title: Clinical meaningfulness of the changes in muscle performance and physical function associated with testosterone administration in older men with mobility limitation. The Veterans Learning to Improve Fitness and Function in Elders Study: a randomized trial of primary care-based physical activity counseling for older men. Effects of Telerehabilitation on Physical Function and Disability for Stroke Patients: A Randomized, Controlled Trial Determinants of self-rated health in old age: A population-based, cross-sectional study using the International Classification of Functioning The effect of resistance training on muscle strength and physical function in older, postmenopausal breast cancer survivors: a randomized controlled trial Reach out to enhance wellness home-based diet-exercise intervention promotes reproducible and sustainable long-term improvements in health behaviors, body weight, and physical functioning in older, overweight/obese cancer survivors. High-Intensity Resistance Training Improves Muscle Strength, Self-Reported Function, and Disability in Long-Term Stroke Survivors Integration of balance and strength training into daily life activity to reduce rate of falls in older people (the LiFE study): randomised parallel trial Community environmental factors are associated with disability in older adults with functional limitations: the MOST study. Measuring disability and function in older women: psychometric properties of the late-life function and disability instrument. Tolerance of an Aquatic Power Training Program by Older Adults with Symptomatic Knee Osteoarthritis Validity of an exercise test based on habitual gait speed in mobility-limited older adults. Increased velocity exercise specific to task training versus the National Institute on Aging's strength training program: changes in limb power and mobility. Measuring physical function in community-dwelling older persons: a comparison of self-administered, interviewer-administered, and performance-based measures. Nutritional Status in Relation to Balance and Falls in the Elderly Wii‐Hab for Pre‐Frail Older Adults A comparison of the frequencies of risk factors for depression in older black and white participants in a study of indicated prevention. Creating a computer adaptive test version of the late-life function and disability instrument. Effects of home-based diet and exercise on functional outcomes among older, overweight long-term cancer survivors: RENEW: a randomized controlled trial. Impact of tai chi on impairment, functional limitation, and disability among preclinically disabled older people: a randomized controlled trial. Sit-to-stand as home exercise for mobility-limited adults over 80 years of age--GrandStand System may keep you standing? Performance-Based Versus Patient-Reported Physical Function: What Are the Underlying Predictors? Improving balance control and self-reported lower extremity function in community-dwelling older adults: a randomized control trial Escitalopram for older adults with generalized anxiety disorder: a randomized controlled trial. Impact of Exercise to Improve Gait Efficiency on Activity and Participation in Older Adults With Mobility Limitations: A Randomized Controlled Trial
abstract: CONTEXT Testosterone in Older Men with Mobility Limitations Trial determined the effects of testosterone on muscle performance and physical function in older men with mobility limitation . Trial 's Data and Safety Monitoring Board recommended enrollment cessation due to increased frequency of adverse events in testosterone arm . The changes in muscle performance and physical function were evaluated in relation to participant 's perception of change . METHODS Men aged 65 years and older , with mobility limitation , total testosterone 100 - 350 ng/dL , or free testosterone less than 50 pg/mL , were r and omized to placebo or 10 g testosterone gel daily for 6 months . Primary outcome was leg-press strength . Secondary outcomes included chest-press strength , stair-climb , 40-m walk , muscle mass , physical activity , self-reported function , and fatigue . Proportions of participants exceeding minimally important difference in study arms were compared . RESULTS Of 209 r and omized participants , 165 had follow-up efficacy measures . Mean ( SD ) age was 74 ( 5.4 ) years and short physical performance battery score 7.7 ( 1.4 ) .  Testosterone arm exhibited greater improvements in leg-press strength , chest-press strength and power , and loaded stair-climb than placebo . Compared with placebo , significantly greater proportion of men receiving testosterone improved their leg-press and chest-press strengths ( 43 % vs 18 % , p = .01 ) and stair-climbing power ( 28 % vs 10 % , p = .03 ) more than minimally important difference . Increases in leg-press strength and stair-climbing power were associated with changes in testosterone levels and muscle mass . Physical activity , walking speed , self-reported function , and fatigue did not change . CONCLUSIONS Testosterone administration in older men with mobility limitation was associated with patient-important improvements in muscle strength and stair-climbing power . Improvements in muscle strength and only some physical function measures should be weighed against the risk of adverse events in this population OBJECTIVES To determine the effects of primary care-based , multicomponent physical activity counseling ( PAC ) promoting physical activity ( PA ) guidelines on gait speed and related measures of PA and function in older veterans . DESIGN R and omized controlled trial . SETTING Veterans Affairs Medical Center of Durham , North Carolina . PARTICIPANTS Three hundred ninety-eight male veterans aged 70 and older . INTERVENTION Twelve months of usual care ( UC ) or multicomponent PAC consisting of baseline in-person and every other week and then monthly telephone counseling by a lifestyle counselor , one-time clinical endorsement of PA , monthly automated telephone messaging from the primary care provider , and quarterly tailored mailings of progress in PA . MEASUREMENTS Gait speed ( usual and rapid ) , self-reported PA , function , and disability at baseline and 3 , 6 , and 12 months . RESULTS Although no between-group differences were noted for usual gait speed , rapid gait speed improved significantly more for the PAC group ( 1.56 + /- 0.41 m/s to 1.68 + /- 0.44 m/s ) than with UC ( 1.57 + /- 0.40 m/sec to 1.59 + /- 0.42 m/sec , P=.04 ) . Minutes of moderate/vigorous PA increased significantly in the PAC group ( from 57.1 + /- 99.3 to 126.6 + /- 142.9 min/wk ) but not in the UC group ( from 60.2 + /- 116.1 to 69.6 + /- 116.1 min/wk , P<.001 ) . Changes in other functional/disability outcomes were small . CONCLUSION In this group of older male veterans , multicomponent PA significantly improved rapid gait and PA . Translation from increased PA to overall functioning was not observed . Integration with primary care was successful Background and Purpose — To determine the effect of a multifaceted stroke telerehabilitation ( STeleR ) intervention on physical function , and secondarily on disability , in veterans poststroke . Methods — We conducted a prospect i ve , r and omized , multisite , single-blinded trial in 52 veterans with stroke from 3 Veterans Affairs medical centers . Veterans with a stroke in the preceding 24 months were r and omized to the STeleR intervention or usual care .  