Higher Levels Of Physical Functioning Research Articles

Comparing Plantarflexor Power and Function using Carbon Fiber Versus Traditional Thermoplastic Ankle Foot Orthoses: Case Series

Background: Thermoplastic ankle foot orthoses (TAFO) control the foot during swing and initial contact of walking. Carbon fiber AFOs (CAFO) has the added ability to store and return energy at push off. The purpose of this report is to determine if plantarflexor power and function can be improved with a CAFO compared to a TAFO and identify factors that may be related to plantarflexor power improvement in two adults with reduced ankle muscle performance. Case Descriptions: Two participants with reduced ankle muscle performance completed a gait analysis and the 6 minute walk (6MW) test wearing each AFO. Physical function was higher in Participant 1 compared to Participant 2 as measured by the Foot and Ankle Ability Measure and walking speed. Outcomes: Participant 1’s 6MW distance and plantarflexor power improved wearing the CAFO compared to the TAFO (6MW distance: TAFO=427 m, CAFO=553 m and Plantarflexor power: TAFO=1.16 W/kg, CAFO=1.56 W/kg). Participant 2 showed similar outcomes in both AFO conditions (6MW distance: TAFO=290 m, CAFO=276 m and plantarflexor power: TAFO=0.89 W/kg, CAFO=0.60 W/kg). Discussion: A CAFO increased walking speed and plantarflexor power compared to a TAFO in a person with a relatively high level of physical function but not in a person with a relatively low level of physical function. These preliminary results suggest a sufficiently high level of physical function is required to “engage” the CAFO and benefit from its energy storing capabilities.

ASSESSMENT OF QUALITY OF LIFE IN PATIENTS AFTER LOWER LIMB AMPUTATION.

Lower extremity amputation is a surgical procedure resulting in important anatomical, functional, psychological, and social consequences that can influence the quality of life of these patients. The aim of this research was to compare the quality of life of patients with lower extremity amputation and people without amputation taking into account gender differences as well as the amputation level. The study was designed as a cross-sectional study which included 56 subjects. The patients from the experimental group underwent prosthetic rehabilitation treatment at the Department of Medical Rehabilitation, Clinical Centre of Vojvodina. The experimental group included 28 patients (21 male, 7 female) with lower extremity amputation, their average age being 65.36±13.64. The control group consisted of 28 age and gender matching subjects without amputation. Research ANd Development (RAND) 36--Item Health Survey 1.0 (SF-36) was used to measure the quality of life. The results showed that patients with lower extremity amputation scored lower than the control group on all SF-36 variables (p<0.05). None of the SF-36 variables differed between the genders (p>0.05). Seventeen (61%) patients were with transfemoral, and 11 (39%) with transtibial level of amputation. The patients with transtibial amputations scored higher on physical functioning and general health status variables (p<0.05). The patients with lower extremity amputations have numerous limitations compared to the control group, regardless of gender, while the patients with lower level of amputation have a higher level of physical functioning.

Physical functioning is associated with processing speed and executive functions in community-dwelling older adults.

The aim of this study was to examine the association between physical functioning and cardiovascular burden on the cognitive performance of community-dwelling older adults. Ninety-three adults aged 60 and older completed a medical evaluation by a geriatrician, performance-based physical tests, and neuropsychological assessments. Cognitive composite scores (memory, speed, and executive) as well as a physical functioning score were created by averaging standardized z-scores of selected tests. A cardiovascular burden index was also computed by totalling the number of cardiovascular risk factors and diseases. Multiple hierarchical regression analyses reveal that higher level of physical functioning was significantly associated with greater processing speed and better executive functions but was not associated with memory performance. These relations were independent of age, sex, and level of education. Cardiovascular burden was not significantly associated with any cognitive domain. These results suggest that cognition is related to simple performance-based physical tests and highlight the importance of intervention studies aimed at enhancing cognitive and physical functioning in older adults.

