Outcomes In Community-dwelling Older Adults Research Articles

Sarcopenia Definition: The Position Statements of the Sarcopenia Definition and Outcomes Consortium.

To develop an evidence-based definition of sarcopenia that can facilitate identification of older adults at risk for clinically relevant outcomes (eg, self-reported mobility limitation, falls, fractures, and mortality), the Sarcopenia Definition and Outcomes Consortium (SDOC) crafted a set of position statements informed by a literature review and SDOC's analyses of eight epidemiologic studies, six randomized clinical trials, four cohort studies of special populations, and two nationally representative population-based studies. Thirteen position statements related to the putative components of a sarcopenia definition, informed by the SDOC analyses and literature synthesis, were reviewed by an independent international expert panel (panel) iteratively and voted on by the panel during the Sarcopenia Position Statement Conference. Four position statements related to grip strength, three to lean mass derived from dual-energy x-ray absorptiometry (DXA), and four to gait speed; two were summary statements. The SDOC analyses identified grip strength, either absolute or scaled to measures of body size, as an important discriminator of slowness. Both low grip strength and low usual gait speed independently predicted falls, self-reported mobility limitation, hip fractures, and mortality in community-dwelling older adults. Lean mass measured by DXA was not associated with incident adverse health-related outcomes in community-dwelling older adults with or without adjustment for body size. The panel agreed that both weakness defined by low grip strength and slowness defined by low usual gait speed should be included in the definition of sarcopenia. These position statements offer a rational basis for an evidence-based definition of sarcopenia. The analyses that informed these position statements are summarized in this article and discussed in accompanying articles in this issue of the journal. J Am Geriatr Soc 68:1410-1418, 2020.

Improving Functional Assessment in Older Adults Transitioning From Hospital to Home.

The purpose of this article is to highlight how scientists have assessed all components of functional status in older adults transitioning from hospital to home to date, discuss ways of improving assessment of functional status, and discuss implications for case management research and practice. This article focuses on case management of older adults transitioning from hospital to home. There any many ways to assess functional status, including basic activities of daily living (BADL), instrumental activities of daily living (IADL), and other nonphysical domains of function such as leisure, social, and productive activities. However, assessment of function in older adults transitioning from hospital to home is primarily limited to BADL. Nonphysical domains of functional status have been linked to important outcomes in community-dwelling older adults and could give clinicians and researchers a better understanding of how older adults are functioning, as well as allow for earlier recognition of those who are beginning to experience functional decline. In case management, it is important to ask older adults about goals regarding their functional status and how they think about their functioning in the hospital and at home. Early identification of older adults' functional goals while in the hospital is the first step toward regaining their ideal or premorbid function after discharge to home. To best determine baseline functional status, we may need to consider assessments that can measure multiple domains of functioning in older adults, such as the Sickness Impact Profile. Gaining a more comprehensive understanding and assessment of functional status for hospitalized older adults would help inform discharge destinations and improve transitions in care.

Interaction between frailty and nutritional status on mortality and long-term hospitalization in older Koreans: A retrospective analysis of data from the 2008 Survey on Health and Welfare Status of the Elderly in Korea

ObjectivesAlthough it is well known that nutritional deficiency influences frailty, and both nutritional status and frailty are closely related to mortality and morbidity in older people, there are no studies concerning this interaction. In this study, we evaluated whether the interaction of frailty and nutritional deficiency is additive and/or multiplicative. MethodsWe analyzed data from 8907 individuals (≥65 years old) who took part in the 2008 Survey on Health and Welfare Status of the Elderly in Korea. We used the Cardiovascular Health Study (CHS) frailty index and the DETERMINE checklist for assessment of frailty and nutritional status, respectively. We conducted Cox regression analysis for the outcomes ‘mortality’ and ‘mortality and long-term hospitalization risk.’ ResultsIn the multivariate analysis for main effect model on ‘mortality’, the hazard ratios (HRs) of frail, high nutritional risk were 2.63 (95% CI 1.76–3.93), 1.04 (95% CI 0.78–1.38), respectively, and on ‘mortality and long-term hospitalization risk’ those values were 2.56 (95% CI 1.72–3.80), 1.18 (95% CI 0.88–1.58), respectively. In interaction effect model, multiplicative interaction existed between frailty and nutritional status (p < 0.001). Participants with frail X high nutritional risk had much higher HRs for ‘mortality’ (4.14, 95% CI 2.43–7.07) and ‘mortality and long-term hospitalization risk’ (4.60, 95% CI 2.74–7.72). ConclusionWe found that frailty and nutritional status have a multiplicative effect on adverse outcomes in community-dwelling older adults. Nutritional status assessment in older people is important because nutritional supplementation can potentially improve both nutritional status and frailty.

