Activities Of Daily Living Dependence Research Articles

Projections of functional dependence among the late middle-aged and older population from 2018-2048 in China: a dynamic microsimulation

BackgroundThe population of China is aging rapidly. However, the long-term trajectories of functionally dependent late middle-aged and older Chinese people are currently absent. The present study aimed to estimate the population size and proportion of late middle-aged and older adults with difficulties and dependence on activities of daily living (ADL) and instrumental activities of daily living (IADL) in China from 2018 to 2048.MethodsWe constructed a dynamic microsimulation model to project the population size and proportions of late middle-aged and older Chinese people who have difficulty and dependence in ADL and IADL from 2018-2048. The model was populated with a representative sample of the target population and allowed individual-level interaction between risk factors, diseases, and health outcomes. Analyses by socioeconomic subgroups were also conducted.ResultsAlmost 25% and 38% of late middle-aged and older people in China will become ADL- and IADL-dependent by 2048, respectively. Also, 17% of the target population will be severely ADL-disabled by 2048. The inequity in functional status across subgroups by sex, educational level, and urban/rural residency will become substantial.ConclusionsThe numbers and percentages of China's functionally difficult and dependent late middle-aged and older population will increase by magnitudes as of the mid-21st century, the pressure of which is compounded by its disproportionate distribution across subgroups. To alleviate the overwhelming challenge, efforts to improve the functional status of the underserved subpopulation should also be iterated.

The association between restricted activity and patient outcomes in older adults: systematic literature review and meta-analysis

BackgroundRestricted activity is a potential early marker of declining health in older adults. Previous studies of this association with patient outcomes have been inconclusive. This review aimed to evaluate the extent to which restricted activity is associated with decline in health.MethodsA search was conducted for studies including people over 65 years old which investigated the association between measures of restricted activity and hospitalisation, cognitive decline, and mortality. Following data extraction by two reviewers, eligible studies were summarised using Inverse Variance Heterogeneity meta-analysis.ResultsThe search identified 8,434 unique publications, with 11 eligible studies. Three measures of restricted activity were identified: bed rest, restricted movement, and dependency for activities of daily living (ADL). Three studies looked at hospitalisations, with two finding a significant association with bed rest or restricted movement and one showing no evidence of an association. Restricted activity was associated with a significant increase in mortality across all three measures (bed rest odds ratio [OR] 6.34, 95%CI 2.51–16.02, I2 = 76%; restricted movement OR 5.38 95%CI 2.60–11.13, I2 = 69%; general ADL dependency OR 4.65 95%CI 2.25–9.26, I2 = 84%). The significant heterogeneity observed could not be explained by restricting the analysis by length of follow-up, or measure of restricted activity. No meta-analysis was conducted on the limited evidence for cognitive decline outcomes.ConclusionsLimited studies have considered the prognostic value of restricted activity in terms of predicting future declining health. Current evidence suggests restricted activity is associated with hospitalisation and mortality, and therefore could identify a group for whom early intervention might be possible.

Home-based supportive and health care services based on functional ability in older adults in Iran

BACKGROUND: Home-based care is affordable due to population aging, increased chronic disease, and higher hospitalization costs. The objective was to evaluate home-based supportive and health care services provided to older adults and identify possible associations between activities of daily living (ADLs), instrumental ADL (IADLs) classifications, sociodemographic variables, clinical characteristics, and perceived social support among older adults. MATERIALS AND METHODS: In this cross-sectional study, 700 people aged 60 years and older were selected by stratified cluster sampling. Areas of Tabriz City were selected as clusters, and 55 comprehensive urban health centers were selected as stratifies. Chi-square, Pearson’s and Spearman’s tests, and multiple linear regression were used for statistical analyses. Statistical analysis was performed using the Statistical Package for Social Sciences (SPSS 24.0, SPSS Inc., Chicago, USA). The study instrument included demographic characteristics of older adults and caregivers, health services provided at home, and two valid questionnaires, including the KATZ index of independence in (instrumental) activities of daily living and a multidimensional scale of perceived social support. Scores on scales and demographic variables were collected during telephone interviews. The study lasted from April 25, 2022, to October 30, 2022. RESULTS: A high level of perceived social support was 56.6%. The study found that 51.3% of participants had family caregivers. Most participants had ADL independence (85.4%), while 22.9% and 24.3% were dependent and needed assistance with IADL, respectively. Women had a lower ADL score and a higher IADL score than men (P < 0.05). The obtained results of multiple regression analysis revealed a negative and significant association between unemployment, illiteracy, increasing age, five and more medications, and ADL and IADL dependency (P < 0.05). CONCLUSION: Empowering older adults to reduce dependency, and designing a formal home-based care system is recommended.

