Predictors Of Physical Disability Research Articles

PS-P11-2: THE PATTERN OF PHYSICAL DISABILITY AND DETERMINANTS OF ACTIVITIES OF DAILY LIVING AMONG DIABETIC PATIENTS IN BANGLADESH: A CROSS-SECTIONAL ANALYSIS.

Objective: Diabetes mellitus is a known predictor of physical disability and decline in activities of daily living (ADL); however, there are existing controversies about the factors explaining the association between diabetes and disability. Therefore, we assessed the proportion of physical disabilities and possible factors associated with ADL decline among diabetic patients in Bangladesh. Design and Methods: We conducted a cross-sectional study among 480 diabetic individuals from a tertiary level hospital in Dhaka, Bangladesh, aged between 40 and 85 years. For determining the ADL decline, we used the Katz Index Scoring, the highest score of 6 indicates no ADL decline. We divided patients into two groups depending on ADL impairment to compare the population characteristics using the unpaired Students t-test or Wilcoxon rank-sum test for continuous variables and the chi-squared test for categorical variables. Age, sex, educational attainment, household expenditure, BMI, HbA1c, hypertension, and medication adherence to anti-diabetic drugs were included in the statistical models. We defined any ADL decline as an event, and multivariable logistic regression was performed to assess the factors associated with ADL decline. Results: The mean age of the participants was 59.0 (standard deviation [SD], 7.0) years. The majority of the participants (76.3%) had at least some sort of physical disability. Age, educational attainment, household expenditure, systolic blood pressure, waist circumference, quality of life, and comorbidities were different among the groups stratified by ADL impairment status. In multivariable logistic regression analysis after adjusting for all covariates simultaneously, age (OR, 95% CI: 1.35, 1.20–1.75), lower educational attainment (0.97, 0.94–0.99), BMI (1.40, 1.12–1.75), existing comorbidities (2.79, 1.48–5.25) and uncontrolled diabetes (1.35,1.10–1.45) were independently associated with ADL decline among diabetic population. Conclusions: Physical disability was common, and ADL decline was associated with age, educational attainment, BMI, comorbidities, and uncontrolled diabetes among diabetic patients in Bangladesh.

The pattern of physical disability and determinants of activities of daily living among people with diabetes in Bangladesh.

IntroductionDiabetes mellitus itself is a known predictor of physical disability and impairment in activities of daily living (ADL); however, there are existing controversies about the factors explaining the association between diabetes and disability. Therefore, we assessed the possible determinants associated with ADL impairment among people with diabetes in Dhaka city, Bangladesh.MethodsWe conducted a cross‐sectional study among 480 people with diabetes aged between 50 and 70 years, and attended a tertiary level hospital in Dhaka city. For determining the ADL impairment, we used the Katz Index Scoring (6 = no impairment; <6 = impairment). Age, sex, educational attainment, household expenditure, body mass index, the status of diabetes (controlled or uncontrolled), hypertension and medication adherence to anti‐diabetic drugs were included in the statistical models, and we defined any ADL impairment (Katz score <6) as an event. Multivariable logistic regression was performed to assess the significance of relevant factors.ResultsThe mean age of the participants was 59.0 (standard deviation [SD], 7.0) years. The majority of the participants (76.3%) had at least some sort of physical disability. In multivariable logistic regression analysis after adjusting for all covariates simultaneously, age (odds ratio [95% confidence interval]: 1.35 [1.20 to 1.75] per 1−SD increment), BMI (1.32 [1.08 to 1.21] per 1−SD increment), higher educational attainment (0.34 [0.09–0.90]), multi‐morbidity (2.79 [1.48–5.25]) and uncontrolled diabetes (1.35 [1.10–1.45]) were independently associated with ADL impairment.ConclusionsPhysical disability was common, and ADL impairment was associated with age, educational attainment, BMI, multi‐morbidities and uncontrolled diabetes among the people with diabetes in Bangladesh.

Sit-to-Stand Power Across the Lifespan: A Cross-Sectional Analysis.

Lower-body power measured by a linear position transducer during the sit-to-stand (STS) movement declines with age and may be a predictor of physical disability in older adults. The purpose of this study was to establish normative data for STS power across the lifespan and to determine if differences exist between age cohorts, sexes, and age cohort-sex subgroups. Adults (N = 557) aged 18-89 were divided into five age cohorts and performed the STS connected to a linear position transducer, which calculated power and velocity during the movement. Significantly lower (p < .01) velocity was observed in a younger age cohort in females than males, whereas males saw a significant average power decrement (p < .01) in a younger age cohort than females. STS power norms give clinicians a metric predicting physical disability and may be of particular interest to males as their power production begins to decline at an earlier age.

Improving Pain Management and Long-Term Outcomes Following High-Energy Orthopaedic Trauma (Pain Study).

