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Objective To develop a comprehensive set of the International Classification of Functioning, Disability and Health (ICF) categories as a minimal standard for reporting and assessing functioning and disability in clinical populations along the continuum of care. The specific aims were to specify the domains of functioning recommended for an ICF Rehabilitation Set and to identify a minimal set of environmental factors (EFs) to be used alongside the ICF Rehabilitation Set when describing disability across individuals and populations with various health conditions. Design Secondary analysis of existing data sets using regression methods (Random Forests and Group Lasso regression) and expert consultations. Setting Along the continuum of care, including acute, early postacute, and long-term and community rehabilitation settings. Participants Persons (N=9863) with various health conditions participated in primary studies. The number of respondents for whom the dependent variable data were available and used in this analysis was 9264. Interventions Not applicable. Main Outcome Measures For regression analyses, self-reported general health was used as a dependent variable. The ICF categories from the functioning component and the EF component were used as independent variables for the development of the ICF Rehabilitation Set and the minimal set of EFs, respectively. Results Thirty ICF categories to be complemented with 12 EFs were identified as relevant to the identified ICF sets. The ICF Rehabilitation Set constitutes of 9 ICF categories from the component body functions and 21 from the component activities and participation. The minimal set of EFs contains 12 categories spanning all chapters of the EF component of the ICF. Conclusions The identified sets proposed serve as minimal generic sets of aspects of functioning in clinical populations for reporting data within and across heath conditions, time, clinical settings including rehabilitation, and countries. These sets present a reference framework for harmonizing existing information on disability across general and clinical populations. [ABSTRACT FROM AUTHOR]

Describes frameworks of disability, universalism and the international classification of impairments, disabilities and handicaps. Development of frameworks and classificatory instruments over 20 years; Finding that universalism as a model for theory development, research and advocacy serves disabled persons more effectively than a civil rights approach.

Abstract: Objective: To explore whether it is possible to construct clinical measures of functioning by integrating information obtained across the categories of the International Classification of Functioning, Disability, and Health (ICF) using the ICF Core Set of osteoarthritis (OA) as a case in point. Study Design and Setting: Psychometric study using data from 437 patients with OA from Germany, Italy, Hungary, Serbia, and Singapore. The analyses were performed with the ICF categories of the comprehensive ICF Core Set for OA addressing functioning and using the Rasch model for ordered response options. Results: A clinical measure with 74 country-specific and seven common ICF categories was created with the pooled data of all countries but Hungary. The overall fit statistic according to the χ 2 was , P =0.054, and the Z-fit statistic was Z mean =−0.041 (Z standard deviation [SD] =1.01) for items and Z mean =−0.15 (Z SD =1.19) for persons. The Person Separation Index rβ was 0.92. Conclusion: For the first time, a cross-cultural clinical measure of functioning was constructed which integrates ICF categories. The results of this investigation are promising and can contribute to the acceptance and usefulness of the ICF in clinical practice. [Copyright &y& Elsevier]

Background and aim Frailty is characterized by several deficits in multiple health related domains. Although cognition is among the important components of frailty, there is lack of evidence on the role of specific neuro-cognitive dimensions. The primary aim of the present work was to evaluate the multidimensional definition of frailty, and to assess whether neuro-cognitive function is a constituent of the frailty syndrome among adults aged ≥50 years living in three European countries. As a secondary aim, the construct validity of the created frailty index was tested (with inpatient and outpatient hospitalization), as well as its determinants. Methods Data were obtained from a cross-sectional, community-based, nationally-representative survey conducted in Finland, Poland and Spain ( n  = 7987 individuals aged ≥50 years). Socio-demographic, clinical, lifestyle and social factors were assessed using validated procedures. Cognitive function was assessed with the following tests: learning and short-term memory, working memory and verbal fluency. A frailty index was constructed based on 31 frailty attributes. Principal component analysis was used to identify the components of the frailty index. Logistic and Poisson regression analysis was also conducted. Results The factor analysis on the components of the index extracted three main dimensions for frailty ( disability and daily functioning , cognitive function, chronic health conditions ), confirming the multiple dimensions of frailty. Various socio-demographic (e.g., financial status, education level) and lifestyle habits (alcohol consumption) were related with frailty. The presence of frailty was associated with 3.1 times higher odds for inpatient hospitalization (95%CI 2.75 to 3.51). Frailty was also related with higher frequency of outpatient visits. Conclusions These findings suggest that frailty is a multidimensional concept with three major dimensions. Neuro-congitive function seems to be a separate dimension of the frailty syndrome. Smoking habits and alcohol intake were positively related with frailty while inpatient and outpatient hospitalization were found to be associated to the level of frailty. [ABSTRACT FROM AUTHOR]