Risk factors of dementia cognitive symptoms among older patients in Vietnam: A cross-sectional study

Background. Dementia has emerged as a significant contributor to declining quality of life and stands as a prominent factor in the increase of disability and dependency among elderly populations globally. This study aimed to explore the relationship between cognitive symptoms of dementia and their risk factors in individuals aged 60 years and older among Vietnamese outpatients who visited Geriatrics Clinic at University Medical Center of Ho Chi Minh city, Vietnam. Methods. 387 participants who were aged ≥ 60 years old were included in the cross-sectional study. Cognitive impairment was assessed by using the Mini Mental State Evaluation (MMSE) questionnaire. The functional limitations in activities of daily living (ADL) and Instrumental Activities of Daily Living (IADL), multimorbidity, and polypharmacy were also evaluated. Frailty was determined by The Canadian Study of Health and Aging Clinical Frailty Scale. Suffering dementia was determined when MMSE score was below 24 and IADL score less than 8. Results. People with dementia cognitive symptoms accounted for 22.74 % of the cohort. The percentage increased with age, and was higher in women than in men. Factors that increased the odds of having dementia symptoms were of older age, female, multimorbidity, Frailty Scale > Grade 4 and ADL dependency. Conclusions. Age, female gender, multimorbidity, frailty and ADL dependency were considered as risk factors of dementia cognitive symptoms among the Vietnamese people aged 60 years and older.

Assessment of Dependency in Activities of Daily Living (ADL) and its Predictors: A Cross-Sectional Study among the Elderly Rural Population in a Sub-Himalayan UT of India.

With an increase in life expectancy over the last few decades, there has been a parallel increase in the prevalence of disabilities among the elderly population. To estimate the prevalence of dependency in activities of daily living (ADL) and its predictors among the rural elderly population. This was a cross-sectional study carried out in the community among the rural geriatric population in the field practice area of PG Department of Community Medicine, Government Medical College Jammu. The Barthel Scale Index was used to measure ADL dependency. PSPP software was used to analyze the data. The mean age of study participants was 68.31 ± 7.9 years. ADL dependency was observed in 46.3% of the subjects, with the majority demonstrating mild to moderate dependence. Only 2.5% of the respondents reported a severe degree of ADL dependence. The mean ADL score was 94.47 ± 8.98. On multivariate logistic regression analysis, age, educational status, the presence of stress in the family, personal history, and the presence of co-morbidities emerged to be independent predictors of ADL dependence. High prevalence of physical disability in the geriatric population is now an area of major concern. This emphasizes the significance of setting up geriatric care centers especially in rural areas preferably integrating with health and wellness centers.

Association between cognitive dysfunction and diabetes in patients over 65 years old: a cross-sectional study using propensity score matching.

To investigate the association between diabetes and cognitive dysfunction in the elderly population, and examine the impact of cognitive dysfunction on level of activities of daily living (ADL) in patients with diabetes. Data analysis was conducted on 2,951 individuals aged over 65 years from the Chinese Longitudinal Healthy Longevity Survey cohort. Propensity score matching was utilized to mitigate selection bias. Multivariate binary logistic regression was performed to analyse the association between diabetes and cognitive dysfunction in the study subjects. In addition, the relationship between ADL and cognitive function in patients with diabetes was analysed using the Wilcoxon rank-sum test. A significant association (p = 0.017) was found between diabetes and the occurrence of cognitive dysfunction in older adults. Subgroup analyses revealed that diabetes patients with cognitive dysfunction exhibited a worse ADL dependence compared with those without cognitive dysfunction (p < 0.001). These findings indicate that diabetes is associated with cognitive dysfunction in older adults. Meanwhile, there is an association between cognitive impairment and ADL level in subjects with diabetes. As such, healthcare professionals should pay close attention to the occurrence of cognitive dysfunction and ADL decline during diagnosis and treatment, and proactive prevention and intervention strategies should be implemented.

