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Byline: Mojtaba. Sharafkhah, Ghasem. Mosayebi, Ali. Massoudifar, Seyed. Seddigh, Ali. Abdolrazaghnejad, Mobina. Alamdara, Peyman. Mokarian, Abolfazl. Mohammadbeigi, Mohsen. Ebrahimi-Monfared Background: There is a strong need to identify simple and cost-effective [...]

Background. Recent studies have suggested that inflammation may play an important role in aging and the development of disabilities, but knowledge about its importance in the development of muscle weakness and functional disabilities in very old people is limited. This study examined associations between inflammatory markers and physical performance among nonagenarians. Methods. The population-based sample consisted of 197 women and 65 men aged 90 years. Physical performance was assessed according to the Barthel Index, the chair stand, and handgrip strength. Plasma levels of interleukin-6 (IL-6), interleukin-1 receptor antagonist (IL-1Ra), and C-reactive protein (CRP) were determined. Results. A gender-adjusted linear regression model showed that high levels of CRR IL-6, and IL-IRa were significantly associated with poor handgrip strength (p = .041, p = .023, p < .001, respectively). After adjustment for diseases, smoking and physical exercise high levels of IL-6 and IL-IRa were still significantly associated with poor hand grip strength (p = .048, p = .004, respectively). In the gender-adjusted model, high levels of CRP, IL-6, and IL-IRa were significantly associated with a worse Barthel Index (p = .009, p = .004, p = .004, respectively). High levels of CRP and IL-6 were still significantly associated with a worse Barthel Index after adjusted for diseases, smoking and physical exercise (p = .034, p = .041, respectively). In the chair stand, no significant association with inflammatory markers was found. Conclusions. Associations between high levels of inflammatory markers and worse handgrip strength as well as a worse Barthel index result were evident among nonagenarians. However, the association with the chair stand was not significant. doi: 10.1093/gerona/glq056

Objectives. The aim of the present study is to investigate differences in total life expectancy (TLE), disability-free life expectancy (DFLE), disabled life expectancy (DLE), and personal care assistance between individuals with and without diabetes in Mexico. Methods. The sample was drawn from the nationally representative Mexican Health and Aging Study. Disability was assessed through a basic Activities of Daily Living (ADL) measure, the Instrumental Activities of Daily Living (IADL) scale, and the Nagi physical performance measure. The Interpolation of Markov Chains method was used to estimate the impact of diabetes on TLE and DFLE. Results. Results indicate that diabetes reduces TLE at ages 50 and 80 by about 10 and 4 years, respectively. Diabetes is also associated with fewer years in good health. DFLE (based on ADL measures) at age 50 is 20.8 years (95% confidence interval [CI]: 19.2-22.3) for those with diabetes, compared with 29.9 years (95% CI: 28.8-30.9) for those without diabetes. Regardless of diabetes status, Mexican women live longer but face a higher disability burden than men. Conclusion. Among older adults in Mexico, diabetes is associated with shorter TLE and DFLE. The negative effect of diabetes on the number of years lived, particularly in good health, creates significant economic, social, and individual costs for elderly Mexicans. Key Words: Aging--Diabetes--Disability--Life expectancy--Mexico. doi: 10.1093/geronb/gbp119

Objectives. We used a life course approach to assess the ways in which childhood socioeconomic position may be associated with disability in later life. Methods. We used longitudinal data from the nationally representative Health and Retirement Study (1998-2006) to examine associations between parental education, paternal occupation, and disabilities relating to activities of daily living (ADLs) and instrumental activities of daily living (IADLs). Results. Respondents whose fathers had low levels of education and those whose fathers were absent or had died while they were growing up were at increased risk of disability in later life, net of social, behavioral, and pathological health risks in adulthood. Social mobility and health behaviors were also important factors in the association between low childhood socioeconomic position and ADL and IADL disabilities. Conclusions. Our findings highlight the need for policies and programs aimed at improving the well-being of both children and families. A renewed commitment to such initiatives may help reduce health care costs and the need for people to use health and social services in later life. (Am J Public Health. 2010; 100:S197-S203. doi: 10.2105/AJPH.2009.160986)

