Relationship between lower-limb muscle strength and functional independence among elderly people according to frailty criteria
a cross-sectional study
Keywords:
Elderly, Muscle strength, Disability evaluation, Activities of daily living, Frail elderlyAbstract
CONTEXT AND OBJECTIVE: Muscle strength and functional independence are considered to be determinants of frailty levels among elderly people. The aim here was to compare lower-limb muscle strength (LLMS) with functional independence in relation to sex, age and number of frailty criteria, and to ascertain the influence of these variables on elderly outpatients’ independence. DESIGN AND SETTING: Quantitative cross-sectional study, in a tertiary hospital. METHODS: The study was conducted on 150 elderly outpatients of both sexes who were in a cognitive condition allowing oral communication, between October 2005 and October 2007. The following instruments were used: five-times sit-to-stand test (FTSST), Functional Independence Measurement (FIM) and Lawton’s Instrumental Activities of Daily Living Scale (IADL). Descriptive, comparative, multivariate, univariate and Cronbach alpha analyses were performed. RESULTS: The mean time taken in the FTSST was 21.7 seconds; the mean score for FIM was 82.2 and for IADL was 21.2; 44.7% of the subjects presented 1-2 frailty criteria and 55.3% > 3 criteria. There was a significant association between LLMS and functional independence in relation to the number of frailty criteria, without homogeneity regarding sex and age. Functional independence showed significant influence from sex and LLMS. CONCLUSION: Elderly individuals with 1 or 2 frailty criteria presented greater independence in all FTSST scores. The subjects with higher LLMS presented better functional independence.
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Doherty TJ. The influence of aging and sex on skeletal muscle mass and strength. Curr Opin Clin Nutr Metab Care. 2001;4(6):503-8.
Goodpaster BH, Park SW, Harris TB, et al. The loss of skeletal muscle strength, mass, and quality in older adults: the health, aging and body composition study. J Gerontol A Biol Sci Med Sci. 2006;61(10):1059-64.
Zhong S, Chen CN, Thompson LV. [Sarcopenia of ageing: functional, structural and biochemical alterations]. Braz J Phys Ther (Impr.) = Rev Bras Fisioter. 2007;11(2):91-7.
Newman AB, Haggerty CL, Goodpaster B, et al. Strength and muscle quality in a well-functioning cohort of older adults: the Health, Aging and Body Composition Study. J Am Geriatr Soc. 2003;51(3):323-30.
Marcell TJ. Sarcopenia: causes, consequences, and preventions. J Gerontol A Biol Sci Med Sci. 2003;58(10):M911-6.
Yu F, Hedström M, Cristea A, Dalén N, Larsson L. Effects of ageing and gender on contractile properties in human skeletal muscle and single fibers. Acta Physiol (Oxf ). 2007;190(3):229-41.
Ostchega Y, Harris TB, Hirsch R, et al. Reliability and prevalence of physical performance examination assessing mobility and balance in older persons in the US: data from the Third National Health and Nutrition Examination Survey. J Am Geriatr Soc. 2000;48(9):1136-41.
Janssen WG, Bussmann HB, Stam HJ. Determinants of sit-to-stand movement: a review. Phys Ther. 2002;82(9):866-79.
Visser M, Kritchevsky SB, Goodpaster BH, et al. Leg muscle mass and composition in relation to lower extremity performance in men and women aged 70 to 79: the health, aging and body composition study. J Am Geriatr Soc. 2002;50(5):897-904.
Greenlund LJ, Nair KS. Sarcopenia--consequences, mechanisms, and potential therapies. Mech Ageing Dev. 2003;124(3):287-99.
Janssen I. Influence of sarcopenia on the development of physical disability: the Cardiovascular Health Study. J Am Geriatr Soc. 2006;54(1):56-62.
Lauretani F, Russo CR, Bandinelli S, et al. Age-associated changes in skeletal muscles and their effect on mobility: an operational diagnosis of sarcopenia. J Appl Physiol. 2003;95(5):1851-60.
Fried LP, Walston J. Frailty and failure to thrive. In: Hazzard WR, Blass JP, Halter JB, Ouslander JG, Tinetti ME, editors. Principles of geriatric medicine and gerontology. 5th ed. New York: McGraw-Hill; 2003. p. 1487-502.
Fried LP, Tangen CM, Walston J, et al. Frailty in older adults: evidence for a phenotype. J Gerontol A Biol Sci Med Sci. 2001;56(3):M146-56.
Vanitallie TB. Frailty in the elderly: contributions of sarcopenia and visceral protein depletion. Metabolism. 2003;52(10 Suppl 2):22-6.
Roubenoff R. Sarcopenia: effects on body composition and function. J Gerontol A Biol Sci Med Sci. 2003;58(11):1012-7.
Walston J, Hadley EC, Ferrucci L, et al. Research agenda for frailty in older adults: toward a better understanding of physiology and etiology: summary from the American Geriatrics Society/National Institute on Aging Research Conference on frailty in Older Adults. J Am Geriatr Soc. 2006;54(6):991-1001.
