ADL Disability Research Articles

Projecting Long-Term Care Costs Among Older Adults With ADL Disabilities and Cognitive Impairment in China.

Mounting evidence suggests that cognitive impairment is strongly associated with disability in activities of daily living (ADL disability) and long-term care (LTC) costs. However, studies forecasting future LTC costs often overlook these relationships. Consequently, this study aims to more accurately project future LTC costs in China over the next 20 years by considering the intertwined association between disability and cognitive impairment on future LTC costs. Data were from 10 959 adults ≥65 years from the 2005-2018 waves of the Chinese Longitudinal Healthy Longevity Surveys. We used the Markov model to project the population of China and track the transition of older adults in the next 20 years between 4 disability-cognition states. We employed a 2-part model to estimate LTC costs (direct and indirect LTC costs) per capita. The proportion of disabled older adults with cognitive impairment was projected to increase from 1.4% in 2021 to 3.4% in 2040, while that of those without cognitive impairment was projected to decrease from 4.7% in 2021 to 4.5% in 2040. The direct and indirect LTC costs were projected to increase from 0.3% and 0.2% of gross domestic product (GDP) in 2021 to 1.4% and 0.7% in 2040 for disabled persons without cognitive impairment and from 0.1% and 0.1% of GDP in 2021 to 1.3% and 1.3% in 2040 for those with cognitive impairment, respectively. Policy-makers could include the assessment of cognition in the LTC needs assessment and allocate more compensation to LTC insurance participants with cognitive impairment.

Metrics of physiological network topology are novel biomarkers to capture functional disability and health.

Physiological networks are highly complex, integrating connections among multiple organ systems and their dynamic changes underlying human aging. It is unknown whether individual-level network could serve as robust biomarkers for health and aging. We used personalized network analysis to construct single sample network and examine the associations between network properties and functional disability in the Rugao Longevity and Aging Study (RuLAS), the China Health and Retirement Longitudinal Study (CHARLS), the Chinese Longitudinal Healthy Longevity Survey (CLHLS), and the National Health and Nutrition Examination Survey (NHANES). We observed impairments in interconnected physiological systems among long-lived adults in RuLAS. Single sample network analysis was applied to reflect the co-occurrence of these multi-system impairments at the individual level. The ADL-disabled individuals' networks exhibited notably increased connectivity among various biomarkers. Significant associations were found between network topology and functional disability across RuLAS, CHARLS, CLHLS and NHANES. Additionally, network topology served as novel biomarkers to capture risks of incident ADL disability in CHARLS. Furthermore, these metrics of physiological network topology predicted mortality across four cohorts. Sensitivity analysis demonstrated that prediction performance of network topology remained robust, regardless of the chosen biomarkers and parameters. These findings showed that metrics of network topology were sensitive and robust biomarkers to capture risks of functional disability and mortality, highlighting the role of single sample physiological networks as novel biomarker for health and aging.

Validating the Definition of Lumbar Instability-A Cross-Sectional Study with 420 Healthy Volunteers.

Background/Objectives: Low back pain is thought to be caused by lumbar instability. To date, multiple definitions of radiological lumbar instability have been used without verifying the "normal range" of the lumbar segmental mobility. Ideally, normative data for lumbar mobility in healthy individuals are required to establish an acceptable threshold for lumbar instability. This study aims to elucidate (i) the prevalence of so-called radiological lumbar instability at each lumbar spine level in conventional criteria and (ii) a practical radiological threshold for lumbar instability in healthy individuals. Methods: Participants completed a questionnaire and underwent standard active dynamic radiography of the lumbar spine in the standing position. Intervertebral range of motion (IROM) and sagittal translation distance (ΔST) were measured at each intervertebral level. Nachemson's criteria of radiological lumbar instability were applied. Results: This study involved four hundred and twenty participants (249 males and 171 females); 76% (320/420) met the criteria for radiological lumbar instability. The definition of lumbar instability based on IROM and ΔST was achieved by 0.2% and 1.7% of participants at the L5-sacrum (L5-S) level, respectively. Conclusions: The normative data of lumbar mobility were obtained from a large number of participants who had less LBP-related ADL disability. The widely accepted criteria for lumbar instability were not applicable except for the L5-S level. Further studies of lumbar mobility, including patients with severe LBP, might prove the relationship between hypermobility of the lumbar spine and LBP.

