Weak grip a strong predictor of metabolic disease and disability in adults

A simple test to determine a person's grip strength may be a predictor of developing metabolic disorders in middle or older age, a new cross-continental study has found. 

A simple test to determine a person's grip strength may be a predictor of developing metabolic disorders in middle or older age, a new cross-continental study has found.
The test locations, demographics and methodology all were selected for a reason.

13 april 2017--"Prevalence of chronic disease is highest in the U.S. and China," says Mark Peterson, Ph.D., M.S., FACSM, assistant professor of physical medicine and rehabilitation at Michigan Medicine and a member of the U-M Global Research, Education and Collaboration in Health and Institute for Healthcare Policy and Innovation. "There's a dire need to identify midlife predictors of disability and diabetes in both populations."
Peterson is the lead author on a new study, published in Journals of Gerontology Series A: Medical Sciences, that investigated if normalized grip strength—which is defined as a person's grip strength divided by their body mass—could serve as a biomarker for both cardiometabolic disease and physical disability in American and Chinese adults.
He teamed up with colleagues from the U-M School of Public Health, Michigan Medicine's Global REACH, the Institute for Social Science Survey and the National School of Development at Peking University in Beijing, China.
One reason for the study's geographic focus: "China represents a unique population," Peterson says. "It's the world's largest population of diabetics, which imposes a huge health and economic burden on their entire country."
He adds, "In 2015, China and the U.S. had a combined $320 billion in diabetes-related health care costs, according to the International Diabetes Federation. The aging populations in both countries are growing because of improved medical care of older adults and longer life expectancy. While on one hand that's great, on the other, it represents two populations that have increasing prevalence estimates of diabetes, cardiovascular health issues and functional impairments. The longer people live with those health issues, the greater the burden is to society."

Analyzing data sets

The research team used data on middle-aged and older adults from the U.S. National Health and Nutrition Examination Survey from 2011 to 2012 and 2013 to 2014, and the 2011 portion of the China Health and Retirement Longitudinal Study. These surveys were selected because they included measures of muscle strength capacity and the necessary information pertaining to disability and cardiometabolic diseases.
"We wanted to examine grip strength in particular because it is highly associated with overall body strength," Peterson says. "To asses someone's grip strength using a handgrip dynamometer takes less than 10 seconds, which makes it extremely attractive to adopt in a clinical or community setting at the population level."
The research team analyzed normalized grip strength for 4,544 U.S. and 6,030 Chinese study participants 50 years of age and older. The study group also had blood samples taken for nonfasting glycated hemoglobin and answered a questionnaire about impairments of functional limitation related to mobility. A subsample of 2,225 adults had fasting measures for glucose, insulin and triglycerides.
Using weighted logistic regression models, the team assessed the association between normalized grip strength and diabetes, hyperglycemia, hypertriglyceridemia, low HDL cholesterol, hypertension and physical disability. They controlled for age, sex and numerous socio-demographic characteristics.

A strong connection

Perhaps the largest finding of the study was that low normalized grip strength was greatly associated with both cardiometabolic diseases and physical disabilities in middle-age to older adults, both men and women, and in both the U.S. and Chinese populations.
For every 0.05 decrement in normalized grip strength in U.S. and Chinese adults, respectively, there were:

• 49 percent and 17 percent increased odds for diabetes
• 46 percent and 11 percent increased odds of hyperglycemia
• 15 percent and 11 percent increased odds of hypertriglyceridemia
• 22 percent and 15 percent increased odds of low HDL cholesterol
• 19 percent and 10 percent increased odds of hypertension
• 36 percent and 11 percent increased odds for disability status

Other highlights from the research team included:

• Prevalence of physical disabilities was higher among older adults (65 years old and older) compared to middle-aged adults (50 years old to 64.9 years old) in both populations.
• In U.S. adults, physical disability status, obesity and abdominal obesity were more prevalent, and diabetes prevalence was higher with increasing age in U.S. men.
• In Chinese adults, diabetes prevalence was higher for women than men in both middle-aged and older adults.
• Diabetes was more prevalent in U.S. than Chinese men in both age categories, but more prevalent in Chinese women than U.S. women.
• Normalized grip strength was higher in Chinese men and women than U.S. men and women in both age categories.

