Showing papers in "Journal of Gerontology in 1994"
TL;DR: Evidence is presented that performance measures can validly characterize older persons across a broad spectrum of lower extremity function and that performance and self-report measures may complement each other in providing useful information about functional status.
Abstract: Background A short battery of physical performance tests was used to assess lower extremity function in more than 5,000 persons age 71 years and older in three communities. Methods Balance, gait, strength, and endurance were evaluated by examining ability to stand with the feet together in the side-by-side, semi-tandem, and tandem positions, time to walk 8 feet, and time to rise from a chair and return to the seated position 5 times. Results A wide distribution of performance was observed for each test. Each test and a summary performance scale, created by summing categorical rankings of performance on each test, were strongly associated with self-report of disability. Both self-report items and performance tests were independent predictors of short-term mortality and nursing home admission in multivariate analyses. However, evidence is presented that the performance tests provide information not available from self-report items. Of particular importance is the finding that in those at the high end of the functional spectrum, who reported almost no disability, the performance test scores distinguished a gradient of risk for mortality and nursing home admission. Additionally, within subgroups with identical self-report profiles, there were systematic differences in physical performance related to age and sex. Conclusion This study provides evidence that performance measures can validly characterize older persons across a broad spectrum of lower extremity function. Performance and self-report measures may complement each other in providing useful information about functional status.
7,417 citations
TL;DR: A Cognitive Performance Scale (CPS) is designed that uses MDS data to assign residents into easily understood cognitive performance categories, and should prove useful to clinicians and investigators using the MDS to determine a resident's cognitive assets.
Abstract: Background Chronic cognitive impairment is a major problem in U.S. nursing homes, yet traditional assessment systems in most facilities included only limited information on cognitive status. Following the Congressional mandate in the Omnibus Reconciliation Act of 1987 (OBRA '87), U.S. nursing homes now complete the Minimum Data Set (MDS), a standardized, comprehensive assessment of each resident's functional, medical, psychosocial, and cognitive status. We designed a Cognitive Performance Scale (CPS) that uses MDS data to assign residents into easily understood cognitive performance categories. Methods Information was drawn from three data sets, including two multistate data sets constructed for the Health Care Financing Administration. The prevalence and reliability of the MDS cognitive performance variables were established when assessed by trained nursing personnel. Five selected MDS items were combined to create the single, functionally meaningful seven-category hierarchical Cognitive Performance Scale. Results The CPS scale corresponded closely with scores generated by the Mini-Mental State Examination and the Test for Severe Impairment, nursing judgments of disorientation, and neurological diagnoses of Alzheimer's disease and other dementias. Conclusions The new CPS provides a functional view of cognitive performance, using readily available MDS data. It should prove useful to clinicians and investigators using the MDS to determine a resident's cognitive assets.
1,740 citations
TL;DR: Lateral spontaneous-sway amplitude was found to be the single best predictor of future falling risk, particularly for the large group of falls that were precipitated by a biomechanical perturbation.
Abstract: BACKGROUND: An ability to predict risk of future falling is needed in order to target high-risk individuals for preventive intervention. The purpose of this study was to compare the ability of different measures of postural balance to predict risk of falling prospectively in an ambulatory and independent elderly population. METHODS: Balance tests were performed on 100 volunteers (aged 62-96), and falling was then monitored prospectively over a one-year period. The balance testing comprised measurements of: (a) spontaneous postural sway, (b) induced anterior-posterior sway, (c) induced medial-lateral sway, (d) anticipatory adjustments preceding volitional arm movements, (e) timed one-leg stance, and (f) performance on a clinical balance assessment scale. Small pseudorandom platform motions were used to perturb balance in the induced-sway tests. Using force plates, the spontaneous- and induced-sway responses were quantified in terms of the amplitude, speed, and mean frequency of the center-of-pressure displacement; input-output models were also used to parameterize the induced-sway performance. RESULTS: Although a number of measures showed evidence of significant differences between fallers and nonfallers, the differences were most pronounced for measures related to the control of lateral stability. Lateral spontaneous-sway amplitude (blindfolded conditions) was found to be the single best predictor of future falling risk, particularly for the large group of falls that were precipitated by a biomechanical perturbation. This measure was able to predict future falling risk with moderate accuracy, even in those individuals with no recent history of falling. CONCLUSIONS: The results suggest that control of lateral stability may be an important area for fall-preventative intervention. The ability of a simple and safe force-plate measure of spontaneous postural sway to predict future falling risk suggests a possible clinical application as a preliminary screening tool for risk of falling. Language: en
1,249 citations
TL;DR: The strong independent association between self-efficacy and function found in this study suggests that clinical programs in areas such as prevention, geriatric evaluation and management, and rehabilitation should attempt simultaneously to improve physical skills and confidence.
