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Jack M. Guralnik - One of the best experts on this subject based on the ideXlab platform.

  • gender differences in four year incidence of self reported and performance based functional Disability the international mobility in aging study
    Archives of Gerontology and Geriatrics, 2019
    Co-Authors: Mohammad Auais, Jack M. Guralnik, Tame Ahmed, Eatriz E Alvarado, Susa P Phillips, Nicole Rosendaal, Carmen Lucia Curcio, Juliana Fernandes, Maria Victoria Zunzunegui
    Abstract:

    Abstract Objectives To examine differences in incidence of functional Disability between older women and men. Methods 2002 participants (65–74 years) were recruited in 2012 from Canada, Brazil, Colombia, and Albania, and re-assessed in 2016. Three measures of functional Disability were used (1) Difficulty in any of five mobility-related Activities of Daily Living (ADL Disability); (2) Self-reported difficulty climbing a flight of stairs or walking 400 m (mobility Disability); and (3) Poor physical performance. We estimated the adjusted gender-specific incidence risk ratios (IRR) for each outcome in 2016. Results In 2016, 1506 participants (52% women) were re-examined, 80% of the surviving cohort. Among those not disabled in 2012, seventy-four (12.9%) men developed ADL Disability, while 105 (19.2%) developed mobility Disability, and 97 (16.1%) developed poor physical performance. For women, numbers were higher 120 (21.4%) developed ADL Disability, 117 (26.5%) developed mobility Disability, and 140 (23.0%) developed poor physical performance. Compared to men, women had a higher adjusted incidence of self-reported ADL Disability (IRR 1.4; 95% CI 1.04–1.88) and mobility Disability (IRR 1.4; 95% CI 1.06–1.77), but not of poor physical performance (IRR 1.03; 95% CI 0.88–1.32). Conclusions Although women have a higher self-reported incidence of ADL and mobility Disability than men, there was no significant difference in poor physical performance. Reasons for this discrepancy between self-reported and performance-based measures require further investigation. Understanding gender differences in functional disabilities can provide the basis for interventions to prevent mobility loss and minimize any gender gap.

  • effect of a biobehavioral environmental approach on Disability among low income older adults a randomized clinical trial
    JAMA Internal Medicine, 2019
    Co-Authors: Sarah L Szanton, Jack M. Guralnik, Cynthia M Boyd, Qian Li Xue, Bruce Leff, Jennifer L Wolff, Elizabeth K Tanner, Roland J Thorpe, David Bishai, Laura N Gitlin
    Abstract:

    Importance Disability among older adults is a strong predictor of health outcomes, health service use, and health care costs. Few interventions have reduced Disability among older adults. Objective To determine whether a 10-session, home-based, multidisciplinary program reduces Disability. Design, Setting, and Participants In this randomized clinical trial of 300 low-income community-dwelling adults with a Disability in Baltimore, Maryland, between March 18, 2012, and April 29, 2016, 65 years or older, cognitively intact, and with self-reported difficulty with 1 or more activities of daily living (ADLs) or 2 or more instrumental ADLs (IADLs), participants were interviewed in their home at baseline, 5 months (end point), and 12 months (follow-up) by trained research assistants who were masked to the group allocation. Participants were randomized to either the intervention (CAPABLE) group (n = 152) or the attention control group (n = 148) through a computer-based assignment scheme, stratified by sex in randomized blocks. Intention-to-treat analysis was used to assess the intervention. Data were analyzed from September 2017 through August 2018. Interventions The CAPABLE group received up to 10 home visits over 5 months by occupational therapists, registered nurses, and home modifiers to address self-identified functional goals by enhancing individual capacity and the home environment. The control group received 10 social home visits by a research assistant. Main Outcomes and Measures Disability with ADLs or IADLs at 5 months. Each ADL and IADL task was self-scored from 0 to 2 according to whether in the previous month the person did not have difficulty and did not need help (0), did not need help but had difficulty (1), or needed help regardless of difficulty (2). The overall score ranged from 0 to 16 points. Results Of the 300 people randomized to either the CAPABLE group (n = 152) or the control group (n = 148), 133 of the CAPABLE participants (87.5%) were women with a mean (SD) age of 75.7 (7.6) years; 126 (82.9%) self-identified as black. Of the controls, 129 (87.2%) were women with a mean (SD) age of 75.4 (7.4) years; 133 (89.9%) self-identified as black. CAPABLE participation resulted in 30% reduction in ADL Disability scores at 5 months (relative risk [RR], 0.70; 95% CI, 0.54-0.93;P = .01) vs control participation. CAPABLE participation resulted in a statistically nonsignificant 17% reduction in IADL Disability scores (RR, 0.83; 95% CI, 0.65-1.06;P = .13) vs control participation. Participants in the CAPABLE group vs those in the control group were more likely to report that the program made their life easier (82.3% vs 43.1%;P  Conclusions and Relevance Low-income community-dwelling older adults who received the CAPABLE intervention experienced substantial decrease in Disability; Disability may be modifiable through addressing both the person and the environment. Trial Registration ClinicalTrials.gov identifier:NCT01576133

