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Development and Validation of a Functional Outcome Measure in the National Health and Aging Trends Study.

ABSTRACT: Background:Despite the rich array of data available on seven self-care and mobility activities, a functional outcome measure, which sums the scores across these activities, has not yet been developed or validated for use in the National Health and Aging Trends Study (NHATS). Methods:Using longitudinal data from NHATS, we evaluted 7,609 participants who were living in community settings. Development of the functional outcome measure was guided by the presence of consistent mortality gradients across a 5-category, 4-category, and two 3-category scales for each of the seven activities, whereas validation was based on predictive accuracy for mortality and concurrent change in physical performance. Results:Consistent mortality gradients were observed only for the two 3-category scales (with each activity scored as 1 [fully able/independent], 2 [vulnerable], or 4 [assistance]). Each version of the corresponding functional outcome measure, which had a range of composite scores from 7 (no disability) to 28 (highest disability), demonstrated strong predictive validity for mortality and concurrent change in physical performance, with a 2-point change being clinically meaningful. The version that defined vulnerability on the basis of accommodations, reduced activities, or difficulty, rather than difficulty alone, is preferable for use in NHATS based on a more even distribution of composite scores, a wider and more consistent mortality gradient without any mortality reversals, and slightly stronger associations with the two outcomes. Conclusions:These results provide strong, albeit preliminary evidence supporting the value of a new functional outcome measure for use in NHATS, a rich resource for investigating late-life disability.

SUBMITTER: Gill TM

PROVIDER: S-EPMC6037123 | biostudies-other | 2018 Jul

REPOSITORIES: biostudies-other

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Development and Validation of a Functional Outcome Measure in the National Health and Aging Trends Study.

Gill Thomas M TM Williams Christianna S CS

The journals of gerontology. Series A, Biological sciences and medical sciences 20180701 8

<h4>Background</h4>Despite the rich array of data available on seven self-care and mobility activities, a functional outcome measure, which sums the scores across these activities, has not yet been developed or validated for use in the National Health and Aging Trends Study (NHATS).<h4>Methods</h4>Using longitudinal data from NHATS, we evaluted 7,609 participants who were living in community settings. Development of the functional outcome measure was guided by the presence of consistent mortalit ...[more]

PMID: 29688265

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Project description:Background and objectivesThe National Health and Aging Trends Study (NHATS) is an ongoing, nationally representative panel study of older adults that collects data on health and disability, including measures on self-reported visual disability (SRVD). Prior studies assessing the association of SRVD with other measures of healthy aging have classified participants as having or not having SRVD, which does not capture the full spectrum of SRVD reported by participants. Therefore, we sought to develop and validate an ordinal indicator of SRVD to facilitate research on the impact of late-life SRVD on health and disability in NHATS.Research design and methodsWe used 2015 NHATS data with community-dwelling participants who answered survey questions about visual functioning and vision aid use. Based on responses, participants were categorized into one of 6 groups: blind, near and distance SRVD without vision aid use, near and distance SRVD with vision aid use, near or distance SRVD without vision aid use, near or distance SRVD with vision aid use, or no SRVD. Multivariable Poisson regression models assessed convergent validity of the ordinal SRVD scale with functional activity and well-being scores, while adjusting for demographic factors and medical comorbidities.ResultsOf the 7061 eligible individuals, 8.3% (n = 742) reported SRVD. Using our novel ordinal indicator of SRVD in NHATS, higher levels of SRVD were significantly associated with lower functional activity scores (p < .001 for all) and subjective well-being (p < .001), except for participants reporting blindness. Significant differences between SRVD groups were found, which could not be captured using a binary SRVD variable.Discussion and implicationsA novel 6-level SRVD scale in NHATS demonstrated convergent validity with functional activity and well-being scales. This scale provides a new tool with improved measurement precision to study the impact of late-life SRVD on health and disability in a nationally representative study of older adults.

Project description:AimsPhysical frailty is a commonly encountered geriatric syndrome among older adults without coronary heart disease (CHD). The impact of frailty on the incidence of long-term cardiovascular outcomes is not known.We aimed to evaluate the long-term association of frailty, measured by the Fried frailty phenotype, with all-cause-mortality and MACE among older adults without a history of CHD at baseline in the National Health and Aging Trends Study.Methods and resultsWe used the National Health and Aging Trends Study, a prospective cohort study linked to a Medicare sample. Participants with a prior history of CHD were excluded. Frailty was measured during the baseline visit using the Fried physical frailty phenotype. Cardiovascular outcomes were assessed during a 6-year follow-up.Of the 4656 study participants, 3259 (70%) had no history of CHD 1 year prior to their baseline visit. Compared to those without frailty, subjects with frailty were older (mean age 82.1 vs. 75.1 years, P < 0.001), more likely to be female (68.3% vs. 54.9%, P < 0.001), and belong to an ethnic minority. The prevalence of hypertension, falls, disability, anxiety/depression, and multimorbidity was much higher in the frail and pre-frail than the non-frail participants. In a Cox time-to-event multivariable model and during 6-year follow-up, the incidences of death and of each individual cardiovascular outcomes were all significantly higher in the frail than in the non-frail patients including major adverse cardiovascular event (MACE) [hazard ratio (HR) 1.77, 95% confidence interval (CI) 1.53, 2.06], death (HR 2.70, 95% CI 2.16, 3.38), acute myocardial infarction (HR 1.95, 95% CI 1.31, 2.90), stroke (HR 1.71, 95% CI 1.34, 2.17), peripheral vascular disease (HR 1.80, 95% CI 1.44, 2.27), and coronary artery disease (HR 1.35, 95% CI 1.11, 1.65).ConclusionIn patients without CHD, frailty is a risk factor for the development of MACEs. Efforts to identify frailty in patients without CHD and interventions to limit or reverse frailty status are needed and, if successful, may limit subsequent adverse cardiovascular events.

Dataset Information

Development and Validation of a Functional Outcome Measure in the National Health and Aging Trends Study.

Publications

Development and Validation of a Functional Outcome Measure in the National Health and Aging Trends Study.

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