@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} }