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Journal ArticleDOI

Instrumental Activities of Daily Living as a Potential Marker of Frailty A Study of 7364 Community-Dwelling Elderly Women (the EPIDOS Study)

TL;DR: The results confirmed that women with disability on at least one IADL item are frailer because they had more associated disorders, poorer cognitive function and more frequent falls.
Abstract: Background. A number of clinical conditions have been shown to be associated with frailty in elderly people. We hypothesized that incapacities on the Instrumental Activities of Daily Living (IADLs) scale could make it possible to identify this population. We investigated the associations between IADL incapacities and the various known correlates of frailty in a cohort of community-dwelling elderly women. Methods. Cross-sectional analysis was carried out on the data from 7364 women aged over 75 years (EPIDOS Study). The IADL was the dependent variable. Sociodemographic, medical, and psychological performance measures were obtained during an assessment visit. Falls in the previous 6 months and fear of falling were also ascertained. Body composition was measured by dual-energy x-ray absorptiometry. The factors associated with disability in at least one IADL were included in a logistic regression model. Results. Thirty-two percent of the population studied had disability in at least one IADL item. This group was significantly older (81.7 � 4.1 yr vs 79.8 � 3.4 yr), had more frequent histories of heart disease, stroke, depression or diabetes, and was socially less active ( p � .001). These associations persisted after multivariate analysis. Cognitive impairment as assessed by the Pfeiffer test (Pfeiffer score � 8) was closely associated with disabilities on the IADL (OR 3.101, 95% confidence interval [CI] 2.19‐4.38). Falls and fear of falling were also more frequent in the group of women with an abnormal IADL ( p � .001) but only fear of falling remained significantly associated with incapacities on at least one IADL item after logistic regression (OR 1.47, 95% CI 1.28‐1.69). Women with disability on at least one IADL item also had lower bone mineral density, this was independent of the other factors. Conclusion. Our results confirmed that women with disability on at least one IADL item are frailer because they had more associated disorders, poorer cognitive function and more frequent falls. Disabilities on this scale could be a good tool for identifying individuals at risk of frailty among elderly persons living at home and in apparent good health. This finding requires confirmation by longitudinal studies.

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TL;DR: In this paper, the authors investigated the prevalence and correlates of functional disability in elderly people living in Ribeirao Preto, Portugal, using a validated questionnaire for population-based epidemiological studies.
Abstract: Objectives: To investigate the prevalence and correlates of functional disability in elderly people living in Ribeirao Preto, SP. Methods: This is a cross-sectional population-based epidemiological study with multistage sampling. Design effect was corrected using a weighted sample composed by 536 elderly people. Disability based on daily living activities dependence (outcome) was assessed by using a validated questionnaire for population-based epidemiological studies. Points and 95% confidence intervals estimated crude and stratified prevalence rates of the outcome according to sociodemographic, behavioral, health-related, and self-reported morbidity variables. To identify the correlates, the crude and adjusted prevalence ratios were estimated using Poisson regression. Results: The crude prevalence of disability was 50.31%. In the multivariate models, after simultaneous intra-group adjustment (final models), the following variables remained independently associated with the outcome: sociodemographic (age, education, and contribution to familiar income); behavioral (daily mean of sitting time); health-related factors (hypertension, ischemic heart disease, medicines taken, and low cognitive performance); and self-reported morbidity (number of diseases and low hearing performance). Conclusions: The high prevalence of disability among elderly people in Ribeirao Preto and the presence of modifiable variables impose the need for specific health promotion and prevention measures, aiming a better quality of life for this population group, which is already well represented in the city's most recent population pyramids.

6 citations

Journal ArticleDOI
TL;DR: Foram propostos pontos de corte específicos para MMA para a população de idosos brasileiros e não foram encontradas correlações entre as variáveis do estudo, exceto para AIVD e comorbidades.
Abstract: Se establecieron puntos de corte alternativos para el calculo de la masa muscular apendicular (MMA) en ancianos brasilenos para clasificar la sarcopenia. Fueron analizados datos de 562 ancianos participantes del estudio Fibra (Debilidad en Ancianos Brasilenos), en el polo Belo Horizonte. Por medio de la ecuacion de Lee, se determinaron puntos de corte para MMA basado en la percentil 20 de su distribucion en la poblacion estudiada. Luego, los sujetos fueron clasificados para sarcopenia de acuerdo con los criterios del Consenso Europeo sobre Definicion y Diagnostico de la Sarcopenia en Ancianos, ademas de evaluadas las posibles asociaciones de esta con la capacidad funcional y comorbidades. La gran parte de la muestra fue compuesta por mujeres (el 65,5%) con edad media de 74,1 (±6,4) y promedio de 1,5 (±1,4) comorbidades. Los puntos de corte para MMA fueron

