Prevalence of foot and ankle conditions in a multiethnic community sample of older adults.

The prevalence of foot and ankle disorders was determined in a community-based, multiethnic (non-Hispanic White, African American, and Puerto Rican) random sample of 784 community-dwelling adults aged 65 or more years in 2001-2002 in Springfield, Massachusetts. Overall, the five most common conditions were toenail disorders (74.9%), lesser toe deformities (60.0%), corns and calluses (58.2%), bunions (37.1%), and signs of fungal infection, cracks/fissures, or maceration between toes (36.3%); 30.9% had some tenderness to palpation of the foot or ankle, and 14.9% had ankle joint pain on most days in the past 4 weeks. Toenail conditions, fungal symptoms, and ulcers or lacerations were more common in men, while bunions and corns and calluses were more common in women (p < 0.001). Significant racial/ethnic differences, independent of education or gender, were found for the prevalence of most toe deformities and flat feet, as well as for corns and calluses, fungal signs, edema, ankle joint pain, tenderness to palpation, and sensory loss. Foot and ankle disorders are common in these older adults. Examination of their prevalence in different segments of the community may inform future studies to determine etiology and means of prevention.

Have we oversold the benefit of late-life exercise?

BACKGROUND: Increasing exercise among older adults to improve function and prevent or decrease disability is widely promoted in developed countries. This review seeks to critically evaluate the degree to which existing scientific evidence supports these claims. METHODS: A literature review was performed in Medline and Best Evidence databases for the years 1985 to 2000. Experimental and quasi-experimental aerobic and resistance exercise interventions were reviewed for impairment, function, and disability outcomes. The impact of exercise on specific impairments, functions, and disabilities was examined by summarizing the findings reported across all studies. RESULTS: Thirty-one studies were identified. Impairment and functional outcomes were reported in 97% and 81% of the studies, respectively; half of the studies examined disability outcomes. The most consistent positive effects of late-life exercise were observed in strength, aerobic capacity, flexibility, walking, and standing balance, with over half of the studies that examined these outcomes finding positive effects. Of the studies that examined physical, social, emotional, or overall disability outcomes, most found no improvements. In the five studies that reported reduced physical disability, the effect sizes ranged from .23 to .88. CONCLUSIONS: Late-life exercise clearly improves strength, aerobic capacity, flexibility, and physical function. Existing scientific evidence, however, does not support a strong argument for late-life exercise as an effective means of reducing disability. This may be due, in part, to methodological limitations in studies that have examined disability outcomes. On the other hand, the theoretical basis of interventions aimed at reducing disability may need to extend beyond exercise and address behavioral and social factors.

Elders' preferences for care setting in short- and long-term disability scenarios.

Preference for long-term care (LTC) location among community-dwelling elders was assessed using short- and long-term disability scenarios (N = 537). Using Wilcoxon rank sum tests, we assessed differences in perceptions of financial difficulty, family strain, and personal stress by predisposing, enabling, and need factors. Using logistic regression we determined which factors were predictive of preference for LTC location. Frail and poor elders and those who lived alone had more financial and familial concerns; elders of higher social class anticipated more personal stress; elders with negative attitudes toward LTC facilities, who had fewer financial, familial and personal concerns, and who were married were more likely to prefer home care.

The experience of knee arthritis in athletic young and middle-aged adults: an heuristic study.

OBJECTIVE: To gain a better understanding of the experience of living with tibiofemoral osteoarthritis (OA) as young and middle-aged adults. METHODS: Heuristic qualitative research methods were used. Four informants between the ages of 25 and 45 years diagnosed with tibiofemoral OA were purposively sampled. Informants were white, college educated, middle class, and physically active. Informants were interviewed for 4 hours. Interviews were transcribed verbatim and analyzed according to a van Kaam method modified by Moustakas. RESULTS: Living with tibiofemoral OA involved pain, fear, isolation, helplessness, and loss of function, identity, and perceived control. The informants struggled with adapting to their pathology. Behavior change and activity modification were difficult and seemed to be related to the physical, sociologic, and psychologic aspects of pathology. CONCLUSIONS: A biopsychosocial model of chronic pathology was developed that may guide health professionals in treating and developing interventions for younger adults with arthritis.

Skeletal malalignments of the lower quarter: correlated and compensatory motions and postures.

Pathology of structures within the neuromusculoskeletal system can result from skeletal malalignment, which the authors define as either abnormal joint alignment or deformity within a bone. Pathology can also result from correlated or compensatory motions or postures, which may accompany skeletal malalignment. The purposes of this clinical perspective are to: 1) link common lower limb skeletal malalignments to their common correlated and compensatory motions and postures; and 2) document the age-specific normal skeletal postural alignment for joints and bones of the lower limb. The authors have combined literature review with their clinical perspectives and the clinical perspectives of selected colleagues in this paper to compile this information, which should be beneficial to health professionals involved in assessment, treatment, and prevention of lower quarter neuromusculoskeletal dysfunction.