Activities Of Daily Living Difficulties Research Articles

Abstract PO1-03-06: Older patients with Early Stage Triple Negative Breast Cancer: The Memorial Sloan Kettering Cancer Center experience

Abstract INTRODUCTION Approximately 15% cases of TNBC are diagnosed in individuals over the age of 70. Older patients remain under-represented in clinical trials. We conducted a retrospective review of patients 70 years of age and older with stage I-III TNBC who were treated at Memorial Sloan Kettering Cancer Center (MSKCC), with the goal of describing the clinical practice patterns and outcomes. MATERIAL AND METHODS A retrospective record review of patients 70 years of age and older with a diagnosis of stage I-III TNBC between January 2015-December 2019 was performed. We report the data on the utilization of systemic chemotherapy and survival analyses. We compared patient characteristics by chemotherapy type using Wilcoxon rank sum test, Pearson’s Chi-squared test, and Fisher’s exact test. Overall Survival (OS), Breast Cancer Specific Survival (BCSS), and Recurrence Free BCSS (RF-BCSS) were examined using Cox proportional hazards models. All statistical analyses were conducted using R. RESULTS A total of 147 patients were included. The median age was 75 years (range 70-96). The number of patients with stage I, II, and III disease was 64 (44%), 66 (45%), 17 (12%), respectively. Twenty-five (18%) patients underwent comprehensive geriatric assessment. Out of total patients, 93 (63%) patients received systemic Chemotherapy (C) while 54 (37%) received no chemotherapy (NC). Patients receiving C were younger (median age 74 years with C vs. 78 years with NC, p< 0.001) and had a higher disease stage (Stage II-III: 66% (C) vs. 41% (NC), p=0.005). There were no significant differences in Activities of Daily Living (ADL) difficulty between both arms. Amongst, Instrumental ADL (IADL) assessment, patients in the NC group reported statistically significant greater difficulty with meal preparation (17% in NC and 4.3% in C, p=0.016). The most common reasons for not receiving chemotherapy were low-risk disease i.e. pT1aN0 or microinvasive (33%), patient preference (29%), and frailty per the treating oncologist (19%). Rate of mastectomy was higher in the NC group (35% in NC vs. 20% in C, p=0.029). Among the 32 patients who had radiation data, breast irradiation rates were higher in the C group (70% in C and 17% in NC, p=0.003). Thirty patients (20%) received neoadjuvant chemotherapy (NAC) and 65 (44%) received adjuvant chemotherapy. Anthracycline-based chemotherapy was the most common NAC (n=17, 57%). Patients who received Cyclophosphamide-Methotrexate-5-Fluorouracil (CMF) were older (age ≥75 years: 51% (CMF) vs. 17% (ACT),p=0.010), more likely treated in an adjuvant setting (87% CMF vs. 61% ACT, p=0.017), had earlier-stage disease (Stage 1: 54% (CMF) vs. 26% (ACT), p=0.028), and reported more ADL (31% in CMF vs. 0% in ACT, p=0.002) and IADL difficulties (31% CMF vs 4.3% in ACT, p=0.021). The use of Docetaxel/Cyclophosphamide (TC) and platinum-based regimens was low (8% and 5%, respectively). In the univariate analysis between the C and NC groups, there was no difference in OS (Hazard Ratio (HR) 0.78, 95% Confidence Interval (CI) 0.42-1.43; p=0.4), BCSS (HR 1.39, 95% CI 0.57-3.39; p=0.5), and RF-BCSS (HR 1.60, 95% CI 0.67-3.83; p=0.3). There was no difference in OS (HR 0.60, 95% CI 0.23-1.55; p=0.3), BCSS (HR 0.48, 95% CI 0.17-1.32; p=0.2), and RF-BCSS (HR 0.71, 95% CI 0.30-1.73; p=0.5) in patients receiving CMF vs. ACT. CONCLUSIONS In our single institutional experience, we observed that two-thirds of older patients with early-stage TNBC received systemic polychemotherapy. A third of patients with NC were very low risk (pT1a or microinvasive disease) which could explain lack of chemotherapy benefit in our study population. Use of CMF was more prevalent in patients aged ≥75, stage I disease, ADL/IADL difficulties, and in the adjuvant setting. We observed no difference in survival outcomes between the two chemotherapy regimens. CMF remains an efficacious option and a potentially viable alternative to ACT in TNBC, especially in the setting of early stage and advanced age. Citation Format: Jasmeet Singh, Diana Lake, West Dente-Ferguson, Yuan Chen, Fiona Erlich, Beatriz Korc-Grodzicki, Mark Robson, Larry Norton, W. Iris Zhi. Older patients with Early Stage Triple Negative Breast Cancer: The Memorial Sloan Kettering Cancer Center experience [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO1-03-06.