Objectives. We investigated trends in disability among older Americans from 1988 through 2004 to test the hypothesis that more recent cohorts show increased burdens of disability. Methods. We used data from 2 National Health and Nutrition Examination Surveys (1988-1994 and 1999-2004) to assess time trends in basic activities of daily living, instrumental activities, mobility, and functional limitations for adults aged 60 years and older. We assessed whether changes could be explained by sociodemographic, body weight, or behavioral factors. Results. With the exception of functional limitations, significant increases in each type of disability were seen over time among respondents aged 60 to 69 years, independent of sociodemographic characteristics, health status, relative weight, and health behaviors. Significantly greater increases occurred among non-Whites and persons who were obese or overweight (2 of the fastest-growing subgroups within this population). We detected no significant trends among respondents aged 70 to 79 years; in the oldest group (aged >80 years), time trends suggested lower prevalence of functional limitations among more recent cohorts. Conclusions. Our results have significant and sobering implications: older Americans face increased disability, and society faces increased costs to meet the health care needs of these disabled Americans. (Am J Public Health. 2010;100: 100-107. doi: 10.2105/AJPH.2008.157388)

Objective. To investigate whether the health and functioning of the Baby Boom generation are better or worse than those of previous cohorts in middle age. Methods. Trend analysis of vital statistics and self-reports from the National Health Interview Survey for the 40-59 population. Specific outcomes (years of data): mortality (1982-2004); poor or fair health (1982-2006); nine conditions (1997-2006); physical functional limitations (1997-2006); and needing help with personal care. routine needs, or either (1997-2006). Results. In 2005, the mortality rate of 59-year-olds, the leading edge of the Baby Boom, was 31% lower than that of 59-year-olds in 1982 (8.3 vs. 12.1 per 1,000). There was a similar proportional decline in poor/fair health, but the decline reversed in the last decade. From 1997 to 2006, the prevalence of reports of four conditions increased significantly, but this trend may reflect improvements in diagnosis and treatment. Functional limitations and need for help with routine needs were stable, but the need lot help with personal care. while quite low, increased. Discussion. Trends varied by indicator, period, and age. It is surprising that, given the socioeconomic, medical, and public health advantages of Baby Boomers throughout their lives, they are not doing considerably better on all counts. Key Words: Trends--Mortality--Chronic Conditions--Functioning--Disability--Baby Boom.