Abstract: BACKGROUND: The relationships of fear of falling and fall-related efficacy with measures of basic and instrumental activities of daily living (ADL-IADL) and physical and social functioning were evaluated in a cohort of community-living elderly persons. METHODS: Sociodemographic, medical, psychological, and physical performance (e.g., gait speed, timed hand function) measures were administered, during an in-home assessment, to a probability sample of 1,103 residents of New Haven, Connecticut, who were > or = 72 years of age. Falls and injuries in the past year, fear of falling, and responses to the Falls Efficacy Scale were also ascertained. The three dependent variables included a 10-item ADL-IADL scale, an 8-item social activity scale, and a scale of relative physical activity level. RESULTS: Among cohort members, 57% denied fear of falling whereas 24% acknowledged fear but denied effect on activity; 19% acknowledged avoiding activities because of fear of falling. Twenty-four percent of recent fallers vs 15% of nonfallers acknowledged this activity restriction (chi 2 = 13.1; p < .001). Mean fall-related efficacy score among the cohort was 84.9 (SD 20.5), 79.8 (SD 23.4), and 88.1 (SD 17.9) among fallers and nonfallers, respectively (p < or = .0001). Fall-related efficacy proved a potent independent correlate of ADL-IADL (partial correlation = .265, p < .001); physical (partial correlation = .234, p < .001); and social (partial correlation = .088, p < .01), functioning in multiple regression models after adjusting for sociodemographic, medical, psychological, and physical performance covariates as well as history of recent falls and injuries. Fear of falling was only marginally related (p = .05) with ADL-IADL functioning and was not associated with higher level physical or social functioning. CONCLUSIONS: The strong independent association between self-efficacy and function found in this study suggests that clinical programs in areas such as prevention, geriatric evaluation and management, and rehabilitation should attempt simultaneously to improve physical skills and confidence. Available knowledge of the factors influencing efficacy should guide the development of these efficacy-building programs.
1,056 citations
TL;DR: This two-part study extended the research on multiple stereotypes of elderly adults by examining the perceptions of young, middle-aged, and elderly adults and showed that differences in complexity exist against a background of general agreement about the nature of aging.
Abstract: This two-part study extended the research on multiple stereotypes of elderly adults by examining the perceptions of young, middle-aged, and elderly adults. First, one set of participants engaged in a trait generation task which yielded a trait list for use in the second part of the study. Second, other participants sorted the set of traits into groups representing different types of elderly individuals. Trait groupings were analyzed with hierarchical cluster analysis. Results supported the hypothesis that older adults have more complex representations of aging than do middle-aged and young ones, and that middle-aged adults have more complex representations than do young ones. For example, middle-aged and elderly adults reported more stereotypes of the elderly than did young adults, and elderly adults reported more stereotypes than did middle-aged adults. Results also showed, as expected, that these differences in complexity exist against a background of general agreement about the nature of aging: Trait lists produced by those in the three age groups were significantly correlated, and the stereotype sets of the three age groups included seven shared stereotypes. Results are interpreted in terms of their support for two alternative explanations of the complexity differences: ingroup/outgroup and developmental.
551 citations
TL;DR: Declines in physical performance within a high-functioning cohort are predictable from sociodemographic and health status characteristics, suggesting that older age is not uniformly associated with declines, indicating the potential for effective interventions to promote more successful aging.
Abstract: BACKGROUND: Performance-based measures of physical performance were examined for an older cohort of relatively high-functioning men and women. Relationships between baseline physical performance and sociodemographic and health status characteristics were also examined. Three-year pattern changes in performance are described, and sociodemographic and health status predictors of change are investigated. METHODS: A cohort of relatively high-functioning men and women, aged 70-79, was identified in 1988 by subsampling from three community-based studies on the basis of physical and cognitive function. Baseline in-home assessments included tests of physical performance and measurement of sociodemographic characteristics and health status. A summary measure of physical performance was developed from tests of balance, gait, lower body strength and coordination, and manual dexterity. In-home assessments were repeated at follow-up in 1991. RESULTS: Better physical performance at baseline was more common among males, Whites, those reporting higher income and education, and those with fewer chronic conditions. In linear regression models, declines in performance were predicted by older age, lower income, higher education, relative weight and blood pressure, lower peak expiratory flow, prevalent diabetes and incident health conditions and hospitalizations during follow-up. Improvements in performance were also observed; the only significant association was with race (i.e., being Black). CONCLUSIONS: Declines in physical performance within a high-functioning cohort are predictable from sociodemographic and health status characteristics. The patterns of both decline and improvement in performance observed in this cohort suggest that older age is not uniformly associated with declines, indicating the potential for effective interventions to promote more successful aging. Language: en
535 citations
TL;DR: Results revealed significant racial and gender differences which consistently withstood controlling for sociodemographic effects, including age, education, marital status, family income, region, urbanicity, and subjective health.
