Valentina Zamboni

Comorbidity and physical function: results from the aging and longevity study in the Sirente geographic area (ilSIRENTE study).

Background: Physical function measures have gained increased importance in the evaluation of older persons. The presence of comorbidity is a major and growing issue in geriatrics. Objective: To evaluate the relationship between comorbidity and physical function in community-dwelling older persons. Methods: Data are from baseline evaluation of the ilSIRENTE study (n = 364). Physical performance was assessed using the Short Physical Performance Battery (SPPB) and the 4-meter walking test. Muscle strength was measured by hand-grip strength. Functional performance was assessed using Basic and Instrumental Activities of Daily Living (ADLs and IADLs, respectively). Comorbidity was defined as ≧3 clinical conditions. Analyses of covariance and linear regressions were performed to evaluate the relationship between comorbidity and physical function. Results: The mean age of participants was 85.9 (SD = 4.9) years. About one third (37.4%) of participants reported ≧3 clinical conditions. Participants with comorbidity had significantly worse results in all the physical function tests. Participants with comorbidity had significantly lower adjusted results for the 4-meter walking test (0.444 m/s) and the SPPB score (6.131) compared to those without comorbidity (0.531 m/s and 7.221; all p = 0.001, respectively). Participants with comorbidity were more IADL-impaired (3.152) than participants without comorbidity (2.767; p = 0.04). No significant association of ADLs and hand-grip strength with comorbidity was reported. Similar strengths of association for the 4-meter walking test (per SD increase, β = –0.280; p = 0.001) and the SPPB (per SD increase, β = –0.285; p = 0.001) with comorbidity were reported. Conclusions: Physical function measures, especially walking speed and SPPB, are associated with comorbidity. Physical performance measures may improve the clinical evaluation of older persons.

Lifetime occupation and physical function: a prospective cohort study on persons aged 80 years and older living in a community

Background: Several studies have reported predictors for loss of mobility and impairments of physical performance among frail elderly people. Aim: To evaluate the relationship between lifetime occupation and physical function in persons aged 80 years or older. Methods: Data are from baseline evaluation of 364 subjects enrolled in the ilSIRENTE study (a prospective cohort study performed in a mountain community in Central Italy). Physical performance was assessed using the physical performance battery score, which is based on three timed tests: 4-metre walking speed, balance, and chair stand tests. Muscle strength was measured by hand grip strength. Lifetime occupation was categorised as manual or non-manual work. Results: Mean age of participants was 85.9 (SD 4.9) years. Of the total sample, 273 subjects (75%) had a history of manual work and 91 subjects (25%) a history of non-manual work. Manual workers had significant lower grip strength and physical performance battery score (indicating worse performance) than non-manual workers. After adjustment for potential confounders (including age, gender, education, depression, cognitive performance scale score, physical activity, number of diseases, hearing impairment, history of alcohol abuse, smoking habit, and haemoglobin level), manual workers had significantly worse physical function (hand grip strength: non-manual workers 32.5 kg, SE 1.4, manual workers 28.2 kg, SE 0.8; physical performance battery score: non-manual workers 7.1, SE 0.4, manual workers 6.1, SE 0.2). Conclusions: A history of manual work, especially when associated with high physical stress, is independently associated with low physical function and muscle strength in older persons.

Association between daily pain and physical function among old-old adults living in the community: results from the ilSIRENTE study.

Abstract Little is known about the impact of pain on physical function among old–old subjects. The aim of the present cross‐sectional study was to assess the association of daily pain with muscle strength and physical performance in a population of subjects aged 80 or older living in the community. We used data from baseline evaluation of the ilSIRENTE Study. Muscle strength was measured by hand grip strength. Physical performance was assessed using the physical performance battery score, which is based on three timed tests: 4‐m walking speed, balance, and chair stand tests. Daily pain was defined as any type of pain or discomfort in any part of the body manifested every day over the 7 days preceding the assessment. Mean age of 273 participants was 85.1 (SD 4.6) years, 181 (66.3%) were women and 150 (54.9%) reported daily pain. After adjustment for potential confounders, participants with daily pain had lower grip strength and physical performance battery score (indicating worse performance) than other participants (hand grip strength: daily pain 31.5 kg, SE 1.4, no daily pain 35.0, SE 1.1, p = 0.02; physical performance battery score: daily pain 6.5, SE 0.3, no daily pain 7.2, SE 0.3, p = 0.05). Both hand grip strength and physical performance battery score progressively declined as pain severity increased. In conclusion, the present study shows that among old–old subjects living in the community, daily pain is highly prevalent and that this condition is associated with impaired muscle strength and physical performance.

