Abdominal Obesity and Mobility Disability in Older Adults: A 4-Year Follow-Up the International Mobility in Aging Study.

BACKGROUND: Abdominal obesity is related to the disability process in older adults, however, little is known about this relationship when adjusted for important confounders such as depression and physical performance measures in a diverse international aged population. OBJECTIVES: To explore the longitudinal relationship between abdominal obesity and mobility disability controlling for physical performance and depression. DESIGN AND SETTING: Longitudinal observational study using data from the International Mobility in Aging Study (IMIAS) Study. PARTICIPANTS: 1104 out of 2002 older adults aged 64-74 years old free of mobility disability at baseline (2012) and then reassessed in 2016. MEASUREMENTS: Mobility disability was defined as reporting difficulty in walking 400 m or climbing stairs. Activities of daily living (ADL) disability was based on any self-reported difficulty in five mobility-related ADLs. Abdominal obesity was defined as waist circumference ≥ 88cm for women or ≥ 102 cm for men. Four meters gait speed, handgrip strength and depressive symptoms (CES-D) were assessed. Generalized Estimating Equations (GEE) and multinomial regressions were used to estimate associations between disability and abdominal obesity. RESULTS: 1104 free of disability participants were followed over 4 years, the mean age was 68.9 (±2.9) years among men and 68.7 (±2.6) years among women. Prevalence and incidence rates of mobility disability varied widely across research site and sex. The longitudinal associations between mobility disability and abdominal obesity remained significant even when adjusted by depressive symptoms, handgrip strength, gait speed, age, sex, education and research site. Participants with abdominal obesity had higher mobility disability (OR=1.68, 95% CI 1.23-1.76, p-value=0.01) and also increased risk for ADL disability (OR: 1.47, 95% CI 1.23-1.76, p-value=0.01). Abdominal obesity in baseline was also predictor of mobility disability in 2016 (OR: 1.93, 95% CI 1.17-3.17, p-value <0.01) but not for ADL disability (OR: 1.59, 95% CI 0.93-2.71, p-value =0.09) with accounting mortality. CONCLUSION: Abdominal obesity is associated longitudinally and predicts mobility disability, even over a short period (4 years) in community-dwelling older adults from different epidemiological contexts.

Association between High Levels of Parathyroid Hormone and Frailty: The Nepean Osteoporosis and Frailty (NOF) Study.

BACKGROUND: Frailty is associated with poor outcomes hence identification of risks factors is pivotal. Since the independent role of parathyroid hormone (PTH) in frailty remains unexplored, we aimed to determine this in a population of older individuals with a history of falling. DESIGN: Cross-sectional study. SETTING: Falls and Fracture Clinic, Nepean Hospital (Penrith, Australia). PARTICIPANTS: 692 subjects (mean age=79, 65% women) assessed between 2009-2015. MEASUREMENTS: Assessment included clinical examination, mood, nutrition, grip strength, gait velocity, bone densitometry and posturography. Chemistry included serum PTH, calcium, vitamin D (25(OH)D3), creatinine and albumin. Normocalcemic subjects were divided into 4 groups: (1) Normal: 25(OH)D3 >50nmol/L and PTH between 1.6-6.8pmol/L; (2) PTH responsive: low 25(OH)D3 (<50nmol/L) and high PTH (>6.8pmol/L); (3) PTH unresponsive: low 25(OH)D3 and normal PTH; (4) Hyper PTH (>6.8pmol/L) with normal 25(OH)D3. Frailty was defined using Fried's criteria. Difference between the groups was assessed using one-way ANOVA and X2 analysis. Multinomial logistic regression evaluated the association between the groups and the number of Fried's criteria adjusted for age, BMI, renal function, 25(OH)D3 levels, and albumin. RESULTS: 22.6% subjects had high PTH levels (>6.8pmol/L). All subjects in the high PTH groups had significantly lower grip strength, gait velocity, limits of stability, and higher BMI. The PTH responsive group had a higher risk of pre-frailty (ß=3.8, 95% CI = 3.42 - 5.22, p≷ 0.01) and frailty (ß=8.26, 95% CI = 2.8-16.1, p<0.01). The risk of frailty was also higher in the Hyper PTH group (ß=2.3, 95% CI = 1.74-4.32, p<0.01). CONCLUSION: We have reported an independent association of high PTH levels with high number of falls and with the clinical components of physical frailty in community dwelling older persons. Our results suggest a possible role of PTH in frailty that deserves further exploration.

Comprehensive nutritional status in sarco-osteoporotic older fallers.

