scholarly journals Frailty and driving status associated with disability: a 24-month follow-up longitudinal study

BMJ Open ◽  
2021 ◽  
Vol 11 (4) ◽  
pp. e042468
Author(s):  
Takehiko Doi ◽  
Kota Tsutsumimoto ◽  
Hideaki Ishii ◽  
Sho Nakakubo ◽  
Satoshi Kurita ◽  
...  
Keyword(s):  
Older Adults ◽  
Cardiovascular Health ◽  
Community Setting ◽  
Community Dwelling ◽  
Health Study ◽  
Cardiovascular Health Study ◽  
Term Care ◽  
Frailty Status ◽  
A Prospective Study

ObjectivesTo examine the relationship of driving status and frailty with disability in older adults.DesignA prospective study.Setting and participantsThe study included 8533 participants (mean age: 72.0±6.1 years (range: 60–98 years), women: 54.1%) in a community setting.MeasuresDriving status and frailty were assessed at baseline. The clinical definition of frailty was used according to the Japanese Cardiovascular Health Study index. Disability was prospectively determined using a record of Japanese long-term care insurance (LTCI).ResultsDuring the follow-up period (mean duration: 23.5 months), 58 (0.7%) participants were regarded as moving out of the city, 80 (0.9%) participants had died and 311 (3.6%) participants were certified by LTCI. The proportion of disability was 1.3% among the not-frail group and 5.3% among the frail group. The proportion of disability was 2.5% in participants who were currently driving and 7.5% in those not driving. Based on frailty status and driving, participants were further classified into four groups: not frail and currently driving (n=2945), not frail and not driving (n=642), frail and currently driving (n=3598) and frail and not driving (n=1348). Compared with older adults who are not frail and driving, the combined status of frail and not driving (adjusted HR: 2.28; 95% CI: 1.47 to 3.52) and frail and driving (HR: 1.91; 95% CI: 1.30–2.81) were risk factors for disability.ConclusionsNot driving and frail were associated with a risk of disability in community-dwelling older adults.

Abstract 19269: Relations and Predictive Value of Post-load and Fasting Glucose for Incident Cardiovascular Disease and Mortality in Older Adults: the Cardiovascular Health Study

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Erika Brutsaert ◽  
Sanyog Shitole ◽  
Mary Lou Biggs ◽  
Kenneth Mukamal ◽  
Ian De Boer ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Older Adults ◽  
Old Age ◽  
Risk Prediction ◽  
Cardiovascular Health ◽  
Fasting Glucose ◽  
Community Dwelling ◽  
Health Study ◽  
Cardiovascular Health Study

Introduction: Elders have a high prevalence of post-load hyperglycemia, which may go undetected with standard screening. Post-load glucose has shown more robust associations with cardiovascular disease (CVD) and death than fasting glucose, but data in advanced old age are sparse. Whether post-load glucose improves risk prediction for CVD and death after accounting for fasting glucose has not been examined. Methods: Fasting and 2-hour post-load glucose were measured at baseline (1989) and follow-up (1996) visits in a prospective study of community-dwelling adults initially ≥65 years old (Cardiovascular Health Study). To evaluate if previously reported associations of fasting and post-load glucose with incident CVD from the baseline visit persist later in life, and apply to mortality, we focused on the 1996 visit (n=2394). To determine the incremental value of post-load glucose for risk prediction, we examined whether it could significantly reclassify baseline (1989) participants (≤75 years) into cholesterol treatment categories based on recent guidelines (n=2542). Results: Among participants in the 1996 visit (mean age 77), there were 543 incident CVD events and 1698 deaths during median follow-up of 11.2 years. In fully adjusted models, both fasting and 2-hour glucose were associated with CVD (HR per SD, 1.13 [1.03-1.25] and 1.17 [1.07-1.28], respectively) and mortality (HR per SD, 1.12 [1.07-1.18] and 1.14 [1.08-1.20]). After mutual adjustment, however, the associations for fasting glucose with either outcome were abolished, but those for post-load glucose remained unchanged. Among subjects ≤75 years old in 1989, there were 416 CVD events and 740 deaths at 10-year follow-up. Post-load glucose did not enhance reclassification using the 7.5% 10-year risk threshold, nor did it improve the C-statistic. Conclusion: In adults surviving to advanced old age, post-load glucose was associated with CVD and mortality independently of fasting glucose, but not vice versa, although there was no associated improvement in risk prediction. These findings affirm the robust association of post-load glucose with CVD and death late in life, but do not support the value of routine oral glucose tolerance testing for prediction of these outcomes in older adults.

