Comprehensive geriatric assessment decreases prevalence of orthostatic hypotension in older persons.

BACKGROUND: Orthostatic hypotension (OH) is associated with significant morbidity and mortality among older people. We have studied whether its prevalence can be reduced by a Comprehensive Geriatric Assessment (CGA). STUDY DESIGN AND SETTING: 1000 randomly-selected persons aged ≥75 years were divided into intervention (n = 500) and control groups (n = 500). We focused on those subjects in whom an orthostatic blood pressure test had been performed at least once during the study period (2004-2007) (n = 365 and 332 for intervention and control groups, respectively). A CGA, including evaluation of the adequacy of the medication, was performed annually in the intervention group but not in the control group. We conducted Markov models to study change in the OH profiles and the effect of CGA on it. Competing risk of mortality was modeled as an absorbing state to avoid attrition bias. RESULTS: Over 3 years, the prevalence of OH decreased (35.0% → 28.0%) in the intervention group, whereas its prevalence increased in the control group (32.8% → 40.8%). By Markov models it was shown that CGA had a statistically significant effect on recovering from OH. In addition, CGA was shown to protect from developing OH. CONCLUSIONS: Repeated CGA performed annually can reduce the prevalence of OH.

Development of sense of coherence in adulthood: a person-centered approach. The population-based HeSSup cohort study.

OBJECTIVE: We sought to identify the most typical patterns of change in sense of coherence (SOC) in adulthood. METHODS: This prospective population-based Health and Social Support (HeSSup) study was based on four age cohorts including men and women initially aged 20-24 years (n = 4,682), 30-34 years (n = 4,248), 40-44 years (n = 4,598), and 50-54 years (n = 4,997). SOC was assessed at baseline and at the 5-year follow-up point. Factor Mixture Modeling was used to identify the latent classes of persons whose mean changes in SOC were similar over time. RESULTS: Three development classes were supported by the data. In all age cohorts, the largest class consisted of those people whose SOC was high at baseline and increased thereafter (46-58% of participants depending on the age group). A class of high SOC with a decreasing trend and that of low SOC with an increasing trend were also found. In all age groups, the rank-order stability was high in the first development class (0.84-0.98) but low in other classes (0.35-0.44). CONCLUSION: This analysis shows continuous increase in the level of SOC over time to be common in adulthood, irrespective of age. High SOC, rather than higher age, seems to determine a stable development of the SOC.

Predicting school students' physical activity intentions in leisure-time and school recess contexts: Testing an integrated model based on self-determination theory and theory of planned behavior.

BACKGROUND: Identifying psychological correlates of children's physical activity intentions may signpost potentially modifiable targets for interventions aimed at promoting physical activity participation. School recess and leisure-time outside of school are appropriate contexts in which such interventions may be delivered. However, few studies have identified correlates of physical activity intentions in these environments. Examining correlates in these contexts may provide formative evidence on which to base interventions to promote physical activity. PURPOSE: The current study adopted an integrated theoretical model to test relations between motivational constructs from self-determination theory, social cognition constructs from the theory of planned behavior, and physical activity intentions in leisure-time and school recess contexts. METHODS: Finnish school children (N = 845, M age = 13.93, SD = 0.99) from three lower-secondary schools completed self-report measures of perceived autonomy support by peers, autonomous and controlled motivation, attitudes, subjective norms, perceived behavioral control, and physical activity intentions for both contexts. RESULTS: Well-fitting structural equation models controlling for past behavior indicated that autonomous motivation in the school recess context and attitude in both contexts were the most pervasive predictors of physical activity intentions, and mediated the relationship between perceived autonomy support and intentions. Multi-group analyses supported invariance of the models in both contexts across gender, grades, and school, with few variations. CONCLUSIONS: The current study supports relations between motivational and social cognition correlates of children's physical activity intentions in school recess and leisure-time contexts. Future research should extend these findings to the prediction of follow-up participation in physical activity.

Measuring deterioration in international classification of functioning domains of people with multiple sclerosis who are ambulatory.

