Activities Of Daily Living Limitations Research Articles

Depression and associated factors among older people in Vietnam: Findings from a National Aging Survey.

Depression is one of the most common mental health disorders among older people. Depressive symptoms are often overlooked and untreated in primary care settings. This study aims to assess the prevalence of depressive symptoms and associated factors among older people in Vietnam. The study analyzed data from the Vietnam National Aging Survey (VNAS) conducted in 2022 with a nationally representative sample of 3,006 older people aged 60 and over in 12 provinces. The 15-item Geriatric Depression Scale (GDS-15) was used to assess depressive symptoms. Bivariate and multiple logistic regression analyses were used to explore the association between depressive symptoms and other related factors such as sociodemographic and economic characteristics, social support, health status, Activities of Daily Living (ADL) and Instrumental Activities of Daily Living (IADL) limitations, chronic diseases, cigarette smoking status, alcoholic drinking, and domestic violence. The prevalence of depressive symptoms among older people was 20.2%. The associated factors that increase the odds of having depression among older people were female gender (OR = 2.21, 95% CI 1.34-3.62), living in rural areas (OR = 1.83, 95% CI 1.15-2.89), the poorest quintile (OR = 2.26, 95% CI 1.39-3.66), self-rated poor health (OR = 11.68, 95% CI 4.96-27.49), ADL limitations (OR = 2.12, 95% CI 1.51-2.99), IADL limitation (OR = 1.61 95% CI 1.16-2.25), and experiencing domestic violence in the last 12 months (OR = 6.66, 95% CI 4.00-11.05). Depression symptoms were prevalent among older people in Vietnam. Depression screening for older people should be included in primary care settings for early identification and treatment of depression.

Limitations and determinants of Activities of Daily Living among older adults in Assam: LASI (Wave-1) analysis

BackgroundThe entire concept of aging gracefully involves maintaining the independence and quality of life among the older adults, with a particular emphasis on the ability to perform Activities of Daily Living (ADL). The number of older adults in the country has grown subsequently, with their dependence on care-givers which has also increased. ObjectivesThe study attempts to understand the prevalence and determinants of the limitations of Activities of Daily Living (ADL) among older adults aged 60 and over living in Indian state of Assam. MethodsThe study use the Longitudinal Ageing Study in India (LASI, 2017–18) Assam data, and information was sought from 816 older adults aged 60 years and above. An index of ADL was created on a scale of two levels, having no levels of ADL and having ADL limitation. ResultsAround 18 % of the older adults reported ADL disability. Females had higher prevalence of ADL than males (22 % v/s 14 %). Those aged 70 plus were also more likely to have ADL functional limitation (OR = 1.78, CI = 1.61–1.96) than those aged 60–69 years. Older adults not involved in any physical activity were more likely to report ADL limitation (OR = 1.50, CI = 1.34–1.68) than their counterparts. ConclusionThe findings of the study call for action to have geriatric care centres as the need of the hour, to promote exercise and other recreational activities that will help the old keep physically active and increase social-participation.

A study to assess the health care utilization and the activities of the daily living status amongst the geriatric population residing in urban and rural field practice areas of a medical college in Tamil Nadu

Background: The prevalence of disability in the activities of daily living (ADL), could probably have a significant impact on the healthcare utilization amongst the geriatric population with disability. Methods: A cross-sectional study in the urban and rural field practice areas of a medical college in Tamil Nadu, using a sample size of 402 elderly individuals. Using the pre-tested, semi-structured questionnaire; the socio-demographic variables, healthcare utilization variables and a comprehensive Katz ADL assessment were used. Results: The overall prevalence of ADL limitation amongst the elderly was seen in 49 (12.2%) elderly individuals mostly with a score of 5 (mildest form) was found in 36 (74%) of the elderly. There was an association found between the follow-up care at health centres, frequency of visits, distance from home to health centres and the ADL limitation with a P- value less than 0.05 (C.I.-95%) using the Pearson chi-square test using SPSS v.26.0. Conclusions: The association between ADL limitation and healthcare utilization calls for initiatives at the family and community level.

