Burden and factors associated with depression in residents of old age homes in a town in West Bengal: A cross sectional study

Objective To investigate cross-sectional associations between spouses’ sensory loss and depressive symptoms, self-rated health, and functional disability. Methods We included 10,410 individuals from the China Health and Retirement Longitudinal Study. We used the cross-sectional design and determined hearing loss, vision loss, and dual sensory loss by self-reports. We assessed depressive symptoms using the Center for Epidemiological Studies Depression Scale. We assessed self-reported health status using one item. Functional disability was defined as having difficulties in activities of daily living (ADL) and instrumental activities of daily living (IADL). Results Individuals with spouses’ dual sensory loss had a higher prevalence of depressive symptoms (45.19%), ADL (17.31%), and IADL impairments (21.97%) and a lower rate of self-rated good health (20.78%) than those with no or single loss. Spouse’s sensory loss was associated with depressive symptoms, self-rated health, ADL, and IADL impairments (p < .05). Husbands’ ADL impairments were associated with wives’ vision loss (p < .05). Wives’ IADL impairments were associated with husbands’ hearing loss (p < .05). Conclusions Spouses’ sensory loss was related to depressive symptoms, self-rated health, ADL, and IADL impairments. There was a gender specificity in the effect of spousal vision loss or hearing loss on ADL and IADL impairments.

BackgroundWhile functional and mobility impairments (FMIs) have garnered the attention of health researchers in low and middle-income countries (LMICs), including India, research has yet to explore whether and to what extent the perception of one’s social status is associated with FMIs. We fill this gap in the literature by examining (1) the association between subjective social status (SSS) and FMIs among older adults in India and (2) whether this association between SSS and FMIs is mediated and moderated by life satisfaction and depression.MethodsData come from the 2017-18 wave 1 of the Longitudinal Aging Study in India (LASI) with a sample of 31,464 older adults aged 60 years and above. FMIs were assessed using established scales on impairments in activities of daily living (ADLs), instrumental activities of daily living (IADLs), and mobility. SSS was assessed using the Macarthur scale. Life satisfaction was measured using responses to five statements gauging respondent’s overall satisfaction with life. Depression was calculated using the shortened version of the Composite International Diagnostic Interview (CIDI-SF). Multivariable regression was employed to examine the association between variables, and the interaction terms and Karlson-Holm-Breen (KHB) method were used separately to test the mediation and moderation effects.Results39.11% of the sample had a low SSS, 8.26% were depressed, and 32.07% reported low life satisfaction. A total of 8.74%, 10.91%, and 8.45% of the study population reported at least one impairment in ADL, IADL, and mobility, respectively. Older adults in the higher SSS group were less likely to have ADL impairment (beta: -0.017, CI: -0.030, -0.0032) and mobility impairment (beta: -0.044, CI: -0.076, -0.013). Depression moderated the association between SSS and mobility impairment (p-value: 0.025), and life satisfaction moderated the association between SSS and ADL impairments (p-value: 0.041) and SSS and IADL impairments (p-value: 0.037). Depression mediated 20.28%, 31.88%, and 18.39% of the associations of SSS with ADL, IADL, and mobility impairments, respectively. Similarly, life satisfaction mediated 23.24%, 52.69%, and 27.22% of the associations of SSS with ADL, IADL, and mobility impairments.ConclusionsThat SSS is associated with FMIs among older Indians, even after considering their objective socioeconomic status (SES), suggests that the use of SSS is relevant to the study of health inequalities in India. The finding that life satisfaction and depression mediate and moderate this association is crucial in pinpointing those older Indians at risk of the functional and mobility-related repercussions of lower SSS.

