@article {6821, title = {Lower Extremity Proximal Muscle Function and Dyspnea in Older Persons.}, journal = {J Am Geriatr Soc}, volume = {63}, year = {2015}, month = {2015 Aug}, pages = {1628-33}, abstract = {

OBJECTIVES: To evaluate the association between performance on a single chair stand and moderate to severe exertional dyspnea.

DESIGN: Cross-sectional.

SETTING: Cardiovascular Health Study.

PARTICIPANTS: Community-dwelling individuals aged 65 and older (N = 4,413; mean age 72.6; female, n = 2,518 (57.1\%); nonwhite, n = 199 (4.5\%); obese, n = 788 (17.9\%); history of smoking, n = 2,410 (54.6\%)).

MEASUREMENTS: Performance on single chair stand (poor (unable to rise without arm use) vs normal (able to rise without arm use)), moderate to severe exertional dyspnea (American Thoracic Society grade >=2), age, sex, ethnicity, obesity, smoking, frailty status (Fried-defined nonfrail, prefrail, frail), high cardiopulmonary risk (composite of cardiopulmonary diseases and diabetes mellitus), spirometric impairment, arthritis, depression, stroke, and kidney disease.

RESULTS: Poor performance on the single chair stand was established in 369 (8.4\%) and moderate to severe exertional dyspnea in 773 (17.5\%). Prefrail status was established in 2,210 (50.1\%), frail status in 360 (8.2\%), arthritis in 2,241 (51.4\%), high cardiopulmonary risk in 2,469 (55.9\%), spirometric impairment in 1,076 (24.4\%), kidney disease in 111 (2.5\%), depression in 107 (2.4\%), and stroke in 93 (2.1\%). In multivariable regression models, poor performance on the single chair stand was associated with moderate to severe exertional dyspnea (unadjusted odds ratio (OR) = 3.48, 95\% confidence interval (CI) = 2.78-4.36; adjusted OR = 1.85, 95\% CI = 1.41-2.41).

CONCLUSION: Poor performance on a single chair stand was associated with an adjusted 85\% greater likelihood of moderate to severe exertional dyspnea than normal performance. These results suggest that reduced proximal muscle function of the lower extremities is associated with moderate to severe exertional dyspnea, even after adjusting for multiple confounders.

}, keywords = {Aged, Aged, 80 and over, Cross-Sectional Studies, Dyspnea, Female, Frail Elderly, Geriatric Assessment, Humans, Lower Extremity, Male, Motor Activity, Muscle Contraction, Prevalence, Retrospective Studies, Spirometry, United States}, issn = {1532-5415}, doi = {10.1111/jgs.13529}, author = {Vaz Fragoso, Carlos A and Araujo, Katy and Leo-Summers, Linda and Van Ness, Peter H} } @article {7251, title = {Dyspnea in Community-Dwelling Older Persons: A Multifactorial Geriatric Health Condition.}, journal = {J Am Geriatr Soc}, volume = {64}, year = {2016}, month = {2016 Oct}, pages = {2042-2050}, abstract = {

OBJECTIVES: To evaluate the associations between a broad array of cardiorespiratory and noncardiorespiratory impairments and dyspnea in older persons.

DESIGN: Cross-sectional.

SETTING: Cardiovascular Health Study.

PARTICIPANTS: Community-dwelling persons (N = 4,413; mean age 72.6, 57.1\% female, 4.5\% African American, 27.2\%

MEASUREMENTS: Dyspnea severity (moderate to severe defined as American Thoracic Society Grade >=2) and several impairments, including those established using spirometry (forced expiratory volume in 1 second (FEV1 )), maximal inspiratory pressure (respiratory muscle strength), echocardiography, ankle-brachial index, blood pressure, whole-body muscle mass (bioelectrical impedance), single chair stand (lower extremity function), grip strength, serum hemoglobin and creatinine, Center for Epidemiologic Studies Depression Scale (CES-D), Mini-Mental State Examination, medication use, and body mass index (BMI).

RESULTS: In a multivariable logistic regression model, impairments that had strong associations with moderate to severe dyspnea were FEV1 less than the lower limit of normal (adjusted odds ratio (aOR) = 2.88, 95\% confidence interval (CI) = 2.37-3.49), left ventricular ejection fraction less than 45\% (aOR = 2.12, 95\% CI = 1.43, 3.16), unable to perform a single chair stand (aOR = 2.10, 95\% CI = 1.61-2.73), depressive symptoms (CES-D score >=16; aOR = 2.02, 95\% CI = 1.26-3.23), and obesity (BMI >=30; aOR = 2.07, 95\% CI = 1.67-2.55). Impairments with modest but still statistically significant associations with moderate to severe dyspnea included respiratory muscle weakness, diastolic cardiac dysfunction, grip weakness, anxiety symptoms, and use of cardiovascular and psychoactive medications (aORs = 1.31-1.71).

CONCLUSION: In community-dwelling older persons, several cardiorespiratory and noncardiorespiratory impairments were significantly associated with moderate to severe dyspnea, akin to a multifactorial geriatric health condition.

