Instrumental Activities Of Daily Living Decline Research Articles

Exploring geriatric assessment-driven rehabilitation referral patterns and its influence on functional outcomes and survival in older adults with advanced cancer.

Older adults with advanced cancer experience functional disability that warrants rehabilitation services; however, evidence indicates inconsistencies in referral. The purpose was to (1) identify predictors of geriatric assessment (GA)-driven referrals to rehabilitation services and (2) explore associations between referral and change in function, health-related quality of life (HRQoL), and overall survival among older adults with advanced cancer. This was a secondary analysis (NCT020107443, UG1CA189961) of a nationwide GA clinical trial. Patients were older adults with advanced cancer who had at least one GA-defined physical performance or functional status impairment. Primary outcomes were oncologist-initiated discussion about or referral to rehabilitation services after the GA (Aim 1) and decline in activities of daily living (ADL), Instrumental ADL (IADL), and HRQoL within 3 months, and overall survival at 1 year (Exploratory Aims). Analyses included multivariable logistic regression and Cox proportional hazards models. Demographic and clinical factors were controlled for by using 1:1 propensity score matching. In total 265 patients were analyzed. After adjustment, impaired cognition (odds ratio [OR] = 2.25, p = 0.01), Karnofsky score indicating disability (OR = 2.86, p < 0.01), and receipt of monoclonal antibodies (OR = 1.95, p = 0.04) were associated with higher odds of referral. In contrast, polypharmacy was associated with lower odds of referral (OR = 0.31, p < 0.01). Referred patients were less likely to decline in ADL (OR 0.30, p = 0.07) and IADL (OR 0.64, p = 0.35), but more likely to decline in HRQoL (OR 1.20, p = 0.67) and have worse survival (HR 1.18, p = 0.62). Cancer treatment, polypharmacy, cognition, and disability status likely influence oncologists' decision to refer for rehabilitation. Referral was not independently associated with change in functional disability, HRQoL, or survival. Future studies should evaluate patients' utilization of rehabilitation services post-referral and determine whether dose/timing of rehabilitation services influence clinical outcomes.

Associations of Resilience, Perceived Control of Health, and Depression with Geriatric Outcomes after Surgery.

To identify if depression, resilience, and perceived control of health are related to 2.5-year mortality and instrumental activities of daily living (IADL) decline among older adults after surgery. The relationships of psychosocial factors with postoperative mortality and IADL decline among older adults are understudied. We identified 3778 community-dwelling older adults in the Health and Retirement Study (HRS) with Medicare claims for surgery (mean [SD] age: 75.4 [7.8] years, 53.9% women, and 86.0% non-Hispanic White). We assessed associations of depression, resilience, and perceived control of health with 2.5-year postoperative mortality and IADL decline using cox and modified Poisson regression analyses, adjusting for sociodemographic and health variables. The incidence of 2.5-year postoperative mortality was 18.5% and IADL decline was 9.4%. Depression was associated with a higher incidence and adjusted hazard [95% CI] of mortality (26% vs. 16%, aHR:1.2[0.9, 1.5]), but high resilience was associated with a lower incidence and adjusted hazard of mortality (9% vs. 21%, aHR:0.6[0.5, 0.8]). Those with depression had higher incidence and adjusted relative risk [95% CI] of IADL decline (17% vs. 7%, aRR:1.6[1.2, 2.2]), but lower incidence and adjusted relative risk of IADL decline was identified for those with high resilience (4% vs. 11%, aRR:0.6[0.4, 1.0]) and high perceived control of health (7% vs. 10%, aRR:0.6[0.4, 1.0]). While depression confers greater risk of mortality and IADL decline, higher resilience and perceived control of health may be protective. Addressing psychosocial factors in the peri-operative period may improve outcomes among older adults.

Aging trajectories of subscales in higher-level functional capacity among community-dwelling older Japanese adults: the Otassha study

