Activities Of Daily Living Limitations Research Articles

The Impact of Unmet ADL Need on the Self-Rated Health and Life Satisfaction of Chinese Older Adults

This study aims to examine the associations of change in unmet need for assistance with Activities of Daily Living (ADL) with the self-rated health and life satisfaction of community-dwelling Chinese older adults. Using national longitudinal data from the Chinese Longitudinal Healthy Longevity Study, we examined the associations of unmet ADL need with self-rated health and with life satisfaction from baseline (T1) to a 3-year follow-up (T2) among 1,914 older adults with ADL limitation. Change in unmet ADL need was categorized into “Persistently Unmet”, “Unmet at T1 Only”, “Unmet at T2 Only”, and “Never Unmet”. Self-rated health and life satisfaction were rated by 5-point Likert scales. Linear mixed models were performed to examine the associations, controlling for sociodemographic factors, health conditions, and social support. The results showed that older adults whose ADL needs were persistently unmet, those unmet at T2 only, and those never unmet, experienced a significant decline in self-rated health from baseline to follow-up, but those unmet at T1 only experienced a significant rise in self-rated health. While the life satisfaction was stable from baseline to follow-up among older adults whose ADL needs were persistently unmet or never unmet, it significantly decreased among those unmet at T2 only and significantly increased among those unmet at T1 only. The effects of unmet ADL need on self-rated health and life satisfaction appeared to be short-term rather than long-term. These findings facilitate a better understanding of unmet ADL need and emphasize the importance to fully meet the ADL needs of older adults.

The Impact of Unmet ADL Need on the Self-Rated Health and Life Satisfaction of Chinese Older Adults

Racial and ethnic disparities in influenza vaccination among nursing home (NH) residents are well-documented and have persisted over time, suggesting that new strategies are necessary to reduce disparities. We conducted a retrospective cohort study to examine the degree to which observable characteristics drove influenza vaccination disparities. We linked Minimum Data Set (MDS) assessments to facility-level data for short- and long-stay NH residents aged ≥65 years. We included residents with six-month continuous enrollment in Medicare and an MDS assessment during the influenza season (October 1, 2013 through March 31, 2014). Using nonlinear Oaxaca-Blinder decomposition, we decomposed the disparities in vaccination between White versus Black and White versus Hispanic residents. We analyzed short- and long-stay residents separately. Our study included 630,373 short-stay and 1,029,593 long-stay residents. Among short-stay residents, 67.2% of Whites, 55.1% of Blacks, and 54.5% of Hispanics were vaccinated against influenza; among long-stay residents, 84.2% of Whites, 76.7% of Blacks, and 80.8% Hispanics were vaccinated against influenza. Across the four comparisons, the crude disparity in influenza vaccination ranged from 3.4-12.7 percentage points. By equalizing 27 characteristics, these disparities could be reduced by 37.7%-59.2%. Living in a predominantly White facility and proxies for NH quality were important contributors to the disparity, although characteristics unmeasured in our data (e.g., NH staff attitudes and beliefs) contributed 40.8%-62.3% to the disparity across comparisons. Intervening on factors associated with NH quality may reduce racial/ethnic disparities in influenza vaccination. Qualitative research is essential to explore potential contributors not captured in our administrative data.

CAPABLE Program Improves Disability in Research and Implementation Settings

Interventions to reduce disability are crucial for older adults with disabilities to avert unnecessary hospitalizations or nursing home placements and improve daily life. Developed and tested at one research site, multiple health systems and community based organizations have since implemented CAPABLE. All published or peer reviewed tests of CAPABLE were reviewed (six studies, 11 sites) with a total of 1087 low-income community-dwelling older adults with disabilities. Participants were an average age of 74-79, cognitively intact, and self-reported difficulty with one or more activities of daily living (ADL). These trials were reviewed by extracting the participants’ scores on main outcomes, ADLs and IADLs, and when available, fall efficacy, depression, pain and cost savings. All studies yielded improvements in ADL and IADL limitations, with small to strong effect sizes. Studies with the complete dose of CAPABLE showed more improvement in ADLs and cost savings than the studies that implemented a decreased dose.

