Risk Factors and Precipitants of Severe Disability Among Community-Living Older Persons

Background: Stroke Coach is a lifestyle coaching telehealth program to improve self-management of stroke risk factors. Aims: To examine the efficacy of Stroke Coach on lifestyle behaviour and risk factor control among community-living stroke survivors within one-year post stroke. Methods: Participants were randomized to Stroke Coach or an attention control Memory Training group. Lifestyle behaviour was measured using the Health Promoting Lifestyle Profile II. Secondary outcomes included specific behavioural and cardiometabolic risk factors, health-related quality of life (HRQoL), cognitive status, and depressive symptoms. Measurements were taken at baseline, post-intervention (6 months), and retention (12 month). Linear mixed-effects models were used to test the study hypotheses (p<0.05). All analyses were intention-to-treat. Results: The mean age of the Stroke Coach (n=64) and Memory Training (n=62) groups was 67.2 and 69.1 years, respectively. The majority of participants (n = 100) had mild stroke (modified Rankin Scale = 1 or 2), were active, with controlled blood pressure (mean = 129/79 mmHg) at baseline. At post-intervention, there were no significant differences in lifestyle (b = -2.87; 95%CI -8.03 to 2.29; p=0.28). Glucose control, as measured by HbA1c (b = 0.17; 95%CI 0.17 to 0.32; p=0.03), and HRQoL, measured using SF-36 Physical Component Summary (b = -3.05; 95%CI -5.88 to -0.21; p=0.04), were significantly improved in Stroke Coach compared to Memory Training, and the improvements were maintained at retention. Conclusion: Stroke Coach did not improve lifestyle behaviour, however, there were improvements to HbA1c and HRQoL among community-living stroke survivors with mild stroke-related disability. (ClinicalTrials.gov identifier: NCT02207023)

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Identifying association between risk factors and subsequent functional status in community-living elderly people helps set priorities for future research and provision of services

Evidence-based Healthcare ◽

10.1054/ebhc.1999.0276 ◽

1999 ◽

Vol 3 (4) ◽

pp. 87

Author(s):

John Young

Keyword(s):

Risk Factors ◽

Functional Status ◽

Elderly People ◽

Community Living ◽

Future Research ◽

Provision Of Services

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Neighborhood Disadvantage and Active, Disabled and Total Life Expectancy Among Community-living Older Persons

10.1101/2021.02.05.21251217 ◽

2021 ◽

Author(s):

Thomas M. Gill ◽

Emma X. Zang ◽

Terrence E. Murphy ◽

Linda Leo-Summers ◽

Evelyne A. Gahbauer ◽

...

Keyword(s):

Prognostic Factors ◽

Life Expectancy ◽

Older Persons ◽

Neighborhood Disadvantage ◽

Community Living ◽

Remaining Life ◽

Disadvantaged Group ◽

Individual Level ◽

Total Life Expectancy ◽

Total Life

AbstractBackgroundNeighborhood disadvantage is a novel social determinant of health that could adversely affect the functional well-being and longevity of older persons. We evaluated whether estimates of active, disabled and total life expectancy differ on the basis of neighborhood disadvantage after accounting for individual-level socioeconomic characteristics and other prognostic factors.MethodsWe used data on 754 community-living older persons from South Central Connecticut, who completed monthly assessments of disability from 1998 to 2020. Scores on the area deprivation index were dichotomized at the 80th state percentile to distinguish neighborhoods that were disadvantaged (81-100) from those that were not (1-80).ResultsWithin 5-year age increments from 70 to 90, active and total life expectancy were consistently lower in participants from neighborhoods that were disadvantaged versus not disadvantaged, and these differences persisted and remained statistically significant after adjustment for individual-level race/ethnicity, education, income, and other prognostic factors. At age 70, adjusted estimates (95% CI) for active and total life expectancy (in years) were 12.3 (11.5-13.1) and 15.0 (13.8-16.1) in the disadvantaged group and 14.2 (13.5-14.7) and 16.7 (15.9-17.5) in the non-disadvantaged group. At each age, participants from disadvantaged neighborhoods spent a greater percentage of their projected remaining life disabled, relative to those from non-disadvantaged neighborhoods, with adjusted values (SE) ranging from 17.7 (0.8) vs. 15.3 (0.5) at age 70 to 55.0 (1.7) vs. 48.1 (1.3) at age 90.ConclusionsLiving in a disadvantaged neighborhood is associated with lower active and total life expectancy and a greater percentage of projected remaining life disabled.

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