Physical function in older adults with and without a cancer history: Findings from the National Health and Aging Trends Study.

BACKGROUND: Previous studies identified physical function limitations in older cancer survivors, but few have included objective measures and most focused on breast and prostate cancer survivors. The current study compared patient-reported and objective physical function measures between older adults with and without a cancer history. METHODS: Our cross-sectional study used a nationally representative sample of community-dwelling, Medicare beneficiaries from the 2015 National Health and Aging Trends Study (n = 7495). Data collected included patient-reported physical function, including a composite physical capacity score and limitations in strength, mobility, and balance, and objectively measured physical performance metrics, including gait speed, five time sit-to-stand, tandem stand, and grip strength. All analyses were weighted to account for the complex sampling design. RESULTS: Thirteen percent of participants (n = 829) reported a history of cancer, of which more than half (51%) reported a diagnosis other than breast or prostate cancer. In models adjusted for demographics and health history, older cancer survivors had lower Short Physical Performance Battery scores (unstandardized beta [B] = -0.36; 95% CI: -0.64, -0.08), slower gait speed (B = -0.03; 95% CI: -0.05, -0.01), reduced grip strength (B = -0.86; 95% CI: -1.44, -0.27), worse patient-reported composite physical capacity (B = -0.43; 95% CI: -0.67, -0.18) and patient-reported upper extremity strength (B = 1.27; 95% CI: 1.07, 1.50) compared to older adults without cancer. Additionally, the burden of physical function limitations was greater in women than in men, which may be explained by cancer type. CONCLUSIONS: Our results extend studies in breast and prostate cancer to show worse objective and patient-reported physical function outcomes in older adults with a range of cancer types compared to those without a cancer history. Moreover, these burdens seem to disproportionately affect older adult women, underscoring the need for interventions to address functional limitations and prevent further health consequences of cancer and its treatment.

Prevalence and sociodemographic characteristics of US community-dwelling older adults with communication disabilities, using the national health and aging trends survey.

INTRODUCTION: Identifying the population-level prevalence of a disability group is a prerequisite to monitoring their inclusion in society. The prevalence and sociodemographic characteristics of older adults with communication disabilities (CDs) are not well established in the literature. In this study we sought to describe the prevalence and sociodemographic characteristics of community-dwelling older adults experiencing difficulties with understanding others or being understand when communicating in their usual language. METHODS: We conducted a cross-sectional analysis of the National Health and Aging Trends Survey (2015), a nationally representative survey of Medicare beneficiaries ages ≥ 65 years old (N = 7,029). We calculated survey weight-adjusted prevalence estimates by mutually exclusive subgroups of no, hearing only, expressive-only, cognitive only, multiple CDs, and an aggregate any-CD prevalence. We described race/ethnicity, age, gender, education, marital status, social network size, federal poverty status, and supplemental insurance for all groups. Pearson's chi-squared statistic was used to compare sociodemographic characteristics between the any-CD and no-CD groups. RESULTS: An estimated 25.3% (10.7 million) of community-dwelling older adults in the US experienced any-CDs in 2015; approximately 19.9% (8.4 million) experienced only one CD while 5.6% (2.4 million) had multiple. Older adults with CDs were more likely to be of Black race or Hispanic ethnicity as compared to older adults without CDs (Black 10.1 vs. 7.6%; Hispanic: 12.5 vs. 5.4%; P < 0.001). They also had lower educational attainment (Less than high school: 31.0 vs 12.4%; P < 0.001), lower poverty levels (<100% Federal poverty level: 23.5% vs. 11.1%; P < 0.001) and less social supports (Married: 51.3 vs. 61.0%; P < 0.001; Social network ≤ 1 person: 45.3 vs 36.0%; P < 0.001). CONCLUSIONS: The proportion of the older adult population experiencing any-CDs is large and disproportionately represented by underserved sociodemographic groups. These findings support greater inclusion of any-CDs into population-level efforts like national surveys, public health goals, health services, and community research aimed at understanding and addressing the access needs of older adults who have disabilities in communication.

Exploring the implementation potential of physical activity assessment and prescription tools in physical therapy practice: a mixed-method study.

