Activities Of Daily Living Disability Research Articles

Disability in activities of daily living before hospitalisation and clinical outcomes following acute-phase rehabilitation in older individuals with cardiovascular disease

Abstract Background Older individuals with cardiovascular disease (CVD) frequently complicate disability in activities of daily living (ADLs), defined as needing assistance performing ADLs, which is at risk for further functional decline and higher mortality. Although acute-phase physical rehabilitation has been recently highlighted for its effectiveness on functional outcomes in older individuals with CVD, the effectiveness in those with pre-hospitalization ADLs disability is uncertain. Purpose To investigate the association between the ADLs disability before hospitalisation and outcomes after acute-phase rehabilitation, including physical function changes during hospitalisation and clinical events after hospital discharge in older individuals with CVD. Methods We studied 2792 individuals aged ≥65 admitted to a university hospital for CVD treatment and received inpatient physical rehabilitation tailored for each patient. The information on disability in ADLs before admission was obtained through interviews about difficulty performing basic ADLs, including feeding, bathing, toileting, dressing, and ambulating. The primary outcome was the Short Physical Performance Battery (SPPB), measured at the initiation of inpatient rehabilitation as a baseline and at hospital discharge to assess the changes in physical function during hospitalisation. We also investigated the five-year composite events of all-cause death and/or rehospitalisation due to heart failure after discharge. The repeated analysis of covariance adjusted for clinical characteristics was used to examine the change in SPPB between ADLs status. We also analysed the association between SPPB change after acute-phase rehabilitation and incidences of composite events in individuals with or without ADLs disability. Results Individuals with ADLs disability before hospitalisation were observed in 163 (5.8%) patients, who showed older age, higher prevalence of heart failure and comorbidities, and lower SPPB at baseline than those with ADLs independent. Conversely, SPPB was significantly higher at hospital discharge than at baseline, even in patients with pre-hospitalization ADLs disability and without interaction between the ADL status (P=0.091, Figure 1). The negative change in SPPB was observed only in 240 (8.6%), and its rate was higher in individuals with ADLs disability than those without (14.2% vs 7.8%, P=0.007). During the median follow-up of 2.6years, the composite events occurred in 760 patients (27.2%), and the combination of negative change in SPPB with ADLs disability was only associated with higher incidences of composite events against preserved SPPB with ADLs independent as reference (adjusted hazard ratio: 2.57, 95% confidence intervals: 1.11–5.97, Figure 2). Conclusions Acute-phase rehabilitation may contribute to better changes in physical function, which is associated with a lower risk of clinical events in older individuals with CVD and pre-hospitalisation ADLs disability.Figure 2

Impact of inpatient cardiac rehabilitation on hospital-associated disability for older patients undergoing transcatheter aortic valve implantation: insight from the JROAD/JROAD-DPC database

Abstract Background Hospital-associated disability (HAD), a decline in the ability to perform activities of daily living (ADL) during hospitalization, is a modifiable target in the integrated care for older adults. Inpatient rehabilitation during the perioperative period is a part of a comprehensive cardiac rehabilitation (CR) program and plays a pivotal role in functional recovery and smooth reintegration into the home, community, and workplace after surgery. Prior research, including meta-analyses, have shown that outpatient CR participation after discharge of patients who underwent transcatheter aortic valve implantation (TAVI) and surgical aortic valve replacement is associated with a significant improvement in exercise capacity and indexes of ADL. However, the impact of inpatient CR on the occurrence of HAD remains unexplored. Purpose Using a large real-world nationwide database in Japan, the aim of this study was to determine the prevalence of HAD and the impact of inpatient CR participation on the development of HAD in older patients undergoing TAVI. Methods Older patients undergoing TAVI were extracted from the Japanese nationwide database (JROAD-DPC) from April 2014 to March 2021 and were divided into patients receiving inpatient CR (CR group) and non-CR group. HAD was defined as a decrease in the Barthel Index score ≥ 5 points at discharge relative to admission. Results Of 19,789 eligible patients, 17,066 (86%) underwent inpatient CR (average age, 84.3 ± 4.9 years; Woman, 65%). The overall prevalence of HAD was 9.6%, with a lower incidence in the CR group than those in the non-CR group (8.8% vs. 14.2%, p < 0.01). Participation in inpatient CR was associated with a significantly lower odds ratio (OR) of HAD in multivariate logistic regression analysis (adjusted OR, 0.62; 95% confidence interval [CI], 0.54–0.70; p < 0.01) and in inverse probability of treatment weighting-adjusted logistic regression analyses (adjusted OR, 0.82; 95% CI, 0.77–0.88; p < 0.01; Table). Analyses in subgroups of interest showed heterogeneity of the effects of inpatient CR with possible loss in patients with a body mass index of less than 18.5 kg/m² or BI score of less than 60 points at admission (Figure). Conclusions A substantial number of older patients undergoing TAVI developed HAD during perioperative period. Participation in inpatient CR was associated with a lower likelihood of HAD in TAVI recipients, but the benefit of inpatient CR for development of HAD was possibly lost in patients with a low BMI and low a BI score at admission, indicating the necessity of HAD-targeted multidisciplinary CR for lean patients with ADL disability before TAVI.Figure

