Stefano Volpato

Handgrip strength and cause-specific and total mortality in older disabled women: Exploring the mechanism

OBJECTIVES: To examine the association between muscle strength and total and cause‐specific mortality and the plausible contributing factors to this association, such as presence of diseases commonly underlying mortality, inflammation, nutritional deficiency, physical inactivity, smoking, and depression.

Change in muscle strength explains accelerated decline of physical function in older women with high interleukin-6 serum levels

OBJECTIVES: To test whether accelerated sarcopenia in older persons with high interleukin (IL)‐6 serum levels plays a role in the prospective association between inflammation and disability found in many studies.

Cardiovascular Disease, Interleukin-6, and Risk of Mortality in Older Women The Women’s Health and Aging Study

Background —Systemic chronic inflammation has been found to be related to all-cause mortality risk in older persons. We investigated whether specific chronic conditions, particularly cardiovascular disease (CVD), affect the association between high interleukin (IL)-6 level and mortality in a sample of disabled older women. Methods and Results —IL-6 serum level was measured at baseline in 620 women ≥65 years old. The presence and severity of medical conditions was ascertained by standard criteria that used multiple sources of information. The sample was surveyed over the 3-year follow-up. After adjustment for potential confounders, compared with those in the lowest tertile, women in the highest IL-6 tertile were at higher risk of all-cause mortality. The presence of CVD, however, strongly affected the risk of mortality associated with high IL-6. Among women with prevalent CVD, those with high IL-6 levels had >4-fold risk of death (RR 4.6; 95% CI 2.0 to 10.5) compared with women in the lowest tertile, whereas the relative risk associated with high IL-6 among those without CVD was much lower and not significant (RR 1.8; 95% CI 0.7 to 4.2). Adjustment for all chronic diseases and disease severity measures, including ankle-brachial index, forced expiratory volume, and exercise tolerance, did not change the results. Conclusions —IL-6 level is helpful in identifying a subgroup of older CVD patients with high risk of death over a period of 3 years. Systemic inflammation, as measured by IL-6, may be related to the clinical evolution of older patients with CVD.

Executive Function Correlates with Walking Speed in Older Persons: The InCHIANTI Study

Objectives: To study the association between performance on psychological tests of executive function and performance on lower extremity tasks with different attentional demands in a large sample of nondemented, older adults.

Reliability and sensitivity to change assessed for a summary measure of lower body function. Results from the Women's Health and Aging Study

A summary performance measure comprised of a hierarchical balance task, a 4-meter walk, and five repetitive chair stands is increasingly being used as a predictor of independent living for older persons. The reliability and sensitivity to change of this summary performance measure have not been investigated, however. Because a measure can be reliable while being unresponsive to change, this study presents information on both the reliability and sensitivity to change for the summary performance measure. This is a 3-year prospective cohort study of 1,002 moderately to severely disabled older women. Short- and long-term reliability was assessed by intraclass correlation coefficients (ICC). Sensitivity to change was assessed by slope differences for three age categories (65-74, 75-84, and >or=85) over six 6-month follow-up periods. Sensitivity to change was also assessed by summary performance change scores for those who did and did not suffer from one of four medical events [myocardial infarction (MI), stroke, hip fracture, or congestive heart failure (CHF)] at follow-up. The summary performance measure showed excellent reliability. Intraclass correlation coefficients ranged from 0.88 to 0.92 for measures made 1 week apart. The 6-month average intraclass correlation coefficient was 0.77 (range 0.72-0.79). The summary performance measure was also highly responsive to change. Subjects who suffered an incident MI, stroke, hip fracture, or CHF at follow-up were significantly more likely to have poorer summary performance change scores (-2.25) compared with those who did not have one of these medical events (-0.24). Additionally, subjects who suffered one of these events improved their summary performance scores in the following assessment period by 0.72. With increasing utilization of the summary performance measure by researchers and clinicians it is important that the measurement properties of this instrument are known. Our results show that the summary performance measure has excellent reliability and is highly sensitive to change.

Just Get Out the Door! Importance of Walking Outside the Home for Maintaining Mobility: Findings from the Women's Health and Aging Study

Objectives: To determine the association between volitional walking behavior and change in walking ability and lower extremity function over 1 year in functionally limited older women.

