Incidence of and predictors for chronic disability in activities of daily living among older people in Taiwan. Activities of daily living function and disability in older adults in a randomized trial of the health enhancement program. One-year outcome of frailty indicators and activities of daily living following the randomised controlled trial; “Continuum of care for frail older people” Performance measures predict onset of activity of daily living difficulty in community-dwelling older adults. Persistent mobility deficit in the absence of deficits in activities of daily living: a risk factor for mortality. Improving Health Related Quality of Life and Independence in Community Dwelling Frail Older Adults through a Client-Centred and Activity-Oriented Program. A Pragmatic Randomized Controlled Trial. A randomized trial of in-home visits for disability prevention in community-dwelling older people at low and high risk for nursing home admission. Physical exercise and the prevention of disability in activities of daily living in older persons with osteoarthritis. Hierarchical components of physical frailty predicted incidence of dependency in a cohort of elderly women. A randomized, controlled trial of disability prevention in frail older patients screened in primary care: the FRASI Study. Design and baseline evaluation Improved functional ability and independence in activities of daily living for older adults at high risk of hospital readmission: a randomized controlled trial. Development of an easy prognostic score for frailty outcomes in the aged. Physical activity is associated with incident disability in community-based older persons. Frailty and functional decline indices predict poor outcomes in hospitalised older people. Hand-grip strength predicts incident disability in non-disabled older men. Instrumental activities of daily living related to impairments and functional limitations in 70-year-olds and changes between 70 and 76 years of age. Health-promoting interventions for persons aged 80 and older are successful in the short term--results from the randomized and three-armed Elderly Persons in the Risk Zone study.
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 BACKGROUND Disability in basic activities of daily living ( ADLs ) implies a loss of independence and increases the risk for hospitalization , nursing home admission , and death . Little is known about ways by which ADL disability can be prevented or reversed . The authors evaluated the efficacy of the Health Enhancement Program in preventing and reducing ADL disability in community-dwelling older adults . METHODS The authors analyzed data from a 12-month , r and omized , single-blinded , controlled trial of a  disability prevention , chronic disease self-management program involving 201 adults aged 70 years and older that was conducted from February 1995 to June 1996 at a senior center in western Washington state .  Activities of daily living disability incidence , improvement , and worsening were assessed using intention-to-treat methods . RESULTS The cumulative incidence of ADL disability among those who were not ADL disabled at baseline ( n = 56 in the intervention group , n = 57 in the control group ) was modestly lower in the intervention group than in the control group at 12 months ( 14.3 % vs 21.3 % , p = .466 ) . Cumulative improvement in ADL function among those who reported any ADL disability at baseline ( n = 41 in the intervention group , n = 43 in the control group ) was greater in the intervention group at 12 months ( 80.5 % vs 46.5 % , p = .026 ) . The likelihood for ADL improvement was greater in the intervention group compared with controls at 12 months ( adjusted hazard ratio , 1.84 ; 95 % confidence interval , 1.05 to 3.22 ; p = .020 ) . Cumulative worsening of ADL function was slightly lower in the intervention group at 12 months ( 18.6 % vs 26.5 % , p = .237 ) . Intervention participants tended to be at lower risk for ADL worsening ( adjusted hazard ratio , 0.71 ; 95 % confidence interval , 0.38 to 1.30 ; p = .266 ) compared with control participants . CONCLUSION The Health Enhancement Program intervention led to improved ADL functioning  in those who were disabled initially and thereby offers a promising strategy for limiting or reversing functional decline in disabled elderly persons Background The intervention ; “ Continuum of Care for Frail Older People ” , was design ed to create an integrated continuum of care from the hospital emergency department through the hospital and back to the older person ’s own home . The aim of this study is to evaluate the