Part of the solution to the growing problem of child injury is to strengthen the care that injured children receive. This paper will point out the potential health gains to be made by doing this and will then review recent advances in the care of injured children in individual institutions and countries. It will discuss how these individual efforts have been aided by increased international attention to trauma care. Although there are no major, well-funded global prograrnmes to improve trauma care, recent guidance documents developed by WHO and a broad network of collaborators have stimulated increased global attention to improving planning and resources for trauma care. This has in turn led to increased attention to strengthening trauma care capabilities in countries, including needs assessments and implementation of WHO recommendations in national policy. Most of these global efforts, however, have not yet specifically addressed children. Given the special needs of the injured child and the high burden of injury-related death and disability among children, clearly greater emphasis on childhood trauma care is needed. Trauma care needs assessments being conducted in a growing number of countries need to focus more on capabilities for care of injured children. Trauma care policy development needs to better encompass childhood trauma care. More broadly, the growing network of individuals and groups collaborating to strengthen trauma care globally needs to engage a broader range of stakeholders who will focus on and champion the improvement of care for injured children. Une traduction en francais de ce resume figure a la fin de l&apos;article. Al final del articulo se facilita una traduccion al espanol. L&apos;une des solutions au probleme grandissant pose par la traumatologie infantile reside dans le renforcement des soins delivres aux enfants victimes de traumatismes. Le present article attire l&apos;attention sur les gains en matiere de sante realisables par un tel renforcement et passe ensuite en revue les progres recemment obtenus par differents etablissements et pays dans les soins aux enfants victimes de traumatismes. II examine comment ces efforts individuels ont ete aides par l&apos;attention internationale grandissante accordee aux soins aux enfatns traumatises. Malgre l&apos;absence de programme mondial de grande envergure et bien finance pour ameliorer ces soins, les recents documents-guides elabores par l&apos;OMS et un large reseau de collaborateurs ont stimule l&apos;interet mondial pour une meilleure planification et un meilleur financement de ces soins. A son tour, cet interet a attire davantage l&apos;attention sur le renforcement des capacites de traitement des traumatismes dans les pays, y compris l&apos;evaluation des besoins et la mise en ceuvre des recommandations de l&apos;OMS dans le cadre des politiques nationales. Neanmoins, la plupart de ces efforts mondiaux ne visaient pas encore specifiquement les enfants. Les besoins particuliers des enfants victimes de traumatismes, comine la mortalite et la charge d&apos;incapacite importantes liees aux traumatismes dans cette classe l&apos;ages, appellent a donner une plus grande priorite aux soins prodigues a ces enfants. Les evaluations de ces soins menees dans un nombre grandissant de pays doivent se concentrer davantage sur les capacites de traitement des enfants. Les politiques de soins aux victimes de traumatismes doivent etre developpees de maniere a mieux integrer les soins aux enfants. Plus largement, le reseau en expansion des individus et des groupes collaborant au renforcement des soins aux victimes de traumatismes doit impliquer une gamme plus etendue de parties prenantes, qui concentreront leurs efforts sur l&apos;amelioration des soins aux enfants aux enfants traumatises et militeront pour cette amelioration. Parte de la solucion al problema creciente de las lesiones infantiles consiste en fortalecer la asistencia que reciben los pacientes. En este articulo se senalan los potenciales beneficios sanitarios que se obtendrian, se examinan los avances recientes que se han realizado en materia de asistencia a los ninos con lesiones en diferentes instituciones y paises, y se analiza como ha contribuido a ello la mayor atencion prestada a nivel internacional a la asistencia a los traumatismos. Aunque no hay grandes programas mundiales bien financiados para mejorar la asistencia a los traumatismos, los documentos de orientacion elaborados recientemente por la OMS y una amplia red de colaboradores han estimulado un aumento de la atencion mundial a la mejora de la planificacion y de los recursos para la asistencia a los traumatismos, lo cual ha generado, a su vez, un aumento de la atencion al fortalecimiento de la capacidad de asistencia a los traumatismos en los paises, y en particular a la evaluacion de las necesidades y a la aplicacion de las recomendaciones de la OMS en las politicas nacionales. Sin embargo, la mayor parte de estos esfuerzos mundiales todavIa no se han ocupado especIficamente de los ninos. Dadas las necesidades especiales de los ninos con lesiones y la elevada mortalidad y discapacidad relacionadas con las lesiones en esta poblacion, hay una necesidad evidente de prestar mayor atencion a la asistencia a los traumatismos en la infancia. La elaboracion de politicas de asistencia a los traumatismos debe prestar mas atencion a los traumatismos infantiles. A un nivel mas general, la creciente red de individuos y grupos que estan colaborando en el fortalecimiento de la asistencia a los traumatismos necesita comprometer a una gama mas amplia de partes interesadas que se centren en la defensa de la mejora de la asistencia a los ninos victimas de lesiones., Introduction Injury has become a leading cause of death and disability globally. The two age groups most affected are older children (aged 5-14 years) and adolescents and younger adults (aged [...]

Objectives. We examined associations between racial discrimination and actualization, defined as the degree of positive integration between self-identity and racial group identity, and self-rated health and physical pain and impairment. Methods. We used logistic regressions to analyze data from 447 gay, lesbian, bisexual, and other sexual-minority American Indians/Alaska Natives. Results. Greater self-reported discrimination was associated with higher odds of physical pain and impairment (odds ratio [OR]=1.42; 95% confidence interval [Cl]=1.13, 1.78); high levels of actualization were associated with lower odds of physical pain and impairment (OR=0.59; 95% Cl=0.35, 0.99) and self-rated fair or poor health (OR=0.54; 95% Cl=0.32, 0.90). Actualization also moderated the influence of discrimination on self-rated health (t=-2.33; P=.020). Discrimination was positively associated with fair or poor health among participants with low levels of actualization, but this association was weak among those with high levels of actualization. Conclusions. Among two-spirit American Indians/Alaska Natives, discrimination may be a risk factor for physical pain and impairment and for fair or poor self-rated health among those with low levels of actualization. Actualization may protect against physical pain and impairment and poor self-rated health and buffer the negative influence of discrimination. (doi:10.2105/AJPH.2007.126003)