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.

Association between chronic disease, sensory impairment, walking limitation, and activities of daily living of community-dwelling older Indians.

Due to the paucity of existing evidence, this study aims to investigate the relationship between chronic disease, sensory impairment, walking limitation, and difficulty in activities of daily living (ADLs) in community-dwelling older Indians. This cross-sectional study included data from 31,394 individuals aged ≥ 60 years from the 2017 to 2018 Longitudinal Ageing Study in India. Participants were divided into 2 groups: 12,993 with chronic disease, sensory impairment, and a walking limitation, and 18,401 healthy individuals without such conditions. Participants with any chronic disease were further divided into 2 groups: sensory impairment (n = 12,462), and a walking limitation (n = 4745). Self-reported close-ended questionnaires with yes or no were used to assess each chronic disease (such as hypertension, diabetes, lung disorders, joint disorders, or heart disease), sensory impairment (vision or hearing), and walking limitation. A walking limitation was defined as being when a person could only walk at their usual pace for less than 500 meters on a flat surface. ADLs were assessed and classified as physical ADLs including basic physical requirements like dressing. Instrumental ADLs (IADLs) included more complicated community-based tasks like meal preparation. Findings showed that older Indians with chronic disease, sensory impairment, and a walking limitation were more likely to be significantly associated with physical ADLs (adjusted odds ratio [aOR] = 1.85, 95% confidence interval [CI] = 1.34-1.57, P < .0001) and IADLs (aOR = 1.45, 95% CI = 1.70-2.03, P < .0001) than those without such conditions. Among older Indians with chronic disease, sensory impairment was more likely associated with physical ADLs (aOR = 1.98, 95% CI = 1.82-2.16, P < .0001) and IADLs (aOR = 1.26, 95% CI = 1.15-1.37, P < .0001) followed by a walking limitation (aOR = 1.53, 95% CI = 1.42-1.65, P < .0001; aOR = 1.27, 95% CI = 1.17-1.38, P < .0001, respectively). These findings suggest that older Indians with chronic disease, sensory impairment, and walking limitation, can experience increased difficulty in overall and individual physical ADL and IADL than those without these conditions. Older Indians with any chronic condition who had sensory impairment or a walking limitation were also more likely to have difficulty with physical ADLs and IADLs.

Patient-reported difficulty in activities of daily living and corresponding muscle weakness in elderly patients undergoing haemodialysis.

Patients undergoing haemodialysis have reduced muscle strength and impaired activities of daily living (ADL). We examined possible relationship between difficult ADL and corresponding muscle weakness in elderly haemodialysis patients. This was a single-centre, cross-sectional study. Patient-reported ADL difficulty was examined using a questionnaire in six ADL using upper limbs (eating, grooming and dressing) and lower limbs (bathing, toileting and locomotion). We measured six muscle strengths by dynamometers of shoulder flexion, shoulder abduction, elbow flexion, handgrip, hip abduction and knee extension. The muscle strength with the lowest Z-score was considered as the weakest muscle strength for the patient. The six scores of ADL difficulty were all inversely associated with the six muscle strengths in the 81 total participants of whom 71 individuals (87.7%) had any ADL difficulty. Among the six measurements of muscle strength, handgrip strength showed the highest associations with all ADL difficulties. In 25 patients who perceived that the most difficult ADL was an activity using upper limbs, the common weakest muscle strengths were the hip abduction, handgrip and elbow flexion. In 44 patients who perceived that the most difficult ADL was an activity using lower limbs, knee extension was the most prevalent weakest muscle strength. This study suggested preferential relationship between the most difficult ADL and corresponding muscle weakness in elderly haemodialysis patients. This finding may be useful in prevention and treatment.