Longitudinal associations between stroke-related neurologic deficits and course of basic activities of daily living up to six months after stroke

Purpose To investigate the course of basic activities of daily living (ADL) from admission up to six months after the stroke and the longitudinal associations between stroke-related neurological deficits at admission to the stroke unit and course of basic ADL. Materials and Methods 180 individuals with a first-ever stroke were assessed at admission to the stroke unit and at follow-ups of three and six months. Stroke-related neurological deficits were assessed at admission with the National Institutes of Stroke Scale (NIHSS). Independence in basic ADL was assessed at admission and three and six months after the stroke by the Modified Barthel Index (MBI). Generalized Estimating Equations (GEE) were performed. Results Dependence in basic ADL reduced overtime, with most changes occurring over the first three months. Individuals, who had moderate/severe stroke-related neurological deficits (NIHSS ≥6) at admission, had higher chances of becoming more dependent in activities related to feeding (OR:1.27;95%CI = 1.03-1.55;p = 0.021), bathing (OR:1.30;95%CI = 1.11-1.50;p = 0.0005), dressing (OR:1.19;95%CI = 1.04-1.36;p = 0.010), transfers (OR:1.24;95%CI = 1.05-1.46;p = 0.0072), stair climbing (OR:1.46;95%CI = 1.27-1.66;p < 0.0001), and ambulation (OR:1.21;95%CI = 1.02-1.43;p < 0.0001). Conclusions Decreases in dependence in basic ADL occurred mainly over three months after the stroke and showed different patterns for specific ADL. Baseline moderate/severe stroke-related neurological deficits were associated with poor functional status in basic ADL over the follow-up period.

Does Old Age Comprise Distinct Subphases? Evidence from an Analysis of the Relationship between Age and Activities of Daily Living, Comorbidities, and Geriatric Syndromes.

Older individuals are usually treated as a homogenous group despite evidence that old age consists of distinct subphases. This observational study including 493 older patients aimed to identify differences among age subgroups of older persons. Receiver operating characteristic (ROC) curve analysis was then applied to identify the optimal age cutoff points to distinguish those age groups. Data were collected on the demographics of older patients, their medical and medication histories, dependence on activities of daily living (ADLs), and instrumental activities of daily living (IADLs). Non-parametric tests (Kruskal-Wallis and Mann-Whitney U tests) and ROC curves were used for statistical analysis. The 65-79 and ≥80 years of age groups showed distinct frailty status, comorbidity, and dependency in ADLs. The median age to remain completely independent in IADLs was 76-79 years, while the median age for being free from geriatric syndromes was slightly higher (77-80 years) and reached 82 years for the absence of delirium, falls, and swallowing problems. In the ROC analysis, the optimal cutoff ages for the presence of frailty, cognitive impairment, and dependency in ADLs were 80-82 years. The 65-79 and ≥80 years of age groups differed significantly in numerous parameters, underscoring the need to address these distinct age groups differently, both for applying medical therapies and interventions, as well as for conducting health research.

Physical Leisure Activities in Adolescents with Disabilities: Data from National Survey of Disabled Persons.

The impact of activities of daily living (ADLs) on the life satisfaction of adolescents with disabilities and the potential role of physical leisure activities as a moderator in this context have received attention. However, little is known about the influence of physical leisure activities on the relationship between ADLs and life satisfaction in adolescents with disabilities. This cross-sectional study aimed to investigate the moderating effect of physical leisure activities on the relationship between ADLs and life satisfaction among adolescents with disabilities. Secondary data analysis was conducted by extracting data from 5364 adolescents aged 12-18 years with disabilities from the 2020 National Survey of Disabled Persons of Korea. The potential moderating effect of physical leisure activities on the relationship between ADLs and life satisfaction was investigated using Pearson's correlation analysis and hierarchical multiple regression. Significant positive correlations were found for living, life satisfaction, and physical leisure activities. Physical leisure activities were found to play a moderating role in the relationship between ADLs and life satisfaction. This study concluded that increasing physical leisure activities, even with dependent ADLs, promotes life satisfaction, especially if ADLs are low, highlighting the necessity of increasing leisure activities in adolescents with disabilities.