Objective. To characterize the influence of the residential neighborhood of older adults on the prevalence of disability. Methods. We combined Census data on disability in older adults living in New York City with environmental information from a comprehensive geospatial database. We used factor analysis to derive dimensions of compositional and physical neighborhood characteristics and linear regression to model their association with levels of disability. Measures of neighborhood collective efficacy were added to these models to explore the impact of the social environment. Results. Low neighborhood socioeconomic status, residential instability, living in areas with low proportions of foreign born and high proportions of Black residents, and negative street characteristics were associated with higher prevalence of both 'physical' disability and 'going outside the home' disability. High crime levels were additionally associated with physical disability, although this relationship disappeared when misdemeanor arrests were removed from the crime variable. Low levels of collective efficacy were associated with more going-outside-the-home disability, with racial/ethnic composition dropping out of this model to be replaced by an interaction term. Conclusion. The urban environment may have a substantial impact on whether an older adult with a given level of functional impairment is able to age actively and remain independent. Key Words: Disability--Elderly--Environment--Neighborhood.

Poor early conditions have been associated with increasing risks of some chronic diseases during adulthood. Since chronic illnesses are known to be important risk factors for disability, poor early conditions should predict disability at older ages. In addition, recent literature suggests that poor early conditions may affect the risk of disability even in the absence of chronic illnesses. We aimed to evaluate the magnitude of differentials in the risk of being disabled according to early conditions experienced by elderly populations in Latin America and the Caribbean, and to identify the group of chronic illnesses responsible for it. We find that poor early conditions exert a strong influence on disability later in life in two ways: by increasing the risk of suffering disability-related chronic illnesses and by increasing the risks of suffering disabilities by those with chronic illnesses. Keywords: early conditions; chronic diseases; disabilities; ageing; Latin America

State-level income inequality has been found to have an effect on individual health outcomes, even when controlled for important individual-level variables such as income, education, age, and gender. The effect of income inequality on health may not be immediate and may, in fact, have a substantial lag time between exposure to inequality and eventual health outcome. We used the 2006 American Community Survey to examine the association of state-level income inequality and 2 types of physical disabilities. We used 6 different lag times, ranging between 0 and 25 years, on the total sample and on those who resided in their state of birth. Income inequality in 1986 had the strongest correlation with 2006 disability levels. Odds ratios were consistently 10% higher for those born in the same state compared with the total population. doi:10.2105/AJPH.2008.134940

Objectives. We examined the relationship of regular exercise and body weight to disability among healthy seniors. Methods. We assessed body mass index (BMI) and vigorous exercise yearly (1989-2002) in 805 participants aged 50 to 72 years at enrollment. We studied 4 groups: normal-weight active (BMI < 25 kg/[m.sup.2]; exercise > 60 min/wk); normal-weight inactive (exercise [less than or equal to] 60 min/wk); overweight active (BMI [greater than or equal to] 25 kg/[m.sup.2]); and overweight inactive. Disability was measured with the Health Assessment Questionnaire (0-3; 0=no difficulty, 3=unable to do). We used multivariable analysis of covariance to determine group differences in disability scores after adjustment for determinants of disability. Results. The cohort was 72% men and 96% White, with a mean age of 65.2 years. After 13 years, overweight active participants had significantly less disability than did overweight inactive (0.14 vs 0.19; P=.001) and normal-weight inactive (0.22; P=.03) participants. Similar differences were found between normal-weight active (0.11) and normal-weight inactive participants (P Conclusions. Being physically active mitigated development of disability in these seniors, largely independent of BMI. Public health efforts that promote physically active lifestyles among seniors may be more successful than those that emphasize body weight in the prevention of functional decline.

Objectives. We sought to determine change in the prevalence of functional limitations and physical disability among the community-dwelling elderly population across 3 decades. Methods. We studied original participants of the Framingham Heart Study, aged 79 to 88 years, at examination 15 (1977-1979; 177 women, 103 men), examination 20 (1988-1990; 159 women, 98 men) and examination 25 (1997-1999; 174 women, 119 men). Self-reported functional limitation was defined using the Nagi scale, and physical disability was defined using the Rosow-Breslau and Katz scales. Results. Functional limitations declined across examinations from 74.6% to 60.5% to 37.9% (P Conclusions. Among community-dwelling elders, the prevalence of functional limitations and physical disability declined significantly in both women and men from the 1970s to the 1990s. This may in part be due to improvements in technological devices used to maintain independence. Further work is needed to identify the underlining causes of the decline so preventative measures can be established that promote independence for the elderly population.