Development and validation of a nomogram to predict the depressive symptoms among older adults: A national survey in China

BackgroundDepressive symptoms (DS) have become a global public health problem. However, a risk prediction model for DS in the elderly population has not been established. The purpose of this study was to develop and validate a predictive nomogram to screen for DS in the elderly population. MethodsA cross-sectional data of 3396 participants aged 60 and over were obtained from the China Health and Retirement Longitudinal Study 2018 (CHARLS). Participants were divided into the development and validation set. Predictive factors were selected through a single-factor analysis, and then a predictive model nomogram was established. The discrimination, calibration, and clinical validity were evaluated using the receiver operating characteristic (ROC) curves, Hosmer-Lemeshow tests, and decision curve analyses (DCA). ResultsA total of 2379 and 1017 participants were included in the development and validation set, respectively. The analysis found that gender, residence, dyslipidemia, self-rated health, and ADL disability were risk factors for DS in older adults, and were included in the final model. This nomogram showed an acceptable predictive performance as evaluated by the area under the ROC curve with values of 0.684 (95 % confidence interval (CI): 0.663–0.706) and 0.687 (95 % CI: 0.655–0.719) in the development and validation set, respectively. The calibration curve indicated that the model was accurate, and DCA demonstrated a good clinical application value. ConclusionFive factors were selected to establish a nomogram for predicting DS in older adults. The nomogram has a good evaluation performance and can be used as a reliable tool to predict DS among older adults.

The prevalence of depression, determinants, and linkage with functional disability amongst postmenopausal women in India: Evidence from the Longitudinal Ageing Study in India

BackgroundThe study objective was estimating the prevalence and determinants of depression amongst postmenopausal women in India. Additionally, we used panel mediation analysis to model the extent to which multimorbidity was associated with depression after adjusting for the effects of functional disability in the participants. MethodsData from 28,160 women aged 50 and above from the Longitudinal Aging Study in India (LASI) Wave 1 were analyzed. Depression was assessed using the Composite International Diagnostic Interview-Short Form (CIDI-SF), with multimorbidity and functional disability (ADL and IADL) considered as key predictor variables. Logistic regression and Karlson-Holm-Breen (KHB) mediation analysis were employed. ResultsThe weighted prevalence of depression among women aged ≥ 50 years was 21.76% (95% CI: 20.81, 22.73), significantly higher women aged < 50 years (17.60%, 95% CI: 16.33, 18.94). Factors independently associated with increased odds of depression included being unmarried, rural residence, and multimorbidity, while higher educational status was associated with lower odds of depression. The relationship between multimorbidity and depression was partially mediated by ADL and IADL disabilities. Notable regional (state) variations in the magnitude of depression were observed. ConclusionsNearly one in five postmenopausal women in India aged 50 years and older have clinical depression. Community screening for reaching the unreached with primary care mental health strengthening need enhanced policy focus.

Mortality and disability risk among older adults unable to complete grip strength and physical performance tests: a population-based cohort study from China

