Healthy Community-dwelling Elders Research Articles

Associations amongst dynamic knee stiffness during gait, quadriceps stiffness, and the incidence of knee osteoarthritis over 24 months: a cohort study with a mediation analysis

BackgroundDecreased strength and increased stiffness of the quadriceps have been associated with a higher risk of developing knee osteoarthritis (OA) in elders. Dynamic joint stiffness (DJS) represents collective resistance from active and passive knee structures for dynamic knee motions. Elevated sagittal knee DJS has been associated with worsening of cartilage loss in knee OA patients. Altered quadriceps properties may affect DJS, which could be a mediator for associations between quadriceps properties and knee OA. Hence, this study aimed to examine whether DJS and quadriceps properties would be associated with the development of clinical knee OA over 24 months, and to explore the mediation role of DJS in associations between quadriceps properties and knee OA.MethodsThis was a prospective cohort study with 162 healthy community-dwelling elders. Gait analysis was conducted to compute DJS during the loading response phase. Quadriceps strength and stiffness were evaluated using a Cybex dynamometer and shear-wave ultrasound elastography, respectively. Knee OA was defined based on clinical criteria 24 months later. Logistic regression with generalized estimating equations was used to examine the association between quadriceps properties and DJS and incident knee OA. Mediation analysis was performed to explore the mediation role of DJS in associations between quadriceps properties and the incidence of knee OA.ResultsA total of 125 participants (65.6 ± 4.0 years, 58.4% females) completed the 24-month follow-up, with 36 out of 250 knees identified as clinical knee OA. Higher DJS (OR = 1.86, 95%CI: 1.33–2.62), lower quadriceps strength (1.85, 1.05–3.23), and greater quadriceps stiffness (1.56, 1.10–2.21) were significantly associated with a higher risk of clinical knee OA. Mediation analysis showed that the DJS was not a significant mediator for the associations between quadriceps properties and knee OA.ConclusionsHigher sagittal knee dynamic joint stiffness, lower quadriceps strength, and greater quadriceps stiffness are potential risk factors for developing clinical knee OA in asymptomatic elders. Associations between quadriceps properties and knee OA may not be mediated by dynamic joint stiffness. Interventions for reducing increased passive properties of the quadriceps and knee joint stiffness may be beneficial for maintaining healthy knees in the aging population.

Swallowing Problems among Community-Dwelling Elderly in Northeastern Thailand.

Introduction/objectivesAging brings deterioration in many organs involving in swallowing, such as, oropharyngeal muscle weakness, decreased salivation, multiple teeth loss, decreased oral sensation, and delayed swallowing response. There are no official statistics and systematic records of swallowing problems in Thailand’s healthy elder populations. Therefore, this study aimed to determine the prevalence of swallowing problems among a Thai healthy elder population.MethodsA survey of 874 elders was conducted at Community Hospitals in region 7 of the Thai National Health Security Office from September to November 2019. All participants were interviewed using a questionnaire focused on, screening for swallowing problems using a 10-item Eating Assessment Tool (EAT-10) and questions about participants’ physical and oral health behaviors.ResultsSixty-six percent of the participants were women and 34% were males, with mean age 69.70 ± 6.79 years. Of these, 11.4% had swallowing problems. The most common swallowing problems were food sticking in the throat, effort on swallowing and choking. Age and having an underlying disease were found to be statistically significantly associated with dysphagia, whereas gender was not associated with dysphagia.ConclusionsThe prevalence of swallowing problems among Thai healthy community-dwelling elders was assessed as about 11%. Early identification and early intervention for swallowing problem is necessary for promoting health and quality of life of our growing elderly population.

Proteinuria and Reduced Estimated Glomerular Filtration Rate are Independently Associated With Lower Cognitive Abilities in Apparently Healthy Community-Dwelling Elderly Men in Japan: A Cross-sectional Study.