OBJECTIVES: In older persons, the combination of osteoporosis and sarcopenia has been proposed as a subset of frailer individuals at higher risk of falls and fractures. However, the particular nutritional status of the sarco-osteoporotic (SOP) patients remains unknown. The goal of this study was to obtain a comprehensive picture of nutritional status in SOP patients. DESIGN: Cross-sectional study. SETTING: Falls and Fractures Clinic, Nepean Hospital (Penrith, Australia). PARTICIPANTS: 680 subjects (mean age=79, 65% female) assessed between 2008-2013. MEASUREMENTS: Assessment included medical history, mini-nutritional assessment, physical examination, bone densitometry and body composition by DXA, and blood tests for nutritional status (albumin, creatinine, hemoglobin, vitamin D, vitamin B-12, calcium, phosphate and folate). Patients were divided in 4 groups: 1) osteopenia/osteoporosis (BMD<-1.0 SD); 2) sarcopenia; 3) SOP; and 4) normal (no sarcopenia/no osteoporosis). Difference between groups was assessed with one-way ANOVA and chi square analysis. Multivariable linear regression evaluated the association between the groups and measures of nutritional parameters. RESULTS: Sarcopenia was present in 47.4% of those with osteopenia (167/352) and 62.7% in those with osteoporosis (91/145). Mean age of the SOP was 80.4±7 years. SOP patients showed significantly higher prevalence of falls and fractures. Univariate analyses showed that SOP were more likely than normal to have a BMI< 25 (OR 2.42 95%CI 1.45-4.041, p<0.001), a MNA score <12 (OR 2.0, 95%CI 1.15-3.49, p<0.05), serum folate <20 nmol/L (OR 4.0 95%CI 1.35-11.87, p<0.01) and hemoglobin <120g/L (OR 2.0 95%CI 1.28-3.30, p<0.01). Multivariate analysis showed that a MNA score <12 was independently associated with SOP compared to normal when adjusted for age and gender. Hemoglobin <120g/L, BMI <25, and GDS >6 remained independently associated with SOP after adjustment for all variables including inflammatory conditions. Hypoalbuminemia (<35 g/L) was associated with just osteopenia/osteoporosis (OR: 2.03, 95%CI 1.08-3.81, p<0.01) and just sarcopenia (OR: 1.77, 95%CI 1.0-3.0, p<0.01) compared to normal. No differences in vitamin D, glomerular filtration rate, albumin, corrected calcium, phosphate, red blood cells folate or vitamin B12 levels were found between the subgroups. CONCLUSIONS: In approaching SOP patients, early prevention protocols directed to optimize their nutritional status would be a key strategy to prevent poor outcomes such as falls and fractures in this high risk population. Therefore, nutritional assessment and early nutritional supplementation should be essential domains in this strategy.

Dizziness as a geriatric condition among rural community-dwelling older adults.

BACKGROUND: Dizziness is a common symptom in older adults. The majority of those with dizziness tend to have more than one risk factor, suggesting that dizziness is a multifactorial geriatric condition. Therefore, associated factors must be determined to permit risk-reduction approaches. OBJECTIVE: To examine the associations between dizziness and socio-demographic, physical, functional and psychological health factors among older persons living in the Andes Mountains. DESIGN: Population-based cross-sectional study. SETTINGS/PARTICIPANTS: One thousand six hundred ninety-two community-living people aged 60 years and over living in four rural and suburban areas of villages in coffee-grower zones in the Colombian Andes Mountains. MEASUREMENTS: Outcome measures included self-reporting of dizziness as a symptom experienced either very frequently or continuously during the last month. Independent variables were demographic, socioeconomic and social factors; disease and biomedical factors; functional status and performance-based measures; and psychological factors such as depressive symptoms and self-rated health. RESULTS: Dizziness was reported by 15.2% of participants in the study. Variables independently associated with dizziness were: number of chronic conditions, visual impairment, and use of more than four medications. Independently associated psychological variables were: poor self-perceived health, cognitive impairment and depression. Health and psychological factors accounted for 85% of dizziness. CONCLUSION: Older persons who reported dizziness were more physically frail, with more instances of chronic conditions and sensory impairments, and had poor self-perceptions of their health. Biomedical and psychological factors showed a strong independent association with dizziness. A multifactorial intervention targeting the identified factors would reduce dizziness in older people. However, this approach may need to address different sets of specific factors related to the dizziness categories.