effects of the intervention on functional ability in terms of activities of daily living ( ADL ) . Methods The study is a non-blinded controlled trial with participants r and omised to either the intervention group or a control group with follow-ups at three- , six- and 12 months . The intervention involved collaboration between a nurse with geriatric competence at the emergency department , the hospital wards and a multi-professional team for care and rehabilitation of the older people in the municipality with a case manager as the hub . Older people who sought care at the emergency department at Sahlgrenska University Hospital/Mölndal and who were discharged to their own homes in the municipality of Mölndal , Sweden were asked to participate . Inclusion criteria were age 80 and older or 65 to 79 with at least one chronic disease and dependent in at least one ADL . Analyses were made on the basis of the intention-to-treat principle . Outcome measures were ADL independence and eight frailty indicators . These were analysed , using Chi-square and odds ratio ( OR ) . Results A total of 161 participated in the study , 76 persons allocated to the control group and 85 to the intervention group were analysed throughout the study . There were no significant differences between the groups with regards to change in frailty compared to baseline at any follow-up . At both the three- and twelve-month follow-ups the intervention group had doubled their odds for improved ADL independence compared to the control ( OR 2.37 , 95 % CI ; 1.20 – 4.68 ) and ( 2.04 , 95 % CI ; 1.03 – 4.06 ) respectively . At six months the intervention group had halved their odds for decreased ADL independence ( OR 0.52 , 95 % CI ; 0.27 – 0.98 ) compared to the control group . Conclusions The intervention has the potential to reduce dependency in ADLs , a valuable benefit both for the individual and for society . Trial registration Clinical Trials.gov : OBJECTIVES To assess the predictive value of five performance-based measures for the onset of difficulty in activities of daily living ( ADLs ) . DESIGN A prospect i ve cohort study ; home visits every 6 months for 18 months . SETTING Community-based . PARTICIPANTS Community-dwelling older adults , n=110 , ( mean age 80.3+/-7.0 ; range 67 - 98 ) who reported no difficulty in basic ADLs .  MEASUREMENTS The  Short Physical Performance Battery ( SPPB ) , gait speed , Berg Balance Scale ( BBS ) , grip strength , and Timed Up and Go Test ( TUG ) were evaluated at baseline . Seven ADL items  were assessed at baseline and 6 , 12 , and 18 months . The onset of ADL disability was self-report of difficulty in any of the seven ADL items . Logistic regression models were fitted for each of the physical performance measures to predict onset of ADL difficulty at 6 , 12 , and 18 months . RESULTS After controlling for age , comorbid conditions , and sex , the BBS was the most consistent and best predictor for the onset of ADL difficulty over an 18-month period ( 6 months , c-statistic=0.725 , ( 95 % confidence interval (CI)=0.60 - 0.85 ; 12 months , c-statistic=0.840 95 % CI=0.75 , 0.93 ; 18 months , c-statistic=0.821 , 95 % CI=0.71 , 0.93 ) . The SPPB showed excellent predictive value for the onset of difficulty at 12 months . Ninety-five , 89 , and 75 older adults completed the 6 , 12 , and 18-month follow-up visits , respectively . CONCLUSION BBS , followed by SPPB , TUG , gait speed , and grip strength , were predictive of the onset of ADL difficulty over an 18-month period in community-dwelling older adults . Screening nondisabled older adults with simple performance tests could allow clinicians to identify those at risk for ADL difficulty and may help to detect early functional decline OBJECTIVES To investigate the extent to which self-reported mobility deficit in the absence of impairment in activities of daily living ( ADL ) is associated with elevated mortality risk . DESIGN Prospect i ve cohort study , with annual assessment s of mobility and ADL status and ongoing monitoring of vital status . SETTING Population -based cohort drawn from Medicare enrollees in New York City . PARTICIPANTS One thous and two hundred ninety-eight older adults reporting functional status at baseline ( 1992 - 1994 ) and 2 years later . MEASUREMENTS Subjects reported  mobility ( e.g. ,  walking , climbing stairs , and rising from a chair )  and  ADL ( e.g. ,  bathing , toilet use , dressing , grooming , and feeding )  limitations . Two-year functional status trajectories were noted . We used two additional follow-up periods , at 2 and 4 years , to examine the likelihood that