Objectives
To examine the association between multiple measures of visual impairment (VI) and incident mobility limitations in older adults.
Design
Prospective observational cohort study.
Setting
...Memphis, Tennessee, and Pittsburgh, Pennsylvania.
Participants
Health, Aging and Body Composition study participants aged 70 to 79 without mobility limitations at the Year 3 visit (N = 1,862).
Measurements
Vision was measured at the Year 3 visit, and VI was defined as distance visual acuity (VA) worse than 20/40, contrast sensitivity (CS) less than 1.55 log Contrast, and stereoacuity (SA) greater than 85 arcsec. Incident persistent walking and stair climbing limitation was defined as two consecutive 6‐month reports of any difficulty walking one‐quarter of a mile or walking up 10 steps after 1, 3, and 5 years of follow‐up.
Results
At Year 3 (baseline for these analyses), 7.4% had impaired VA, 27.2% had impaired CS, and 29.2% had impaired SA. At all follow‐up times, the incidence of walking and stair climbing limitations was higher in participants with VA, CS, or SA impairment. After 5 years, impaired CS and SA were independently associated with greater risk of walking limitation (hazard ratio (HR)CS = 1.3, 95% confidence interval (CI) = 1.1–1.7; HRSA = 1.3, 95% CI = 1.1–1.6) and stair climbing limitation (HRCS = 1.4, 95% CI = 1.1–1.8; HRSA = 1.3, 95% CI=1.1–1.7). Having impaired CS and SA was associated with greater risk of mobility limitations (HRwalking limitations = 2.0, 95% CI = 1.6–2.5; HRstair limitation = 2.1, 95% CI = 1.6–2.8).
Conclusion
Multiple aspects of VI may contribute to mobility limitations in older adults. Addressing more than one component of vision may be needed to reduce the effect of vision impairment on functional decline.
Personality traits and cardiorespiratory fitness in older adults are reliable predictors of health and longevity. We examined the association between personality traits and energy expenditure at rest ...(basal metabolic rate) and during normal and maximal sustained walking. Personality traits and oxygen (VO(2)) consumption were assessed in 642 participants from the Baltimore Longitudinal Study of Aging. Results indicate that personality traits were mostly unrelated to resting metabolic rate and energy expenditure at normal walking pace. However, those who scored lower on neuroticism (r = -0.12) and higher on extraversion (r = 0.11), openness (r = 0.13), and conscientiousness (r = 0.09) had significantly higher energy expenditure at peak walking pace. In addition to greater aerobic capacity, individuals with a more resilient personality profile walked faster and were more efficient in that they required less energy per meter walked. The associations between personality and energy expenditure were not moderated by age or sex, but were in part explained by the proportion of fat mass. In conclusion, differences in personality may matter the most during more challenging activities that require cardiorespiratory fitness. These findings suggest potential pathways that link personality to health outcomes, such as obesity and longevity.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Objectives
To evaluate perceived fatigability as a predictor of meaningful functional decline in non‐mobility‐limited older adults.
Design
Longitudinal analysis of data from the Baltimore ...Longitudinal Study of Aging (BLSA).
Setting
National Institute on Aging, Clinical Research Unit, Baltimore, Maryland.
Participants
Men and women aged 60 to 89 participating in the BLSA with concurrent perceived fatigability and functional assessments and follow‐up functional assessment within 1 to 3 years (N = 540).
Measurements
Perceived fatigability was ascertained using the Borg rating of perceived exertion (RPE) after 5 minutes of treadmill walking at 1.5 miles per hour. Functional assessments included usual and fast gait speed, the Health, Aging and Body Composition physical performance battery (HABC PPB) and reported walking ability. Reported tiredness and energy level were examined as complementary predictors. Covariates included age, age squared, race, follow‐up time, and baseline function. Meaningful decline was defined as 0.05 m/s per year for usual gait speed, 0.07 m/s per year for fast gait speed, 0.12 points/year for HABC PPB, and 1 point for walking ability index.