Dynapenic abdominal obesity and activities of daily living disability among older adults residing in low- and middle-income countries

BackgroundDynapenic abdominal obesity (DAO) may be associated with an increased risk of disability. However, to date, this has not been investigated in low- and middle-income countries (LMICs), while the mediators are largely unknown.AimsTherefore, we aimed to investigate the association between DAO and activities of daily living (ADL) disability, and to identify potential mediators among older adults from six LMICs.MethodsCross-sectional, nationally representative data from the WHO Study on global AGEing and adult health were analyzed. Data on 20,198 adults aged ≥ 60 years were analyzed [mean (SD) age 69.3 (13.1) years; 54.1% females]. Dynapenia was defined as handgrip strength of < 26 kg for men and < 16 kg for women. Abdominal obesity was defined as waist circumference of > 88 cm for women and > 102 cm for men. DAO was defined as having both dynapenia and abdominal obesity. Disability was defined as severe or extreme difficulty in conducting at least one of six types of ADL. Multivariable logistic regression and mediation analysis were conducted.ResultsCompared to no dynapenia and no abdominal obesity, DAO was significantly associated with 2.08 (95%CI = 1.37–3.17) times higher odds for ADL disability Mediation analysis showed that diabetes (mediated percentage 4.7%), hypertension (7.2%), and angina (7.7%) were significant mediators in the association between DAO and ADL disability.ConclusionsDAO was associated with increased odds for ADL disability among older adults from LMICs. Future longitudinal studies are warranted to assess temporal associations, and whether addressing or preventing DAO can impact on future occurrence of disability.

Activities of Daily Living Disability Transition Patterns in Older Adults with Chronic Diseases: A Four-Year Cohort Study in China.

Older adults with chronic diseases often experience higher rates of Activities of Daily Living (ADL) disability, with research primarily examining the transition between states of ADL disability and non-disability. The current study aims to analyze the patterns and factors of mutual transitions between multiple different ADL disability states in older adults with chronic diseases. This longitudinal study utilized data from the Shanghai Elderly Care Unified Needs Assessment (SECUNA) spanning 2014 to 2017, with 2014 being the baseline. The study included older adults aged 60 years and older with chronic diseases. Using the Markov model, individuals were classified into three states: no ADL disability, mild ADL disability, and severe ADL disability. Transition patterns were analyzed by calculating the frequency, intensity, and probability of transition, and the influencing factors of six transition scenarios were evaluated. Older adults with mild ADL disability were more likely to experience improvement (transition intensity: 0.4731) rather than deterioration (transition intensity: 0.2226) in their ADL disability states. However, those with severe ADL disability faced challenges in improving their states (transition intensities: 0.0068 and 0.1204). Among the six ADL disability transition scenarios, place of residence was associated with four scenarios, age and economic sources were associated with three scenarios, sex was associated with two scenarios, and other factors were associated with one scenario. The transition patterns and factors differ among individuals with varying ADL disability states. It is essential for relevant agencies to implement tailored preventive healthcare strategies to effectively manage the health status of older adults with chronic diseases.

Patterns of intrinsic capacity trajectory and onset of activities of daily living disability among community-dwelling older adults.

