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BACKGROUND/OBJECTIVES: To assess whether gait speed under complex conditions predicts long-term risk for mobility disability as well as or better than usual-pace gait speed. DESIGN: Longitudinal cohort study. SETTING/PARTICIPANTS: Subsample of Health Aging and Body Composition study with follow-up from 2002 to 2003 to 2010 to 2011, including 337 community-dwelling adults (mean age = 78.5 years, 50.7% female, 26.1% black). MEASUREMENTS: Associations of gait speed measured under usual-pace, fast-pace, dual-task, and narrow-path conditions with mobility disability, defined by any self-reported difficulty walking » mile assessed annually, were tested by Cox proportional hazard models adjusted for demographic and health characteristics. Models were fitted for each walking condition, and R2 statistics were used to compare predictive value across models. Models were repeated for persistent mobility disability, defined as at least two consecutive years of mobility disability. RESULTS: Mobility disability occurred in 204 (60.5%) participants over the 8-year follow-up. There was a lower hazard of developing mobility disability with faster gait speed under all conditions. Hazard ratios, confidence intervals, and R2 of gait speed predicting mobility disability were similar across all four walking conditions (R2 range = 0.22-0.27), but were strongest for dual-task gait speed (hazard ratio [95% confidence interval], R2 of fully adjusted models = 0.81 [0.75-0.88], 0.27). Results were comparable for persistent mobility disability (R2 range = 0.26-0.28). CONCLUSION: Slower gait speed under both usual-pace and complex conditions may be a clinical indicator of future risk of mobility disability. These results support the call for increased use of gait speed measures in routine geriatric care. J Am Geriatr Soc 67:2072-2076, 2019.

Asunto(s)

Evaluación de la Discapacidad , Limitación de la Movilidad , Velocidad al Caminar , Anciano , Artralgia/epidemiología , Artralgia/fisiopatología , Estudios de Cohortes , Depresión/epidemiología , Diabetes Mellitus/epidemiología , Personas con Discapacidad , Femenino , Humanos , Articulación de la Rodilla/fisiopatología , Estudios Longitudinales , Masculino , Obesidad/epidemiología , Pruebas de Función Respiratoria , Factores Sexuales

RESUMEN

BACKGROUND: Performance on complex walking tasks may provide a screen for future cognitive decline. OBJECTIVE: To identify walking tasks that are most strongly associated with subsequent cognitive decline. METHODS: Community-dwelling older adults with Modified Mini-Mental State (3MS) >85 at baseline (n = 223; mean age = 78.7, 52.5% women, 25.6% black) completed usual-pace walking and three complex walking tasks (fast-pace, narrow-path, visuospatial dual-task). Slope of 3MS scores for up to 9 subsequent years (average = 5.2) were used to calculate a cognitive maintainer (slope ≥0) or decliner (slope <0) outcome variable. Logistic regression models assessed associations between gait speeds and being a cognitive decliner. A sensitivity analysis in a subsample of individuals (n = 66) confirmed results with adjudicated mild cognitive impairment (MCI) or dementia at 8-9 years post-walking assessment. RESULTS: Cognitive decliners were 52.5% of the sample and on average were slower for all walking tasks compared to maintainers. In models adjusted for demographic and health variables, faster fast-pace (OR = 0.87 per 0.1 m/s, 95% CI: 0.78, 0.97) and dual-task (OR = 0.84 per 0.1 m/s, 95% CI: 0.73, 0.96) gait speeds were associated with lower likelihood of being a cognitive decliner. Usual-pace gait speed was not associated (OR = 0.96 per 0.1 m/s, 95% CI: 0.85, 1.08). Results were nearly identical in analyses with adjudicated MCI or dementia as the outcome. CONCLUSION: Fast-pace and dual-task walking may provide simple and effective tools for assessing risk for cognitive decline in older individuals with high cognitive function. Such screening tools are important for strategies to prevent or delay onset of clinically meaningful change.

Asunto(s)

Disfunción Cognitiva/diagnóstico , Caminata , Anciano , Anciano de 80 o más Años , Cognición , Disfunción Cognitiva/fisiopatología , Disfunción Cognitiva/psicología , Estudios de Cohortes , Demencia/diagnóstico , Demencia/fisiopatología , Femenino , Humanos , Masculino , Pruebas Neuropsicológicas , Pronóstico , Medición de Riesgo , Sensibilidad y Especificidad

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OBJECTIVE: We assessed associations between specific personality factors and health, and tested whether specific personality factors were related to health outcomes independent of each other. METHOD: We performed cross-sectional analyses of personality and health among a sample of community-dwelling older men (n = 613, M age = 81.4, SD = 5.04 years) living in Pittsburgh, Pennsylvania. RESULTS: Personality factors (dispositional optimism, conscientiousness, and goal adjustment) were crudely related to both physical and mental health, but adjusting for other personality factors completely attenuated several of these associations. Conscientiousness remained uniquely related to every physical and mental health outcome. Optimism remained uniquely related to all health outcomes, except physical activity (which was more highly related to conscientiousness and goal adjustment). Associations between goal adjustment and probable depression appeared to be explained by conscientiousness and optimism. DISCUSSION: Correlations among multiple aspects of personality may mask unique associations of specific personality aspects with successful aging.