Moderating Effects of Informal Care on the Relationship Between ADL Limitations and Adverse Outcomes in Stroke Survivors.

Stroke survivors with limitations in activities of daily living (ADL) have a greater risk of experiencing falls, hospitalizations, or physical function decline. We examined how informal caregiving received in hours per week by stroke survivors moderated the relationship between ADL limitations and adverse outcomes. In this retrospective cohort, community-dwelling participants were extracted from the National Health and Aging Trends Study (2011-2020; n=277) and included if they had at least 1 formal or informal caregiver and reported an incident stroke in the prior year. Participants reported the amount of informal caregiving received in the month prior (low [<5.8], moderate [5.8-27.1], and high [27.2-350.4] hours per week) and their number of ADL limitations (ranging from 0 to 7). Participants were surveyed 1 year later to determine the number of adverse outcomes (ie, falls, hospitalizations, and physical function decline) experienced over the year. Poisson regression coefficients were converted to average marginal effects and estimated the moderating effects of informal caregiving hours per week on the relationship between ADL limitations and adverse outcomes. Stroke survivors were 69.7% White, 54.5% female, with an average age of 80.5 (SD, 7.6) years and 1.2 adverse outcomes at 2 years after the incident stroke. The relationships between informal caregiving hours and adverse outcomes and between ADL limitations and adverse outcomes were positive. The interaction between informal caregiving hours per week and ADL limitations indicated that those who received the lowest amount of informal caregiving had a rate of 0.12 more adverse outcomes per ADL (average marginal effect, 0.12 [95% CI, 0.005-0.23]; P=0.041) than those who received the highest amounts. Informal caregiving hours moderated the relationship between ADL limitations and adverse outcomes in this sample of community-based stroke survivors. Higher amounts relative to lower amounts of informal caregiving hours per week may be protective by decreasing the rate of adverse outcomes per ADL limitation.

Sensory impairments and depressive symptoms in Europe: a cross-national cohort study

Objectives To investigate the associations between sensory impairments and the development of depressive symptoms across sex, age, and European regions, and to examine the mediating role of cognitive function, activities of daily living (ADL), and physical activity. Method A cohort study including 56,847 Europeans aged 50+ participating in at least two waves of the Survey of Health, Ageing and Retirement in Europe (SHARE). Associations were analyzed using mixed effects logistic regression models considering several confounders. Results Overall, 17.8% developed depressive symptoms. Compared to participants with good vision and hearing, those with vision impairment (VI) (odds ratio (OR) = 1.35, 95% confidence interval (CI) 1.27–1.44), hearing impairment (HI) OR = 1.32, 95% CI 1.21–1.43, and dual sensory impairment (DSI, i.e. VI and HI) (OR = 1.93, 95% CI 1.75–2.13) had increased odds of depressive symptoms. The associations were consistent across sex and European regions but became stronger with advancing age among men. Dose-response relationships were found for all associations. Mediation analyses revealed that preventing cognitive decline, ADL limitations, and physical inactivity would eliminate 15.0%, 11.5%, and 21.4% of the total effect for VI, HI, and DSI, respectively. Conclusion Our findings emphasize the importance of preventing sensory impairments to avoid depressive symptoms.

Clinical and radiological aspects of the forearm in children with congenital radioulnar synostosis: a cohort study

