Customer-oriented counseling for physical activity in older people: study protocol and selected baseline results of a randomized-controlled trial (ISRCTN 07330512).

The objective of this study is to describe the rationale, design and selected baseline results of a 2-year randomized-controlled trial (RCT) on the effects of physical activity counseling in community-living older people. After a four-phase screening and data-collection process targeting all independently living people in the city center of Jyväskylä, Finland, six hundred and thirty-two 75-81-year-old cognitively intact, sedentary persons who were able to move independently outdoors at least minimally and willing to take part in the RCT were randomized into intervention and control groups. At baseline, over half of the subjects exercised less than two to three times a month and two-thirds were willing to increase their physical activity level. The desire to increase physical activity was more common (86%) among subjects with mobility limitation compared with those without (60%, P=0.004). The intervention group received an individualized face-to-face counseling session, followed by phone contacts every 3 months throughout the intervention. The study outcomes include physical activity level, mobility limitation, functional impairments, disability, mood, quality of life, use of services, institutionalization and mortality. The screening and recruitment process was feasible and succeeded well, and showed that unmet physical activity needs are common in older people.

Muscle strength before and mortality after a bone fracture in older people.

We studied whether muscle strength measured before a bone fracture predicts mortality following the fracture. The participants were a sub-cohort of 82 people of a total of 493 Evergreen project participants initially aged 75- and 80 years, who had participated in knee extension strength tests as part of the baseline examinations, and who subsequently suffered at least one bone fracture. Maximal isometric knee extension strength was measured at baseline using an adjustable dynamometer chair. Fracture surveillance was carried out from patient records for 5 years, and mortality surveillance from population register for 10 years after baseline examinations. Average time till a fracture occurred after the baseline was 878 days (SD 576). Subsequent to the fracture, 32 deaths occurred. Using gender-specific cut-offs, three equal distribution-based groups were formed. A gradient risk of mortality was found according to baseline strength. The crude mortality rate per 1000 person-months was 15.2 in the lowest 4.9 in the middle and 1.7 in the highest third of baseline knee extension strength. The adjusted relative risk (RR) of death was 4.40 (95% confidence interval, CI 1.40-13.80) in the lowest and 2.39 (95% CI 0.68-8.4) in the middle tertile vs the highest tertile of muscle strength. Poor muscle strength measured before a fracture occurred was a powerful predictor of increased mortality after the fracture. Poor muscle strength may be a good indicator of overall vulnerability and frailty in old age, and strength testing could be helpful in targeting older people for preventive interventions.

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.

Disability, physical activity, and muscle strength in older women: the Women's Health and Aging Study.

OBJECTIVE: To study associations of motor disability, physical activity, and muscle strength in older women, in particular to investigate whether model of spiraling decrease is expressed in the data. DESIGN: Cross-sectional analysis using data from the baseline measurements of The Women's Health and Aging Study (WHAS). SETTING: Participants' homes. PARTICIPANTS: A total of 1,002 disabled women aged 65 years and older living in the community. OUTCOME MEASURES: Motor disability was measured by the number of self-reported difficulties in grasping, lifting 101b, walking across a small room, walking 1/4 mile, climbing 10 steps, and doing heavy housework. Level of physical activity was determined from response to a series of questions on the frequency and amount of common activities and physical exercise. Hand grip and knee extension forces were measured using portable hand-held dynamometers. RESULTS: Disability and physical activity were inversely associated, with inactivity being most common among the most disabled women. Those with poorer strength reported more difficulties in motor activities. Greater strength was found among the physically more active. In stratified analyses, the positive association of physical activity on knee extension strength was consistent across disability levels. Multiple regression analysis showed that both physical activity and muscle strength were significant predictors for severity of disability. Structural equation model (LISREL) showed that muscle strength had a mediating role between physical activity and disability; disability was associated with physical inactivity, which correlated with lower muscle strength, which was associated with greater degree of disability. CONCLUSION: Even though causality cannot be confirmed in this cross-sectional analysis, our findings suggested a spiraling model of decline in which muscle strength has a significant role.

