Predictors of mobility status one year post hip fracture among community-dwelling older adults prior to fracture: A prospective cohort study.

BACKGROUND: Orthopedists and other clinicians assess recovery potential of hip fracture patients at 2 months post-fracture for care planning. It is unclear if examining physical performance (e.g., balance, gait speed, chair stand) during this follow-up visit can identify individuals at a risk of poor functional recovery, especially mobility, beyond available information from medical records and self-report. METHODS: Data came from 162 patients with hip fracture enrolled in the Baltimore Hip Studies-7th cohort. Predictors of mobility status (ability to walk 1 block at 12 months post-fracture) were the Short Physical Performance Battery (SPPB) comprising balance, walking and chair rise tasks at 2 months; baseline medical chart information (sex, age, American Society of Anesthesiologist physical status rating, type of fracture and surgery, and comorbidities); and self-reported information about the physical function (ability to walk 10 feet and 1 block at pre-fracture and at 2 months post-fracture). Prediction models of 12-month mobility status were built using two methods: (1) logistic regression with least absolute shrinkage and selection operator (LASSO) regularization, and (2) classification and regression trees (CART). Area under ROC curves (AUROC) assessed discrimination. RESULTS: The participants had a median age of 82 years, and 49.3% (n = 80) were men. Two-month SPPB and gait speed were selected as predictors of 12-month mobility by both methods. Compared with an analytic model with medical chart and self-reported information, the model that additionally included physical performance measures had significantly better discrimination for 12-month mobility (AUROC 0.82 vs. 0.88, p = 0.004). CONCLUSION: Assessing SPPB and gait speed at 2 months after a hip fracture in addition to information from medical records and self-report significantly improves prediction of 12-month mobility. This finding has important implications in providing tailored clinical care to patients at a greater risk of being functionally dependent who would not otherwise be identified using regularly measured clinical markers.

Consistent Honor, Persistent Disadvantage: American Indian and Alaska Native Veteran Health in the National Survey of Veterans.

Objective: To examine self-rated health and activities of daily living (ADLs) limitations among American Indian and Alaska Native (AI/AN) veterans relative to white veterans. Methods: We use the 2010 National Survey of Veterans and limit the sample to veterans who identify as AI/AN or non-Hispanic white. We calculated descriptive statistics, confidence intervals, and used logistic regression. Results: AI/AN veterans are younger, have lower levels of income, and have higher levels of exposure to combat and environmental hazards compared to white veterans. We found that AI/AN veterans are significantly more likely to report fair/poor health controlling for socioeconomic status and experience an ADL controlling for age, health behaviors, socioeconomic status, and military factors. Discussion: The results indicate that AI/AN veterans are a disadvantaged population in terms of their health and disability compared to white veterans. AI/AN veterans may require additional support from family members and/or Veteran Affairs to address ADLs.

The association between Dietary Inflammatory Index and disability in older adults.

BACKGROUND & AIMS: The impact of the potential inflammatory effect of diet on disability has not been adequately investigated. We examined the association of Dietary Inflammatory Index (DII) on disability in older American adults and detected if these associations differed by stratification across sex and body mass index (BMI) level. METHODS: Data were from the National Health and Nutrition Examination Survey (2007-2016). DII scores were calculated through two 24-h dietary recall interviews. Disability including functional limitations and activities of daily living (ADL) limitations were self-reported. The associations of DII scores on functional limitations and ADL limitations were evaluated by age-sex and multivariable adjusted logistic regression models and further stratification of these associations by sex and BMI level. Restricted cubic splines analyses were used to assess the shapes of these associations. RESULTS: A total of 6893 participants aged 60 years and above were eligible for this study. DII was related to higher odds of functional limitations. Compared to the lowest quintile of DII scores, the odds ratio (OR) for participants in the second, third, fourth, and highest quintile were 1.61 (95%CI:1.20-2.15), 1.42(95%CI:1.09-1.85), 1.51 (95%CI:1.09-2.09) and 1.97 (95%CI:1.37-2.82) for functional limitations (P-trend = 0.003). The positive associations between DII scores and functional limitations were observed both in men and women. The corresponding ORs (95%CI) across all quintiles were 1.68(1.07-2.66), 1.54(1.06-2.25), 2.03(1.18-3.47), 2.11(1.19-3.74) in men (P-trend = 0.008) and 1.52(1.03-2.27), 1.32(0.86-2.02), 1.24(0.81-1.90), 1.74(1.11-2.73) in women (P-trend = 0.089). In the stratified analyses by BMI level, comparing the lowest quintiles, the corresponding ORs of functional limitations in second, third, fourth, and fifth quintiles were 2.71 (95% CI: 1.57-4.68), 2.39(95% CI: 1.38-4.11), 2.34(95% CI: 1.31-4.19), 2.54(95% CI: 1.25-5.13) in overweight (P-trend = 0.019) and 1.32(95% CI: 0.81-2.15), 1.17(95% CI: 0.71-1.92), 1.33(95% CI: 0.77-2.30), 2.15(95% CI: 1.19-3.87) in obesity (P-trend = 0.032). CONCLUSIONS: The results provide evidence of a positive association between DII score and functional limitations in American older adults, especially participants with overweight and obesity.

Influence of Health and Functional Status and Co-occurring Chronic Conditions on Healthcare Expenditures Among Community-dwelling Adults With Kidney Cancer in the United States: A Propensity-score-matched Analysis.

BACKGROUND: Health and functional status, as well as co-occurring chronic conditions, have a profound influence on healthcare expenditures. However, no study to date has assessed their influence among community-dwelling adults with kidney cancer (KC) in the United States (US). This study assessed the impact of health and functional status, along with co-occurring chronic conditions, on KC healthcare expenditures. METHODS: This study used a retrospective, cross-sectional, propensity-score-matched, case-control study design using 2002 to 2011 Medical Expenditure Panel Survey data. The case group was comprised of adults with KC, whereas the control group consisted of propensity-score matched adults with other forms of cancer. To examine the impact of health and functional status and co-occurring chronic conditions, ordinary least square regressions on log-transformed expenditures were conducted on total and subtypes of healthcare expenditures. The percentage change in expenditure was calculated using the formula (expß - 1). RESULTS: Findings from this study indicate that the annual average total healthcare expenditures ($15,078 vs. $8182; P < .001) for adults with KC were significantly higher compared with propensity-score-matched adults with other forms of cancer. Total healthcare expenditures for adults with KC were 80% (ß = 0.588; P < .001) higher compared with propensity-score-matched controls when only demographic characteristics were adjusted. After adjusting for health and functional status and co-occurring chronic conditions, the percentage decreased from 80% to 43% (ß = 0.359; P < .01). CONCLUSIONS: Findings from this nationally representative sample suggest that health and functional status and co-occurring chronic conditions have a significant impact on healthcare expenditures among community-dwelling adults with KC in the US.