This article presents the results of a study on the correlates of disability in old age. We found that at the descriptive level and in the regression model that includes only demographic variables as controls, the odds of Black and Hispanic elderly persons being disabled were greater. However, when socioeconomic factors and demographic factors were taken into account, the racial/ethnic disadvantage disappears. In the model that dealt with disability based on the composite indexes of disability (that is, all types of disability combined) and in the model that dealt with disability based on functional limitations, we found that the odds of Black and Hispanic elderly persons being disabled were smaller than the odds of White elderly persons being disabled. We conclude that socioeconomic factors--not race/ethnicity--correlate with disability in old age. Implications for policy are discussed. KEYWORDS. Race/ethnicity, disability, socioeconomic class, old age, functional limitations, ADL, IADL, income, net worth, education

Axonal degeneration is an important determinant of progressive neurological disability in multiple sclerosis (MS). Thus, therapeutic approaches promoting neuroprotection could aid the treatment of progressive MS. Here, we used what we believe is a novel water-soluble fullerene derivative (ABS-75) attached to an NMDA receptor antagonist, which combines antioxidant and anti-excitotoxic properties, to block axonal damage and reduce disease progression in a chronic progressive EAE model. Fullerene ABS-75 treatment initiated after disease onset reduced the clinical progression of chronic EAE in NOD mice immunized with myelin-oligodendrocyte glycoprotein (MOG). Reduced disease progression in ABS-75-treated mice was associated with reduced axonal loss and demyelination in the spinal cord. Fullerene ABS-75 halted oxidative injury, [CD11b.sup.+] infiltration, and CCL2 expression in the spinal cord of mice without interfering with antigen-specific T cell responses. In vitro, fullerene ABS-75 protected neurons from oxidative and glutamate-induced injury and restored glutamine synthetase and glutamate transporter expression in astrocytes under inflammatory insult. Glutamine synthetase expression was also increased in the white matter of fullerene ABS-75-treated animals. Our data demonstrate the neuroprotective effect of treatment with a fullerene compound combined with a NMDA receptor antagonist, which may be useful in the treatment of progressive MS and other neurodegenerative diseases., Introduction Epidemiologic studies show that approximately 85% of patients with MS initially develop a relapsing-remitting form of the disease (1), (2). However, within 10 years, approximately half of those with [...]

Objective: Increased wait times for total joint arthroplasty (TJA) are a concern nationally and provincially. Additionally, the number of patients requiring revision of their initial TJA is increasing. The purpose [...]

Between 40 million and 50 million people in the United States--at least one in seven residents--currently report having some kind of disability that limits their daily activities or restricts their […]

Skeletal muscle constitutes [approximately equal to]40% of the human body mass, and alterations in muscle mass and strength may result in physical disability. Therefore, the elucidation of the factors responsible for muscle force development is of paramount importance. Excitation--contraction coupling (ECC) is a process during which the skeletal muscle surface membrane is depolarized, causing a transient release of calcium from the sarcoplasmic reticulum that activates the contractile proteins. The ECC machinery is complex, and the functional role of many of its protein components remains elusive. This study demonstrates that deletion of the gene encoding the sarcoplasmic reticulum protein JP45 results in decreased muscle strength in young mice. Specifically, this loss of muscle strength in JP45 knockout mice is caused by decreased functional expression of the voltage-dependent [Ca.sup.2+] channel [Ca.sub.v]1.1, which is the molecule that couples membrane depolarization and calcium release from the sarcoplasmic reticulum. These results point to JP45 as one of the molecules involved in the development or maintenance of skeletal muscle strength. calcium release | excitation-contraction coupling

