Risk Factors For Physical Disability Research Articles

Multidisciplinary understanding of modifiable physical disability risk factors for health professionals: A scoping review protocol.

Physical disability represents a major burden to health and lifespan, particularly as the proportion of older adults within the United States is expected to grow. Prevention efforts for physical disability targets methods and strategies to decrease modifiable risk factors. Potential challenges for health professionals may exist in synthesizing and interpreting this broad spectrum of literature due to the discipline-specific nuance of language used, practice type or specialty, and lack of interdisciplinary resources. This scoping review will map and synthesize the literature across healthcare disciplines to identify modifiable risk factors and the evidence related to their ability to predict physical disability. We will also draw attention to the possibility of modifiable risk factors for physical disability being operationalized as pre-disability in order to strengthen primary and secondary prevention efforts. A planned search strategy using physical disability terminology will be searched in English across MEDLINE, CINAHL, Health Source, PEDro, and REHABDATA by two reviewers in line with our review objectives and inclusion criteria. Eligibility for inclusion include peer-reviewed primary research published in the English language and have established a relationship between a person-level measurable characteristic that is modifiable by changes in lifestyle behaviors and any of the commonly accepted terms used to categorize or describe physical disability. Presentation of results will be using the PRISMA flowchart, with additional mapping and synthesis of evidence for modifiable risk factors for physical disability to clarify divergent terms used in classifying and measuring these factors and their potential for prediction of physical disability. It is anticipated that this scoping review will identify and highlight a variety of modifiable risk factors for physical disability that may aid primary and secondary prevention efforts for health professionals.

RISK FACTORS FOR PHYSICAL DISABILITY IN PATIENTS WITH LEPROSY: A SYSTEMATIC REVIEW

Background: Leprosy is also referred to as Hansen disease. It is a chronic granulomatous infection generally caused by Mycobacterium leprae and Mycobacterium lepromatosis, both of which primarily affects the skin and peripheral nerves. Physical disability (PD) can occur before leprosy diagnosis, during treatment and post-release from treatment. However, although patients may be exposed to risk factors that potentiate the risk of more severe PD they stop being routinely evaluated once the treatment of active leprosy has been completed. The aim: This study aims to show about risk factor for physical disability in patients with leprosy. Methods: By comparing itself to the standards set by the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) 2020, this study was able to show that it met all of the requirements. So, the experts were able to make sure that the study was as up-to-date as it was possible to be. For this search approach, publications that came out between 2013 and 2023 were taken into account. Several different online reference sources, like Pubmed and SagePub, were used to do this. It was decided not to take into account review pieces, works that had already been published, or works that were only half done. Result: In the PubMed database, the results of our search brought up 104 articles, whereas the results of our search on SagePub brought up 77 articles. The results of the search conducted for the last year of 2013 yielded a total 88 articles for PubMed and 48 articles for SagePub. The result from title screening, a total 7 articles for PubMed and 28 articles for SagePub. In the end, we compiled a total of 10 papers. We included five research that met the criteria. Conclusion: Delayed diagnosis, nerve damage, no skin lesions, WHO and Ridley-Jopling classifications, leprosy reactions, advanced age, rural occupation, Han ethnicity, and male sex were associated with disability in leprosy patients. Identifying risk factors could help to prevent physical disability.

Risk factors for physical disability in patients with leprosy disease in Yunnan, China: Evidence from a retrospective observational study.

