title: Hand grip strength and incident ADL disability in elderly Mexican Americans over a seven-year period Prognostic significance of potential frailty criteria. Modifiable risk factors predict functional decline among older women: a prospectively validated clinical prediction tool. The Study of Osteoporotic Fractures Research Group. Frailty and incidence of activities of daily living disability among older Mexican Americans. Body weight dynamics and their association with physical function and mortality in older adults: the Cardiovascular Health Study. Incidence of and predictors for chronic disability in activities of daily living among older people in Taiwan. Walking speed as a good predictor for the onset of functional dependence in a Japanese rural community population. Instrumental activities of daily living related to impairments and functional limitations in 70-year-olds and changes between 70 and 76 years of age. The development of insidious disability in activities of daily living among community-living older persons. Hand-grip strength predicts incident disability in non-disabled older men. Predictors for functional decline among nondisabled older Japanese living in a community during a 3-year follow-up. A comparison of frailty indexes for the prediction of falls, disability, fractures, and mortality in older men. Predictors of functional change: a longitudinal study of nondemented people aged 65 and older. Risk factors for disability subtypes in older persons. Going Outdoors Daily Predicts Long-Term Functional and Health Benefits Among Ambulatory Older People
abstract: Background and aims : Little is known about muscle strength as a predictor of  disability among older Mexican Americans . The aim of this study was to examine the association between h and grip strength  and 7-year incidence of ADL disability in older Mexican American men and women . Methods : A 7-year prospect i ve cohort study of 2493 non-institutionalized Mexican American men and women aged 65 or older residing in five south-western states .  Maximal h and grip strength test , body mass index , cognitive function , activities of daily living , self-reports of medical conditions ( arthritis , diabetes , heart attack , stroke , cancer , hip fracture ) , and depressive symptoms were obtained . Results : In a Cox proportional regression analysis , there was a linear relationship between h and grip strength at baseline and risk of incident ADL disability over a 7-year follow-up . Among non-disabled men at baseline , the hazard ratio of any new ADL limitation was 1.90(95 % CI 1.14–3.17 ) for those in the lowest quartile , when compared with men in the highest h and grip strength quartile , after controlling for age , marital status , medical conditions , high depressive symptoms , MMSE score , and BMI at baseline . Among non-disabled women at baseline , the hazard ratio of any new ADL limitation was 2.28 ( 95 % CI 1.59–3.27 ) for those in the lowest quartile , when compared with women in the highest h and grip strength quartile . Conclusions : H and grip strength is an independent predictor of ADL disability  among older Mexican American men and women . The h and grip strength test is an easy , reliable , valid , inexpensive method of screening to identify older adults at risk of disability OBJECTIVES To determine the independent prognostic effect of seven potential frailty criteria , including five from the Fried phenotype , on several adverse outcomes . DESIGN Prospect i ve cohort study . SETTING Greater New Haven , Connecticut . PARTICIPANTS Seven hundred fifty-four initially nondisabled , community-living persons aged 70 and older . MEASUREMENTS An assessment of seven potential frailty criteria ( slow gait speed , low physical activity , weight loss , exhaustion , weakness , cognitive impairment , and depressive symptoms ) was completed at baseline and every 18 months for 72 months . Participants were followed with monthly telephone interviews for up to 96 months to determine the occurrence of chronic disability , long-term nursing home ( NH ) stays , injurious falls , and death . RESULTS In analyses adjusted for age , sex , race , education , number of chronic conditions , and the presence of the other potential frailty criteria , three of the five Fried criteria ( slow gait speed , low physical activity , and weight loss ) were independently associated with chronic disability , long-term NH stays , and death . Slow gait speed was the strongest predictor of chronic disability ( hazard ratio (HR)=2.97 , 95 % confidence interval (CI)=2.32 - 3.80 ) and long-term NH stay ( HR=3.86 , 95 % CI=2.23 - 6.67 ) and