Higher Short Physical Performance Battery Research Articles

Extracting actigraphy-based walking features with structured functional principal components.

We extract walking features from raw accelerometry data while accounting for varying cadence and commonality of features among subjects. Walking is the most performed type of physical activity. Thus, we explore if an individual's physical health is related to these walking features. We use data collected using ActiGraph GT3X+ devices (sampling rate=80Hz) as part of the Developmental Epidemiologic Cohort Study (DECOS), I=48, age=78.7+/-5.7years, 45.8% women. We apply structured functional principal component analysis (SFPCA) to extract features from walking signals on both, the subject-specific and the subject-spectrum-specific level of a fast-paced 400m walk, an indicator of aerobic fitness in older adults. We also use the subject-specific level feature scores to study their associations with age and physical performance measures. Specifically, we transform the raw data into the frequency domain by applying local Fast Fourier Transform to obtain the walking spectra. SFPCA decomposes these spectra into easily interpretable walking features expressed as cadence and acceleration, which can be related to physical performance. We found that five subject-specific and 19 subject-spectrum-specific level features explained more than 85% of their respective level variation, thus significantly reducing the complexity of the data. Our results show that 54% of the total data variation arises at the subject-specific and 46% at the subject-spectrum-specific level. Moreover, we found that higher acceleration magnitude at the cadence was associated with younger age, lower BMI, faster average cadence and higher short physical performance battery scores. Lower acceleration magnitude at the cadence and higher acceleration magnitude at cadence multiples 2.5 and 3.5 are related to older age and higher blood pressure. SFPCA extracted subject-specific level empirical walking features which were meaningfully associated with several health indicators and younger age. Thus, an individual's walking pattern could shed light on subclinical stages of somatic diseases.

Changes in Coordination and Its Variability with an Increase in Functional Performance of the Lower Extremities

Clinical gait analysis has a long-standing tradition in biomechanics. However, the use of kinematic data or segment coordination has not been reported based on wearable sensors in "real-life" environments. In this work, the skeletal kinematics of 21 healthy and 24 neurogeriatric participants was collected in a magnetically disturbed environment with inertial measurement units (IMUs) using an accelerometer-based functional calibration method. The system consists of seven IMUs attached to the lower back, the thighs, the shanks, and the feet to acquire and process the raw sensor data. The Short Physical Performance Battery (SPPB) test was performed to relate joint kinematics and segment coordination to the overall SPPB score. Participants were then divided into three subgroups based on low (0-6), moderate (7-9), or high (10-12) SPPB scores. The main finding of this study is that most IMU-based parameters significantly correlated with the SPPB score and the parameters significantly differed between the SPPB subgroups. Lower limb range of motion and joint segment coordination correlated positively with the SPPB score, and the segment coordination variability correlated negatively. The results suggest that segment coordination impairments become more pronounced with a decreasing SPPB score, indicating that participants with low overall SPPB scores produce a peculiar inconsistent walking pattern to counteract lower extremity impairment in strength, balance, and mobility. Our findings confirm the usefulness of SPPB through objectively measured parameters, which may be relevant for the design of future studies and clinical routines.

Brain natriuretic peptide levels and short physical performance battery scores independently influence short-term readmission rates in older patients with heart failure.

The Short Physical Performance Battery (SPPB) is a well-established tool to assess the lower extremity physical performance status. The purpose of this study is to examine the impact of brain natriuretic peptide (BNP) levels and SPPB scores on short-term readmission in older patients with heart failure (HF). This prospective cohort study enrolled 325 patients with HF who were hospitalized for acute decompensated HF between November 2017 and December 2021. Variables were analyzed using the Cox proportional hazards model, receiver operating characteristic (ROC) curve, and Kaplan-Meier analysis. The 107 patients who met the inclusion criteria were divided into readmission (within 90days of discharge; n = 25) and non-readmission (n = 82) groups. Multivariate analysis revealed that BNP level and SPPB score were independent risk factors for readmission within 90days after discharge. Patients were classified into three groups according to the BNP and SPPB cutoff values calculated using ROC curves. The risk of readmission was significantly higher in Group 3 (BNP ≥ 384pg/mL and SPPB ≤ 7 points) than in Group 1 (BNP < 384pg/mL and SPPB > 7 points; hazard ratio: 27.68, 95% confidence interval: 3.672 - 208.700, P = 0.0012). Our study showed that HF patients with high BNP levels and low SPPB scores have a dramatically increased risk of readmission within 90days of discharge.

