Activities Of Daily Living Disability Research Articles

Gender Differences in Disability Life Expectancy Among Older Adults in Colombia Age 60 and Older

Life expectancy has increased rapidly in Colombia but it is unclear whether these added years of life are healthy years. The objective of this paper is to estimate gender differences in disability life expectancy for older adults. We use data from the first nationally representative survey of adults ages 60 and over in Colombia, the 2015 Survey of Aging, Health and Wellbeing (SABE) (N=23,694) to determine age- and gender-specific prevalence. Mortality data come from the Latin American Mortality Database. We created prevalence base life tables using the Sullivan′s method to calculate disability life expectancy. We define disability as having any reported difficulty with any of the following activities of daily living (ADL): eating, dressing, bathing, toileting, getting out of bed, and walking across a room. The age-adjusted prevalence of ADL disability was 8.7% for men and 12.4% for women. Life expectancy at age 60 for women was 20.6 years, of which 3.0 years (14%) were lived with disability. In contrast, men’s life expectancy at age 60 was 18.2 years, of which 1.7 years (10%) were lived with disability. Women have lower mortality rates than men at older ages, but because they have higher disability prevalence, they live proportionately more years with disability relative to men. We also investigated patterns at different ages, and functional limitations, and found similar gender differences. This study provides new insights into how mortality and disability patterns at older ages contribute to the gender health disparity in older Colombians.

Improvements of Disability Outcomes in CAPABLE Older Adults Differ by Financial Strain Status.

The Community Aging in Place-Advancing Better Living for Elders (CAPABLE) program reduces disability in low-income older adults. In this study, we used CAPABLE baseline and 5-month data to examine whether its effects in reducing activities of daily living (ADLs) and instrumental ADLs (IADLs) difficulties differed by participants' financial strain status. At baseline, participants with financial strain were more likely to report higher scores on depression (p < .001), have low energy (p < .001), and usually feel tired (p = .004) compared with participants without financial strain, but did not differ in ADL/IADL scores. Participants with financial strain benefited from the program in reducing ADL (relative risk [RR]: 0.61, 95% confidence interval [CI]: 0.43, 0.86) and IADL disabilities (RR: 0.69, 95% CI: 0.54, 0.87), compared with those with financial strain receiving attention control. Individuals with financial strain benefited more from a home-based intervention on measures of disability than those without financial strain. Interventions that improve disability may be beneficial for financially strained older adults.

Integrated Care for Older People Screening Tool for Measuring Intrinsic Capacity: Preliminary Findings From ICOPE Pilot in China.

Objectives: The World Health Organization (WHO) proposed the Integrated Care for Older People (ICOPE) screening tool to identify older people with priority conditions associated with declines in intrinsic capacity (IC). We aimed to determine the clinical utility of the WHO ICOPE screening tool in a Chinese population.Method: A total of 376 adults aged 68.65 ± 11.41 years participated in the study. IC was assessed with the WHO ICOPE screening tool, covering five domains: cognitive, locomotor, sensory, vision, and psychological capacity. We assessed the activities of daily living (ADL); instrumental activities of daily living (IADL); the Fried frailty phenotype; FRAIL scale; Strength, Assistance With Walking, Rising From chair, Climbing Stairs, and Falls (SARC-F) scale; Mini-mental State Examination (MMSE); Geriatric Depression Scale (GDS); social frailty; and quality of life.Results: There were 260 (69.1%) participants who showed declines in one or more IC dimensions. The percentages of decline in mobility, cognition, vitality, hearing, vision, and psychological capacity were 25.3, 46.8, 16.2, 15.4, 11.7, and 12.0%, respectively. IC decreased with increasing age. After adjusting for age, sex, and multimorbidity, participants with declines in IC were more likely to be older, frail, and disabled. They also had worse physical, mental, and overall health. There was a higher prevalence of declines in IC in participants with frailty. After adjusting for age, IC was positively correlated with walking speed, resilience score, and MMSE score and negatively correlated with frailty, SARC-F score, IADL score, GDS score, and physical and mental fatigue. The IC score was not associated with body composition variables such as fat-free mass, body fat percentage, or visceral fat area. Higher IC was associated with better quality of life. The area under the curve of the receiver operating characteristic (AUC-ROC) for the ICOPE screening tool vs. Fried phenotype, FRAIL, ADL disability, IADL disability, and SARC-F were 0.817, 0.843, 0.954, 0.912, and 0.909, respectively.Conclusion: Our research affirms that the ICOPE screening tool is useful to identify adults with poor physical and mental function in a Chinese sample. This tool may assist in identifying declines in IC in an integrative care model and help slow down function decline and onset of care dependence.