Introduction The upper limb functional limitations in congenital radioulnar synostosis may significantly affect the daily activities of patients. Classifications of the condition are descriptive and have limited practical application.Purpose Determine a functionally significant quantitative criterion for anatomical changes in the forearm.Material and methods 92 children (136 forearms) with congenital radioulnar synostosis were examined for limitations in activities of daily living (ADL), health-related quality of life measured with PedsQL questionnaire; pronation of the forearm and radiographic parameters. A comparative and correlation analysis, ROC analysis were performed to determine the relationship between the forearm pronation and limitations of ADL.Results Statistically significant correlations were revealed between symptoms and the forearm alignment (p &lt; 0.01, rxy = 0.5); subluxation of the ulnar head and forearm alignment (p &lt; 0.001, rxy = 0.6); bowing deformity of the radius, forearm alignment and subluxation of the ulnar head and between the length of the forearm bones and bowing deformity of the radius (p &lt; 0.05, rxy = 0.4 and rxy = 0.5). A statistically significant inverse correlation was revealed between symptoms and PedsQL scores (p = 0.038, rxy = –0.4). Pronation of 45° was the threshold value of the forearm alignment with a high risk of ADL limitation. The area under the ROC curve corresponding to the relationship between symptoms and the forearm alignment was 0.955 ± 0.021 (95 % CI: 0.915–0.995). There was a statistically significant (p &lt; 0.01) decrease in the lumen of the medullary canal in the middle third of the ulnar shaft with the radius lumen being unchanged. Dorsal subluxation of the ulnar head was detected In 30 % of cases.Discussion The characteristics identified demonstrated changes in the forearm bones with functional impairments being correlated with the forearm pronation.Conclusion The correlation between the patient’s symptoms and the forearm alignment must be taken into account in the classification and when determining indications for surgical treatment distinguishing between functional (&lt; 45° pronation) and dysfunctional (≥ 45° pronation) options.

Abstract P249: Association Between Loneliness and Functionality in an Elderly Population

Background: Functionality plays a pivotal role in the well-being and autonomy of older individuals. Discovering new predictors of functional decline is a pressing concern, with loneliness emerging as an unconventional risk factor for chronic diseases. However, its role in functional limitations remains poorly understood. Hypothesis: Loneliness is an independent predictor of limitations in Activities of Daily Living (ADLs) and Instrumental ADLs (IADLs) among individuals aged 80 or older. Methods: A cross-sectional analysis was conducted using data from Wave 8 of the Survey of Health, Ageing, and Retirement in Europe (SHARE), spanning 28 European countries, for participants aged 80 and above, excluding residents in long-term care institutions. Loneliness was assessed using a reduced version of the R-UCLA Loneliness Scale, including measures of companionship, feeling left out, and isolation on a 3-point Likert scale ("often," "some of the time," "hardly ever or never"). Participants scoring 4 to 9 were categorized as lonely. The outcome was defined as the presence of limitations in one or more of the six ADLs and/or the nine IADLs. Logistic regression models were employed to control for potential confounding factors. Multivariate analysis included covariates with p&lt;0.200 and no multicollinearity. Model quality was evaluated using the area under the ROC curve, and the significance level was set at 5%. The analysis was conducted using IBM SPSS, version 28.0. Results: The study included 7,434 individuals, with 58.2% (n=4,323) being female and a mean age of 84.4 (±3.8) for both genders. A majority of participants (52.5%, n=3,879) had low levels of education (ISCED-97 from 0 to 2). Comorbidities included cardiovascular disease (22%, n=1,634), stroke (7%, n=523), diabetes mellitus (17.2%, n=1,281), cancer (6.6%, n=494), and obesity (16.8%, n=1,180). In the univariate analysis, older adults classified as lonely exhibited an odds ratio (OR) of 2.213 (95% CI: 2.016 - 2.428) for presenting limitations in one or more ADLs/IADLs. The multiple model showed an OR of 1.472 (95% CI: 1.313 - 1.649) for having one or more ADLs/IADLs limitations in the presence of loneliness. This association remained significant even after adjusting for confounders (age, gender, education, chronic diseases, hip fracture, pain and European region). The AUC was 76,4%. Conclusions: Our study reveals an independent link between loneliness and limitations in ADLs and IADLs among individuals aged 80 or older from the SHARE dataset. These findings lend support to interventions aimed at preventing loneliness and preserving functionality in this age group.