Global population ageing has brought about new challenges for elderly care. Exploring intrinsic capacity (IC) over time, which is designed as a composite measure of an individual's physical and mental capabilities, is essential for promoting healthy ageing and preventing dependency, such as that emerging from disability in activities of daily living (ADL). We aimed to identify and examine the differences between classes of IC trajectory and onset of ADL disability. We conducted an observational study using data from three waves (2011-15) of the China Health and Retirement Longitudinal Study, comprising 2609 participants with 6034 observations. IC was measured by five domains, including locomotion, cognition, psychological, sensory capacities, and vitality. We used joint latent class modelling to identify distinct classes with similar patterns of IC trajectory and onset of ADL disability, as well as to explore the variation in IC trajectory and predict five-year risks of ADL disability considering the heterogeneity in the elderly population. The average baseline IC score was 7.15 (range: 0-15). We observed that IC scores slowly decreased with age, with 17.25% of participants developing ADL disability. We identified three classes of IC, which could be described as moderate health (class 1: n = 1634, 62.63%), at-risk (class 2: n = 716, 27.44%; had the highest risk of ADL disability), and optimal health (class 3: n = 259, 9.93%; had the lowest baseline risk of ADL disability). The probability of being in the moderate health class was decreased the most by emotional problems (odds ratio (OR) = 0.219; P < 0.001). Having a self-rated poor standard of living substantially reduced the chances of moderate (OR = 0.308; P = 0.001) and optimal health (OR = 0.110; P < 0.001). Observing IC trajectories and the onset of ADL disability can stratify the elderly into heterogeneous groups, as well as provide data for implementing person-centred care plans to reverse the trend and delay the adverse outcomes in clinical practice.

Interaction between tea consumption and genes on activities of daily living disability in older adults.

The effects of tea consumption on delaying aging and the onset of age-related disabilities have been reported; however, it is unclear whether these benefits are impacted by genes. This study aimed to examine the associations between tea consumption and activities of daily living (ADL) and explore the role of genetic factors. Data from 46,487 older adults aged 64-105 who participated in at least one data wave of the Chinese Longitudinal Healthy Longevity Survey (CLHLS) conducted in 2002, 2005, 2008, 2011, 2014, and 2018 were analyzed. Genetic data were produced using the Affymetrix Axiom™myDesign™ (384-format) Human Genotyping Array. The generalized estimation equation and multiple logistic regression models were constructed to examine the effects of tea consumption, polygenic risk score, and their interactions on ADL. Tea consumption was related to reduced ADL decline-the effect was statistically significant among men but not women. A significant interaction between tea consumption and polygenic risk score (PRS) was observed. Tea consumption was associated with a decreased risk of ADL disability only among individuals with a low PRS. These findings indicate that tea consumption plays a role in preventing disability in older adults with low polygenic risk.

Association between frailty and activities of daily living disability in older adults residing in a high-altitude Peruvian Andean community: the Aunqui-Andes study

BackgroundThe prevalence of frailty and activities of daily living (ADL) disability may be higher in high-altitude Andean regions, due to chronic hypoxia, malnutrition, and physical challenges. and their association is relevant. This study aimed to evaluate the association between frailty and ADL disability among older adults residing in the Totos district in Peru during the year 2022.MethodsA cross-sectional study was conducted in Totos district (mean altitude: 3286 m above sea level), located in Ayacucho, Peru, during 2022. A complete census was employed including residents aged 60 and above. The exposure variable was frailty, defined by fulfilling 3 or more criteria of the Fried phenotype. The outcome variable was ADL disability, defined as a score below 95 on the Barthel index. Generalized linear models with a Poisson family, logarithmic link function, and robust variances were employed to estimate crude prevalence ratios and adjusted prevalence ratios (aPRs), along with their corresponding 95% confidence intervals (CIs).ResultsWe evaluated 272 older adults with a mean age of 74 years, of whom 59.9% were female, 62.1% were cohabiting or married and 83.1% had not completed primary education. We found that 19.5% were frail, while 51.1% had ADL disability. In the adjusted regression model, we found frailty increased the prevalence of ADL disability (aPR = 1.77; 95%CI: 1.44–2.16; p < 0.001).ConclusionFrailty was associated with an increased prevalence of ADL disability. These findings could contribute to establishing government intervention plans to manage disability and frailty within the high-risk group comprising older adults living at high altitudes.

Association between frailty and subsequent disability trajectories among older adults: a growth curve longitudinal analysis from the Survey of Health, Ageing and Retirement in Europe (2004-19).

