Functional Status Of Older Persons Research Articles

Current status and the future trajectory of geriatric services in Nigeria

The world population of people aged 65 and above, termed as older persons, is increasing rapidly. The number of people aged 65 years or older worldwide is projected to more than double, rising from 761 million in 2021 to 1.6 billion in 2050. The number of people aged 80 years or older is growing even faster. Population ageing is an irreversible global trend. It is the inevitable result of the demographic transition – the trend toward longer lives and smaller families – that is taking place even in countries with relatively youthful populations. In 2021, one in 10 people worldwide were aged 65 or above. In 2050, this age group is projected to account for one in six people globally [1]. People are living longer because of better nutrition, sanitation, healthcare, education, and economic well-being. With increasing age, older adults become at greater risk for diseases, disability, and side effects of medications. The common geriatric syndromes suffered by older persons include degenerative joint diseases, falls and mobility issues, sensory impairments (visual and hearing), dementia, sleep disturbances, frailty, and urinary incontinence. These syndromes are described as ‘Giants of Geriatrics’ on account of the impact on quality of life, and functional status of older persons. Geriatricians provide person-centered holistic care that attempts to preserve function and maintain a good quality of life by deploying the comprehensive geriatrics assessment and management approach which involves a multidisciplinary team (MDT). Nigeria has an increasing ageing population that will benefit from a healthcare system that is aligned to their peculiar care needs in the different settings care will be sought. This can be achieved by building capacity in the various disciplines involved in providing comprehensive care to older persons, and including geriatric medicine in the training curriculum for medical students, nurses and all allied health workers.

Functional Status in Older Persons After Hip Fracture Surgery: A Longitudinal Study of Indonesian Patients.

Hip fractures are one of the most serious injuries affecting older adults. Evidence-based knowledge regarding the functional status of older persons after hip fracture can provide information critical for developing effective continuous-care and rehabilitation programs. This study was developed to examine the post-hospital-discharge outcome measures and predictors of functional status in older adults in Indonesia after hip fracture surgery. The functional status of 109 patients discharged from an orthopedic hospital in Indonesia after hip fracture surgery was evaluated in this prospective cohort study. Functional status was evaluated using measures of physical and independent activities of daily living (PADL and IADL, respectively) at 1, 3, and 6 months postdischarge. Predictors of changes in functional status, including age, length of hospital stay, comorbidity, prefracture walking ability, type of surgery, status of depression and nutrition, type of insurance, and residential status (urban vs. rural), were also examined. Data were analyzed using generalized estimating equations. Significant improvements in PADL were found at 3 and 6 months, and significant improvements in IADL were found at 6 months. Predictors of poor outcomes found in this study included age, a dependent prefracture walking ability, depression, and having public health insurance. The findings of this study support the effectiveness of using presurgery assessments to identify individuals at a higher postdischarge risk of having poor PADL and IADL outcomes. Home nursing or subacute rehabilitation is recommended to improve and maintain functional status in older persons after hip fracture surgery. In addition, interventions and rehabilitation should take into consideration different recovery periods for PADL and IADL after hospital discharge after hip fracture surgery.

Functional Effects of Intervening Illnesses and Injuries After Critical Illness in Older Persons.

Intervening illnesses and injuries have pronounced deleterious effects on functional status in older persons, but have not been carefully evaluated after critical illness. We set out to evaluate the functional effects of intervening illnesses and injuries in the year after critical illness. Prospective longitudinal study of 754 nondisabled community-living persons, 70 years old or older. Greater New Haven, CT, from March 1998 to December 2018. The analytic sample included 250 ICU admissions from 209 community-living participants who were discharged from the hospital. None. Functional status (13 activities) and exposure to intervening illnesses and injuries leading to hospitalization, emergency department visit, or restricted activity were assessed each month. Comprehensive assessments (for covariates) were completed every 18 months. In the year after critical illness, recovery of premorbid function was observed for 169 of the ICU admissions (67.6%), and the mean (sd) number of episodes of functional decline (from 1 mo to the next) was 2.2 (1.6). The adjusted hazard ratios (95% CI) for recovery were 0.18 (0.09-0.39), 0.46 (0.17-1.26), and 0.75 (0.48-1.18) for intervening hospitalizations, emergency department visits, and restricted activity, respectively. For functional decline, the corresponding odds ratios (95% CI) were 2.06 (1.56-2.73), 1.78 (1.12-2.83), and 1.25 (0.92-1.69). The effect sizes for hospitalization and emergency department visit were larger than those for any of the covariates. In the year after critical illness, intervening illnesses and injuries leading to hospitalization and emergency department visit are strongly associated with adverse functional outcomes, with effect sizes larger than those of traditional risk factors. To improve functional outcomes, more aggressive efforts will be needed to prevent and manage intervening illnesses and injuries after critical illness.

