Predictors of functional status in Japanese community-dwelling older persons during a 2-year follow up

Abstract Background Community-dwelling older persons with cognitive impairment (CI) following discharge from geriatric rehabilitation are at high risk of losing life-space mobility (LSM). Interventions to improve their LSM are, however, still lacking. The aim of this study was to evaluate the effects of a CI-specific, home-based physical training and activity promotion program on LSM. Methods Older persons with mild-to-moderate CI (Mini-Mental State Examination: 17–26 points) discharged home from rehabilitation were included in this double-blinded, randomized, placebo-controlled trial with a 12-week intervention period and 12-week follow-up period. The intervention group received a CI-specific, home-based strength, balance, and walking training supported by tailored motivational strategies. The control group received a placebo activity. LSM was evaluated by the Life-Space Assessment in Persons with Cognitive Impairment, including a composite score for LSM and 3 subscores for maximal, equipment-assisted, and independent life space. Mixed-model repeated-measures analyses were used. Results One hundred eighteen participants (82.3 ± 6.0 years) with CI (Mini-Mental State Examination: 23.3 ± 2.4) were randomized. After the intervention, the home-based training program resulted in a significant benefit in the Life-Space Assessment in Persons with Cognitive Impairment composite scores (b = 8.15; 95% confidence interval: 2.89–13.41; p = .003) and independent life-space subscores (b = 0.39; 95% confidence interval: 0.00–0.78; p = .048) in the intervention group (n = 63) compared to control group (n = 55). Other subscores and follow-up results were not significantly different. Conclusions The home-based training program improved LSM and independent life space significantly in this vulnerable population. Effects were not sustained over the follow-up. The program may represent a model for improved transition from rehabilitation to the community to prevent high risk of LSM restriction.

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Incidence and multidimensional predictors of occasional and recurrent falls among Malaysian community‐dwelling older persons

BMC Geriatrics ◽

10.1186/s12877-021-02103-2 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Theng Choon Ooi ◽

Devinder Kaur Ajit Singh ◽

Suzana Shahar ◽

Nor Fadilah Rajab ◽

Divya Vanoh ◽

...

Keyword(s):

Incidence Rate ◽

Older Persons ◽

Test Score ◽

Community Dwelling ◽

Chair Stand ◽

Stand Test ◽

Chair Stand Test ◽

Recurrent Falls ◽

History Of

Abstract Background Falls incidence rate and comprehensive data on factors that predict occasional and repeated falls from large population-based studies are scarce. In this study, we aimed to determine the incidence of falls and identify predictors of occasional and recurrent falls. This was done in the social, medical, physical, nutritional, biochemical, cognitive dimensions among community-dwelling older Malaysians. Methods Data from 1,763 Malaysian community-dwelling older persons aged ≥ 60 years were obtained from the LRGS-TUA longitudinal study. Participants were categorized into three groups according to the presence of a single fall (occasional fallers), ≥two falls (recurrent fallers), or absence of falls (non-fallers) at an 18-month follow-up. Results Three hundred and nine (17.53 %) participants reported fall occurrences at an 18-month follow-up, of whom 85 (27.51 %) had two or more falls. The incidence rate for occasional and recurrent falls was 8.47 and 3.21 per 100 person-years, respectively. Following multifactorial adjustments, being female (OR: 1.57; 95 % CI: 1.04–2.36), being single (OR: 5.31; 95 % CI: 3.36–37.48), having history of fall (OR: 1.86; 95 % CI: 1.19–2.92) higher depression scale score (OR: 1.10; 95 % CI: 1.02–1.20), lower hemoglobin levels (OR: 0.90; 95 % CI: 0.81-1.00) and lower chair stand test score (OR: 0.93; 95 % CI: 0.87-1.00) remained independent predictors of occasional falls. While, having history of falls (OR: 2.74; 95 % CI: 1.45–5.19), being a stroke survivor (OR: 8.57; 95 % CI: 2.12–34.65), higher percentage of body fat (OR: 1.04; 95 % CI: 1.01–1.08) and lower chair stand test score (OR: 0.87; 95 % CI: 0.77–0.97) appeared as recurrent falls predictors. Conclusions Having history of falls and lower muscle strength were predictors for both occasional and recurrent falls among Malaysian community-dwelling older persons. Modifying these predictors may be beneficial in falls prevention and management strategies among older persons.

