Reference values of gait characteristics in community-dwelling older persons with different physical functional levels.

BACKGROUND: Mobility is one major component of healthy ageing of older persons. It includes gait speed, nowadays valued as the sixth vital sign of ageing. Quantitative gait analysis can support clinical diagnostics, monitor progression of diseases and provide information about the efficacy of interventions. Fast gait speed is an additional marker in the area of functional ability. Our aim was to contribute reference values of gait parameters of older persons based on their functional ability. METHODS: We visualised and combined three different established frameworks that assess gait characteristics into a new framework based approach that comprises eight gait parameters: gait speed, stride length, walk ratio, single and double support time, step width, step width CV (coefficient of variance), stride length CV. Gait parameters were stratified by two instruments that indicate levels of functional ability: First, the LUCAS Functional Ability Index (FAI), a self-administered screening tool easy to apply to a public-health orientated approach and second the Short Physical Performance Battery (SPPB), an established performance test widely used in comprehensive geriatric assessments (CGA). Gait parameters of older community-dwelling persons were measured with an objective Gait system (GAITRite) across differing functional ability ranging from robust to transient (postrobust and prefrail) to frail physical status. RESULTS: Of 642 community-dwelling participants (age 78.5 ± 4.8; n = 233 male, n = 409 female) categorisations by SPPB were 27.1% for robust (11-12 points), 44.2% for transient (8-10 points), 28.7% for frail (0-7 points), and 16.2, 50.3, 33.5% for robust, transient, frail by LUCAS FAI. Overall, our results showed that distinction by functional level only uncovers a wide spectrum of functional decline for all investigated gait parameters. Stratification by functional ability (biological age) revealed a greater range of differentiation than chronological age. CONCLUSIONS: Gait parameters, carefully selected by literature, showed clinically meaningful differences between the functional featuring a gradient declining from robust over transient to frail in most gait parameters. We found discriminative power of stratifications by SPPB to be the highest, closely followed by LUCAS FAI, age groups and dichotomous age making the application of the LUCAS FAI more cost and time effective than conducting SPPB.

[Effectiveness of "Active health promotion in old age" : Results regarding compression of morbidity by target groups in 13.8 years of observation in LUCAS]. / Wirksamkeit der "Aktiven Gesundheitsförderung im Alter" : Zielgruppenspezifische Ergebnisse bezüglich einer Kompression von Morbidität über 13,8 Jahre LUCAS Verlauf.

BACKGROUND AND OBJECTIVE: Healthy ageing as defined by the World Health Organization (WHO) is the development and maintenance of functional competence. Unfavourable ageing is described by the term frailty and is characterised by a decline in functional reserves. The frailty process can be influenced in a positive way. Previous interventions concerned mostly hospital patients and residents of nursing homes. In this study we examined the maintenance of functional competence in an urban community setting. MATERIAL AND METHODS: The programme "Active health promotion in old age" was carried out by a health advisory team with geriatric expertise for independent persons 60 years and older without disabilities. Its effectiveness was evaluated in the Longitudinal Urban Cohort Ageing Study (LUCAS) over a period of 13.8 years. Survival and disability-free survival were calculated separately for persons with a high level of functional competence (many reserves) and persons with few functional reserves, using Kaplan-Meier curves. Adjustments were made for unequal distribution of age, gender, educational level, chronic diseases and functional status using multivariate Cox regressions. This methodology facilitates the study of interrelationships between mortality and morbidity (compression of morbidity) including an impact from life style interventions. RESULTS: Participants with a high level of functional competence had longer disability-free lifes (p < 0.001), and their average proportion of life time with disability was shorter than either for non-participants, or those with low functional competence. CONCLUSION: There is evidence from these analyses on compression of morbidity that the health promotion programme had its strongest effects in persons with high functional competence, exactly those people for whom it has been developed.

