Less exercise and more TV: leisure-time physical activity trends of Shanghai elders, 1998-2008.

BACKGROUND: Surveillance of physical activity trends in older adults is limited in developing nations. This study examined 10-year leisure-time physical activity trends of elderly residents of Shanghai, the largest Chinese city with the nation's highest proportion of senior citizens. METHODS: The study used panel data from the Shanghai Longitudinal Survey of Elderly Life and Opinion (1998, 2003, 2005 and 2008). Leisure-time physical activity questions included (i) 16 major leisure-time habitual activities and (ii) regular exercise in the previous 6 months. RESULTS: In comparison to 1998, for Shanghai elders, the trend for engaging in leisure-time habits not related to physical activity increased over time, becoming statistically significant in 2005 and 2008 (e.g. OR for watching TV in 2003, 2005 and 2008 is 1.04 [0.91, 1.19], 1.17 [1.00, 1.38] and 1.78 [1.51, 2.09], respectively). Simultaneously, the trend for engaging in regular exercise declined significantly in each observation year in comparison to 1998 (OR in 2003, 2005 and 2008 is 0.70 [0.61, 0.80], 0.36 [0.30, 0.42] and 0.28 [0.24, 0.33], respectively). Discussion An increasingly sedentary lifestyle has evolved over the past decade in Shanghai. This highlights a need for public health agencies to develop effective active lifestyle interventions and physical activity promotion programs for local elders.

Memory complaint is not necessary for diagnosis of mild cognitive impairment and does not predict 10-year trajectories of functional disability, word recall, or short portable mental status questionnaire limitations.

OBJECTIVES: To evaluate the prevalence and utility of memory complaint in a geographically representative cohort and, in cases with mild cognitive impairment (MCI), to determine whether memory complaint alters 10-year trajectories of disability in activities of daily living (ADLs), Short Portable Mental Status Questionnaire (SPMSQ) score, and 20-item word recall. DESIGN: Prospective cohort study. SETTING: Washington and Iowa counties, Iowa. PARTICIPANTS: Iowa Established Populations for Epidemiologic Studies of the Elderly (N = 3,673; aged > or =65; 61.3% female; 99.9% white). MEASUREMENTS: Age, sex, education, SPMSQ score, 20-item word recall, ADL or instrumental ADL disability, and chronic medical conditions. RESULTS: The prevalence of memory complaint was 34%. Although proportionally more cognitively impaired individuals were in the memory complaint group (34% vs 27%), the pattern of subclassification into cognitively intact and MCI Stage 1 and 2 subgroups was similar for people with and without memory complaint. Median SPMSQ score and number of words recalled at baseline were comparable across memory complaint categories in each subgroup. MCI participants without subjective memory complaint constituted a larger proportion of the overall sample than individuals with subjective memory complaint (460 (14%) vs 295 (8.9%)) and of persons objectively classified as having MCI (61% vs 39%). The distribution of individual 10-year change in ADL disability, SPMSQ score, and word recall were similar for those with and without memory complaint across all subgroups of cognitive impairment. CONCLUSION: Memory complaint is not necessary for MCI diagnosis and does not distinguish cases with different progression rates in disability or cognitive impairment. 2006.

Identifying frailty in hospitalized older adults with significant coronary artery disease.

