Health status and lifestyle behaviours of older adults in a Hilly Municipality of Dhankuta, Nepal.

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.

To examine the outcomes of the Elderly Persons in the Risk Zone study, which was designed to evaluate whether it is possible to delay deterioration if a health-promoting intervention is made when an older adult (≥80) is at risk of becoming frail and whether a multiprofessional group intervention is more effective in delaying deterioration than a single preventive home visit with regard to frailty, self-rated health, and activities of daily living (ADLs) at 3-month follow-up. Randomized, three-armed, single-blind, controlled trial performed between November 2007 and May 2011. Two urban districts of Gothenburg, Sweden. Four hundred fifty-nine community-living adults aged 80 and older not dependent on the municipal home help service. A preventive home visit or four weekly multiprofessional senior group meetings with one follow-up home visit. Change in frailty, self-rated health, and ADLs between baseline and 3-month follow-up. Both interventions delayed deterioration of self-rated health (odds ratio (OR) = 1.99, 95% confidence interval (CI) = 1.12-3.54). Senior meetings were the most beneficial intervention for postponing dependence in ADLs (OR = 1.95, 95% CI = 1.14-3.33). No effect on frailty could be demonstrated. Health-promoting interventions made when older adults are at risk of becoming frail can delay deterioration in self-rated health and ADLs in the short term. A multiprofessional group intervention such as the senior meetings described seems to have a greater effect on delaying deterioration in ADLs than a single preventive home visit. Further research is needed to examine the outcome in the long term and in different contexts.

Cognitive impairment and functional status are both important determinants of poor outcomes in heart failure (HF). However, little is known about how functional status impacts the changes in cognitive status during the disease course. This study aimed to describe the cognitive transitions in patients with HF and assess the relationship of these transitions to functional status, which was assessed by the dependency of activities of daily living (ADL). This retrospective cohort study included 1764 patients with an International Classification of Diseases-10 code of HF (≥65years, mean age 82.3±7.9years, 39% male) from a long-term care and medical insurance database from Nobeoka city, a rural city of south-western Japan. Cognitive status at baseline and 6, 12, 18, and 24month time points was collected, and participants were stratified based on ADL status at baseline. Generalized estimating equations and multi-state modelling were used to examine associations between ADL dependency and cognitive changes/mortality. Transition probabilities were estimated using multi-state modelling. At baseline, there were 1279 (73%) and 485 (27%) patients with independent and dependent ADL, respectively. In overall patients, 1656 (93.9%) patients had normal/mild cognitive status and 108 (6%) patients had a moderate/severe cognitive status at baseline. The majority [104 (96%) patients] of patients with moderate/severe cognitive status at baseline had dependent ADL. In patients with moderate/severe cognitive status, the number of patients with dependent ADL always outnumbered that of the independent ADL throughout the follow-up. Multi-state modelling estimated that patients with dependent ADL and normal/mild cognitive status at baseline had 47% probability of maintaining the same cognitive status at 24months, while the probability of maintaining the same cognitive status was 86% for those with independent ADL. Patients with normal/mild cognitive status in the dependent ADL group at baseline had a higher risk of experiencing a transition to moderate/severe cognitive status at any time point during 24months compared with those with independent ADL [hazard ratio 5.24 (95% confidence interval 3.47-7.90)]. In older patients with HF, the prevalence of cognitive impairment was always higher for those with reduced functional status. Despite having a normal/mild cognitive status at baseline, patients with dependent ADL are at high risk of experiencing cognitive decline over 24months with substantially less chance of maintaining their cognitive status. ADL dependency was an important risk factor of cognitive decline in patients with HF.

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.

Functional impairment, measured by Activities of Daily Living (ADL), is a major predictor of poor outcomes in older adults. However, among patients with acute myocardial infarction (AMI), a prognostic model that incorporates ADL status is lacking. This study aimed to develop and validate such a model for predicting one-year mortality in older adults with AMI. This study included 43,308 AMI patients admitted to the Tianjin Health and Medical Big Data Superplatform from January 2010 to March 2024. Patients were categorized by Barthel Index into ADL normal (n=41,312), mildly impaired ADL (n=1,318), moderately impaired ADL (n=452), and severely impaired ADL (n=226). The cohort was randomly split 7:3 for model development and validation. A nomogram for 1-year all-cause mortality was constructed using predictors identified by Lasso regression, with model performance evaluated through receiver operating characteristic curve (ROC), decision curve analysis (DCA), and calibration curve. Baseline characteristics revealed that with increasing ADL impairment, patients were significantly older [median (IQR): 73·0 (68·0-78·0) vs 78·0 (73·0-83·0) vs 79·0 (73·0-84·0) vs 78·0 (73·0-83·0), p < 0·001], had higher Killip class, and received less percutaneous coronary intervention (PCI) (48·9% vs 25·0% vs 17·3% vs 8·9%, p < 0·001). Kaplan-Meier analysis showed significantly increased mortality risks (p < 0·001). The final model incorporated seven predictors: ADL status, age, Killip class, ST-elevation myocardial infarction (STEMI) diagnosis, history of stroke, valvular heart disease, and diabetes mellitus. The nomogram achieved area under the curve (AUC) values of 0·794 and 0·780 in the training and validation cohorts, respectively. We developed and validated a clinically applicable nomogram for predicting one-year mortality in older adults with AMI, integrating ADL impairment into risk assessment. Incorporating functional evaluation into prognostic modeling may improve individualized management and early rehabilitation planning in geriatric cardiology.