Symmetric bimanual coordination discrepancy and activities of daily living in individuals with autism spectrum disorder

Impairments in bimanual coordination are commonly observed in individuals with autism spectrum disorder (ASD). Bimanual coordination is essential for the performance of activities of daily living (ADLs). However, it remains unclear whether bimanual coordination impairment is associated with performing ADLs in adults with ASD. This study examined the relationship between bimanual tasks and subjective ADL difficulty in adults with ASD. Nineteen adults with ASD (41.95 ± 10.89) and 20 aged-matched (41.70 ± 11.07) controls completed a bimanual thumb–index finger opposition task and a questionnaire on subjective difficulty in ADL performance, which was evaluated using a visual analogue scale. The bimanual thumb–index finger opposition task was evaluated using a motion capture system, which quantified the coefficient of variation (COV) between bilateral finger movements. The subjective ADL difficulty scores were significantly higher in adults with ASD than in controls (p = 0.003). The COV in adults with ASD was also higher than in controls (p = 0.025). A moderate correlation was found between bimanual task COVs and subjective ADL difficulty scores in adults with ASD (r = 0.56, p = 0.013). Thus, a discrepancy in bimanual coordination may increase the effort required to perform ADLs in adults with ASD.

Mitochondria in depression: The dysfunction of mitochondrial energy metabolism and quality control systems.

Depression is the most disabling neuropsychiatric disorder, causing difficulties in daily life activities and social interactions. The exact mechanisms of depression remain largely unclear. However, some studies have shown that mitochondrial dysfunction would play a crucial role in the occurrence and development of depression. To summarize the known knowledge about the role of mitochondrial dysfunction in the pathogenesis of depression. We review the recent literature， including 105 articles, to summarize the mitochondrial energy metabolism and quality control systems in the occurrence and development of depression. Some antidepressants which may exert their effects by improving mitochondrial function are also discussed. Impaired brain energy metabolism and (or) damaged mitochondrial quality control systems have been reported not only in depression patients but in animal models of depression. Although the classical antidepressants have not been specially designed to target mitochondria, the evidence suggests that many antidepressants may exert their effects by improving mitochondrial function. This brief review focuses on the findings that implicate mitochondrial dysfunction and the quality control systems as important etiological factors in the context of depressive disorders. It will help us to understand the various concepts of mitochondrial dysfunction in the pathogenesis of depression, and to explore novel and more targeted therapeutic approaches for depression.

Factors associated with informal, and professional care, and unmet care needs in persons with deficits in activities of daily living in Austria. Results of two repetitive population-based surveys in people aged ≥65 years.

Introduction: Europe’s population is growing older, a trend that is projected to continue. Increased life expectancy means, older individuals are at risk of falls, hip fractures, long-term health conditions, re-hospitalization, which leads to the possibility of increased time spent in poor health. Hence, it is paramount to identify the diverse factors influencing the ageing process and subsequent limitation in Activities of Daily Living (ADLs)—eating and drinking independently, getting up and sitting down, dressing and undressing, using the toilet, and bathing or showering. Evidence shows worsening disability and developing new difficulty in ADLs has become more common with age, and leads to reduced quality of life, loss of independence and increased dependency and the increased need for care.&#x0D; Methods: Data was obtained from the Austrian Health Interview Surveys. 2931 and 2922 study participants aged ≥65 from 2014 and 2019, respectively, were included in the analysis. Three binary logistic regression was conducted with informal care, professional care and unmet care needs as dependent variable, and socio-demographic, health-related, and lifestyle-related parameters as independent variables, and the latter were mutually adjusted for each other.&#x0D; Results: In 2014, 12.8% of men and 17.9% of women, respectively, had difficulty in at least one ADL domain, compared to 19.2% and 25.7%, in 2019 (p&lt;0.001). Of men and women with ADL deficits, 50.2% and 50.0% sought help from family members or friends, 14.1% and 27.5% received help from professional caregivers, and 17.4% and 30.4% said they would need more help than they actually get. The probability of both informal and professional care with ADL deficits increased significantly from 2014 to 2019 (OR; 95% CI: 1.88; 1.47-2.41; 2.42; 1.76 -3.33), however, there was no change in unmet care needs (1.06; 0.81-1.39). Male sex was associated with professional care (1.67; 1.16-2.40) and unmet care needs (2.04; 1.48-2.82). Higher age was associated with all three measures of care (2.54; 1.96-3.30; 2.77; 2.00-3.85; 2.09; 1.56-2.79). Lower education was associated with informal care (2.90; 1.57-5.35 for primary education; 2.53; 1.38-4.64 for secondary education). Being born in other European states (EU or EFTA) was associated with a higher chance for professional care (3.11; 1.93-5.02) and unmet care needs (1.90; 1.22-2.95). Living in a big city was negatively associated with informal care (0.60; 0.44-0.83). Not living in a relationship was negatively associated with informal (0.55; 0.42-0.73) and positively with professional care (2.18; 1.56-3.06). Having at least one chronic disease was associated with informal care (2.16; 1.56-3.00) and unmet care needs (2.56; 1.69-3.88). Lack of physical activity was associated with all three care parameters (2.90; 1.32-4.28; 11.87; 2.03-69.45; 2.09; 1.02-4.29). Being underweight was associated with a higher chance for informal care (3.33; 1.11-10.01), and obesity with unmet care needs (1.49; 1.05-2.13).&#x0D; Conclusions: Socio-economic, health and lifestyle-related factors are significantly associated with formal and professional and unmet care needs in older people with ADL deficits. To deliver a sustainable integrated care for older people in Europe, the importance of physical health, social, cultural, and emotional needs must be recognized and supported in all levels of care.