Age-Related Ethnic Differences in Self-Reported Hand Function

Barriers to affordable insurance may worsen disparities among underserved populations. Immigrants with <5 years of residence are not eligible for Medicare and Medicaid and are potentially without affordable alternatives. This study aims to look at the relationship between length of residence in the U.S. and insurance coverage within U.S. Chinese older adults ages 65+.This study used data from a representative sample of 2,365 community-dwelling U.S. Chinese older adults age 65+. The association between length in the U.S. (<5, 6-10, 10+) and insurance status was analyzed using chi squared test and logistic regressions. Within this sample, 58 (2.78%) participants had coverage outside Medicare and Medicaid, with 279 participants reporting no coverage. The vast majority of participants living in the U.S. <5 years had no insurance (81.48%). In a fully adjusted model, participants who were older and female were positively associated with having insurance coverage (OR:1.11 [1.07,1.15] and OR:1.29 [0.88,1.90]). Conversely, both living in the U.S. <5 years (OR:0.009 [0.006, 0.014]),and between 5-10 years (OR:1.20 [0.13,0.30]) were negatively associated with insurance coverage. When including coverage outside of Medicaid and Medicare, residence <5 years and 5-10 years were still negatively associated with insurance coverage ((OR:0.13 [0.009,0.02]), and (OR:0.19 [0.13,0.30])). Vulnerable populations such as older immigrants may not have access to insurance outside of public options, making a 5-year waiting period an additional barrier to quality health care.

Predicting Technology Use Among Older Adults During the COVID-19 Pandemic With Community Participation

The social isolation imposed by the Covid-19 pandemic has significantly affected older adults, and has impacted both their physical and mental health. The pandemic has led to an increase in ageism associated with poorer mental health and a lower sense of dignity, self-esteem and contribution to society. This cross-cultural study involved 24 participants from Italy and Israel aged 79 to 92. The aim was to develop a brief art-based online intervention to enhance the participants’ sense of dignity and sense of meaning in life during this time of crisis. The process focused on the creation of digital photo-collages that captured the participants’ values through three perspectives: their past experiences, legacy, and future perspectives. It employed an arts-based research methodology to explore the participants’ experiences by analysing their relationship with the artistic expression, the photo collage, and its creative process.

Formal and informal care use over the course of dementia among adults with limitations in daily activities

AbstractBackgroundThe dynamics between formal and informal care among persons with an activity limitation may substantially differ over the course of their cognitive decline.MethodBased on a nationally representative study of older adults, the sample included 3,685 adults (11,856 year‐persons) who had at least one activity of daily living (ADL) limitation at the time of interview and transitioned to dementia between the years of 1998 – 2016. We estimated probabilities of using formal care and informal care in the years prior to and over the course of dementia, after controlling for sociodemographic factors, survey mode, and proxy interview status.ResultAmong study participants with an ADL limitation, the probability of receiving care from an informal helper increased before the onset of dementia: 36% (95% CI 32‐40) in 4 years prior to the onset (T=‐4); 46% (95% CI 43‐50) at T=‐2; and 48% (95% CI 46‐51) at T=0 (onset); the likelihood of receiving care changed very little over the subsequent years of dementia. In contrast, changes in the probability of receiving formal care are pronounced primarily at the onset of dementia. For example, the probability of overnight nursing home stay was significantly greater at the onset of dementia compared to the years prior to the onset: 12% (95% CI 10‐15) at T=‐2 vs. 31% (95% CI 28‐34) at T=0; this increased over the subsequent years of dementia (e.g., 39% at T=6; 95% CI 34‐43). The probability of receiving nursing home care at the onset of dementia was significantly greater for women vs. men (e.g., Adjusted risk ratio (ARR)=1.21; p=0.010); non‐Hispanic white vs. Hispanic (e.g., ARR=1.62; p=0.004); those with low wealth vs. high wealth (e.g., ARR=1.60; p&lt;0.001); those without a spouse vs. with a spouse prior to the onset (e.g., ARR=1.39; p&lt;0.001); and those with all adult children living far vs. at least one coresident adult child prior to the onset (e.g., ARR=1.51; p=&lt;0.001).ConclusionPublic policies and interventions aimed at planning and providing for the needs of people with dementia should consider disparities in care use over the course of dementia and the potential role of economic resources and family care availability.