was the only significant predictor of injurious falls ( HR=2.19 , 95 % CI=1.33 - 3.60 ) . Cognitive impairment was also associated with chronic disability ( HR=1.82 , 95 % CI=1.40 - 2.38 ) , long-term NH stay ( HR=2.64 , 95 % CI=1.75 - 3.99 ) , and death ( HR=1.54 , 95 % CI=1.13 - 2.10 ) , and the magnitude of these associations was comparable with that of weight loss . CONCLUSION The results of this study provide strong evidence to support the use of slow gait speed , low physical activity , weight loss , and cognitive impairment as key indicators of frailty while raising concerns about the value of self-reported exhaustion and muscle weakness OBJECTIVE To identify modifiable predictors of functional decline among community-residing older women and to derive and vali date a clinical prediction tool for functional decline based only on modifiable predictors . DESIGN A prospect i ve cohort study . SETTING Four geographic areas of the United States . PARTICIPANTS Community-residing women older than age 65 recruited from population -based listings between 1986 and 1988 ( n = 6632 ) . MEASUREMENTS Modifiable predictors were considered to be those that a clinician seeing an older patient for the first time could reasonably expect to change over a 4-year period : benzodiazepine use , depression , low exercise level , low social functioning , body-mass index , poor visual acuity , low bone mineral density , slow gait , and weak grip . Known predictors of functional decline unlikely to be amenable to intervention included age , education , medical comorbidity , cognitive function , smoking history , and presence of previous spine fracture . All variables were measured at baseline ; only modifiable predictors were c and i date s for the prediction tool . Functional decline was defined as loss of ability over the 4-year interval to perform one or more of five vigorous or eight basic daily activities . RESULTS Slow gait , short-acting benzodiazepine use , depression , low exercise level , and obesity were significant modifiable predictors of functional decline in both vigorous and basic activities . Weak grip predicted functional decline in vigorous activities , whereas long-acting benzodiazepine  use and poor visual acuity predicted functional decline in basic activities . A prediction rule based on these eight modifiable predictors classified women in the derivation set into three risk groups for decline in vigorous activities ( 12 % , 25 % , and 39 % risk ) and two risk groups for decline in basic activities ( 2 % and 10 % risk ) . In the validation set , the probabilities of functional decline were nearly identical . CONCLUSIONS A substantial portion of the variation of functional decline can be attributed to risk factors amenable to intervention over the short term . Using eight modifiable predictors that can be identified in a single office visit , clinicians can identify older women at risk for functional decline OBJECTIVE To examine the association between frailty status and incidence of disability among non-disabled older Mexican Americans . DESIGN A 10-year prospect i ve cohort study . SUBJECTS A total of 1645 non-institutionalized Mexican Americans aged 67 years and older from the Hispanic Established Population for the Epidemiological Study of the Elderly ( H-EPESE ) , who reported no limitation in activities of daily living at baseline . METHODS Frailty was defined as meeting 3 or more of the following components : ( i ) unintentional weight loss of > 2.26 kg ; ( ii ) weakness ( lowest 20 % in h and grip strength ) ; ( iii ) self-reported exhaustion ; ( iv ) slow walking speed ; and ( v ) low physical activity level . Socio-demographic factors , Mini Mental State Examination , medical conditions , body mass index , and self-reported activities of daily living were obtained . RESULTS Of the 1645 non-disabled subjects at baseline , 820 ( 50 % ) were not frail , 749 ( 45.7 % ) were pre-frail , and 71 ( 4.3 % ) were frail . The hazard ratio of activities of daily living disability at 10-year follow-up for pre-frail subjects was 1.32 ( 95 % confidence interval 1.10 - 1.58 ) and 2.42 ( 95 % confidence interval 70 - 3.46 ) for frail subjects compared with not frail subjects . This association remained statistically significant after controlling for potential confounding factors at baseline . CONCLUSION Pre-frail and frail status in older Mexican Americans was associated with an increased risk of activities of daily living disability over a 10-year period among non-disabled subjects BACKGROUND To estimate the associations of weight dynamics with physical functioning and mortality in