Activities Of Daily Living Disability Research Articles

Assessing Patterns and Stability of ADL Hierarchical Scales for Functional Disability Assessment.

This study examined the stability over time of activities of daily living (ADL) items in 3 comparable longitudinal data sets and evaluated ADL loss sequences for older adults in the United States, South Korea, and Japan. Data from the U.S. Health and Retirement Study, and its 2 international sister surveys, were analyzed. Participants were community-dwelling adults aged 60 and older. For each data set, Rasch analysis was implemented to determine if the ordering of items remained stable across multiple waves (2006-2014), such that a single ADL hierarchy may be derived from multiwave data. Data fitted the Rasch model well. Item calibrations were sufficiently stable across measurement periods in each data set, reflecting a stable frame of reference. Results were also robust to sample variations. The derived ADL hierarchies based on scaled logit scores revealed that "dressing" and "bathing" were relatively more difficult items for older adults in all study populations. Scale stability is essential when exploiting longitudinal data to analyze patterns in ADL disabilities. The consistency in ADL scales across measurement periods supports their use as screening tools and identifying those at risk for transitions in care. Interventions to reduce dependency in bathing and dressing can help improve independent functioning for community-dwelling older adults.

Chronic condition clusters and associated disability over time.

ObjectivesRecent evidence shows that more complex clusters of chronic conditions are associated with poorer health outcomes. Less clear is the extent to which these clusters are associated with different types of disability (activities of daily living (ADL) and functional mobility (FM)) over time; the aim of this study was to investigate this relationship.MethodsThis was a longitudinal analysis using the National Health and Aging Trends Study (NHATS) (n = 6179). Using latent class analysis (LCA), we determined the optimal clusters of chronic conditions, then assigned each person to a best-fit class. Next, we used mixed-effects models with repeated measures to examine the effects of group (best-fit class), time (years from baseline), and the group by time interaction on each of the outcomes in separate models over 4 years.ResultsWe identified six chronic condition clusters: Minimal Disease, Cognitive/Affective, Multiple Morbidity, Osteoporosis, Vascular, and Cancer. Chronic condition cluster was related to ADL and FM outcomes, indicating that groups experienced differential disability over time. At time point 4, all chronic condition groups had worse FM than Minimal Disease.DiscussionThe clusters of conditions identified here are plausible when considered clinically and in the context of previous research. All groups with chronic conditions carry risk for disability in FM and ADL; increased screening for disability in primary care could identify early disability and prevent decline.

Novel physical performance-based models for activities of daily living disability prediction among Chinese older community population: a nationally representative survey in China

BackgroundPhysical performances including upper and lower limb functions have predictive roles in activities of daily living (ADL) disability, but they have rarely been incorporated into prediction models. This study primarily aimed to develop and validate novel physical performance-based models for ADL disability among Chinese older adults. Comparisons of predictive performance across multiple models were performed, and model simplification was further explored.MethodsData were obtained from the China Health and Retirement Longitudinal Study in the 2011 and 2015 waves, containing 2192 older adults over 60 years old. Our models were constructed by logistic regression analysis, using a backward stepwise selection. Model performance was internally validated by discrimination, calibration, and clinical utility. Integrated Discrimination Improvement (IDI) and Net Reclassification Improvement (NRI) were used to assess the incremental benefit of the extended models. Moreover, nomograms were built for visualization.ResultsWe selected gender, age, smoking, self-report health condition, BMI, depressive symptoms, and cognitive function into the fundamental model (Model 1). Based on Model 1, five novel prediction models were constructed by adding handgrip strength (Model 2), Short Physical Performance Battery (SPPB) (Model 3), gait speed (Model 4), handgrip strength plus SPPB (Model 5), and handgrip strength plus gait speed (Model 6), respectively. Significant improvement in predictive values were observed for all five novel models compared with Model 1 (C-index = 0.693). The lower limb model (Model 3 SPPB model: C-index = 0.731) may play a key role in the prediction of ADL disability, reflecting a comparable predictive value to the comprehensive models combining both upper and lower limbs (Model 5 handgrip strength + SPPB model: C-index = 0.732). When we simplified the lower limb models by replacing SPPB with gait speed, the predictive values attenuated slightly (C-index: Model 3 vs Model 4: 0.731 vs 0.714; Model 5 vs Model 6: 0.732 vs 0.718), but still better than the upper limb model (Model 2 handgrip strength model: C-index = 0.701).ConclusionsPhysical performance-based models, especially lower limb model, provided improved prediction for ADL disability among Chinese older adults, which may help guide the targeted intervention.

