Peripheral nerve decline: an underappreciated cause of injurious falls

周围神经衰退：受伤性跌倒的一个未被充分认识的原因

• 批准号: 8850362
• 负责人: Elsa S. Strotmeyer
• 金额: $ 43.27万
• 依托单位: UNIVERSITY OF PITTSBURGH AT PITTSBURGH
• 依托单位国家: 美国
• 财政年份: 2007
• 资助国家: 美国
• 起止时间: 2007-09-15 至 2017-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8850362
• 关键词: Adult; Age; Aged, 80 and over; Amputation; Bone Density; Caring; Caucasians; Cessation of life; Clinical; Cohort Studies; Data; Diabetes Mellitus; Diabetic Neuropathies; Disease; Durable Medical Equipment; Elderly; Epidemiology; Exercise; Expenditure; Fracture; Funding; Geriatrics; Goals; Health; Height; Home Health Agency; Hospitalization; Impairment; Injury; Inpatients; Link; Long-Term Care; Measures; Medical; Medicare; Motor; Muscle; Musculoskeletal; Nerve; Neural Conduction; Neuropathy; Office Visits; Outcome; Outpatients; Patient Self-Report; Performance; Peripheral; Peripheral Nerves; Peripheral Nervous System Diseases; Peripheral Vascular Diseases; Physicians; Preventive; Renal Glycosuria; Risk; Risk Factors; Sensory; Services; Skilled Nursing Facilities; Staging; Syndrome; Testing; Time; Ulcer; Vitamin B 12; Vitamins; Woman; Work; afferent nerve; aged; clinically relevant; cohort; cost; diabetic; end of life; fall risk; falls; high risk; hospice environment; inpatient service; men; mortality; muscle strength; non-diabetic; novel; post gamma-globulins

DESCRIPTION (provided by applicant): This competing renewal of Peripheral nerve function in an aged cohort will determine for the first time if poor sensorimotor peripheral nerve function, a novel potential risk factor, is associated with major clinical outcomes of fall injuries requirin medical care, fractures, Medicare utilization, Medicare expenditures, and mortality in older adults. In the initial funding period of this project, we demonstrated that loss of sensorimotor peripheral nerve function is very common in both diabetic and non-diabetic older adults. We found significant and independent predictors for nerve function decline, such as taller height, white race, and older age, and preventable, disease-related factors such as diabetes, renal impairment (high cystatin C), subclinical peripheral vascular disease, and low vitamin B12. Poor nerve function can be detected long before presenting as overt clinical peripheral neuropathy and we have established associations with lower bone mineral density, muscle strength and physical performance. These associations are not explained by diabetes. These musculoskeletal factors likely contribute to fall injuries, fractures, and increased mortality. Utilization and expenditures associated with peripheral nerve decline in older adults are not characterized. We will link our cohort data to Centers for Medicare Services data to determine if sensorimotor peripheral nerve function predicts fall injuries and is associated with higher utilization, total expenditures, and mortality. The specific aims are to determine if poor peripherl sensory and motor nerve function is associated with 1) treated fall injuries, including fractures, and 2) greater total and fall-related Medicare utilization, Medicare expenditures, and mortality. The Health ABC Study is a large NIA supported cohort study that included 3075 black and white men and women (42% Black; 52% women) at baseline in 1997-98, with an initial assessment of nerve function in 2000-01. In the first stage of this project, we reassessed peripheral nerve function in 2007-2008 (N=1175, aged 80-89 and mean 83.3¿2.7 years) to determine rates of sensory and motor nerve function decline and risk factors for decline. In this renewal we will take the next step and prospectively assess the major geriatric outcomes associated with poor nerve function. Our initial R01 did not assess fall injuries or fractures and did not include medical utilization and expenditures, which have been only recently linked to the Health ABC data. The availability of linked Medicare data enriches our opportunities to fully characterize these outcomes. This project will define the major clinical outcomes of peripheral nerve function: treated fall injuries, fractures, medical utilization, expenditures and death. Our well characterizd epidemiologic cohort with linked Medicare data provides the ideal opportunity for this work. We will generate a validated approach that may be applied to Medicare data to examine injurious fall outcomes in our other large epidemiologic cohorts. The ultimate goal is to determine if peripheral nerve testing identifies older adults at higher risk for fall injuries, fractures and deth that may benefit from preventive measures for nerve decline or clinical outcomes.