Asunto(s)

Estado de Salud , Personalidad , Anciano , Anciano de 80 o más Años , Envejecimiento/psicología , Estudios Transversales , Depresión/psicología , Objetivos , Humanos , Vida Independiente , Masculino , Pennsylvania

RESUMEN

OBJECTIVES: To study the association between blood lead concentration (BPb) and bone mineral density (BMD), physical function, and cognitive function in noninstitutionalized community-dwelling older men. DESIGN: Cross-sectional study. SETTING: University of Pittsburgh clinic, Pittsburgh, Pennsylvania. PARTICIPANTS: Non-Hispanic Caucasian men aged 65 and older (N = 445) recruited as a subset of a prospective cohort for the Osteoporotic Fractures in Men Study. MEASUREMENTS: BPb was measured in 2007/08. From 2007 to 2009, BMD (g/cm(2)) was measured using dual-energy X-ray absorptiometry. At the same time, physical performance was measured using five tests: grip strength, leg extension power, walking speed, narrow-walk pace, and chair stands. Cognitive performance was assessed using the modified Mini-Mental State Examination and the Trail-Making Test Part B. Participants were categorized into quartiles of BPb. Multivariate regression analysis was used to evaluate the independent relationship between BPb, BMD, and cognitive and physical function. RESULTS: Mean BPb ± standard deviation was 2.25 ± 1.20 µg/dL (median 2 µg/dL, range 1-10 µg/dL). In multivariate-adjusted models, men in higher BPb quartiles had lower BMD at femoral neck and total hip (P-trend < .001 for both). Men with higher BPb had lower age-adjusted score for grip strength (P-trend < .001), although this association was not significant in multivariate-adjusted models (P-trend < .15). BPb was not associated with lumbar spine BMD, cognition, leg extension power, walking speed, narrow-walk pace, or chair stands. CONCLUSION: Environmental lead exposure may adversely affect bone health in older men. These findings support consideration of environmental exposure in age-associated bone fragility.

Asunto(s)

Carga Corporal (Radioterapia) , Densidad Ósea/fisiología , Fuerza de la Mano , Plomo/sangre , Osteoporosis/inducido químicamente , Absorciometría de Fotón , Anciano , Antropometría , Trastornos del Conocimiento/diagnóstico , Estudios Transversales , Humanos , Masculino , Pruebas Neuropsicológicas , Osteoporosis/diagnóstico por imagen , Factores de Riesgo , Espectrofotometría Atómica , Encuestas y Cuestionarios , Estados Unidos

RESUMEN

OBJECTIVE: To assess whether sensorimotor peripheral nerve function is associated with muscle power in community-dwelling older men. DESIGN: Longitudinal cohort study with 2.3±0.3 years of follow-up. SETTING: One clinical site. PARTICIPANTS: Participants (n=372; mean age ± SD, 77.2±5.1y; 99.5% white; body mass index, 27.9±3.7kg/m(2); power, 1.88±0.6W/kg) at 1 site of the Osteoporotic Fractures in Men Study (N=5994). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: A nerve function ancillary study was performed 4.6±0.4 years after baseline. Muscle power was measured using a power rig. Peroneal motor nerve conduction amplitude, distal motor latency, and mean f-wave latency were measured. Sensory nerve function was assessed using 10-g and 1.4-g monofilaments and sural sensory nerve conduction amplitude and distal latency. Peripheral neuropathy symptoms at the leg and feet were assessed by self-report. RESULTS: After adjustments for age, height, and total body lean and fat mass, 1 SD lower motor (ß=-.07, P<.05) and sensory amplitude (ß=-.09, P<.05) and 1.4-g (ß=-.11, P<.05) and 10-g monofilament insensitivity (ß=-.17, P<.05) were associated with lower muscle power/kg. Compared with the effect of age on muscle power (ß per year, -.05; P<.001), this was equivalent to aging 1.4 years for motor amplitude, 1.8 years for sensory amplitude, 2.2 years for 1.4-g monofilament detection, and 3.4 years for 10-g detection. Baseline 1.4-g monofilament detection predicted a greater decline in muscle power/kg. Short-term change in nerve function was not associated with concurrent short-term change in muscle power/kg. CONCLUSIONS: Worse sensory and motor nerve function were associated with lower muscle power/kg and are likely important for impaired muscle function in older men. Monofilament sensitivity was associated with a greater decline in muscle power/kg, and screening may identify an early risk for muscle function decline in late life, which has implications for disability.