Nomogram for predicting the 12-year risk of ADL disability among older adults.

Previous studies have identified plenty of risk factors for activities of daily living (ADL). However, there are no reliable and widely available prediction models for ADL disability up to now. This study aimed to develop and validate a nomogram for predicting the 12-year risk of ADL disability in older adults. Data from 4,809 participants in the English Longitudinal Study of Ageing (ELSA) and 18,620 participants in the Survey of Health, Ageing and Retirement in Europe (SHARE) were used as training set and validation set, respectively. We used the least absolute shrinkage and selection operator (LASSO) and Cox regression to screen the predictors and develop the nomogram. The P value, concordance index (C-index), integrated area under the ROC (receiver operating characteristic) curve (AUC) and calibration curves were used to validate the nomogram. During 12years, 30.0% (n = 1,441) participants developed ADL disability in the training set, while the corresponding percentages were 18.5% in the validation set (n = 3,445). After screening, 13 variables were contained in the final prediction model. In ADL nomogram, the C-index and AUC were 0.744 ± 0.013 and 0.793 in internal valid ation, respectively, while in external validation, the C-index and AUC were 0.755 ± 0.009 and 0.796. This study developed and validated a nomogram that predicts functional disability. The application of the predictive model could have important implications for patient prognosis and health care.

Trends in activities of daily living disability among Chinese older adults from 1998 to 2018: an age-period-cohort analysis.

This study aims to investigate the age, period, and cohort effects on trends in activities of daily living (ADL) disability among Chinese older adults; and to explore these three temporal effects on gender and residence disparities in disability. We utilized multiple cross-sectional waves of the Chinese Longitudinal Healthy Longevity Survey data (1998-2018), including 89,511 participants aged above 65years old. Our measurement of disability is the number of ADL items (dressing, bathing, indoor transferring, toileting, eating, and continence) participants can't perform independently. Hierarchical age-period-cohort cross-classified random effects models were conducted to investigate age, period and cohort trends in ADL disability. Results showed that ADL disability increased with age at an increasing rate. A V-shaped cohort trend and a fluctuated period trend were identified. Females and urban residents were associated with more ADL limitations. When age increased, the gender and residence gaps in disability further increased. The cohort-based gender and residence inequalities in ADL limitations converged with successive cohorts. The period-based residence gap in ADL limitations diverged throughout the 20-year period, while the corresponding period-based change in gender disparity was not significant. These findings suggested that age, period, and cohort had different and independent effects on ADL disability among Chinese older adults. The age effect on trends in ADL is stronger compared to period and cohort effects. The gender and residence disparities in disability increased with age and decreased with successive cohorts. These patterns might help inform healthcare planning and the priorities for medical resource allocation accordingly.

Pain management, activities of daily living and the assessment of the WHOQOL-OLD module: results of a cross-sectional analysis of a cohort of older men with oncological diagnoses

Cancer represents a major public health problem worldwide, especially in the older adult population which is increasing rapidly. Previous studies show that the majority of older adults with cancer report poor health-related quality of life (QoL) and that up to 90% of patients with metastases or terminal stage disease complain of pain at some point. Nevertheless, the impact of pain and disability on highly important aspects of older adults’ health, such as intimacy or the perception of autonomy, has been scarcely studied. This cross-sectional study aimed to identify the association between poor pain management and disability for activities of daily living (ADL) and 6 aspects of older adults’ health assessed by a short version of the WHOQOL-OLD module in 891 older male patients with a newly diagnosed malignant neoplasm. The mean age of the participants was 79.1 years (SD 3.2) and the most frequent tumor location was the prostate. In the adjusted analyses, the raw total score of the WHOQOL-OLD module decreased by 7.43 in patients with ADL disability and by 9.44 points in patients with poor pain management. Comprehensive and adequate diagnostic and therapeutic approaches to pain and disability are recommended in older adults with cancer to improve health-related QoL and impact aspects of health such as those assessed by the WHOQOL-OLD.