BackgroundThe association of proteinuria and reduced estimated glomerular filtration rate (eGFR) with cognition needs more clarification. We cross-sectionally examined whether proteinuria and reduced eGFR, even in moderate stages, were independently associated with lower cognition in a community-based sample of elderly men.MethodsOur cohort initially comprised 1,094 men aged 40–79 years from a random sample from Shiga, Japan in 2006–2008. Of 853 men who returned for the follow-up examination (2009–2014), we analyzed 561 who were ≥65 years, free of stroke, and completed the Cognitive Abilities Screening Instrument (CASI) at follow-up (higher CASI scores [range 0 to 100] indicate better cognition). Proteinuria was assessed via dipstick. eGFR was calculated according to the Chronic Kidney Disease Epidemiology Collaboration Equation. Participants were divided into three groups either by eGFR (≥60, 59–40, and <40 mL/min/1.73 m2) or by proteinuria (no, trace, and positive), considered normal, moderate, and advanced, respectively. Using linear regression, we computed mean CASI score, with simultaneous adjustment for proteinuria and eGFR in addition to other potential confounders.ResultsSignificant trends of lower cognition were observed across the groups of worse proteinuria and lower eGFR independently: multivariable-adjusted mean CASI scores were 90.1, 89.3, and 88.4 for proteinuria (Ptrend = 0.029), and 90.0, 88.5, and 88.5 for eGFR (Ptrend = 0.015) in mutual-adjustment model.ConclusionsProteinuria and reduced eGFR, even in their moderate stages, were independently associated with lower cognition in a community-based sample of elderly men. The results suggest the importance of proteinuria and low eGFR for early detection and prevention of cognitive decline.

Sclerostin and Its Associations With Bone Metabolism Markers and Sex Hormones in Healthy Community-Dwelling Elderly Individuals and Adolescents.

Sclerostin is an important regulator of bone mass involving Wnt/β-catenin signaling pathway. We aimed to obtain the profile of serum sclerostin level and explore its associations with bone metabolism markers and sex hormones in healthy community-dwelling Chinese elderly individuals and adolescents. A cross-sectional study was performed in three communities in Shanghai. In all, 861 participants, including 574 healthy elderly individuals, and 287 healthy adolescents, were recruited. The levels of serum sclerostin, procollagen type 1 N-terminal propeptide (P1NP), β-CrossLaps of type I collagen containing cross-linked C-telopeptide (β-CTX), parathyroid hormone (PTH), 25-hydroxyvitamin D [25(OH)D], estradiol (E2), testosterone (T), and sex hormone-binding globulin (SHBG) were measured in blood samples from all participants. Median sclerostin level was higher in males than in females and in elderly individuals than in adolescents (elderly males: 54.89 pmol/L, elderly females: 39.95 pmol/L, adolescent males: 36.58 pmol/L, adolescent females: 27.06 pmol/L; both P < 0.05). In elderly individuals, serum sclerostin was positively correlated with age (β = 0.176, P < 0.001) and T (β = 0.248, P = 0.001), but negatively associated to P1NP (β = −0.140, P = 0.001). In adolescents, circulating sclerostin was significantly and positively associated with P1NP (β = 0.192, P = 0.003). The directions of the association between sclerostin and P1NP were opposite in Chinese elderly individuals and adolescents, which may reflect that sclerostin plays distinct roles in different functional states of the skeleton. Our findings revealed the rough profile of circulating sclerostin level in general healthy Chinese population and its associations with bone metabolism markers and sex hormones, which may provide a clue to further elucidate the cross action of sclerostin in bone metabolism and sexual development.

EFFECTS OF SYNBIOTIC SUPPLEMENTATION ON GUT FUNCTIONING AND SYSTEMIC INFLAMMATION OF COMMUNITY-DWELLING ELDERS - SECONDARY ANALYSES FROM A RANDOMIZED CLINICAL TRIAL.