BackgroundMaintaining higher-level functional capacity is important for independent living in older age. The aging trajectory of the Tokyo Metropolitan Institute of Gerontology Index of Competence (TMIG-IC) has three patterns; however, the subscale patterns are unclear.AimsThis study aimed to clarify the aging trajectory patterns of the TMIG-IC subscales among community-dwelling older Japanese.MethodsParticipants were 3,169 community-dwelling older Japanese who participated in the 2012–2022 mail survey of the Otassha study. The aging trajectory patterns of the TMIG-IC total and subscale scores for those aged 65–90 years were identified using group-based trajectory modeling. Further, the combination frequency of the subscale trajectory patterns was determined.ResultsThree patterns were identified: early-onset decreasing, late-onset decreasing, and high-stable.DiscussionThe instrumental activities of daily living (IADL) trajectory was maintained until approximately 80 years of age; however, chronic disease prevailed the most in the early-onset decreasing pattern. The early-onset decreasing pattern of intellectual activity (IA) was present in 25% of participants, showing impaired IA from 65 years of age. The late-onset decreasing pattern of social roles (SR) was present in 30% of participants, showing a sharp decline compared to other subscales. For many people, the patterns of decrease in SR and IA overlapped.ConclusionsTo maintain higher-level functional capacity, interventions that include disease management and prevention of decline in IADL and increase the awareness of the social support provided throughout old age and interventions for people with an early decline in IA should be implemented.

Trajectories of activities of daily living according to dementia among middle-aged and older people in South Korea: a longitudinal study from 2006 to 2020 (14 years).

The aging population in South Korea faces numerous health challenges, one of which is the decline in Activities of Daily Living (ADL) and Instrumental Activities of Daily Living (IADL). This study aims to investigate the patterns of change in ADL and IADL among older adults and examines how these patterns vary between individuals with and without dementia. We conducted an analysis of data collected from the Korea Longitudinal Study of Ageing (KLoSA) between 2006 and 2022. Our cohort consisted of individuals aged 45 and older with non-dementia conditions, including mild cognitive impairment (N=6042), and a smaller group with dementia (N=91). Using Latent Growth Curve Models, we explored the developmental trajectories of ADL and IADL among our sample. Our findings indicate a linear decline in both ADL and IADL scores as individuals age. The decline in IADL was more pronounced in the dementia group, suggesting a greater sensitivity to sociocultural factors within this domain. The data revealed that individuals with dementia had consistently lower ADL and IADL scores. Notably, the variance in scores within the dementia group increased with age, signifying a worsening in daily living performance and an increase in individual variation (F=226.630, p<.001). The results of this study underscore the impact of dementia on both the self-regulation function and the social and cultural aspects of daily living performance, particularly reflected in IADL scores. These findings point to the necessity for comprehensive care strategies that address the multifaceted needs of older adults with dementia, including support for complex daily activities that are influenced by sociocultural factors.

Abstract 2228: Long-term trajectories of functional disability in older adults with cancer

Abstract Background: Older individuals with cancer history have lower risk of developing Alzheimer’s disease (AD). Cognitive impairment is associated with lower functioning in Instrumental Activities of Daily Living (IADL) and Activities of Daily Living (ADL). However, little is known about long-term IADL and ADL trajectories among individuals with cancer, hindering understanding of the underlying biological mechanisms between cancer and AD. We investigated the long-term functional disability trajectories of adults with cancer, comparing them with similarly aged individuals without a cancer diagnosis. Methods: Our study included 16,006 individuals aged 50 and older without a cancer history at baseline from the Health and Retirement Study. Biennial assessments were conducted from 1998 to 2020, including self-reported cancer status, IADL, and ADL. Linear probability models with repeated measures were used to assess IADL and ADL independence probabilities, adjusting for demographic and socioeconomic covariates. Results: Among 16,006 participants (mean [SD] baseline age, 66.1 [9.9] years; 9,169 [57.3%] female), 3,723 (23.3%) reported a cancer diagnosis during follow-up. Before cancer diagnosis, individuals who later developed cancer had a higher probability of IADL independence and experienced a slower decline in independence compared to their similarly aged counterparts who remained cancer-free. Probability of IADL independence was 0.05 lower immediately after cancer diagnosis compared to the pre-cancer phase, followed by accelerated independence losses relative to the pre-cancer period. After diagnosis, the rate of decline in probability of IADL independence remained slower for individuals with cancer than their cancer-free counterparts, but differences in the rate of decline were smaller than prior to cancer diagnosis. Similar trends were observed for ADL independence. Conclusions: We observed a decline in both IADL and ADL independence around the time of cancer diagnosis, possibly attributed to treatments. Overall, individuals with cancer experienced a more gradual loss in functional independence compared to individuals who remained cancer-free, consistent with the documented inverse association between cancer and AD. Funding information: The current research was supported by the National Cancer Institute of the National Institutes of Health (T32CA009142), T32 Training Grants from the NCI/NIH, and the National Institute on Aging (RF1AG059872). Citation Format: Gina E. Nam, Elizabeth Rose Mayeda, Zuo-Feng Zhang. Long-term trajectories of functional disability in older adults with cancer [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 2228.