  • basic ADL Disability and functional limitation rates among older americans from 2000 2005 the end of the decline
    Journals of Gerontology Series A-biological Sciences and Medical Sciences, 2009
    Co-Authors: Esme Fullerthomson, Jack M. Guralnik, Amani Nurujeter, Meredith Minkler
    Abstract:

    THE 1990s saw the continuation of a slow but steady decline in Disability rates among older Americans (1,2). This decline was confirmed by numerous studies (3–5) and documented in an influential systematic review, which showed an annual Disability decline of 1–1.5% from the late 1980s through the 1990s (1). The falling rates were driven primarily by declines in limitations in instrumental activities of daily living (e.g., difficulties in shopping and cleaning) and functional limitations (e.g., difficulty reaching, bending, and/or stooping), which fell substantially during this period (2). Although findings on trends in limitations in basic activities of daily living (ADL) disabilities (e.g., bathing, dressing, and getting around inside the home) were much less consistent, a National Institute on Aging consensus panel concluded that there were declines of between 1% and 2.5% annually in ADL limitations in the population aged 70 and older during the mid- and late 1990s (2). In an updated examination of trends in Disability through 2005, Manton et al. (6) concluded that the declining trends in Disability observed in the 1990s continued and, in fact, accelerated between 1999 and 2004–2005. During this latter period, they reported that chronic Disability, a combined measure of ADL and instrumental ADL limitations, declined 2.2% per annum. Accurately monitoring changes in Disability rates is critical, both in the context of the anticipated doubling of the older population between 2000 and 2030 (7) and because Disability is considered “a better predictor of medical and social service need than simple prevalence or incidence figures of disease.” (8) In this study, we examine trends in basic ADL disabilities and functional limitations among older adults from 2000 to 2005 using the American Community Survey (ACS), the largest nationally representative survey of community-dwelling elderly adults (response rates >93%), and the 2004 National Nursing Home Survey (NNHS). By examining basic ADL disabilities and functional limitations separately, we can better examine the differences and similarities in these trends than a combined chronic disease measure allows.

  • an association between incident Disability and depressive symptoms over 3 years of follow up among older women the women s health and aging study
    Aging Clinical and Experimental Research, 2009
    Co-Authors: Mila Chang, Antonia K Coppi, Michiel Van Der Linde, Linda P. Fried, Caroline L Phillips, Luigi Ferrucci, Jack M. Guralnik
    Abstract:

    Background and aims: To examine the impact of new Disability on the incidence of depressive symptoms, with 3-year biannual data from The Woman’s Health and Aging Study. Methods: Subjects (n=671) were selected if they were independent at baseline in 5 basic activities of daily living (ADLs) and were not depressed [scored <14 on the Geriatric Depression Scale (GDS; range 0 to 30)]. During the follow-ups, worsening of ADL Disability (needed help on an increased number of ADLs) and onset of depressive symptoms (GDS score ≥14) were defined. For each pair of consecutive interviews in which depressive symptoms were not present in the first interview in the pair, we assessed incidence of worsening Disability and depressive symptoms in the second interview of the pair. We also summarized the incidence of depressive symptoms 6 months later among the people who did not develop depressive symptoms at the time they reported a new Disability. Results: Compared with those not developing Disability, after adjusting for demographic characteristics, number of diseases, and ADL difficulty level at the moment of onset of the Disability, the odds ratio (OR) for developing depressive symptoms at Disability onset was 2.2 (95% Confidence Interval (CI) 1.1–4.3). For those developing new Disability without depressive symptoms, the adjusted OR for developing depressive symptoms 6 months later was 1.7 (CI 0.6–4.8). Conclusion: Onset of new Disability in basic ADLs had a significant impact on the development of depressive symptoms at the moment of onset. Our results demonstrate that clinicians should carefully evaluate depressive symptoms in patients with new onset of Disability.

