Construction and validation of a model for predicting disability in older adults with chronic lung disease.

Existing studies on the association between depressive symptoms and functional disability in older adults have mainly focused on average effects. However, limited evidence is available on how this association varies across different levels of disability, and the potential nonlinear relationship between the two remains unclear. This study used data from the 2015, 2018, and 2020 waves of the China Health and Retirement Longitudinal Study (CHARLS). A balanced panel of 1,189 older adults with disability was constructed. A two-way fixed-effects model was used to estimate the association between depressive symptoms and functional disability. Quantile regression (QR)was employed to examine heterogeneity across different quantiles of disability. Quantile random forest (QRF)was further used to explore the nonlinear relationship between depressive symptoms and functional disability. Depressive symptoms were significantly positively associated with functional disability (β = 0.171, p < 0.001). QR analyses showed that this association differed substantially across quantiles of disability and increased progressively from lower to higher quantiles (from 0.034 to 0.267). QRF analysis further revealed the effect became markedly stronger at higher levels of depressive symptoms. SHAP analysis at the individual level further supported these findings. Depressive symptoms are an important factor affecting functional disability in older adults. Their effect shows significant distributional heterogeneity and nonlinear characteristics. Strengthening depression intervention among older adults with higher levels of disability may help delay the progression of functional decline.

Sarcopenia is associated with functional disability in older adults. However, no consistent conclusions have been reached considering the differences in the measurement and criteria of sarcopenia. We aimed to examine the association between sarcopenia status and functional disability based on China Health and Retirement Longitudinal Study (CHARLS). A nationally representative longitudinal study. Participants aged at least 60 years old from the CHARLS 2015y were included. Sarcopenia was assessed according to the Asian Working Group for Sarcopenia 2019 algorithm. The outcomes of this study were basic activities of daily living (ADLs) and instrumental activities of daily living (IADLs). The logistic regression model was conducted to analyze the cross-sectional and longitudinal associations between sarcopenia status and ADLs and IADLs disability. In the cross-sectional study, 37.2% of the 6893 participants were defined as having sarcopenia. Any form of sarcopenia was associated with ADLs and IADLs disability. During three years of follow-up, 786 (16.5%) participants developed new-onset ADLs disability, and 980 (22.5%) participants developed new-onset IADLs disability. Compared with the no-sarcopenia, participants with possible sarcopenia (OR: 1.62, 95%CI: 1.34-1.95), sarcopenia (OR: 1.58, 95%CI: 1.18-2.11), or total sarcopenia (OR: 1.58, 95%CI: 1.34-1.88) had a higher risk of ADLs disability. While, the risk of IADLs disability for participants with possible sarcopenia (OR: 1.68, 95%CI: 1.41-2.00), sarcopenia (OR: 1.87, 95%CI: 1.40-2.51), or total sarcopenia (OR: 1.71, 95%CI: 1.45-2.00) was still significantly increased. With statistical interaction between sarcopenia status and residence or sex in ADLs and IADLs disability, older adults in urban, with ORs ranging from 2.14 to 2.44, were at a higher risk of functional disability than those in rural. Possible sarcopenia was associated with a much higher risk of ADLs disability (OR: 1.68, 95%CI: 1.26-2.25) in males and a higher risk of IADLs disability (OR: 1.98, 95%CI: 1.56-2.52) in females. Sarcopenia was associated with an increased risk of ADLs and IADLs disability among older Chinese adults. Even possible sarcopenia still significantly impacted ADLs and IADLs disability, and this association varied by sex and residence.