EMPLOYMENT AS A FORM OF SOCIAL PARTICIPATION AMONG OLDER ADULTS: LINKS TO COGNITIVE AND FUNCTIONAL HEALTH

Abstract Within the active aging literature, studies on social participation and health concur that people who are better socially integrated and engage in social activities tend to have better physical, mental, and cognitive health. This study revisits the literature by aiming to address three primary knowledge gaps in prior literature: 1) we explicitly examine the change within the 5-year-interval in cognition, activities of daily living (ADL), instrumental activities of daily living (IADL) associated with social participation five years prior; 2) we examine diversity in participation’s association with not only cognitive function, but also ADL and IADL, which we lack knowledge of; 3) we conceptualize employment in later life as a kind of social participation, a part of older adults’ lives that is overlooked in the social participation literature. We also examine whether the relationship between social participation and cognition, ADL, and IADL is the same for men and women, and for those employed and those not employed. The study finds that neighborhood participation at a high level indicates worse cognitive, ADL, and IADL outcomes 5 years later, and a higher level of neighborhood participation is more indicative of worse cognitive outcomes for men than for women. Full-time employment predicts better cognitive, ADL, and IADL outcomes 5 years later. We also find evidence that full-time work creates a stronger buffer against cognitive decline, developing ADL difficulties, and IADL difficulties, even among older adults who socialize with family and friends, participate in the community, and the neighborhood at a high level, respectively.

Exploring the Intersectionality of Place and Gender Among Older Adults in Ghana: An Examination of Women's Disability Disadvantage.

Ghana's older adult population is growing rapidly and is projected to double by 2050. It is well-documented that social, health, and housing factors influence segmented aging trajectories that lead to disparate rates of disability. However, little is known about how the intersection of place (i.e., urban and rural) and gender (i.e., woman and man) inform rates of disability among older Ghanaians. We seek to examine this gap in the literature through an intersectional approach. Using logistic regression with Wave 1 (2007/2008) data from the World Health Organization's Study on global AGEing and adult health (SAGE) Ghana, we investigate the prevalence of reporting activities of daily living (ADL) disability among respondents ages 50+ (n = 4,106). To document gender differences by place, we compute separate adjusted odds ratio models among urban and rural respondents. We also control for health, social, and housing factors that might explain gender differences. Compared to urban men, urban women's ADL disability disadvantage was explained by marital status, particularly widowhood. In contrast, rural women consistently reported an ADL disability disadvantage when compared to rural men. Additionally, we found that the morbidity profiles of those who reported ADL disability differed by place and that certain ADL difficulties (i.e., bed transferring and toileting) were especially common among women respondents. Women, regardless of urban or rural residence, were especially vulnerable to ADL disability. Marital status, particularly widows, explained the difference in disability risk between urban men and urban women. This finding suggests that urban women's risk of ADL disability is attenuated during the partnership. Also, we speculate that varied morbidity associations with ADL disability are due to different stressors in urban versus rural environments. These findings also generate further interest in about rural women's disability disadvantage.

