To describe functional outcomes in the year following discharge for elders discharged from the hospital after an acute medical illness with a new or additional disability in their basic self-care activities of daily living(ADL)(compared to their preadmission baseline two weeks before admission), compared to elders discharged with baseline ADL function, and identify predictors of failure to recover to baseline function one year after discharge.
Tertiary care hospital, Community teaching hospital
Older(≥70 years) patients non-electively admitted to general medical services(1993-1998).
Number of ADL disabilities 1,3,6,&12 months after discharge compared to pre-admission baseline. Outcomes were death, sustained decline in ADL function, and recovery to baseline ADL function at each timepoint.
By 12 months after discharge, among those discharged with new or additional ADL disability, 41.3% died, 28.6% were alive but had not recovered to baseline function, and 30.1% were at their baseline function. Among those discharged with baseline function, 17.8% died, 15.2% were alive but with worse than baseline function, and 67% were at their baseline function(p<.001). Among those discharged with new or additional ADL disability, the presence or absence of recovery by one month was associated with long-term outcomes. Age, cardiovascular disease, dementia, cancer, low albumin, and greater number of dependencies in IADL independently predict failure to recover.
Among elders discharged with new or additional disability in ADL following hospitalization for medical illness, prognosis for functional recovery is poor. Rehabilitation interventions of longer duration and timing than current reimbursement allows, caregiver support, and palliative care should be evaluated.
hospitalization; functional decline; recovery
To determine the association between depression and functional recovery among community-living older persons who had a decline in function after an acute hospital admission.
Prospective cohort study.
General community in greater New Haven, Connecticut, from March 1998 to December 2008.
Seven-hundred fifty four persons, aged 70 years or older.
Hospitalization and disability in essential activities of daily living (ADLs) and mobility were assessed each month for up to 129 months, and depressive symptoms were assessed every 18 months using the Center for Epidemiologic Studies of Depression (CES-D) Scale. Functional recovery was defined as returning to the community within 6 months at or above the pre-hospital level of ADL function and mobility, respectively.
A decline in ADL function and mobility was observed following 42% and 41% of the hospitalizations, respectively. After controlling for several potential confounders, clinically significant depressive symptoms (CES-D ≥20) was associated with a lower likelihood of recovering mobility function (HR= 0.79; 95%CI 0.63, 0.98), but not ADL function (HR= 0.91; 95%CI 0.75, 1.10), within 6 months of hospitalization.
Following a disabling hospitalization among community-living older persons, those with pre-existing depression may be less likely to recover their pre-hospitalization level of mobility function, but not ADL function. Yet, the reasons remain to be elucidated.
Depression; hospitalization; functional decline; recovery
This study sought to determine whether the rates of basic activities of daily living (ADL) disabilities and functional limitations declined, remained the same, or increased between 2000 and 2005 when (a) only community-dwelling Americans aged 65 and older were examined and (b) when institutionalized older adults were included.
Using data from the American Community Survey and the National Nursing Home Survey, we calculated annual prevalence rates of basic ADL disabilities and functional limitations and fitted regression lines to examine trends over time.
The rates of basic ADL disabilities among community-dwelling adults aged 65 and older increased 9% between 2000 and 2005. When institutionalized elders were included, basic ADL disability rates were stable among men but increased among women. Functional limitation rates did not significantly change between 2000 and 2005.
These findings suggest an end of the decline in disability rates among older Americans, which, if confirmed, could have important implications for health care.
Disability; Activities of daily living; Functional limitations; American Community Survey; National Nursing Home Survey
Accurate measurement of quality of life in older ICU survivors is difficult but critical for understanding the long-term impact of our treatments. Activities of daily living (ADLs) are important components of functional status and more easily measured than quality of life (QOL). We sought to determine the cross-sectional associations between disability in ADLs and QOL as measured by version one of the Short Form 12-item Health Survey (SF-12) at both one month and one year post-ICU discharge.
Data was prospectively collected on 309 patients over age 60 admitted to the Yale-New Haven Hospital Medical ICU between 2002 and 2004. Among survivors an assessment of ADL's and QOL was performed at one month and one-year post-ICU discharge. The SF-12 was scored using the version one norm based scoring with 1990 population norms. Multivariable regression was used to adjust the association between ADLs and QOL for important covariates.
