynurenines. In humans, kynurenine strongly correlated with age, frailty status, TNF-αR1 and IL-6, weaker grip strength, and slower walking speed. To study the effects of elevated neurotoxic kynurenines on motor neuronal cell viability and axonal degeneration, we used motor neuronal cells treated with 3-hydroxykynurenine and quinolinic acid and observed neurite degeneration in a dose-dependent manner and potentiation of toxicity between 3-hydroxykynurenine and quinolinic acid. These results suggest that kynurenines mediate neuromuscular dysfunction associated with chronic inflammation and aging.

Plasma Ceramides and Risk of Impaired Lower-Extremity Function in Older Adults: A Nested Case-Control Study.

Higher levels of ceramides have been linked to several chronic diseases; also there is emerging cross-sectional evidence that ceramides are associated with lower physical functioning. This research assessed for the first time the prospective relationship between ceramide species and impaired lower-extremity function (ILEF) in older adults. Case-control study with 43 cases of ILEF and 86 age- and sex-matched controls, which was nested in the Seniors-ENRICA cohort of community-dwelling older adults. Incident ILEF from 2015 to 2017 was ascertained with the Short Physical Performance Battery. In 2015, 27 ceramide species were measured in plasma by liquid chromatography-tandem mass spectrometry. Conditional logistic regression models were used to assess the longitudinal relationship between ceramides concentration and incidence of ILEF. After adjusting for education level, body mass index, alcohol and total energy intake, physical activity, and presence of chronic conditions, some ceramide species were related to 2-year incidence of ILEF. Specifically, the odds ratios of ILEF per 1-SD increase in ceramide concentration were: 1.66 [95% CI = (1.03, 2.68)] for ceramide C14:0, 1.61 (1.00, 2.59) for ceramide C16:0, and 1.64 (1.03, 2.60) for ceramide C16:1 (n-7). In the case of ceramides C16:0 and C16:1 (n-7), a stronger relationship was found in those with a higher body mass index; systolic blood pressure could also mediate the relationship between ceramide C16:1 (n-7) and ILEF (p for interaction = .03). Higher plasma levels of ceramides C14:0, C16:0, and C16:1 (n-7) are associated with higher risk of ILEF, and might serve as risk markers for functional decline in older adults.

Serum biomarkers that predict lean mass loss over bed rest in older adults: An exploratory study

BackgroundLean mass (LM) loss during extended bed rest contributes to long term functional decline in older adults. Identifying blood biomarkers that predict a hospitalized individual’s risk of losing LM could allow for timely intervention. MethodsLM from 19 healthy subjects (age 60–76 y, 4 males, 15 females), who were confined to 10 days of complete bed rest, was measured pre- and post-bed rest. One hundred eighty-seven biomarkers from pre-bed rest fasted serum samples were obtained from all evaluable subjects (n = 18), analyzed using multiplexed immunoassay array and pooled. Decision tree analysis was used to identify pre-bed rest markers that predict LM loss over bed rest. ResultsSixty-three markers were excluded due to being below assay detection limits. One pair of markers, Tissue inhibitor of metalloprotease-1 (TIMP1) and tenascin C (TNC), were found to correlate with percent change in total LM over bed rest: [R2 = 0.71, all subjects; R2 = 0.76, females]. Subjects with pre-bed rest TIMP1 ≥ 141 ng/ml had the highest loss of total LM over bed rest, whereas subjects with pre-bed rest TIMP1 < 141 and TNC ≥ 461 ng/ml maintained total LM over bed rest. An additional marker set was found to correlate with percent change in leg LM loss over bed rest: matrix metalloprotease-3 (MMP3) and apolipoprotein A2 (APOA2) [R2 = 0.59, females]. Females with pre-bed rest MMP3 < 6.93 ng/ml had the highest loss of leg LM over bed rest. Whereas females with pre-bed rest MMP3 ≥ 6.93 and ApoA2 < 276 ng/ml, maintained leg lean mass at the end of bed rest. ConclusionsPanels of blood biomarkers associated with the muscle extracellular matrix may predict the likelihood for LM loss over extended bed rest.

Social vulnerability underlying disability amongst older adults: A systematic review.