BACKGROUND: Despite the benefits of physical activity (PA), especially related to aging, physical therapists do not perform regular PA prescriptions secondary to various barriers, including lack of tools. Therefore, we developed the Inventory of Physical Activity Barriers (IPAB). OBJECTIVE: Explore potential solutions that could address the current lack of PA prescription among United States-based physical therapists treating patients 50 years and older. METHOD: A convergent parallel mixed-method design consisting of focus groups and self-report questionnaires. Descriptive statistics were used for all quantitative variables. Focus groups were thematically coded. RESULTS: The 26 participants had 8.6 years (SD = 6.4) of clinical experience, 88.4% (n = 23) reported they regularly have PA conversations with patients, 65.4% (n = 17) regularly assess PA levels, and 19.2% (n = 5) regularly provide PA prescriptions. We identified three themes: 1) opportunities and challenges related to PA prescriptions; 2) lack of standardization in PA assessments and interventions; and 3) implementation potential for innovative solutions that address the current informal PA assessments and interventions. CONCLUSION: Physical therapists are amenable to incorporating innovative solutions that support physical activity prescription behavior. Therefore, we recommend the continued development and implementation of PA assessment and prescription tools.

Community-Dwelling Older Adults and Physical Activity Recommendations: Patterns of Aerobic, Strengthening, and Balance Activities.

Though it is known that most older adults do not meet the recommended physical activity (PA) guidelines, little is known regarding their participation in balance activities or the full guidelines. Therefore, we sought to describe PA patterns among 1,352 community-dwelling older adult participants of the Adult Changes in Thought study, a longitudinal cohort study exploring dementia-related risk factors. We used a modified version of the Community Healthy Activities Model Program for Seniors questionnaire to explore PA performed and classify participants as meeting or not meeting the full guidelines or any component of the guidelines. Logistic regression was used to identify factors associated with meeting PA guidelines. Despite performing 10 hr of weekly PA, only 11% of participants met the full guidelines. Older age, greater body mass index, needing assistance with instrumental daily activities, and heart disease were associated with decreased odds of meeting PA guidelines. These results can guide interventions that address PA among older adults.

Symptom Burden Among Community-Dwelling Older Adults in the United States.

OBJECTIVES: To determine the prevalence and impact of common co-occurring symptoms among community-dwelling older adults in the United States. DESIGN: The National Health and Aging Trends Study is a nationally representative, prospective study with annual data collection between 2011 and 2017. SETTING: Community-based, in-person interviews (survey response rates, 71%-96%). PARTICIPANTS: A total of 7,609 community-dwelling Medicare beneficiaries, 65 years or older. MEASUREMENTS: Symptoms assessed at baseline include pain, fatigue, breathing difficulty, sleeping difficulty, depressed mood, and anxiety. Total symptom count ranged from zero to six. Several outcomes were examined, including grip strength, gait speed, and overall lower-extremity function as well as incidence of recurrent falls (two or more per year), hospitalization, disability, nursing home admission, and mortality. RESULTS: Prevalence of zero, one, two, three, and four or more symptoms was 25.0%, 26.6%, 20.7%, 14.0%, and 13.6%, respectively. Symptom count increased with advancing age and was higher in women than in men. Pain and fatigue were the most common co-occurring symptoms. Higher symptom count was associated with decreased physical capacity. For example, participants with one, two, three, and four or more symptoms had gait speeds that were 0.04, 0.06, 0.09, and 0.13 m/s slower, respectively, than those with no symptoms, adjusting for specific diseases, total number of diseases, and other potential confounders (P < .001). The risk of several adverse outcomes also increased with greater symptom count. For example, compared with those with no symptoms, the adjusted risk ratios for recurrent falls were 1.48 (95% confidence interval [CI] = 1.30-1.70), 1.54 (95% CI = 1.32-1.80), 1.90 (95% CI = 1.55-2.32), and 2.38 (95% CI = 2.00-2.83) for older adults with one, two, three, and four or more symptoms, respectively. CONCLUSIONS: Symptoms frequently co-occur among community-dwelling older adults and are strongly associated with increased risk of a range of adverse outcomes. Symptoms represent a potential treatment target for improving outcomes and should be systematically captured in health records. J Am Geriatr Soc 67:223-231, 2019.

