Patterns of sedentary time are a potential risk factor for falls but have been largely unexamined. Women in the prospective OPACH Study (n = 5537; mean age = 78.8 +/-6.7; 44% reported 1+ falls) wore accelerometers for 7 days and kept fall calendars for one-year. Accelerometer sedentary patterns included: alpha (summarizes the frequency and duration of sedentary bouts), sedentary breaks, and mean sedentary bout duration. Negative binomial regression models tested each sedentary pattern variable (in quartiles) in relation to fall counts (adjusted for demographics, health, and physical activity). Higher alpha (more breaks and shorter sedentary bouts) was inversely associated with falls (Q4 vs Q1: IRR, 0.80, 95% CI 0.70, 0.92), whereas mean bout duration was positively associated (IRR, 1.18, 95% CI 1.02, 1.38). There was a trend for lower falls with greater sedentary breaks (p < .07). Changing patterns of sedentary time could be important to reduce fall risk.

Accelerometers have been widely deployed in public health studies in recent years and research has mainly focused on summarized metrics provided by accelerometers manufactures, such as the activity counts (AC). Such measures do not have a publicly available formula and can vary by device manufacturer. To address these problems, we developed the activity index (AI), a new metric for summarizing raw tri-axial accelerometry data, and compared the AI to AC’s performance for distinguishing various types of activities and estimating energy expenditure. The analysis was conducted using data from the Women’s Health Initiative, in which tri-axial raw acceleration data and energy expenditure were collected at the same time. ROC analyses indicated that AI better distinguished between different types of activities than AC. AI better associated with METs as well. The proposed AI provides a transparent and reliable way to summarize densely sampled raw acceleration data.

The consistently observed associations for self-reported physical activity (PA) and sedentary behavior (SB) with mortality may be underestimated by exposure measurement error, especially in older adults. We examined accelerometer measured PA and SB with all-cause mortality in 6,385 women ages 63–91 followed a mean of 2.5 years. Vector magnitude counts/15-sec epoch from hip worn triaxial accelerometers (required ≥4 of 7 days with ≥10 hr/day wear time) were used to define time in SB (0–18 counts/15 sec) and total PA (≥19 counts/15 sec; all intensities combined) based on cutpoints determined from a calibration study among similarly aged women. Cox regression was used to estimate hazard ratios (HR) and 95% confidence intervals (CI) for these associations. There were 271 (4.2%) deaths during 14,212 person-years follow-up. An inverse gradient in mortality rates was observed across incremental PA quartiles: 38.2, 16.5, 13.9, 8.5 per 1,000 person-years (trend, p<.001). Adjusting for accelerometer wear-time, age, and race, corresponding HRs (CI) for PA quartiles were 1.00 (referent), 0.50 (0.37–0.69), 0.52 (0.37–0.73), 0.36 (0.24–0.54), trend p<.001. Mortality rates for incremental SB quartiles were 10.5, 13.8, 23.1, and 29.3 per 1,000 person-years (p<.001). Corresponding adjusted HRs (CI) for SB quartiles were 1.00 (referent), 1.19 (0.78–1.82), 1.90 (1.29–2.81), 2.25 (1.53–3.33), trend p<.001. Preliminary additional adjustments for smoking, alcohol, comorbidities and measured physical functioning did not substantively change the pattern of association with mortality for PA or SB. Total PA and SB measured by accelerometry are associated with mortality in older women. Intervening on both behaviors could improve longevity at older ages.

Falls are associated with reduced physical function in older adults. However few large epidemiologic cohort studies have characterized fall injuries that were self-treated or all injuries treated in outpatient and inpatient settings. The Study of Osteoporotic Fractures in Men (MrOS) is an ongoing cohort of ambulatory men (N=5,994; 10% minorities; 2000–02 enrollment) aged ≥65 years at 6 U.S. sites. The Study of Women’s Health Across the Nation (SWAN; N=3,302; 53% minority; 1996 enrollment) is an ongoing multi-racial/ethnic cohort of women from 7 U.S. sites followed through menopausal transition for 20 years and now in early old age. The Health, Aging and Body Composition (Health ABC) Study enrolled well-functioning, ambulatory Medicare beneficiaries, aged 70–79 years (N=3,075; 52% women, 42% black) at 2 U.S. sites in 1997–98. Each study collected self-reported falls and fall injuries, including non-fracture and fracture injuries. Additionally Health ABC linked Medicare Fee-For-Service claims from denominator, inpatient, outpatient, physician/supplier, and carrier files to treated fall injuries and fractures over 8 years. Perceived fatigue levels will be associated with fall risk in MrOS men (Welburn). Sensory peripheral nerve impairments will be described as fall and fall injury risk factors in SWAN women (Ylitalo). Quadriceps strength will be related to incident fall injuries in Health ABC (Winger). Medicare payments will be compared pre- vs. post-injury for non-fracture and fracture fall injuries in Health ABC (Strotmeyer). The Discussant (Buchner) will focus on the importance of all fall injuries, including self- or outpatient-treated, as these may be early signs of late life decline.

require a latent variable approach.

organizational structures and delivery strategies for providing critical transportation for older adults, the sustainability of their funding models, and the applicability of such approaches for other communities.Through our research, we address the following three questions: (1) what types of innovative transportation services exist in United States communities that are not served by traditional fixed-route transit?; (2) how are innovative transportation services organized, financed, and delivered by service providers?; and (3) how are innovative transportation services utilized by older Americans?The project research design encompasses a relevant literature review to develop a typology of innovative service strategies that frames case studies of six strategies and two key informant interviews associated with each case.