Instrumental activities of daily living in older patients with metastatic prostate cancer: results from the meet-URO network ADHERE prospective study

Instrumental activities of daily living (IADL) are significant health indicators closely related to executive functions and able to detect mild cognitive impairment. A decline in IADL usually precedes ADL limitation, including taking medications, and may therefore predict a cognitive decline. We aimed to investigate the association of patients’ IADL score with other clinical factors, with a particular focus on the presence of a caregiver, and the impact on adherence to androgen receptor pathway inhibitors (ARPIs) and survival outcomes within the Meet-URO 5—ADHERE study. It was a large prospective multicentre observational cohort study monitoring adherence to ARPIs in 234 metastatic castrate-resistant PC (mCRPC) patients aged ≥ 70. We observed an association between impaired IADL and lower geriatric G8 scores (p < 0.01), and lower adherence to ARPIs whether assessed by pill counting (p = 0.01) or self-reported by the patient himself (p = 0.03). The combination of an IADL < 6 and the absence of a caregiver resulted in a significantly high risk of non-adherence to the ARPIs at the multivariable analysis (HR 9.23, 95% confidence interval 2.28–37.43, p = 0.01). IADL alongside the geriatric G8 scales represent essential tools to identify frail and less auto-sufficient patients who are extremely vulnerable particularly if not supported by a caregiver and have the highest risk of nonadherence to ARPIs.

Associations of depressive symptoms and instrumental activities of daily living decline by employment or participation in social activities among younger-older Japanese in the New Integrated Suburban Seniority Investigation (NISSIN) Project

ObjectivesThis study investigated the association between depressive symptoms and the instrumental activities of daily living (IADL) decline among physically and socially independent older people according to being employed or participating in social activities in a Japanese age-specific cohort. MethodsWe performed a prospective cohort study including 1,508 (716 men and 792 women) aged 64/65. Depressive symptoms were assessed at baseline (2000–2005). The change in IADL status was ascertained in the secondary survey when the participants reached 70 years of age. Multivariable odds ratios (ORs) and confidence intervals (CIs) of depressive symptoms for IADL decline were calculated using a logistic regression model adjusted for enroll year, sex, employment status, marital status, education, smoking status, alcohol consumption status, body mass index, walking status, daily sleep duration, and medical histories of cancer, cardio-cerebrovascular diseases, hypertension, and diabetes mellitus. We also formally tested for potential interaction effects by employment and participation in social activities. ResultsThe OR of the presence of depressive symptoms and not employed was 3.25 (95% CI 1.57–6.75), compared to participants without depressive symptoms and employed, after adjusting for potential confounders. Compared to participants without depressive symptoms and with a high frequency of participation in social activities, participants with depressive symptoms and a low frequency of participation in social activities were associated with IADL decline (OR 2.45; 95% CI 1.23–4.90). However, we observed no evidence of an interaction effect by employment and participation in social activities. ConclusionsThis age-specific cohort study revealed that being employed or participating in social activities may prevent IADL decline among depressed older adults.

The Effect of Depression in Instrumental Activities of Daily Living in Mild Cognitive Impairment: The mediating role of cognitive dysfuction

AbstractBackgroundGeriatric depression can affect on decline of various cognitive functions including executive function and can lead to disabilities in instrumental activities of daily living (IADL). Decline in IADL was related to conversion to dementia even though there was no decline in screening tests such as MMSE. Therefore it is important to manage the factors affecting IADL. We examined the relationship between depression, cognitive dysfunction and IADL in mild cognitive impairment (MCI) to reveal the effect of depression on IADL.MethodWe recruited 132 patients with MCI who visited the Department of Neurology at Pusan National University Yangsan Hospital from March 2019 to June 2022. Using the Short‐Geriatric Depression Scale (S‐GDS: cuf‐off 8), these patients were divided into 64 depressed groups (mean age 75±6.7) and 68 non‐depressed groups (mean age: 71±8.1). To evaluate cognitive function, the Seoul Neuropsychological Screening Battery, which consists of five domains: attention, language functions, visuospatial functions, memory, and executive functions, was conducted. K‐IADL (Korean Instrumental Activities of Daily Living) was conducted to evaluate IADL. We investigated the mediation effect of cognitive functions between depression and IADL using mediation analysis.ResultDepression and K‐IADL showed positive correlation (B = 0.023, p &lt; 0.001). Mediation analysis of cognitive function between depression and IADL showed significant effect of executive function (B = ‐0.001, p = 0.019) and visuospatial function (B = ‐0.001, p = 0.045). Memory, language and attention domains had no significant mediation effect between depression and ADL.ConclusionIn our study, depression related to decline in IADL, and not only the effects of depression but also mediation effects of executive and visuospatial dysfunction could affect IADL. In terms of IADL maintenance, it is necessary to actively manage the depressed mood of MCI patients.