Abstract MP034: Muscle strength and Short-term Risk of Cardiovascular Outcomes in Community-dwelling Older Adults: The Atherosclerosis Risk in Communities (ARIC) Study

Background: Muscle weakness has been shown to predict mortality in older adults. However, its contribution to different cardiovascular disease (CVD) subtypes is not well known. Methods: Among 5,484 participants (age 67-91 years) in the ARIC Study at visit 5 (2011-13), we quantified the associations of grip strength (measured by Jamar Hydraulic Hand Dynamometer) with the risk of coronary heart disease (CHD including myocardial infarction or coronary death), stroke, and heart failure (HF) using Cox models. Results: Over a median follow-up of 1.7 years, there were 119 cases of CHD, 47 cases of stroke, and 168 cases of HF. In crude models, the lowest sex-specific quartile of grip strength demonstrated significantly higher risk of CHD and HF compared to the highest quartile (Table). After accounting for potential confounders such as diabetes, body mass index, and blood pressure, the significant association was only observed for HF (HR 2.09 [95% CI 1.25-3.50] between the lowest vs. highest quartile). Conclusion: Weaker muscle strength was significantly associated with CVD risk in community-dwelling older adults, but its independent association was most evident for HF. Our results suggest the pathophysiological link between skeletal muscle function and HF as well as potential usefulness of grip strength to classify HF risk in older adults.

Effects of WiiActive exercises on fear of falling and functional outcomes in community-dwelling older adults: a randomised control trial.

the study compares the effects of a Nintendo Wii exercise programme and a standard Gym-based exercise intervention on fear of falling, knee strength, physical function and falls rate in older adults. eighty community-dwelling adults aged 60 years and above with short physical performance battery score of 5-9 points and modified falls efficacy scale (MFES) score of ≤9 points participated in the parallel-group randomised trial. Each intervention arm involved an hour of intervention per week, totalling 12 sessions over 12 weeks. Besides 1-year fall incidence, the participants were evaluated on MFES, knee extensor strength (KES), timed-up-and-go test, gait speed, 6-minute walk test and narrow corridor walk test at weeks 13 and 24. at week 13, between interventions, the effect of MFES changes did not reach statistical significance (difference=-0.07 point, 95% CI -0.56 to 0.42, P=0.78); at week 24, the Wii group showed statistically significant effects over the Gym group (difference=0.8 point, 95% CI 0.27 to 1.29, P<0.01). For KES, the two groups did not differ statistically at week 13 (difference=-2.0%, 95% CI -5.6 to -1.7, P=0.29); at week 24, the Gym group had greater strength gains than the Wii group (difference=-5.1%, 95% CI -8.7 to -1.5, P<0.01). No between-group differences were observed for other outcome measures. on completion of a 12-week Nintendo Wii exercise programme, there was no significant benefit seen on fear of falling when compared to a standard Gym-based exercise intervention; however, post-intervention there was an apparent reduction in fear of falling in the group allocated to Wii training, despite knee strength apparently improving more in those allocated to the Gym. It is possible that long-term gains after using the Wii might be due to a carry-over effect. Australian New Zealand Clinical Trials Registry, ACTRN12610000576022.

Associations between the settings of exercise habits and health-related outcomes in community-dwelling older adults.

[Purpose] The purpose of this study was to examine the associations between the settings of exercise habits and health-related outcomes in community-dwelling older adults. [Subjects] A total of 304 Japanese community-dwelling older adults (70.3 ± 4.1 years; 113 males and 191 females) participated in this study. [Methods] Demographic characteristics, medical conditions, exercise habits, and health-related outcomes were assessed by face-to-face interviews and self-reported questionnaires. Older adults who had exercise habits were classified into two groups: individual- and group-based exercise habits groups, and the health-related outcomes were compared between groups. [Results] The scores for the Geriatric Depression Scale, exercise self-efficacy, and dietary variety of older adults who had group-based exercise habits were better than those of older adults who had individual-based exercise habits. In addition, the exercise settings (individual- and group-based) were significantly associated with scores for the Geriatric Depression Scale (odds ratio = 0.76) and exercise self-efficacy (odds ratio = 1.26), even after adjusting for age and gender. [Conclusion] These results implied that habitual exercise in group settings may have an effective role in promoting exercise self-efficacy and mental health.