older adults . METHODS Longitudinal cohort study using prospect ively collected data on weight , physical function , and health status in four U.S. Communities in the Cardiovascular Health Study . Included were 3,278 participants ( 2,013 women and 541 African Americans ) , aged 65 or older at enrollment , who had at least five weight measurements . Weight was measured at annual clinic visits between 1992 and 1999 , and summary measures of mean weight , coefficient of variation , average annual weight change , and episodes of loss and gain ( cycling )  were calculated . Participants were followed from 1999 to 2006 for activities of daily living ( ADL ) difficulty , incident mobility limitations , and mortality . RESULTS Higher mean weight , weight variability , and weight cycling increased the risk of new onset of ADL difficulties and mobility limitations . After adjustment for risk factors , the hazard ratio ( 95 % confidence interval ) for weight cycling for incident ADL impairment was 1.28 ( 1.12 , 1.47 ) , similar to that for several comorbidities in our model , including cancer and diabetes . Lower weight , weight loss , higher variability , and weight cycling were all risk factors for mortality , after adjustment for demographic risk factors , height , self-report health status , and comorbidities . CONCLUSIONS Variations in weight are important indicators of future physical limitations and mortality in the elderly and may reflect difficulties in maintaining homeostasis throughout older ages . Monitoring the weight of an older person for fluctuations or episodes of both loss and gain is an important aspect of geriatric care OBJECTIVES To estimate the incidence of chronic activities of daily living ( ADL ) disability and to analyze the sociodemographic , health status , adverse lifestyle , and leisure-time physical activity predictors for chronic ADL disability . DESIGN We recruited a cohort of community-dwelling older people in Taipei , Taiwan , who were not ADL disabled in August 1993 , and we followed them until August 1996 . SETTING S AND PARTICIPANTS The study subjects were 1321 community-dwelling people aged 65 years or older who were ADL intact at the initial interview in August 1993 . The study sample was a subset of a probability sample ( n = 1583 ) r and omly selected from household registration s in the four districts of the Taipei metropolitan area . MEASUREMENTS Baseline information regarding various factors potentially associated with the development of chronic ADL disability was assessed and collected at the beginning of the study . Study participants were assessed annually for ADL function by a structured home interview using a six-item scale . Participants who were unable to perform independently at least one of the six items -- eating , bathing , dressing , toileting ,  transfers , and walking inside the house -- for more than 3 months were considered chronically ADL disabled . Cox proportional hazard regression models were utilized to examine the independent effect of the potential predictors on risk of chronic ADL disability . RESULTS During the 3-year study period , 145 ( 11.0 % ) participants developed chronic ADL disability , 58 ( 4.4 % ) participants were lost to follow-up , and 83 ( 6.3 % ) participants died . Multiple hazard regression analysis showed that individuals aged 70 to 79 years or older than age 80 had increased risk of ADL disability ( relative risk : 2.05 ( 95 % confidence interval ( CI ) , 1.35 - 3.11 ) and 3.89 ( 95%CI , 2.33 - 6.50 ) , respectively ) compared with those participants younger than age 70 . Risk of chronic ADL disability was inversely associated with routine exercise ( RR = 0.52 ; 95 % CI , 0.39 - 0.68 ) . CONCLUSIONS Age is the most significant predictor of chronic ADL disability . Lack of routine exercise is also a significant predictor of ADL disability in older adults OBJECTIVE to investigate and compare the predictive values of four physical performance measures for the onset of functional dependence in older Japanese people living at home . DESIGN a population -based prospect i ve cohort study . SETTING Nangai village , Akita Prefecture , Japan . METHODS out of the population aged 65 years and older living in Nangai ( n = 940 ) in 1992 , we measured h and grip-strength , one-leg st and ing , and usual and maximum walking speeds  in 736 subjects who were independent in the five basic activities of daily living . Their functional status was assessed each year for the subsequent 6 years . The outcome event was the onset of functional dependence , defined as a new disability in one or more of the five basic activities of