Protein intake and physical function in older adults: A systematic review and meta-analysis.

The present study explored cross-sectional and longitudinal associations between protein intake and physical function in older adults. We conducted a systematic review and meta-analysis of cross-sectional and longitudinal studies that investigated the association between protein intake and measures of physical function in older adults. Cross-sectional, case-control, and longitudinal cohort studies that investigated the association between protein intake and physical function as a primary or secondary outcome in people aged 60+years were included. Studies published in languages other than English, Italian, Portuguese, or Spanish were excluded. Studies were retrieved from MEDLINE, SCOPUS, EMBASE, CINAHL, AgeLine, and Food Science Source databases through January 31, 2022. A pooled effect size was calculated based on standard mean differences (SMD), MD, log odds ratio (OR) and Z-score.. Twenty-two cross-sectional studies examined a total of 11,332 community-dwellers, hospitalized older adults, and elite senior athletes with a mean age of approximately 75 years. The pooled analysis indicated that a protein intake higher than the recommended dietary allowance (RDA) was significantly associated with higher Short Physical Performance Battery (SPPB) scores (SMD: 0.63, 95% CI: 0.27, 0.99, P-value: 0.0006), faster walking speed, greater lower-limb (SMD: 0.22, 95% CI: 0.04, 0.40, P-value: 0.02) and isometric handgrip strength (Z-score: 0.087, 95% CI: 0.046-0.128, P-value: 0.0001), and better balance (SMD: 0.33, 95% CI: 0.05, 0.62, P-value: 0.02). Nine longitudinal studies investigated 12,424 community-dwelling and native older adults with a mean age of approximately 85 years. A protein intake higher than the current RDA was not associated with lower decline in either isometric handgrip strength (logOR: 0.99, 95% CI: 0.97-1.02, P-value= 0.67) or walking speed (logOR: 0.92, 95% CI: 0.77-1.10, P-value= 0.35). A protein intake higher than the RDA is cross-sectionally associated with better physical performance and greater muscle strength in older adults. However, a high consumption of proteins does not seem to prevent physical function decline over time.

Physical Function and Subsequent Risk of Cardiovascular Events in Older Adults: The Atherosclerosis Risk in Communities Study.

BackgroundReduced physical function, a representative phenotype of aging, has been associated with cardiovascular disease (CVD). However, few studies have comprehensively investigated its association with composite and individual CVD outcomes in community‐dwelling older adults and its predictive value for CVD beyond traditional risk factors.Methods and ResultsWe studied 5570 participants (mean age 75 [SD 5] years, female 58%, Black 22%) at visit 5 (2011–2013) of the ARIC (Atherosclerosis Risk in Communities) study. Physical function was evaluated with the Short Physical Performance Battery (SPPB), which incorporates a walk test, chair stands, and balance tests. The SPPB score was modeled categorically (low [0–6], intermediate [7–9], and high [10–12]) and continuously. We assessed the associations of SPPB score with subsequent composite (coronary heart disease, stroke, or heart failure) and individual CVD outcomes (components within composite outcome) using multivariable Cox models adjusting for major CVD risk factors and history of CVD. We also evaluated improvement in C‐statistics by adding SPPB to traditional CVD risk factors in the Pooled Cohort Equation. Among the study participants, 13% had low, 30% intermediate, and 57% high SPPB scores. During a median follow‐up of 7.0 (interquartile interval 5.3–7.8) years, there were 930 composite CVD events (386 coronary heart disease, 251 stroke, and 529 heart failure cases). The hazard ratios of composite CVD in low and intermediate versus high SPPB score were 1.47 (95% CI, 1.20–1.79) and 1.25 (95% CI, 1.07–1.46), respectively, after adjusting for potential confounders. Continuous SPPB score demonstrated independent associations with each CVD outcome. The associations were largely consistent across subgroups (including participants with prevalent CVD at baseline). The addition of SPPB to traditional CVD risk factors significantly improved the C‐statistics of CVD outcomes (eg, ΔC‐statistic 0.019 [95% CI, 0.011–0.027] for composite CVD).ConclusionsReduced physical function was independently associated with the risk of composite and individual CVD outcomes and improved their risk prediction beyond traditional risk factors in community‐dwelling older adults. Although confirmatory studies are needed, our results suggest the potential usefulness of SPPB for classifying CVD risk in older adults.