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

Background: Dependence is a significant health-related condition for older adults (OA) and implies that self-care is transferred to other people, the community or institutions. Recent studies have analyzed the relationship between out-of-pocket (OOP) healthcare expenditures and dependence. Nonetheless, these studies were not specifically designed to estimate the economic impact of dependence. Our aim was to estimate the total adjusted annual OOP healthcare expenditures in dependent older adults compared to independent ones. Additionally, we explore the potential combined effect of basic activities of daily living (ADL) and instrumental activities of daily living (IADL) dependence on OOP healthcare expenditures.Methods: Data comes from the cross-sectional study “Economic impact of physical dependence in older adults and the burden of informal care” conducted in 2018 with a sample of 735 community-dwelling older Mexican adults ages 60 and older. We used direct (medical and non-medical) and indirect costs to estimate the OOP healthcare expenditures associated with dependence. We applied the Katz scale to assess dependence in ADL and the Lawton scale to assess dependence in IADL. Two-Part regression models were used to analyze the relationship between dependence and OOP health expenditures.Results: Presence of ADL dependence represented a higher level of expenditure, 107% compared to non-dependent OA (β = 1.07, CI95%: 0.43–1.71), and 97% for IADL dependence (β = 0.97, CI95%: 0.49–1.45). The combined effect of ADL and IADL dependence (132%) was greater (β = 1.32, CI95%: 0.74–1.90) than the effect of ADL or IADL dependence alone. In monetary terms, OA with ADL dependence had a total annualized mean OOP healthcare expenditure of $31,865 (Mexican pesos), OA with IADL $26,912, and combined ADL and IADL $39,520.Conclusions: ADL and IADL dependence are associated with the total annualized OOP healthcare expenditures. This association is even higher when both conditions are present together. These findings highlight the economic implications of the dependence for individuals, their families, and the health system. Given that current evidence on effective interventions to prevent dependence in OA is insufficient, future studies should be conducted to estimate their costs and determine what interventions work, as well as their effectiveness and cost-effectiveness in different sub-groups of the population, and how these might be appropriately implemented.

Many older adults experience decline in function, but maintain high levels of life satisfaction. The factors associated with high life satisfaction among those with functional impairment are not well understood. Examine the proportion of older adults with functional impairment reporting high life satisfaction and the predictors of high life satisfaction. Cross-sectional cohort study. Health and Retirement Study. A total of 7,287 community-dwelling participants, 65years or older, who completed the leave-behind questionnaire in 2014 or 2016. The main predictor was having difficulty or needing help in performing Activities of Daily Living (ADL). The primary outcome was reporting high life satisfaction, defined using a three-item Diener scale. Significant factors were identified using modified Poisson regression models adjusted for demographic characteristics. Those with no ADL impairment were more likely to report high levels of life satisfaction than those with ADL difficulty or ADL dependence (54.4 vs 38.6 vs 27.6%, P < 0.001). Among those with ADL dependence, we identified several factors associated with high life satisfaction, including: not being lonely (38.2 vs 23.2%, ARR = 1.6 (1.2, 2.2)), satisfied with family life (35.1 vs 12.8%, ARR = 2.7 (1.6, 4.4)), and satisfied with financial situation (40.8 vs 16.6%, ARR = 2.5 (1.8, 3.6)). Similar associations were present among those with ADL difficulty. A substantial proportion of older adults with ADL impairment report high life satisfaction, and it is associated with social and economic well-being. Understanding the factors associated with high life satisfaction can lead to clinical practices and policy guidelines that promote life satisfaction in older adults.

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.

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.