daily living , or death of a subject who had shown no disability at the previous follow-up . RESULTS even after controlling for age , sex and a number of chronic conditions , lower scores on each baseline performance measure showed increased risk for the onset of functional dependence . Maximum walking speed  was most sensitive in predicting future dependence for those aged 65 - 74 years , while usual walking speed was most sensitive for people aged > or = 75 years . CONCLUSION  walking speed  was the best physical performance measure for predicting the onset of functional dependence in a Japanese rural older population The aim of this study was to analyse in particular dependence in instrumental daily life activities ( I-ADLs ) and its association with physical impairments and functional limitations in the elderly . The study was based on cross-sectional data on 70-year-olds ( n = 602 ) and longitudinal data on subjects followed up to the age of 76 ( n = 371 ) . Persons dependent in ADL  had lower values in maximum walking speed , grip strength , knee extensor strength , stair climbing capacity and in forward reach , compared with those who were independent in ADL .  Walking speed in both women and men and sight impairment in men had the greatest influence on dependence in ADL . Possible critical levels for disability in ADL are discussed , as persons who developed dependence between 70 and 76 already had a lower capacity in walking speed and knee extensor strength at age 70 than persons who retained their independence in ADL PURPOSE To determine how often disability in essential activities of daily living develops insidiously , and to evaluate whether the likelihood of insidious disability differs on the basis of physical frailty . METHODS We conducted a prospect i ve study of 754 nondisabled , community-living persons aged 70 years or older . Participants were categorized according to the presence or absence of physical frailty , which was defined on the basis of gait speed . Participants were subsequently followed with monthly telephone interviews for 3 years to determine the occurrence of disability in bathing , dressing , walking , or transferring  , and to ascertain exposure to precipitating events , which included acute hospital admissions and other illnesses , injuries , or problems leading to restricted activity . RESULTS For first episodes of disability , 73 ( 36 % ) of 203 developed insidiously among the 322 participants who were physically frail and 26 ( 18 % ) of 141 developed insidiously among the 432 participants who were not physically frail ( P < 0.001 ) . Physical frailty was the only factor that was associated significantly with the development of insidious disability , with an adjusted odds ratio of 2.4 ( 95 % confidence interval : 1.4 to 4.1 ) . The likelihood that an episode of disability was insidious increased progressively , from 29 % of the 344 first episodes to 65 % of the 155 fourth or higher episodes ( P for trend < 0.001 ) . CONCLUSION Disability in essential activities of daily living often occurs insidiously , particularly among older persons who are physically frail or who have had prior episodes of disability OBJECTIVES To verify if h and -grip performance in older men is a predictor of disability . DESIGN Population -based prospect i ve study . SETTING A sample from the Italian rural cohorts of the FINE study ( Finl and , Italy , Netherl and s Elderly ) , representative of the general population of elderly men surveyed in 1991 and 1995 . PARTICIPANTS 140 men aged 71 - 91 years who reported no disability in performing activities of daily living ( ADLs ) , instrumental activity of daily living ( IADLs ) and mobility activities at baseline examination and provided information on their functional status at follow-up 4 years later . MEASUREMENTS Disability was defined as needing help in performing ADLs , IADLs and mobility . H and -grip strength  was evaluated at baseline by a mechanical dynamometer . RESULTS After adjusting for potential confounding variables , a lower concentration of high-density lipoprotein cholesterol was the only factor predicting disability in men aged 76 years or younger and only reduced h and -grip strength predicted incident disability in men 77 years or older . CONCLUSION Poor h and strength as measured by h and -grip is a predictor of  disability  in older people . The h and -grip test is an easy and inexpensive screening tool to identify elderly people at risk of disability OBJECTIVES To examine predictors for functional decline in basic activities of daily living ( BADL ) as well as predictors for decline in instrumental