  • phenotype of frailty characterization in the women s health and aging studies
    Journals of Gerontology Series A-biological Sciences and Medical Sciences, 2006
    Co-Authors: Kare Andeenroche, Jack M. Guralnik, Luigi Ferrucci, Paulo H M Chaves, Qian Li Xue, Jeremy D Walsto, Sco L Zege, Linda P. Fried
    Abstract:

    Background "Frailty" is an adverse, primarily gerontologic, health condition regarded as frequent with aging and having severe consequences. Although clinicians claim that the extremes of frailty can be easily recognized, a standardized definition of frailty has proved elusive until recently. This article evaluates the cross-validity, criterion validity, and internal validity in the Women's Health and Aging Studies (WHAS) of a discrete measure of frailty recently validated in the Cardiovascular Health Study (CHS). Methods The frailty measure developed in CHS was delineated in the WHAS data sets. Using latent class analysis, we evaluated whether criteria composing the measure aggregate into a syndrome. We verified the criterion validity of the measure by testing whether participants defined as frail were more likely than others to develop adverse geriatric outcomes or to die. Results The distributions of frailty in the WHAS and CHS were comparable. In latent class analyses, the measures demonstrated strong internal validity vis a vis stated theory characterizing frailty as a medical syndrome. In proportional hazards models, frail women had a higher risk of developing activities of daily living (ADL) and/or instrumental ADL Disability, institutionalization, and death, independently of multiple potentially confounding factors. Conclusions The findings of this study are consistent with the widely held theory that conceptualizes frailty as a syndrome. The frailty definition developed in the CHS is applicable across diverse population samples and identifies a profile of high risk of multiple adverse outcomes.

Robert G Cumming - One of the best experts on this subject based on the ideXlab platform.

  • longitudinal associations between body composition sarcopenic obesity and outcomes of frailty Disability institutionalisation and mortality in community dwelling older men the concord health and ageing in men project
    Age and Ageing, 2017
    Co-Authors: Vasant Hirani, Vasi Naganathan, Fiona M Blyth, David Le G Couteur, Markus J Seibel, Louise M Waite, David J Handelsman, Robert G Cumming
    Abstract:

    Background: to explore the longitudinal associations between body composition measures, sarcopenic obesity and outcomes of frailty, activities of daily living (ADL) and instrumental ADL (IADL) Disability, institutionalisation and mortality. Methods: men aged ≥ 70 years (2005-07) from the Concord Health and Ageing in Men Project were assessed at baseline (n = 1,705), 2 (n = 1,366) and 5 years (n = 954). The main outcome measures were frailty (adapted Fried criteria), ADL, including personal care and mobility and IADL Disability (ability to perform tasks for independent living), institutionalisation and mortality. The Foundation for the National Institutes of Health cut-points were used for low muscle mass: appendicular lean mass (ALM):Body Mass Index (BMI) ratio (ALMBMI) 30% fat. Generalised estimating equations were used to examine the longitudinal associations between the independent variables (obesity alone, low muscle mass and sarcopenic obesity) and frailty, ADL and IADL Disability. Results: in unadjusted, age adjusted and fully adjusted analysis, men with low muscle mass showed increased risk of frailty and IADL Disability. In fully adjusted analysis, men with sarcopenic obesity had an increased risk of frailty (odds ratio (OR): 2.00 (95% confidence of interval (CI): 1.42, 2.82)) ADL Disability (OR: 1.58 (95% CI: 1.12, 2.24)) and IADL Disability (OR: 1.36 (95% CI: 1.05, 1.76)). Obesity alone was protective for institutionalisation (OR: 0.51 (95% CI: 0.31, 0.84)) but was not associated with any other outcomes. Conclusions: low muscle mass and sarcopenic obesity were associated with poor functional outcomes, independent of confounders. This would suggest that future trials on frailty and Disability prevention should be designed to intervene on both muscle mass and fat mass.