Asunto(s)

Extremidad Inferior/fisiología , Fuerza Muscular/fisiología , Conducción Nerviosa/fisiología , Nervio Peroneo/fisiología , Nervio Sural/fisiología , Potenciales de Acción/fisiología , Anciano , Anciano de 80 o más Años , Envejecimiento/fisiología , Estudios de Cohortes , Humanos , Modelos Lineales , Estudios Longitudinales , Extremidad Inferior/inervación , Masculino

RESUMEN

National Institute for Occupational Safety and Health (NIOSH) certified particulate respirators need to be properly fit tested before use to ensure workers' respiratory protection. However, the effectiveness of American National Standards Institute-/Occupational Safety and Health Administration (ANSI-/OSHA)-accepted fit tests for particulate respirators in predicting actual workplace protection provided to workers is lacking. NIOSH addressed this issue by evaluating the fit of half-mask particulate filtering respirators as a component of a program designed to add total inward leakage (TIL) requirements for all respirators to Title 42 Code of Federal Regulations Part 84. Specifically, NIOSH undertook a validation study to evaluate the reproducibility of the TIL test procedure between two laboratories. A PortaCount® was used to measure the TIL of five N95 model filtering facepiece respirators (FFRs) on test subjects in two different laboratories. Concurrently, filter efficiency for four of the five N95 FFR models was measured using laboratory aerosol as well as polydisperse NaCl aerosol employed for NIOSH particulate respirator certification. Results showed that two N95 models passed the TIL tests at a rate of ~80-85% and ~86-94% in the two laboratories, respectively. However, the TIL passing rate for the other three N95 models was 0-5.7% in both laboratories combined. Good agreement (≥83%) of the TIL data between the two laboratories was obtained. The three models that had relatively lower filter efficiency for laboratory aerosol as well as for NaCl aerosol showed relatively low TIL passing rates in both laboratories. Of the four models tested for penetration, one model with relatively higher efficiency showed a higher passing rate for TIL tests in both laboratories indicating that filter efficiency might influence TIL. Further studies are needed to better understand the implications of the data in the workplace.

Asunto(s)

Contaminantes Ocupacionales del Aire/análisis , Falla de Equipo , Filtración/instrumentación , Exposición por Inhalación/prevención & control , Máscaras/normas , Ensayo de Materiales/métodos , Dispositivos de Protección Respiratoria/normas , Aerosoles , Diseño de Equipo/normas , Humanos , Exposición por Inhalación/análisis , National Institute for Occupational Safety and Health, U.S. , Exposición Profesional/prevención & control , Salud Laboral , Tamaño de la Partícula , Reproducibilidad de los Resultados , Estados Unidos

RESUMEN

OBJECTIVES: The objective of this study was to explore the associations between openness to experience and conscientiousness, two dimensions of the five-factor model of personality, and usual gait speed and gait speed decline. METHOD: Baseline analyses were conducted on 907 men and women aged 71-82 years participating in the Cognitive Vitality substudy of the Health, Aging, and Body Composition study. The longitudinal analytic sample consisted of 740 participants who had walking speed assessed 3 years later. RESULTS: At baseline, gait speed averaged 1.2 m/s, and an average decline of 5% over the 3-year follow-up period was observed. Higher conscientiousness was associated with faster initial walking speed and less decline in walking speed over the study period, independent of sociodemographic characteristics. Lifestyle factors and disease status appear to play a role in the baseline but not the longitudinal association between conscientiousness and gait speed. Openness was not associated with either initial or decline in gait speed. DISCUSSION: These findings extend the body of evidence suggesting a protective association between conscientiousness and physical function to performance-based assessment of gait speed. Future studies are needed to confirm these associations and to explore mechanisms that underlie the conscientiousness mobility connection in aging adults.

Asunto(s)

Composición Corporal , Cognición , Conciencia , Marcha , Limitación de la Movilidad , Caminata , Anciano , Anciano de 80 o más Años , Femenino , Estudios de Seguimiento , Evaluación Geriátrica/métodos , Estado de Salud , Humanos , Estudios Longitudinales , Masculino , Actividad Motora

RESUMEN

OBJECTIVES: To examine the association between openness to experience and conscientiousness and incident reported walking limitation. METHOD: The study population consisted of 786 men and women aged 71-81 years (M = 75 years, SD = 2.7) participating in the Health, Aging, and Body Composition-Cognitive Vitality Substudy. RESULTS: Nearly 20% of participants (155/786) developed walking limitation during 6 years of follow-up. High openness was associated with a reduced risk of walking limitation (hazard ratio [HR] = 0.83, 95% confidence interval [CI] = 0.69-0.98), independent of sociodemographic factors, health conditions, and conscientiousness. This association was not mediated by lifestyle factors and was not substantially modified by other risk factors for functional disability. Conscientiousness was not associated with risk of walking limitation (HR = 0.91, 95% CI = 0.77-1.07). DISCUSSION: Findings suggest that personality dimensions, specifically higher openness to experience, may contribute to functional resilience in late life.