Peterson would like to see these research results translated to the clinical setting.
"We hope these findings illustrate how important a simple grip strength test could be in the clinical setting," Peterson says. "It's an easy way to screen and identify people who are at early risk for these health issues."

More information: Journals of Gerontology Series A: Medical Sciences, DOI: 10.1093/gerona/glx031


Provided by University of Michigan

Stress symptoms in midlife predict old-age disability, study finds

Nearly 30% of adult workers suffer from work-related stress, and it is commonly acknowledged that stress has damaging effects on individual's health. Recently published prospective cohort study by Dr. Jenni Kulmala and co-workers from the Gerontology Research Center (GEREC) at the University of Jyväskylä, Finland, provides strong evidence that perceived work-related stress in midlife predicts functional limitations and disability later in old age.

13 feb 2013--Previously stress has been described as a rather uniform entity in all individuals, with more or less consistent symptoms, but this study shows that dominant stress symptoms in middle age may vary between persons. The study involved more than 5,000 persons who were followed up for almost thirty years from working age to old age.

"We were able to identify four different stress profiles among occupationally active persons aged from 44 to 58 years: negative reactions to work and depressiveness; perceived decrease in cognition; sleep disturbances; and somatic symptoms. Some people suffered from occasional symptoms, but in some cases these symptoms were observed in several time points and thus were considered as continuous," says Dr. Jenni Kulmala.

All kinds of stress symptoms in midlife correlated with disability 28 years later. Persons who had reported long-term stress symptoms in midlife had more difficulties in the basic activities of daily living, such as bathing and dressing, and also in more demanding instrumental daily activities, such as shopping, coping with light housework, handling financial matters, taking medication and using the telephone at the mean age of 78 years. Additionally, the risk for inability to walk two kilometres was 2–3 times higher for those with constant stress symptoms in midlife. Occasional stress symptoms in midlife also increased the severity of disability, but less than constant symptoms.

"Stress symptoms are associated with chronic conditions and a maladaptive lifestyle, which may partly explain the found association. However, in our study, the association was not completely explained by such mediators. Therefore, it is also possible that the chronic activation of stress responses may result in the "wear and tear" of the human body and thus increase the risk of old age disability," says Dr. Kulmala.

The results obtained in this study offer targets for interventions aimed at preventing the decline of physical functioning, and promoting healthy aging.

More information: Kulmala J. et al. Perceived stress symptoms in midlife predict disability in old age. A 28-year prospective cohort study. The Journals of Gerontology Series A: Biological Sciences and Medical Sciences 2013; doi: 10.1093/gerona/gls339

Provided by Academy of Finland

Mental illness the largest contributor to disability worldwide

Mental illness is the largest contributor to disability, according to a report card on the world's health, The Global Burden of Disease 2010 (GBD 2010). The seven papers and two commentaries that make up the report  published in The Lancet   this week. 

16 dec 2012--GBD 2010 is a collaborative project led by the Institute for Health Metrics and Evaluation at the University of Washington (UW) in the US and involves 302 institutions across 50 countries. This is the first report since the inaugural study was published in the early 1990s.

Close to a quarter of the world's disability burden is attributed to mental and behavioural disorders combined (22.7 per cent). These include major depressive disorder, anxiety, Alzheimer's, schizophrenia and bipolar disease.

Major depressive disorder alone accounts for 8.1 per cent of the disability burden and is second only to low back pain. This compares with cardiovascular and circulatory diseases, which account for 2.8 per cent of the disability burden.

"This report looks at the total impact of disease over a person's life. So serious conditions like heart disease and cancer contribute relatively small amounts to the disability burden because they usually occur in later life," says UNSW Professor Philip Mitchell, who assisted in assessing the impact of bipolar disease around the world for the report.

"The mental illnesses present very commonly when people are in their 20s and 30s and they often reoccur, so the lifetime disability is greater," says Professor Mitchell, Head of Psychiatry at UNSW, who is based at the Black Dog Institute.