The STeleR intervention consisted of 3 home visits , 5 telephone calls , and an in-home messaging device provided over 3 months to instruct patients in functionally based exercises and adaptive strategies . Usual care participants received routine rehabilitation care as prescribed by their physicians . The primary outcome measures were improvement in function at 6 months , measured by both the motor subscale of the Telephone Version of Functional Independence Measure and by the function scales of the Late-Life Function and Disability Instrument . Results — The 2 complementary primary outcomes ( Late-Life Function and Disability Instrument Function and Telephone Version of Functional Independence Measure ) improved at 6 months for the STeleR group and declined for the usual care group , but the differences were not statistically significant ( P=0.25 , Late-Life Function and Disability Instrument ; P=0.316 ) . Several of secondary outcomes were statistically significant . At 6 months , compared with the usual care group , the STeleR group showed statistically significant improvements in 4 of the 5 Late-Life Function and Disability Instrument disability component subscales ( P<0.05 ) , and approached significance in 1 of the 3 Function component subscales ( P=0.06 ) . Conclusions — The STeleR intervention significantly improved physical function , with improvements persisting up to 3 months after completing the intervention . STeleR could be a useful supplement to traditional poststroke rehabilitation given the limited re sources available for in-home rehabilitation for stroke survivors . Clinical Trial Registration — URL : http://www . clinical trials.gov . Unique identifier : NCT00384748 Background Self-rated health ( SRH ) is a widely used indicator of general health and multiple studies have supported the predictive validity of SRH in older population s concerning future health , functional decline , disability , and mortality . The aim of this study was to use the theoretical framework of the International Classification of Functioning , Disability and Health ( ICF ) to create a better underst and ing of factors associated with SRH among community-dwelling older people in urban and rural areas . Methods The study design was population -based and cross-sectional . Participants were 185 Icel and ers , r and omly selected from a national registry , community-dwelling , 65 - 88 years old , 63 % urban residents , and 52 % men . Participants were asked : " In general , would you say your health is excellent , very good , good , fair , or poor ? " Associations with SRH were analyzed with ordinal logistic regression . Explanatory variables represented aspects of body functions , activities , participation , environmental factors and personal factors components of the ICF . Results Univariate analysis revealed that SRH was significantly associated with all analyzed ICF components through 16 out of 18 explanatory variables . Multivariate analysis , however , demonstrated that SRH had an independent association with five variables representing ICF body functions , activities , and personal factors components : The likelihood of a better SRH increased with advanced lower extremity capacity ( adjusted odds ratio [ adjOR ] = 1.05 , p < 0.001 ) , upper extremity capacity ( adjOR = 1.13 , p = 0.040 ) , household physical activity ( adjOR = 1.01 , p = 0.016 ) , and older age ( adjOR = 1.09 , p = 0.006 ) ; but decreased with more depressive symptoms ( adjOR = 0.79 , p < 0.001 ) . Conclusions The results highlight a collection of ICF body functions , activities and personal factors associated with higher SRH among community-dwelling older people . Some of these , such as physical capacity , depressive symptoms , and habitual physical activity are of particular interest due to their potential for change through public health interventions . The use of ICF conceptual framework and widely accepted st and ardized assessment s should make these results comparable and relevant in an international context Introduction Older breast cancer survivors ( BCS ) report more falls and functional limitations than women with no cancer history .  Exercise training could reduce risk factors for future falls and disability . Methods We conducted a r and omized , controlled trial in 106 early-stage , postmenopausal BCS who were ≥50 years old at diagnosis and post-treatment . Women were r and omly assigned to a 1-year resistance + impact exercise program or a stretching placebo program . Endpoints were one repetition maximum bench press and leg press strength , timed five chair st and s , 4 m usual walk speed , timed stance tests , h and grip strength , self-report physical function , and fatigue . We also examined the influence of age , adjuvant hormone therapy use , and exercise adherence on study outcomes . Results Women in the resistance + impact training program significantly improved maximal leg ( p < 0 .02 ) and bench ( p < 0 .02 ) press strength compared to the stretching group . Women who attended 50 % or more of prescribed resistance training sessions had significantly better changes in maximal strength measures compared to less adherent women . Conclusions Resistance + impact exercise is superior to stretching at improving maximal muscle strength and exercise adherence contributes to the degree of improvement . Implication s for cancer survivorsOlder BCS can safely engage in resistance exercise that improves lower and upper body strength , thereby reducing a risk factor for falls and future disability . However , the ability of resistance training to shift other indices of fall and disability risk , i.e. , balance and function , is unclear . Strategies to promote adherence to resistance training could lead to greater improvements in strength PURPOSE Diet and exercise interventions have been tested in cancer survivors as a means to reduce late effects and comorbidity , but few have assessed adherence and health outcomes long term . METHODS Between July 2005 and May 2007 , the Reach Out to Enhance Wellness ( RENEW ) trial accrued 641 locoregionally staged , long-term ( ≥ 5 years from diagnosis ) colorectal , breast , and prostate cancer survivors in the United States ( 21 states ) , Canada , and the United Kingdom . All participants were sedentary ( < 150 minutes of physical activity [ PA ] a week ) , overweight or obese ( body mass index , 25 to 40 kg/m(2 ) ) , and over age 65 years . The trial tested a diet-exercise intervention delivered via mailed print material s and telephone counseling . RENEW used a wait-list control , cross-over design ( ie , participants received the year-long intervention immediately or after a 1-year delay ) , which allowed the opportunity to assess program efficacy ( previously reported primary outcome ) , durability , and reproducibility ( reported herein ) . Measures included diet quality ( DQ ) , PA , BMI , and physical function ( PF ) . RESULTS No significant relapse was observed in the immediate-intervention arm for DQ , PA , and BMI ; however , rates of functional decline increased when the intervention ceased . From year 1 to year 2 , significant improvements were observed in the delayed-intervention arm ; mean change scores in behaviors and BMI and PF slopes were as follows : DQ score , 5.2 ( 95 % CI , 3.4 to 7.0 ) ; PA , 45.8 min/wk ( 95 % CI , 26.9 to 64.6 min/wk ) ; BMI , -0.56 ( 95 % CI , -0.75 to -0.36 ) ; and Short Form-36 PF , -1.02 versus -5.52 ( P < .001 for all measures ) . Overall , both arms experienced significant improvements in DQ , PA , and BMI from baseline to 2-year follow-up ( P < .001 ) . CONCLUSION Older cancer survivors respond favorably to lifestyle interventions and make durable changes in DQ and PA that contribute to sustained weight loss . These changes positively reorient functional decline trajectories during intervention delivery Background and Purpose — To evaluate the efficacy of supervised high-intensity progressive resistance training ( PRT ) on lower extremity strength , function , and disability in older , long-term stroke survivors . Methods — Forty-two volunteers aged 50 years and above , 6 months to 6 years after a single mild to moderate stroke , were r and omized into either a control group of upper extremity stretching or a PRT group that received a 12-week supervised high-intensity resistance training program consisting of bilateral leg press ( LP ) , unilateral paretic and nonparetic knee extension ( KE ) , ankle dorsiflexion ( DF ) , and plantarflexion ( PF ) exercises .  Functional performance was assessed using the 6-minute walk , stair-climb time , repeated chair-rise time , and habitual and maximal gait velocities . Self-reported changes in function and disability were evaluated using the Late Life Function and Disability Instrument ( LLFDI ) . Results — Single-repetition maximum strength significantly improved in the PRT group for LP ( 16.2 % ) , paretic KE ( 31.4 % ) , and nonparetic KE ( 38.2 % ) with no change in the control group . Paretic ankle DF ( 66.7 % versus −24.0 % ) , paretic ankle PF ( 35.5 % versus −20.3 % ) , and nonparetic ankle PF ( 14.7 % versus −13.8 % ) significantly improved in the PRT group compared with the control . The PRT group showed significant improvement in self-reported function and disability with no change in the control . There was no significant difference between groups for any performance-based measure of function . Conclusions — High-intensity PRT improves both paretic and nonparetic lower extremity strength after stroke , and results in reductions in functional limitations and disability Objectives To determine whether a lifestyle integrated approach to balance and strength training is effective in reducing the rate of falls  in older , high risk people living at home . Design Three arm , r and omised parallel trial ; assessment s at baseline and after six and 12 months . R and omisation done by computer generated r and om blocks , stratified by sex and fall history and concealed by an independent secure website . Setting Residents in metropolitan Sydney , Australia . Participants Participants aged 70 years or older who had two or more falls or one injurious fall in past 12 months , recruited from Veteran ’s Affairs data bases and general practice data bases . Exclusion criteria were moderate to severe cognitive problems , inability to ambulate independently , neurological conditions that severely influenced gait and mobility , resident in a nursing home or hostel , or any unstable or terminal illness that would affect ability to do exercises . Interventions Three home based interventions : Lifestyle integrated Functional Exercise ( LiFE ) approach ( n=107 ; taught principles of balance and strength training and integrated selected activities into everyday routines ) , structured programme ( n=105 ; exercises for balance and lower limb strength , done three times a week ) , sham control programme ( n=105 ; gentle exercise ) . LiFE and structured groups received five sessions with two booster visits and two phone calls ; controls received three home visits and six phone calls . Assessment s made at baseline and after six and 12 months . Main outcome measures Primary measure : rate of falls over 12 months , collected by self report . Secondary measures : static and dynamic balance ; ankle , knee and hip strength ; balance self efficacy ; daily living activities ; participation ; habitual physical activity ; quality of life ; energy expenditure ; body mass index ; and fat free mass . Results After 12 months ’ follow-up , we recorded 172 , 193 , and 224 falls in the LiFE , structured exercise , and control groups , respectively . The overall incidence of falls in the LiFE programme was 1.66 per person years , compared with 1.90 in the structured programme and 2.28 in the control group . We saw a significant reduction of 31 % in the rate of falls for the LiFE programme compared with controls ( incidence rate ratio 0.69 ( 95 % confidence interval 0.48 to 0.99 ) ) ; the corresponding difference between the structured group and controls was non-significant ( 0.81 ( 0.56 to 1.17 ) ) . Static balance on an eight level hierarchy scale , ankle strength , function , and participation were significantly better in the LiFE group than in controls . LiFE and structured groups had a significant and moderate improvement in dynamic balance , compared with controls . Conclusions The LiFE programme provides an alternative to traditional exercise to consider for fall prevention . Functional based exercise should be a focus for interventions to protect older , high risk people from falling and to improve and maintain functional capacity . Trial registration Australia and New Zeal and Clinical Trials Registry 12606000025538 BACKGROUND There is limited evidence supporting the hypothesized environment-disability link . The objectives of this study were to ( a ) identify the prevalence of community mobility barriers and transportation facilitators and ( b ) examine whether barriers and facilitators were associated with disability among older adults with functional limitations . METHODS Four hundred and thirty-five participants aged 65 + years old with functional limitations were recruited from the Multicenter Osteoarthritis Study , a prospect i ve study of community-dwelling adults with or at risk of developing symptomatic knee osteoarthritis . Presence of community barriers and facilitators was ascertained by the Home and Community Environment survey . Two domains of disability , ( a ) daily activity limitation ( DAL ) and ( b ) daily activity frequency ( DAF ) , were assessed with the Late-Life Disability Instrument . Covariates included age , gender , education , race , comorbidity , body mass index , knee pain , and functional limitation . Multivariable logistic regression was used to examine adjusted associations of community factors with presence of DAL and DAF . RESULTS Approximately one third of the participants lived in a community with high mobility barriers and low transportation facilitators .  