The effect of local anaesthetic wound infiltration on chronic pain after total hip replacement: a randomised controlled trial

The effect of local anaesthetic wound infiltration on chronic pain after total hip replacement: a randomised controlled trial

Cost-utility of exercise therapy added to general practitioners’ care versus general practitioners’ care alone in patients with hip osteoarthritis

Purpose: To determine the cost-effectiveness over a period of 12 months of exercise therapy added to general practitioners’ care compared to general practitioners’ care alone in patients with a new episode of hip OA in general practice. Methods: A cost-utility study was performed in conjunction with a multi-center randomized controlled trial with a parallel group design. Patients participated if they were 45 years or older, comply with the clinical American College of Rheumatology criteria for hip OA, and visited their general practitioner (GP) for a new episode of complaints due to hip osteoarthritis. Patients were excluded if they: 1) were already treated with exercise therapy in the present episode of hip OA, 2) had a hip pain score of <2 on the 11-point numeric rating scale (0 to 10), 3) had a high level of physical function, a score of <2 on the walking ability and the physical function sections of the Algofunctional index, 4) had undergone hip surgery or on the waiting list, 5) had severe disabling co-morbidity and 6) had insufficient comprehension of the Dutch language and/or were mentally incapable of participation. The patients were allocated at random in two treatment groups: one group received exercise therapy supervised by a physiotherapist (up to 15 sessions in the first 3 months and 3 follow-up sessions in month 5, 7 and 9) added to GP care and the control group received GP care only. The cost-utility study was primarily conducted from a societal perspective, but the healthcare perspective was also applied. Data on direct medical costs, productivity costs and quality of life was collected at baseline and at 6, 13, 26, 39 and 52 weeks follow-up. Annual costs were determined by adding up the costs per period. The costs for the time between the measurement periods (week 6–7) were established through linear interpolation. All costs were based on Euro 2011 cost data. The quality of life score per patient during the 52 weeks follow up was estimated by combining the EQ-5D scores at all measurement moments. Differences between the intervention and control group were assessed by means of the independent sample T test (for variables showing a normal distribution), the Mann Whitney U test (for variables not normally distributed) or Pearson Chi-square test (for variable fractions). Using nonparametric bootstrapping (drawing 2,500 observations at random), the degree of uncertainty for costs and health effects and the cost-utility ratio was examined on the so-called CE-plane. In addition, an acceptability curve was generated to indicate the probability that the intervention has lower incremental costs per quality adjusted life year (QALY) gained than various thresholds for the maximum willingness to pay for an extra QALY. Results: The study took place in the period 2009–2012 and finally 203 patients were included. The annual direct medical costs per patient were significantly lower for the exercise group (€ 1,233) compared to the control group (€ 1,331) despite additional physiotherapy visits. The average annual societal costs per patient were lower in the exercise group (€ 2,634 versus € 3,241; P = 0,002). Productivity costs were higher than direct medical costs. Patients in the exercise group experienced a slightly, but not significantly, higher quality of life (0.776 versus 0.770). We found a societal average cost effectiveness (CE)-ratio of – € 107,505 per quality adjusted life year (exercise cost effective). When only direct medical costs were included, the average cost per quality adjusted life year amounted to € −17,441, but the uncertainty around both CE-ratios was substantial. Conclusions: Over a period of 52 weeks, with a CE-ratio of – € 107,505 per QALY from the societal perspective and a CE-ratio of € −17,441 per QALY from the healthcare perspective, our study revealed a considerable probability that exercise therapy added to GP care is cost saving or cost effective as compared to GP care alone.

Physical functioning after occupational rehabilitation and returning to work among employees with chronic musculoskeletal pain and comorbid depressive symptoms

BackgroundThe aim of this investigation was to assess whether measures of physical functioning after multidisciplinary rehabilitation are associated with return to work among individuals with chronic musculoskeletal pain conditions and comorbid depressive symptoms.MethodsIncluded were 92 employees with chronic musculoskeletal disorders who had participated in a 57- week multidisciplinary rehabilitation program. Their ages ranged from 25–59 years. The Hospital Anxiety and Depression Scale was used to assess depressive symptoms. Different aspects of physical functioning (muscle strength, mobility, endurance capacity, and balance) were measured with single-item visual analog scales, and physical fitness was measured with the validated COOP/WONCA charts. Being on “active work strategies,” such as receiving rehabilitation benefit/vocational rehabilitation or being reported partly or completely fit, was defined as “on their way into/in work”. Cross-sectional associations were measured using logistic regression models, estimating odds ratio with 95% confidence intervals.ResultsThere were no differences between the “on their way into/in work” group (n=70) and the “on their way out/out of work” group (n=22) regarding age, sex, or levels of anxiety or pain. Surprisingly, regression analyses showed that those with higher levels of physical functioning had significantly lower odds of returning to work.ConclusionThe findings of an inverse relationship between self-reported physical function and returning to work in this sample illustrate that the return-to-work process among employees with chronic musculoskeletal pain and comorbid depressive symptoms is multifactorial and influenced by factors other than physical functioning at the individual level. Further research, especially longitudinal studies, is needed to assess the occupational trajectories among employees with chronic musculoskeletal pain and comorbid depressive symptoms after participation in a multidisciplinary rehabilitation program.