Asunto(s)

Anciano/fisiología , Anciano/psicología , Estado de Salud , Estilo de Vida , Limitación de la Movilidad , Personalidad , Caminata , Anciano de 80 o más Años , Envejecimiento/fisiología , Envejecimiento/psicología , Composición Corporal , Femenino , Estudios de Seguimiento , Humanos , Masculino , Fenómenos Fisiológicos Musculoesqueléticos , Rango del Movimiento Articular , Estados Unidos

RESUMEN

The objective of this study was to determine if ultraviolet germicidal irradiation (UVGI), moist heat incubation (MHI), or microwave-generated steam (MGS) decontamination affects the fitting characteristics, odor, comfort, or donning ease of six N95 filtering facepiece respirator (FFR) models. For each model, 10 experienced test subjects qualified for the study by passing a standard OSHA quantitative fit test. Once qualified, each subject performed a series of fit tests to assess respirator fit and completed surveys to evaluate odor, comfort, and donning ease with FFRs that were not decontaminated (controls) and with FFRs of the same model that had been decontaminated. Respirator fit was quantitatively measured using a multidonning protocol with the TSI PORTACOUNT Plus and the N95 Companion accessory (designed to count only particles resulting from face to face-seal leakage). Participants' subjective appraisals of the respirator's odor, comfort, and donning ease were captured using a visual analog scale survey. Wilcoxon signed rank tests compared median values for fit, odor, comfort, and donning ease for each FFR and decontamination method against their respective controls for a given model. Two of the six FFRs demonstrated a statistically significant reduction (p < 0.05) in fit after MHI decontamination. However, for these two FFR models, post-decontamination mean fit factors were still ≥ 100. One of the other FFRs demonstrated a relatively small though statistically significant increase (p < 0.05) in median odor response after MHI decontamination. These data suggest that FFR users with characteristics similar to those in this study population would be unlikely to experience a clinically meaningful reduction in fit, increase in odor, increase in discomfort, or increased difficulty in donning with the six FFRs included in this study after UVGI, MHI, or MGS decontamination. Further research is needed before decontamination of N95 FFRs for purposes of reuse can be recommended.

Asunto(s)

Descontaminación/métodos , Odorantes , Dispositivos de Protección Respiratoria , Femenino , Humanos , Exposición por Inhalación/prevención & control , Masculino , Ensayo de Materiales , Microondas , Exposición Profesional/prevención & control , Vapor

RESUMEN

CONTEXT: Survival estimates help individualize goals of care for geriatric patients, but life tables fail to account for the great variability in survival. Physical performance measures, such as gait speed, might help account for variability, allowing clinicians to make more individualized estimates. OBJECTIVE: To evaluate the relationship between gait speed and survival. DESIGN, SETTING, AND PARTICIPANTS: Pooled analysis of 9 cohort studies (collected between 1986 and 2000), using individual data from 34,485 community-dwelling older adults aged 65 years or older with baseline gait speed data, followed up for 6 to 21 years. Participants were a mean (SD) age of 73.5 (5.9) years; 59.6%, women; and 79.8%, white; and had a mean (SD) gait speed of 0.92 (0.27) m/s. MAIN OUTCOME MEASURES: Survival rates and life expectancy. RESULTS: There were 17,528 deaths; the overall 5-year survival rate was 84.8% (confidence interval [CI], 79.6%-88.8%) and 10-year survival rate was 59.7% (95% CI, 46.5%-70.6%). Gait speed was associated with survival in all studies (pooled hazard ratio per 0.1 m/s, 0.88; 95% CI, 0.87-0.90; P < .001). Survival increased across the full range of gait speeds, with significant increments per 0.1 m/s. At age 75, predicted 10-year survival across the range of gait speeds ranged from 19% to 87% in men and from 35% to 91% in women. Predicted survival based on age, sex, and gait speed was as accurate as predicted based on age, sex, use of mobility aids, and self-reported function or as age, sex, chronic conditions, smoking history, blood pressure, body mass index, and hospitalization. CONCLUSION: In this pooled analysis of individual data from 9 selected cohorts, gait speed was associated with survival in older adults.

Asunto(s)

Marcha , Esperanza de Vida , Anciano , Estudios de Cohortes , Femenino , Evaluación Geriátrica/métodos , Humanos , Masculino , Análisis de Supervivencia , Estados Unidos/epidemiología

RESUMEN

BACKGROUND: A possible familial component to fracture risk may be mediated through a genetic liability to fall recurrently. METHODS: Our analysis sample included 186 female sibling-ships (n=401) of mean age 71.9 yr (SD=5.0). Using variance component models, we estimated residual upper-limit heritabilities in fall-risk mobility phenotypes (e.g., chair-stand time, rapid step-ups, and usual-paced walking speed) and in recurrent falls. We also estimated familial and environmental (unmeasured) correlations between pairs of fall-risk mobility phenotypes. All models were adjusted for age, height, body mass index, and medical and environmental factors. RESULTS: Residual upper-limit heritabilities were all moderate (P<0.05), ranging from 0.27 for usual-paced walking speed to 0.58 for recurrent falls. A strong familial correlation between usual-paced walking speed and rapid step-ups of 0.65 (P<0.01) was identified. Familial correlations between usual-paced walking speed and chair-stand time (-0.02) and between chair-stand time and rapid step-ups (-0.27) were both nonsignificant (P>0.05). Environmental correlations ranged from 0.35 to 0.58 (absolute values), P<0.05 for all. CONCLUSIONS: There exists moderate familial resemblance in fall-risk mobility phenotypes and recurrent falls among older female siblings, which we expect is primarily genetic given that adult siblings live separate lives. All fall-risk mobility phenotypes may be coinfluenced at least to a small degree by shared latent familial or environmental factors; however, up to approximately one-half of the covariation between usual-paced walking speed and rapid step-ups may be due to a common set of genes.

