BACKGROUND AND AIMS: The level of physical functioning (PF) late in life has, in recent years, been shown to be influenced by genetic factors. One of the most extensively studied genetic variants associated with PF and trainability is insertion/deletion (I/D) polymorphism in the gene encoding Angiotensin Converting Enzyme (ACE). However, ACE studies have mainly been conducted among younger persons in excellent physical shape. In this study, we examine whether the level of PF, trainability, or rate-of-change are associated with the ACE genotype among the elderly. METHODS: We used data from 4 randomized training studies of elderly Danes (N = 203). The measures of PF were self-report, maximal oxygen uptake, muscle strength, walking speed, and body composition. RESULTS: Overall, a favorable change in the measures of PF was observed in training groups compared with control groups. However, within groups, neither pre- or post-training/control period levels of PF nor differences in pre- and post-levels were associated with the ACE genotype. CONCLUSIONS: On the basis of our randomized studies, we could not detect any association between the ACE genotype and the level of PF or change, regardless of whether response to physical training or spontaneous changes was studied.
This study examines the adequacy of the dietary intake based on age, sex, and level of nutritional risk among 98 frail elderly persons receiving home care through Community Care Access Centres. The dietary intakes were measured using 24-hour recalls and were compared with the dietary reference intake. The participants' intakes of both macronutrients and micronutrients were found to be inadequate. On average, elderly persons were consuming more than the recommended amount of protein, but the average intakes of many vitamins and minerals were less than optimal based on the average intakes. Paradoxically, more than half of elderly participants were overweight or obese. The results highlight the need for appropriate nutrition, education, and support for elderly persons receiving home care.
Throughout the world all populations are seeing burgeoning numbers of "elders", defined as persons aged 65 year and older. In many countries, including Japan, the United States, Norway, Sweden and the United Kingdom, those aged over 65 are at or approaching 15% of the population. As their numbers have increased, so have their health care expenses, leading to extensive research on the health, well being, and life expectancy of these increasingly older elders. Today this group is further sub-divided: the young-old ages 65-74, the old-old ages 75-84, and the oldest-old ages 85+, for both health care and research purposes. However broad variation still characterizes even these groupings. Rates of frailty and disability increase with increasing age among these elders. For example, inabilities to complete at least one activity of daily living increased from about 5-7% at ages 65-69 years to about 28-36% at ages 85+ in 1987. Death rates continue to decline at all ages past 50 years and rates of disability seem to be doing the same. For the foreseeable future, we may expect increasing numbers of older, frail elders than in previous decades. Thus, people are not only living longer, they generally are healthier at advanced ages than were previous cohorts, thus "old age" disabilities of the 20th century will be put off to even older ages during the 21st century. As yet there is no clear way to assess senescent changes in humans, although activities of daily living, allostatic load, and frailty indices have all been suggested. One future need is greater development and use of universal and accessible design in all aspects of the built environment.
Although apolipoprotein E (ApoE) polymorphism is associated with variable risks of several illnesses, and with mortality, no persuasive relationship has been demonstrated with frailty. Here, the clinical examination cohort (n=1452 older adults, aged 70+ years at baseline) of the Canadian Study of Health and Aging was evaluated, with 5-year follow-up data. Frailty was defined using both the phenotypic definition from the Cardiovascular Health Study (Frailty-CHS) and the 'Frailty Index', from which age-specific trajectories of deficit accumulation can be estimated. In age-sex adjusted analyses, people with ApoE 4 allele had a higher risk of death (hazard ratio [HR]=1.20; 95% confidence interval: 1.01-1.45), but this relationship was not significant when adjusted for cognitive impairment (1.06; 95% confidence interval: 0.88-1.27). There was no association between frailty and ApoE polymorphism, defined in age-sex adjusted models either as Frailty-CHS (ApoE4 HR 1.17; 95% confidence interval: 0.98-1.40, frailty HR 1.37; 95% confidence interval: 1.28-1.46) or by the Frailty Index (ApoE4 HR 1.07; 95% confidence interval: 0.90-1.29, frailty HR 35.3; 95% confidence interval: 20.4-61.1). The data do not support an association between ApoE polymorphism and frailty. This result did not depend on how frailty was defined.
To evaluate the potential of an artificial neural network (ANN) in predicting survival in elderly Canadians, using self-report data.
Cohort study with up to 72 months follow-up.
Forty self-reported characteristics were obtained from the community sample of the Canadian Study of Health and Aging. An individual frailty index score was calculated as the proportion of deficits experienced. For the ANN, randomly selected participants formed the training sample to derive relationships between the variables and survival and the validation sample to control overfitting. An ANN output was generated for each subject. A separate testing sample was used to evaluate the accuracy of prediction.
A total of 8,547 Canadians aged 65 to 99, of whom 1,865 died during 72 months of follow-up.
The output of an ANN model was compared with an unweighted frailty index in predicting survival patterns using receiver operating characteristic (ROC) curves.
The area under the ROC curve was 86% for the ANN and 62% for the frailty index. At the optimal ROC value, the accuracy of the frailty index was 70.0%. The ANN accuracy rate over 10 simulations in predicting the probability of individual survival mean+/-standard deviation was 79.2+/-0.8%.
An ANN provided more accurate survival classification than an unweighted frailty index. The data suggest that the concept of biological redundancy might be operationalized from health survey data.
The aim of this study was to investigate the use and need of assistive devices (ADs) in a cross-national European sample of very old persons, focusing on national similarities and differences as well as similarities and differences according to age and level of health status. Data from the ENABLE-AGE research project were utilized involving very old persons in Sweden, Germany, Latvia, Hungary, and the United Kingdom (UK). Personal interviews with single-living old persons were conducted (n = 1918). Of the total sample 65% reported that they had and used one or more ADs, and 24% reported unfilled need. The most commonly used ADs were devices for communication, followed by devices for mobility. Participants in Hungary and Latvia used a lower total number of ADs. Comparisons among sub-groups according to age between the Western and the Eastern European national samples showed significant differences. The result can to some extent be explained by different welfare systems and presumably differences in knowledge and awareness of ADs, and further research is called for. However, the result can serve as input for future planning and development of information, services, and community-based occupational therapy, to improve healthcare and social services for older people.
To describe the association between specific nursing interventions performed in the context of nurse case management and older people's quality of life and functional ability.
Nurse case management through a university hospital and two community health centers.
One hundred seventy-five community-dwelling frail older persons (> or =70 and at risk for repeated hospitalizations).
Specific groups of nursing interventions provided in the context of nurse case management over a 10-month period--coping assistance, lifespan care, risk management, and physical comfort promotion--were focused on. These interventions were recorded using a standardized nursing language. Outcomes were measured using telephone and home interview and medical record review using the 36-item Short Form and the Older American Resources and Services Multidimensional Functional Assessment Questionnaire.
Older people receiving coping assistance interventions demonstrated an increase in instrumental activity of daily living functioning although they had lower general health, role-emotional, and mental health scores.
Coping assistance is one nursing intervention of several provided in the context of nurse case management that is independently associated with improving the functional status of frail older persons even in the presence of declining health normally associated with aging over several months. Examining the relationships between specific nursing activities and health outcomes of frail older persons may be useful in furthering understanding of the results of randomized trials of nurse case management in this population.