OBJECTIVES: To characterize physiological variation in hospitalized older adults with severe coronary artery disease (CAD) and evaluate the prevalence of frailty in this sample, to determine whether single-item performance measures are good indicators of multidimensional frailty, and to estimate the association between frailty and 6-month mortality. DESIGN: Observational cohort study. SETTING: Inpatient hospital cardiology ward. PARTICIPANTS: Three hundred nine consecutive inpatients aged 70 and older admitted to a cardiology service (n = 309; 70% male, 84% white) with minimum two-vessel CAD determined using cardiac catheterization. MEASUREMENTS: Two standard frailty phenotypes (Composite A and Composite B), usual gait speed, grip strength, chair stands, cardiology clinical variables, and 6-month mortality. RESULTS: Prevalence of frailty was 27% for Composite A versus 63% for Composite B. Utility of single-item measures for identifying frailty was greatest for gait speed (receiver operating characteristic curve c statistic = 0.89 for Composite A, 0.70 for Composite B) followed by chair-stands (c = 0.83, 0.66) and grip strength (c = 0.78, 0.57). After adjustment, composite scores and single-item measures were individually associated with higher mortality at 6 months. Slow gait speed (< or =0.65 m/s) and poor grip strength (< or =25 kg) were stronger predictors of 6-month mortality than either composite score (gait speed odds ratio (OR)=3.8, 95% confidence interval (CI) = 1.1-13.1; grip strength OR = 2.7, 95% CI = 0.7-10.0; Composite A OR = 1.9, 95% CI = 0.60-6.1; chair-stand OR = 1.5, 95% CI = 0.5-5.1; Composite B OR = 1.3, 95% CI = 0.3-5.2). CONCLUSION: Gait speed frailty was the strongest predictor of mortality in a population with CAD and may add to traditional risk assessments when predicting outcomes in this population.

Mild cognitive impairment and 10-year trajectories of disability in the Iowa Established Populations for Epidemiologic Studies of the Elderly cohort.

OBJECTIVES: To apply diagnostic criteria for mild cognitive impairment (MCI) to a geographically representative sample, to estimate the prevalence of MCI, and to estimate 10-year trajectories of incident disability for cognitively intact participants and subgroups with MCI. DESIGN: Prospective cohort; 10 years of follow-up. SETTING: Community-based survey of noninstitutionalized population aged 65 and or older in two rural Iowa counties (Washington and Iowa). PARTICIPANTS: Iowa Established Populations for Epidemiologic Studies of the Elderly (aged > or = 65; N = 3,673; 61.3% female; 99.9% white). MEASUREMENTS: Age, sex, education, Short Portable Mental Status Questionnaire (SPMSQ), 20-item word recall, activities of daily living (ADLs), instrumental activities of daily living (IADLs), chronic medical conditions. RESULTS: MCI was prevalent in 24.7% of participants at baseline. Most participants in the overall cohort remained stable or changed slowly (< or = 1 new limitations) over 10 years (63.1% for SPMSQ, 89.3% for word recall, and 61.7% for ADL disability). For MCI/no prevalent IADL disability (Stage 1 MCI), disability progression was similar to that in the cognitively intact subgroup (median = 0.08 vs 0.05 disabilities per year). For MCI plus prevalent IADL disability (Stage 2 MCI), the median rate of change was equivalent to that of the severely impaired (0.23 disabilities per year; interquartile range = 0.12-0.36). CONCLUSION: Unlike participants with MCI who reported no IADL limitations, those with such limitations were more likely to develop ADL disability--a prerequisite for a diagnosis of dementia.

Plasma hypertonicity: another marker of frailty?

OBJECTIVES: To determine whether plasma hypertonicity might be a marker of early frailty, this study tested the associations between plasma hypertonicity, incident disability, and mortality in nondisabled older adults. DESIGN: Longitudinal, observational study. SETTING: Community-based. PARTICIPANTS: Older adults (> or =70), who reported no disability and gave blood in the 1992 Duke Established Populations for Epidemiologic Studies of the Elderly survey (n=705), were re-interviewed in 1996 for functional status (n=561) and followed for all deaths up to January 1, 2000. MEASUREMENTS: Plasma tonicity was estimated from plasma glucose, sodium, and potassium measures and used to classify subjects as normo- (285-294 mOsm/L) or hypertonic (> or =300 mOsm/L). Disability was defined as any impairment on the Rosow-Breslau, activity of daily living (ADL), and instrumental activity of daily living (IADL) scales. The relative risk (RR) of any new disability and relative hazard of death associated with hypertonicity were estimated using logistic regression models and Cox proportional hazards models, respectively. All models were controlled for age, sex, race, weight status, current smoking, activity level, plasma blood urea nitrogen and creatinine, cognitive impairment, depression, and chronic disease status. To determine whether observed effects were attributable to plasma glucose alone, all models were repeated on a subsample of nondiabetic, normoglycemic subjects. RESULTS: Plasma hypertonicity (observed in 15% of subjects) was associated with increased risk of new Rosow-Breslau (RR=2.1, 95% confidence interval (CI)=1.2-3.6), IADL (RR=2.3, 95% CI=1.2-4.3), and ADL (RR=2.7 95% CI=1.3-5.6) disability by 1996 and mortality by 2000 (RR=1.4, 95% CI=1.0-1.9). Results were similar for the normoglycemic subgroup (ADL: RR=2.9, 95% CI=1.0-8.0; IADL: RR=2.5, 95% CI=1.0-6.3; Rosow-Breslau: RR=1.8, 95% CI=0.8-3.9; mortality: RR=1.5, 95% CI=0.9-2.3). CONCLUSION: Plasma hypertonicity may be a marker of early frailty. It was prevalent in this sample of nondisabled community-dwelling older adults and predicted incident disability and mortality. Further research to identify its determinants and consequences may help inform interventions against frailty.