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Patterns of multimorbidity and risk of disability in community-dwelling older persons

Aging Clinical and Experimental Research ◽

10.1007/s40520-020-01773-z ◽

2021 ◽

Author(s):

Alessandra Marengoni ◽

Roselyne Akugizibwe ◽

Davide L. Vetrano ◽

Albert Roso-Llorach ◽

Graziano Onder ◽

...

Keyword(s):

Daily Living ◽

Older Persons ◽

Healthcare Resource ◽

Resource Planning ◽

Total Sample ◽

Community Dwelling ◽

National Study ◽

Sensory Impairment ◽

Multinomial Models

AbstractThe aim was to analyze the association between specific patterns of multimorbidity and risk of disability in older persons. Data were gathered from the Swedish National Study on Aging and Care in Kungsholmen (SNAC-K); 2066 60 + year-old participants living in the community and free from disability at baseline were grouped according to their multimorbidity patterns and followed-up for six years. The association between multimorbidity patterns and disability in basic (ADL) and instrumental (IADL) activities of daily living was examined through multinomial models. Throughout the follow-up, 434 (21.0%) participants developed at least one ADL and 310 (15.0%) at least one IADL. Compared to the unspecific pattern, which included diseases not exceeding their expected prevalence in the total sample, belonging to the cardiovascular/anemia/dementia, the sensory impairment/cancer and the musculoskeletal/respiratory/gastrointestinal patterns was associated with a higher risk of developing both ADL and IADL, whereas subjects in the metabolic/sleep disorders pattern showed a higher risk of developing only IADL. Multimorbidity patterns are differentially associated with incident disability, which is important for the design of future prevention strategies aimed at delaying functional impairment in old age, and for a better healthcare resource planning.

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The association between functional status and health care cost in community dwelling older persons

European Geriatric Medicine ◽

10.1016/j.eurger.2013.07.281 ◽

2013 ◽

Vol 4 ◽

pp. S86

Author(s):

M. van Rijn ◽

J.J. Suijker ◽

E.P. Moll van Charante ◽

S.E. de Rooij ◽

B.M. Buurman

Keyword(s):

Health Care ◽

Functional Status ◽

Older Persons ◽

Health Care Cost ◽

Community Dwelling

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Decline in Literacy and Incident AD Dementia Among Community-Dwelling Older Persons

Journal of Aging and Health ◽

10.1177/0898264317716361 ◽

2017 ◽

Vol 30 (9) ◽

pp. 1389-1405 ◽

Cited By ~ 9

Author(s):

Lei Yu ◽

Robert S. Wilson ◽

S. Duke Han ◽

Sue Leurgans ◽

David A. Bennett ◽

...

Keyword(s):

Confidence Interval ◽

Older Persons ◽

Hazard Ratio ◽

Community Dwelling ◽

Cognitive Outcomes ◽

Longitudinal Change ◽

Time To Event ◽

Time To Event Data ◽

Clinical Diagnoses

Objective: To quantify longitudinal change in financial and health literacy and examine the associations of declining literacy with incident Alzheimer’s disease (AD) dementia and mild cognitive impairment (MCI). Method: Data came from 799 participants of an ongoing cohort study. Literacy was measured using a battery of 32 questions. Clinical diagnoses were made annually following uniform structured procedures. The associations of declining literacy with incident AD dementia and MCI were tested using a joint model for longitudinal and time-to-event data. Results: We observed an overall decline in total literacy score over up to 6 years of follow-up ( p < .001). Faster decline in literacy was associated with higher risks for incident AD dementia (hazard ratio = 4.526, 95% confidence interval = [2.993, 6.843], p < .001) and incident MCI (hazard ratio = 2.971, 95% confidence interval = [1.509, 5.849], p = .002). Discussion: Declining literacy among community-dwelling older persons predicts adverse cognitive outcomes and serves as an early indicator of impending dementia.

