human
***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Background and aims : Little is known about muscle strength as a predictor of  disability among older Mexican Americans . The aim of this study was to examine the association between h and grip strength  and 7-year incidence of ADL disability in older Mexican American men and women . Methods : A 7-year prospect i ve cohort study of 2493 non-institutionalized Mexican American men and women aged 65 or older residing in five south-western states .  Maximal h and grip strength test , body mass index , cognitive function , activities of daily living , self-reports of medical conditions ( arthritis , diabetes , heart attack , stroke , cancer , hip fracture ) , and depressive symptoms were obtained . Results : In a Cox proportional regression analysis , there was a linear relationship between h and grip strength at baseline and risk of incident ADL disability over a 7-year follow-up . Among non-disabled men at baseline , the hazard ratio of any new ADL limitation was 1.90(95 % CI 1.14–3.17 ) for those in the lowest quartile , when compared with men in the highest h and grip strength quartile , after controlling for age , marital status , medical conditions , high depressive symptoms , MMSE score , and BMI at baseline . Among non-disabled women at baseline , the hazard ratio of any new ADL limitation was 2.28 ( 95 % CI 1.59–3.27 ) for those in the lowest quartile , when compared with women in the highest h and grip strength quartile . Conclusions : H and grip strength is an independent predictor of ADL disability  among older Mexican American men and women . The h and grip strength test is an easy , reliable , valid , inexpensive method of screening to identify older adults at risk of disability OBJECTIVES To determine the independent prognostic effect of seven potential frailty criteria , including five from the Fried phenotype , on several adverse outcomes . DESIGN Prospect i ve cohort study . SETTING Greater New Haven , Connecticut . PARTICIPANTS Seven hundred fifty-four initially nondisabled , community-living persons aged 70 and older . MEASUREMENTS An assessment of seven potential frailty criteria ( slow gait speed , low physical activity , weight loss , exhaustion , weakness , cognitive impairment , and depressive symptoms ) was completed at baseline and every 18 months for 72 months . Participants were followed with monthly telephone interviews for up to 96 months to determine the occurrence of chronic disability , long-term nursing home ( NH ) stays , injurious falls , and death . RESULTS In analyses adjusted for age , sex , race , education , number of chronic conditions , and the presence of the other potential frailty criteria , three of the five Fried criteria ( slow gait speed , low physical activity , and weight loss ) were independently associated with chronic disability , long-term NH stays , and death . Slow gait speed was the strongest predictor of chronic disability ( hazard ratio (HR)=2.97 , 95 % confidence interval (CI)=2.32 - 3.80 ) and long-term NH stay ( HR=3.86 , 95 % CI=2.23 - 6.67 ) and was the only significant predictor of injurious falls ( HR=2.19 , 95 % CI=1.33 - 3.60 ) . Cognitive impairment was also associated with chronic disability ( HR=1.82 , 95 % CI=1.40 - 2.38 ) , long-term NH stay ( HR=2.64 , 95 % CI=1.75 - 3.99 ) , and death ( HR=1.54 , 95 % CI=1.13 - 2.10 ) , and the magnitude of these associations was comparable with that of weight loss . CONCLUSION The results of this study provide strong evidence to support the use of slow gait speed , low physical activity , weight loss , and cognitive impairment as key indicators of frailty while raising concerns about the value of self-reported exhaustion and muscle weakness OBJECTIVE To identify modifiable predictors of functional decline among community-residing older women and to derive and vali date a clinical prediction tool for functional decline based only on modifiable predictors . DESIGN A prospect i ve cohort study . SETTING Four geographic areas of the United States . PARTICIPANTS Community-residing women older than age 65 recruited from population -based listings between 1986 and 1988 ( n = 6632 ) . MEASUREMENTS Modifiable predictors were considered to be those that a clinician seeing an older patient for the first time could reasonably expect to change over a 4-year period : benzodiazepine use , depression , low exercise level , low social functioning , body-mass index , poor visual acuity , low bone mineral density , slow gait , and weak grip . Known predictors of functional decline unlikely to be amenable to intervention included age , education , medical comorbidity , cognitive function , smoking history , and presence of previous spine fracture . All variables were measured at baseline ; only modifiable predictors were c and i date s for the prediction tool . Functional decline was defined as loss of ability over the 4-year interval to perform one or more of five vigorous or eight basic daily activities . RESULTS Slow gait , short-acting benzodiazepine use , depression , low exercise level , and obesity were significant modifiable predictors of functional decline in both vigorous and basic activities . Weak grip predicted functional decline in vigorous activities , whereas long-acting benzodiazepine  use and poor visual acuity predicted functional decline in basic activities . A prediction rule based on these eight modifiable predictors classified women in the derivation set into three risk groups for decline in vigorous activities ( 12 % , 25 % , and 39 % risk ) and two risk groups for decline in basic activities ( 2 % and 10 % risk ) . In the validation set , the probabilities of functional decline were nearly identical . CONCLUSIONS A substantial portion of the variation of functional decline can be attributed to risk factors amenable to intervention over the short term . Using eight modifiable predictors that can be identified in a single office visit , clinicians can identify older women at risk for functional decline OBJECTIVE To examine the association between frailty status and incidence of disability among non-disabled older Mexican Americans . DESIGN A 10-year prospect i ve cohort study . SUBJECTS A total of 1645 non-institutionalized Mexican Americans aged 67 years and older from the Hispanic Established Population for the Epidemiological Study of the Elderly ( H-EPESE ) , who reported no limitation in activities of daily living at baseline . METHODS Frailty was defined as meeting 3 or more of the following components : ( i ) unintentional weight loss of > 2.26 kg ; ( ii ) weakness ( lowest 20 % in h and grip strength ) ; ( iii ) self-reported exhaustion ; ( iv ) slow walking speed ; and ( v ) low physical activity level . Socio-demographic factors , Mini Mental State Examination , medical conditions , body mass index , and self-reported activities of daily living were obtained . RESULTS Of the 1645 non-disabled subjects at baseline , 820 ( 50 % ) were not frail , 749 ( 45.7 % ) were pre-frail , and 71 ( 4.3 % ) were frail . The hazard ratio of activities of daily living disability at 10-year follow-up for pre-frail subjects was 1.32 ( 95 % confidence interval 1.10 - 1.58 ) and 2.42 ( 95 % confidence interval 70 - 3.46 ) for frail subjects compared with not frail subjects . This association remained statistically significant after controlling for potential confounding factors at baseline . CONCLUSION Pre-frail and frail status in older Mexican Americans was associated with an increased risk of activities of daily living disability over a 10-year period among non-disabled subjects BACKGROUND To estimate the associations of weight dynamics with physical functioning and mortality in older adults . METHODS Longitudinal cohort study using prospect ively collected data on weight , physical function , and health status in four U.S. Communities in the Cardiovascular Health Study . Included were 3,278 participants ( 2,013 women and 541 African Americans ) , aged 65 or older at enrollment , who had at least five weight measurements . Weight was measured at annual clinic visits between 1992 and 1999 , and summary measures of mean weight , coefficient of variation , average annual weight change , and episodes of loss and gain ( cycling )  were calculated . Participants were followed from 1999 to 2006 for activities of daily living ( ADL ) difficulty , incident mobility limitations , and mortality . RESULTS Higher mean weight , weight variability , and weight cycling increased the risk of new onset of ADL difficulties and mobility limitations . After adjustment for risk factors , the hazard ratio ( 95 % confidence interval ) for weight cycling for incident ADL impairment was 1.28 ( 1.12 , 1.47 ) , similar to that for several comorbidities in our model , including cancer and diabetes . Lower weight , weight loss , higher variability , and weight cycling were all risk factors for mortality , after adjustment for demographic risk factors , height , self-report health status , and comorbidities . CONCLUSIONS Variations in weight are important indicators of future physical limitations and mortality in the elderly and may reflect difficulties in maintaining homeostasis throughout older ages . Monitoring the weight of an older person for fluctuations or episodes of both loss and gain is an important aspect of geriatric care OBJECTIVES To estimate the incidence