Context Survival estimates help individualize goals of care for geriatric patients, but life tables fail to account for the great variability in survival. Physical performance measures, such as gait speed, might help account for variability, allowing clinicians to make more individualized estimates. Objective To evaluate the relationship between gait speed and survival. Design, Setting, and Participants Pooled analysis of 9 cohort studies (collected between 1986 and 2000), using individual data from 34 485 community-dwelling older adults aged 65 years or older with baseline gait speed data, followed up for 6 to 21 years. Participants were a mean (SD) age of 73.5 (5.9) years; 59.6%, women; and 79.8%, white; and had a mean (SD) gait speed of 0.92 (0.27) m/s. Main Outcome Measures Survival rates and life expectancy. Results There were 17 528 deaths; the overall 5-year survival rate was 84.8% (confidence interval [CI], 79.6%-88.8%) and 10-year survival rate was 59.7% (95% CI, 46.5%-70.6%). Gait speed was associated with survival in all studies (pooled hazard ratio per 0.1 m/s, 0.88; 95% CI, 0.87-0.90; P  Conclusion In this pooled analysis of individual data from 9 selected cohorts, gait speed was associated with survival in older adults.

https://jamanetwork.com/journals/jama/articlepdf/644554/joc05171_50_58.pdf

Gait speed and survival in older adults.

Accurate assessment is required to assess current and changing physical activity levels, and to evaluate the effectiveness of interventions designed to increase activity levels. This study systematically reviewed the literature to determine the extent of agreement between subjectively (self-report e.g. questionnaire, diary) and objectively (directly measured; e.g. accelerometry, doubly labeled water) assessed physical activity in adults. Eight electronic databases were searched to identify observational and experimental studies of adult populations. Searching identified 4,463 potential articles. Initial screening found that 293 examined the relationship between self-reported and directly measured physical activity and met the eligibility criteria. Data abstraction was completed for 187 articles, which described comparable data and/or comparisons, while 76 articles lacked comparable data or comparisons, and a further 30 did not meet the review's eligibility requirements. A risk of bias assessment was conducted for all articles from which data was abstracted. Correlations between self-report and direct measures were generally low-to-moderate and ranged from -0.71 to 0.96. No clear pattern emerged for the mean differences between self-report and direct measures of physical activity. Trends differed by measure of physical activity employed, level of physical activity measured, and the gender of participants. Results of the risk of bias assessment indicated that 38% of the studies had lower quality scores. The findings suggest that the measurement method may have a significant impact on the observed levels of physical activity. Self-report measures of physical activity were both higher and lower than directly measured levels of physical activity, which poses a problem for both reliance on self-report measures and for attempts to correct for self-report – direct measure differences. This review reveals the need for valid, accurate and reliable measures of physical activity in evaluating current and changing physical activity levels, physical activity interventions, and the relationships between physical activity and health outcomes.

/pdf/a-comparison-of-direct-versus-self-report-measures-for-ebc2zoxerg.pdf

A comparison of direct versus self-report measures for assessing physical activity in adults: a systematic review

Background Inadequate dietary intake of calcium and vitamin D may contribute to the high prevalence of osteoporosis among older persons. Methods We studied the effects of three years of dietary supplementation with calcium and vitamin D on bone mineral density, biochemical measures of bone metabolism, and the incidence of nonvertebral fractures in 176 men and 213 women 65 years of age or older who were living at home. They received either 500 mg of calcium plus 700 IU of vitamin D3 (cholecalciferol) per day or placebo. Bone mineral density was measured by dual-energy x-ray absorptiometry, blood and urine were analyzed every six months, and cases of nonvertebral fracture were ascertained by means of interviews and verified with use of hospital records. Results The mean (±SD) changes in bone mineral density in the calcium–vitamin D and placebo groups were as follows: femoral neck, +0.50±4.80 and -0.70±5.03 percent, respectively (P = 0.02); spine, +2.12±4.06 and +1.22±4.25 percent (P = 0.04); and total body,...

Effect of Calcium and Vitamin D Supplementation on Bone Density in Men and Women 65 Years of Age or Older

https://www.archives-pmr.org/article/S0003-9993(01)63215-5/pdf

Gait variability and fall risk in community-living older adults: A 1-year prospective study

OBJECTIVE: To review reliability, validity, and normative data from 7 different studies, involving a total of 1,988 people with diabetes, and provide a revised version of the Summary of Diabetes Self-Care Activities (SDSCA) measure. RESEARCH DESIGN AND METHODS: The SDSCA measure is a brief self-report questionnaire of diabetes self-management that includes items assessing the following aspects of the diabetes regimen: general diet, specific diet, exercise, blood-glucose testing, foot care, and smoking. Normative data (means and SD), inter-item and test-retest reliability, correlations between the SDSCA subscales and a range of criterion measures, and sensitivity to change scores are presented for the 7 different studies (5 randomized interventions and 2 observational studies). RESULTS: Participants were typically older patients, having type 2 diabetes for a number of years, with a slight preponderance of women. The average inter-item correlations within scales were high (mean = 0.47), with the exception of specific diet; test-retest correlations were moderate (mean = 0.40). Correlations with other measures of diet and exercise generally supported the validity of the SDSCA subscales (mean = 0.23). CONCLUSIONS: There are numerous benefits from standardization of measures across studies. The SDSCA questionnaire is a brief yet reliable and valid self-report measure of diabetes self-management that is useful both for research and practice. The revised version and its scoring are presented, and the inclusion of this measure in studies of diabetes self-management is recommended when appropriate.

https://care.diabetesjournals.org/content/diacare/23/7/943.full.pdf

The summary of diabetes self-care activities measure: results from 7 studies and a revised scale.