Background: Cognitive frailty is a newly proposed clinical entity, referring to concurrent cognitive impairment and physical frailty in the absence of dementia. The clinical significance of cognitive frailty remains poorly understood. We aimed to investigate the association between cognitive frailty and functional disability in older adults. Methods: A total of 1,644 non-demented older adults aged ≥65 years (mean age: 73 ± 6 years; men: 41.8%) and without functional disability at baseline were followed-up for 4 years. Cognitive frailty was defined as the presence of both physical frailty (based on the modified Cardiovascular Health Study criteria) and cognitive impairment (Mini-Mental State Examination score of <24 points). Functional disability was identified using the database of Japan’s Long-term Care Insurance System. Association between cognitive frailty and functional disability was assessed by using the Cox proportional hazard models. Results: During the follow-up, 152 participants were identified as being functionally disabled. There was a significant interaction between physical frailty and cognitive impairment on the development of functional disability (P <0.1). Compared with being robust both physically and cognitively, the hazard ratio (95% confidence interval) of functional disability was 8.40 (4.05-17.42) for cognitively frailty, after adjustment for age, sex, education, living alone, smoking, drinking, number of comorbidities (hypertension, stroke, chronic heart disease, diabetes, chronic kidney disease, poor hearing, poor vision, osteoarthritis or rheumatism, minor trauma fracture, or cancer). Conclusion: Cognitive frailty was associated with an increased risk of functional disability in community-dwelling older adults. Cognitive frailty could be an underrecognized risk factor for functional disability.

Many older adults develop restrictions in the performance of activities that are essential to daily living, referred to as functional limitations. Functional limitations can lead to disability, the inability to complete tasks necessary to function in society. A better understanding of how impairments in body systems affect functional limitations and disability in older adults could lead to improved medical management of older adults. The purpose of this study was to examine how impairments in lower extremity muscle performance (strength, power, and endurance) are related to functional limitations and disability in community dwelling older adults. Thirty-four subjects were recruited to participate in this cross-sectional analysis study with 30 individuals completing the study. The Keiser 420 Leg Press was used to measure impairments in lower extremity muscle performance. Functional limitations were classified through the Short Physical Performance Battery, the Six-Minute Walk Test, the Late Life Function and Disability Index (LLFDI) Functional Limitation Component, and average walking speed, average walking distance and average number of steps per day over a six-day period obtained from the AMP 331 physical activity monitor. Disability was measured through the LLFDI Disability Component Limitation Category. Regression analysis was used to examine the direct effect between impairments in muscle performance and functional limitations. Mediation analysis was used to examine the indirect effect of impairments on disability. The results of this study support a relationship between impairments in lower extremity strength and power to functional limitations and disability in community dwelling older adults. Impairments in lower extremity power consistently demonstrated a stronger relationship than strength to all measures of functional limitations and disability. The results of this study did not support a relationship of impairments in endurance to functional limitations or disability. The overall findings of this study would indicate that community dwelling older adults should focus on maintaining and improving lower

BackgroundAs the population continues to age, the prevalence of mild cognitive impairment (MCI) has increased steadily. Studies have shown that older adults with chronic diseases are more likely to develop MCI than those without chronic conditions, suggesting that chronic diseases may play a significant role in the onset of MCI. Therefore, this study is designed to develop a predictive model for MCI among older individuals with chronic diseases in China and to identify the major factors influencing the occurrence of MCI.MethodThe training and internal validation data are from the 2018 China Health and Retirement Longitudinal Study (CHARLS), using retrospective data with 4,712 older adults with chronic diseases. The external validation data are from the General Hospital of Southern Theater Command in Guangdong, using prospective data with 1,000 cases. This is an observational study. Univariate logistic regression was used to select statistically significant predictors, and ultimately, a combination of LASSO regression and random forest results identified 9 optimal predictors, which were used to construct the nomogram. The model’s discrimination, calibration, clinical applicability, and generalizability were assessed using the receiver operating characteristic (ROC) curve, calibration curve, decision curve analysis (DCA), and internal validation.ResultsAge, education level, child satisfaction, marital status, depressive symptoms, ADL score, income, SCD, and the number of chronic diseases were identified as significant predictors of MCI in older adults with chronic diseases. The AUC values exceeded 0.7 across the training, internal validation, and external validation sets.The calibration curves closely align with the diagonal, and the P values of the Hosmer-Lemeshow test are all greater than 0.05, indicating strong consistency between the predicted and actual outcomes. The DCA further demonstrates that the model has significant clinical utility.ConclusionThe nomogram prediction model deeloped in this study demonstrated good predictive performance and may serve as a useful tool to help identify older adults with chronic diseases who are at increased risk of MCI. These findings may inform future strategies for individualized risk assessment and early management.Supplementary InformationThe online version contains supplementary material available at 10.1186/s12877-025-06924-3.