Hypertension combined with limitations in activities of daily living and the risk for cardiovascular disease

ObjectiveThe aim of present study was to evaluate the combined effect of hypertension and activities of daily living (ADL)/instrumental activities of daily living (IADL) with the risk of CVD, stroke and cardiac events.MethodsA total of 14,083 participants aged 45 years or older from the China Health and Retirement longitudinal study were included in current study. Participants were divided into 4 groups according to hypertension and ADL/IADL status. Cox proportional hazards regression model was used to explore the associations between hypertension, ADL/IADL and new-onset CVD, stroke and cardiac events.ResultsDuring the 7-year follow-up, a total of 2,324 respondents experienced CVD (including 783 stroke and 1,740 cardiac events). Individuals with limitations in ADL alone, or with hypertension alone, or with both limitations in ADL and hypertension were associated with increased risk of CVD, with the adjusted hazard ratios (95% confidence intervals) were 1.17(1.00-1.35), 1.36(1.24–1.49) and 1.44(1.23–1.68), respectively. Those with limitations in ADL and hypertension also had higher risk of stroke (hazard ratios = 1.64; 1.26–2.14) and cardiac events (hazard ratios = 1.37; 1.14–1.64). Similarly, individuals with both limitations in IADL and hypertension were associated with increased risk of CVD (hazard ratios = 1.34; 1.15–1.57), stroke (hazard ratios = 1.50; 1.17–1.95) and cardiac events (hazard ratios = 1.27; 1.06–1.53).ConclusionHypertension and limitations in ADL/IADL jointly increased the risk of CVD, stroke and cardiac events.

Longitudinal reciprocal associations between volunteering, health and well-being: evidence for middle-aged and older adults in Europe.

There is substantial evidence on the importance of voluntary activities for the health of middle-aged and older adults. Evidence on the effects of health and well-being on volunteering is more limited. This study examines reciprocal longitudinal associations between voluntary and/or charity activities and 21 indicators related to physical health, well-being, cognitive impairment and daily life functioning among middle-aged and older adults. Longitudinal data were collected between 2011 and 2020 from a sample of 19 821 middle-aged and older adults from 15 countries participating in the Survey of Health, Ageing and Retirement in Europe. An outcome-wide analysis and an exposure-wide analysis were applied and generalized estimating equations were used. Robustness analyses were conducted. Voluntary and/or charity activities almost every week or more often were prospectively associated with greater emotional well-being, reduced risks of limitations in activities of daily living and of being diagnosed with Alzheimer's disease at a 6-year follow-up. Positive reverse associations were found from emotional well-being to volunteering. Limitations in daily life activities, increased loneliness, high blood cholesterol, hypertension and chronic lung disease were found to impede participation in voluntary and/or charity activities over time. Feedback loops between voluntary and/or charity activities and well-being and limitations in daily activities may exist. Understanding the reciprocal nature of the relationship between volunteering and health and well-being can help identify strategies to encourage volunteering among middle-aged and older adults with specific health conditions and to target health promotion efforts towards volunteers.

Activities of daily living limitations and the use of physical examination among older adults with informal care in China: do gender and residence make differences?

BackgroundThis study investigated the relationship between activities of daily living (ADL) limitations and the use of physical examination among older adults receiving informal care, and to further examine whether this relationship varies by gender and urban-rural areas.MethodsThe data in this study were obtained from the sixth Health Service of Shandong province, China. In total, 8,358 older adults aged 60 years or older who received informal care were included in the analysis. Binary logistic regression models were conducted to explore the association between ADL limitations and the use of physical examination and examine the differences between gender and urban-rural areas.ResultsThe prevalence of limitations in ADL and physical examination utilization rate among older adults receiving informal care in Shandong Province were 14.12% and 72.31%, respectively. After adjusting for confounders, ADL limitations were negatively correlated with the utilization of physical examination services among older adults receiving informal care (OR = 0.74, 95% CI: 0.64, 0.87, P < 0.001), and there were gender and rural-urban differences. The association between ADL limitations and the use of physical examination was statistically significant in older women receiving informal care (OR = 0.65, 95% CI: 0.53, 0.80, P < 0.001). And only among urban older adults receiving informal care, those with ADL limitations had lower utilization of physical examination services than participants without ADL limitations (OR = 0.59, 95% CI: 0.47, 0.74, P < 0.001).ConclusionsOur study suggested that the relationship between ADL limitations and the use of physical examination among older adults receiving informal care differed by gender and urban-rural areas in Shandong, China. These findings implied that the government should provide more health resources and personalized physical examination service programs, especially to meet the differential needs of women and urban old adults receiving informal care, to contribute to the implementation of healthy aging strategies.