5 Longer Prospective Memory Delays Independently Predict Severity of Functional Decline in TBI

Objective:Prospective memory (PM) tasks are common in everyday life and have been implicated in optimal daily functioning. However, less is known about the parameters of PM tasks that most influence functional decline, as well as the domains of everyday functioning most sensitive to PM impairment. The present study sought to examine these questions in individuals with traumatic brain injury (TBI).Participants and Methods:Participants included 30 adults with chronic moderate-to-severe TBI who were at least one year removed from their injury (median [IQR] = 8.1 years [10.8]). Participants completed the Memory for Intentions Test (MIST), which is a 30-minute task that assesses time- and event-based PM with varying cue-intention delay length (2 versus 15 min) in the context of an ongoing task. Total scores were generated for each delay length and cue type. Additionally, participants completed a comprehensive neuropsychological battery, including assessments of processing speed, executive functions, attention, working memory, verbal fluency, and episodic learning and memory. Participants also completed questionnaires of self-reported cognitive and everyday functioning, including the Functional Behavior Profile (FBP), Prospective and Retrospective Memory Questionnaire (PRMQ) and a modified Lawton &amp; Brody Instrumental Activities of Daily Living (IADL) Scale, which separately assessed 11 domains of everyday functioning.Results:Pearson’s r correlations revealed that total number of domains showing decline on the modified Lawton &amp; Brody IADL scale was strongly correlated with MIST 15-min delay (MIST-15; r=-0.503, p=0.005), such that worse PM performance on long delay items was associated with more domains of IADL decline; this relationship was also reflected in the MIST Total Score (r=-0.389; p=0.033). No other MIST index was associated with IADL decline (ps&gt;0.10). MIST-15 did not significantly correlate with any other measure of self-reported functioning (PRMQ, FBP; all ps&gt;0.10), but was associated with specific declines in buying groceries (p=0.009), performing home repairs (p=0.021), shopping (p=0.033), and doing laundry (p=0.035). Relationships at a trend level included declines in housekeeping (p=0.05), managing finances (p=0.097), cooking (p=0.092), and taking medication (p=0.066). To determine specificity of the relationship between MIST-15 and everyday functioning, a linear regression was conducted using covariates that were significantly correlated with total number of domains of IADL decline (i.e., Selective Reminding Test total learning trials, CVLT-II Long Delay Free Recall, Symbol Digit Modalities Test total). This regression was statistically significant [F(4,24)=4.263; p=0.10; R2=0.415), and MIST-15 remained an independent predictor (p=0.047; R2 change=0.107).Conclusions:Results suggest that the ability to remember to carry out intended actions after longer delay periods may be uniquely related to severity of declines in everyday functioning. Longer PM delays place higher demands on both memory and executive processes, as the encoded intention must survive a longer decay wherein monitoring for the appropriate cue is extended, and likely better mimic PM tasks in daily life (e.g., remembering to pick up milk after the workday). In light of these findings, clinicians may seek to include brief trials of long delay PM tasks as part of a comprehensive battery to screen for functional decline.

The interaction between instrumental activities of daily living and dual sensory function on cognition among the elderly in China: A cross-sectional survey.

To explore the interaction of instrumental activities of daily living (IADLs) and dual sensory function on cognition in the elderly. A cross-sectional survey was conducted in six general hospitals in China, from October 2022 to December 2022. Data collection included general information, IADLs scale, self-reported sensory function questionnaire, and mini-mental state examination (MMSE). Binary logistic regression was used to examine the association between factors and cognition. The interactive effect was evaluated by synergy index (S), relative excess risk due to interaction (RERI), and attributable proportion due to interaction (AP). The odds ratio (OR) of IADLs decline in cognition is 4.412 (95% confidence interval [CI]: 3.633-5.358, p < 0.001); the OR of dual sensory difficulty on cognition is 2.502 (95% CI: 1.272-4.921, p = 0.008). The OR of interaction between IADLs decline and dual sensory difficulty on cognition is 13.737 (95% CI: 9.726-19.400, p < 0.001). RERI (95% CI) = 7.823 (3.230-12.417), AP (95% CI) = 0.570 (0.392-0.747), S (95% CI) = 2.593 (1.616-4.160). IADLs decline and dual sensory difficulty are associated with cognitive decline. IADLs decline and dual sensory difficulty have interaction with cognitive decline; the interaction is greater than the sum effect of those two on cognitive decline independently. Sensory and IADLs assessment can be used as early screening items for cognition among the elderly. In addition, protecting sensory function and maintaining IADLs in the elderly can help protect their cognition.