Association Between Plasma 25-hydroxyvitamin D Concentrations and Incident Activities of Daily Living Disability: A Longitudinal Community-Based Cohort Study

ObjectivesA few studies of Western populations have found inconsistent results regarding the associations between vitamin D status and physical function. We explored the association between circulating vitamin D status [plasma 25-hydroxyvitamin D, 25(OH)D] and incident activities of daily living (ADL) disability among Chinese older adults. DesignCommunity-based longitudinal cohort study. Setting and ParticipantsA total of 2453 men and women (median age 84.0 years) in 7 Chinese longevity areas were included. MeasuresCox proportional hazards regression models were used to estimate hazard ratios (HRs) with 95% confidence intervals (CIs) for incident ADL, with adjustments for potential sociodemographic, and lifestyle confounders and biomarkers. Because there was a statistically significant interaction between plasma 25(OH)D and sex in relation to incident ADL, men and women were analyzed separately. ResultsThe median concentrations of plasma 25(OH)D were 46.6 nmol/L and 36.4 nmol/L for men and women, respectively. Compared with the lowest quartile in the fully adjusted model, the HR for incident ADL disability for the highest quartile was 0.55 (95% CI 0.36–0.85) for women; for men, a null association was indicated (HRhighest vs lowest 0.61, 95% CI 0.37–1.00). However, when using the recommended circulating 25(OH)D thresholds by the US Institute of Medicine, those with vitamin D sufficiency (≥50 nmol/L) had better ADL disability prognoses than those with vitamin D deficiency (<30 nmol/L) in both sexes (men HR 0.45, 95% CI 0.28–0.72; women HR 0.58, 95% CI 0.37–0.90). Conclusions and ImplicationsThe relationship between plasma 25(OH)D concentration and incident ADL disability was sex-specific among Chinese older adults. However, participants with recommended vitamin D sufficiency may have better disability prognoses in both sexes, suggesting that the recommended 25(OH)D concentration for bone health may extend to functional outcomes such as ADL disability in Chinese older adults.

The Effect of Foot Functional Training on Gait Ability in Older Adults with Activities of Daily Living Disability: A Randomized Controlled Trial

Background: Physical training can prevent gait ability decline in older adults. However, it is unknown whether foot functional training improves gait ability in older adults with activities of daily living (ADL) disability. Therefore, this study aimed to investigate the effects of foot functional training on gait ability in older adults with ADL disability. Methods: We conducted a single-center randomized controlled study involving 27 older Japanese adults (≥ 75 years) with ADL disability between December, 2017 and March, 2018. Participants were randomly assigned to an intervention group or a control group. The intervention group underwent 60-min foot functional training twice weekly for 4 months, in addition to routine activities that the nursing home typically offered to attendees. Results: Gait speed and speed of sound significantly increased after the 4-month training in the intervention group (gait speed: before vs. after, 0.61 ± 0.22 m/s vs. 0.84 ± 0.26 m/s, p ＜ 0.001; speed of sound: before vs. after, 1536 ± 16 m/s vs. 1550 ± 19 m/s), but not in the control group. The change in the peak pressure of the forefoot at the propulsive phase of gait was significantly higher in the intervention group than in the control group (p = 0.003). Gait speed was significantly correlated with the peak pressures of the forefoot (r = 0.27, p = 0.048) in the propulsive phase. Conclusion: The foot functional training significantly improved gait speed, bone strength, and plantar pressure distribution in older adults with ADL disability.