Results
Over a mean 2.1 years, 20–31% of participants declined across functional assessments. Fatigability was associated with a 13–19% greater likelihood of meaningful decline in all measures (P = .002– .02) per 1‐unit RPE increase. After considering tiredness and energy level separately, findings were essentially unchanged, and neither was associated with gait speed or physical performance decline. In contrast, each separately predicted decline in reported walking ability independent of fatigability (P = .03 and P < .001, respectively).
Conclusion
Routine assessment of fatigability may help identify older persons vulnerable to greater‐than‐expected functional decline.
IMPORTANCE Hypoglycemia commonly occurs in patients with diabetes mellitus (DM) and may negatively influence cognitive performance. Cognitive impairment in turn can compromise DM management and lead ...to hypoglycemia. OBJECTIVE To prospectively evaluate the association between hypoglycemia and dementia in a biracial cohort of older adults with DM. DESIGN AND SETTING Prospective population-based study. PARTICIPANTS We studied 783 older adults with DM (mean age, 74.0 years; 47.0% of black race/ethnicity; and 47.6% female) who were participating in the prospective population-based Health, Aging, and Body Composition Study beginning in 1997 and who had baseline Modified Mini-Mental State Examination scores of 80 or higher. MAIN OUTCOME MEASURES Dementia diagnosis was determined during the follow-up period from hospital records indicating an admission associated with dementia or the use of prescribed dementia medications. Hypoglycemic events were determined during the follow-up period by hospital records. RESULTS During the 12-year follow-up period, 61 participants (7.8%) had a reported hypoglycemic event, and 148 (18.9%) developed dementia. Those who experienced a hypoglycemic event had a 2-fold increased risk for developing dementia compared with those who did not have a hypoglycemic event (34.4% vs 17.6%, P < .001; multivariate-adjusted hazard ratio, 2.1; 95% CI, 1.0-4.4). Similarly, older adults with DM who developed dementia had a greater risk for having a subsequent hypoglycemic event compared with participants who did not develop dementia (14.2% vs 6.3%, P < .001; multivariate-adjusted hazard ratio, 3.1; 95% CI, 1.5-6.6). Further adjustment for stroke, hypertension, myocardial infarction, and cognitive change scores produced similar results. CONCLUSION AND RELEVANCE Among older adults with DM, there seems to be a bidirectional association between hypoglycemia and dementia.
Assessing Fatigability in Mobility-Intact Older Adults Simonsick, Eleanor M.; Schrack, Jennifer A.; Glynn, Nancy W. ...
Journal of the American Geriatrics Society (JAGS),
February 2014, Letnik:
62, Številka:
2
Journal Article
Recenzirano
Odprti dostop
Objectives
To evaluate the criterion validity of two measures of fatigability, defined as performance deterioration or perceived effort to perform a standardized task.
Design
Cross‐sectional analysis ...of data from the Baltimore Longitudinal Study of Aging (BLSA).
Setting
National Institute on Aging, Intramural Research Program, Clinical Research Unit, Baltimore, Maryland.
Participants
Six hundred five men (53.7%) and women aged 65 to 97 participating in the BLSA and eligible for endurance walk testing without a walking aid.
Measurements
Fatigability was assessed using completion status and lap times from a 400‐m walk performed “as quickly as possible” and perceived exertion rating using the Borg scale (range 6–20) after 5 minutes of treadmill walking at 1.5 miles per hour (0.67 m/s). Criterion measures included self‐report of tiredness, level of weakness and energy in past month, and walking ability and objective measures of usual and fast gait speed, time to complete 10 chair stands, and grip strength. Covariates included age, race, sex, obesity, smoking status, and walking activity.
Results
Of mobility‐intact older persons, 23% exhibited performance deterioration (slowed or stopped) during the 400‐m walk, and one‐third reported more than very light exertion after a 5‐minute slow walk. Slowing was strongly associated with self‐reported fatigue and walking ability but weakly associated with performance‐based mobility measures. High perceived exertion was associated with tiredness, weakness, and reported and observed mobility deficits.
