Quantifying Physical Resilience after Knee or Hip Surgery in Older Australian Women Based on Long-Term Physical Functioning Trajectories.

INTRODUCTION: To improve outcomes after knee or hip surgery, better insight is needed in long-term recovery patterns in the context of ageing-related decline. We examined long-term trajectories of physical functioning (PF) in older women with and without hip and knee surgery and described profiles of cases with higher and lower resilience after surgery. METHODS: This observational study used data from 10,434 women (73-79 years) who completed survey 2 of the Australian Longitudinal Study on Women's Health. Data were used from surveys 2 (1999) to 6 (2011). Covariable-adjusted linear mixed models were run to examine the surgery-by-time (-12 to +12 years) interaction in association with PF (SF-36 subscale). The differences between observed and expected PF were calculated, with positive/negative values reflecting higher/lower resilience, respectively. RESULTS: Women with hip surgery (n = 982) had lower PF than those without surgery (n = 8,117) (p < 0.001). Among hip surgery patients, the decline was more rapid pre-surgery than post-surgery (Δslope = -0.7, p < 0.001). Women with knee surgery (n = 1,144) had lower PF than those without surgery (n = 7,971), but with a slower rate of decline (p = 0.01). Among knee surgery patients, the rate of decline was similar pre- and post-surgery (Δslope = -0.3, p = 0.25). Both in hip and knee patients, women with higher resilience had fewer comorbidities and symptoms and were more often physically active and independent in daily activities than those with lower resilience (all p < 0.05). CONCLUSION: Compared with women without surgery, PF was lower and declined more rapidly around the time of hip surgery, but not for knee surgery. Women with better long-term recovery after surgery had fewer health problems and were more independent around the time of surgery.

Association between Muscle Fatigability, Self-Perceived Fatigue and C-Reactive Protein at Admission in Hospitalized Geriatric Patients.

Background: The capacity to perceived vitality (CPV) ratio is a novel measure for intrinsic capacity or resilience based on grip work and self-perceived fatigue. CPV has been associated with pre-frailty in older adults and post-surgery inflammation in adults. To better understand the utility of this measure in a frail population, we examined the association between CPV and inflammation in geriatric inpatients. Methods: Data were obtained from 104 hospitalized geriatric patients. The average age of participants was 83.3 ± 7.5 years, and 55.8% of participants were women. In the cross-sectional analyses, associations between C-reactive protein (CRP), grip work (GW), self-perceived fatigue (SPF) and the CPV ratio (higher values indicate better capacity) were examined using linear regression adjusted for confounders. Results: The adjusted association between CRP (abnormal vs. normal) and the CPV ratio was not statistically significant (B = -0.33, 95% CI = -4.00 to 3.34). Associations between CRP and GW (B = 25.53, 95% CI = -478.23 to 529.30) and SPF (B = 0.57, 95% CI = -0.64 to 1.77) were also not statistically significant. Similar results were found in unadjusted models and analyses of cases with complete data. Conclusions: In this frail group of geriatric inpatients, inflammation, routinely assessed with CRP, was not associated with CPV or its components, GW and SPF. Further research is needed to explore whether CPV is a useful indicator of frailty or recovery capacity in hospitalized geriatric patients.

Association between clusters of back and joint pain with opioid use in middle-aged community-based women: a prospective cohort study.

BACKGROUND: To determine the relationship between clusters of back pain and joint pain and prescription opioid dispensing. METHODS: Of 11,221 middle-aged participants from the Australian Longitudinal Study of Women's Health, clusters of back pain and joint pain from 2001 to 2013 were identified using group-based trajectory modelling. Prescription opioid dispensing from 2003 to 2015 was identified by linking the cohort to Pharmaceutical Benefit Scheme dispensing data. Multinomial logistic regression was used to examine the association between back pain and joint pain clusters and dispensing of prescription opioids. The proportion of opioids dispensed in the population attributable to back and join pain was calculated. RESULTS: Over 12 years, 68.5 and 72.0% women reported frequent or persistent back pain and joint pain, respectively. There were three clusters ('none or infrequent', 'frequent' and 'persistent') for both back pain and joint pain. Those in the persistent back pain cluster had a 6.33 (95%CI 4.38-9.16) times increased risk of having > 50 opioid prescriptions and those in persistent joint pain cluster had a 6.19 (95%CI 4.18-9.16) times increased risk of having > 50 opioid prescriptions. Frequent and persistent back and joint pain clusters together explained 41.7% (95%CI 34.9-47.8%) of prescription opioid dispensing. Women in the frequent and persistent back pain and joint pain clusters were less educated and reported more depression and physical inactivity. CONCLUSION: Back pain and joint pain are major contributors to opioid prescription dispensing in community-based middle-aged women. Additional approaches to reduce opioid use, targeted at those with frequent and persistent back pain and joint pain, will be important in order to reduce the use of opioids and their consequent harm in this population.