Functional Effects of Intervening Illnesses and Injuries After Hospitalization for Major Surgery in Community-living Older Persons.

To evaluate the functional effects of intervening illnesses and injuries, that is, events, in the year after major surgery. Intervening events have pronounced deleterious effects on functional status in older persons, but have not been carefully evaluated after major surgery. From a cohort of 754 community-living persons, aged 70+ years, 317 admissions for major surgery were identified from 244 participants who were discharged from the hospital. Functional status (13 activities) and exposure to intervening hospitalizations, emergency department (ED) visits, and restricted activity were assessed each month. Comprehensive assessments (for covariates) were completed every 18 months. In the year after major surgery, exposure rates (95% CI) per 100-person months to hospitalizations, ED visits, and restricted activity were 10.0 (8.0-12.5), 3.9 (2.8-5.4), and 12.3 (10.2-14.8) for functional recovery and 7.2 (6.1-8.5), 2.5 (1.9-3.2), 11.2 (9.8-12.9) for functional decline. Each of the 3 intervening events were independently associated with reduced recovery, with adjusted hazard ratios (95% CI) of 0.20 (0.09-0.47), 0.35 (0.15-0.81), and 0.57 (0.36-0.90) for hospitalizations, ED visits, and restricted activity. For functional decline, the corresponding odds ratios (95% CI) were 5.68 (3.87-8.33), 1.90 (1.13-3.20), and 1.30 (0.96-1.75). The effect sizes for hospitalizations and ED visits were larger than those for the covariates. Intervening illnesses/injuries are common in the year after major surgery, and those leading to hospitalization and ED visit are strongly associated with adverse functional outcomes, with effect sizes larger than those of traditional risk factors.

Relationships among clinic, home, and ambulatory blood pressures with small vessel disease of the brain and functional status in older people with hypertension

Subcortical small vessel disease, represented as white matter hyperintensity (WMH) on magnetic resonance images (MRI) is associated with functional decline in older people with hypertension. We evaluated the relationships of clinic and out-of-office blood pressures (BP) with WMH and functional status in older persons. Using cross-sectional data from 199 older study participants enrolled in the INFINITY trial, we analyzed the clinic, 24-hour ambulatory, and home BPs and their relationships with WMH burden and mobility and cognitive outcomes. Volume of WMH was associated with clinic and 24-hour ambulatory systolic BP but not home systolic BP. The mobility measure, supine-to-sit time, had a significant association with 24-hour systolic BP and pulse pressure but not with diastolic BP or values obtained by home BP. Cognitive measures of processing speed (Trails Making Test Part A and the Stroop Word Test) were significantly associated with 24-hour systolic BP, but not clinic and home BPs. These data demonstrate that ambulatory BP measurements in older people are more strongly associated with WMH and certain measures of functional status compared to home BP measurements. Hence, home BP may not be a useful substitute for ambulatory BP for assessing subcortical small vessel disease and its consequences. Further longitudinal analyses comparing clinic and various types of out-of-office BP measures with small vessel brain disease are needed. Clinicaltrials.gov identifier: NCT01650402.