BackgroundLeprosy is potentially debilitating. The risk factors related to physical disabilities associated with leprosy disease in Yunnan, China was not clear.Methodology/Principal findingsWe studied 10644 newly detected leprosy patients from Yunnan, China, from 1990 to 2019. Factors associated with Grade 1 (G1D) and Grade 2 (G2D) physical disabilities or overall physical disabilities (combined G1D and G2D) associated with leprosy were analyzed using multinomial and ordinal logistic regression analyses. The following factors were associated with the development of physical disability in these patients with leprosy: delayed diagnosis [odds ratio (OR): 5.652, 4.399, and 2.275; 95% confidence intervals (CIs): 4.516–7.073, 3.714–5.212, and 2.063–2.509; for ≥ 10, 5–10 y, and 2–5 years, respectively], nerve damage (OR: 3.474 and 2.428; 95% CI: 2.843–4.244, and 1.959–3.008; for 2 and 1 damaged nerves, respectively), WHO classification of PB (OR: 1.759; 95% CI: 1.341–2.307), Ridley-Jopling classification (OR: 1.479, 1.438, 1.522 and 1.239; 95% CI: 1.052–2.079, 1.075–1.923, 1.261–1.838, and 1.072–1.431; for TT, BT, BB, and BL when compared with LL, respectively), advanced age (OR: 1.472 and 2.053; 95% CI: 1.106–1.960 and 1.498–2.814; for 15–59 and over 60 years old, respectively), zero skin lesions (OR: 1.916; 95% CI: 1.522–2.413), leprosy reaction (OR: 1.528; 95% CI: 1.195–1.952), rural occupation (OR: 1.364; 95% CI: 1.128–1.650), Han ethnicity (OR: 1.268; 95% CI: 1.159–1.386), and male sex (OR: 1.128; 95% CI: 1.024–1.243).ConclusionsDelayed diagnosis, nerve damage, no skin lesions, WHO and Ridley-Jopling classifications, leprosy reactions, advanced age, rural occupation, Han ethnicity, and male sex were associated with disability in leprosy patients. Identifying risk factors could help to prevent physical disability.

Creatinine index as a predictive marker of sarcopenia in patients under hemodialysis.

Sarcopenia is a clinical condition that comprises declined skeletal muscle (SM) mass and SM strength, and is a risk factor for physical disability, impaired quality of life, and advanced morbidity and mortality in patients on hemodialysis (HD). The existing difficulty in evaluating SM mass and consequently of sarcopenia, with affordable and practical methods in clinical practice, is well established. The purpose of this study is to examine the creatinine index (CrI), a surrogate of SM mass, as a potential predictive marker of sarcopenia. In this cross-sectional study, we included 130 patients on HD with a mean age of 66.17 ± 12.47years. SM mass and SM strength were evaluated with CrI and hand grip strength, respectively. Anthropometric, adiposity, nutritional, and biochemical assessments were also performed. Partial correlation and multivariate regression analyses were applied to investigate the association between CrI and SM strength. Correlation analysis showed that mid-arm circumference, calf circumference, Geriatric nutritional index, and albumin-to-total protein ratio were positively associated with SM strength. Multivariate model indicated that CrI (β = 2.05, p < 0.001) and dialysis duration (β =-0.53, p = 0.001) were independently related to SM strength. The significant positive correlation between CrI and SM strength remained unaffected even after adjusting for potential confounders. Creatinine Index was significantly associated with SM strength highlighting its value as a new emerging practical in clinical setting sarcopenia predictive marker in HD patients.

Risk factors for physical disability due to leprosy: a case-control study

ABSTRACT Background The main consequence of leprosy is physical disability. Objective To identify risk factors of physical disabilities due to leprosy. Method Case-control study carried out at the Notifiable Diseases Information System – Leprosy in the 9th Regional Health District of the state of Paraíba, Brazil, between 2001 and 2014. Cases were individuals who presented degree of physical disability 1 or 2 at diagnosis or discharge; and controls included individuals with degree of physical disability 0 also at diagnosis and discharge. A 1:1 (case:control) proportion was used. Data were analyzed using the Epi Info and BioEstat software packages. Results The following cases and controls (428 each) at risk for physical disability were analyzed: aged ≥15 years (96.5%, OR=0.33, p&lt;0.01), males (59.3%, OR=1.82, p&lt;0.01), low education level (70.4%, OR=2.66, p&lt;0.01), multibacillary classification (72.9%, OR=9.29; p&lt; 0.01), number of lesions ≥5 (34.3%, OR=0.18, p&lt;0.01), and number of nerves affected ≥1 (12.6%, OR=0.05; p&lt;0.01). Late diagnosis, missing/inadequately filled data, absence/non-registration of dermato-neurological evaluation, and low control of contacts were observed. Conclusion The need for active surveillance and early detection of leprosy cases and contacts is highlighted.