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The Elderly Nutritional Index for Geriatric Malnutrition Assessment (ENIGMA): concurrent, construct and predictive validity in an external evaluation cohort of community-dwelling older persons

British Journal Of Nutrition ◽

10.1017/s0007114521003433 ◽

2021 ◽

pp. 1-25

Author(s):

Tze Pin Ng ◽

Shan Hai ◽

Qi Gao ◽

Xinyi Gwee ◽

Denise QL Chua ◽

...

Keyword(s):

Predictive Validity ◽

Mortality Risk ◽

Older Persons ◽

Risk Index ◽

The Elderly ◽

Community Dwelling ◽

Functional Dependency ◽

External Evaluation ◽

Nutritional Index

Abstract We previously developed a malnutrition risk index, the Elderly Nutritional Index for Geriatric Malnutrition Assessment (ENIGMA) with good predictive accuracy for mortality risk in an original population cohort (SLAS1). Herein, we further evaluate the concurrent and predictive validity of the ENIGMA construct in an external validation cohort (SLAS-2) of 2824 community-dwelling older adults aged 55+. They were assessed on the ENIGMA index, Mini Nutritional Assessment-Short Form (MNA-SF) and the Geriatric Nutritional Risk Index (GNRI), known correlates of malnutrition, and baseline and follow-up functional dependency and 10-year mortality risk. Higher ENIGMA risk categories were significantly associated (p<0.001) with lower education, living alone, smoking, low physical activity, BMI <18.5kg/m2, poorer muscle strength and functional mobility, exhaustion, physical frailty, homocysteine, eGFR, haemoglobin, red and white blood cell counts, platelets, systemic inflammation indexes, metabolic syndrome, cardiovascular disease, cognitive impairment and depressive symptoms (GDS≥5). ENIGMA scores showed statistically significant (p<0.001) correlations but low-to-moderate concordance with MNA-SF (r=0.148, agreement=45.9%, kappa=0.085) and GNRI scores (r=0.156, agreement=45.8%, kappa=0.096). Controlling for known correlates of malnutrition, only high-risk ENIGMA among the indexes significantly predicted baseline functional dependency (OR=1.64, 95%CI 1.01-2.65) and mortality (HR=1.65 (95%CI 1.04, 2.62). ENIGMA marginally out-performed MNA-SF and GNRI in predicting baseline functional dependency (AUC: 0.625 vs 0.584 vs 0.526), follow up functional dependency (AUC: 0.594 vs 0.525 vs 0.479) and 10-year mortality risk (AUC: 0.641 vs 0.596 vs 0.595). The concurrent and predictive validity of the ENIGMA construct is replicated in an external evaluation study of community-dwelling older persons.

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The Association between Different Levels of Alcohol Use and Gait under Single and Dual Task in Community-Dwelling Older Persons Aged 65 to 70 Years

Current Gerontology and Geriatrics Research ◽

10.1155/2016/2018507 ◽

2016 ◽

Vol 2016 ◽

pp. 1-6 ◽

Cited By ~ 2

Author(s):

Laurence Seematter-Bagnoud ◽

Christophe Büla ◽

Brigitte Santos-Eggimann

Keyword(s):