Spirituality in geriatric psychiatry

Academic recognition of the implications of religion/spirituality (R/S) for mental health is increasing, with a growing number of studies involving older adults. The present review provides an overview of these studies, highlighting the influence of R/S on older adults' mental health and the clinical implications of addressing R/S in the geriatrics and gerontology context. The available evidence suggests that R/S involvement is usually associated with lower levels of depression, substance use/abuse, and cognitive declining and better quality of life, well being, and functional status in older persons. Despite the number of studies showing this relationship, few have yet investigated the effects of addressing spiritual needs or carrying out R/S interventions in this age group. Evidence is mounting that R/S is most important in geriatric psychiatry. In general, studies have shown a positive relationship between R/S and mental health in the older population. Health professionals should be attentive to these spiritual needs. Nevertheless, more studies are needed to investigate the mechanisms of the R/S-mental health association and how to integrate R/S in clinical practice.

Medications Affecting Functional Status in Older Persons

Current evidence suggests that functional status is an important outcome of pharmacologic treatments in older people. At the moment, studies have shown diverse effects of medications on functional status. For example, some have shown potentially detrimental effects, while others have found improvements on physical function in elders. Overall, suboptimal prescribing and the occurrence of adverse drug reactions (ADRs) may negatively affect functional status. The use of selected drugs acting on central nervous system (CNS), e.g. benzodiazepines and antipsychotics, is generally associated with an increased risk of functional decline. The greater sensitivity of older people to these drugs, together with age-related changes in pharmacokinetics and pharmacodynamics, account for the observed detrimental effect and suggests a cautious approach to older and frail patients when prescribing CNS agents. On the other hand, selected drugs may slow or delay functional decline in older people. In particular, drugs aimed at targeting sarcopenia (loss in muscle mass and strength), such as testosterone in androgen deficiency, ACE-inhibitors, vitamin D and β-hydroxy β-methyl butyrate (HMB), as well as the recently developed selective androgen receptor modulators (SARMs) may hold extreme importance. This review will provide available evidence of the diverse impacts of drug medications on functional status in older persons.

Development and Initial Testing of Functional Task Exercise on Older Adults with Cognitive Impairment at Risk of Alzheimer's Disease – FcTSim Programme – A Feasibility Study

The purpose of this study was to illustrate the development of a new functional task-based exercise programme and initially test its feasibility as well as effectiveness for older adults with mild cognitive impairment (MCI). This study used a single-group repeated-measures design. A total of 11 patients (mean age 71.8 years) were recruited to participate in a structured functional task exercise programme for 10 weeks. All outcome measures were undertaken at baseline, post-intervention and post-3-month follow-up using the Neurobehavioral Cognitive Status Examination (NCSE), Verbal Fluency Test (VFT), Chinese Version Verbal Learning Test (CVVLT), Lawton Instrumental Activities of Daily Living Scale (Lawton IADL) and Problems in Everyday Living test (PEDL). Data were analysed using a repeated-measures analysis of variance. Cohen's d effect size was used to assess the practical significant effects. The participants showed significant improvement in NCSE composite score, VFT, CVVLT total free recall, CVVLT 10-minute delayed free recall, Lawton IADL and PEDL. Results of this study demonstrate that the newly designed functional task exercise programme, which uses simulated tasks, is feasible and beneficial to cognitive functions and functional status of older persons with MCI. The findings of the current study further reinforce occupational therapy practitioners' understanding that "occupation" is a "means" and an "end". Further study with a larger population is needed to draw more definitive conclusions.

Skeletal Muscle Apoptotic Signaling Predicts Thigh Muscle Volume and Gait Speed in Community-Dwelling Older Persons: An Exploratory Study