Trajectories of health conditions and their associations with the risk of cognitive impairment among older adults: insights from a national prospective cohort study

BackgroundThe associations between trajectories of different health conditions and cognitive impairment among older adults were unknown. Our cohort study aimed to investigate the impact of various trajectories, including sleep disturbances, depressive symptoms, functional limitations, and multimorbidity, on the subsequent risk of cognitive impairment.MethodsWe conducted a prospective cohort study by using eight waves of national data from the Health and Retirement Study (HRS 2002–2018), involving 4319 adults aged 60 years or older in the USA. Sleep disturbances and depressive symptoms were measured using the Jenkins Sleep Scale and the Centers for Epidemiologic Research Depression (CES-D) scale, respectively. Functional limitations were assessed using activities of daily living (ADLs) and instrumental activities of daily living (IADLs), respectively. Multimorbidity status was assessed by self-reporting physician-diagnosed diseases. We identified 8-year trajectories at four examinations from 2002 to 2010 using latent class trajectory modeling. We screened participants for cognitive impairment using the 27-point HRS cognitive scale from 2010 to 2018 across four subsequent waves. We calculated hazard ratios (HR) using Cox proportional hazard models.ResultsDuring 25,914 person-years, 1230 participants developed cognitive impairment. In the fully adjusted model 3, the trajectories of sleep disturbances and ADLs limitations were not associated with the risk of cognitive impairment. Compared to the low trajectory, we found that the increasing trajectory of depressive symptoms (HR = 1.39; 95% CI = 1.17–1.65), the increasing trajectory of IADLs limitations (HR = 1.88; 95% CI = 1.43–2.46), and the high trajectory of multimorbidity status (HR = 1.48; 95% CI = 1.16–1.88) all posed an elevated risk of cognitive impairment. The increasing trajectory of IADLs limitations was associated with a higher risk of cognitive impairment among older adults living in urban areas (HR = 2.30; 95% CI = 1.65–3.21) and those who smoked (HR = 2.77; 95% CI = 1.91–4.02) (all P for interaction < 0.05).ConclusionsThe results suggest that tracking trajectories of depressive symptoms, instrumental functioning limitations, and multimorbidity status may be a potential and feasible screening method for identifying older adults at risk of cognitive impairment.

Moderating role of functional/ mobility limitations in the association between sleep problems and hypertension among middle-aged and older adults in India

Hypertension has become a global health concern and is recognized as an important modifiable risk factor for cardiovascular diseases (CVDs). There are very limited studies in India and worldwide focused on sleep problems, activities of daily living (ADL), instrumental ADL (IADL) and mobility limitations, and their discrete and combined effects on hypertension. Therefore, this study examined whether sleep problems are associated with hypertension, and whether the association is more pronounced among middle-aged and older adults with functional/mobility limitations. This study used data from the Longitudinal Ageing Study in India (LASI) wave 1, 2017–18, with a total sample of 59,951 adults aged 45 years and above. Log-binomial regression, and interaction terms were used to assess the relationship between sleep problems and hypertension, and the moderating effect of functional/mobility limitations. Respondents with sleep problems had a 29 % higher prevalence of hypertension [PR (prevalence ratio): 1.29; CI (confidence interval): 1.20–1.39]. Those with ADL and IADL limitations had 20 % [PR: 1.20; CI: 1.09–1.32] and 9 % [PR: 1.09; CI: 1.00–1.18] greater prevalence of hypertension. Interaction analysis revealed that individuals with ADL, IADL, and mobility limitations had 58 %, 52 %, and 45 % higher prevalence of hypertension, respectively, and was especially pronounced among women. Our findings highlight that improved sleep can reduce the prevalence of hypertension in middle-aged and older adults. Individuals with functional/mobility limitations may need additional care and support from their family members or the community, which could lower the prevalence of elevated blood pressure due to their sleep problems.

Interaction between activities of daily living and cognitive function on risk of depression.