Risk Factors for Physical Disability in Patients With Leprosy

The World Health Organization (WHO) 2016-2020 Global Leprosy Strategy aims to reinvigorate efforts to control leprosy and avert leprosy disability to less than 1 per million population. To systematically identify clinical factors associated with physical disability in patients with leprosy. Searches were conducted in Scopus, PubMed, and Web of Science databases to identify studies published from January 23, 1988, to May 23, 2018, using the keywords leprosy and physical disability and related terms. Studies that evaluated patients using the WHO leprosy disability grading system and reported the number of patients with and without disability by clinical characteristics were included. The odds ratio (OR) was used as a measure of association between the clinical features and physical disability. Summary estimates were calculated using random-effects models. The primary outcome was physical disability according to the WHO disability classification. The association between clinical features and physical disability was evaluated. The search identified 2447 reports. After screening titles and abstracts, 177 full-text articles were assessed for eligibility, and 32 studies were included in the systematic review; 24 of the 32 studies included sex information (39 571 patients), of whom 24 218 (61.2%) were male. Male patients with leprosy were more likely to have physical disability than female patients with leprosy (pooled OR, 1.66; 95% CI, 1.43-1.93; I2, 81.3%; P < .001). Persons with multibacillary leprosy were 4-fold more likely to have physical disability than those with paucibacillary leprosy (pooled OR, 4.32; 95% CI, 3.37-5.53; I2, 88.9%, P < .001). Patients having leprosy reactions were more likely to have disability (pooled OR, 2.43; 95% CI, 1.35-4.36; I2, 92.1%; P < .001). Patients with lepromatous leprosy experienced 5- to 12-fold higher odds of disability. This systematic review and meta-analysis confirms the association between the presence of physical disabilities and male sex, multibacillary leprosy, leprosy reactions, and lepromatous presentation. These findings can guide the development of targeted interventions for early identification of individuals at greater risk of developing physical disabilities and education campaigns to promote early consultation to institute treatment for leprosy reactions and prevent physical disability.

Risk factors for physical disability upon release from multidrug therapy in new cases of leprosy at a referral center in Brazil.

ABSTRACTThe present study sought to investigate the risk factors for physical disability upon release from multidrug therapy (MDT) in new cases of leprosy, registered at a referral center in Brazil. This is a longitudinal and retrospective study that evaluated 260 patients. Multivariate analyses, using both the ordinal logistic regression, as well as the classification and regression tree (CART) algorithm were performed to determine the factors associated with physical disability upon release from treatment. The prevalence of disability did not differ significantly between diagnosis and release from treatment. Number of affected nerves and sensory impairment upon diagnosis were risk factors for disability at the end of MDT. The analysis using the CART algorithm resulted in the development of a clinical score to predict the risk of disability upon release from MDT. The decision tree may have a direct applicability in clinical practice for professionals dealing with leprosy, as it allows them to identify patients with a higher risk of physical disability through the use of simple and widely available clinical tests. This study also shows that the disability grade upon admission is the main risk factor for disability upon release from MDT. This result draws attention to the importance of early diagnosis in disability prevention.

Prevalence of, and Risk Factors for, Physical Disability among Nurses in Europe

Aims and objectives: This study investigates possible causes of physical disability among European nurses, and deals with personal, physical and (social) work environment factors. Design: 39,898 (51.7%) nurses responded to our survey (6335 head nurses; 4933 specialized nurses; 24,142 state-registered nurses; and 4488 nursing aids). Methodology: First, the prevalence of physical disability among nurses in Europe was investigated. Second, multivariate analyses were performed to better understand the influence of possible risk factors for physical disability. A Strobe statement has been added. Results: In general, the risk of physical disability is positively associated with the amount of physical load and the nurses’ dissatisfaction with this, with a lack of teamwork quality, harassment by supervisors, colleagues not (quite) ready to help, not having lifting aids, a high quantitative work demand, and having to work in split shifts. The main moderating or buffering factors addressed in this study are having a part-time job, practice of sport and/or hobbies, and the nurses’ social work environment. Relevance to Clinical Practice: Today, there is a substantial shortage of nurses in Europe, and management in healthcare organizations that fails to improve physical working conditions and to provide adequate (career) support might suffer from, will experience growing levels of disability and dissatisfaction among nursing staff that might result in premature leave, reduced productivity or higher absenteeism.

The Association between Glucose Control and Functional Indices in Older People with Diabetes.