BackgroundThe link between low grip strength, diminished physical performance, and adverse health outcomes in older adults has been well-established. However, the impact of older adults who cannot complete these tests on disability and mortality rates remains unexplored without longitudinal study.MethodsWe collected data from the China Health and Retirement Longitudinal Study (CHARLS). Participants aged 60–101 were enrolled at baseline. We analyzed the prevalence of populations unable to complete handgrip strength (HGS), gait speed (GS), and five times chair stand test (FTCST). Completing risk models were used to estimate the risk of mortality and disability over seven years.ResultsA total of 3,768 participants were included in the analysis. The percentage of older adults unable to complete the GS and FTCST tests increased notably with age, from 2.68 to 8.90% and 2.60–20.42%, respectively. The proportion of older people unable to perform the HGS was relatively stable, ranging from 1.40 to 3.66%. Compared to older adults who can complete these tests, those who cannot perform FTCST face a significantly higher risk of mortality, with 49.1% higher risk [hazard ratio (HR) = 1.491, 95% CI = 1.156, 1.922; subdistribution hazard ratio (SHR) = 1.491, 95%CI = 1.135,1.958)]. Participants who were unable to complete the GS test had a higher risk of developing ADL disability, regardless of whether they were compared to the lowest-performing group (HR = 1.411, 95%CI = 1.037,1.920; SHR = 1.356, 95%CI = 1.030,1.785) or those who can complete the GS (HR = 1.727, 95%CI = 1.302,2.292; SHR = 1.541, 95%CI = 1.196,1.986). No statistically significant difference in the risk of developing ADL disability among older adults who were unable to complete the HGS test compared with either the poorest performing group (HR = 0.982, 95% CI = 0.578, 1.666; SHR = 1.025, 95% CI = 0.639, 1.642) or those who were able to complete the HGS test (HR = 1.008, 95% CI = 0.601, 1.688; SHR = 0.981, 95% CI = 0.619, 1.553). The risk of all-cause mortality was not significantly different for older adults who were unable to complete the HGS test compared to those with the worst performance (HR = 1.196, 95%CI = 0.709–2.020; SHR = 1.196, 95%CI = 0.674, 2.124) or those who were able to complete the test (HR = 1.462, 95%CI = 0.872–2.450; SHR = 1.462, 95%CI = 0.821,2.605).ConclusionThe risks of adverse events faced by older adults unable to complete the tests vary, indicating the necessity for future research to conduct separate analyses on this high-risk population.

Joint trajectories of physical frailty and social frailty and associations with adverse outcomes: A prospective cohort study

BackgroundWe examined joint trajectories of physical frailty and social frailty as well as their associations with adverse outcomes. MethodsWe conducted a prospective cohort study by using five waves of national data from China Health and Retirement Longitudinal Study (CHARLS 2011–2020), involving 4531 participants aged ≥60 years. We identified 4-year trajectories at three examinations from 2011 to 2015 using parallel process latent class growth analysis. Adverse outcomes were obtained from 2015 to 2020 across two subsequent waves. We calculated hazard ratios (HR) using Cox proportional hazard models. We also conducted analyses by gender. ResultsThree joint trajectories were identified, including persistent absence of physical and social frailty (58.5 %), no physical frailty but social frailty (28.1 %), and persistent combination of physical and social frailty (13.4 %). Compared with persistent absence of physical and social frailty, no physical frailty but social frailty and persistent combination of physical and social frailty were associated with higher risk of instrumental activities of daily living (IADL) disability (HR = 1.182–2.020, 95 % CI: 1.014–2.416) and all-cause mortality (HR = 1.440–2.486, 95 % CI: 1.211–3.009). The persistent combination of physical and social frailty was also associated with ADL disability (HR = 2.412, 95 % CI: 1.999–2.911) and falls (HR = 1.410, 95 % CI: 1.196–1.662). Gender differences were observed in relationships between joint trajectories and adverse outcomes. ConclusionCommunity-dwelling older adults exhibit distinct joint trajectories and those with persistent combination of physical and social frailty experience greatest risk of incident adverse outcomes. Clinical and public health measures targeting physical or social frailty should account for both and be gender-specific.

Disabled life expectancy among older Colombian men and women.