BACKGROUND AND PURPOSE: Measures to detect important effects related to physical therapy interventions must be able to detect an important change. The purpose of this study was to select the most responsive physical functioning measures for multiple sclerosis (MS) using the International Classification of Functioning, Disability and Health (ICF) as a framework. SUBJECTS: The participants were 120 people with MS who were ambulatory from a population-based sample. METHODS: Physical functioning was assessed by quantitative clinical measures of activities (n=5) and body functions (n=7) and by self-reported performance in self-care, mobility, and domestic life domains in the activities and participation component of the ICF at baseline and 2 years later. A participant's perception of change and a change in Expanded Disability Status Scale (EDSS) scores were used as external criteria in the analysis of the receiver operating characteristic curve and the minimally important change score. The minimal detectable change was calculated as distribution-based responsiveness. RESULTS: According to the external criteria, 51% of the participants showed deterioration as measured by their own perceptions compared with the 26% of the participants who showed deterioration as rated by the clinician. Regardless of the external criterion applied, the measures most responsive to deterioration were self-reported scores in self-care, mobility, and domestic life; distance walked and change in heart rate during a 6-minute walk test; 10-m walk test speeds, stride length, and cadence; repetitive squatting; and Box and Block Test scores. DISCUSSION AND CONCLUSION: The results show the relative responsiveness of different measures in the subsample who deteriorated and provide data that can facilitate the interpretation of score changes in people with MS who are ambulatory for future studies and in clinical practice.

Measures of physical functioning predict self-reported performance in self-care, mobility, and domestic life in ambulatory persons with multiple sclerosis.

OBJECTIVE: To determine the associations between clinically measured physical functioning variables and self-reported performance in mobility, self-care, and domestic life in ambulatory persons with multiple sclerosis (MS), using the International Classification of Functioning, Disability and Health (ICF) as a framework. DESIGN: Survey study. SETTING: Community setting in Finland. PARTICIPANTS: A population-based sample of 120 ambulatory persons with MS (30 men, 90 women) with mean age 45.0+/-10.8 years (range, 20-71 y), mean disease duration from symptom onset 12.3+/-8.8 years (range, 1-39 y), and mean Expanded Disability Status Scale 2.8+/-2.0 (range, 0-6.5). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: The primary dependent variables were self-reported performance in self-care, mobility, and domestic life from the Functional Status Questionnaire. The physical functioning variables were drawn from the ICF activities (n=9) and body functions (n=14) categories. Age- and sex-adjusted odds ratios from multinomial logistic regression were estimated for the physical functioning variables associated with activities of daily living (ADL) performance. RESULTS: Overall, of this cohort 31% reported difficulties or dependence in self-care, 52% in mobility, and 68% in domestic life. The most significant predictors of perceived difficulties or dependence in ADL performance were: (1) lower scores in the Box and Block Test; (2) lower Berg Balance Scale scores; (3) greater velocity moment when standing with eyes open; (4) slower ten-meter walk test times and shorter stride length at normal speed; and (5) shorter distance in the six-minute walk test. CONCLUSIONS: Perceived difficulties and dependence were most prominent in domestic life. In particular, measures of activities predicted difficulties in ADL performance. Monitoring of physical functioning should be extended to those independent MS persons reporting difficulties in ADL performance.

Reading development subtypes and their early characteristics.

The present findings are drawn from the Jyväskylä Longitudinal Study of Dyslexia (JLD), in which approximately 100 children with familial risk of dyslexia and 100 control children have been followed from birth. In this paper we report data on the reading development of the JLD children and their classmates, a total of 1,750 children from four measurement points during the first two school years. In the total sample, we examined whether heterogeneous developmental paths can be identified based on profiles of word recognition and reading comprehension. Secondly, we studied what kind of early language and literacy skill profiles and reading experiences characterize the children with differing reading development in the follow-up sample. The mixture modeling procedure resulted in five subtypes: (1) poor readers, (2) slow decoders, (3) poor comprehenders, (4) average readers, and (5) good readers. The children with familial risk for dyslexia performed on average at a lower level in all reading tasks than both their classmates and the controls, and they were overrepresented in slow decoders subtype. Differences between the subtypes were found in the early language and literacy skill development, as well as in the reading experiences of the reading subtypes.

Developmental dynamics between mathematical performance, task motivation, and teachers' goals during the transition to primary school.