Associations between level and change in physical function and brain volumes.

BackgroundHigher levels of fitness or physical function are positively associated with cognitive outcomes but the potential underlying mechanisms via brain structure are still to be elucidated in detail. We examined associations between brain structure and physical function (contemporaneous and change over the previous three years) in community-dwelling older adults.Methodology/Principal FindingsParticipants from the Lothian Birth Cohort 1936 (N=694) underwent brain MRI at age 73 years to assess intracranial volume, and the volumes of total brain tissue, ventricles, grey matter, normal-appearing white matter, and white matter lesions. At ages 70 and 73, physical function was assessed by 6-meter walk, grip strength, and forced expiratory volume. A summary ‘physical function factor’ was derived from the individual measures using principal components analysis. Performance on each individual physical function measure declined across the three year interval (p<0.001). Higher level of physical function at ages 70 and 73 was associated with larger total brain tissue and white matter volumes, and smaller ventricular and white matter lesion volumes (standardized β ranged in magnitude from 0.07 to 0.17, p<0.001 to 0.034). Decline in physical function from age 70 to 73 was associated with smaller white matter volume (0.08, p<0.01, though not after correction for multiple testing), but not with any other brain volumetric measurements.Conclusions/SignificancePhysical function was related to brain volumes in community-dwelling older adults: declining physical function was associated with less white matter tissue. Further study is required to explore the detailed mechanisms through which physical function might influence brain structure, and vice versa.

The course of Health Related Quality of Life in postmenopausal women with breast cancer from breast surgery and up to five years post-treatment

BackgroundPrevious studies include too few patients over 70 years to be able to assess treatment effects on Health Related Quality Of Life (HRQOL) in the older age group. We aimed to follow HRQOL in postmenopausal women (55–80 years) with breast cancer receiving adjuvant treatment, until five years post-treatment, and compare with a general population. Patients and methodsThe patient sample included 150 women (adjuvant CT n = 75 and RT n = 75) and two reference samples from the Swedish SF-36 norm database. ResultsData from baseline showed significantly higher levels of physical functioning and general health among the patients compared to the reference sample, and significantly lower levels of bodily pain, emotional role functioning and mental health. Longitudinal analyses showed significant changes in all scales, and three different patterns (a decrease-stable, a decrease-increase, and a stable- increase pattern) were identified. ConclusionPostmenopausal women seem to successfully manage the effects of adjuvant treatment on HRQOL.

AB0505 Enhanced improvement in physical functioning with secukinumab treatment among RA patients: An application of IRT methodology

BackgroundThe effectiveness of rheumatoid arthritis (RA) treatment in improving physical functioning is most often measured using the HAQ-DI and SF-36v2 physical functioning (PF) scales. Items of the HAQ-DI assess lower...

Impact of two different exercise programs on persistent cancer-related fatigue and physical fitness