Colombia's population is rapidly aging and older adults are living longer, however, we have limited information on the level of disability and number of years older Colombians spend with disability. We estimated age-and-gender specific ADL, IADL and mobility disability prevalence and disabled life expectancy (DLE) and to examined gender differences. Life tables came from the Colombian vital statistics and disability prevalence data came from the cross-sectional 2015 Colombia National Survey of Health, Well-being, and Aging. Disabled life expectancy (DLE) was calculated using Sullivan's method. About one-third to one-half of remaining years will be spent with IADL or mobility disability. The remaining years of life spent with ADL was relatively low at younger ages, but by age 85, about half of remaining life will be spent with disability. Compared to men, women had higher levels of disability and are estimated to spend more years with disability. Gender differences in ADL did not emerge until ages 70 and older. Older Colombians, in particularly women, are estimated to live a significant proportion of their life with disability, particularly IADL and mobility disability. High levels of disability are concerning because the country lacks adequate infrastructure and has limited options for long term care.

ASSOCIATIONS BETWEEN DISABILITY, CHRONIC DISEASES, AND DEPRESSIVE SYMPTOMS IN VIETNAMESE OLDER ADULTS

Abstract After the fall of Saigon in 1975, several waves of Vietnamese immigrants/refugees migrated to the U.S. currently comprising 2.2 million individuals, the 4th-largest Asian-origin subgroup in the U.S. Despite the large number and their traumatic, adverse lifelong experiences, health research on this population is scarce. To fill this gap, we developed the Vietnamese Aging and Care Survey and collected health data on older Vietnamese in Houston, Texas, the 2nd-largest Vietnamese-populated metropolitan area in the nation. The purpose of this study was to examine the associations between their physical disability, chronic diseases, and depressive symptoms. Respondents (N=210) were 76 years old (mean), married (63%), and female (56%) with 8 years of education. They lived in the U.S. for 25 years (mean) and spoke Vietnamese only (88%) in multi-generation (80%) low-income households (91%, ≤$25K). They self-rated their health as fair/poor (80%) with ≥1 chronic condition (76%). Those with higher depressive symptoms were less likely to be married (p=0.004) and have more chronic diseases (p=0.004) compared to those without depressive symptoms. Regression analyses showed significant associations between arthritis (β=2.73), liver disease (β=6.24), ADL disability (β=0.72), and higher depressive symptoms. Limited control over their basic function (ADL disability) would restrict their daily lives, and mobility issues and pain (arthritis and liver disease) might impact them psychologically. While older Vietnamese may leverage their multi-generation living condition, and receive tangible support with ADL disability within their families, healthcare professionals should connect them with culturally and linguistically relevant adult daycare centers that provide social and exercise opportunities.

COMPARING COVID-19 CASES AND MORTALITY RATES: THE GREEN HOUSE VERSUS THE TRADITIONAL NURSING HOME IN THE UNITED STATES

Abstract Introduction The COVID-19 pandemic has posed significant challenges to nursing home (NH) care. However, Green Houses (GH), with their small size and unique care model, may offer a solution for infection control and COVID-19 prevention. This study aims to compare COVID-19 case and mortality rates between GHs and traditional NHs in the United States. Methods Secondary data were used to compare COVID-19 case and mortality rates among three groups: GHs (n=19), traditional small NHs (n=266), and traditional large NHs (n=2932) located in 10 US states from June 2020 to September 2022. Poisson regressions using generalized estimating equations (GEE) were utilized to quantify differences in COVID-19 case and mortality rates while controlling for average age, gender, and ADL score. Results The study population had a mean age of 73.38 and was primarily female (57.8%) and white (78.2%). The GEE results indicated that small and large NHs have significantly higher relative risks (RR) of COVID-19 cases (RR = 1.61; 95% CI 1.25-2.08 and RR = 1.75; 95% CI 1.36-2.24, respectively) compared to GHs. For COVID-19 mortality rates, there is an increased risk in large NHs compared to GHs (RR = 1.67; 95% CI 1.01-2.77), but no difference between GHs and small NHs. Conclusion After adjusting for age, gender, and ADL disability, GHs have lower COVID-19 incidence and mortality rates than traditional NHs. These differences may be attributable to GHs having fewer beds, offering more resident privacy, and having a higher certified nursing assistant-to-resident ratio compared to traditional NHs.