Associations of sensory-motor functions with poor mobility in 75- and 80-year-old people.

This study investigated the associations of sensory-motor functions with mobility in elderly people. All 75- and 80-year-old residents of the city of Jyväskylä, Finland, were invited to take part in the study. A total of 617 (93%) persons were interviewed, and 500 (75%) took part in laboratory examinations. Self-reported mobility was recorded during the interview. Basic mobility functions (maximal walking speed and stair-mounting ability) and sensory-motor functions (maximal isometric muscle strength, standing balance, reaction time and visual acuity) were measured in the laboratory. Multivariate analyses showed that poor sensory-motor functions were significantly associated with poor performance in basic mobility functions and that poor performance in basic mobility functions was associated with self-reported disability in mobility. The associations discovered were consistent with models of the disablement process. Muscle strength, balance, reaction time and vision all have individual significance for mobility, underlining the need for multifactorial approaches in prevention and rehabilitation.

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.

Morbidity and disability in 75- and 80-year-old men and women. A five-year follow-up.

Purpose of this report is to describe the changes that occurred in morbidity, symptoms of illness and disability of 75- and 80-year-old residents of Jyväskylä, Finland, over a five-year period. The study population consisted of the elderly residents of the city of Jyväskylä in central Finland who were born in 1914 and 1910. At baseline (in 1989 and 1990), 355 (92.9%) persons from the younger age group and 262 (91.9%) from the older age group were interviewed and 311 (81.4%) and 230 (80.7%), respectively, took part in the physical examination. At follow-up (in 1994 and 1995), the corresponding numbers were 250 (93.3%) and 148 (88.6%) for the interviews and 217 (81.0%) and 127 (76.0%) for the physical examinations. The prevalence of chronic conditions was determined in connection with the medical examinations on the basis of self-report and the respondent's prescriptions and medical information cards. To measure the occurrence of symptoms, the respondents were asked whether during the past 14 days they had suffered from any of 17 listed symptoms. Functional capacity was assessed in connection with the interview carried out at the respondent's home in terms of needing help in activities of daily living (ADL). In the baseline examinations, subjects were found to have on average 2-3 diseases. During the follow-up the number of diseases and the proportion of people with co-morbidity increased in both age groups. Both men and women had on average 1-2 symptoms that caused them much trouble, and the number of such symptoms increased to some extent during the follow-up. The proportions of those needing help increased during the follow-up in all groups and the increase was most prominent among the women of the older age group. Of those who managed independently with physical ADL (PADL) at baseline, 14.9%-44.9% reported need of help in at least one task at follow-up. The need for help in PADL was greatest with cutting toe-nails, negotiating stairs, moving outdoors, washing the upper body and in instrumental ADL (IADL) with vacuuming, shopping, handling finances and in the use of public transport. Successful prevention and postponement of functional disabilities in the elderly population depends not only on the early diagnosis of illness but also on identifying even minor signs and symptoms of disease and functional limitations, and to focus health care interventions accordingly.

Difficulties in mobility among elderly people and their association with socioeconomic factors, dwelling environment and use of services.

The purpose of this study was to clarify the extent to which elderly people have difficulties in mobility, and determine their association with socioeconomic factors, dwelling environment and use of services. The study groups were composed of two random samples of 800 persons aged 65-74 and 75-84, respectively. In all, 1224 non-institutionalized persons (80%) were interviewed at home. The respondents were asked to assess their ability to get about the house, negotiate stairs and walk outdoors, as well as manage certain physical exercise tasks. Difficulties in getting about outdoors were found most frequently among the women in the older age group (52% reported difficulties), and least frequently among the women in the younger age group (23%). Logistic regression analyses showed that difficulties in getting about outdoors were significantly explained by length of education and defects in the dwelling environment. Also, difficulties in getting about outdoors explained significantly the use of home help. It is concluded that difficulties in mobility among elderly people, especially among elderly women, should be reduced more actively either by improving their physical abilities or by developing compensation strategies for their own use or in regard to the environment.