Cancer-related fatigue is a common symptom in patients with cancer, which is experienced by 70% to 100% of these patients and brings some impairment of physical and mental performance, hinders their working or carrying out regular daily activities, and hence results in a substantial reduction of the quality of life. Physical exercise has consistently been identified as a central element of rehabilitation for many chronic diseases like cancer, and increasing evidence supports the contention that physical activity is a valuable intervention that can be utilized in conjunction with conventional therapies during CRF treatment. Objective: The aim of this study was to assess the impact of a program of physical exercise on fatigue levels and physical performance of cancer patients. Method: A consecutive series of 44 adult patients with neoplastic disease (solid or hematological), with a medical diagnosis of fatigue, who were enrolled in an oncological treatment, with the ability to walk and willing to enter a rehabilitation program of exercise for at least 4 consecutive months. The exercise program was performed two times per week, each session lasting one hour and consisting of aerobic, resistance, and flexibility exercises. The protocol was divided into aerobic exercise and resistance training combined with aerobic exercise. The patients were evaluated with two assessments: one prior to their beginning the exercise program and other at the end of the four-month program. In both assessments the patients completed the Revised Piper Fatigue Scale and the six-minute walk test. The primary outcome of change over baseline and after 16 weeks in PFS-R score and six-minute walk test were compared using a two sample two-sided t-test for both groups. Alpha level was set at p &lt; 0.05. Results: After 16 weeks, the patients who participated in the aerobic or the combined exercise program reported significantly higher levels of physical functioning (6-minute walking test, p = 0.0009 and p = 0.001, respectively) and significantly lower fatigue (PFS-R, p = 0.003 and p = 0.002, respectively) than at the beginning the exercise program. Conclusion: The results of patients who underwent aerobic or aerobic + anaerobic exercise showed statistically significant improvement of physical performance and of fatigue. Data from this study corroborates with the literature showing that exercise programs with aerobic or resistance exercises are an effective strategy for the treatment of fatigue. The results of this study confirm that physical exercise could be useful in rehabilitation of cancer survivors, especially for fatigued patients.

The influence of sport participation on physical function in patients with osteoarthritis during and after exercise therapy

Introduction: The objectives of this study were to investigate 1) in which sports activities patients with osteoarthritis (OA) participate, 2) the cross sectional differences in functional outcome between sports participants and nonsports participants and 3) the influence of regular sports participation on the effectiveness of exercise therapy with respect to physical function. Methods: A prospective observational follow-up study was performed investigating the influence of sport participation on patients’ outcome. Data were obtained from a single blinded randomized controlled trial comparing two different exercise therapy interventions in 200 patients with hip and knee OA. At baseline, after 3 and 15 months, primary (self-reported physical function) and secondary patient outcome and sport participation were obtained. Patients were defined as sports participants when they performed a sport activity for at least 60 minutes per week at the time of assessment (regardless the kind and intensity of the sport activity) or as non-sports participants when they did not perform a sport activity for at least 60 minutes per week. Patients were defined as regular sports participants if they participated in sports activities at two out of three assessment moments. Results: Thirty-eight percent of the patients with OA participated in 11 different sports activities. Sports participants had a higher level of physical function at baseline, 3 and 15 months’ assessments. Physical function improved significantly within both the regular sports participants SP and the non-regular sports participants at 3 and 15 months’ assessments. However, the regular group improved significantly more compared to the non-regular group. Conclusion: A minority of patients with OA participated in sports activities. The sports activities in which they participated had a moderate to vigorous intensity. The influence of participation in sports activities on physical function and the effect of exercise therapy seems positive. The influence of sports participation on physical function and the effect of exercise therapy seems positive within patients who underwent an exercise therapy intervention. Therefore, we confirm the opinion that patients with OA should continue participating in sports which do not provoke their pain, as well as that patients with OA should be stimulated to participate in sports activities.

Lumbar Decompression and Fusion in a Centenarian

The incidence of chronic and debilitating conditions in the aging population is steadily increasing, and the treatment of extreme elderly patients with spinal conditions can be challenging. Spinal stenosis and spondylolisthesis can dramatically affect patient quality of life, and patients commonly seek a surgical solution for their condition. Many extreme elderly patients are cautioned against surgery secondary due to their high complication and in-hospital mortality rates when compared with younger patients. This article describes the oldest patient (101 years old) in the English literature with severe spinal stenosis and spondylolisthesis who underwent primary lumbar decompression and fusion. His symptomatology dramatically affected his quality of life, and he was denied surgical care at another institution secondary to his advanced age and high potential risks. A successful outcome was ultimately achieved, and he was able to return to a higher level of physical functioning and social participation prior to his death of unrelated causes 3 years later. This case questions the strict indications of surgery in less-than-ideal and extreme elderly surgical candidates. The authors believe that surgery should not be denied in extreme elderly patients who have failed conservative treatment modalities and continue to have functional impairments. Successful spinal surgery may allow extreme elderly patients an improved quality to the remainder of their life.

