High Physical Impairment Research Articles

Long-term Trajectories of Low Back Pain in Older Men: A Prospective Cohort Study With 10-Year Analysis of the Osteoporotic Fractures in Men Study.

Although low back pain (LBP) may persist or recur over time, few studies have evaluated the individual course of LBP over a long-term period, particularly among older adults. Based on data from the longitudinal Osteoporotic Fractures in Men (MrOS) Study, we aimed to identify and describe different LBP trajectories in older men and characterize members in each trajectory group. A total of 5 976 community-dwelling men (mean age = 74.2) enrolled at 6 U.S. sites were analyzed. Participants self-reported LBP (yes/no) every 4 months for a maximum of 10 years. Latent class growth modeling was performed to identify unique LBP trajectory groups that explained variation in the LBP data. The association of baseline characteristics with trajectory group membership was assessed using univariable and multivariable multinominal logistic regression. A 5-class solution was chosen; no/rare LBP (n = 2 442/40.9%), low frequency-stable LBP (n = 1 040/17.4%), low frequency-increasing LBP (n = 719/12%), moderate frequency-decreasing LBP (n = 745/12.5%), and high frequency-stable LBP (n = 1 030/17.2%). History of falls (OR = 1.52), history of LBP (OR = 6.37), higher physical impairment (OR = 1.51-2.85), and worse psychological function (OR = 1.41-1.62) at baseline were all associated with worse LBP trajectory groups in this sample of older men. These findings present an opportunity for targeted interventions and/or management to older men with worse or increasing LBP trajectories and associated modifiable risk factors to reduce the impact of LBP and improve quality of life.

Anxiety and physical impairment in patients with central vestibular disorders.

There is increasing evidence for close interrelations between vestibular and emotional brain networks. A study in patients with bilateral peripheral vestibulopathy (BVP) showed relatively low vertigo-related anxiety (VRA), despite high physical impairment. The current working hypothesis proposes the integrity of the peripheral vestibular system as a prerequisite for development of VRA. Here we contribute by evaluating VRA and vestibular-related handicap in central vestibular disorders. Of 6396 patients presenting in a tertiary vertigo centre, 306 were identified with four clear central vestibular disorders: pure cerebellar ocular motor disorder (COD; 61), cerebellar ataxia (CA; 63), atypical parkinsonian syndromes (APS; 28), vestibular migraine (VM; 154). Their results of the Vertigo Handicap Questionnaire (VHQ), with its subscales for anxiety and handicapped activity, were compared to those of 65 BVP patients. Postural instability was measured on a force-plate. Multivariate linear regression was used to adjust for patient demographics. Patients with chronic central vestibular disorders (COD, CA, APS) had relatively low VRA levels comparable to those in BVP, independent of increased handicapped activity or postural instability. Only VM patients showed significantly higher VRA, although their activity impairment and postural instability were lowest. No significant differences within chronic central vestibular disorders were found for VRA and subjective activity impairment. Subjective and objective vestibular-related impairment are not necessarily correlated with vestibular-related anxiety in central vestibular disorders. Our findings rather support the hypothesis that, in addition to an intact peripheral, an intact central vestibular system could also serve as a prerequisite to develop specific VRA.

Association of drug burden index with delirium in community-dwelling older adults with dementia: a longitudinal observational study.

The Drug Burden Index (DBI) is a validated tool for assessing the dose-dependent cumulative exposure to sedative and anticholinergic medications. However, the increased risk of delirium superimposed dementia (DSD) with high DBI levels has not yet been investigated. This study aimed to examine the potential association between DBI scores and delirium in community-dwelling older adults with dementia. A total of 1105 participants with cognitive impairment underwent a comprehensive geriatric assessment. Experienced geriatricians made the final diagnosis of delirium based on DSM-IV-TR and DSM-V. We calculated the DBI as the sum of all sedatives and anticholinergics taken continuously for at least four weeks before admission. Polypharmacy was defined as regular use of five or more medications. We classified the participants as having no exposure (DBI = 0), low exposure (0 < DBI < 1), and high exposure (DBI ≥ 1). Of the 721 patients with dementia, the mean age was 78.3 ± 6.7years, and the majority were female (64.4%). In the whole sample, low and high exposures to anticholinergic and sedative medications at admission were 34.1% (n = 246) and 38.1% (n = 275), respectively. Patients in the high-exposure group had higher physical impairment (p = 0.01), higher polypharmacy (p = 0.01), and higher DBI scores (p = 0.01). In the multivariate Cox regression analysis, high exposure to anticholinergic and sedative medications increased the risk of delirium 4.09-fold compared to the no exposure group (HR = 4.09, CI: 1.63-10.27, p = 0.01). High exposure to drugs with sedative and anticholinergic properties was common in community-dwelling older adults. A high DBI was associated with DSD, highlighting the need for an optimal prescription in this vulnerable population. The trial was retrospectively registered at ClinicalTrials.gov. Identifier: NCT04973709 Registered on 22 July 2021.

