Suzanne G. Leveille

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.

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.

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.

Preventing disability and falls in older adults: a population-based randomized trial

OBJECTIVES Because preventing disability and falls in older adults is a national priority, a randomized controlled trial was conducted to test a multicomponent intervention program. METHODS From a random sample of health maintenance organization (HMO) enrollees 65 years and older, 1559 ambulatory seniors were randomized to one of three groups: a nurse assessment visit and follow-up interventions targeting risk factors for disability and falls (group 1, n = 635); a general health promotion nurse visit (group 2, n = 317); and usual care (group 3, n = 607). Data collection consisted of a baseline and two annual follow-up surveys. RESULTS After 1 year, group 1 subjects reported a significantly lower incidence of declining functional status and a significantly lower incidence of falls than group 3 subjects. Group 2 subjects had intermediate levels of most outcomes. After 2 years of follow-up, the differences narrowed. CONCLUSIONS The results suggest that a modest, one-time prevention program appeared to confer short-term health benefits on ambulatory HMO enrollees, although benefits diminished by the second year of follow-up. The mechanisms by which the intervention may have improved outcomes require further investigation.

Preventing Disability and Managing Chronic Illness in Frail Older Adults: A Randomized Trial of a Community-Based Partnership with Primary Care

BACKGROUND: Effective new strategies that complement primary care are needed to reduce disability risks and improve self‐management of chronic illness in frail older people living in the community.

Does walking decrease the risk of cardiovascular disease hospitalizations and death in older adults

OBJECTIVES: The purpose of this study was to determine whether walking is associated with a reduced risk of cardiovascular disease hospitalization and death in community‐dwelling older men and women.

PSYCHOACTIVE MEDICATIONS AND INJURIOUS MOTOR VEHICLE COLLISIONS INVOLVING OLDER DRIVERS

Older drivers have the second highest risk for motor vehicle collisions of any age group, after adolescents. Psychoactive medications may place older drivers at increased risk for injurious motor vehicle collisions. We conducted a population-based matched case-control study of older drivers who were involved in injurious crashes during 1987 and 1988. The 234 cases and 447 controls were members of a large Seattle-based health maintenance organization. Use of antidepressants and opioid analgesics by older drivers was associated with increased risk for injurious motor vehicle collisions. Compared with non-users, current users of cyclic antidepressants had an adjusted relative risk (RR) of 2.3 [95% confidence interval (CI) = 1.1–4.8]. Opioid analgesic use was also associated with an elevated crash risk (adjusted RR = 1.8; 95% CI = 1.0–3.4). We found no evidence of a doserelated effect with either class of drug. Current use of benzodiazepines or sedating antihistamines had little association with increased risk for injurious collisions. (Epidemiology 1994;5:591–598)

Coimpairments as Predictors of Severe Walking Disability in Older Women

OBJECTIVE: Severe disabilities are common among older people who have impairments in a range of physiologic systems. It is not known, however, whether the presence of multiple impairments, or coimpairments, is associated with increased risk of developing new disability. The aim of this study was to determine the combined effects of two impairments, decreased knee‐extension strength and poor standing balance, on the risk of developing severe walking disability among older, moderately‐to‐severely disabled women who did not have severe walking disability at baseline.

Musculoskeletal pain and risk for falls in older disabled women living in the community.

To determine whether musculoskeletal pain increased risk for falls in older women with disabilities.

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.