Factors associated with dysphagia among community-dwelling Palestinian older adults.

To characterize relationships between self-reported co-morbidity and functional outcomes in community-dwelling older adults, and to assess whether the impact of co-morbidity persists even after adjustment for baseline functional status. Prospective observational study. We examined associations between self-reported co-morbidity at baseline and functional outcomes at one year, with and without adjustment for baseline functional status. Outpatient clinics at a managed care and a Veterans Affairs site. Four hundred and fifty-seven community-dwelling older adults representing a broad spectrum of overall health status. (a) New basic ADL (activities of daily living) problem during follow-up; (b) 10-point decline in the physical function index of the MOS-36 (MOS-PFI). Co-morbidity was associated with adverse functional outcomes in bivariable analyses. After adjustment for age and baseline functional status, an accumulated co-morbidity score provided additional explanatory power for predicting new ADL problems; odds ratios were 2.30 (1.09, 5.09) and 2.96 (1.48, 6.25) for 2 and > or = 3 affected co-morbidity domains, respectively. The impact of baseline status was also important; odds ratios for new ADL problems were 4.77 (2.68, 8.81) when at least one instrumental activity of daily living (IADL) problem was present at baseline, and 15.6 (8.05, 31.3) when at least one basic ADL problem was present at baseline. Accumulated self-reported co-morbidity has significant negative effects on function at one year; these effects are attenuated but not eliminated by adjustment for baseline status. Co-morbidity adjustment is probably an important design element in clinical research focused on functional outcomes in older adults.

Objective This study aimed to investigate the association between nutritional status assessed by the Mini Nutritional Assessment Short-Form (MNA-SF) and activities of daily living (ADL) after 1 year and changes in ADL among community-dwelling older adults. Methods This study included 95 community-dwelling older adults using outpatient rehabilitation (74.7% female). ADL was assessed using the Barthel index (BI), and the MNA-SF was used to assess nutritional status. Multiple regression analysis was performed with the BI after 1 year as the objective variable and MNA-SF, age, sex, updated Charlson comorbidity index, number of medications, body mass index, Food Intake Level Scale (FILS), and baseline BI as independent variables. Logistic regression analysis was performed with improvement or deterioration in ADL as the objective variable. Results The results of multiple regression analysis with BI after 1 year as the objective variable indicated that baseline BI, FILS, and MNA-SF were significant variables (R 2 = 0.835). The results of the logistic regression analysis with ADL improvement/deterioration as the objective variable indicated only MNA-SF as a significant variable (odds ratio: 0.663 [95% CI: 0.528–0.923]). Conclusions These results indicate that the MNA-SF was related to changes in ADL and ADL after 1 year among community-dwelling older adults.

Aimed to investigate the risk factors associated with depression in community-dwelling older adults with cognitive frailty and to examine the mediating role of sleep quality in the relationship between activities of daily living (ADL) and depression. A cross-sectional study was conducted using convenience sampling, enrolling older adults with cognitive frailty from six communities in Beijing from July 2023 to December 2023. Cognitive frailty was assessed using the Montreal Cognitive Assessment (MoCA) alongside with the Fried Frailty Phenotype, while depressive symptoms were measured with the Geriatric Depression Scale (GDS-15). Multivariate logistic regression analysis was used to identify risk factors influencing depression, and mediation analysis was employed to explore the mediating effect of sleep quality on the relationship between ADL and depression. Among the 529 elderly participants with cognitive frailty, 128 (24.2%) were found to exhibit depressive symptoms. Multivariate logistic regression identified ADL [Mild Dependence: OR = 176.729 (95% CI 32.427-963.172), p < 0.001; Moderate Dependence: OR = 51.769 (95% CI 12.541-213.697), p < 0.001], loneliness [OR = 13.821 (95% CI 6.095-31.338), p < 0.001], and sleep quality [Suspected Insomnia: OR = 7.310 (95% CI 2.316-23.074), p = 0.001] were significantly associated with depression. Sleep quality was found to mediate the relationship between ADL and depression, accounting for 2.82% of the total effect. Dependence in ADL, loneliness, and poor sleep quality are potential risk factors of depression for cognitive frailty in aging adults. Moreover, sleep quality was found to mediate the relationship between ADL dependence and depressive symptoms.

