Publications (11)3.04 Total impact
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Article: Day length and weather conditions profoundly affect physical activity levels in older functionally impaired people.
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ABSTRACT: Regular physical activity is vital for maintaining the health and independence of older people. Few objective data exist on the effect of weather on physical activity levels in this group. The objective of this study was to evaluate the effect of weather using an objective measure of physical activity. This was a retrospective study of 127 participants, >65 years old, who were enrolled in a previous randomised controlled trial. The main outcome was daily activity counts measured using the RT3 triaxial accelerometer over 1-week periods. These were correlated with local weather data including daily maximum temperature, sunshine, precipitation and wind speed that were obtained from the metrological office. The mean age of the subjects was 78.6 years; 90/127 were female; and 720 usable daily counts were obtained for the 127 participants. The mean daily counts showed a striking seasonal variation, with maximum activity in June and minimum in February (137 557 vs 65 010 counts per day, p<0.001). Day length, mean maximum temperature and mean daily sunshine were able to explain 72.9% of the monthly variance in daily activity levels. Daily counts showed moderate correlation with day length (r = 0.358, p<0.001), maximum temperature (r = 0.345, p<0.001), duration of sunshine (r = 0.313, p<0.001) and rain (r = -0.098, p = 0.008) but not with wind speed (r = 0.093, p = 0.12). Multivariate analysis showed that day length, sunshine duration and maximum temperature were independent predictors of daily activity (adjusted R(2) = 0.16). Physical activity levels among older people are much higher in summer than in winter. Day length, sunshine duration and maximum temperature have a significant influence on physical activity levels.Journal of epidemiology and community health 12/2008; 63(4):305-9. · 3.04 Impact Factor -
Article: Validation of an individualised quality of life measure in older day hospital patients
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ABSTRACT: Abstract Background To test the ease of use, reliability, responsiveness and construct validity of the Patient Generated Index, an individualised quality of life score, in older people attending a Medicine for Older People Day Hospital. Methods Prospective longitudinal study in patients attending a specialist Medicine for Older People Day Hospital in Scotland. The Patient Generated Index was administered at baseline, one week later, and at the end of Day Hospital attendance. Functional Limitations Profile, Hospital Anxiety and Depression Score, Barthel index and global subjective impressions of change were also collected and compared with baseline scores and change in Patient Generated Index scores. Reliability was assessed using intraclass correlation coefficients in subjects reporting no change in global quality of life; responsiveness was assessed using effect size and Guyatt coefficients in subjects reporting change in global quality of life. External validity was assessed via correlation with measures of physical function, comorbid disease and psychological state. Results 75 patients were enrolled, mean age 81 years. Mean completion time was 5.0 minutes at baseline. Reliability was moderate (intraclass correlation coefficient 0.72) but there were weak and inconsistent responses to change (effect sizes 0.02 to 0.15; Guyatt responsiveness coefficient 0.29). Patient Generated Index scores correlated with Functional Limitation Profile scores (r = 0.51, p < 0.001), baseline anxiety score (r = -0.25, P = 0.039) and baseline depression score (r = -0.37, P = 0.002) but displayed only weak, non-significant correlation with number of comorbid diseases (r = -0.22, P = 0.07), number of medications (r = -0.21, P = 0.08) and Barthel score (r = 0.09, p = 0.45). Conclusion The Patient Generated Index appears moderately reliable and easy to complete, but is poorly responsive to change, limiting its usefulness in clinical practice or research.Health and Quality of Life Outcomes. 01/2008; -
Article: When "no" might not quite mean "no"; the importance of informed and meaningful non-consent: results from a survey of individuals refusing participation in a health-related research project