The Association of Physical Activity Fragmentation with Physical Function in Older Adults: Analysis from the SITLESS Study

The distribution of physical activity bouts through the day may provide useful information for assessing the impacts of interventions on aspects such as physical function. This study aimed to investigate the associations between physical activity fragmentation, tested using different minimum physical activity bout lengths, with physical function in older adults. The SITLESS project recruited 1360 community-dwelling participants from four European countries (≥65 years old). Physical activity fragmentation was represented as the active-to-sedentary transition probability (ASTP), the reciprocal of the average physical activity bout duration measured using ActiGraph wGT3X+ accelerometers. Four minimum bout lengths were utilised to calculate the ASTP: ≥10-s, ≥60-s, ≥120-s and ≥300-s. Physical function was assessed using the 2-min walk test (2MWT) and the composite score from the Short Physical Performance Battery (SPPB) test. Linear regression analyses, after adjusting for relevant covariates, were used to assess cross-sectional associations. After adjustment for relevant covariates, lower ASTP using ≥10-s bouts were associated with longer 2MWT distances and higher SPPB scores. Lower ASTP using ≥120-s bouts and ≥300-s bouts were associated with longer 2MWT distances but not the SPPB. Less fragmented physical activity patterns appeared to be associated with better physical function in community-dwelling older adults.

The impact of sex and physical performance on long-term mortality in older patients with myocardial infarction

BackgroundSex influences outcome of patients with acute coronary syndrome (ACS). If there is a relationship between sex and physical performance is unknown.MethodsThe analysis is based on older (≥70 years) ACS patients included in the FRASER, HULK, and LONGEVO SCA prospective studies. Physical performance was assessed by Short Physical Performance Battery (SPPB). The primary outcome was all-cause mortality.ResultsThe study included 1388 patients, and 441 (32%) were women. At presentation, women were older and more compromised than men. After a median follow-up of 998 [730–1168] days, all-cause death occurred in 334 (24.1%) patients. At univariate analysis, female sex was related to increased risk of death. After adjustments for confounding factors, female sex was no longer associated with mortality. Women showed poor physical performance compared with men (p < 0.001). SPPB values emerged as an independent predictor of death. Including clinical features and SPPB in the multivariable model, we observed a paradigm shift in the prognostic role of female sex that becomes a protective factor (HR 0.73, 95% CI 0.56–0.96). Sex and physical performance showed a significant interaction (p = 0.03). For lower SPPB values (poor physical performance), sex-related changes in mortality were not recorded, while in patients with higher SPPB values (preserved physical performance), female sex was associated with better survival.ConclusionsTwo key findings emerged from the present real-life cohort of older ACS patients: (i) physical performance strongly influences long-term mortality; (ii) women with preserved physical performance have a better outcome compared to men.Trial registrationwww.clinicaltrials.gov NCT02386124 and NCT03021044

Snow Removal Maintains Physical Function in Hemodialysis Patients after One Year: A Pilot Study

Physical activity is an important prognostic factor in managing hemodialysis patients. During winter, physical activity decreases, which necessitates interventions to maintain physical function. This study investigated whether snow removal is an effective physical activity to maintain physical function in hemodialysis patients. This retrospective cohort study examined 32 patients (aged 68.9 ± 14.2 years, 21 men) who underwent hemodialysis at Uonuma Kikan Hospital from March 2021 to March 2022. The patients were divided into snow-remover and non-snow-remover groups. The primary outcome was the Short Physical Performance Battery (SPPB). Secondary outcomes were grip strength, skeletal muscle index, and physical activity level. Differences in outcomes between the groups were investigated at 1 year of follow-up. The snow-remover group had significantly high SPPB score, grip strength (men), skeletal muscle index (men), and physical activity at baseline. The decline in SPPB after 1 year was significantly smaller in the snow-remover group than in the non-snow-remover group. The level of physical activity in the non-snow-remover group decreased over time. Snow removal contributed to the maintenance of physical function in hemodialysis patients after 1 year. However, snow removal is not recommended for all hemodialysis patients, and further studies should identify other safe winter activities to maintain physical function.