Abstract: Using data from four national surveys, this article presents findings on racial and gender differences in religiosity among older adults. Surveys include the second Quality of American Life study, the Myth and Reality of Aging study, wave one of Americans' Changing Lives, and the 1987 sample of the General Social Survey. These four data sources collectively include a broad range of items which tap the constructs of organizational, nonorganizational, and subjective religiosity. In all four studies, and for most indicators, results revealed significant racial and gender differences which consistently withstood controlling for sociodemographic effects, including age, education, marital status, family income, region, urbanicity, and subjective health.
448 citations
TL;DR: It is found that the best predictors of the development of functional limitation were cerebrovascular disease, arthritis, and possibly coronary artery disease, which may produce a modest reduction in the incidence of severe functional limitation.
Abstract: Background The role of chronic medical conditions in elderly persons' loss of functional abilities is intuitively important but not well defined. This analysis was designed to identify chronic medical conditions that lead to the development of severe functional limitation. Methods Functionally intact members of a multistage probability sample (n = 6,862) of all noninstitutionalized U.S. civilians age 70 years or older were interviewed in 1984. Based on data from the National Death Index and from follow-up telephone interviews in 1988 with survivors, subjects were classified as functionally intact, functionally limited (unable to perform one or more of seven essential activities), or decreased. Results After adjusting for the effects of exercise habits and demographic, socioeconomic, and psychosocial factors, we found that the best predictors of the development of functional limitation were cerebrovascular disease (OR = 2.14; 95% CL = 1.16, 3.98) and arthritis (OR = 1.51; 95% CL = 1.08, 2.11). The contribution of coronary artery disease also approached statistical significance (OR = 1.49; 95% CL = 0.99, 2.27). Conclusion In the future, the primary prevention or effective treatment of cerebrovascular disease, arthritis, and possibly coronary artery disease may produce a modest reduction in the incidence of severe functional limitation.
409 citations
TL;DR: The findings are consistent with the hypotheses that slowing of behavior is a continuous process over the adult life span, characterized by age-associated increases in within-participant variability and a direct function of task complexity.
Abstract: This study analyzed auditory reaction time (RT) data from 1,265 community-dwelling volunteers (833 males and 432 females) who ranged in age from 17 to 96. Cross-sectional analyses revealed slowing of simple (SRT) and relatively greater slowing of disjunctive (DRT; aka "go-no-go") reaction time across decades for both males and females. Repeated testing within participants (longitudinal analyses) over eight years showed consistent slowing and increased variability with age. Males were faster than females cross age groups, RT tasks, and visits. Beginning at about age 20, RTs increased at a rate of approximately 0.5 msec/yr for SRT and 1.6 msec/yr for DRT. Errors also increased, making unlikely a tradeoff of accuracy for faster responses. The findings are consistent with the hypotheses that slowing of behavior is: (a) a continuous process over the adult life span; (b) characterized by age-associated increases in within-participant variability; (c) a direct function of task complexity and, presumably, the degree of mediation by higher regions in the central nervous system; and (d) greater in women than men.
399 citations
TL;DR: It is indicated that older adults are less likely than younger adults to acknowledge dysphoria or anhedonia even at the same level of depression, and bias against older adults may account in part for the low rates of Major Depression reported for older persons from epidemiologic studies employing the standard diagnostic criteria.
Abstract: Our hypothesis was that older adults are less likely than younger adults to acknowledge dysphoria or anhedonia even at the same level of depression. Study subjects were 3,141 participants in Baltimore, Maryland, and 3,469 participants in the Durham-Piedmont region of North Carolina who had complete data on symptoms of depression active in the one month prior to interview, as well as several covariates thought to be related to depression. The effect of age on the endorsement of the dysphoria/anhedonia stem question from the section on Major Depression in the Diagnostic Interview Schedule was estimated in the two independently gathered samples employing structural equations with a measurement model. The results indicate that, even accounting for differences due to overall level of depressive symptoms, as well as gender, minority status, educational attainment, marital status, employment status, and cognitive impairment, dysphoria was less likely to be endorsed by persons 65 years of age and older. This bias against older adults may account in part for the low rates of Major Depression reported for older persons from epidemiologic studies employing the standard diagnostic criteria.
361 citations
TL;DR: Social participation, social support, and feelings of loneliness are found to have indirect effects on the mortality of the Japanese elders through their linkages with chronic diseases, functional status, and self-rated health.