BackgroundWith the global increase in the older adults population, early detection of health risks and the promotion of healthy aging have become increasingly important. Accordingly, the aim of this study is to investigate the relationship between dietary diversity and frailty, cognitive function, activities of daily living, phytonutrients intake and nutritional status in Turkish older adults.MethodsThis cross-sectional study included a total of 1744 community-dwelling individuals aged 65 and older from different geographical regions of Türkiye. Sociodemographic characteristics and certain anthropometric measurements of the participants were recorded. The Dietary Diversity Score (DDS), Mini Nutritional Assessment Short Form (MNA-SF), two-day 24-h dietary recall for dietary intake, Phytonutrient Index, Katz Index of Independence in Activities of Daily Living (Katz ADL), Edmonton Frailty Scale (EFS), and Standardized Mini Mental State Examination (SMMSE) were used.ResultsOf the participants, 3.3% were classified as severely frail, 20.7% were at risk of malnutrition, 21.7% had moderate to severe cognitive impairment, and 18.6% had low DDS. A significant positive correlation was found between DDS and energy intake (r = 0.453, p < 0.01), carbohydrate (g) (r = 0.341, p < 0.01), protein (g) (r = 0.434, p < 0.01), fat (g) (r = 0.438, p < 0.01), phytonutrient intake (r = 0.296, p < 0.01), nutritional status (MNA-SF: r = 0.088, p < 0.01), and cognitive function (SMMSE: r = 0.075, p < 0.01). A negative correlation was found between DDS and frailty (r = −0.060, p < 0.05). However, according to the multinomial logistic regression model, the associations between DDS and MNA-SF, SMMSE, ADL, and frailty did not persist. Additionally, participants in the low DDS group were significantly less likely to exhibit high phytonutrient intake (p < 0.001).ConclusionNo significant association was found between dietary diversity and nutritional status, activities of daily living, functional and cognitive frailty in the older adults Turkish population. It is considered that regular monitoring of nutritional status and interventions aimed at increasing dietary diversity in the older adults population may promote healthy aging.

Anorexia of aging is characterized by an age-associated reduction of appetite, whose aetiology in most cases is multifactorial and which often triggers malnutrition. The Simplified Nutritional Appetite Questionnaire (SNAQ) is an established screening tool. This study aimed to investigate reliability, validity, and feasibility of its telephone administration (T-SNAQ) in German community-dwelling older adults. This cross-sectional single-centre study recruited participants from April 2021 to September 2021. First, the SNAQ was translated into German according to an established methodology. After translation, reliability, construct validity, and feasibility of the T-SNAQ were analysed. A convenience sample of community-dwelling older adults aged ≥70years was recruited. The following measurements were applied to all participants: T-SNAQ, Mini Nutritional Assessment - Short Form (MNA-SF), six-item Katz index of independence in activities of daily living (ADL), eight-item Lawton instrumental activities of daily living (IADL), telephone Montreal Cognitive Assessment (T-MoCA); FRAIL scale, Geriatric Depression Scale (GDS-15) and Charlson co-morbidity index as well as daily caloric and protein intake. One hundred twenty participants (59.2% female) with a mean age of 78.0±5.8years were included in the present study. The percentage of participants identified with poor appetite based on T-SNAQ was 20.8% (n=25). T-SNAQ showed a good internal reliability with a Cronbach's alpha coefficient of 0.64 and a good test-retest reliability [intraclass coefficient of 0.95 (P<0.05)]. Regarding construct validity, T-SNAQ was significantly positively correlated with MNA-SF (r=0.213), T-MoCA (r=0.225), daily energy (r=0.222) and protein intake (r=0.252) (P<0.05). It also demonstrated a significant negative association with GDS-15 (r=-0.361), FRAIL scale (r=-0.203) and Charlson co-morbidity index (r=-0.272). Regarding applicability, the mean time for T-SNAQ was 95s and completion rate was 100%. The T-SNAQ is a feasible screening instrument for anorexia of aging in community-dwelling older adults via telephone interviews.