Older adults face radical changes in their social life during ageing, dealing with several age-related social adaptations. The aim of this review is to systematically explore the literature on social vulnerability (SV) and its association with functional decline activity of daily living (ADL)/instrumental activities of daily living (IADL) as an endpoint in older adults. We searched for relevant studies in three different databases: PubMed, Ovid Medline and PsychInfo. Inclusion criteria included: prospective cohort studies assessing SV correlation; studies in English, Italian, French and Spanish to the end of March 2018; a general population aged >65years living in a community setting and/or studies including younger participants if the mean age was >65years; and basic ADL and/or IADL by Katz and Lawton, respectively, as functional decline and clinical outcomes. We identified 65 manuscripts that assessed the role of SV in functional decline. Our systematic analysis showed that 26, 36 and 19 studies observed a correlation between Basic Social Needs, Social Resources and Social Behaviour and Activity, respectively, and the onset of ADL/IADL functional decline. Twenty-six studies explored the correlation between General Social Resources and the onset of ADL/IADL functional decline. When examining a wide set of social variables, the "quality," rather than just structure, and "type" of social relationship represents the core feature of SV that predicts functional decline in older adults. By defining individual SV, its measurement and evaluation, we can plan effective social interventions aimed at preventing or delaying functional decline or death.

Adiposity is inversely associated with strength in older adults with type 2 diabetes mellitus.

Several biological mechanisms describing the pathway to mobility disability and functional decline in older adults with type 2 diabetes mellitus (T2DM) have been postulated, including skeletal muscle atrophy and the concurrent accumulation of fat mass. Therefore, we explored the association between adiposity, muscle strength and physical performance in community-dwelling older adults with T2DM. Adiposity was measured by waist circumference (WC) or body fat percentage (BF %) derived from dual-energy X-ray absorptiometry (DXA). The Short Physical Performance Battery (SPPB) and gait speed were used to evaluate lower extremity physical function. Muscle strength was assessed using hand-grip strength (HGS) or chair stands. Multiple regression analysis was used to examine the association between measures of adiposity, SPPB score, gait speed, HGS and chair stands adjusted for age, gender and total appendicular skeletal muscle (ASM). A total of n = 87 participants (71.2 ± 8.2years; BMI 29.5 ± 5.8kg/m2; BF % 37.8 ± 7.3%) were included in this cross-sectional analysis. Pearson's correlation coefficients revealed that BF% was negatively associated with hand-grip strength (r = -0.430; P < 0.001) and total ASM (r = -0.223; P = 0.03), but positively associated with increased time to compete chair stands (r = 0.366; P < 0.001). After adjusting for age, gender and total ASM, WC and BF% were inversely associated with HGS (WC: β = -0.385; P = 0.001; BF% β = -0.487; P < 0.001). Similarly, in the adjusted model, both WC and BF% were positively associated with increased time to complete chair stands (WC: β = 0.479; P < 0.001; BF% β = 0.415; P = 0.002). Adiposity, independent of the criteria used, was inversely associated with muscle strength, suggesting that adiposity negatively influences muscle quality in older adults with T2DM. Screening for poor muscle strength and quality has the potential to facilitate early exercise and dietary interventions aimed at preserving muscle function in older adults with T2DM.

Sleep Quality Associated With Motor Function Among Older Adult Survivors of Critical Illness.