Abstract: This study examined the effects of social networks and social support on the mortality of a national probability sample of 2,200 elderly Japanese persons during a three-year period. The direct and indirect effects of social relationships were assessed by using hazard rate models in conjunction with ordinary least squares regressions. Among the five measures of social relationships, social participation is shown to have a strong impact on mortality, and this effect remains statistically significant when other factors are considered. Social participation, social support, and feelings of loneliness are found to have indirect effects on the mortality of the Japanese elders through their linkages with chronic diseases, functional status, and self-rated health. On the other hand, marital status and social contacts are not shown to have statistically significant effects on the risk of dying, either directly or indirectly.
TL;DR: Larger studies are needed to determine the cognitive factors that independently predict driving performance, and the safety, reliability, and validity of a systematic road test for elderly drivers with a range of cognitive skills.
Abstract: BACKGROUND Our driving population is aging and faces increased risk for injury and death from motor vehicle crashes. Clinicians are often asked to judge the driving safety of their patients without adequate guidelines. This article describes the development of a systematic performance-based road test for measuring driving skills of elderly drivers and its correlation with cognitive measures. METHODS This was a prospective, masked, observational study in which a driving instructor's global scores ("criterion standard") and cognitive test scores were correlated with research driving scores created by two independent research raters sitting in the back seat of the care during each driving test. A convenience sample of 30 licensed drivers with a broad range of cognitive skills, over age 60, were studied on a closed course and in traffic. RESULTS Statistically significant correlations were observed between the "criterion standard" and closed course scores (r = .35, p < .05) and between the "criterion standard" and in-traffic scores (r = .64, p < .01). Significant correlations were obtained between in-traffic and cognitive test scores, e.g., Mini-Mental State Exam (r = .72, p < .01). Inter-rater reliability on the closed course was .84 and on the in-traffic component was .74. Internal consistency for the closed course was .78 and for in-traffic was .89. CONCLUSION This study documented the safety, reliability, and validity of a systematic road test for elderly drivers with a range of cognitive skills. Larger studies are needed to determine the cognitive factors that independently predict driving performance.
TL;DR: Balance training designed to improve intersensory interaction could effectively improve balance performance in healthy older adults.
Abstract: BACKGROUND The effects of standing balance training on the ability to maintain stability in both static two-leg and one-leg stance were tested in healthy older adults. METHODS Subjects (age range 65-90 years) were randomly assigned to a training (n = 12) or control group (n = 12). Training subjects received a 10-hour balance training program which selectively manipulated sensory inputs from the visual, vestibular, and somatosensory systems. RESULTS Training subjects showed significantly improved stability (root-mean-square values of anteroposterior platform torque) after training in five of the eight training conditions (when somatosensory inputs were changed or when two or more sensory systems were simultaneously manipulated) (p < .006). When tested 4 weeks after completion of training, subjects (a) fell less frequently when the ankle/foot somatosensory inputs were minimized and (b) stood longer on one leg than the control group (p < .001). CONCLUSIONS Balance training designed to improve intersensory interaction could effectively improve balance performance in healthy older adults.
TL;DR: This study drew on a life course approach and a sample of 293 women from four birth cohorts in upstate New York to examine the relationship over time between women's paid work and their informal caregiving of aging or infirm relatives.
Abstract: This study drew on a life course approach and a sample of 293 women from four birth cohorts in upstate New York to examine the relationship over time between women's paid work and their informal caregiving of aging or infirm relatives. We find that such caregiving is an increasingly likely role for women, both as they age and across birth cohorts. One in four (24%) women became caregivers at some time between ages 35-44, and over one in three (36%) of these same women became caregivers between ages 55-64. Only 45 percent of the oldest cohort (born 1905-1917) were ever caregivers, compared to 64 percent of the most cohort (born 1927-1934), an increase of almost 20 percent. Clearly changes in the labor force participation of more recent cohorts of women do not appear to alter their caregiving responsibilities. In fact, women in this sample were equally likely to become caregivers, regardless of whether or not they were employed.
TL;DR: The results suggest that prolonged moderate to high intensity resistance training may be carried out by healthy older adults with reasonable compliance, and that such training leads to sustained increases in muscle strength.