Other key findings relating to mental health: 

• The burden of major depression and anxiety have each increased by 37 per cent in 20 years
• Alzheimer's disease has increased by 80 per cent
• Major depressive disorders account for 63 million years spent living with a disability (YLD)

Other contributions from UNSW experts include: 

• UNSW Conjoint Professor Guy Marks contributed to the work on respiratory diseases. Pneumonia, tuberculosis, chronic obstructive pulmonary disease (or COPD, the occurrence of chronic bronchitis or emphysema) and lung cancer are major contributors to the global burden of disease and premature death. One of the key findings is that the disability-adjusted life years (DALYs) due to pneumonia and other lower respiratory infections has decreased by 44 per cent over the past 20 years. However, the burden of lung cancer has increased while COPD, asthma and tuberculosis have remained relatively unchanged.
• Professor Louisa Degenhardt of the National Drug and Alcohol Research Centre at UNSW co-chaired the Expert Group on Mental Disorders and Illicit Drug Use. The results will be published in detail next year, but illicit drugs have become a bigger contributor to the global burden of disease over the past 20 years (from 1990 to 2010).

More information: www.thelancet.com/… n-of-disease

We're living longer but with more disability

The Global Burden of Disease Study 2010 (GBD 2010), has found people around the world are living longer but often with many years of compromised health.

15 dec 2012--The study is co-authored by the Head of The University of Queensland's School of Population Health, Professor Alan Lopez and the Director for the Institute for Health Metrics and Evaluation (IHME) at the University of Washington, Dr Christopher Murray.

It reveals the leading causes of death, disability and injury.

GBD 2010 – set to be launched at London's Royal Society on 14 December - is the world's largest ever investigation of global health.

Involving 1000 collaborators over five years, the study examines 291 conditions and 67 risk factors for 21 global regions.

Professor Lopez said that the study's update was driven by need.

"We know that dozens of countries have taken the methodology of GBD and applied it to their own situation to better inform local health planning and policies. However, we knew we could improve it," Professor Lopez said.

"We knew we needed to update our 20-year-old estimates and make use of today's better methods, enhanced availability of data and increased expertise and there was a huge demand for it.

"Studies such as this which provide us with comprehensive and reliable health information are essential if countries are to be better informed about their health priorities and how these are changing."

Results of the study will be featured in a special issue of The Lancet, which will be devoted entirely to GBD 2010 findings.

These findings include: 

• People are living longer all over the world but especially in high-income countries.
• Life expectancy in Australia has risen so much since 1990 that the country now has among the 10 longest life expectancies in the world for both women and men.
• The years that people are living with a disability is growing, particularly in high-income countries.
• The increase in disability has largely been driven by increases in population and population ageing, and has important implications for health services.
• Child mortality is do
• Dietary risk factors and physical inactivity collectively caused 10 per cent of the disease burden.
• wn, even in sub-Saharan Africa and other poor countries, but much less progress has been made in preventing death among young adults, particularly men, who are dying, mostly due to violence, injuries, suicide and HIV/AIDS.
• High blood pressure is the world's leading cause of mortality and disability.
• It is no longer just the rich world's problem, with a high salt diet seeing the issue surface in poor countries as well.
• The second biggest burden on world health is tobacco smoking which is falling in the developed world but rising in the developing world.
• Child malnutrition has decreased, as has the burden of disease from unsafe water and sanitation, showing global health progress has been made.
• But while malnutrition is down, GBD 2010 found that rising rates of obesity and other lifestyle-related risk factors were becoming the dominant forces in disease.These latest findings update the original GBD 1990, which was the first study to measure not just mortality, but the impact of disease and years lived with disability.

It is one of the world's most cited investigations and has influenced health policies and budgets around the globe.

Provided by University of Queensland

Even mild stress is linked to long-term disability

Even relatively mild stress can lead to long term disability and an inability to work, reveals a large population based study published online in the Journal of Epidemiology and Community Health.

27 mar 2011--It is well known that mental health problems are associated with long term disability, but the impact of milder forms of psychological stress is likely to have been underestimated, say the authors.

Between 2002 and 2007, the authors tracked the health of more than 17,000 working adults up to the age of 64, who had been randomly selected from the population in the Stockholm area.