older people with mobility deficit may face an increased risk of death without first passing through a state of enduring ADL disability . RESULTS At 2 years , 12.7 % had incident mobility deficit without ADL disability , and 21.3 % were persistently disabled in mobility without ADL disability . Relative to subjects free of disability at baseline and follow-up , risk of mortality in the incident mobility deficit group was elevated at 2 and 4 years but did not achieve statistical significance . By contrast , for subjects with persistent mobility impairment who did not report ADL impairment , the mortality risk was significantly elevated both at 2 years ( relative risk ( RR ) = 2.5 ; 95 % confidence interval ( CI ) = 1.1 - 5.7 ) ) and 4 years ( RR = 2.9 ; 95 % CI = 1.7 - 4.9 ) ) of follow-up . Mortality was significantly elevated in this group in analyses restricted to respondents with no or only one comorbid condition . CONCLUSION Continuing , self-reported mobility impairment in the absence of ADL deficit is a risk factor for mortality . Older people with self-reported mobility deficit face an increased risk of mortality without first passing through enduring states of ADL disability INTRODUCTION AND AIM In the ageing society , a considerable part of the older adults are frail . Frailty has a major impact on the individual 's quality of life , independence and also on his environment . This study aim ed to investigate - as a secondary prevention of disability - the effectiveness of a client-centred and activity-oriented intervention program for frail community living older adults . It was hypothesized that this program could be effective in improving basic Activities of Daily Living ( b-ADL ) and increasing Health Related Quality of Life ( HRQoL ) . METHOD This study was a single blind r and omized controlled trial with an intervention and a control group ( pre-test-post-test control group design ) . Analysis of covariance ( ANCOVA ) was used to compare the outcome across groups with post-test as outcome and baseline values as a covariate . Data were analysed using the intention-to-treat principle . RESULTS The intervention group ( n = 86 ) experienced more improvement on b-ADL and HRQoL compared with the control group ( n = 82 ) . These effects were statistically significant for the b-ADL index ( p = 0.013 ) and the ' physical subscale pain ' ( p = 0.049 ) . DISCUSSION AND CONCLUSION These positive results can be seen as promising for further development of intervention strategies , although follow-up study should be conducted to determine long term effectiveness BACKGROUND In-home preventive visits with multidimensional geriatric assessment s can delay the onset of disabilities in older people . METHODS This was a stratified r and omized trial . There were 791 participants , community-dwelling people in Bern , Switzerl and , older than 75 years . The participants ' risk status was based on 6 baseline predictors of functional deterioration . The intervention consisted of annual multidimensional assessment s and quarterly follow-up in-home visits by 3 public health nurses ( nurses A , B , and C ) , who , in collaboration with geriatricians , evaluated problems , gave recommendations , facilitated adherence with recommendations , and provided health education . Each nurse was responsible for conducting the home visits in 1 ZIP code area . RESULTS After 3 years , surviving participants at low baseline risk in the intervention group were less dependent in instrumental activities of daily living ( ADL ) compared with controls ( odds ratio , 0.6 ; 95 % confidence interval , 0.3 - 1.0 ; P = .04 ) . Among subjects at high baseline risk , there were no favorable intervention effects on ADL and an unfavorable increase in nursing home admissions ( P= .02 ) . Despite the similar health status of subjects , nurse C identified fewer problems in the subjects who were visited compared with those assessed by nurses A and B. Subgroup analysis revealed that among low-risk subjects visited by nurses A and B , the intervention had favorable effects on instrumental ADL ( P = .005 ) and basic ADL ( P = .009 ) , reduced nursing home admissions ( P = .004 ) , and result ed in net cost savings in the third year ( US $ 1403 per person per year ) . Among low-risk subjects visited by nurse C , the intervention had no favorable effects . CONCLUSIONS These data suggest that this intervention can reduce disabilities among elderly people at low risk but not among those at high risk for functional impairment , and that these effects are likely related to the home visitor 's performance in conducting the visits BACKGROUND The prevention of disability in activities of daily living ( ADL ) may prolong older persons ' autonomy ( older persons are defined in this study as those aged > or = 60 years ) . However , proved preventive strategies for ADL disability are lacking . A sedentary lifestyle is an important cause of disability . This study examines whether an exercise program can prevent ADL disability . METHODS A 2-center , r and omized , single-blind , controlled trial was conducted in which participants were assigned to an aerobic exercise program , a resistance exercise program , or an attention control group .  