Asunto(s)

Accidentes por Caídas , Fracturas Óseas/genética , Actividad Motora , Sistema Musculoesquelético/fisiopatología , Accidentes por Caídas/prevención & control , Anciano , Ambiente , Femenino , Fracturas Óseas/etnología , Fracturas Óseas/fisiopatología , Fracturas Óseas/prevención & control , Predisposición Genética a la Enfermedad , Evaluación Geriátrica , Herencia , Humanos , Modelos Estadísticos , Linaje , Fenotipo , Recurrencia , Medición de Riesgo , Factores de Riesgo , Hermanos , Estados Unidos/epidemiología , Caminata , Población Blanca/genética

RESUMEN

OBJECTIVES: To determine whether sensory and motor nerve function is associated cross-sectionally with quadriceps or ankle dorsiflexion strength in an older community-based population. DESIGN: Cross-sectional analyses within a longitudinal cohort study. SETTING: Two U.S. clinical sites. PARTICIPANTS: Two thousand fifty-nine Health, Aging and Body Composition Study (Health ABC) participants (49.5% male, 36.7% black, aged 73-82) in 2000/01. MEASUREMENTS: Quadriceps and ankle strength were measured using an isokinetic dynamometer. Sensory and motor peripheral nerve function in the legs and feet was assessed using 10-g and 1.4-g monofilaments, vibration threshold, and peroneal motor nerve conduction amplitude and velocity. RESULTS: Monofilament insensitivity, poorest vibration threshold quartile (>60 mu), and poorest motor nerve conduction amplitude quartile (<1.7 mV) were associated with 11%, 7%, and 8% lower quadriceps strength (all P<.01), respectively, than in the best peripheral nerve function categories in adjusted linear regression models. Monofilament insensitivity and lowest amplitude quartile were both associated with 17% lower ankle strength (P<.01). Multivariate analyses were adjusted for demographic characteristics, diabetes mellitus, body composition, lifestyle factors, and chronic health conditions and included all peripheral nerve measures in the same model. Monofilament insensitivity (beta=-7.19), vibration threshold (beta=-0.097), and motor nerve conduction amplitude (beta=2.01) each contributed independently to lower quadriceps strength (all P<.01). Monofilament insensitivity (beta=-5.29) and amplitude (beta=1.17) each contributed independently to lower ankle strength (all P<.01). Neither diabetes mellitus status nor lean mass explained the associations between peripheral nerve function and strength. CONCLUSION: Reduced sensory and motor peripheral nerve function is related to poorer lower extremity strength in older adults, suggesting a mechanism for the relationship with lower extremity disability.

Asunto(s)

Envejecimiento/fisiología , Composición Corporal/fisiología , Pierna/inervación , Neuronas Motoras/fisiología , Fuerza Muscular/fisiología , Nervios Periféricos/fisiología , Células Receptoras Sensoriales/fisiología , Actividades Cotidianas/clasificación , Anciano , Estudios de Cohortes , Estudios Transversales , Neuropatías Diabéticas/diagnóstico , Neuropatías Diabéticas/fisiopatología , Femenino , Evaluación Geriátrica , Humanos , Masculino , Examen Neurológico , Estudios Prospectivos , Músculo Cuádriceps/inervación , Valores de Referencia , Umbral Sensorial/fisiología , Estados Unidos , Vibración

RESUMEN

CONTEXT: There is substantial variability across ethnic groups in the predisposition to obesity and associated metabolic abnormalities. Skeletal muscle fat has been identified as an important depot that increases with aging and may contribute to the development of diabetes. OBJECTIVE: We tested whether men of African ancestry have greater calf intermuscular adipose tissue (IMAT), compared to Caucasian men, and whether IMAT is associated with type 2 diabetes (T2D). DESIGN: We measured fasting serum glucose, body mass index, total body fat by dual-energy x-ray absorptiometry, and calf skeletal muscle composition by quantitative computed tomography in 1105 Caucasian and 518 Afro-Caribbean men aged 65+. RESULTS: Compared to Caucasian men, we found greater IMAT and lower sc adipose tissue in Afro-Caribbean men at all levels of total adiposity (P < 0.0001), including the subset of men matched on age and dual-energy x-ray absorptiometry total body fat percentage (P < 0.001). In addition, IMAT was 29 and 23% greater, whereas sc adipose tissue was 6 and 8% lower among Caucasian and Afro-Caribbean men with T2D, respectively, compared to men without T2D (P < 0.01). Observed differences in intermuscular and sc fat, both ethnic and between men with and without T2D, were independent of age, height, calf skeletal muscle and total adipose tissue, and lifestyle factors. CONCLUSIONS: Our analyses suggest that despite lower total adiposity, skeletal muscle fat infiltration is greater among African than among Caucasian ancestry men and is associated with T2D in both ethnic groups. Additional studies are needed to determine the mechanisms contributing to ethnic differences in skeletal muscle adiposity and to define the metabolic and health implications of this fat depot.