Our analysis of SF-12 data from 110 patients at one month post-ICU discharge showed that depression and ADL disability were associated with decreased QOL. Our model accounted for 17% of variability in SF12 physical scores (PCS) and 20% of variability in SF12 mental scores (MCS). The mean PCS of 37 was significantly lower than the population mean whereas the mean MCS score of 51 was similar to the population mean. At one year mean PCS scores improved and ADL disability was no longer significantly associated with QOL. Mortality was 17% (53 patients) at ICU discharge, 26% (79 patients) at hospital discharge, 33% (105 patients) at one month post ICU admission, and was 45% (138 patients) at one year post ICU discharge.
In our population of older ICU survivors, disability in ADLs was associated with reduced QOL as measured by the SF-12 at one month but not at one year. Although better markers of QOL in ICU survivors are needed, ADLs are a readily observable outcome. In the meantime, clinicians must try to offer realistic estimates of prognosis based on available data and resources are needed to assist ICU survivors with impaired ADLs who wish to maintain their independence. More aggressive diagnosis and treatment of depression in this population should also be explored as an intervention to improve quality of life.
The concurrent influence of depressive symptoms, medical conditions, and disabilities in activities of daily living (ADL) upon the rates of decline in older Americans’ cognitive function is unknown.
This study examined a national sample of 6,476 adults born before 1924 to determine differences in cognitive function trajectories by prevalence and incidence of depressive symptoms, chronic diseases, and ADL disabilities. Cognitive performance was tested 5 times between 1993 and 2002 with a multifaceted inventory that we examined as a global measure (range: 0–35, standard deviation (SD) 6.00) and with word recall (range: 0–20, SD 3.84) analyzed separately.
Baseline prevalence of depressive symptoms, stroke, and ADL limitations were each independently and strongly associated with lower baseline cognition scores, but did not predict future cognitive decline. Each incident depressive symptom was independently associated with 0.06 point reduction (95% confidence interval (CI):0.02–0.10) in recall score, incident stroke with 0.59 point reduction in total score (95% CI:0.20–0.98), each new basic ADL limitation with 0.07 point (95% CI:0.01–0.14) reduction in recall score and 0.16 point reduction in total score (95% CI:0.07–0.25), and each incident instrumental ADL limitation with 0.20 point reduction in recall score (95% CI:0.10–0.30) and 0.52 point reduction in total score (95% CI:0.37–0.67).
Prevalent and incident depressive symptoms, stroke, and ADL disabilities contribute independently to reductions in cognitive functioning in older Americans, but do not appear to influence rates of future cognitive decline. Therefore, prevention, early identification, and aggressive treatment of these conditions may ameliorate the burdens of cognitive impairment.
depression; cognitive decline; physical health; physical disabilities
Early studies reported controversial findings on association of Apolipoprotein E (APOE) polymorphism with disability.
To analyze sex-specific associations of APOE genotypes with impairments in (Instrumental) Activities of Daily Living [(I)ADL] and mortality.
Population-based 1999 National Long Term Care Survey of the U.S. older (65+) individuals.
Genetic data are available for 1805 individuals.
Each of six genotypes of three common alleles of the APOE locus (ε2, ε3, and ε4) was tested on the association with a disability index or mortality.
APOE ε3/3 genotype significantly decreases odds ratio (OR) for IADL disability in males (OR=0.48; 95% Confidence Interval [CI]: 0.31–0.76) while it exhibits no association in females. The OR for ADL disability is 0.19 (CI: 0.04–0.99) for ε4/4 female carriers. The ε2/3 genotype increases the chances of IADL disability for males (OR=2.33; CI: 1.28–4.25). No significant association between APOE polymorphism and mortality was found. A surprising observation was that ε4/4 female carriers have a 5.3 times lower chance of having ADL disability than do non-ε4/4-carriers.
Associations of the APOE polymorphism with disability and lack of association with mortality supports the view that APOE gene actions may be more significant as modulators of frailty than of longevity.