BackgroundPreclinical studies strongly suggest that accelerated apoptosis in skeletal myocytes may be involved in the pathogenesis of sarcopenia. However, evidence in humans is sparse. In the present study, we investigated whether apoptotic signaling in the skeletal muscle was associated with indices of muscle mass and function in older persons.Methodology/Principal FindingsCommunity-dwelling older adults were categorized into high-functioning (HF) or low-functioning (LF) groups according to their short physical performance battery (SPPB) summary score. Participants underwent an isokinetic knee extensor strength test and 3-dimensional magnetic resonance imaging of the thigh. Vastus lateralis muscle samples were obtained by percutaneous needle biopsy and assayed for the expression of a set of apoptotic signaling proteins. Age, sex, number of comorbid conditions and medications as well as knee extensor strength were not different between groups. HF participants displayed greater thigh muscle volume compared with LF persons. Multivariate partial least squares (PLS) regressions showed significant correlations between caspase-dependent apoptotic signaling proteins and the muscular percentage of thigh volume (R2 = 0.78; Q2 = 0.61) as well as gait speed (R2 = 0.81; Q2 = 0.56). Significant variables in the PLS model of percent muscle volume were active caspase-8, cleaved caspase-3, cytosolic cytochrome c and mitochondrial Bak. The regression model of gait speed was mainly described by cleaved caspase-3 and mitochondrial Bax and Bak. PLS predictive apoptotic variables did not differ between functional groups. No correlation was determined between apoptotic signaling proteins and muscle strength or quality (strength per unit volume).Conclusions/SignificanceData from this exploratory study show for the first time that apoptotic signaling is correlated with indices of muscle mass and function in a cohort of community-dwelling older persons. Future larger-scale studies are needed to corroborate these preliminary findings and determine if down-regulation of apoptotic signaling in skeletal myocytes will provide improvements in the muscle mass and functional status of older persons.

Anorexia, Physical Function, and Incident Disability Among the Frail Elderly Population: Results From the ilSIRENTE Study

Increasing evidence suggests that anorexia of aging can cause physical and mental impairment. The aim of the present study was to evaluate the relationship between anorexia of aging and measures of physical performance, muscle strength, and functional status in older persons aged 80 years or older. Data are from baseline evaluation of 364 subjects enrolled in the ilSIRENTE study. The ilSIRENTE study is a prospective cohort study performed in the mountain community living in the Sirente geographic area (L'Aquila, Abruzzo) in central Italy. Physical performance was assessed using the physical performance battery score (SPPB), which is based on 3 timed tests: 4-meter walking speed, balance, and chair stand tests. Muscle strength was measured by hand grip strength. We defined anorexia as the presence of loss of appetite and/or lower food intake. Analyses of covariance were performed to evaluate the relationship of anorexia with physical function. In the unadjusted model, all the physical performance, muscle strength, and functional measures showed significant associations with the presence of anorexia. After adjustment for potential confounders (age, gender, BMI, number of diseases, depression, congestive heart failure, lung diseases) these associations were weaker but still statistically significant (physical performance battery score: subjects without anorexia 6.8, SE 0.2, subjects with anorexia 5.8, SE 0.4, P = .03; 4-meter walking speed: subjects without anorexia 0.5 m/s, SE 0.1, subjects with anorexia 0.3 m/s, SE 0.1, P = 5.001 hand grip strength: subjects without anorexia 30.8 kg, SE 0.7, subjects with anorexia 27.9 kg, SE 1.5, P = .03). Furthermore, relative to participants without anorexia, those subjects with anorexia showed a significantly higher risk of developing disability after 2 years of follow-up (hazard ratio 2.25; 95% confidence intervals 1.15-4.39). Anorexia is common among community older subjects in Italy. Our results suggest that among old-old subjects, the presence of anorexia is associated with impaired physical performance and with a significant increased risk of incident disability, irrespective of potential confounders.

The impact of hip fracture (HF) on the functional status (FS) of older persons in Rio de Janeiro, Brazil: Results of a prospective cohort study

There is no prospective study investigating the impact of hip fracture (HF) on functional status (FS) in Brazil. The objective of this study was to investigate the impact of a HF on the FS of older persons 1 year after the fracture and the factors associated with decline in FS 1 year after the fracture. Two hundred and forty-six patients who were admitted to one of four hospitals after HF participated. The sample for this study consisted of 160 patients who were still alive and had information on functional limitations after 1 year. The Brazil Old Age Schedule (BOAS) was used to assess FS before and 1 year after HF. Logistic regression analyses were used to identify predictors of decline 1 year after fracture. Of the patients, 46.3% did not achieve their prior FS. Older age, being underweight, total length of stay and the use of psychotics/sedatives and anxiolitics were associated in multivariate analyses with decline in FS. Working before the fracture was protective of decline in FS. We conclude that HF severely compromised the FS of older persons in Rio de Janeiro, Brazil.