Activity Space and Functional Outcomes in Frail Older Persons Using GPS analysis

With increasing age, walking becomes a main functional ability to participate in activities of daily living and supports independence and mobility. Frailty in older, multimorbid patients has a negative impact on physical activity and may reduce the personal activity space (AS). In this pilot study, GPS data were used to identify walking tracks to define individual AS and to compare functional performance in frail older persons. GPS data of 20 community-dwelling adults (84.5(±5.2)years, 85% women, mean frailty phenotype 1.9 (70% ≥2)points) were analyzed using a customized software to assess individual AS over a ten-months period. A geriatric home assessment including Short Physical Performance Battery (SPPB), gait speed (GS) and Timed-up-and-Go (TUG) was conducted monthly. GPS analysis revealed three different walking types presenting AS similarities: Type A walkers prefer smaller short walks nearby the home while Type B can be characterized by taking larger regular walks. Type C presents the widest AS using different transportation modes, but only a moderate number of walks. Mean group difference in functional performance of Type A walkers showed significantly reduced GS (0.45(±0.1)m/s), TUG (23.4s(±4.9)) and SPPB scores (3.8(±0.8) points; p<0.05) compared to Type C (0.82(±0.1)m/s (GS); 13.2(±1.4)s (TUG); 7.0(±1.3) points (SPPB)). Functional performance of Type B walkers (0.63(±0.2)m/s (GS); 17.1(±4.4)s (TUG); 6.5(±2.4)points (SPPB)) revealed significantly higher SPPB scores compared to Type A (p<0.05). Walks and individual AS can be mapped via GPS under everyday conditions. High heterogeneity within frail older people was observed. Persons with lower functional performance showed a reduced AS and physical activity.

Dietary omega-3 polyunsaturated fatty acid and alpha-linolenic acid are associated with physical capacity measure but not muscle mass in older women 65–72 years

PurposeThe aim was to investigate the cross-sectional association of dietary omega-3 polyunsaturated fatty acids PUFA (alpha-linolenic acid (ALA), eicosapentaenoic acid (EPA), and docosahexaenoic acid (DHA)) intake with multiple physical functions, muscle mass and fat mass in older women.MethodStudy subjects were 554 women from the Osteoporosis Risk Factor and Prevention Fracture Prevention Study, with dietary intake assessed with 3-day food record. Body composition was measured by dual-energy X-ray absorptiometry. Physical function measures included walking speed 10 m, chair rises, one leg stance, knee extension, handgrip strength and squat. Short physical performance battery (SPPB) score was defined based on the European working group on sarcopenia criteria.ResultsThe multivariable adjusted models showed statistically significant associations for dietary ALA with higher SPPB (β = 0.118, P = 0.024), knee extension force at baseline (β = 0.075, P = 0.037) and lower fat mass (β = − 0.081, P = 0.034), as well as longer one-leg stance (β = 0.119, P = 0.010), higher walking speed (β = 0.113, P = 0.047), and ability to squat to the ground (β = 0.110, P = 0.027) at baseline. Total dietary omega-3 PUFA was associated with better SPPB (β = 0.108, P = 0.039), one-leg stance (β = 0.102, P = 0.041) and ability to squat (β = 0.110, P = 0.028), and with walking speed (β = 0.110, P = 0.028). However, associations for dietary EPA and DHA with physical function and body composition were not significant.ConclusionDietary omega-3 and ALA, but not EPA and DHA, were positively associated with muscle strength and function in older women. The intake of omega-3 and its subtypes was not associated with muscle mass. Longitudinal studies are needed to show whether omega-3 intake may be important for muscle function in older women.

80 The impact of sex and physical performance on long-term mortality in older patients with myocardial infarction

Abstract Aims To investigate the prognostic role of sex and physical performance on long-term mortality in older adults hospitalized for acute coronary syndrome (ACS). Methods and results The analysis is based on older (≥70 years) ACS patients included in the FRASER, HULK, and LONGEVO SCA prospective studies. Physical performance was assessed with the Short Physical Performance Battery (SPPB). The primary outcome was all-cause mortality. The study included 1388 patients, 441 (32%) were women. At presentation, women were older and more compromised than men. After a median follow-up of 998 (730–1168) days, all-cause death occurred in 334 (24.1%) patients. At univariate analysis, female sex was related to increased risk of death. After adjustments for confounding factors, female sex was no longer associated with mortality. Women showed poor physical performance compared with men (P &amp;lt; 0.001). SPPB values emerged as independent predictor of death. Including clinical features and SPPB in the multivariable model, we observed a paradigm shift in the prognostic role of female sex that becomes a protective factor (HR: 0.73, 95% CI: 0.56–0.96). Sex and physical performance showed a significant interaction (P = 0.03). For lower SPPB values (poor physical performance), sex-related changes in mortality were not recorded, while in patients with higher SPPB values (preserved physical performance), female sex was associated with better survival. Conclusions Two key findings emerged from the present real-life cohort of older ACS patients: (i) physical performance strongly influences long-term mortality and (ii) women with preserved physical performance have a better outcome compared to men.