Abstract: BACKGROUND To study the effects of resistance training on muscle strength and size in older people, we enrolled 8 men and 17 women (mean age 68.2 +/- 1 SEM) into a one-year exercise trial. METHODS Subjects were randomly assigned to exercise or control groups. Muscle biopsies were obtained from 11 subjects (8 exercisers/3 controls) at baseline and after 15 weeks; exercisers underwent another biopsy at 30 weeks. After testing maximum strength using the 1-RM method, the exercisers began a 12-exercise circuit (3 sets of 8 repetitions at 75% of 1-RM), 3 times a week. The controls repeated the strength testing every 15 weeks. They were asked to continue usual activities and not to start any exercise program. RESULTS With exercise, muscle strength increased, average increases ranging from 30% (hip extensors) to 97% (hip flexors). Strength increased rapidly over 3 months, then plateaued for the duration of the experiment. No strength changes were observed in sedentary controls. Cross-sectional area of type 1 muscle fibers increased in exercisers by 15 weeks (29.4 +/- 1%, p < .02) and after 30 weeks (58.5 +/- 13.7%, p < .002) compared to baseline. Type 2 fiber area did not change at 15 weeks, but increased by 30 weeks of training (66.6 +/- 9.5%, p < .0002). CONCLUSIONS These results suggest that prolonged moderate to high intensity resistance training may be carried out by healthy older adults with reasonable compliance, and that such training leads to sustained increases in muscle strength. These improvements are rapidly achieved and are accompanied by hypertrophy of both type 1 and type 2 muscle fibers.
TL;DR: Gender differences in spousal caregiving in currently married people with cancer who were undergoing outpatient treatment indicate that husbands were less likely than wives to help their sick spouses with household tasks, and husbands who helped were more likely to have other helpers, whereas wives tended to be sole caregivers.
Abstract: This study investigated gender differences in spousal caregiving in a sample of 353 currently married people with cancer who were undergoing outpatient treatment. Results indicate that husbands were less likely than wives to help their sick spouses with household tasks, and husbands who helped were more likely to have other helpers, whereas wives tended to be sole caregivers. Wives provided approximately twice the hours of care that husbands provided. Women undergoing treatment who experienced high levels of morbidity received more hours of help with household tasks from nonspousal sources than men with comparable levels of morbidity, thus compensating for the deficit in hours of care provided by their husbands. At lower levels of morbidity, however, compensatory help to women was not sufficient to fill the gap in care. Women were more likely than men to report unmet need for assistance with household tasks, although not with personal care.
TL;DR: A music-facilitated psychoeducational strategy was developed as a cost-effective and accessible intervention for older adults experiencing symptoms of depression, distress, and anxiety and improvements were clinically significant and maintained over a 9-month follow-up period.
Abstract: A music-facilitated psychoeducational strategy was developed as a cost-effective and accessible intervention for older adults experiencing symptoms of depression, distress, and anxiety. Thirty older adults who had been diagnosed with major or minor depressive disorder were randomly assigned to one of three 8-week conditions: (1) a home-based program where participants learned music listening stress reduction techniques at weekly home visits by a music therapist; (2) a self-administered program where participants applied these same techniques with moderate therapist intervention (a weekly telephone call); or (3) a wait list control. Participants in both music conditions performed significantly better than the controls on standardized tests of depression, distress, self-esteem, and mood. These improvements were clinically significant and maintained over a 9-month follow-up period. The potential for this type of intervention with homebound elders and others who have limited access to services is discussed.
TL;DR: Self-rated health is predictive of mortality in controlled analyses, with the greatest impact seen in healthy individuals, and health care professionals should be sensitive to the significance of poor self-rating health in apparently healthy patients.
Abstract: BACKGROUND This study tested the predictive value of self-rated health on 3-year mortality, with attention focused on healthy, high-functioning elders. METHODS Data from the MacArthur Field Study of Successful Aging were utilized. Subjects were 70-79-year-old (at baseline) residents of the communities of East Boston, MA, New Haven, CT, and a five-county area in and around Durham County, NC (N = 1192) which comprise three sites of the Established Populations for Epidemiologic Studies of the Elderly (EPESE). In-home interviews were conducted in 1988 and 1991. Logistic regression was performed to create odds ratios adjusted for age, sex, race, marital status, education, alcohol consumption, cigarette smoking, chronic diseases, past hospitalizations, and cognitive function. The sample was then divided into healthy and less healthy cohorts based on number of chronic diseases, and the analyses were repeated. RESULTS The adjusted odds ratios for self-rated health (poor/bad ratings compared to excellent ratings) in relation to mortality were 19.56 in the general sample, 93.51 in the healthy cohort, and 2.75 in the less healthy cohort. CONCLUSION Self-rated health is predictive of mortality in controlled analyses, with the greatest impact seen in healthy individuals. Health care professionals should be sensitive to the significance of poor self-rated health in apparently healthy patients.
TL;DR: It is proposed that the enhanced ability of Age strains to cope with environmental stress may be mechanistically related to their lower age-specific mortality rates.