Risk Factors for Incident Dementia Among Older Cubans.

Introduction: Little is known about risk factors of dementia in Latin American countries. We aimed to identify socio-demographic, health and lifestyle risk factors of incident dementia in Cuban older adults. Methods: Data were from 1,846 participants in the Cuban cohort of the 10/66 Dementia Research Group. Participants completed questionnaires, health examinations, and cognitive tests at baseline (2003-2006) and 4.5 years later (2007-2010). Associations between risk factors (baseline) and incident dementia (follow-up) were examined using logistic regression. Results: Just over 9% of participants developed dementia. Overall, older age and low physical activity were associated with incident dementia. In those 65-74 years of age, depression, stroke and low physical activity were associated with incident dementia. In those ≥75 years of age, low physical activity, never eating fish, and smoking were associated with incident dementia. Conclusions: Modifiable lifestyle factors play an important role in developing dementia in Cuban older adults. This knowledge opens up opportunities for preventive strategies.

Longitudinal associations between lifestyle, socio-economic position and physical functioning in women at different life stages.

Women's physical functioning declines with age and the rate of decline increases with age, but substantial disparities exist in trajectories over time. To inform development of interventions to optimise physical functioning across the adult life span, the aim is to explore which lifestyle and socio-economic position (SEP) factors contribute to disparities in physical functioning across the adult life span in women. Younger (born 1973-1978, n = 14,247), middle-aged (born 1946-1951, n = 13,715) and older (born 1921-1926, n = 12,432) participants from the Australian Longitudinal Study on Women's Health completed six questionnaires between 1996 and 2012 at approximate 3-year intervals. Physical functioning was measured with a 10-item subscale of the Short-Form Health Survey (score 1-100). Relationships between age and physical functioning were modelled using spline regression, stratified by baseline categories of physical activity, alcohol intake, smoking status, level of education, managing on income and index of neighbourhood socio-economic disadvantage for area. Multivariable models excluding one of the six factors were compared with models including all six factors to examine the relative importance of each factor. Women with unhealthy lifestyles (inactive, smokers or risky alcohol intake) and lower SEP had lower levels of physical functioning and more rapid declines across the adult life span. The variables with the greatest relative contribution to the models for physical functioning differed by age cohort: i.e. education and physical activity in younger women, managing on income and physical activity in middle-aged women and physical activity in older women. For optimal physical functioning, socio-economic factors seemed particularly important in younger and middle-aged women, while physical activity seemed important at all ages.

Do patients have a say? A narrative review of the development of patient-reported outcome measures used in elective procedures for coronary revascularisation.

PURPOSE: Patient-reported outcome measures (PROMs) capture health information from the patient's perspective that can be used when weighing up benefits, risks and costs of treatment. This is important for elective procedures such as those for coronary revascularisation. Patients should be involved in the development of PROMs to accurately capture outcomes that are important for the patient. The aims of this review are to identify if patients were involved in the development of cardiovascular-specific PROMs used for assessing outcomes from elective coronary revascularisation, and to explore what methods were used to capture patient perspectives. METHODS: PROMs for evaluating outcomes from elective coronary revascularisation were identified from a previous review and an updated systematic search. The studies describing the development of the PROMs were reviewed for information on patient input in their conceptual and/or item development. RESULTS: 24 PROMs were identified from a previous review and three additional PROMs were identified from the updated search. Full texts were obtained for 26 of the 27 PROMs. The 26 studies (11 multidimensional, 15 unidimensional) were reviewed. Only nine studies reported developing PROMs using patient input. For eight PROMs, the inclusion of patient input could not be judged due to insufficient information in the full text. CONCLUSIONS: Only nine of the 26 reviewed PROMs used in elective coronary revascularisation reported involving patients in their conceptual and/or item development, while patient input was unclear for eight PROMs. These findings suggest that the patient's perspective is often overlooked or poorly described in the development of PROMs.

