Moderate Activity Limitations Research Articles

The role of multidimensional health patterns over time in older workers' labor force participation

Abstract Background A non-negligible share of workers is affected by adverse health at the end of their careers. While many of them drop out of the labor force, others remain, prompting the question of how various health indicators interact to influence these different pathways. Therefore, we investigate the effect of multidimensional health patterns on labor force participation among older workers. Methods We used six-year-longitudinal data from 5007 older workers (Mean age: 55.8 years; 55.9 % female) from the Survey of Health, Ageing and Retirement in Europe. First, we conducted a latent transition analysis with four indicators (chronic diseases, limitations with activities, perceived health, and depression) to identify multidimensional health patterns. Second, we examined individual change in these patterns over time and their association with workers’ job situations and changes in work hours four years later using Wald-tests. Results We identified four multidimensional health patterns with high structural stability over time (ranging from <.005 to .25): (1) Overall healthy workers, (2) workers with moderate activity limitations and low perceived health, (3) overall unhealthy workers, and (4) physically healthy workers with low perceived health and depressive symptoms. Furthermore, individuals predominantly remain in the same pattern over time, except for pattern (4), where 56% of the individuals transition to pattern (1). Moreover, we found differences between the patterns in job situation (p < .001) and changes in work hours (p < .001) four years later with patterns (2) and (4) showing the greatest reduction in working hours. Conclusions The high rate of transitions from the pattern (4) to the more favorable pattern (1) may be explained by the relatively high potential for recovery from depression. Our findings suggest that interventions among older workers with depressive symptoms and moderate activity limitations may improve their chances to remain in the labor force. Key messages • We identified four largely stable multidimensional health patterns over time. • Older workers with moderate activity limitations and low perceived health reduced their work hours most strongly.

Self-report and device-based physical activity measures and adherence to physical activity recommendations: a cross-sectional survey among people with inflammatory joint disease in four European countries

ObjectivesSelf-monitoring of physical activity (PA) has the potential to contribute to successful behaviour change in PA interventions in different populations, including people with inflammatory joint diseases (IJDs). The objectives of...

Self-reported exercise capacity among current smokers eligible for lung cancer screening: Distribution and association with key comorbidities

One concernas lung cancer screening (LCS) is implemented is that patients will be screened who are too ill to benefit. Poor exercise capacity (EC) predicts adverse outcomes following lung resection. ObjectiveDescribe the distribution of EC among smokers eligible for LCS and examine associations with comorbidities. MethodsCross-sectional analysis of baseline data from a randomized controlled trial of tobacco treatment in the context of LCS. Participants responded regarding limitations in moderate activities, ability to climb stairs, and frequency of dyspnea on a scale from never/almost never to all or most of the time. Responses were assigned a numeric score and summed to categorize exercise limitation. Associations between poor EC and key comorbidities were examined using adjusted logistic regression. Results660 participants completed a survey with the following characteristics: 64.4% male, 89.5% white, mean age 64.5. Overall EC categories were: good 39.0%, intermediate 41.6%, and poor 19.4%. Prevalence of poor EC was higher among patients with COPD (OR 4.62 95%CI 3.05–7.02), heart failure (OR 3.07 95%CI 1.62–5.82) and cardiovascular disease (OR 2.24, 95%CI 1.45–3.47), and was highest among patients with multimorbidity. Among patients with COPD and heart failure, 57% had poor and 0% had good EC. In adjusted logistic regression, only COPD and Charlson comorbidity index remained significantly associated with poor EC. ConclusionsMany patients eligible for LCS reported poor EC, with increased odds of poor EC among patients with comorbidities. More research is needed to determine how to best integrate EC and comorbidity into eligibility and shared decision-making conversations.