Abstract: Age-synchronous cohorts of Caenorhabditis elegans were grown at 20 degrees C, then stressed at 30 degrees C or 35 degrees C. Intrinsic thermotolerance of wild type and age-1 mutant strains was assessed by measuring either progeny production or survival. In addition to increased life span (Age), mutation of age-1 results in a highly significant increased intrinsic thermotolerance (Itt) as measured by survival at 35 degrees C. Mean survival of Age strains is approximately 45% longer than that of non-Age strains for both sterile and nonsterile worms. Thermotolerance declines across the life span of both Age and non-Age strains, but Itt was observed at almost all ages. Unstressed age-1 animals showed a consistent and significant fertility deficit. Short thermal stresses can cause a dramatic reduction in progeny production for both Age and non-Age genotypes. Mutants of age-1 showed a small but consistent increased thermotolerance as measured by fertility. We propose that the enhanced ability of Age strains to cope with environmental stress may be mechanistically related to their lower age-specific mortality rates.
TL;DR: The rise in plasma total cholesterol among apparently healthy young men and women and its fall in the elderly are significantly associated with similar trends for obesity and the key determinants of a decline in HDL-C are an increase in obesity and advancing age itself.
Abstract: Objective The purpose of the study was to assess the determinants of change of total cholesterol and high density lipoprotein cholesterol (HDL-C) change in an adult population. Methods The prospective cohort was examined at baseline and eight years later. A total of 2,222 men and 2,677 women age 20-79 years at baseline were included. Analyses were performed in 15-year age groups, and persons with cardiovascular disease or cancer during the observation period were excluded. Results In longitudinal analyses, body mass index (BMI) and plasma total cholesterol levels of each rose in concert among younger age groups, whereas levels declined in older individuals. Mean levels of BMI and total cholesterol peaked at a later age in women than in men. The corresponding changes in HDL-C were negative at all ages, and greater declines were seen in the elderly. A decrease in plasma total cholesterol was highly associated with greater age and a decrease in body mass index over the study interval, whereas the decline in HDL-C was proportional to change in body mass index. These changes remained significant after adjustment for baseline age and change in alcohol intake, cigarette consumption, diuretic use, and oral estrogen use. Conclusions The rise in plasma total cholesterol among apparently healthy young men and women and its fall in the elderly are significantly associated with similar trends for obesity. The key determinants of a decline in HDL-C are an increase in obesity and advancing age itself. A decline in total cholesterol and in HDL-C is particularly common among the elderly, and it can be expected to occur without specific dietary or pharmacologic intervention.
TL;DR: FBOS is a reliable measure and is decreased on average in older persons, not related to increased sway while standing or leaning, and has potential as a measure of change in this dimension of balance and as a predictor of falls risk in older Persons.
Abstract: Background Poor balance in older persons increases the risk of injurious falls during daily activities. Functional base of support (FBOS), the anterior-posterior proportion of foot length used in maximal sustained forward and backward leaning, tests controlled center of mass movement, a component of balance required in daily activities. The purpose of this study was to examine the relationship between FBOS and age and establish the reliability of this measure. Methods Subjects were 113 community-dwelling men and women, ages 20 to 91. FBOS, measured on a force platform, is the difference between mean center of pressure location during sustained forward and backward leaning, divided by foot length. Forward lean (FL), backward lean (BL), and average sway distance during normal standing (STAND SWAY) and while leaning (FBOS SWAY) were also measured. Results Mean FBOS was .60 +/- .07 in subjects under age 60, and .42 +/- .12 in subjects 60 and older. FBOS remained constant in younger subjects; beyond age 60, FBOS declined about 16% per decade and was more variable. FL and BL also declined with age, remaining 66% and 34% of FBOS, respectively. STAND SWAY and FBOS SWAY were significantly correlated with each other, but not with FBOS. Conclusions FBOS is a reliable measure and is decreased on average in older persons. This decrease is not related to increased sway while standing or leaning. FBOS is a simple force platform test that has potential as a measure of change in this dimension of balance and as a predictor of falls risk in older persons.
TL;DR: A significant interaction shows larger regression coefficients for roles among men than women on life satisfaction, and a three-way interaction indicates a stronger association of roles with self-efficacy for Black men than the other three gender-ethnicity combinations.
Abstract: Activity theory and the role enhancement hypothesis predict that multiple role involvement in late life is linked to greater psychological well-being, but the disengagement hypothesis and the role change hypothesis anticipate a negative association between these variables. In this study, the association between multiple roles and psychological well-being is tested among adults age 60 and over from a national sample. Three measures of well-being are regressed on background variables, number of roles (from among employee, spouse, parent, volunteer, homemaker, grandparent, caregiver, and student), and interaction terms. Multiple roles are associated with higher life satisfaction and self-efficacy and lower depressive symptoms. A significant interaction shows larger regression coefficients for roles among men than women on life satisfaction, and a three-way interaction indicates a stronger association of roles with self-efficacy for Black men than the other three gender-ethnicity combinations. Findings support the role enhancement hypothesis and the activity perspective among older adults.
