Failure to complete performance-based measures is associated with poor health status and an increased risk of death
TL;DR: The aim of the study was to establish whether the use of antipsychotic medication in elderly people with dementia is aversive to their quality of life and promote well-being.
Abstract: design, execution, analysis and interpretation of data, or preparation of the study. ALASTAIR MACDONALD1∗, DIMITRIOS ADAMIS2, ADRIAN TRELOAR2, FINBARR MARTIN3 1Institute of Psychiatry, Psychological Medicine, London, UK Email: alastair.macdonald@iop.kcl.ac.uk 2Oxleas NHS Trust, Old Age Psychiatry, London, UK 3Guy’s and St Thomas’ NHS Foundation Trust, Elderly Care Unit, London, UK ∗To whom correspondence should be addressed
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TL;DR: An index of physical fitness age (fitness age score, FAS) for older Japanese adults is developed and sex differences based on the estimated FAS are investigated and revealed that women had relatively lower physical fitness compared with men, but their rate of physical Fitness aging was slower than that of men.
Abstract: A standardized method for assessing the physical fitness of elderly adults has not yet been established. In this study, we developed an index of physical fitness age (fitness age score, FAS) for older Japanese adults and investigated sex differences based on the estimated FAS. Healthy elderly adults (52 men, 70 women) who underwent physical fitness tests once yearly for 7 years between 2002 and 2008 were included in this study. The age of the participants at the beginning of this study ranged from 60.0 to 83.0 years. The physical fitness tests consisted of 13 items to measure balance, agility, flexibility, muscle strength, and endurance. Three criteria were used to evaluate fitness markers of aging: (1) significant cross-sectional correlation with age; (2) significant longitudinal change with age consistent with the cross-sectional correlation; and (3) significant stability of individual differences. We developed an equation to assess individual FAS values using the first principal component derived from principal component analysis. Five candidate fitness markers of aging (10-m walking time, functional reach, one leg stand with eyes open, vertical jump and grip strength) were selected from the 13 physical fitness tests. Individual FAS was predicted from these five fitness markers using a principal component model. Individual FAS showed high longitudinal stability for age-related changes. This investigation of the longitudinal changes of individual FAS revealed that women had relatively lower physical fitness compared with men, but their rate of physical fitness aging was slower than that of men.
82 citations
Cites background from "Failure to complete performance-bas..."
...In addition, Rockwood et al. (2007) pointed out the importance of managing missing data if the study includes large population who cannot perform the test....
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...In addition, Rockwood et al. (2007) pointed out the importance of managing missing data if the study includes large population who cannot perform the test....
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TL;DR: To develop and evaluate a modification of the Fried frailty assessment using population‐independent cutpoints and to determine frailty prevalence of community‐dwelling elderly people in a German population.
Abstract: Objectives: To develop and evaluate a modification of the Fried frailty assessment using population-independent cutpoints and to determine frailty prevalence of community-dwelling elderly people in a German population.
Design: Cross-sectional analysis of 8-year follow-up data of a large German cohort study.
Setting: Saarland, Germany.
Participants: Three thousand one hundred twelve community-dwelling adults aged 59 and older.
Measurements: Frailty was operationalized using modified Fried frailty criteria. Criteria were categorized according to quintiles (lowest-quintile approach) or using population-independent cutpoints derived from the literature (population-independent approach). Agreement and construct validity of frailty classification according to both approaches were evaluated according to weighted kappa (?) and Spearman rank correlation (rSp). Associations between frailty and covariates were assessed using multiple logistic regression models.
Results: Although more participants were identified as frail according to the population-independent index (8.9%) than the lowest-quintile index (6.5%), agreement and correlation of frailty classification using both approaches was high (? = 0.75 and rSp = 0.84). Sex differences in frailty prevalence were more pronounced when the population-independent approach was used (women 11.4%; men 6.1%). Similarly strong significant associations with sociodemographic, lifestyle, and medical factors such as older age, female sex, smoking, and obesity were seen for both approaches.
Conclusion: The modified Fried index using literature-derived cutpoints independent from the frailty criteria distributions in the underlying study population showed good correlation with the lowest-quintile approach and enables prevalence estimates that are directly comparable between different populations.
73 citations
Cites background from "Failure to complete performance-bas..."
...Frailty criteria based on the physical tests were met if participants scored below the cutpoints or were not able to complete the tests at all.(24) Overall frailty was defined according to the number of positive frailty indicators ( 3, frail; 1–2, prefrail; 0, nonfrail)....
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TL;DR: The three month occupational therapy and physiotherapy programme had no significant effect on mobility and independence and the variation in residents’ functional ability, the prevalence of cognitive impairment, and the prevalenceof depression were considerably higher in this sample than expected on the basis of previous work.
