Dan K. Kiely

The Relationship Between Leg Power and Physical Performance in Mobility‐Limited Older People

The purpose of this study was to assess the influence of leg power and leg strength on the physical performance of community‐dwelling mobility‐limited older people.

Parental history is an independent risk factor for coronary artery disease: The Framingham Study

Family history of CAD, defined as parental death by CAD, was found to be a significant independent predictor of CAD in a logistic regression model controlling for standard risk factors and length of follow-up among the 5209 participants in the Framingham Study. Persons with a positive parental history have a 29% increased risk of CAD, and the strength of the association between parental history and CAD is similar to that found for other standard risk factors such as systolic blood pressure, cholesterol level, and cigarette smoking. No evidence was found that persons with a family history of CAD have a decreased capacity to cope with the deleterious effects of known risk factors; that is, no significant interaction was found between any of the risk factors and parental history of CAD. Among men with low risk for CAD by risk-factor profile (i.e., nonsmoking, thin, nonhypertensive persons), more than two thirds of those who experience CAD have a positive parental history. This study suggests that CAD among persons who are predicted to be at low risk by standard risk factors may have a substantial genetic component and that the risk associated with parental history may not be reduced by modification of these factors. Nevertheless, among persons with a positive family history, those with a favorable risk profile are at substantially less risk for CAD than those with an unfavorable risk profile.

Chronic Musculoskeletal Pain and the Occurrence of Falls in an Older Population

CONTEXT Chronic pain is a major contributor to disability in older adults; however, the potential role of chronic pain as a risk factor for falls is poorly understood. OBJECTIVE To determine whether chronic musculoskeletal pain is associated with an increased occurrence of falls in a cohort of community-living older adults. DESIGN, SETTING, AND PARTICIPANTS The Maintenance of Balance, Independent Living, Intellect, and Zest in the Elderly (MOBILIZE) Boston Study is a population-based longitudinal study of falls involving 749 adults aged 70 years and older. Participants were enrolled from September 2005 through January 2008. MAIN OUTCOME MEASURE Participants recorded falls on monthly calendar postcards mailed to the study center during an 18-month period. RESULTS There were 1029 falls reported during the follow-up. A report of 2 or more locations of musculoskeletal pain at baseline was associated with greater occurrence of falls. The age-adjusted rates of falls per person-year were 1.18 (95% confidence interval [CI], 1.13-1.23) for the 300 participants with 2 or more sites of joint pain, 0.90 (95% CI, 0.87-0.92) for the 181 participants with single-site pain, and 0.78 (95% CI, 0.74-0.81) for the 267 participants with no joint pain. Similarly, more severe or disabling pain at baseline was associated with higher fall rates (P < .05). The association persisted after adjusting for multiple confounders and fall risk factors. The greatest risk for falls was observed in persons who had 2 or more pain sites (adjusted rate ratio [RR], 1.53; 95% CI, 1.17-1.99), and those in the highest tertiles of pain severity (adjusted RR, 1.53; 95% CI, 1.12-2.08) and pain interference with activities (adjusted RR, 1.53; 95%CI, 1.15-2.05), compared with their peers with no pain or those in the lowest tertiles of pain scores. CONCLUSIONS Chronic pain measured according to number of locations, severity, or pain interference with daily activities was associated with greater risk of falls in older adults.

Delirium accelerates cognitive decline in Alzheimer disease.

Objective: To examine the impact of delirium on the trajectory of cognitive function in a cohort of patients with Alzheimer disease (AD). Methods: A secondary analysis of data collected from a large prospective cohort, the Massachusetts Alzheimer’s Disease Research Center’s patient registry, examined cognitive performance over time in patients who developed (n = 72) or did not develop (n = 336) delirium during the course of their illnesses. Cognitive performance was measured by change in score on the Information-Memory-Concentration (IMC) subtest of the Blessed Dementia Rating Scale. Delirium was identified using a previously validated chart review method. Using linear mixed regression models, rates of cognitive change were calculated, controlling for age, sex, education, comorbid medical diagnoses, family history of dementia, dementia severity score, and duration of symptoms before diagnosis. Results: A significant acceleration in the slope of cognitive decline occurs following an episode of delirium. Among patients who developed delirium, the average decline at baseline for performance on the IMC was 2.5 points per year, but after an episode of delirium there was further decline to an average of 4.9 points per year (p = 0.001). Across groups, the rate of change in IMC score occurred about three times faster in those who had delirium compared to those who did not. Conclusions: Delirium can accelerate the trajectory of cognitive decline in patients with Alzheimer disease (AD). The information from this study provides the foundation for future randomized intervention studies to determine whether prevention of delirium might ameliorate or delay cognitive decline in patients with AD.