Trajectories of leg strength and gait speed among sedentary older adults: longitudinal pattern of dose response.

BACKGROUND: Current theory about how an older adult's leg strength influences walking speed is based primarily on nonlinear patterns of association observed in cross-sectional data. Compared with adults with normal or high levels of leg muscle strength, weak older adults are thought to have a greater capacity for functional change in response to changes in lower extremity strength. Longitudinal data, however, have not been applied to study this putative pattern of dose response. METHODS: Three repeated measures of leg strength, gait speed, and covariates were evaluated in a cohort of 134 sedentary, community-dwelling male and female participants (aged >64 years) of a randomized exercise intervention. Empirical Bayes methods were used to evaluate the association between trajectories of strength and gait speed during the course of the study. RESULTS: We observed a potentially clinically important, positive linear association between strength change and gait speed change. Each additional unit increase in the monthly rate of strength change increased the rate of gait speed change by 0.29 meters/minute/month (95% CI [confidence interval] = 0.03, 0.55 m/min/mo). Absolute change in walking velocity due to strength changes in the cohort ranged from a gain of approximately 15 m/min to a loss of approximately 13 m/min over the 9-month period (changes of -18% to +20% relative to a normal walking speed of 72 m/min). CONCLUSIONS: In this cohort, change in functional walking speed depended more on the rate of strength change observed than on the amount of muscle weakness present at baseline. These results have important implications for screening and intervention programs designed to change functional walking ability among sedentary older adults.

Competing risk of household expansion or institutionalization in late life.

OBJECTIVES: The purpose of this study was to evaluate predictors of change in household size and institutionalization in late life. METHODS: The Duke Established Populations for Epidemiologic Studies of the Elderly cohort (n = 3730) was assessed annually (1986-1996). Independent variables included home ownership, income, cognitive and functional ability, chronic illness, mood, household size, social support, and stressful life events. Competing risk of household expansion or institutionalization was modeled using (a) hazard of either event and (b) odds of household expansion or institutionalization among elders who experienced an event. RESULTS: Hazard of either event was associated with younger age, Black race, lower income, cognitive problems and stability, functional abilities and deterioration, low chronic illness burden, being unmarried, having more living children, and recent life events. Among those who reported either event, odds of institutionalization (vs. household expansion) were associated with older age, White race, cognitive and functional problems, high chronic illness burden, being married, having fewer living children, smaller household size, social isolation, and exits of nonspouse coresidents. DISCUSSION: Modeling separate effects of whether there was a household expansion or institutionalization, and if so, which type of event occurred, and taking into account acute and evolving states, enabled more precise understanding of the complex mechanisms involved in determining continued community residence or institutionalization.

Trends in ADL and IADL disability in community-dwelling older adults in Shanghai, China, 1998-2008.