Abstract: Objective To compare the clinical effectiveness of a programme of physiotherapy and occupational therapy with standard care in care home residents who have mobility limitations and are dependent in performing activities of daily living. Design Cluster randomised controlled trial, with random allocation at the level of care home. Setting Care homes within the NHS South Birmingham primary care trust and the NHS Birmingham East and North primary care trust that had more than five beds and provided for people in the care categories “physical disability” and “older people.” Participants Care home residents with mobility limitations, limitations in activities of daily living (as screened by the Barthel index), and not receiving end of life care were eligible to take part in the study. Intervention A targeted three month occupational therapy and physiotherapy programme. Main outcome measures Scores on the Barthel index and the Rivermead mobility index. Results 24 of 77 nursing and residential homes that catered for residents with mobility limitations and dependency for activities of daily living were selected for study: 12 were randomly allocated to the intervention arm (128 residents, mean age 86 years) and 12 to the control arm (121 residents, mean age 84 years). Participants were evaluated by independent assessors blind to study arm allocation before randomisation (0 months), three months after randomisation (at the end of the treatment period for patients who received the intervention), and again at six months after randomisation. After adjusting for home effect and baseline characteristics, no significant differences were found in mean Barthel index scores at six months post-randomisation between treatment arms (mean effect 0.08, 95% confidence interval −1.14 to 1.30; P=0.90), across assessments (−0.01, −0.63 to 0.60; P=0.96), or in the interaction between assessment and intervention (0.42, −0.48 to 1.32; P=0.36). Similarly, no significant differences were found in the mean Rivermead mobility index scores between treatment arms (0.62, −0.51 to 1.76; P=0.28), across assessments (−0.15, −0.65 to 0.35; P=0.55), or interaction (0.71, −0.02 to 1.44; P=0.06). Conclusions The three month occupational therapy and physiotherapy programme had no significant effect on mobility and independence. On the other hand, the variation in residents’ functional ability, the prevalence of cognitive impairment, and the prevalence of depression were considerably higher in this sample than expected on the basis of previous work. Further research to clarify the efficacy of occupational therapy and physiotherapy is required if access to therapy services is to be recommended in this population. Trial registration ISRCTN79859980
65 citations
Cites methods from "Failure to complete performance-bas..."
...Another limitation is the absence of physical performance data. The timed “up & go” test was used as an outcome measure; however, the majority of participants were unable to complete the task, thus precluding analyses on this outcome. Other research suggests that an inability to complete the timed “up & go” test is associated with poor health and mortality....
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TL;DR: OH may be a marker of the system dysregulation seen in frailty, but as a state variable is a less powerful marker of vulnerability than is the FI-CGA.
52 citations
Cites background or result from "Failure to complete performance-bas..."
...This finding is in keeping with an earlier report from this same cohort, which suggested that missing data in performance measures should be treated as equivalent to poor performance (Rockwood et al., 2007)....
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...Clinical experience suggests that, as with other performance measures (Rockwood et al., 2007), OH is commonly infeasible for clinicians to measure in people who are ill or who have balance problems....
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...Earlier, we had noted that frailer participants were less likely to have completed performance measures (Rockwood et al., 2007)....
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TL;DR: In this paper, the authors proposed automated algorithms for the unobtrusive measurement of sit-to-stand timing and symmetry using bed pressure sensors, which can increase the precision and efficiency in clinical SiSt assessments.
Abstract: Sit-to-stand (SiSt) analysis has been widely used in clinical practice to assess the risk of falls in the older adult population. This paper proposes automated algorithms for the unobtrusive measurement of SiSt timing and symmetry using bed pressure sensors. An integrated signal comprising all of the sensor outputs was analyzed to measure both the bed-departure timing and the timing of three clinical phases within the transfer. Data collected in clinical trials, along with independent clinical video analysis, verified the success of the bed-departure timing algorithm with a mean error of 0.11 s. The phase measurement algorithm showed significant differences (p <; 0.001) between younger and older adults in Phases II and III of the transfers, comparing well with studies found in recent clinical literature. The sensor outputs were then used to form sequences of pressure images, and an automated region of interest (ROI) detection algorithm was designed to extract regional signals from the hips and the hands. The final algorithm was designed to measure the symmetry of the body throughout the SiSt transfer from the extracted regional signals. A system accuracy of 93.0% was obtained for the automated symmetry classification of transfers. The techniques proposed in this paper can increase the precision and efficiency in clinical SiSt assessments. Their unobtrusive nature makes them particularly suitable for integration into a continuous monitoring system such as those required within the smart home environment.
45 citations
References
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TL;DR: This study provides a potential standardized definition for frailty in community-dwelling older adults and offers concurrent and predictive validity for the definition, and finds that there is an intermediate stage identifying those at high risk of frailty.
Abstract: Background: Frailty is considered highly prevalent in old age and to confer high risk for falls, disability, hospitalization, and mortality. Frailty has been considered synonymous with disability, comorbidity, and other characteristics, but it is recognized that it may have a biologic basis and be a distinct clinical syndrome. A standardized definition has not yet been established.
Methods: To develop and operationalize a phenotype of frailty in older adults and assess concurrent and predictive validity, the study used data from the Cardiovascular Health Study. Participants were 5,317 men and women 65 years and older (4,735 from an original cohort recruited in 1989-90 and 582 from an African American cohort recruited in 1992-93). Both cohorts received almost identical baseline evaluations and 7 and 4 years of follow-up, respectively, with annual examinations and surveillance for outcomes including incident disease, hospitalization, falls, disability, and mortality.