Prevalence of Dependence in Activities of Daily Living in Adults with Sickle Cell Disease and Its Association with Disease Complications

Falls contribute to impairments in activities of daily living (ADLs), resulting in significant declines in the quality of life, safety, and functioning of older adults. Understanding the magnitude and duration of the effect of falls on ADLs, as well as identifying the characteristics of older adults more likely to have post-fall ADL impairment is critical to inform fall prevention and post-fall intervention. The purpose of this study is to 1) Quantify the association between falls and post-fall ADL impairment and 2) Model trajectories of ADL impairment pre- and post-fall to estimate the long-term impact of falls and identify characteristics of older adults most likely to have impairment. Study participants were from the Ginkgo Evaluation of Memory Study, a randomized controlled trial in older adults (age 75+) in the United States. Self-reported incident falls and ADL scores were ascertained every 6 months over a 7-year study period. We used Cox proportional hazards analyses (n = 2091) to quantify the association between falls and ADL impairment and latent class trajectory modeling (n = 748) to visualize trajectories of ADL impairment pre-and post-fall. Falls reported in the previous 6 months were associated with impairment in ADLs (HR: 1.42; 95% CI 1.32, 1.52) in fully adjusted models. Based on trajectory modeling (n = 748), 19% (n = 139) of participants had increased, persistent ADL impairment after falling. Participants who were female, lived in a neighborhood with higher deprivation, or experienced polypharmacy were more likely to have ADL impairment post-fall. Falls are associated with increased ADL impairment, and this impairment can persist over time. It is crucial that all older adults, and particularly those at higher risk of post-fall ADL impairment have access to comprehensive fall risk assessment and evidence-based fall prevention interventions, to help mitigate the negative impacts on ADL function.

Impairment in activities of daily living and cognitive decline mediate the association between depressive symptoms and incident hip fractures in Chinese older adults.

ObjectivesThe importance of impairment in performing activities of daily living (ADL) is likely to increase in sub-Saharan Africa because few care options for affected people exist. This study investigated the prevalence of ADL impairment, the extent to which care need was met, and described characteristics of people with ADL impairment and unmet need in Burkina Faso.MethodsThis study used data from the Centre de Recherche en Santé de Nouna Heidelberg Aging Study, a population-based study among 3,026 adults aged older than 40 years conducted in rural Burkina Faso. Information on 6 basic ADL items was sought, with a follow-up question asking whether care need was not met, partially met, or met. Bivariable correlations and multivariable logistic regression were used to determine sociodemographic and health characteristics associated with ADL impairment and unmet need.ResultsADL impairment of any kind was reported by 1,202 (39.7%) respondents and was associated with older age (adjusted odds ratio: 1.05 [95% CI: 1.04–1.06]), being a woman (1.33 [1.06–1.60]), and reporting depressive symptoms (1.90 [1.65–2.18]). Among those with ADL impairment, 67.8% had at least one unmet need. Severe ADL impairment was found in 202 (6.7%) respondents, who reported a lower prevalence of unmet need (43.1%). Severe ADL impairment was associated with depressive symptoms (2.55 [2.11–3.07]) to a stronger degree than any ADL impairment.DiscussionPrevalence of ADL impairment and unmet need was high in this setting. Variation in impairment across the population highlighted key groups for future interventions. Unmet need for care was highest in middle-aged adults, indicating a gap in care provision.

Lumbar spinal stenosis (LSS) impairs activities of daily living (ADL) in older adults. Factors associated with ADL impairment in LSS have not been identified. This study aimed to ascertain the pre-admission living conditions in older adults with LSS and investigate the factors associated with impairment in ADL. A total of 261 community-dwelling older adults aged ≥65 years with LSS, scheduled for surgery were included. The Oswestry Disability Index (ODI) was used to assess ADL impairment. The Life-Space Assessment was used to assess the extent and frequency of outings. Pain, numbness, continuous walking distance, and health-related quality of life as psychosomatic functions. Falls self-efficacy and the degree of social isolation were assessed as social life status. Factors associated with ADL impairment were examined using multiple logistic regression analysis. Significant differences were found in psychosomatic functioning, living space, and falls self-efficacy depending on the presence or absence of ADL impairment. The ODI sub-components showed a stronger degree of impairment in pain intensity, walking, standing, and social life. There were significant differences in the frequency of going outside the home and inside the neighborhood, ADL impairment was shown to affect the frequency of outings within close proximity to their lives. Numbness was associated with ADL impairment (odds ratio=1.2; 95% confidence interval 1.1-1.4). Assessing the degree of numbness is important in predicting ADL impairment in older adults with LSS. Additionally, assessing the living conditions and taking an appropriate approach before admission can help prevent ADL impairment.

