Abstract
BackgroundInstrumental Activities of Daily Living (IADL) disability is a common health burden in aging populations. The identification of high-risk individuals is essential for timely targeted interventions. Although predictors for IADL disability have been well described, studies constructing prediction tools for IADL disability among older adults were not adequately explored. Our study aims to develop and validate a web-based dynamic nomogram for individualized IADL disability prediction in older adults.MethodsData were obtained from the China Health and Retirement Longitudinal Study (CHARLS). We included 4791 respondents aged 60 years and over, without IADL disability at baseline in the 2011 to 2013 cohort (training cohort) and 371 respondents in the 2013 to 2015 cohort (validation cohort). Here, we defined IADL disability as needing any help in any items of the Lawton and Brody’s scale. A web-based dynamic nomogram was built based on a logistic regression model in the training cohort. We validated the nomogram internally with 1000 bootstrap resamples and externally in the validation cohort. The discrimination and calibration ability of the nomogram was assessed using the concordance index (C-index) and calibration plots, respectively.ResultsThe nomogram incorporated ten predictors, including age, education level, social activity frequency, drinking frequency, smoking frequency, comorbidity condition, self-report health condition, gait speed, cognitive function, and depressive symptoms. The C-index values in the training and validation cohort were 0.715 (bootstrap-corrected C-index = 0.702) and 0.737, respectively. The internal and external calibration plots for predictions of IADL disability were in excellent agreement. An online web server was built (https://lilizhang.shinyapps.io/DynNomapp/) to facilitate the use of the nomogram.ConclusionsWe developed a dynamic nomogram to evaluate the risk of IADL disability precisely and expediently. The application of this nomogram would be helpful for health care physicians in decision-making.
Highlights
Instrumental Activities of Daily Living (IADL) disability is a common health burden in aging populations
Functional disability is defined as dependency in performing daily activities which are categorized into activities of daily living (ADL) and instrumental activities of daily living (IADL) [5]
Study design and participants Data were obtained from the China Health and Retirement Longitudinal Study (CHARLS), a nationally representative longitudinal survey among Chinese middle-aged and older adults
Summary
Instrumental Activities of Daily Living (IADL) disability is a common health burden in aging populations. Functional disability is a common health problem in older adults It causes multiple adverse events such as falls, hospitalization, and mortality [1,2,3] and places a heavy burden on health care systems [4]. Functional disability is defined as dependency in performing daily activities which are categorized into activities of daily living (ADL) and instrumental activities of daily living (IADL) [5]. ADL disability refers to needing help in routine self-care activities, whereas IADL disability is more related to living independently under a given circumstance [6, 7]. Identifying people at risk for IADL disability is critically essential for timely, targeted interventions to delay, slow, or even partially reverse the process of becoming care-dependent
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