Conclusion
Slowing down may have low sensitivity for identifying fatigability in older persons, but ascertaining perceived exertion during a defined workload shows promise. In seemingly healthy, motivated individuals, fatigue and fatigability were common and may affect socially meaningful mobility behaviors. Assessment of fatigability in well‐elderly examinations may help identify threats to independent functioning earlier in the decline process.
Physical activity (PA) prevents disease and promotes longevity; yet, few older adults meet the recommended daily guidelines. Wearable PA and heart rate monitors provide the opportunity to define ...age-related differences in the absolute and relative intensity of daily activities, and provide insight into the underlying factors influencing PA in older adults.
Participants in the Baltimore Longitudinal Study of Aging (n = 440, 52% male, aged 31 to 88 years) completed a clinical assessment and wore an Actiheart monitor in the free-living environment. The association between age and minutes per day in sedentary, light, moderate, and vigorous PA was assessed using relative intensity, as defined by heart rate reserve, and absolute intensity using activity count thresholds.
In cross-sectional analyses, time spent in sedentary and light activities as defined by relative intensity did not differ across age (p > 0.05), whereas time spent in moderate and vigorous relative PA was higher for each 1 year increase in age (p < .01). Using absolute intensity PA thresholds, older adults registered fewer activity counts per day with more sedentary time and lesser amounts of light, moderate, and vigorous PA (p < .05). Persons with higher relative and lower absolute PA intensity had poorer functional performance and higher subclinical disease indicators.
These findings suggest that time spent in moderate or higher intensity activities may not be lower with age after considering changes in physiology, functional ability, and subclinical disease burden and highlight the need for more age- and ability-specific PA research to inform future interventions and public health guidelines.
Objectives: To define clinically relevant cutpoints for usual gait speed and to investigate their predictive value for health‐related events in older persons.
Design: Prospective cohort study.
...Setting: Health, Aging and Body Composition Study.
Participants: Three thousand forty‐seven well‐functioning older persons (mean age 74.2).
Measurements: Usual gait speed on a 6‐m course was assessed at baseline. Participants were randomly divided into two groups to identify (Sample A; n=2,031) and then validate (Sample B; n=1,016) usual gait‐speed cutpoints. Rates of persistent lower extremity limitation events (mean follow‐up 4.9 years) were calculated according to gait speed in Sample A. A cutpoint (defining high‐ (<1 m/s) and low risk (≥1 m/s) groups) was identified based on persistent lower extremity limitation events. The predictive value of the identified cutpoints for major health‐related events (persistent severe lower extremity limitation, death, and hospitalization) was evaluated in Sample B using Cox regression analyses.
Results: A graded response was seen between risk groups and health‐related outcomes. Participants in the high‐risk group had a higher risk of persistent lower extremity limitation (rate ratio (RR)=2.20, 95% confidence interval (CI)=1.76–2.74), persistent severe lower extremity limitation (RR=2.29, 95% CI=1.63–3.20), death (RR=1.64, 95% CI=1.14–2.37), and hospitalization (RR=1.48, 95% CI=1.02–2.13) than those in the low‐risk group.
Conclusion: Usual gait speed of less than 1 m/s identifies persons at high risk of health‐related outcomes in well‐functioning older people. Provision of a clinically meaningful cutpoint for usual gait speed may facilitate its use in clinical and research settings.
Abstract
Background
Socioeconomics may explain black–white differences in physical performance; few studies examine racial differences among socioeconomically similar groups. Performance is also ...affected by body composition and specific strength, which differ by race. We assessed whether racial differences in physical performance exist among older adults with high education and similar income and whether body composition and specific strength attenuate observed differences.
Methods
Cross-sectional analysis of 536 men (18% black) and 576 women (28% black) aged more than 60 years from the Baltimore Longitudinal Study of Aging. Body composition was evaluated using dual-energy x-ray absorptiometry. Specific strength was assessed by quadricep peak torque divided by height-normalized thigh cross-sectional area and grip strength divided by body mass index-normalized appendicular lean mass. Physical performance was assessed using usual gait speed and fast 400 m walk time. Sex-stratified linear regression models, adjusted for age, height, education, and recent income, determined whether body composition or specific strength attenuated associations between race and physical performance.