Stakeholder and Data-Driven Fall Screen in a Program of All-Inclusive Care for the Elderly: Quality Improvement Initiative.

The Program of All-Inclusive Care for the Elderly (PACE) delivers community-based long-term care services to low-income, nursing home eligible adults. In the PACE population, one of the most common reasons for hospitalizations is falls. The purpose of this quality improvement study was to create a stakeholder-driven process for developing a fall risk screen and evaluate how well this process discriminated injurious and noninjurious fallers. The quality improvement design was a prospective, longitudinal data collection for 5 PACE programs in Colorado. Physical therapists collected the Short Physical Performance Battery (SPPB) on participants at least annually. The Kotter practice change framework guided the processes for practice and organizational change in developing and implementing a fall screen. An iterative, stakeholder, and data-driven process allowed our team of researchers and a PACE program to establish a fall risk screen to stratify PACE participants. We provided feedback to PACE staff regarding screening rates and results on discrimination of faller status to promote continued uptake of screening and discussion regarding next steps. Rehabilitation therapists screened 66% of the PACE population, and participants were stratified into high risk (1-7 points) or low risk (8-12 points) based on the SPPB. Participants with low SPPB scores had 79% greater risk of a fall (risk ratio [RR] = 1.8; 95% confidence interval [CI], 1.5-2.1) and 86% greater risk of an injurious fall (RR = 1.9; 95% CI, 1.4-2.4), compared with those with high SPPB scores. Our study describes a collaboration to address fall rates in a PACE population. Program of All-Inclusive Care for the Elderly clinicians can use the identified cut-offs to stratify PACE populations at risk for falls and allocate scarce rehabilitation resources efficiently to best serve participants at highest risk, while using less resource-intensive interventions for those at lower risk.

The association between nutrient intake, nutritional status and physical function of community-dwelling ethnically diverse older adults

BackgroundThere are limited longitudinal data regarding nutrient intake, nutritional status and physical function in community-dwelling ethnically diverse older adults. This study explored these variables and their relationship at baseline (n = 100) and 8-months’ follow-up (n = 81) among community-dwelling ethnically diverse older adults (≥60 years) in Birmingham, United Kingdom.MethodsMultiple-pass 24-h dietary recalls and the Mini Nutritional Assessment-Short Form assessed nutritional intake and status, respectively. Short Physical Performance Battery (SPPB) and handgrip strength measured physical function. Linear and multinomial regressions were used to predict relationships between physical function, nutritional status and nutrient intake.ResultsComplete data were collected at baseline (n = 100) and 8-months’ follow-up (n = 81). Mean (SD) age was 70 (8.1) years (60% male), with 62% being obese. Statistically significant decreases in intakes of vitamin B6, vitamin B1, iron, folate, and magnesium occurred over time. Daily intake of all micronutrients except vitamin B12, phosphorus and manganese were below the Recommended Nutrient Intakes (RNI). SPPB (Z = -4.01, p < 0.001) and nutritional status (Z = -2.37, p = 0.018) declined over time. Higher SPPB scores at baseline (OR = 0.54 95% CI 0.35, 0.81) were associated with a slower decline in nutritional status.ConclusionThe observed declines and inadequate nutrient intakes in the absence of weight loss in just 8 months may pose serious challenges to healthy ageing, identifying an urgent need to re-evaluate and tailor appropriate dietary advice for this population. Additionally, the associations of nutrition and physical function observed in this study serves as an essential resource to design and implement community/faith-based interventions targeting early screening of nutritional status and physical function to ensure most older adults are assessed and treated accordingly.

