Markku Kauppinen

Activity as a predictor of mental well-being among older adults

This eight-year follow-up study examines the roles of physical and leisure activity as predictors of mental well-being among older adults born in 1904–1923. As part of the Evergreen project, 1224 (80%) persons aged 65–84 years were interviewed at baseline (1988), and 663 (90%) persons in the follow-up (1996). Mental well-being factors including depressive symptoms, anxiety, loneliness, self-rated mental vigour and meaning in life were constructed using factor analysis. The predictors of mental well-being included physical and leisure activity, mobility status and number of chronic illnesses. We used a path analysis model to examine the predictors of mental well-being. At baseline, low number of chronic illnesses, better mobility status and leisure activity were associated with mental well-being. Baseline mental well-being, better mobility status and younger age predicted mental well-being in the follow-up. Explanatory power of the path analysis model for the mental well-being factor at baseline was 19% and 35% in the follow-up. These findings suggest that mental well-being in later life is associated with activity, better health and mobility status, which should become targets for preventive measures.

Hearing as a Predictor of Falls and Postural Balance in Older Female Twins

BACKGROUND The purpose of the present study was to examine, first, whether hearing acuity predicts falls and whether the potential association is explained by postural balance and, second, to examine whether shared genetic or environmental effects underlie these associations. METHODS Hearing was measured using a clinical audiometer as a part of the Finnish Twin Study on Aging in 103 monozygotic and 114 dizygotic female twin pairs aged 63-76 years. Postural balance was indicated as a center of pressure (COP) movement in semi-tandem stance, and participants filled in a fall-calendar daily for an average of 345 days after the baseline. RESULTS Mean hearing acuity (better ear hearing threshold level at 0.5-4 kHz) was 21 dB (standard deviation [SD] 12). Means of the COP velocity moment for the best to the poorest hearing quartiles increased linearly from 40.7 mm(2)/s (SD 24.4) to 52.8 mm(2)/s (SD 32.0) (p value for the trend = .003). Altogether 199 participants reported 437 falls. Age-adjusted incidence rate ratios (IRRs) for falls, with the best hearing quartile as a reference, were 1.2 (95% confidence interval [CI] = 0.4-3.8) in the second, 4.1 (95% CI = 1.1-15.6) in the third, and 3.4 (95% CI = 1.0-11.4) in the poorest hearing quartiles. Adjustment for COP velocity moment decreased IRRs markedly. Twin analyses showed that the association between hearing acuity and postural balance was not explained by genetic factors in common for these traits. CONCLUSION People with poor hearing acuity have a higher risk for falls, which is partially explained by their poorer postural control. Auditory information about environment may be important for safe mobility.

Poor vision accompanied with other sensory impairments as a predictor of falls in older women

OBJECTIVES we studied visual acuity (VA) and co-existing hearing impairment and poor standing balance as predictors of falls. DESIGN prospective study with 1-year follow-up. SETTING research laboratory and residential environment. PARTICIPANTS 428 women aged 63-76 years from the Finnish Twin Study on Aging. MEASUREMENTS participants were followed up for incidence of falls over 1 year. VA, hearing ability and standing balance were assessed at the baseline. The incidence rate ratios (IRR) for falls were computed using the negative binomial regression model. RESULTS during the follow-up, 47% of participants experienced a fall. After adjusting for age and interdependence of twin sisters, participants with vision impairment (VA of <1.0) but no other sensory impairments had a higher, but non-significant, risk for falls compared to persons with normal vision (IRR 1.5, 95% CI 0.6-4.2). Co-existing vision impairment and impaired balance increased the risk (IRR 2.7, 95% CI 0.9-8.0), as also did co-existing vision and hearing impairment (IRR 4.2, 95% CI 1.5-11.3), compared to those with normal vision. Among persons with all three impairments, the IRR for falls increased to 29.4 (95% CI 5.8-148.3) compared to participants with good vision. CONCLUSION the impact of vision impairment on fall risk was higher when accompanied with other sensory and balance impairments, probably because the presence of other impairments prevented the reception of compensatory information about body posture and environment being received from other sensory sources. When aiming to prevent falls and their consequences in older people, it is important to check whether poor vision is accompanied with other impairments.