6 citations

Journal Article
TL;DR: In this article, the authors examined the relationship between the fear of falling and difficulty with grocery shopping among seniors, taking into account their functional capacity and found that those who reported difficulty had significantly lower scores for dynamic balance, balance confidence and fall efficacy compared to those who did not.
Abstract: Fear of falling is associated with self-imposed restrictions of basic and instrumental activities of daily living (ADL/IADL), leading greater risk for functional decline and falls. The inability to independently grocery shop, a food-related IADL, negatively affects nutritional status and survival among seniors. Thus, this study examined the relationship between the fear of falling and difficulty with grocery shopping among seniors (n=98, mean age=82, 83% female), taking into account their functional capacity. Demographic profile, eating problems, physical fitness (mobility, balance, endurance, leg strength), and fear of falling (balance confidence, falls efficacy) were measured. Fifty-six percent of participants reported difficulty with grocery shopping. Those who reported difficulty had significantly lower scores for dynamic balance, balance confidence and fall efficacy compared to those who did not. This study revealed a relationship between the fear of falling and perceived difficulty with grocery shopping. Interventions should address fear of falling among the frail seniors.

6 citations

Journal Article
TL;DR: In this article, the relationship between cardiorespiratory fitness and cardiovascular risk factors among obese subjects aged 58 years and older was analyzed using the six-minute walk test, body composition by dual-energy x-ray absorptiometry and blood pressure were measured in a non-representative sample of 76 obese Portuguese subjects.
Abstract: BACKGROUND A better physical fitness may have survival advantages in adults. AIM To analyze the relationship between cardiorespiratory fitness and cardiovascular risk factors among obese subjects aged 58 years and older. MATERIAL AND METHODS Cardiorespiratory fitness using the six-minute walk test, body composition by dual-energy x-ray absorptiometry and blood pressure were measured in a non-representative sample of 76 obese Portuguese subjects aged 58 to 87 years (55 women). Participants were stratified in tertiles of walking capacity according to the six-minute walk test. RESULTS Six minutes walk test results were negatively correlated with percentage body fat (r = -0.28; p = 0.012) and systolic blood pressure (r = -0.23; p = 0.045). Participants located in the lowest tertile for the six minutes walk test had an odds ratio of 4.34 (95% confidence intervals: 1.02-18.43) for elevated blood pressure. CONCLUSIONS A lower six minutes walk test result is associated with a higher risk for high blood pressure.

5 citations

Journal ArticleDOI
TL;DR: El estudio PYCAF nos muestra that los pacientes ancianos tienen mayor prevalencia of enfermedades cronicas cardiovasculares y no cardiov asculares, lo that conduce a una elevada polimedicacion.
Abstract: Resumen Objetivo Describir las caracteristicas clinicas y sociosanitarias de los pacientes mayores de 65 anos atendidos en consultas de atencion primaria. Material y metodos El estudio PYCAF (Prevalencia Y Caracteristicas del Anciano Fragil) es un estudio descriptivo, transversal y multicentrico. Se incluyeron de manera consecutiva sujetos mayores de 65 anos, atendidos en las consultas de atencion primaria de toda Espana en condiciones de practica clinica habitual. Resultados Se analizaron un total de 2.461 pacientes (edad media de 76,0 ± 6,9 anos; 57,9% mujeres). La coexistencia de factores de riesgo cardiovascular y comorbilidades fue frecuente, siendo las mas prevalentes: hipertension arterial (73,7%), dislipidemia (58,3%), artrosis (56,4%), obesidad (34,0%) y diabetes (28,9%). El 13,4% de los pacientes tenian algun grado de deterioro cognitivo. Las mujeres mostraron un mayor grado de fragilidad (61,0% vs. 51,8%; p Conclusiones El estudio PYCAF nos muestra que los pacientes ancianos tienen mayor prevalencia de enfermedades cronicas cardiovasculares y no cardiovasculares, lo que conduce a una elevada polimedicacion. Esta ultima tiene consecuencias tanto en la seguridad del paciente como en los costes directos e indirectos sobre el Sistema Nacional de Salud que emanan de la asistencia al paciente mayor de 65 anos. La prevalencia de fragilidad alcanza a la mitad de la muestra.