Decline of instrumental activities of daily living is a risk factor for nutritional deterioration in older adults: a prospective cohort study

BackgroundThe association between functional capacity and the subsequent risk of nutritional deterioration is yet to be understood. The purpose of this study was to elucidate the relationship between functional capacity, comprising instrumental activities of daily living (IADL), intellectual activity, and social function, and future decline in nutritional status.MethodsThe current study is a two-year prospective cohort study. A total of 468 community-dwelling older adults without nutritional risks were enrolled. We used the Mini Nutritional Assessment Screening Form. Functional capacity, including IADL, intellectual activity, and social function, was assessed using the Tokyo Metropolitan Institute of Gerontology Index of Competence at baseline. The nutritional status was reassessed at a 2-year follow-up. Risk ratios (RR) of functional capacity for the incidence of nutritional decline were estimated.ResultsLow functional capacity was significantly associated with future deterioration of nutritional status (RR 1.12, 95% confidence interval [CI] 1.02–1.25). Of the subdomains of functional capacity, IADL decline (adjusted RR 2.21, 95% CI 1.18–4.13) was an independent risk factor for the incidence of nutritional risk. Intellectual and social activities were not significant.ConclusionDecline in functional capacity, especially IADL, is a risk factor for future deterioration in nutritional status. Further studies are required to elucidate the effect of interventions for IADL decline on maintaining nutritional status in older adults.

Subjective Memory Complaints Predict Decline in Memory, Instrumental Activities of Daily Living, and Social Participation in Older Adults: A Fixed-Effects Model.

Although subjective memory complaints (SMCs) have been suggested to be associated with future memory impairment, limitations in instrumental activities of daily living (IADLs), and social participation restriction, these associations are still inconclusive. To determine whether changes in SMCs over time predict decline in memory, IADLs, and social participation in older adults. Longitudinal study. Community. Sample 1 included 2,493 community-dwelling older adults drawn from the Health and Retirement Study (HRS) data collected between 2004 and 2018. Sample 2 included 1,644 community-dwelling older adults drawn from the HRS data collected between 2008 and 2018. Self-reported SMCs, memory function, self-reported IADL performance, and self-reported social participation. The mean age of Sample 1 at baseline was 70.16 yr; 1,468 (58.88%) were female. In Sample 1, immediate and delayed memory (all ps < .001) and IADL performance (p < .01) declined over time. Increases in SMCs over time significantly predicted future immediate and delayed memory declines (p < .01 and p < .001, respectively) and future IADL performance decline (p < .001), after controlling for depressive symptoms. The mean age of Sample 2 at baseline was 71.52 yr; 928 (56.45%) were female. In Sample 2, social participation declined over time (all ps < .001). Increases in SMCs over time significantly predicted future social participation decline (p < .05), after controlling for depressive symptoms. Increases in SMCs predict future decline in memory, IADL performance, and social participation after accounting for depressive symptoms. What This Article Adds: SMCs can be used as an early indicator of future memory impairment, IADL limitations, and social participation restrictions in older adults. Furthermore, interventions that minimize SMCs may help older adults achieve successful aging.

Associations of frailty with overall survival (OS) and functional decline among older adults with non–small-cell lung cancer (NSCLC) receiving chemotherapy, immunotherapy, and/or targeted therapy.