Plasma superoxide dismutase activity in relation to disability in activities of daily living and objective physical functioning among Chinese older adults

BackgroundThis study aimed to examine the associations of plasma superoxide dismutase (SOD) activity, an indicator of oxidative stress, with disability in activities of daily living (ADL) and objective physical functioning among Chinese older adults. MethodsWe used cross-sectional data of 2223 older adults (≥65 years, including 1505 adults≥80 years) from the 2011/2012 main survey of the Chinese Longitudinal Healthy Longevity Survey (CLHLS) and the 2012 biomarker sub-study. Plasma SOD activity was assessed by the T-SOD assay kit based on the hydroxylamine method. Outcomes included ADL disability and disability in three objective physical tasks (standing up from a chair, picking up a book from the floor, and turning around 360°). Logistic regression models were used to examine the associations of plasma SOD activity with outcomes. ResultsAfter controlling for age and sex, compared with participants in the lowest quartile group of SOD activity, those in the highest quartile group had 31% lower odds of ADL disability (odds ratio [OR]: 0.69; 95%CI: 0.48, 0.98); 60% lower odds of disability in standing up from a chair (OR: 0.40; 95%CI: 0.25, 0.63); and 57% lower odds of disability in picking up a book from a floor (OR: 0.43; 95%CI: 0.28, 0.65). The results did not change substantially after controlling for additional covariates. We did not observe statistically significant age and sex differences. ConclusionsOverall, plasma SOD activity was associated with subjectively and objectively measured disability in Chinese older adults, highlighting the potential of SOD activity to serve as a biomarker of physical functioning.

Socioeconomic status and ADL disability of the older adults: Cumulative health effects, social outcomes and impact mechanisms.

Socioeconomic status (SES) is one of the important indicators affecting individual's social participation and resource allocation, and it also plays an important role in the health shock of individuals. Faced by the trend of aging society, more and more nations across the world began to pay attention to prevent the risk of health shock of old adults. Based on the data of China Health and Retirement Longitudinal Study (CHARLS) in 2013, 2015 and 2018, this study uses path analysis and ologit model to empirically estimate the effects of SES and health shock on the activities of daily living (ADL) disability of old adults. As a result, first, it was found that SES has significant impact on the disability of old adults. Specifically, economic conditions (income) plays dominant role. Economic status affects the risk of individual disability mainly through life security and health behavior. Secondly, SES significantly affecting health shock, with education and economic status showing remarkable impact, and there is an apparent group inequality. Furthermore, taking high education group as reference, the probability of good sight or hearing ability of the low education group was only 49.76% and 63.29% of the high education group, respectively, while the rates of no pain and severe illness were 155.50% and 54.69% of the high education group. At last, the estimation of path effect of SES on ADL disability indicates evident group inequality, with health shock plays critical mediating role. SES is an important factor influencing residents' health shock, and health shocks like cerebral thrombosis and cerebral hemorrhage will indirectly lead to the risk of individual ADL disability. Furthermore, among the multi-dimensional indicators of SES, individual income and education are predominant factors affecting health shock and ADL disability, while occupation of pre-retirement have little impact.