Potentially Inappropriate Medications in Community-Dwelling Older Adults

Potentially inappropriate medication (PIM) use is a significant worldwide public health problem. Community-dwelling older adults are susceptible to the negative outcomes associated with the use of PIMs. A database search (January 1991-June 2013) produced 19 prospective correlational and 10 intervention studies. The current state of the science reveals that conceptual clarity is lacking regarding the use of PIMs. The prevalence of PIM use is well documented in an abundance of descriptive studies. However, researchers have not examined an intervention's effects on health outcomes in community-dwelling older adults. Although independent older adults can acquire PIMs outside of a provider, current interventions aim to change the behavior of the prescribing physician and pharmacist. Nurses need to collaborate with other disciplines in PIM use research. Priority needs are to design interventions that reduce the use of PIMs and negative health outcomes.

Validity of an early risk score for older adults.

To determine if a risk score developed in hospitalised older adults in the UK in 1962 is correlated with other measures of health and if this risk score predicts death or institutionalisation in community-living older adults. A total of 1,735 older adults residing in the community in 1991 were followed over five years. We replicated the original risk index, a composite score of cognitive status, disability and continence. Other measures included age, gender, education, self-rated health (SRH), life satisfaction (LS) and frailty. Death and nursing home (NH) admission were determined five years later. The risk score was strongly associated with frailty, SRH and LS. The index predicted mortality and NH use: The adjusted odds ratio (95% confidence interval) from multinomial logistic regression models was 0.74 (0.69, 0.79) for death and 0.74 (0.67, 0.83) for NH. A risk score devised to measure inpatient rehabilitation also predicts outcomes in community-dwelling older adults. Cognition and function predict a variety of adverse outcomes in a variety of settings in different historic eras.

Literature Review for the Effects of Physical Activity on Musculoskeletal Outcomes in Community-dwelling Older Adults.

The purpose of this study was to review the effects of physical activity on musculoskeletal outcomes in older Koreans. Experimental studies were retrieved from the search engines (PubMed, CINAHL, PsycINFO, Cochrane, RISS, KISS, and KoreaMed). The selected studies for analysis were 27 articles of musculoskeletal outcomes (gait, muscle strength, flexibility, balance, grip strength, endurance, body fat, and weight) from 515 articles. The most common type of physical activity was a resistance exercise. There were significant improvements in gait (71.4%), muscle strength (86.7%), flexibility (63.6%), balance (72.2%), grip strength (71.4%), endurance (71.4%), body fat (57.1%), and weight (28.6%). The activity programs that apply over 150 minutes a week showed greater improvement of 69.5% than 65.0% from those did not meet the guidelines totally. Based on the review, we conclude that regular physical activity in the elderly may improve the musculoskeletal outcomes. To be more effective programs, it is necessary to meet the guidelines of 150 minutes a week or 30 minutes of moderate-intensity activities on 5 days per week for the elderly.

Muscle Quality in Older Adults

The population of older adults in the United States is steadily growing and identifying factors that contribute to healthy aging is a public health priority. Changes in body composition are a hallmark of the aging process and have been implicated in the loss of physical function among older adults. In particular, age-related declines in muscle strength and power occur at a faster rate than the loss of muscle mass (sarcopenia), and this suggests a decrease in muscle quality of older adults. Muscle quality has traditionally been defined as muscle function (strength or power) per unit of muscle size (mass or cross-sectional area) and a growing body of literature suggests that lower body muscle quality may be critical for maintaining functional independence with age. However, the literature regarding the definition of muscle quality and its relationship with health outcomes in older adults has not been adequately reviewed. Thus, the aim of this report is to highlight the contemporary literature regarding age-related changes in muscle quality and its relationship with health outcomes in community-dwelling older adults.

Adult Hearing Screening: Follow-Up and Outcomes1

To screen hearing and evaluate outcomes in community-dwelling older adults. Three thousand and twenty-five adults responded to an invitation to be screened by questionnaire, otoscopy, and pure-tone audiometry. Pure-tone average (PTA) >35 dB HL in the worse ear, unilateral hearing loss, or otoscopic findings were the criteria for referral for services. A questionnaire related to compliance with referral recommendations was completed by telephone interview for 160 randomly selected participants after 1-2 years from referral. The referral rate for audiologic/hearing aid evaluation was 46%, and referral for cerumen removal/medical evaluation was 17%. Of the people referred for audiologic/hearing aid evaluation, 18% tried a hearing aid; 2 years later, 11% were using a hearing aid. Screening recommendations affected participants' decision to seek help. Study participants stated that the screening was helpful, it should be offered to everybody, and they would participate in future screenings. Although adult hearing screening offered timely identification of hearing loss for adults seeking help, follow-up with hearing aid treatment was low.