Frailty is associated with adverse health outcomes in ageing populations, yet its long-term effect on the development of disability is not well defined. The study examines to what extent frailty affects disability trajectories over 15 years in older adults aged 50+. Using seven waves of data from the Survey of Health, Ageing and Retirement in Europe (SHARE), the study estimates the effect of baseline frailty on subsequent disability trajectories by multilevel growth curve models. The sample included 94360 individuals from 28 European countries. Baseline frailty was assessed at baseline, using the sex-specific SHARE-Frailty-Instrument (SHARE-FI), including weight loss, exhaustion, muscle weakness, slowness, and low physical activity. Disability outcomes were the sum score of limitations in activities of daily living (ADL) and Instrumental ADL (IADL). Analyses were stratified by sex. Over 15 years, baseline frailty score was positively associated with disability trajectories in men [βADL = 0.074, 95% confidence interval (CI) = 0.064; P = .083; βIADL = 0.094, 95% CI = 0.080; P = 0.107] and women (βADL = 0.097, 95% CI = 0.089; P = .105; βIADL = 0.108, 95% CI = 0.097; P = .118). Frail participants showed higher ADL and IADL disability levels, independent of baseline disability, compared with prefrail and robust participants across all age groups. Overall, participants displayed higher levels of IADL disability than ADL disability. Study findings indicate the importance of early frailty assessment using the SHARE-FI in individuals 50 and older as it provides valuable insight into future disability outcomes.

Intrinsic capacity and recent falls in adults 80 years and older living in the community: results from the ilSIRENTE Study

BackgroundFalls in older adults significantly impact overall health and healthcare costs. Intrinsic capacity (IC) reflects functional reserve and is an indicator of healthy aging.AimsTo explore the association between IC and recent falls (≤ 90 days) in community-dwelling octogenarians from the Aging and Longevity in the Sirente geographic area (IlSIRENTE) study.MethodsThe Minimum Data Set for Home Care (MDS−HC) and supplementary questionnaires and tests were used to assess the five IC domains: locomotion, cognition, vitality, psychology, and sensory. Scores in each domain were rescaled using the percent of maximum possible score method and averaged to obtain an overall IC score (range 0−100).ResultsThe study included 319 participants (mean age 85.5 ± 4.8 years, 67.1% women). Mean IC score was 80.5 ± 14.2. The optimal IC score cut-off for predicting the two-year risk of incident loss of at least one activity of daily living (ADL) was determined and validated in a subset of 240 individuals without ADL disability at baseline (mean age 84.7 ± 4.4 years, 67.1% women). Participants were then stratified into low (< 77.6) and high (≥ 77.6) IC categories. Those with high IC (63.9%) were younger, more often males, and had lower prevalence of recent falls, disability, multimorbidity, and polypharmacy. Logistic regression models including IC as a continuous variable revealed a significant association between higher IC and lower odds of falls. This association was significant in the unadjusted (odds ratio [OR] 0.96, 95% confidence interval [CI] 0.94–0.98, p < 0.001), age- and sex-adjusted (OR 0.96, 95% CI 0.94–0.98, p < 0.001), and fully adjusted models (OR 0.96, 95% CI 0.93–0.99, p = 0.003). When considering IC as a categorical variable, unadjusted logistic regression showed a strong association between high IC and lower odds of falls (OR 0.31, 95% CI 0.16–0.60, p < 0.001). This association remained significant in both the age- and sex-adjusted (OR 0.30, 95% CI 0.15–0.59, p < 0.001) and fully adjusted models (OR 0.33, 95% CI 0.16–0.82, p = 0.007). The locomotion domain was independently associated with falls in the unadjusted (OR 0.98, 95% CI 0.97–0.99, p < 0.001), age- and sex-adjusted (OR 0.97, 95% CI 0.96–0.99, p < 0.001), and fully adjusted model (OR 0.98, 95% CI 0.96–0.99, p < 0.001).DiscussionThis is the first study using an MDS−HC-derived instrument to assess IC. Individuals with higher IC were less likely to report recent falls, with locomotion being an independently associated domain.ConclusionsLower IC is linked to increased odds of falls. Interventions to maintain and improve IC, especially the locomotion domain, may reduce fall risk in community-dwelling octogenarians.