Aging is a complex process marked by alterations on gut functioning and physiology, accompanied by an increase on the inflammatory status, leading to a scenario called "inflammaging". To evaluate the effects of a synbiotic substance on systemic inflammation, gut functioning of community-dwelling elders. This is a secondary analysis from a randomized clinical trial, lasting 24 weeks, including 49 elders, distributed into two groups: SYN (n=25), which received a synbiotic substance (Frutooligossacaride 6g, Lactobacillus paracasei LPC-31 109 to 108 UFC, Lactobacillus rhamnosus HN001 109 to 108 UFC, Lactobacillus acidophilus NCFM 109 to 108 UFC e Bifidobacterium lactis HN019 109 to 108 UFC), or PLA (n=24), receiving placebo. The evaluations consisted of serum IL-10 e TNF-α (after overnight fasting), evaluation of chronic constipation (by Rome III Criteria) and faeces types (by Bristol Stool Form Scale). Data were compared before and after the supplementation time, and between groups. No significant differences were found between baseline and final values of serum inflammatory markers. Some subtle beneficial changes were observed in SYN, concerning both gut functioning and faeces types. From our data, synbiotic supplementation showed a subtle benefit in gut functioning in apparently healthy community-dwelling elders. Our findings can suggest that the benefits in healthy individuals were less expressive than the ones presented in studies with individuals previously diagnosed as dysbiosis. Future studies, comparing elders with and without gut dysbiosis can confirm our findings.

The Association between Mineral and Trace Element Concentrations in Hair and the 10-Year Risk of Atherosclerotic Cardiovascular Disease in Healthy Community-Dwelling Elderly Individuals.

This cross-sectional analysis included 137 Korean subjects aged 60–79 years. All subjects underwent anthropometric measurements and laboratory tests. Scalp hair samples were obtained from each individual, the concentrations of 36 minerals and trace elements were analyzed, and 16 ratios of elements were calculated. ASCVD risk was estimated using pooled cohort ASCVD risk assessment equations for 10-year risk profiles. The 137 subjects were divided into three risk groups: low (<5%, n = 28), intermediate (5% to <7.5%, n = 21), and high (≥7.5%, n = 88) risk groups. After adjusting for obesity (BMI ≥ 25 kg/m2) and sex, Na concentration (mg%) in hair was significantly lower in the low-risk (13.91 ± 7.02) than in the intermediate-risk (47.18 ± 8.08) and high-risk (36.76 ± 3.95) groups (p for trend = 0.024). The concentration of K (mg%) in hair was also positively associated with the severity of ASCVD risk (10.50 ± 8.37, 23.62 ± 9.63, 33.31 ± 4.71, respectively; p for trend = 0.017), but their differences were not statistically significant (p = 0.059). By contrast, the levels of Co, U, and Hg, and the Ca/P and Ca/Mg ratios, were negatively correlated with the severity of ASCVD risk (p for trend < 0.05). Mean Na concentration in hair was significantly lower in the low-risk than in the other risk groups. By contrast, Co, U, and Hg concentrations showed significant negative associations with risk severity. Further studies are needed to assess whether dietary modification for trace elements could lower the risk of ASCVD.

Establishing the reliability and concurrent validity of physical performance tests using virtual reality equipment for community-dwelling healthy elders

Purpose: The aim of this study was to determine the reliability and concurrent validity of commonly used physical performance tests using the OmniVR™ Virtual Rehabilitation System for healthy community-dwelling elders. Method: Participants (N = 40) were recruited by the authors and were screened for eligibility. The initial method of measurement was randomized to either virtual reality (VR) or clinically based measures (CM). Physical performance tests included the five times sit to stand, Timed Up and Go (TUG), Forward Functional Reach (FFR) and 30-s stand test. A random number generator determined the testing order. The test–re-test reliability for the VR and CM was determined. Furthermore, concurrent validity was determined using a Pearson product moment correlation (Pearson r). Results: The VR demonstrated excellent reliability for 5 × STS intraclass correlation coefficient (ICC) = 0.931(3,1), FFR ICC = 0.846(3,1) and the TUG ICC = 0.944(3,1). The concurrent validity data for the VR and CM (ICC 3, k) were moderate for FFR ICC = 0.682, excellent 5 × STS ICC = 0.889 and excellent for the TUG ICC = 0.878. The concurrent validity of the 30-s stand test was good ICC = 0.735(3,1). Conclusions: This study supports the use of VR equipment for measuring physical performance tests in the clinic for healthy community-dwelling elders.Implications for RehabilitationVirtual reality equipment is not only used to treat balance impairments but it is also used to measure and determine physical impairments through the use of physical performance tests.Virtual reality equipment is a reliable and valid tool for collecting physical performance data for the 5 × STS, FFR, TUG and 30-s stand test for healthy community-dwelling elders.