TL;DR: BANS-S may be a useful tool for the evaluation of different treatment strategies in severe DAT and for the correlation of clinical and pathological findings.
Abstract: Background In late stages of dementia of the Alzheimer type (DAT), most scales measuring only cognitive or functional deficits lose their sensitivity to detect further disease progression. Methods By combining ratings of cognitive (speech, eye contact) and functional deficits (dressing, eating, ambulation) with occurrence of pathological symptoms (sleep-wake cycle disturbance, muscle rigidity/contractures), a scale was developed (BANS-S) which does not lose its sensitivity until the patient reaches a vegetative state. BANS-S was tested on three Special Care Dementia Units. Results Data from 74 patients with the clinical diagnosis of DAT indicated that BANS-S has good reliability and reproducibility. BANS-S scores correlated with scores of Mini-Mental State Examination, Katz ADL, Test for Severe Impairment, and Language Assessment. In 25 patients with the diagnosis of DAT confirmed by autopsy, BANS-S scores determined within 3 months of death correlated with density of neurofibrillary tangles in CA2 and CA3 areas of the hippocampus. Conclusion BANS-S may be a useful tool for the evaluation of different treatment strategies in severe DAT and for the correlation of clinical and pathological findings.
TL;DR: Elderly women show impairments of balance when simultaneously deprived of visual and somatosensory inputs or during a backwards destabilization, and biomechanical origins are a more likely cause.
Abstract: Background Prior studies indicate that older women fall more often than men although there is no evidence of gender-based balance differences. Using a force platform, we measured the effects of restricted sensory input and support surface movement to detect gender differences in balance. Methods Healthy, elderly community dwellers (N = 234, mean age = 76 +/- 5 years, 52% female) were administered the following perturbations on the balance platform: The platform and/or visual surround were fixed or tilted proportionally to the subject's sway with the eyes open or closed, forward or backward horizontal translations, and toes-up and toes-down rotations. Results Gender-based balance differences were not present during quiet standing, or when the support surface or visual input were manipulated separately. Women swayed and lost their balance more than men when the surface was sway-referenced while vision was compromised, but by the third trial their sway control was comparable to the men. Women also initially lost their balance more frequently than men during toes-up and -down rotations, and compared to men continued to lose their balance more often during repeated toes-up rotations. Finally, women developed less angular momentum than men in response to forward platform rotations. Discussion Elderly women show impairments of balance when simultaneously deprived of visual and somatosensory inputs or during a backwards destabilization. Since there is little evidence for a CNS source for such gender differences, biomechanical origins (e.g., dorsiflexion strength and range of motion) are a more likely cause. Limited postural control of women under conditions stressing balance may explain their greater frequency of falling.
TL;DR: Initial evidence of the acute iatrogenic effects of caregiving on physiological as well as psychological response systems is provided.
Abstract: BACKGROUND Although the informal caregiving role is associated with a range of stressors that are both chronic and severe, little is known concerning the acute physical and psychological effects of caregiving in the natural setting. This study evaluated the hemodynamic and psychological responses of five women identified as family caregivers who also worked outside the home and five matched working noncaregivers. METHODS Subjects wore an ambulatory blood pressure monitor that recorded blood pressure and heart rate on an hourly basis throughout a one- to two-day period. They also completed hourly logs evaluating psychological, physical, and health-related variables through use of a preprogrammed pocket computer. Within- and between-group responses were compared in clinical, work, and postwork settings. RESULTS Caregivers and noncaregivers showed comparable ambulatory blood pressure levels in the clinic and work settings. However, in contrast to noncaregivers, who showed the expected decrease in blood pressure level upon leaving the work setting (p values < .03), caregivers demonstrated a significant increase in systolic blood pressure levels following work when they were in the presence of the care recipient (p < .0002). The differences observed in blood pressure responses between the two groups were similarly reflected in the patterns of affective response recorded in the work and postwork settings. CONCLUSIONS The results provide initial evidence of the acute iatrogenic effects of caregiving on physiological as well as psychological response systems.
TL;DR: The results suggest a decline in motor coordination rather than any simple strategic preference for caution in movement and the hesitancy of movement to some extent parallels that seen in Parkinson's disease.
Abstract: Background. While older adults typically exhibit slower hesitant movements, this may simply reflect a preference for a cautious movement strategy, rather than any pathological process.
TL;DR: Delays as small as 50 or 100 ms in observing or reacting to obstacles in real-life situations may significantly lower the rate of success that subjects of any age have in avoiding them.