Asunto(s)

Tejido Adiposo/metabolismo , Envejecimiento/metabolismo , Composición Corporal , Músculo Esquelético/anatomía & histología , Tejido Adiposo/anatomía & histología , Adiposidad , Anciano , Población Negra , Índice de Masa Corporal , Humanos , Resistencia a la Insulina , Masculino , Caminata , Población Blanca

RESUMEN

OBJECTIVES: To determine whether positive affect is associated with a lower incidence of frailty over 2 years in elderly community-dwelling women and to test the stress-buffering hypothesis by evaluating whether these associations differed in caregivers and noncaregivers. DESIGN: Prospective cohort study with three annual interviews conducted in four U.S. communities between 1999 and 2004. SETTING: Home-based interviews. PARTICIPANTS: Three hundred thirty-seven caregiver and 617 noncaregiver participants from the Caregiver-Study of Osteoporotic Fractures (Caregiver-SOF) who were not frail at the baseline Caregiver-SOF interview. MEASUREMENTS: High and low positive affect and depressive symptoms were derived from the baseline 20-item Center for Epidemiologic Studies Depression Scale. Frailty was the development of three or more indicators (weight loss, exhaustion, slow walking speed, or weak grip strength) at the first or second follow-up interview. RESULTS: Respondents' mean age was 81.2. Caregivers and noncaregivers had similar levels of positive affect (56.3% vs 58.3%) and frailty incidence (15.4% vs 15.9%) but differed in perceived stress (mean Perceived Stress Scale score 16.7 vs 14.8, P<.001). Frailty risk was lower in respondents with high positive affect than in those with low positive affect in the total sample (adjusted hazard ratio (HR)=0.49, 95% confidence interval (CI)=0.35-0.70), caregivers (adjusted HR=0.44, 95% CI=0.24-0.80) and noncaregivers (adjusted HR=0.50, 95% CI=0.32-0.77). CONCLUSION: These findings add to the evidence that positive affect protects against health decline in older adults, although it had no additional stress-buffering effect on health in elderly caregivers.

Asunto(s)

Afecto , Cuidadores/psicología , Depresión/psicología , Fracturas Óseas/psicología , Anciano Frágil , Osteoporosis/psicología , Estrés Psicológico/psicología , Actividades Cotidianas , Anciano , Anciano de 80 o más Años , Depresión/complicaciones , Depresión/epidemiología , Femenino , Fracturas Óseas/epidemiología , Fracturas Óseas/etiología , Humanos , Incidencia , Entrevistas como Asunto , Osteoporosis/complicaciones , Osteoporosis/epidemiología , Modelos de Riesgos Proporcionales , Estudios Prospectivos , Escalas de Valoración Psiquiátrica , Factores de Riesgo , Estrés Psicológico/epidemiología , Estrés Psicológico/etiología , Encuestas y Cuestionarios , Estados Unidos/epidemiología

RESUMEN

OBJECTIVE: To examine the association of fast-adapting receptor-mediated vibrotactile sensitivity and slow-adapting receptor-mediated pressure sensitivity with self-selected usual gait speed and gait speed over a challenging narrow (20 cm wide) course. DESIGN: Participants from the population-based older cohort of the Health ABC study were included (n = 1721; age: 76.4 +/- 2.8 yrs). Usual gait speed over 6 m and gait speed over a 6-m narrow course were measured. Vibration perception threshold (100 Hz) was measured on the plantar surface, and monofilament testing (1.4 and 10 g) was performed on the dorsum of the great toe. Covariates including knee extensor torque, standing balance, visual acuity and contrast sensitivity, knee pain, depressive symptoms, high fasting glucose levels, and peripheral arterial disease were evaluated. RESULTS: Vibrotactile and monofilament sensitivity were significantly worse in slower gait speed groups in both walking conditions (P < 0.001 to P = 0.015). Adjusting for covariates, vibrotactile (P < 0.001) but not monofilament sensitivity (P = 0.655) was independently associated with self-selected normal gait speed. Neither sensory function was associated with narrow-base gait speed. CONCLUSIONS: In the elderly, poor lower limb vibrotactile sensitivity measured on the plantar surface of the great toe, but not the pressure sensitivity as measured by monofilament testing on the dorsum of the great toe, is independently associated with slower self-selected normal gait speed. Narrow-based walking seems to depend on other neuromuscular mechanisms.