Apolipoprotein E; disability; sex differences; elderly
OBJECTIVES—To examine the association between the longest held occupation in a lifetime and risk of disability in activities of daily living (ADL) among elderly people (65 years and older) in northern Taiwan.
METHODS—A case-control design was used nested within two cohorts of a total of 2198 elderly people who had been followed up either between 1993 and 1997 or between 1996 and 1997. Cases were 360 elderly people with ADL disability within the study period. For each case, two sex matched controls were randomly sampled from the pool of elderly people free from ADL disability. Occupational data were collected through interviews conducted in 1997. Performed job contents were classified into occupational categories and occupation based social classes. Unconditional logistic regression techniques were used to estimate relative risk and 95% confidence intervals (95% CIs) of ADL disability.
RESULTS—Compared with people who were former legislators, government administrators, or business executives and managers, workers in agriculture, animal husbandry, forestry, or fishing (odds ratio (OR) 1.9, 95% CI 1.1 to 3.5) and workers in craft and related trades (OR 1.9, 95% CI 1.1 to 3.4) had significantly increased risks of subsequent ADL disability. Differential risks of ADL disability were found across social classes, with a significant dose-response trend in which unskilled blue collar workers had an 1.8 times higher risk of ADL disability than higher social classes of white collar workers.
CONCLUSIONS—After adjustment for education, there was still an inverse relation between risk of ADL disability and social class. Although total control for all the known risk factors for ADL disability among elderly people was impossible, the results tend to suggest a potential for an effect of longest held occupation in a lifetime on risk of ADL disability.
Keywords: activity of daily living; occupation; socioeconomic status
To explore the impact of adjusting for income and education on disparities in functional limitations and limitations in activities of daily living (ADLs) between Black and White older Americans.
Data from the 2003 American Community Survey were used to examine the associations of education and income, stratified by race and gender, with functional limitations and ADLs, in a sample of 16,870 non-Hispanic Blacks and 186,086 non-Hispanic Whites aged 55 to 74. Sequential logistic regressions were used to examine the relative contribution of income and education to racial disparities.
Ninety percent of the Black–White difference in disability rates for men and 75% of the difference for women aged 55 to 64 were explained by income and education.
The greatly elevated risk of disability among Blacks aged 55 to 74 is largely explained by differences in socioeconomic status. Reductions in Black–White health disparities require a better understanding of the mechanisms whereby lower income and education are associated with functional outcomes in older persons.
African Americans; ethnicity; health inequalities; activities of daily living; functional limitations
Among community-dwelling, disabled older women who were hospitalized, to determine: 1) the rates and predictors of functional decline, 2) the probability and time course of subsequent functional recovery, and 3) predictors of functional recovery.
Population-based observational cohort study.
Woman’s Health and Aging Study
A subset of the 1002 moderately to severely disabled community-dwelling older women who were hospitalized over 3 years(n=457).
Functional decline and complete and partial recovery were defined using a 0-6 scale of dependencies in Activities of Daily Living(ADL), evaluated every six months over 3 years. Complete recovery was defined as returning to baseline function after functional decline; partial recovery was defined as any improvement in the ADL scale after functional decline. Multiple logistic regression analysis was used to determine predictors of functional decline. Kaplan-Meier curves were produced to estimate the proportions recovering as a function of time since hospitalization. Discrete-time proportional hazards models were used to regress the time-to-recovery hazards on the predictor variables.
33% of hospitalized women experienced functional decline. Older age, frailty, length of stay and higher education were associated with functional decline. 50% fully recover over the subsequent 30 months, with 33% recovering within 6 months, and an additional 14% over the next 6 months. Younger women were more likely to recover (80 to 70 year old women,Hazard Ratio=0.39, 95%CI 0.24,0.64).
While most recovery of function occurs by 6 months after the first visit after a hospitalization, a significant proportion of women recover over the next 2 years.
Hospitalization; Activities of Daily Living; Disability; Recovery
To evaluate the association between cognitive dysfunction and other barriers and glycemic control in older adults with diabetes.