Poor pain control after orthopaedic trauma is a predictor of physical disability and numerous negative long-term outcomes. Despite increased awareness of the negative consequences of poorly controlled pain, analgesic therapy among hospitalized patients after orthopaedic trauma remains inconsistent and often inadequate. The Pain study is a 3 armed, prospective, double-blind, multicenter randomized trial designed to evaluate the effect of standard pain management versus standard pain management plus perioperative nonsteroidal anti-inflammatory drugs or pregabalin in patients of ages 18-85 with extremity fractures. The primary outcomes are chronic pain, opioid utilization during the 48 hours after definitive fixation and surgery for nonunion in the year after fixation. Secondary outcomes include preoperative and postoperative pain intensity, adverse events and complications, physical function, depression, and post-traumatic stress disorder. One year treatment costs are also compared between the groups.

Maintaining Muscle Strength in Crohn’s Disease: Can a Vitamin D Daily Keep Muscle Loss Away?

Intact skeletal muscle strength and function are underappreciated aspects of normal human functioning. Moreover, it is widely accepted that muscle strength is a predictor of physical disability in patients with chronic diseases similar to inflammatory bowel disease (IBD, comprising Crohn’s disease and ulcerative colitis) such as rheumatoid arthritis [1], but also in normal ageing where healthy persons with a greater reserve in muscle function appear to have longer life spans [2]. Despite the intuitive importance of skeletal muscle in daily living, and the recent interest in the characterization of disability in patients with IBD [3], hitherto there are few studies examining muscle dysfunction in IBD [4]. In this issue, Salacinski et al. [5] have objectively demonstrated reduced lower limb muscle strength in subjects with Crohn’s disease (CD) compared to healthy controls, confirming the work of previous studies [6, 7]. However, the study was unable to show that this reduced strength was directly attributable to lower vitamin D (25(OH) or vitamin D3) levels in CD subjects as originally hypothesized. This exemplifies the complexity of teasing out potential causative and/or contributing factors in the reduced muscle strength and performance seen in CD. Delving Further into Vitamin D

Advances in understanding gray matter pathology in multiple sclerosis: Are we ready to redefine disease pathogenesis?

The purpose of this special issue in BMC Neurology is to summarize advances in our understanding of the pathological, immunological, imaging and clinical concepts of gray matter (GM) pathology in patients with multiple sclerosis (MS). Review articles by Lucchinetti and Popescu, Walker and colleagues, Hulst and colleagues and Horakova and colleagues summarize important recent advances in understanding GM damage and its implications to MS pathogenesis. They also raise a number of important new questions and outline comprehensive approaches to addressing those questions in years to come. In the last decade, the use of immunohistochemistry staining methods and more advanced imaging techniques to detect GM lesions, like double inversion recovery, contributed to a surge of studies related to cortical and subcortical GM pathology in MS. It is becoming more apparent from recent biopsy studies that subpial cortical lesions in early MS are highly inflammatory. The mechanisms responsible for triggering meningeal inflammation in MS patients are not yet elucidated, and they should be further investigated in relation to their role in initiating and perpetuating the disease process. Determining the role of antigens, environmental and genetic factors in the pathogenesis of GM involvement in MS is critical. The early involvement of cortical and subcortical GM damage in MS is very intriguing and needs to be further studied. As established in numerous cross-sectional and longitudinal studies, GM damage is a better predictor of physical disability and cognitive impairment than WM damage. Monitoring the evolution of GM damage is becoming an important marker in predicting future disease course and response to therapy in MS patients.

Anemia, Physical Disability, and Survival in Older Patients With Heart Failure

Background Anemia is common in congestive heart failure, and it has been associated with poor prognosis. The effect of anemia on functional ability in heart failure has not been described. We evaluated the relationship of anemia, physical disability, and survival in patients with heart failure. Methods and Results One-year longitudinal study of 567 non-disabled, hospitalized heart failure patients, age ≥65 years, enrolled in the Italian Group of Pharmacoepidemiology in the Elderly Study. Anemia was defined according to the World Health Organization criteria. Physical disability was defined as dependence in performing at least 2 basic activities of daily living. After adjustment for disease severity and health-related variables, anemia was associated with higher risk of disability (odds ratio = 2.17; 95% confidence interval [CI] = 1.12–4.24). After stratification according to gender, a strong relationship of anemia and risk of disability persisted in women, but it was reduced in men. Anemic women were significantly more likely to die during the follow-up, even after adjustment for potential confounders (hazard ratio = 2.33; CI = 1.02–5.30). Conclusion Anemia is a predictor of physical disability in older heart failure patients, and in women anemia is associated with increased mortality.

Age Differences in the Correlates of Physical Functioning in Patients With Chronic Pain

Pain-related disability in the elderly is a major contributor to poor quality of life. In this study, the author examined age-related differences in the factors associated with physical disability in the context of chronic pain. A large cohort of chronic pain patients was categorized into four age groups, and correlates of physical disability were evaluated within each age category. Several important age differences in the predictors of physical disability were noted. Affective distress was unrelated to physical disability among the elderly, whereas this association was quite strong among younger patients. In contrast, pain severity was a weak predictor of disability within the younger group, but it accounted for more than one fourth of the variance in physical disability in those older than 65. These data suggest that the determinants of functioning may vary across the life span, implying a potential for pain management programs tailored to a patient's age.

