Falls are common among elderly people, and the risk increase with age. Falls are associated with both health and social consequences for the patient, and major societal costs. Identification of risk factors should be investigated to prevent falls. Previous studies have shown anemia to be associated with increased risk of falling, but the results are inconsistent. The aim of this study was to investigate the association between anemia and self-reported falls among community-living elderly people. The study is a replication of the study by Thaler-Kall and colleagues from 2014, who studied the association between anemia and self-reported falls among 967 women and men 65 years and older in the KORA-Age study from 2009.
We included 2441 participants (54% women) 65 years and older from the population-based Tromsø 5 Study 2001-2002. Logistic regression models were used to investigate the association between anemia (hemoglobin
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Understanding whether there is an agreement between older persons who provide information on their functional status and clinicians who assess their function is an important step in the process of creating sound outcome instruments.
To examine whether there is agreement between self-reported and clinician assessment of similar performance items in older adults.
Fifty independent older adults aged 70-91 years (mean age 80.3?±?5.2 years) who live in the community were examined separately and blindly in two data collection sessions. Self-reported and observed lower and upper extremity physical tasks were compared. Life Function and Disability Instrument (LLFDI) was used in both sessions. We performed intra-class correlation coefficients (ICC) as indices of agreement and "mountain plots" that were based on a cumulative distribution curve. Associations between self-reported and observed function with Fear of Fall Scale (FES) and Geriatric Depression Scale (GDS) were also assessed.
ICCs were high between self-reported lower extremity function and observed lower extremity function (ICC?=?0.83), and were poorer for self-reported and observed upper extremity function (ICC?=?0.31). In both comparisons, mountain plots revealed a right shift that was larger for upper than lower extremity functions, indicating systematic differences in self-reported and observed assessments. Associations with FES and GDS were higher for self-reported than observed function.
There is a systematic bias between self-reported and clinician observation. Professionals should be aware that information provided by patients and observation of activity assessed by clinicians could differ substantially, especially for upper extremity function. Implications for Rehabilitation There is a systematic bias between self-reported and clinician assessment of similar performance items in older adults. In general, older adults overestimate their physical function or clinicians underestimate older adults function. The bias between self-reported and clinician assessment for upper extremity function is larger than that for lower extremity function. The conclusions regarding agreement across upper extremity and lower extremity function scores are not different when using mountain plots graphs versus relying solely on the value of the ICCs. However, the graphs expand our understanding of the direction and magnitude of score differences. Professionals should be aware that information provided by patients and assessment by clinicians could differ substantially, especially for upper extremity function.
The aim of this study was to analyze whether the associations between perceived environmental and individual characteristics and perceived walking limitations in older people differ between those with intact and those with poorer lower extremity performance.
Persons aged 75 to 90 ( N = 834) participated in interviews and performance tests in their homes. Standard questionnaires were used to obtain walking difficulties; environmental barriers to and, facilitators of, mobility; and perceived individual hindrances to outdoor mobility. Lower extremity performance was tested using Short Physical Performance Battery (SPPB).
Among those with poorer lower extremity performance, the likelihood for advanced walking limitations was, in particular, related to perceived poor safety in the environment, and among those with intact performance to perceived social issues, such as lack of company, as well as to long distances.
The environmental correlates of walking limitations seem to depend on the level of lower extremity performance.
To determine the effect of chronic disorders and their co-occurrence on survival and functioning in community-dwelling older adults.
Population-based cohort study.
Kungsholmen, Stockholm, Sweden.
Individuals aged 78 and older examined by physicians four times over 11 years (N = 1,099).
Chronic diseases (grouped according to 10 organ systems according to the International Classification of Diseases, Tenth Revision, code) and multimorbidity (=2 coexisting chronic diseases) were evaluated in terms of mortality, population attributable risk of death, median years of life lost, and median survival time with and without disability (need of assistance in =1 activities of daily living).
