PHYSICAL FRAILTY IN URBAN AFRICAN AMERICANS

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DESCRIPTION: (Adapted from Investigator's Abstract) This application is a five-year competitive continuation of a NIA-sponsored project entitled "Physical Frailty in Urban African Americans," funded from 1991-7 (RO1 AG10436). In pursuit of its long range goal of identifying strategies for improving the active life expectancy of this population, the investigators investigated 646 African Americans living in a five-square mile, poor inner-city area of St. Louis who were aged 70-99 years at baseline evaluation in 1992-94. They identified increased disability and risk for functional decline among inner-city dwelling African Americans compared to Anglo Americans and to national samples of age- and gender-matched African Americans. They also demonstrated specific problems (e.g., obesity, high nutritional risk, dehydration, and renal insufficiency) that appear to contribute significantly to this excess disability. The present project proposes to continue pursuit of the stated long-term goal by extending investigation of the consequences and causes of the demonstrated disability in two directions. The first direction involves continued follow up of the original cohort using short telephone contacts in years 1, 3, and 4; longer contacts in 2 and 5; and yearly death searches. These data will address the project's first specific aim, i.e., to evaluate the effects of obesity, weight loss, fear of falling, lack of walking, and lower instrumental activities of daily living (ADL) functioning on subsequent fall, excess hospitalization, and increased basic ADL dependencies; and the impact of these factors on mortality. The second direction involves the recruitment and evaluation of a new cohort of 1200 younger African Americans from metropolitan St. Louis stratified by socioeconomic status. Data collection will involve in-home evaluations at waves 1 and 4, telephone follow-ups at waves 2, 3, and 5, and will also involve detailed evaluations of body composition and muscle strength in a 25% at waves 1 and 4. The investigators state that data from this new cohort will allow pursuit of specific Aims 2 and 3, i.e., the time of development, precursors and consequences of sarcopenia (Aim 2) and subclinical disability (Aim 3). Extensive data verification and internal reliability and validity studies will be performed. Primary analytic methods involve event history models predicting falls, incident basic ADL dependencies, hospitalization, and mortality in the original cohort as well as incident subclinical disability and functional limitation in the new cohort, adjusting for important covariates. Secondary analyses (e.g., studies involving fear of falling, bone mineral metabolism, adverse effects of dehydration and renal insufficiency, and supine-to-stand transfers) will also be pursued.