of chronic activities of daily living ( ADL ) disability and to analyze the sociodemographic , health status , adverse lifestyle , and leisure-time physical activity predictors for chronic ADL disability . DESIGN We recruited a cohort of community-dwelling older people in Taipei , Taiwan , who were not ADL disabled in August 1993 , and we followed them until August 1996 . SETTING S AND PARTICIPANTS The study subjects were 1321 community-dwelling people aged 65 years or older who were ADL intact at the initial interview in August 1993 . The study sample was a subset of a probability sample ( n = 1583 ) r and omly selected from household registration s in the four districts of the Taipei metropolitan area . MEASUREMENTS Baseline information regarding various factors potentially associated with the development of chronic ADL disability was assessed and collected at the beginning of the study . Study participants were assessed annually for ADL function by a structured home interview using a six-item scale . Participants who were unable to perform independently at least one of the six items -- eating , bathing , dressing , toileting ,  transfers , and walking inside the house -- for more than 3 months were considered chronically ADL disabled . Cox proportional hazard regression models were utilized to examine the independent effect of the potential predictors on risk of chronic ADL disability . RESULTS During the 3-year study period , 145 ( 11.0 % ) participants developed chronic ADL disability , 58 ( 4.4 % ) participants were lost to follow-up , and 83 ( 6.3 % ) participants died . Multiple hazard regression analysis showed that individuals aged 70 to 79 years or older than age 80 had increased risk of ADL disability ( relative risk : 2.05 ( 95 % confidence interval ( CI ) , 1.35 - 3.11 ) and 3.89 ( 95%CI , 2.33 - 6.50 ) , respectively ) compared with those participants younger than age 70 . Risk of chronic ADL disability was inversely associated with routine exercise ( RR = 0.52 ; 95 % CI , 0.39 - 0.68 ) . CONCLUSIONS Age is the most significant predictor of chronic ADL disability . Lack of routine exercise is also a significant predictor of ADL disability in older adults OBJECTIVE to investigate and compare the predictive values of four physical performance measures for the onset of functional dependence in older Japanese people living at home . DESIGN a population -based prospect i ve cohort study . SETTING Nangai village , Akita Prefecture , Japan . METHODS out of the population aged 65 years and older living in Nangai ( n = 940 ) in 1992 , we measured h and grip-strength , one-leg st and ing , and usual and maximum walking speeds  in 736 subjects who were independent in the five basic activities of daily living . Their functional status was assessed each year for the subsequent 6 years . The outcome event was the onset of functional dependence , defined as a new disability in one or more of the five basic activities of daily living , or death of a subject who had shown no disability at the previous follow-up . RESULTS even after controlling for age , sex and a number of chronic conditions , lower scores on each baseline performance measure showed increased risk for the onset of functional dependence . Maximum walking speed  was most sensitive in predicting future dependence for those aged 65 - 74 years , while usual walking speed was most sensitive for people aged > or = 75 years . CONCLUSION  walking speed  was the best physical performance measure for predicting the onset of functional dependence in a Japanese rural older population The aim of this study was to analyse in particular dependence in instrumental daily life activities ( I-ADLs ) and its association with physical impairments and functional limitations in the elderly . The study was based on cross-sectional data on 70-year-olds ( n = 602 ) and longitudinal data on subjects followed up to the age of 76 ( n = 371 ) . Persons dependent in ADL  had lower values in maximum walking speed , grip strength , knee extensor strength , stair climbing capacity and in forward reach , compared with those who were independent in ADL .  Walking speed in both women and men and sight impairment in men had the greatest influence on dependence in ADL . Possible critical levels for disability in ADL are discussed , as persons who developed dependence between 70 and 7 
    Output:
    
agent
Conclusions This review shows that physical frailty indicators can predict ADL disability in community-dwelling elderly people .
Slow gait speed and low physical activity/exercise seem to be the most powerful predictors followed by weight loss , lower extremity function , balance , muscle strength , and other indicators .
