Minna Mänty

Fear of moving outdoors and development of outdoor walking difficulty in older people

OBJECTIVES: To study which individual characteristics and environmental factors correlate with fear of moving outdoors and whether fear of moving outdoors predicts development of mobility limitation.

Mobility decline in old age

Mobility is important for community independence. With increasing age, underlying pathologies, genetic vulnerabilities, physiological and sensory impairments, and environmental barriers increase the risk for mobility decline. Understanding how mobility declines is paramount to finding ways to promote mobility in old age.

Mobility-Related Fatigue, Walking Speed, and Muscle Strength in Older People

BACKGROUND Fatigue is an important early marker of functional decline among older people, but the mechanisms underlying this association are not fully understood. The purpose of the present study was to examine the association between mobility-related fatigue and walking speed and to test the degree to which muscle strength accounts for this association. METHODS The study is based on baseline (n = 523) and 5-year follow-up data (n = 292) from a cohort of 75-year-old persons. Standardized assessments include self-report measures of mobility-related fatigue (score range 0-6) and medical history, as well as performance-based assessment of walking speed and maximal isometric strength of knee extension, body extension, and handgrip. RESULTS In the cross-sectional baseline analysis, one unit increase in fatigue score was associated with 0.03 m/s (β = -.03, p < .001) and 0.05 m/s (β = -.05, p < .001) slower maximum walking speed among women and men, respectively, while adjusting for important covariates. Among women, muscle strength accounted up to 21% and among men up to 24% for the association. In the prospective analysis, fatigue at baseline was predictive of change in walking speed among men (β = -.04, p < .001) but not among women (β = -.005, p = .64). Among men, muscle strength accounted up to 15% for the association between baseline fatigue and change in maximum walking speed. CONCLUSIONS Mobility-related fatigue is associated with slower walking speed in older adults. The results suggest that muscle strength is one of the underlying factors explaining this association.

Perceived barriers in the outdoor environment and development of walking difficulties in older people

SIR—Older people with mobility limitations often report more barriers in their outdoor environment than people with intact mobility [1]. However, it is uncertain whether older people perceive their environment as problematic because of their mobility limitations or whether the environmental barriers precede incident mobility limitation, as most studies have been limited to cross-sectional analyses [2–5]. Only a few longitudinal studies have shown that barriers in the outdoor environment, such as poor street conditions, poor lighting and heavy traffic, increase the risk for overall functional loss [6, 7] and decrease physical activity participation [8]. More knowledge is needed about the characteristics of outdoor environments that threaten the mobility of older people [9]. The aim of the study reported in this letter was to explore whether perceived barriers in the outdoor environment predict development of difficulties in advanced and basic mobility among community-dwelling people who did not have walking difficulties at baseline. (Less)

Fatigue, General Health, and Ischemic Heart Disease in Older Adults

BACKGROUNDS Fatigue has been shown to predict ischemic heart disease (IHD) and mortality in nonsmoking middle-aged men free of cardiovascular disease. The aim of this study was to investigate the predictive value of fatigue for IHD and general health in nondisabled individuals free of cardiovascular disease and older than 70 years. METHODS The study population was drawn from The Longitudinal Study of Aging Danish Twins. In total, 1,696 participants were followed up for 2-10 years by questionnaires and 10-16 years through registries. Kaplan Meier, Cox Proportional Hazard and logistic regression were used to analyze data. Fatigue was measured with the mobility-tiredness scale, and multivariable-adjusted models included age, sex, socioeconomic position, life style factors, and depression symptomatology. Good general health was defined as no hospitalization due to IHD, no self-reported IHD-related diagnoses, no use of heart medication, sustained good mobility, and participation at follow-up. IHD was defined as first hospitalization due to IHD (ICD10: I20-I25) or death due to IHD as primary cause. RESULTS Participants without fatigue had higher chances of a sustained good general health at 2 (odds ratio [OR] = 1.45 confidence interval [CI] 95%: 1.08-1.93) and 4 years of follow-up (OR = 1.55 CI 95%: 1.11-2.16), compared with participants with fatigue. Further, participants with fatigue had a significantly higher hazard of IHD during the 10-16 years of follow-up (hazard ratio [HR] = 1.47 CI 95%: 1.08-2.00) compared with participants without fatigue. CONCLUSION We concluded that fatigue in nondisabled older adults free of cardiovascular disease is an early predictor for development of subsequent poor general health and IHD.

Fatigability in basic indoor mobility in nonagenarians.

To evaluate the prevalence and associated health factors of indoor mobility–related fatigability in nonagenarians.