Sex differences in functional limitations and the role of socioeconomic factors: a multi-cohort analysis

SummaryBackgroundWomen are more likely to have functional limitations than are men, partly because of greater socioeconomic disadvantage. However, how sex differences vary by severity of functional limitations remains unclear. We examined sex differences in functional limitations, with attention to socioeconomic factors and severity of limitations.MethodsLongitudinal data on limitations in basic activities of daily living (ADL) and instrumental activities of daily living (IADL) and mobility activities were drawn from 62 375 participants from 14 countries. For ADL, IADL, and mobility, participants were categorised based on number of limited activities (0, 1, 2, or ≥3). Sex differences in limitations in four birth cohorts (1895–1929, 1930–38, 1939–45, and 1946–60) were analysed before and after adjustment for socioeconomic factors (education and labour force status).FindingsThe prevalence of IADL and ADL limitations was higher in women than in men. After adjustment for socioeconomic factors, this sex difference was attenuated. The sex difference in IADL limitations at age 75 years (in the 1895–1929 cohort) was 3·7% before adjustment for socioeconomic factors (95% CI 2·6–4·7) and 1·7% (1·1–2·2) after adjustment. For ADL, the sex difference in limitations at age 75 years (in the 1895–1929 cohort) was 3·2% (2·3–4·1) before adjustment for socioeconomic factors and 1·4% (0·9–1·8) after adjustment. Sex differences in mobility limitations (16·1%, 95% CI 14·4–17·7) remained after adjustment for socioeconomic factors (14·3%, 12·7–15·9). After age 85 years, women were more likely to have three or more IADL or mobility limitations and men were more likely to have one or two limitations.InterpretationSocioeconomic factors largely explain sex differences in IADL and ADL limitations but not mobility. Sex differences in mobility limitations in midlife are important targets for future research and interventions.FundingNational Institute on Aging, UK National Institute for Health Research, European Commission, and US Social Security Administration.

Abstract 11555: Prevalence of Depressive and Anxiety Related Symptoms Among Patients Living with Hypertrophic Cardiomyopathy

Introduction: Hypertrophic cardiomyopathy (HCM) is a common heart condition that affects at least 1:500 individuals in the United States. Patients with HCM can suffer from life-threatening arrhythmias, requiring implantable cardiac devices and several limitations in daily life activities. Only limited data exist describing impacts on quality of life among these patients. Hypothesis: We hypothesize that patients living with HCM may suffer from an increased prevalence of depressive or anxiety related symptoms. Methods: Patients were approached via survey invitation on the Hypertrophic Cardiomyopathy Association (HCMA) website. Surveys were made accessible to all the members of the HCMA who had provided an active email address. Survey data were collected via the HCMA and de-identified for subsequent analyses. Demographic variables along with 40 questions assessing signs and symptoms of depression and anxiety were included. Answers to questions ranged from never to nearly always and were transformed on a Likert scale. Results: Survey invitations were sent to 1425 patients/families with HCM. Of these, 737 (52%) completed the survey adequately. Around 93% of respondents were Caucasian, with a mean age of 52.1 ±1.4, and composed of almost an equal number of men and women. Around 70% of patients with HCM reported that they never or rarely felt worthless, helpless, hopeless, anxious or depressed. Meanwhile, less than 3% reported depressive or anxiety related symptoms on a daily basis. On the contrary, around 52% of respondents found it difficult to engage in daily exercise or activities such as lifting items and helping with household chores. Conclusions: In conclusion, patients with HCM infrequently suffered from depressive or anxiety related symptoms, while many reported increased levels of exercise-related limitations. Further studies are warranted to better understand the effects of HCM on the physical and psychological well-being.

Limitations in Activities of Daily Living Among Spanish Women Diagnosed With Endometriosis.

Understanding the impact of endometriosis symptoms on patients' activities of daily living (ADLs) is a priority to establish effective and personalized intervention programs. To explore limitations in ADLs and instrumental ADLs (IADLs) and their association with pelvic pain (PP), chronic fatigue, and pain-catastrophizing thoughts among women with endometriosis. Cross-sectional study. Spain. Two hundred thirty women with endometriosis. Outcomes and Measures: Information regarding performance of ADLs (Barthel Index) and IADLs (Lawton-Brody questionnaire), PP intensity (Numeric Rating Scale), chronic fatigue (Piper Fatigue Scale), and pain-catastrophizing thoughts (Pain Catastrophizing Scale) was gathered. Multivariate regression analyses were created, and mediating effects of fatigue and pain-catastrophizing thoughts on the association between PP and ADL and IADL limitations were assessed. The prevalence of limitations in at least one ADL and one IADL was 22.6% (95% confidence interval [CI] [17.2, 28.1]) and 39.1% (95% CI [32.8, 45.5]), respectively. Limitations in bowel continence, housework, shopping, and meal preparation were reported most frequently. Women reporting severe PP showed higher risk for ADL (odds ratio [OR] = 3.33, 95% CI [1.10, 10.10]) and IADL (OR = 7.99, 95% CI [2.86, 22.34]) limitations. Chronic fatigue and pain-catastrophizing thoughts were also positively related to ADL-IADL limitations, showing a mediating effect on the association between PP and ADL-IADL limitations. This study reveals the widespread presence of difficulties in ADL-IADL performance among women with endometriosis, with some symptoms underlying these difficulties in occupational performance. This study points to the need for cost-effective occupational therapy interventions for affected women. What This Article Adds: This research shows that the occupational performance of women with endometriosis is frequently impaired; therefore, the effectiveness of occupational therapy interventions should be addressed in the near future.