Unveiling the arthritis divide: Exploring treatment response and impact in late-onset vs. young-onset rheumatoid arthritis.

Impact of osteoarthritis (OA) on the initial treatment response of rheumatoid arthritis (RA) by treat to target (T2T) practice was compared between the patients with an onset age ≥65 years old (late-onset RA [LORA]) and those with an onset age <65 years old (young-onset RA [YORA]). A retrospective study was conducted on the patients with RA, who were referred to our clinic without treatment between January 2021 and July 2022. Patients with grade ≥3 OA according to the Kellgren-Lawrence (K-L) classification either in the knee or hand were classified in the OA(+) group and others were in the OA(-) group. The clinical data were compared at the diagnosis and one year after the initial treatment between the groups for 74 LORA and 59 YORA patients, respectively. One year after starting treatment in the LORA patients, the OA(+) group had poorer disease activity control and greater disability in the several activities of daily living (ADL) than the OA(-) group. In the YORA patients, there were no differences in ADL disability between the groups. In the initial treatment of the LORA patients, the prevalence of OA was high, and impact of OA on LORA was larger than on YORA.

Total life expectancy and disability-free life expectancy and differences attributable to cigarettes’ smoking among Chinese middle-aged and older adults

ObjectivesMiddle-aged and older adults smoking for years are afflicted by smoking-related diseases and functional limitations; however, little is known about the effect of smoking on nonfatal conditions in middle and later life. This study aims to investigate the impact of smoking on both total life expectancy (TLE) and disability-free life expectancy (DFLE) and the variations in such effects by educational level in China.MethodsData were drawn from the China Health and Retirement Longitudinal Study (CHARLS), 2011–2018, with a total sample of 16,859 individuals aged 45 years or older involved in the final analysis. The Activities of Daily Living (ADL) scale was used to measure disability, and the population-based multistate life table method was used to estimate the differences in TLE and DFLE by smoking status and educational attainment.ResultsAt baseline, 28.9% of participants were current smokers, 8.5% were former smokers, and 62.6% never smoked. Approximately 5.6% were identified with ADL disability. Both current smokers and former smokers experienced lower TLE and DFLE than never smokers, and such differences were particularly prominent among men. Intriguingly, former smokers manifested a lower DFLE for both sexes and a lower TLE among women, though a longer TLE among men, compared with current smokers. Similar differences in TLE and DFLE by smoking status were observed for groups with different levels of education.ConclusionNever smokers live longer and healthier than current smokers and persons who quit smoking. Smoking was associated with greater reductions in TLE and DFLE among men. However, educational attainment might not moderate the adverse effect of smoking on both fatal and nonfatal conditions in the context of China. These findings have implications for disability prevention, aged care provision and informing policies of healthy aging for China and elsewhere.

Bidirectional, longitudinal associations between depressive symptoms and IADL/ADL disability in older adults in China: a national cohort study

IntroductionBased on the data from the China Health and Retirement longitudinal study (CHARLS), we aimed to investigate the bidirectional relationship between depressive symptoms and functional disability.MethodsData were collected across 3 waves from 2013 to 2018. The activities of daily living (ADLs) and the instrumental activities of daily living (IADLs) scales were used to measure functional disability and the CESD-10 was used to measure depressive symptoms. Cross-lagged models were performed to examine cross effect between depressive symptoms and functional disability across three waves.ResultsData on 10,092(mean [SD] age, 61.98[8.44] years; 3764 females [37.30%]) and 10,180 participants (mean [SD] age, 62.01[8.46] years; 3788 females [37.21%]) in IADL sample and ADL sample were included in the analyses. For IADL disability, the cross-lagged model shows a bidirectional association across three waves; the multivariable GEE model revealed that changes in CESD-10 score across waves were associated with worse IADL disability (β ranges: 0.08–0.10) and vice versa, worsen of IADL disability ascending developing of CESD-10 score (β ranges: 0.09–0.10). For ADL disability, the cross-lagged model shows a bidirectional association across three waves; the multivariable GEE model revealed that changes of CESD-10 score across waves were associated with worse IADL disability (β ranges: 0.08–0.10) and vice versa, worsen of IADL disability ascending developing of CESD-10 score (β ranges: 0.09–0.10).DiscussionStudy findings underscore a significant bidirectional between depressive symptoms and functional disability in older adults. Thus, simultaneous intervention should be taken to manage the mutual development of functional disability and depression.