  • sarcopenia is associated with incident Disability institutionalization and mortality in community dwelling older men the concord health and ageing in men project
    Journal of the American Medical Directors Association, 2015
    Co-Authors: Robert G Cumming, Vasi Naganathan, Vasant Hirani, Fiona M Blyth, David Le G Couteur, Markus J Seibel, Louise M Waite, David J Handelsman
    Abstract:

    Introduction: Sarcopenia is associated with an increased risk of adverse outcomes. The aim of this study was to explore the relationship between severity of sarcopenia and incident activities of daily living (ADL) Disability, institutionalization, and all-cause mortality among community-dwelling older men participating in the Concord Health and Ageing in Men Project (CHAMP). Methods: Longitudinal analysis of 1705 participants aged 70 years or older at baseline (2005e2007) living in the community in Sydney, Australia. Measurements: The main outcome measures were incident ADL Disability, institutionalization, and mortality. Of the 1705 participants who completed the baseline assessments, a total of 1678 men (mean age 77 years) had complete measures by dual-energy x-ray absorptiometry, to assess sarcopenia in terms of low appendicular lean mass (ALM), using the Foundation for the National Institutes of Health (FNIH) criteria. To differentiate between severity of sarcopenia we used low ALM alone (sarcopenia I), low ALM with weakness (sarcopenia II), and sarcopenia with weakness and poor gait speed (sarcopenia III). Cox proportional hazard models and logistic regression models were used to assess the risk of mortality and institutionalization, and incidence of ADL Disability. Results: From baseline to follow-up, 103 (11.3%) men had incident ADL Disability, 191 (11.2%) men were institutionalized, and 535 (31.9%) had died. At baseline,14.2% had sarcopenia I, 5.3% had sarcopenia II, and 3.7% had sarcopenia III. Fully adjusted analysis (adjusted for demographics, lifestyle factors, comorbidities and health conditions, and blood measures) showed that sarcopenia I, II, and III were associated with increased risk of Disability, institutionalization, and mortality. Associations between sarcopenia I, II, and III and risk of incident Disability were as follows: odds ratio (OR) 2.77 95% confidence interval (CI) 1.30e5.87, OR 3.78 95% CI 1.23e11.64, and OR 4.53 95% CI 0.90e22.72; associations with institutionalization were hazard ratio (HR) 1.96 95% CI 1.14e3.35, HR 2.53 95% CI 1.31e4.90, and HR 2.27 95% CI 1.08e4.80; and with mortality were HR 1.65 95% CI 1.30e2.09, HR 1.50 95% CI 1.08e2.08, and HR 1.69 95% CI 1.17e2.44.

  • prevalence and correlates of physical Disability and functional limitation among community dwelling older people in rural malaysia a middle income country
    BMC Public Health, 2010
    Co-Authors: Noran Naqiah Hairi, Robert G Cumming, Vasi Naganathan, Awang Bulgiba, Izzuna Mudla
    Abstract:

    The prevalence and correlates of physical Disability and functional limitation among older people have been studied in many developed countries but not in a middle income country such as Malaysia. The present study investigated the epidemiology of physical Disability and functional limitation among older people in Malaysia and compares findings to other countries. A population-based cross sectional study was conducted in Alor Gajah, Malacca. Seven hundred and sixty five older people aged 60 years and above underwent tests of functional limitation (Tinetti Performance Oriented Mobility Assessment Tool). Data were also collected for self reported activities of daily living (ADL) using the Barthel Index (ten items). To compare prevalence with other studies, ADL Disability was also defined using six basic ADL's (eating, bathing, dressing, transferring, toileting and walking) and five basic ADL's (eating, bathing, dressing, transferring and toileting). Ten, six and five basic ADL Disability was reported by 24.7% (95% CI 21.6-27.9), 14.4% (95% CI 11.9-17.2) and 10.6% (95% CI 8.5-13.1), respectively. Functional limitation was found in 19.5% (95% CI 16.8-22.5) of participants. Variables independently associated with 10 item ADL Disability physical Disability, were advanced age (≥ 75 years: prevalence ratio (PR) 7.9; 95% CI 4.8-12.9), presence of diabetes (PR 1.8; 95% CI 1.4-2.3), stroke (PR 1.5; 95% CI 1.1-2.2), depressive symptomology (PR 1.3; 95% CI 1.1-1.8) and visual impairment (blind: PR 2.0; 95% CI 1.1-3.6). Advancing age (≥ 75 years: PR 3.0; 95% CI 1.7-5.2) being female (PR 2.7; 95% CI 1.2-6.1), presence of arthritis (PR 1.6; 95% CI 1.2-2.1) and depressive symptomology (PR 2.0; 95% CI 1.5-2.7) were significantly associated with functional limitation. The prevalence of physical Disability and functional limitation among older Malaysians appears to be much higher than in developed countries but is comparable to developing countries. Associations with socio-demographic and other health related variables were consistent with other studies.

