Category Archive for: ‘Functional outcomes’
Disability and depressive symptoms related to all-cause mortality
Self-rated health, disability and depressive symptoms were independent from each other, and were associated with all-cause mortality in elderly men from Finland, The Netherlands and Italy (the FINE study). After adjustment for the prevalence of chronic diseases severity of disability and depressive symptoms remained related to all-cause mortality.
Combinations of measures also associated with all-cause mortality
For the combination of disability and self-rated health a 3-fold greater mortality risk was observed for men who had severe disability and a poor self-rated health compared to the reference group. Men with severe disability in the two highest categories of depressive symptoms had also a 3-fold higher mortality risk.
These results suggest that for adequate prognosis of mortality and for developing intervention strategies information is needed on other and different health outcomes.
Widowhood associated with disability
Elderly men from Finland, The Netherlands and Italy who became widowed during 10 years of observation had a 2-fold greater risk of disabilities related to instumental activities or mobility than those who did not lose their wives. Widowed men living alone had 75% fewer mobility-related disabilities and 98% fewer basic activities-related disability than those living with other adults. The associations among countries did not differ.
Observations among widowed men
In elderly men of the FINE study, duration of widowhood more or less than 5 years was studied according to household composition: living alone, with family, or in an institution. Standardized questionnaires were used for measuring different Activities of Daily Living.
Physical activity relates to lower risk of disability
Elderly European men with a high level of physical activity at entry had a 54% lower risk of subsequent disability compared to men with a low activity level. This was related to the length of time the physical activities were caried out and not to their intensity.
The results suggest that even in old age among relatively healthy men, a physically active lifestyle protects against disability and the duration of such activities appeared more important than their intensity.
Measuring physical activity and disability
Different aspects of physical activity and disability were investigated in the FINE study of elderly men from Finland, Italy and The Netherlands, with 10 years of follow-up. Information on self-reported physical activity was based on a validated questionnaire on activities such as walking, biking and gardening. Self-reported disabilities were evaluated with the WHO-questionnaire on Activities of Daily Living.
Cardiovascular risk factors associated with disability.
Elderly men from Zutphen were divided at baseline in those with a high cardiovascular risk, defined as 2 or more of the following traditional cardiovascular risk factors: obesity, smoking, hypertension, hypercholesterolemia and diabetes and a low-risk group with less than 2 risk factors. Men at baseline with a high cardiovascular risk had compared to those with a low risk a 2-fold or greater risk of functional disabilities after 5, 10 or 15 years. These results suggest that elevated cardiovascular risk factor might prevent or postpone disability.
Design of the study
In the Zutphen Elderly Study, traditional cardiovascular risk factors measured in 1985 were evaluated in relation to information on self-reported disabilities collected in 1990, 1995 and 2000.
Quality of self-reported measures of functional status.
In the Zutphen Elderly Study, self-reported functional status was measured with the self-administered 13-item WHO-questionnaire on Activities of Daily Living. A hierarchic disability-scale was constructed based on basic activities of daily living (e.g. walking indoors), mobility-related (e.g. moving outdoors) and instrumental activities of daily living (e.g. preparing meals). The reproducibility of the self-reported disabilities was fair to good.
Quality of the performance-based measures of functional status
Performance-based measures of functional status are more objective than self-reported measures. A score from performance-based limitations was based on the results of four tests: standing balance, walking speed, ability to rise from a chair, and external shoulder rotation. Three of the four performance tests were highly reproducible, the shoulder rotation test was not.
Disability associated with depressive symptoms
An increasing severity of disability from entry to 5 year follow-up was positively associated with depressive symptoms. Men with no disability scored lower on depressive symptoms than those with disability in any of three domains (see below). The associations were stronger in Finland and Italy than in the Netherlands.
Among men with mild disability, whose disability status worsened over 5 years, scored higher on depressive symptoms than those whose status improved.
In elderly men from Finland, Italy and the Nethelands, self-reported information on disability and depressive symptoms was collected on 2 surveys, in 1990 and 1995. Three domains of disability were distinguished: instrumental, mobility-related and basic activities using the WHO questionnaire on Activities of Daily Living.
Need for help increases with age but is lower in later generations
In the HALE project, in elderly European men and women disability and need for help increased with advancing age but at the same time decreased over time among more recent generations. Prospective analysis showed a favorable time trend in self care abilities for men and women and in need for self care help in men.
Mobility varies across cultures
Mobility-related disability among men and self care disability among women decreased overall but more in cohorts from the south than from the north of Europe. This suggests that the proportion of elderly people with disability is decreasing and that physical function differs across cultures.
Measuring physical function
Physical function was measured with the self-administered WHO-questionnaire on Activities of Daily Living.
Disabilities differ among countries
Elderly men from Italy and The Netherlands had approximately 50% more self-reported disabilities than those from Finland. The performance-based limitation score was highest in Italy and lowest in The Netherlands. The number of self-reported disabilities was positively related to the performance-based limitations score and that relation did not differ among countries.
Self-reported disability score relates to performance-based limitation score
Cross-sectional analysis showed that the mean self-reported disability score had a graded relation to the performance-based limitation score in the FINE study. This was confirmed in prosprective data analysis carried out in the Zutphen Elderly Study.
- Hoeymans et al. J Clin Epidemiol 1996;49:1103-10
- Van den Brink et al. J Am Geriatr Soc 2003;51:782-8