Latent Mobility Abnormalities And Frailty

描述(由申请人提供)：这是针对PA关于脆弱性的修订的新调查员意见书(AGO25119-01)。65岁以上的成年人中，超过三分之一的人报告至少有一项严重残疾。“脆弱”的概念已经被用来识别生理储备低、残疾风险增加的老年人。然而，缺乏老年人早期虚弱的临床和生物学标志。我们计划通过正在进行的对老年人的前瞻性队列研究-爱因斯坦老龄化研究-来解决这一差距。 非残疾老年人的亚临床功能丧失在常规评估中可能不明显，但可能表现为压力，因为低储备提供了一种临床相关的方法来识别残疾风险个体。在这项建议中，我们将潜伏性活动异常定义为未被身体和认知压力掩盖的亚临床活动能力丧失。需要评估的具体假设是，潜在的活动异常将识别行动能力正常的非残疾老年人的脆弱并预测残疾。具体地说，我们将1)检查身体和认知压力测试后潜在的活动异常，作为残疾的预测指标。2)建立潜伏性活动异常的生物学基础，重点研究炎性标志物。3)。由于亚临床疾病可能导致不理想的活动能力，我们还将在两周的时间内研究受试者子集在六个疗程中每天的个体内活动变异性，作为非常早期脆弱的标志。 为了实现这些目标，参与爱因斯坦老龄化研究的300名最初没有残疾的老年人将被招募，并在五年内每隔六个月进行一次全面的定性和定量行动能力评估。这些研究将提供有关早期脆弱的认知和身体属性及其生物学基础的新的重要信息，并确定在高危老年人早期引入特定干预措施的机会，以改善残疾和保持功能独立。

DESCRIPTION (provided by applicant): This is a revised new investigator submission (AGO25119-01) in response to a PA on frailty. Over one-third of adults over age 65 report at least one severe disability. The concept of "frailty" has been used to identify older adults with low physiological reserves at increased risk for disability. However, clinical and biological markers of early frailty in older adults are lacking. We plan to address this gap by building on an ongoing, prospective cohort study of older adults, the Einstein Aging Study. Subclinical functional loss in nondisabled older adults may not be apparent on routine evaluation, but may manifest in stress due to low reserves providing a clinically relevant approach to identify individuals at risk for disability. In this proposal, we define latent mobility abnormalities as subclinical mobility loss unmasked by physical and cognitive stresses. The specific hypothesis to be evaluated is that latent mobility abnormalities will identify frailty and predict disability in nondisabled older adults with normal mobility. Specifically, we will 1) Examine latent mobility abnormalities in response to physical and cognitive stress tests as predictors of disability. 2) Establish the biological basis of latent mobility abnormalities, focusing on inflammatory markers. 3). Since subclinical disease may lead to suboptimal mobility performance, we will also study daily intra-individual variability in mobility in six sessions over a two-week period in a subset of subjects as a marker of very early frailty. To achieve these aims, 300 initially nondisabled older adults participating in the Einstein Aging Study will be recruited and assessed with comprehensive qualitative and quantitative mobility assessments at six monthly intervals over five years. These studies will provide new and vital information about the cognitive and physical attributes of early frailty, their biological basis, and identify opportunities to introduce specific interventions very early in at-risk older adults to ameliorate disability and maintain functional independence.