Background. The prevalence of disability in bathing and the likelihood of a long-term nursing home admission increase substantially with age. We performed a prospective study to determine whether the occurrence of persistent disability in bathing is associated with the risk of a long-term nursing home admission, independent of potential confounders, including persistent disability in other essential activities of daily living. Methods. We studied 754 community-living persons, 70 years old or older, who were nondisabled in four essential activities of daily living. Participants were followed with monthly telephone interviews for a median of 75 months to determine the occurrence of persistent (i.e., present for at least 2 consecutive months) disability in bathing and the time to the first long-term nursing home admission, defined as longer than 3 months. Results. One hundred thirteen (15.0%) participants had a long-term nursing home admission. At least one episode of persistent bathing disability occurred among 59 (52.2%) participants with a long-term nursing home admission and 210 (32.8%) without a long-term admission (p < .001). In a proportional hazards model that was fully adjusted for potential confounders, the occurrence of persistent bathing disabilty increased the risk of a long-term nursing home admission by 77% (hazard ratio 1.77, 95% confidence interval 1.05 to 2.98), but had no effect on the risk of a short-term nursing home admission (hazard ratio 0.87, 95% confidence interval 0.51 to 1.49). Conclusions. Among community-living older persons, the occurrence of persistent disability in bathing is independently associated with the risk of a long-term nursing home admission, but has no effect on short-term admissions. Interventions directed at the prevention and remediation of bathing disability have the potential to reduce the burden and expense of long-term care services.

Byline: Justin M. Nash (1,3), David M. Williams (1), Robert Nicholson (2), Peter C. Trask (1) Keywords: headache; disability; pain anxiety; self-efficacy; locus of control Abstract: Disability associated with headache cannot be fully accounted for by pain intensity and headache frequency. As such, a variety of cognitive and affective factors have been identified to help explain headache-related disability beyond that accounted for by pain levels. Pain-related anxiety, a multidimensional construct, also has been found to contribute to disability in headache sufferers. What is not known is whether pain-related anxiety is unique in contributing to disability beyond the role of headache-specific cognitive factors and emotional distress. The present study examines the influence of pain-related anxiety on disability, after controlling for pain, cognitive (self-efficacy and locus of control), and affective factors (emotional distress) in a sample of 96 primary headache sufferers. Pain, headache-related control beliefs, and emotional distress accounted for 32%, with locus of control related to health care professionals contributing unique variance. In the full model, with the addition of pain-related anxiety, only pain-related anxiety was a unique predictor of disability. These findings suggest that pain-related anxiety may have a unique and important role in contributing to disability in headache sufferers. Author Affiliation: (1) Centers for Behavioral and Preventive Medicine, Brown Medical School/The Miriam Hospital, Providence, Rhode Island, USA (2) Department of Community and Family Medicine, St. Louis University School of Medicine, St. Louis, Missouri, USA (3) Centers for Behavioral and Preventive Medicine, Brown Medical School/The Miriam Hospital, Providence, Rhode Island, USA Article History: Registration Date: 29/09/2005 Accepted Date: 11/07/2005 Online Date: 06/01/2006

Nearly 20% of US citizens are disabled. Epidemiologic studies have shown that people with physical disabilities have a 1.2- to 3.9-fold increase in obesity prevalence. Obesity is becoming a serious problem in disabled individuals. The mechanisms by which obesity occurs in people with physical disabilities is not clear, but pathophysiological changes of body composition and energy metabolism, physical inactivity, and muscle atrophy all favor the development of obesity. Health professionals should identify disabled patients at risk and provide early prevention guidance. Research is needed to help generate detailed clinical guidelines to promote weight control among people with physical disabilities. Key words: Physical disability, obesity, body composition, energy metabolism, secondary condition

Background. This paper reports the association between self-reported diseases and impairments and 2-year onset of disability in a prospective study of people aged 65 years or older in five urban and rural centers in England and Wales (Medical Research Council Cognitive Function and Ageing Study; MRC-CFAS). Methods. We initially reviewed risk factors for onset of disability in 35 prospective studies of functional decline in older people published in 1998-2001. In the present study, disability was defined as requiring help from another person at least several times a week and was assessed by dependency in activities of daily living. Polytomous and bivariate logistic regression models were fitted for onset of disability and mortality among those nondisabled at baseline (n = 7913), adjusting for age, sex, and sociodemography. Results. Among prevalent conditions, arthritis (population-attributable risk 11.4%) and cognitive impairment indicated by a Mini-Mental State Examination score of [less than or equal to] 21 (population-attributable risk 6.8%) were powerful predictors of incident disability. Baseline cognitive impairment, stroke, treated diabetes, chronic airways obstruction, coronary heart disease, and treated hypertension were significantly associated with both incident disability and mortality, whereas Parkinson's disease, eyesight problems, and arthritis were statistically significant disabling conditions not associated with mortality. Stroke, heart attack, cognitive impairment, eyesight problems, and hearing problems were newly occurring conditions significantly associated with onset of disability. Conclusions. Cognitive impairment, arthritis, followed by stroke, and problems with vision have major impact on population disability at older ages. Both prevalent and incident conditions must be considered as risk factors to accurately assess potential benefits from prevention.