Subjective age contributes to a range of health and functional outcomes in older adults. Most of the evidence comes from studies in community dwelling older adults. The current study explores whether younger subjective age serves as a protective factor against hospital associated physical, cognitive, and emotional decline. This paper is a secondary analysis of a subsample (N=250) from the HoPE-MOR (Hospitalization Process Effects on Mobility Outcomes and Recovery) study for which subjective age was assessed at the time of hospital admission and outcomes were measured one-month post-discharge. Psychological and physiological subjective age was measured as a person’s report on the degree to which they feel older or younger compared to their chronological age on a 5-point Likert-type scale. Measures of independency in Activities of Daily Living, Life-space mobility, cognitive function and depressive symptoms, were based on participants’ assessment at admission and one-month post-discharge. In a sample of acutely ill participants, age 77.5±6.6, those with younger psychological subjective age had a significantly lower odds for poorer mental (OR=0.66, 95%CI 0.45-0.97), functional (OR=0.62, 95%CI 0.43-0.90) and cognitive state (OR=0.60, 95%CI 0.36-0.98), and better life-space mobility (OR=0.67, 95%CI 0.47-0.95). Findings were significant after controlling for numerous demographic, functional, cognitive, emotional and chronic and acute health predictors. Physiological subjective age was not significantly related to post hospitalization outcomes. Psychological subjective age could serve as a relatively simple parameter to identify older adults who are at risk for poor hospitalization outcomes for consideration of inclusion in preventive in-hospital and post discharge interventions.

The aging society in Japan is progressing rapidly compared with that in the United States and European countries. Aging limits activities of daily living (ADL) in older adults, declining their lives and functions at home. Therefore, improving their ADL to effectively support their functioning at home for as long as possible is vital. Consequently, supporters need to have a common understanding, be promptly aware of the decline in ADL, and quickly introduce rehabilitation. The Functional Independence Measure (FIM) and Barthel Index (BI) are the main scales used to quantitatively assess ADL. However, previous studies have reported that FIM requires specialized knowledge for evaluation, and BI does not appropriately capture changes in ADL. The Self-Assessment Burden Scale-Motor (SAB-M) was developed as a scale for family caregivers to appropriately assess changes in ADL in older adults. Previous studies using the SAB-M have confirmed its reliability and validity in hospitalized patients as assessed by their family caregivers. Therefore, this study aimed to investigate the reliability and validity of the SAB-M among community-dwelling older adults as assessed by their family caregivers. This study included community-dwelling older adults who received home-visit rehabilitation at the first author's facility between October 2020 and December 2020 in Japan. Following previous studies, the SAB-M was used by family caregivers to assess 20 older adults twice for intra-rater reliability. Furthermore, 168 older adults were evaluated by family caregivers for internal consistency using the SAB-M. For criterion validity, the SAB-M was used for the assessment by family caregivers, and therapists used the FIM-Motor (FIM-M). This study used the weighted kappa, Cronbach's alpha, and Spearman's rank correlation coefficients for the statistical analysis of intra-rater reliability, internal consistency, and criterion validity, respectively. The weighted kappa coefficient for the total score was 0.98 (p<0.01) and individual item, it was 0.93 for feeding (p<0.01), 0.91 for bathing (p<0.01), 0.98 for dressing (p<0.01), 0.94 for transfer (p<0.01), 0.94 for walking/wheelchair (p<0.01), 0.95 for stairs (p<0.01), and 0.96 for bladder management (p<0.01). The Cronbach's alpha was 0.93 for the seven items. The Spearman's rank correlation coefficient between the SAB-M and FIM-M scores was 0.91 (p<0.01). The SAB-M has sufficient reliability and validity among community-dwelling older adults. Family caregivers can routinely assess changes in the ADL of community-dwelling older adults using the SAB-M, enabling them to promptly consider introducing rehabilitation when older adults' ADL declines. Therefore, implementing SAB-M helps older adults live and function at home for as long as possible.