Spousal Concordance in the Development of Functional Limitations Among Married Adults in China

Functional limitation is increasingly common as people age and is often associated with negative consequences. Evidence of the dynamics of functional limitation within couples in China is still inadequate. To examine whether functional limitation was associated within middle-aged and older couples and to explore sex differences in spousal associations. In this nationwide, population-based cohort study performed from January 1, 2011, to December 31, 2018, participants were selected using multistage probability sampling, and 5207 community-dwelling couples (10 414 individuals) 45 years or older were included in the nationally representative China Health and Retirement Longitudinal Study. Data analysis was performed from January 1 to February 28, 2021. The exposure variable was the presence of functional limitation in spouses. Functional limitation was measured by the activities of daily living (ADLs) and instrumental activities‎ of daily ‎living (IADLs) scales and was defined as having difficulty in independently performing at least 1 ADL or IADL item. The main outcome was functional limitation in index participants. Multivariable logistic regression with generalized estimating equations was used to estimate the reciprocal association of functional limitation within couples over time. A total of 5207 married, different-sex couples (mean [SD] age, 59.1 [8.8] years for husbands and 57.0 [8.2] years for wives) were included in the study. For husbands, the number (percentage) of participants classified with baseline functional limitation was 1140 (21.9%), the number (percentage) with ADL limitation was 684 (13.1%), and the number (percentage) with IADL limitation was 834 (16.0%). For wives, the number (percentage) of participants classified with baseline functional limitation was 1502 (28.8%), the number (percentage) with ADL limitation was 887 (17.0%), and the number (percentage) with IADL limitation was 1183 (22.7%). Longitudinal results demonstrated an association in spouses developing functional limitation (adjusted odds ratio [OR], 2.55; 95% CI, 2.41-2.69; P < .001), ADL limitation (adjusted OR, 2.26; 95% CI, 2.11-2.41; P < .001), and IADL limitation (adjusted OR, 2.58; 95% CI, 2.43-2.73; P < .001). Subgroup analyses by sex revealed similar patterns of spousal health concordance in terms of all studied outcomes, indicating no sex specificity. This population-based cohort study suggests that among Chinese middle-aged and older couples there is significant concordance in the development of functional limitation. This study of spousal functional ability from a dyadic perspective may help in the understanding of health risks within a wider familial context and offers novel insights for prioritizing policy focus from individual centered to couple based.

Independent and Interactive Effects of Activity Performance, Sociodemographic Factors, and Insurance Type Upon Acute Care Occupational Therapy Utilization

<h3>Research Objectives</h3> Hospitalized patients with difficulty performing activities of daily living (ADL) may benefit from occupational therapy (OT) services. However, disparities in access to acute care OT are poorly understood. We sought to investigate whether need (i.e., ADL limitations) predicts acute care OT utilization, and whether this relationship differs across sociodemographic factors and insurance type. <h3>Design</h3> In a secondary analysis of electronic health records data, we applied logistic regression models to determine whether ADL performance predicted acute care OT utilization. Interactions between ADL performance and both sociodemographic factors (e.g., age; race/ethnicity; significant other status) and insurance type were included to investigate whether the relationship between ADL performance and OT utilization varied across patient characteristics. <h3>Setting</h3> Five regional hospitals from a single health system. <h3>Participants</h3> 56,022 adults admitted between 2014 and 2018 who received an OT evaluation. <h3>Interventions</h3> None. <h3>Main Outcome Measures</h3> Acute care OT treatment utilization; Activity Measure for Post-Acute Care (AM-PAC) "6-Clicks" measure of ADLs. <h3>Results</h3> 44% of patients evaluated for OT received subsequent treatment. Patients with lower ADL performance were more likely to receive OT treatment (odds ratio = 1.08, 95% confidence interval = 1.08, 1.09). However, interaction terms indicated that among patients with low ADL performance, those who 1) were younger; 2) were white, non-Hispanic; 3) had significant others; and 4) had private insurance (vs. public) were more likely to receive treatment. These differences diminished in patients with greater ADL performance, who had similarly low probabilities of receiving OT. <h3>Conclusions</h3> Patients with greater need were more likely to receive acute care OT, but this relationship was moderated by age, minority status, significant other status, and insurance type. Findings provide direction for exploring determinants of disparities in OT utilization. <h3>Author(s) Disclosures</h3> None.