Indications, labeling, and outcomes assessment for drugs aimed at improving functional status in older persons: a conversation between aging researchers and FDA regulators.

Indications, labeling, and outcomes assessment for drugs aimed at improving functional status in older persons: a conversation between aging researchers and FDA regulators.

HDL-cholesterol and physical performance: results from the ageing and longevity study in the sirente geographic area ( ilSIRENTE Study)

High-density lipoprotein (HDL) cholesterol has been hypothesised to be a reliable marker of frailty and poor prognosis among the oldest elderly. We evaluate the relationship of HDL-cholesterol with measures of physical performance, muscle strength, and functional status in older persons aged 80years or older. Data are from baseline evaluation of the ageing and longevity study in the Sirente geographic area (ilSIRENTE study) (n = 364). Physical performance was assessed using the physical performance battery score [short physical performance battery (SPPB)], which is based on three-timed tests: 4-m walking-speed, balance, and chair-stand tests. Muscle strength was measured by hand-grip strength. Analyses of covariance were performed to evaluate the relationship of different HDL-cholesterol levels with physical function. In the unadjusted analyses, physical function (as measured by the 4-m walking-speed, theSPPB score, the basic and instrumental activities of daily living scales scores), but not hand-grip strength, improved significantly as HDL-cholesterol tertiles increased. After adjustment for potential confounders, which included age, gender, living alone, alcohol abuse, physical activity, congestive heart failure, diabetes, cerebrovascular diseases, osteoarthritis, albumin, urea, C-reactive protein and LDL cholesterol, the association of HDL-cholesterol tertiles with the 4-m walking-speed and the SPPB score was still consistent. The present study suggests that among very old subjects living in the community the higher levels of HDL-cholesterol are associated with better functional performance.

Change in serum albumin and subsequent decline in functional status in older persons

This study examines whether a three-year change in serum albumin concentration is associated with subsequent decline in functional status in older persons. A total of 588 participants from the Longitudinal Aging Study Amsterdam aged 65-85 years were followed for six years. The three-year change in serum albumin was classified in four groups: chronic low (< or =43 g/L at both time points), decrease (decrease of 2.4% or more) from normal to low, decrease but still normal, and stable normal albumin (reference group). During the subsequent three years, absolute change and a decline of one standard deviation or more (termed substantial decline) in functional status was assessed. Functional status was measured in two ways: using performance tests and self-reported functional ability. Substantial decline in functional performance and functional ability was observed in 243 persons (41.3%) and 133 persons (22.6%), respectively. After adjustment for baseline functional status and potential confounders, chronic low albumin and a decrease from normal to low albumin were associated with a greater absolute decline in functional performance and in self-reported functional ability. Using the outcome substantial decline in functional status, only decrease to low serum albumin was associated with decline in functional ability [odds ratio (OR)=1.97; one-sided 95% Confidence Limit (CL)=1.09]. This study indicates that chronic low serum albumin is a determinant of decline in functional status. However, a decrease in serum albumin from normal to low levels but within the normal range was a stronger determinant of future decline in functional status. Change in serum albumin level within the normal range measured between two points in time may be used as a general marker of future functional decline.