Approximately one in four deaths were attributable to cardiovascular and one in six to neuropsychiatric diseases. Malignancy was the condition with the shortest survival time (2.5 years). Malignancies and cardiovascular disorders each accounted for approximately 5 years of life lost. In contrast, neurosensorial and neuropsychiatric conditions had the longest median survival time (>6 years), and affected people were disabled for more than half of this time. The most-prevalent and -burdensome condition was multimorbidity, affecting 70.4% of the population, accounting for 69.3% of total deaths, and causing 7.5 years of life lost. Finally, people with multimorbidity lived 81% of their remaining years of life with disability (median 5.2 years).
Survival in older adults differs in length and quality depending on specific conditions. The greatest negative effect at the individual (shorter life, greater dependence) and societal (number of attributable deaths, years spent with disability) level was from multimorbidity, which has made multimorbidity a clinical and public health priority.
Older people often use multiple drugs, and some of them have anticholinergic activity. Anticholinergic drugs may cause adverse reactions, and therefore their use should be limited. To identify anticholinergic load, several ranked lists with different drugs and scoring systems have been developed and used widely in research. We investigated, if a comprehensive geriatric assessment (CGA) decreased the anticholinergic drug score in a 4-year period. We used four different anticholinergic ranked lists to determine the anticholinergic score and to describe how the results differ depending on the list used.
We analyzed data from population-based intervention study, in which a random sample of 1000 persons aged =75 years were randomized to either an intervention group or a control group. Those in the intervention group underwent CGA including medication assessment annually between 2004 and 2007. Current medication use was assessed annually. The anticholinergic load was calculated by using four ranked lists of anticholinergic drugs (Boustani's, Carnahan's, Chew's and Rudolph's) for each person and for each year.
CGA had no statistically significant effect on anticholinergic exposure during the 4-year follow-up, but improvements towards more appropriate medication use were observed especially in the intervention group. However, age, gender and functional comorbidity index were associated to higher anticholinergic exposure, depending on the list used.
Repeated CGAs may result as more appropriate anticholinergic medication use. The selection of the list may affect the results and therefore the selection of the list is important.
Fatigue is considered an important indicator of aging-related declines in health and functional abilities. Previous studies have indicated strong associations between fatigue and depressive symptoms among younger populations and in patient groups with specific diseases. However, it is not known how different measures of fatigue are associated with depressive symptoms among general older populations. The purpose of this study is to describe the prevalence of depressive symptoms among community-dwelling older adults reporting mobility-related or general feelings fatigue. The study population consisted of 75-year-old community-living individuals (n = 561). Both, mobility-related and general fatigue, were associated in a stepwise relationship with depressive symptoms: a higher level of fatigue was related to higher level of depressive symptoms. Especially major general fatigue was strongly associated with high level of depressive symptoms. It is important for professionals of the field to be aware of the associations between different measures of fatigue and depressive symptoms.
The kynurenine pathway, the main metabolic route of tryptophan degradation, has been related to inflammatory responses. Some of its metabolites, referred to as kynurenines, have been associated with prevalence of coronary heart disease (CHD) in cross-sectional studies. This prospective study aims to investigate whether increased concentrations of kynurenines are associated with risk of acute coronary events, defined as unstable angina pectoris, acute myocardial infarction, and/or sudden death in community-dwelling elderly.
The baseline examinations included 2819 individuals aged 71-74 years recruited into the Hordaland Health Study. Participants with known CHD at baseline were excluded from analyses. Baseline plasma concentrations of tryptophan, kynurenine, kynurenic acid, anthranilic acid, 3-hydroxykynurenine, xanthurenic acid, and 3-hydroxyanthranilic acid were measured by LC-MS/MS. During a median follow-up period of 10.8 years, with linkage to acute coronary event endpoints through the CVDNOR project, hazard ratios (HRs) for acute coronary events (n = 376) were estimated using Cox proportional hazard analyses.