Validez y fiabilidad de la escala de Braden para predecir riesgo de úlceras por presión en ancianos / Validity and reliability of the Braden scale to predict pressure ulcer risk in the elderly

OBJETIVO: Determinar la validez predictiva y la fiabilidad de la escala de Braden para predecir el riesgo de úlceras por presión (UP) en ancianos en una institución de referencia de tercer nivel de atención. DISEÑO: Estudio de cohorte. MATERIAL Y MÉTODOS: Se tomaron los 831 pacientes sin UP al ingreso, mayores de 60 años, hospitalizados al menos durante 72 horas en el Hospital de Caldas durante un año, septiembre 1988-1999. Las variables demográficas y el diagnóstico primario al ingreso a las salas de hospitalización se tomaron de la historia clínica. Se clasificó el tipo de piel, se valoró el estado funcional mediante la escala de Barthel. La versión original en inglés de la escala de Braden se tradujo al español y se aplicó a las 72 horas del ingreso y cada semana hasta tres semanas, evaluando de forma simultánea el desarrollo de UP, las cuales se estadificaron de I a IV. La sensibilidad, la especificidad, el Valor Predictivo Positivo (VPP) y el Valor Predictivo Negativo (VPN) fueron calculados para los diferentes puntajes de laEscala de Braden en las cuatro aplicaciones o hasta la evaluación anterior a la detección de la primera UP. RESULTADOS: El promedio de edad fue 71,9 (DE 8), 57 por ciento eran hombres y 96,9 por ciento procedían del hogar. El puntaje en la escala de Barthel osciló entre 0 y 100 con una media de 46,9. En cuanto a los diagnósticos al ingreso las enfermedades cardiovasculares, osteomusculares, gastrointestinales y neurológicas fueron en su orden las patologías más frecuentes. El 8,04 por ciento de los sujetos estudiados desarrollaron UP durante el estudio, 71,6 por ciento la desarrollaron durante la primera semana, 20,8 por ciento en la segunda y 7,5 por ciento en la tercera semana. Se presentaron principalmente en sacro y en estados I y II. El rango de los puntajes en la Escala de Braden osciló entre 6 y 23. El percentil 25 en todas las evaluaciones estuvo entre 15 y 16 puntos, y el percentil 75 en 21. Las variaciones de los puntajes entre las tres evaluaciones fueron mínimas. Las Curvas Operantes de Receptor (COR) derivadas de los datos muestran que un puntaje de 16 produce un punto de corte óptimo donde simultáneamente se maximiza la sensibilidad a 85,4 por ciento y la especificidad a 63,2 por ciento con un VPP de 12,5 en ese punto y un VPN de 98,6. CONCLUSIONES: Este estudio permite concluir que en ancianos hospitalizados la escala de Braden para predecir riesgo de UP es confiable y válida, con un punto de corte de 16. Además sugiere que se deben tener en cuenta otros factores que afectan su validez como la edad y el estado funcional (AU)

Validez y reproducibilidad de medidas de evaluación funcional basadas en la ejecución / Validity and reproducibility of functional assessment based on performance status

OBJETIVO: El objetivo de este estudio fue establecer la validez y reproducibilidad de varias medidas basadas en la ejecución en su versión en español y de una versión adaptada de la escala de Lawton para medición de AVD instrumental. MÉTODO: Estudio trasversal que tomó al azar 135 mayores de 60 años, independientes en marcha, divididos en tres grupos: 45 que realizaban ejercicio en forma regular tres veces por semana, 45 sedentarios que asistían a programas sociales y 45 que pertenecían a una institución de cuidado crónico. A todos los participantes se les realizaron las siguientes medidas basadas en la ejecución: equilibrio estático en posición de pie (prueba de Romberg modificada), alcance funcional, velocidad de la marcha, incorporarse de una silla y escala de movilidad de Tinetti (subescala de equilibrio). Para establecer la reproducibilidad se hizo una prueba de test-retest una semana después a 30 sujetos tomados al azar (10 por cada grupo). El coeficiente de correlación de Pearson fue utilizado para verificar la validez de constructo. La reproducibilidad test-retest es estimada con el coeficiente de correlación intraclase. Se establecieron la sensibilidad y reproducibilidad de las pruebas. RESULTADOS: El promedio de la velocidad de la marcha fue 0,62 m/seg. con una sensibilidad del 78 por ciento y una especificidad de 91 por ciento, para la detección de deterioro en la subescala de movilidad de Barthel. El promedio del alcance funcional fue de 28,4 cm, y mostró una sensibilidad del 60 por ciento y una especificidad del 80 por ciento en cuanto a la presencia de caídas. Ancianos con menos de 20 cm tenían caídas recurrentes (dos o más) el año anterior. El promedio del tiempo utilizado para incorporarse de una silla fue de 1,94 seg. Tanto la medición de autoevaluación (AVD instrumental) como las medidas basadas en la ejecución realizadas en esta población heterogénea (que hacían y no ejercicio) tiene una reproducibilidad de moderada a alta, con coeficientes de correlación de Pearson y coeficientes de correlación intraclase que oscilaban entre 0,56 y 0,95. CONCLUSIONES: Se puede afirmar que la versión en español de las medidas basadas en la ejecución (prueba de equilibrio de Romberg modificada, alcance funcional, velocidad de la marcha, incorporarse de una silla y la subescala de equilibrio de la batería de Tinetti) son válidas y confiables para su utilización en el medio. De ellas, la velocidad de la marcha tiene la mejor validez y reproducibilidad (AU)