Minimizing comprehensive geriatric assessment to identify deterioration of physical performance in a healthy community-dwelling older cohort: longitudinal data of the AEQUIPA Versa study.

BACKGROUND: It is important to identify the relevant parameters of physical performance to prevent early functional decline and to prolong independent living. The aim of this study is to describe the development of physical performance in a healthy community-dwelling older cohort aged 70+ years using comprehensive assessment over two years and to subsequently identify the most relevant predictive tests for physical decline to minimize assessment. METHODS: Physical performance was measured by comprehensive geriatric assessment. Predictors for the individual decline of physical performance by Principal Component and k-means Cluster Analysis were developed, and sensitivity and specificity determined accordingly. RESULTS: 251 subjects (Ø 75.4 years) participated in the study. Handgrip strength was low in 21.1%. The follow-up results of tests were divergent. Handgrip strength [- 16.95 (SD 11.55)] and the stair climb power test (power) [- 9.15 (SD 16.84)] yielded the highest percentage changes. Four most relevant tests (handgrip strength, stair climb power time, timed up & go and 4-m gait speed) were identified. A predictor based on baseline data was determined (sensitivity 82%, specificity 96%) to identify subjects characterized by a high degree of physical decline within two years. DISCUSSION: Although the cohort of older adults is heterogeneous, most of the individuals in the study exhibited high levels of physical performance; only a few subjects suffered a relevant decline within the 2-year follow-up. Four most relevant tests were identified to predict relevant decline of physical function. CONCLUSION: In spite of ceiling effects of the geriatric assessment in high-performers, we assume that it is possible to predict an individual's risk of physical decline within 2 years with four tests of a comprehensive geriatric assessment.

Driving risk and rural life: everyday and reconstructed realities.

This article details the complex network of circumstances and meanings that influence rural people's driving behavior, and describes the manner in which some rural drivers' relevant social patterns support the everyday reality of driving and risk taking on rural roads. To fulfill the purpose of the study, 20 focus group interviews were conducted with 212 rural citizens in Alberta, Canada. The findings indicate that rural drivers routinely break traffic laws because: they do not perceive the harm in breaking laws, they believe that breaking laws is a natural thing to do, they negotiate the efficacy of laws according to their personal situations, and they believe in the maxim that the "ends justify the means. " It is common for rural drivers to break or "negotiate" traffic laws if it helps them in their work lives or in fulfillment of their immediate needs. They judge some traffic laws as unreasonable and question their effect on safety. Hence, they do not feel committed to universally honoring traffic laws. This information can be used to design intervention strategies for rural traffic safety that are relevant to rural drivers and thereby have optimal opportunity for success.