Objectives: Although there is substantial evidence that psychological factors play an important role in the onset and course of cardiovascular disease (CVD), less is known about their combined effect and the pathways by which they affect cardiovascular health. The present work aimed to prospectively explore the effects of depression and anxiety on the 10-year CVD incidence, in relation to other lifestyle determinants, as linking factors in the context of the ATTICA study. Study design/Main outcome measures: The ATTICA study is a population-based, health and nutrition prospective cohort study (2002-2012), during which 853 middle-aged participants without a history of CVD [453 men (aged 45±13years) and 400 women (aged 44±18years)], underwent psychological evaluations at enrollment. The latent trait of depression and anxiety combined measure was estimated and referred as "Psychological distress"; path analysis was applied to describe the relationships among the different factors.Results: "Psychological distress" was positively associated with the 10-year CVD incidence (adjusted OR per 10 units: 1.4, 95% CI: 1.1, 1.7). Three linking pathways were revealed: sedentariness, inflammation and metabolic syndrome. Moreover, "Psychological distress" mediated the association between socioeconomic status (SES) and CVD, with participants of low SES scoring higher on the psychological measure (adjusted linear regression coefficient b: -7.1, 95% CI: -9.7, -4.5).Conclusions: Lifestyle and clinical factors seem to link psychological distress with CVD development. Joint psychological assessments should be considered for inclusion in CVD preventive strategies, which should incorporate interventions for interrupting the linking pathways. [ABSTRACT FROM AUTHOR]

Objectives To explore the joint association of depression and cognitive function with severe disability in nationally-representative samples of community-dwelling adults aged 50 years and older from Finland, Poland and Spain. Design Cross-sectional. Setting Community-based. Participants Population-based sample of 7987 non-institutionalized adults aged 50 and older. Measurements The outcome was severe disability, defined as ≥ 90th percentile of the 12-item version of the World Health Organization Disability Assessment Schedule (WHODAS 2.0). Past 12-month DSM-IV major depressive disorder was assessed with the depression module of the WHO Composite International Diagnostic Interview (CIDI). A global cognitive function score was obtained through neuropsychological tests. Product terms between depression and cognition were introduced in multivariable logistic regression models to test for interaction. Results Lower cognitive function and depression were both significantly associated with severe disability in all countries. A significant interaction was only found in Finland where the ORs (95% CIs) of depression for severe disability at the 25th (worse), 50th, and 75th (better) percentiles of cognitive function were 7.26 (4.28–12.32), 11.1 (6.7–18.38), and 17.56 (9.29–33.2), respectively. Conclusion People with depression and cognitive decline are likely to benefit from the usual evidence-based treatments to reduce the burden of disability. However, in Finland, those with better cognitive function may benefit from more aggressive depression treatment. Future research is warranted to assess whether our results may be replicated. [ABSTRACT FROM AUTHOR]

Background: The aim of this study was to evaluate the association of sarcopenia and sarcopenic obesity with disability among older adults (= 65 years old) in nine high-, middle- and low-income countries from Asia, Africa, Europe, and Latin America. Methods: Data were available for 53,289 people aged = 18 years who participated in the Collaborative Research on Ageing in Europe (COURAGE) survey conducted in Finland, Poland, and Spain, and the WHO Study on global AGEing and adult health (SAGE) survey conducted in China, Ghana, India, Mexico, Russia, and South Africa, between 2007 and 2012. Skeletal muscle mass, skeletal muscle mass index, and percent body fat were calculated with specific population formulas. Sarcopenia and sarcopenic obesity were defined by specific cut-offs used in previous studies. Disability was assessed with the WHODAS 2.0 score (range 0-100) with higher scores corresponding to higher levels of disability. Multivariable linear regression analysis was conducted with disability as the outcome. Results: The analytical sample consisted of 18,363 people (males; n = 8116, females; n = 10247) aged = 65 years with mean (SD) age 72.9 (11.1) years. In the fully-adjusted overall analysis, sarcopenic obesity was associated with greater levels of disability [b-coefficient 3.01 (95% CI 1.14-4.88)]. In terms of country-wise analyses, sarcopenia was associated with higher WHODAS 2.0 scores in China [b-coefficient 4.56 (95% CI: 3.25-5.87)], Poland [b-coefficient 6.66 (95% CI: 2.17-11.14)], Russia [b-coefficient 5.60 (95% CI: 2.03-9.16)], and South Africa [b-coefficient 7.75 (95% CI: 1.56-13.94)]. Conclusions: Prevention of muscle mass decline may contribute to reducing the global burden of disability. [ABSTRACT FROM AUTHOR]