High mobility barriers was associated with greater odds of DAL ( odds ratio [ OR ] = 2.0 , 95 % confidence interval [ CI ] 1.2 - 3.1 ) after adjusting for covariates , and high transportation facilitators was associated with lower odds of DAL ( OR = 0.5 , 95 % CI 0.3 - 0.8 ) but not with DAF in adjusted models . CONCLUSION People with functional limitations who live in communities that were more restrictive felt more limited in doing daily activities but did not perform these daily activities any less frequently BACKGROUND The recent development of the Late-Life Function and Disability Instrument ( LL-FDI ) was an important contribution to the measurement of function and disability in older adults . The present study examined the psychometric properties and construct validity of the LL-FDI measure in a sample of older women . METHODS Older black ( n = 81 ) and white ( n = 168 ) women completed the LL-FDI  , several measures of physical function , and physical activity measures , and had their body mass index assessed at baseline of an ongoing prospect i ve study . Confirmatory factor analyses ( CFA ) and correlational analyses were used to examine factorial and construct validity of the measure . RESULTS The CFA , using an iterative model modification technique , result ed in an acceptable 15-item solution for the function component and an 8-item solution for the disability component . This abbreviated instrument demonstrated high correlations with the original scales . Construct validity for the LL-FDI was supported . Participants who demonstrated better physical function , reported being more active , and had lower body mass index reported less disability and less difficulty with function on the LL-FDI . CONCLUSIONS The LL-FDI appears to be an effective instrument for assessing function and disability in older women , and the abbreviated version reported here may prove useful in certain circumstances due to its brevity . However , continued determination of the construct validity of the complete and abbreviated scales is recommended Objective . To determine the tolerance and feasibility of aquatic-based power training for improving lower limb muscle power , impairments , and mobility in adults with symptomatic knee OA . Participants . Twenty-nine adults , age 50 years and over , with symptomatic knee OA ( ACR clinical criteria ) and mobility limitation ( 400-meter walk time slower than median for sex and decade ) completed 45-minute aquatic power training sessions twice weekly for 6 weeks . Main Outcome Measurements . Prospect i ve outcomes included tolerance of the program , as well as change in stair climb power , 400-meter walk time , overall and knee-specific pain , activities of daily living ( ADL ) , quality of life ( QOL ) , and lower limb function at 6- and 12-week follow-up . Results . The training intensity required modification for 9 of the 29 participants .  Lower limb muscle power , ADL , QOL , and overall pain were improved immediately and 6 weeks following completion ( all P < 0.05 ) . However , 400-meter walk times , and lower limb function did not differ from baseline . Conclusions . A 6-week aquatic rehabilitation program appears to be well tolerated by adults with symptomatic knee OA with mobility limitations and may result in improved lower limb muscle power , symptoms , ADL , and QOL . However , this intervention may have insufficient specificity or intensity for improving physical function OBJECTIVE To evaluate whether a customized exercise tolerance testing ( ETT ) protocol based on an individual 's habitual gait speed ( HGS ) on level ground would be a valid mode of exercise testing older adults . Although ETT provides a useful means to risk-stratify adults , age-related declines in gait speed paradoxically limit the utility of st and ard ETT protocol s for evaluating older adults . A customized ETT protocol may be a useful alternative to these st and ard methods , and this study hypothesized that this alternative approach would be valid . DESIGN We performed a cross-sectional analysis of baseline data from a r and omized controlled trial of older adults with observed mobility problems . Screening was performed using a treadmill-based ETT protocol customized for each individual 's HGS . We determined the content validity by assessing the results of the ETTs , and we evaluated the construct validity of treadmill time in relation to the Physical Activity Scale for the Elderly ( PASE ) and the Late Life Function and Disability Instrument ( LLFDI ) . SETTING Outpatient rehabilitation center . PARTICIPANTS Community-dwelling , mobility-limited older adults ( N=141 ) . INTERVENTIONS Not applicable . MAIN OUTCOME MEASURES Cardiac instability , ETT duration , peak heart rate , peak systolic blood pressure , PASE , and LLFDI . RESULTS Acute cardiac instability was identified in 4 of the participants who underwent ETT . The remaining participants ( n=137 , 68 % female ; mean age , 75.3 y ) were included in the subsequent analyses . Mean exercise duration was 9.39 minutes , with no significant differences in duration s being observed after evaluating among tertiles by HGS status . Mean peak heart rate and mean peak systolic blood pressure were 126.6 beats/min and 175.0 mmHg , respectively . Within separate multivariate models ,  ETT duration in each of the 3 gait speed groups was significantly associated ( P<.05 ) with PASE and LLFDI . CONCLUSIONS Mobility-limited older adults can complete this customized ETT protocol , allowing for the identification of acute cardiac instability and the achievement of optimal exercise parameters BACKGROUND This study was design ed to evaluate the benefits of InVEST ( Increased Velocity Specific to Task ) training on limb power and mobility among mobility-limited older adults . METHODS We conducted a single blinded , r and omized controlled trial among 138 