Recent data suggest that the association between obesity and high cholesterol, high blood pressure, and mortality has decreased.1, 2 If the health status of obese adults improves because of primary prevention efforts to reduce the burden of disease, then the association between obesity and disability may also decrease,3 although if their health status improves because of secondary or tertiary prevention efforts, the link between obesity and disability will grow stronger, even though people may live longer with disease. One study showed that the effect of obesity on disability was stable over time,4 whereas another study found that the effect of obesity on disability increased over time.3 These two studies were conducted in United States, and this question has not been studied in developing countries such as China. The objective of the current study was to determine whether the relationship between obesity and activity of daily living (ADL) limitations changed between 1997 and 2006 in Chinese adults aged 55 and older. ADL impairment was focused on because it has been used extensively to predict long-term care need.5 This analysis uses data from the 1997 and 2006 surveys of the China Health and Nutrition Survey (CHNS)6 to examine change in ADL impairment according to body mass index (BMI) category. The CHNS covers nine provinces, and the survey drew a random sample of respondents aged 16 and older; 5,591 (2,143 in 1997 and 3,448 in 2006) respondents aged 55 and older were the focus of this study. Participants were classified as having an ADL impairment if they said they needed help or could not dress, walk, use the toilet, bathe, and eat at all. Weight categories were based on measured height and weight using Asian criteria:7 underweight (BMI ≤ 18.5 kg/m2), normal weight (BMI = 18.5–22.9 kg/m2), overweight (BMI = 23.0–24.9 kg/m2), and obese (BMI ≥ 25.0 kg/m2). Covariates included self-reported age, sex, years of education, presence of medical conditions, smoking, and health insurance status. The prevalence of obesity increased 26.7% (P < .001) from 23.6% of the population aged 55 and older in 1997 to 29.9% in 2006, whereas the prevalence of ADL impairment decreased from 5.1% in 1997 to 3.8% in 2006. In 1997, obese individuals were more likely than normal-weight individuals to have ADL impairments. Examining trends over time showed that the prevalence of ADL limitations decreased from 4.5% to 1.7% in the overweight group (P = .01) and from 6.4% to 3.3% in the obese group (P = .009) but did not change in the underweight and normal-weight groups. Table 1 shows that, after adjusting for medical conditions, availability of medical insurance, and smoking (Model 2), the effects of the significant interaction between time and obesity on ADL impairment persisted (odds ratio (OR) = 0.46, 95% confidence interval (CI) = 0.23–0.91). Specifically, the link between obesity and ADL impairment went from significant in 1997 (OR = 1.86, 95% CI = 1.01–3.44) to nonsignificant in 2006 (OR = 0.70, 95% CI = 0.42–1.14). Despite the recent increase in obesity, it appears that the link between obesity and ADL impairment has weakened in China. Specifically, the disparity between obese and normal-weight individuals has decreased over time, and the link between obesity and ADL impairment went from significant in 1997 to nonsignificant in 2006. Changes in sociodemographic characteristics, medical conditions, the availability of health insurance, and smoking behavior of the samples did not explain these changes in the association. Consistent with a U.S. study,3 a significant effect of the interaction between time and obesity on ADL impairment was found, but the results differed in how that relationship changed. The association between obesity and ADL impairment went from significant and positive to nonsignificant; the U.S. study found that the association increased by a factor of 1.56 over a period of 10 years. The difference may be due to how the studies measured ADLs. In the current study, dressing, walking, using the toilet, eating, and bathing were included; the U.S. study included only getting in and out of bed, eating, and dressing. Understanding the effect of obesity on ADL impairment is important because disability strongly affects quality of life, health care, and long-term care expenditure in old age. Findings from the current research have important implications for public health. There was no difference in disability between obese and normal-weight participants in 2006, but obese participants in 1997 were more likely to report disability than normal-weight participants. These findings suggest that effect of obesity on disability greatly declined in the intervening decade and that obese participants are healthier than they used to be in terms of functional capacity. Conflict of Interest: Dr. Chou has no conflict of interest to report. Dr. Chou had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. This study used data from the CHNS. We thank the National Institute of Nutrition and Food Safety, the China Center for Disease Control and Prevention, the Carolina Population Center, the University of North Carolina at Chapel Hill, the National Institute of Health (NIH; R01-HD30880, DK056350, and R01-HD38700), and the Fogarty International Center. We thank the NIH for financial support for CHNS data collection and analysis files from 1989 to 2006. We also thank the China-Japan Friendship Hospital and the Ministry of Health for supporting the CHNS 2009 and future surveys. Author Contributions: Chou is responsible for preparation of the paper, study concept, design, and methods, analysis and interpretation of data. Sponsor Role: The study design and interpretation of results were solely the responsibility of the author.

