1,721,075 research outputs found
Reliability and Sensitivity to Change Assessed for a Summary Measure of Lower Body Function: Results from the Women’s Health and Aging Study
No full textA summary performance measure comprised of a hierarchical balance task, a 4-meter walk, and five repetitive chair stands is increasingly being used as a predictor of independent living for older persons. The reliability and sensitivity to change of this summary performance measure have not been investigated, however. Because a measure can be reliable while being unresponsive to change, this study presents information on both the reliability and sensitivity to change for the summary performance measure. This is a 3-year prospective cohort study of 1,002 moderately to severely disabled older women. Short- and long-term reliability was assessed by intraclass correlation coefficients (ICC). Sensitivity to change was assessed by slope differences for three age categories (65-74, 75-84, and >or=85) over six 6-month follow-up periods. Sensitivity to change was also assessed by summary performance change scores for those who did and did not suffer from one of four medical events [myocardial infarction (MI), stroke, hip fracture, or congestive heart failure (CHF)] at follow-up. The summary performance measure showed excellent reliability. Intraclass correlation coefficients ranged from 0.88 to 0.92 for measures made 1 week apart. The 6-month average intraclass correlation coefficient was 0.77 (range 0.72-0.79). The summary performance measure was also highly responsive to change. Subjects who suffered an incident MI, stroke, hip fracture, or CHF at follow-up were significantly more likely to have poorer summary performance change scores (-2.25) compared with those who did not have one of these medical events (-0.24). Additionally, subjects who suffered one of these events improved their summary performance scores in the following assessment period by 0.72. With increasing utilization of the summary performance measure by researchers and clinicians it is important that the measurement properties of this instrument are known. Our results show that the summary performance measure has excellent reliability and is highly sensitive to change
Risk factors for falls in older disabled women with diabetes: The women's health and aging study
No full textBackground. The aim of this study was to determine whether older disabled women with diabetes have an increased risk
of falls compared to women without diabetes and to identify fall risk factors among this high-risk subgroup of patients.
Methods. Data are from the Women’s Health and Aging Study I (n1⁄41002, age . 65 years), a prospective, populationbased
cohort study of the one third most disabled women in the Baltimore (MD) urban community-dwelling population.
Participants were followed semiannually for 3 years. Falls were ascertained at each interview. Diabetes was ascertained by
means of a standardized algorithm using multiple sources of information.
Results. Baseline prevalence of diabetes was 15.5%. Of the 878 women who participated in at least one follow-up visit
and were able to walk at baseline, 64.9% fell at least once during the study and 29.6% experienced two or more falls
during a follow-up interval. After adjustment for traditional risk factors, women with diabetes had a higher probability of
any fall (odds ratio [OR] 1.38; 95% confidence interval [CI], 1.04-1.81) and of falling two or more times during a followup
interval (OR 1.69; CI, 1.18-2.43), compared with women without diabetes. Among diabetic women, presence of
widespread musculoskeletal pain (OR 5.58; CI, 1.89-16.5), insulin therapy (OR 2.02; CI, 1.10-3.71), overweight (OR
3.50; CI, 1.21-10.1), and poor lower-extremity performance (OR 7.76; CI, 1.03-58.8) were independently associated with
increased likelihood of recurrent falls, after adjusting for major risk factors. There were synergistic effects of diabetes and
lower-extremity pain and also diabetes and body mass index levels on the risk of falling ( p for interactions , .05).
