Is the emergence of functional ability decline in early old age related to change in speed of cognitive processing and also to change in personality?

OBJECTIVE: To test whether the onset of functional ability decline in early old age is related to change in speed of cognitive processing and personality characteristics. METHOD: Among 500 randomly sampled participants, the 230 cases that did not show impairment in functional ability were selected. Mean age at Time 1 was 62.4 years. For this subsample, the emergence of functional ability decline was tracked across a 12-year observation period. RESULTS: The emergence of functional ability decline was related to change in speed of cognitive processing. Decline in functional ability was also related to increased neuroticism and external control, whereas this was not the case regarding extraversion and internal control. DISCUSSION: Cognitive processing speed was shown to be a predictor of functional disability decline; in addition, the results provided initial evidence that functional ability decline in the early aging phase could be accompanied by changes in personality, particularly neuroticism and external control.

An association between incident disability and depressive symptoms over 3 years of follow-up among older women: the Women's Health and Aging Study.

BACKGROUND AND AIMS: To examine the impact of new disability on the incidence of depressive symptoms, with 3-year biannual data from The Woman's Health and Aging Study. METHODS: Subjects (n=671) were selected if they were independent at baseline in 5 basic activities of daily living (ADLs) and were not depressed [scored <14 on the Geriatric Depression Scale (GDS; range 0 to 30)]. During the follow-ups, worsening of ADL disability (needed help on an increased number of ADLs) and onset of depressive symptoms (GDS score > or =14) were defined. For each pair of consecutive interviews in which depressive symptoms were not present in the first interview in the pair, we assessed incidence of worsening disability and depressive symptoms in the second interview of the pair. We also summarized the incidence of depressive symptoms 6 months later among the people who did not develop depressive symptoms at the time they reported a new disability. RESULTS: Compared with those not developing disability, after adjusting for demographic characteristics, number of diseases, and ADL difficulty level at the moment of onset of the disability, the odds ratio (OR) for developing depressive symptoms at disability onset was 2.2 (95% Confidence Interval (CI) 1.1-4.3). For those developing new disability without depressive symptoms, the adjusted OR for developing depressive symptoms 6 months later was 1.7 (CI 0.6-4.8). CONCLUSION: Onset of new disability in basic ADLs had a significant impact on the development of depressive symptoms at the moment of onset. Our results demonstrate that clinicians should carefully evaluate depressive symptoms in patients with new onset of disability.

Use of the Short Physical Performance Battery Score to predict loss of ability to walk 400 meters: analysis from the InCHIANTI study.

BACKGROUND: Early detection of mobility limitations remains an important goal for preventing mobility disability. The purpose of this study was to examine the association between the Short Physical Performance Battery (SPPB) and the loss of ability to walk 400 m, an objectively assessed mobility outcome increasingly used in clinical trials. METHODS: The study sample consisted of 542 adults from the InCHIANTI study aged 65 and older, who completed the 400 m walk at baseline and had evaluations on the SPPB and 400 m walk at baseline and 3-year follow-up. Multiple logistic regression models were used to determine whether SPPB scores predict the loss of ability to walk 400 m at follow-up among persons able to walk 400 m at baseline. RESULTS: The 3-year incidence of failing the 400 m walk was 15.5%. After adjusting for age, sex, education, body mass index, Mini-Mental State Examination, number of medical conditions, and 400 m walk gait speed at baseline, SPPB score was significantly associated with loss of ability to walk 400 m after 3 years. Participants with SPPB scores of 10 or lower at baseline had significantly higher odds of mobility disability at follow-up (odds ratio [OR] = 3.38, 95% confidence interval [CI]: 1.32-8.65) compared with those who scored 12, with a graded response across the range of SPPB scores (OR = 26.93, 95% CI: 7.51-96.50; OR = 7.67, 95% CI: 2.26-26.04; OR = 8.28, 95% CI: 3.32-20.67 for SPPB < or = 7, SPPB 8, and SPPB 9, respectively). CONCLUSIONS: The SPPB strongly predicts loss of ability to walk 400 m. Thus, using the SPPB to identify older persons at high risk of lower body functional limitations seems a valid means of recognizing individuals who would benefit most from preventive interventions.

Age-associated declines in complex walking task performance: the Walking InCHIANTI toolkit.

OBJECTIVES: To describe a set of complex walking tasks (CWTs) that can be used to evaluate mobility and to characterize age- and sex-specific performance on these tests. DESIGN: A population-based study of persons living in the Chianti geographic area (Tuscany, Italy). SETTING: Community. PARTICIPANTS: One thousand two hundred twenty-seven persons (aged 20-95) selected from the city registries of Greve and Bagno a Ripoli (Tuscany, Italy). MEASUREMENTS: Gait velocity (m/s) was measured during 13 walking tests (Walking InCHIANTI Toolkit (WIT)) used to examine walking ability under a range of conditions and distances. Other measures included performance on the Short Physical Performance Battery and self-reported health and functional status, including disability in activities of daily living. RESULTS: Age-associated differences on the WIT were reflected in the number of older adults unable to complete CWTs and a decrease in gait velocity. For all tasks, decrements in walking speed with increasing age were significantly larger at aged 65 and older. Performance on CWTs was highly variable and could not be explained by usual gait speed measured under low-challenge conditions alone. CONCLUSION: CWTs may provide important insight into mobility function, particularly in persons with normal or near-normal usual gait speed. Further research is needed to elucidate the specific physiological mechanisms that contribute to declining performance on CWT with increasing age.