BACKGROUND: It has been suggested that children's learning motivation and interest in a particular subject play an important role in their school performance, particularly in mathematics. However, few cross-lagged longitudinal studies have been carried out to investigate the prospective relationships between academic achievement and task motivation. Moreover, the role that the classroom context plays in this development is largely unknown. AIMS: The aim of the study was to investigate the developmental dynamics of maths-related motivation and mathematical performance during children's transition to primary school. The role of teachers' pedagogical goals and classroom characteristics on this development was also investigated. SAMPLE: A total of 196 Finnish children were examined four times: (0) in October during their preschool year; (1) in October and (2) April during their first grade of primary school; and (3) in October during their second grade. METHOD: Children's mathematical performance was tested at each measurement point. Task motivation was examined at measurement points 2, 3, and 4 using the Task-value scale for children. First-grade teachers were interviewed in November about their pedagogical goals and classroom characteristics. RESULTS AND CONCLUSIONS: The results showed that children's mathematical performance and related task motivation formed a cumulative developmental cycle: a high level of maths performance at the beginning of the first grade increased subsequent task motivation towards mathematics, which further predicted a high level of maths performance at the beginning of the second grade. The level of maths-related task motivation increased in those classrooms where the teachers emphasized motivation or self-concept development as their most important pedagogical goal.

A cohort study found good respiratory, sensory and motor functions decreased mortality risk in older people.

BACKGROUND AND OBJECTIVE: The main aims of this study were to evaluate the separate and joint effects of respiratory, sensory, and psychomotor function, muscle strength, and mobility in predicting mortality in older men and women, and to find a way to control multicollinearity in a multivariate Cox regression model. METHODS: Mortality was followed for 10 years (1990-2000) in an entire cohort of 75-year-old residents of the city of Jyvaskyla, Finland (born in 1914; N=388). Cox regression models and principal component estimation were employed to study the association between the covariates and mortality. RESULTS: The study indicated that, after adjustment for fatal diseases and cognitive capacity, vital capacity, tapping rate, muscle strength, and walking speed predict mortality in elderly men and women to a similar extent. The hazard ratio for mortality for those in the lowest tertile of the principal component representing all the significant physiological functions was from three to four times higher than for those in the highest tertile. CONCLUSION: Our results suggest that a poor level in any of the measured functions has a similar impact on the risk for mortality, which is further increased by combining the different results. No single, dominant predictor of mortality emerged.

Impact of missing data mechanism on the estimate of change: a case study on cognitive function and polypharmacy among older persons.

Longitudinal studies typically suffer from incompleteness of data. Attrition is a major problem in studies of older persons since participants may die during the study or are too frail to participate in follow-up examinations. Attrition is typically related to an individual's health; therefore, ignoring it may lead to too optimistic inferences, for example, about cognitive decline or changes in polypharmacy. The objective of this study is to compare the estimates of level and slope of change in 1) cognitive function and 2) number of drugs in use between the assumptions of ignorable and non-ignorable missingness. This study demonstrates the usefulness of latent variable modeling framework. The results suggest that when the missing data mechanism is not known, it is preferable to conduct analyses both under ignorable and non-ignorable missing data assumptions.

Physical and psychosocial prerequisites of functioning in relation to work ability and general subjective well-being among office workers.

OBJECTIVES: The purpose of the study was to investigate the physical and psychological prerequisites of functioning, as well as the social environment at work and personal factors, in relation to work ability and general subjective well-being in a group of office workers. METHODS: The study was a descriptive cross-sectional investigation, using path analysis, of office workers. The subjects comprised 88 volunteers, 24 men and 64 women, from the same workplace [mean age 45.7 (SD 8.6) years]. The independent variables were measured using psychosocial and physical questionnaires and physical measurements. The first dependent variable, work ability, was measured by a work ability index. The second dependent variable, general subjective well-being, was assessed by life satisfaction and meaning of life. The variables were structured according to a modified version of the International Classification of Functioning, Disability and Health. RESULTS: Forward flexion of the spine, intensity of musculoskeletal symptoms, self-confidence, and mental stress at work explained 58% of work ability and had indirect effects on general subjective well-being. Self-confidence, mood, and work ability had a direct effect on general subjective well-being. The model developed explained 68% of general subjective well-being. Age played a significant role in this study population. CONCLUSIONS: The prerequisites of physical functioning are important in maintaining work ability, particularly among aging workers, and psychological prerequisites of functioning are of even greater importance in maintaining general subjective well-being.