All participants completed a validated questionnaire (GHQ-12) at the start of the study to measure their mental health and stress levels, as well as other aspects of health and wellbeing.

During the monitoring period, 649 people started receiving disability benefit - 203 for a mental health problem and the remainder for physical ill health.

Higher levels of stress at the start of the study were associated with a significantly greater likelihood of subsequently being awarded long term disability benefits.

But even those with mild stress were up to 70% more likely to receive disability benefits, after taking account of other factors likely to influence the results, such as lifestyle and alcohol intake.

One in four of these benefits awarded for a physical illness, such as high blood pressure, angina, and stroke, and almost two thirds awarded for a mental illness, were attributable to stress.

The authors say that it is important to consider their findings in the context of modern working life, which places greater demands on employees, and social factors, such as fewer close personal relationships and supportive networks.

These factors lead them to ask: "Are the strains and demands of modern society commonly exceeding human ability?" And they conclude that while mild stress should not be over-medicalised, their findings suggest that it should be taken more seriously than it is.

Provided by British Medical Journal

Age, Education Affect Post-Sick Leave Transition to Disability

Twenty percent of Norwegian group with two-month work absence later went on disability

28 june 2009-- In adults with musculoskeletal disorders who had a lengthy sickness-related work absence, their age, diagnosis, and socioeconomic factors predicted their transition to disability pension in following years, according to research published in the June 15 issue of Spine.

Sturla Gjesdal, M.D., of the University of Bergen in Norway, and colleagues analyzed data from more than 60,000 individuals with musculoskeletal disorders who had an episode of sickness absence lasting more than eight weeks in 1997. Participants were followed up for five years to track their transition to disability pension.

The researchers found that 20 percent overall obtained disability pension during follow-up. Compared to fractures and injuries, relative risk of disability pension was higher for rheumatoid arthritis (4.2), myalgia/fibromyalgia (3.3), osteoarthrosis (2.8), and back problems (2.0). The authors further note that age most strongly predicted disability pension, followed by education and income.

"The study showed that the long-term prognosis differed substantially between subgroups of musculoskeletal disorders. This points to the need to go beyond the general label musculoskeletal, when the risk of permanent disability among sickness absentees is studied," the authors write. "The estimates in this article for Norwegians on sick leave cannot be directly generalized to the United States, but the main results regarding diagnostic and social risks may have a bearing on cases with similar medical conditions, who meet the Social Security Disability Insurance earnings criteria."

Abstract
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Neighborhood Safety Is Linked to Disability

31 may 2009 -- Living in unsafe neighborhoods -- or even believing that a neighborhood is unsafe -- can lead to disability among elderly, low-income people, suggests a new study.

"Our results suggest that dangerous neighborhoods get from the mind into the body and engender mobility disability through psychosocial or psychological processes," Dr. Cheryl Clark, of Brigham and Women's Hospital in Boston, said in a news release from BioMed Central, which is publishing the study in its journal BMC Public Health.

The study included 1,884 people, age 65 and older, whose perceptions of danger were compared with levels of violent crime reported in their neighborhoods. The two matched up well, the study found, but it was the participants' sense that their neighborhood was unsafe that was most strongly associated with the development of a physical disability.

There may be a number of reasons for this, the researchers suggested. Lower-income seniors in unsafe neighborhoods might have fewer resources to cope with neighborhood stresses, and areas with high crime rates could have difficulty attracting businesses that provide products and services.

"Our findings underscore the importance of neighborhood safety to healthy aging," Clark said. "Specifically intervening to improve perceptions of neighborhood safety at retirement age may be an important step to reduce the risk of mobility disability among elders."

About 1 in 5 Americans say they are disabled

CHICAGO, 01 may 2009- About 1 in 5 Americans have a disability and that will increase as baby boomers age, U.S. health officials said on Thursday.

The number of Americans with a disability rose 7.7 percent, or by 3.4 million people, to nearly 48 million between 1999 and 2005, the U.S. Centers for Disease Control and Prevention said.