A study done reveals that adverse cognitive sequelae are more frequent outcome among more mature preterm populations. The cognitive impairments explain the educational difficulties that exist for extremely low-birth-weight children.

Background. Physical performance measures can predict incident disability, but little research has assessed and compared how these measures predict progressive and rapid-onset (catastrophic) disability. The authors evaluated the ability of upper and lower extremity performance measures to predict progressive and catastrophic disability in activities of daily living (ADL), mobility, and upper extremity function. Methods. The incidence of progressive and catastrophic disability was assessed semiannually during a 3-year period in 884 women participating in the Women's Health and Aging Study I. Four-meter walking speed, balance, and chair stands tests were used to evaluate lower extremity function. The putting-on-blouse test, the Purdue pegboard test, and grip strength were used to assess upper extremity function. Summary performance scores (SPS) for the lower and upper extremities were calculated. Among participants in whom disability developed, those who reported no difficulty in the previous year were defined as cases of catastrophic disability, and those who previously reported little or some difficulty were considered to be cases of progressive disability. Cox proportional hazard regression analyses were used to evaluate the association of performance measures and time to incident disability. The predictive ability of performance measures was compared using receiver-operator characteristic curves. Results. All lower and upper extremity measures, with the exception of grip strength, significantly predicted the onset of progressive ADL disability, but only walking speed was significantly associated with the onset of catastrophic ADL disability. The chair stands test, walking speed, and the lower extremity SPS were significantly associated with the onset both progressive and catastrophic mobility disability. Only lower extremity individual tests and SPS significantly predicted the onset of both progressive and catastrophic upper extremity disability. The receiver-operator characteristic curves for ADL and mobility disability showed that all performance measures evaluated had a greater predictive ability for progressive than for catastrophic incident disability. This finding was not consistent for upper extremity disability. The areas under the curve for walking speed and lower extremity SPS were very similar, ranging from 0.58 to 0.81 and from 0.57 to 0.85, and the predictive ability of these two measures was the greatest for all disability outcomes assessed. Conclusion. Physical performance measures of lower extremity and, in particular, walking speed and lower extremity SPS are valuable tools to predict different forms of disability, especially those with a progressive onset.

Objectives. This study examined,whether body mass index (BMI) or change in BMI raises the risk of disability in adulthood. Methods. The relation between BMI and upper- and lower-body disability was examined among adult subjects from a national longitudinal survey (n = 6833). Tobit regression models were used to examine the effect of BMI on disability 10 and 20 years later. Results. Obesity (BMI [greater than or equal to] 30) at baseline or becoming obese during the study was associated with higher levels of upper- and, especially, lower-body disability. In persons who began the study with a BMI of 30 or more and became normal weight, disability was not reduced. Underweight persons (BMI < 18.5) also manifested higher disability in most instances. Conclusions. Disability risk was higher for obese persons, but overweight was not consistently associated with higher disability.

This study examines the composition of elderly population at risk of disability and speculates the impact of disability on the quality of their lives and their longevity. Using census and survey data collected in Fiji, life table estimates of unimpaired life expectancy across time are presented for older people and the potential costs of disability, in terms of productive years of life lost. From a planning perspective, the study discusses medical and support services that may be needed to support older individuals in Fiji. The study also describes policy implications of the findings, focusing on the older women, and considers the implications for older women of other developing countries. KEYWORDS. Aging, disability, developing country, gender and health, Pacific Islands

