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Reducing the Impact of Geriatric Conditions by Physical Activity

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Reducing the Impact of Geriatric Conditions by Physical Activity Reducing the impact of geriatric conditions by physical activity Erwin Cornelis Petrus Maria Tak KvL-L.12-08Proefschrift ErwinbB5.indd 1 26-8-2013 13:24:43 The 6 studies presented in this thesis were conducted at the Netherlands Organisation for Applied Scientific Research TNO in Leiden and partly at Body@Work, Research Center on Physical Activity, Work and Health, the EMGO institute for Health and Care Research, VU University Amsterdam and The Erasmus Medical Center, Department of Epidemiology, Rotterdam. Body@Work, Research Center on Physical Activity, Work and Health, is a joint initiative of VU University Medical Center (Department of Public and Occupational Health, EMGO Institute for Health and Care Research), VU University Amsterdam, and the Netherlands Organisation for Applied Scientific Research TNO. The studies were funded by the Praeventiefonds and Body@Work, Research Center on Physical Activity, Work and Health. Financial support for the printing of this thesis has kindly been provided by Body@Work, Research Center on Physical Activity, Work and Health. Graphic design: Jaap van der Plas. Cover design: Jaap van der Plas and Erwin Tak. Printed by Ridderprint ISBN 978-90-5986-434-4 © 2013, Erwin CPM Tak, The Netherlands All rights reserved. No part of this thesis may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, recording or any information storage and retrieval system, without prior permission of the holder of the copyright. KvL-L.12-08Proefschrift ErwinbB5.indd 2 26-8-2013 13:24:43 VRIJE UNIVERSITEIT Reducing the impact of geriatric conditions by physical activity ACADEMISCH PROEFSCHRIFT ter verkrijging van de graad Doctor aan de Vrije Universiteit Amsterdam, op gezag van de rector magnificus prof.dr. F.A. van der Duyn Schouten, in het openbaar te verdedigen ten overstaan van de promotiecommissie van de Faculteit der Geneeskunde op donderdag 31 oktober 2013 om 13.45 uur in de aula van de universiteit, De Boelelaan 1105 door Erwin Cornelis Petrus Maria Tak geboren te Oud en Nieuw Gastel KvL-L.12-08Proefschrift ErwinbB5.indd 3 26-8-2013 13:24:44 promotor: prof.dr. M. Hopman-Rock copromotor: dr.ir. A.M.J. Chorus KvL-L.12-08Proefschrift ErwinbB5.indd 4 26-8-2013 13:24:44 Contents Chapter 1 General introduction 7 PART I The association between physical activity and disability Chapter 2 Prevention of onset and progression of basic ADL 23 disability in community dwelling older adults by physical activity: a systematic review and meta-analysis Chapter 3 Changes in disability in older adults with generalized radiological 47 osteoarthritis: a role for physical activity? PART II Reducing the impact of geriatric conditions by physical activity Chapter 4 Does improved functional performance help to reduce urinary 69 incontinence in institutionalized older women? A multicenter randomized clinical trial Chapter 5 The effects of an exercise program for older adults with 87 osteoarthritis of the hip PART III Sustaining the impact of physical activity Chapter 6 Adherence to exercise programs and determinants of maintenance 107 in older adults with mild cognitive impairment Chapter 7 Predictors of self-reported change in physical activity in older 125 adults with knee or hip osteoarthritis Chapter 8 General discussion 147 Chapter 9 Summary 171 Nederlandse samenvatting Chapter 10 Acknowledgements 185 Dankwoord About the Author Publications 5 KvL-L.12-08Proefschrift ErwinbB5.indd 5 26-8-2013 13:24:44 KvL-L.12-08Proefschrift ErwinbB5.indd 6 26-8-2013 13:24:44 General Introduction REDUCING THE IMPACT OF GERIATRIC CONDITIONS BY PHYSICAL 1 ACTIVITY CHAPTER KvL-L.12-08Proefschrift ErwinbB5.indd 7 26-8-2013 13:24:44 KvL-L.12-08Proefschrift ErwinbB5.indd 8 26-8-2013 13:24:44 General introduction The aging society Over the coming decades most Western societies will be facing demographic and epidemiologic challenges. Between 2010 and 2050 the number of persons aged 65 or older in the Netherlands, will increase from 2.4 to 4.5 million 1. Due to this increase and the fact that diseases that used to be fatal are now better treated and managed, the number of older adults with chronic diseases will rise. In primary care, the prevalence of those with one chronic disease in the general Dutch population is 33.7%, and this rises with age from 30.0% for 25-54 years-old to 83.5% for 75 years and older 2. Multimorbidity, i.e. having two or more chronic diseases, rises from 8.1% in 25-54 year-olds, to 59.2% for those aged 75 and older. It is estimated that the number of older adults (over the age of 65) with multimorbidity will rise from one million in 2008 to 1.5 million in 2020 3. This increase in older adults with multiple chronic diseases will lead to a higher demand for care 4, which will have to be met by a shrinking work force 5. The consequences of old age and