The Physical Activity Scale for the Elderly (PASE): development and evaluation.

OBJECTIVES. The Nutrition Screening Initiative is a national collaborative effort committed to the identification and treatment of nutritional problems in older persons. METHODS. A 14-item checklist of characteristics associated with nutritional status was administered to a random sample of Medicare beneficiaries, aged 70 years and older, in New England. Regression analysis was used to derive item weights that would predict poor nutrient intakes and low perceived health status. Sensitivity and specificity values were reviewed to define low, moderate, and high nutritional risk scores. RESULTS. A revised checklist containing 10 yes/no items was adopted. Scores of 6 or more points defined persons at high nutritional risk. Twenty-four percent of the Medicare population was estimated to be at high nutritional risk according to the checklist. Among those in the high-risk group, 56% perceived their health to be "fair" or "poor" and 38% had dietary intakes below 75% of the recommended dietary allowances for three...

Nutrition and health risks in the elderly: the nutrition screening initiative.

Background and Purpose Although individuals with low back pain frequently receive treatment from a physical therapist, few published studies exist that describe who sees a physical therapist for their low back pain nor is much known about physical therapy episodes of care for this condition Secondary analysis of data from the American Physical Therapy Association's Survey of Physical Therapy Outpatient Practice provides new descriptive data on services provided to a national, representative sample of patients discharged from hospital-based and private outpatient practices In addition, specific hypotheses were tested on clinical and background factors believed to influence low back pain episodes of care Subjects Patients with low back pain represented over 25% of all outpatient discharges from physical therapy practices Methods A mail survey was conducted with representatives of a national probability sample of facilities that provided outpatient physical therapy services Data were provided on each facility and on a discharge sample of patients treated at each facility Results On average, episodes of care extended over 5 weeks and consisted of 11 therapy visits, for an average charge of $76670 Duration and charge for low back episodes of care did not differ, on average, in private versus hospital-based practices Certain aspects of care, however, did vary across regions of the country Episodes of care charged to workers' compensation were costlier than those charged to other insurance carriers, and whites were charged less, on average, than nonwhites Duration of back symptoms was related to intensity, duration, and charges incurred for the episode of care Conclusion and Discussion Further research is needed to understand the reasons for the relationships observed in this study, as well as studies that relate care provided by physical therapists to specific patient outcomes Further research is also needed to compare outcomes achieved across different health professions

Physical Therapy Episodes of Care for Patients With Low Back Pain

Objectives. The Home Care Satisfaction Measure (HCSM) is an easy to administer, psychometrically sound instrument based on consumer-defined notions of satisfaction, including perspectives of ethnic minorities. The HCSM provides an overall home care satisfaction score and subscale scores for 5 common services, all on a 0‐100 scale. Methods. Focus groups with African American, Hispanic, and non-Hispanic White older adults were audiotaped. Tapes were transcribed and analyzed with grounded theory methods. Correlational and common factor analyses were conducted to select items, and the instrument was field tested with 228 frail, low-income, older home care recipients. Results. Test-retest reliabilities ranged from .68 to .88, with high internal consistency reliabilities. Substantial concurrent validity was achieved for subscale and overall HCSM scores. Home care satisfaction was not related to gender, age or race but was negatively associated with physical disability. Significant social desirability effects were found. Discussion. In the increasingly important area of home care, the HCSM is the first measure developed on the basis of the views of older consumers that also meets standard psychometric criteria. The HCSM provides a consumer-based indicator of quality and can be used to examine changes in satisfaction over time and differences among providers or within a single agency.

The Home Care Satisfaction Measure A Client-Centered Approach to Assessing the Satisfaction of Frail Older Adults With Home Care Services

Objective : To describe the extent of readiness for participation in home, school and community life at discharge from inpatient rehabilitation and selected factors associated with participation readiness in children and adolescents with acquired brain injuries. Methods : Staff from eight sites used retrospective review to complete a prototype clinical performance measure on up to 10 of their most recent discharges. Data were obtained on 65 children and adolescents, aged 6 months to 18 years (X = 9.5 years). The extent of participation readiness was analysed descriptively. Associations between selected variables and participation readiness were examined using correlation and multiple regression analyses. Results : Only 3-27% of the children were deemed ready for age-expected participation at discharge in 15 domains of home, school and community life. Social behavioural activity performance at discharge explained 74% of the variance associated with participation readiness at discharge. Conclusions : The lo...

Kevin W. Smith

Papers

The Physical Activity Scale for the Elderly (PASE): development and evaluation.

Nutrition and health risks in the elderly: the nutrition screening initiative.

Physical Therapy Episodes of Care for Patients With Low Back Pain

The Home Care Satisfaction Measure A Client-Centered Approach to Assessing the Satisfaction of Frail Older Adults With Home Care Services

Participation readiness at discharge from inpatient rehabilitation in children and adolescents with acquired brain injuries.