Background : Hyper-polypharmacy and potentially inappropriate prescribing (PIP) are common among older inpatients. This study investigated associations between hyper-polypharmacy and PIP with clinical and functional outcomes in older adults at 3-months after hospital discharge. Research design and method : At discharge, prescribed medications were collected and PIPs, comprising potentially inappropriate medications (PIM) and potential prescribing omissions (PPO), were retrospectively identified using STOPP/START version 2. Clinical and functional outcomes were collected prospectively via telephone follow-up and audit. Results : Data for 232 patients (mean age 80 years, 51.7 % female) were analysed. PIP prevalence at discharge was 73.7% (PIMs 62.5%, PPOs 36.6%). Exposure to at least 1 PIM was associated with an increased occurrence of unplanned hospital readmission (adjusted odds ratio (AOR) 5.09; 95% CI 2.38─10.85), emergency department presentation (AOR 4.69; 95% CI 1.55─14.21) and the composite outcome (AOR 6.83; 95% CI 3.20─14.57). The number rather than presence of PIMs was significantly associated with increased dependency in at least 1 activity of daily living (ADL) (AOR 2.31; 95% CI 1.08─4.20). Increased PIP use was associated with mortality (AOR 1.45; 95% CI 1.05─1.99). Conclusion : PIPs overall, and PIMs specifically, were frequent in older adults at hospital discharge, and were associated with increased re-hospitalizations and dependence in ADLs at 3-months post-discharge.

Influence of Studies Published by the Journal of the American Geriatrics Society: Top 20 Articles from 2000-2015.

Functional recovery in older adults following mild traumatic brain injury: a systematic review.

Awareness of difficulty chewing may limit the diversity of food intake in older adults. However, few studies have clarified which factors are related to subjective difficulty in chewing. The aim was to identify factors related to subjective difficulty in chewing in 70- and 80-year-old Japanese older adults. A total of 1680 participants (792 men, 888 women) were surveyed. Difficulty in chewing was assessed with questionnaires regarding food intake, such as rice, apples, beef, and hard rice crackers. The participants were classified into two groups, the "with difficulty" group (participants who answered "cannot eat," "can eat with difficulty," and "can eat if small") and the "without difficulty" group (participants who answered "can eat without problems"), according to their answers to questionnaires for each food. A logistic regression analysis with subjective difficulty in chewing as the dependent variable was performed for each food. Subjective difficulty in chewing was associated with age, occlusal force, and depression for rice; age, number of remaining teeth, occlusal force, and depression for apples; number of remaining teeth, occlusal force, and depression for beef; and number of remaining teeth and occlusal force for hard rice crackers. Age, number of remaining teeth, and occlusal force, as well as depression, might be related to subjective evaluation of difficulty chewing in community-dwelling Japanese older adults. Geriatr Gerontol Int 2024; 24: 327-333.

Examining an older adult cohort to determine how different types of visual impairment affect independence in activities of daily living (ADLs) and instrumental activities of daily living (IADLs) is an important first step to better understand how to support older adults with specific types of visual dysfunction and enhance their functional abilities. To examine the relationship between distance visual acuity, near visual acuity, and contrast sensitivity and individual ADLs (dressing, toileting, bathing, eating) and IADLs (laundry, shopping, making hot meals, money management, self-management of medications) among community-dwelling older adults. A retrospective, cross-sectional design was used to analyze the relationship between visual function and independence in ADLs and IADLs. We retrieved data for 4,947 people included in the National Health and Aging Trends Study in 2022. We used a series of multivariable logistic regression analyses and estimated the relationship between visual function and independence in specific ADLs and IADLs. Near visual acuity and contrast sensitivity were statistically associated with specific ADLs and IADLs. Distance visual acuity was significantly associated with specific IADLs but was not significantly associated with any ADLs. Certain visual impairments were associated with specific ADLs and IADLs and therefore should be considered in the care of community-dwelling older adults. Plain-Language Summary: Normal aging can cause vision to decline. Visual impairment and blindness are expected to nearly double by 2050. Vision is a key component of independence for specific activities of daily living (ADLs; such as dressing, toileting, bathing, eating) and instrumental activities of daily living (IADLs; such as laundry, shopping, making hot meals, money management, self-management of medications). This study examined the relationship between visual impairments and individual ADLs and IADLs among community-dwelling older adults. The study found that certain visual impairments were associated with specific ADLs and IADLs and therefore should be considered in the care of community-dwelling older adults. This study also provides evidence that specific visual impairments are closely linked to older adults' ability to perform ADLs and IADLs. The findings confirm the importance of addressing visual function in occupational therapy practice to support the independence of community-dwelling older adults.