RESEARCH DESIGN AND METHODS
Patients over the age of 70 years presenting to a geriatric diabetes clinic were evaluated for barriers to successful diabetes management. Patients were screened for cognitive dysfunction with the Mini Mental State Examination (MMSE) and a clock-drawing test (CDT) scored by 1) a method validated by Mendez et al. and 2) a modified CDT (clock in a box [CIB]). Depression was evaluated with the Geriatric Depression Scale. Interview questionnaires surveyed activities of daily living (ADLs) and instrumental ADLs (IADLs), as well as other functional disabilities.
Sixty patients (age 79 ± 5 years, diabetes duration 14 ± 13 years) were evaluated. Thirty-four percent of patients had low CIB (≤5), and 38% of patients had low CDT (≤13). Both CIB as well as CDT were inversely correlated with HbA1c, suggesting that cognitive dysfunction is associated with poor glycemic control (r = −0.37, P < 0.004 and r = −0.38, P < 0.004, respectively). Thirty-three percent of patients had depressive symptoms with greater difficulty completing the tasks of the IADL survey (5.7 ± 1.7 vs. 4.6 ± 2.0; P < 0.03). These older adults with diabetes had a high incidence of functional disabilities, including hearing impairment (48%), vision impairment (53%), history of recent falls (33%), fear of falls (44%), and difficulty performing IADLs (39%).
Older adults with diabetes have a high risk of undiagnosed cognitive dysfunction, depression, and functional disabilities. Cognitive dysfunction in this population is associated with poor diabetes control.
Background and purpose
Examine the association between attendance at religious services and incidence of ADL disability over a period of seven years among older Mexican Americans 65 years and older.
Using data from the Hispanic Established Population for the Epidemiological Study of the Elderly (H-EPESE), logistic generalized estimation equation (GEE) models were used to analyze the contribution of attendance at religious services to the differences in incidence of ADL disability over seven years, controlling for demographics, medical conditions, and physical mobility.
Frequent attendees at religious services had 30% lower odds of developing ADL disability over seven years compared to the non-regular attendance group. The odds were reduced to 23%, but remained significant when physical and mental health were controlled.
In this older Mexican American population, regular attendees at religious services were less likely to develop ADL disability over a period of seven years compared to those who attended services less often.
Religion; disability; Hispanics
A majority of patients with dementia present behavioral and psychological symptoms, such as agitation, which may increase their suffering, be difficult to manage by caregivers, and precipitate institutionalization. Although internal factors, such as discomfort, may be associated with agitation in patients with dementia, little research has examined this question. The goal of this study is to document the relationship between discomfort and agitation (including agitation subtypes) in older adults suffering from dementia.
This correlational study used a cross-sectional design. Registered nurses (RNs) provided data on forty-nine residents from three long-term facilities. Discomfort, agitation, level of disability in performing activities of daily living (ADL), and severity of dementia were measured by RNs who were well acquainted with the residents, using the Discomfort Scale for patients with Dementia of the Alzheimer Type, the Cohen-Mansfield Agitation Inventory, the ADL subscale of the Functional Autonomy Measurement System, and the Functional Assessment Staging, respectively. RNs were given two weeks to complete and return all scales (i.e., the Cohen-Mansfield Agitation Inventory was completed at the end of the two weeks and all other scales were answered during this period). Other descriptive variables were obtained from the residents' medical file or care plan.
Hierarchical multiple regression analyses controlling for residents' characteristics (sex, severity of dementia, and disability) show that discomfort explains a significant share of the variance in overall agitation (28%, p < 0.001), non aggressive physical behavior (18%, p < 0.01) and verbally agitated behavior (30%, p < 0.001). No significant relationship is observed between discomfort and aggressive behavior but the power to detect this specific relationship was low.
Our findings provide further evidence of the association between discomfort and agitation in persons with dementia and reveal that this association is particularly strong for verbally agitated behavior and non aggressive physical behavior.
Socioeconomic disparities are associated with the prevalence of disability in the general population; however, it is unknown whether a similar association exists between socioeconomic status and disability from chronic kidney disease (CKD, defined as albuminuria or an estimated glomerular filtration rate of 15-59 mL/min/1.73 m2).