The ilSIRENTE study: a prospective cohort study on persons aged 80 years and older living in a mountain community of Central Italy

Background and aims: “Invecchiamento e Longevità nel Sirente” (Aging and Longevity in the Sirente geographic area, ilSIRENTE) aims at investigating the socio-demographic, functional, clinical and biological characteristics of all subjects aged 80 years and older residing in a well-defined mountain area of Central Italy. Methods: Data are from the baseline evaluation of the ilSIRENTE prospective cohort study. A list of all persons living in the Sirente area was obtained from the Registry Offices of the 13 municipalities involved in the study. Data collection started in December 2003 and was completed in September 2004. Among the 429 residents older than 80 years eligible for the study, 364 accepted to participate (response rate 84%). Participants were assessed by trained staff who collected information on socio-demographic factors, clinical conditions, medication use, physical performance and muscle strength. All participants were also evaluated using the Minimum Data Set for Home Care (MDS-HC) form and a slightly modified version of the “Invecchiare in CHIANTI” study. Results: The mean age of participants was 85.6±4.8 years (range 80–102 years), with over 20% of participants aged 90 years or older. More than 65% of participants were women. Most participants (70%) were independent or required limited assistance in performing basic activities of daily living (ADL), whereas 30% of participants were independent in instrumental activities of daily living (IADL). Cognitive function (assessed by the Cognitive Performance Score) was normal in 80% of the sample. Higher degrees of disabilities (defined as the sum of dependencies in ADLs and IADLs) were associated with worse physical performance and lower muscle strength. Conclusions: Data on the socio-demographic characteristics and health status of very old people living in the Sirente mountain community are discussed and compared with findings from other epidemiological studies.

Depression and physical function: results from the aging and longevity study in the Sirente geographic area (ilSIRENTE Study).

Depression in older persons represents a major issue because of its relevant prevalence and the associated higher risk of adverse health-related events. The aim of this study was to evaluate the relationship of depressive symptoms with measures of physical performance, muscle strength, and functional status. Data are from baseline evaluation of the ilSIRENTE Study (n = 364). Physical performance was assessed using the Short Physical Performance Battery and the 4-meter walking test. Muscle strength was measured by hand-grip strength. Functional performance was assessed using Basic and Instrumental Activities of Daily Living. Depression was defined by analyzing the different depressive manifestations included in the Minimum Data Set for Home Care Form: verbal expression of sad and/or anxious mood and demonstrated signs of mental distress. Analyses of covariance and linear regressions were performed to evaluate the relationship between depression and physical function. Participants with depression showed significantly worse results in all of the physical function tests. Subjects with depression presented significantly lower adjusted mean results for the 4-meter walking test (0.41 m/s; SE, 0.03) and the Short Physical Performance Battery score (5.68; SE, 0.38) compared with those without depression (0.50 m/s; SE, 0.01 and 6.93; SE, 0.21; all P < .01, respectively). Participants with depressed mood also presented a higher number of impaired instrumental activities of daily living (3.69; SE, 0.25) compared with participants with less than 3 depressive symptoms (2.85; SE, 0.14; P = .005). No significant difference was reported for the hand-grip strength and the Basic Activities of Daily Living scale. In conclusion, physical performance and functional status measures are significantly and negatively influenced by the presence of depression in community-dwelling older persons aged 80 years and older. (J Geriatr Psychiatry Neurol 2007;20:131-137)

Functional Status and Mortality in Older Women With Gynecological Cancer

BACKGROUND Screening tools for the identification of vulnerable older patients with cancer are needed. Aim of this study is to measure the prognostic value of multiple screening tools for the assessment of mortality risk in oncogeriatrics. METHODS The prognostic value of the following assessment tools was tested in 200 older women with gynecological cancer (mean age = 73.5 years) for 1-year mortality: Short Physical Performance Battery, usual gait speed, handgrip strength, Eastern Cooperative Oncology Group Performance Status scale, Karnofsky Performance Status scale, Vulnerable Elders Scale-13, activities of daily living, and instrumental activities of daily living. Cox proportional hazard models were performed to estimate the associations of the performance measures with mortality. Areas under receiver operating characteristic curves were also estimated. RESULTS Twenty-three participants (11.5%) died during the follow-up. The Short Physical Performance Battery, usual gait speed, and instrumental activities of daily living were the only parameters significantly associated with mortality, even after adjustment for confounders. No statistically significant results were reported for other functional measures. Similar results were obtained when testing the predictive values of the performance measures at the receiver operating characteristic analyses. CONCLUSIONS The Short Physical Performance Battery and especially the usual gait speed may represent promising tools for measuring the mortality risk of older cancer patients, thus potentially supporting clinical decisions. Further studies are needed to confirm and extend the present findings.

Self-Assessed Health Status, Walking Speed and Mortality in Older Mexican-Americans