Results: Frailty was defined as a clinical syndrome in which three or more of the following criteria were present: unintentional weight loss (10 lbs in past year), self-reported exhaustion, weakness (grip strength), slow walking speed, and low physical activity. The overall prevalence of frailty in this community-dwelling population was 6.9%; it increased with age and was greater in women than men. Four-year incidence was 7.2%. Frailty was associated with being African American, having lower education and income, poorer health, and having higher rates of comorbid chronic diseases and disability. There was overlap, but not concordance, in the cooccurrence of frailty, comorbidity, and disability. This frailty phenotype was independently predictive (over 3 years) of incident falls, worsening mobility or ADL disability, hospitalization, and death, with hazard ratios ranging from 1.82 to 4.46, unadjusted, and 1.29-2.24, adjusted for a number of health, disease, and social characteristics predictive of 5-year mortality. Intermediate frailty status, as indicated by the presence of one or two criteria, showed intermediate risk of these outcomes as well as increased risk of becoming frail over 3-4 years of follow-up (odds ratios for incident frailty = 4.51 unadjusted and 2.63 adjusted for covariates, compared to those with no frailty criteria at baseline).
Conclusions: This study provides a potential standardized definition for frailty in community-dwelling older adults and offers concurrent and predictive validity for the definition. It also finds that there is an intermediate stage identifying those at high risk of frailty. Finally, it provides evidence that frailty is not synonymous with either comorbidity or disability, but comorbidity is an etiologic risk factor for, and disability is an outcome of, frailty. This provides a potential basis for clinical assessment for those who are frail or at risk, and for future research to develop interventions for frailty based on a standardized ascertainment of frailty.
16,255 citations
"Failure to complete performance-bas..." refers background in this paper
...Sir—Mobility impairment is common in elderly people, often leads to adverse outcomes [1–4] and is intertwined with frailty [5, 6]....
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TL;DR: A new Geriatric Depression Scale (GDS) designed specifically for rating depression in the elderly was tested for reliability and validity and compared with the Hamilton Rating Scale for Depression (HRS-D) and the Zung Self-Rating Depression Scale(SDS) as discussed by the authors.
13,014 citations
TL;DR: This study evaluated a modified, timed version of the “Get‐Up and Go” Test (Mathias et al, 1986) in 60 patients referred to a Geriatric Day Hospital and suggested that the timed “Up & Go’ test is a reliable and valid test for quantifying functional mobility that may also be useful in following clinical change over time.
Abstract: This study evaluated a modified, timed version of the "Get-Up and Go" Test (Mathias et al, 1986) in 60 patients referred to a Geriatric Day Hospital (mean age 79.5 years). The patient is observed and timed while he rises from an arm chair, walks 3 meters, turns, walks back, and sits down again. The results indicate that the time score is (1) reliable (inter-rater and intra-rater); (2) correlates well with log-transformed scores on the Berg Balance Scale (r = -0.81), gait speed (r = -0.61) and Barthel Index of ADL (r = -0.78); and (3) appears to predict the patient's ability to go outside alone safely. These data suggest that the timed "Up & Go" test is a reliable and valid test for quantifying functional mobility that may also be useful in following clinical change over time. The test is quick, requires no special equipment or training, and is easily included as part of the routine medical examination.
12,004 citations
"Failure to complete performance-bas..." refers background or methods in this paper
...We did not use the original cutpoints for the TUG, but rather used the performance tertiles....
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...Here, those with missing data on either one of the TUG or FR had worse outcomes than those with poor performance, and those with missing data for both had the worst outcomes....
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...As with those whose performance on both the FR and TUG was impaired, patients with missing data on either or both the FR/TUG were more likely to be older women and to have worse scores for mood, cognition, function and co-morbidity (Table 1)....
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...Kaplan-Meier curves of survival over 5 years for each of the FR (Panel A) and TUG (Panel B) ability and inability groups....
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...However, in three recent investigations of mobility in the elderly, the proportion with missing data varied widely from 1.0 to 19.5% for the FR and 0.7 to 51% for the TUG [10, 13, 23]....
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TL;DR: A large number of changes, distant from the site or sites of inflammation and involving many organ systems, may accompany inflammation, and the mechanisms mediating them are becoming better understood.
Abstract: A large number of changes, distant from the site or sites of inflammation and involving many organ systems, may accompany inflammation. In 1930 interest was focused on these changes by the discovery of C-reactive protein (so named because it reacted with the pneumococcal C-polysaccharide) in the plasma of patients during the acute phase of pneumococcal pneumonia.1 Accordingly, these systemic changes have since been referred to as the acute-phase response,2 even though they accompany both acute and chronic inflammatory disorders. New acute-phase phenomena continue to be recognized, and the mechanisms mediating them are becoming better understood. This review summarizes much of . . .
6,157 citations