PERSONAL MASTERY AND LOWER BODY MOBILITY IN COMMUNITY DWELLING OLDER PERSONS: THE INVECCHIARE IN CHIANTI STUDY.
MILANESCHI Y, BANDINELLI S, ET AL: JOURNAL OF THE AMERICAN GERIATRICS SOCIETY 2010; 58 (JANUARY): 98-103
Objectives: To test the hypothesis that, in older persons, sense of personal mastery, defined as the extent to which one regards one’s life chance as being under one’s own control, predicts change in lower extremity performance during a six-year follow-up study.
Participants: Six hundred twenty-six participants aged 65 and older.
Methods: Personal mastery was assessed at baseline using Pearlin's mastery scale. Lower extremity performance was measured at baseline and at six-year follow-up using the Short Physical Performance Battery (SPPB) of lower extremity function.
Results: Higher sense of mastery was associated with a significantly less-steep decline in lower extremity performance. Participants in the two lowest quartiles of personal mastery had, respectively, a 2.6 and 3.2 higher risk of experiencing a substantial decline (≥3 points) in SPPB scores after six years as those in the highest quartile.
Conclusion: Older individuals with poor sense of personal mastery are at high risk of accelerated lower extremity physical function decline. Whether interventions aimed at improving personal mastery may prevent disability remains unknown.
KEVIN’S COMMENTS: This study adds to the growing body of research that demonstrates that the dimensions of wellness are intimately and dynamically connected. Previous research has proven that social engagement is a more potent predictor of longevity than age or medical conditions. Depression is an independent risk factor for stroke. This study demonstrates that those persons who have a sense of personal mastery (that is, being in control and having a sense of purpose and self efficacy) actually have less risk of physical decline over time. Hopefully, future studies will show that interventions that help people find purpose and meaning in their lives will reduce their risk for functional decline and disability.
DISABILITY TRENDS AMONG OLDER AMERICANS: NATIONAL HEALTH AND NUTRITION EXAMINATION SURVEYS, 1988-1994 AND 1999-2004.
SEEMAN TE, MERKIN SS, ET AL: AM J PUBLIC HEALTH; 2010; 100 (JANUARY): 100-107
Background: In the last several decades, Americans have had important changes in the rate of obesity among most all age groups and among most ethnic groups. The National Health and Nutrition Examination Surveys (NHANES) are carried out by the Centers for Disease Control and Prevention.
Objective: To examine trends in the prevalence of reported disability among older adults. In particular, there was a hypothesis that trends among those who were in the 60- to 69-year-old age group might provide a clue of the health status of the baby boomer generation to follow.
Participants/Methods: The NHANES was a survey of adults aged ≥60 years. The results from 4688 participants from the time period of 1988 to 1994 were compared to the results from 4239 participants from the time period of 1999 to 2004. Each survey provided a national representative sample of the United States population. The surveys included questions about activities of daily living, such as walking from room to room, getting in and out of bed, and eating and dressing. The researchers reported the prevalence of types of disabilities for each age group when one time period was compared to the other. The survey participants were broken down into three age groups: 60 to 69 years old; 70 to 79 years olds, and those ≥80 years old.
Results: Seniors from 1988 to 1994 were compared to those who were surveyed between 1999 and 2004. The patient characteristics of seniors were similar, except that the seniors who were surveyed from 1999 to 2004 had a higher body mass index and a larger waist circumference. In addition, the physical activity levels declined in the more recent survey than in the early survey. Among patients who were between 60 and 69 years old, those in the more recent time period had worsened activities of daily living and instrumental activities of daily living, as well as more troubles with mobility. There were no significant differences among the oldest survey participants. In several logistic regression models, the prevalence in all types of disability among those 60 to 69 years of age increased from the early to the more recent time period.
Conclusion: Levels of disability among individuals in the 60- to 69-year-old age group have increased in recent years. These trends of worsened disability were noted at highest levels among non-whites, obese, and overweight persons.
KEVIN’S COMMENTS: Two thirds of adults and nearly one third of children are overweight or obese. Dr. Ruth Benjamin, the Surgeon General of the United States, stated in a recent report that obesity has contributed significantly to the current epidemics of hypertension, diabetes, heart disease, and other chronic illnesses. The economic impact of obesity and related disorders is staggering—many billions of dollars are spent every year on care and lost productivity. Quite alarming is that the rate of disability among 60-69 year olds has increased in recent years.