203 Background: Hospitalized patients with cancer often have impaired ADLs related to age, comorbidities, and both cancer and treatment-related morbidity. However, the relationship between ADL impairment and patients’ symptom burden and clinical outcomes has not been well described. Methods: We prospectively enrolled patients with advanced cancer with unplanned hospitalizations at an academic medical center. Upon admission, nurses assessed patients’ ADLs (mobility, feeding, bathing, dressing, and grooming). We used the Edmonton Symptom Assessment Scale (ESAS) and Patient Health Questionnaire-4 to assess physical and psychological symptoms, comparing symptom burden between patients with and without ADL impairment. We used regression models adjusted for age, sex, education, Charlson comorbidity index, months since advanced cancer diagnosis, and cancer type to assess the relationship between any ADL impairment and hospital length of stay, the composite outcome of death or readmission within 90 days of discharge, and survival. Results: Among 932 patients, 40.2% had at least one ADL impairment. Patients with ADL impairment were older (67.2 vs. 60.8 years, p&lt;0.001), had higher Charlson comorbidity index (1.1 vs. 0.7, p&lt;0.001), and higher physical symptom burden (ESAS Physical 35.2 vs. 30.9, p&lt;0.001). Those with ADL impairment were more likely to have moderate to severe constipation (46.7% vs. 36.0%, p&lt;0.01), pain (74.9% vs. 63.1%, p&lt;0.01), drowsiness (76.6% vs. 68.3%, p&lt;0.01), as well as symptoms of depression (38.3% vs. 23.6%, p&lt;0.01) and anxiety (35.9% vs. 22.4%, p&lt;0.01). In adjusted models, ADL impairment was associated with longer hospital length of stay (B=1.30, p&lt;0.01), higher odds of death or readmission within 90 days (odds ratio=2.26, p&lt;0.01), and worse survival (hazard ratio=1.73, p&lt;0.01). Conclusions: Hospitalized patients with advanced cancer who have ADL impairment experience a significantly higher symptom burden and worse health outcomes compared to those without ADL impairment. These findings highlight the need to assess and address ADL impairment among this population to enhance their quality of life and care.

BackgroundImpairment in activities of daily living (ADL) is an important predictor of outcomes although many administrative databases lack information on ADL function. We evaluated the impact of ADL function on predicting postoperative mortality among older adults with hip fractures in Ontario, Canada.MethodsSociodemographic and medical correlates of ADL impairment were first identified in a population of older adults with hip fractures who had ADL information available prior to hip fracture. A logistic regression model was developed to predict 360-day postoperative mortality and the predictive ability of this model were compared when ADL impairment was included or omitted from the model.ResultsThe study sample (N = 1,329) had a mean age of 85.2 years, were 72.8% female and the majority resided in long-term care (78.5%). Overall, 36.4% of individuals died within 360 days of surgery. After controlling for age, sex, medical comorbidity and medical conditions correlated with ADL impairment, addition of ADL measures improved the logistic regression model for predicting 360 day mortality (AIC = 1706.9 vs. 1695.0; c -statistic = 0.65 vs 0.67; difference in - 2 log likelihood ratios: χ2 = 16.9, p = 0.002).ConclusionsDirect measures of ADL impairment provides additional prognostic information on mortality for older adults with hip fractures even after controlling for medical comorbidity. Observational studies using administrative databases without measures of ADLs may be potentially prone to confounding and bias and case-mix adjustment for hip fracture outcomes should include ADL measures where these are available.

