Three-year trajectories in functional limitations and cognitive decline among Dutch 75+ year olds, using nine-month intervals

Maura Kyra Maria Gardeniers,Marjolein Irene Broese Van Groenou,Erik Jan Meijboom,Martijn Huisman

doi:10.1186/s12877-021-02720-x

Maura Kyra Maria Gardeniers, Marjolein Irene Broese Van Groenou + Show 2 more

Open Access

https://doi.org/10.1186/s12877-021-02720-x

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Abstract

BackgroundUsing longitudinal panel data, we aimed to identify three-year trajectories in cognitive and physical functioning among Dutch older adults, and the characteristics associated with these trajectories.MethodsWe used Group-based Trajectory Modelling with mortality jointly estimated to identify trajectories, using a scale composed of 6 Activities of Daily Living (ADL) as a measure of physical functioning, and the short mini mental status examination (sMMSE) or the Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE) as a measure of cognitive functioning. Data came from 574 Dutch adults aged 75+, collected in five nine-month measurement waves (2015–2018) for the Longitudinal Aging Study Amsterdam.ResultsFor physical functioning five trajectories were identified: ‘high’, ‘moderate’, ‘steeply declining’, ‘gradually declining’, and ‘continuously low’; and for cognitive functioning: ‘high’, ‘moderate’, ‘declining’, and ‘low’. Living in an institution, and being lower educated increased the probability of the two continuously low functioning trajectories, whereas old age and multimorbidity increased the probability of low physical functioning, but multimorbidity decreased the probability of low cognitive functioning. Associations for steeply declining physical functioning were absent. Being older and having multimorbidity increased the probability of gradually declining physical functioning and declining cognitive functioning. A higher prevalence of lung- and heart disease, cancer, and rheumatic disease was found in the gradually declining physical functioning group; and a higher prevalence of diabetes, cerebrovascular accidents, and cancer was found in the declining cognitive functioning group. High and moderate physical functioning and high cognitive functioning were characterized by being younger, community-dwelling, and higher educated. Having multimorbidity negatively predicted high and moderate physical functioning, but was not associated with high and moderate cognitive functioning.ConclusionsThis study identified trajectories comparable to studies that used longer time intervals, showing the consistent presence of heterogeneity in both physical and cognitive trajectories. Co-modelling mortality resulted in bigger group sizes for the more adverse trajectories. The favourable trajectories, containing most of the participants, were mostly characterized by absence of disease. The prevalence of chronic diseases differed between the declining trajectories, suggesting that certain diseases tend to induce cognitive decline rather than physical decline, and vice versa.

Highlights

Using longitudinal panel data, we aimed to identify three-year trajectories in cognitive and physical functioning among Dutch older adults, and the characteristics associated with these trajectories
Participants with low cognitive scores were included in the sample because we aimed to study whether the trajectories in functional limitations and cognitive decline showed overlap
Despite there being indications of the IQCODE and MMSE not entirely measuring the same construct [35], we argue that keeping the participants that were assigned the IQCODE at some point during the study in the analyses is better than excluding them

Summary

Introduction

We aimed to identify three-year trajectories in cognitive and physical functioning among Dutch older adults, and the characteristics associated with these trajectories. Depending on various aspects of study design- such as the chosen indicator of functioning, the density of observation points, and the age of the population studied- previous studies identified between two and nine trajectories of physical or cognitive functioning [7,8,9,10,11,12,13,14,15,16,17,18,19,20]. Despite this wide variety in the number of trajectories observed, the trajectories consistently differed based on age. Studies focussing on younger populations (~ 55–75 years) sometimes report recovery or fluctuating trajectories [13, 23,24,25], whereas studies that focus on older populations (75+) tend to report no recovery [16, 21, 22]

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