Introduction: Antiplatelet and anticoagulant medications often used to manage cardiovascular disease increase the risk of extracranial hemorrhage (ECH), such as gastrointestinal bleeding. There are few long-term data on the loss of function following ECH. This study’s goal was to measure the acute and persistent loss of independence in activities of daily living (ADLs) after ECH hospitalization. Methods: We used data from 1995-2015 from the Health and Retirement Study, a longitudinal, nationally representative survey of older Americans. We included subjects over age 65 who consented to Medicare linkage. We examined the association of ECH hospitalization with ability to perform all ADLs independently (walk across a room, dress, bathe, eat, toilet, get out of bed). To compare rates of ADL independence over time between those with ECH and a control group without ECH, we fit a logistic regression model that included an interaction term between ECH hospitalization and time and adjusted for comorbidities and sociodemographics. Results: In a cohort of 8950 with an average follow-up time of 7.3 years (65,335 person-years), 882 (10%) participants were hospitalized for ECH. Mean age was 78, and 59% were women. In the control group without ECH, the baseline rate of ADL independence declined by an average of 3.1% per year (average marginal effect [AME], 95% CI -3.1% to -3.3%). Assuming hospitalization for ECH at 5.2 years, the median time to ECH in this cohort, ECH was associated with an immediate decrease in ADL independence from 68% to 53% (AME -15%, 95% CI -11% to -18%). Following ECH, the average annual baseline rate of function loss did not change. Conclusions: In this nationally representative cohort, ECH hospitalization was associated with an immediate and pronounced decline in function that was equivalent to accelerating ADL disability by 5 years. After ECH, ADL independence continued to decline and did not recover to pre-ECH levels of independence over time.

BackgroundThis study aimed to examine the association between oral health-related quality of life and probable sarcopenia in community-dwelling older adults, and to evaluate the potential role of oral health assessment in routine geriatric care.MethodsThis cross-sectional study included 315 individuals aged ≥65 years who were registered with the Home Health Unit and the Geriatric Outpatient Clinic of a tertiary hospital in Türkiye. Oral health-related quality of life was measured using the Geriatric Oral Health Assessment Index (GOHAI). Muscle strength was assessed with a handgrip dynamometer, and probable sarcopenia was defined according to the revised European Working Group on Sarcopenia in Older People (EWGSOP2) criteria as low muscle strength. Additional assessments included the Mini Nutritional Assessment–Short Form (MNA-SF), Strength, Assistance with walking, Rise from a chair, Climb stairs, and Falls (SARC-F) questionnaire, Clinical Frailty Scale (CFS), Katz Index of Independence in Activities of Daily Living, and Mini-Cog test. Correlation, logistic regression, and receiver operating characteristic (ROC) analyses were performed.ResultsParticipants had a mean age of 80.8 years (SD 7.5); 43.5% were male. Handgrip strength was positively correlated with GOHAI (r = 0.376, p <0.001), MNA-SF (r = 0.446, p <0.001), and Mini-Cog (r = 0.126, p <0.05), and negatively correlated with age, SARC-F, and frailty. GOHAI correlated positively with MNA-SF (r = 0.206, p <0.01) and negatively with SARC-F (r = –0.134, p <0.05). In univariate logistic regression, lower GOHAI, lower MNA-SF, older age, polypharmacy, and higher SARC-F scores were significantly associated with probable sarcopenia. In multivariate analysis, GOHAI, MNA-SF and polypharmacy remained independent predictors.ConclusionPoor oral health–related quality of life was independently associated with probable sarcopenia in older adults. Incorporating an oral health measure such as the GOHAI into routine geriatric assessment may facilitate early detection of at-risk individuals and support timely, targeted interventions.

Exploring the association of frailty and swallowing function with postoperative changes in activities of daily living among older patients undergoing cardiac surgery.