ObjectivesHandgrip strength (HGS) and muscle mass are strong predictors for dependency in Activities of Daily Living (ADL) and Instrumental Activities of Daily Living (IADL) in community dwelling older adults. Whether this also applies to older hospitalized patients is yet unknown. We studied the association between HGS and muscle mass with ADL and IADL dependency at admission and change of ADL and IADL dependency at three months after discharge in older hospitalized patients.DesignObservational longitudinal inception cohort (EMPOWER) including 378 patients aged 70 years and older.SettingFour different clinical wards of a university teaching hospital, The Netherlands.MeasurementsHGS and muscle mass were measured within 48 hours after admission using hand dynamometry and Bio-electrical Impedance Analysis respectively. ADL dependency was assessed using the Katz score (0-6 points) and IADL dependency using the Lawton and Brody score (0-8 points) within 48 hours after admission and three months after discharge.ResultsAt admission, lower HGS was associated with ADL dependency in both males and females. Lower muscle mass was associated with ADL dependency in males. Lower HGS was associated with IADL dependency, but only in males. Lower HGS at admission in males was associated with an increase in ADL dependency three months after discharge.ConclusionIn hospitalized older patients, HGS is associated with ADL and IADL and muscle mass measures with ADL in male patients only. HGS should be explored as predictive marker for outcome of hospitalized older patients after discharge.

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.

Background Activities of daily living (ADLs) and instrumental activities of daily living (IADLs) are essential for independent living and are predictors of morbidity and mortality in older populations. Older adults who are dependent in ADLs and IADLs are also more likely to have poor muscle measures defined as low muscle mass, muscle strength, and physical performance, which further limit their ability to perform activities. The aim of this systematic review and meta‐analysis was to determine if muscle measures are predictive of ADL and IADL in older populations. Methods A systematic search was conducted using four databases (MEDLINE, EMBASE, Cochrane, and CINAHL) from date of inception to 7 June 2018. Longitudinal cohorts were included that reported baseline muscle measures defined by muscle mass, muscle strength, and physical performance in conjunction with prospective ADL or IADL in participants aged 65 years and older at follow‐up. Meta‐analyses were conducted using a random effect model. Results Of the 7760 articles screened, 83 articles were included for the systematic review and involved a total of 108 428 (54.8% female) participants with a follow‐up duration ranging from 11 days to 25 years. Low muscle mass was positively associated with ADL dependency in 5/9 articles and 5/5 for IADL dependency. Low muscle strength was associated with ADL dependency in 22/34 articles and IADL dependency in 8/9 articles. Low physical performance was associated with ADL dependency in 37/49 articles and with IADL dependency in 9/11 articles. Forty‐five articles were pooled into the meta‐analyses, 36 reported ADL, 11 reported IADL, and 2 reported ADL and IADL as a composite outcome. Low muscle mass was associated with worsening ADL (pooled odds ratio (95% confidence interval) 3.19 (1.29–7.92)) and worsening IADL (1.28 (1.02–1.61)). Low handgrip strength was associated with both worsening ADL and IADL (1.51 (1.34–1.70); 1.59 (1.04–2.31) respectively). Low scores on the short physical performance battery and gait speed were associated with worsening ADL (3.49 (2.47–4.92); 2.33 (1.58–3.44) respectively) and IADL (3.09 (1.06–8.98); 1.93 (1.69–2.21) respectively). Low one leg balance (2.74 (1.31–5.72)), timed up and go (3.41 (1.86–6.28)), and chair stand test time (1.90 (1.63–2.21)) were associated with worsening ADL. Conclusions Muscle measures at baseline are predictors of future ADL and IADL dependence in the older adult population.

Maintaining independence after hip fracture repair is important for geriatric patients and general welfare. We investigated the effects of anesthetic methods on postoperative activities of daily living (ADLs) following hip fracture surgery in elderly patients. The medical records of 12,342 patients aged ≥65 years who underwent typical surgeries for hip fracture using either general anesthesia or spinal anesthesia were reviewed. To adjust for baseline differences and minimize selection bias for the chosen method of anesthesia, patients were matched by propensity scores. Factors affecting the deterioration in ADLs during hospital stay were also investigated in all subjects using a multivariate logistic regression analysis. Eating, grooming, toileting, bathing, and walking were selected as the ADL parameters, as they are considered important for an independent life. Of the 12,342 patients, 6918 (56.1%) received general anesthesia and 5424 (43.9%) received spinal anesthesia. After the propensity score matching, the anesthesia types were not associated with ADL scores except toileting at discharge. Results from the multivariate logistic regression analysis showed that the types of anesthesia were not associated with deterioration in ADL scores. Advanced age, male sex, high Charlson Comorbidity Index scores, psychiatric disease, no administration of nonsteroidal anti-inflammatory drugs, and short length of hospital stay were associated with deterioration in ADL scores. The anesthesia types were not associated with ADL dependency except toileting at discharge. Spinal anesthesia adversely affected toilet use at hospital discharge. However, anesthesia types were not factors that affected deterioration in ADL during hospital stay in elderly patients who underwent hip fracture surgery.