Of the 439 community-dwelling persons aged 60 years or older with knee osteoarthritis originally recruited , the 250 participants initially free of ADL disability were used for this study .  Incident ADL disability , defined as developing difficulty in transferring from a bed to a chair , eating , dressing , using the toilet , or bathing , was assessed quarterly during 18 months of follow-up . RESULTS The cumulative incidence of ADL disability was lower in the exercise groups ( 37.1 % ) than in the attention control group ( 52.5 % ) ( P = .02 ) . After adjustment for demographics and baseline physical function , the relative risk of incident ADL disability for assignment to exercise was 0.57 ( 95 % confidence interval , 0.38 - 0.85 ; P = .006 ) . Both exercise programs prevented ADL disability ; the relative risks were 0.60 ( 95 % confidence interval , 0.38 - 0.97 ; P = .04 ) for resistance exercise and 0.53 ( 95 % confidence interval , 0.33 - 0.85 ; P = .009 ) for aerobic exercise . The lowest ADL disability risks were found for participants with the highest compliance to exercise . CONCLUSIONS Aerobic and resistance exercise may reduce the incidence of ADL disability in older persons with knee osteoarthritis .  Exercise may be an effective strategy for preventing ADL disability and , consequently , may prolong older persons ' autonomy OBJECTIVE To identify the most important predictors of early disability  incidence and devise a simple score of physical frailty . METHODS A cohort of 545 high-functioning women aged 75 years and older was followed for 7 years . Every year , the self-reported loss of at least one instrumental activity of daily living was chosen as definition of disability . An extension of the logistic regression for repeated responses , the r and om-effect model , was used to assess the effects of baseline predictors . The regression coefficients of the final multivariate model were scaled and rounded to create a practical score . RESULTS The proportion of women reporting disability increased from 22.1 % to 52.1 % throughout the follow-up . In the multivariate model , increasing age , lower performances in mobility and balance tests , bad perceived health , lower muscle strength , higher body mass index , lower educational level , and lower reported physical activity were strong predictors of disability . Evaluating the predictive value of the simplified predictive score on an independent cohort gave a c-statistic equal to .71 . CONCLUSION The use of a powerful fitting method allows to establish a hierarchy between the components of physical frailty and to provide a predictive score with substantial practical value for clinicians and public health professionals Background and aims : We describe the enrollment and intervention phases of FRASI ( FRAilty , Screening and Intervention ) , a r and omized controlled trial aim ed at preventing ADL disability in frail older persons screened in primary care . Methods : Patients , 70–85 years old , non-disabled and non-cognitively impaired , were screened for frailty ( score ≤9 on the Short Physical Performance Battery , SPPB ) during primary care visits . Of 447 eligible persons , 410 came to the study clinic and 251 were r and omized into treatment ( n=126 ) and control groups ( n=125 ) . The active group received an intensive medical intervention , and sixteen 90-minute supervised exercise sessions over 8 weeks . The primary outcome was time to ADL disability onset or death in the 12-month period after study enrollment . Results : The two study arms were similar for demographics , cognitive function , physical function and health status . Compared with a population -based sample selected according to FRASI inclusion criteria except SPPB score , FRASI participants had significantly worse health and functional status . Restricting the comparison to persons with SPPB ≤9 , all differences disappeared . The 99 participants ( 78.6 % of 126 ) who completed the intervention