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.

Public Health Relevance

This competing renewal 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 requiring medical care, fractures, total and fall-related Medicae utilization/expenditures, and mortality in older adults. In the initial funding period, we demonstrated that loss of sensorimotor peripheral nerve function is very common in both diabetic and non- diabetic older adults, has preventable risk factors, and is related to lower bone mineral density, muscle strength and physical performance. The ultimate goal is to determine if peripheral nerve testing identifies older adults at a higher risk for fall injuries, fractures and death that may benefit from preventive measures for nerve decline or clinical outcomes.

Agency
National Institute of Health (NIH)
Institute
National Institute on Aging (NIA)
Type
Research Project (R01)
Project #
2R01AG028050-05A1
Application #
8501804
Study Section
Special Emphasis Panel (ZRG1-PSE-K (02))
Program Officer
Chen, Wen G
Project Start
2007-09-15
Project End
2016-05-31
Budget Start
2013-06-15
Budget End
2014-05-31
Support Year
5
Fiscal Year
2013
Total Cost
$462,667
Indirect Cost
$154,435
Name
University of Pittsburgh
Department
Public Health & Prev Medicine
Type
Schools of Public Health
DUNS #
004514360
City
Pittsburgh
State
PA
Country
United States
Zip Code
15213
Ward, Rachel E; Boudreau, Robert M; Caserotti, Paolo et al. (2015) Sensory and motor peripheral nerve function and longitudinal changes in quadriceps strength. J Gerontol A Biol Sci Med Sci 70:464-70
Hall, Martica H; Smagula, Stephen F; Boudreau, Robert M et al. (2015) Association between sleep duration and mortality is mediated by markers of inflammation and health in older adults: the Health, Aging and Body Composition Study. Sleep 38:189-95
Tian, Qu; Simonsick, Eleanor M; Erickson, Kirk I et al. (2014) Cardiorespiratory fitness and brain diffusion tensor imaging in adults over 80 years of age. Brain Res 1588:63-72
White, Daniel K; Neogi, Tuhina; King, Wendy C et al. (2014) Can change in prolonged walking be inferred from a short test of gait speed among older adults who are initially well-functioning? Phys Ther 94:1285-93
Murphy, Rachel A; Bureyko, Taylor F; Miljkovic, Iva et al. (2014) Association of total adiposity and computed tomographic measures of regional adiposity with incident cancer risk: a prospective population-based study of older adults. Appl Physiol Nutr Metab 39:687-92
Goldenstein, Leonard; Driver, Todd H; Fried, Linda F et al. (2014) Serum bicarbonate concentrations and kidney disease progression in community-living elders: the Health, Aging, and Body Composition (Health ABC) Study. Am J Kidney Dis 64:542-9
Kaup, Allison R; Simonsick, Eleanor M; Harris, Tamara B et al. (2014) Older adults with limited literacy are at increased risk for likely dementia. J Gerontol A Biol Sci Med Sci 69:900-6
Khan, Hassan; Kalogeropoulos, Andreas P; Zannad, Faiez et al. (2014) Incident heart failure in relation to vascular disease: insights from the Health, Aging, and Body Composition Study. Eur J Heart Fail 16:526-34
Sarnak, Mark J; Katz, Ronit; Newman, Anne et al. (2014) Association of urinary injury biomarkers with mortality and cardiovascular events. J Am Soc Nephrol 25:1545-53
Tian, Qu; Erickson, Kirk I; Simonsick, Eleanor M et al. (2014) Physical activity predicts microstructural integrity in memory-related networks in very old adults. J Gerontol A Biol Sci Med Sci 69:1284-90

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