mobility-limited community-dwelling older adults , evaluating two 16-week supervised exercise programs . The intervention group participated in InVEST training , and the control group participated in the National Institute on Aging 's ( NIA ) strength training program . Primary outcomes were changes in limb power per kilogram and mobility performance as measured by the Short Physical Performance Battery ( SPPB ) . RESULTS After 16 weeks , InVEST produced significantly greater improvements in limb power than NIA ( p=.02 ) . There was no significant difference in strength improvements . Both groups had significant changes in SPPB of greater than 1 unit . Self-reported function was also significantly improved in both groups . Differences between groups were not statistically different . In a post hoc analysis when participants were categorized by the manifestation of baseline leg velocity impairments ( N=68 ) , InVEST training produced effect size differences in SPPB that were clinical ly meaningful ( SPPB Group x Time difference 0.73 units , p=.05 ) . CONCLUSIONS Among mobility-limited older adults , both NIA and InVEST produce robust changes in observed physical performance and self-reported function . These improvements were not meaningfully different by statistical or clinical criteria . Compared with NIA , InVEST training produced greater improvements in limb power and equivalent improvements in strength . Observed differences between NIA and InVEST based upon baseline leg impairment status are informative for futures studies PURPOSE To compare two self-administered , one interviewer-administered , and one performance-based measure of physical function in community-based older persons . METHODS Eighty-three subjects were recruited from meal sites , senior recreation centers , and senior housing units for a comprehensive geriatric assessment program . At the time of screening , study participants self-administered the Functional Status Question naire ( FSQ ) and were administered the Katz Activities of Daily Living ( ADL ) and the Older Americans Re sources and Services Instrumental Activities of Daily Living ( OARS-IADL ) instruments by interview . Participants also completed the Physical Performance Test ( PPT ) and were given the  Medical Outcomes Study SF-36 to self-administer on site or at home and return by mail . RESULTS All 83 subjects completed FSQ , Katz ADL , OARS-IADL , and PPT ; 72 returned SF-36 forms . Correlations between the two self-administered physical function measures ( FSQ and SF-36 ) were higher than between self-administered and interviewer-assessed ( ADL and OARS-IADL ) or performance-based ( PPT ) measures . When assessed for construct validity , the self-administered , OARS , and PPT measures had comparable correlations with role limitations as a result of physical health problems , but relationships between physical functional status measures and other SF-36 measures of health were inconsistent . CONCLUSION The relationships between commonly used self-administered , interviewer-administered , and performance-based measures of physical function were inconsistent and weak , suggesting that these instruments are not measuring the same construct Background / Aim : In elderly persons , fall-related injury is a serious public health problem . We investigated the impact of essential nutritional elements on falls in the elderly . Methods : Clinical function , balance , gait and disability tests and health and nutritional status assessment s were performed . All subjects were interviewed regarding the occurrence of falls in the last year . Blood tests for serum vitamin D , folate and B12 were conducted among a r and omly selected sub sample of 54 participants in the same month . Results : One hundred 65- to 91-year-old volunteers participated in the study , and 29 of them fell at least once during the past year .  The depression score was higher ( indicating more depressive symptoms ) among fallers compared with non-fallers ( 4.0 ± 3.2 vs. 2.5 ± 2.3 , respectively ) . The overall function score ( indicating better function ) was marginally higher in non-fallers . Subsequent comparisons between fallers and non-fallers were adjusted for overall function and depression scores . Serum folate  was significantly lower in fallers ( 9.5 ± 7.1 vs. 16.2 ± 6.7 ng/ml , p = 0.02 ) . Dietary intake  was equal in both groups . Correlation analyses indicate a significant association between vitamin D and the functional measurements : timed get up and go ( negative ) , Berg balance test , overall functional score , lower extremity score and limitation score ( positive correlation coefficients ) . Serum folate was highly and negatively associated with the number of falls and with prescribed medications and was the only protective factor against falls in a multivariate analysis . Conclusions : Vitamin D was related to most functional and balance measurements . Serum folate was protective against falls . For every 1 ng/ml increase in serum folate the occurrence of falls decreased by 19 % Purpose : To examine the effectiveness of a novel intervention aim ed at decreasing indices related to frailty through systematic , Progressive Functional Rehabilitation ( PFR ) . Methods : Pre‐frail volunteers were recruited to participate in a 15 week exercise intervention or control group .  Those who met study criteria and consented were r and omized into one of three groups : control , seated exercise , or Wii ® ‐fit . Test measures were completed before and after the 15 week intervention period on all participants . Measures included : Senior Fitness Test , Body Weight , Balance Efficacy Scale , CHAMPS , Late‐Life Function and Disability Index , MOS SF‐36 . Attendance was also recorded . Results : There were improvements on several of the measures included in the Senior Fitness Test including chair st and s , arm curls , step 2 , six minute walk , sit and reach , and the timed up and go . A few participants did lose weight . All of the differences reflected improved physical functional status in the seated exercise or Wii‐fit groups compared with the control group . Discussion : Increased physical activity was beneficial for all who participated . There were improvements in physical performance scores on several of the measures on the senior fitness test in both the seated exercise and Wii‐fit groups . Participants in the Wii‐fit group also showed improvement in their reported caloric expenditure and balance confidence . Conclusion : This pilot study suggests a rehabilitation effect that was similar to the effect of community based senior fitness classes . A home video game console system with weight vest could be an effective alternative for pre‐frail senior adults to group exercise classes BACKGROUND To compare the frequencies of risk factors , we describe risks