OBJECTIVES: To determine whether benzodiazepine use is associated with incident disability in mobility and activities of daily living (ADLs) in older individuals.DESIGN: A prospective cohort study.SETTING: Four sites of the Established Populations for Epidemiologic Studies of the Elderly.PARTICIPANTS: This study included 9,093 subjects (aged ≥65) who were not disabled in mobility or ADLs at baseline.MEASUREMENTS: Mobility disability was defined as inability to walk half a mile or climb one flight of stairs. ADL disability was defined as inability to perform one or more basic ADLs (bathing, eating, dressing, transferring from a bed to a chair, using the toilet, or walking across a small room). Trained interviewers assessed outcomes annually.RESULTS: At baseline, 5.5% of subjects reported benzodiazepine use. In multivariable models, benzodiazepine users were 1.23 times as likely as nonusers (95% confidence interval (CI)=1.09–1.39) to develop mobility disability and 1.28 times as likely (95% CI=1.09–1.52) to develop ADL disability. Risk for incident mobility was increased with short‐ (hazard ratio (HR)=1.27, 95% CI=1.08–1.50) and long‐acting benzodiazepines (HR=1.20, 95% CI=1.03–1.39) and no use. Risk for ADL disability was greater with short‐ (HR=1.58, 95% CI=1.25–2.01) but not long‐acting (HR=1.11, 95% CI=0.89–1.39) agents than for no use.CONCLUSION: Older adults taking benzodiazepines have a greater risk for incident mobility and ADL disability. Use of short‐acting agents does not appear to confer any safety benefits over long‐acting agents.

Physical activity offers one of the greatest opportunities for people to extend years of active independent life and reduce functional limitations. The article identifies key practices for promoting physical activity in older adults, with a focus on those with chronic disease or low fitness and those with low levels of physical activity. Key practices identified: (a) A multidimensional activity program that includes endurance, strength, balance, and flexibility training is optimal for health and functional benefits; (b) principles of behavior change including social support, self-efficacy, active choices, health contracts, assurances of safety, and positive reinforcement enhance adherence; (c) manage risk by beginning at low intensity but gradually increasing to moderate physical activity, which has a better risk:benefit ratio and should be the goal for older adults; (d) an emergency procedure plan is prudent for community-based programs; and (e) monitoring aerobic intensity is important for progression and motivation. Selected content review of physical activity programming from major organizations and institutions is provided.

OBJECTIVES:The authors examined patterns of benzodiazepine use in older adults. Specifically, they describe prevalence and incidence of benzodiazepine use during the index year, describe persistence and intensity of benzodiazepine use over a 4-year period; and examine factors associated with benzodiazepine use in the upcoming year.METHODS:Authors performed a secondary analysis of data collected as part of a health promotion intervention trial conducted from 1986 to 1992 in older health maintenance organization enrollees (N=1,505). Benzodiazepine use was ascertained from computerized pharmacy records. Demographic characteristics, health status, and health behaviors were ascertained from mailed questionnaires.RESULTS:During the index year, the prevalence and incidence of benzodiazepine use was 12.3% and 6.6%, respectively. Of those using during the index year, 16% of new users and 63% of previous users continued to use for the following 3 years. The factors significantly associated with benzodiazepine use in the following year were female gender, high school education, higher chronic disease score, higher levels of self-reported pain and stress, low-to-normal body mass index (BMI), and self-reported nervous disorder.CONCLUSIONS:New users had low intensity of use and a low probability of continuing use over the following 3 years. A very small percentage of this sample had evidence of daily use for 4 years. Of concern, benzodiazepines were used by the segment of the sample that were at greatest risk for hip fractures (women with normal/low BMI). Clinicians should assess the need for continued benzodiazepine use at regular intervals.

Objectives: To determine whether benzodiazepine use in older women increased the risk of decline in physical function. Design: A four‐year prospective cohort study. Setting: The communities of Iowa and Washington counties, Iowa. Participants: Eight hundred eighty‐five women aged 70 and older who had completed physical performance tests in 1988 and 1992. Measurements: Benzodiazepine use was determined during in‐home interviews and classified by dose, duration, indication for use, and half‐life. Physical performance tests included an assessment of standing balance, walking speed (8‐foot distance), and repeated chair raises. Results: Ninety (10.2%) reported benzodiazepine use at baseline. After adjustment for baseline physical performance score and potential confounders, benzodiazepine use was associated with a greater decline in physical performance over 4 years than nonuse (β=–1.16; standard error (SE)=0.25; P <.001). The use of higher‐than‐recommended dose was related to decline (β=–2.26; SE=0.47; P <.001), and use of lower doses was not (β=–0.53; SE=0.46; P =.246). Long‐term use (≥3 years) was related to decline (β=–1.65; SE=0.34; P <.001), whereas recent and past use were not. Similar results were obtained when restricting the sample to those without disability at baseline. Conclusion: This study provides evidence that older women who used benzodiazepines were at risk for decline in physical performance. Subgroup analyses indicated that risk was greater with use of higher‐than‐recommended doses or for long duration (≥3 years). These findings highlight the importance of using benzodiazepines at the lowest effective dose for a limited duration in older women.