Abate M, Di Iorio A, Di Renzo D, et al. Frailty in the elderly: the physical dimension. Eura Medicophys. 2007;43(3):407-15.
Woods NF, LaCroix AZ, Gray SL, et al. Frailty: emergence and consequences in women aged 65 and older in the Women’s Health Initiative Observational Study. J Am Geriatr Soc. 2005;53(8):1321-30.
Barbosa AR, Souza JM, Lebrão ML, Laurenti R, Marucci Mde F. [Functional limitations of Brazilian elderly by age and gender differences: data from SABE Survey]. Cad Saude Publica. 2005;21(4):1177-85.
Bertolucci PH, Brucki SM, Campacci SR, Juliano Y. O Mini-Exame do Estado Mental em uma população geral. Impacto da escolaridade [The Mini-Mental State Examination in a general population: impact of educational status]. Arq Neuropsiquiatr. 1994;52(1):1-7.
Guralnik JM, Simonsick EM, Ferrucci L, et al. A short physical performance battery assessing lower extremity function: association with self-reported disability and prediction of mortality and nursing home admission. J Gerontol. 1994;49(2):M85-94.
Nakano MM. Versão brasileira da Short Physical Performance Battery – SPPB: adaptação cultural e estudo da confiabilidade [Brazilian version of the Short Physical Performance Battery - SPPB: cross-cultural adaptation and reliability study] (Dissertation). Campinas: Faculdade de Educação da Universidade Estadual de Campinas; 2007. Available from: http://cutter.unicamp.br/document/?code=vtls000412296. Accessed in 2013 (Sep 24).
Radloff LS. The CES-D scale: A self-report depression scale for re- search in the general population. Applied Psychological Measure- ment. 1977;1(3):385-401. Available from: http://apm.sagepub.com/content/1/3/385.abstract. Accessed in 2013 (Sep 24).
Batistoni SS, Neri AL, Cupertino AP. Validade da escala de depressão do Center for Epidemiological Studies entre idosos brasileiros [Validity of the Center for Epidemiological Studies Depression Scale among Brazilian elderly]. Rev Saude Publica. 2007;41(4):598-605.
Riberto M, Miyazaki MH, Jorge Filho D, Sakamoto H, Battistella LR. Reprodutibilidade da versão brasileira da Medida de independência funcional [Reproductivity brazilian version of functional independence measure]. Acta Fisiátrica. 2001;8(1):45-52.
Riberto M, Miyazaki MH, Jucá SSH, et al. Validação da versão brasileira da Medida de Independência Funcional [Validation of the brazilian version of Functional Independence Measure]. Acta Fisiátrica. 2004;11(2):72-6.
Lawton MP, Brody EM. Assessment of older people: self-maintaining and instrumental activities of daily living. Gerontologist. 1969;9(3):179-86.
Freitas EV, Miranda RD. Parâmetros clínicos do envelhecimento e avaliação geriatrica ampla. In: Freitas EV, Py L, Cançado FAX, et al., editores. Tratado de geriatria e gerontologia. 2a ed. Rio de Janeiro: Guanabara Koogan; 2006. p. 900-9.
Brasil. Instituto Brasileiro de Geografia e Estatística. Projeção da população do Brasil por sexo e idade: 1980-2050 – Revisão 2008. Available from: http://www.ibge.gov.br/home/estatistica/populacao/projecao_da_populacao/2008/. Accessed in 2013 (Sep 24).
Gomes GA, Cintra FA, Batista FS, et al. Elderly outpatient profile and predictors of falls. Sao Paulo Med J. 2013;131(1):13-8.
Costa TB, Neri AL. Medidas de atividade física e fragilidade em idosos: dados do FIBRA Campinas, São Paulo, Brasil [Indicators of physical activity and frailty in the elderly: data from the FIBRA study in Campinas, São Paulo State, Brazil]. Cad Saude Publica. 2011;27(8):1537-50.
Ostchega Y, Harris TB, Hirsch R, et al. Reliability and prevalence of physical performance examination assessing mobility and balance in older persons in the US: data from the Third National Health and Nutrition Examination Survey. J Am Geriatr Soc. 2000;48(9):1136-41.
Aoyagi K, Ross PD, Nevitt MC, et al. Comparison of performance- based measures among native Japanese, Japanese-Americans in Hawaii and Caucasian women in the United States, ages 65 years and over: a cross-sectional study. BMC Geriatr. 2001;1:3.
Lord SR, Murray SM, Chapman K, Munro B, Tiedemann A. Sit-to- stand performance depends on sensation, speed, balance, and psychological status in addition to strength in older people. J Gerontol A Biol Sci Med Sci. 2002;57(8):M539-43.