DESCRIPTION (provided by applicant): This competing renewal of Peripheral nerve function in an aged cohort will determine for the first time if poor sensorimotor peripheral nerve function, a novel potential risk factor, is associated with major clinical outcomes of fall injuries requirin medical care, fractures, Medicare utilization, Medicare expenditures, and mortality in older adults. In the initial funding period of this project, we demonstrated that loss of sensorimotor peripheral nerve function is very common in both diabetic and non-diabetic older adults. We found significant and independent predictors for nerve function decline, such as taller height, white race, and older age, and preventable, disease-related factors such as diabetes, renal impairment (high cystatin C), subclinical peripheral vascular disease, and low vitamin B12. Poor nerve function can be detected long before presenting as overt clinical peripheral neuropathy and we have established associations with lower bone mineral density, muscle strength and physical performance. These associations are not explained by diabetes. These musculoskeletal factors likely contribute to fall injuries, fractures, and increased mortality. Utilization and expenditures associated with peripheral nerve decline in older adults are not characterized. We will link our cohort data to Centers for Medicare Services data to determine if sensorimotor peripheral nerve function predicts fall injuries and is associated with higher utilization, total expenditures, and mortality. The specific aims are to determine if poor peripherl sensory and motor nerve function is associated with 1) treated fall injuries, including fractures, and 2) greater total and fall-related Medicare utilization, Medicare expenditures, and mortality. The Health ABC Study is a large NIA supported cohort study that included 3075 black and white men and women (42% Black; 52% women) at baseline in 1997-98, with an initial assessment of nerve function in 2000-01. In the first stage of this project, we reassessed peripheral nerve function in 2007-2008 (N=1175, aged 80-89 and mean 83.3¿2.7 years) to determine rates of sensory and motor nerve function decline and risk factors for decline. In this renewal we will take the next step and prospectively assess the major geriatric outcomes associated with poor nerve function. Our initial R01 did not assess fall injuries or fractures and did not include medical utilization and expenditures, which have been only recently linked to the Health ABC data. The availability of linked Medicare data enriches our opportunities to fully characterize these outcomes. This project will define the major clinical outcomes of peripheral nerve function: treated fall injuries, fractures, medical utilization, expenditures and death. Our well characterizd epidemiologic cohort with linked Medicare data provides the ideal opportunity for this work. We will generate a validated approach that may be applied to Medicare data to examine injurious fall outcomes in our other large epidemiologic cohorts. The ultimate goal is to determine if peripheral nerve testing identifies older adults at higher risk for fall injuries, fractures and deth that may benefit from preventive measures for nerve decline or clinical outcomes.

项目成果

Muscle Health Patterns and Brain MRI Indices: A Cluster Analysis.

• DOI: 10.1093/geroni/igac073
• 发表时间: 2023
• 期刊: INNOVATION IN AGING
• 影响因子: 7
• 作者: Wu, Shou-En;Chen, Wei-Liang
• 通讯作者: Chen, Wei-Liang

Influence of aspirin on aging skeletal muscle: Insights from a cross-sectional cohort of septuagenarians.

• DOI: 10.14814/phy2.15669
• 发表时间: 2023-04
• 期刊: Physiological reports
• 影响因子: 2.5

Association of Hearing Impairment and Anxiety in Older Adults.

• DOI: 10.1177/0898264316634571
• 发表时间: 2017-03
• 期刊: Journal of aging and health
• 影响因子: 2.8
• 作者: Contrera KJ;Betz J;Deal J;Choi JS;Ayonayon HN;Harris T;Helzner E;Martin KR;Mehta K;Pratt S;Rubin SM;Satterfield S;Yaffe K;Simonsick EM;Lin FR;Health ABC Study
• 通讯作者: Health ABC Study

Swallowing impairment in older adults: association with sensorimotor peripheral nerve function from the Health, Aging and Body Composition study.

• DOI: 10.1007/s40520-020-01522-2
• 发表时间: 2021-01
• 期刊: Aging clinical and experimental research
• 影响因子: 4
• 作者: Rech RS;Strotmeyer ES;Lange-Maia BS;Hugo FN;de Goulart BNG;Hilgert JB;Simonsick EM
• 通讯作者: Simonsick EM

Inflammation as a Mediator of the Association Between Race and Atrial Fibrillation: Results from the Health, Aging, and Body Composition Study.

炎症作为种族与心房颤动之间关联的中介：健康、衰老和身体成分研究的结果。

• DOI: 10.1016/j.jacep.2015.04.014
• 发表时间: 2015
• 期刊: JACC. Clinical electrophysiology
• 作者: Dewland,ThomasA;Vittinghoff,Eric;Harris,TamaraB;Magnani,JaredW;Liu,Yongmei;Hsu,Fang-Chi;Satterfield,Suzanne;Wassel,Christina;Marcus,GregoryM
• 通讯作者: Marcus,GregoryM