Activity and Participation Are Associated With Future Falls, Hospitalizations, and Emergency Visits in Community-Dwelling Older Adults.

OBJECTIVE: Activity and participation are important for older adults as they are associated with well-being and quality of life. Falls, emergency department (ED) visits, and hospitalizations are adverse health outcomes that impact older adults. Limited research has investigated whether measurement of activity and participation are related to adverse health events in community dwelling older adults. This study sought to examine the association between activity and participation with falls, ED visits, and hospitalization over 1 year in community dwelling older adults. METHODS: A secondary analysis of a longitudinal clinical trial of 341 community dwelling older adults was conducted. The sample mean age was 80.9 (SD = 7.7) years and 83% were female. One-year risk of falls was associated with baseline Late Life Function and Disability Instrument (LLFDI) components of overall function and disability (frequency and limitations dimensions). Incident rate ratios (IRRs) and 95% CIs were calculated. RESULTS: For each five-point higher score (clinically meaningful difference) in activity as measured by LLFDI-overall function (adjusted for age, race, sex, comorbidities and fall history), there was an 18% lower rate of falls (IRR = 0.82, 95% CI = 0.74-0.92), 12% reduction in hospitalizations (IRR = 0.88; 95% CI = 0.77-0.99), and 11% lower rate of emergency room visits (IRR = 0.89, 95% CI = 0.81-0.98). Greater participation as measured by the LLFDI limitations dimension was related to fewer falls (IRR = 0.93, 95% CI = 0.87-1.00) and hospitalizations (IRR = 0.91, 95% CI = 0.83-0.99). CONCLUSION: Greater activity and participation are associated with a lower incidence of falls, ED visits, and hospitalizations representing an important consideration for targeted physical therapist interventions. IMPACT STATEMENT: Physical therapists are uniquely positioned to identify and address reduced activity and participation. If activity and participation are specifically targeted and improved through physical therapy, undesirable distal health outcomes might be prevented or minimized. LAY SUMMARY: Greater activity and participation were found to be related to lower rate of falls, ED visits, and hospitalizations in a sample of 341 older adults who lived in the community.

The Role of the Environment on Sedentary Behavior in Community-Dwelling Older Adults.

OBJECTIVES: To compare amounts of sedentary behavior and physical activity in adults residing in planned group residential settings to those residing in private homes. METHODS: Thirty-one older adults who resided in planned group residential settings (n=13) and in private homes (n=18) participated. Daily activities were measured using the Sensewear Armband for 7 days. Estimates of the duration of daily activities performed across sedentary, light, and moderate-to-vigorous intensities were captured. RESULTS: Participants in planned group residential settings were older (age 85.9±3.5 vs 78.3±7.2; p=0.001) and spent more time in sedentary behaviors (12.7±1.5 vs 11.3±1.6; p=0.02) than participants in private homes. The difference was attenuated slightly after controlling for age and wear time (adjusted difference 1.2±0.6 hours, p=0.06). DISCUSSION: Adults residing in planned group residential settings, which provide supportive services, were more sedentary than adults residing in private homes. The environment in which older adults live may contribute to sedentary behavior.

The Test-Retest Reliability of Indirect Calorimetry Measures of Energy Expenditure During Overground Walking in Older Adults With Mobility Limitations.

The purpose of this study was to assess the relative and absolute reliability of metabolic measures of energy expenditure and gait speed during overground walking in older adults with mobility limitations. Thirty-three (mean age [SD] = 76.4 [6.6] years; 66% female) older adults with slow gait participated. Measures of energy expenditure and gait speed were recorded during two 6-min bouts of overground walking (1 week apart) at a self-selected "usual" walking pace. The relative reliability for all variables was excellent: ICC = .81-.91. Mean differences for five of the six outcome variables was less than or equal to the respected SEM, while all six mean differences fell below the calculated MDC95. Clinicians and researchers can be confident that metabolic measures of energy expenditure and gait speed in older adults with slow walking speeds can be reliably assessed during overground walking, providing an alternative to traditional treadmill assessments.

The Influence of Body Mass Index on Self-report and Performance-based Measures of Physical Function in Adult Women.

PURPOSE: Little is known about limitations in physical function across BMI categories in middle aged women using both self-report and performance-based measures. Furthermore, the impact of BMI on the measurement of function has not been explored. The purpose of this study was to assess physical function in adult women across BMI categories using self-report and performance-based measures and determine the influence of BMI on the relationship between the measures. METHODS: Fifty sedentary females (10 in each BMI category: normal weight, overweight, obese class I, II, and III) aged 51.2 ± 5.4 years participated. Assessments included demographics, past medical history, physical activity level, BMI, and self-report (Late Life Function and Disability Instrument) and performance-based measures of physical function (6-Minute Walk Test, timed chair rise, gait speed). Physical function was compared between BMI categories using analysis of variance. The influence of BMI on the relationship of self-report and performance-based measures was analyzed using linear regression. RESULTS: Compared to those that were normal weight or overweight, individuals with obesity scored lower on the self-report measure of physical function (LLFDI) for capability in participating in life tasks and ability to perform discrete functional activities. On the performance-based measures, the individuals with obesity had slower gait speed compared to the normal and overweight weight groups. For the 6-Minute Walk Test and timed chair stands, individuals with obesity had poorer performance compared to those who were normal weight. Linear regression analyses revealed that BMI attenuated the relationship between the self-report and performance-based measures by approximately 50%. CONCLUSIONS: While those with severe obesity were most impaired, adult women with less severe obesity also demonstrated significant decrements in physical function.