Conclusion. Even among disabled older women diabetes is associated with an increased risk of falling, independent of
established fall risk factors. In this specific group of older women, pain, high body mass index, and poor lower-extremity
performance are powerful predictors of falling
Association of IGF-I levels with muscle strength and mobility in older women
No full textThe functional consequences of the age-associated decline in IGF-I are unknown. We hypothesized that low IGF-I levels in older women would be associated with poor muscle strength and mobility. We assessed this question in a population representative of the full spectrum of health in the community, obtaining serum IGF-I levels from women aged 70-79 yr, enrolled in the Women's Health and Aging Study I or II. Cross-sectional analyses were performed using 617 women with IGF-I levels drawn within 90 d of measurement of outcomes. After adjustment for age, there was an association between IGF-I and knee extensor strength (P = 0.004), but not anthropometry or other strength measures. We found a positive relationship between IGF-I levels and walking speed for IGF-I levels below 50 microg/liter (P < 0.001), but no relationship above this threshold. A decline in IGF-I level was associated with self-reported difficulty in mobility tasks. All findings were attenuated after multivariate adjustment. In summary, in a study population including frail and healthy older women, low IGF-I levels were associated with poor knee extensor muscle strength, slow walking speed, and self-reported difficulty with mobility tasks. These findings suggest a role for IGF-I in disability as well as a potential target population for interventions to raise IGF-I levels
Risk factors for falling in homedwelling older women with stroke: The Women’s Health and Aging Study
No full textBACKGROUND AND PURPOSE: Much of our knowledge of risk factors for falls comes from studies of the general population. The aim of this study was to estimate the risk of falling associated with commonly accepted and stroke-specific factors in a home-dwelling stroke population. METHODS: This study included an analysis of prospective fall reports in 124 women with confirmed stroke over 1 year. Variables relating to physical and mental health, history of falls, stroke symptoms, self-reported difficulties in activities of daily living, and physical performance tests were collected during home assessments. RESULTS: Risk factors for falling commonly reported in the general population, including performance tests of balance, incontinence, previous falls, and sedative/hypnotic medications, did not predict falls in multivariate analyses. Frequent balance problems while dressing were the strongest risk factor for falls (odds ratio, 7.0). Residual balance, dizziness, or spinning stroke symptoms were also a strong risk factor for falling (odds ratio, 5.2). Residual motor symptoms were not associated with an increased risk of falling. CONCLUSIONS: Interventions to reduce the frequency of balance problems during complex tasks may play a significant role in reducing falls in stroke. Clinicians should be aware of the increased risk of falling in women with residual balance, dizziness, or spinning stroke symptoms and recognize that risk assessments developed for use in the general population may not be appropriate for stroke patients
What constitutes normal hemoglobin concentration in community-dwelling disabled older women?
No full textOBJECTIVES: To examine the associations between hemoglobin (Hb) concentration and (1) 5-year all-cause mortality and (2) serum erythropoietin (EPO), as the basis for the identification of data-driven thresholds, and to assess the clinical relevance of mildly low Hb. DESIGN: Prospective study. SETTING: Population based. PARTICIPANTS: Community-dwelling women aged 65 and older with moderate-to-severe disability--Women's Health and Aging Study I, Baltimore, Maryland, 1992-2000. METHODS: Proportional hazards regression was used to model the relationship between baseline Hb (available for 686 subjects) and time to death. A generalized linear model was used to assess the cross-sectional association between Hb and EPO in 641 subjects. RESULTS: A curvilinear slope of steady mortality decrease up to the Hb threshold of 13.9 g/dL was observed. Hb of 11 g/dL was independently associated with greater mortality than the World Health Organization (WHO) low-normal cutoff of Hb of 12 g/dL (hazard ratio (HR)=1.2, 95% confidence interval (CI)=1.1-1.4), whereas Hb of 14 g/dL was linked to 24% lower mortality (HR=0.76, 95% CI=0.63-0.92), after comprehensive adjustment for major health status and disease-burden indicators. A curvilinear, statistically significant slope of steady EPO decrease with increasing Hb up to the threshold of 14.3 g/dL was consistently observed. CONCLUSION: The meaningfully lower mortality risk with higher Hb levels provides empirical evidence against the notion that Hb currently perceived as mildly low is clinically benign. Furthermore, the mortality risk gradient observed even within the WHO normal Hb range suggests that Hb levels higher than what is currently recommended might offer clinical advantage. The relationship between Hb and EPO provided supporting physiological evidence for this hypothesis