Profile of Nursing Home Residents with Dementia Who Require Assistance with Mouth Care

The majority of nursing home residents require assistance with activities of daily living, including oral care. Poor oral health is common in the nursing home because residents are not given appropriate assistance to support this aspect of their care. The purpose of this study was to describe the demographic, functional, and behavioral profile of nursing home residents with dementia who require verbal or physical assistance with mouth care. Residents who required verbal support to complete mouth care exhibited higher levels of physical function, higher levels of cognitive functioning in the domains of language and executive function, lower levels of passivity, and higher scores for the personality trait of openness than residents who required physical assistance. Best practices for implementing verbal and physical assistance during mouth care to persons with dementia are presented on the basis of these profiles.

Food shopping habits, physical activity and health-related indicators among adults aged ≥70 years

To investigate the food shopping habits of older adults in the UK and explore their potential associations with selected health-related indicators. A cross-sectional study including objectively measured physical activity levels, BMI, physical function and self-reported health status and dietary intake. Bristol, UK. A total of 240 older adults aged ≥70 years living independently. Mean age was 78·1 (sd 5·7) years; 66·7 % were overweight or obese and 4 % were underweight. Most (80·0 %) carried out their own food shopping; 53·3 % shopped at least once weekly. Women were more likely to shop alone (P < 0·001) and men more likely to shop with their spouse (P < 0·001). Men were more likely than women to drive to food shopping (P < 0·001), with women more likely to take the bus or be driven (P < 0·001). Most reported ease in purchasing fruit and vegetables (72·9 %) and low-fat products (67·5 %); 19·2 % reported low fibre intakes and 16·2 % reported high fat intakes. Higher levels of physical function and physical activity and better general health were significantly correlated with the ease of purchasing fresh fruit, vegetables and low-fat products. Shopping more often was associated with higher fat intake (P = 0·03); higher levels of deprivation were associated with lower fibre intake (P = 0·019). These findings suggest a pattern of food shopping carried out primarily by car at least once weekly at large supermarket chains, with most finding high-quality fruit, vegetables and low-fat products easily accessible. Higher levels of physical function and physical activity and better self-reported health are important in supporting food shopping and maintaining independence.

Physical Activity and Physical Function in Individuals Post-bariatric Surgery

A better understanding of the physical activity behavior of individuals who undergo bariatric surgery will enable the development of effective post-surgical exercise guidelines and interventions to enhance weight loss outcomes. This study characterized the physical activity profile and physical function of 40 subjects 2-5 years post-bariatric surgery and examined the association between physical activity, physical function, and weight loss after surgery. Moderate-to-vigorous intensity physical activity (MVPA) was assessed with the BodyMedia SenseWear® Pro (SWPro) armband, and physical function (PF) was measured using the physical function subscale of the 36-Item Short Form Health Survey instrument (SF-36(PF)). Height and weight were measured. Percent of excess weight loss (%EWL) was associated with MVPA (r = 0.44, p = 0.01) and PF (r = 0.38, p = 0.02); MVPA was not associated with PF (r = 0.24, p = 0.14). Regression analysis demonstrated that MVPA was associated with %EWL (β = 0.38, t = 2.43, p = 0.02). Subjects who participated in ≥150 min/week of MVPA had a greater %EWL (68.2 ± 19, p = 0.01) than those who participated in <150 min/week (52.5 ± 17.4). Results suggest that subjects are capable of performing most mobility activities. However, the lack of an association between PF and MVPA suggests that a higher level of PF does not necessarily correspond to a higher level of MVPA participation. Thus, the barriers to adoption of a more physically active lifestyle may not be fully explained by the subjects' physical limitations. Further understanding of this relationship is needed for the development of post-surgical weight loss guidelines and interventions.