A total of 4,257 US adults aged 20 years or older with CKD who participated in the National Health and Nutrition Examination Survey 1999-2008 completed standardized questionnaires assessing self-reported difficulties in activities of daily living (ADL), instrumental ADL (IADL), lower-extremity mobility (LEM), and leisure and social activities (LSA). We used multivariable logistic regression with population-based weighting to obtain adjusted prevalence estimates of disability by demographic, socioeconomic, health care access, and clinical characteristics.
Participants with less education had more disability (age- and sex-adjusted prevalence of disability by lowest vs highest level of education: ADL, 24.5% vs 16.9%; IADL, 34.0% vs 20.3%; LEM, 56.9% vs 44.6%; LSA, 26.2% vs 16.8%; P < .001 for all). We observed similar trends for income. After further adjustment for other sociodemographic factors, health care access, and comorbid conditions, education and income both remained significantly associated, by any measure, with lower prevalence of disability.
Among people with CKD in the United States, lower socioeconomic status is associated with greater risk of disability, independent of race/ethnicity, health care access, and comorbid conditions. Our findings suggest that people with CKD and limited education or lower income should be targeted for early intervention to limit disability and further loss of income, both of which could worsen outcomes in CKD.
Disability threatens the independence of older adults and has large economic and societal costs. This article examines the population impact of arthritis on disability incidence among older Americans.
The present study used longitudinal data (1998–2000) from the Health and Retirement Study, a national probability sample of elderly Americans. Disability was defined by the inability to perform basic activities of daily living (ADL). A total of 7,758 participants ages ≥65 years with no ADL disability at baseline were included in the analyses. Multiple logistic regression was used to measure the impact of baseline arthritis (self reported) on incidence of subsequent ADL disability after controlling for baseline differences in demographics, health factors, health behaviors, and medical access.
Older adults who had baseline arthritis had a substantially higher incidence of ADL disability compared with those without arthritis (9.3% versus 4.5%). The strong relationship of arthritis and ADL disability was partially explained by demographic, health, behavioral, and medical access factors. However, even after adjusting for all other risk factors, arthritis remained as an independent and significant predictor for developing ADL disability (adjusted odds ratio 1.5, 95% confidence interval 1.2–1.8). Almost 1 in every 4 new cases of ADL disability was due to arthritis (adjusted population attributable fraction: 23.7%).
The high frequency of incident ADL disability attributable to arthritis points to the importance of intervention programs that address the entire spectrum of health and functional problems in persons with arthritis to prevent disability.
Arthritis; ADL; Longitudinal data; Disability
Prevalence of cirrhosis among older adults is expected to increase; therefore, we studied the health status, functional disability, and need for supportive care in a large national sample of individuals with cirrhosis. A prospective cohort of individuals with cirrhosis was identified within the longitudinal, nationally representative Health and Retirement Study (HRS). Cirrhosis cases were identified in linked Medicare data via ICD-9-CM codes, and compared to an age-matched cohort without cirrhosis. Two primary outcome domains were assessed: 1) patients’ health status (perceived health status, comorbidities, healthcare utilization, and functional disability as determined by activities of daily living [ADLs] and instrumental activities of daily living [IADLs]), and 2) informal caregiving (hours of caregiving provided by a primary informal caregiver and associated cost). Adjusted negative binomial regression was used to assess the association between cirrhosis and functional disability. 317 individuals with cirrhosis and 951 age-matched comparators were identified. Relative to the comparison group, individuals with cirrhosis had worse self-reported health status, more comorbidities, and used significantly more health care services (hospitalizations, nursing home stays, physician visits; p<0.001 for all bivariable comparisons). They also had greater functional disability (p<0.001 for ADLs and IADLs), despite adjustment for covariates such as comorbidities and healthcare utilization. Individuals with cirrhosis received over twice the number of informal caregiving hours per week (p<0.001), at an annual cost of $4,700 per person.
Older Americans with cirrhosis have high rates of disability, health care utilization, and need for informal caregiving. Improved care coordination and caregiver support is necessary to optimize management of this frail population.
Elderly; Chronic liver disease; Disability; Informal Caregiving; Healthcare utilization
Obesity increases the risk of many chronic diseases and contributes to functional disabilities. We assessed the relationship among obesity and obesity related chronic disease and disability in Korean adults.