Low serum vitamin D does not predict new disability and loss in muscle strength in elderly women
No full textOBJECTIVES: To determine whether serum levels of 25-hydroxyvitamin D (25(OH)D) and parathyroid hormone (PTH) predict accelerated decline in muscular strength or onset of new disability in mobility and upper extremity functioning over a 3-year follow-up. DESIGN: A community-based prospective cohort study. PARTICIPANTS: Six hundred twenty-eight moderately to severely disabled women aged 65 and older living in the community. MEASUREMENTS: Subjects were divided into three groups of baseline 25(OH)D serum levels (deficiency: or =53 nmol/L) and into tertiles of PTH levels. Objective performance measures (hip flexor, knee extensor, and grip strengths; walking speed; and time for repeated chair stands) and disability in activities involving mobility and upper extremity function were assessed at baseline and every 6 months for 3 years. Decline in performance measures and onset of new disability were compared between 25(OH)D and PTH groups using random effects models and proportional hazards models, respectively, while adjusting for age, race, education, body mass index, baseline performance, and chronic conditions. RESULTS: The annual rate of decline over 3 years in muscular strength, walking speed, and time to perform repeated chair stands was similar across 25(OH)D groups. We observed a nonsignificantly faster decline in proximal muscle strength and walking speed with increasing PTH levels. There was no association for either measure between serum levels and the risk of incident disability in activities relating to mobility and upper extremity function. CONCLUSION: This study does not support the hypothesis that vitamin D deficiency is associated with loss in muscular strength and decline in mobility and upper extremity functioning over time in older women who were moderately to severely disabled at baseline
Progression of lower-extremity disability in older women with diabetes: the Women's Health and Aging Study
No full textOBJECTIVE: Older patients with diabetes are more likely to have a higher prevalence of multiple risk factors for physical disability, as a result of diabetic complications. We evaluated the pace of decline in lower-extremity function and the risk for progression of disability in older women with diabetes. RESEARCH DESIGN AND METHODS: We conducted a 3-year longitudinal cohort study of a random sample of 729 physically impaired older women (age > or =65 years) living in the community (Baltimore, MD). Diabetes was ascertained by standard criteria. Self-reported functional status and objective performance measures were assessed at baseline and over six semiannual follow-up visits. RESULTS: The baseline prevalence of diabetes was 14.4%. After adjustment for age and compared with women without diabetes, those with diabetes had an RR of 1.8 (95% CI 1.3-2.5) for incident mobility disability and 1.6 (1.2-2.1) for incident activity of daily living disability. The increased incidence of new disability associated with diabetes was paralleled by a greater decline in objective measures of lower-extremity function. Adjustment for multiple risk factors for disability did not significantly attenuate the risk for disability associated with diabetes. CONCLUSIONS: In older patients, impaired lower-extremity function is a long-term diabetic complication. Comprehensive assessment of older diabetic patients should include a standardized evaluation of lower-extremity performance
Hand grip strength, cause-specific mortality and total mortality in older disabled women: exploring the mechanism
No full textOBJECTIVES: To examine the association between muscle strength and total and cause-specific mortality and the plausible contributing factors to this association, such as presence of diseases commonly underlying mortality, inflammation, nutritional deficiency, physical inactivity, smoking, and depression. DESIGN: Prospective population-based cohort study with mortality surveillance over 5 years. SETTING: Elderly women residing in the eastern half of Baltimore, Maryland, and part of Baltimore County. PARTICIPANTS: Nine hundred nineteen moderately to severely disabled women aged 65 to 101 who participated in handgrip strength testing at baseline as part of the Women's Health and Aging Study. MEASUREMENTS: Cardiovascular disease (CVD), cancer, respiratory disease, other measures (not CVD, respiratory, or cancer), total mortality, handgrip strength, and interleukin-6. RESULTS: Over the 5-year follow-up, 336 deaths occurred: 149 due to CVD, 59 due to cancer, 38 due to respiratory disease, and 90 due to other diseases. The unadjusted relative risk (RR) of CVD mortality was 3.21 (95% confidence interval (CI) = 2.00-5.14) in the lowest and 1.88 (95% CI = 1.11-3.21) in the middle compared with the highest tertile of handgrip strength. The unadjusted RR of respiratory mortality was 2.38 (95% CI = 1.09-5.20) and other mortality 2.59 (95% CI = 1.59-4.20) in the lowest versus the highest grip-strength tertile. Cancer mortality was not associated with grip strength. After adjusting for age, race, body height, and weight, the RR of CVD mortality decreased to 2.17 (95% CI = 1.26-3.73) in the lowest and 1.56 (95% CI = 0.89-2.71) in the middle, with the highest grip-strength tertile as the reference. Further adjustments for multiple diseases, physical inactivity, smoking, interleukin-6, C-reactive protein, serum albumin, unintentional weight loss, and depressive symptoms did not materially change the risk estimates. Similar results were observed for all-cause mortality. CONCLUSION: In older disabled women, handgrip strength was a powerful predictor of cause-specific and total mortality. Presence of chronic diseases commonly underlying death or the mechanisms behind decline in muscle strength in chronic disease, such as inflammation, poor nutritional status, disuse, and depression, all of which are independent predictors of mortality, did not explain the association. Handgrip strength, an indicator of overall muscle strength, may predict mortality through mechanisms other than those leading from disease to muscle impairment. Grip strength tests may help identify patients at increased risk of deterioration of health
Cardiovascular Disease, Interleukin-6 and the Risk of Mortality in older Women: The Women's Health and Aging Study
No full textBACKGROUND: Systemic chronic inflammation has been found to be related to all-cause mortality risk in older persons. We investigated whether specific chronic conditions, particularly cardiovascular disease (CVD), affect the association between high interleukin (IL)-6 level and mortality in a sample of disabled older women. METHODS AND RESULTS: IL-6 serum level was measured at baseline in 620 women >/=65 years old. The presence and severity of medical conditions was ascertained by standard criteria that used multiple sources of information. The sample was surveyed over the 3-year follow-up. After adjustment for potential confounders, compared with those in the lowest tertile, women in the highest IL-6 tertile were at higher risk of all-cause mortality. The presence of CVD, however, strongly affected the risk of mortality associated with high IL-6. Among women with prevalent CVD, those with high IL-6 levels had >4-fold risk of death (RR 4.6; 95% CI 2.0 to 10.5) compared with women in the lowest tertile, whereas the relative risk associated with high IL-6 among those without CVD was much lower and not significant (RR 1.8; 95% CI 0.7 to 4.2). Adjustment for all chronic diseases and disease severity measures, including ankle-brachial index, forced expiratory volume, and exercise tolerance, did not change the results. CONCLUSIONS: IL-6 level is helpful in identifying a subgroup of older CVD patients with high risk of death over a period of 3 years. Systemic inflammation, as measured by IL-6, may be related to the clinical evolution of older patients with CVD
Comorbidities and impairments explaining the association between diabetes and lower extremity disability: The women's health and aging study
No full textOBJECTIVE: To elucidate the role of diabetes-related impairments and comorbidities in the association between diabetes and physical disability, this study examined the association between diabetes and lower extremity function in a sample of disabled older women. RESEARCH DESIGN AND METHODS: Cross-sectional analysis of 1,002 women (aged >or=65 years) enrolled in the Women's Health and Aging Study (one-third most disabled of the total community-dwelling population). Diabetes and other medical conditions were ascertained by standard criteria that used multiple sources of information. Functional status was assessed using self-reported and objective performance measures. RESULTS: Women with diabetes were significantly more likely to have cardiovascular diseases, peripheral nerve dysfunction, visual impairment, obesity, and depression. After adjustment for age, women with diabetes had a greater prevalence of mobility disability (odds ratio [OR] 1.85, 95% CI 1.12-3.06), activities of daily living disability (1.61, 1.06-2.43), and severe walking limitation (2.34, 1.56-3.50), and their summary mobility performance score (0-12 scale based on balance, gait speed, chair stands) was 1.4 points lower than in nondiabetic women (P < 0.001). Peripheral artery disease, peripheral nerve dysfunction, and depression were the main individual contributing factors; however, none of these conditions alone fully explained the association between diabetes and disability. Conversely, only after adjusting for all potential mediators was the relationship between diabetes and disability reduced to a large degree. CONCLUSIONS: Even among physically impaired older women, diabetes is associated with a major burden of disability. A wide range of impairments and comorbidities explains the diabetes-disability relationship, suggesting that the mechanism for such an association is multifactorial
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