216 The relationship between anxiety and physical functional decline in older Irish adults: analysis of the Irish Longitudinal Study on Ageing

Abstract Background Research has shown the prevalence of anxiety in the older adult population and its significant impact on physical health. The Irish population is ageing and will have an increasing proportion of the population experiencing physical functional decline. Both anxiety and physical functional decline are associated with reduced quality of life and increased healthcare costs. The aim of this study was to explore if there is an association between anxiety and physical functional decline in older Irish adults. Methods This study used data from the Irish Longitudinal Study on Ageing (TILDA). The sample cohort were derived from those who had completed the Hospital Anxiety and Depression Scale (HADS-A) and who reported having difficulty with Activities of Daily Living (ADL) at Wave 1. This cohort were analysed at Wave 2 for a possible association between anxiety, as measured by the HADS-A and physical functional decline, as measured by an ADL self-reporting questionnaire and a Timed Up and Go (TUG). Results The sample cohort consisted of 535 participants. The result of the logistic regression found that the odds of continuing to report an ADL difficulty at Wave 2 are 1.78 (95% Confidence Interval [CI]: 1.15, 2.76) times higher for those with anxiety compared to those without and is statistically significant at p = 0.029. The result of the logistic regression analysis found that those with anxiety are more likely to have a longer TUG time (12.4 sec) than those without (11.19 sec) and the result is statistically significant (p = 0.023). Conclusion Anxiety is a mental health condition that has a significant impact on physical health. This study has established that there is an association between anxiety and physical functional decline in the older adult population in Ireland. Further research is needed to establish the nature and directionality of the relationship.

Prevalence and correlates of loneliness in the later life-insights from Longitudinal Ageing Study in India (LASI) Wave-1.

Loneliness is a psychosocial problem that can affect anyone at any age in any circumstances, but it has become a serious issue of concern among the elderly. The present study aims to examine the overall and state and union-territories-wise prevalence of loneliness among India's elderly population and exploring the correlates of loneliness in old age. The study is based on secondary data from Longitudinal Ageing Study in India (LASI) Wave-1 (2017-2018) data collected from a total of 30,394 older adults aged 60 and above excluding missing responses. Frequent loneliness was measured using a single question asking how often you feel alone. Descriptive statistics, the Chi-square test, and bivariate logistic regression were used to meet the objectives. The statistical significance was set at <0.05. 13.4% of elderly reported frequent loneliness. The prevalence of loneliness among elderly was found to be maximum in Andaman and Nicobar Island and minimum in Tripura. Age, current marital status, region, religion, MPCE quintile, number of chronic conditions, number of Activities of Daily Living (ADL), and Instrumental Activities of Daily Living (IADL) difficulties, involvement in physical activity, involvement in yoga/meditation, number of social networks, participation in social activities, and involvement in leisure activities like reading books, watching TV, or using computer were found to be significantly associated with loneliness. Not being in a marital union, having more than two chronic conditions, more than two ADL and IADL difficulties, being physically inactive, non-involvement in Yoga/Meditation, and small social network are associated with higher loneliness.

Internet access and older adults' health: Evidence from China

In the context of China's rapid population aging and internet expansion, this study examines the impact of information and communication technologies on the of older adults’ health. Using the China Health and Retirement Longitudinal Study 2011–2018, we find that internet access improves older adults' self-reported health, mental health, and activities of daily living (ADL). Further investigations provide evidence for several underlying mechanisms, including improving social participation, promoting healthy behaviors, and encouraging intergenerational interactions. Heterogeneity analyses show that disadvantaged groups, such as those with any ADL difficulty and without social participation or a spouse, benefit more from internet access.

Clustering populations by health and social care with multiple long-term conditions: a cohort study - the English Longitudinal Study of Ageing (ELSA).