Diabetes may be viewed as a disease of accelerated aging as it is a risk factor for physical disability and impairment in simple and complex activities, and is a higher risk for falls and fractures. Data from the last several years suggests that this increased risk is due not only to recognized diabetes complications but also to an accelerated decline in physical capacity due to lower muscle quality and a more rapid decline in muscle mass and lower extremity strength over time. Aim. To find the association between glucose control and functional indices. Methods. A cross-sectional study conducted at the Center for Successful Aging with Diabetes at the Sheba Medical Center. Individuals with a diagnosis of type 2 diabetes over the age of 60 were included. Functional status was assessed using tools that assess aerobic, strength, and balance capacities. Medical assessment was conducted through interview, physical examination, and collection of information from medical records. The association between functional indices and A1C was assessed using linear regression. Results. 153 consecutive individuals were evaluated. There was an inverse association between A1C and score achieved on the 6-minute walk; with increasing meters walked on the 6-minute walk test, there was a reduction in A1C (p = 0.003). There was also an inverse association with the 10-meter walk (p = 0.007), BERG balance test (p = 0.0006), and timed up and go (p = 0.01). Conclusion. In this cohort of older people with diabetes, there was an association between A1C and measures of functional indices. Future studies of glucose-lowering medication should include physical and functional assessment.

Workshop on Synergies Between Alzheimer's Research and Clinical Gerontology and Geriatrics: Current Status and Future Directions.

Age is the strongest risk factor for physical disability and Alzheimer's disease (AD) and related dementias. As such, other aging-related risk factors are also shared by these two health conditions. However, clinical geriatrics and gerontology research has included cognition and depression in models of physical disability, with less attention to the pathophysiology of neurodegenerative disease. Similarly, AD research generally incorporates limited, if any, measures of physical function and mobility, and therefore often fails to consider the relevance of functional limitations in neurodegeneration. Accumulating evidence suggests that common pathways lead to physical disability and cognitive impairment, which jointly contribute to the aging phenotype. Collaborations between researchers focusing on the brain or body will be critical to developing, refining, and testing research paradigms emerging from a better understanding of the aging process and the interacting pathways contributing to both physical and cognitive disability. The National Institute of Aging sponsored a workshop to bring together the Claude D. Pepper Older Americans Independence Center and AD Center programs to explore areas of synergies between the research concerns of the two programs. This article summarizes the proceedings of the workshop and presents key gaps and research priorities at the intersection of AD and clinical aging research identified by the workshop participants.

Relationships of depressive behavior and sertraline treatment with walking speed and activity in older female nonhuman primates.

Depression is the most common mental health problem in aging persons and is a leading risk factor for physical disability, especially in women. Though antidepressant drugs such as serotonin reuptake inhibitors (SSRI) are commonly prescribed, epidemiological evidence reveals mixed effects of long-term antidepressant use on physical function and activity, possibly depending on depressive status. The purpose of this preclinical trial was to determine the relationships of depressive behavior and the potential for an SSRI treatment to modulate walking speed and activity patterns in older adult female cynomolgus monkeys (Macaca fascicularis). We evaluated the effects of depression and a commonly prescribed SSRI, sertraline HCl (20mg/kg/day p.o.), on (a) walking speed, (b) accelerometry-derived activity (counts) and sedentariness (daytime 60-s sedentary epochs), and (c) observed locomotor and sedentary behaviors (% time) in adult female depressed and nondepressed monkeys (n=42; 17.2±1.8years) during an 18month pre-treatment phase and an 18month treatment phase using a longitudinal, stratified placebo-control study design. Monkeys that were depressed prior to treatment (19/42) subsequently had slower walking speeds (F D [1, 38] =4.14; p≤0.05) and tended to be more sedentary during the daytime (F D [1, 38] =3.63; p≤0.06). Sertraline did not affect depressive behaviors, walking speed, accelerometry-derived physical activity or sedentariness, or time observed in total locomotor or sedentary behavior (all p>0.10). This study provides the first experimental demonstration of relationships between nonhuman primate behavioral depression and walking speed, activity, and sedentariness and provides evidence for a lack of an effect of SSRI treatment on these phenotypes.

Food insufficiency and food insecurity as risk factors for physical disability among Palestinian refugees in Lebanon: Evidence from an observational study