Effect of diagnosis with a chronic disease on physical activity behavior in middle-aged women.

OBJECTIVE: Although regular physical activity is an effective secondary prevention strategy for patients with a chronic disease, it is unclear whether patients change their daily physical activity after being diagnosed. Therefore, the aims of this study were to (1) describe changes in levels of physical activity in middle-aged women before and after diagnosis with a chronic disease (heart disease, diabetes, asthma, breast cancer, arthritis, depression); and to (2) examine whether diagnosis with a chronic disease affects levels of physical activity in these women. METHODS: Data from 5 surveys (1998-2010) of the Australian Longitudinal Study on Women's Health (ALSWH) were used. Participants (N=4840, born 1946-1951) completed surveys every three years, with questions about diseases and leisure time physical activity. The main outcome measure was physical activity, categorized as: nil/sedentary, low active, moderately active, highly active. RESULTS: At each survey approximately half the middle-aged women did not meet the recommended level of physical activity. Between consecutive surveys, 41%-46% of the women did not change, 24%-30% decreased, and 24%-31% increased their physical activity level. These proportions of change were similar directly after diagnosis with a chronic disease, and in the years before or after diagnosis. Generalized estimating equations showed that there was no statistically significant effect of diagnosis with a chronic disease on levels of physical activity in women. CONCLUSION: Despite the importance of physical activity for the management of chronic diseases, most women did not increase their physical activity after diagnosis. This illustrates a need for tailored interventions to enhance physical activity in newly diagnosed patients.

Determinants of physical activity in a cohort of young adult women. Who is at risk of inactive behaviour?

OBJECTIVES: To identify the biological, socio-demographic, work-related and lifestyle determinants of physical activity in young adult women. DESIGN: Prospective cohort study. METHODS: Self-reported data from 11,695 participants (aged 22-27 years in 2000) in the Australian Longitudinal Study on Women's Health were collected over 9 years in 2000, 2003, 2006 and 2009. Generalised Estimating Equations were used to examine univariable and multivariable associations of body mass index, country of birth, area of residence, education, marital status, number of children, occupational status, working hours, smoking, alcohol intake, and stress with physical activity status (active, ≥600 MET·min/week; or inactive, <600 MET·min/week, consistent with public health guidelines). RESULTS: All variables were significantly associated with physical activity in univariable models. In the multivariable model, the lowest odds of being active (compared with the relevant reference categories) were for women who: were born in Asia (OR=0.53), had less than 12 years of education (OR=0.79), were married (OR=0.66) or in a de facto relationship (OR=0.79), had at least one child (OR ranging from 0.67 to 0.69), and were classified as non (OR=0.66) or rare drinkers (OR=0.79). CONCLUSIONS: These results are among the first to confirm the biological, socio-demographic, work-related and lifestyle determinants of physical activity in women in their twenties and early thirties. These findings may be used to inform and improve the development of strategies, and to identify target groups most in need of intervention effort.

Should physical activity intervention efforts take a whole population, high-risk or middle road strategy?

PURPOSE: This study was designed to compare theoretical strategies for changing physical activity (PA) in terms of their potential to reduce the incidence of chronic conditions in midage women: (1) whole population: +30 minutes/week in all, (2) high-risk: +60 minutes/week in the lowest 25% of the PA distribution, and (3) middle road: shift all those not meeting guidelines to a level commensurate with meeting guidelines. METHODS: 10,854 participants (50-55 years in 2001) in the Australian Longitudinal Study of Women's Health completed mail surveys in 2001, 2004, 2007, and 2010. PA was calculated as MET · minutes/week spent in walking, moderate and vigorous PA in the previous week. Incidence rates per 1000 person-years for diabetes, heart disease, hypertension, cancer, and depression were calculated for the actual distribution and after modeled shifts in PA. RESULTS: The incidence rates were 10.6 for diabetes, 7.0 for heart disease, 30.7 for hypertension, 8.0 for cancer, and 28.4 for depression. Greater reductions in incidence were found for the middle road strategy than for the whole population and high-risk strategies, with reductions ranging from -6.3% for cancer to -12.3% for diabetes. DISCUSSION: This theoretical modeling showed that a middle road strategy to increasing PA was superior to the whole population and high-risk strategies, in terms of reducing incidence rates of chronic conditions in middle-aged women.