Systematic Literature Review of Randomized Control Trials Assessing the Effectiveness of Nutrition Interventions in Community-Dwelling Older Adults

Objective Nutrition interventions may play an important role in maintaining the health and quality of life in community-dwelling older adults. To the authors' knowledge, no systematic literature review has been conducted on the effectiveness of nutrition interventions in the community-dwelling older adult population. Design Systematic literature review followed by descriptive data extraction and critical appraisals for studies meeting inclusion criteria. Setting Medical Literature and Retrieval System Online (MEDLINE) and Cumulative Index to Nursing and Allied Health Literature (CINAHL) search for randomized controlled trials (RCTs) assessing nutrition interventions in community-dwelling older adults. Participants Fifteen RCTs involving nutrition-related outcomes in community-dwelling older adults. Analysis Descriptive data extraction and critical appraisals using the Jaded scale. Outcome measures included study blinding, allocation concealment, intention-to-treat analysis, and a priori calculations. Results Ten RCTs involved nutrition counseling, education, or dietary advice, whereas 5 involved nutrition supplements. Jaded scores ranged from 1 (n = 8) to 2 (n = 4) to 4 (n = 3). Ten RCTs reported positive results post-intervention. Conclusions and Implications Nutrition counseling interventions involving active participation and collaboration showed the most promise in affecting positive nutrition-related outcomes in community-dwelling older adults. Future research should determine which nutrition interventions will benefit community-dwelling older adults with less active participation and health perceptions, and lower educational attainment.

Evaluation of a geriatric day rehabilitation centre: subjective and objective outcomes in community-dwelling older adults

Pre and post testing were conducted on community-dwelling older adults referred to a geriatric day rehabilitation centre (DRC). Consecutive DRC clients were screened for inclusion over a 16-month period and were eligible if: aged 60+ years; cognitively intact; and reason for referral involved spinal or lower limb musculoskeletal impairment, disability or surgery, and/or reduced functional mobility or falls. Clients were excluded if they had a neurological disorder, or did not complete the program. Outcome measures included: lower limb strength; balance; mobility; self-reported pain; activities of daily living; and quality of life. Data were summarised using descriptive statistics and analysed using paired t-tests. Of the 137 participants recruited, 110 were female and the mean age was 79.5 ± 7.3 years. In total, 106 participants completed the DRC program and were assessed at baseline and re-assessed at discharge. The mean length of stay was 12.4 ± 2.9 weeks, with 21.4 ± 5.4 attendances. From baseline to discharge, statistically significant differences were found for all objective measures of physical functioning, balance, and for all lower limb strength tests (P &lt; 0.0001). Glasgow Pain Questionnaire scores demonstrated statistically significant improvements in all five domains of the scale (P &lt; 0.0001). The Barthel Index and Multi-dimensional Functional Assessment Questionnaire both showed a statistically significant improvement in the level of independence in activities of daily living (ADL) (P &lt; 0.05). The Assessment of Quality of Life Questionnaire showed a statistically significant improvement (P = 0.027). The Exercise Benefits/Barriers Scale also showed a statistically significant improvement over DRC attendance (P = 0.005). The Falls Efficacy Scale showed a positive change, but the improvement was not statistically significant (P = 0.80). The study’s results indicate that community-dwelling older adults with physical disabilities and multiple comorbidities who attended the interdisciplinary geriatric DRC, significantly improved their lower limb strength, balance and physical function, and also showed significant decreases in self-reported pain, and improvements in independence in ADL and quality of life. Given the limitations of the current study, further research, in the form of high quality studies with larger sample sizes that involve direct comparisons with other forms of care or against a control group, is needed to determine whether day rehabilitation centre programs provide the optimum mode of rehabilitation for this population in the most cost effective manner.