"The number of adults reporting a disability likely will increase, along with the need for appropriate medical and public health services, as more persons enter the highest risk age group," Dr. Chad Helmick, of the U.S. Centers for Disease Control and Prevention, wrote in the CDC's weekly report on death and disease.

Helmick said meeting the expected increased demand of these people will require more and better interventions aimed at preventing disability.

Arthritis was the leading cause of disability, affecting 8.6 million people. Another 7.6 million Americans said back or spine problems were the main cause of their disability and 3 million people reported heart trouble.

Women were slightly more likely to be disabled than men at any age. The CDC also found that the number of people reporting a disability doubled for each successive age group, with about 11 percent of people ages 18-44 reporting a disability, 23.9 percent for ages 45-64, and 51.8 percent for ages 65 or older.

Dr. John H. Klippel, president and CEO of the Arthritis Foundation, said in a statement 46 million Americans have some form of arthritis.

"With the aging of baby boomers, the prevalence of arthritis is expected to rise by 40 percent - that is up to 67 million people -- by the year 2030," he said.

"These findings suggest a critical need to expand the reach of effective strategies aimed at disability prevention and management," Klippel said.

Disability Affects Three Out of Every 10 U.S. Adults

By Kristina Fiore

HYATTSVILLE, Md., July 25 -- Nearly 30% of the noninstitutionalized adult U.S. population -- about 62 million people -- have some disability that affects daily activity.
More than 20% of the population reported difficulties walking, bending, reaching overhead, or using their fingers to grasp something, Barbara M. Altman, Ph.D., formerly of the CDC, and colleagues wrote in a National Center for Health Statistics report this week.
"What we have is a large segment of the population who have problems, and they're not all being taken care of," Dr. Altman said.
About two-thirds of these disabled Americans are younger than 65, Dr. Altman said.
"You see so much about the aging population, but you don't see as many numbers about the population from ages 18 to 64," she said. "However there's a larger number of people with disabilities under 65."
Dr. Altman said disability among those younger than 65 was likely related to problems associated with obesity -- such as diabetes and arthritis -- and heart disease, which may also be associated with obesity.
"It's what we see after age 65, but it's the beginning of it and we don't pay as much attention when people are younger," she said. "But that's the point in time to take preventive measures."
The findings emerged from an analysis of data collected by the National Health Interview Survey (NHIS), which canvassed 157,976 adults from 2001-2005 via the Sample Adult Core Questionnaire.
Other significant disabilities involved vision and hearing, with more than 13% of those surveyed reporting difficulties. Emotional or cognitive difficulties were less prevalent, with only 3% of the population reporting each difficulty.
Problems with more complex activities like working, participating in social activities, or being able to manage self-care were reported by 14% of the population.
Work complications were the biggest problem, reported by 12% of those surveyed; just 4% reported difficulties with self-care.
Other survey findings included:
Over half of noninstitutionalized adults with self-care limitations were ages 65 and older; about half of adults with emotional difficulties were under 45 years old.
Adults without disabilities were more than twice as likely to have a college degree as adults who had trouble with complex activities and 70% more likely to have a college degree than those with basic actions difficulty.
Almost one-third of adults with complex activity limitation and 30% of those with basic actions difficulty were obese, compared with 19% of adults with no reported disability.
About 40% of adults ages 18 to 44 with either complex or basic activity limitation reported being smokers, compared with 22% of nondisabled adults in the same age group.
Dr. Altman said the rate of smoking in the 18- to 44-year-old age group with disabilities was particularly concerning because it "furthers their risk for other health problems."
Primary source: National Center for Health StatisticsSource reference:Altman B, et al "Disability and health in the United States, 2001 -- 2005" National Center for Health Statistics 2008.