Psychosocial aspects and support networks associated with disability in two longevous populations in Brazil: a cross-sectional study

BackgroundAmong the oldest old, aged 80 years and over, the prevalence of disability is higher than in other age groups and can be considered a predictor of mortality.ObjectiveTo evaluate how psychosocial aspects and support networks influence the disability of these oldest-old individuals, performing a comparison between two longevous populations, one living in one of the poorest regions of Brazil, in the backlands of Paraíba, and another living in one of the largest urban centres in Latin America.MethodA cross-sectional study in which 417 oldest-old persons aged 80 years and older were interviewed, with data collected through the “Health, Welfare and Ageing” survey conducted in two Brazilian cities. Disability was assessed by reporting the need for assistance in Activities of Daily Living (ADLs) and Instrumental Activities of Daily Living (IADLs). Bivariate and multiple analyses were performed using R statistical software.ResultsFood insufficiency in the first years of life had negative repercussions on the disability of oldest old people living in the northeast. On the other hand, in this region, older people have a higher rate of support and live longer with their peers, which may contribute to reducing feelings of loneliness, depressive symptoms, and worse self-perception of health. In the Southeast, financial constraints, subjective poverty, and unmet needs may favour the development of functional limitations between long-lived people.ConclusionOur findings indicate that regional differences in Brazil may influence the disability of older people aged 80 and older. In northeast Brazil, having no partner may contribute to disability for ADLs and IADLs; while, in the longevous population of São Paulo, having a worse self-rated health may contribute to disability for IADLs.

Influences of Financial Strains Over the Life Course Before Initiating Hemodialysis on Health Outcomes Among Older Japanese Patients: A Retrospective Study in Japan.

PurposeThis study analyzed the influence of financial strains over the life course before initiating hemodialysis on the health outcomes of older Japanese patients. This study was limited to financial strains over the life course before initiating hemodialysis to eliminate the influence of financial strains resulting from resignation from paid jobs. We examined which of the four life course models—pathway, latent, social mobility, and accumulation—were appropriate to describe the influences of financial strains over the life course on older patients’ health.Patients and MethodsData were obtained from a cross-sectional survey of 6,644 outpatients in dialysis facilities across Japan. We selected participants aged 60 years and older at the time of the survey. Numbers of dialysis complications, activities of daily living (ADL) disability, and depressive symptoms were selected as health outcomes. Benchmark periods over the life course were constructed in three parts: less than 18 years (childhood), 18–35 years (young adults), and 35–50 years (middle-aged). We retrospectively measured financial strains over the life course.ResultsPathway models best described the influence of financial strains over the life course on the three types of health outcomes. Experiences of financial strains as young adults had a direct influence on ADL disability of older patients. This result supports latent models. Social mobility models (upward and downward mobility) and accumulation models explained the number of dialysis complications, ADL disability, and depressive symptoms in older patients.ConclusionThese results suggest that socioeconomic disadvantages over the life course before initiating hemodialysis were significantly associated with health outcomes in older patients.

Association between body mass index, multi-morbidity and activities of daily living among New Zealand nursing home older adults: a retrospective analysis of nationwide InterRAI data

BackgroundObesity is a well-established risk factor for multi-morbidity and disability among older adults in the community and acute care settings. However, nursing home residents with body mass index (BMI) below 18.5 kg/m2 and above 25.0 kg/m2 have been understudied. We examined the prevalence of multi-morbidity and disability in activities of daily living (ADL) by BMI category and further investigated the association between BMI, multi-morbidity, and disability of ADL in a large cohort of older adults in nursing homes in New Zealand.MethodsA retrospective review of nursing home residents’ data obtained from the New Zealand International Resident Assessment Instrument national dataset from 2015 to 2018. One hundred ninety-eight thousand seven hundred ninety older adults (≥60 years) living in nursing homes were included. BMI was calculated as weight in kilograms (kg) divided by height in meters squared (m2). Multimorbidity was defined as the presence of ≥2 health conditions. The risk of disability was measured by a 4-item ADL self-performance scale. The prevalence ratio (PR) of the association between BMI and multi-morbidity and between BMI and disability in ADL was assessed using Poisson regression with robust variance.ResultsOf the 198,790 residents, 10.6, 26.6, 11.3 and 5.4% were underweight, overweight, obese, and extremely obese, respectively. 26.4, 31.3 and 21.3% had one, two and three disease conditions, respectively, while 14.3% had four or more conditions. 24.1% could perform only one ADL, and 16.1% could perform none. The prevalence of multi-morbidity increased with increasing BMI, whereas mean disability in ADL decreased with increasing BMI. The risk of multi-morbidity was higher for the overweight (PR, 95%CI: 1.03, 1.02–1.03) and obese (PR, 95% CI: 1.07, 1.06–1.08) compared to normal weight after controlling for age, sex, ethnicity, and region. BMI was inversely associated with mean ADL; β, 95% CI for overweight (− 0.30, − 0.32, − 0.28) and obese − 0.43, − 0.45, − 0.40 compared to normal weight.ConclusionBeing underweight was associated with a decline in the performance of ADL in nursing home residents. In contrast, being overweight and obese positively affected functional performance, demonstrating that the obesity paradox plays an important role in this population. The observed associations highlight areas where detection and management of underweight and healthy aging initiatives may be merited.