This study used data from the 2005 Korean National Health and Nutrition Examination Survey. A total of 5,462 persons (2,325 men, 3,137 women) aged 20 years and older were included in this analysis. Obesity was measured by body mass index and abdominal obesity was by waist circumference. Information on the presence of chronic diseases was based on the self-report of having been diagnosed by physicians. Functional disability was assessed using the Korean activities of daily living (K-ADL) and the Korean instrumental ADL (K-IADL) scales.
The relationship between obesity and prevalence of obesity-related chronic diseases was higher in the older aged group (>60 years for men, >70 years for women) than in the younger aged group. Waist circumference was more related to a higher prevalence of chronic diseases than body mass index in the younger aged group. Abdominal obesity increased the risk (odds ratio, 2.59; 95% confidence interval, 1.19 to 5.66) of having limitation in activities of daily living for the younger aged men after adjustments for age, smoking status, presence of chronic diseases, and body mass index. Body mass index was not associated with disability in either men or women.
The association between obesity and prevalence of chronic disease differed depending on age and sex. It is important to control abdominal obesity to prevent disability in younger aged men.
Obesity; Disability; Waist Circumference; Body Mass Index; Activities of Daily Living
Background: the identification of modifiable risk factors for preventing disability in older individuals is essential for planning preventive strategies.
Purpose: to identify cross-sectional correlates of disability and risk factors for the development activities of daily living (ADL) and instrumental ADL (IADL) disability in community-dwelling older adults.
Methods: the study population consisted of 897 subjects aged 65–102 years from the InCHIANTI study, a population-based cohort in Tuscany (Italy). Factors potentially associated with high risk of disability were measured at baseline (1998–2000), and disability in ADLs and IADLs were assessed both at baseline and at the 3-year follow-up (2001–03).
Results: the baseline prevalence of ADL disability and IADL disability were, respectively, 5.5% (49/897) and 22.2% (199/897). Of 848 participants free of ADL disability at baseline, 72 developed ADL disability and 25 of the 49 who were already disabled had a worsening in ADL disability over a 3-year follow-up. Of 698 participants without IADL disability at baseline, 100 developed IADL disability and 104 of the 199 who already had IADL disability had a worsening disability in IADL over 3 years. In a fully adjusted model, high level of physical activity compared to sedentary state was significantly associated with lower incidence rates of both ADL and IADL disability at the 3-year follow-up visit (odds ratio (OR): 0.30; 95% confidence intervals (CI) 0.12–0.76 for ADL disability and OR: 0.18; 95% CI 0.09–0.36 for IADL disability). After adjusting for multiple confounders, higher energy intake (OR for difference in 100 kcal/day: 1.09; 95% CI 1.02–1.15) and hypertension (OR: 1.91; 95% CI 1.06–3.43) were significant risk factors for incident or worsening ADL disability.
Conclusions: higher level of physical activity and lower energy intake may be protective against the development in ADL and IADL disability in older persons.
prevention; disability; physical activity; energy; ageing; elderly
To evaluate, by age, the performance of 2 disability measures based on needing help: one using 5 classic activities of daily living (ADL) and another using an expanded set of 14 activities including instrumental activities of daily living (IADL), walking, getting outside, and ADL (IADL/ADL).
Guttman and item response theory (IRT) scaling methods are used with a large (N = 25,470) nationally representative household survey of individuals aged 18 years and older.
Guttman scalability of the ADL items increases steadily with age, reaching a high level at ages 75 years and older. That is reflected in an IRT model by age-related differential item functioning (DIF) resulting in age-biased measurement of ADL. Guttman scalability of the IADL/ADL items also increases with age but is lower than the ADL. Although age-related DIF also occurs with IADL/ADL items, DIF is lower in magnitude and balances out without causing age bias.
An IADL/ADL scale measuring need for help is hierarchical, unidimensional, and unbiased by age. It has greater content validity for measuring need for help in the community and shows greater sensitivity by age than the classic ADL measure. As demand for community services is increasing among adults of all ages, an expanded IADL/ADL measure is more useful than ADL.