[Comparability of studies of epidemiological research on aging : Results from the Longitudinal Urban Cohort Ageing Study (LUCAS) and three representative Hamburg cross-sectional studies of healthy aging]. / Vergleichbarkeit von Studien epidemiologischer Alternsforschung : Ergebnisse aus der Longitudinalen Urbanen Cohorten-Alters-Studie (LUCAS) und drei repräsentativen Hamburger Querschnitt-Studien zur Gesundheit im Alter.

BACKGROUND: Participants of the Longitudinal Urban Cohort Ageing Study (LUCAS) were recruited from patients 60 years and older from general practitioner's offices in Hamburg. This is different from the usual methods of drawing representative samples. OBJECTIVES: The research question addressed the comparability of LUCAS results with those from cross-sectional surveys with participants randomly chosen from a population list. Therefore, the LUCAS data collected in four waves during the first 12 years were compared with data (age, gender) from the Hamburg Statistics Office (HSO), and selected characteristics (socio-demography, health, mobility) from three representative cross-sectional surveys in older Hamburg citizens. METHODS: First, HSO data compiled in population pyramids for older men and women were compared with equivalent pyramids based on the LUCAS data at recruitment (2000/01) and in waves 2 to 4. Second, characteristics worded identically in the cross-sectional surveys and the simultaneous LUCAS waves were compared. RESULTS: The LUCAS population pyramids were in good accordance at all time points with those of the general older population in Hamburg (except ages 60-64 in men in 2000). Good comparability was also found for health related characteristics from the three representative studies and simultaneous LUCAS waves (e. g. need of nursing care in 2012: LUCAS 7.1 %; Hamburg 7.4 %). CONCLUSIONS: Information on health in old age generated periodically in the LUCAS cohort was largely comparable with that from representative cross-sectional studies and statistics registries. Older people are frequently under-represented in epidemiological studies. Therefore, the LUCAS data may provide useful information for Hamburg and similar metropolitan areas in Germany.

Long-term prediction of changes in health status, frailty, nursing care and mortality in community-dwelling senior citizens­results from the Longitudinal Urban Cohort Ageing Study (LUCAS).

BACKGROUND: The detection of incipient functional decline in elderly persons is not an easy task. Here, we propose the self-reporting Functional Ability Index (FA index) suitable to screen functional competence in senior citizens in the community setting. Its prognostic validity was investigated in the Longitudinal Urban Cohort Ageing Study (LUCAS). METHODS: This index is based equally on both, resources and risks/functional restrictions which precede ADL limitations. Since 2001, the FA index was tested in the LUCAS cohort without any ADL restrictions at baseline (n = 1,679), and followed up by repeated questionnaires in Hamburg, Germany. RESULTS: Applying the index, 1,022 LUCAS participants were initially classified as Robust (60.9%), 220 as postRobust (13.1%), 172 as preFrail (10.2%) and 265 as Frail (15.8%). This classification correlated with self-reported health, chronic pain and depressive mood (rank correlations 0.42, 0.26, 0.21; all p < .0001). Survival analyses showed significant differences between these classes as determined by the FA index: the initially Robust survived longest, the Frail shortest (p < .0001). Analyses of the time to need of nursing care revealed similar results. Significant differences persisted after adjustment for age, sex and self-reported health. CONCLUSIONS: Disability free lifetime and its development over time are important topics in public health. In this context, the FA index presented here provides answers to two questions. First, how to screen the heterogeneous population of community-dwelling senior citizens, i.e. for their functional ability/competence, and second, how far away they are from disability/dependency. Furthermore, the index provides a tool to address the urgent question whether incipient functional decline/incipient frailty can be recognized early to be influenced positively. The FA index predicted change in functional status, future need of nursing care, and mortality in an unselected population of community-dwelling seniors. It implies an operational specification of the classification into Robust, postRobust, preFrail and Frail. Based on a self-administered questionnaire, the FA index allows easy screening of elderly persons for declining functional competence. Thereby, incipient functional decline is recognized, e.g. in GPs' practices and senior community health centers, to initiate early appropriate preventive action.