}, issn = {1532-5415}, doi = {10.1111/jgs.14290}, author = {Miner, Brienne and Tinetti, Mary E and Van Ness, Peter H and Han, Ling and Leo-Summers, Linda and Newman, Anne B and Lee, Patty J and Vaz Fragoso, Carlos A} } @article {7673, title = {Spirometric impairments, cardiovascular outcomes, and noncardiovascular death in older persons.}, journal = {Respir Med}, volume = {137}, year = {2018}, month = {2018 Apr}, pages = {40-47}, abstract = {

BACKGROUND: In prior work involving older persons, the reported associations of spirometric impairments with cardiovascular outcomes may have been confounded by age-related changes in lung function. Hence, using more age-appropriate spirometric criteria from the Global Lung Function Initiative (GLI), we have evaluated the associations of spirometric impairments, specifically restrictive-pattern and airflow-obstruction, with cardiovascular death (CV-death) and hospitalization (CV-hospitalization). In these analyses, we also evaluated the competing outcome of noncardiovascular death (nonCV-death) and calculated measures of relative and absolute risk.

METHODS: Our study sample was drawn from the Cardiovascular Health Study (CHS), including 4232 community-dwelling white persons aged >=65 years. Multivariable regression models included the following baseline predictors: GLI-defined restrictive-pattern and airflow-obstruction, age, male gender, obesity, waist circumference, current smoker status, >=10 pack-years of smoking, hypertension, dyslipidemia, diabetes, and cardiovascular and cerebrovascular disease. Outcomes included adjudicated CV-death, CV-hospitalization, and nonCV-death, ascertained over 10 years of follow-up. Measures of association included hazard ratios (HRs), rate ratios (RRs), and average attributable fraction (AAF), each with 95\% confidence intervals.

RESULTS: Restrictive-pattern and airflow-obstruction were associated with CV-death (adjusted HRs: 1.57 [1.18, 2.09] and 1.29 [1.04, 1.60]) and with nonCV-death (adjusted HRs: 2.10 [1.63, 2.69] and 1.79 [1.51, 2.12]), respectively. Airflow-obstruction, but not restrictive-pattern, was also associated with CV-hospitalization (adjusted RRs: 1.18 [1.02, 1.36] and 1.20 [0.96, 1.50], respectively). The adjusted AAFs of restrictive-pattern and airflow-obstruction were 1.68\% (0.46, 3.06) and 2.35\% (0.22, 4.72) for CV-death, and 3.44\% (1.97, 5.08) and 7.77\% (5.15, 10.60) for nonCV-death, respectively.

CONCLUSION: Assessment of GLI-defined spirometric impairments contributes to broad geriatric risk stratifications for both cardiovascular and non-cardiovascular outcomes.

}, issn = {1532-3064}, doi = {10.1016/j.rmed.2018.02.018}, author = {Vaz Fragoso, Carlos A and Van Ness, Peter H and Murphy, Terrence E and McAvay, Gail J} } @article {8291, title = {FEV as a Standalone Spirometric Predictor and the Attributable Fraction for Death in Older Persons.}, journal = {Respir Care}, volume = {65}, year = {2020}, month = {2020 Feb}, pages = {217-226}, abstract = {

BACKGROUND: Commonly used thresholds for staging FEV have not been evaluated as standalone spirometric predictors of death in older persons. Specifically, the proportion of deaths attributed to a reduced FEV, when staged by commonly used thresholds in L, percent of predicted (\% pred), and Z scores, has not been previously reported.

METHODS: In 4,232 white persons >= 65 y old, sampled from the Cardiovascular Health Study, FEV was stratified as stage 1 (FEV >= 2.00 L, >=80\% pred, and Z score >=-1.64), stage 2 (FEV 1.50-1.99 L, 50-79\%pred, and Z score -2.55 to -1.63), and stage 3 (FEV < 1.50 L, < 50\% pred, and Z score < -2.55). Notably, a Z score threshold of -1.64 defines normal-for-age lung function as the lower limit of normal (ie, 5th percentile of distribution), and accounts for differences in age, sex, height, and ethnicity. Next, adjusted odds ratios and average attributable fractions for 10-y all-cause mortality were calculated, comparing FEV stages 2 and 3 against stage 1, expressed in L, \% pred, and Z scores. The average attributable fraction estimates the proportion of deaths attributed to a predictor by combining the prevalence of the predictor with the relative risk of death conferred by that predictor.

RESULTS: FEV stage 2 and 3 in L, \% pred, and Z scores yielded similar adjusted odds ratios of death: 1.40-1.51 for stage 2 and 2.35-2.66 for stage 3. Conversely, FEV stages 2 and 3 in L, \% pred, and Z scores differed in prevalence: 12.8-28.6\% for stage 2 and 6.4-17.5\% for stage 3, and also differed in the adjusted average attributable fraction for death: 3.2-6.4\% for stage 2 and 4.5-9.1\% for stage 3.

CONCLUSIONS: In older persons, the proportion of deaths attributed to a reduced FEV is best stratified by Z score staging thresholds because these yield a similar relative risk of death but a more age- and sex-appropriate prevalence of FEV stage.

}, issn = {1943-3654}, doi = {10.4187/respcare.07012}, author = {Vaz Fragoso, Carlos A and Van Ness, Peter H and McAvay, Gail J} }