McCarthy EK, Horvat MA, Holtsberg PA, Wisenbaker JM. Repeated chair stands as a measure of lower limb strength in sexagenarian women. J Gerontol A Biol Sci Med Sci. 2004;59(11):1207-12.
Forrest KY, Zmuda JM, Cauley JA. Correlates of decline in lower extremity performance in older women: A 10-year follow-up study. J Gerontol A Biol Sci Med Sci. 2006;61(11):1194-200.
Ferreira FFP, Izzo H, Filho WJ. Impacto da capacidade física na saúde percebida entre idosos em velhice avançada. Saúde Coletiva. 2007;4(17):154-7. Available from: http://www.redalyc.org/articulo.oa?id=84201705. Accessed in 2013 (Sep 24).
Aslan UB, Cavlak U, Yagci N, Akdag B. Balance performance, aging and falling: a comparative study based on a Turkish sample. Arch Gerontol Geriatr. 2008;46(3):283-92.
Mazzà C, Benvenuti F, Bimbi C, Stanhope SJ. Association between subject functional status, seat height, and movement strategy in sit- to-stand performance. J Am Geriatr Soc. 2004;52(10):1750-54.
Singh AS, Chin A Paw MJ, Bosscher RJ, van Mechelen W. Cross- sectional relationship between physical fitness components and functional performance in older persons living in long-term care facilities. BMC Geriatr. 2006;7:6:4.
Lima-Costa MF, Barreto SM, Giatti L. Condições de saúde, capacidade funcional, uso de serviços saúde e gastos com medicamentos da população idosa brasileira: um estudo descritivo baseado na Pesquisa Nacional por Amostra de Domicílios [Health status, physical functioning, health services utilization, and expenditures on medicines among Brazilian elderly: a descriptive study using data from the National Household Survey]. Cad Saude Publica. 2003;19(3):735-43.
Duarte YA, Lebrão ML, Lima FD. Contribuição dos arranjos domiciliares para o suprimento de demandas assistenciais dos idosos com comprometimento funcional em São Paulo, Brasil [The contribution of living arrangements in the provision of care for elderly persons with functional impairments in São Paulo, Brazil]. Rev Panam Salud Publica. 2005;17(5-6):370-8.
Santos JL, Lebrão ML, Duarte YA, Lima FD. [Functional performance of the elderly in instrumental activities of daily living: an analysis in the municipality of São Paulo, Brazil]. Cad Saude Publica. 2008;24(4):879-86.
Leveille SG, Penninx BW, Melzer D, Izmirlian G, Guralnik JM. Sex differences in the prevalence of mobility disability in old age: the dynamics of incidence, recovery, and mortality. J Gerontol B Psychol Sci Soc Sci. 2000;55(1):S41-50.
Wray LA, Blaum CS. Explaining the role of sex on disability: a population-based study. Gerontologist. 2001;41(4):499-510.
Rosa TE, Benício MH, Latorre Mdo R, Ramos LR. Fatores determinantes da capacidade funcional entre idosos [Determinant factors of functional status among the elderly]. Rev Saude Publica. 2003;37(1):40-8.
Guerra RO, Alvarado BE, Zunzunegui MV. Life course, gender and ethnic inequalities in functional disability in a Brazilian urban elderly population. Aging Clin Exp Res. 2008;20(1):53-61.
Murtagh KN, Hubert HB. Gender differences in physical disability among an elderly cohort. Am J Public Health. 2004;94(8):1406-11.
Zunzunegui MV, Alvarado BE, Béland F, Vissandjee B. Explaining health differences between men and women in later life: a cross- city comparison in Latin America and the Caribbean. Soc Sci Med. 2009;68(2):235-42.
Guralnik JM, Ferrucci L, Simonsick EM, Salive ME, Wallace RB. Lower- extremity function in persons over the age of 70 years as a predictor of subsequent disability. N Engl J Med. 1995;332(9):556-61.
Ostir GV, Markides KS, Black SA, Goodwin JS. Lower body functioning as a predictor of subsequent disability among older Mexican Americans. J Gerontol A Biol Sci Med Sci. 1998;53(6):M491-95.
Guralnik JM, Ferrucci L, Pieper CF, et al. Lower extremity function and subsequent disability: consistency across studies, predictive models, and value of gait speed alone compared with the short physical performance battery. J Gerontol A Biol Sci Med Sci. 2000;55(4):M221-31.
Atkinson HH, Cesari M, Kritchevsky SB, et al. Predictors of combined cognitive and physical decline. J Am Geriatr Soc. 2005;53(7):1197-1202.
Onder G, Penninx BW, Ferrucci L, et al. Measures of physical performance and risk for progressive and catastrophic disability: results from the Women’s Health and Aging Study. J Gerontol A Biol Sci Med Sci. 2005;60(1):74-9.
Rolland Y, Lauwers-Cances V, Cesari M, et al. Physical performance measures as predictors of mortality in a cohort of community- dwelling older French women. Eur J Epidemiol. 2006;21(2):113-22.