for depression as a function of race among consecutively admitted participants in a r and omized clinical trial of indicated depression prevention in later life . METHODS Seventy-two black and 143 white participants were screened for risk factors for depression . RESULTS Black participants were more likely to have fewer years of education and lower household income . They were more likely to be obese , live alone , experience functional disability , have a history of alcohol and drug abuse , and have lower scores on the Mini-mental State Examination and the Executive Interview ( EXIT ) . White participants were not found to have greater prevalence or higher mean score on any risk factor . On average , black participants experienced approximately one more risk factor than white participants ( t(213 ) = 3.32 , p = 0.0011 ) . CONCLUSIONS In our sample , black participants had higher frequencies of eight risk factors for depression and a greater mean number of risk factors compared to white participants BACKGROUND This study applied item response theory ( IRT ) and computer adaptive testing ( CAT ) method ologies to develop a prototype function and disability assessment instrument for use in aging research . Herein , we report on the development of the CAT version of the Late-Life Function and Disability Instrument ( Late-Life FDI ) and evaluate its psychometric properties . METHODS We used confirmatory factor analysis , IRT methods , validation , and computer simulation analyses of data collected from 671 older adults residing in residential care facilities . We compared accuracy , precision , and sensitivity to change of scores from CAT versions of two Late-Life FDI scales with scores from the fixed-form instrument . Score estimates from the prototype CAT versus the original instrument were compared in a sample of 40 older adults . RESULTS Distinct function and disability domains were identified within the Late-Life FDI item bank and used to construct two prototype CAT scales . Using retrospective data , scores from computer simulations of the prototype CAT scales were highly correlated with scores from the original instrument . The results of computer simulation , accuracy , precision , and sensitivity to change of the CATs closely approximated those of the fixed-form scales , especially for the 10- or 15-item CAT versions . In the prospect i ve study , each CAT was administered in <3 minutes and  CAT scores were highly correlated with scores generated from the original instrument . CONCLUSIONS CAT scores of the Late-Life FDI were highly comparable to those obtained from the full-length instrument with a small loss in accuracy , precision , and sensitivity to change CONTEXT Five-year survival rates for early stage colorectal , breast , and prostate cancer currently exceed 90 % and are increasing . Cancer survivors are at greater risk for second malignancies , other comorbidities , and accelerated functional decline . Lifestyle interventions may provide benefit , but it is unknown whether long-term cancer survivors can modify their lifestyle behaviors sufficiently to improve functional status . OBJECTIVE To determine whether a telephone counseling and mailed print material -based diet and exercise intervention is effective in reorienting functional decline in older , overweight cancer survivors . DESIGN , SETTING , AND PARTICIPANTS R and omized controlled trial of 641 overweight ( body mass index > or = 25 and < 40 ) , long-term ( > or = 5 years ) survivors ( aged 65 - 91 years ) of colorectal , breast , and prostate cancer , who were r and omly assigned to an intervention group ( n = 319 ) or delayed intervention ( control ) group ( n = 322 ) in Canada , the United Kingdom , and 21 US states . Individuals were recruited for the Reach out to Enhance Wellness ( RENEW ) trial from July 1 , 2005 , through May 17 , 2007 . INTERVENTION A 12-month , home-based tailored program of telephone counseling and mailed material s promoting exercise , improved diet quality , and modest weight loss . The control group was wait-listed for 12 months . MAIN OUTCOME MEASURES Change in self-reported physical function on the Short-Form 36 physical function subscale ( score range , 0 - 100 ; a high score indicates better functioning ) from baseline to 12 months was the primary end point . Secondary outcomes included changes in function on the basic and advanced lower extremity function subscales of the Late Life Function and Disability Index ( score range , 0 - 100 ) , physical activity , body mass index , and overall health-related quality of life . RESULTS The mean baseline Short-Form 36 physical function score was 75.7 . At the 12-month follow-up , the mean function scores declined less rapidly in the intervention group ( -2.15 ; 95 % confidence interval [ CI ] , -0.36 to -3.93 ) compared with the control group ( -4.84 ; 95 % CI , -3.04 to -6.63 ) ( P = .03 ) . The mean baseline basic lower extremity function score was 78.2 . The mean changes in basic lower extremity function were 0.34 ( 95 % CI , -0.84 to 1.52 ) in the intervention group compared with -1.89 ( 95 % CI , -0.70 to -3.09 ) in the control group ( P = .005 ) . Physical activity , dietary behaviors , and overall quality of life increased significantly in the intervention group compared with the control group , and weight loss also was greater ( 2.06 kg [ 95 % CI , 1.69 to 2.43 kg ] vs 0.92 kg [ 95 % CI , 0.51 to 1.33 kg ] , respectively ; P < .001 ) . CONCLUSION Among older , long-term survivors of colorectal , breast , and prostate cancer , a diet and exercise intervention reduced the rate of self-reported functional decline compared with no intervention . TRIAL REGISTRATION clinical trials.gov Identifier : NCT00303875 OBJECTIVES To test the effect of tai chi on the progression of pre clinical disability to manifest disability compared with seated flexibility exercise , and to examine whether tai chi mediates delayed disability by reducing impairments in musculoskeletal , cardiovascular , and neurologic systems , and related functional limitations . DESIGN Multisite parallel group individually r and omized controlled trial . SETTING General community . PARTICIPANTS Pre clinical ly disabled community-dwelling people older than 70 years ( n=503 ) , without major medical conditions or moderate to severe cognitive impairment . INTERVENTION Modified Sun style tai chi exercise compared with seated flexibility exercise , both programs delivered in groups for 60 minutes twice weekly for 24 weeks . MAIN OUTCOME MEASURES Disability measured with the Late-Life Function and Disability Instrument . Secondary outcomes were impairments and functional limitations of the musculoskeletal , neurologic , and cardiovascular systems . RESULTS There was little change within or between the 2 groups . The mean change in the Disability