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ABSTRACT: Abstract Background Low participation rates can lead to sampling bias, delays in completion and increased costs. Strategies to improve participation rates should address reasons for non-participation. However, most empirical research has focused on participants' motives rather than the reasons why non-participants refuse to take part. In this study we investigated the reasons why older people choose not to participate in a research project. Methods Follow-up study of people living in Tayside, Scotland who had opted-out of a cross-sectional survey on activities in retirement. Eight hundred and eighty seven people aged 65–84 years were invited to take part in a home-based cross-sectional survey. Of these, 471 refused to take part. Permission was obtained to follow-up 417 of the refusers. Demographic characteristics of people who refused to take part and the reasons they gave for not taking part were collected. Results 54% of those invited to take part in the original cross-sectional survey refused to do so. However, 61% of these individuals went on to participate in the follow-up study and provided reasons for their original refusal. For the vast majority of people initial non-participation did not reflect an objection to participating in research in principle but frequently stemmed from barriers or misunderstandings about the nature or process of the project itself. Only 28% indicated that they were "not interested in research". The meaningfulness of expressions of non-consent may therefore be called into question. Hierarchical log-linear modelling showed that refusal was independently influenced by age, gender and social class. However, this response pattern was different for the follow-up study in which reasons for non-participation in the first survey were sought. This difference in pattern and response rates supports the likely importance of recruitment issues that are research and context specific. Conclusion An expression of non-consent does not necessarily mean that a fully informed evaluation of the pros and cons of participation and non-participation has taken place. The meaningfulness of expressions of non-consent may therefore be a cause for concern and should be subject to further research. Many reasons for non-participation may be specific to a particular research topic or population. Information sheets should reflect this by going beyond standardised guidelines for their design and instead proactively seek out and address areas of concern or potential misunderstanding. The use of established behavioural theory in their design could also be considered.BMC Health Services Research. 01/2007; -
Article: Effect of a seated exercise program to improve physical function and health status in frail patients ≥70 years of age with heart failure
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ABSTRACT: Eighty-two patients aged ≥70 years with heart failure were randomized to a gentle, seated exercise program or to usual care. Six-minute walk distance and quality of life did not change between groups, but daily activity as measured by accelerometry increased in the exercise group relative to the control group. -
Article: Why older people do not participate in leisure time physical activity: a survey of activity levels, beliefs and deterrents
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ABSTRACT: Background: regular physical activity has been shown to have many health benefits. However, many older people are physically inactive. Objective: to investigate why older people are reluctant to participate in leisure time physical activity and to identify strategies to encourage increased activity. Design: cross-sectional survey. Setting: 16 general practices in Dundee, Scotland. Methods: 409 randomly selected older people (65–84 years) who lived independently were interviewed at home. Forty-six percent of those invited to take part were recruited into the study. Results: levels of knowledge about the specific health benefits of physical activity were high. Almost all participants (95%) believed that physical activity was beneficial and 79% believed that they did enough to keep healthy. However, 36% did no leisure time physical activity and a further 17% did less than 2 hours per week. Regression modelling identified 11 factors that exerted significant independent effects on levels of leisure time physical activity. The most powerful deterrent was lack of interest (OR = 7.8). Other factors included lack of daily access to a car, shortness of breath, joint pain, dislike of going out alone or in the evening, perceived lack of fitness, lack of energy, doubting that exercise can lengthen life, not belonging to a group and doubting that meeting new people is beneficial. Conclusions: increasing leisure time physical activities poses major challenges. Beliefs about desirable levels of activity in older people would need to be changed. Action would be needed to relieve physical symptoms and address fears about perceived ability to undertake physical activity. Finally, easily accessible facilities would be needed to encourage participation in physical activity. -
Article: Effects of exercise on depressive symptoms in older adults with poorly responsive depressive disorder : randomised controlled trial