OBJECTIVES: We investigated trends in activities of daily living (ADL) and instrumental activities of daily living (IADL) disability from 1998 to 2008 among elder adults in Shanghai, China. METHOD: Our data came from 4 waves of the Shanghai Longitudinal Survey of Elderly Life and Opinion (1998, 2003, 2005, and 2008). ADL and IADL disabilities were recorded dichotomously (difficulty vs. no difficulty). The major independent variable was survey year. Covariates included demographics, socioeconomic conditions, family and social support, and other health conditions. Nested random-effect models were applied to estimate trends over time, referenced to 1998. RESULTS: In comparison with the baseline year (1998), older adults in 2008 had lower odds of being ADL disabled, though the effect was no longer statistically significant when other health conditions were taken into account. Elders in 2003, 2005, and 2008 were 20%-26%, 17%-38%, and 53%-64% less likely to be IADL disabled than those in 1998, respectively, depending on the set of covariates included in the model. DISCUSSION: Shanghai elders experienced substantial improvements in both ADL and IADL disability prevalence over the past decade. The trend toward improvement in IADL function is more consistent and substantial than that of ADL function.

A new classification of function and disability in China: subtypes based on performance-based and self-reported measures.

OBJECTIVES: To develop a new classification method to describe incidence and prevalence of function and disability and their predictors in Chinese older adults. METHODS: Data were obtained from 16,020 older adults in the 2002 wave of Chinese Longitudinal Healthy Longevity Survey (CLHLS). The subtypes of function and disability were defined by combining physical performance (PP) tests and self-reported assessments of activities of daily living (ADL). RESULTS: The most prevalent subtype involved PP limitations without ADL dependency. Rural living made it more likely that an individual with physical performance limitations would be independent in ADL, whereas city residence made dependence in ADL more likely, regardless of whether performance limitations were present. DISCUSSION: Self-reported and performance-based tools can be used in combination to estimate conceptually different subtypes of function and disability, with different epidemiological rates of incidence and different social, medical, and environmental predictors.

Association of slower walking speed with incident knee osteoarthritis-related outcomes.

OBJECTIVE: To determine whether slower walking speed was associated with an increased risk of incident hip and knee osteoarthritis (OA)-related outcomes. METHODS: After providing informed consent, community-dwelling participants in the Johnston County Osteoarthritis Project completed 2 home-based interviews and an additional clinic visit for radiographic and physical evaluation. One thousand eight hundred fifty-eight noninstitutionalized residents ages ≥ 45 years living for at least 1 year in 1 of 6 townships in Johnston County, North Carolina, completed the study's questionnaires and clinical examinations at baseline and at followup testing. Walking time was assessed using a manual stopwatch in 2 trials over an 8-foot distance, and walking speed was calculated as the average of both trials. For the hip and knee, we examined 3 outcomes per joint site: radiographic OA (weight-bearing anteroposterior knee radiographs, supine anteroposterior pelvic radiographs of the hip), chronic joint symptoms, and symptomatic OA. Covariates included age, sex, race, education, marital status, body mass index, number of self-reported chronic conditions diagnosed by a health care provider, number of prescriptions, depressive symptoms, self-rated health, number of lower body functional limitations, smoking, and physical activity. RESULTS: Faster walking speed was consistently associated with a lower incidence of radiographic (adjusted odds ratio [OR] 0.88, 95% confidence interval [95% CI] 0.79-0.97) and symptomatic knee OA (adjusted OR 0.84, 95% CI 0.75-0.95); slower walking speed was associated with a greater incidence of these outcomes across a broad range of different clinical and radiographic OA outcomes. CONCLUSION: Slower walking speed may be a marker for incident knee OA, but other studies must confirm this finding.

The Junior Faculty Laboratory: an innovative model of peer mentoring.

