Functional Status in Older Adults with Peripheral Artery Disease in Korea: A Cross-Sectional Study

Peripheral artery disease (PAD) is a chronic, progressive atherosclerotic disease resulting in worse functional status. It is an important factor that affects mobility and quality of life in older adults with PAD. This study aimed to identify the functional status and its associated factors of older adults diagnosed with PAD. We conducted a cross-sectional study among older adults aged 65 above diagnosed with PAD at a tertiary hospital in Seoul, Korea. Participants' functional status was measured using a Walking Impairment Questionnaire (WIQ) which consisted of distance, speed, and stair-climbing. We measured cardiac health behavior, social support, health perception, and clinical manifestation through self-administered questionnaires. Among 94 participants, the mean age was 74.98±6.21 years, and 91.5% were male. The mean score of WIQ was 0.59±0.30 out of 1; the mean scores for distance, speed, and stair-climbing of WIQ were 0.67±0.40, 0.45±0.27, and 0.64±0.37, respectively. Participants' functional status was significantly associated with age (β=-0.012, P=.002), sex (β=-0.284, P=.001), ulcers of the lower extremity (LE) (β=-0.242, P=.031), using a walking-assist device (β=-0.240, P=.002), walking difficulty due to pain of LE (β=-0.142, P=.006), and health behavior about physical activity (β=0.099, P=.021). This regression model predicted 53.5% of participants' functional status (F=8.63, P<.001). This study indicated that younger age, female, independent walking, no ulcers of LE, no walking difficulty, and higher physical activity behavior were significantly associated with better functional status in older adults with PAD. Therefore, healthcare professionals should develop and provide interventions to promote physical activity and alleviate symptoms to enhance functional status.

Physical activity scaled to preferred walking speed as a predictor of walking difficulty in older adults: a 2-year follow-up

Background The usual accelerometry-based measures of physical activity (PA) are dependent on physical performance. We investigated the associations between PA relative to walking performance and the prevalence and incidence of early and advanced walking difficulties compared to generally used measures of PA. Methods Perceived walking difficulty was evaluated in 994 community-dwelling participants at baseline (age 75, 80 or 85 years) and two years later over two kilometers (early difficulty) and 500 meters (advanced difficulty). We used a thigh-mounted accelerometer to assess moderate-to-vigorous PA, daily mean acceleration and relative PA as movement beyond the intensity of preferred walking speed in a 6-minute walking test (PArel). Self-reported PA was assessed using questionnaires. Results The prevalence and incidence were 36.2 % and 18.9 % for early, and 22.4 % and 14.9 % for advanced walking difficulty, respectively. PArel was lower in participants with prevalent (mean 42 (SD 45) vs. 69 (91) mins/week, p<0.001) but not incident early walking difficulty (53 (75) vs. 72 (96) mins/week, p=0.15) compared to those without difficulty. The associations between absolute measures of PA and incident walking difficulty were attenuated when adjusted for preferred walking speed. Conclusions The variation in habitual PA may not explain the differences in the development of new walking difficulty. Differences in physical performance explain a meaningful part of the association of PA with incident walking difficulty. Scaling of accelerometry to preferred walking speed demonstrated independence on physical performance and warrants future study as a promising indicator of PA in observational studies among older adults.

Self-Reported Walking Difficulty Associated with Stiff-Knee Gait in Japanese Patients with Knee Osteoarthritis: A Preliminary Cross-Sectional Study

Background: Individuals with knee osteoarthritis are restricted in their daily activity because of walking difficulty. The purpose of this investigation was to examine the association between self-reported walking difficulty and knee flexion excursion during gait in Japanese patients with knee osteoarthritis. Methods: Twenty-eight patients with knee osteoarthritis participated in this study. Knee flexion excursions in loading response and swing during gait were measured through an inertial measurement unit-based motion capture system. The walking difficulty was assessed by a subitem in the Japanese Knee Osteoarthritis Measure. Pain intensity was assessed by a visual analog scale. Characteristics and gait variables were compared between groups that were determined a priori using the results of the walking difficulty assessment. The relationship between knee flexion excursion during gait and walking difficulty were analyzed using logistic regression. Results: The participants with walking difficulty had significantly small knee flexion excursion in both loading response and swing with large pain. After controlling the effect of pain, only knee flexion excursion in the swing was significantly related to the walking difficulty. Conclusions: This study suggested that the knee flexion excursion in swing during gait is helpful for understanding the walking difficulty experienced in Japanese patients with knee osteoarthritis.