chronic conditions One important consequence of chronic disease in older adults is the increased risk of becoming disabled 6,7. Disability is defined as difficulty or dependency in carrying out activities essential to independent living including essential roles needed for self-care and activities important to one’s life. Compared with having no disease, suffering from a chronic disease increases the risk of developing disability 3.5 fold. If co-morbidity is present, this figure rises to 4.7 8-10. This is especially true if a second disease has impact on another bodily system, for instance when knee osteoarthritis (musculoskeletal system) occurs together with heart disease (cardio-respiratory system) 11. As well as diagnosed diseases, the so-called geriatric conditions are known to have a strong negative impact on daily life 12. These conditions can be described as a collection of signs and symptoms common in older and particularly vulnerable adults which are not necessarily related to a specific disease 13. They are multi-factorial in cause, may be triggered by a variety of acute insults, are typically episodic in nature and are often followed by functional decline 14. Although there is a lack of consensus on the exact definition, there seems to be a consensus that cognitive impairment, falls, incontinence, immobility and vision and hearing problems belong to these geriatric conditions. As a result a large proportion of older persons experience difficulties in performing activities necessary for independent living. The prevalence of disability in older age groups (55+) is reported to vary between 13% (severe) to 29% (mild) depending on level of disability 10. Over a 6-year period the incidence of disability is around 45% for older adults (55-88 years) increasing to 68% in older age groups (75-88 years). Recovery from disability is reported in up to 20% of these persons within a 6-year period, this percentage being lower in the older 9 KvL-L.12-08Proefschrift ErwinbB5.indd 9 26-8-2013 13:24:44 Chapter 1 age groups. Several sub-types of disability are reported, including instrumental, locomotor, mobility, and activities of daily living (ADL) 15. Disability in ADL activities in particular limits an older person’s autonomy and is directly related to loss of independence, an increased risk of requiring outpatient care, hospitalization, institutionalization and death 16-19. As well as increasing the demand for and cost of care, difficulty in performing everyday activities also has a negative impact on quality of life 20 and threatens the participation in society such as volunteer work and social contacts by older adults 21. Supporting participation and independent living are key Dutch governmental policy targets in elderly care 22. Successful aging is no longer restricted to postponing death or curing disease, but is focusing more and more on preventing the negative effects of disease and increasing the participation of older adults in society. According to the Dutch Health Council this means that as well as the prevention of disease, prevention should also be function-oriented and focus on identifying which determinants can be positively influenced 23. The goal should be to prevent the onset of disability, minimize its progression and to enable older adults to recover from disabilities. Recent studies show that disability is a dynamic process with individuals moving in and out of states of disability 24-26. It is therefore necessary to identify modifiable factors associated with this process. This leads to the question - what are the factors that cause diseases and aging to result in disability? The disablement process The Disablement Process Model (DPM) 27 can help us to understand the pathway from disease to disability. According to this model, pathology (presence of disease, trauma) leads to impairment (anatomical and structural abnormalities) which in turn lead to functional limitations (restrictions in basic and mental actions) that eventually result in disability (difficulty carrying out activities of daily life). Figure 1 shows a model of the main pathway and a number of other factors that can speed up and slow down the journey along the pathway 27, or affect the direction of the process. Next to risk factors, these include extra and intra-individual factors such as interventions (introduced to slow down and reverse disablement) and accelerators (factors that have the harmful effect of speeding up disablement) 28. 10 KvL-L.12-08Proefschrift ErwinbB5.indd 10 26-8-2013 13:24:44 General introduction EXTRA-INDIVIDUAL FACTORS PATHOLOGY IMPAIRMENTS FUNCTIONAL DISABILITY Diagnoses of disease, Dysfunctions and structural LIMITATIONS Difficulty doing activities injury, congenital / abnormalities in specific Restrictions in basic of daily life developmental condition body systems physical and mental actions RISK FACTORS INTRA-INDIVIDUAL FACTORS Figure 1: The Disablement Process Model 27 The model is best illustrated by an example.
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