Comparing Different Stretching Exercises on Pain, Stiffness, and Physical Function Disability in Older Adults With Knee Osteoarthritis

IntroductionBased on the data from the China Health and Retirement longitudinal study (CHARLS), we aimed to investigate the bidirectional relationship between depressive symptoms and functional disability.MethodsData were collected across 3 waves from 2013 to 2018. The activities of daily living (ADLs) and the instrumental activities of daily living (IADLs) scales were used to measure functional disability and the CESD-10 was used to measure depressive symptoms. Cross-lagged models were performed to examine cross effect between depressive symptoms and functional disability across three waves.ResultsData on 10,092(mean [SD] age, 61.98[8.44] years; 3764 females [37.30%]) and 10,180 participants (mean [SD] age, 62.01[8.46] years; 3788 females [37.21%]) in IADL sample and ADL sample were included in the analyses. For IADL disability, the cross-lagged model shows a bidirectional association across three waves; the multivariable GEE model revealed that changes in CESD-10 score across waves were associated with worse IADL disability (β ranges: 0.08–0.10) and vice versa, worsen of IADL disability ascending developing of CESD-10 score (β ranges: 0.09–0.10). For ADL disability, the cross-lagged model shows a bidirectional association across three waves; the multivariable GEE model revealed that changes of CESD-10 score across waves were associated with worse IADL disability (β ranges: 0.08–0.10) and vice versa, worsen of IADL disability ascending developing of CESD-10 score (β ranges: 0.09–0.10).DiscussionStudy findings underscore a significant bidirectional between depressive symptoms and functional disability in older adults. Thus, simultaneous intervention should be taken to manage the mutual development of functional disability and depression.

Effects of comorbid physical frailty and low muscle mass on incident disability in community-dwelling older adults: A 24-month follow-up longitudinal study

BackgroundDepressive symptoms, sleep disturbances, and functional disability are interrelated. However, the bidirectional pathways between depression, sleep disturbances, and disability in instrumental activities of daily living (IADLs) remain underexplored in China.ObjectiveWe aimed to examine the bidirectional longitudinal relationships between depression and disability in IADLs among older Chinese adults, with a focus on elucidating the mediating role of sleep disturbances in this dynamic interplay.MethodsThe study encompassed 2677 older adults who provided complete data at T1 (2015), T2 (2018), and T3 (2020) for the China Health and Retirement Longitudinal Study (CHARLS). Depressive symptoms were assessed using the 10-item Center for Epidemiological Studies Depression (CESD-10) scale, and a 6-item scale was used to measure disability in IADLs. Sleep disturbances were self-reported. Temporal associations between depressive symptoms and disability in IADLs as well as the longitudinal mediating effect of sleep disturbances were examined using a cross-lagged panel model.ResultsPrior depression significantly predicted subsequent disability in IADLs at T2 (β=0.070, P<.001) and T3 (β=0.074, P<.001), and prior disability in IADL predicted subsequent depression at T2 (β=0.094, P<.001) and T3 (β=0.100, P<.001). Additionally, the indirect effect of prior disability in IADLs on subsequent depression via sleep disturbances was statistically significant (β=0.062, SE=0.010, P<.001), with the mediation effect accounting for 50.41% of the total effect. In contrast, after accounting for this mediation, the direct effect of prior depression on subsequent disability in IADLs was not significant (β=0.009, SE=0.018, P=.61). Consequently, the impact of depression on disability in IADLs was fully mediated through sleep disturbances in this cohort of older Chinese adults.ConclusionsDepressive symptoms and disability in IADLs are bidirectionally linked, and sleep disturbances play a longitudinal mediating role in the bidirectional relationship among older Chinese adults. The potential longitudinal bidirectionality highlights the importance of sleep health for interventions on depression and functional disability in older adults.