Poor sleep is associated with worse motor function in older adults. Sleep may affect motor function specifically among older adults recovering from critical illness after transfer out of an intensive care unit (ICU). Describe motor function (grip strength) of older ICU survivors and explore relationships between sleep and ICU-acquired weakness in the early post-ICU transition period. We enrolled 30 older adults who were functionally independent prior to hospitalization, mechanically ventilated while in ICU, and within 24-48 hours post-ICU discharge. Handgrip dynamometry assessed post-ICU motor function (fully corrected T score on the National Institutes of Health Motor Battery Grip Strength Test). Actigraphy estimated post-ICU sleep duration (total sleep time [TST]) and fragmentation (wake after sleep onset) over two consecutive nights from 22:00 p.m. to 06:00 a.m.. We identified differences in grip strength by history of obstructive sleep apnea (OSA) using independent-samples t tests. We examined associations between sleep duration and grip strength using exploratory multivariate regression analyses, after adjustment for clinically relevant covariates. Grip strength among this cohort of older ICU survivors was almost 2 SDs below the norm for healthy older adults, indicating considerable ICU-acquired weakness. Grip strength was lower among subjects with history of OSA than those without OSA. Greater TST was associated with worse grip strength, after adjusting for history of OSA and Pittsburgh Sleep Quality Index global score. Moreover, among the subset of male subjects (n = 19), greater TST was significantly and negatively associated with grip strength, after adjusting for Acute Physiology, Age, and Chronic Health Evaluation III score, and Pittsburgh Sleep Quality Index global score. Sleep promotion may be a potentially modifiable risk factor to mitigate ICU-acquired weakness in older ICU survivors. We propose that improving sleep throughout recovery from critical illness may indirectly promote better outcomes, as poor grip strength is linked to longer length of hospital stay, higher acuity of discharge disposition, and worsened functional decline in older adults.

Rate of Force Development as a Predictor of Mobility in Community-dwelling Older Adults.

Rate of force development (RFD) is influential, and possibly more influential than other muscular performance parameters, for mobility in older adults. However, only a few studies have investigated this matter, and this has not been examined for the plantar flexors (PFs). The purpose of this study was to examine the contribution of PF RFD and other common tests of muscular performance to Up-and-Go (UG) performance and walking speed (WS) in older adults. Twenty-six (19 females) healthy, community-dwelling older adults (73.7 ± 4.9 years) were recruited from a senior citizen center for this observational study. Handgrip strength, UG performance, as well as preferred and maximal WS were obtained. Time taken to complete 5-chair rises and the number of chair rises completed in 30 seconds were recorded. Rate of force development of the PFs was obtained during a rapid, bilateral calf raise performed on a force plate. Hierarchical multiple linear regression was used to identify significant predictors, after adjusting for physical activity level and body mass index, of mobility (ie, UG, preferred and maximal WS). No muscular performance variables correlated with preferred WS. Rate of force development (adjusted R2 = 0.356; P = .008) and handgrip strength (adjusted R2 = 0.293; P = .026) were the only predictors of maximal WS and accounted for a 21.7% and 16.1% change in R2, respectively, after accounting for physical activity level and body mass index. Rate of force development was the only predictor of UG performance (adjusted R2 = 0.212; P = .006) and accounted for a 29.2% change in R2 after adjustment variables were applied. Compared to common assessments of muscular performance, such as handgrip strength and chair rise performance, PF RFD was a greater predictor of mobility in older adults. These findings, in conjunction with recent reports, indicate that the assessment of RFD likely complements strength testing, thereby enabling a more robust assessment of functional decline in older adults.

Cognitive reserve predicts future executive function decline in older adults with Alzheimer's disease pathology but not age-associated pathology

Cognitive reserve has been described as offering protection against Alzheimer's disease (AD) and other neurodegenerative conditions, but also against age-associated brain changes. Using data from the Alzheimer's Disease Neuroimaging Initiative, we defined cognitive reserve using the residual reserve index: episodic memory performance residualized for 3T MRI-derived brain volumes and demographics. We examined whether cognitive reserve predicted executive function (EF) decline equally across 2 groups of older adults—AD biomarker–positive (n = 468) and –negative (n = 402)—defined by the tau-to-amyloid ratio in cerebrospinal fluid. A significant interaction between the residual reserve index and biomarker group revealed that the effect of cognitive reserve on EF decline was dependent on pathology status. In the biomarker-positive group, higher cognitive reserve predicted EF decline over five years. However, cognitive reserve did not predict EF decline in the biomarker-negative group. These results suggest a certain level of AD pathology may be needed before cognitive reserve exerts its protective effects on future cognition; however, further research that tracks cognitive reserve longitudinally is needed.

120 Communicating Medication-Related Fall Risk via a Patient Portal: What is Important According to Older Fallers in Europe?