activities of daily living ( IADL ) among nondisabled older Japanese people living in a community during a 3-year interval from 1992 to 1995 . DESIGN A prospect i ve cohort study . SETTING A community-based environment . PARTICIPANTS A total of 583 men and women aged 65 to 89 at baseline who were independent in both BADL and IADL . MEASUREMENTS Independent variables regarding various factors potentially associated with functional decline were obtained from an interview survey and medical examinations at baseline . Dependent variables were functional status in BADL and IADL obtained at the time of the 3-year follow-up . RESULTS During the 3-year follow-up , significant predictors for functional decline in BADL and only IADL decline included ( 1 ) age of > or = 75 , ( 2 ) less h and -grip strength , and ( 3 ) a history of hospitalization during the past 1 year . In addition , having poor intellectual activities and having poor social roles were identified as significant predictors for functional decline in only IADL during the 3-year follow-up . Furthermore , not having the habit of taking a walk was identified as a significant predictor of functional decline in BADL during the 3-year interval . CONCLUSION Having a high level h and -grip strength , good intellectual activities , and good social roles are strongly associated with remaining independence in IADL for the nondisabled Japanese persons aged > or = 65 OBJECTIVES To compare the validity of a parsimonious frailty index ( components : weight loss , inability to rise from a chair , and poor energy ( Study of Osteoporotic Fractures ( SOF ) index ) ) with that of the more complex Cardiovascular Health Study ( CHS ) index ( components : unintentional weight loss , low grip strength , poor energy , slowness , and low physical activity ) for prediction of adverse outcomes in older men . DESIGN Prospect i ve cohort study . SETTING Six U.S. centers . PARTICIPANTS Three thous and one hundred thirty-two men aged 67 and older . MEASUREMENTS Frailty status categorized as robust , intermediate stage , or frail using the SOF index and criteria similar to those used in CHS index . Falls were reported three times for 1 year . Disability ( > or=1 new impairments in performing instrumental activities of daily living ) ascertained at 1 year . Fractures and deaths ascertained during 3 years of follow-up . Analysis of area under the receiver operating characteristic curve ( AUC ) statistics compared for models containing the SOF index versus those containing the CHS index . RESULTS Greater evidence of frailty as defined by either index was associated with greater risk of adverse outcomes .  Frail men had a higher age-adjusted risk of recurrent falls ( odds ratio (OR)=3.0 - 3.6 ) , disability ( OR=5.3 - 7.5 ) , nonspine fracture ( hazard ratio (HR)=2.2 - 2.3 ) , and death ( HR=2.5 - 3.5 ) ( P<.001 for all models ) . AUC comparisons revealed no differences between models with the SOF index and models with the CHS index in discriminating falls ( AUC=0.63 , P=.97 ) , disability ( AUC=0.68 , P=.86 ) , nonspine fracture ( AUC=0.63 , P=.90 ) , or death ( AUC=0.71 for model with SOF index and 0.72 for model with CHS index , P=.19 ) . CONCLUSION The simple SOF index predicts risk of falls , disability , fracture , and mortality in men as well as the more-complex CHS index OBJECTIVES To identify factors associated with functional change in an older population and investigate interactions among selected potential risk factors . DESIGN A population -based prospect i ve cohort study . SETTING A r and om sample was selected from the Group Health Cooperative members in the Seattle area from 1994 to 1996 and followed biennially . PARTICIPANTS Two thous and five hundred eighty-one people aged 65 and older , cognitively intact at baseline . MEASUREMENTS Functional status was measured by activities of daily living , instrumental activities of daily living , and performance-based physical function testing .  RESULTS The cohort status at the time of these analyses was : deceased , 391 ; withdrawn , 179 ; dementia , 152 ; and on study , 1,873 . The mean follow-up time was 3.4 years . Using linear regressions with Generalized Estimating Equation , selected medical conditions ( diabetes mellitus , hypertension , coronary heart disease , cerebrovascular disease ( CVD ) , osteoporosis , arthritis , and cancer ) , low cognitive function , depression , and smoking were associated with worse functional outcomes .  Exercise and moderate alcohol use were associated with better functional outcomes . Over the follow-up period , coronary heart disease , CVD , and depression were associated with increased rates of functional decline .  