الفهرس 
Age Related Changes and SarcopeniaOnly 14 pages are availabe for public view
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Abstract
Aging is a multifactorial irreversible process associated with decline in muscle mass, physical fitness and neuromuscular functions. One of the most efficient methods to counteract age-related changes in muscle mass and function is physical exercise.
Physical activity (PA) can attenuate the physiological declines associated with aging and muscular disuse, prevent the onset of chronic diseases, prevent or mitigate functional limitations, and improve cognitive function and mental health.
Functional capacity is characterized by people’s ability to carry out daily activities independently and autonomously. The loss of functioning in seniors is associated with multiple factors and increases the risk of hospitalization, dependency and falls. Functional decline makes the elderly more vulnerable and dependent, leading to a decrease in their well-being and quality of life. This justifies the need to assess the functionality of this population to detect potential risks of functional decline. It will also facilitate the design of preventive strategies
As the general population increases in age, there is a need for a valid and reliable tool that can quickly and accurately screen for functional decline.
Currently, there is no consensus on the use of a “gold –standard” for assessment of functional ability in elderly. Many tools have been evaluated for assessment of elder functional capacity. These include: patient self-report; observations made by the managing health care team; or the use of formal functional evaluation scales by interviewing family members.
Self-reported (subjective or proxy-reported) functional status can be obtained by questionnaire or telephone interview, thus facilitating convenience and reducing administrative costs. Furthermore, subjective assessment generally focuses on items that have direct clinical and caregiving relevance, such as shopping or bathing. Furthermore, dependency in the traditionally assessed self-reported items, such as basic and instrumental activities of daily living is uncommon which results in ceiling effects (i.e., a large proportion will score at the top of the scale or are unimpaired) which limit the range that can be captured, so our primary aim of this study was Standardization/ validation of advanced tool of physical performance of community dwelling elderly male and the secondary aim was to validate hand strength measurement using sphygmomanometer compared to hand grip strength test using Jamar dynamometer.
A randomized cross sectional cohort study performed on 102 elderly male patients 60 years old and the care givers of the admitted inpatients and accepted to participate in the study follow up of ADL, IADL, Modified Barthel index was done after 3 months using telephone and only 97 participants continued the study.All participants were subjected to:
1. Informed consent.
2. Personal history including age, marital status and smoking history
3. Full medical past history was taken
4. Weight and height assessment.
5. Comprehensive geriatric assessment including:
A) Mini Mental status examination (MMSE) (Folstein et al., 1975)
B) Geriatric depression scale (GDS-15) (Yesavage et al., 1982)
C) Activities of daily living (ADL) (Mahoney and Barthel, 1965), (Katz et al., 1970)
D) Instrumental Activities of Daily Living (IADL) (Lawton et al., 1969).
6. Objective functional assessment tools include:
A. Hand grip strength test (Roberts et al., 2011).
B. Bed side grip assessment with the sphygmomanometer test (Hamilton et al., 1992).
C. Short physical performance battery (SPPB) (Puthoff et al., 2008).
7. Subjective functional assessment tools include:
A. Incidental and planned exercise questionnaire (Delbaere et al., 2010).
B. Modified Barthel ADL index (Wade et al., 1988).
8. Patients were followed up regarding functional decline by telephone call after three months of initial office visit using ADL, IADL, Modified Barthel Index.
Mean ADL score was 5.66 (± 0.8) at baseline assessment, with 9 (8.8%) patients were dependent, and 93 (91.2%) patients were independent and mean score of ADL after 3 months follow up was 5.44 (± 1.15) with 15 (15.5%) patients was dependent and 82 (84.5%) patients were independent. IADL mean score was 6.79 (± 1.75) at baseline assessment with 38 (37.3%) patients were dependent and 64 (62.7%) patients were independent, and mean IADL score after 3 months follow up was 6.36 (± 2.18), with 39 (40.2%) patients were dependent and 58 (59.8%) patients were independent. Mean Modified Barthel score was 18.91 (± 1.92) at baseline assessment and 65 (63.7%) of patients were totally independent and after 3 months the mean score was 18.28 (± 2.99) and 59 (60.8%) of patients were totally independent.
• Age, hypertension, cerebrovascular stroke, BPH and charlson comorbidity index score, MMSE Score, GDS score, modified Barthel score, total activity, incidental activity, walking activity, planned activity, planned walking activities, planned sport activities, hand grip strength test by Jamar, hand grip strength by sphygmomanometer, total balance score, repeated chair stand score 0:4, gait score and final SPPB score were significantly lower in ADL, IADL dependent compared to ADL independent group. (P value <0.05).
• There was a significant agreement between ADL, IADL and modified Barthel at the base line assessment of the study and after 3 months follow up (P value=0.000), (P value=0.000) respectively.
• Predictors of ADL dependency after 3 months: Grip strength by Jamar significantly at cut-off < 26, Grip strength by sphygmomanometer highest reading at cut-off <160, Total balance score at cut-off <3, Repeated chair stand score at cut-off <3, Gait score at cut-off< 2, Total activity of IPEQ at cut-off <7.31.
• There was a positive correlation between grip strength by sphygmomanometer and grip strength Jamar (P value <0.001).
• There was no significant difference between calculated grip strength and grip strength by Jamar so we can validate this equation to predict Hand Grip strength in Kg/strength using Hand grip strength measured in mmHg using sphygmomanometer and age.
Grip strength as measured by Jamar (Kg/strength) =
12.592 + [(0.211 * grip strength as measured by sphygmomanometer in mmHg) + (-0.261 * age years)]
Univariate logistic regression analysis can predict ADL dependency after 3 months assessment if age was more than 71 years old, charleson comorbidity index score was ≥ 3, patient had positive screening of depression using GDS-15 questionnaire, total activity of IPEQ was ≤ 7.31, Planned activity was ≤ 2.63, hand grip strength by Jamar dynamometer was ≤ 26 and total SBPB score was ≤ 10 at baseline assessment, multivariate logistic regression analysis shows that the most important factors predict ADL dependency after 3 months were; age more than 71 years old with OR (95% CI) of 4.932 (1.006-24.181) with p-value = 0.048 and charlson score ≥ 3with OR (95% CI) of 12.971 (2.363-71.190) with p-value = 0.008.