5 citations

References
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Journal ArticleDOI
TL;DR: Two scales first standardized on their own population are presented, one of which taps a level of functioning heretofore inadequately represented in attempts to assess everyday functional competence, and the other taps a schema of competence into which these behaviors fit.
Abstract: THE use of formal devices for assessing function is becoming standard in agencies serving the elderly. In the Gerontological Society's recent contract study on functional assessment (Howell, 1968), a large assortment of rating scales, checklists, and other techniques in use in applied settings was easily assembled. The present state of the trade seems to be one in which each investigator or practitioner feels an inner compusion to make his own scale and to cry that other existent scales cannot possibly fit his own setting. The authors join this company in presenting two scales first standardized on their own population (Lawton, 1969). They take some comfort, however, in the fact that one scale, the Physical Self-Maintenance Scale (PSMS), is largely a scale developed and used by other investigators (Lowenthal, 1964), which was adapted for use in our own institution. The second of the scales, the Instrumental Activities of Daily Living Scale (IADL), taps a level of functioning heretofore inadequately represented in attempts to assess everyday functional competence. Both of the scales have been tested further for their usefulness in a variety of types of institutions and other facilities serving community-resident older people. Before describing in detail the behavior measured by these two scales, we shall briefly describe the schema of competence into which these behaviors fit (Lawton, 1969). Human behavior is viewed as varying in the degree of complexity required for functioning in a variety of tasks. The lowest level is called life maintenance, followed by the successively more complex levels of func-

14,832 citations

Journal ArticleDOI
Eric Pfeiffer1
TL;DR: A 10‐item Short Portable Mental Status Questionnaire (SPMSQ), easily administered by any clinician in the office or in a hospital, has been designed, tested, standardized and validated.
Abstract: Clinicians whose practice includes elderly patients need a short, reliable instrument to detect the presence of intellectual impairment and to determine the degree. A 10-item Short Portable Mental Status Questionnaire (SPMSQ), easily administered by any clinician in the office or in a hospital, has been designed, tested, standardized and validated. The standardization and validation procedure included administering the test to 997 elderly persons residing in the community, to 141 elderly persons referred for psychiatric and other health and social problems to a multipurpose clinic, and to 102 elderly persons living in institutions such as nursing homes, homes for the aged, or state mental hospitals. It was found that educational level and race had to be taken into account in scoring individual performance. On the basis of the large community population, standards of performance were established for: 1) intact mental functioning, 2) borderline or mild organic impairment, 3) definite but moderate organic impairment, and 4) severe organic impairment. In the 141 clinic patients, the SPMSQ scores were correlated with the clinical diagnoses. There was a high level of agreement between the clinical diagnosis of organic brain syndrome and the SPMSQ scores that indicated moderate or severe organic impairment.

4,897 citations

Journal ArticleDOI
TL;DR: Among nondisabled older persons living in the community, objective measures of lower-extremity function were highly predictive of subsequent disability.
Abstract: Background Functional assessment is an important part of the evaluation of elderly persons. We conducted this study to determine whether objective measures of physical function can predict subsequent disability in older persons. Methods This prospective cohort study included men and women 71 years of age or older who were living in the community, who reported no disability in the activities of daily living, and who reported that they were able to walk one-half mile (0.8 km) and climb stairs without assistance. The subjects completed a short battery of physical-performance tests and participated in a follow-up interview four years later. The tests included an assessment of standing balance, a timed 8-ft (2.4-m) walk at a normal pace, and a timed test of five repetitions of rising from a chair and sitting down. Results Among the 1122 subjects who were not disabled at base line and who participated in the four-year follow-up, lower scores on the base-line performance tests were associated with a statisticall...

3,388 citations

Journal ArticleDOI
10 Jul 1987-Science
TL;DR: Research on the risks associated with usual aging and strategies to modify them should help elucidate how a transition from usual to successful aging can be facilitated.
Abstract: Research in aging has emphasized average age-related losses and neglected the substantial heterogeneity of older persons. The effects of the aging process itself have been exaggerated, and the modifying effects of diet, exercise, personal habits, and psychosocial factors underestimated. Within the category of normal aging, a distinction can be made between usual aging, in which extrinsic factors heighten the effects of aging alone, and successful aging, in which extrinsic factors play a neutral or positive role. Research on the risks associated with usual aging and strategies to modify them should help elucidate how a transition from usual to successful aging can be facilitated.

2,809 citations

Journal ArticleDOI
TL;DR: Among older people living in the community falls are a strong predictor of placement in a skilled-nursing facility; interventions that prevent falls and their sequelae may therefore delay or reduce the frequency of nursing home admissions.
Abstract: Background Falls warrant investigation as a risk factor for nursing home admission because falls are common and are associated with functional disability and because they may be preventable. Methods We conducted a prospective study of a probability sample of 1103 people over 71 years of age who were living in the community. Data on demographic and medical characteristics, use of health care, and cognitive, functional, psychological, and social functioning were obtained at base line and one year later during assessments in the participants' homes. The primary outcome studied was the number of days from the initial assessment to a first long-term admission to a skilled-nursing facility during three years of follow-up. Patients were assigned to four categories during follow-up: those who had no falls, those who had one fall without serious injury, those who had two or more falls without serious injury, and those who had at least one fall causing serious injury. Results A total of 133 participants (12.1 perce...

1,337 citations