Prevalence and determinants of activity of daily living and instrumental activity of daily living among elderly in India

BackgroundThe increase in life expectancy has proliferated the number of elderly and subsequently increased the prevalence of disability among the elderly. This study assesses the prevalence of Activity of Daily Living (ADL) and Instrumental Activity of Daily Living (IADL) and analyzes determinants of ADL and IADL among elderly aged 60 and over living in India.MethodsThe study utilized the Longitudinal Ageing Study in India (LASI, 2017–18) data, and information was sought from 31,464 elderly aged 60 years and above. An index of ADL and IADL was created on a scale of three levels, exhibiting no, moderate, or severe levels of ADL/IADL disability. Multinomial logistic regression was used to determine the effect of socio-demographic parameters on ADL and IADL disability among the elderly.ResultsAround 3% of the elderly reported severe ADL disability, and 6% elderly reported severe IADL disability. Elderly who were not involved in any physical activity than their counterparts were more likely to report severe ADL (RRR = 2.68, C.I. = 1.66–4.32) and severe IADL (RRR = 2.70, C.I. = 1.98–3.67) than no ADL and no IADL, respectively.ConclusionAmidst the study finding, the study emphasizes the importance of setting-up of geriatric care centers in rural and urban areas. It would be feasible to provide geriatric care under the umbrella of already functioning government health facilities in different parts of the country. Community interventions earmarking the elderly with a focus on physical activity, specifically based in group physical exercise and implemented through existing networks, are rewarding for the elderly.

Association Between Mediterranean Diet and Functional Status in Older Adults: A Longitudinal Study Based on the Washington Heights-Inwood Columbia Aging Project.

Current evidence on the association between Mediterranean diet (MeDi) intake and activities of daily living (ADL) is limited and inconsistent in older adults. This study included 1 696 participants aged ≥65 years in the Washington Heights-Inwood Community Aging Project study. The MeDi score was calculated based on data collected from the Willett's semiquantitative food frequency questionnaire. The multivariable-adjusted Cox regression model was applied to examine the association of MeDi score with risks of disability in basic (BADL) and instrumental ADL (IADL), as well as the overall ADL (B-IADL). Eight hundred and thirty-two participants with incident ADL disability were identified over a median follow-up of 5.39 years. The continuous MeDi score was significantly associated with decreased risk of disability in B-IADL (hazard ratio = 0.95, 95% confidence interval = 0.91-0.99, p = .018) in a model adjusted for age, sex, race/ethnicity, educational level, and dietary calories intake but was no longer significant after additionally adjusted for multiple comorbidities and physical activities (0.97 [0.93, 1.01], p = .121). The continuous MeDi score was significantly associated with decreased risk of disability in B-IADL (0.92 [0.85, 1.00], p = .043) and BADL (0.90 [0.82, 0.99], p = .030) in non-Hispanic Whites, but not in non-Hispanic Blacks and Hispanics (p > .05 for all). Higher MeDi score was associated with decreased risk of ADL disability, particularly in non-Hispanic Whites.