The aim of the study was to evaluate the association between various factors and diabetes type II (DM) with a particular emphasis on indicators of central obesity, and to compare the effect of DM on disability among elder populations (≥ 50 years old) in nine countries. Data were available for 52,946 people aged ≥ 18 years who participated in the WHO Study on global AGEing and adult health and the Collaborative Research on Ageing in Europe studies conducted between 2007 and 2012. DM was defined as self-report of physician diagnosis. Height, weight, and waist circumference were measured. Disability status was assessed with the WHODAS II questionnaire. The overall prevalence of DM was 7.9% and ranged from 3.8% (Ghana) to 17.6% (Mexico). A 10 cm increase in waist circumference and waist-to-height ratio of > 0.5 were associated with a significant 1.26 (India) to 1.77 (Finland), and 1.68 (China, Spain) to 5.40 (Finland) times higher odds for DM respectively. No significant associations were observed in Mexico and South Africa. DM was associated with significantly higher disability status in all countries except Mexico in the model adjusted for demographics and smoking. The inclusion of chronic conditions associated with diabetes in the model attenuated the coefficients in varying degrees depending on the country. A considerable proportion of the studied older population had DM. Central obesity may be a key factor for the prevention of DM among older populations globally. Prevention of DM especially among the older population globally may contribute to reducing the burden of disability. [ABSTRACT FROM AUTHOR]

Background The evidence suggesting that gait speed may represent a sensitive marker for cognitive decline in the elderly requires support from diverse racial groups. Objective We investigated the relationship between gait speed and cognitive decline over 2 years in a community dwelling sample of elderly Africans. Methods Data are from the Ibadan study of aging (ISA) conducted among a household multi-stage probability sample of 2149 Yoruba Nigerians aged 65 years or older. Gait speed was measured as the time taken to complete a 3 or 4 m distance at normal walking speed. We assessed cognitive functions with a modified version of the 10-word learning list and delay recall test, and examined the relationship between baseline gait speed, as well as gait speed changes, and follow-up cognition using multiple linear regression and longitudinal analyses using random effects. Results Approximately 71% of 1461 participants who were dementia free and who had their gait speed measured at baseline (2007) were successfully followed up in two waves (2008 and 2009). Along with increasing age, poor health and economic status, a slower baseline gait speed was independently associated with poorer follow-up cognition in both linear regression (1.2 words, 95% CI = 0.48–2.0) and longitudinal analyses (0.8 words, 95% CI = 0.44–1.2). Also, a greater change in gait speed between 2007 and 2009 was associated with the worst follow-up cognition (0.3 words, 95% CI = 0.09–0.51). Conclusion The finding that a substantial change in gait speed was associated with reduced cognitive performance is of potential importance to efforts aimed at early identification of cognitive disorders in this population. [ABSTRACT FROM AUTHOR]

Objective : The aim of this study was to evaluate the factors associated with different components of arterial blood pressure in nine nationally-representative samples of people aged ≥50 years. Methods : Data were available for 53,289 people aged ≥18 years who participated in the SAGE (WHO Study on global AGEing and adult health) study conducted in China, Ghana, India, Mexico, Russia, and South Africa, and the COURAGE (Collaborative Research on Ageing in Europe) study conducted in Finland, Poland, and Spain, between 2007 and 2012. Standard procedures were used to obtain diastolic and systolic blood pressure (DBP, SBP) measurements to identify hypertensive participants, and to determine mean arterial blood pressure (MAP) and pulse pressure (PP). Results : The analytical sample consisted of 42,116 people aged 50 years or older. South Africa had the highest prevalence of hypertension (78.3%), and the highest measurements of MAP ± SD (113.6 ± 36.4 mmHg), SBP ± SD (146.4 ± 49.5 mmHg), and DBP ± SD (97.2 ± 33.9 mmHg). In the adjusted models, dose-dependent positive associations between Body Mass Index (BMI) and MAP or PP were observed in most countries ( p < 0.05). Diabetes was positively associated with PP in most countries but the association between diabetes and MAP was less consistent. Stroke was associated with both higher MAP and PP in China, Ghana, and South Africa ( p < 0.05). Conclusions : Obesity and diabetes remain important modifiable risk factors for arterial peripheral resistance and stiffness as reflected by MAP and PP respectively. Controlling arterial pressure abnormalities after stroke events may be important for secondary prevention, particularly in developing countries. [ABSTRACT FROM AUTHOR]