There is a lack of literature about the joint effects of activities of daily living (ADL) limitation and cognitive impairment on depression. This study aimed to estimate the association of ADL limitation and cognitive impairment with depression among Chinese older adults aged 65 and above and to test their interaction on both additive and multiplicative scales. Data was drawn from the Chinese Longitudinal Healthy Longevity Survey (CLHLS), including 11,025 eligible participants. Logistic regression models were fitted, and both multiplicative and additive interactions for ADL limitation and cognitive impairment were tested. A total of 3,019(27.4%) participants reported depressive symptoms. After controlling for potential confounding factors, ADL limitation and cognitive impairment were both positively associated with depression. The adjusted additive interaction of basic and instrumental activities of daily living limitation were 2.47 (95%CI:1.92-3.19) and 3.67 (95%CI:2.88-4.66), respectively, but the multiplicative interaction items were both insignificant. ADL limitation and cognitive impairment were both risk factors for depression among Chinese older adults. Moreover, the significant interaction of ADL limitation and cognitive impairment was found in the additive model, suggesting that improving ADL may be helpful in reducing the risk of depression among older people with cognitive impairment.

Does a Reduction in Receiving Assistance With Daily Activities Among Older Adults in Mexico Indicate An Increase in Unmet Needs or a Decrease in Needs for Care?

The percentage of older adults in Mexico with difficulty completing activities of daily living (ADL) who receive assistance from family appears to be decreasing. We compared 2 birth cohorts of older adults in Mexico to investigate whether this trend reflects an increase in unmet caregiving needs or a decrease in the need for care. We selected Mexican Health and Aging Study participants aged 60-76 in 2001 (n = 4,805) and 2018 (n = 6,494). ADL tasks were dressing, walking, bathing, getting in and out of bed, and toileting. Participants who reported difficulty with an ADL were asked if anyone helped them with the task. Logistic regression was used to estimate adjusted odds ratios (aOR) for cohort differences in ≥1 ADL limitations and help with ≥1 ADL. We used a decomposition analysis to identify participant characteristics that mediated cohort differences in receiving help with ≥1 ADL. The 2018 cohort had higher odds for ≥1 ADL limitations (aOR = 1.85, 95% CI = 1.60-2.14) but lower odds for help with ≥1 ADL (aOR = 0.66, 95% CI = 0.49-0.89). Among participants with ADL disability, the 2018 cohort had fewer living children and a lower prevalence of probable dementia. The lower number of living children and lower prevalence of probable dementia explained 9.34% and 43.7% of the cohort effect on receiving help with ≥1 ADL, respectively. The declining percentage of older adults in Mexico with ADL disability receiving assistance may not reflect increasing unmet needs. However, the increased prevalence of ADL disability will increase the number of older adults needing informal care.

RACIAL–ETHNIC DISPARITIES IN STRESS EXPOSURE AND THE ONSET OF LATER-LIFE LIMITATIONS IN ACTIVITIES OF DAILY LIVING

Abstract This study investigates the relationship between stress exposure – including cumulative stress burden and domain-specific stressors – and the onset of activities of daily living (ADL) limitations in later life and examines whether there are racial-ethnic and nativity differences in this relationship. Examining data from the Health and Retirement study (HRS), we apply logistic regression and Weibull accelerated failure-time models to examine associations between stress and baseline ADL limitations as well as stress exposure and age of onset of ADL limitations over a decade. Interaction tests between stress and race-ethnicity and nativity were employed to understand how stress exposure uniquely influences ADL limitations among White, Black, US-born Hispanic, and foreign-born Hispanic older adults. Black, US-born Hispanic, and foreign-born Hispanic adults were more likely to develop an ADL limitation at a younger age compared to White adults (β = -0.06; β = -0.07; β = -0.09; respectively). Cumulative stress burden, childhood traumatic events, adult financial strain, everyday discrimination, and major lifetime discrimination were associated with an earlier onset of ADL limitation among White, Black, US-born Hispanic and foreign-born Hispanic adults. Further, US-born Hispanic adults that experienced the same amount of childhood traumatic events as White adults experienced an earlier transition to ADL limitation by a factor of 0.65 or in about 35% of the time. Reducing racial-ethnic and nativity disparities in ADL limitations in later-life will require efforts to adjudicate the long lasting historical and structural disadvantages that contribute to differential stress exposure across the life course.

