03415nas a2200385 4500008004100000022001400041245011100055210006900166260001300235300001100248490000700259520232400266653003102590653000902621653002202630653002002652653002102672653003302693653001102726653002502737653001102762653002002773653000902793653003702802653001702839653001602856653002602872653001802898100001502916700001902931700001202950700001702962700001402979856003602993 1994 eng d a0895-435600aPhysical disability in older adults: a physiological approach. Cardiovascular Health Study Research Group.0 aPhysical disability in older adults a physiological approach Car c1994 Jul a747-600 v473 a

Measures of physical function have been developed primarily to assess health status, prognosis, and service needs. They are now, increasingly, being used as outcome measures in studies seeking to determine the causes of disability. However, the extent to which these standardized measures, as they currently are constituted, are meaningful for the evaluation of underlying pathophysiology is not defined. To assess evidence for an etiologic rationale for these measures, we evaluated self-report of difficulty in physical function in the Cardiovascular Health Study, a study of 5201 men and women 65 years and older in four U.S. communities. We determined (by factor analysis) that self-reported difficulty with each of 17 tasks of daily life aggregates in four groups; i.e. difficulty in one task is associated with having difficulty in the other tasks in the group. These groups include (1) activities primarily dependent on mobility and exercise tolerance; (2) complex activities heavily dependent on cognition and sensory input; (3) selected basic self-care activities; and (4) upper extremity activities. Groups 2 and 3 are similar, but not identical, to Instrumental Activities of Daily Living (IADL) and Activities of Daily Living (ADL), respectively. We then tested whether these groupings were associated with different underlying impairments. Multiple logistic regression analyses indicate that there are constellations of physiologic and disease characteristics significantly (p < 0.01) associated with difficulty in each of these four groups of activities, among 15 chronic diseases and conditions ascertained. Some diseases are uniquely associated with difficulty in one group of tasks; some overlap, and are associated with 2, 3 or 4 groups of tasks. The associations found with difficulty in performing tasks in groups 2 and 3 were frequently stronger than those with the larger groups of ADL or IADL tasks, suggesting increased specificity of associations found with these new groupings. These results suggest that re-grouping of tasks of daily life may provide a more refined physiologically-based outcome measure for use in evaluating causes of disability. The ability to define risk factors for disability may be enhanced by choosing outcome measures with a demonstrated physiologic rationale.

10aActivities of Daily Living10aAged10aAged, 80 and over10aChronic Disease10aDisabled Persons10aFactor Analysis, Statistical10aFemale10aGeriatric Assessment10aHumans10aLogistic Models10aMale10aOutcome Assessment (Health Care)10aRisk Factors10aSex Factors10aSocioeconomic Factors10aUnited States1 aFried, L P1 aEttinger, W, H1 aLind, B1 aNewman, A, B1 aGardin, J uhttps://chs-nhlbi.org/node/141704047nas a2200409 4500008004100000022001400041245011700055210006900172260001600241300001100257490000800268520296800276653000903244653002203253653002603275653001603301653001503317653001003332653001503342653001103357653002203368653002003390653001103410653000903421653002603430653001203456653001603468100001403484700001603498700001203514700001803526700001503544700001403559700001503573700001403588856003503602 2001 eng d a0098-748400aInvolvement in caregiving and adjustment to death of a spouse: findings from the caregiver health effects study.0 aInvolvement in caregiving and adjustment to death of a spouse fi c2001 Jun 27 a3123-90 v2853 a

CONTEXT: Most deaths in the United States occur among older persons who have 1 or more disabling conditions. As a result, many deaths are preceded by an extended period during which family members provide care to their disabled relative.

OBJECTIVE: To better understand the effect of bereavement on family caregivers by examining predeath vs postdeath changes in self-reported and objective health outcomes among elderly persons providing varying levels of care prior to their spouse's death.

DESIGN AND SETTING: Prospective, population-based cohort study conducted in 4 US communities between 1993 and 1998.

PARTICIPANTS: One hundred twenty-nine individuals aged 66 to 96 years whose spouse died during an average 4-year follow-up. Individuals were classified as noncaregivers (n = 40), caregivers who reported no strain (n = 37), or strained caregivers (n = 52).

MAIN OUTCOME MEASURES: Changes in depression symptoms (assessed by the 10-item Center for Epidemiological Studies-Depression [CES-D] scale), antidepressant medication use, 6 health risk behaviors, and weight among the 3 groups of participants.

RESULTS: Controlling for age, sex, race, education, prevalent cardiovascular disease at baseline, and interval between predeath and postdeath assessments, CES-D scores remained high but did not change among strained caregivers (9.44 vs 9.19; P =.76), while these scores increased for both noncaregivers (4.74 vs 8.25; F(1,116) = 14.33; P<.001) and nonstrained caregivers (4.94 vs 7.13; F(1,116) = 4.35; P =.04). Noncaregivers were significantly more likely to be using nontricyclic antidepressant medications following the death than the nonstrained caregiver group (odds ratio [OR], 12.85; 95% confidence interval [CI], 1.02-162.13; P =.05). The strained caregiver group experienced significant improvement in health risk behaviors following the death of their spouse (1.47 vs 0.66 behaviors; F(1,118) = 20.23; P<.001), while the noncaregiver and nonstrained caregiver groups showed little change (0.27 vs 0.27 [P =.99] and 0.46 vs 0.27 [P =.39] behaviors, respectively). Noncaregivers experienced significant weight loss following the death (149.1 vs 145.3 lb [67.1 vs 65.4 kg]; F(1,101) = 8.12; P =.005), while the strained and nonstrained caregiving groups did not show significant weight change (156.2 vs 155.2 lb [70.3 vs 69.8 kg] [P =.41] and 156.2 vs 154.0 lb [70.3 vs 69.3 kg] [P =.12], respectively).

CONCLUSIONS: These data indicate that the impact of losing one's spouse among older persons varies as a function of the caregiving experiences that precede the death. Among individuals who are already strained prior to the death of their spouse, the death itself does not increase their level of distress. Instead, they show reductions in health risk behaviors. Among noncaregivers, losing one's spouse results in increased depression and weight loss.

10aAged10aAged, 80 and over10aAntidepressive Agents10aBereavement10aCaregivers10aDeath10aDepression10aFemale10aFollow-Up Studies10aHealth Behavior10aHumans10aMale10aSocioeconomic Factors10aSpouses10aWeight Loss1 aSchulz, R1 aBeach, S, R1 aLind, B1 aMartire, L, M1 aZdaniuk, B1 aHirsch, C1 aJackson, S1 aBurton, L uhttps://chs-nhlbi.org/node/653