Individual and environmental factors underlying life space of older people – study protocol and design of a cohort study on life-space mobility in old age (LISPE)

BackgroundA crucial issue for the sustainability of societies is how to maintain health and functioning in older people. With increasing age, losses in vision, hearing, balance, mobility and cognitive capacity render older people particularly exposed to environmental barriers. A central building block of human functioning is walking. Walking difficulties may start to develop in midlife and become increasingly prevalent with age. Life-space mobility reflects actual mobility performance by taking into account the balance between older adults internal physiologic capacity and the external challenges they encounter in daily life. The aim of the Life-Space Mobility in Old Age (LISPE) project is to examine how home and neighborhood characteristics influence people’s health, functioning, disability, quality of life and life-space mobility in the context of aging. In addition, examine whether a person’s health and function influence life-space mobility.DesignThis paper describes the study protocol of the LISPE project, which is a 2-year prospective cohort study of community-dwelling older people aged 75 to 90 (n = 848). The data consists of a baseline survey including face-to-face interviews, objective observation of the home environment and a physical performance test in the participant’s home. All the baseline participants will be interviewed over the phone one and two years after baseline to collect data on life-space mobility, disability and participation restriction. Additional home interviews and environmental evaluations will be conducted for those who relocate during the study period. Data on mortality and health service use will be collected from national registers. In a substudy on walking activity and life space, 358 participants kept a 7-day diary and, in addition, 176 participants also wore an accelerometer.DiscussionOur study, which includes extensive data collection with a large sample, provides a unique opportunity to study topics of importance for aging societies. A novel approach is employed which enables us to study the interactions of environmental features and individual characteristics underlying the life-space of older people. Potentially, the results of this study will contribute to improvements in strategies to postpone or prevent progression to disability and loss of independence.

Health and functional capacity as predictors of community dwelling among elderly people

The aim of this study was to identify factors that predict community dwelling (i.e., nonuse of institutional bed-days) among elderly people. This was a longitudinal study of institution use including both short-term and long-term use of hospitals and nursing homes. The impact of health, functional performance, and carrying out the activities of daily living on community dwelling was studied using the method of path analysis. The participants were all the 75-year-old (N = 388) and 80-year-old (N = 291) men and women resident in the City of Jyväskylä, Finland. Predictor variables included disease severity, symptoms of illness, cognitive capacity, walking speed, muscle strength, hearing, and ability to carry out the activities of daily living. The outcome variable was community dwelling. Over 70% of the elderly people had received institutional care during the 5-year follow-up. The path analysis models showed that disease severity and symptoms of illness had an effect on community dwelling: those with a more severe disease or more symptoms needed more institutional care. The effect was also mediated through limitations in physical performance and cognitive capacity and need for assistance in activities of daily living. The explanatory power of these models varied from 23% to 36%. The results of this study suggest that prevention, treatment, and rehabilitation programs aimed at the promotion of community dwelling in elderly people should focus on the severity of diseases, functional performance, and the ability to carry out the activities of daily living.

Quality of Life and Barriers in the Urban Outdoor Environment in Old Age

OBJECTIVES: To examine the association between barriers in the outdoor environment and perceived quality of life (QoL) in old age and to assess whether fear of moving outdoors and unmet physical activity need contribute to this association.

Factors related to carrying out everyday activities among elderly people aged 80

The study was based on an epidemiological model in which performing activities of daily living (ADL) was the dependent variable. Variation in performing was explained by physical and mental health, and by physical performance. The population consisted of all 80-year-old residents (N=291) of the city of Jyväskylä in central Finland; 90% of them agreed to take part in the interviews at home, while 72% took part in the laboratory examinations to determine health status and functional capacity. Difficulties in at least some PADL (Physical Activities of Daily Living) tasks were reported by 86.5% of the men, and 87.2% of the women; none said they could perform all IADL (Instrumental Activities of Daily Living) tasks without difficulty. Physical performance (grip strength and stair mounting test in men, and stair mounting test, balance, and upper extremity function test in women) and visual acuity showed a significant association with ADL performance both in men and in women. In addition, depressive symptoms in women, and cognitive capacity in men were associated with both PADL and IADL, and ADL performance, respectively. In the search for pathways to reduced ADL performance, it is important to look not only at chronic diseases but also at the aging processes as well as the disabilities caused by inactivity. Tests of cognitive capacity, psychological well-being and physical performance provide valuable information on the factors that underlie the aged individual’s reduced functional capacity. (Aging Clin. Exp. Res. 6: 433-443, 1994)