ADL; Age bias; IADL; Measurement
To examine the prevalence and type of disability in the oldest-old (90+), the fastest growing age group in the US.
The current study included functional data on 697 participants from The 90+ Study, a population based longitudinal study of aging and dementia in people aged 90 and older. Data were obtained by participant’s informants via a written questionnaire. The prevalence of disability was calculated for two definitions using Activities of Daily Living (ADLs). ADL difficulty was defined as difficulty with one or more ADLs whereas ADL dependency was defined as needing help on one or more ADLs.
ADL difficulty was present in 71% in 90–94 year olds, 89% in 95–99 year olds and 97% in centenarians. ADL dependency was present in 44% of 90–94 year olds, 66% of 95–99 year olds and 92% of centenarians. The ADL most commonly causing difficulty was walking (70%) whereas the ADL most commonly causing dependency was bathing (51%). Age, gender and institutionalization were significantly associated with both ADL difficulty and ADL dependency.
Similar to studies in younger individuals, the current study suggests that the prevalence of disability continues to increase rapidly in people aged 90 and older. With the rapid growth in the number of people in this age group, disability in the oldest-old has major public health implications.
disability; oldest-old; ADLs; functional loss; prevalence; population-based
To identify the factors that predict recovery in activities of daily living (ADLs) among disabled older persons living in the community.
Prospective cohort study with 2-year follow-up.
213 men and women 72 years or older, who reported dependence in one or more ADLs.
MEASUREMENTS AND MAIN RESULTS
All participants underwent a comprehensive home assessment and were followed for recovery of ADL function, defined as requiring no personal assistance in any of the ADLs within 2 years. Fifty-nine participants (28%) recovered independent ADL function. Compared with those older than 85 years, participants aged 85 years or younger were more than 8 times as likely to recover their ADL function (relative risk [RR] 8.4; 95% confidence interval [CI] 2.7, 26). Several factors besides age were associated with ADL recovery in bivariate analysis, including disability in only one ADL, self-efficacy score greater than 75, Folstein Mini-Mental State Examination (MMSE) score of 28 or better, high mobility, score in the best third of timed physical performance, fewer than five medications, and good nutritional status. In multivariable analysis, four factors were independently associated with ADL recovery—age 85 years or younger (adjusted RR 4.1; 95% CI 1.3, 13), MMSE score of 28 or better (RR 1.7; 95% CI 1.2, 2.3), high mobility (RR 1.7; 95% CI 1.0, 2.9), and good nutritional status (RR 1.6; 95% CI 1.0, 2.5).
Once disabled, few persons older than 85 years recover independent ADL function. Intact cognitive function, high mobility, and good nutritional status each improve the likelihood of ADL recovery and may serve as markers of resiliency in this population.
activities of daily living (ADLs); recovery; elderly; prospective cohort study; prognosis
Functional limitation is a major driver of medical costs. This study evaluates the prevalence of functional limitation among adults with arthritis, the frequency of functional decline over two years, and investigates factors amenable to public health intervention that predict functional decline.
Longitudinal data (1998–2000) from a cohort of 5715 adults 65 years or older with arthritis from a national probability sample are analyzed. Function was defined from ability to perform instrumental activities of daily living (IADL) and basic ADL tasks. Adjusted odds ratios (AOR) from multiple logistic regression estimated the association between functional decline with comorbid conditions, health behaviors, and economic factors.
Overall, 19.7% of this cohort had functional limitation at baseline, including 12.9% with ADL limitations. Over the subsequent two years, function declined in 13.6% of those at risk. Functional decline was most frequent among older women (15.0%) and minorities with arthritis (18.0% Hispanics, 18.7% African Americans). Lack of regular vigorous physical activity (RVPA), the most prevalent risk factor (65%), almost doubled the odds of functional decline (AOR=1.9 95% CI =1.5, 2.4) controlling for all risk factors. If all subjects engaged in RVPA, the expected functional decline could be reduced as much as 36%. Other significant predictors included cognitive impairment, depressive symptoms, diabetes, physical limitations, no alcohol use, stroke, and vision impairment.