The integration of health and social care services is a potential solution for improving care, despite monetary constraints and increasing demand. How two or more multiple long-term conditions (MLTC) cluster, interact and associate with socioeconomic factors, and affect access to unscheduled primary healthcare services is understudied. To cluster an MLTC population by health and social care, examine clusters, and quantify associations with health outcomes. A retrospective cohort study was conducted using the ELSA database (2002 to 2019) on 19802 participants aged ≥50 years. Ten major health conditions, and social care need, including difficulty in activities of daily living (ADL) and mobility, for example, were used to cluster MLTC by latent class modelling. Multivariate logistic regression models were used to establish further association. The mean age of the participants at baseline (wave 2) was about 66 years and 55% of participants were female, with more than 60% developing MLTC in their lifetime (waves 2 to 9). Of the five distinct latent clusters, cluster 5 was the most significant cluster composed of lung diseases, stroke, dementia, and high ADL and mobility difficulty scores. The majority of the participants were aged 70-79 years, female, and married. The odds of having a longer nursing home stay were 8.97 (95% confidence interval = 4.36 to 18.45), and death was 10% higher in this cluster compared to the highest probability cluster 4 in the maximally adjusted regression model. This study identified MLTC clusters by social care need with the highest primary care demand. Targeting clinical practice to prevent MLTC progression for these groups may lessen future pressures on primary care demand.

Impact of Light Conditions on Visual Performance following Premium Pseudophakic Presbyopia Corrections.

The primary objective of this study was to objectively compare the visual performance of patients following premium pseudophakic presbyopia corrections in different light combinations for near- and intermediate-vision activities of daily living (ADLs). This is a prospective, comparative study. A total of 75 patients populated three study groups: G1-patients with bilateral trifocal implantation, G2-patients with bilateral bifocal implantation, and G3-patients with bilateral monofocal implantation. All participants addressed 10 ADLs in nine combinations of light temperature (3000 K, 4000 K, and 6000 K) and light intensity (25 fc, 50 fc, and 75 fc) and declared their subjectively optimal light combination while reading. G2 and G3 had the best total ADL scores in 6000 K/75 fc, while G1 had the best total ADL score in 4000 K/75 fc. Total ADL, easy ADL, and moderate difficulty ADL scores were significantly better in G2, while difficult ADL score was significantly better in G1. The majority of all groups selected 6000 K/75 fc as the most comfortable light combination, and no group selected 3000 K and 25 fc. In conclusion, trifocal patients benefit from intense daylight, while bifocal and monofocal patients benefit from intense, cold lighting. Trifocal patients present superior near-vision capacity in difficult near-vision daily tasks, while bifocal patients present superiority in easy and moderate-difficulty ADLs.

Associations between intrinsic capacity, functional difficulty, and fall outcomes among older adults in India

The construct of intrinsic capacity (IC) in the context of integrated care for older adults emphasizes functional assessment from a holistic perspective. It provides reliable and comparable insights on subsequent functioning and disability. Given the paucity of research on IC and health outcomes in low- and middle-income countries (LMICs), the present study examined the association of IC with geriatric conditions of functional limitations and multiple fall outcomes among older adults in India. The data used for analysis come from the first wave of the Longitudinal Aging Study in India (LASI), 2017–2018. The final sample size contains 24,136 older adults (11,871 males and 12,265 females) age 60 years or above. Multivariable binary logistic regression is employed to examine the association of IC and other explanatory factors with outcome variables of difficulty in activities of daily living (ADL) and instrumental activities of daily living (IADL), falls, fall injury, and multiple falls. Of the total sample, 24.56% of older adults were observed to be in the high IC category. The prevalence of ADL difficulty, IADL difficulty, falls, multiple falls and fall-related injury is estimated to be 19.89%, 45.00%, 12.36%, 5.49% and 5.57%, respectively. Older adults who reported high IC had a significantly lower prevalence of ADL difficulty (12.26% vs 22.38%) and IADL difficulty (31.13% vs 49.52%) than those who reported low IC. Similarly, a lower prevalence of falls (9.42% vs 13.34%), fall-related injury (4.10% vs 6.06%) and multiple falls (3.46% vs 6.16%) were reported among those who had high IC. After adjusting for a large number of confounders such as age, sex, health-related attributes and lifestyle behaviors, older adults with high IC had significantly lower odds of ADL difficulty [aOR: 0.63, CI: 0.52–0.76], IADL difficulty [aOR: 0.71, CI: 0.60–0.83], falls [aOR: 0.80, CI: 0.67–0.96], multiple falls [aOR: 0.73, CI: 0.58–0.96] and fall-related injury [aOR: 0.78, CI: 0.61–0.99]. That a high IC was independently associated with a lower risk of functional difficulty and fall outcomes in later life is of enormous value in predicting subsequent functional care needs. More specifically, the findings here imply that because regular IC monitoring can predict poor health outcomes in older adults, improvements in IC should be prioritized while formulating disability and fall prevention strategies.