Prediction of 6-year risk of activities of daily living disability in elderly aged 65 years and older in China

Objective: To construct an easy-to-use risk prediction tool for 6-year risk of activities of daily living(ADL) disability among Chinese elderly aged 65 and above. Methods: A total of 34 349 elderly aged 65 and above were recruited from the Chinese Longitudinal Healthy Longevity Survey. Demographic characteristics, lifestyle and chronic diseases of the elderly were collected through face-to-face interviews. The functional status of the elderly was evaluated by the instrumental activities of daily living(IADL) scale. The mental health status of the elderly was evaluated by the Mini-Mental State Examination. The height, weight, blood pressure and other information of the subjects were obtained through physical examination and body mass index(BMI) was calculated. The ADL status was evaluated by Katz Scale at baseline and follow-up surveys. Taking ADL status as the dependent variable and the key predictors were selected from Lasso regression as the independent variables, a Cox proportional risk regression model was constructed and visualized by the nomogram tool. Area under the receiver operating characteristic curve(AUC) and calibration curve were used to evaluate the discrimination and calibration of the model. A total of 200 bootstrap resamples were used for internal validation of the model. Sensitivity analysis was used to evaluate the robustness of the model. Results: The M(Q1, Q3) of subjects' age as 86(75, 94) years old, of which 9 774(46.0%) were males. A total of 112 606 person-years were followed up, 4 578 cases of ADL disability occurred and the incidence density was 40.7/1 000 person-years. Cox proportional risk regression model analysis showed that older age, higher BMI, female, hypertension and history of cerebrovascular disease were associated with higher risk of ADL disability [HR(95%CI) were 1.06(1.05-1.06), 1.05(1.04-1.06), 1.17(1.10-1.25),1.07(1.01-1.13) and 1.41(1.23-1.62), respectively.]; Ethnic minorities, walking 1 km continuously, taking public transportation alone and doing housework almost every day were associated with lower risk of ADL disability [HR(95%CI): 0.71(0.62-0.80), 0.72(0.65-0.80), 0.74(0.68-0.82) and 0.69(0.64-0.74), respectively]. The AUC value of the model was 0.853, and the calibration curve showed that the predicted probability was highly consistent with the observed probability. After excluding non-intervening factors(age, sex and ethnicity), the AUC value of the model for predicting the risk of ADL disability was 0.779. The AUC values of 65-74 years old and 75 years old and above were 0.634 and 0.765, respectively. The AUC values of the model based on walking 1 km continuous and taking public transport alone in IADL and the model based on comprehensive score of IADL were 0.853 and 0.851, respectively. Conclusion: The risk prediction model of ADL disability established in this study has good performance and robustness.

Multimorbidity Patterns and the Disablement Process among Public Long-Term Care Insurance Claimants in the City of Yiwu (Zhejiang Province, China).

This study aimed to identify multimorbidity patterns and explore the disablement process by utilizing the model raised by Verbrugge and Jette as a theoretical framework. This cross-sectional study used public Long-term Care Insurance (LTCI) claimants’ assessment data of Yiwu city in Zhejiang Province, China, for 2604 individuals aged 60 years and older, from September through December 2018. Latent Class Analysis (LCA) was conducted using 10 common chronic conditions. Structural Equation Modeling was used to examine the disablement process. The latent classes of multimorbidity patterns were the “coronary atherosclerotic heart disease” class (19.0%), the “lower limb fractures” class (26.4%), and the “other diseases” class (54.6%). The structural model results show that coronary atherosclerotic heart disease had a significant influence on incontinence, but it was not statistically significant in predicting vision impairment and mobility impairment. Lower limb fractures had significant effects on vision impairment, incontinence, and mobility impairment. Vision impairment, incontinence, and mobility impairment had significant effects on physical activities of daily living (ADLs). Our findings suggest that different impairments exist from specific patterns of multimorbidity to physical ADL disability, which may provide insights for researchers and policy makers to develop tailored care and provide support for physically disabled older people.

Lean mass, grip strength, and hospital-associated disability among older adults in Health ABC.