Robert B Wallace - One of the best experts on this subject based on the ideXlab platform.

  • 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
    Journal of the American Geriatrics Society, 2006
    Co-Authors: Jama L Purser, Gerda G Fillenbaum, Robert B Wallace
    Abstract:

    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 ≥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.

  • mild cognitive impairment and 10 year trajectories of Disability in the iowa established populations for epidemiologic studies of the elderly cohort
    Journal of the American Geriatrics Society, 2005
    Co-Authors: Jama L Purser, Gerda G Fillenbaum, Carl F Pieper, Robert B Wallace
    Abstract:

    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 ≥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 (≤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.

  • lower extremity function and subsequent Disability consistency across studies predictive models and value of gait speed alone compared with the short physical performance battery
    Journals of Gerontology Series A-biological Sciences and Medical Sciences, 2000
    Co-Authors: Jack M. Guralnik, Suzanne G. Leveille, Luigi Ferrucci, Kyriakos S Markides, Lisa F Berkman, Carl F Pieper, Glenn V Ostir, Stephanie A Studenski, Robert B Wallace
    Abstract:

    Background. Although it has been demonstrated that physical performance measures predict incident Disability in previously nondisabled older persons, the available data have not been fully developed to create usable methods for determining risk profiles in community-dwelling populations. Using several populations and different follow-up periods, this study replicates previous findings by using the Established Populations for the Epidemiologic Study of the Elderly (EPESE) performance battery and provides equations for the prediction of Disability risk according to age, sex, and level of performance. Methods. Tests of balance, time to walk 8 ft, and time to rise from a chair 5 times were administered to 4,588 initially nondisabled persons in the four sites of the EPESE and to 1,946 initially nondisabled persons in the Hispanic EPESE. Follow-up assessment for activity of daily living (ADL) and mobility-related Disability occurred from 1 to 6 years later. Results. In the EPESE, compared with those with the best performance (EPESE summary performance score of 10‐ 12), the relative risks of mobility-related Disability for those with scores of 4‐6 ranged from 2.9 to 4.9 and the relative risk of Disability for those with scores of 7‐9 ranged from 1.5 to 2.1, with similar consistent results for ADL Disability. The observed rates of incident Disability according to performance level in the Hispanic EPESE agreed closely with rates predicted from models developed from the EPESE sites. Receiver operating characteristic curves showed that gait speed alone performed almost as well as the full battery in predicting incident Disability. Conclusions. Performance tests of lower extremity function accurately predict Disability across diverse populations. Equations derived from models using both the summary score and the gait speed alone allow for the estimation of risk of Disability in community-dwelling populations and provide valuable information for estimating sample size for clinical trials of Disability prevention.

  • serum il 6 level and the development of Disability in older persons
    Journal of the American Geriatrics Society, 1999
    Co-Authors: Luigi Ferrucci, Jack M. Guralnik, Brenda W J H Penninx, Marco Pahor, Maria Chiara Corti, Robert B Wallace, Harvey J Cohen, Tamara B Harris, Russell P Tracy, Richard J Havlik
    Abstract:

    BACKGROUND: The serum concentration of interleukin 6 (IL-6), a cytokine that plays a central role in inflammation, increases with age. Because inflammation is a component of many age-associated chronic diseases, which often cause Disability, high circulating levels of IL-6 may contribute to functional decline in old age. We tested the hypothesis that high levels of IL-6 predict future Disability in older persons who are not disabled. METHODS: Participants at the sixth annual follow-up of the Iowa site of the Established Populations for Epidemiologic Studies of the Elderly aged 71 years or older were considered eligible for this study if they had no Disability in regard to mobility or in selected activities of daily living (ADL), and they were re-interviewed 4 years later. Incident cases of mobility-Disability and of ADL-Disability were identified based on responses at the follow-up interview. Measures of IL-6 were obtained from specimens collected at baseline from the 283 participants who developed any Disability and from 350 participants selected randomly (46.9%) from those who continued to be non-disabled. FINDINGS: Participants in the highest IL-6 tertile were 1.76 (95% CI, 1.17-2.64) times more likely to develop at least mobility-Disability and 1.62 (95% CI, 1.02-2.60) times more likely to develop mobility plus ADL-Disability compared with to the lowest IL-6 tertile. The strength of this association was almost unchanged after adjusting for multiple confounders. The increased risk of mobility-Disability over the full spectrum of IL-6 concentration was nonlinear, with the risk rising rapidly beyond plasma levels of 2.5 pg/mL. INTERPRETATION: Higher circulating levels of IL-6 predict Disability onset in older persons. This may be attributable to a direct effect of IL-6 on muscle atrophy and/or to the pathophysiologic role played by IL-6 in specific diseases. J Am Geriatr Soc 47:639–646, 1999.