Results
Blacks were younger, with higher weight and appendicular lean mass. Black women had higher percent fat and specific strength. In both sexes, blacks had poorer physical performance after adjustment for socioeconomic factors. In women, neither body composition nor specific strength altered the association with gait speed. In men, neither body composition nor specific strength attenuated racial differences in either performance measure.
Conclusions
Poorer physical performance among black compared to white older adults persists among persons with high education and similar income and cannot generally be attributed to differences in body composition or specific strength.
Diet quality may be protective of physical function and muscle strength during aging.
We aimed to investigate associations of the Mediterranean-Dietary Approaches to Stop Hypertension (DASH) ...Intervention for Neurodegenerative Delay (MIND) diet with physical function and grip strength.
Data were obtained from men and women in the Baltimore Longitudinal Study of Aging (mean ± SD age: 68 ± 14 y at first diet visit; n = 1358). Diet was assessed by FFQ. MIND diet score was calculated from 15 food groups, with a higher score indicating better diet quality; tertile categories of averaged MIND score across visits were used. Physical function was assessed using the Short Physical Performance Battery (SPPB), with a score < 10 indicative of impaired function, and the Health, Aging and Body Composition Physical Performance Battery (HABCPPB). The highest value of grip strength over 3 trials was used. Multivariable logistic and linear mixed-effects models were examined with repeated measurements of physical function and grip strength, respectively.
MIND score was inversely associated with physical function impairment (per 1-point increment: OR: 0.81; 95% CI: 0.71, 0.93; P < 0.01), and with each SPPB component, over a median 6 y of follow-up. Participants in the highest compared with the lowest tertile of MIND diet score had 57% lower odds of functional impairment (OR: 0.43; 95% CI: 0.25, 0.73; P < 0.01), and slower decline by the HABCPPB. Men and women in the highest compared with the lowest tertiles of MIND score had 1.86-kg (95% CI: 0.33, 3.40 kg; P < 0.05) and 1.24-kg (95% CI: 0.04, 2.45 kg; P < 0.05) greater grip strength, respectively.
Adherence to the MIND dietary pattern was associated with lower odds of physical function impairment and decline, and with better muscle strength, indicating that the MIND dietary pattern may be protective of physical functional health in older adults.
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Background: In older adults, every 0.1-m/s slower gait speed is associated with a 12% higher mortality. However, little research has identified risk factors for gait-speed decline.Objective: We ...assessed the association between several measures of body composition and age-related decline in gait speed.Design: Data were from 2306 older adults who were participating in the Health, Aging, and Body Composition cohort and were followed for 4 y (50% women; 38% black). Usual walking speed (m/s) over 20 m was measured in years 2 through 6, and the baseline and changes in several measures of body composition were included in mixed-effects models.Results: Gait speed declined by 0.06 ± 0.00 m/s over the 4-y period. Baseline thigh intermuscular fat predicted the annual gait-speed decline (±SE) in both men and women (−0.01 ± 0.00 and −0.02 ± 0.00 m/s per 0.57 cm2, respectively; P < 0.01). In men, but not in women, this relation was independent of total body adiposity. In longitudinal analyses, changes in thigh intermuscular fat and total thigh muscle were the only body-composition measures that predicted gait-speed decline in men and women combined. When modeled together, every 5.75-cm2 increase in thigh intermuscular fat was associated with a 0.01 ± 0.00-m/s decrease in gait speed, whereas every 16.92-cm2 decrease in thigh muscle was associated with a 0.01 ± 0.00-m/s decrease in gait speed.Conclusions: High and increasing thigh intermuscular fat are important predictors of gait-speed decline, implying that fat infiltration into muscle contributes to a loss of mobility with age. Conversely, a decreasing thigh muscle area is also predictive of a decline in gait speed.
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