Age, functional capacity, and health-related quality of life in patients with heart failure

BackgroundAlthough heart failure disproportionately affects older persons and is associated with significant physical disability, existing data on physical limitations and health-related quality of life (HRQL) derive largely from studies of younger subjects. We compared the relationship between functional limitation and HRQL between older and younger patients with heart failure. Methods and resultsWe evaluated 546 outpatients with heart failure enrolled in a multicenter prospective cohort study. At baseline and 6±2 weeks later, functional status was assessed by New York Heart Association (NYHA) classification and 6-minute walk testing. HRQL was measured with the Kansas City Cardiomyopathy Questionnaire (KCCQ). Comparing older (age >65 years, n=218) and younger patients (n=328), we assessed baseline HRQL across strata of functional status. In the 484 patients who completed follow-up (194 older and 290 younger patients), we also assessed the changes in HRQL associated with changes in functional status over time. At baseline, older patients had better HRQL than younger patients (mean KCCQ score 60±25 versus 54±28, P=.005) in spite of worse NYHA class (mean 2.54 versus 2.35, P < .001) and lower 6-minute walk distances (824±378 versus 1064±371 feet, P < .001). After multivariable adjustment including baseline NYHA class, older age was independently correlated with better HRQL (β=+7.9 points, P < .001). At follow-up, older patients with a deterioration in NYHA class experienced marked declines in HRQL compared with younger patients (mean HRQL change of −14.4 points versus +0.3 points, respectively, P < .001). Analyses using 6-minute walk distance as the functional measure yielded similar results. ConclusionsAlthough older patients with heart failure have relatively good HRQL in spite of significant functional limitations, they are at risk for worsening HRQL with further decline in functional status. These results underscore the importance of treatments aimed at maintaining functional status in older persons with heart failure, including those with significant baseline functional limitations.

Nursing home case-mix instruments: validation of the RUG-III system in Italy.

The current Italian reimbursement system for long-term care does not adequately consider the great variability in the health and functional status of older persons who are admitted to long-term care institutions. Furthermore, no procedure is implemented to monitor the quality of care provided to older residents. We conducted this study to verify whether the RUG-III (Resource Utilization Groups-version III), a tool for assessing the case-mix of nursing home residents, which is widely used in the United States and in many European countries, can be effectively used in the Italian health care system. We administered an Italian version of the RUG-III to 1000 older residents of 11 intermediate- and long-term care institutions. We also collected objective information on the amount of care provided directly or indirectly to each resident by nurses, physical therapists, and other health professionals. The RUG-III 44 group classification system explained 61 and 44% of the variance in rehabilitative and nursing wage-adjusted care time, respectively. Our findings provide strong evidence that the RUG-III classification, applied to Italian intermediate- and long-term care institutions, provides a robust estimate of the amount of nursing and rehabilitation resources consumed by older residents.

Coagulation and activation of inflammatory pathways in the development of functional decline and mortality in the elderly

Purpose This study was performed to determine the effects of markers of inflammation (interleukin 6) and coagulation (D-dimer) on mortality and functional status in older persons. Methods Subjects were selected for the Duke Established Populations for Epidemiologic Studies of the Elderly. In 1992, 2569 subjects (age >71 years) were interviewed, of whom 1723 had interleukin-6 and D-dimer measurements. Values of interleukin 6 and D-dimer were categorized into quartiles. Outcomes were mortality (through 5 years) and functional status (through 4 years). Relative risks were estimated with proportional hazards models that adjusted for potential confounders. Results The relative risk of mortality was 1.28 (95% confidence interval [CI]: 0.98 to 1.69; P = 0.06) for those with only interleukin-6 levels in the highest quartile, 1.53 (95% CI: 1.18 to 1.97; P = 0.001) for subjects with only D-dimer levels in the highest quartile, and 2.00 (95% CI: 1.53 to 2.62; P = 0.0001) for those with levels of both in the highest quartile, as compared with those who were not in either of the highest quartiles. Those with high interleukin-6 and high D-dimer levels had the greatest declines in all measures of function. Conclusion Activation of the coagulation and inflammatory pathways is associated with mortality and decline in function, and may be part of the explanation for the development of a frailty phenotype in the elderly.

Social and functional status of older persons in a north Indian community.