Kyriakos S Markides - One of the best experts on this subject based on the ideXlab platform.

  • influence of type ii diabetes and high depressive symptoms on the likelihood for developing activities of daily living ADL Disability and mortality in older puerto ricans
    Journal of Aging and Health, 2017
    Co-Authors: Brian Downer, Michael Crowe, Kyriakos S Markides
    Abstract:

    Objective: To examine the development of activities of daily living (ADL) Disability and mortality according to diabetes and high depressive symptoms among Puerto Rican adults aged 60 and older. Method: Data came from Wave I and Wave II of the Puerto Rican Elderly: Health Conditions Study (n = 3,419). Logistic regression was used. Using insulin and receiving psychiatric treatment were proxy measures of disease severity for diabetes and depressive symptoms, respectively. Results: High depressive symptoms at baseline were associated with developing ADL Disability (OR = 2.21; 95% CI = [1.68, 2.91]). Diabetes at baseline was associated with mortality at follow-up (OR = 1.72; 95% CI = [1.34, 2.19]). Baseline diabetes was associated with developing ADL Disability but only for those who reported using insulin (OR = 1.69; 95% CI = [1.08, 2.61]). Participants with comorbid diabetes and high depressive symptoms had the highest odds for developing ADL Disability and mortality. Discussion: Diabetes and high depressiv...

  • influence of type ii diabetes and high depressive symptoms on the likelihood for developing activities of daily living ADL Disability and mortality in older puerto ricans
    Journal of Aging and Health, 2017
    Co-Authors: Brian Downer, Michael Crowe, Kyriakos S Markides
    Abstract:

    Objective: To examine the development of activities of daily living (ADL) Disability and mortality according to diabetes and high depressive symptoms among Puerto Rican adults aged 60 and older. Me...

  • cognitive status muscle strength and subsequent Disability in older mexican americans
    Journal of the American Geriatrics Society, 2005
    Co-Authors: Mukaila A Raji, Kyriakos S Markides, Soham Al Snih Al Snih, Yong Fang Kuo, Kristen M Peek, Kenneth J Ottenbacher
    Abstract:

    Objectives: To examine the association between Mini-Mental State Examination (MMSE) score and subsequent muscle strength (measured using handgrip strength) and to test the hypothesis that muscle strength will mediate any association between impaired cognition and incident activity of daily living (ADL) Disability over a 7-year period in elderly Mexican Americans who were initially not disabled. Design: A 7-year prospective cohort study (1993–2001). Setting: Five southwestern states (Texas, New Mexico, Colorado, Arizona, and California). Participants: Two thousand three hundred eighty-one noninstitutionalized Mexican-American men and women aged 65 and older with no ADL Disability at baseline. Measurements: In-home interviews in 1993/1994, 1995/1996, 1998/1999, and 2000/2001 assessed social and demographic factors, medical conditions (diabetes mellitus, stroke, heart attack, and arthritis), body mass index (BMI), depressive symptomatology, handgrip muscle strength, and ADLs. MMSE score was dichotomized as less than 21 for poor cognition and 21 or greater for good cognition. Main outcomes measures were mean and slope of handgrip muscle strength over the 7-year period and incident Disability, defined as new onset of any ADL limitation at the 2-, 5-, or 7-year follow-up interview periods. Results: In mixed model analyses, there was a significant cross-sectional association between having poor cognition (MMSE<21) and lower handgrip strength, independent of age, sex, and time of interview (estimate=−1.41, standard error (SE)=0.18; P<.001). With the introduction of a cognition-by-time interaction term into the model, there was also a longitudinal association between poor cognition and change in handgrip strength over time (estimate=−0.25, SE=0.06; P<.001), indicating that subjects with poor cognition had a significantly greater decline in handgrip strength over 7 years than those with good cognition, independent of age, sex, and time. This longitudinal association between poor cognition and greater muscle decline remained significant (P<.001) after controlling for age, sex, education, and time-dependent variables of depression, BMI, and medical conditions. In general estimation equation models, having poor cognition was associated with greater risk of 7-year incident ADL Disability (odds ratio=2.01, 95% confidence interval (CI)=1.60–2.52); the magnitude of the association decreased to 1.66 (95% CI=1.31–2.10) when adjustment was made for handgrip strength. Conclusion: Older Mexican Americans with poor cognition had steeper decline in handgrip muscle strength over 7 years than those with good cognition, independent of other demographic and health factors. A possible mediating effect of muscle strength on the association between poor cognition and subsequent ADL Disability was also indicated.