Sex differences in the association of physical functions with hospitalization and mortality events among community-dwelling older adults with disabilities

This study aimed to investigate the role of sex in the association between physical function and the occurrence of hospitalization and mortality among community-dwelling older adults with impairments in activities of daily living (ADL). Participants included community-dwelling older adults aged ≥65 years with ADL disabilities. Physical functions (hand grip strength [HGS], knee extension muscle strength, and comfortable walking speed [CWS]) were measured at baseline and analyzed for association with hospitalization and mortality by sex using Cox regression analysis, adjusted for potential confounders. In this Cox regression analysis, HGS was significantly associated with the occurrence of hospitalization and mortality in women, whereas CWS was significantly associated with the occurrence of hospitalization and HGS with mortality in men. These findings reveal that the predictive ability of adverse events in community-dwelling older adults with disabilities differs by sex, requiring outcome- and sex-specific prognostication.

Interactions between patterns of multimorbidity and functional status among hospitalized older patients: a novel approach using cluster analysis and association rule mining

BackgroundMultimorbidity (MM) is generally defined as the presence of 2 or more chronic diseases in the same patient and seems to be frequently associated with frailty and poor quality of life. However, the complex interplay between MM and functional status in hospitalized older patients has not been fully elucidated so far. Here, we implemented a 2-step approach, combining cluster analysis and association rule mining to explore how patterns of MM and disease associations change as a function of disability.MethodsThis retrospective cohort study included 3366 hospitalized older patients discharged from acute care units of Ancona and Cosenza sites of Italian National Institute on Aging (INRCA-IRCCS) between 2011 and 2017. Cluster analysis and association rule mining (ARM) were used to explore patterns of MM and disease associations in the whole population and after stratifying by dependency in activities of daily living (ADL) at discharge. Sensitivity analyses in men and women were conducted to test for robustness of study findings.ResultsOut of 3366 included patients, 78% were multimorbid. According to functional status, 22.2% of patients had no disability in ADL (functionally independent group), 22.7% had 1 ADL dependency (mildly dependent group), and 57.4% 2 or more ADL impaired (moderately-severely dependent group). Two main MM clusters were identified in the whole general population and in single ADL groups. ARM revealed interesting within-cluster disease associations, characterized by high lift and confidence. Specifically, in the functionally independent group, the most significant ones involved atrial fibrillation (AF)-anemia and chronic kidney disease (CKD) (lift = 2.32), followed by coronary artery disease (CAD)-AF and heart failure (HF) (lift = 2.29); in patients with moderate-severe ADL disability, the most significant ARM involved CAD-HF and AF (lift = 1.97), thyroid dysfunction and AF (lift = 1.75), cerebrovascular disease (CVD)-CAD and AF (lift = 1.55), and hypertension-anemia and CKD (lift = 1.43).ConclusionsHospitalized older patients have high rates of MM and functional impairment. Combining cluster analysis to ARM may assist physicians in discovering unexpected disease associations in patients with different ADL status. This could be relevant in the view of individuating personalized diagnostic and therapeutic approaches, according to the modern principles of precision medicine.

Factors Associated with Quality of Life in Patients with Dementia with Lewy Bodies: Additional Analysis of a Cross-Sectional Study.

Quality of life (QOL) and treatment needs of patients with dementia with Lewy bodies (DLB) and their caregivers are important factors to consider when developing treatment strategies. To investigate factors associated with QOL in patients with DLB, and to examine factors associated with activities of daily living (ADL) if ADL was associated with QOL. We previously conducted a questionnaire survey study to investigate the treatment needs of patients with DLB and their caregivers. This pre-specified additional analysis evaluated the Physical Component Score (PCS) and Mental Component Score (MCS) of the Short Form-8 for QOL, and the Movement Disorder Society-Unified Parkinson's Disease Rating Scale (MDS-UPDRS) Part II total score for ADL. In total, 231 patient- caregiver pairs and 38 physicians were included. Multivariable analysis of QOL showed that the MDS-UPDRS Part II total score (standard regression coefficient [β], - 0.432) was associated with the PCS, and presence of depression (β, - 0.330) was associated with the MCS. The severity of postural instability/gait disorder (PIGD) (β, 0.337) and rigidity (β, 0.266), presence of hallucinations (β, 0.165), male sex (β, 0.157), and use of "short stay" or "small-scale, multifunctional home care" (β, 0.156) were associated with worsened ADL. In patients with DLB, QOL was negatively impacted by severity of ADL disability and depression, and ADL was negatively impacted by severity of PIGD and rigidity, hallucinations, male sex, and use of "short stay" or "small-scale, multifunctional home care."