A Propensity-Matched Study of the Association of Peripheral Arterial Disease With Cardiovascular Outcomes in Community-Dwelling Older Adults

The association between peripheral arterial disease (PAD) and outcomes has not been studied in a propensity-matched population of community-dwelling older adults. A public-use copy of the Cardiovascular Health Study (CHS) data was analyzed to test the hypothesis that baseline PAD is associated with increased all-cause mortality and cardiovascular morbidity. Of the 5,795 CHS participants, 5,630 had data on baseline ankle-brachial index, and 767 had PAD, defined as ankle-brachial index <0.9. Propensity scores for PAD were calculated for each participant using 66 baseline covariates and were used to match 679 pairs of participants with and without PAD. Matched Cox regression models were used to estimate associations of PAD with outcomes during a median follow-up period of 7.5 years. Overall, 55% of matched participants died from all causes during 9,958 patient-years of follow-up. All-cause mortality occurred in 61% (rate 8,710/100,000 patient-years) and 50% (rate 6,503/100,000 patient-years) of participants, respectively, with and without PAD (matched hazard ratio for PAD vs no PAD 1.47, 95% confidence interval (CI) 1.23 to 1.76, p <0.0001). Prematch unadjusted, multivariable-adjusted, and propensity-adjusted hazard ratios for PAD-associated all-cause mortality were 2.90 (95% CI 2.61 to 3.21, p <0.0001), 1.53 (95% CI 1.36 to 1.71, p <0.0001), and 1.57 (95% CI 1.39 to 1.78, p <0.0001), respectively. Matched hazard ratios for PAD for incident heart failure and symptomatic PAD were 1.32 (95% CI 1.00 to 1.73, p = 0.052) and 3.92 (95% CI 2.13 to 7.21, p <0.0001), respectively. In conclusion, in a propensity-matched well-balanced population of community-dwelling older adults, baseline PAD was associated with increased all-cause mortality and cardiovascular morbidity.

Detection and management of falls and instability in vulnerable elders by community physicians.

To investigate quality of care for falls and instability provided to vulnerable elders. Six process of care quality indicators (QIs) for falls and instability were developed and applied to community-living persons aged 65 and older who were at increased risk of death or decline. QIs were implemented using medical records and patient interviews. Northeastern and southwestern United States. Three hundred seventy-two vulnerable elders enrolled in two senior managed care plans. Percentage of QIs satisfied concerning falls or mobility disorders. Of the 372 consenting vulnerable elders with complete medical records, 57 had documentation of 69 episodes of two or more falls or fall with injury during the 13-month study period (14% of patients fell per year, 18% incidence). Double this frequency was reported at interview. An additional 22 patients had documented mobility problems. Clinical history of fall circumstances, comorbidity, medications, and mobility was documented from 47% of fallers and two or more of these four elements from 85%. Documented physical examination was less complete, with only 6% of fallers examined for orthostatic blood pressure, 7% for gait or balance, 25% for vision, and 28% for neurological findings. The evaluation led to specific recommendations in only 26% of cases, but when present they usually led to appropriate treatment modalities. Mobility problems without falls were evaluated with gait or balance examination in 23% of cases and neurological examination in 55%. Community physicians appear to underdetect falls and gait disorders. Detected falls often receive inadequate evaluation, leading to a paucity of recommendations and treatments. Adhering to guidelines may improve outcomes in community-dwelling older adults.

Co-morbidity adjustment for functional outcomes in community-dwelling older adults.

To characterize relationships between self-reported co-morbidity and functional outcomes in community-dwelling older adults, and to assess whether the impact of co-morbidity persists even after adjustment for baseline functional status. Prospective observational study. We examined associations between self-reported co-morbidity at baseline and functional outcomes at one year, with and without adjustment for baseline functional status. Outpatient clinics at a managed care and a Veterans Affairs site. Four hundred and fifty-seven community-dwelling older adults representing a broad spectrum of overall health status. (a) New basic ADL (activities of daily living) problem during follow-up; (b) 10-point decline in the physical function index of the MOS-36 (MOS-PFI). Co-morbidity was associated with adverse functional outcomes in bivariable analyses. After adjustment for age and baseline functional status, an accumulated co-morbidity score provided additional explanatory power for predicting new ADL problems; odds ratios were 2.30 (1.09, 5.09) and 2.96 (1.48, 6.25) for 2 and > or = 3 affected co-morbidity domains, respectively. The impact of baseline status was also important; odds ratios for new ADL problems were 4.77 (2.68, 8.81) when at least one instrumental activity of daily living (IADL) problem was present at baseline, and 15.6 (8.05, 31.3) when at least one basic ADL problem was present at baseline. Accumulated self-reported co-morbidity has significant negative effects on function at one year; these effects are attenuated but not eliminated by adjustment for baseline status. Co-morbidity adjustment is probably an important design element in clinical research focused on functional outcomes in older adults.