Self-rated resilience and mobility limitations as predictors of change in active aging during COVID-19 restrictions in Finland: a longitudinal study

Social distancing during the COVID-19 pandemic decreased older people’s opportunities to lead an active life. The purpose of this study was to investigate whether walking difficulties predict changes in leading an active life during the COVID-19 social distancing recommendation compared to 2 years before, and whether self-rated resilience moderates this association among older people. Data were collected during social distancing recommendation in May and June 2020 and 2 years before (2017–18) among community-living AGNES study participants initially aged 75, 80, or 85 years (n = 809). Leading an active life was assessed with the University of Jyväskylä Active Aging Scale (UJACAS; total score range 0–272) and resilience with the 10-item Connor-Davidson Resilience Scale (0–40). Self-reported walking difficulties over a 2 km distance were categorized into no difficulty, difficulty, and unable to walk. The total UJACAS score declined 24.9 points (SD 23.5) among those without walking difficulty, 27.0 (SD 25.0) among those reporting walking difficulty and 19.5 (SD 31.2) among those unable to walk 2 km. When adjusted for baseline UJACAS score, those unable to walk 2 km demonstrated the greatest decline. Baseline resilience moderated this association: Higher resilience was associated with less declines in UJACAS scores among persons with or without walking difficulty, and with more declines among persons unable to walk 2 km. When opportunities for leading an active life are compromised, those with less physical and psychological resources become particularly vulnerable to further declines in activity.

Use of walking modifications, perceived walking difficulty and changes in outdoor mobility among community-dwelling older people during COVID-19 restrictions

Background Outdoor mobility enables participation in essential out-of-home activities in old age. Aim To compare changes in different aspects of outdoor mobility during COVID-19 restrictions versus two years before according to self-reported walking. Methods Community-dwelling participants of AGNES study (2017–2018, initial age 75–85) responded to AGNES-COVID-19 postal survey in spring 2020 (N = 809). Life-space mobility, autonomy in participation outdoors, and self-reported physical activity were assessed at both time points and differences according to self-reported walking modifications and difficulty vs. intact walking at baseline were analyzed. Results Life-space mobility and autonomy in participation outdoors had declined (mean changes -11.4, SD 21.3; and 6.7, SD 5.3, respectively), whereas physical activity had increased (5.5 min/day, SD 25.1) at follow-up. Participants perceiving walking difficulty reported the poorest baseline outdoor mobility, a steeper decline in life-space mobility (p = 0.001), a smaller increase in physical activity (p < 0.001), and a smaller decline in autonomy in participation outdoors (p = 0.017) than those with intact walking. Those with walking modifications also reported lower baseline life-space mobility and physical activity, a steeper decline in life-space mobility and a smaller increase in physical activity those with intact walking (p < 0.001 for both). Discussion Participants reporting walking modifications remained the intermediate group in outdoor mobility over time, whereas those with walking difficulty showed the steepest decline in outdoor mobility and hence potential risk for accelerated further functional decline. Conclusion Interventions should target older people perceiving walking difficulty, as they may be at the risk for becoming homebound when environmental facilitators for outdoor mobility are removed.

Symptomatic primary hyperparathyroidism in a young woman presenting with multiple skeletal destructions: a case report and review of literature

Background Multiple pathological manifestations are rarely present in patients with primary hyperparathyroidism (PHPT). Here we described a case of a young woman who presented with multiple skeletal destructions and received an unclear diagnosis at several hospitals. Case presentation A 30-year-old woman was admitted to our hospital due to pain in both knees and walking difficulty that lasted for 6 and 2 years, respectively. Her laboratory test results revealed a high parathyroid hormone level (822 pg/ml) and hypercalcemia (2.52 mmol/L) in the blood. Parathyroid imaging revealed a lumpy concentration of radioactive uptake detected at the lower pole in the right lobe of the thyroid, and was nearly 2.2 cm * 2.4 cm in size. Next, the patient was treated with parathyroidectomy that resulted in a significant improvement in physiological and clinical symptoms. Moreover, the skeletal destruction and bone mineral density were significantly improved after a 5-years follow-up period. Conclusions Multiple skeletal destructions can be caused by PHPT that should be taken into consideration in young patients with complex bone lesions.