Background: Self-assessed health status (SAHS) and physical performance measures (in particular, walking speed) are strong predictors of health-related events. Nevertheless, the possible interaction between them in predicting major outcomes has not been clearly explored. Objective: The aim of the study is to evaluate the predictive and additive value for mortality of a SAHS measure and a walking speed test. Methods: Data are from 2,139 Mexican-Americans aged ≥65 years enrolled in the Hispanic Established Populations for Epidemiologic Studies of the Elderly, and followed for 5.8 years. At the baseline visit, participants were asked to answer to the question ‘How is your health in general?’ presented as a four-level Likert item (i.e., poor, fair, good, excellent). They were also asked to ‘walk down and back as fast as it felt safe and comfortable’ along an 8-ft track. Cox proportional hazard models, receiver operating characteristic (ROC) curve, and specificity/sensitivity analyses were performed to evaluate the predictive value of SAHS and walking speed for mortality. Results: The mean age of the sample was 72.1 years. Participants reporting ‘poor’ SAHS were more likely to die compared to those with ‘excellent’ SAHS, even after adjustment for potential confounders (HR 1.52, 95% CI 1.10–2.10). Similar results were obtained for participants with slow walking speed (<0.29 m/s; HR 1.68, 95% CI 1.27–2.24; reference group: walking speed ≥0.81 m/s). A statistically significant, but weak, correlation between SAHS and walking speed was observed (Pearson’s r = 0.069, p = 0.001). No significant differences in areas under curves from ROC analyses were reported for the prediction of mortality when the SAHS and walking speed were tested (alone or in combination). Both tests presented high specificity (≥80%) for the prediction of mortality. Conclusion: SAHS and walking speed are not only significant and independent predictors of mortality in older Mexican-Americans, but also present a similar predictive value. The additive prognostic value of the two measures is limited.

Functional decline in frail community‐dwelling stroke patients

Patients who suffer a stroke event are at high risk of functional decline after the post‐acute rehabilitation period. The aim of the present study was the evaluation of factors associated with functional decline in a large sample of older patients with stroke living in the community. The study population consisted of all patients admitted to home care programs after a post‐acute rehabilitation program – with at least 1 year of follow‐up – in twenty‐two Italian Home Health Agencies from 2000 to 2002 (n =1338). For the present study we selected 355 (26%) patients with diagnosis of stroke. After 1 year of in‐home care program, 149 out of 355 stroke survivors (42%) had presented a worsening in the activities of daily living (ADL) scale score. In the final adjusted model, patients with cognitive impairment (OR 2.59, 95% CI, 1.45–4.64), pressure ulcer (OR 2.74, 95% CI, 1.45–5.18), urinary incontinence (OR 1.64, 95% CI, 1.01–3.29), or hearing impairment (OR 1.83, 95% CI, 1.02–3.29) were more likely to significantly decline in physical functioning after a period of 1 year in‐home care program. Our study documents that functional decline of stroke patients was largely dependent on specific subjects’ clinical characteristics. Three of four concomitant disabling conditions associated in our sample with functional decline – pressure ulcer, urinary incontinence, hearing – can be prevented and eventually treated or modified. Appropriate post‐acute rehabilitation programs and adequate home care interventions focused on the prevention and treatment of these conditions might be correlated to better outcomes in older post‐stroke patients.

Vitamin D hormone: A multitude of actions potentially influencing the physical function decline in older persons

Vitamin D, a secosteroid (pro)‐hormone, has been traditionally considered as a key regulator of bone metabolism, and calcium and phosphorous homeostasis through a negative feedback with the parathyroid hormone. However, during the last 20 years, the role played by vitamin D has been largely revised by recognizing its pleiotropic action on a wide spectrum of systems, apparatuses and tissues. Thus, vitamin D has growingly been involved as a primary determinant of biological modifications and specific clinical conditions. The effect of vitamin D on skeletal muscle and related outcomes (including physical function decline and disability) is surely one of the most relevant to study in the context of global aging. In the present review, the subclinical and clinical consequences of vitamin D deficiency/insufficiency, extremely frequent conditions in older age, are described. Special focus is given to skeletal muscle and physical function. Limitations of available scientific evidence on the topic are also discussed. Geriatr Gerontol Int 2011; 11: 133–142.

Effects of an Occupational Therapy Program on Functional Outcomes in Older Stroke Patients

Background: During the last decade, occupational therapy has gained increasing importance as component of the rehabilitation programs in disabled patients. Objective: To evaluate the efficacy of occupational therapy programs in patients with a recent stroke. Methods: We selected all patients with a primary diagnosis of ischemic stroke (n = 50) consecutively admitted to the two post-acute Geriatric Rehabilitation Units (CEMI 2 and 3) of the ‘A. Gemelli’ Hospital – Catholic University of Sacred Heart, Rome, Italy. Patients in the unit CEMI 3 (intervention group) received 8 weeks (3 h per day) of a combined rehabilitation program based on occupational therapy and physiotherapy. Patients admitted to the control unit (CEMI 2) received no input from the occupational therapist. Results: Overall, patients had a moderate-to-severe impairment in basic activities of daily living; the mean ADL score was 30.8 (SD ± 7.8) in the intervention group and 30.7 (SD ± 6.1) in the control group (p = 0.9). After 8 weeks of treatment the mean ADL score in the intervention group was 13.2 (SD ± 9.9) compared to 20.3 (SD ± 11.5) in the control group (p = 0.02). Differences between the intervention and control groups were statistically significant for transfers (+2.8 vs. +1.6 points on the ADL scale, p = 0.006), locomotion (+3.4 vs. +1.7 points on the ADL scale, p = 0.01), dressing (+3.0 vs. +1.8 points on the ADL scale, p = 0.01) and self-care (+3.4 vs. +1.8 points on the ADL scale, p = 0.005). Conclusion: Our results show that patients with stroke who received occupational therapy had a greater level of independence in activities of daily living over a period of 8 weeks than patients who did not.