Nevertheless , our study suggests that monitoring physical frailty indicators in community-dwelling elderly people might be useful to identify elderly people who could benefit from disability prevention programs
***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Background and aims : Little is known about muscle strength as a predictor of  disability among older Mexican Americans . The aim of this study was to examine the association between h and grip strength  and 7-year incidence of ADL disability in older Mexican American men and women . Methods : A 7-year prospect i ve cohort study of 2493 non-institutionalized Mexican American men and women aged 65 or older residing in five south-western states .  Maximal h and grip strength test , body mass index , cognitive function , activities of daily living , self-reports of medical conditions ( arthritis , diabetes , heart attack , stroke , cancer , hip fracture ) , and depressive symptoms were obtained . Results : In a Cox proportional regression analysis , there was a linear relationship between h and grip strength at baseline and risk of incident ADL disability over a 7-year follow-up . Among non-disabled men at baseline , the hazard ratio of any new ADL limitation was 1.90(95 % CI 1.14–3.17 ) for those in the lowest quartile , when compared with men in the highest h and grip strength quartile , after controlling for age , marital status , medical conditions , high depressive symptoms , MMSE score , and BMI at baseline . Among non-disabled women at baseline , the hazard ratio of any new ADL limitation was 2.28 ( 95 % CI 1.59–3.27 ) for those in the lowest quartile , when compared with women in the highest h and grip strength quartile . Conclusions : H and grip strength is an independent predictor of ADL disability  among older Mexican American men and women . The h and grip strength test is an easy , reliable , valid , inexpensive method of screening to identify older adults at risk of disability OBJECTIVES To determine the independent prognostic effect of seven potential frailty criteria , including five from the Fried phenotype , on several adverse outcomes . DESIGN Prospect i ve cohort study . SETTING Greater New Haven , Connecticut . PARTICIPANTS Seven hundred fifty-four initially nondisabled , community-living persons aged 70 and older . MEASUREMENTS An assessment of seven potential frailty criteria ( slow gait speed , low physical activity , weight loss , exhaustion , weakness , cognitive impairment , and depressive symptoms ) was completed at baseline and every 18 months for 72 months . Participants were followed with monthly telephone interviews for up to 96 months to determine the occurrence of chronic disability , long-term nursing home ( NH ) stays , injurious falls , and death . RESULTS In analyses adjusted for age , sex , race , education , number of chronic conditions , and the presence of the other potential frailty criteria , three of the five Fried criteria ( slow gait speed , low physical activity , and weight loss ) were independently associated with chronic disability , long-term NH stays , and death . Slow gait speed was the strongest predictor of chronic disability ( hazard ratio (HR)=2.97 , 95 % confidence interval (CI)=2.32 - 3.80 ) and long-term NH stay ( HR=3.86 , 95 % CI=2.23 - 6.67 ) and was the only significant predictor of injurious falls ( HR=2.19 , 95 % CI=1.33 - 3.60 ) . Cognitive impairment was also associated with chronic disability ( HR=1.82 , 95 % CI=1.40 - 2.38 ) , long-term NH stay ( HR=2.64 , 95 % CI=1.75 - 3.99 ) , and death ( HR=1.54 , 95 % CI=1.13 - 2.10 ) , and the magnitude of these associations was comparable with that of weight loss . CONCLUSION The results of this study provide strong evidence to support the use of slow gait speed , low physical activity , weight loss , and cognitive impairment as key indicators of frailty while raising concerns about the value of self-reported exhaustion and muscle weakness OBJECTIVE To identify modifiable predictors of functional decline among community-residing older women and to derive and vali date a clinical prediction tool for functional decline based only on modifiable predictors . DESIGN A prospect i ve cohort study . SETTING Four geographic areas of the United States . PARTICIPANTS Community-residing women older than age 65 recruited from population -based listings between 1986 and 1988 ( n = 6632 ) . MEASUREMENTS Modifiable predictors were considered to be those that a clinician seeing an older patient for the first time could reasonably expect to change over a 4-year period : benzodiazepine use , depression , low exercise level , low social functioning , body-mass