Social networks and their influences on nutrient intake, nutritional status and physical function in community-dwelling ethnically diverse older adults: a mixed-methods longitudinal study

BackgroundThe United Kingdom population is ageing and becoming increasingly diverse; thus, it is vital to develop and implement interventions supporting this population shift. Social networks (SN) significantly impact health outcomes in later life, however relatively little is known about SN of community-dwelling ethnically diverse older adults. This study aimed to: 1) profile SN and changes in SN in this population over 8 months; 2) examine associations between SN, dietary intake, nutritional status, and physical function.MethodsSN were assessed using the Wenger Practitioner Assessment of Network Type. Energy and nutrient intakes were measured using multiple-pass 24-h recalls. The Mini Nutritional Assessment-Short Form (MNA-SF) assessed nutritional status. Physical function was measured using the Short Physical Performance Battery (SPPB) and handgrip strength. Data were collected at baseline and 8-months. Correlation and regression analyses examined relationships between SN, physical function, nutrient intake and nutritional status. Semi-structured interviews were conducted at baseline (n = 92) and follow-up (n = 81) to identify potential influences of SN. Interviews were transcribed verbatim and analysed using directed content analysis.ResultsQuantitative data were obtained from 100 participants at baseline and 81 at follow-up. Mean (SD) age was 70.8 (8.1) years (59% male), comprising African/Caribbean (60%), South Asian (34%), and other ethnicities (6%). Five SN typologies were identified under two broad areas: integrated-SN consisting of locally integrated (44%) and wider community (8%); and non-integrated-SN consisting of family dependent (25%), local self-contained (17%), and private restricted (6%). At follow-up, 37% remained in non-integrated networks, 19% transitioned to non-integrated networks, 11% transitioned to, and 33% remained in, integrated networks. Participants within integrated networks at baseline had higher SPPB scores at follow-up. Compared to the private restricted, local self-contained SN significantly predicted zinc, riboflavin and vitamin B6 intakes. Participants remaining in, or transitioning to, non-integrated networks had low MNA-SF scores. Qualitative findings indicate that participants with reductions in SN perceived it as causing poorer physical function and eating behaviours.ConclusionIn the present study, integrated SN were associated with higher physical function and nutritional status at 8-month’s follow-up. These results can inform the design of interventions to improve social networks, physical function and healthy nutrition within this population.

Short physical performance battery discriminates clinical outcomes in hospitalized patients aged 75 years and over

AimLow physical function is associated with poor outcomes in hospitalized patients; however, little is known about vulnerable populations such as those aged ≥ 75 years. We examined whether the Short Physical Performance Battery (SPPB) was associated with clinical outcomes in hospitalized patients aged ≥ 75 years. MethodsIn total, 147 patients aged ≥ 75 years (mean age, 86.5 ± 4.7 years; 89 males) completed the SPPB and Mini-Mental State Examination (MMSE) before hospital discharge. Patients were divided into three groups by SPPB score: 0 (unable to perform SPPB), 1–6 (low performance), and 7–12 (high performance). The first occurrence of all-cause unplanned readmission or all-cause mortality within 1 year after discharge was set as the endpoint. ResultsThe median SPPB score of the study population was 2; 41 % were unable to perform SPPB, 33 % had low performance, and 26 % had high performance. High SPPB was associated with younger age, higher body weight, and higher MMSE score. During the follow-up period, 35 (23.8 %) patients were readmitted to hospital and 19 (12.9 %) died. Even after adjusting for covariates, SPPB score was a significant and independent predictor of poor outcomes (hazard ratio for 1 point increase in SPPB, 0.88; P = .002). The subgroup analysis showed SPPB was inversely associated with the occurrence of poor outcomes in patients with cognitive impairment. ConclusionsSPPB is inversely associated with risks for readmission and mortality in hospitalized patients aged ≥ 75 years, especially those with cognitive impairment. The present results indicate the SPPB is useful for accurate prognosis in hospital settings.

Discrepancy between food offered and consumed during hospitalization in older adult patients