Development and External Validation of Models to Predict Need for Nursing Home Level of Care in Community-Dwelling Older Adults With Dementia

Most older adults living with dementia ultimately need nursing home level of care (NHLOC). To develop models to predict need for NHLOC among older adults with probable dementia using self-report and proxy reports to aid patients and family with planning and care management. This prognostic study included data from 1998 to 2016 from the Health and Retirement Study (development cohort) and from 2011 to 2019 from the National Health and Aging Trends Study (validation cohort). Participants were community-dwelling adults 65 years and older with probable dementia. Data analysis was conducted between January 2022 and October 2023. Candidate predictors included demographics, behavioral/health factors, functional measures, and chronic conditions. The primary outcome was need for NHLOC defined as (1) 3 or more activities of daily living (ADL) dependencies, (2) 2 or more ADL dependencies and presence of wandering/need for supervision, or (3) needing help with eating. A Weibull survival model incorporating interval censoring and competing risk of death was used. Imputation-stable variable selection was used to develop 2 models: one using proxy responses and another using self-responses. Model performance was assessed by discrimination (integrated area under the receiver operating characteristic curve [iAUC]) and calibration (calibration plots). Of 3327 participants with probable dementia in the Health and Retirement Study, the mean (SD) age was 82.4 (7.4) years and 2301 (survey-weighted 70%) were female. At the end of follow-up, 2107 participants (63.3%) were classified as needing NHLOC. Predictors for both final models included age, baseline ADL and instrumental ADL dependencies, and driving status. The proxy model added body mass index and falls history. The self-respondent model added female sex, incontinence, and date recall. Optimism-corrected iAUC after bootstrap internal validation was 0.72 (95% CI, 0.70-0.75) in the proxy model and 0.64 (95% CI, 0.62-0.66) in the self-respondent model. On external validation in the National Health and Aging Trends Study (n = 1712), iAUC in the proxy and self-respondent models was 0.66 (95% CI, 0.61-0.70) and 0.64 (95% CI, 0.62-0.67), respectively. There was excellent calibration across the range of predicted risk. This prognostic study showed that relatively simple models using self-report or proxy responses can predict need for NHLOC in community-dwelling older adults with probable dementia with moderate discrimination and excellent calibration. These estimates may help guide discussions with patients and families in future care planning.

Self-perceived cognitive fluctuations and their relationship to everyday functioning in older adults with and without HIV disease

Objective: HIV is associated with elevated performance-based cognitive intra-individual variability (IIV) in the laboratory that can reflect difficulty regulating cognitive resources over time (i.e., cognitive fluctuations) and disrupt everyday functioning. Whether persons living with HIV (PLWH) experience appreciable cognitive fluctuations in their daily lives is unclear. This study examined the presence of cognitive fluctuations and their relationship to everyday functioning in PLWH. Methods: Participants were 145 PLWH and 61 seronegative individuals age ≥ 50 years who completed a self-report version of the Mayo Fluctuations Scale (MFS), structured psychiatric interview, medical evaluation, and well-validated measures of mood, cognitive symptoms, and activities of daily living (ADLs). A confirmatory factor analysis of the MFS yielded three factors, including a 7-item cognitive fluctuations scale. Results: Univariable analyses showed that HIV was associated with moderately higher MFS Cognitive Fluctuation subscale scores (d = 0.46), but this effect was no longer significant a multiple regression model that included medical comorbidities and affective disorders, which emerged as unique predictors. Of clinical relevance, higher MFS Cognitive Fluctuation subscale scores were independently associated with more frequent cognitive symptoms and dependence in ADLs in the full sample. Conclusions: Higher frequency of self-perceived cognitive fluctuations disrupts management of ADLs among middle-aged and older adults independent of HIV status and general cognitive symptoms. Future studies are needed to understand the full clinical significance of self-perceived cognitive fluctuations among PLWH and their impact on daily life.

Aging at home: factors associated with independence in activities of daily living among older adults in Norway-a HUNT study.

