Departures from linearity in the relationship between measures of muscular strength and physical performance of the lower extremities: the Women's Health and Aging Study.

Background: Sarcopenia, an age-related reduction in muscular mass and strength, may cause a decline in physical functioning and subsequent loss of autonomy. It has been suggested that strength is associated with lower extremity function mainly in the lower portion of the range of strength. Identifying the threshold under which strength is most critical to function may help in targeting groups who may benefit most from exercise interventions.

Potential applications of GH secretagogs in the evaluation and treatment of the age-related decline in growth hormone secretion.

The two classes of GH secretagogs--GH-releasing hormone (GHRH) and the GH-releasing peptides and their analogs (GHRP's)--retain their ability to endogenous GH secretion in healthy and frail elderly subjects. They have very limited utility in assessment of the state of the GH/IGF-I axis except to confirm an intact pituitary, but they are attractive potential alternatives to GH as therapeutic agents. There is wide interest in the possibility that elevating GH and IGF-I might increase muscle mass, physical strength and performance, and possible sleep and cognition in aging.

The effect of strength and endurance training on gait, balance, fall risk, and health services use in community-living older adults.

Background: The study tested the effect of strength and endurance training on gait, balance, physical health status, fall risk, and health services use in older adults.

Methods: The study was a single-blinded, randomized controlled trial with intention-to-treat analysis. Adults (n = 105) age 68-85 with at least mild deficits in strength and balance were selected from a random sample of enrollees in a health maintenance organization.

Approaches to prostate cancer by managed care organizations.

Objectives: Managed care organizations (MCOs) are developing population-based approaches to illnesses with large numbers of patients, wide variations in care and outcomes, and high costs. This is the first survey that evaluates current prostate cancer approaches by MCOs.

Methods: Case studies and a survey of corporate medical directors at large MCOs were conducted.

A comparison of the effects of three types of endurance training on balance and other fall risk factors in older adults.

We hypothesized that short-term endurance training improves balance in older adults, if training involves movements that "stress" balance. We tested the hypothesis by looking for a dose-response relationship between movement during exercise and balance improvement. The study was a single-blinded, randomized controlled trial.

Reliability of physical performance measures in nursing home residents with Alzheimer's disease.

Background: Investigation of the effects of exercise on frail, institutionalized individuals with dementia has been impeded by concerns about the reliability of physical performance measures when used in this population.

Methods: The physical performance of 33 institutionalized subjects with Alzheimer's disease was measured during both the morning and afternoon of day 1 by rater 1 and during both the morning and afternoon of day 2, one week later, by rater 1 and rater 2. Intraclass correlation coefficients (ICCs) were calculated to examine the inter- and intrarater reliability of "sit to stand," "25-foot walk," and "the distance walked in 6 minutes" and walking speed over 25 feet and for 6 minutes.

Patterns of anti-inflammatory therapy in the post-guidelines era: a retrospective claims analysis of managed care members.

Published and widely disseminated guidelines for the care and management of asthma characterize asthma as a chronic, inflammatory disease and propose specific recommendations for therapy with inhaled anti-inflammatory medications. In a retrospective analysis of medical and pharmacy claims data of approximately 28,000 asthmatic members from five managed care settings, the dominant pattern of pharmacologic therapy that emerged was the use of bronchodilators without inhaled anti-inflammatory drug therapy. In addition, a significant proportion of asthmatic patients received no prescription drug therapy for asthma.

Continuous-scale physical functional performance in healthy older adults: a validation study.

Objective: The continuous-scale physical functional performance test (CS-PFP) is an original instrument designed to provide a comprehensive, in-depth measure of physical function that reflects abilities in several separate physical domains. It is based on a concept of physical function as the integration of physiological capacity, physical performance, and psychosocial factors.

Setting: The test was administered under standard conditions in a hospital facility with a neighborhood setting.

Factors associated with changes in gait speed in older adults.

Background: The study addressed whether changes in gait speed in community-dwelling older adults were associated with changes in fitness (strength and aerobic capacity), physical health status, and/or depressive symptoms.

Methods: The study sample comprised 152 community-dwelling adults aged 68-85 who had participated in an exercise study. Study measures at baseline and 6-month follow-up included gait speed, a leg strength score, maximal aerobic capacity (VO2max), CES-Depression scale, and physical health status (SIP Physical Dimension).