Prospective Associations of Physical Frailty With Future Falls and Fear of Falling: A 48-Month Cohort Study

2021 ◽  
Author(s):  
K Makino ◽  
S Lee ◽  
S Bae ◽  
I Chiba ◽  
K Harada ◽  
...  
Keyword(s):  
Older Adults ◽  
Cohort Study ◽  
Fear Of Falling ◽  
Community Dwelling ◽  
Cardiovascular Health Study ◽  
Physical Frailty ◽  
Frailty Status ◽  
Community Dwelling Older Adults ◽  
The Relationship

Abstract Objective The present study aimed to examine the prospective associations of physical frailty with future falls and fear of falling (FOF) among community-dwelling older adults. Methods A prospective cohort study with a 48-month follow-up was conducted in a Japanese community. Participants were 2469 community-dwelling older adults aged 65 years or older who completed baseline and follow-up assessments at intervals of 48±2 months. Primary outcomes were recent falls (defined as at least one fall within the past year) and FOF (determined by response to “Are you afraid of falling?”) at follow-up survey. Physical frailty, operationalized by the frailty phenotype (slowness, weakness, exhaustion, weight loss, and low activity) based on the criteria of the Japanese version of the Cardiovascular Health Study (J-CHS), was also assessed as a predictor of future falls and FOF. Results Multivariate logistic regression showed that pre-frailty or frailty increase the risk of not only future falls (OR: 1.57; 95%CI = 1.20-2.05) but also FOF (OR: 1.33; 95%CI = 1.05-1.69). In addition, the relationship between baseline frailty status and future falls remained significant after adjusting for baseline FOF (OR: 1.55; 95%CI = 1.19-2.02), and the relationship between baseline frailty status and future FOF also remained significant after adjusting for baseline falls (OR: 1.32; 95%CI = 1.04-1.68). Conclusions Frailty status may predict future falls and FOF among community-dwelling older adults. Strategies to prevent frailty may be beneficial to prevent not only future falls but also future FOF in a community setting. Impact Falls and FOF have a close relationship but a different clinical meaning. Older adults with physical frailty may require monitoring as high-risk not only for falls but also for FOF.

scholarly journals Association of Frailty With Recovery From Disability Among Community-Dwelling Older Adults: Results From Two Large U.S. Cohorts

2018 ◽  
Vol 74 (4) ◽  
pp. 575-581 ◽  
Author(s):  
Chenkai Wu ◽  
Dae H Kim ◽  
Qian-Li Xue ◽  
David S H Lee ◽  
Ravi Varadhan ◽  
...  
Keyword(s):  
Older Adults ◽  
Daily Living ◽  
Cardiovascular Health ◽  
Community Dwelling ◽  
Health Study ◽  
Cardiovascular Health Study ◽  
Factors Affecting ◽  
Frailty Assessment ◽  
Community Dwelling Older Adults ◽  
Retirement Study

Abstract Background Disability in activities of daily living (ADLs) is a dynamic process and transitions among different disability states are common. However, little is known about factors affecting recovery from disability. We examined the association between frailty and recovery from disability among nondisabled community-dwelling elders. Methods We studied 1,023 adults from the Cardiovascular Health Study (CHS) and 685 adults from the Health and Retirement Study (HRS), who were ≥65 years and had incident disability, defined as having difficulty in ≥1 ADL (dressing, eating, toileting, bathing, transferring, walking across a room). Disability recovery was defined as having no difficulty in any ADLs. Frailty was assessed by slowness, weakness, exhaustion, inactivity, and shrinking. Persons were classified as “nonfrail” (0 criteria), “prefrail” (1–2 criteria), or “frail” (3–5 criteria). Results In total, 539 (52.7%) CHS participants recovered from disability within 1 year. Almost two-thirds of nonfrail persons recovered, while less than two-fifths of the frail recovered. In the HRS, 234 (34.2%) participants recovered from disability within 2 years. Approximately half of the nonfrail recovered, while less than one-fifth of the frail recovered. After adjustment, prefrail and frail CHS participants were 16% and 36% less likely to recover than the nonfrail, respectively. In the HRS, frail persons had a 41% lower likelihood of recovery than the nonfrail. Conclusions Frailty is an independent predictor of poor recovery from disability among nondisabled older adults. These findings validate frailty as a marker of decreased resilience and may offer opportunities for individualized interventions and geriatric care based on frailty assessment.

scholarly journals Association Between Activity Diversity and Frailty in Community-Dwelling Older Japanese: A Cross-Sectional Study

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 185-185
Author(s):  
Junta Takahashi ◽  
Shuichi Obuchi ◽  
Hisashi Kawai ◽  
Kaori Ishii ◽  
Koichiro Oka ◽  
...  
Keyword(s):  
Older Adults ◽  
Health Outcomes ◽  
Cardiovascular Health ◽  
Economic Status ◽  
Japanese Version ◽  
Community Dwelling ◽  
Health Study ◽  
Cardiovascular Health Study ◽  
Cross Sectional ◽  
Indirect Contact