AbstractMalnutrition is one of the most frequent geriatric syndromes and a key contributor to frailty. Ageing is commonly associated with modifications in eating habits with changes in appetite and food intake. Malnutrition is not only a sign of illness, but its presence increases morbidity, hospital stay, institutionalization, poor quality of life, in-hospital complications, expenses, and mortality. Hospitalized patients have increased calorie requirements to overcome the increased energy expenditure due to acute disease. We aimed to evaluate the actual consumption of the food offered to a sample of hospitalized older adults. Sixty hospitalized patients (women/men = 23/37) were recruited sequentially. After participants signed an informed consent, we evaluated their mean actual intake of macronutrients (carbohydrates, proteins, and fats) at lunch during three consecutive days, calculated with a nutrition analysis software from the weighted food (first course, second course, side dishes) measured before and after consumption. Other parameters assessed included self-sufficiency by the capacity to perform basic and instrumental activities of daily living (ADL, IADL), cognitive performance with Mini Mental State Evaluation (MMSE), Geriatric Depression Scale (GDS), physical performance with the Short Physical Performance Battery (SPPB) and handgrip dynamometry, EAT-10 test for the assessment of swallowing capacity, and anthropometric parameters. Mean ± SD of the main parameters assessed were as follows: age 77.8 ± 9.3 years, BMI 27.1 ± 8.7 Kg/m2, ADL 3.8 ± 2.0, IADL 4.1 ± 2.8 (indicative of compromise self-efficacy), MMSE 21.8 ± 5.9, SSPB 5.3 ± 3.1, handgrip dynamometry 16.5 ± 7.8 Kg (indicative of mild to moderate cognitive and physical impairment). The mean intake of macronutrients for the 3-day assessment was 65.7 ± 20.6% of carbohydrates, 74.3 ± 30.4% of proteins, and 47.4 ± 38.1% of fats of the total amount offered at lunch. Older patients tended to have lower intakes of carbohydrates, proteins, and fats, while participants with higher SPPB had higher intakes of carbohydrates and proteins. The results of the present study show that hospitalized older adults, with compromised autonomy, physical and cognitive performance, had lower consumption compared to what is offered to them in the hospital despite their elevated nutritional needs due to the acute illness leading to hospitalization. Undernutrition and weight-loss are key factors associated with increased mortality and morbidity. Therefore, it is crucial to set appropriate nutritional interventions in hospitalized patients, particularly those with disability and cognitive decline. Early recognition and treatment of malnutrition are essential preventive measures to improve the quality of care, quality of life, and decrease mortality risk in hospitalized older adults.

NUTRITIONAL INTAKE AND STATUS AND PHYSICAL FUNCTION OF OLDER ETHNIC MINORITIES: A LONGITUDINAL STUDY

There are limited longitudinal data regarding nutritional intake and status, and physical function in community-dwelling ethnically diverse older adults. This study explored these variables and their relationship at baseline (n=100) and after 8-months (n=81) among community-dwelling ethnically diverse older adults (≥60 years) in Birmingham, United Kingdom. Multiple pass 24-hour dietary recalls and the Mini Nutritional Assessment-Short Form assessed nutritional intake and status, respectively. The Short Physical Performance Battery(SPPB) and handgrip strength measured physical function. Linear and multinomial regression analyses were used to predict the relationship between nutritional intake, status and physical function. Mean(SD) age was 70(8.1) years (60% male), with 62% of the sample being obese. Significant decreases in intakes of vitamin B6(0.88-0.77mg/day, p=0.014); vitamin B1(0.73-0.63mg/day, p=0.029); iron(6.16-5.85mg/d, p=0.045); folate(113.23-106.66µg/d, p=0.043); and magnesium(154.54-144.59mg/d, p=0.031) occurred over time. At both timepoints, across sexes, daily intakes of all micronutrients except vitamin B12, phosphorus and manganese were below the Recommended Nutrient Intakes. There were significant declines in SPPB scores(Z=-4.01, p<0.001) and nutritional status(Z=-2.37,p=0.018) over time. At baseline, younger age, better nutritional status, and higher vitamin D and fibre intakes were associated with higher SPPB scores. At follow-up, higher baseline SPPB scores (OR=0.54 95% CI:0.35, 0.81) were associated with reduced decline in nutritional status. The observed declines in nutritional status and physical function, and the inadequate nutrient intakes in the absence of weight loss within eight months pose serious challenges to healthy ageing. There is an urgent need to re-evaluate and tailor appropriate dietary advice for this population to support them to age healthily.

Reduced Lower Extremity Functioning Is Associated With an Increased Rate of Being a Nondriver: The National Health and Aging Trends Study.

Driving a motor vehicle is an important aspect of mobility for older adults. Limited lower extremity functioning performance, as measured by the Short Physical Performance Battery (SPPB), has been associated with various negative health outcomes, but little is known about the association of SPPB scores with driving status. The purpose of this study was to evaluate whether lower (poorer) SPPB scores are associated with an increased rate for being a current nondriver among a nationally representative sample of community-dwelling older adults. The National Health and Aging Trends Study is a longitudinal cohort study. A population of 5935 participants, surveyed annually from 2011 to 2014 for the National Health and Aging Trends Study, was used to examine the relationship between SPPB and driving status. Using weighted data, multivariable Poisson regression with generalized estimating equations was used to calculate the rate ratios, adjusting for covariates and clustering due to the complex survey design. Participants with a low (poor) SPPB score (0-5) had a rate for being a current nondriver 2.01 times the rate (or 101% increase) of those with a high (good) SPPB score (10-12) (adjusted 95% confidence interval = 1.78-2.26). Current nondrivers were not asked whether they planned to resume driving if they had not driven in the previous year. Unlike other factors, such as cognitive decline, lower SPPB scores (poorer lower extremity functioning) are significantly associated with an increased rate of being a current nondriver and are a modifiable risk factor. Further research is needed to examine whether optimum exercises and other physical therapist interventions focused on improving lower extremity strength and balance ultimately improve driving outcomes.