  • hand grip strength and incident ADL Disability in elderly mexican americans over a seven year period
    Aging Clinical and Experimental Research, 2004
    Co-Authors: Soham Al Snih Al Snih, Kyriakos S Markides, Kenneth J Ottenbacher, Mukaila A Raji
    Abstract:

    Background and aims: Little is known about muscle strength as a predictor of Disability among older Mexican Americans. The aim of this study was to examine the association between hand grip strength and 7-year incidence of ADL Disability in older Mexican American men and women. Methods: A 7-year prospective cohort study of 2493 non-institutionalized Mexican American men and women aged 65 or older residing in five south-western states. Maximal hand grip strength test, body mass index, cognitive function, activities of daily living, self-reports of medical conditions (arthritis, diabetes, heart attack, stroke, cancer, hip fracture), and depressive symptoms were obtained. Results: In a Cox proportional regression analysis, there was a linear relationship between hand grip strength at baseline and risk of incident ADL Disability over a 7-year follow-up. Among non-disabled men at baseline, the hazard ratio of any new ADL limitation was 1.90(95% CI 1.14–3.17) for those in the lowest quartile, when compared with men in the highest hand grip strength quartile, after controlling for age, marital status, medical conditions, high depressive symptoms, MMSE score, and BMI at baseline. Among non-disabled women at baseline, the hazard ratio of any new ADL limitation was 2.28 (95% CI 1.59–3.27) for those in the lowest quartile, when compared with women in the highest hand grip strength quartile. Conclusions: Hand grip strength is an independent predictor of ADL Disability among older Mexican American men and women. The hand grip strength test is an easy, reliable, valid, inexpensive method of screening to identify older adults at risk of Disability.

  • lower extremity function and subsequent Disability consistency across studies predictive models and value of gait speed alone compared with the short physical performance battery
    Journals of Gerontology Series A-biological Sciences and Medical Sciences, 2000
    Co-Authors: Jack M. Guralnik, Suzanne G. Leveille, Luigi Ferrucci, Kyriakos S Markides, Lisa F Berkman, Carl F Pieper, Glenn V Ostir, Stephanie A Studenski, Robert B Wallace
    Abstract:

    Background. Although it has been demonstrated that physical performance measures predict incident Disability in previously nondisabled older persons, the available data have not been fully developed to create usable methods for determining risk profiles in community-dwelling populations. Using several populations and different follow-up periods, this study replicates previous findings by using the Established Populations for the Epidemiologic Study of the Elderly (EPESE) performance battery and provides equations for the prediction of Disability risk according to age, sex, and level of performance. Methods. Tests of balance, time to walk 8 ft, and time to rise from a chair 5 times were administered to 4,588 initially nondisabled persons in the four sites of the EPESE and to 1,946 initially nondisabled persons in the Hispanic EPESE. Follow-up assessment for activity of daily living (ADL) and mobility-related Disability occurred from 1 to 6 years later. Results. In the EPESE, compared with those with the best performance (EPESE summary performance score of 10‐ 12), the relative risks of mobility-related Disability for those with scores of 4‐6 ranged from 2.9 to 4.9 and the relative risk of Disability for those with scores of 7‐9 ranged from 1.5 to 2.1, with similar consistent results for ADL Disability. The observed rates of incident Disability according to performance level in the Hispanic EPESE agreed closely with rates predicted from models developed from the EPESE sites. Receiver operating characteristic curves showed that gait speed alone performed almost as well as the full battery in predicting incident Disability. Conclusions. Performance tests of lower extremity function accurately predict Disability across diverse populations. Equations derived from models using both the summary score and the gait speed alone allow for the estimation of risk of Disability in community-dwelling populations and provide valuable information for estimating sample size for clinical trials of Disability prevention.