Toward a Multidimensional Understanding of Later Life Disability: A Latent Profile Analysis

Disability is difficult to define succinctly. Current literature on disability has primarily focused on physical functional limitations. However, relying on a single dimension or index cannot accurately represent disability as the experience of disability is nuanced and complex. To address these gaps, this study aims to understand the multidimensional nature of disability among retired, community-dwelling older adults. Using a sample of 414 older adults between the ages of 72 and 106 years (M=84.84, SD=4.56), latent profile analysis was employed to identify classes based on five indicators of disability across three domains. The five indicators of disability included difficulties with activities of daily living (ADLs), cognitive impairment, physical impairment, sensory impairment, and participation restrictions. Three classes were found to represent the data best. The most favorable and highly functioning group comprised the highest number of participants (n=242, 59.5%). The next group, class 2 (n=157, 37.9%), was characterized by high physical impairment and ADL-difficulty. The smallest group, class 3 (n=15, 3.6%), had the highest ADL-difficulty and participation restrictions but drastically lower cognitive and sensory impairment. Multinomial logistic regression revealed that class membership was related to sociodemographic characteristics. Finally, class membership predicted several mental health outcomes such as depressive symptoms, positive affect, and life satisfaction in the expected direction. If supported by future work, these findings could inform practitioners in developing more specific interventions relevant to older adults based on their disability profiles. Understanding various combinations of disablement has potential implications for services and interventions to be tailored to individuals’ distinct disability-related needs.

Development of a Physical Impairment Prediction Model for Korean Elderly People using Synthetic Minority Over-Sampling Technique and XGBoost

The old people's 'physical functioning' is a key factor of active ageing as well as a major factor in determining the quality of life and the need for long-term care in old age. Previous studies that identified factors related to ADL mostly used regression analysis to predict groups of high physical impairment risk. Regression analysis is useful for confirming individual risk factors, but has limitations in grasping multiple risk factors. As methods for resolving this limitation of regression models, machine learning ensemble boosting models such as random forest and eXtreme Gradient Boosting (XGBoost) are widely used. Nonetheless, the prediction performances of XGBoost, such as accuracy and sensitivity, remain to be verified additionally by follow-up studies. This article proposes an effective method of dealing with imbalanced data for the development of ensemble-based machine learning, by comparing the performances of disease data sampling methods. This study analyzed 3,351 old people aged 65 or above who resided in local communities and completed the survey. As machine learning models to predict physical impairment in old age, this study compared the logistic regression model, XGBoost and random forest, with respect to the predictive performances of accuracy, sensitivity, and specificity. This study selected as the final model a model whose sensitivity and specificity were 0.6 or above and whose accuracy was highest. As a result, synthetic minority over-sampling technique (SMOTE)-based XGBoost whose accuracy, sensitivity, and specificity were 0.67, 0.81, and 0.75, respectively, was determined as the most excellent predictive performance. The results of this study suggest that in case of developing a predictive model using imbalanced data like disease data, it is efficient to use the SMOTE-based XGBoost model.

Beyond the Health Deficit Count: Examining Deficit Patterns in a Deficit-Accumulation Frailty Index.