Language barriers surrounding medication use among older Latinos.

Limited English language proficiency forms a significant challenge for many Latinos in clinical settings. Although medications are commonly used by older individuals as a means of maintaining good health and managing health problems, the extent to which English proficiency is related to medication use among older Latinos is not known. Focus groups were conducted with Latino, community-residing individuals aged 50 and over in eastern Massachusetts. Qualitative evaluation of the group interviews suggests that language is a barrier in dealing with medication for these individuals. Limited English proficiency appears to be related to feelings of being discriminated against in clinical and pharmacy settings. As well, communicating directly with health professionals in a common language is associated with level of trust and confidence in medical settings. Use of formal and informal interpreters, as well as seeking Spanish-speaking physicians and pharmacies with Spanish-speaking staff, are identified as strategies for overcoming health-related obstacles surrounding language.

Association of executive function and performance of dual-task physical tests among older adults: analyses from the InChianti study.

BACKGROUND: previous studies have reported an association between cognitive function and physical performance, particularly among older adults. OBJECTIVE: to examine the association between executive function and performance difference on complex versus usual walking tasks in a sample of non-demented older adults. DESIGN: population-based epidemiological study of older people residing in the Chianti area (Tuscany, Italy). PARTICIPANTS: 737 community-dwelling individuals aged 65 years and older. METHODS: gait speed (m/s) was measured during the performance of complex walking tasks (walking/talking, walking/picking-up an object, walking/carrying a large package, walking over obstacles, walking with a weighted vest) and reference walking tasks (7 m usual pace, 7 m fast pace and 60 m fast pace). Executive function was assessed using the Trail Making Test (TMT). Other measures included Mini-Mental State Examination (MMSE), sociodemographic characteristics and selected physiological impairments. RESULTS: gait speed for the selected reference and complex walk tasks was consistently lower among participants with poor executive function. Per cent decline in gait speed compared with the reference task differed by executive function for certain tasks (e.g. walking/obstacles: 30 versus 24% decline in low versus high executive function respectively, P = 0.0006) but not for others. CONCLUSIONS: poor executive function is associated with measures of gait, including specific challenges. Overall, the results showed that the cost associated with the addition of a challenge to the basic walking task differs by executive function and the nature of the task. Further research is needed to determine whether improvement in executive function abilities translates to better performance on selected complex walking tasks.

Midlife physical activity and mobility in older age: The InCHIANTI study.

BACKGROUND: Among older adults, loss of mobility represents a critical stage in the disablement process, whereby the risk for disability is significantly increased. Physical activity is a modifiable risk factor that is associated with reduced risk of losing mobility in older adulthood; however, few studies have examined physical activity performed earlier in life in relation to mobility later in life. METHODS: Data from a population-based study of 1155 adults aged 65 years and older living in the Chianti region of Italy in 1998-2000 were analyzed in 2005 and 2006. Participants retrospectively recalled their physical activity levels in midlife and underwent mobility testing and medical examination. Two objective mobility outcomes were examined as a function of past physical activity: the Short Physical Performance Battery (SPPB) and the ability to walk 400 meters. RESULTS: Older Italian adults (mean age 74.8, standard deviation 7.3) who engaged in higher levels of physical activity in midlife were significantly more likely to perform better on the SPPB than individuals who were less physically active in midlife. In addition, failure to complete the 400-meter walk test was significantly less likely among physically active men (Level II) (odds ratio [OR] = 0.37, 95% confidence interval [CI] = 0.15-0.93) and very active men (Level III) (OR = 0.23, 95% CI = 0.09-0.63) when compared to men who were less active (Level I) in the past (p for trend, 0.008). These associations remained after adjustment for demographic factors, medical conditions, and physiologic impairments. CONCLUSIONS: Older adults who reported higher levels of physical activity in midlife had better mobility in old age than less physically active ones.

Low socioeconomic status and disability in old age: evidence from the InChianti study for the mediating role of physiological impairments.

BACKGROUND: Low socioeconomic status (SES) has been associated with increased risk of disability in later life. The purpose of this study was to determine if SES has an impact on mobility functioning and to explore which physiological impairments are also associated with SES and may explain its relationship with mobility. METHODS: The study sample consisted of 1025 individuals aged 65 years or older residing in the Chianti area (Italy). Number of years of education was used as an indicator of SES. Mobility functioning was assessed using gait speed (400 m) and the Short Physical Performance Battery (SPPB). Mobility-related physiological impairments were assessed with tests of executive functioning, nerve conduction velocity, muscle power, hip-ankle range of motion, Ankle-Brachial Index, and visual acuity. Linear regression models were used to study the association between number of years of education and mobility and to estimate the contribution of each of the selected physiological impairments to this association. RESULTS: Adjusting for age and sex, slower gait speed (1.16 vs 1.26 m/s, p <.0001) and lower SPPB scores (9.55 vs 10.11, p =.006) were seen in persons with < or =5 years of total education compared with those persons with >5 years of total education. Leg power and executive function decreased the strength of the association between educational level and gait speed by more than 15%. Controlling for all selected impairments (full model) decreased the education-gait speed association by 49%. Low education continued to be significantly associated with gait speed (p <.01). Adjusting for all physiological impairments substantially reduced the low education-SPPB score association by 100%, and this association was no longer significant. CONCLUSIONS: Low SES is related to multiple physiological impairments, which explain a large amount of the association between education and gait limitations. Further work must be done to understand the mechanisms whereby low SES translates into the impairments that play an important role in mobility.