Maintaining independence in activities of daily living (ADL) is essential for the well-being of older adults. This study examined the relationship between demographic and living situation factors and ADL independence among community-dwelling older adults in Norway. Data was collected in Norway between 2017 and 2019 as part of the fourth wave of the ongoing Trøndelag Health Study (HUNT) survey, sent to all citizens in Trøndelag county over 20 years of age, which is considered representative of the Norwegian population. Included in the current cross-sectional study were 22,504 community-living individuals aged 70 years or older who completed the survey and responded to all items constituting the ADL outcome measure. Group differences in ADL independence were examined with Chi Square tests, while crude and adjusted associations with ADL independence were examined with logistic regression analyses. Statistical significance was set at p < 0.05. The participants reported a high degree of independence in primary ADL and slightly lower in instrumental ADL. In the fully adjusted analyses, ADL independence was associated with lower age, female gender, higher levels of education and income, higher subjective well-being, having no chronic or disabling disease, and having someone to talk to in confidence. Surprisingly, women who were married had higher likelihood of ADL independence than unmarried women, whereas married men had lower likelihood of ADL independence than unmarried men. In addition to known demographic and disease-related factors, the social context affects independence in ADL even in a society that offers advanced health and homecare services to all older adults equally. Furthermore, the same social setting can have differential effects on men and women. Despite the healthcare system in Norway being well-developed, it does not completely address this issue. Further improvements are necessary to address potential challenges that older adults encounter regarding their social connections and feelings of inclusion. Individuals with limited education and income are especially susceptible to ADL dependency as they age, necessitating healthcare services to specifically cater to this disadvantaged demographic.

[Risk factors associated with cognitive impairment in aged: Cross-sectional study].

With the increase in life expectancy, conditions related to older age have increased in incidence, one of these pathologies is Cognitive Impairment (CI), which has a prevalence of up to 28%, conditions that increase the presence of CI are known. However, there is controversy about the factors that increase the risk of CI. To determine the factors associated with cognitive impairment in older adults. We conducted a cross-sectional, analytical, observational, retroprolective study that included adults ≥65 years of age, with no history of cerebral vascular event, cranioencephalic trauma. Demographic factors were analyzed, CI was assessed with the Mini Mental State Examination test. For statistical analysis we used Odds Ratio (OR) and 95% confidence interval (95% CI) for each factor and multiple logistic regression as multivariate analysis. 420 older adults were included, 61% were women, 32.6% with age >75 years, 84.5% with schooling <9 years, in the multiple logistic regression the following were independent factors for the presence of mild CI: dependence on basic activities of daily living (ADLs) with OR 5.88, absence of cognitive stimulation RM 4.50, age >75 years OR 2.92, polypharmacy OR 2.16, uncontrolled blood pressure OR 1.92. ADLs dependence, absence of cognitive stimulation, age >75 years, polypharmacy and uncontrolled blood pressure are risk factors associated with CI in older adults.

Myocardial infarction and physical function: the REasons for Geographic And Racial Differences in Stroke prospective cohort study

ObjectiveTo examine associations between myocardial infarction (MI) and multiple physical function metrics.MethodsAmong participants aged≥45 years in the REasons for Geographic And Racial Differences in Stroke prospective cohort study, instrumental activities...

Cognitive transitions based on functional status in older adults with heart failure: a population-based study.

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.

Death and ADL Dependency After Scoring Zero on the NIHSS: A Swedish Retrospective Registry-Based Study.