Mentoring in academic medicine has been shown to contribute to the success of junior faculty, resulting in increased productivity, career satisfaction, and opportunities for networking. Although traditional dyadic mentoring, involving one senior faculty member and one junior protégé, is the dominant model for mentoring in the academic environment, there is increasing recognition that the sharing of knowledge, skills, and experiences among peers may also contribute to the career development of junior faculty. The authors describe the structure, activities, and outcomes of the Junior Faculty Laboratory (JFL), a self-organized, flexible, and dynamic peer-mentoring model within the Duke University Center for the Study of Aging and Human Development. As an innovative mentoring model, JFL is entirely peer driven, and its activities are determined by the real-time needs of members. In contrast to some other peer-mentoring models, JFL lacks senior faculty input or a structured curriculum, members are multidisciplinary, meeting times are project driven rather than preset, and participation in collaborative projects is optional based on the interests and needs of group members. Additionally, JFL was not formed as a substitute for, but as a complement to, the dyadic mentoring relationships enjoyed by its members. The model, now in its fifth year, has demonstrated success and sustainability. The authors present the JFL as an innovative, mentoring model that can be reproduced by other junior faculty seeking to foster collegial relationships with peers while simultaneously enhancing their career development.

Effect of new disability subtype on 3-year mortality in Chinese older adults.

OBJECTIVES: To examine a new method of classifying disability subtypes by combining self-reported and performance-based tools to predict mortality in older Chinese adults. DESIGN: Prospective cohort study. SETTING: Community-dwelling older adults. PARTICIPANTS: Sixteen thousand twenty Chinese adults aged 65 and older from the Chinese Longitudinal Healthy Longevity Survey (CLHLS). MEASUREMENTS: Self-reported activities of daily living (ADLs) and physical performance (PP) tests (chair standing, lifting a book from floor, turning 360°) cross-classified to create mutually exclusive disability subtypes: subtype 0 (no limitations in PP or ADLs), subtype 1 (limitations in PP, no limitations in ADLs), subtype 2 (no limitations in PP, limitations in ADLs), and subtype 3 (limitations in PP and ADLs). Outcome was mortality over 3 years. RESULTS: Cox proportional hazard models, controlling for sociodemographic variables, living situation, healthcare access, social support, health status, and life-style, showed that older adults without any limitations in ADLs or PP had significantly lower mortality risk than those with other disability subtypes and that there was a graded pattern of greater mortality according to subtype 1 (hazard ratio (HR)=1.31, 95% confidence interval (CI)=1.20-1.42), 2 (HR=1.39, 95% CI=1.23-1.59), and 3 (HR=1.88, 95% CI=1.72-2.05). When compared with the average survival curve in the cohort, subtypes of isolated performance deficits or self-reported disability did not substantially discriminate risks of death over 3 years. CONCLUSION: Combined use of self-reported and PP tools is necessary when screening for mutually exclusive disability subtypes that confer significantly higher or lower mortality risks on a population of older adults.

Measurement of paretic-lower-extremity loading and weight transfer after stroke.

BACKGROUND: Weight bearing through, or "loading" of, the paretic lower extremity and transfer of weight from one lower extremity to the other are important impairment-level goals of stroke rehabilitation. Improvements in these limb-loading and weight-transfer abilities have been shown to relate to improved performance of many functional activities. Unfortunately, valid and practical clinical measures of paretic-lower-extremity loading and weight transfer have not been identified. OBJECTIVE: The purpose of this study was to assess convergent validity of the Step Test (ST) and the knee extension component of the Upright Motor Control Test (UMCe) as measures of paretic-limb loading and of the Repetitive Reach Test (RR) as a measure of weight transfer in the first 6 months after stroke. DESIGN: This was a prospective cohort study of 33 adults with lower-extremity motor impairment following unilateral, noncerebellar stroke. Participants were tested one time per month from 1 to 6 months poststroke. RESULTS: Scores on the ST (performed with the nonparetic leg as the stepping leg) and UMCe were positively correlated with peak vertical ground reaction forces (GRFs) beneath the paretic limb during functional tasks (R(2)=.35-.76 for the ST, pseudo R(2)=.21-.34 for the UMCe). Scores on the RR were positively correlated with change in vertical GRF beneath the paretic limb during the diagonal reach task (R(2)=.45) and with weight-transfer time during stepping with the nonparetic limb (R(2)=.15). CONCLUSIONS: The ST, performed with the nonparetic leg as the stepping leg, is a valid measure of paretic-limb loading during stroke recovery. Of the clinical measures tested, the ST correlated most strongly with the force platform measures.