Self-Care Capacity and Its Relationship to Age, Disability, and Perceived Well-Being in Medicare Beneficiaries.

Self-care is a multicomponent set of capacities that influence beliefs about health and well-being. We examined the relationship between self-care capacity, age, and disability status with two perceptions of well-being in a cohort of Medicare beneficiaries. The current study is part of a multisite research project to determine factors associated with cross-sectional and longitudinal morbidity and mortality trajectories observed in Medicare beneficiaries. Variable selection was informed by the health disparities and outcomes model. Using data from the 2013 Medicare Current Beneficiary Survey and logistic regression models, we determined associations between self-care capacity, including indicators of self-care ability and self-care agency and two perceptions of well-being. Participants were divided into four groups based on how they qualified for Medicare: (a) over 65 years of age, and below 65 years of age and disabled because of (b) physical or (c) mental disorder, or (d) disabled and could not be classified as physically or mentally disabled as the primary cause of eligibility. Self-care ability limitations in activities of daily living (ADL), instrumental activities of living (IADL), and social activity participation were associated with both health perceptions. Those with physical disabilities reported more ADL and IADL limitations when compared with the other eligibility groups and were significantly more likely to have negative health perceptions. Those with serious mental illness were most likely to report the most severe IADL limitations. The over 65 years of age group reported less self-care incapacity than the other three eligibility types. Other components of self-care, including health literacy, agency, and health behaviors, significantly influenced perceptions of health. Women and people identifying as non-Whites were more likely to have negative health perceptions. Self-care capacity is a complex construct, and its varied elements have differential relationships with perceptions of well-being. Those with physical disabilities reported more self-care limitations, poorer perceived health, and more health worries than the other groups. Still, there were different patterns of self-care capacities in the serious mental illness type-especially in IADL limitations. The study adds empirical evidence to previous research documenting inequities in health outcomes for women and non-Whites. Findings provide empirical support for the health disparities and outcomes model.

Menstrual and reproductive factors and limitations in activities of daily living: A case–control study within the Japan Public Health Center‐based Prospective Study

Although menstrual/reproductive factors are known to be associated with physical disability, little is known about these associations in relation to activities of daily living (ADL). This study aimed to clarify associations between menstrual/reproductive factors and ADL limitations in peri- and postmenopausal women. A nested case-control study of the Japan Public Health Center-based Prospective (JPHC) Study. The main outcome measure was self-reported ADL levels in the 10-year follow-up questionnaire survey of the JPHC Study conducted between 2000 and 2004 (N=36 460). Women who "live inside almost independently, but go out with assistance" or had a lower level of activity were considered to have ADL limitations ("cases"), and all others served as controls. Candidate menstrual/reproductive predictors were as follows: menarcheal age, menopausal status, menopausal age, regularity of menses, menstrual cycle, number of pregnancies, age at first pregnancy, number of deliveries, age at first delivery, and breast feeding. Multiple logistic regression analyses were conducted, and odds ratios adjusted for age and past lifestyle were calculated. Mean ages of cases (N=592) and controls (N=38 656) were 68.3 (SD=7.6) and 61.1 (SD=7.7) years, respectively. With respect to menopausal age, groups aged <45 and ≥55 years had significantly higher adjusted ORs (1.44, 95% CI: 1.09-1.90 and 1.55, 95%CI: 1.09-2.18, respectively) than the reference group (50-54 years). Multiparous women had significantly lower ORs than nulliparous women. Our findings suggest that menopausal age and parity may predict future ADL limitations in women.