BackgroundPotential interactions between malnutrition and disability are increasingly recognized, and both are important global health issues. Causal effects working from nutrition to disability and from disability back to nutrition present an empirical challenge to measuring either of these effects. However, disability affects nutrition whatever the cause of disability, whereas nutrition is likelier to affect disease-related disability than war- or work-related disability. ObjectiveThis paper investigates the association of food insufficiency with the risk of physical disability. Data on disability by cause allow us to address the difficulty of reverse causality. MethodsMultinomial logit regressions of disability by cause on food insufficiency are run using survey data from 2010 on 2575 Palestinian refugee households in Lebanon. Controls include household sociodemographic, health and economic characteristics. Regressions of food insufficiency on disability by cause are also run. ResultsDisability has a significant coefficient in regressions of food insufficiency, whatever the cause of disability; but in regressions of disability on food insufficiency, food insufficiency is significant only for disease-related disability (log odds of disease-related disability .78 higher, p = .008). The difference in the results by cause of disability is evidence of a significant association between food insufficiency and disease-related disability, net of any reverse effect from disability to food access. ConclusionsThe association between disease-related disability and food insufficiency is statistically significant suggesting that even taking into account feedback from disability to nutrition, nutrition is an effective level of intervention to avert the poverty-disability trap resulting from the impoverishing effect of disability.

The Cooperative Lifestyle Intervention Program-II (CLIP-II): Design and methods

A complication of cardiovascular disease (CVD) and the metabolic syndrome (MetS) among older adults is loss of mobility. The American Heart Association has identified weight management as a core component of secondary prevention programs for CVD and is an important risk factor for physical disability. The American Society for Nutrition and the Obesity Society have highlighted the need for long-term randomized clinical trials to evaluate the independent and additive effects of diet-induced weight loss (WL) and physical activity in older persons on outcomes such as mobility, muscle function, and obesity related diseases.Here we describe the rationale, design, and methods of a translational study, the Cooperative Lifestyle Intervention Program-II (CLIP-II).CLIP-II will randomize 252 obese, older adults with CVD or MetS to a weight loss only treatment (WL), aerobic exercise training (AT)+WL, or resistance exercise training (RT)+WL for 18months. The dual primary outcomes are mobility and knee extensor strength. The interventions will be delivered by YMCA community partners with our staff as trainers and advisers. This study will provide the first large scale trial to evaluate the effects of diet-induced WL on mobility in obese, older adults with CVD or MetS as compared to WL combined with two different modes of physical activity (AT and RT). Because uncertainty exists about the best approach for promoting WL in older adults due to concerns with the loss of lean mass, the design also permits a contrast between AT+WL and RT+WL on muscle strength.

Effects of physical exercise on the activation and differentiation potential of satellite cells from skeletal muscles of old mice: an in vitro study.

Sarcopenia is an age-related loss of muscle mass, strength and function and represents an important risk factor for physical disability in elderly (Thompson, 2009). The mechanisms leading to sarcopenia are still largely unknown and no specific therapy is at present available to counteract its onset or progress. Many studies have stressed the importance of physical exercise as an effective approach to prevent/limit the sarcopenic drive (Zancanaro et al., 2007; Malatesta et al., 2011). The aim of this investigation was to evaluate the effects of adapted physical exercise (treadmill running) on the proliferation and differentiation potential of cultured satellite-cell-derived myoblasts isolated from skeletal muscles of old mice. Ultrastructural morphology and immunocytochemistry were applied, with special attention to molecular markers of satellite cell activation and RNA processing. The results demonstrate that treadmill running markedly improved the structural and functional features of both myoblasts and myotubes in comparison to old sedentary mice.

A systematic review and meta-analysis of diabetes and risk of physical disability and functional impairment - protocol.

BackgroundDiabetes and increased age are known risk factors for physical disability. With the increasing prevalence of diabetes within our aging population, the future burden of disability is expected to increase. To date, there has not been a pooled estimate of the risk for disability associated with diabetes or its precursor states, impaired glucose tolerance and impaired fasting glucose. We aim to conduct a systematic review and meta-analysis of the association between prediabetes and diabetes with disability, and quantify the risk of association.Methods/designWe will search for relevant studies in Medline via Pubmed, Embase, Cochrane library and Cumulative Index to Nursing and Allied Health Literature (CINAHL), as well as scan reference lists from relevant reviews and publications included in our review. We will review all publications that include studies on human adults (18 years and older) where information is included on diabetes status and at least one measure of disability (Activities of Daily Living (ADL), Instrumental ADL (IADL) or functional/mobility limitation), and where a risk association is available for the relationship between diabetes and/or prediabetes with disability, with reference to those without diabetes.We will further conduct a meta-analysis to pool estimates of the risk of disability associated with prediabetes and diabetes. Sensitivity analysis will be conducted to assess for publication bias and study quality.Findings from this systematic review and meta-analysis will be widely disseminated through discussions with stake-holders, publication in a peer-reviewed journal and conference presentation.