Self-reported fatigue and physical function in late mid-life

OBJECTIVE To determine the association between the 5 subscales of the Multidimensional Fatigue Inventory (MFI-20) and physical function in late mid-life. DESIGN Cross-sectional study. SUBJECTS A population-based sample of adults who participated in the Copenhagen Aging and Midlife Biobank population cohort (n = 4,964; age 49-63 years). METHODS Self-reported fatigue was measured using the MFI-20 comprising: general fatigue, physical fatigue, reduced activity, reduced motivation, and mental fatigue. Handgrip strength and chair rise tests were used as measures of physical function. Multiple logistic regression analyses were used to determine the associations between handgrip strength and the chair rise test with the MFI-20 subscales, adjusted for potential confounders. RESULTS After adjustments for potential confounders, handgrip strength was associated with physical fatigue (adjusted odds ratio (OR) 0.75 (95% confidence interval (CI) 0.66-0.86); p ≤ 0.001) and reduced motivation (adjusted OR 0.85 (95% CI 0.75-0.96); p ≤ 0.05), but not with the other subscales. After these adjustments, the chair rise test was associated with physical fatigue (adjusted OR 0.61 (0.53-0.69); p ≤ 0.001), general fatigue (adjusted OR 0.72 (0.62-0.84); p ≤ 0.001), reduced activity (adjusted OR 0.79 (0.70-0.90); p ≤ 0.001) and reduced motivation (adjusted OR 0.84 (0.74-0.95); p ≤ 0.01), but not with mental fatigue. Subgroup analyses for sex did not show statistically significant different associations between physical function and fatigue. CONCLUSION The present study supports the physiological basis of 4 subscales of the MFI-20. The association between fatigue and function was independent of gender.

Bidirectional longitudinal relationship between leisure-time physical activity and psychotropic medication usage: A register linked follow-up study

This study aimed to examine the bidirectional relationship between psychotropic medication use and changes in leisure-time physical activity (LTPA) among a population cohort study. Phase 1 data were collected by mail surveys in 2000-2002 among 40-60-year-old employees of the City of Helsinki, Finland, and phase 2 follow up survey was conducted in 2007. Based on self-report, the respondents were classified as inactive and active (≥14.75 MET-hours/week) at the phases 1 and 2. Hazard ratios (HR) were calculated for subsequent (2007-10) psychotropic medication purchasing according to changes in physical activity (phases 1-2). Odds ratios (OR) for physical inactivity at phase 2 were calculated according to the amount of psychotropic medication between phases 1-2. Overall, 5361 respondents were included (mean age 50 years, 80% women). Compared with the persistently active, the persistently inactive, those decreasing and adopting LTPA had an increased risk for psychotropic medication. Only the persistently inactive remained at increased risk for psychotropic medication use, following the adjustment for prior psychotropic medication use. Compared with those having no medication, the risk for physical inactivity increased as the psychotropic medication increased. Our data suggest that physical activity has an important role in maintaining wellbeing and reducing psychotropic medication usage.

Changes in psychosocial and physical working conditions and common mental disorders

BACKGROUND Previous studies on changes in working conditions and mental health are few and have typically focused only on psychosocial working conditions. We assessed the impact of changes in both psychosocial and physical working conditions on common mental disorders (CMDs) in a cohort of midlife and older employees. METHODS Repeat data were derived from the Helsinki Health Study, which is a cohort study on employees of the City of Helsinki, Finland (aged 40-60 years at baseline). Changes in working conditions were assessed between Phase 1 (2000-2002) and Phase 2 (2007). CMD was assessed at Phase 1, Phase 2 and Phase 3 (2012) using the 12-item General Health Questionnaire. In total, 4946 participants (82% women) who were still employed at Phase 2 were available for the analyses. Logistic regression analyses using generalized estimating equations were conducted to examine the association between changes in working conditions and the likelihood of CMD. ORs and their 95% CIs were estimated. RESULTS After adjustment for sex, age, marital status, health behaviours and obesity; increased and repeated exposure to low job control, high job demands and repetitive movements and repeated exposure to awkward postures and rotation of back were associated with a higher likelihood of CMD at Phases 1-3. Fully adjusted ORs ranged from 1.27 to 2.39 for psychosocial, and from 1.18 to 1.29 for physical working conditions. CONCLUSIONS Repeated and increased exposures to several adverse psychosocial and physical working conditions are associated with a higher likelihood of CMD.

Musculoskeletal pain and physical functioning in the oldest old.

Little is known about the impact of pain on physical functioning among the oldest‐old subjects. In this study, we first examined the associations between the number of painful sites and measures of physical functioning reflecting different stages of the disablement process (physical impairment, functional limitation and disability) among nonagenarians (more than ninety years old persons). Second, we described the effect of painful sites on disability during a 2‐year follow‐up period.