participated in a mean of 15.3±1.6 exercise sessions . Conclusions : Screening in primary care for non-disabled , older persons with SPPB ≤9 yields individuals with substantial morbidity , impairments and functional limitations that can be successfully involved in an intensive medical and exercise intervention . Whether such an intervention effectively prevents new disability remains to be confirmed OBJECTIVE During hospitalization older people often experience functional decline which impacts on their future independence . The objective of this study was to evaluate a multifaceted transitional care intervention including home-based exercise strategies for at-risk older people on functional status , independence in activities of daily living ( ADLs ) and walking ability . METHODS A r and omized controlled trial was undertaken in a metropolitan hospital in Australia with 128 patients ( 64 intervention , 64 control ) aged over 65 years with an acute medical admission and at least one risk factor for hospital readmission . The intervention group received an individually tailored programme for exercise and follow-up care which was commenced in hospital and included regular visits in hospital by a physiotherapist and a registered nurse , a home visit following discharge and regular telephone follow-up for 24 weeks following discharge . The programme was design ed to improve health-promoting behaviours , strength , stability , endurance and mobility . Data were collected at baseline , then 4 , 12 and 24 weeks following discharge using the Index of ADL , Instrumental Activities of Daily Living ( IADL ) and the Walking Impairment Question naire ( WIQ ; modified ) . RESULTS Significant improvements were found in the intervention group in IADL scores ( P < 0.001 ) , ADL scores ( P < 0.001 ) and WIQ scale scores ( P < 0.001 ) in comparison to the control group . The greatest improvements were found in the first 4 weeks following discharge . CONCLUSIONS Early introduction of a transitional model of care incorporating a tailored exercise programme and regular telephone follow-up for hospitalized at-risk older adults can improve independence and functional ability BACKGROUND identification of frailty is recommended in geriatric practice . However , there is a lack of frailty scores combining easy-to-collect predictors from multiple domains . OBJECTIVE to develop a frailty score including only self-reported information and easy-to-perform st and ardised measurements recommended in routine geriatric practice . DESIGN prospect i ve population -based study . SETTING / PARTICIPANTS included 1,007 Italian subjects aged 65 and over . MEASUREMENTS seventeen baseline possible mortality predictors from several domains , 4-year risk of mortality and other adverse health outcomes associated with frailty [ fractures , hospitalisation , and new and worsening activities of daily living ( ADL ) disability ] . METHODS a multivariate Cox model was used to identify the best sub-group of independent predictors and to develop a mortality prognostic score , defined as the number of adverse predictors present . Logistic regression was used to verify whether the score also predicted risk of other frailty outcomes in the cohort survivors . RESULTS nine independent mortality predictors were identified . Among subjects with score > or =3 , each one point increase in the score was associated with a doubling in mortality risk and , among survivors , with an increased risk of all the other adverse health outcomes . CONCLUSIONS nine easy-to-collect predictors may identify aged people at increased risk of adverse health outcomes associated with frailty OBJECTIVES To examine the association between physical activity and the risk of incident disability , including impairment in activities of daily living ( ADLs ) and instrumental activities of daily living ( IADLs ) , in community-based older persons free of dementia . DESIGN Prospect i ve , observational cohort study . SETTING Approximately 40 retirement communities across the Chicago metropolitan area . PARTICIPANTS More than 1,000 older persons from the Rush Memory and Aging Project , an ongoing longitudinal clinical -pathological study of common chronic conditions of old age . MEASUREMENTS All participants underwent detailed annual clinical evaluations that included assessment s of  physical activity , ADLs , IADLs , and gait performance . The associations between  physical activity , mortality , and incident disability were examined using a series of Cox proportional hazards models controlled for age , sex , education , and baseline gait . RESULTS At baseline , participants spent a mean+/-st and ard deviation of 3.0+/-3.5 hours per week engaging in physical activity ( range 0 - 35 ) . In a proportional hazards model , the risk of death decreased 11 % ( hazard ratio (HR)=0.89 , 95 % confidence interval (CI)=0.83 - 0.95 ) for each additional hour of physical activity per week . For those who were not disabled at baseline , the risk of developing disability in ADLs decreased 7 % ( HR=0.93 , 95 % CI=0.88 - 0.98 ) for each additional hour of physical activity per week . Similarly , the risk of disability in IADLs decreased 7 % ( HR=0.93 , 95 % CI=0.89 - 0.99 ) for each additional hour of physical activity . CONCLUSION For community-based older persons without dementia , physical activity is associated with maintenance of functional status , including a reduced risk of developing impairment in ADLs and IADLs BACKGROUND admission to a Geriatric Evaluation and Management Unit ( GEMU ) can optimise a patient 's chance of functional recovery . OBJECTIVE to evaluate the ability of several commonly used frailty and functional decline indices to predict GEMU outcomes , both at discharge and at 6 months . DESIGN prospect i ve , observational study . SETTING AND PARTICIPANTS consecutive GEMU patients aged ≥70 years . METHODS patients were classified as ' frail ' or ' at high risk of functional decline ' using several frailty and functional decline instruments . Predictive ability was evaulated using logistic regression and area under receiver operator characteristic ( ROC ) curves ( auROC ) . RESULTS a total of 172 patients were included . Frailty prevalence varied from 24 to 94 % depending on the instrument used . Several instruments predicted patients at risk of poor outcome , including the Frailty Index of Accumulative Deficits ( FI-CD ) , Fried 's Cardiovascular Health Study index , the Study of Osteoporotic Fractures index , an adapted Katz score of activities of daily living ( ADL ) , Instrumental ADL , the Score Hospitalier d'Evaluation du Risque de Perte d'Autonomie ( SHERPA ) and grip strength [ odds ratio ( OR ) range of 2.06 - 6.47 ] . Adequate discriminatory power for discharge outcome was achieved by the FI-CD ( auROC = 0.735 , P < 0.001 ) and an adapted Katz score ( auROC = 0.704 , P = < 0.001 ) . The FI-CD also showed adequate discriminatory power for a poor 6-month outcome ( auROC = 0.702 , P < 0.001 ) . CONCLUSION frailty and functional decline instruments can predict older patients at risk of poor outcome . However , only the FI-CD showed adequate discriminatory power for outcome prediction at both follow-up time-points 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 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 OBJECTIVES To examine the outcomes of the Elderly Persons in the Risk Zone study , which was design ed to evaluate whether it is possible to delay deterioration if a health-promoting intervention is made when an older adult ( ≥80 ) is at risk of becoming frail and whether a multiprofessional group intervention is more effective in delaying deterioration than a single preventive home visit with regard to frailty , self-rated health , and activities of daily living ( ADLs ) at 3-month follow-up . DESIGN R and omized , three-armed , single-blind , controlled trial performed between November 2007 and May 2011 . SETTING Two urban districts of Gothenburg , Sweden . PARTICIPANTS Four hundred fifty-nine community-living adults aged 80 and older not dependent on the municipal home help service . INTERVENTION A preventive home visit or four weekly multiprofessional senior group meetings with one follow-up home visit .  MEASUREMENTS Change in frailty , self-rated health , and ADLs between baseline and 3-month follow-up . RESULTS Both interventions delayed deterioration of self-rated health ( odds ratio ( OR ) = 1.99 , 95 % confidence interval ( CI ) = 1.12 - 3.54 ) . Senior meetings were the most beneficial intervention for postponing dependence in ADLs ( OR = 1.95 , 95 % CI = 1.14 - 3.33 ) . No effect on frailty could be demonstrated . CONCLUSION Health-promoting interventions made when older adults are at risk of becoming frail can delay deterioration in self-rated health and ADLs in the short term . A multiprofessional group intervention such as the senior meetings described seems to have a greater effect on delaying deterioration in ADLs than a single preventive home visit . Further research is needed to examine the outcome in the long term and in different context
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 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 .