Pia Laukkanen

Tiredness in daily activities among nondisabled old people as determinant of onset of disability.

The purpose of this article was to examine whether self-reported tiredness in daily activities at age 75 is an independent determinant of onset of disability at 5-year follow-up. The investigation is based on two subgroups of nondisabled participants of 75 year olds who survived and participated in the follow-up study 5 years later (n = 510 and 429). Persons who felt tired in their daily activities had a larger risk of becoming disabled in mobility (OR = 3.2, 95% CI = 1.4-7.6) and in daily activities (OR = 2.1, 95% CI = 1.0-4.2) compared to persons without tiredness. In addition, persons with poor cognitive function, little diversity in social relations and no physical activity had an independent risk of onset of disability. The results indicate that it is important to take it seriously when older people complain about tiredness in daily activities, as these people are at higher risk of becoming disabled than others.

Mobility limitations and cognitive deficits as predictors of institutionalization among community-dwelling older people.

Purpose: Mobility limitations and cognitive disorders have often been observed as risks for institutionalization. However, their combined effects on risk of institutionalization among initially community-dwelling older people have been less well reported. Design: A prospective cohort study with 10-year surveillance on institutionalization. Subjects: Study population (n = 476) consisted of 75- and 80-year-old people who were community-dwelling, had not been diagnosed with dementia, and participated in tests on walking speed and cognitive capacity at a research centre. Measures: Cognitive capacity was measured with three validated psychometric tests that were from the Wechsler Adult Intelligence Scale, Wechsler Memory Scale and Schaie- Thurstone Adult Mental Abilities Test. Mobility was measured with walking speed over a 10-m distance. Exclusive distribution based study groups were formed with cut-offs at the lowest third as follows: no limitation, solely mobility limitation, solely cognitive deficits, and combined mobility limitation and cognitive deficits. Cox proportional hazards model was used to determine the relative risks of institutionalization for the study groups. Results: Eleven percent of the participants were institutionalized during the 10-year surveillance. The risk for institutionalization was 4.9 times greater (95% confidence interval: 2.1–11.2) for those who had co-existing mobility limitations and cognitive deficits than for those with no limitations. Conclusions: The findings show that the accumulation of limitations in physical and cognitive performance substantially decreases the possibility for a person remaining at home. This might be due to a decreased reserve capacity and ineffective compensatory strategies. Therefore, interventions targeted to improve even one limitation, or prevent accumulation of these risk factors, could significantly reduce the risk of institutionalization.

Calcaneal Bone Mineral Density Predicts Fracture Occurrence: A Five‐Year Follow‐up Study in Elderly People

A 5‐year follow‐up study investigated calcaneal bone mineral density (BMD) and changes in BMD in relation to fracture occurrence. The subjects comprised two cohorts born in 1914 and 1910 living in the city of Jyväskylä in central Finland. One hundred and three men (82%) and 188 women (73%), aged 75, and 57 men (74%) and 136 women (65%), aged 80, of the eligible population participated in the baseline bone measurements. The follow‐up bone measurements were obtained for 59 men (68%) and 119 women (66%), aged 80 years, and for 21 men (53%) and 61 women (48%), aged 85 years. During the follow‐up period, 8 men and 36 women from the younger and 11 men and 24 women from the older cohort sustained at least one fracture. When the baseline levels of BMD were related to fracture occurrence, the results clearly showed that with increased BMD values the probability of fracture decreased. Where men and women had similar BMD values, they also had a similar fracture probability. Except for one woman in the older cohort, none of those who had initial BMD values more than 1 standard deviation above the mean for their age developed a fracture during the follow‐up period. The mean annual decrease in BMD was greater in the women (2.5–2.7%) than in the men (0.8–1.0%). The BMD change tended to associate with fracture occurrence only in the 75‐year‐old women (p = 0.075). The results suggest that calcaneus BMD can be used as a predictor of fracture occurrence in 75− to 80‐year‐old men and women. However, associating fractures with the change in BMD was difficult due to the limited number of survivors and initial differences in BMD values.

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.

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)

A comparative study of factors related to carrying out physical activities of daily living (PADL) among 75-year-old men and women in two nordic localities

The aim of this cross-sectional and cross-national study was to describe and compare the ability to carry out physical activities of daily living (PADL) and examine factors that might explain variation in this ability in two Nordic populations. Seven hundred and six men and women aged 75 from two populations (Glostrup, Denmark, and Jyväskylä, Finland) were interviewed and given a laboratory examination in 1989–90. The ability to carry out the PADL activities was studied by interview. Tests were given to determine depressive symptoms, cognitive capacity, and selected physical and sensory performance domains. Four different regression models (men and women in Jyväskylä and Glostrup) were used to analyze a number of variables describing physical and psychological health and performance related to the PADL. Knee extension strength and stair mounting height in three models (men and women in Jyväskylä and women in Glostrup), and walking speed in one model (men in Glostrup) emerged as explanatory factors on the basis of the physical performance tests done. Sight, except in the women in Glostrup, hearing in the men in Jyväskylä, and balance in the women in Glostrup also explained PADL functioning. In addition, symptoms of depression in the men in Glostrup, and symptoms of illness, except in the men in Jyväskylä, and cognitive capacity in the men in Jyväskylä emerged as explanatory factors in the regression models. There were, however, no major differences in the determinants of PADL functioning in the two Nordic populations of elderly people. Physical, psychological and sensory tests provide useful information, complementary to self-reports regarding declining PADL functional capacity.