Abstract In addition to intensity and quality, diversity of activity will be an important factor to explain health outcomes among older adults. Few studies, though, examined an association between activity diversity and health outcomes. This study aimed to examine the association between activity diversity and frailty among community-dwelling older Japanese. Participants were community-dwelling older adults who participated in a cohort study, the “Otassya-Kenshin” in 2018 . The participants were asked frequency of 20 daily activities, inside/outside chores, leisure activities with/without physically, direct/indirect contact with friends and so on, in a week and activity diversity score were calculated using the formula of Shannon’s entropy. Frailty was defined by the Japanese version of the Cardiovascular Health Study criteria. The difference in diversity score between frail and non frail were examined by t-test. Logistic regression analysis with covariates, age, sex, economic status, living alone, BMI, Mini-Mental State Examination, and IADL was adopted to find association between activity diversity score and presence of frailty. Of 652 participants (age: 72.8±6.3, women: 60.6%) analyzed, 27 (4.1%) were defined as frail. Frailty group revealed significantly lower activity diversity score than non-frailty group (0.66±0.11 vs 0.75±0.08, P<0.01). 0.2 point of decrease in diversity score increase 5 times chance of frailty after controlling covariates. We found significant relationship between activity diversity and health outcome among older subjects. The activity diversity may provide additional information to number or intensity of activity.

Eating patterns of community-dwelling older adults: The cardiovascular health study

1994 ◽  
Vol 4 (5) ◽  
pp. 404-415 ◽  
Author(s):  
Shiriki Kumanyika ◽  
Grethe S Tell ◽  
Lynn Shemanski ◽  
Joseph Polak ◽  
Peter J Savage
Keyword(s):  
Older Adults ◽  
Cardiovascular Health ◽  
Community Dwelling ◽  
Health Study ◽  
Cardiovascular Health Study ◽  
Eating Patterns ◽  
Community Dwelling Older Adults

scholarly journals Neighborhood Characteristics Are Associated with Racial and Gender Variation Among Walking in Older Adults: the Cardiovascular Health Study

2016 ◽  
Vol 26 (1) ◽  
pp. 17
Author(s):  
Tingjian Yan ◽  
Li-Jung Liang ◽  
Stefanie Vassar ◽  
Monica Cheung Katz ◽  
Jose J. Escarce ◽  
...  
Keyword(s):  
Older Adults ◽  
Socioeconomic Status ◽  
African Americans ◽  
Cardiovascular Health ◽  
Statistical Significance ◽  
Community Dwelling ◽  
Health Study ◽  
Cardiovascular Health Study ◽  
Neighborhood Socioeconomic Status ◽  
And Gender

<p><strong>Objective:</strong> To examine variation by race and gender in the association between neighborhood socioeconomic status and walking among community-dwelling older adults.</p><p><strong>Design:</strong> Cross-sectional.</p><p><strong>Setting:</strong> Cardiovascular Health Study, a longitudinal population-based cohort.</p><p><strong>Participants:</strong> 4,849 adults aged &gt;65 years.</p><p><strong>Measurements:</strong> Participants reported number of city blocks walked in the prior week. Neighborhood socioeconomic status (NSES) measured at the level of the census tract. Negative binominal regression models were constructed to test the association between NSES and blocks walked. In the fully adjusted models, we included two-way and three-way interaction terms among race, gender, and NSES. </p><p><strong>Results</strong>: In adjusted analyses, among White residents in the lowest NSES quartile (most disadvantaged), men walked 64% more than women (<em></em>P&lt;.001), while in the highest NSES (most advantaged), men walked 43% more than women (<em></em>P&lt;.001).  Among African American residents in the lowest NSES quartile, men walked 196% more blocks than women (<em></em>P&lt;.001), while in the highest NSES, men walked 43% more blocks than women, but this did not reach statistical significance (<em></em>P=.06). </p><p><strong>Conclusions:</strong> Female gender is more strongly associated with walking for African Americans than for Whites in low SES neighborhoods but had a similar association with walking for both African Americans and Whites in high SES neighborhoods. <em>Ethn Dis. </em>2016;26(1):17-26; doi:10.18665/ed.26.1.17</p>

scholarly journals Fibroblast Growth Factor 23, Bone Mineral Density, and Risk of Hip Fracture Among Older Adults: The Cardiovascular Health Study