12040 Background: Among older adults with cancer receiving chemotherapy, frailty indices can predict poor outcomes including survival and toxicity. Given the increasing use of immunotherapy and targeted therapy to treat NSCLC, we assessed the prognostic importance of frailty among older adults with NSCLC receiving systemic therapy. Methods: This multi-site prospective cohort study enrolled adults age ≥65 with advanced NSCLC starting chemotherapy, immunotherapy, and/or targeted therapy with non-curative intent. Patients completed geriatric assessments pretreatment and at 1, 2, 4, and 6 months. We constructed a 47-item deficit-accumulation frailty index including pretreatment demographic, geriatric assessment, and clinical factors using established methodology. Frailty scores ranged from 0 (no frailty deficits) to 1 (all frailty deficits present). We categorized patients as robust ( &lt; 0.2), pre-frail (0.2-0.34), or frail (≥0.35). The primary outcome was OS. Secondary outcomes included treatment-related grade ≥3 adverse events (AE), unplanned hospitalization, and functional decline in instrumental activities of daily living (IADL). We conducted a Kaplan-Meier survival analysis to estimate OS by frailty group and Cox proportional hazards models adjusting for treatment type. We used logistic regression models to evaluate the association of frailty with secondary outcomes adjusting for treatment type. Results: Among 149 patients, median age was 73 (range 65-94). During the study, 32% received targeted therapy, 29% immunotherapy, 27% chemoimmunotherapy, and 12% chemotherapy. Overall 43% of patients were robust, 38% pre-frail, and 19% frail. Frailty was associated with Asian race, lower education, Medicaid insurance, and no prior NSCLC surgery. Notably, frailty was not associated with age or treatment type. Median OS was 18.7 months overall: not reached for robust patients, 8.9 months for pre-frail, and 5.6 months for frail patients. Adjusting for treatment type, pre-frail (HR 2.11, 95% CI 1.24-3.60; p = 0.006) and frail (HR 2.86, 95% CI 1.52-5.39; p = 0.001) patients had worse OS compared to robust patients. During treatment, 29% developed a grade ≥3 AE, 31% had an unplanned hospitalization, and 41% developed IADL decline. Pre-frail/frail patients were more likely to develop IADL decline (HR 2.18, 95% CI 1.02-4.68; p = 0.04) than robust patients, but there were no differences in toxicity or hospitalization. Conclusions: Frailty is prognostic for OS among older adults with advanced NSCLC receiving systemic therapy across treatment types and predicted IADL decline. Frailty assessment before initiation of systemic therapy may help identify older adults with advanced NSCLC at higher risk of poor outcomes to inform decision making, individualize anticipatory guidance, and optimize supportive care.

Relationship between instrumental activities of daily living decline during hospitalization and one-year mortality in elderly patients with heart failure: A multi-center prospective cohort study

BackgroundIt remains unclear whether instrumental activities of daily living (IADL) decline during hospitalization is related to mortality rates. This study examined the relationship between IADL decline during hospitalization and the one-year mortality rate in elderly heart failure (HF) patients. MethodsFive hundred seventy-six consecutive patients who were hospitalized for acute decompensated HF and underwent rehabilitation were divided into groups based on changes in IADL during hospitalization: IADL maintained and IADL decline. IADL was assessed by the National Center for Geriatrics and Gerontology-Activities of Daily Living Scale (NCGG-ADL). IADL decline was defined as Δ NCGG-ADL ≤ −1 point. The primary outcome was one-year all-cause mortality rate after discharge. Outcomes were examined using the Kaplan–Meier method with the log-rank test and Cox proportional hazards models using the existing prognostic risk factors for HF. ResultsOf 576 patients, 20% (n = 113) had IADL decline during hospitalization, and 9.2% (n = 35) and 6.0% (n = 18) died of all-cause and cardiovascular disease within one year after discharge, respectively. The IADL-decline group had significantly higher one-year all-cause mortality rates after adjusting for risk factors (hazard ratio: 1.923, 95% confidence interval 1.085–3.409; P = 0.023). Among the IADL subcategories, outdoor activity items such as “go out by oneself,” “take a bus or train,” and “shop for necessities” were more likely to change from independent to dependent during hospitalization. ConclusionIADL decline during hospitalization was associated with an increased all-cause mortality rate at one-year after discharge in elderly HF patients.

Association between choices of transportation means and instrumental activities of daily living: observational cohort study of community-dwelling older adults

IntroductionThe association between the physical health of older people and the frequency of going out has been reported, and in recent years, local governments have developed transportation support programs for older people. Although previous studies show an association between the frequency of going out and functional health status, little has been reported on the impact of the choice of means of transport on instrumental activities of daily living (IADL).ObjectiveTo evaluate the association between choice of transportation means and the risk of decline in IADL among older adults.MethodsWe conducted an observational, population (community-dwelling)-based cohort study using data from the Resident Health Status Survey, and longitudinal panel data at 2-time points in 2016 and 2019. In addition, we combined this panel data and a database on people who were certified as requiring long-term care to identify participants’ IADL. The propensity score matching method was used to classify the respondents into two groups, “active means of transportation” and “passive means of transportation,“ and determine the risk of a decline in means-tested independence after 3 years.ResultsActive means were used by 6,280 (76.2%) and passive means were used by 1,865 (22.6%). 999 (12.1%) individuals declined in IADL in 2019. The results of the comparison by balancing the attributes of “active means of transportation” and “passive means of transportation,“ with propensity score matching, showed that “passive means of transportation” were more likely to be “active” than “passive means of transportation,“ and “active” was more likely to be “passive” The risk of IADL decline was significantly higher than that of “active means of transportation” with an RR of 1.93 (95% CI: 1.62–2.30).ConclusionPassive means of transportation in older adults could be a possible risk for decreasing IADL 3 years later. Increasing the number of opportunities and places in the community for older adults to use active means of transportation may be effective in encouraging socially independent living among older adults.