Determination of Persons at a High Risk of Falling in a Population of Healthy Community-dwelling Elderly Japanese

Falling is an important social issue for the elderly. This study’s aim is to determine useful risk factors that could be used to screen for the elderly at high risk of falling. Participants included 965 healthy elderly individuals ≥ 60 years of age (349 males and 616 females; men age: 70.1 ± 7.1 years). We assessed fall risk in these elderly using Demura et al’s fall-risk assessment scale (DFRA), which consists of previous experiences with falls and 50 other fall-risk assessment items representing the five risk factors related to the potential for falling, physical function, disease and physical symptoms, environment, and behavior and character (Demura et al., 2010). Receiver-operating characteristics analysis was conducted using previous experiences with falls (faller or non-faller) as the dependent variable and each fall-risk factor score in the DFRA as the independent variable. The potential for falling was calculated as the highest area under the ROC curve (AUC) (AUC = 0.80; sensitivity = 0.87; specificity = 0.75). However, it was difficult to screen for the elderly as high risk of falling using other fall-risk factor scores. These results suggest that the potential for falling is a useful risk factor that can be used to screen for the elderly at high risk of falling.

Prevalence of Sarcopenia among Older Community-Dwelling People with Normal Health and Nutritional State

This study analyzed whether sarcopenia, a risk factor for disability in the aged, also occurs in healthy community-dwelling elders with normal nutritional state. As indicators, body cell mass (BCM) and lean body mass (LBM) were determined in 110 Germans (ages 60–83) using bioimpedance analysis. Nutritional status, muscle function, anthropometry, and physical activity level were investigated. Sarcopenia was already present in well nourished healthy elders. Its prevalence depended on the measure of muscle mass used (BCM percent, 22 percent males, 20 percent females; LBM percent, 4 percent males, 11 percent females). In conclusion, screening for presence of sarcopenia is needed in healthy, well-nourished elderly populations requiring an international standardization.

Subjective memory decline in healthy community-dwelling elders. What does this complain mean?

Subjective feelings of memory decline are fairly common among the elderly. The causes of this are heterogeneous, and may be related to both affective and cognitive disorders. We attempted to explore the associations between subjective and cognitive measures. Healthy subjects were studied. They completed questionnaires regarding memory difficulties and lifestyle habits, the Geriatric Depression scale (GDS), and the Spielberger State-Trait Anxiety Inventory. Cognitive functions were tested using the Mini-Mental State Exam and supplemented with NeuroTrax, a computerized neurophysiological battery. Univariate logistic regression model was applied to estimate odd ratios (OR) and 95% confidence intervals of associations. Of 341 consecutive non-depressed subjects, 257 participants (75.4%) reported subjective memory decline (SMD). Subjects with and without SMD did not differ in age, gender, education, marital status, employment and life-style. Subjects with SMD had elevated GDS scores (OR = 1.14, 95% CI: 1.003-1.29), white anxiety level showed a tendency to be increased (OR = 1.03, 95% CI: 0.99-1.06). Comparison of cognitive performance has not revealed differences in cognitive domains between subjects with and without SMD. SMD in healthy elderly people is associated with sub-clinical depression even among those without objectively measured cognitive decline.

Clinical Utility of Trial 1 of the Test of Memory Malingering (TOMM)

The clinical utility of Trial 1 of the Test of Memory Malingering (TOMM) has recently become a topic of investigation. The current study cross-validated previous research suggesting that those participants who score 45 or greater on Trial 1 of the TOMM will continue to do so on Trial 2 and the Retention Trial and extended these findings to broader clinical and nonclinical populations. Two archival samples were included for analyses: one sample of healthy community-dwelling elders and another sample drawn from an outpatient neuropsychology clinic. As demonstrated previously, 100% of those patients that scored 45 or greater on TOMM Trial 1 scored above cut-scores on Trial 2 and the Retention Trial, supporting the utility of a possible discontinuation rule on Trial 1. When combined with previous research, the current results provide further support for the clinical utility of Trial 1 in predicting overall performance on the TOMM; however, use of any nonstandard administration of the TOMM may not satisfy Daubert criteria in forensic settings and may not be appropriate.