Beneficial Effect of Dietary Diversity on the Risk of Disability in Activities of Daily Living in Adults: A Prospective Cohort Study

Disability in activities of daily living (ADL) is common in elderly people. Dietary diversity is associated with several age-related diseases. The evidence on dietary diversity score (DDS) and ADL disability is limited. This study was based on the China Health and Nutrition Survey. Prospective data of 5004 participants were analyzed. ADL disability was defined as the inability to perform at least one of the five self-care tasks. Cox proportional regression models were conducted to estimate the association of cumulative average DDS with the risk of ADL disability. Logistic regression models were performed to estimate the odds ratios for the average DDS, the baseline DDS, and the recent DDS prior to the end of the survey in relation to ADL disability, respectively. The results indicate that higher average DDS was associated with a decreased risk of ADL disability (T3 vs. T1: hazard ratio 0.50; 95% confidence interval 0.39–0.66). The association was stronger among participants who did not had comorbidity at baseline than those who did (P-interaction 0.035). The average DDS is the most pronounced in estimating the association of DDS with ADL disability of the three approaches. In summary, higher DDS has beneficial effects on ADL disability, and long-term dietary exposure is more preferable in the investigation of DDS and ADL.

Frailty as a predictor of future falls and disability: a four-year follow-up study of Chinese older adults

BackgroundFrailty, which is defined as aging-related multisystem impairments, can lead to adverse health outcomes. However, evidence for such a connection in Chinese older adults remains lacking. This study examined the association between frailty and future falls and disability among community-dwelling Chinese older adults.MethodsData were obtained from the 2011 and 2015 waves of the China Health and Retirement Longitudinal Study. Participants were aged 60 years and above at baseline in 2011 and completed the follow-up survey in 2015. Outcome measures were future falls, incident disability in activities of daily living (ADLs) and instrumental activities of daily living (IADLs), and worsening performance of ADLs and IADLs. A multivariate logistic regression was conducted to examine the association between frailty phenotype and falls, incident disability, and worsening disability during a four-year period.ResultsWe found that frail participants were at increased risk at follow-up for: falls (OR 1.54, 95% CI, 1.14–2.08); developing new ADL difficulties (OR 4.10, 95% CI, 2.79–6.03) and IADL difficulties (OR 3.06, 95% CI, 2.03–4.61); and worsening ADLs performance (OR 2.27, 95% CI, 1.27–4.06), after adjusting for potential confounders. Prefrailty was also significantly associated with future falls, incident disability in ADLs and IADLs, but with a lower magnitude of effect.ConclusionsFrailty phenotype is an independent predictor of future falls, incident disability, and worsening performance in ADLs among Chinese older adults. The association suggests the need to pay special attention in caring for frail and prefrail elders and improving individuals’ frailty status.

Safety and Efficacy of Nontuberculous Mycobacteria Treatment among Elderly Patients.

Background and objectives: Incidence rates of pulmonary nontuberculous mycobacterial (NTM) disease have been increasing, especially in the elderly population. Given the limited evidence regarding the safety and efficacy of NTM treatment, this study aimed to evaluate the same among elderly patients. Material and methods: Patients diagnosed with NTM disease at a tertiary hospital from January 2007 to December 2017 were enrolled and data were then retrospectively collected. Data of elderly patients who received antimycobacterial treatment were then analyzed. Results: A total of 161 patients satisfied the diagnostic criteria for NTM disease. There were 40 elderly patients who received treatments. Of the patients, 60% received the guideline oriented standard regimens. Single drug regimens were administered to 22.5% of patients. Only 55.0% of the patients were able to continue any treatment. Treatment-related discontinuation was observed in 44.4% of discontinued or changed patients. There were no significant differences in the characteristics of patients with or without adverse events. Patients who were able to continue the treatment for >12 months had a lower proportion of activities of daily living (ADL) disability (nine in 18, 50.0% vs. three in 22, 13.6%, p = 0.018) and heart disease (six in 18, 33.3% vs. 1/22, 4.6%, p = 0.033). Sputum culture conversion was achieved in 28 out of 40 (70.0%) elderly patients treated, and those who achieved sputum culture conversion had more standard regimens prescribed than those who failed sputum culture conversion (21 in 28, 75% vs. 3 in 12, 25%; p = 0.005). Conclusion: Age may not be an obstacle for receiving the benefits of the treatment of NTM disease with a precise evaluation of patient’s comorbidities. Furthermore, elderly patients without heart disease and ADL disability may have better rate of continuing the NTM treatment. The current study suggested that selecting standard regimens to treat pulmonary NTM is important for elderly patients.