The bidirectional association between the disability in activities of daily living and depression: a longitudinal study in Chinese middle-aged and older adults

AimDepression and disability in activities of daily living (ADL) are common in middle-aged and older adults. This study investigated the bidirectional relationship between depression and disability in ADL in Chinese middle-aged and older adults.MethodsData from a baseline study of 17,596 participants from the China Health and Retirement Longitudinal Study (CHARLS) and two follow-up visits at 4 and 7 years were included. We designed Study A and Study B to explore the interaction between depression and disability in ADL in middle-aged and older people.ResultsIndividuals with disability in ADL at baseline had adjusted odds ratios (ORs) of 1.331 (1.118, 1.584) and 1.969 (1.585, 2.448) for developing depression compared with those without disability in ADL at the 4- and 7-year follow-ups, respectively. Individuals with depression at baseline had adjusted ORs of 1.353 (1.127, 1.625) and 1.347 (1.130, 1.604), respectively, for developing disability in ADL 4 and 7 years later.ConclusionsThere was a bidirectional relationship between depression and disability in ADL. Depression increased the risk of disability in ADL, but this risk did not increase with time, whereas the effect of disability in ADL on depression increased with time.

Loneliness, functional disability and lower urinary tract symptoms suggestive of benign prostatic hyperplasia in aging men: Insights from the China health and retirement longitudinal study

BackgroundResearch has demonstrated that social isolation and loneliness are linked to functional disability in older adults. With the intensification of global aging, functional disability and lower urinary tract symptoms suggestive of benign prostatic hyperplasia (LUTS/BPH) have become common public health issues affecting elderly men. MethodsThis study utilized data from the CHARLS database. The functional status of participants was evaluated through activities of daily living (ADL) and instrumental activities of daily living (IADL). Logistic regression analyses were employed to investigate variables associated with LUTS/BPH. ResultsUnivariate logistic regression revealed associations between loneliness (OR: 1.26; 95 % CI: 1.08–1.46) (excluding social isolation), ADL (OR: 2.17; 95 % CI: 1.86–2.52), IADL disability (OR: 1.37; 95 % CI: 1.16–1.60), and LUTS/BPH. Following rigorous adjustment for potential confounding factors, it was determined that ADL disability independently correlated with LUTS/BPH (OR: 1.92; 95 % CI: 1.17–3.17). ConclusionADL disability is significantly linked to an elevated risk of LUTS/BPH in Chinese elderly men. These findings enhance our understanding of the relationship between functional status and LUTS/BPH.

Functional disability and receipt of informal care among Chinese adults living alone with cognitive impairment

BackgroundAdults with cognitive impairment are prone to living alone in large numbers but receive relatively little attention. This study aimed to evaluate whether living alone with cognitive impairment was associated with a higher burden of functional disability but lack of informal care. Methods982 observations of adults living alone with cognitive impairment and 50,695 observations of adults living with others and with normal cognition were identified from 4 waves (2011/2012, 2013, 2015, and 2018) of the China Health and Retirement Longitudinal Study (CHARLS). A matched comparator was selected using propensity score matching (1:2). Functional disability included disability in Activities of Daily Living (ADL), Instrumental Activities of Daily Living (IADL), and mobility. The time of receiving informal care was measured in monthly hours. ResultsAdults living alone with cognitive impairment demonstrated significantly higher odds ratio of ADL disability (OR = 1.59, 95 % CI: 1.30, 1.95), IADL disability (OR = 1.19, 95 % CI: 1.00, 1.44), mobility disability (OR = 1.38, 95 % CI: 1.12, 1.70), but received fewer hours of informal care (β = −127.7 h per month, standard error = 25.83, P < 0.001), compared to the adults living with others and with normal cognition. ConclusionsThis study highlights the high burden of functional disability but low coverage of informal care among Chinese adults living alone with cognitive impairment and calls for more resources to be allocated to this vulnerable subpopulation to improve the functional health and to increase the provision of long-term care services.

