PHYSICAL AND COGNITIVE STATUS OF AN OLDER PERSON

Physical And Cognitive Status Of An Older Person

Physical And Cognitive Status Of An Older Person

Introduction

In a recent study, Gill and colleagues (1996) showed independent contributions of impairments in physical performance and cognitive status to the risk of functional dependence in non-disabled, high-functioning, community-living older adults. The authors conclude that a better understanding of the processes underlying functional dependence may facilitate the design of e€ective and ecient strategies to prevent or slow functional decline. Although several other studies showed associations between cognitive status and functional depen- dence too (Gill et al., 1996), Kempen et al. (1996a) recently found only marginal independent con- tributions of cognitive status (ie short-term memory and verbal intelligence) to ADL disability in a cross-sectional study. From a review of the literature, they concluded that the unique associ- ations between cognitive status and ADL disability remain unclear.

In the present short article, we seek to examine the independent contributions of cogni- tive impairments to subsequent levels of ADL disability in low-functioning, non-institutionalized older adults. Less than 40% of patients experiencing a hip fracture recover their pre-fracture mobility. One-year mortality rates are also high, ranging from 15 to 20 percent and life expectancy is decreased by almost 2 years among those aged 80 or older. The estimated per patient cost of hip fracture ranges from $19,335 to $66,000 (1995 dollars).

Risk factors for hip fracture include age, female gender, chronic medical conditions, heredity, smoking, medications and impaired visual function. These factors are associated with falls or loss of bone mineral density (BMD) in older adults. Weight loss and poor cognition are also predictors of hip fracture. In a prospective case-controlled study, a significant association between low body mass index (BMI) and hip fracture was found. An association has also been reported between low cognitive function and hip fracture. In a large community-based study of adults 75 and older, Guo and colleagues reported the risk of hip fracture was twofold higher among persons identified as cognitively impaired.

METHODS

Subjects

The data were obtained from a subsample (N . 753) of the baseline participants (N . 5279) in the Groningen Longitudinal Ageing Study (GLAS) in 1993. This is a population-based pros- pective follow-up study of the determinants of health-related quality of life of older people, with special emphasis on physical and social disability and well-being (Kempen et al., 1997a,b). The source population of GLAS is de®ned as people aged 557 years who lived in the North of The Netherlands either independently or in adapted housing for elderly people in 1993. Those with severe cognitive impairments at baseline (Mini- Mental State Exam (MMSE) score of 16 or lower) (Folstein et al., 1975) were excluded (N . 78). We assumed that these persons would not be able to participate in the interviews. The subsample in this article comprises 753 elderly (14.3%) with the lowest scores on the six-item physical functioning scale of the MOS Short-Form General Health Survey (SF-20) (Stewart et ...