Background. Physical disability and dependency are serious, and frequent, adverse health outcomes associated with aging and resulting from chronic disease. Reasoning has suggested that there might be a preclinical, intermediate phase of disablement which might develop in parallel with progression of underlying disease and precede and predict disability. Definition of this stage could provide a basis for screening and early intervention to prevent disability. The objective of this study was to determine preclinical functional predictors of incident mobility difficulty and provide evidence for a preclinical stage of disability. Methods. A prospective, population-based cohort study was carried out in Baltimore, Maryland, with two evaluations 18 months apart. The participants were 436 community-dwelling women, 70-80 years of age at baseline, not cognitively impaired, and reporting difficulty in no areas, or only one area, of physical function (primarily mobility), who were participating in the Women's Health and Aging Study II. Participants were recruited from a population-based, age-stratified random sample. Incident mobility disability was studied in the subset without such disability at baseline. The main outcome measure was selfreported incident difficulty walking *5 mile or climbing up 10 steps. Results. At baseline, 69.3% of the cohort reported no difficulty with mobility. After 18 months, 16.0 and 11.7% of this group reported incident difficulty walking ~/2 mile or climbing up 10 steps, respectively. Those reporting baseline task modification due to underlying health problems, our measure of preclinical disability, were at three- to fourfold higher odds of progressing to difficulty than were those without such modification. In multivariate logistic regression analyses, this self-report measure, task modification without difficulty, and objective measures of performance were independently and jointly predictive of incident mobility difficulty. Specifically, for incident difficulty walking *5 mile, self-reported task modification odds ratio (OR) = 3.67, walking speed (.5 m/s difference) OR = 2.16; for incident difficulty climbing up 10 stairs, OR for task modification = 3.84, for stair climb speed (~3 step/s difference) = 2.08 (95% CI did not include 1 for any). Covariates, age, living alone, number of chronic diseases, depression score, knee strength, and balance by functional reach, were not significant predictors in either model. Conclusions. Two indicators of functional changes in older women without mobility difficulty, self-report of modification of method of doing a task in the absence of difficulty and performance measures, are independent and strong predictors of risk of incident mobility disability. The self-report measure provides substantial strength in predicting risk of incident disability across the full range of performance, and may identify a vulnerable point at which other risk factors act to cause transitions to disability. Together, the preclinical indicators identify a subset of high-functioning older women who are at high risk of mobility disability, and provide a potential basis for screening for disability risk and targeting interventions to prevent mobility disability.

Objective. The purpose of this study was to identify risk factors that consistently predict staying healthy in contrast to developing clinical illness and/or physical and mental impairments. Methods. More than 8000 men of Japanese ancestry were followed for 28 years with repeat examinations and surveillance for deaths and incident clinical illness. Physical and cognitive functions were measured in 1993. Measures of healthy aging included surviving and remaining free of major chronic illnesses and physical and cognitive impairments. Results. Of 6505 healthy men at baseline, 2524 (39%) died prior to the final exam. Of the 3263 available survivors, 41% remained free of major clinical illnesses, 40% remained free of both physical and cognitive impairment, and 19% remained free of both illness and impairment. The most consistent predictors of healthy aging were low blood pressure, low serum glucose, not smoking cigarettes, and not being obese. Conclusions. Beyond the biological effects of aging, much of the illness and disability in the elderly is related to risk factors present at midlife. (Am J Public Health. 1998;88:1463-1468)

Objectives. The purpose of this investigation was to study the role of dementia and other common age-related diseases as determinants of dependence in activities of daily living (ADL) in the elderly. Methods. The study population consisted of 1745 persons, aged 75 years and older, living in a district of Stockholm. They were examined at baseline and after a 3-year follow-up interval. Katz's index was used to measure functional status. Functional dependence at baseline, functional decline, and development of functional dependence at follow-up were examined in relation to sociodemographic characteristics and chronic conditions. Results. At baseline, factors associated with functional dependence were age, dementia, cerebrovascular disease, heart disease, and hip fracture. However, only age and dementia were associated with the development of functional dependence and decline after 3 years. In a similar analysis, including only nondemented subjects, Mini-Mental State Examination scores emerged as one of the strongest determinants. The population-attributable risk percentage of dementia in the development of functional dependence was 49%. Conclusions. In a very old population, dementia and cognitive impairment make the strongest contribution to both the development of long-term functional dependence and decline in function. (Am J Public Health. 1998; 88:1452-1456)