index , poor visual acuity , low bone mineral density , slow gait , and weak grip . Known predictors of functional decline unlikely to be amenable to intervention included age , education , medical comorbidity , cognitive function , smoking history , and presence of previous spine fracture . All variables were measured at baseline ; only modifiable predictors were c and i date s for the prediction tool . Functional decline was defined as loss of ability over the 4-year interval to perform one or more of five vigorous or eight basic daily activities . RESULTS Slow gait , short-acting benzodiazepine use , depression , low exercise level , and obesity were significant modifiable predictors of functional decline in both vigorous and basic activities . Weak grip predicted functional decline in vigorous activities , whereas long-acting benzodiazepine  use and poor visual acuity predicted functional decline in basic activities . A prediction rule based on these eight modifiable predictors classified women in the derivation set into three risk groups for decline in vigorous activities ( 12 % , 25 % , and 39 % risk ) and two risk groups for decline in basic activities ( 2 % and 10 % risk ) . In the validation set , the probabilities of functional decline were nearly identical . CONCLUSIONS A substantial portion of the variation of functional decline can be attributed to risk factors amenable to intervention over the short term . Using eight modifiable predictors that can be identified in a single office visit , clinicians can identify older women at risk for functional decline OBJECTIVE To examine the association between frailty status and incidence of disability among non-disabled older Mexican Americans . DESIGN A 10-year prospect i ve cohort study . SUBJECTS A total of 1645 non-institutionalized Mexican Americans aged 67 years and older from the Hispanic Established Population for the Epidemiological Study of the Elderly ( H-EPESE ) , who reported no limitation in activities of daily living at baseline . METHODS Frailty was defined as meeting 3 or more of the following components : ( i ) unintentional weight loss of > 2.26 kg ; ( ii ) weakness ( lowest 20 % in h and grip strength ) ; ( iii ) self-reported exhaustion ; ( iv ) slow walking speed ; and ( v ) low physical activity level . Socio-demographic factors , Mini Mental State Examination , medical conditions , body mass index , and self-reported activities of daily living were obtained . RESULTS Of the 1645 non-disabled subjects at baseline , 820 ( 50 % ) were not frail , 749 ( 45.7 % ) were pre-frail , and 71 ( 4.3 % ) were frail . The hazard ratio of activities of daily living disability at 10-year follow-up for pre-frail subjects was 1.32 ( 95 % confidence interval 1.10 - 1.58 ) and 2.42 ( 95 % confidence interval 70 - 3.46 ) for frail subjects compared with not frail subjects . This association remained statistically significant after controlling for potential confounding factors at baseline . CONCLUSION Pre-frail and frail status in older Mexican Americans was associated with an increased risk of activities of daily living disability over a 10-year period among non-disabled subjects BACKGROUND To estimate the associations of weight dynamics with physical functioning and mortality in older adults . METHODS Longitudinal cohort study using prospect ively collected data on weight , physical function , and health status in four U.S. Communities in the Cardiovascular Health Study . Included were 3,278 participants ( 2,013 women and 541 African Americans ) , aged 65 or older at enrollment , who had at least five weight measurements . Weight was measured at annual clinic visits between 1992 and 1999 , and summary measures of mean weight , coefficient of variation , average annual weight change , and episodes of loss and gain ( cycling )  were calculated . Participants were followed from 1999 to 2006 for activities of daily living ( ADL ) difficulty , incident mobility limitations , and mortality . RESULTS Higher mean weight , weight variability , and weight cycling increased the risk of new onset of ADL difficulties and mobility limitations . After adjustment for risk factors , the hazard ratio ( 95 % confidence interval ) for weight cycling for incident ADL impairment was 1.28 ( 1.12 , 1.47 ) , similar to that for several comorbidities in our model , including cancer and diabetes . Lower weight , weight loss , higher variability , and weight cycling were all risk factors for mortality , after adjustment for demographic risk factors , height , self-report health status , and comorbidities . CONCLUSIONS Variations in weight are important indicators of future physical