Step Test scores are related to measures of activity and participation in the first 6 months after stroke.

BACKGROUND: The Step Test (ST) is a measure of dynamic standing balance and paretic-lower-extremity motor control in patients with stroke. Little is known about the extent to which impairments assessed by the ST relate to activity and participation during stroke recovery. OBJECTIVE: The purpose of this study was to determine relationships between ST scores and measures of activity and participation during the first 6 months after stroke. DESIGN: This was a prospective cohort study. METHODS: Thirty-three individuals (18 men, 15 women) with a diagnosis of a single, unilateral stroke participated in the study. Participants were tested one time per month from 1 to 6 months poststroke. The ST was considered an impairment-level measure. Self-selected gait speed and the Medical OUTCOMES: Study 36-Item Short-Form Health Survey (SF-36) Physical Function Index (PFI) were used to assess physical function. Three domains (mobility, basic and instrumental activities of daily living, participation) of the Stroke Impact Scale were used to assess self-reported disability. Regression analyses were conducted to examine the bivariate associations between ST scores and each physical function and disability measure at each time point (1-6 months). RESULTS: The ST scores were positively associated with both physical function measures. The associations were stronger for self-selected gait speeds (R(2)=.60-.79) than for the PFI scores (R(2)=.32-.60). During the first 6 months after stroke, each additional step with the paretic lower extremity on the ST corresponded to a 0.07-m/s to 0.09-m/s increase in gait speed, and each additional step with the nonparetic lower extremity was associated with a 0.07-m/s to 0.08-m/s gait speed increase. The impairment-disability associations were weaker than the impairment-physical function associations. LIMITATIONS: Limitations of the study include a relatively small sample size and lack of examiner blinding with regard to participant characteristics. CONCLUSIONS: Impairments in balance and paretic-lower-extremity motor control, as measured by the ST, relate to physical function and disability during the first 6 months following stroke.

Emergency department discharge diagnosis and adverse health outcomes in older adults.

OBJECTIVES: To determine the relationship between the reason for an emergency department (ED) visit and subsequent risk of adverse health outcomes in older adults discharged from the ED. DESIGN: Secondary analysis of data from the Medicare Current Beneficiary Survey. SETTING: ED. PARTICIPANTS: One thousand eight hundred fifty-one community-dwelling Medicare fee-for-service enrollees aged 65 and older discharged from the ED between January 2000 and September 2002. MEASUREMENTS: Independent variables were ED discharge diagnosis groups: injury or musculoskeletal (MSK) (e.g., fracture, open wound), chronic condition (e.g., chronic obstructive pulmonary disorder, heart failure), infection, non-MSK symptom (e.g., chest pain, abdominal pain), and unclassified. Adverse health outcomes were hospitalization or death within 30 days of the index ED visit. RESULTS: Injury or MSK was the largest ED diagnosis group (31.4%), followed by non-MSK symptom (22.2%), chronic condition (20.9%), and infection (7.8%); 338 (17.8%) had ED discharge diagnoses that were unclassified. In adjusted analyses, a discharge diagnosis of injury or MSK condition was associated with lower risk of subsequent adverse health outcomes (hazard ratio (HR)=0.69, 95% confidence interval (CI)=0.50-0.96) than for all other diagnosis groups. Patients seen in the ED for chronic conditions were at greater risk of adverse outcomes (HR=1.86, 95% CI=1.37-2.52) than all others. There were no significant differences in risk between patients with infections, those with non-MSK symptoms, and the unclassified group. CONCLUSION: Adverse health outcomes were common in older patients with an ED discharge diagnosis classified as a chronic condition. ED discharge diagnosis may improve risk assessment and inform the development of targeted interventions to reduce adverse health outcomes in older adults discharged from the ED.

Frailty predicts some but not all adverse outcomes in older adults discharged from the emergency department.