Slowness as a Predictor of Functional Decline in Older Adults: Comparison of Moberg Picking-Up Test and Walking Speed.

Slowness, generally assessed by walking speed (WS), is an estimator of frailty and its outcomes. Because of potential difficulties in assessing WS, the Moberg picking-up test (MPUT) might be an alternative. This study investigated the capacity of slowness measurements (WS and MPUT) to predict nonfatal adverse consequences of frailty: primarily, decline in basic activities of daily living (BADL); and secondarily, decline in instrumental activities of daily living (IADL), fall, hospitalization, and incident disease. Observational (prospective longitudinal study). This study used data from the population-based Lausanne cohort 65+. At baseline, 1887 individuals (aged 72-77years) completed both WS (time to walk 20m at usual pace) and MPUT (time to pick up 12 objects) assessments. All outcomes, assessed at 1- and 4-year follow-ups, were entered in separate logistic regression models with adjustment for age, sex, and respective values at baseline. The prediction of all outcomes by either WS or MPUT was assessed using area under the receiver operating characteristic curve and compared by χ2 tests. There were positive associations between slowness either assessed by WS [relative risk (RR)= 2.48; P < .001] or MPUT (RR= 1.91; P < .001) and decline in BADL at 1-year follow-up. These associations remained significant at 4-year follow-up for both WS (RR= 2.28; P < .001) and MPUT (RR= 1.95; P < .001). There was no significant difference between predictive values of slow WS and MPUT for decline in BADL at 1-year (P= .328) and 4-year follow-ups (P= .413). The prediction was not significantly different for secondary outcomes, except for decline in IADL for which the prediction was slightly better for WS. MPUT may be an alternative measurement of slowness with predictive value of functional decline. No significant difference in predictive capabilities of MPUT and WS for specific adverse consequences of frailty is promising in favor of using MPUT for measuring slowness.

Determining the Minimal Important Change of Everyday Functioning in Dementia: Pursuing Clinical Meaningfulness.

Background and ObjectivesDecline in everyday functioning is a key clinical change in Alzheimer disease and related disorders (ADRD). An important challenge remains the determination of what constitutes a clinically meaningful change in everyday functioning. We aimed to investigate this by establishing the minimal important change (MIC): the smallest amount of change that has a meaningful effect on patients' lives. We retrospectively investigated meaningful change in a memory clinic cohort.MethodsIn the first, qualitative part of the study, community-recruited informal caregivers of patients with ADRD and memory clinic clinicians completed a survey in which they judged various situations representing changes in everyday functioning. Their judgments of meaningful change were used to determine thresholds for MIC, both for decline and improvement, on the Amsterdam Instrumental Activities of Daily Living (IADL) Questionnaire. In the second, quantitative part, we applied these values in an independent longitudinal cohort study of unselected memory clinic patients.ResultsMIC thresholds were established at the average threshold of caregivers (N = 1,629; 62.4 ± 9.5 years; 77% female) and clinicians (N = 13): −2.2 points for clinically meaningful decline and +5.0 points for clinically meaningful improvement. Memory clinic patients (N = 230; 64.3 ± 7.7 years; 39% female; 60% dementia diagnosis) were followed for 1 year, 102 (45%) of whom showed a decline larger than the MIC, after a mean of 6.7 ± 3.5 months. Patients with a dementia diagnosis and more atrophy of the medial temporal lobe had larger odds (odds ratio [OR] = 3.4, 95% CI [1.5–7.8] and OR = 5.0, 95% CI [1.2–20.0], respectively) for passing the MIC threshold for decline than those with subjective cognitive complaints and no atrophy.DiscussionWe were able to operationalize clinically meaningful decline in IADL by determining the MIC. The usefulness of the MIC was supported by our findings from the clinical sample that nearly half of a sample of unselected memory clinic patients showed a meaningful decline in less than a year. Disease stage and medial temporal atrophy were predictors of functional decline greater than the MIC. Our findings provide guidance in interpreting changes in IADL and may help evaluate treatment effects and monitor disease progression.