Daily Living Geriatric Ills Overlooked by Disease-Oriented Clinicians

ANN ARBOR, Mich., Aug. 9 -- Common complaints of aging such as memory problems, falls, or incontinence may be overlooked by clinicians focused on chronic diseases, found investigators here.
A survey of more than 11,000 patients ages 65 and older found that half had one or more conditions that impaired them in their daily lives, reported Christine T. Cigolle, M.D., M.P.H., of the University of Michigan, and colleagues.
"Geriatric conditions are similar in prevalence to chronic diseases in older adults and in some cases are as strongly associated with disability," they wrote in the Aug. 7 issue of the Annals of Internal Medicine.
But the authors also found that "the high prevalence of geriatric conditions and the strength of their association with activities of daily living dependency demonstrate that these conditions go largely unrecognized in the current disease-based model of clinical care."
Cognitive impairment, falls, incontinence, weight loss, dizziness, and hearing and vision loss don't fit neatly into diagnostic pigeonholes, but such conditions "are important to the health and function of older adults and should be addressed in their care," the authors wrote.
The investigators drew their conclusions from a cross-sectional analysis of 11,093 patients who took part in the Health and Retirement Study survey administered in 2000. The sample, which included those living in the community or nursing homes, was chosen to represent 34.5 million older Americans.
The authors looked at the prevalence of seven common geriatric conditions and their association with dependence in activities of daily living such as bathing, dressing, eating, transferring/walking, and toileting.
The geriatric conditions were cognitive impairment, falls, incontinence, low body mass index, dizziness, vision impairment and hearing impairment.
The authors found that 49.9% of the respondents reported having one or more of the conditions, and that some of the conditions were comparable in prevalence to chronic diseases.
For example, falls resulting in injuries were reported by 9.6% of respondents, similar to a prevalence of 9.2% for heart disease. The prevalence of urinary incontinence was 12.7%, compared with 13.2% for diabetes, the authors noted.
They also found a strong and significant association between geriatric conditions and dependency in activities of daily living. After adjusting for demographic factors such as age, gender, marital status, race, income, and education, the risk ratio for activities of daily living dependency among patients with one of the geriatric conditions was 2.1 (95% confidence interval, 1.9 to 2.4).
The adjusted risk ratio nearly doubled with each additional geriatric condition, to 3.6 (95% CI, 3.1 to 4.1) for two conditions, and to 6.6 (95% CI 5.6 to 7.6) for three or more conditions.
The conditions most strongly associated with activities of daily living dependency were cognitive impairment, incontinence, and vision impairment. In contrast, hearing impairment was not associated with activities of daily living dependency.
"Geriatric conditions present a challenge to the clinician because they are prevalent and are associated with disability but typically lack an underlying cause that may be cured," they wrote. "Yet, identifying and assessing geriatric conditions are clinically important because these conditions can be prevented or delayed (vision impairment), managed (cognitive impairment, falls, incontinence vision impairment, hearing impairment), and sometimes treated (low BMI, dizziness), with resulting improvement in symptoms and decrease in disability."
They acknowledged that the study was limited by its cross-sectional design, use of self-reported data, and a lack of information on possible confounders such as delirium and frailty. They also noted that the estimates may have been influenced by survival bias.
The study was supported by grants to researchers from the John A. Hartford Foundation, National Institute on Aging, Ann Arbor Veterans Affairs Geriatric Research, Education and Clinical Center, and Paul Beeson Physician Faculty Scholars in Aging Research Award. The Health and Retirement Study was funded by the National Institute on Aging.
The authors had no conflict of interest disclosures.Primary source: Annals of Internal MedicineSource reference: Cigolle CT et al. "Geriatric Conditions and Disability: The Health and Retirement Study." Ann Intern Med. 2007;147:156-164.

Geriatric Conditions Strongly Associated with Disability

Adults with at least one geriatric condition are likely to need help performing activities of daily living, reports a study in Annals of Internal Medicine.
Researchers evaluated data on some 11,000 adults aged 65 and older who were interviewed for the national Health and Retirement Study. Participants reported whether they had certain geriatric conditions (injury from falling; incontinence; low BMI; dizziness; and vision, hearing, or cognitive impairment) and whether they required help with ADLs. Among the findings:
Having even one geriatric condition, except hearing impairment, significantly increased the risk for ADL dependency.
The risk associated with geriatric conditions was similar to or greater than the risk associated with chronic diseases (e.g., heart disease).
Cognitive impairment, incontinence, and vision impairment conferred the greatest risk.
The authors note that "geriatric conditions fall outside models that now govern much of health care" and call for "an approach to [elder] care that includes the identification and management" of such conditions.