Frequency Score was 0.3 and 0.1 points ( 100-point scale ) for the intervention and control groups , respectively ( adjusted difference -.21 ; 95 % confidence interval [ CI ] -.99 to .56 ) . The mean change in the Disability Limitation Score was -0.1 and -.04 points for the intervention and control groups , respectively ( adjusted difference -0.6 ; 95 % CI -2.31 to 1.11 ) . There was little effect on impairments or functional limitations . A higher proportion of intervention participants ceased attending the exercise program ( difference=17.9 % , 95 % CI 9.6 - 25.8 ) . Multiple imputation of missing data did not change the results . CONCLUSIONS Modified Sun style tai chi did not have an impact on impairment , functional limitations , or disability in pre clinical ly disabled older people when delivered for 24 weeks . Withdrawal from the exercise classes was high but did not explain the null result . Improved compliance , or a longer or more intensive program , may be required PURPOSE To compare the effects of functional home exercise of repeated sit-to-st and s with low-intensity progressive resistance training , on performance measures in mobility-limited adults over 80 years of age . SETTING Participants ' homes . DESIGN Community-dwelling older adults > or = 80 years of age were invited to participate in a r and omised controlled clinical trial . Baseline and outcome measures were : comfortable gait velocity , 30-s chair-st and test , 15-s step test , Berg Balance Scale , Modified Falls Efficacy Scale and the Late-Life Function and Disability Instrument-function component . Participants r and omised to the intervention group performed repeated sit-to-st and s using a Gr and St and System ; a biofeedback device that recorded and displayed the number of repetitions performed . Participants r and omised to the control group performed knee extensions using ankle cuff weights . Both groups performed the exercises daily for 6 weeks . RESULTS Sixty-six older adults took part . The intervention group had a statistically significant improvement in Berg Balance Scale mean score , 1.67 + /- 2.64 points , P = 0.001 ( control group 0.73 + /- 3.63 points , P = 0.258 ) , indicating an improvement in balance over the 6-week exercise period . There was no statistically significant effect of either intervention on the other outcome measures . CONCLUSIONS In a highly variable population of older adults with mobility limitations , low-intensity functional home exercise of repeated sit-to-st and s using the Gr and St and System improved Berg Balance Scale score while low-intensity progressive resistance training did not . While statistically significant , the improvement in Berg Balance Scale score was modest raising the issue of what extent of change in score is clinical ly significant in this population Background Functional limitations have been operationally defined for studies of rehabilitation science through measures of physical performance and patient-reported function . Although conceived as representing similar concepts , differences between these 2 modes of measuring physical functioning have not been adequately characterized scientifically . Objective The purpose of this study was to compare the Short Physical Performance Battery ( SPPB ) with the function component of the Late-Life Function and Disability Instrument ( LLFDI ) with respect to their association with physiologic factors and other psychosocial and health factors potentially influencing rehabilitative care . Design This study was a cross-sectional analysis of baseline data from a sample of community-dwelling older adults ( N=137 ) with mobility limitations enrolled in a r and omized controlled trial of exercise . Methods A performance-based measure of function ( the SPPB ) and a self-report measure of function ( the LLFDI ) served as functional outcomes . Physiologic factors included measures of leg strength , leg velocity , and exercise tolerance test ( ETT ) duration , which served as a surrogate measure of aerobic capacity . Psychosocial and health factors included age , sex , height , body mass index , number of chronic conditions , depression , and falls efficacy . Results Separate multivariable regression models predicting SPPB and LLFDI scores described 33 % and 42 % of the variance in each outcome ( R2 ) , respectively . Leg velocity and ETT duration were positively associated with both performance-based and patient-reported functional measures . Leg strength and age were positively associated with SPPB scores , whereas number of chronic conditions , sex , and falls efficacy were associated with the LLFDI scores . Limitations This study included older adults with mobility limitations and may not generalize to other population s. Conclusions Performance-based and patient-reported measures of physical function appear to assess different aspects of an older person 's functioning . The SPPB was associated with age and physiologic factors , whereas patient-reported function measured by the LLFDI was associated with these factors as well as with psychosocial and health factors Objectives : To evaluate the effect of a group-based functional and specific balance training programme that included dual-task exercises on balance function  in healthy older adults . Design : A single-blind r and omized controlled trial . Setting : General community . Participants : Sixty-six community-dwelling older adults ( age 77.0 ± 6.5 years ) , without functional balance impairment were recruited and allocated at r and om to an intervention group ( n = 33 ) or a reference group ( n = 33 ) . Intervention : The intervention group received 24 training sessions over three months that included perturbation as well as dual-task exercises . The reference group received no intervention . Outcome measures : The voluntary step execution times during single- and dual-task conditions , stabilogram-diffusion analysis in upright st and ing , and self-reported physical function ; all were measured assessed at baseline and at the end of intervention . The intervention group was retested after six months . Results : Compared with the reference group , participation in group-based functional and specific balance training led to faster voluntary step execution times under single-task ( P = 0.02 ; effect size ( ES ) = 0.34 ) and dual-task ( P = 0.036 ; ES = 0.55 ) conditions ; lower transition displacement and shorter transition time of the stabilogram-diffusion analysis under eyes-closed conditions ( P = 0.007 , ES = 0.30 and P = 0.08 , ES = 0.44 , respectively ) ; and improved self-reported lower extremity function ( P = 0.006 , ES = 0.37 ) . Effects were lost at six-month follow-up . Conclusions : Functional and specific balance training can improve voluntary stepping and balance control in healthy older non-fallers , parameters