Older adults with cognitive impairment, including those with Alzheimer's disease and related dementias, are particularly at risk for hospitalization and hospital-associated disability. Understanding of key risk factors for hospital-associated disability is limited. Sarcopenia, age-related declines in muscle mass and strength, is common in older adults with cognitive impairment and may be an important risk factor for hospital-associated disability. Using data from the Health ABC Study, we examined associations of pre-hospitalization appendicular lean mass (ALM) and grip strength with the development of a new activity of daily living (ADL) disability at the next annual assessment after hospitalization. Grip strength, but not ALM, was negatively associated with increased risk of hospital-associated ADL disability, and this association was greater among those with cognitive impairment compared to those without. Lower grip strength may be an important risk factor for hospital-associated ADL disability in older adults, particularly those with cognitive impairment.

Disability and self-rated health: Exploring foreign- and U.S.-born differences across adulthood

There is limited inquiry regarding how immigrant status intersects with disability to influence health across adulthood. As the U.S. population continues to age, especially immigrants, understanding how disability influences health is imperative. Using 2010–2018 National Health Interview Survey data (n = 461,010) and logistic regression models, we investigate how differences in reporting Activity of Daily Living (ADL) disability influence reports of self-rated health (SRH) between foreign- and U.S.-born respondents (ages 25+) by race/ethnicity (non-Hispanic White, non-Hispanic Black, Hispanic, and non-Hispanic Asian) by age group (25–64 and 65+). Among those ages 25–64, foreign-born respondents generally report lower or similar rates of fair/poor SRH and ADL disability when compared to their U.S.-born peers. Among those ages 65+, we find that foreign-born respondents are at greater risk of fair/poor SRH compared to their U.S.-born peers. Additionally, while having ADL disability greatly increases the likelihood of fair/poor SRH, the impact of this association differs by race/ethnicity/nativity and age. Among those 25–64, having ADL disability appears to be especially, negatively impactful for SRH among foreign-born groups, particularly Hispanics and non-Hispanic Whites. However, among those ages 65+, having ADL disability is less impactful on the SRH of foreign-born respondents, especially non-Hispanic Blacks and Hispanics. Our findings shed new light on marginalization-related diminished returns by showing how ADL disability influences SRH differently between foreign-born groups across adulthood.

Analysis of the characteristics and influencing factors of early comprehensive symptoms in elderly patients after ICU

Research methods: In order to solve the early syndrome of elderly patients after ICU and provide reference for the treatment of elderly patients with post ICU syndrome, this paper studied the characteristics of early symptoms of elderly patients and analyzed the influencing factors. This article describes the frequency of newly acquired cognitive impairment, activities of daily living (ADL) and depression among the elderly survivors of critical illness. Finally, the predictive factors of asymptomatic elderly patients with post intensive care syndrome (PICS) (i.e., no PICS problems) were evaluated and analyzed. Subjects: This article selects many elderly ICU patients from the internal medicine and surgery departments of ICU in major hospitals in a city. They all have respiratory failure, shock and other characteristics, ignoring patients with cognitive impairment or ADL disability. To study the characteristics of the above elderly patients at 3 and 12 months after discharge. The research samples were divided into eight groups, and the mental health problems, cognitive problems and physical disability problems of these eight groups of elderly patients were studied in combination. By using the control variable method and multivariable logistic regression analysis, the relationship between age, education level, weakness report entering ICU, time of mechanical ventilation, delirium and severe sepsis and the probability of no PICS was obtained. Study data: The sample is 406 patients, of whom the average age is 61 years old. The study found that 64% of the elderly patients had one or more PICS problems at 3 months, and the total number of patients with more than 2 PICS accounted for 25% of the total proportion, while only 6% of patients with more than 3 PICS; When the time was 12 months, the proportion of patients with one or more PICS problems decreased to 56%, and the total number of patients with more than 2 PICS accounted for 21% of the total proportion, while only 4% of patients with more than 3 PICS. This means that when the recovery time of patients after ICU is longer and longer, the proportion of patients will gradually decline. In addition, the longer the elderly patients were educated, the greater the possibility of no PICS. The data showed that at 3 and 12 months, P<0.001. The low probability of no PICS was associated with more severe frailty. The data showed that P=0.005 at 3 months and P=0.048 at 12 months. Conclusion: In this multicenter cohort study, most survivors have one or more PICS problems, but only 1/4 of the patients have merger problems. Future studies need to better understand the heterogeneous subtypes of PICS and identify modifiable risk factors. In the elderly patient group, the incidence rate of PICS has nothing to do with whether they have received education, but it is related to the doctor's weak diagnosis report of elderly patients when they enter the ICU. The lower the score of the report, the higher the incidence rate of PICS.