The Influence of Exercise, Nutritional Status, and Disease on the Functional Ability to Undertake Activities of Daily Living and Instrumental Activities of Daily Living in Old Taiwanese People

This study aimed to examine the influence of changes in exercise status, nutritional status, and a number of comorbidities on functional ability in Taiwanese community-dwelling older adults. Data were obtained from the Taiwan Longitudinal Study of Aging. The results revealed that current exercise and consistent exercise were negatively associated with subsequent 4- and 8-year activities of daily living (ADL) and instrumental ADL (IADL) decline (all p &lt; 0.05). The Mini-Nutritional Assessment (MNA) score was negatively associated with subsequent 8-year IADL decline (all p &lt; 0.05), while the number of diseases was positively associated with subsequent 4- and 8-year IADL decline (all p &lt; 0.05). Current exercise and consistent exercises are beneficial for adults aged ≥65 years to maintain their functional ability in ADL and IADL and to prevent declines in functional ability. Consistency of exercise, MNA score, and the number of chronic diseases are good predictors of IADL decline.

Early strong predictors of decline in instrumental activities of daily living in community-dwelling older Japanese people.

ObjectiveOur aim is to determine the strong predictors of the onset of instrumental activities of daily living (IADL) decline in community-dwelling older people.DesignA prospective cohort study with a two-year follow-up.SettingKashiwa City, Chiba Prefecture, Japan and Toshima Ward, Tokyo Metropolitan, Japan.ParticipantsThe data were acquired from two cohorts. The final sample comprised 1,523 community-dwelling older people aged 65–94 years (681 men, 842 women). They were individuals who were independent in IADL at baseline and participated in follow-up IADL assessments two years later.MeasurementsAt baseline, comprehensive assessments were performed including: health interview, gait function, hand-grip strength, skeletal muscle mass, balance function, oral function, dietary lifestyle, cognitive function, quality of life, mental status, and social network. When the two-year follow-up was performed, IADL declines were observed in 53 out of 1,523 people. The association of each Z-transformed parameter with the occurrence of IADL decline was examined by employing a binominal logistic regression model adjusting for age, gender, body weight, body height, and medical history. An odds ratio (OR) and a 95% confidence interval were calculated and compared between different parameters.ResultsA decrease in walking speed and one-legged stance time, whereas an increased timed up & go test time was associated with significant ORs for the occurrence of IADL decline.ConclusionGait-related parameters appear to be the strong predictors of the onset of IADL decline in community-dwelling older people.

Postoperative cognitive dysfunction in older surgical patients associated with increased healthcare utilization: a prospective study from an upper-middle-income country

BackgroundPerioperative neurocognitive disorder includes postoperative cognitive dysfunction (POCD) and postoperative delirium (POD). Concerning inconclusive consequences of POCD compared with POD, we explored the association between either POCD or POD and functional decline as well as healthcare utilization.MethodsPatients aged at least 60 years who underwent a major operation were enrolled. POCD was defined as a decrease in the Montreal Cognitive Assessment (MoCA) score (≥ 2) 1 week after surgery. Postoperative delirium (POD) was defined according to the criteria of the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). The primary outcome was instrumental activities of daily living (IADLs) 3 months after discharge. Secondary outcomes were the length of stay (LOS), hospital cost, and factors that affected functional decline 3 months after surgery. The multivariate model, including potential confounding factors, namely age, gender, surgery type, and postoperative complications, was used to analyze possible factors that influenced a reduction in function, and the results were expressed by using adjusted relative risk (RR) and 95%CI.ResultsTwo hundred eighty-nine patients with a mean age of 72 years were enrolled. The incidence of POCD at 1 week was 28.5%. At their 3-month follow-ups, the patients with POCD were not associated with IADL decline. Nevertheless, patients with POCD were more likely to need a prolonged LOS (11 days [1, 46] vs. 8 days [2, 42]; P = 0.01), and incur higher hospital costs (8973.43 USD [3481.69, 11 763.74] vs. 5913.62 USD [332.43, 19 567.33]; P < 0.001). Additionally, the patients experiencing POD demonstrated increased risks of reducing their IADLs (adjusted RR 2.33; 95% CI, 1.15–4.71; P = 0.02).ConclusionsPOCD at 1 week leaded to increase healthcare utilization in a middle-income country. POD during hospitalization was associated with a decline in function after surgery and increased health care utilization.Trial registrationThai Clinical Trials Registry TCTR20190115001.