Personality and functional impairment. Evidence from the Survey of Health, Ageing and Retirement in Europe

To date, only a few studies have investigated the association between personality and functional impairment. Therefore, our purpose was to add to this knowledge. Data from wave 7 of the Survey of Health, Ageing and Retirement in Europe (SHARE) were used (70 028 individuals in the analytical sample). Personality was measured using the 10-item Big Five Inventory (BFI-10). Functional impairment was quantified using activities of daily living (ADL) and instrumental activities of daily living (IADL) indices. Multiple linear regressions were conducted. Regressions showed that an increased likelihood of limitations in ADL was associated with higher extraversion, higher agreeableness, lower conscientiousness, higher neuroticism, and higher openness to experience. Similarly, an increased likelihood of limitations in IADL was associated with higher agreeableness, lower conscientiousness, higher neuroticism, and higher openness to experience (only with one IADL index). This knowledge of associations between personality and functional limitations may help in determining individuals at risk for increased functional impairment (e.g., individuals with low conscientiousness or high neuroticism). Future research is needed to clarify the underlying mechanisms.

Functional limitations in people with multimorbidity and the association with mental health conditions: Baseline data from the Canadian Longitudinal Study on Aging (CLSA).

IntroductionIncreasing multimorbidity is often associated with declining physical functioning, with some studies showing a disproportionate impact on functioning when mental health conditions are present. More research is needed because most multimorbidity studies exclude mental health conditions.ObjectivesThis study aims to improve our understanding of the association between functional limitation and multimorbidity, including a comparison of those with multimorbidity that includes versus excludes mental health conditions.MethodsThis is a population-based, cross-sectional analysis of data from The Canadian Longitudinal Study on Aging. Functional limitation was defined as the presence of any of 14 activities of daily living (ADLs) or instrumental activities of daily living (IADLs). Multimorbidity, measured by the number of chronic conditions, included mood and anxiety disorders. Logistic regression explored the association between multimorbidity (with and without mental health conditions) and functional limitation. Factor analysis identified common condition clusters to help understand clinical complexity in those with mood/anxiety disorders and the potential influences on functional limitation.ResultsThere were 51,338 participants, with a similar proportion of men and women (49% versus 51%) and 42% age 65 years or older. Fifteen percent (15%) had no chronic conditions and 17% had 5+. Ten percent (10%) reported at least one ADL or IADL limitation. Odds ratios (ORs) for functional limitation increased with multimorbidity and were generally higher for those with versus without mental health conditions (e.g., ORs from 1 to 5+ chronic conditions increased 1.9 to 15.8 for those with mood/anxiety disorders versus 1.8 to 10.2 for those without). Factor analysis showed that mood/anxiety conditions clustered with somatic conditions (e.g., migraines, bowel/gastrointestinal disorders).ConclusionThis study found higher odds of functional limitation for those with multimorbidity that included versus excluded mental health conditions, at all levels of multimorbidity. It highlights the need for concurrent management of mental and physical comorbidities to prevent functional limitations and future decline. This approach is aligned with the NICE clinical assessment and management guidelines for people with multimorbidity.

Impact of musculoskeletal disorders on healthy life expectancy in Japan

BackgroundMusculoskeletal disorders are a key cause of morbidity in elderly people. How musculoskeletal disorders relate to healthy life expectancy remain elusive. Hence, we aimed to estimate gains in healthy life expectancy from the elimination of musculoskeletal diseases and injuries by using recent national health statistics data in Japan.MethodsMortality data were taken from Japanese national life tables and death certificates in 2016. Information on medical diagnoses, injuries, and activity were obtained from the 2016 Comprehensive Survey of Living Conditions. We examined five disorders: rheumatoid arthritis, arthrosis, low back pain, osteoporosis, and fracture. The prevalence of limitations in activities of daily living (ADL) in the population after eliminating the disorder was estimated as the proportion of outpatients without the disorder and ADL limitations, inpatients without the disorder in hospitals and clinics, and people without the disorder who reside in long-term elderly care facilities.ResultsThere were small gains in life expectancy from elimination of all selected musculoskeletal disorders (0.0–0.1 years). Elimination of rheumatoid arthritis, osteoporosis, and fracture slightly increased the expected years without activity limitation (0.1–0.4) and slightly decreased years with activity limitation (0.1–0.4 years). Meanwhile, elimination of arthrosis, low back pain, and arthrosis and low back pain moderately increased expected years without activity limitation (0.3–1.5 years) and decreased years with activity limitation (0.3–1.5 years). In addition, elimination of rheumatoid arthritis, arthrosis, low back pain, osteoporosis, and fracture decreased expected years with ADL limitations (0.0–0.8 years) and non-ADL limitations (0.0–0.3 years). A combination of arthrosis and low back pain showed a moderate decrease in expected years with both ADL limitations (0.7–1.1 years) and non-ADL limitations (0.3–0.4).ConclusionsThese findings provide clinical evidence that among the musculoskeletal disorders low back pain and arthrosis are the key factors for the elongation of healthy life expectancy.