limitations and mortality in the elderly and may reflect difficulties in maintaining homeostasis throughout older ages . Monitoring the weight of an older person for fluctuations or episodes of both loss and gain is an important aspect of geriatric care OBJECTIVES To estimate the incidence of chronic activities of daily living ( ADL ) disability and to analyze the sociodemographic , health status , adverse lifestyle , and leisure-time physical activity predictors for chronic ADL disability . DESIGN We recruited a cohort of community-dwelling older people in Taipei , Taiwan , who were not ADL disabled in August 1993 , and we followed them until August 1996 . SETTING S AND PARTICIPANTS The study subjects were 1321 community-dwelling people aged 65 years or older who were ADL intact at the initial interview in August 1993 . The study sample was a subset of a probability sample ( n = 1583 ) r and omly selected from household registration s in the four districts of the Taipei metropolitan area . MEASUREMENTS Baseline information regarding various factors potentially associated with the development of chronic ADL disability was assessed and collected at the beginning of the study . Study participants were assessed annually for ADL function by a structured home interview using a six-item scale . Participants who were unable to perform independently at least one of the six items -- eating , bathing , dressing , toileting ,  transfers , and walking inside the house -- for more than 3 months were considered chronically ADL disabled . Cox proportional hazard regression models were utilized to examine the independent effect of the potential predictors on risk of chronic ADL disability . RESULTS During the 3-year study period , 145 ( 11.0 % ) participants developed chronic ADL disability , 58 ( 4.4 % ) participants were lost to follow-up , and 83 ( 6.3 % ) participants died . Multiple hazard regression analysis showed that individuals aged 70 to 79 years or older than age 80 had increased risk of ADL disability ( relative risk : 2.05 ( 95 % confidence interval ( CI ) , 1.35 - 3.11 ) and 3.89 ( 95%CI , 2.33 - 6.50 ) , respectively ) compared with those participants younger than age 70 . Risk of chronic ADL disability was inversely associated with routine exercise ( RR = 0.52 ; 95 % CI , 0.39 - 0.68 ) . CONCLUSIONS Age is the most significant predictor of chronic ADL disability . Lack of routine exercise is also a significant predictor of ADL disability in older adults OBJECTIVE to investigate and compare the predictive values of four physical performance measures for the onset of functional dependence in older Japanese people living at home . DESIGN a population -based prospect i ve cohort study . SETTING Nangai village , Akita Prefecture , Japan . METHODS out of the population aged 65 years and older living in Nangai ( n = 940 ) in 1992 , we measured h and grip-strength , one-leg st and ing , and usual and maximum walking speeds  in 736 subjects who were independent in the five basic activities of daily living . Their functional status was assessed each year for the subsequent 6 years . The outcome event was the onset of functional dependence , defined as a new disability in one or more of the five basic activities of daily living , or death of a subject who had shown no disability at the previous follow-up . RESULTS even after controlling for age , sex and a number of chronic conditions , lower scores on each baseline performance measure showed increased risk for the onset of functional dependence . Maximum walking speed  was most sensitive in predicting future dependence for those aged 65 - 74 years , while usual walking speed was most sensitive for people aged > or = 75 years . CONCLUSION  walking speed  was the best physical performance measure for predicting the onset of functional dependence in a Japanese rural older population The aim of this study was to analyse in particular dependence in instrumental daily life activities ( I-ADLs ) and its association with physical impairments and functional limitations in the elderly . The study was based on cross-sectional data on 70-year-olds ( n = 602 ) and longitudinal data on subjects followed up to the age of 76 ( n = 371 ) . Persons dependent in ADL  had lower values in maximum walking speed , grip strength , knee extensor strength , stair climbing capacity and in forward reach , compared with those who were independent in ADL .  Walking speed in both women and men and sight impairment in men had the greatest influence on dependence in ADL . Possible critical levels for disability in ADL are discussed , as persons who developed dependence between 70 and 7 
    Output:
    