Rehabilitation Services Use of Older Adults According to Fall-Risk Screening Guidelines.

OBJECTIVES: To characterize rehabilitation services use of older adults according to fall-risk classification based on screening guidelines. DESIGN: Cross-sectional analysis of 2015 National Health and Aging Trends Study. SETTING: Study participants' homes. PARTICIPANTS: National sample of 7,440 community-dwelling Medicare beneficiaries. MEASUREMENTS: In-person interviews and functional assessments. Based on Centers for Disease Control and Prevention Stopping Elderly Accidents, Deaths and Injuries criteria, participants were classified as low, moderate, or high fall risk. RESULTS: Twenty-three percent of older adults classified as moderate fall-risk (n = 2602) and 40.6% of those at high fall-risk (n = 940) reported rehabilitation services use in the past year. Among older adults who reported rehabilitation services in the past year (n = 1,505), treatment to address falls was reported by 2.8%, 12.6%, and 34.7% of those classified with low, moderate, and high fall-risk, respectively (p < 0.001). Older adults with high fall-risk who did not receive rehabilitation services had significantly better self-reported physical capacity (p = 0.02) but comparable physical performance (all p's > 0.05) relative to those who received rehabilitation. CONCLUSION: Older adults at high risk for falls were significantly more likely to report rehabilitation services use compared to those with low and moderate risk of falling. The findings also indicate that there is low adherence to national clinical recommendations for rehabilitation services use in older adults vulnerable to falls-related injury. Among the high fall-risk group, those who did not receive rehabilitation services had similarly low physical function as compared with those who received rehabilitation, indicating potential unmet need to address physical impairments related to fall-risk. J Am Geriatr Soc 67:100-107, 2019.

Rehabilitation Services Use and Patient-Reported Outcomes Among Older Adults in the United States.

OBJECTIVE: To characterize rehabilitation service use among community-dwelling older adults in the United States by identifying predictors of rehabilitation utilization, patient-reported functional improvement, and rehabilitation goal attainment. DESIGN: Cross-sectional analysis of the 2015 National Health and Aging Trends Study, which used an age-stratified, multistage sampling design and oversampled blacks and the oldest old (≥85y). SETTING: Standardized, in-person home interviews and physical performance testing. PARTICIPANTS: Nationally representative sample of community-dwelling Medicare beneficiaries (N=7487) aged ≥65 years. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Rehabilitation services use (physical therapy, occupational therapy, and speech therapy) across all settings in the last year, patient-reported functional improvement, and patient-reported rehabilitation goal attainment. RESULTS: Twenty percent of older adults reported rehabilitation use in the last year. In a multivariable model, rehabilitation use was significantly lower among blacks and higher among those with higher education, chronic medical conditions, pain, history of falls, and severe limitations in physical performance. Overall, 72% reported functional improvement during rehabilitation, and 75% reported meeting their goals by discharge. Improved function was associated with longer duration of rehabilitation. A significantly lower percentage of older adults with bothersome pain and severe physical limitations reported meeting rehabilitation goals. CONCLUSIONS: Most older adults who received rehabilitation reported functional improvement and meeting rehabilitation goals. However, social disparities were evident with lower rehabilitation utilization among blacks and those with less education. Importantly, functional improvement and goal attainment did not vary by demographics or diagnoses. Longer duration of rehabilitation and improved pain management may be necessary for functional improvement and goal attainment.

Relationships between sitting time and health indicators, costs, and utilization in older adults.

OBJECTIVE: To examine whether self-reported sitting time is related to various health indicators, health costs, and utilization in adults over age 65. METHODS: A retrospective cross-sectional cohort study was conducted using the electronic health record (EHR) from an integrated health system in Washington State. Members who completed an online health risk assessment (HRA) between 2009 and 2011 (N = 3538) were eligible. The HRA assessed sitting time, physical activity, and health status. Diagnosis codes for diabetes and cardiovascular disease (CVD), height and weight for body mass index (BMI) calculations, health care utilization and health costs were extracted from the EHR. Linear regression models with robust standard errors tested differences in sitting time by health status, BMI category, diabetes and CVD, health costs, and utilization adjusting for demographic variables, BMI, physical activity, and health conditions. RESULTS: People classified as overweight and obese, that had diabetes or CVD, and with poorer self-rated health had significantly higher sitting time (p < .05). Total annual adjusted health care costs were $126 higher for each additional hour of sitting (p < .05; not significant in final models including health conditions). CONCLUSION: Sitting time may be an important independent health indicator among older adults.