Objective Prostate-specific antigen (PSA) testing for prostate cancer is controversial. Although prostate cancer-specific mortality is probably reduced, the all-cause mortality benefit of aggressive prostate cancer treatment is unproven and probably small at best. There is a substantial negative impact of treatment on men9s quality of life. As a result, PSA screening should be discussed with all men but generally reserved for men who are likely to live at least 10 years, as reflected in recommendations from national organizations. Since functional limitation generally indicates poorer prognosis, we would expect that PSA testing should decrease with the presence of impairment in activities of daily living (ADL) and instrumental ADL (IADL) in Medicare beneficiaries. Method We performed a retrospective cross-sectional analysis of the Medicare Current Beneficiary Survey (MCBS), a nationally representative sample of noninstitutionalized Medicare beneficiaries (age ≥ 65) from the 2002 wave of the MCBS. Using logistic regression, we explored the relationship of PSA to age, race, HMO status, each of eight comorbidities, and any ADL or IADL impairment. Results Of 3,729 surveyed Medicare beneficiaries, 70% reported having undergone PSA testing in the past year. With age 65, white race, and no impairment or comorbidity as the reference group, factors associated with significantly higher odds of PSA testing included cardiovascular disease (odds ratio [OR] =1.24, 95% CI 1.05-1.45), hypertension (OR = 1.60, 1.38-1.88), cancer (OR = 1.60, 1.23-2.08), and arthritis (OR = 1.30, 1.12-1.52). Significantly lower than reference odds for PSA testing were seen for African American race (OR = 0.66, 0.51-0.87), IADL impairment (OR = 0.89, 0.84-0.96), and stroke (OR = 0.79, 0.63-0.99). No significant difference was seen for age, ADL impairment, HMO membership, diabetes, COPD, or psychiatric comorbidity. Conclusion There is no evidence of reduction in PSA testing with ADL impairment and little for IADL impairment in Medicare beneficiaries in the 2002 MCBS survey. There may be an opportunity to reduce the adverse quality of life impact of PSA testing and subsequent treatment for men who are unlikely to derive a longevity benefit, specifically those men who are unlikely to live 10 years. The study is limited in that we cannot determine if PSA testing was used as a screening or diagnostic test in response to urinary symptoms and that functional status is an imperfect predictor of prognosis.

Background and ObjectiveSocietal aging and increasing average life expectancy have led to a significant increase in the population of individuals aged 75 years or above. Hence, it is becoming more meaningful and appropriate for researchers to divide those above the age of 65 years into various subgroups, such as young-old and old-old. Based on this division, we investigated the prevalence and correlates of impairments in activities of daily living (ADLs) among community-dwelling older adults (young-old vs. old-old) in South Korea.&#x0D; Material and MethodsThis was a cross-sectional study. We used the data of 4,368 older adults (≥65 years old) from the 2012 Korean Longitudinal Study of Aging. ADL impairment was assessed using a modified version of the Katz Index of Independence in Activities of Daily Living.&#x0D; ResultsThe prevalence of ADL impairment was greater in old-old participants (12.7%) than in young-old ones (3.0%). ADL impairment was significantly associated with gender, perceived health status, regular exercise, cognitive function, and depressive symptoms in young-old individuals. By contrast, in old-old individuals, the significant predictors were residential area, socioeconomic status, perceived health status, regular exercise, cognitive function, and depressive symptoms. Among both age subgroups, cognitive function was the strongest predictive factor of ADL impairment.&#x0D; Conclusion&#x0D; We found clear age differences in the prevalence and correlates of ADL impairment in older Koreans. Such age differences should be considered when studying and developing interventions for ADL impairment in older adults.