DIFFERENCES IN FRAILTY BETWEEN TRADITIONAL MEDICARE AND MEDICARE ADVANTAGE BENEFICIARIES

Abstract Medicare Advantage (MA) plans cover at a minimum the same services as fee-for-service Medicare (FFS), but may target patient populations that differ in health and frailty. Leveraging 2011 and 2015 National Health and Aging Trends Study (NHATS) linked to Medicare claims, we classified participants as FFS or MA beneficiaries based on 12 months of Medicare enrollment. We calculated a deficit accumulation-based frailty index (FI) and phenotypic frailty from the survey assessment. All analyses accounted for the complex sampling design and weighted to reflect national estimates. In 2011, MA beneficiaries were more likely to be female (MA vs FFS: 59.1% vs 55.6%), Black (9.6% vs 7.4%) or other race (9.8% vs 5.2%), and to have an estimated income &amp;lt;$25,000 (44.5% vs 39.4%). Although the mean FI was similar between MA and FFS (MA vs FFS: 0.25 vs 0.25), MA beneficiaries were more likely to have mild frailty by FI (20.1% vs 18.6%) but less likely to have severe frailty by FI (10.0% vs 11.7%) or phenotypic frailty (13.5% vs 14.0%). MA beneficiaries had a higher prevalence of some comorbidities, such as hypertension (MA vs FFS: 64.9% vs 63.3%) and diabetes (24.4% vs 23.3%), but a lower mean number of ADL disability (0.32 vs 0.39). In 2015 the results were similar, although MA beneficiaries had a higher prevalence of pre-frailty (MA 46.0% vs 43.3%). In conclusion, MA beneficiaries seem to have a lower level of deficit-accumulation frailty and phenotypic frailty. This difference is driven by comorbidities, but not functional disability.

CELLULAR IMMUNE AGING AND PHYSICAL DISABILITY: RESULTS FROM THE HEALTH AND RETIREMENT STUDY

Abstract Given long-standing inequities in physical disability, we leveraged data from the nationally-representative Health and Retirement Study to investigate gender differences in the association between advanced immune aging and physical disability. Among women, we found a one standard deviation increase in the CD8+:CD4+ ratio, a marker of advanced immune aging, was associated with a 24% greater prevalence of ADL disability (PR= 1.24, 95% CI: 1.23, 1.25). No association was observed among men. Results suggest that among women, advanced immune aging may serve as a salient risk factor in shaping physical disability.

Cross-sectional and longitudinal associations of obesity with disability between age 50 and 90 in the SHARE study

BackgroundObesity is associated with disability but whether age and ageing modify this association remains unclear. We examined whether this association changes between 50 and 90 years, and whether change in disability rates over 14 years differs by body mass index (BMI) categories. MethodsBMI and ADL-disability data on 28,453 individuals from 6 waves (2004–2018, SHARE study) were used to examine the cross-sectional absolute and relative associations, extracted at age 50, 60, 70, 80, and 90 years using logistic mixed models. Then baseline BMI and change in disability rates over 14-years were examined using logistic-mixed models. ResultsAt age 50, the probabilities of ADL disability in individuals with BMI 30–34.9 and ≥35 kg/m² were 0.07 (0.06, 0.09) and 0.11 (0.09, 0.12), increasing to 0.47 (0.44, 0.50) and 0.55 (0.50, 0.60) at age 90; the increase in both these groups was greater than that in the normal-weight group (p for increase with age<0.001). On the relative scale the OR at age 50 in these obesity groups was 2.37 (1.79, 3.13) and 5.03 (3.38, 7.48), decreasing to 1.51 (1.20, 1.89) and 2.19 (1.50, 3.21) at age 90; p for decrease with age=0.05 and 0.02 respectively. The 14-year increase in probability of disability was greatest in those with BMI≥35 kg/m² at age 50, 60, and 70 at baseline: differences in increase compared to normal weight were 0.08 (0.02, 0.14), 0.11 (0.07, 0.15), and 0.09 (0.02, 0.16) respectively. ConclusionsADL disability is increasingly prevalent with age in individuals with obesity. Relative measures of change obscure the association between obesity and disability due to age-related increase in disability rates in all groups.