Predictive Value of the Short Physical Performance Battery Following Hospitalization in Older Patients

BACKGROUND Hospitalization represents a stressful and potentially hazardous event for older persons. We evaluated the value of the Short Physical Performance Battery (SPPB) in predicting rates of functional decline, rehospitalization, and death in older acutely ill patients in the year after discharge from the hospital. METHODS Prospective cohort study of 87 patients aged 65 years and older who were able to walk and with a Mini-Mental State Examination score ≥ 18 and admitted to the hospital with a clinical diagnosis of congestive heart failure, pneumonia, chronic obstructive pulmonary disease, or minor stroke. Patients were evaluated with the SPPB at hospital admission, were reevaluated the day of hospital discharge, and 1 month later. Subsequently, they were followed every 3 months by telephone interviews to ascertain functional decline, new hospitalizations, and vital status. RESULTS After adjustment for potential confounders, including self-report activity of daily living and comorbidity, the SPPB score at discharge was inversely correlated with the rate of decline in activity of daily living performance over the follow-up (p < .05). In a multivariable discrete-time survival analysis, patients with poor SPPB scores at hospital discharge (0-4) had a greater risk of rehospitalization or death (odds ratio: 5.38, 95% confidence interval: 1.82-15.9) compared with those with better SPPB scores (8-12). Patients with early decline in SPPB score after discharge also had steeper increase in activity of daily living difficulty and higher risk of rehospitalization or death over the next year. CONCLUSIONS In older acutely ill patients who have been hospitalized, the SPPB provides important prognostic information. Lower extremity performance-based functional assessment might identify older patients at high risk of poor outcomes after hospital discharge.

Relationship of Alcohol Intake With Inflammatory Markers and Plasminogen Activator Inhibitior-1 in Well-Functioning Older Adults The Health, Aging, and Body Composition Study

Background—Increased levels of acute-phase reactants predict the onset of poor health outcomes. A U-shaped association has been reported between alcohol intake and health outcomes, which suggests that alcohol intake may modify levels of acute-phase reactants. We investigated the relationship between weekly alcohol intake and interleukin-6 (IL-6), C-reactive protein (CRP), tumor necrosis factor-&agr; (TNF-&agr;), and plasminogen activator inhibitor-1 (PAI-1). Methods and Results—Data are from year 1 of the Health, Aging, and Body Composition study, a biracial cohort of 3075 well-functioning men and women aged 70 to 79 years, living in Memphis, Tenn, and Pittsburgh, Pa. The analysis included 2574 persons (51.2% women; 40.1% black) with complete data. After adjustment for age, race, smoking status, history of diabetes, history of cardiovascular disease, physical activity, high-density lipoprotein cholesterol, antiinflammatory medications, statins, and total fat mass, alcohol intake showed a J-shaped relationship with mean IL-6 (P for quadratic term <0.001) and CRP (P =0.014) levels. The association was consistent in both men and women. Compared with subjects who consumed 1 to 7 drinks per week, those who never drank had an increased likelihood of having high levels of both IL-6 and CRP, as did those who drank 8 or more drinks per week. We found no relationship between alcohol intake and levels of TNF-&agr; and PAI-1 (P =0.137 and 0.08, respectively). Conclusions—In well-functioning older persons, light alcohol consumption is associated with lower levels of IL-6 and CRP. These results might suggest an additional biological explanation to the epidemiological link between moderate alcohol consumption and cardiovascular events.

Late-Life Body Mass Index and Dementia Incidence: Nine-Year Follow-Up Data from the Kungsholmen Project

OBJECTIVES: To describe the association between late‐life body mass index (BMI) and dementia development with a time perspective and to investigate the effect of weight changes on dementia incidence.

Progressive versus Catastrophic Loss of the Ability to Walk: Implications for the Prevention of Mobility Loss

OBJECTIVES: Loss of mobility is an important functional outcome that can have devastating effects on quality of life and the ability of older persons to remain independent in the community. Although a large amount of research has been done on risk factors for disability onset, little work has focused on the pace of disability progression. This study characterizes the development of severe walking disability over time and evaluates risk factors and subsequent mortality as they relate to mobility disability with progressive or catastrophic onset.