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ABSTRACT: Background Depression is common in later life. Aims To determine whether exercise is effective as an adjunct to antidepressant therapy in reducing depressive symptoms in older people. Method Patients were randomised to attend either exercise classes or health education talks for 10 weeks. Assessments were made ‘blind’ at baseline, and at 10 and 34 weeks. The primary outcome was seen with the 17-item Hamilton Rating Scale for Depression (HRSD). Secondary outcomes were seen with the Geriatric Depression Scale, Clinical Global Impression and Patient Global Impression. Results At 10 weeks a significantly higher proportion of the exercise group (55% v. 33%) experienced a greater than 30% decline in depression according to HRSD (OR=2.51, P=0.05, 95% CI 1.00-6.38). Conclusions Because exercise was associated with a modest improvement in depressive symptoms at 10 weeks, older people with poorly responsive depressive disorder should be encouraged to attend group exercise activities. Biomedical and Therapeutics Committee of the Chief Scientist's Office, Department of Health K/MRS/50/C2692 -
Article: Perindopril improves six minute walking distance in older patients with left ventricular systolic dysfunction: a randomised double blind placebo controlled trial
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ABSTRACT: Objective: To evaluate the effects of the angiotensin converting enzyme inhibitor perindopril on six minute walking distance and quality of life in very old patients with left ventricular systolic dysfunction. Design: Prospective, double blind placebo controlled trial. Setting: Medicine for the elderly day hospital. Patients: 66 patients (average age 81) with left ventricular systolic dysfunction identified by echocardiography. Interventions: 10 weeks of treatment with titrated doses of perindopril or placebo. Main outcome measures: Six minute walking distance 10 weeks following treatment, quality of life measurements including the Minnesota living with heart failure questionnaire and the 36 item short form health survey. Results: In patients with left ventricular systolic dysfunction, six minute walking distance was significantly increased in the treatment group (37.1 m) compared with the placebo group (-0.3 m, p < 0.001). The medication was well tolerated and there were no significant adverse events. Conclusions: Six minute walking distance is improved considerably by treatment with perindopril in older patients with heart failure caused by left ventricular systolic dysfunction. Servier Laboratories Ltd. -
Article: Effect of perindopril on physical function in elderly people with functional impairment: a randomized controlled trial
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ABSTRACT: Background: Physical function and exercise capacity decline with age and are a major source of disability in older people. Recent evidence suggests a potential role for the renin–angiotensin system in modulating muscle function. We sought to examine the effect of the angiotensin-converting-enzyme (ACE) inhibitor perindopril on physical function in elderly people with functional impairment who had no heart failure or left ventricular systolic dysfunction. Methods: In this double-blind randomized controlled trial, participants aged 65 years and older who had problems with mobility or functional impairment were randomly assigned to receive either perindopril or placebo for 20 weeks. The primary outcome was the change in the 6-minute walking distance over the 20 weeks. Secondary outcomes were changes in muscle function, daily activity levels, self-reported function and health-related quality of life. Results: A total of 130 participants were enrolled in the study (mean age 78.7, standard deviation 7.7 years); 95 completed the trial. At 20 weeks, the mean 6-minute walking distance was significantly improved in the perindopril group relative to the placebo group (mean between-group difference 31.4 m, 95% confidence interval [CI] 10.8 to 51.9 m; p = 0.003). There was a significant impact on health-related quality of life: although the mean score for part 1 of the EQ-5D questionnaire deteriorated over time in the placebo group, quality of life was maintained in the perindopril group, for a between-group difference of 0.09 (p = 0.046). There were no significant differences between the 2 groups in the other outcomes. Interpretation: Use of the ACE inhibitor perindopril improved exercise capacity in functionally impaired elderly people who had no heart failure and maintained health-related quality of life. The degree of improvement was equivalent to that reported after 6 months of exercise training. (International Standard Randomised Controlled Trial Register no. ISRCTN67679521). © 2007 Canadian Medical Association or its licensors Perindopril was supplied free of charge by Servier Laboratories, Slough The study was funded by the Chief Scientist Office, Scottish Executive -
Article: Using an individualised quality of life measure in older heart failure patients