Association between vitamin D insufficiency and depressive symptoms, and functional disability in community-dwelling Brazilian older adults: results from ELSI-Brazil study

Low serum 25(OH)D levels (< 30 nmol/L) have been associated with increased depressive symptom scores over time, and it is believed that functionality may play a mediating role in the relationship between 25(OH)D and depressive symptoms. To comprehend the association between these factors could have significant implications for public health policy. The aim of this study was to verify the association between simultaneous vitamin D insufficiency and depressive symptoms, and functional disability in community-dwelling older adults. This was a cross-sectional study with data from the Brazilian Longitudinal Study of Aging (ELSI-Brazil), collected between 2015 and 2016. The outcomes were functional disability assessed through basic activities of daily living (ADL) and instrumental activities of daily living (IADL). The exposures were vitamin D insufficiency (< 30 nmol/L) and depressive symptoms (≥ 4 points in 8-item version of the Center for Epidemiological Studies-Depression). Crude and adjusted Poisson regression was performed to estimate associations. A total of 1781 community-dwelling older adults included in this study, 14.6% had disability in ADL and 47.9% in IADL; 59.7% had vitamin D insufficient levels, and 33.2% depressive symptoms. The concomitant presence of vitamin D insufficient and depressive symptoms increased the prevalence of ADL by 2.20 (95% CI: 1.25; 3.86) and IADL by 1.54 (95% CI: 1.24; 1.91), respectively. Therefore, preventive strategies to keep older adults physically and socially active, with a good level of vitamin D, are essential to avoid depression and functional disability.

Association between depressive symptoms and sarcopenia among middle-aged and elderly individuals in China: the mediation effect of activities of daily living (ADL) disability

BackgroundDepressive symptoms and sarcopenia, often observed among middle-aged and elderly individuals, are significant health concerns in China, particularly given the country’s rapidly aging population. Depressive symptoms, characterized by persistent feelings of sadness and loss of interest, can significantly impact quality of life. Little is known about the underlying pathway connecting these two conditions.MethodsThe data for this study were derived from the China Health and Retirement Longitudinal Study (CHARLS). Depressive symptoms were evaluated using the Centre for Epidemiological Studies Depression (CSED) scale. Logistic regression analyses were employed to investigate the association between depressive symptoms, activities of daily living (ADL) disability, and sarcopenia, while adjusting for potential confounding factors. The selection of predictor variables, including social activity, chronic diseases, demographic factors, and lifestyle habits, was based on their known associations with mental health, physical functioning and sarcopenia. These variables were included to ensure a comprehensive adjustment for potential confounding factors and to provide a more accurate estimation of the relationship between depressive symptoms and sarcopenia. Additionally, mediation analysis was conducted to assess the mediating role of ADL disability in the relationship between depressive symptoms and sarcopenia.ResultsA comprehensive study was conducted on a total of 8,238 participants aged 45 years and older, comprising 3,358 men and 4,880 women. Logistic regression analyses were conducted to identify significant associations between depressive symptoms (OR = 1.30, P = 0.0269,95%CI = 1.03–1.63), ADL disability (OR = 1.94, P < 0.001,95%CI = 1.37–2.75) and sarcopenia. The results revealed significant relationships among these variables. Furthermore, mediation effect analyses demonstrated that ADL disability partially mediated the association between depressive symptoms and sarcopenia (estimated indirect effect: 0.006, 95% CI: 0.003, 0.008, proportion of mediation effect: 20.00%).ConclusionsThe study underscores a significant association between depressive symptoms and sarcopenia among middle-aged and elderly individuals in China, with ADL disability acting as a mediator. These findings offer novel insights for targeted health interventions. Future interventions should effectively combat sarcopenia by integrating psychological support with muscle-strengthening exercise programs. By addressing both depressive symptoms and ADL disability, clinicians and public health professionals can enhance outcomes for this demographic. Collaborative efforts across disciplines are essential for providing comprehensive health management tailored to the needs of middle-aged and elderly individuals. Future research should longitudinally assess the impact of such integrated interventions on sarcopenia prevention and depressive symptom alleviation. Additionally, investigating the role of social and environmental factors in mediating this relationship is crucial for developing more effective health strategies for this vulnerable population.