Exercise and moderate alcohol consumption were associated with decreased rates of functional decline . Significant interactions were observed between exercise and coronary heart disease , moderate alcohol use and CVD , and cognition and CVD . CONCLUSIONS Our study has identified not only risk factors associated with functional decline but also the interactions among these factors . These observations , along with other published research , add to the growing underst and ing of the underlying process of functional change and could provide a basis to design effective strategies to delay functional decline OBJECTIVES To identify risk factors for five different subtypes of disability . DESIGN Prospect i ve cohort study . SETTING Greater New Haven , Connecticut . PARTICIPANTS Seven hundred fifty-four community-living residents aged 70 and older and initially nondisabled in four essential activities of daily living ( bathing , dressing , walking , and transferring ) . MEASUREMENTS C and i date risk factors were measured every 18 months for 90 months during comprehensive home-based assessment s. Disability was assessed during monthly telephone interviews for up to 108 months . In participants who were nondisabled at the start of an 18-month interval , incident episodes of five different disability subtypes were determined during the subsequent 18 months : transient , short-term , long-term , recurrent , and unstable . RESULTS The cumulative incidence rates per 100 person-intervals were 9.8 ( 95 % confidence interval (CI)=8.9 - 10.6 ) for transient disability , 3.8 ( 95 % CI=3.3 - 4.3 ) for short-term disability , 7.1 ( 95 % CI=6.4 - 7.8 ) for long-term disability , 4.7 ( 95 % CI=4.1 - 5.3 ) for recurrent disability , and 4.4 ( 95 % CI=3.9 - 5.0 ) for unstable disability . In a multivariate analysis , the Short Physical Performance Battery ( SPPB ) was associated with each of the five disability subtypes , with adjusted hazard ratios ranging from 1.10 for transient disability to 1.35 for long-term disability . The only other factors associated with short-term , long-term , and recurrent disability were stroke , visual impairment , and poor grip strength , respectively . Transient disability and unstable disability shared the same set of risk factors-depressive symptoms , stroke , and poor grip strength-in addition to the SPPB . CONCLUSION These results provide mixed evidence to support the distinct nature of the five disability subtypes Objective : This article examines the association between frequency of going out of the house and health and functional status among older people . Method : A r and omly chosen cohort of ambulatory participants born in 1920 or 1921 from the Jerusalem Longitudinal Study underwent assessment s for health , functional , and psychosocial variables at ages 70 and 77 . Twelve-year mortality data were collected . Results : Women went out daily less than did men . Participants going out daily at age 70 reported significantly fewer new complaints at age 77 of musculoskeletal pain , sleep problems , urinary incontinence , and decline in activities of daily living ( ADLs ) . Logistic regression analysis indicated that not going out daily at age 70 was predictive of subsequent dependence in ADL , poor self-rated health , and urinary incontinence at age 77 . Discussion : Going out daily is beneficial among independent older people , correlating with reduced functional decline and improved health measures
target: Conclusions This review shows that physical frailty indicators can predict ADL disability in community-dwelling elderly people .
  Slow gait speed and low physical activity/exercise seem to be the most powerful predictors followed by weight loss , lower extremity function , balance , muscle strength , and other indicators .
  Nevertheless , our study suggests that monitoring physical frailty indicators in community-dwelling elderly people might be useful to identify elderly people who could benefit from disability prevention programs
background: Background Disability in Activities of Daily Living ( ADL ) is an adverse outcome of frailty that places a burden on frail elderly people , care providers and the care system .
  Knowing which physical frailty indicators predict ADL disability is useful in identifying elderly people who might benefit from an intervention that prevents disability or increases functioning in daily life .
  The objective of this study was to systematic ally review the literature on the predictive value of physical frailty indicators on ADL disability in community-dwelling elderly people .