With increase in life expectancy, the geriatric population is growing in developing countries. The Union Territory of Chandigarh has a population of about 0.9 million with nearly 90% in urban and 10% in rural areas. This cross-sectional, descriptive study was conducted in Chandigarh over a period of one year; 1998-99 among 362 subjects 65 years or more of age covering a population of 7937 family members in 1882 houses. The sampling was done by random sampling technique covering urban and rural population. The proportion of older persons in Chandigarh comprised 5.47% of the population. Most of the respondents were living with their spouses. More than one-fifth of urban and two third of rural older persons were illiterate. About 86% were living with their families and only 3.6% were living alone. Major modes of recreation were visiting religious places by two-thirds followed by going to parks and gardens by nearly one-fourth. Among 203 older persons having living partners in the study, one in every fifth older persons had indulged in sexual intercourse in the past six months. Nearly 2% of older persons needed assistance (partial or full) in activities of daily living like bathing, dressing, toileting, feeding, continence etc. The study also observed rural and urban variation in the use of aids and appliances by older persons. On the basis of very few having functional limitations, there is a need to include components of recreational facilities, activities of daily living, and not just assistance and aids and appliances, while developing a comprehensive geriatric health care programme in developing countries.

What can we do to improve physical function in older persons with type 2 diabetes?

Older persons with type 2 diabetes are at higher risk for functional impairment than are their age-matched counterparts without-diabetes. We therefore sought to identify factors associated with impaired physical function in older persons with type 2 diabetes by using a cross-sectional study design. We studied 1238 persons with type 2 diabetes who were 55 years of age or older and enrolled in the Type II Diabetes Patient Outcomes Research Team (PORT) project. Subjects were primary care patients at a large staff model health maintenance organization who had completed a mailed survey that collected information about demographics (age, race, marital status, income, education, gender, and body mass index [BMI]), health behaviors (exercise, smoking, and alcohol), care and control of diabetes (therapy, self-reported glucose control, home glucose monitoring, and disease duration), mood (Center for Epidemiologic Studies--Depression Scale [CES-D]), comorbidity, and the Short-Form-36 health survey (SF-36). We evaluated the bivariate relationships between the PFI- 10, a 10-item measure of physical function from the SF-36, and candidate independent variables from the domains described previously. Variables that were significant at an a level of .10 were entered into a multiple linear regression model. There were eight independent predictors of impaired physical function (all p < .05, R2 = .40). Factors associated with impaired function in order of their relative importance were as follows: a higher comorbidity score, older age, obesity, lack of regular exercise, CES-D score higher than 20, taking insulin, lower formal education, and abstinence from alcohol. Increased comorbidity and older age are associated with poorer function, as is the severity of diabetes and less formal education. Exercise, lower BMI, and better mood are associated with better function. Therefore, promoting regular exercise and weight loss, in addition to treating depression, are likely to preserve or even improve the functional status of older persons with type 2 diabetes. Moderate alcohol use may be beneficial as well. The extent to which these relationships persist in prospective studies or clinical trials remains to be evaluated.

Functional status of older persons with chronic mental illness living in a home setting

The purpose of the study was to determine the functional status of older persons with chronic mental illness. One hundred subjects living in their homes were interviewed in face-to-face interviews using the Older Adult Resources Survey (OARS) to determine functioning in five areas: social, economic, mental, physical, and activities of daily living. Pearson product moment correlation showed significant relationships among all functional scores. Twenty-nine percent of the total sample had social relationships of poor quality. Thirty-five percent of subjects had severe economic impairment. The majority (53%) of subjects had psychiatric symptoms. The most common psychiatric diagnosis was depression (42%), followed by schizophrenia (22%), and bipolar illness (13%). Twenty-nine percent of subjects had a serious medical problem that required medical treatment. Cardiovascular diseases were the most frequently reported (92%), followed by arthritis (45%) and urinary tract disorders (19%). All subjects perceived that their physical health had deteriorated over the 5 years. Polypharmacy and drug misuse were common among the sample. A mean of four prescribed drugs was taken daily over the past month. Psychotropic (83%), antihypertensive (32%), and cardiac (20%) medications were the most frequently prescribed drugs. Twenty-five percent of the sample regularly required assistance with at least four activities of daily living.