previously found to be related to increased risk of falls and injury in older adults CONTEXT Generalized anxiety disorder ( GAD ) is one of the most common psychiatric disorders in older adults ; however , few data exist to guide clinicians in efficacious and safe treatment . Selective serotonin reuptake inhibitors ( SSRIs ) are efficacious for younger adults with GAD , but benefits and risks may be different in older adults . OBJECTIVE To examine the efficacy , safety , and tolerability of the SSRI escitalopram in older adults with GAD . DESIGN , SETTING , AND PARTICIPANTS A r and omized controlled trial in primary care practice s and related specialty clinics in Pittsburgh , Pennsylvania , of 177 participants aged 60 years or older with a principal diagnosis of GAD r and omized to receive either escitalopram or placebo and conducted between January 2005 and January 2008 . INTERVENTIONS Twelve weeks of 10 to 20 mg/d of escitalopram ( n = 85 ) or matching placebo ( n = 92 ) . MAIN OUTCOME MEASURES Cumulative response defined by Clinical Global Impressions-Improvement score of much or very much improved ; time to response ; and anxiety and role functioning changes measured by the Clinical Global Impressions-Improvement scale , Hamilton Anxiety Rating Scale , Penn State Worry Question naire , Late-Life Function and Disability Instrument activity limitations subscale , and the role-emotional impairment and social function subscales of the Medical Outcome Survey 36-item Short Form . RESULTS In the primary analytic strategy in which participants ( n = 33 ) were censored at the time of dropout , mean cumulative response rate for escitalopram was 69 % ( 95 % confidence interval [ CI ] , 58%-80 % ) vs 51 % ( 95 % CI , 40%-62 % ) for placebo ( P = .03 ) . A conservative intention-to-treat analysis showed no difference in mean cumulative response rate between escitalopram and placebo ( 57 % ; 95 % CI , 46%-67 % ; vs 45 % ; 95 % CI , 35%-55 % ; P = .11 ) . Participants treated with escitalopram showed greater improvement than with placebo in anxiety symptoms and role functioning ( Clinical Global Impressions-Improvement scale : effect size , 0.93 ; 95 % CI , 0.50 - 1.36 ; P < .001 ; Penn State Worry Question naire : 0.30 ; 95 % CI , 0.23 - 0.48 ; P = .01 ; activity limitations : 0.32 ; 95 % CI , 0.01 - 0.63 ; P = .04 ; and the role-emotional impairment and social function : 0.96 ; 95 % CI , 0.03 - 1.90 ; P = .04 ) . Adverse effects of escitalopram ( P < .05 vs placebo ) were fatigue or somnolence ( 35 patients [ 41.1 % ] ) , sleep disturbance ( 12 [ 14.1 % ] ) , and urinary symptoms ( 8 [ 9.4 % ] ) . CONCLUSIONS Older adults with GAD r and omized to escitalopram had a higher cumulative response rate for improvement vs placebo over 12 weeks ; however , response rates were not significantly different using an intention-to-treat analysis . Further study is required to assess efficacy and safety over longer treatment duration s. TRIAL REGISTRATION clinical trials.gov Identifier : NCT00105586 Background Definitive evidence that exercise interventions that improve gait also reduce disability is lacking . A task-oriented , motor sequence learning exercise intervention has been shown to reduce the energy cost of walking and improve gait speed , but whether the intervention also improves activity and participation has not been demonstrated . Objective The objective of this study was to compare the impact of a task-oriented , motor sequence learning exercise ( TO ) intervention and the impact of an impairment-oriented , multicomponent exercise ( IO ) intervention on activity and participation outcomes in older adults with mobility limitations . The mediating effects of a change in the energy cost of walking on changes in activity and participation also were determined . Design This study was a single-blind , r and omized controlled trial . Setting The study was conducted in an ambulatory clinical research training center . Participants The study participants were 47 older adults ( mean age=77.2 years , SD=5.5 ) with slow and variable gait . Intervention The intervention was a 12-week , physical therapist – guided program of TO or IO . Measurements Measures of activity ( gait speed over an instrumented walkway ; daily physical activity measured with an accelerometer ; confidence in walking determined with the Gait Efficacy Scale ; and physical function determined with the total , basic lower-extremity , and advanced lower-extremity components of the Late-Life Function and Disability Instrument [ Late-Life FDI ] ) and participation ( disability limitation dimension and instrumental role [ home and community task performance ] domain components of the Late-Life FDI ) were recorded before and after the intervention . The energy cost of walking was determined from the rate of oxygen consumption during self-paced treadmill walking at the physiological steady state st and ardized by walking speed . An adjusted comparison of activity and participation outcomes in the treatment arms was made by use of an analysis of covariance model , with baseline and change in energy cost of walking added to the model to test for mediation . Tests were used to determine the significance of the mediating effects . Results Activity improved in TO but not in IO for confidence in walking ( Gait Efficacy Scale ; mean adjusted difference=9.8 [ SD=3.5 ] ) and physical function ( Late-Life FDI basic lower-extremity component ; mean adjusted difference=3.5 [ SD=1.7 ] ) . Improvements in TO were marginally greater than those in IO for gait speed , physical activity , and total physical function . Participation improved marginally more in TO than in IO for disability limitations and instrumental role . Limitations The older adults were r and omized to the intervention group , but differences in baseline measures had to be accounted for in the analyses . Conclusions A TO intervention that improved gait also led to improvements in some activity and participation outcomes in older adults with mobility limitations
target: High test-retest reliability was found for the Function component , while results for the Disability component were more variable .
  Conclusions There is extensive evidence to support the construct validity and sensitivity to change of the LLFDI among various clinical population s of community-dwelling older adults .
background: Background The choice of measure for use as a primary outcome in geriatric research is contingent upon the construct of interest and evidence for its psychometric properties .
  The Late-Life Function and Disability Instrument ( LLFDI ) has been widely used to assess functional limitations and disability in studies with older adults .
  The primary aim of this systematic review was to evaluate the current available evidence for the psychometric properties of the LLFDI .