BackgroundAlthough there are studies on disabilities in older persons, most of these studies have been carried out in developed countries. Hence, there are limited studies on disability in older adults in sub-Saharan Africa, including Ghana. The few studies that have examined the prevalence and correlates of disability in older adults used survey data for their analyses. To contribute to addressing this knowledge gap that has arisen, this study used a national census, the 2021 Ghana Population and Housing Census, to examine the prevalence and correlates of disability in older adults in Ghana.MethodsThe 2021 Ghana Population and Housing Census data was used for this study. A sample size of 197,057 Ghanaians aged 60 years and above was used for this study. The Washington Group questions on disability were used to measure disability by asking older adults about their difficulties in performing the six domains of disability (physical, sight, intellectual, hearing, self-care, and speech). A multinomial logistic regression housed in STATA was used to analyse the correlates of disability in older adults in Ghana. A p-value less than 0.05 was used for statistical significance.ResultsThe results show that slightly more than one-third (38.4%) of the older adults were disabled. In terms of the number of disabilities in older adults, 16.9% had one disability condition, while 2.4% had six disability conditions. Also, 9.4% had two disability conditions. Older adults who were females, aged 70–79 years and 80 years and above, resided in rural areas, with primary, JHS/Middle, SHS, unaffiliated with religion, ever married and never married, unemployed, and belonged to the middle and rich households were more likely to have a disability condition. Also, older adults residing in the Middle and Northern zones, having no health insurance, and using clean cooking fuel were less likely to have a disability condition.ConclusionsThe results show that socio-demographic and household factors were associated with disability in older adults in Ghana. Hence, policymakers and researchers should target these factors when designing appropriate policies, programmes, and interventions to improve the wellbeing of older adults.

Our objective was to evaluate the association between depressive symptoms and disability in older adults residing in 12 high Andean communities in Peru. We carried out a secondary data analysis of a cross-sectional study that included older adults (60years or older) from 12 high Andean communities in Peru from 2013 to 2019. Depressive symptoms were defined as a score of two or more in the abbreviated Geriatric Depression Scale, while disability was defined as a score of less than 95 in the Barthel index. We also included sociodemographic characteristics, medical and personal history, and functional and performance-based tests. We used crude and adjusted Poisson regression models to evaluate the association of interest and estimated prevalence ratios (PR) with their respective 95% confidence intervals (95% CI). We included 442 older adults with a mean age of 73±6.9 in the analysis; 63.1% (n=279) were women, and 79.9% (n=353) had no education or incomplete primary school. 50.9% (n=225) of the participants had depressive symptoms, and 49.8% (n=220) had disability. The adjusted Poisson regression model showed that depressive symptoms increased the probability of disability (adjusted PR=1.67; 95% CI: 1.34-2.08; p<0.001) in older adults living at high altitude. Depressive symptoms was associated with a greater probability of disability in older adults living at high altitude. Longitudinal studies are needed for better understanding of this association in high altitude populations along with timely interventions to reduce the impact of both geriatric syndromes.