Three methods for studying developmental change: a case of reading skills and self-concept.

AIMS: First, to introduce and compare three statistical methods for investigating development as a cumulative process: a simplex model, latent growth curve analysis, and clustering by cases. Second, to investigate the developmental dynamics of reading skills, and self-concept of reading ability, across the first year of primary school. SAMPLE: One hundred and five (61 boys, 44 girls) 6- to 7-year-old children from four first-grade classes in two primary schools participated in the study. METHOD: Children were studied three times during their first school year using an identical set of measurements: a Reading Skills Test and the Self-Concept of Ability scale. RESULTS: A uni-construct 'Matthew' effect was found for the development of self-concept, but not for the reading skills. However, the results showed that there was a multi-construct cumulative cycle between children's reading skills and their self-concept. CONCLUSIONS: Simultaneous use of variable- and person-oriented methods in developmental research seems to be a valuable approach, which not only provides a proper way to investigate the cumulative developmental cycles but also an option to examine how large a proportion of the sample follows the positive and negative pattern found in variable-oriented analyses.

A note on alternative parameterizations of a model for evaluating agreement between two tests.

The agreement between two competing tests which purport to measure the same trait is a common concern in test development. In this paper three alternative parameterizations of the measurement model useful in this context are presented. Both one-factor and two-factor approaches are applied. Lord's classic example, where the main problem is to investigate whether time limits represent an extra speed component in a vocabulary test, is used to illustrate the ideas.

Tracking of physical activity from early childhood through youth into adulthood.

PURPOSE: The aim of the study was to investigate the tracking of physical activity (PA) from preschool age to adulthood in six age cohorts of males and females. METHODS: A random sample of 3596 boys and girls age 3-18 yr participated in the Cardiovascular Risks in Young Finns Study in 1980. The follow-up measurements were repeated in 1986, 1992, 2001, and 2007. The PA was measured by mother's report in 3- and 6-yr-olds and self-report in 9-yr-olds and older. Tracking of PA was analyzed using the Spearman rank-order correlation and a simplex model. RESULTS: Mother-reported PA at age 3 and 6 yr significantly predicted self-reported PA in youth and in young adulthood, and there was a significant indirect effect of mother report on adult PA 2007 in males. Simplex models that fitted the data very well produced higher stability coefficients than the Spearman rank-order correlations showing moderate or high tracking. The tracking was higher in males than that in females. CONCLUSION: This study has shown that physically active lifestyle starts to develop very early in childhood and that the stability of PA is moderate or high along the life course from youth to adulthood.

Predictive role of physical education motivation: the developmental trajectories of physical activity during grades 7-9.

In this study we examined adolescents' physical activity (PA) stability as well as individual differences in PA across grades 7-9. In addition, we tested the predictive role of adolescents' self-determination and goal orientations in physical education at grade 6 in relation to their PA development. Adolescents' (N = 812) self-reported PA was measured five times and physical education motivation once. Results revealed a decreasing trajectory of PA, with individual differences diminishing over time. Although boys' showed a consistently higher PA level, gender did not moderate the change in PA. Finally, self-determination and task orientation (boys only) predicted PA levels but did not predict change in PA.

The role of parenting styles and teacher interactional styles in children's reading and spelling development.

This study examined the associations between parenting styles, teacher interactional styles, and children's reading and spelling skills. The sample consisted of 864 Finnish-speaking children and their parents (864 mothers, 864 fathers) and teachers (N=123). Children's risk for reading disabilities and reader status were assessed in kindergarten. Children were also tested on reading and spelling skills in Grades 1 and 2. Parenting styles and teacher interactional styles were measured using parents' and teachers' self-reports in Grade 1. First, the results indicated that both an authoritative parenting style and authoritative teacher interactional style positively predicted children's spelling skill development. Second, authoritative parenting was particularly beneficial for the spelling skill development of children who were at risk for reading disabilities. Third, authoritative teaching promoted spelling skill development particularly among children who were nonreaders in kindergarten but had no risk for reading disabilities. Finally, some evidence was found that authoritative teaching could compensate for the negative impact of nonauthoritative parenting on reading development among kindergarten nonreaders.