OBJECTIVES: To determine whether frail older adults, based on a deficit accumulation index (DAI), are at greater risk of adverse outcomes after discharge from the emergency department (ED). DESIGN AND SETTING: Secondary analysis of data from the Medicare Current Beneficiary Survey. PARTICIPANTS: One thousand eight hundred fifty-one community-dwelling Medicare fee-for-service enrollees, aged 65 and older who were discharged from the ED between January 2000 and September 2002. MEASUREMENTS: The primary dependent variable was time to first adverse outcome, defined as repeat outpatient ED visit, hospital admission, nursing home admission, or death, within 30 days of the index ED visit. RESULTS: Time to first adverse outcome was shortest in individuals with the highest number of accumulated deficits. The frailest participants were at greater risk of adverse outcomes after ED discharge than those who were least frail (hazard ratio (HR)=1.44, 95% confidence interval (CI)=1.06-1.96). The frailest individuals were also at higher risk of serious adverse outcomes, defined as hospitalization, nursing home admission, or death (HR=1.98, 95% CI=1.29-3.05). In contrast, no association was detected between degree of frailty and repeat outpatient ED visits within 30 days (HR=1.06, 95% CI=0.73-1.54). CONCLUSION: The DAI as a construct of frailty was a robust predictor of serious adverse outcomes in the first 30 days after ED discharge. Frailty was not found to be a major determinant of repeat outpatient ED visits; therefore, additional study is needed to investigate this particular type of health service use by older adults.

Geographical segregation and IL-6: a marker of chronic inflammation in older adults.

AIM: To examine environmental sociodemographic risks of high IL-6, a marker of chronic inflammation in older adults. METHODS: We spatially linked 1990 USA Census tract demographic and economic measures to a prospective cohort study of representative community residents aged 71 years and older, from over 1700 of whom a cytokine protein and biological marker of chronic inflammation. IL-6, was collected. Using generalized interactive mixed models, we modeled 1989-1990 individual and census level risk factors for the dependent variable high IL-6 between 1992-1993 (high IL-6 = upper quartile: >2.96 pg/ml). RESULTS: After individual health risk adjustment, IL-6 remained elevated in communities with greater densities of poor older adults (odd ratio [OR]: 1.25 per 10% increase in exposure. 95% confidence interval [CI]: 1.05, 1.48) and in racially segregated communities (OR: 1.14 per 10% increase in exposure. 95% CI: 1.04, 1.25). CONCLUSIONS: Socially disadvantaged environments may influence IL-6, a biomarker of age-associated inflammation.

Walking speed predicts health status and hospital costs for frail elderly male veterans.

This study evaluated the use of walking speed as an indicator of function and health status in acutely ill, hospitalized, older male veterans. Hospital inpatients in a Department of Veterans Affairs (VA) study of Geriatric Evaluation and Management (GEM) (n = 1,388, age 74.2 +/- 5.7, 98% male) were followed for 1 year. The results indicate that each 0.10 m/s reduction in baseline walking speed was associated with poorer health status (36-item short form [SF-36] beta = 4.5 [95% confidence interval (CI) 2.8 to 6.1]), poorer physical functioning (beta = 2.1 [6.9 to 14.8]), more disabilities (beta = 0.63 [0.53 to 0.73]), additional rehabilitation visits (2.0 [1.4 to 2.5]), increased medical-surgical visits (2.8 [1.9 to 3.7]), longer hospital stays (2.2 [1.4 to 2.9]), and higher costs ($1,334 [$869 to $1,798]). In addition, each 0.10 m/ s/yr increase in walking speed resulted in improved health status (SF-36 beta = 8.4 [6.0 to 10.7]), improved physical function (beta = 2.9 [2.5 to 3.3]), fewer basic disabilities (0.30 [0.2 to 0.4]), fewer instrumental disabilities (0.7 [0.6 to 0.8]), fewer hospitalization days (2.3 [1.3 to 3.3]), and 1-year cost reductions of $1,188 [-$65 to $2,442]. Walking speed is useful for the functional assessment of acutely ill, hospitalized older adults. Measurement of walking speed over time may help predict those who will need and use more health-related services.