Pain, particularly musculoskeletal (MSK) and multi-site pain, significantly impacts activities of daily living (ADL) in the elderly, leading to a decline in overall quality of life (QoL). This study, comprising 7490 participants, (mean age: 69 ± 10; females: 57%) from the sixth wave of the Korean Longitudinal Study of Aging (KLoSA), aimed to assess the association between self-reported pain and ADL impairment among the elderly population. Notably, 62% of participants reported experiencing pain, with back pain being the most prevalent (36%) and stomachache the least (0.39%). A majority (61%) of individuals reported MSK-related pain. Additionally, 20% reported pain at one site and 0.03% experienced pain at 12 sites. ADL impairment was observed in 376 (5.0%) participants. Compared to those without pain, participants reporting moderate and severe pain had higher odds of ADL impairment [2.31 (95% CI, 1.66-3.21) and 2.98 (95% CI, 1.95-4.53), respectively]. Pain experienced in the shoulder, arm, wrist, back, hip, leg, and ankle had a significant association with ADL impairment, with ORs ranging from 2.66 (95% CI, 1.80-3.93; hip pain) to 1.36 (95% CI 1.07-1.72; back pain). Furthermore, multi-site pain was associated with higher ADL impairment [1-6 sites: OR: 1.49 (95% CI, 1.11-2.01); 7-12 sites: OR: 7.16 (95% CI, 3.60-14.26)]. These findings underscore the importance of addressing MSK and multi-site pain through targeted interventions, potentially enhancing ADL and contributing to an improved QoL among the elderly population.

Ageing is a global concern, and the growing geriatric population in developing countries such as Nepal faces significant health and social challenges. This study aimed to assess the health status and lifestyle behaviours of older adults. A cross-sectional analytical study was conducted in 2023 with 275 older adults in Mahalaxmi Municipality, Dhankuta, Nepal, using non-probability convenience sampling. Structured interview schedules, based on WHO recommendations and the Katz Index of Independence in Activities of Daily Living (ADLs), were used to collect data. Descriptive and Inferential statistical analyses were performed, followed by a binary multiple logistic regression model to assess statistically significant factors associated with chronic health problems and functional status in ADLs among older adults. The mean age of participants was 73.12 ± 5.29 years; 50.9% were male, and 96.7% were unable to read and write. Nearly half of the older adults reported at least one chronic health problem (48.4%), and 45.0% mentioned moderate to severe functional impairment in ADL. The fitted model revealed that unmarried or widowed older adults had higher odds of chronic health problems (AOR:2.83, 95% CI:1.42-5.66, p = 0.003). Smoking was also associated with increased odds (AOR: 2.10, 95% CI: 1.03-4.30, p = 0.042), whereas engagement in light-to-moderate physical activity was associated with significantly lower odds of chronic health problems (AOR = 0.15, 95%CI:0.08-0.29, p < 0.001). Functional impairment in ADL was more likely among older adults aged ≥ 75 years (AOR = 2.09, 95% CI:1.07-4.08, p = 0.03) and was strongly associated with the presence of chronic health problems (AOR = 18.43, 95% CI: 9.64-35.24, p < 0.001). The findings indicate a high burden of self-reported chronic health problems and functional dependency among older adults in a hilly municipality of Nepal. Marital status, smoking, and physical activity were significantly associated with chronic illness, while age and chronic illness were significantly associated with ADL dependency. These results highlight the need for community-based geriatric screening and targeted behavioural interventions to improve health status among older adults.

Mild impairment in activities of daily living (ADL) can occur in Mild Cognitive Impairment (MCI), but the nature and extent of these difficulties need to be further explored. The Canadian occupational performance measure (COPM) is one of the few individualized scales designed to identify self-perceived difficulties in ADL. The present study investigated impairments in ADL using the COPM in elderly with MCI. A total of 58 MCI patients were submitted to the COPM for studies of its validity and reliability. The COPM proved a valid and consistent instrument for evaluating ADL in elderly MCI patients. A total of 74.6% of the MCI patients reported difficulties in ADL. Of these problems, 41.2% involved self-care, 31.4% productivity and 27.4% leisure. This data further corroborates recent reports of possible functional impairment in complex ADL in MCI.