Falls in Older Adults with Multiple Myeloma

Introduction: Multiple myeloma (MM) is a disease of aging. The prognosis of older adults with MM is influenced by the presence of geriatric syndromes, including dependence in daily activities and comorbidities. Falls, another common geriatric syndrome, are associated with greater risk for severe toxicity of chemotherapy and survival in older adults with solid tumors. Among older adults with MM, the prevalence of falls and factors predictive of falls are yet unknown. Thus, we sought to determine the prevalence of falls in a cohort of older adults with newly diagnosed MM and examine associations between falls and functional status, comorbidities and self-reported health.Methods: Using data from the linkage of the Surveillance, Epidemiology, and End Results (SEER) national cancer registry with the Medicare Health Outcomes Survey (MHOS), we identified unique patients with a diagnosis of MM in the SEER registry who participated in the MHOS survey, which includes individuals who are enrolled in Medicare Advantage organizations. An item inquiring about falls was present in the MHOS survey starting in 2006. For this analysis, participants (pts) were included if they completed the MHOS baseline survey within 1 year of their diagnosis of MM. Baseline characteristics were examined with descriptive statistics. Associations between falls and patient-reported data on function, comorbidities and self-rated health were examined using Student's t-test, Pearson Chi-square or Fisher's exact test, as appropriate. We identified 1327 unique patients, of whom 376 completed their baseline MHOS survey within 1 year of diagnosis. Of these, 190 provided responses to the item regarding falls and are included in this analysis.Results: The median age of the cohort was 77 years (range 47-97). The cohort was diverse, with 58.9% white race, 19.5% Asian/Pacific Islander, 11.6% Hispanic/Latino and 10.0% black race. Half (50.0%) were male, 48.4% female, and 1.6% unknown gender. Over one-quarter (25.2%) of pts reported a fall within the prior 12 months. Fallers were more likely to report a history of congestive heart failure than nonfallers (22.7% vs 7.9%, p=0.012); the remaining comorbidities examined (coronary artery disease, stroke, chronic obstructive pulmonary disease and diabetes) were not associated with falls. Of those who reported 2 or more weeks of depression in the past year, 41.4% reported a fall, compared with only 20.1% of those who did not report depression (p=0.004). Fallers were more likely to report limitations in moderate activities (81.2% vs 62.1%, p=0.015) and in climbing several flights of stairs (89.1% vs 64.9%, p=0.001). Pts who reported numbness in their feet some, most or all of the time were numerically but not statistically more likely to report a fall (35% vs 21.9%, p=0.070). Compared with nonfallers, fallers reported more days in the past 30 days when their physical health was not good (15.8 vs 10.0 days, p=0.024), more days in the past 30 days when their mental health was not good (10.7 days vs 4.1 days, p=0.002) and more days in the past 30 days when their health interfered with their daily activities (14.3 vs 7.0 days, p=0.001). Pts who had fallen were more likely to report that their health was fair or poor than those who had not fallen (67.4% vs 33.8%, p<0.001).Of pts who reported a fall, one-third (33.3%) had not talked with their doctor about falling or walking problems. Nonetheless, pts who had fallen were much more likely to have received a recommendation to use an assistive device, attend physical therapy, or have other fall-prevention screenings performed (72.9% vs 29.4%, p<0.001). The median overall survival among fallers was 25.0 months (95% confidence intervals 15.3-34.7), versus 52.0 months (95% CI 36.7-67.3), p=0.072.Conclusions: Falls are a common occurrence in older adults with newly diagnosed MM, occurring in 25% of pts in the past year. Falls are associated with more limited activity, depression and congestive heart failure. Pts who fell also reported poorer physical and mental health than nonfallers. Prospective studies are needed to determine factors predictive of falls in order to target interventions to those at high fall-risk and to prevent falls. DisclosuresTuchman:celgene: Consultancy, Honoraria, Research Funding, Speakers Bureau; Millennium/takeda: Honoraria, Research Funding, Speakers Bureau. O'Donnell:Millennium: Consultancy. Vij:Celgene, Onyx, Takeda, Novartis, BMS, Sanofi, Janssen, Merck: Consultancy; Takeda, Onyx: Research Funding.

SAT0334 Three Trajectories of Activity Limitations in Early Symptomatic Knee Osteoarthritis: a 5-Year Follow-Up Study

BackgroundOsteoarthritis (OA) is a leading cause of activity limitations among older adults. The knee OA population is heterogeneous and is likely to consist of subgroups with distinct trajectories of activity...

Three trajectories of activity limitations in early symptomatic knee osteoarthritis: a 5-year follow-up study

ObjectivesKnee osteoarthritis (OA) is a leading cause of activity limitations. The knee OA population is likely to consist of subgroups. The aim of the present study was to identify homogeneous...

