Showing papers by "Jeff D. Williamson published in 1996"

Functional Decline in Older Adults: Expanding Methods of Ascertainment

Abstract: Background. There is substantial interest in the prevention of physical disability associated with aging. However, little is known about how to screen for declining function at sufficiently early stages to prevent frank disability. This work provides an initial description and assessment of a new self-report method for measuring Function in older adults which complements standard methods and may be sensitive to subtler degrees of disablement than currently employed methods. We operationalize the method and demonstrate that it identifies a meaningful number of people as potentially disabled who are not identified by standard methods; also, we evaluate the method's reliability and validity for identifying subtle functional decline relative to existing methods.Methods. This is a cross-sectional, observational study of a volunteer population of 231 adults 59 years and older, evaluated in a multidisciplinary laboratory. Self-reported difficulty and dependency in each of 27 tasks of daily life were assessed as the measure of disability. Those without difficulty were evaluated for other functional change, by self-report, defined as either: (a) modification of method, or (b) decreased frequency of task performance, when due to health rather than change in social circumstances. prevalence, test-retest reliability, construct, and criterion validity were evaluated.Results. In a study population in which from 1% to 50% of participants reported difficulty with each of 27 tasks, from 2% to 33% reported modification of task performance while not having difficulty. Few participants reported decreased frequency without modification. Persons with task modifications, particularly in mobility tasks, showed intermediate levels of performance on objectively measured tests and an intermediate number of chronic diseases, compared to those reporting difficulty and those reporting neither difficulty nor modification.Conclusions. Cross-sectional evidence supports the ability of the proposed method to identify meaningful numbers of people with functional decline wile were not identified by standard self-report methods. In some cases, these were individuals with functional losses comparable to those who did report difficulty. In other cases, these may have been individuals with earlier functional loss, perhaps representing a preclinical stage of disability. Prospective evaluation will identify whether this method predicts the onset of difficulty or disability, and whether it predicts decline with sufficient precision to identify at-risk individuals in a clinical setting.

Characterization of older adults who attribute functional decrements to old age

Abstract: OBJECTIVE: Understanding the contributors to physical disability in older adults is an important component of the national health objective of expanding disability-free life by the year 2000. The purpose of this study was to determine the frequency with which older adults attribute their difficulty performing a number of common daily tasks to “old age” and to identify specific conditions and diseases associated with this attribution. Finally we sought to determine the characteristics that might differentiate persons able to attribute their disability to specific conditions from those who cite old age as the etiology of their disability. DESIGN: A cross-sectional, observational, study. SETTING: The Johns Hopkins Functional Status Laboratory. PARTICIPANTS: Two hundred thirty community-dwelling volunteers 60 years of age and older who could stand unassisted for ≥1 minute and who were without cognitive impairment. MEASUREMENTS: A 1-day evaluation included physical performance evaluations, both performance-based and self-reported function for 27 tasks, and self-report of physician-diagnosed diseases. Those with difficulty in a task and those who denied difficulty but had changed the method of task performance (modification) because of an underlying health or physical condition were identified and asked to name the cause of their difficulty or task modification; options were specific diseases/medical conditions or “old age.” The prevalence of “old age” citation as a cause of functional limitation, as well as its associated characteristics and medical conditions, was determined. MAIN RESULTS: Twenty percent of the 230 participants cited “old age” as the cause of their disability in two or more tasks. Tasks for which difficulty was most frequently attributed to “old age” were dressing oneself (31%), walking around the home (25%), walking 1/2 mile (5–6 blocks) (25%), cutting toenails (16%), getting in or out of a bed or chair or out a car (14% each), and ascending/descending stairs (13%). Significantly higher levels of arthritis, heart disease, and hearing loss were reported in persons attributing their disability to “old age” than in those not reporting “old age” as the cause of their disability. We found no differences in age, gender, race, education, or cognitive status for the two groups. However, individuals citing “old age” as the cause of functional decrements walked more slowly than those who cited a specific disease. CONCLUSIONS: These data suggest that a significant proportion of functional decline attributed to “aging” in older adults may be associated with specific conditions. Identifying and reducing the impact of these conditions may prove to be a useful approach to preventing or minimizing functional loss.

Experimental approaches to determining the choice of first-step therapy for patients with hypertension

Abstract: Detection, treatment and control of hypertension is one of the best proven approaches to prevention of cardiovascular disease. Antihypertensive treatment trials have convincingly demonstrated that diuretics and beta-blockers reduce the risk of stroke and coronary heart disease. Corresponding information is not yet