Mobility performance and its sensory, psychomotor and musculoskeletal determinants from age 75 to age 80.

BACKGROUND AND AIMS: Prospective studies on the simultaneous effects of multiple determinants on objectively assessed mobility are few. The aim of this study was to analyse mobility performance, its stability and sensory, psychomotor and musculoskeletal determinants in an older population from age 75 to age 80. METHODS: Sixty-three men and 121 women aged 75 participated at baseline and, five years later, in the follow-up phase of this population-based prospective study. Maximal walking speed and step-mounting height were assessed at baseline and follow-up. Maximal isometric knee extension strength, standing balance on force platform, reaction time, visual acuity and limitations in range of motion (ROM) of hips and knees were assessed at baseline. Structural equation modeling was used to analyse the associations. RESULTS: The stability of mobility performance from baseline to the five-year follow- up was high (coefficient 0.80 in men, 0.78 in women). In men, knee extension strength, standing balance, ROM limitations and visual acuity explained 69% of the variation in mobility performance at baseline and, indirectly, 59% of that variation at follow-up. Among women, knee extension strength, standing balance, visual acuity and reaction time explained 52% of the variation of mobility performance at baseline and, indirectly, 30% at the five-year follow-up. CONCLUSIONS: Results indicate that the predictive effects of sensory, psychomotor and musculoskeletal functions on mobility performance extend over five years in older people. In seeking to prevent mobility limitations, vision, reaction time and lower extremity ROM need to be targeted, in addition to muscle strength and balance.

Self-rated health and mortality in older men and women: a time-dependent covariate analysis.

Although the relation between self-rated health (SRH) and mortality is widely known, most of the studies have relied in baseline measurements unheeding the dynamics of the phenomenon. Our aim was to analyze how SRH both as a constant and as a time-dependent covariate predicts mortality in older men and women and to compare these different approaches. Subjects consisted of 110 male and 208 female (n=318) residents in the city of Jyväskylä, central Finland, aged 75 years at the baseline in 1989. The follow-up data was gathered in 1994 and mortality was followed for 10 years. Results showed that poor SRH was strongly associated with higher mortality risk in women in all models. In men, the association was found only in time-dependent and 5 year follow-up models and these associations were explained by baseline health status. To conclude, our analyses showed that there are gender differences in association between SRH and mortality and that the use of time-dependent covariate in a Cox regression model enables advantage to be taken of all the information in a longitudinal study design.

The choice between retirement and bridge employment: a continuity theory and life course perspective.

The rapid aging of the workforce in most developed countries, and the strengthening presence of bridge employment among older employees, has brought about a need for a deeper theoretical and practical understanding of this employment phenomenon. This study examined the concept of bridge employment from a continuity theory and life course perspective. Several personal and job-related antecedents of 539 middle-aged and older U.S. Federal Government employees' intentions of full retirement or engagement in bridge employment were investigated. A multinomial logistic regression analysis provided support for most of the hypotheses on the antecedents of full retirement and overall bridge employment intentions and hence offered several practical implications for the U.S. Federal Government, as well as other governmental employers. Implications of these results are discussed from a continuity theory and life course perspective.

Resident care needs and work stressors in special care units versus non-specialized long-term care units.

Differences in how elderly residents' care needs affect staff's experiences of work stressors between special care units (SCUs) for dementia and psychiatric residents and non-SCUs were investigated. The data were drawn from 390 staff members in 38 long-term care SCUs, and 587 staff in 53 non-SCUs in Finland. Residents' care needs were based on the Resident Assessment Instrument (RAI) system measured by the Minimum Data Set 2.0. Work stressors (time-pressure and role-conflicts) were assessed with a staff survey questionnaire. Multiple-group regression analysis showed that residents' dependency in activities of daily living (ADL) was related to increased work stressors only in SCUs. A high proportion of behavioral problems was related to fewer work stressors for SCU staff, but more for non-SCU staff. Work stressors may be reduced by specializing, so that residents with similar care needs are placed together and care is focused.