Late‐life social activity and subsequent risk of dementia and mild cognitive impairment

AbstractBackgroundPrevious research reported associations between more social engagement and better cognitive health. Social engagement is a multidimensional construct encompassing interrelated but distinct domains such as social activity, social network size, perceived social support, and loneliness. These domains are not equally amenable to interventions. We therefore focused on late‐life social activity, as a potentially modifiable facet of social engagement, and examined its relation to risks of dementia and MCI, independent of other aspects of social engagement, lifestyle, and health.MethodIn the Rush Memory and Aging Project (MAP), 1923 older adults without dementia at baseline were followed longitudinally, with annual clinical evaluation of dementia and MCI. The frequency of participation in six common social activities was assessed by a validated scale at baseline (mean = 2.6, range: 1‐4.3), as were size of social network, perceived social support, and perceived loneliness. A clinical diagnosis of MCI or dementia was rendered annually based on cognitive tests and diagnostic classification by a clinician. We used Cox proportional hazard models to quantify associations between social activity score and incident dementia or MCI. Primary models controlled for demographics; additional models included covariates for health, other social engagement indicators, and income. In secondary analyses, to consider reverse causality, we excluded participants who developed MCI or dementia within two years after baseline.ResultDuring a mean follow‐up of 6.7 (std = 4.7) years, 545 (28%) participants developed dementia, and 695 (49% of those without MCI at baseline) developed MCI. Each one‐unit increment in social activity score was associated with a 37% reduction in dementia risk [HR = 0.63, 95% CI: 0.53‐0.74] after adjusting for age, sex, education, race/ethnicity, and marital status (Figure 1A). Social activity was also related to a lower risk of MCI [HR = 0.77, 95% CI: 0.66‐0.89] (Figure 1B). Results were not meaningfully different after adjusting for vascular disease burden, BMI, ADL disability, physical activity, depressive symtoms, social network size, social support, social isolation, and income. Excluding participants who developed MCI or dementia soon after baseline did not change the patterns.ConclusionKeeping socially active at older age is related to lower dementia risk, possibly informing strategies for developing preventive interventions.

Revealing the divide: Contrasting COVID-19 outcomes in Green Houses and traditional nursing homes in the United States

IntroductionThis study compares COVID-19 case and mortality rates in Green Houses (GHs) and traditional nursing homes (NHs) during the COVID-19 pandemic. MethodsCMS data from 10 states (June 2020 to September 2022) were analyzed for GHs (n = 19), small NHs (n = 266), and large NHs (n = 2,932). Multivariate Poisson regressions with GEE were used. ResultsParticipants (mean age 73.4) were predominantly female (57.8 %) and White (78.2 %). Small and large NHs had a significantly higher COVID-19 case risk (RR = 1.61; 95 % CI 1.25–2.08 and RR = 1.75; 95 % CI 1.36–2.24, respectively) compared to GHs. Large NHs also had an increased mortality risk (RR = 1.67; 95 % CI 1.01–2.77) compared to GHs, with no difference found between GHs and small NHs. ConclusionAfter adjusting for age, gender, and ADL disability, GHs demonstrated lower COVID-19 case and mortality rates than traditional NHs, likely due to their unique features, including person-centered care, size, and physical structure.