Evidence for a non-linear relationship between leg strength and gait speed.

Although the relationship between strength and physical performance in older adults is probably non-linear, few empirical studies have demonstrated that this is so. In a population-based sample of adults aged 60-96 years (n = 409), leg strength was measured in four muscle groups (knee extensor, knee flexor, ankle plantar flexor, ankle dorsiflexor) of both legs using an isokinetic dynamometer. A leg strength score was calculated as the sum of the four strength measurements in the right leg.

The relationship of joint symptoms with exercise performance in older adults.

Objectives: The objective of this study is to determine if exercise increases joint symptoms in older adults with a history of arthritis or produces symptoms in older adults without such history. In addition, we examine whether joint symptoms explain the large observed variation in strength gain in older adults undergoing vigorous strength training exercise, and report the incidence of musculoskeletal injuries upon initiation of an exercise program.

Design: A population-based, single blinded, randomized controlled trial with three exercise groups and one control group.

A cross-sectional validation study of the FICSIT common data base static balance measures. Frailty and Injuries: Cooperative Studies of Intervention Techniques.

Background: Two simple balance scales comprising three or four familiar tests of static balance were developed, and their validity and reliability are described. The scales were such that the relative difficulties of the basic tests were taken into consideration.

Methods: Using FICSIT data, Fisher's method was used to construct scales combining ability to maintain balance in parallel, semi-tandem, tandem, and one-legged stances.

Relationship between physical performance and self-perceived physical function.

Objective: The objective of this study was to compare two methods of measuring physical function in subjects with a broad range of abilities and to evaluate the effects of cognitive, social, educational, and age factors on the relationship between the two methods.

Design: Multiple regression analysis was used to compare self-perceived (dependent variables) with performance measures (independent variables). Covariates included age, gender, Mini-Mental State Exam score, education, living status, and depression score.

Do surgical brain lesions present as isolated dementia? A population-based study.

Objective: To determine the incidence of clinically important subdural hematoma (SDH), hydrocephalus not associated with a recent intracranial bleed, and intracranial tumor that is not obviously metastatic, and to test the sensitivity of a promising decision rule for computerized tomography (CT) in dementia.

Design: Population-based, retrospective, sequential case series.

Setting: Staff model health maintenance organization (HMO).

Isokinetic testing of ankle strength in older adults: assessment of inter-rater reliability and stability of strength over six months.

The study purposes were (1) to estimate the inter-rater reliability of isokinetic strength tests at the ankle in older adults (test-retest interval of three to 7 days), and to determine whether more experienced examiners were more reliable; and (2) to estimate 6 month stability of strength tests. Inter-rater reliability was high for plantar flexion and dorsiflexion tests where average strength was more than about 10 Newton-meters (Nm) (Pearson R = 0.87-0.

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.

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.

Inpatient geriatric evaluation and management units: organization and care patterns in the Department of Veterans Affairs.

Geriatric evaluation and management units (GEMs) are designed to improve the functional health and placement of frail elderly hospital inpatients. We surveyed Department of Veterans Affairs (VA) GEMs to describe their care patterns and organization. GEMs meeting consensus standards (n = 46) varied considerably.

Inpatient geriatric evaluation and management units (GEMs) in the veterans health system: diamonds in the rough?

Background: Research suggests that inpatient geriatric evaluation and management units (GEMs), which undertake interdisciplinary diagnosis to improve the health of frail elderly patients, are effective. The Department of Veterans Affairs (VA) helped pioneer U.S.

Medical conditions and motor vehicle collision injuries in older adults.

Objective: To determine whether medical conditions that can impair sensory, cognitive, or motor function increase the risk of injury due to motor vehicle collision in older drivers.

Design: Case-control study.

Setting: Group Health Cooperative of Puget Sound, a large prepaid health plan.

Motor vehicle collision injuries and sensory impairments of older drivers.

To determine whether ocular disease, impaired vision, or diminished hearing might increase the risk of motor vehicle collision injuries in older drivers, we conducted a population-based case-control study at a large Health Maintenance Organization (HMO). All study subjects were HMO members who were licensed drivers age 65 or over. Cases were drivers treated for injuries sustained in a police-reported collision that occurred in 1987 or 1988.