Genetic and environmental effects on isometric muscle strength and leg extensor power followed up for three years among older female twins

The purpose of this study was to examine changes in the contribution of genetic and environmental effects to isometric knee extensor strength and leg extensor power among 63- to 76-year-old female twins over a 3-yr follow-up. At baseline in 2000 the sample comprised 206 monozygotic (MZ) and 228 dizygotic (DZ) twin individuals, and at follow-up in 2003 the sample comprised 149 MZ and 164 DZ twin individuals. Genetic modeling showed that genetic effects explained 58% (95% CI: 46-68%) of the variance in muscle strength at baseline and 56% (95% CI: 41-68%) at follow-up, with no occasion-specific genetic effect. Nonshared environmental effects accounted for 42% (95% CI: 32-54%) of the variation at baseline and 15% (95% CI: 7-26%) at follow-up. In addition, new nonshared environmental effects explained the remaining variance, 29% (95% CI: 22-37%) of muscle strength at follow-up. For muscle power, the same genetic effects accounted for 67% (95% CI: 57-74%) of the variation at baseline and 48% (95% CI: 34-61%) at follow-up. Nonshared environmental effects in common at both measurement points explained 33% (95% CI: 25-43%) of the total variation at baseline and 11% (95% CI: 5-21%) at follow-up. The remaining variance of muscle power at follow-up was accounted for by time-specific environmental effects. Results indicated that the contribution of genetic effects to isometric muscle strength was stable, whereas for leg extensor power the proportion of genetic effects decreased during the follow-up. We observed new specific environmental effects underlying follow-up muscle strength and power, which effects could be due to the onset of new disease processes or changes in lifestyle.

Genetic and environmental influence on structural strength of weight-bearing and non-weight-bearing bone: a twin study.

A bivariate genetic analysis among 217 older female twin pairs showed that, although the structural strength of tibia and radius are mainly regulated by same genetic and environmental factors, the tibia is more affected by environment.

Promoting mobility after hip fracture (ProMo): study protocol and selected baseline results of a year-long randomized controlled trial among community-dwelling older people.

BackgroundTo cope at their homes, community-dwelling older people surviving a hip fracture need a sufficient amount of functional ability and mobility. There is a lack of evidence on the best practices supporting recovery after hip fracture. The purpose of this article is to describe the design, intervention and demographic baseline results of a study investigating the effects of a rehabilitation program aiming to restore mobility and functional capacity among community-dwelling participants after hip fracture.Methods/DesignPopulation-based sample of over 60-year-old community-dwelling men and women operated for hip fracture (n = 81, mean age 79 years, 78% were women) participated in this study and were randomly allocated into control (Standard Care) and ProMo intervention groups on average 10 weeks post fracture and 6 weeks after discharged to home. Standard Care included written home exercise program with 5-7 exercises for lower limbs. Of all participants, 12 got a referral to physiotherapy. After discharged to home, only 50% adhered to Standard Care. None of the participants were followed-up for Standard Care or mobility recovery. ProMo-intervention included Standard Care and a year-long program including evaluation/modification of environmental hazards, guidance for safe walking, pain management, progressive home exercise program and physical activity counseling. Measurements included a comprehensive battery of laboratory tests and self-report on mobility limitation, disability, physical functional capacity and health as well as assessments for the key prerequisites for mobility, disability and functional capacity. All assessments were performed blinded at the research laboratory. No significant differences were observed between intervention and control groups in any of the demographic variables.DiscussionTen weeks post hip fracture only half of the participants were compliant to Standard Care. No follow-up for Standard Care or mobility recovery occurred. There is a need for rehabilitation and follow-up for mobility recovery after hip fracture. However, the effectiveness of the ProMo program can only be assessed at the end of the study.Trial registrationCurrent Controlled Trials ISRCTN53680197