Exploring deficit patterns among frail people may reveal subgroups of different prognostic importance. Analysis of National Health and Aging Trends Study. Community. Community dwelling older adults with mild to moderate frailty (deficit-accumulation frailty index (FI) of 0.25-0.40) (n = 1821). Latent class analysis identified distinct clinical subgroups based on comorbidity (range: 0-10), National Health and Aging Trends Study dementia classification, and short physical performance battery (SPPB) (range: 0-12). Survival analyses compared 5-year mortality by subgroups. Three latent classes existed: Class 1 (n = 831, mean FI = 0.30) had 2.7% probable dementia, high comorbidities (mean = 3.6), and low physical impairment (SPPB mean = 9.9); Class 2 (n = 734, mean FI = 0.32) had 6.9% probable dementia, low comorbidities (mean = 2.8), and moderate physical impairment (SPPB mean = 6.2); Class 3 (n = 256, mean FI = 0.34) had 20.7% probable dementia, low comorbidities (mean = 2.4), and high physical impairment (SPPB mean = 2.0). Compared to Class 1, Classes 2 and 3 experienced higher 5-year mortality (C2: 1.28 (95% confidence intervals (CI) = 1.00-1.62); C3: 1.87 (95% CI = 1.29-2.73)). Deficit patterns among the mild-to-moderately frail provide additional prognostic information and highlight opportunities for preventive interventions.

American Medical Association Impairment Ratings and Earnings Losses Due to Disability

Abstract The AMA Guides to the Evaluation of Permanent Impairment (AMA Guides) has been criticized because it was designed to measure the severity of impairment (loss of function of a body part) rather than disability (eg, inability to work), and the AMA Guides uses whole person impairment that accords higher priority to body regions that are deemed more important to functionality even though no objective evidence supports the relative importance of different body regions. This article reports on a study funded by the California Commission on Health and Safety and Workers’ Compensation (CHSWC) to address these concerns. The study found that the AMA Guides, Fifth Edition, is an effective tool for ranking the effect of physical impairments on the ability to work; people with higher physical impairment ratings, measured using the AMA Guides, consistently had higher earnings losses. The authors conclude that ratings based on the AMA Guides, Fifth Edition, probably are more accurate and consistent than ratings conducted under the previous system in California, the system used by the Veterans Administration, or systems used by Wisconsin and Florida in the 1960s. The authors also identified significant challenges to using ratings based on the AMA Guides to determine financial compensation, particularly across body regions, and some evidence suggests that the relationship between impairment ratings and losses was attenuated at higher ratings.

Coping with amyotrophic lateral sclerosis: an integrative view

ObjectivesTo identify predictors of psychosocial adjustment to motor neurone disease.MethodsA total of 27 individuals with a confirmed diagnosis of amyotrophic lateral sclerosis (ALS) participated in the study. The ALS functional...

Psychosocial factors, physical symptoms and physical function after lung transplantation

Relationships between psychosocial factors, physical symptoms, and physical function were explored in 50 lung transplant recipients (LTR) to determine whether psychosocial factors rendered LTR vulnerable to increased physical symptoms or functional impairment. Structured assessments were conducted to evaluate personal and family psychiatric history, post-transplant psychiatric distress (SCL-90 anxiety and depression symptoms), selfesteem, sense of mastery, and coping strategies, as well as current physical symptoms and physical functional impairment. Psychological distress, symptoms, and physical impairment were common. The percentage of cohort with each characteristic was: family (31%) and personal psychiatric histories (47%); high anxiety (39%), high depression (36%), low self-esteem (46%), low mastery (52%); low active cognitive (39%), low active behavioral (28%) and high avoidance coping (26%). Pre-transplant psychiatric history increased risk for post-transplant anxiety (r .38) and depression (r .38) and these correlated with physical symptoms (r .54-.65) and impairment (r .49-.51). Anxiety and depression exceeded non-patient norms, and lung recipients had higher depression, symptoms and impairment (p .05) than heart/lung. Low mastery correlated with high physical impairment (r .36). Mean physical impairment scores (16. 23.8) were comparable to other pulmonary populations, including transplant candidates, but were higher than other samples of LTR 3 months post-transplant. Mean physical symptom scores (16.8 5) were higher, but endorsed items were comparable to other LTR samples. Anxiety and depression correlated with symptoms and impairment and symptoms correlated with impairment (r .60). Psychosocial factors explained variance in physical symptoms (R .646) and impairment (R .545). Directions of influence between correlates need to be examined. Interventions to reduce psychological distress need to be developed.