Familial aggregation of stroke. The Framingham Study.

Background and Purpose Family history is perceived to be an important risk factor for stroke despite conflicting published data. We examined patterns of familial aggregation of stroke among three generations using data from the Framingham Study. Methods Cox proportional hazards analyses, adjusting for known stroke risk factors, were used to examine familial concordance in three groups: (1) members of the original Framingham cohort using reported parental stroke death; (2) members of the Framingham Offspring Study and their parents (members of the original Framingham Study); and (3) sibships within the original Framingham cohort. Results We found no association between stroke or transient ischemic attack among original cohort members and their reported parental stroke death (n=4933; relative risk [RR] = 1.07). Using verified cases of parental stroke or transient ischemic attack, the Offspring analyses revealed that both paternal (n=1762; RR=2.4; 95% confidence interval [CI], 0.96 to 6.03) and maternal (n=2074; RR=1.4; 95% CI, 0.60 to 3.25) histories were associated with an increased risk. Parental history of coronary heart disease was strongly associated with stroke or transient ischemic attack among Offspring Study members (RR=3.33; 95% CI, 1.27 to 8.72). Sibling history of stroke or transient ischemic attack was not associated with stroke or transient ischemic attack among original cohort members, although a non-statistically significant increased risk associated with sibling history of atherothrombotic brain infarction was observed (RR=1.8; 95% CI, 0.68 to 4.94). Conclusions These analyses suggest that parental history of stroke may be a risk factor for stroke. As more stroke or transient ischemic attack events develop among the Offspring Study members, it will be valuable to reexamine these associations.

The Association of Serum Anticholinergic Activity With Delirium in Elderly Medical Patients

To investigate the hypothesis that elevated serum anticholinergic activity is independently associated with delirium in ill elderly persons, the authors performed a cross-sectional study of 67 acutely ill older medical inpatients. The presence of delirium was evaluated with the Confusion Assessment Method, and the presence of many delirium symptoms was measured by the Delirium Symptom Interview. Demographic data and clinical characteristics that may be important for the development of delirium were also collected. Logistic regression techniques demonstrated that elevated serum anticholinergic activity was independently associated with delirium. Among the subjects with delirium, a greater number of delirium symptoms was associated with higher serum anticholinergic activity.

Identifying Nursing Home Residents at Risk for Falling

OBJECTIVES: To develop a fall risk model that can be used to identify prospectively nursing home residents at risk for falling. The secondary objective was to determine whether the nursing home environment independently influenced the development of falls.

Coronary risk associated with age and sex of parental heart disease in the Framingham Study

Data from the Framingham Study, a population-based prospective study of 5,209 persons, were analyzed to determine whether a parental history of death by coronary artery disease (CAD) before or after 65 years of age was an independent risk factor for CAD of early onset (age younger than 60 years) or late onset (age 60 years or older) among the men and women in the cohort. Death due to CAD in parents was associated with a 30% increase in the risk of CAD. The effect was apparently stronger for an early CAD outcome, with adjusted relative risks of 1.5 for early and 1.2 for late outcome CAD. The effect of parental CAD death on risk was not mediated by other shared risk factors for CAD. These findings were similar for those with either a mother or a father with CAD, if CAD onset in the offspring occurred before the age of 60 years. For persons with CAD at age 60 years or older, maternal CAD death was a stronger predictor of CAD than paternal CAD death. The association with parental history of CAD was similar among men and women in the cohort, with adjusted relative risks of 1.3 and 1.2, respectively. However, early age of parental CAD death may account for the association among women (RR = 1.6), whereas late age of CAD death for either parent was associated with the risk of CAD among men (RR = 1.4).

Outcomes of Older People Admitted to Postacute Facilities with Delirium: OUTCOMES OF DELIRIUM IN POSTACUTE CARE

Objectives: To compare outcomes of patients admitted to postacute skilled nursing facilities with delirium, subsyndromal delirium, and no delirium.

Increased Velocity Exercise Specific to Task (InVEST) Training: A Pilot Study Exploring Effects on Leg Power, Balance, and Mobility in Community‐Dwelling Older Women

Objectives: To evaluate a dynamic form of weighted vest exercise suitable for home use and designed to enhance muscle power, balance, and mobility.