Trends in activity limitations: the Dutch older population between 1990 and 2007

It is not clear whether recent increases in life expectancy are accompanied by a concurrent postponement of activity limitations. The objective of this study was to give best estimates of the trend in the prevalence of activity limitations among the non-institutionalized population aged 55-84 years over the period 1990-2007 in The Netherlands. We examined self-reports on 12 measures of moderate or severe activity limitations in stair climbing, walking and getting dressed as assessed by OECD long-term disability questionnaire or Short Form-36 (SF-36) items, using original data from five population-based cross-sectional and longitudinal surveys (n = 54,847 respondents). To account for heterogeneity between surveys, we used meta-analyses to study time trends. Time trends of 10 out of the 12 activity limitation variables studied were stable. The prevalence of at least moderate activity limitations in stair climbing [odds ratio (OR) = 1.03)] and getting dressed (OR = 1.04) based on OECD items increased over the study period. Age- and gender-stratified time trend analyses showed consistent patterns. No declines were observed in the prevalence of activity limitations in the Dutch older population over the period 1990-2007. The increase in life expectancy in this period is accompanied by a stable prevalence of most activity limitations.

Neck pain patients’ preference scores for their current health

PurposeTo elicit neck pain (NP) patients’ preference scores for their current health, and investigate the association between their scores and NP disability.MethodsRating scale scores (RSs) and standard gamble scores (SGs) for current health were elicited from chronic NP patients (n = 104) and patients with NP following a motor vehicle accident (n = 116). Patients were stratified into Von Korff Pain Grades: Grade I (low-intensity pain, few activity limitations); Grade II (high-intensity pain, few activity limitations); Grade III (pain with high disability levels, moderate activity limitations); and Grade IV (pain with high disability levels, several activity limitations). Multivariable regression quantified the association between preference scores and NP disability.ResultsMean SGs and RSs were as follows: Grade I patients: 0.81, 0.76; Grade II: 0.70, 0.60; Grade III: 0.64, 0.44; Grade IV: 0.57, 0.39. The association between preference scores and NP disability depended on type of NP and preference-elicitation method. Chronic NP patients’ scores were more strongly associated with depressive symptoms than with NP disability. In both samples, NP disability explained little more than random variance in SGs, and up to 51% of variance in RSs.ConclusionHealth-related quality-of-life is considerably diminished in NP patients. Depressive symptoms and preference-elicitation methods influence preference scores that NP patients assign to their health.

LEARNING NEEDS AND ACTIVITY LIMITATIONS OF ELDERLY JAPANESE WITH PHYSICAL DISABILITIES

The study reported in this article examined the relationship between learning needs and activity limitations of the elderly with physical disabilities in Japan. A questionnaire survey was conducted among 364 elderly over age 60 with physical disabilities. According to the survey results, 87.3% of the respondents have learning needs. Areas of medical concern were highly mentioned, but areas of communication with other elderly, gardening, and pottery also were mentioned. Analysis of the structure of learning needs by Hayashi's quantification method III disclosed that the most dominant axis was that of "Instrumental and Social Learning" versus "Expressive and Communicative Learning." Analysis of the relationship between learning needs and activity limitations revealed that the elderly who have serious activity limitations have an orientation toward "Instrumental and Social--External" learning, and the elderly who have moderate activity limitations have an orientation toward "Expressive and Communicative--Internal." According to Londoner (1985), "the elderly tend to have instrumental needs for survival," (p. 94). This seems to be particularly true among the elderly with serious activity limitations.

Functional status in women with lung cancer

Lung cancer remains the number one cause of cancer-related death and the third most common cancer for women in the United States. The major purpose of this study was to describe physical functional status in a sample of women with lung cancer. Functional status was objectively measured by the Karnofsky Performance Status Scale, and subjectively by the Rand Physical Function Scale, and the Physical Function Subscale of the CARES-Short Form. A convenience sample of 69 women participated in a one-time data collection. The typical subject was < 65 years of age, had lived with primary or recurrent lung cancer for > 12 months, had non-small cell limited disease, and was not currently receiving treatment. The most prevalent disruptions in physical function were reduced energy (59%), difficulty with household chores (33%), and interference with work (28%). A third of the sample had serious limitations in three or more activities. Approximately 26% of the sample had severe limitations in moderate activities, 20% in walking short distances, and 16% in walking one flight of stairs. Only a quarter were satisfied with their level of activity. Physical function was different by income category (one-way analysis of variance), with those with the lowest income having the poorest function.