As responsible citizens, we all need to hear and heed the Surgeon General’s call if we are to reverse these trends. All of us need to be good role models for future generations as well. The American Heart Association recommends seven simple steps: 1. Get moving (engage in a regular fitness program); 2. Eat better (The Mediterranean diet has been shown to reduce heart disease risk and more recently to reduce risk for strokes.); 3. Maintain a healthy weight (Check a BMI table or more simply measure your waist to hip ratio. The waist measurement divided by the hip measurement should be less than 0.8 in women and less than 0.95 in men.); 4. Don’t smoke (Get help from your health care provider if you need help to quit.); 5. Control cholesterol (Normal total cholesterol is less than 200, but the amount of HDL, the good cholesterol, and the LDL, bad cholesterol, as well as triglycerides are important. Your health care provider can help you interpret your lipid profile and determine the best management.) 6. Manage blood pressure (Normal blood pressure is less than 120/80, but risk starts to rise after blood pressure exceeds 115/75. Your doctor will help you determine where you should be based on other factors.); and 7. Control blood sugar (Guidelines have recently changed and the glycated hemoglobin A1C test is being recommended to diagnose diabetes. Diabetes is a level greater than 6.5. Prediabetes is a level of 6-6.5.)
PHYSICAL FRAILTY IS ASSOCIATED WITH INCIDENT MILD COGNITIVE IMPAIRMENT IN COMMUNITY-BASED OLDER PERSONS.
BOYLE PA, BUCHMAN AS, ET AL: JOURNAL OF THE AMERICAN GERIATRICS SOCIETY; 2011; 58 (FEBRUARY): 248-255
Objectives: To test the hypothesis that physical frailty is associated with risk of mild cognitive impairment (MCI).
Participants: More than 750 older persons without cognitive impairment at baseline from approximately 40 retirement communities across the Chicago metropolitan area.
Measurements: Physical frailty, based on four components (grip strength, timed walk, body composition, and fatigue), was assessed at baseline, and cognitive function was assessed annually. Proportional hazards models adjusted for age, sex, and education were used to examine the association between physical frailty and the risk of incident MCI, and mixed effect models were used to examine the association between frailty and the rate of change in cognition.
Results: During up to 12 years of annual follow-up, 305 of 761 (40%) persons developed MCI. In a proportional hazards model adjusted for age, sex, and education, physical frailty was associated with a high risk of incident MCI, such that each one-unit increase in physical frailty was associated with a 63% increase in the risk of MCI. This association persisted in analyses that required MCI to persist for at least one year and after controlling for depressive symptoms, disability, vascular risk factors, and vascular diseases. Furthermore, a higher level of physical frailty was associated with a faster rate of decline in global cognition and five cognitive systems (episodic memory, semantic memory, working memory, perceptual speed, and visuospatial abilities).
Conclusion: Physical frailty is associated with risk of MCI and a rapid rate of cognitive decline in aging.
Kevin’s Comments: MCI or mild cognitive impairment is a syndrome characterized by cognitive changes that do not fulfill the diagnostic criteria for dementia. A significant percentage of these individuals (approximately 12% per year) will progress to Alzheimer’s disease and by five years about 50% fulfill criteria for dementia. Physical frailty is associated with a rapid rate of cognitive decline. Aggressive attempts have to be made to prevent or retard physical decline. The importance of engaging these individuals in a regular physical activity program cannot be overstated. Not only may we be helping to reduce their risk of falls, but hopefully reducing their risk for dementia as well.
NOTE: Brookdale associates who serve as nurses, therapists, lifestyle directors or on a community dining team are invited to submit questions for Geriatric News You Can Use directly to GeriatricNews@brookdaleliving.com.
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Dr. Kevin O’Neil is the Medical Director for Brookdale Senior Living Inc., the largest senior housing provider in the United States. He is board-certified in both Internal Medicine and Geriatric Medicine. Dr. O’Neil is also a Fellow of the American College of Physicians and a member of the American Geriatrics Society as well as being a member of the American Medical Directors Association and a certified medical director.
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