Lean mass, muscle strength, and physical function in a diverse population of men: a population-based cross-sectional study

BackgroundAge-related declines in lean body mass appear to be more rapid in men than in women but our understanding of muscle mass and function among different subgroups of men and their changes with age is quite limited. The objective of this analysis is to examine racial/ethnic differences and racial/ethnic group-specific cross-sectional age differences in measures of muscle mass, muscle strength, and physical function among men.MethodsData were obtained from the Boston Area Community Health/Bone (BACH/Bone) Survey, a population-based, cross-sectional, observational survey. Subjects included 1,157 black, Hispanic, and white randomly-selected Boston men ages 30-79 y. Lean mass was assessed by dual-energy x-ray absorptiometry. Upper extremity (grip) strength was assessed with a hand dynamometer and lower extremity physical function was derived from walk and chair stand tests. Upper extremity strength and lower extremity physical function were also indexed by lean mass and lean mass was indexed by the square of height.ResultsMean age of the sample was 47.5 y. Substantial cross-sectional age differences in grip strength and physical function were consistent across race/ethnicity. Racial/ethnic differences, with and without adjustment for covariates, were evident in all outcomes except grip strength. Racial differences in lean mass did not translate into parallel differences in physical function. For instance, multivariate modeling (with adjustments for age, height, fat mass, self-rated health and physical activity) indicated that whereas total body lean mass was 2.43 kg (approximately 5%) higher in black compared with white men, black men had a physical function score that was approximately 20% lower than white men.ConclusionsIn spite of lower levels of lean mass, the higher levels of physical function observed among white compared with non-white men in this study appear to be broadly consistent with known racial/ethnic differences in outcomes.

Training to Improve Functional Performance Also Increases Mucosal IgA in Elderly Women

Functional ability has been inversely correlated with short-term morbidity and the need for assisted living among older adults. Exercise has been used as one method to help elderly maintain high levels of physical function, but exercise may increase their risk for infection. PURPOSE: To evaluate the effect of two different training methods on immune function in elderly women. METHODS: Ninety women over the age of 70 were randomly assigned to either a resistance training group (RT; n = 35); an activities of daily living group (ADL; n = 35); or a non-intervention control group (C; n= 20). The C group maintained normal levels of activity; the exercise groups completed 3 sessions of exercise per week for 24 weeks. The RT group completed 3 sets of 15, bilateral repetitions, of 10 different exercises using Thera Band® resistance bands, body weight and hand weights while the ADL group completed a battery of ADL's and flexibility exercises. Physical outcome measures were taken from the Senior Fitness test: 30-second chair stand, 30 second arm curl, chair sit-and-reach, back-scratch, get-up-and-go and the 6-minute walk. Unstimulated saliva samples were collected for 4 min at baseline and week 25. s-IgA was measured and secretion rates were calculated. Subjects completed forms indicating symptoms of upper respiratory tract infection (URTI) each week. Each test was analyzed separately using a 3 (Groups: C v. RT v. ADL) X 2 (Time: baseline v. post) Analysis of Variance. Post-hoc procedures were used to assess significant interactions and main effects. The statistical package used to run all analysis was SPSS (Ver. 16.0), Chicago, IL. RESULTS: There was a significant main effect of group or time and a significant interaction on every measure. Post-hoc analysis revealed that both training groups increased in all measures from the Senior Fitness Test, s-IgA and the secretion rate of s-IgA compared to the controls. The resistance training group had a significantly lower incidence of URTI than the functional training group or the controls. CONCLUSIONS: This data suggests that both methods of training are effective for increasing select measures of functional performance and immune function as measured by s-IgA in elderly women, but resistance training is better for reducing URTI's in this population.

Associations with worry about dying and hopelessness in ambulatory ovarian cancer patients

Women with ovarian cancer face a poor prognosis, with prolonged periods of treatment but relatively high levels of physical functioning. Their thoughts and feelings regarding the prospect of dying are complex and have not been adequately studied. Various demographic, medical and psychosocial factors were examined to determine their independent associations with fear of dying and hopelessness in a cross-sectional design. Two hundred fifty-four ovarian cancer patients were assessed at the beginning of a new chemotherapy regimen. Separate logistic regressions were performed for worry about dying and loss of hope. For each analysis, psychosocial variables were entered after the demographic and medical variables to determine whether the psychosocial variables had an independent association with the respective outcome. Fifty-five percent of the sample acknowledged fear of dying, and 31.6% acknowledged loss of hope in the fight against their illness. Being younger (p = .001), being of non-Hispanic White ethnicity (p = .026), and having poorer physical well-being (p = .000) were significantly associated with worry about dying after controlling for all other variables in the model. Regarding loss of hope, depressive symptoms (p = .002), lack of social support/well-being (p = .001), and number of treatments (p = .04) were significant. This is one of the largest studies to examine end-of-life concerns in a sample of advanced cancer patients. Our results underscore the importance of demographic and psychosocial variables in the examination of ovarian cancer patients' end-of-life concerns. Their fears and concerns should be openly acknowledged, even when the clinical focus is still on curative treatment.