Longitudinal associations of loneliness with mental ill-health, physical ill-health, lifestyle factors and mortality in ageing adults in Thailand

ObjectivesThe aim of this study was to assess the longitudinal association between loneliness, mental and physical ill-health indicators, lifestyle factors and mortality among middle-aged and older adults in Thailand.MethodsWe analyzed prospective cohort data of participants 45 years and older from three consecutive waves in 2015 (n = 5616), 2017 (n = 3600), and in 2020 (n = 2863) of the Health, Aging and Retirement in Thailand (HART) study. Loneliness was assessed with a single item. To assess the longitudinal associations between loneliness and health outcomes between 2015 (baseline), 2017 (first follow-up) and 2020 (second follow-up), we conducted Generalized Estimating Equations analysis (GEE).ResultsThe proportion of loneliness was 21.6% in 2015, 23.8% in 2017 and 21.3% in 2020. In the adjusted GEE logistic regression model, loneliness was positively associated with mental ill-health (poor self-rated mental health status, poor quality of life/happiness, depressive symptoms, and insomnia symptoms), physical ill-health (poor self-rated physical health status, hypertension, kidney disease, osteoporosis, and ADL disability), and lifestyle factors (physical inactivity, and having underweight). Furthermore, in adjusted Cox proportional hazards regression, loneliness was associated with mortality. In adjusted logistic regression, compared to without loneliness in all three study waves, having loneliness in one wave and/or two to three waves was positively associated with incident mental ill-health (incident poor self-rated mental health status, incident poor quality of life/happiness, incident depressive symptoms, and incident insomnia symptoms), incident physical ill-health (incident poor self-rated physical health status, incident diabetes, incident kidney disease, and incident ADL disability), and incident lifestyle factors (having incident underweight).ConclusionWe found that loneliness was associated with several mental and physical ill-health indicators, lifestyle factors and mortality. Enhanced screening and treatment of loneliness may reduce mental and physical ill-health indicators in Thailand.

Factors associated with performance in basic and instrumental activities of daily in older with 70 years and more

To analyze performance in basic and instrumental activities of daily living and associated factors in older elderly people in the community. This is a cross-sectional study with 221 older adults aged ≥70 years from the central region of Brazil. The outcome variables were disability in at least one activity of daily living. Multiple regression models were applied to the three outcomes, considering demographic and health conditions as exposure variables. The mean age was 79.1 years (5.7), and 67.4% were women. The prevalence of disability in BADL was 37.3%, while for IADL it was 80.1% and for ADL 81.4%. The associated factors for disability in BADL were hospitalization in the last year, falls, and reduction in gait speed. IADL was associated with age ≥80, 4 years or less of schooling, and falls. Total disability in ADL was associated with age ≥80 years and falls. The prevalence of disability was high, especially for instrumentals, and the association with advanced age (≥80 years) and falls, demonstrates the need for continuous surveillance of these characteristics.

Lower HbA1C of glycemic control is associated with higher risk of depressive symptoms in elderly with type 2 diabetes mellitus–A Nationwide Community-based study

ObjectiveWe investigated the correlation between glycemic control status and depressive symptoms in type 2 diabetes elderly. MethodsA total of 1527 participants with type 2 diabetes aged 55 years and older from the Healthy Aging Longitudinal Study in Taiwan study were included in this cross-sectional study. The Center for Epidemiologic Studies Depression Scale (CESD) (20 items) score of ≥16 was indicative of depressive symptoms. The participants were divided into HbA1c ≥ 6.5% and < 6.5% representing the glycemic control. Multiple logistic regression (MLR) and Generalized linear model (GLM) were used. ResultsThe MLR analysis showed that the low HbA1c group had significant two-fold increased odds of depressive symptoms compared to the high HbA1c group (OR 1.89, 95% CI 1.17–3.05). The risk of depressive symptoms was lower among males (OR 0.49, 95% CI 0.30–0.80) and those with higher BMI (OR 0.93, 95% CI 0.86–1.00); whereas the risk was higher among those who lived alone (OR 2.37, 95% CI 1.31–4.27) and with ADL disability (OR 3.01, 95% CI 1.85–4.89). The GLM showed that the dimension of depressive affect reached statistical significance with lower HbA1c. ConclusionThis nationwide community-based study shows that depressive symptoms are associated with lower HbA1C, reminding us that more attention should be paid to the presence of depressive symptoms in those with lower HbA1C. Further research is needed to clarify the causal relationship.

