Higher Levels Of Social Activity Decrease The Risk Of Developing Disability In Old Age

Afraid of becoming disabled in old age, not being able to dress yourself or walk up and down the stairs? Staying physically active before symptoms set in could help. But so could going out to eat, playing bingo and taking overnight trips.

According to research conducted at Rush University Medical Center, higher levels of social activity are associated with a decreased risk of becoming disabled. The study has just been posted online and will be published in the April issue of the Journal of Gerontology: Medical Sciences.

"Social activity has long been recognized as an essential component of healthy aging, but now we have strong evidence that it is also related to better everyday functioning and less disability in old age," said lead researcher Bryan James, PhD, postdoctoral fellow in the epidemiology of aging and dementia in the Rush Alzheimer's Disease Center. "The findings are exciting because social activity is potentially a risk factor that can be modified to help older adults avoid the burdens of disability."

The study included 954 older adults with a mean age of 82 who are participating in the Rush Memory and Aging Project, an ongoing longitudinal study of common chronic conditions of aging. At the start of the investigation, none of the participants had any form of disability. They each underwent yearly evaluations that included a medical history and neurological and neuropsychological tests.

Social activity was measured based on a questionnaire that assessed whether, and how often, participants went to restaurants, sporting events or the teletract (off-track betting) or played bingo; went on day trips or overnight trips; did volunteer work; visited relatives or friends; participated in groups such as the Knights of Columbus; or attended religious services.

To assess disability, participants were asked whether they could perform six activities of daily living without help: feeding, bathing, dressing, toileting, transferring and walking across a small room. They were also asked whether they could perform three tasks that require mobility and strength: walking up and down a flight of stairs, walking a half mile and doing heavy housework. Finally, they were asked about their ability to perform what are referred to as "instrumental" activities of daily living, such as using the telephone, preparing meals and managing medications. Difficulties with household management and mobility are more common and represent less severe disability than difficulty with self-care tasks, so the measures represented a range of disability.

Results showed that a person who reported a high level of social activity was about twice as likely to remain free of a disability involving activities of daily living than a person with a low level of social activity, and about 1.5 times as likely to remain free of disability involving instrumental activities of daily living or mobility.

Why social activity plays a role in the development of disability is not clear, James said. Possibly, social activity may reinforce the neural networks and musculoskeletal function required to maintain functional independence.

Future research is needed to determine whether interventions aimed at increasing late-life social activity can play a part in delaying or preventing disability, James said.

Other researchers at Rush involved in the study were Patricia Boyle, PhD, Dr. Aron Buchman and Dr. David Bennett.

Source:
Rush University Medical Center

Daily Number: Internet Challenges for the Disabled - Pew Research Center

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Americans living with a disability are less likely than other adults to use the internet. According to a national survey conducted by the Pew Internet & American Life Project in September 2010, 54% of adults living with a disability use the internet, compared with 81% of adults who report none of the disabilities listed in the survey. Two percent of American adults say they have a disability or illness that makes it harder or impossible for them to use the internet. The survey found that about one-in-four (27%) American adults live with a disability that interferes with activities of daily living. Statistically speaking, disability is associated with being older, less educated, and living in a lower-income household. By contrast, internet use is statistically associated with being younger, college-educated, and living in a higher-income household. People living with disability, once they are online, are also less likely than other internet users to have high-speed access or wireless access. The Pew Internet Project report provides context for the continuing conversation about who does -- and does not -- use the internet in the U.S., including a proposal to extend the enforcement of the Americans with Disabilities Act to include websites operated by certain entities. Read more

Questionable Billing by Skilled Nursing Facilities

Image via WikipediaThe Department of Health and Human Services' Office of Inspector General has released the following report: Questionable Billing by Skilled Nursing Facilities (OEI-02-09-00202) http://go.usa.gov/rCy

Skilled nursing facilities (SNF) categorize beneficiaries into resource utilization groups (RUG) based on their care and resource needs. Medicare generally pays the most for ultra high therapy RUGs. Medicare also pays more for RUGs for beneficiaries who require more assistance with certain activities of daily living, such as eating.

The OIG found that SNFs increasingly billed Medicare for higher paying RUGs from 2006 to 2008, even though beneficiary characteristics remained largely unchanged. Specifically, they found large increases in RUGs for ultra high therapy, with payments to SNFs for ultra high therapy increasing by nearly 90 percent from 2006 to 2008, rising from $5.7 billion to $10.7 billion. In addition, RUGs for high levels of assistance with daily activities increased. The investigators  also found that for-profit SNFs were far more likely than nonprofit or government SNFs to bill for higher paying RUGs, and that a number of SNFs had questionable billing in 2008. Taken together, these findings raise concerns about the potentially inappropriate use of higher paying RUGs, particularly those for ultra high therapy.

HDL Loses Power After LDL Lowering MedPage Today

By Charles Bankhead, Staff Writer, MedPage Today

The predictive value of HDL cholesterol all but disappeared with treatment-induced low levels of LDL, according to a new analysis of data from a large trial of lipid-lowering therapy.

Among patients treated with rosuvastatin (Crestor), the usual inverse association between HDL levels and vascular risk lost its statistical significance. Neither baseline (P=0.82) nor on-treatment (P=0.97) HDL levels predicted the risk of clinical events, Paul M. Ridker, MD, of Harvard, and colleagues reported online in The Lancet.

In contrast, HDL levels in placebo-treated patients had a significant association with subsequent events both at baseline (P=0.0039) and during randomized treatment (P=0.0047).

"Our data should not reduce enthusiasm for measurement of HDL-cholesterol concentration as part of an initial cardiovascular risk assessment," Ridker and his co-authors wrote in conclusion. "As shown here among those allocated to placebo, HDL cholesterol was a powerful inverse risk predictor.

"However, these primary prevent data and recent secondary prevention data from [other] trials provide little evidence to support the hypotheses that HDL cholesterol levels predict risk of vascular events in the setting of high-dose statin therapy."

In multiple randomized clinical trials, statin therapy has consistently led to large, statistically significant reductions in cardiovascular events. The benefits have been observed in both primary- and secondary-prevention trials, the authors wrote.

However, in every trial, residual risk has remained among patients assigned to statin therapy. One possible explanation for the residual risk is low levels of HDL.

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