Lack of RVPA is a potentially modifiable risk factor, which could substantially reduce functional decline and associated health care costs. Prevention/intervention programs should include RVPA, weight maintenance, and medical intervention for health needs.
To determine whether benzodiazepine use is associated with incident disability in mobility and activities of daily living (ADLs) in older individuals.
A prospective cohort study.
Four sites of the Established Populations for Epidemiologic Studies of the Elderly.
This study included 9,093 subjects (aged ≥65) who were not disabled in mobility or ADLs at baseline.
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.
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.
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.
benzodiazepines; activities of daily living; disability; adverse drug event
To examine the association of living arrangements with functional disability among older persons and explore the mediation of impact factors on the relationship.
Cross-sectional analysis using data from Healthy Aging study in Zhejiang Province.
Analyzed sample was drawn from a representative rural population of older persons in Wuyi County, Zhejiang Province, including 1542 participants aged 60 and over in the second wave of the study.
Living arrangements, background, functional disability, self-rated health, number of diseases, along with contemporaneous circumstances including income, social support (physical assistance and emotional support). Instrument was Activities of Daily Living (ADL) scale, including Basic Activities Daily Living (BADL) and Instrumental Activities of Daily Living (IADL).
Living arrangements were significantly associated with BADL, IADL and ADL disability. Married persons living with or without children were more advantaged on all three dimensions of functional disability. Unmarried older adults living with children only had the worst functional status, even after controlling for background, social support, income and health status variables (compared with the unmarried living alone, ß for BADL: −1.262, ß for IADL: −2.112, ß for ADL: −3.388; compared with the married living with children only, ß for BADL: −1.166, ß for IADL: −2.723, ß for ADL: −3.902). In addition, older adults without difficulty in receiving emotional support, in excellent health and with advanced age had significantly better BADL, IADL and ADL function. However, a statistically significant association between physical assistance and functional disability was not found.
Functional disabilities vary by living arrangements with different patterns and other factors. Our results highlight the association of unmarried elders living with children only and functioning decline comparing with other types. Our study implies policy makers should pay closer attention to unmarried elders living with children in community. Community service especially emotional support such as psychological counseling is important social support and should be improved.
Little is known regarding the normative levels of leisure activities among the oldest old and the factors that explain the age-associated decline in these activities.
The sample included 303 cognitively intact community-dwelling elderly persons with no disability in Activities of Daily Living (ADL) and minimal dependency in Instrumental ADL (IADL) in Shiga prefecture, Japan. We examined (i) the nature and frequency of leisure activities, comparing the oldest old versus younger age groups; (ii) factors that explain the age-associated differences in frequencies of engagement in these activities; and (iii) domain-specific cognitive functions associated with these activities, using three summary index scores: physical and nonphysical hobby indexes and social activity index.
The oldest old (85 years old or older) showed significantly lower frequency scores in all activity indexes, compared with the youngest old (age 65–74 years). Gait speed or overall mobility consistently explained the age-associated reduction in levels of activities among the oldest old, whereas vision or hearing impairment and depressive symptoms explained only the decline in social activity. Frequency of engagement in nonphysical hobbies was significantly associated with all cognitive domains examined.
Knowing the factors that explain age-associated decline in leisure activities can help in planning strategies for maintaining activity levels among elderly persons.
Oldest old; Normative data; Leisure activities; Healthy aging; Japanese cohort; Takashima Study
A ranked activities of daily living (ADL) scale has been developed for stroke patients, on which an individual's score predicts his/her overall function ability. With an unranked scale the same total score can be obtained from different combinations of items and gives little idea of the patient's general pattern or degree of disability. The items in the scale are easy to assess on both inpatients and outpatients, and accepted criteria for valid ranking are fulfilled. A strong relation was found between scale score one month post-stroke and length of stay in hospital. Low scores at one month were also associated with high mortality during the subsequent five months. "Formal" and "informal" methods of ADL assessment were compared, and only small and unimportant differences were found. Assessments by postal questionnaire were also evaluated and agreed well with formal assessments carried out by visiting the patients' homes. Use of some or all of these methods would help to simplify and standardise follow up records for both routine care and research.