GENDER DIFFERENCES AS FACTORS IN SUCCESSFUL AGEING: A FOCUS ON SOCIOECONOMIC STATUS

Over the past century, the population of Korea has aged rapidly as a result of decreasing fertility and mortality. Furthermore, the percentage of the population aged 65 and older is expected to double from 7% to 14% within 18 years, a much shorter doubling period than in most other developed countries. As Korean society ages, interest in healthy and successful ageing has increased. However, although previous studies have examined various determinants of successful ageing, such as socioeconomic status, gender differences have been neglected. This study investigated gender differences as factors in successful ageing among elderly men and women. Successful ageing has been defined as having high levels of physical and social functioning. Physical functioning includes having no difficulties with activities of daily living (ADL) or instrumental activities of daily living (IADL). Social functioning is defined as participation in at least one of the following social activities: paid work, religious gatherings or volunteer service. Data for this study were obtained from a representative sample of 761 community-living individuals aged 65-84 years (340 males, 421 females); the respondents were interviewed face-to-face as part of the third wave of the Hallym Ageing Study (2007). Socioeconomic status appears to have a greater gender-specific effect on physical functioning than on social functioning. Especially for elderly men, a higher monthly individual income was significantly related to a higher level of physical functioning. Among elderly women, a higher level of education was associated with a higher level of physical functioning. In a major metropolis, elderly men had low social functioning and elderly women had low physical functioning. As Korea's population ages, successful ageing has received much attention. This study shows that policies promoting successful ageing must consider gender differences and associated socioeconomic factors.

Predictive value of serial measurements of quality of life on all-cause mortality in prostate cancer patients: data from CaPSURE™ (cancer of the prostate strategic urologic research endeavor) database

IntroductionHealth-related quality of life (HRQOL) is a legitimate construct for evaluating treatment and its side effects. Recently, predictive value of HRQOL on survival also has been of interest. In light of the longer survival in patients with prostate cancer and importance of quality of life, we seek to evaluate the association between HRQOL and survival using traditional and novel techniques.MethodsPatients from CaPSURE (Cancer of the Prostate Strategic Urologic Research Endeavor) who were treated within 6 months of diagnosis and had pre-treatment and sufficient post-treatment follow-up information constituted the study population. A sample consisting of 2,899 patients met the study criteria. SF-36 domains were used to measure HRQOL outcomes. Categorical variables were created for HRQOL based on the baseline distribution of the lower 10th percentile and the remainder of the patients. Association between HRQOL and survival (defined by all-cause mortality) in patients with prostate cancer was evaluated using Cox proportional hazards models controlling for age at diagnosis, type of treatment received, clinical risk classification, and number of comorbidities. Sequential bootstrap resampling was implemented to evaluate stability of the model. Univariate and multivariate Cox proportional hazards models were fit using various time points over the course of follow-up.ResultsIn the analysis looking at association of HRQOL baseline measurements, higher levels of physical function and general health were significantly associated with better survival (HR 0.49 95% CI 0.32–0.78 and HR 0.51 95% CI 0.35–0.75, respectively). Post-treatment analysis demonstrated similar results. In time-dependent analysis, higher levels of physical function, role physical, and general health were significantly associated with better survival (HR ranged from 0.57 to 0.65). In addition, analysis looking at change in HRQOL scores demonstrated an association between higher scores on physical function, role physical, vitality, social function, and general health and longer survival (HR ranged from 0.56 to 0.63).ConclusionThis study demonstrated that several domains of HRQOL were significantly associated with survival in a large group of patients with localized prostate cancer. This association was maintained over the course of disease regardless of the time of the assessment. Results from our study have both research and clinical relevance. They could provide information that enable us to not only improve communication with patients and families, but also to develop interventions and treatments best suited for the patient.