Of all strokes, mild strokes (defined as 5 points or less on the National Institutes of Health Stroke Scale [NIHSS]) are in the majority. However, up to one-third of patients with mild strokes still exhibit significant deficits 3 months after the stroke. Studies on the presumably mildest strokes, defined by zero points on the NIHSS (0-NIHSS) at admission, are scarce. Hence, we aimed to study patient characteristics and outcomes among patients with 0-NIHSS strokes. Our retrospective registry-based study included a total of 6,491 adult patients with stroke admitted to 3 different stroke units in Gothenburg, Sweden, from November 2014 to June 2019. Our main outcome was a composite measure including death and activities of daily living (ADL) dependency 3 months after the stroke. Analyses of patient characteristics were followed by adjusted analyses including multiple confounders. In total, 5,945 patients had data on NIHSS at admission, of whom 1,412 (24%) presented with a 0-NIHSS stroke. Among these, the median age was 72 years, 600 (42%) were female, and 86 (6%) had a hemorrhagic stroke. Among previously ADL-independent patients, 65 (6%) were either dead or ADL-dependent 3 months after the stroke. Prestroke physical inactivity (OR 2.48, 95% CI 1.40-4.38) and age (OR 1.05 per gained year, 95% CI 1.02-1.08) significantly increased the risk of death and ADL dependency. One of 17 patients has either died or become ADL-dependent 3 months after a 0-NIHSS stroke, stressing that these strokes are not always benign. Older and physically inactive patients are at greater risk of an adverse outcome.

The Severity of Pain and Comorbidities Significantly Impact the Dependency on Activities of Daily Living among Musculoskeletal Patients in Jizan, Saudi Arabia.

Limited research has been carried out on the effects of pain, comorbidity, and impaired function in musculoskeletal patients in Jizan, Saudi Arabia. A cross-sectional study was conducted on 115 patients (aged ≥ 55 years) with physician-diagnosed musculoskeletal conditions in Jizan to investigate the association between pain severity, comorbidities, and dependence on activities of daily living (ADLs). Self-reported questionnaires were used to collect data on pain, comorbidities, and physical function measured by ADLs. In ADLs, participants were categorized as dependent (n = 36) or independent (n = 79). Logistic regression analysis was employed to determine the predictors of dependence. The results showed that higher pain severity (adjusted odds ratio (OR): 1.69, 95% confidence interval (CI): 1.21-2.38, p = 0.002) and a greater number of comorbidities (adjusted OR: 1.52, 95% CI: 1.06-2.17, p = 0.021) were independently associated with dependence in ADLs. These associations remained significant even after controlling for covariates. This study concluded that patients with musculoskeletal conditions in Jizan who experience high levels of pain and comorbidities are at risk of dependence on basic daily activities. Therefore, addressing pain and comorbidities is crucial for maintaining independence and improving quality of life. Personalized rehabilitation programs are needed to manage these conditions in this region.

Reliability and Effectiveness of the Japanese Version of the Mobilization Quantification Score.

Background The mobilization quantification score (MQS) provides an opportunity to quantify the duration and intensity of mobilization therapy in the intensive care unit (ICU)and predictfunctional outcomes in ICU patients after surgery and stroke. MQS is a numerical measurement of early mobilization dose in the ICU, and its relationship with activities of daily living (ADL) dependence has been shown. We created and validated the Japanese version of the MQS using the endpoint ADL in a mixed population of patients in the ICU. Materials and methods In this prospective study, consecutive patients who were admitted to one of three ICUs of a tertiary care hospital in Japan, aged ≥18 years, and who received mechanical ventilation for >48 hours were enrolled. The Japanese version of the MQS was applied twice daily by an ICU physiotherapist and data recorded for analysis. The primary outcome was ADL dependence at hospital discharge, defined as a Barthel index (BI) of <70 or in-hospital death. The reliability among assessors was verified by calculating the interclass correlation coefficient (ICC) (2.1) for the average daily MQS. We performed a multiple logistic regression analysis to examine and identify a binary cutoff point for high-/low-dose rehabilitation. Results Of the 340 target patients, eight were aged <18 years, 109 had neurological complications, 11 had a BI <70 before admission, 79 had a lack of communication skills, 16 were terminally ill, eight did not complete the assessment during their ICU stay, 18 died in the ICU, and 53 denied consent. After 302 patients were excluded, 38 were included in the study.Six assessors, two at each hospital, measured the MQS in 38 patients. The ICC (2.1) for the MQS mean value was 0.98 (0.96-0.99) during the ICU stay. Logistic regression analysis using the mean MQS on admission to ICUs as an explanatory variable showed a significant association between increased MQS and decreased ADL dependence at discharge (odds ratio (OR): 0.76, confidence interval (CI): 0.61-0.96, adjusted p = 0.009). Logistic regression analysis using a high MQS on admission to ICUs as an explanatory variable showed a significant association between increased MQS and decreased ADL dependence at hospital discharge (OR: 0.14, CI: 0.03-0.66, adjusted p = 0.013). Conclusions We present a validated version of the Japanese MQS with a high inter-rater reliability that predicts ADL dependence at hospital discharge. The instrument can be used in future clinical trials in the ICU to control for the mobilization level in the ICU. The increased utilization of mobilization acutely in the ICU setting as quantified by the MQS may improve patient outcomes.