Examining the Association of Pain and Pain Frequency With Self-Reported Difficulty in Activities of Daily Living and Instrumental Activities of Daily Living Among Community-Dwelling Older Adults: Findings From the Longitudinal Aging Study in India.

We examined the prevalence and associations of self-reported difficulty in activities of daily living (ADL) and instrumental activities of daily living (IADL) with pain among community-dwelling older adults in India. We also explored the interaction effects of age and sex in these associations. We used the Longitudinal Ageing Study in India (LASI) Wave 1 data (2017-2018). Our unweighted sample included 31,464 older adults aged 60 years and above. Outcome measures were having difficulty in at least 1 ADL/IADL. We conducted multivariable logistic regression analyses to examine the association of pain with functional difficulties controlling for selected variables. A total of 23.8% of older adults reported ADL and 48.4% reported IADL difficulty. Among older adults who reported pain, 33.1% reported difficulty in ADL and 57.1% reported difficulty in IADL. The adjusted odds ratio (aOR) for ADL was 1.83 (confidence interval [CI]: 1.70-1.96) and for IADL was 1.43 (CI: 1.35-1.51) when respondents reported pain compared with those without pain. Older adults who reported frequent pain had 2.28 and 1.67 times higher odds of ADL (aOR: 2.28; CI: 2.07-2.50) and IADL difficulty (aOR: 1.67; CI: 1.53-1.82) compared with those with no pain. Additionally, age and sex of the respondents significantly moderated the associations of pain and difficulty in ADL and IADL. Given the higher prevalence and likelihood of functional difficulties among older Indian adults who experienced frequent pain, interventions to mitigate pain in this vulnerable population are needed to ensure active and healthy aging.

코로나19 시기, 성인 장애인의 일상생활활동 어려움 비교 분석 : 국가 단위 실증 조사 자료 기반으로

Objectives: This study purposed to analyzed of safety awareness, quarantine, and difficulties in daily life activities experienced by people with disabilities in the COVID-19 situation by type of disability. It is an empirical analysis study to derive what the country needs to improve in the COVID-19 pandemic by type of disability. Methods: The 2020 Survey on the Status of Persons with Disabilities a large-scale sample data at the national level was used. 4,590 external physical disabilities, 1,191 internal organ disabilities, and 879 mental disabilities were studied. Using the SPSS 26.0 program, frequency analysis and chi-square test were used to analyze. Results: First, there was a statistically significant difference in safety awareness from disasters and accidents by disability type. It was recognized that external physical functional disabilities and mental disabilities were relatively dangerous compared to internal organ disabilities. Second, people with mental disabilities had relatively greater difficulties in obtaining information and purchasing and using quarantine equipment than other types of disabilities. Third, due to COVID-19, it was found that people with disabilities have great difficulties in daily activities such as going out, medical use, and emotional difficulties. Fourth, during the COVID-19 period, the people with disabilities had the largest support for quarantine products. Fifth, the demand for facilities and equipment in preparation for disasters considering the characteristics of disabilities was the highest as a national improvement to resolve the difficulties of people with disabilities. Conclusion: People with disabilities are suffering from difficulties in their daily lives activity such as going out, medical use, and emotional difficulties during the COVID-19 period, and more support for mental health-related health education programs is required.