Patterns of Self-Care Behaviors and Their Influence on Maintaining Independence: The National Health and Aging Trends Study.

Importance: Few studies have addressed the combined effects of health-promoting and self-care behaviors among older adults. Thus, new research is needed to assess the potential for behavior change to prolong independence in later life. Objectives: To determine the relationships between self-care behaviors and risks of mobility and activities of daily living (ADLs) over time. Design: Longitudinal data was used from the National Health and Aging Trends Study (NHATS) cohort. Eight baseline self-care behaviors were summarized using latent class analysis. Separately, longitudinal latent classes of mobility and ADLs were created. Setting: Annual in-person interviews conducted for a nationally representative sample. Participants: The baseline study sample included 7,609 Medicare beneficiaries aged ≥65 from NHATS who were living in community or residential care settings, with a 71% response rate. The average age was 75, with 57% female, 81% white and 78% high school graduates or higher. Approximately, 80% (n = 6,064) completed 5 years of follow-up. Exposures: Favorable vs. unfavorable self-care latent classes measured at baseline. Main outcomes and Measures: Associations were measured between baseline classes and longitudinal classes of mobility and ADLs difficulty. Among decedents, 5-year associations were measured between baseline classes and years of overall, healthy, able, and healthy/able life. Results: Two habitual baseline self-care behavioral patterns (46% favorable; 54% unfavorable) and three trajectories of change in mobility and ADLs disability (maintaining independence; shifting to accommodation/difficulty; shifting to assistance) emerged over time. Participants with a favorable baseline pattern had 92% (0.90–0.94) reduced risk in shifting to assistance class and 70% (0.64–0.76) reduced risk for shifting to accommodation/difficulty class for mobility disability. Participants with a favorable baseline pattern had 86% (0.83–0.89) reduced risk in shifting to assistance class and 24% (0.11–0.36) reduced risk in shifting to accommodation/difficulty class for ADLs disability. Those with an unfavorable pattern had 2.54 times greater risk of mortality by the end of the 5-year follow-up compared to those with a favorable pattern. Conclusion: Self-care behaviors in older age represent a habitual pattern. A favorable self-care behavioral pattern decreased the risk of moving towards a more disabled profile and added years of life. Interventions should encourage self-care behaviors constituting a favorable pattern.

Persistent Disability Six Months after Initial Disability Less Likely in Older Women

Many community-dwelling older adults develop activity of daily living (ADL) disability and subsequently regain function. Using data from the ASPirin in Reducing Events in the Elderly (ASPREE) clinical trial, we examined the relationship of gender, incident disability, and persistent disability 6 months after the incident disability. Walking, bathing, dressing, transferring, toileting, and eating were assessed as ADLs, at bi-annual interviews. ADL disability was defined as requiring help with or inability to do or severe difficulty with ≥1 ADL; persistent disability was an ADL loss at 6 months after a first (incident) ADL disability. Discrete time, multivariable Cox proportional hazards regression was utilized to estimate associations with developing incident ADL disability described as cause-specific hazard ratios, with death as a competing outcome. For persons with incident ADL disability, odds of developing persistent disability at 6 months as compared to recovery was determined using multivariable logistic regression. These analyses included 18,414 (51.6% women) ASPREE participants in the United States and Australia aged 70+ years (65+ years if U.S. ethnic minority) without ADL disability at trial entry. During a median follow-up of 4.7 years, 1,485 participants (63.2% women) developed an incident ADL disability, and, of those, 272 (57.0% women) met criteria for persistent disability at 6 months. Women had an increased risk (HR=1.17, 95% CI=1.05 to 1.32) of developing incident ADL disability; however, women were less likely to have persistent disability versus recovery 6 months later (OR=0.66, 95% CI=0.49 to 0.89). Why persistent disability development is lower in older women needs further exploration.