Predicting functional dependency using machine learning among a middle-aged and older Chinese population

ObjectiveTo develop prediction models for assessing functional dependency in a middle-aged and older Chinese population. MethodAdults ≥45 years old from the China Health and Retirement Longitudinal Study (CHARLS) and without functional dependency at baseline were included. Functional dependency was defined as needing any help in any basic activities of daily living (ADL) or instrumental activities of daily living (IADL). The outcomes were overall functional dependency, ADL and IADL dependency. Stacked ensemble models were constructed based on five selected machine learning models. Models were trained and tested in the 2011–2015 cohort, and were externally validated in the 2015–2018 cohort. SHapley Additive exPlanations (SHAP) was utilized to quantify the significance of predictors. ResultIn the training cohort, a total of 6,297 participants were included at baseline, 1,893 developed functional dependency during the follow-up period. The stacked ensemble model achieved the best performance in terms of discrimination ability for predicting overall functional dependency, ADL and IADL dependency, with AUCs of 0.750, 0.690 and 0.748, respectively; in external validation cohort, the corresponding AUCs were 0.725, 0.719 and 0.727, respectively. A compact model was further developed and maintained similar predictive performance. ConclusionThe stacked ensemble approach can serve as a useful tool for identifying the risk of functional dependency in a large Chinese population. For ADL dependency, arthritis, age, self-report health, and waist circumference were identified as highly significant predictors. Conversely, cognitive function, age, living in rural areas, and performance in chair stand test emerged as highly ranked predictors for IADL dependency.

Comparison of functional disabilities, place of death and end-of-life medical expenditures among centenarians and non-centenarians in China: a series of cross-sectional studies

BackgroundLong-term and end-of-life (EOL) care for older adults has become a global concern due to extended longevity, which is generally accompanied by increased rates of disability. However, differences in the rates of disability in activities of daily living (ADLs), place of death and medical expenditures during the last year of life between centenarians and non-centenarians in China remain unknown. This study aims to fill this research gap to inform policy efforts for the capacity-building of long-term and EOL care for the oldest-old, especially for centenarians in China.MethodsData from 20,228 decedents were derived from the 1998–2018 Chinese Longitudinal Healthy Longevity Survey. Weighted logistic and Tobit regression models were used to estimate differences in the prevalence of functional disability, rate of death in hospitals and EOL medical expenditures by age groups among oldest-old individuals.ResultsOf the 20,228 samples, 12,537 oldest-old individuals were female (weighted, 58.6%, hereafter); 3,767 were octogenarians, 8,260 were nonagenarians, and 8,201 were centenarians. After controlling for other covariates, nonagenarians and centenarians experienced a greater prevalence of full dependence (average marginal differences [95% CI]: 2.7% [0%, 5.3%]; 3.8% [0.3%, 7.9%]) and partial dependence (6.9% [3.4%, 10.3%]; 15.1% [10.5%, 19.8%]) but a smaller prevalence of partial independence (-8.9% [-11.6%, -6.2%]; -16.0% [-19.1%, -12.8%]) in ADLs than octogenarians. Nonagenarians and centenarians were less likely to die in hospitals (–3.0% [–4.7%, –1.2%]; –4.3% [–6.3%, –2.2%]). Additionally, nonagenarians and centenarians reported more medical expenditures during the last year of life than octogenarians with no statistically significant differences.ConclusionThe oldest-old experienced an increased prevalence of full and partial dependence in ADLs with increasing age and reported a decline in the prevalence of full independence. Compared with octogenarians, nonagenarians and centenarians were less likely to die in hospitals. Therefore, future policy efforts are warranted to optimise the service provision of long-term and EOL care by age patterns for the oldest-old population in China.