Abstract: We compared prevalence estimates of self-rated health (SRH) derived indirectly using four different small area estimation methods for the Vadu (small) area from the national Study on Global AGEing (SAGE) survey with estimates derived directly from the Vadu SAGE survey. The indirect synthetic estimate for Vadu was 24% whereas the model based estimates were 45.6% and 45.7% with smaller prediction errors and comparable to the direct survey estimate of 50%. The model based techniques were better suited to estimate the prevalence of SRH than the indirect synthetic method. We conclude that a simplified mixed effects regression model can produce valid small area estimates of SRH. [Copyright &y& Elsevier]

Abstract: Objective: There has been no attempt to obtain a continuous summary measure of disability from the checklist of the International Classification of Functioning, Disability and Health (ICF). Our objective was to assess whether valid scales of Capacity and Performance could be developed from the “Activities and Participation” domain of the ICF checklist. Study Design and Setting: A multicenter, observational study of 1,092 patients with 12 different chronic conditions from five European countries was conducted. Exploratory and confirmatory factor analyses were performed to assess the underlying factor structure. Reliability and validity of the Capacity and Performance scales were evaluated. Construct validity was assessed calculating effect size coefficients between extreme severity groups (discriminant ability). Results: The good fit of the confirmatory factor model supported the global scales of Capacity and Performance and their “Psychosocial” and “Physical” subscales. Reliability was excellent (coefficients=0.79–0.92). Effect sizes of most conditions were large for the Capacity global scale (0.50–3.05), and slightly lower for the Performance global scale (0.45–2.57). Conclusions: Our findings support the measurement model, reliability, and validity of the Capacity and Performance scales. Summary measures of functioning based on the ICF can be obtained using these scales, which should facilitate their incorporation in clinical and epidemiological studies. [Copyright &y& Elsevier]

Background: Physical inactivity is an important risk factor for chronic diseases, but for many (mainly developing) countries, no prevalence data have ever been published. Objective: To present data on the prevalence of physical inactivity for 51 countries and for different age groups and settings across these countries. Methods: Data analysis (conducted in 2007) included data from 212,021 adult participants whose questionnaires were culled from 259,526 adult observations from 51 countries participating in the World Health Survey (2002–2003). The validated International Physical Activity Questionnaire (IPAQ) was used to assess days and duration of vigorous, moderate, and walking activities during the last 7 days. Results: Country prevalence of physical inactivity ranged from 1.6% (Comoros) to 51.7% (Mauritania) for men and from 3.8% (Comoros) to 71.2% (Mauritania) for women. Physical inactivity was generally high for older age groups and lower in rural as compared to urban areas. Conclusions: Overall, about 15% of men and 20% of women from the 51 countries analyzed here (most of which are developing countries) are at risk for chronic diseases due to physical inactivity. There were substantial variations across countries and settings. The baseline information on the magnitude of the problem of physical inactivity provided by this study can help countries and health policymakers to set up interventions addressing the global chronic disease epidemic. [Copyright &y& Elsevier]

Depression and loneliness act in a synergistic way among older adults. We tested two indicators of the perceived neighborhood built environment (BE) as moderators of the association between these conditions in older European adults. Positive perceptions of neighborhood BE were related to lower levels of loneliness but not to major depressive disorder (MDD). Reporting low BE usability was significantly related to a higher likelihood of feeling lonely except for those suffering from MDD, whereas reporting low BE walkability was significantly related with a high likelihood of loneliness particularly among those with MDD. Therefore, improving neighborhood BE and, specifically, its walkability, might result in a reduction in the prevalence of loneliness. [ABSTRACT FROM AUTHOR]

Abstract: Objective: To exemplify the construction of interval scales for specified categories of the International Classification of Functioning, Disability and Health (ICF) by integrating items from a variety of patient-oriented instruments. Study Design and Setting: Psychometric study using data from a convenience sample of 122 patients with rheumatoid arthritis. Patients completed six different patient-oriented instruments. The contents of the instrument items were linked to the ICF. Rasch analyses for ordered-response options were used to examine whether the instrument items addressing the ICF category b130: Energy and drive functions constitute a psychometrically sound interval scale. Results: Nineteen items were linked to b130: Energy and drive functions. Sixteen of the 19 items fit the Rasch model according to the chi-square (χ 2) statistic (χ 2 df=32 =38.25, P =0.21) and the Z-fit statistic (Z Mean =0.451, Z SD =1.085 and Z Mean =−0.223, Z SD =1.132 for items and persons, respectively). The Person Separation Index r β was 0.93. Conclusion: The ICF category interval scales to operationalize single ICF categories can be constructed. The original format of the items included in the interval scales remains unchanged. This study represents a step forward in the operationalization and future implementation of the ICF. [Copyright &y& Elsevier]