FUNCTIONAL LIMITATION: DIFFERENCES BY EPIGENETIC AGING, ETHNICITY, AND EXPERIENCES OF DISCRIMINATION

Abstract Epigenetic aging provides an opportunity to rethink processes of aging and policy and health interventions to address health disparities across the life course. Previous research has shown that social factors can result in accelerated epigenetic aging, with subsequent unfavorable health outcomes. This cross-sectional study aimed to evaluate the relationship between epigenetic aging and functional and instrumental limitations in White and Hispanic older adults and to explore how recent experiences of perceived discrimination may differentially impact this association. We used 2014 and 2016 Health and Retirement Study (HRS) data for White (n=1072) and Hispanic (n=139) adults aged 50 and older and epigenetic clock data from the 2016 HRS Venous Blood Study. We hypothesized that accelerated epigenetic aging (PhenoAge epigenetic clock regressed on chronological age) would be associated with greater limitations in activities of daily living (ADLs) and instrumental activities of daily living (iADLs), and this impact would differ by ethnicity and perceived discrimination. On average, Hispanics reported significantly more limitations in ADLs (1.10 vs .47, p&amp;lt;.0001) and iADLs (1.22 vs .72, p&amp;lt;.0001), and more experiences of being treated differently in service situations (44.6% vs 33.3%, p=.0084) and of people acting as if they were afraid of them (28.78% vs 22.01%, p=.0738). Epigenetic age was associated with discrimination (b=-1.98, p=.0078), with ADLs in Hispanics (b=-0.04, p=.0812), and with iADLs in Whites (b=.0069, p=.0443). Further studies of the impact of epigenetic aging on functional and instrumental limitations should be longitudinal, utilize larger samples of older adults, and oversample racial and ethnic minorities.

Unmet need and public financing of home care in England

AbstractBackgroundPersons living with dementia often wish to remain in their own homes for as long as possible. Given the unpredictable nature and progression of dementia, this means that many adults will require some degree of home‐based support in the initial stages of the disease, as well as requiring continuous, intensive support in the later stages. Public financing can play a central role in ensuring equitable access to home care, however, public financing is limited in many nations due to the high cost of these services. Without consistent government financing, many vulnerable adults may forgo needed care, risking adverse outcomes. In this study, we seek to examine unmet need and the role of public financing of home care among English adults over 50.MethodDrawing on waves 6‐9 (2013‐2019) of the English Longitudinal Study of Ageing, we use longitudinal fixed effects and pooled cross‐sectional models to understand patterns and predictors of unmet need for home care support services. We focus particularly on the type of home care received, differentiating between publicly financed and/or provided care, privately paid formal care, and informal home care services. We also differentiate between unmet need, where no help is received, and ‘under‐met’ need, where help is received but it does not fully meet the needs of the care recipient.ResultWorsening cognition and greater limitations in activities of daily living (ADL) and instrumental activities of daily living (IADL) are associated with fewer entirely unmet needs. Receipt of publicly financed and/or provided care is also associated with fewer unmet needs as compared to receiving informal and/or formal privately paid care. However, shifting from publicly financed/provided home care to exclusively informal and/or formal privately paid care is associated with lower odds of under‐met need, where the help provided does not fully meet the home care support needs of the recipient.ConclusionGreater ADL and IADL limitations and worsening cognition may trigger access to home care support services. Public financing/provision of home care may guard against needs going entirely unmet, however, the care that is received may not fully meet the support needs of those with dementia.

Resource Utilization Groups in transitional home care: validating the RUG-III/HC case-mix system in hospital-to-home care programs