Abstract Background Falls are the leading cause of injury and functional decline in older adults. Medication is a leading cause of falls, second only to mobility impairments. Older adults with Fall Risk Increasing Drug (FRID) use are not aware of having a risk of falling and most of them don’t relate fall risk to their drug use. With this European survey we explored if: 1) older adults want to know their personal fall risk, 2) if they want this to be shown via a patient portal, 3) what other elements a patient portal should contain and 4) what potential barriers and facilitators exist for usage of a patient portal. Methods We distributed a questionnaire in 10 European countries that was filled in by 58 older fallers (mean age 75,5 years) who visited a geriatric outpatient clinic. Results Most participants wanted to know their fall risk (82,8%). The most important elements for the Portal, besides fall risk, were information on FRIDs and patient’s illnesses (62%) and access to the medical record (57%). Paying for the system (63%) and privacy issues (53%) were the most important barriers for using the Portal. A user-friendly Portal (57%), the ability to share information with the doctor (47%) and recommendation by doctors (47%) were the most important facilitators. Conclusion More knowledge dissemination is needed to make older fallers aware of medications that can cause falls. This can be done via a Patient Portal. For a successful implementation, the barriers and facilitators should be taken into account.

ALTERED TRYPTOPHAN DEGRADATION LINKS CHRONIC INFLAMMATION TO FUNCTIONAL DECLINE &amp; FRAILTY IN MICE AND HUMANS

Chronic inflammation is associated with frailty and functional decline in older adults but the molecular mechanisms of this linkage are not well understood. We sought to examine metabolic and physiologic states associated with aging and frailty by analyzing the composition of metabolites in the blood of a population of community dwelling young, and older adults. Serum inflammatory cytokines and demographic and physiological covariates were collected in a set of community-dwelling adults age 20-97 (n=166). We then used LC/MS technology to profile 121 metabolites from five substance classes. Associations of the cytokines and metabolites with grip strength, walking speed, falls and outcomes were assessed in young, robust, pre-frail and frail participants. Age and frailty status positively correlated with IL6, TNFα, TNFαR1, IL1β (p<0.0001). Analysis of metabolites revealed significant alterations in tryptophan degradation pathway with aging and frailty. Among the top metabolites to correlate with age and frailty status were kynurenine (p<0.0001) and the kynurenine/tryptophan ratio (p<0.0001). The kynurenine/tryptophan ratio also tightly correlated with serum inflammatory cytokines TNFαR1 (p<0.0001) and IL-6 (p<0.0001). Higher kynurenine/tryptophan levels were associated with weaker grip strength and slower walking speed, even after adjusting for age, gender, BMI and blood pressure. Further dissection of the pathway revealed the accumulation of 3-hydroxykynurenine, a cytotoxic and neurotoxic intermediate from the kynurenine pathway, with frailty. The increased levels of cytotoxic and neurotoxic molecules in this pathway may in part explain the link between inflammation and cognitive and physical decline in frailty.

Association of Seropositivity to Borrelia burgdorferi With the Risk of Neuropsychiatric Disorders and Functional Decline in Older Adults

Exposure to Borrelia burgdorferi (Bb) has been reported to be associated with certain neuropsychiatric disorders. To establish the association between seropositivity to Bb and incidental neuropsychiatric disorders (eg, cognitive decline, incident dementia, and depressive symptoms) as well as functional decline. This prospective, 6-year follow-up cohort study was conducted in a rural southwestern region of France and included 689 retired farmers 65 years or older randomly recruited from the Farmer Health Insurance System who agreed to submit a blood sample and were participants in the Aging Multidisciplinary Investigation study, an ongoing epidemiological prospective study of aging initiated in 2007. The data were analyzed from April to May 2019. Borrelia burgdorferi serology testing was performed in a 2-tiered approach. During the follow-up period, cognitive decline, incident dementia, depressive symptoms, and functional decline were repeatedly assessed. Diagnosis of dementia relied on a 3-step procedure; cognitive decline was determined using the Mini-Mental State Examination and depressive symptomatology was assessed using the Center for Epidemiologic Studies Depression scale. For disability, scores on instrumental and basic activities of daily living were investigated. Of 689 participants, 432 (62.2%) were men and the mean (SD) age was 75.8 (6.4) years. The seroprevalence rate of Bb was 6.5%. At baseline, compared with Bb- participants, those who were Bb+ were older, predominantly men, and had lower depressive symptoms. No association between seropositivity and any of the studied outcomes (ie, cognitive decline, depressive symptoms, or functional decline) was found in the crude analysis and after adjusting for confounding variables. Regarding incident dementia, no increased risk was found among Bb+ participants (hazard ratio, 0.42; 95% CI, 0.1-1.17; adjusted for diverse confounders). To our knowledge, this is one of the few longitudinal studies exploring the risk of neuropsychiatric disorders and functional decline associated with exposure to Bb. Despite its limitations (eg, a lack of information if clinical manifestations of Lyme borreliosis existed, date of exposure, or treatment received), this study suggests that seropositivity to Bb is not a risk factor for incidental neuropsychiatric disorders and functional decline.