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ABSTRACT: Background Existing tools purporting to measure quality of life in heart failure do not allow expression of individual needs and preferences. The Patient Generated Index is a recently introduced tool that allows individualised assessment of quality of life. Methods 59 patients aged 65 years and over with a clinical diagnosis of chronic heart failure were administered the Patient Generated Index at baseline, 1 week and 12 weeks, along with the Guyatt chronic heart failure questionnaire, Minnesota Living with Heart failure questionnaire and Short Form-12 tool. Changes in questionnaire scores were used to calculate reproducibility and responsiveness to change. Comparison of Patient Generated Index scores with the other questionnaires and with New York Heart Association class was used to determine construct validity. Results All four questionnaires were completed by > 90% of participants. Intraclass correlation coefficients denoting reproducibility were high for the Guyatt (0.93) and Minnesota questionnaires (0.89), moderate for the Patient Generated Index (0.65) and Short Form-12 (0.59). Responsiveness to change was similar for all questionnaires, but lower than in previous studies. The Patient Generated Index correlated with New York Heart association class and correlated moderately with the other questionnaires. The most important domains nominated on the Patient Generated Index were walking, performing daily activities, feeling tired and climbing stairs. Conclusions The Patient Generated Index can be administered successfully to older heart failure patients; usefulness is limited by suboptimal reproducibility and responsiveness. Impairment of physical function is the factor most cited by older heart failure patients affecting their quality of life. -
Article: B-type natriuretic peptide is associated with mortality in older functionally impaired patients
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ABSTRACT: Objectives: To determine the predictive power of B-type natriuretic peptide (BNP) regarding death in older, functionally impaired patients with multiple comorbidity. Design: Prospective cohort study. Setting: Specialist geriatric assessment clinic and day hospital. Participants: Two hundred ninety-nine older, functionally impaired patients, mean age 79 at enrollment. Measurements: Full clinical history and examination, baseline BNP, and echocardiography. Date and cause of death were ascertained from Scottish death records. Kaplan-Meier survival curves were constructed for quartiles of log (BNP), and the contribution of BNP to prediction of death was investigated. Results: The follow-up period ranged from 3.9 to 5.2 years (mean 4.4 years). BNP was a powerful independent predictor of all-cause and cardiovascular mortality. BNP was a more powerful predictor than blood pressure, diabetes mellitus, smoking, echocardiographic left ventricular hypertrophy, left ventricular systolic dysfunction, or age. BNP predicted death in those with and without a previous cardiovascular event at baseline. Conclusion: BNP has significant predictive power for death in older, functionally impaired patients. The definitive version is available at www3.interscience.wiley.com -
Article: Predictors of exercise capacity and everyday activity in older heart failure patients
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ABSTRACT: Background: Exercise capacity and daily activity are key outcomes for older, frail heart failure patients. Little is known about the determinants of these outcomes in this patient group. Aims: To explore predictors of exercise capacity and daily activity in older, frail heart failure patients. Methods: Analysis of prospectively collected data from a cohort of 82 patients aged 70 years and over, enrolled in a randomised controlled trial of exercise in heart failure patients. Pathophysiological, demographic, psychological and social factors were analysed by multivariate regression to determine predictors of exercise capacity (6-min walk distance) and daily activity (daily accelerometer counts). Results: Between 49% and 55% of the variance in 6-min walk distance was explained by variables including New York Heart Association class, depression score, attitude to ageing and use of walking aids. Only 11% to 26% of the variance in accelerometer scores was explained by the model; 6-min walk distance was the only consistent predictor of daily activity. Conclusions: Physical, psychological and attitudinal variables contribute to variance of the 6-min walk. Six-minute walk distance predicts a small amount of the variance in daily activity, but the majority of variance in daily activity remains unexplained and requires further investigation. The Health Foundation (formerly PPP Health Foundation) 2006/918
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2008
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University of Dundee
Dundee, SCT, United Kingdom
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