To the Editor: It is unclear whether self-perceived oral status is associated with objective functional assessment.1, 2 After Japan's long-term care insurance system underwent major reform in 2006, the Japanese Ministry of Health, Welfare, and Labor introduced the 25-item Kihon Checklist (KCL) nationwide as a screening tool to detect elderly adults at risk of requiring care. This tool has become widely used in Japanese communities,3, 4 but few studies have reported the results of KCL screening and its relationship with health status in elderly adults in the community.5, 6 There are three items in the KCL for screening elderly adults at high risk of oral dysfunction: chewing difficulties, choking or coughing, and dry mouth. Despite the importance of oral health in later life, oral health screening in community-dwelling elderly adults has not led to sufficient attention in practice. The objective of the current study was to evaluate the association between oral dysfunction, ADL dependency, and depressive mood using the KCL. The study population comprised 680 individuals aged 65 and older (271 men, 409 women; mean age 76.7 ± 7.7) living in Tosa, Kochi Prefecture, Japan. Using self-reported questionnaires (response rate 53.2%), oral function, activities of daily living (ADLs), and depressive status were assessed in community-dwelling elderly adults in 2014. Oral function was assessed according to three KCL items: “Do you have any greater difficulty eating hard foods than 6 months ago?” “Have you choked on your tea or soup recently?” and “Do you often experience a dry mouth?”4 To assess ADLs, scores on seven items (walking, ascending and descending stairs, feeding, dressing, using the toilet, bathing, grooming) were summed using a rating scale from 0 (completely dependent) to 3 (completely independent) into an ADL score ranging from 0 to 21.7 Physical disability (ADL dependency) was defined as having an ADL score of 20 or lower. Depressive symptoms were screened using the Japanese version of the 15-item Geriatric Depression Scale (GDS-15),8 and depressive mood was defined as having a GDS-15 score of 6 or higher. Statistical analysis was conducted using IBM SPSS Statistics 19.0 (SPSS, Inc., Chicago, IL) with a significance of P < .05. Table 1 shows the results of the multivariate logistic regression analysis for the associations between each of the three oral function items and ADL dependency and depressive mood, with Model 1 adjusted for age and sex and Model 2 adjusted for ADL dependency or depressive state in addition to age and sex. In Model 1, those with chewing difficulty, choking or coughing, and dry mouth had a greater risk of ADL dependency (odds ratio (OR) = 2.1, OR = 2.0, and OR = 2.2, respectively) and risk of depressive state (OR = 2.7, OR = 3.0, and OR = 2.5, respectively). In Model 2, ADL dependency was still significantly associated with chewing difficulty (OR = 1.6) and dry mouth (OR = 1.8). Similarly, depressive mood was still related to chewing difficulty (OR = 2.5), choking or coughing (OR = 2.8), and dry mouth (OR = 2.3). This study found close associations between oral dysfunction, ADL dependency, and depressive mood. Considering the interrelationship between ADL dependency and depressive mood, they were adjusted for each other using age, sex, and depressive mood for the association between ADL dependency and oral dysfunction and age, sex, and ADL dependency for the association between depressive mood and oral dysfunction; there were still significant independent associations between oral dysfunction and ADL dependency and between oral dysfunction depressive mood. Previous studies have reported that community-dwelling elderly adults with chewing difficulties have a higher level of disability and depression.2, 9 In this study, other oral functional problems (e.g., choking, coughing, dry mouth) were also important factors to be screened for in the community. Self-reported dry mouth is reportedly associated with depressive mood,10 and the current findings are in line with those of previous studies. Moreover, ADL dependency was found to be related to dry mouth independent of depressive mood. In conclusion, community-dwelling elderly adults with oral dysfunction have higher levels of disability and depression than those without. These findings suggest that three simple questions can effectively detect oral dysfunction associated with ADL dependency and depressive mood; greater attention should be paid to these questions on oral function in the KCL when screening elderly adults at risk for disabilities and depression. The authors are grateful to the participants and municipal officers in Tosa. This research was supported by Lotte Research Promotion Grant. Author Contributions: Chang, Kimura, Matsubayashi: study concept and design, analysis and interpretation of data, preparation of manuscript. All authors: survey and interpretation of data, manuscript revisions, approval of manuscript. Sponsor's Role: The sponsor had no role in study design, methods, subject recruitment, data collection, data analysis, or preparation of paper.