Who is at Risk? Social Support, Relationship Dissolution, and Illness in a Rural Context.

This study focuses on a cohort of adults (40-plus) in rural South Africa to unpack associations between physical health and receipt of social support, and the extent to which these associations were moderated by marital status. We use logistic regression to estimate the odds of having received emotional, physical, or financial support separately for men (N = 2247) and women (N = 2609). Our results suggest having an Activity of Daily Living (ADL) limitation or having at least one chronic condition was not significantly associated with social support receipt for women, but having an ADL limitation was associated with reduced odds of receiving financial support among men. Although marital status was strongly and significantly associated with receipt of social support for both men and women, marital status moderated the relationship between health indicators and social support receipt only for men. Our findings suggest that when men, but not women, experience a marital dissolution and are suffering from a disability or a chronic condition, their networks respond by providing needed social support.

Terminal decline in objective and self-reported measures of motor function before death: 10 year follow-up of Whitehall II cohort study

ObjectivesTo examine multiple objective and self-reported measures of motor function for their associations with mortality.DesignProspective cohort study.SettingUK based Whitehall II cohort study, which recruited participants aged 35-55 years in 1985-88;...

Limitations in activities of daily living increase the risk of stroke in older Chinese adults: a population-based longitudinal study.

It remains unclear whether limitations in activities of daily living (ADL) increase the risk of stroke in older Chinese adults. This longitudinal study used data from the Chinese Longitudinal Healthy Longevity Survey to investigate the effects of limitations in ADL on the incidence of stroke in older adults. Between 2002 and 2011, 46,728 participants from 22 provinces in China were included in this study. Of participants, 11,241 developed limitations in ADL at baseline. A 3-year follow-up was performed to determine the incidence of stroke. During the 3-year follow-up, 929 participants (8.26%) and 2434 participants (6.86%) experienced stroke in the ADL limitations group and non-ADL limitations group, respectively. Logistic regression was used to analyze the effect of ADL limitations on the risk of stroke. The results showed that after adjusting for the confounding factors gender, age, weight, hypertension, diabetes, heart disease, natural teeth, hearing impairment, visual impairment, smoking, alcohol abuse, exercise, ethnicity, literacy, residential area, and poverty, the ADL limitations group had a 77% higher risk of developing stroke than the non-ADL limitations group. After propensity score matching, the ADL limitations group still had a 33% higher risk of developing stroke than the non-ADL limitations group (OR = 1.326, 95% CI: 1.174-1.497). These findings suggest that limitations in ADL are a stroke risk factor.

Improved Healing of Rabbit Patellar Tendon Defects After an Atelocollagen Injection

Background: Patellar tendinopathy is a common cause of limitations in daily life activities in young and/or active people. The patellar tendon consists of a complex of collagen fibers; therefore, collagen could be used as a scaffold in the treatment of patellar tendinopathy. Purpose: To evaluate the healing capacity of injected atelocollagen as a treatment scaffold for patellar tendon defect and, hence, its potential for the treatment of patellar tendinopathy. Study Design: Controlled laboratory study. Methods: After receiving a full-thickness patellar tendon defect, 24 New Zealand White rabbits were divided into a control group (without treatment) and an experimental group that received an atelocollagen injection into the defect. Six rabbits from each group were subsequently used for either histologic scoring or biomechanical testing. The Mann-Whitney U test was used to compare histologic evaluation scores and load to failure between the 2 groups. Statistical significance was set at P < .05. Results: The experimental group showed excellent repair of the damaged patellar tendon and good remodeling of the defective area. In contrast, the control group showed defective healing with loose, irregular matrix fibers and adipose tissue formation. A statistically significant difference was found between the 2 groups in both histologic scores and biomechanical tests at postoperative week 12. Conclusion: Injection of atelocollagen significantly improved the regeneration of damaged patellar tendons. Clinical Relevance: Atelocollagen gel injections could be used to treat patellar tendinopathy in outpatient clinic settings.