BackgroundTransitional hospital-to-home care programs support safe and timely transition from acute care settings back into the community. Case-mix systems that classify transitional care clients into groups based on their resource utilization can assist with care planning, calculating reimbursement rates in bundled care funding models, and predicting health human resource needs. This study evaluated the fit and relevance of the Resource Utilization Groups version III for Home Care (RUG-III/HC) case-mix classification system in transitional care programs in Ontario, Canada.MethodsWe conducted a retrospective analysis of clinical assessment data and administrative billing records from a cohort of clients (n = 1,680 care episodes) in transitional home care programs in Ontario. We classified care episodes into established RUG-III/HC groups based on clients’ clinical and functional characteristics and calculated four case-mix indices to describe care relative resource utilization in the study sample. Using these indices in linear regression models, we evaluated the degree to which the RUG-III/HC system can be used to predict care resource utilization.ResultsA majority of transitional home care clients are classified as being Clinically complex (41.6%) and having Reduced physical functions (37.8%). The RUG-III/HC groups that account for the largest share of clients are those with the lowest hierarchical ranking, indicating low Activities of Daily Living limitations but a range of Instrumental Activities of Daily Living limitations. There is notable heterogeneity in the distribution of clients in RUG-III/HC groups across transitional care programs. The case-mix indices reflect decreasing hierarchical resource use within but not across RUG-III/HC categories. The RUG-III/HC predicts 23.34% of the variance in resource utilization of combined paid and unpaid care time.ConclusionsThe distribution of clients across RUG-III/HC groups in transitional home care programs is remarkably different from clients in long-stay home care settings. Transitional care programs have a higher proportion of Clinically complex clients and a lower proportion of clients with Reduced physical function. This study contributes to the development of a case-mix system for clients in transitional home care programs which can be used by care managers to inform planning, costing, and resource allocation in these programs.

Marital dissatisfaction and functional performance in older adults: Heterogeneity in the association by educational level

RationaleThe marital relationship is an important source of the well-being of older adults. Despite existing literature on marital dissatisfaction and adverse health outcomes, little is known about whether marital dissatisfaction is associated with functional performance in older adults. ObjectiveDrawing on stress process model and health behavior model, this study examined the longitudinal association between marital dissatisfaction and older adults’ functional performance. Furthermore, we sought to investigate whether this association varies based on educational level. MethodsUsing seven waves (12 years) of the Korean Longitudinal Study of Ageing (KLoSA) from 2006 to 2019, this study estimated fixed effects models to account for unobserved individual-level confounders. Objectively measured hand grip strength and subjective assessments of vision, hearing, masticatory functions, as well as limitations in activities of daily living (ADLs) and instrumental activities of daily living (IADLs) were used to evaluate functional performance. An interaction model was used to determine whether educational level moderates the association. ResultsFixed effects estimates revealed that marital dissatisfaction is negatively associated with grip strength, as well as masticatory, vision, and hearing functions, while also showing a positive association with limitations in ADLs and IADLs. The results of this study provided evidence on heterogeneity in the association by educational level. The associations between marital dissatisfaction and functional performance, including grip strength, mastication, and hearing, were driven primarily by those with older adults with a higher level of education. ConclusionThe findings of this study suggest that marital dissatisfaction is a robust predictor of functional performance in older adults. Efforts to address marital dissatisfaction has the potential to improve functional performance, particularly for older adults with higher levels of education.

Prevalence and Trends of Basic Activities of Daily Living Limitations in Middle-Aged and Older Adults in the United States.

Population-level surveillance of the prevalence and trends of basic self-care limitations will help to identify the magnitude of physical disablement in the rapidly growing older American demographic. We sought to evaluate the prevalence and trends of activities of daily living (ADL) limitations in the United States. The analytic sample included 30,418 Americans aged ≥50 years from the 2006-2018 waves of the Health and Retirement Study. ADLs were self-reported. Weighted prevalence estimates were presented, and trends analyses were performed. Although overall ADL disability prevalence was 16.5% (95% confidence interval: 15.8-17.2) in 2018, there were no changes in limitations during the study period (p = 0.52). Older adults had a greater ADL disability prevalence than middle-aged adults (p < 0.001). While older persons experienced a declining trend of ADL limitations (p < 0.001), middle-aged persons had an increasing trend (p < 0.001). Males had a lower ADL limitation prevalence than females (p < 0.001). Hispanic and non-Hispanic Black had a higher ADL disability prevalence than non-Hispanic White (p < 0.001). This investigation revealed that while the estimated prevalence of ADL limitations in the United States was substantial, changes in such limitations were not observed. Our findings can help guide ADL screening, target sub-populations with an elevated ADL limitation prevalence, and inform interventions.