Highlights of Papers in Clinical Investigations Section: Depressive Disorder as a Predictor of Physical Disability in Old Age

In this longitudinal study with a 5‐year follow‐up, 786 subjects were assessed for the impact of depression on physical disability. Depression present at baseline did not predict lowering of functional abilities during the follow‐up period. However, new‐onset depression that was relapsing or long‐term in course was associated with increased risk for lowering functional abilities, even when age, sociodemographic factors, physical diseases, and baseline disabilities were controlled. Depressed older people should be placed on a program to maintain their functional abilities through physical exercise and training in activities of daily living and intermediate activities of daily living.

Depressive Disorder as a Predictor of Physical Disability in Old Age

To determine whether the occurrence of depression predicts physical disability in older people. A longitudinal epidemiological study with a follow-up of 5 years. A comparison between depressed and nondepressed participants. The series consisted of the persons who participated in the longitudinal epidemiological study on depression in old age performed in Ahtari, Finland. The first round of interviews and examinations was performed in 1984/1985 and the second round in 1989/1990. The study series (N = 786) was composed of persons functionally independent in activities of daily living (ADLs) during the first round and alive and participating in both rounds. Depression was determined according to DSM-III criteria. Physical functional abilities were measured with self-assessments of ability to manage ADLs. In bivariate analyses, depression at the baseline did not predict lowering of functional abilities during follow-up, but the occurrence of depression with a long-term or relapsing course during follow-up and the onset of depression during follow-up in persons not depressed at the baseline predicted lowering of functional abilities during follow-up. The logistic regression analyses showed the presence of the following variables measured during the first round--older age, low basic education, poor self-perceived health, and occurrence of a physical disease--and the onset of the following diseases during follow-up--any physical disease, neurological disease, cerebrovascular disease, or depressive symptoms (in persons nondepressed at the baseline)--predicted lowered functional abilities after a follow-up of 5 years. Depression that developed during the follow-up in previously nondepressed persons was associated with an increased risk for lowering of functional abilities, even when controlling for age, sociodemographic factors, physical diseases, and baseline disabilities. Depressed older people are at high risk for physical disability, and an individually planned program to maintain their functional abilities by training in ADLs and instrumental activities of daily living (IADLs) and physical exercise should be included in their treatment.

Predictors of Physical Disability After Age 50

Predictors of Physical Disability After Age 50

Predictors of physical disability after age 50

Predictors of disability were studied over 6 years among 50- to 80-year-old members of a runners club (N = 407) and a university population (N = 299). Data have been collected annually since 1984 on sociodemographic characteristics, health habits, medical history, medication use, family history, psychological parameters, and physical disability as measured by the Health Assessment Questionnaire. Members of the runners club, compared to university participants, had better overall health and less disability at baseline (0.03 versus 0.08) and at 6-year follow-up (0.04 versus 0.24). Predictors of greater subsequent disability among university participants were greater baseline disability, greater medication use, greater number of pack-years of cigarette smoking, older age, being unmarried, higher blood pressure, history of arthritis, and less physical activity compared to one's peers. In addition, changes in characteristics during follow-up that were independently associated with greater disability were development of joint pain, arthritis, or bone fracture and increased body mass index. Predictors of greater disability in the runners group included greater baseline disability, being a nonrunner at baseline, greater dietary salt intake, more years of running at baseline, and greater frequency of physician visits for running injuries. Greater disability in this group also was associated with increases in medication use, declining alcohol consumption, and development of joint pain over 6 years. Results of this study suggest that physical disability is linked to a constellation of characteristics, health habits, medical history, comorbidities, and marital status. While self-selection bias cannot be ruled out entirely, these data are consistent with the hypothesis that those who engage in high levels of physical activity beyond middle age will continue to maintain better functional abilities.

Predictors of physical disability in elderly blacks and whites of the Charleston heart study

During the 1984/1985 recall of the Charleston Heart Study Cohort, physical function data were obtained for 247 white males, 376 white females, 123 black males, 247 black females and 71 high socioeconomic status (SES) black males over 60 years of age. Black females had the highest prevalence of physical disability (55.8%), followed by white females (43.2%), black males (39.0%) and white males (25.8%) and high SES black males (22.3%). Physical disability was 1.5–2.5 times as prevalent among individuals with a history of cardiovascular disease (CVD) than those without such a history. Among individuals without a current history of CVD univariate analyses showed the following as significant (lower 95% CI > 1.0) predictors of physical disability: elevated systolic blood pressure in white females, black males, and black females; elevated cholesterol in black females; obesity in black females; and low educational level in white females. Regression analyses indicated that obesity in 1960 accounted for 10.9 and 2.9% respectively of the variability in physical disability scores in 1985 for black females and white females.