After adjustment for established cardiovascular risk factors, HRs (95% CI) comparing the 4th vs 1st quartile were 1.86 (1.19-2.92) for kynurenine and 1.72 (1.19-2.49) for 3-hydroxykynurenine. Tryptophan, kynurenic acid, anthranilic acid, xanthurenic acid and 3-hydroxyanthranilic acid were not associated with acute coronary events.
Kynurenine and 3-hydroxykynurenine were associated with increased risk of acute coronary events in community-dwelling elderly without a known history of CHD. These results suggest the involvement of the kynurenine pathway in the early development of CHD, and their potential usefulness to estimate CHD risk.
Several theoretical viewpoints suggest that older adults need to modify their personal goals in the face of functional decline. The aim of this study was to investigate longitudinally the association of mobility limitation with changes in personal goals among older women.
Eight-year follow-up of 205 women aged 66-78 years at baseline.
Health-related goals were the most common at both measurements. Goals related to independent living almost doubled and goals related to exercise and to cultural activities substantially decreased during the follow-up. Higher age decreased the likelihood for engaging in new goals related to cultural activities and disengaging from goals related to independent living. Women who had developed mobility limitation during the follow-up were less likely to engage in new goals related to exercise and more likely to disengage from goals related to cultural activities and to health and functioning.
The results of this study support theories suggesting that age-related losses such as mobility limitation may result in older adults modifying or disengaging from personal goals.
In community dwelling, 75-year-old women followed 10 years, a frailty index was created at each of three visits. Frailty score increased by ~?6-7% annually. A higher frailty score was equivalent to being 5-10 years chronologically older. Frailty was associated with low bone density and higher risk of dying.
To understand the distribution of frailty among a population-based sample of older community-dwelling women, progression over 10 years, and association with mortality and osteoporosis.
The study is performed in a cohort designed to investigate osteoporosis. The OPRA cohort consists of 75-year-old women, n?=?1044 at baseline, and follow-up at age 80 and 85. A frailty index (scored from 0.0-1.0) based on deficits in health across multiple domains was created at all time-points; outcomes were mortality up to 15 years and femoral neck bone density.
At baseline, the proportion least frail, i.e., most robust (FI 0.0-0.1) constituted 48%, dropping to 25 and 14% at age 80 and 85. On average, over 10 years, the annual linear frailty score progression was approximately 6-7%. Among the least frail, 11% remained robust over 10 years. A higher frailty score was equivalent to being 5 to 10 years older. Mortality was substantially higher in the highest quartile compared to the lowest based on baseline frailty score; after 10 years, 48.7% had died vs 17.2% (p?=?1.7?×?10-14). Mortality risk over the first 5 years was highest in the frailest (Q4 vs Q1; HRunadj 3.26 [1.86-5.73]; p?
ErratumIn: Osteoporos Int. 2019 Feb 25;: PMID 30805676
ErratumIn: Osteoporos Int. 2019 Feb 25;: PMID 30805677
The Seniors in the Community: Risk Evaluation for Eating and Nutrition II (SCREEN II) Questionnaire assesses nutritional risk among elderly people living at home. Our aim was to produce a Swedish language version of the SCREEN II and to examine response patterns, data completeness and the relationship between malnutrition and general health.
The SCREEN II was translated into Swedish using dual panel methodology, and then followed up with field test interviews of 24 seniors (median age, 83 years). We used the survey data (n = 565) to assess item and score distribution, missing responses, and the relationship to the subject's general and nutritional health.
The Swedish SCREEN II was considered easy to understand, respond to, and relevant (n = 21; 88% of subjects found it so in all three respects) and its median completion time was 5 minutes. The level of survey item data completeness was 94-99%, and 82% of surveys had computable total scores. Of those subjects with completed forms, 35% had no nutritional risk; 35% had moderate risk; and 30% were at high risk. The malnutrition risk increased with poorer perceived health.
Our study results are similar to those using previous screen ii versions, indicating that the scale adaptation was successful and providing initial support for use of the Swedish SCREEN II questionnaire.