Physical Training Modulates Structural and Functional Features of Cell Nuclei in Type II Myofibers of Old Mice

Aging is associated with a progressive loss of muscle mass, strength, and function, a condition known as sarcopenia, which represents an important risk factor for physical disability in elderly. The mechanisms leading to sarcopenia are still largely unknown, and no specific therapy is presently available to counteract its onset or progress. Many studies have stressed the importance of physical exercise as an effective approach to prevent/limit the age-related muscle mass loss. This study investigated the effects of physical training on pre-mRNA pathways in quadriceps and gastrocnemius muscles of old mice by ultrastructural cytochemistry: Structural and in situ molecular features of myonuclei and satellite cell nuclei of type II fibers were compared in exercised versus sedentary old mice, using adult individuals as control. Our results demonstrated that in myonuclei of old mice physical exercise stimulates pre-mRNA transcription, splicing, and export to the cytoplasm, likely increasing muscle protein turnover. In satellite cells, the effect of physical exercise seems to be limited to the reactivation of some factors involved in the transcriptional and splicing apparatus without increasing RNA production, probably making these quiescent cells more responsive to activating stimuli.

Pediatric patients with a malignant bone tumor: when does functional assessment make sense?

The diagnosis of a malignant bone tumor in the lower limb is a risk factor for physical disability, limiting physical performance. Walking ability especially, which is essential for most activities of daily living, is limited in those patients. In the present study, the extent of limitations during the course of treatment was investigated to determine when the assessment of functional parameters is meaningful in those patients. In the present study, activity levels were determined in 20 patients with a malignant bone tumor in the lower limb who received endoprosthetic replacement of the affected bone and in 20 healthy individuals. A uniaxial accelerometer was used to investigate patients at five different time points after surgery. Patients performed significantly less amounts and intensities of activity than control individuals at all measurements. Significant increases in the volume of activity were observed after cessation of treatment. However, the intensity of activity only showed minor increases. Patients experiencing complications of surgery revealed greater restriction than those without even 18 months after surgery. After cessation of treatment for their disease, patients recovered markedly and showed great improvements in physical activity. However, some limitations appeared to persist. Comparisons with patients with longer follow-up revealed that meaningful functional assessment does not make sense within the first 12 months after surgery. More research is needed to show if longer follow-up periods reveal further improvements. Based on such information, it should be more promising to develop individually tailored activity recommendations and intervention programs.

Risk factors for physical disability at diagnosis of 19,283 new cases of leprosy

The purpose of this study was to evaluate risk factors for physical disability at the moment of leprosy diagnosis. This is a retrospective, descriptive and exploratory investigation of 19,283 patients with leprosy, registered in the State of Minas Gerais, Brazil, between 2000 and 2005. The risk of Grade 2 disability was 16.5-fold higher in patients with lepromatous leprosy, and 12.8-fold higher in patients presenting the borderline form, compared to patients presenting indeterminate leprosy. The occurrence of more than one thickened nerve increased the odds of a patient developing Grade 2 disability, 8.4-fold. Age <15 years, multibacillary leprosy and no formal education presented 7.0, 5.7 and 5.6 odds of developing physical disability, respectively. These factors should be considered as strong prognostic indicators in the development of physical disability at diagnosis.

Apolipoprotein E Genotype and Risk of Developing Physical Limitations in Elderly People