Self-reported Physical Function Decline and Mortality in Older Adults Receiving Hemodialysis

Rationale & ObjectiveTimely recognition of functional decline in older adults receiving dialysis will allow clinicians to pursue interventions to prevent further disability and/or lead patient-centered goals of care discussions. Annual change in the 12-Item Short Form Health Survey (SF-12) physical component score (PCS) could identify patients with functional decline. Our objectives were to assess SF-12 PCS change over a year, risk factors associated with SF-12 PCS change, and the association of SF-12 PCS change with mortality in a survivor cohort of older adults receiving dialysis.Study DesignRetrospective study.Setting & Participants1,371 adults 65 years or older receiving hemodialysis for 6 or more months who completed SF-12 PCSs 300 or more days apart from 2012 to 2013.ExposuresSerum albumin level; hemodialysis access type; SF-12 PCS change (for mortality analyses).OutcomesSF-12 PCS change and mortality.Analytical ApproachMultivariable-adjusted linear regression model; Cox proportional hazards model.ResultsWe excluded 24% (n = 801) of our cohort for death before the second SF-12 PCS. Among the 1,371 with sufficient SF-12 PCS data, mean age was 79.9 ± 4.5 years. Average SF-12 PCS change in 1 year was minimal (−0.9 ± 9.6), but 39.3% (n = 539) and 32.2% (n = 442) had clinically relevant SF-12 PCS decline and improvement, respectively. Albumin level and access type were not statistically associated with SF-12 PCS change. SF-12 PCS change was not associated with mortality (adjusted HR, 0.98; 95% CI, 0.96-1.00).Limitations2 time points to assess SF-12 PCS change; covariate assessment only at baseline; survivor bias.ConclusionsIn this cohort of older adults receiving hemodialysis, nearly one-fourth died, while among survivors, it was more common for SF-12 PCS to decline than improve in a year. Annual SF-12 PCS change was not associated with traditional risk factors for functional impairment or mortality risk. Additional research is needed to identify appropriate measures and frequency of assessment for functional decline.

A laboratory-based algorithm to predict future kidney function decline in older adults with reduced estimated glomerular filtration rate

Reduced estimated glomerular filtration rate (eGFR) in older adults is common and may reflect normal aging or significant kidney disease. Our objective was to develop a predictive model to better triage these individuals using routine laboratory data. Using a large US laboratory data set, we calculated individual eGFR regression slopes for 43,523 individuals aged 60-75 years with baseline eGFRs between 30 and 59 mL/min/1.73m2. We developed general linear models to predict the eGFR regression slope using urine protein measurements and other routinely available laboratory data as dependent variables. We validated these models on a similar data set comprised of 11,979 individuals. In a model utilizing log10 urine albumin/creatinine (UACR), the variables that significantly predicted the eGFR regression slope were log10 UACR, initial eGFR, serum albumin, chloride, glucose, and aspartate aminotransferase (AST). In an otherwise identical model substituting log10 urine protein/creatinine (UPCR) for UACR, results were similar except that serum calcium was significant and AST was not. We analyzed the correspondence between actual eGFR regression slopes and those predicted by our models using receiver operator characteristic (ROC) statistics to calculate areas under the curves (AUC) for four eGFR slope cut points: -2, -3, -4, and -5mL/min/year. AUCs using the UACR and UPCR models ranged from 0.716to0.900 and 0.751to0.868, respectively, for the training data set. Results were nearly identical for the validation data set. Use of a laboratory-based predictive model of eGFR decline for older adults with eGFR 30-59 mL/min/1.73m2 may help distinguish between individuals with and without risk for further decline in kidney function.