Outcomes Associated with Concomitant Lower-Limb Amputation in Persons with Major Upper-Limb Amputation: Results of a National Study

ABSTRACT Introduction The challenges faced by persons with amputations are amplified for those with multiple limb loss, compared with single limb loss. However, there is limited research describing the functional outcomes of mixed upper and lower limb loss or the long-term psychosocial and health-related quality of life (HRQoL) outcomes among this group. Materials and Methods A cross-sectional, national telephone survey of 808 US veterans with major upper-limb amputation (ULA) with and without concomitant lower-limb amputation (LLA) who received care at US Veterans Affairs Medical Centers between 2010 and 2015 was conducted. T-tests and χ2 tests identified any significant differences in characteristics and outcomes of groups with and without LLA. Linear regressions examined the association between amputation laterality and outcomes. Results In comparison to those with no LLA, respondents with concomitant LLA were slightly younger (60.0 vs. 63.7) and had similar mean time in years from initial amputation (31.5 vs. 31.4). Transfemoral was the most common level of LLA (67.7%), and there was no significant difference in the distribution of ULA levels between the 2 groups. Phantom pain was less common among those with concomitant LLA compared with ULA only (64.4% vs. 74.5%, P &lt; 0.05). No significant differences were found in prevalence of residual limb, neck, or back pain; measures of disability (QuickDASH); HRQoL; or need for activities of daily living help across the two groups. Conclusions In veterans with concomitant LLA and ULA, transfemoral amputation was the most common level of LLA. Those with concomitant LLA were less likely to report phantom limb pain. No statistically significant differences were found by group in need for ADL help, disability, or HRQoL. Clinical Relevance These results provide clinicians with a greater appreciation of the similarities and differences between the two groups in relation to amputation characteristics, pain, prosthesis utilization, prosthesis satisfaction, and functional outcomes.

Proportion of Non-severe Ischemic Stroke Patients Returning to Work

OBJECTIVE To explore the proportion of non-severe ischemic stroke patients returning to work (RTW) and to examine the association of demographic, clinical, and evaluative information with RTW outcomes. METHODS This observational study included non-severe ischemic stroke patients at the stroke ward, Srinagarind Hospital, Khon Kaen, Thailand between September 2021 and November 2022. Patients included were over 18-year-old, had NIHSS scores not exceeding 14, were currently employed and wanted to RTW. Patients were assessed at the discharged time, 2-week-follow-up, and 3-month-follow-up. Bivariate analysis was conducted using either Chi-square or Fisher’s exact test. RESULTS Sixty-four patients were recruited of whom 4 dropped out, leaving a total of 60. The cumulative proportions of successful RTW patients at the discharged time, 2-week-follow-up, 1-month-follow-up, and 3-month-follow-up were 26.7%, 51.7%, 70%, and 76.7% (95%CI 16.8-38.8, 39.2-64.0, 57.7-80.5, 64.9-86.0), respectively. Most patients could RTW in the first month, then the number plateaued at 3 months. More successful RTW patients included those in cognitive demand occupations, evaluated as normal to minor neurological severity, motor power graded 4-5 at discharge, passed MoCA or MMSE test, and who were rated as independent by either the mRS or the BI. Bivariate analysis revealed statistically significant association between RTW proportion and occupation type, neurological severity, motor power, and ADL disability. CONCLUSIONS Most non-severe ischemic stroke patients could RTW within 3 months after discharge. Occupational type, neurological severi-ty, motor power, and ADL associated with the proportion of RTW (3-month-follow-up). RTW evaluation of non-severe stroke patients should be assessed at short intervals for 3 months after discharge. KEYWORDS return to work, ischemic stroke, occupation, cognition, activities of daily living