Instrumental Activities of Daily Living as a Potential Marker of Frailty A Study of 7364 Community-Dwelling Elderly Women (the EPIDOS Study)
01 Jul 2001-Journals of Gerontology Series A-biological Sciences and Medical Sciences (Oxford University Press)-Vol. 56, Iss: 7
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: Dietary self-management persists in well, independent seniors without financial constraints, whatever their living arrangements, whereas nutritional risk is high among those in poor health and lacking in resources.
Abstract: Among seniors, food choice and related activities are affected by health status, biological changes wrought by aging and functional abilities, which are mediated in the larger arena by familial, social and economic factors. Determinants of healthy eating stem from individual and collective factors. Individual components include age, sex, education, physiological and health issues, psychological attributes, lifestyle practices, and knowledge, attitudes, beliefs and behaviours, in addition to other universal dietary determinants such as income, social status and culture. Collective determinants of healthy eating, such as accessible food labels, an appropriate food shopping environment, the marketing of the “healthy eating” message, adequate social support and provision of effective, community-based meal delivery services have the potential to mediate dietary habits and thus foster healthy eating. However, there is a startling paucity of research in this area, and this is particularly so in Canada. Using search and inclusion criteria and key search strings to guide the research, this article outlines the state of knowledge and research gaps in the area of determinants of healthy eating among Canadian seniors. In conclusion, dietary self-management persists in well, independent seniors without financial constraints, whatever their living arrangements, whereas nutritional risk is high among those in poor health and lacking in resources. Further study is necessary to clarify contributors to healthy eating in order to permit the development and evaluation of programs and services designed to encourage and facilitate healthy eating in older Canadians.
182 citations
TL;DR: In conclusion, disability and co-morbidity greatly overlap with other deficits that might be used to define frailty and add to their ability to predict mortality.
178 citations
Cites background or result from "Instrumental Activities of Daily Li..."
...Likewise, the consequences of disability and accumulated co-morbidities is perhaps more applicable to the frail older population than to any other segment of the population (Nourhashémi et al., 2001; Topinkova, 2008)....
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...This finding is consistent with previous findings that disability and co-morbidity are highly associated with frailty and that both measures could be used in quantifying it (Nourhashémi et al., 2001; Robinson et al., 2009; Wong et al., 2010)....
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...Likewise, the consequences of disability and accumulated co-morbidities is perhaps more applicable to the frail older population than to any other segment of the population (Nourhashémi et al., 2001; Topinkova, 2008)....
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...This finding is consistent with previous findings that disability and co-morbidity are highly associated with frailty and that both measures could be used in quantifying it (Nourhashémi et al., 2001; Robinson et al., 2009; Wong et al., 2010)....
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TL;DR: Frailty is more strongly associated with self-reported functional decline in older persons than with performance decline, and is independent of chronic diseases.
171 citations
TL;DR: In this paper, a review summarizes evidence that supports the notion that advancing age and physical frailty are associated with a reduction in the fasting rate of mixed and myosin heavy chain protein synthesis, which contributes to muscle protein wasting in advancing age.
Abstract: Age-associated alterations in muscle protein quantity and quality that adversely affect muscle structure, composition, and function have been referred to as sarcopenia. Muscle protein is metabolically active, and the age-associated loss of muscle protein mass is related to a loss of physical function and an inability to perform activities of daily living (physical frailty). It is important to maintain adequate reserves of muscle protein and amino acids as we age. As in all cachectic conditions, sarcopenia can be explained by an imbalance between the rates of muscle protein synthesis and muscle proteolysis, in which net muscle protein balance is negative. This review summarizes evidence that supports the notion that: (a). advancing age and physical frailty are associated with a reduction in the fasting rate of mixed and myosin heavy chain protein synthesis, which contributes to muscle protein wasting in advancing age; (b). this impairment can be corrected because resistance exercise acutely and dramatically increases the rate of muscle protein synthesis in men and women aged 76 years and older; and (c). resistance exercise training maintains a modest increment in the rate of muscle protein synthesis and contributes to muscle hypertrophy and improved muscle strength in frail elderly men and women. The cellular mechanisms responsible for these adaptations, as well as the role of nutrition and hormone replacement in reversing sarcopenia, require further investigation.
166 citations
TL;DR: Las variables that mostraron una asociacion directa con dificultades para realizar ABVD y AIVD en las ciudades estudiadas fueron: padecer de un mayor numero de enfermedades no transmisibles, de ECV o de artrosis, asi como tener mayor edad, ser mujer, evaluar the salud propia como mala, tener deterioro
Abstract: OBJETIVO: Identificar la relacion entre determinadas enfermedades cronicas y la presencia de discapacidad en habitantes de 60 anos o mas de siete centros urbanos de America Latina y el Caribe que participaron en el estudio multicentrico Salud, Bienestar y Envejecimiento (SABE). METODOS: En 2000 y 2001 se realizo un estudio descriptivo de corte transversal con una muestra de 10 891 personas de 60 anos o mas que residian en siete ciudades de la Region: Bridgetown, Barbados; Buenos Aires, Argentina; Ciudad de La Habana, Cuba; Mexico, D.F., Mexico; Montevideo, Uruguay; Santiago, Chile, y Sao Paulo, Brasil. Las variables dependientes fueron la dificultad para realizar actividades basicas y actividades instrumentales de la vida diaria (ABVD y AIVD, respectivamente). Las variables independientes, recopiladas mediante autoinforme, fueron la edad, el sexo, el nivel educacional, el vivir solo o acompanado, la evaluacion de la propia salud y la presencia o no de hipertension arterial, diabetes mellitus, cancer, enfermedad pulmonar obstructiva cronica, cardiopatia isquemica (CI), enfermedades cerebrovasculares (ECV) y artrosis. Se evaluo la presencia de depresion y deterioro cognoscitivo en los participantes y se calculo su indice de masa corporal. Para comparar el grado de influencia de las diferentes variables sobre la discapacidad, se calculo un coeficiente estandarizado para cada caso. RESULTADOS: Las variables que mostraron una asociacion directa con dificultades para realizar ABVD y AIVD en las ciudades estudiadas fueron: padecer de un mayor numero de enfermedades no transmisibles, de ECV o de artrosis, asi como tener mayor edad, ser mujer, evaluar la salud propia como mala, tener deterioro cognoscitivo y padecer de depresion. En general, las asociaciones mas fuertes se encontraron entre la dificultad para realizar AIVD, por un lado, y por el otro la depresion, mayor edad, la evaluacion de la salud propia como mala y la presencia de ECV, artrosis o deterioro cognoscitivo. CONCLUSIONES: Se ofrece por primera vez una descripcion sistematizada de la asociacion entre la presencia de discapacidad y de enfermedades cronicas no transmisibles en adultos mayores en America Latina y el Caribe. Como las dificultades de los adultos mayores para realizar AIVD son las primeras en aparecer, se deben establecer mecanismos de seguimiento que permitan detectar tempranamente este tipo de discapacidad.
161 citations
Cites background from "Instrumental Activities of Daily Li..."
...Las mujeres sufren caídas con mayor frecuencia que los hombres, su función cognoscitiva se deteriora con mayor rapidez y su carga de enfermedades, en particular de artrosis, es mayor (45)....
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...El sexo femenino se ha asociado reiteradamente con la discapacidad (45, 46)....
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References
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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
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
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
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
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