Factors Associated with Functional Decline in Older Adults After Discharge from an Acute-Care Hospital

PurposeThis study was conducted to investigate the trend in functional changes over time and factors associated with the number of areas showing functional decline in older adults who had been discharged from acute care hospitals. MethodsThis longitudinal study involved 156 patients aged ≥ 65 years who were admitted to one tertiary hospital in Seoul and discharged home. Authors investigated patient demographic and health-care characteristics and the number of areas showing functional decline at 1 and 3 months after discharge. The data were analyzed using univariate and multivariate Poisson regression models. ResultsThe number of areas showing functional decline increased between admission and 1 month after discharge and had declined slightly at 3 months after discharge. The factors associated with the number of areas showing functional decline at 3 months after discharge were age, education level, and length of hospitalization (p < .05); the factors associated at 1 month after discharge were medical department and caregiver relationship (p < .05). ConclusionThe results indicate that older patients with no spouse or those with their elderly spouse as their caregiver are at risk of functional decline in a greater number of areas after discharge. Therefore, a comprehensive health-care policy to ensure care continuity is required for functional health maintenance for older adults after hospital discharge.

Determinants of functional decline in older adults experiencing cancer (the INCAPAC study).

Previous studies have reported on the higher risk of functional decline among older patients with cancer. However, few have focused on factors of functional decline in older persons with cancer and are mainly hospital-based and focus on consequences of cancer treatment. The aim of the study was to identify determinants of functional decline in older subjects with cancer in a population-based study. Using cancer registries, we identified older subjects (age ≥ 65 years) with cancer in three prospective cohort studies from Gironde, a French department. Functional status was measured using the Instrumental Activities of Daily Living (IADL) and the basic Activities of Daily Living (ADL) scales, and functional decline was measured between cancer pre- and post-diagnosis visits. Studied variables were demographic and socioeconomic (age at diagnosis, sex, living alone, education), cancer-related (stage at diagnosis, treatment received), smoking status, health-related (polypharmacy, depressive symptomatology), and geriatric-specific (cognitive impairment or dementia). Analyses were performed using logistic regression models. Age (≥85 years), cognitive impairment or dementia, and advanced stage at diagnosis were associated with a higher risk of ADL limitations, whether considering death or not. Age (≥85 years), education and polypharmacy were associated with a higher risk of ADL and/or IADL limitations. We identified factors that could impact on ADL and/or IADL limitations in older patients with cancer. The information on these determinants is useful in clinical settings to identify patients with cancer at high risk of functional decline.

Exploring 2.5-Year Trajectories of Functional Decline in Older Adults by Applying a Growth Mixture Model and Frequency of Outings as a Predictor: A 2010-2013 JAGES Longitudinal Study.

BackgroundWe explored the distinct trajectories of functional decline among older adults in Japan, and evaluated whether the frequency of outings, an important indicator of social activity, predicts the identified trajectories.MethodsWe analyzed data on 2,364 adults aged 65 years or older from the Japan Aichi Gerontological Evaluation Study. Participants were initially independent and later developed functional disability during a 31-month follow-up period. We used the level of long-term care needs certified in the public health insurance system as a proxy of functional ability and linked the fully tracked data of changes in the care levels to the baseline data. A low frequency of outings was defined as leaving one’s home less than once per week at baseline. We applied a growth mixture model to identify trajectories in functional decline by sex and then examined the association between the frequency of outings and the identified trajectories using multinomial logistic regression analysis.ResultsThree distinct trajectories were identified: “slowly declining” (64.3% of men and 79.7% of women), “persistently disabled” (4.5% and 3.7%, respectively), and “rapidly declining” (31.3% and 16.6%, respectively). Men with fewer outings had 2.14 times greater odds (95% confidence interval, 1.03–4.41) of being persistently disabled. The association between outing frequency and functional decline trajectory was less clear statistically among women.ConclusionsWhile the majority of older adults showed a slow functional decline, some showed persistent moderate disability. Providing more opportunities to go out or assistance in that regard may be important for preventing persistent disability, and such needs might be greater among men.