Asunto(s)

Pie/fisiología , Limitación de la Movilidad , Caminata/fisiología , Anciano , Estudios de Cohortes , Prueba de Esfuerzo , Femenino , Humanos , Masculino , Reflejo Anormal/fisiología , Trastornos Somatosensoriales/complicaciones

RESUMEN

OBJECTIVE: Poor peripheral nerve function is prevalent in diabetes and older populations, and it has great potential to contribute to poor physical performance. RESEARCH DESIGN AND METHODS: Cross-sectional analyses were done for the Health, Aging, and Body Composition (Health ABC) Study participants (n = 2,364; 48% men; 38% black; aged 73-82 years). Sensory and motor peripheral nerve function in legs/feet was assessed by 10- and 1.4-g monofilament perception, vibration detection, and peroneal motor nerve conduction amplitude and velocity. The Health ABC lower-extremity performance battery was a supplemented version of the Established Populations for the Epidemiologic Studies of the Elderly battery (chair stands, standing balance, and 6-m walk), adding increased stand duration, single foot stand, and narrow walk. RESULTS: Diabetic participants had fewer chair stands (0.34 vs. 0.36 stands/s), shorter standing balance time (0.69 vs. 0.75 ratio), slower usual walking speed (1.11 vs. 1.14 m/s), slower narrow walking speed (0.80 vs. 0.90 m/s), and lower performance battery score (6.43 vs. 6.93) (all P < 0.05). Peripheral nerve function was associated with each physical performance measure independently. After addition of peripheral nerve function in fully adjusted models, diabetes remained significantly related to a lower performance battery score and slower narrow walking speed but not to chair stands, standing balance, or usual walking speed. CONCLUSIONS: Poor peripheral nerve function accounts for a portion of worse physical performance in diabetes and may be directly associated with physical performance in older diabetic and nondiabetic adults. The impact of peripheral nerve function on incident disability should be evaluated in older adults.

Asunto(s)

Población Negra , Neuropatías Diabéticas/epidemiología , Nervios Periféricos/fisiopatología , Enfermedades del Sistema Nervioso Periférico/epidemiología , Aptitud Física , Población Blanca , Absorciometría de Fotón , Anciano , Composición Corporal , Índice de Masa Corporal , Estudios Transversales , Femenino , Humanos , Entrevistas como Asunto , Estilo de Vida , Masculino , Pennsylvania , Equilibrio Postural , Postura , Valores de Referencia , Caminata

RESUMEN

OBJECTIVE: Older adults with type 2 diabetes are more likely to fall, but little is known about risk factors for falls in this population. We determined whether diabetes-related complications or treatments are associated with risk of falls in older diabetic adults. RESEARCH DESIGN AND METHODS: In the Health, Aging, and Body Composition cohort of well-functioning older adults, participants reported falls in the previous year at annual visits. Odds ratios (ORs) for more frequent falls among 446 diabetic participants whose mean age was 73.6 years, with an average follow-up of 4.9 years, were estimated with continuation ratio models. RESULTS: In the first year, 23[corrected]% reported falling; 22, 26, 30[corrected], and 31[corrected]% fell in subsequent years. In adjusted models, reduced peroneal nerve response amplitude (OR 1.50 -95% CI 1.07-2.12], worst quartile versus others); higher cystatin-C, a marker of reduced renal function (1.38 [1.11-1.71], for 1 SD increase); poorer contrast sensitivity (1.41 [0.97-2.04], worst quartile versus others); and low A1C in insulin users (4.36 [1.32-14.46], A1C 8%) were associated with risk of falls. In those using oral hypoglycemic medications but not insulin, low A1C was not associated with risk of falls (1.29 [0.65-2.54], A1C 8%). Adjustment for physical performance explained some, but not all, of these associations. CONCLUSIONS: In older diabetic adults, reducing diabetes-related complications may prevent falls. Achieving lower A1C levels with oral hypoglycemic medications was not associated with more frequent falls, but, among those using insulin, A1C

Asunto(s)

Accidentes por Caídas/estadística & datos numéricos , Diabetes Mellitus Tipo 2/complicaciones , Diabetes Mellitus Tipo 2/tratamiento farmacológico , Accidentes por Caídas/prevención & control , Factores de Edad , Anciano , Glucemia/metabolismo , Estudios de Cohortes , Complicaciones de la Diabetes/sangre , Complicaciones de la Diabetes/prevención & control , Diabetes Mellitus Tipo 2/sangre , Femenino , Estudios de Seguimiento , Hemoglobina Glucada/metabolismo , Humanos , Hipoglucemiantes/efectos adversos , Hipoglucemiantes/uso terapéutico , Insulina/efectos adversos , Insulina/uso terapéutico , Masculino , Oportunidad Relativa , Factores de Riesgo

RESUMEN

BACKGROUND: Breast cancer survival is inversely related to body mass index (BMI), but previous studies have not included large numbers of older women. This study investigated the association between BMI and mortality after breast cancer diagnosis in a cohort of older Caucasian women enrolled in the Study of Osteoporotic Fractures. METHODS: All women were age >or=65 at study entry (N = 533). Cox proportional hazards regression analysis was used to determine the effect of BMI as a continuous variable on risk of all-cause, cardiovascular, any cancer, and breast cancer mortality. Interaction terms were included to evaluate effect modification by age at diagnosis. RESULTS: Mean age at diagnosis was 78.0 years (SD 5.7) with an average of 8.1 years (SD 4.4) of follow-up after diagnosis. There were 206 deaths during follow-up. The effect of BMI on mortality depended on age (P(interaction) = 0.02). At age 65, the risk of mortality was 1.4 times higher for a BMI of 27.3 kg/m(2) [95% confidence interval (95% CI), 1.03-2.01] and 2.4 times higher for a BMI of 34.0 kg/m2 (95% CI, 1.07-5.45) compared with women with a BMI of 22.6 kg/m2. At age 85, risk of death was lower for a BMI of 27.3 kg/m2 (hazard ratio, 0.81; 95% CI, 0.65-1.01) or a BMI of 34.0 kg/m2 (hazard ratio, 0.61; 95% CI, 0.36-1.02) compared with a BMI of 22.6 kg/m2. Similar results were observed for any cancer and breast cancer mortality. BMI was not associated with cardiovascular mortality. CONCLUSIONS: In this population of older women, the effect of increased BMI on risk of mortality after breast cancer varied by age. These results differ from those observed among populations of younger postmenopausal breast cancer survivors.