Alcohol Use ◽

Dual Task ◽

Gait Speed ◽

Older Persons ◽

Heavy Drinking ◽

Community Dwelling ◽

Cross Sectional ◽

Single Task ◽

Moderate Drinking

Objectives. This study aimed to describe the cross-sectional and longitudinal association between alcohol intake and gait parameters in older persons.Methods. Community-dwelling persons aged 65–70 years (N=807). Information on health, functional status, and alcohol use was self-reported at baseline and at 3-year follow-up, whereas gait speed and stride-to-stride variability were measured while walking only (single task) and under dual tasking (counting backwards).Results. Compared to light-to-moderate drinking, heavy drinking was associated with slower gait speed in single task (adj. coeff.: −.040, 95% CI: −.0.78 to −.002,p=.035). No significant association was observed between heavy drinking and gait speed variability. Nondrinkers walked significantly slower than light-to-moderate drinkers in dual task and had significantly higher gait speed variability in both single and dual task, but these associations disappeared after adjustment for comorbidity. At follow-up, 35.2% and 34.1% of the participants walked significantly slower in single and dual task, respectively. This proportion varied a little across drinking categories.Conclusion. At baseline, heavy alcohol consumption was significantly associated with slower gait speed in single task. Selective survival of the fittest heavy drinkers probably explains why this association faded in longitudinal analyses. The trend of poorer gait performance in nondrinkers disappeared after adjustment for comorbidity, suggesting confounding by a worse health status.

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EFFECT OF FREQUENCY OF PARTICIPATING IN THE REGION ACTIVITY ON FUNCTIONAL DECLINE

Innovation in Aging ◽

10.1093/geroni/igz038.454 ◽

2019 ◽

Vol 3 (Supplement_1) ◽

pp. S124-S124

Author(s):

Masashi Yasunaga ◽

Hisashi Kawai ◽

Hirohiko Hirano ◽

Hiroyuki Suzuki ◽

Yoshinori Fujiwara ◽

...

Keyword(s):

Older Adults ◽

Functional Status ◽

Functional Decline ◽

Mail Survey ◽

Community Dwelling ◽

Independent Effect ◽

Logistic Regression Models ◽

Japanese Older Adults ◽

Independent Effects

Abstract This 3-year prospective study was conducted to explore whether frequency of participating in the region activity exert independent effect on preventing functional decline among urban Japanese older adults after controlling for potential confounders. We examined a prospective cohort of 2,524 community-dwelling persons, aged 65 years or older, who responded to the baseline mail survey in Toshima ward, Tokyo, Japan in 2014. They were followed for the subsequent 3 years in terms of functional status. Multiple logistic regression models were used to analyze independent effects of frequency of participating in the region activity, such as 1) no participation, 2) no participation in the past year, 3) less than one day per month, 4) few days per month, 5) over one day per week, on functional status, controlling for potential confounders such as age, gender, self-rated health, chronic conditions and social capital at baseline. At baseline, the mean age of 1,261 participants who completely responded to follow-up survey in 2018 was72.1 years (SD=5.0), and 56.9% were women. As results of analyzing, only “over one day per week” was significant predictors of preventing subsequent functional decline even after adjustment for confounders (odds ratios .361; 95% CI .180–.725). Frequency of participating in the region activity over one day per week have effect on preventing functional decline among urban Japanese older adults after controlling for potential confounders.

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Obesity, sarcopenia and their functional consequences in old age

Proceedings of The Nutrition Society ◽

10.1017/s0029665110003939 ◽

2010 ◽

Vol 70 (1) ◽

pp. 114-118 ◽

Cited By ~ 24

Author(s):

Marjolein Visser

Keyword(s):

Muscle Strength ◽

Functional Status ◽

Old Age ◽

Muscle Mass ◽

Older Persons ◽

Functional Decline ◽

Overweight And Obesity ◽

Community Dwelling ◽

Age Related ◽

The Impact

The prevalence of obesity is high in older persons and recent trends show a rapid increase in this prevalence. Results from observational and intervention studies (i.e. weight loss studies) show the strong negative impact of obesity on functional status in old age. There are different potential pathways through which obesity may lead to functional decline in older persons. Furthermore, the presence of overweight and obesity during the life course and trends in medical care are likely to influence the impact of obesity on disability. The concepts sarcopenia (age-related loss of muscle mass) and dynapenia (age-related loss of muscle strength) receive a lot of research attention as potential determinants of functional decline in old age. There is no consensus on the definitions of these concepts. Recent studies conducted in large cohort studies of mainly community-dwelling older persons show that poor muscle strength is strongly associated with functional decline compared to low muscle mass. In several studies, no association between muscle mass and functional status was observed. Current research on the combination of obesity with poor muscle strength (dynapenic-obesity) suggests a potential additive effect of both components on poor functional status in old age which seems independent of the level of physical activity.

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