To examine the effects of employment engagement, classified by frailty and working status, on the incidence of disability in urban community-dwelling older adults. We used data from 6386 initially nondisabled residents aged 65-84 years from Ota City, Tokyo, Japan, in 2016. The observation duration was 3.6 years. Self-administered questionnaires applied the Cox proportional hazard model by assessing the existence of frailty through Check-List 15 (with a score ≥4 indicating the state of frailty), controlling for age, sex, living situation, education level, equivalent income, chronic conditions, body mass index, instrumental activities of daily living, self-rated health, drinking and smoking status, and social activities. We evaluated the predictive value of working status (full-time, part-time, temporary, or nonworker) at baseline for cause-specific disability (dementia-type vs. non-dementia-type) incidence, identified using the long-term care insurance system's nationally unified database. Of the 6386 participants, 806 (63/1134 full-time workers; 58/1001 part-time workers; 61/547 temporary workers; 624/3704 nonworkers) presented with disabilities during the 3.6-year-long duration. Adjustments for conventional covariates showed that nonfrail full-time and part-time workers, as well as frail full-time workers, had significantly lower risks of all-cause disability incidence. Furthermore, nonfrail and frail full-time workers had significantly lower risks of dementia-type and nondementia-type disabilities, respectively. The incidence of disability in older adults was influenced by working and frailty status. Engaging in full-time work thus prevents disabilities in older adults, regardless of their frailty status. Meanwhile, nonfrail older adults are able to avoid disabilities even when engaging in part-time work. Geriatr Gerontol Int 2023; 23: 855-863.

This study aimed to evaluate the potential preventive effects of a water-based exercise program on disability in community-dwelling older adults. The study design was a propensity score-matched retrospective study. Older adults were contacted through a mail survey carried out by City Hall, and those who scored ≥3 points on the physical domain of the Kihon Checklist were encouraged to participate in the water-based exercise program. The program consisted of aerobic and walking exercises in the water for 1 h, once a week for 6 months. Propensity scores were used to match individuals who participated in the exercise program with control individuals based on age, sex, height, weight, body mass index and Kihon Checklist score. Among matched pairs, the study included 278 participants (control group 139, intervention group 139). The main outcome was the number of participants who received a new long-term care insurance certification during the first follow-up year, which was used to indicate disability. Of the 278, 13 participants (5.5%) required long-term care insurance certification. A significantly smaller proportion of intervention group members required long-term care insurance certification (intervention group 0.7% [1/139 participants] vs control group 8.6% [12/139 participants], P = 0.003). Water-based exercise program appears to effectively prevent disability in community-dwelling older adults. Because water-based exercise program is associated with a minimal burden on joints and lower risk of falling, it might particularly enable the prevention of disability in older adults with chronic pain and restricted mobility. Geriatr Gerontol Int 2019; 19: 1282-1288.

Physical activity to prevent or reverse disability in sedentary older adults

The rising incidence of chronic lung disease (CLD) has emerged as a critical health problem. While numerous studies have explored lifestyle factors contributing to CLD, the critical role of sleep remains understudied. This cohort study aimed to assess the association between night sleep duration and incidence of CLD through a 9-year follow-up survey: 10527 participants were enrolled from the China Health and Retirement Longitudinal Study (CHARLS), and the data on incident CLD from the 2011 baseline survey and four subsequent follow-up waves were analysed statistically. Night-time sleep duration was categorized into three groups: short (< 7 h per night), optimal (7-9 h), and long night-time sleep duration (> 9 h). We used multivariate Cox regression modelling to examine the effect of baseline night sleep duration on the onset of CLD. After the 9-year follow-up, the incidence of CLD in participants with short, optimal, and long night-time sleep duration was 17.71, 13.76 and 19.76/1000 person-years, respectively. Compared with individuals with optimal night sleep duration, individuals with short night sleep duration had a 26.3% higher risk of developing CLD (HR: 1.263, 95% CI: 1.136-1.404), and those with long night sleep duration had a 39.0% higher risk of developing CLD (HR: 1.390, 95% CI: 1.095-1.764). Longer or shorter night sleep duration is associated with an increased risk of developing CLD. Maintaining an optimal night-time sleep schedule may help reduce the risk of CLD in middle-aged and older adults.