Asunto(s)

Índice de Masa Corporal , Neoplasias de la Mama/mortalidad , Fracturas de Cadera/epidemiología , Osteoporosis/complicaciones , Sobrevivientes , Distribución por Edad , Anciano , Anciano de 80 o más Años , Estatura , Neoplasias de la Mama/epidemiología , Estudios de Cohortes , Femenino , Fracturas de Cadera/etiología , Humanos , Obesidad/complicaciones , Posmenopausia , Estudios Prospectivos , Factores de Riesgo , Tasa de Supervivencia , Estados Unidos/epidemiología

RESUMEN

OBJECTIVES: To examine the association between poorer performance on concurrent walking and reaction time and recurrent falls. DESIGN: Cross-sectional analysis. SETTING: Community. PARTICIPANTS: Three hundred seventy-seven older community-dwelling adults (mean age+/-standard deviation 78+/-3). MEASUREMENTS: Reaction times on push-button and visual-spatial decision tasks were assessed while seated and while walking a 20-m course (straight walk) and a 20-m course with a turn at 10 m (turn walk). Walking times were recorded while walking only and while performing a reaction-time response. Dual-task performance was calculated as the percentage change in task times when done in dual-task versus single-task conditions. A history of recurrent falls (> or = 2 vs < or = 1 falls) in the prior 12 months was self-reported. Multivariate logistic regression models were used to predict the standardized odds ratios (ORs) of recurrent falls history. The standardized unit for dual-task performance ORs was interquartile range/2. RESULTS: On the push-button task during the turn walk, poorer reaction time response (slower) was associated with 28% lower (P=.04) odds of recurrent fall history. On the visual-spatial task, poorer walking-time response (slower) was associated with 34% (P=.02) and 42% (P=.01) higher odds of recurrent falls history on the straight and turn walks, respectively. CONCLUSION: These findings suggest that walking more slowly in response to a visual-spatial decision task may identify individuals at risk for multiple falls. Prospective studies are needed to confirm the prognostic value of poor walking responses in a dual-task setting for multiple falls.

Asunto(s)

Accidentes por Caídas , Evaluación Geriátrica , Tiempo de Reacción , Análisis y Desempeño de Tareas , Caminata , Anciano , Estudios Transversales , Femenino , Conductas Relacionadas con la Salud , Humanos , Modelos Logísticos , Masculino

RESUMEN

Physical activity and physical performance have been linked to fall risk in the elderly. The authors examined the relation between physical activity and physical performance with incident falls in the Osteoporotic Fractures in Men Study, a large prospective cohort study of 5,995 community-dwelling men in the United States at least 65 years of age. The authors also examined what types of activities are associated with falling. Incident falls between 2000 and 2005 were captured from up to 17 triannual follow-up questionnaires per participant and analyzed with generalized estimating equations. Follow-up averaged 4.5 years. The average risk of falling in the first 4 months of follow-up was 6.6%. The most active quartile had a significantly greater fall risk than did the least active quartile (relative risk = 1.18, 95% confidence interval (CI): 1.07, 1.29). Men with greater leg power and grip strength had significantly reduced fall risk (for highest leg power quartile vs. lowest: relative risk = 0.82, 95% CI: 0.73, 0.92; for highest grip strength quartile vs. lowest: relative risk = 0.76, 95% CI: 0.69, 0.85). Partitioning components of activity showed no association between fall risk and leisure activities but a positive association with household activities (for highest quartile vs.lowest: relative risk = 1.17, 95% CI: 1.07, 1.28).

Asunto(s)

Accidentes por Caídas/estadística & datos numéricos , Actividades Cotidianas , Evaluación Geriátrica , Actividad Motora , Accidentes por Caídas/prevención & control , Anciano , Antropometría , Estudios de Seguimiento , Fracturas Óseas/epidemiología , Fracturas Óseas/etiología , Fuerza de la Mano , Humanos , Incidencia , Pierna/fisiopatología , Actividades Recreativas , Modelos Lineales , Modelos Logísticos , Masculino , Análisis Multivariante , Debilidad Muscular/complicaciones , Debilidad Muscular/fisiopatología , Osteoporosis/complicaciones , Osteoporosis/epidemiología , Medición de Riesgo , Factores de Riesgo , Encuestas y Cuestionarios , Estados Unidos/epidemiología