Type 1 neurofibromatosis and its relation to the occurrence of cerebral vascular accident

Context: Neurofibromatosis type 1 (NF1) is characterized by “café-au-lait” (CAL) spots, ephelids, cutaneous neurofibromas and iris Lisch nodules. Case report: A 63 year-old female patient came to evaluation due to NF1. She had a history of CAL spots, nodules on the skin, cognitive deficit and seizures. Chest X-ray showed several small nodules scattered in soft tissues of the thoracic wall. Magnetic resonance imaging of the skull demonstrated a possible increase in intracranial pressure. Computed tomography scan of the skull showed a hypodense area in the left hemisphere, consistent with a recent ischemic stroke. At the consultation, the patient reported episodes of headache, dizziness, nausea, vomiting, walking difficulty and pain in the thighs. On physical exam, she presented macrocephaly and diffuse nodular lesions. She also had masses in the abdominal and pelvic regions. On neurological exam, there was a pyramidal syndrome with right release pathway; ataxic gait; grade IV strength and Babinski sign. The patient was referred for surgical removal of the neurofibromas and died due to perioperative complications. Conclusions: Among patients with NF1, stroke is more common and occurs at a younger age than in the general population. The vasculopathy seen in NF1 involves the anterior and middle cerebral arteries, which can have serious or even fatal consequences. Anatomical vascular variants and intracranial aneurysms also occur more frequently in individuals with NF1.

Associations Between Accelerometer-Based Free-Living Walking and Self-Reported Walking Capability Among Community-Dwelling Older People

The authors examined whether accelerometer-based free-living walking differs between those reporting walking modifications or perceiving walking difficulty versus those with no difficulty. Community-dwelling 75-, 80-, or 85-year-old people (N = 479) wore accelerometers continuously for 3–7 days, and reported whether they perceived no difficulties, used walking modifications, or perceived difficulties walking 2 km. Daily walking minutes, walking bouts, walking bout intensity and duration, and activity fragmentation were calculated from accelerometer recordings, and cut points for increased risk for perceiving walking difficulties were calculated using receiver operating characteristic analysis. The authors’ analyses showed that accumulating ≤83.1 daily walking minutes and walking bouts duration ≤47.8 s increased the likelihood of reporting walking modifications and difficulties. Accumulating walking bouts ≤99.4 per day, having walking bouts ≤0.119 g intensity, and ≥0.257 active to sedentary transition probability fragmented activity pattern were associated only with perceiving walking difficulties. The findings suggest that older people’s accelerometer-based free-living walking reflects their self-reported walking capability.

Physical activities and surgical outcomes in elderly patients with acute type A aortic dissection

Objective: Although elderly patients undergoing surgery for acute type A aortic dissection (ATAAD) is increasing, their physical activities are not fully understood. We report the physical activities and surgical outcomes in the elderly patients who underwent ATAAD. Methods: From 2009 to 2019, 103 consecutive patients underwent surgery for ATAAD at our institution. Surgical outcomes along with pre- and postoperative physical activities in 52 elderly patients (≥70 years old) were compared with those in 51 younger patients (<70 years old). Postoperative walking difficulty was defined as taking ≥30 days to regain the ability to walk 200 m postoperatively or as the inability to walk at discharge. Results: It took longer for elderly patients to regain the ability to walk 100 or 200 m postoperatively. ROC analysis revealed the AUC of the duration for walking 200 m postoperatively as a prognostic indicator for late deaths was 0.878, with the highest accuracy at 30 days (sensitivity = 83.3%, specificity = 91.8%). Hospital mortality within 30 days was 3.8%, and 1-, 3-, and 5-years survival rates were 92%, 84.7%, 84.7%, respectively, for elderly patients, with no significant differences between groups. Cox proportional hazard analysis showed postoperative walking difficulty was an independent risk factor for late mortality in all cohorts (P = 0.017). Conclusions: Elderly patients undergoing surgical ATAAD repair showed acceptable surgical outcomes. However, they were more likely to decrease their physical activities postoperatively. Postoperative difficulty in walking was an independent risk factor for the late mortality in patients with ATAAD.