To the Editor: Apolipoprotein E (APOE) gene is one of the genes with a huge impact on longevity and successful aging. The APOE polymorphism has been associated with lipid or cognitive disorders, which may result in cardiovascular disease or Alzheimer’s disease.1 In older adults, stroke and cognitive impairment are all risk factors for physical disability. Thus more researches have been conducted to examine whether the APOE genotype is independently associated with physical limitations in the older population. While these studies 2–5 do improve our knowledge on the relationship between APOE gene and physical function in older adults, no attention has been paid to investigating the role of this gene in the development of functional decline at different stages. The progressive decline of physical function in older adults usually begins with the limitation of mobility function, continues to deteriorate into difficulty in coping with complex household works, and finally results in inability to complete self-care tasks.6 We conducted a prospective nested case-control study of genetic variation in the APOE gene and risk of deterioration in physical functioning in Taiwan, with a particular interest in the transitions of mobility, Instrumental Activities of Daily Living (IADL), and Activities of Daily Living (ADL) decline. Samples were from 924 study participants of the Social Environment and Biomarkers of Aging Study (SEBAS) in 2000.7 SEBAS included an in-home interview and a physical examination at the hospital. The in-home interview collected information on self-reports of physical limitations, demographic and social variables, and cognitive measures. Mobility includes 9 tasks involving general mobility function of upper and lower extremities. IADL covers six tasks involving living environment. ADL incorporates six personal care tasks. Mobility decline was defined as having no difficulty in all 21 tasks in 2000 but experiencing difficulty in at least one of the 9 mobility tasks in 2003. IADL decline was defined as having difficulty in at least one mobility task but no difficulty in all ADL and IADL tasks in 2000, but experiencing difficulty in at least one mobility and one IADL task but no difficulty in all ADL tasks in 2003. ADL decline was defined as having difficulty in at least one mobility and one IADL task but no difficulty in all ADL tasks in 2000, and experiencing difficulty in at least one mobility, one IADL, and one ADL task in 2003. The APOE genotyping was conducted using DNA extract obtained from whole blood. During the three years of follow-up, there were 91, 79, and 35 participants identified as having mobility, IADL, and ADL decline, respectively. For each subject with mobility, IADL, or ADL decline, one control subject without the specific decline was matched for age and sex. For example, one subject with only mobility difficulty in both the 2000 and the 2003 interviews was age- and sex- matched to the subject with IADL decline. Odds ratios (ORs) for subjects carrying e2 or e4 allele were estimated using conditional logistic regression adjusting for risk factors relevant to functional decline,8,9 including body mass index (BMI), heart disease, stroke, arthritis, cognitive impairment, and physical activity. Updated information of these covariates obtained from the 2003 interview was used in the adjusted models. Because physical function of cases at baseline had not deteriorated, the prevalence of disability-related diseases and factors including BMI, cognitive impairment, and physical activity was similar and tested without statistically significant differences between cases and controls. The distribution of all sixAPOE genotypes (e2/e2, e2/e3, e2/e4, e3/e3, e3/e4, and e4/e4) and frequencies of the three APOE alleles (e2, e3, and e4) were statistically insignificant between cases with controls for all three groups. Table 1 shows the risks of developing mobility, IADL, or ADL limitations for older adults with the e2 or e4 allele. The presence of APOEe2 or e4 allele was not related to the declines of physical functioning. Table 1 Associations between APOE alleles and risk of mobility, IADL, or ADL decline This lack of association is in agreement with findings from three similar studies using ADL tasks, 3 a mobility task only, 10 or a combination of mobility, IADL, and ADL as the measures of physical limitations. 4 The e4 allele has been linked with decreased longevity through developing cognitive impairment and cardiovascular disease, whereas the e2 allele increases longevity and promotes successful aging. 1 Although APOE plays an important role in aging process, both e2 and e4 alleles, based on our study results, do not have a direct link with the decline of physical function at different stages. It is possible that APOE may affect physical function indirectly through cognitive impairment and cardiovascular disease, and the association disappears when cardiovascular disease and cognitive function are all considered.

Physical Performance Limitations in the Childhood Cancer Survivor Study Cohort

Physical performance limitations are one of the potential long-term consequences following diagnosis and treatment for childhood cancer. The purpose of this review is to describe the risk factors for and the participation restrictions that result from physical performance limitations among childhood cancer survivors who participated in the Childhood Cancer Survivor Study (CCSS). Articles previously published from the CCSS cohort related to physical performance limitations were reviewed and the results summarized. Our review showed that physical performance limitations are prevalent among childhood cancer survivors and may increase as they age. Host-based risk factors for physical disability include an original diagnosis of bone tumor, brain tumor, or Hodgkin's disease; female sex; and an income less than $20,000 per year. Treatment-based risk factors include radiation and treatment with a combination of alkylating agents and anthracyclines. Musculoskeletal, neurologic, cardiac, pulmonary, sensory, and endocrine organ system dysfunction also increase the risk of developing a physical performance limitation. In summary, monitoring of physical performance limitations in an aging cohort of childhood cancer survivors is important and will help determine the impact of physical performance limitations on morbidity, mortality, and caregiver burden. In addition, in developing restorative and preventive interventions for childhood cancer survivors, we must take into account the special needs of survivors with physical disability to optimize their health and enhance participation in daily living activities.