Mobility performance and its sensory, psychomotor and musculoskeletal determinants from age 75 to age 80

Background and aims: Prospective studies on the simultaneous effects of multiple determinants on objectively assessed mobility are few. The aim of this study was to analyse mobility performance, its stability and sensory, psychomotor and musculoskeletal determinants in an older population from age 75 to age 80. Methods: Sixty-three men and 121 women aged 75 participated at baseline and, five years later, in the follow-up phase of this population-based prospective study. Maximal walking speed and step-mounting height were assessed at baseline and follow-up. Maximal isometric knee extension strength, standing balance on force platform, reaction time, visual acuity and limitations in range of motion (ROM) of hips and knees were assessed at baseline. Structural equation modeling was used to analyse the associations. Results: The stability of mobility performance from baseline to the five-year follow-up was high (coefficient 0.80 in men, 0.78 in women). In men, knee extension strength, standing balance, ROM limitations and visual acuity explained 69% of the variation in mobility performance at baseline and, indirectly, 59% of that variation at follow-up. Among women, knee extension strength, standing balance, visual acuity and reaction time explained 52% of the variation of mobility performance at baseline and, indirectly, 30% at the five-year follow-up. Conclusions: Results indicate that the predictive effects of sensory, psychomotor and musculoskeletal functions on mobility performance extend over five years in older people. In seeking to prevent mobility limitations, vision, reaction time and lower extremity ROM need to be targeted, in addition to muscle strength and balance.

Multidimensional health assessment of 75- and 80-year-old men and women: A five-year prospective study

Background and aims: There are no earlier reports of regular multidimensional health check programs in elderly people. The aim of this study was to establish the number and type of previously unrecognized health conditions in two cohorts of elderly people examined twice during a 5-year period, and to determine how these conditions were subsequently evaluated and treated. Methods: This population-based study, carried out at a university research center in Finland, consisted of a multidimensional and multiphased health assessment including interviews, health questionnaires and medical examinations and tests, and follow-up of subsequent examinations and treatment. Participants were all 75- (N=388) and 80-year-old (N=291) people residing in the city of Jyväskylä in 1989 and 1990 respectively. Results: A total of 780 health assessments were carried out, 500 at baseline and 280 five years later. Large numbers of previously unrecognized conditions were found on both occasions, ranging from tumors to impacted cerumen. At baseline, 180 persons (36% of those assessed) were referred for further examinations or treatment, at follow-up 127 (4:5%). Half of the referred persons received treatment, 13–39% were evaluated but not treated. For 12–33%, no information was obtained on post-hoc events. Conclusions: Comprehensive health assessments in older people reveal a large number of previously unrecognized conditions that require further examination and/or treatment, suggesting the need for systematic and regular assessments of health and functional capacity.

Benefits of home-based rocking-chair exercise for physical performance in community-dwelling elderly women: a randomized controlled trial — a pilot study

Background and aims: Home-based exercise is a viable alternative for older adults with difficulties in exercise opportunities outside the home. The aim of this study was to investigate the benefits of homebased rocking-chair training, and its effects on the physical performance of elderly women. Methods: Community-dwelling women (n=51) aged 73–87 years were randomly assigned to the rocking-chair group (RCG, n=26) or control group (CG, n=25) by drawing lots. Baseline and outcome measurements were hand grip strength, maximal isometric knee extension, maximal walking speed over 10 meters, rising from a chair five times, and the Berg Balance Scale (BBS). The RCG carried out a sixweek rocking-chair training program at home, involving ten sessions per week, twice a day for 15 minutes per session, and ten different movements. The CG continued their usual daily lives. After three months, the RCG responded to a mail questionnaire. Results: After the intervention, the RCG improved and the CG declined. The data showed significant interactions of group by time in the BBS score (p=0.001), maximal knee extension strength (p=0.006) and maximal walking speed (p=0.046), which indicates that the change between groups during the follow-up period was significant. Adherence to the training protocol was high (96%). After three months, the exercise program had become a regular home exercise habit for 88.5% of the subjects. Conclusions: Results indicate that home-based elderly women benefit from this easily implemented rocking-chair exercise program. The subjects became motivated to participate in training and continued the exercises. This is a promising alternative exercise method for maintaining physical activity and leads to improvements in physical performance.