The Longitudinal Urban Cohort Ageing Study (LUCAS): study protocol and participation in the first decade.

BACKGROUND: We present concept, study protocol and selected baseline data of the Longitudinal Urban Cohort Ageing Study (LUCAS) in Germany. LUCAS is a long-running cohort study of community-dwelling seniors complemented by specific studies of geriatric patients or diseases. Aims were to (1) Describe individual ageing trajectories in a metropolitan setting, documenting changes in functional status, the onset of frailty, disability and need of care; (2) Find determinants of healthy ageing; (3) Assess long-term effects of specific health promotion interventions; (4) Produce results for health care planning for fit, pre-frail, frail and disabled elderly persons; (5) Set up a framework for embedded studies to investigate various hypotheses in specific subgroups of elderly. METHODS/DESIGN: In 2000, twenty-one general practitioners (GPs) were recruited in the Hamburg metropolitan area; they generated lists of all their patients 60 years and older. Persons not terminally ill, without daily need of assistance or professional care were eligible. Of these, n = 3,326 (48 %) agreed to participate and completed a small (baseline) and an extensive health questionnaire (wave 1). In 2007/2008, a re-recruitment took place including 2,012 participants: 743 men, 1,269 women (647 deaths, 197 losses, 470 declined further participation). In 2009/2010 n = 1,627 returned the questionnaire (90 deaths, 47 losses, 248 declined further participation) resulting in a good participation rate over ten years with limited and quantified dropouts. Presently, follow-up data from 2007/2008 (wave 2) and 2009/2010 (wave 3) are available. Data wave 4 is due in 2011/2012, and the project will be continued until 2013. Information on survival and need of nursing care was collected continuously and cross-checked against official records. We used Fisher's exact test and t-tests. The study served repeatedly to evaluate health promotion interventions and concepts. DISCUSSION: LUCAS shows that a cohort study of older persons is feasible and can maintain a good participation rate over ten years, even when extensive self-reported health data are collected repeatedly through self-filled questionnaires. Evidently individual health developments of elderly persons can be tracked quantifying simultaneously behaviour, co-morbidity, functional competence and their changes. In future, we expect to generate results of significance about the five study aims listed above.

[Disease sequelae on function in persons 70 years and older and the acceptance of a new supporting network, the NetzWerk GesundAktiv (NWGA)]. / Funktionale Krankheitsfolgen von Menschen im Alter ab 70 Jahren und die Akzeptanz eines neuen Unterstützungs-Netzwerkes, das NetzWerk GesundAktiv (NWGA).

BACKGROUND: The growing need of nursing care as life expectancy increases is a problem. The Netzwerk AktivGesund (NWGA) tries to change this development in a positive way. In a pilot region of the city of Hamburg, persons 70 years and older were invited by their health insurance companies to participate in the NWGA supportive network. Results of the acceptance analysis are described here. METHODS: In order to focus on persons at risk of need for help functional competence was assessed by using the LUCAS functional ability index (selfreport questionnaire). In an explorative way, participants, refusers, persons interested (excluded due to high functional competence), and non-responders were compared in a retrospective observational study. Sociodemographic and routine data were used as ICD diagnoses from hospitalisations, number of contacts to physicians and level of need of nursing care during the 12 months before recruitment. RESULTS: There were 962 participants (7.4 %), 948 refusers (7.2 %), 2437 persons with interest (18.6 %) and 8753 non-responders (66.8 %) from the 13 100 persons contacted by mail. The sociodemographic factors differed between these groups. ICDs typical of older patients and ICD codes of functional impairment from the 5422 hospital stays showed different frequencies. Persons with interest had nearly no need of nursing care and the lowest level of morbidity. CONCLUSIONS: The results show that impairments of motoric and cognitive functions, in particular, and sociodemographic factors have impact on the acceptance of the NWGA. The recruitment for participation should be improved using approaches that are differentiated, respectively. Awareness of functional impairment as disease sequelae and pacemaker of need of nursing care, in general, might facilitate health promotion and prevention in older persons. An interest in preventative activities was remarkably frequent among the persons 70 years and older.