How do they do it: working women meeting physical activity recommendations.

OBJECTIVE: To identify factors that facilitate adherence to physical activity among employed women. METHODS: Participants were 103 employed women (Mean 44.4 years ±11.8). Measures included physical activity by accelerometry, location by global positioning systems, and psychosocial constructs, perception of worksite policies and the built environment by questionnaire. RESULTS: Meeting physical activity recommendations was significantly associated with use of the built environment, self-regulation, perception of higher land-use mix diversity, and perception of lower infrastructure and safety for walking. Perception of worksite policies, self-efficacy, and social support were not associated with meeting recommendations. CONCLUSIONS: The findings provide evidence that working women's physical activity behavior is influenced by both psychosocial and environmental factors.

Inter-worker variability in lower body postures during assembly line work: implications for exposure assessment.

This study evaluated inter-worker variability in lower body posture and work activity during highly-structured assembly line work. Data were collected from 79 unique assembly line workstations in an engine manufacturing plant. Because the plant utilized work teams, 4-8 workers rotated through each workstation. At least 30 min of videotape was collected from at least three workers at each workstation. A computer-assisted work sampling procedure randomly selected 200 video "freeze-frames" for each worker. Lower body posture/movement (e.g., sit, stand, walk, etc.) was determined for each frame and used to estimate the percentage of time the worker spent in various postures and activities. Chi-square analyses were performed for each workstation to assess the significance of inter-worker differences. Due to variations in individual work methods, significant differences (p <.05) were found at 57 out of 79 workstations (72%). The greatest differences occurred when workers had the option to choose between standing and sitting (significant in 8 of 8 cases; in extreme examples, sit time ranged between 0-100% on one job, and 6.5-98% on another). Studying a single worker (or "proxy") can contribute to substantial error when estimating exposures in workplace studies of ergonomic stressors, since the proxy may not be representative of all workers who perform the job. Individual measurements are preferable, particularly for jobs where workers have substantial latitude to develop individualized work methods.

Incidence of carpal tunnel syndrome among automobile assembly workers and assessment of risk factors.

OBJECTIVES: This study defined the incidence rate of carpal tunnel syndrome (CTS) among active assembly workers and evaluated risk factors. METHODS: This study followed 189 automobile assembly workers over 1 year. Incident cases were defined as workers who had no current or prior history of CTS and were subsequently diagnosed with CTS by means of active surveillance during the study. RESULTS: The estimated annual incidence rate ranged from 1% to 10%, depending on the case definition. Significant predictors for CTS include a higher baseline median-ulnar peak latency difference, history of wrist/hand/finger tendonitis, history of diabetes, nonneutral wrist and elbow postures, and a lower self-reported social support. CONCLUSIONS: This is similar to other prospective studies that demonstrate both ergonomic and medical history are independent risk factors for development of CTS.

A longitudinal study of industrial and clerical workers: incidence of carpal tunnel syndrome and assessment of risk factors.

This study followed workers over an extended period of time to identify factors which may influence the onset of Carpal Tunnel Syndrome (CTS). The purpose was to evaluate incidence of CTS and to create a predictive model of factors that play a role in the development of CTS. This prospective study followed 432 industrial and clerical workers over 5.4 years. Incident cases were defined as workers who had no prior history of CTS at baseline testing and were diagnosed with CTS during the follow-up period or at the follow-up screening. On the basis of logistic regression, significant predictors for CTS include baseline median-ulnar peak latency difference, a history of wrist/hand/finger tendonitis, a history of numbness, tingling, burning, and/or pain in the hand, and work above the action level of the peak force and hand activity level threshold limit value. This longitudinal study supports findings from previous cross-sectional studies identifying both work related ergonomic stressors and physical factors as independent risk factors for CTS.