Subjective memory beliefs and cognitive performance in normal and mildly impaired older adults

Previous research suggests that subjective perceptions of memory may be related to objective memory performance. In the present study, healthy community-dwelling elders (N = 73, mean age = 75.25 years, education = 16.2 years) completed a neuropsychological assessment, including two questionnaires of subjective memory beliefs. Each participant was identified, via consensus conference, as belonging to either an amnestic mild cognitive impairment (MCI, n = 16) or no mild cognitive impairment (noMCI, n = 57) group. Results indicated that subjective memory capacity beliefs were significantly related to verbal memory performance in the MCI group, but not in the noMCI group. This differential relationship persisted even after controlling for depressive symptoms, and was not reflective of unequal variances in the two groups. Thus, results indicate that subjective memory beliefs may be better indicators of performance in those with possible incipient cognitive impairment than normal older adults, perhaps because persons with MCI have heightened insight into their memory functioning, and that this relationship is not due to group differences in depressive symptoms.

Effect of Blood Pressure on Cognitive Functions in Elderly Persons

Little is known about what specific cognitive functions are affected by elevated blood pressure (BP) and how orthostatic BP change is related to cognitive impairment. The aim of this study was to determine the effect of BP and its postural change on cognitive functions in otherwise healthy elders. In 70 healthy persons (mean age, 72 +/- 4 years), supine systolic BP (SBP) was assessed 3 times using a sphygmomanometer, and the average values were obtained for the analysis. After 1, 3, and 5 minutes of standing, 3 BP measurements were obtained and the orthostatic SBP changes were determined by subtracting these values from the supine average. Neuropsychological tests were administered to assess short-term and long-term verbal and visual memory, visuospatial skills, and frontal-executive functions. Participants were considered impaired in the specific cognitive performance if their scores fell below the 25th percentile of the study population. Multiple logistic regression models were used to evaluate the relation of SBP and the magnitude of orthostatic SBP decline to risk for impairment in each of the cognitive tests. Controlling for potential confounders, each 10 mmHg increase in supine SBP was associated with a 2.31-fold increase (95% confidence interval, 1.14 to 4.66) in risk for impairment in psychomotor speed and set shifting as measured using the Trailmaking Part-B test. There was no significant association between cognitive functions and orthostatic SBP decline at 1, 3, and 5 minutes of standing. Elevation of BP is associated with a selective impairment in executive function in otherwise healthy community-dwelling elders.

A Preliminary Investigation to Explore the Effects of Daytime Physical Activity Patterns on Health-Related QOL in Healthy Community-Dwelling Elderly Subjects

A Preliminary Investigation to Explore the Effects of Daytime Physical Activity Patterns on Health-Related QOL in Healthy Community-Dwelling Elderly Subjects

A Preliminary Investigation to Explore the Effects of Daytime Physical Activity Patterns on Health-Related QOL in Healthy Community-Dwelling Elderly Subjects

The purpose of this study was to determine if different lifestyles of healthy elderly subjects would exert some influence on their daytime physical activity patterns and health-related QOL. Sixty-nine elders were categorized into age-gender, marital status, and body mass index (BMI)-matched groups by lifestyle; 12 males living alone (MA), 20 males living with spouse (MS), 16 females living alone (FA), and 21 females living with spouse (FS). Daytime physical activity (DPA) was recorded with the actigraph: a wrist-worn device. Health-related QOL scales consisted of Zung Self-Rating Depression Scale (SDS), Life Satisfaction Index-Z (LSI), and Visual Analogue Scale of Happiness.Among the four lifestyles, statistical analysis revealed a significant difference in SDS and LSI (both, p < 0.05), and DPA (p < 0.01). Trends in these parameters characteristically indicated that (1) the greatest SDS and the lowest others were observed in MA, compared with FA and (2) greater SDS and DPA, and lower LSI, were shown in FS than MS. The current findings demonstrate that lifestyle of the elderly subjects residing in urban wards might appreciably exercise influences on QOL and physical activity. The preliminary study suggests that more attention to daily physical activity and lifestyle of healthy community-dwelling elderly subjects may not be less efficacious than conventional care in rehabilitative intervention, but the characteristics of elderly handicapped subjects remain unclear.