Abstract: BACKGROUND: Falls during walking are often triggered when a foot contacts an obstacle in its path. Yet little is known about the ability of individuals of any age to successfully negotiate obstacles, especially under time-critical conditions. METHODS: The gait of 24 young and 24 old healthy adults (mean ages 23 and 73 years) was studied as they approached and tried to avoid stepping on a band of light, not knowing when or where it might appear on an 8 m-long walkway. This virtual obstacle was placed at the predicted location of the next footfall with available response times (ART) before heel strike that were varied randomly in 50 ms increments from 200 to 450 ms. In addition, their gait was observed as they stepped over a fixed virtual obstacle and over an obstacle that appeared with approximately a 1000 ms ART. RESULTS: The old had an increased risk of obstacle contact while negotiating obstacles under time-critical conditions (p = .082). Mean rates-of-success (RS) in obstacle avoidance for the young ranged from .205 at a 200 ms ART to .969 at a .450 ms ART. Corresponding mean RS for the old were .157 and .920. Lower extremity simple reaction time (SRT) test made under static conditions showed that the mean SRT of the old were approximately 80 ms longer than those of the young. Regression analyses suggested that the old in fact would have needed only 30 ms additional ART to achieve RS equal to that of the young for obstacles appearing with ART from 300 to 450 ms. CONCLUSIONS: Reductions in ART significantly decreased RS. Delays as small as 50 or 100 ms in observing or reacting to obstacles in real-life situations may significantly lower the rate of success that subjects of any age have in avoiding them. Age differences in SRT do not always reliably indicate age differences in obstacle avoidance under time-critical situations. Language: en
TL;DR: Dependence is a distinct, measurable component of dementing disease and should be considered an important outcome in studies of AD.
Abstract: Background While cognitive and functional deficits are the hallmark of Alzheimer's disease (AD), loss of social function (and the dependence this implies) is also critical, especially in early stages of disease. Little attention has been directed to this facet of dementing disease. We describe a scale for assessing dependency in AD and present a baseline profile of dependency in a cohort of AD patients. Methods In a study of the predictors of the course of AD, 233 patients in early stages of disease (modified MMS > or = 30) were assessed. Psychometric properties of the dependence scale were established. To validate the scale, dependence scores at baseline were correlated with a series of measures assessing cognition and function. The course of dependency over 18 months of follow-up was also analyzed. Results The scale shows adequate reliability (test-retest, intraclass correlation). Dependence stage was related to other measures of disease severity. Scalogram analysis shows that the dependence scale is consistent with the course of functional loss established for dementing disease. Prospective data indicate sensitivity of the scale to disease progression. Conclusion Dependency is a distinct, measurable component of dementing disease and should be considered an important outcome in studies of AD.
TL;DR: The findings indicated that the propensity of adult children to provide instrumental support and emotional support was indirectly affected by the influence of the early parent-child relationship on contemporary filial concern and relationship quality.
Abstract: This research investigated the effects of early family experiences on the quality of the adult child-parent relationship and on the extent of instrumental and emotional support provided elderly parents by their adult children. The analysis was based on adult children's reports regarding 1,135 aging parents. Panel data were used to reduce method effects attributable to transient mood states. Health of aging parent, geographical proximity of parents and children, and parent's living situation were controlled in the models. The findings indicated that the propensity of adult children to provide instrumental support (e.g., transportation and health care when parents were ill) and emotional support was indirectly affected by the influence of the early parent-child relationship on contemporary filial concern and relationship quality.
TL;DR: NIRS measurements show promise as a method of evaluating the kinetics of oxygen saturation, particularly in patients with mild peripheral vascular disease, particularly during and after mild plantar flexion exercise.
Abstract: This study noninvasively measured hemoglobin oxygen saturation in young (n = 6, 28 +/- 6 yrs), old healthy (n = 20, 68 +/- 7 yrs), and old subjects with mild peripheral vascular disease (PVD) (n = 8, 72 +/- 4 yrs). Hemoglobin oxygen saturation was measured as the difference in absorption at 760 and 850 nm light using near-infrared spectroscopy (NIRS). The lateral soleus muscle was studied after mild plantar flexion exercise. The time constant of recovery of oxygen saturation (HBO2Tc) was 21.5 +/- 8.6 s in young, 26.9 +/- 13.5 s in old healthy subjects. PVD subjects had HbO2Tc values of 104.4 +/- 41.1 s in their "bad" leg and 57.6 +/- 42.2 s in their "good" leg. The correlation between HbO2Tc and ankle-arm pressures was significant (r2 = .63, p < .001). Six younger normal, five older normal, and seven PVD subjects also performed a progressive walking test. Normal subjects completed the test without difficulty, and older normal subjects showed progressive deoxygenation. PVD subjects complained of calf pain (4 out of 5 were able to finish) and showed near-maximal deoxygenation throughout the test. In summary, NIRS measurements show promise as a method of evaluating the kinetics of oxygen saturation, particularly in patients with mild peripheral vascular disease.