Migration status, physical limitations and associated self-rated health: a study of older Indian adults

BackgroundMigrant status with mobility impairment becomes a double burden for health and wellbeing of older adults. This study examined the independent relationships and multitude effects between migrant status, functional and mobility impairments and poor self-rated health (SRH) among older Indian adults.MethodsThis study utilised nationally representative Longitudinal Ageing Study in India wave-1 (LASI) data, including a sample of 30,736 individuals aged 60 years and above. The main explanatory variables were migrant status, difficulty in activities of daily living (ADL), difficulty in instrumental activities of daily living (IADL) and mobility impairments; and the outcome variable was poor-SRH. Multivariable logistic regression and stratified analyses were used to fulfil the study objectives.ResultsOverall, about 23% of older adults reported poor-SRH. Reporting poor-SRH was more prevalent (28.03%) among recent migrants (less than ten years). The prevalence of reporting poor-SRH was significantly higher among older adults who had mobility impairment (28.65%), difficulty in ADL or IADL (40.82% & 32.57%). Migrant older adults (regardless of duration) who had mobility impairment had significantly greater odds of reporting poor-SRH compared with non-migrant older adults who did not have mobility impairment. Similarly, older respondents who had problems in ADL and IADL with migration status had higher odds of reporting poor-SRH than their non-migrant counterparts with no such problems.ConclusionsThe study revealed the vulnerability of migrant older adults with functional and mobility disability, as well as those with limited socioeconomic resources and suffering from multimorbidity on rating their perceived health. The findings can be utilised to target outreach programmes and provision of services for migrating older individuals with mobility impairments and enhance their perceived health and ensure active ageing.

Feasibility of a combined intermittent theta-burst stimulation and video game-based dexterity training in Parkinson’s disease

BackgroundPersons with Parkinson’s disease (PD) often exhibit difficulties with dexterity during the performance of activities of daily living (ADL), inter alia due to dysfunctional supplementary motor area (SMA). Combined intermittent theta-burst stimulation (iTBS) over the SMA followed by video game-based training (VBT) may therefore improve dexterity related ADL. The VBT may induce high flow levels related to high performance during the training. The aim of this study is to evaluate the feasibility of a combined iTBS-VBT intervention in persons with PD.MethodsA total of nine persons with PD (mean age 63.3 ± 8.76 years) with self-reported difficulties with dexterity related ADL were included in this pilot iTBS-VBT study. All participants received either iTBS or sham stimulation over the SMA followed by a 45-min VBT, three times a week for a total of three weeks. Feasibility was measured by means of the adherence rate and the system usability (System Usability Scale). Moreover, flow was measured after the last VBT session.ResultsAdherence rate was excellent with 100%. High system usability scores (i.e., mean 80%, range 55–97.5) and a significant Spearman’s correlation with the Flow State Scale (r = .762, p = .017) further point to the high feasibility of the VBT. Neither demographic variables nor difficulties in dexterity related ADL affected the usability of the VBT.ConclusionThis study demonstrates the high feasibility of a combined iTBS-VBT intervention. Moreover, the level of self-reported usability was related to flow experience. Whether this kind of combined iTBS-VBT intervention improves dexterity will be evaluated in a randomized controlled trial.Trial registration clincaltrials.gov NCT04699149, date of registration 1. June 2021

Decreased Physical and Daily Living Activities in Patients with Peripheral Arterial Disease on Hemodialysis.

Decreased physical activity and activities of daily living (ADL) in patients on hemodialysis (HD) are associated with a poor prognosis. Additionally, comorbid peripheral arterial disease is associated with further deterioration. We conducted a cross-sectional study of ADL difficulty and life-space assessment (LSA) in three groups of patients on hemodialysis according to their ankle-brachial index (ABI) values. The 164 patients were divided into ABI Low (ABI < 0.9), Normal (0.9 ≤ ABI < 1.3), and High (1.3 ≤ ABI) groups, and compared using analysis of covariance with LSA and ADL difficulty adjusted for age. The Kihon checklist (KCL) was used to assess the presence of frailty. The LSA was lower in the Low group than in the High group (F = 3.192, p = 0.044). Similarly, the ADL difficulty was significantly lower in the Low group than in the Normal group (F = 3.659, p = 0.028). In the Low group, the proportion of patients with frailty was 47.1% and KCL physical was significantly lower, indicating that patients on HD with a lower ABI had a higher prevalence of frailty and lower LSA and ADL difficulty. In conclusion, patients on HD with decreased ABI values most likely exhibit decline in physical activity and ADL due to frailty and claudication.