Abstract 008: Poor Lower Extremity Physical Function Increases Risk for Cardiovascular Disease Events in Older Women: The OPACH Study

Background: Good lower extremity physical functioning is paramount to healthy aging as it prevents social isolation, enables civic engagement, and facilitates physical activity. Strong evidence links physical functioning with all-cause mortality, but little is known about its relationship to cardiovascular disease (CVD). Methods: Women (n=5043, mean age=79±7) with no history of myocardial infarction or stroke completed the Short Physical Performance Battery (SPPB) consisting of three timed tasks to assess standing balance, strength (5 chair stands), and gait (4m walk). Results were summarized using prespecified cutpoints yielding a score from 0 (worst) to 12 (best). Women were followed for CVD events for up to 6 years. Hazard ratios (HR) were estimated for women with poor, low, moderate, and high functioning (respective SPPB ranges for each group; 0-3, 4-6, 7-9, and 10-12) using Cox proportional hazard models adjusted for several covariates including accelerometer-measured moderate to vigorous physical activity (MVPA) and sedentary behavior. Effect modification of associations between SPPB and CVD by age, MVPA, Reynolds Risk Score, race-ethnicity, and self-rated health were tested by including multiplicative interaction terms in fully adjusted Cox models with statistical significance for interactions set to 0.10. Results: Covariate-adjusted HRs (95% CIs) for CVD [ 1.00 (ref.); 0.85 (0.62, 1.15); 0.69 (0.51, 0.93); 0.49 (0.35, 0.68)] and CVD mortality [ 1.00 (ref.); 0.72 (0.45, 1.15); 0.44 (0.27, 0.72); 0.35 (0.19, 0.62)] decreased across poor, low, moderate, and high SPPB subgroups, respectively (p-trend&lt;.001

Time spent lying, sitting, and upright during hospitalization after stroke: a prospective observation study

BackgroundEarly mobilization has been an important part of acute stroke unit treatment. However, early and intense mobilization within the first 24 h post stroke may cause an unfavorable outcome. Recently, objective measurements using body-worn sensors have been applied, enabling continuous monitoring of physical activity in the hospital setting. This study aimed to use body-worn sensors to quantify the amount of physical activity and how activity levels changed over time during hospitalization in patients with acute stroke. We also wanted to investigate which factors were associated with upright and sitting activity.MethodsThis was a prospective study including patients admitted to hospital within seven days after onset of stroke. Physical activity was measured by two sensors (ActivPALs from PAL Technologies Ltd., Glasgow, UK), one attached on sternum and one on the thigh of the unaffected side, monitoring continuously from inclusion until discharge. Data were processed in Matlab R 2015B and provided information about daily time in lying, sitting, and upright positions, and daily average duration of sitting and upright bouts. A linear mixed model was used to analyze changes over time.Results58 patients were included (31 women, mean (SD) age; 75.1 (12.0)). Patients were hospitalized for 12.1 (7.6) days and had a mean score on the National Institute of Health Stroke Scale of 6.2 (5.5) points. Time spent sitting and time spent upright increased per day during hospitalization by 22.10 min (95% Confidence interval (CI): 14.96, 29.24) and 3.75 min (95% CI: 1.70, 5.80) respectively. Increased time upright was associated with improved Modified Rankin Scale scores (− 38.09 min, 95% CI: -61.88, − 14.29) and higher Short Physical Performance Battery scores (6.97 min, 95% CI: 1.99, 11.95), while prolonged bouts of sitting were associated with more severe stroke (4.50 min, 95% CI: 0.80, 8.19), and older age (1.72 min, 95% CI: 0.20, 3.26).ConclusionsPatients increased their daily time spent sitting and upright during the initial hospital stay after stroke. Prolonged bouts of sitting were associated with older age and more severe strokes. Hence future research should investigate the benefit of interventions aimed at breaking up sitting time after stroke.