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  • muscle mass assessed by the d3 creatine dilution method and incident self reported Disability and mortality in a prospective observational study of community dwelling older men
    Journals of Gerontology Series A-biological Sciences and Medical Sciences, 2021
    Co-Authors: Peggy M Cawthon, Terri Blackwell, Steven R Cummings, Eric S Orwoll, Kate Duchowny, Deborah M Kado, Katie L Stone, Kristine E Ensrud
    Abstract:

    BACKGROUND Whether low muscle mass is a risk factor for Disability and mortality is unclear. Associations between approximations of muscle mass (including lean mass from dual-energy x-ray absorptiometry [DXA]), and these outcomes are inconsistent. METHODS Muscle mass measured by deuterated creatine (D3Cr) dilution and appendicular lean mass (ALM, by DXA) were assessed at the Year 14 Visit (2014-2016) of the prospective Osteoporotic Fractures in Men study (N = 1,425, age 77-101 years). Disability in activities of daily living (ADLs), instrumental ADLs, and mobility tasks was self-reported at the Year 14 visit and 2.2 years later; deaths were centrally adjudicated over 3.3 years. Relative risks and 95% confidence intervals (CI) were estimated per standard deviation decrement with negative binomial, logistic regression, or proportional hazards models. RESULTS In age- and clinical center-adjusted models, the relative risks per decrement in D3Cr muscle mass/wgt was 1.9 (95% CI: 1.2, 3.1) for incident self-reported ADL Disability; 1.5 (95% CI: 1.3, 1.9) for instrumental ADL Disability; and 1.8 (95% CI: 1.5, 2.2) for mobility Disability. In age-, clinical center-, and weight-adjusted models, the relative risks per decrement in D3Cr muscle mass was 1.8 (95% CI: 1.5, 2.2) for all-cause mortality. In contrast, lower DXA ALM was not associated with any outcome. Associations of D3Cr muscle mass with these outcomes were slightly attenuated after adjustment for confounding factors and the potentially mediating effects of strength and physical performance. CONCLUSIONS Low muscle mass as measured by D3Cr dilution is a novel risk factor for clinically meaningful outcomes in older men.

  • muscle mass assessed by d3 creatine dilution method and incident self reported Disability and mortality in a prospective observational study of community dwelling older men
    Journals of Gerontology Series A-biological Sciences and Medical Sciences, 2020
    Co-Authors: Peggy M Cawthon, Terri Blackwell, Steven R Cummings, Eric S Orwoll, Kate Duchowny, Deborah M Kado, Katie L Stone, Kristine E Ensrud, Jane A Cauley, William J Evans
    Abstract:

    BACKGROUND: Whether low muscle mass is a risk factor for Disability and mortality is unclear. Associations between approximations of muscle mass (including lean mass from dual energy x-ray absorptiometry (DXA)) and these outcomes are inconsistent. METHODS: Muscle mass measured by deuterated creatine (D3Cr) dilution and appendicular lean mass (ALM, by DXA) were assessed at the Year 14 Visit (2014-6) of the prospective MrOS study (N=1425, age 77-101 years). Disability in activities of daily living (ADLs), instrumental ADLS (IADLs), and mobility tasks was self-reported at the Year 14 visit and 2.2 years later; deaths were centrally adjudicated over 3.3 years. Relative risks (RR) and 95% confidence intervals (CI) were estimated per standard deviation decrement with negative binomial, logistic regression or proportional hazards models. RESULTS: In age and clinical center adjusted models, the RR per decrement in D3Cr muscle mass/wgt was 1.9 (95% CI: 1.2, 3.1) for incident self-reported ADL Disability; 1.5 (95% CI: 1.3, 1.9) for IADL Disability; and 1.8 (95% CI: 1.5, 2.2) for mobility Disability. In age, clinical center and weight adjusted models, the RR per decrement in D3Cr muscle mass was 1.8 (95% CI: 1.5, 2.2) for all-cause mortality. In contrast, lower DXA ALM was not associated with any outcome. Associations of D3Cr muscle mass with these outcomes were slightly attenuated after adjustment for confounding factors and the potentially mediating effects of strength and physical performance. CONCLUSIONS: Low muscle mass as measured by D3Cr dilution is a novel risk factor for clinically meaningful outcomes in older men.