The inter-relationship between depressed mood, functional decline and disability over a 10-year observational period within the Longitudinal Urban Cohort Ageing Study (LUCAS).

BACKGROUND: The WHO defines 'healthy ageing' as 'the process of developing and maintaining the functional ability'. Late-life depression and frailty compromise well-being and independence of older people. To date, there exists little research on the interaction of the dynamic processes of frailty and depression and only a few studies were longitudinal. Conclusions about the direction of effects remained uncertain. METHODS: Data were obtained from each of the last six biyearly waves (2007-2017) of the Longitudinal Urban Cohort Ageing Study (LUCAS) in Hamburg, Germany, a prospective observational cohort study of manifold aspects of ageing. Screening of predictor and event variables: depressed mood: one question from the 5-item Mental Health Inventory Screening Test; frailty: LUCAS Functional Ability Index, status 'frail'; disability: one question on need for human help with basic activities of daily living. Kaplan-Meier curves and Cox's proportional hazards regression were used for time-to-event analyses with shifting baseline. RESULTS: Sample size in 2007 was 2012, average age 76.2 years; ±6.5. Main results were as follows: (1) depression significantly increased the hazard of subsequent frailty (HR=1.581; 95% CI 1.257 to 1.988; p<0.001); (2) frailty significantly increased the hazard of subsequent depression (HR=2.324; 95% CI 1.703 to 3.172; p<0.001); (3) depression significantly increased the hazard of subsequent disability (HR=2.589; 95% CI 1.885 to 3.557; p<0.001) and (4) disability did not significantly increase the hazard of subsequent depression (HR=1.540; 95% CI 0.917 to 2.579; p=0.102). CONCLUSION: Our results suggest an interdependence of the processes of depression and frailty/disability rather than unidirectional dependencies. These observable processes may be representative of underlying unobservable profound life changes. Obviously, there is a need for early screening to initiate appropriate interventions.

Geriatric patients with cognitive impairment.

BACKGROUND: Hospitals are now faced with increasing numbers of cognitively impaired patients aged 80 and older who are at increased risk of treatment complications. This study concerns the outcomes when such patients are treated in a specialized ward for cognitive geriatric medicine. METHODS: Observation of a cohort of 2084 patients from 2009 to 2014, supplemented by a sample of 380 patients from the hospital cohort of the Longitudinal Urban Cohort Ageing Study (LUCAS) for the years 2010 and 2011. RESULTS: Geriatric inpatients with cognitive impairment tend to be multimorbid. Half of the patients studied (1031 of 2084 patients) were admitted to the hospital on an emergency basis. Complications arising on the ward that necessitated transfer elsewhere arose in 2.6% (51 of 2084 patients). Moreover, analysis of the sample of 380 patients from the LUCAS cohort revealed that the treatments they underwent during hospitalization were associated with an improvement of their functional state: their mean overall score on the Barthel index rose from 39.8 ± 24.3 (median, 35) on admission to 52.7 ± 27.0 (median, 55) on discharge. The percentage of patients being treated with 5 or more drugs fell from 98.2% (373/380) on admission to 79.3% (314/362) on discharge. The percentage receiving potentially inappropriate medications (PIM), as defined by the PRISCUS list, fell from 45% to 13.3%, while the percentage of drug orders and prescriptions involving PIM fell from 7.8 % (327/4181) to 2.0% (53/2600). 70% of the patients were discharged to the same living situation where they had been before admission. CONCLUSION: In this study, structured geriatric treatment in a cohort of older acutely ill patients with cognitive impairment was associated with improvement of functions that are relevant to everyday life, as well as with a reduction of polypharmacy. Controlled studies are needed to confirm the observed benefit.