2013 ◽  
Vol 98 (8) ◽  
pp. 3323-3331 ◽  
Author(s):  
Anna Jovanovich ◽  
Petra Bùžková ◽  
Michel Chonchol ◽  
John Robbins ◽  
Howard A. Fink ◽  
...  
Keyword(s):  
Older Adults ◽  
Hip Fracture ◽  
Lumbar Spine ◽  
Cardiovascular Health ◽  
Fibroblast Growth Factor 23 ◽  
Community Dwelling ◽  
Health Study ◽  
Cardiovascular Health Study ◽  
Mineral Density ◽  
Total Hip

Context: Fibroblast growth factor 23 (FGF23) is a phosphaturic hormone that also inhibits calcitriol synthesis. Objective: Our objective was to evaluate the relationships of plasma FGF23 concentrations with bone mineral density (BMD) and hip fracture in community-dwelling older adults. Design and Setting: Linear regression and Cox proportional hazard models were used to examine the associations of plasma FGF23 concentrations with BMD and incident hip fracture, respectively. Analyses were also stratified by chronic kidney disease. Participants: Participants included 2008 women and 1329 men ≥65 years from the 1996 to 1997 Cardiovascular Health Study visit. Main Outcome Measures: Dual x-ray absorptiometry measured total hip (TH) and lumbar spine (LS) BMD in 1291 participants. Hip fracture incidence was assessed prospectively through June 30, 2008 by hospitalization records in all participants. Results: Women had higher plasma FGF23 concentrations than men (75 [56–107] vs 66 [interquartile range = 52–92] relative units/mL; P &lt; .001). After adjustment, higher FGF23 concentrations were associated with greater total hip and lumbar spine BMD in men only (β per doubling of FGF23 = 0.02, with 95% confidence interval [CI] = 0.001–0.04 g/cm2, and 0.03 with 95% CI = 0.01–0.06 g/cm2). During 9.6 ± 5.1–11.0 years of follow-up, 328 hip fractures occurred. Higher FGF23 concentrations were not associated with hip fracture risk in women or men (adjusted hazard ratio = 0.95, with 95% CI = 0.78–1.15, and 1.09 with 95% CI = 0.82–1.46 per doubling of FGF23). Results did not differ by chronic kidney disease status (P &gt; .4 for interactions). Conclusions: In this large prospective cohort of community-dwelling older adults, higher FGF23 concentrations were weakly associated with greater lumbar spine and total hip BMD but not with hip fracture risk.

scholarly journals Risk Factors for Incident Carotid Artery Revascularization among Older Adults: The Cardiovascular Health Study

2016 ◽  
Vol 6 (3) ◽  
pp. 129-139 ◽  
Author(s):  
Parveen K. Garg ◽  
Willam J.H. Koh ◽  
Joseph A. Delaney ◽  
Ethan A. Halm ◽  
Calvin H. Hirsch ◽  
...  
Keyword(s):  
Risk Factors ◽  
Older Adults ◽  
Carotid Artery ◽  
Cardiovascular Health ◽  
Multivariable Analysis ◽  
Population Based ◽  
Health Study ◽  
Cardiovascular Health Study ◽  
Increased Risk

Background: Population-based risk factors for carotid artery revascularization are not known. We investigated the association between demographic and clinical characteristics and incident carotid artery revascularization in a cohort of older adults. Methods: Among Cardiovascular Health Study participants, a population-based cohort of 5,888 adults aged 65 years or older enrolled in two waves (1989-1990 and 1992-1993), 5,107 participants without a prior history of carotid endarterectomy (CEA) or cerebrovascular disease had a carotid ultrasound at baseline and were included in these analyses. Cox proportional hazards multivariable analysis was used to determine independent risk factors for incident carotid artery revascularization. Results: Over a mean follow-up of 13.5 years, 141 participants underwent carotid artery revascularization, 97% were CEA. Baseline degree of stenosis and incident ischemic cerebral events occurring during follow-up were the strongest predictors of incident revascularization. After adjustment for these, factors independently associated with an increased risk of incident revascularization were: hypertension (HR 1.53; 95% CI: 1.05-2.23), peripheral arterial disease (HR 2.57; 95% CI: 1.34-4.93), and low-density lipoprotein cholesterol (HR 1.23 per standard deviation [SD] increment [35.4 mg/dL]; 95% CI: 1.04-1.46). Factors independently associated with a lower risk of incident revascularization were: female gender (HR 0.51; 95% CI: 0.34-0.77) and older age (HR 0.69 per SD increment [5.5 years]; 95% CI: 0.56-0.86). Conclusions: Even after accounting for carotid stenosis and incident cerebral ischemic events, carotid revascularization is related to age, gender, and cardiovascular risk factors. Further study of these demographic disparities and the role of risk factor control is warranted.

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