Association between cognitive declines and disability in activities of daily living in older adults with COPD: evidence from the China health and retirement longitudinal study

ObjectivesThis study aimed to investigate the relationship between disability and domain-specific cognitive function in older adults with chronic obstructive pulmonary disease (COPD).DesignCross-sectional analyses combined with retrospective longitudinal analyses.SettingWe included 450...

Prevalence and health correlates of anaemia among community-dwelling Chinese older adults: the China Health and Retirement Longitudinal Study

ObjectivesTo identify the prevalence of anaemia among older adults in China by sociodemographic and geographical regions, and cross-sectionally examine the associations between anaemia and several geriatric outcomes.DesignCross-sectional study.Setting and participantsParticipants...

Household heating associated with disability in activities of daily living among Chinese middle-aged and elderly: a longitudinal study

BackgroundThe health hazards of indoor air pollution are well-established but studies of the health effects due to pollution from heating are rare. This study investigated the association of heating and disability for activities of daily living among Chinese middle-aged and elderly.MethodsWe used two consecutive surveys in a cohort of over 17,000 adults aged 45 or older, who were interviewed first in 2011–2012 and then in 2013. In these surveys, taking advantage of random survey time, we applied a random effects logit regression model that included an interaction between pollution-producing heating fuel and a dummy variable, which measured interview time based on whether or not it was heating season.ResultsExposure to pollution-producing heating fuel was associated with a 39.9% (OR 1.399; 95%CI 1.227–1.594) and 71.0% (OR 1.710; 95%CI 1.523–1.920) increase in the likelihood of disability in activities of daily living (DADL) and disability in instrumental activities of daily living (DIADL), respectively. In heating season between year 2011 and 2013, moving from clean heating energy for heating to pollution-producing fuel was linked with an increase in the likelihoods having DADL and DIADL, with the OR of 2.014 (95%CI 1.126–3.600) and 1.956 (95%CI 1.186–3.226), respectively. However, disability increases due to change from clean energy to pollution-producing heating energy did not appear in advantaged education respondents.ConclusionsWe found that exposure to heating by burning of coal, wood, or crop residue was associated with disability in performing daily living activities. Health policymakers should take indoor pollution due to heating into consideration as it is a major determinant of activities of daily living in elderly people; especially, such policy should focus on elderly people who have disadvantaged education.

Depressive symptoms in child caregivers of very old Mexican Americans

Objective To study the effects of disability, cognitive impairment, and neuropsychiatric disturbance among older Mexican Americans on depressive symptoms in their children caregivers. Methods This study utilizes data from Wave 7 (2010-2011) of the Hispanic Established Populations for the Epidemiologic Study of the Elderly (HEPESE). The final sample included 200 adult children caregivers that provided direct personal care with activities of daily living (ADL) (e.g. bathing, toileting, dressing, etc.) to their older parents (average age = 87). We analyzed the influence of ADL disability, cognition (MMSE), and neuropsychiatric symptoms (NPI) of the care recipient on depressive symptoms of the adult child caregiver. A cross-sectional multivariable linear regression analysis was conducted to examine the effect of neuropsychiatric disturbance on caregiver depressive symptoms. Results Presence of care recipient NPI symptoms was associated with higher depressive symptoms for caregivers. Additional characteristics associated with caregiver depressive symptoms were not being married, and higher perceived social stress. ADL disability of the care recipient, cognitive functioning of the care recipient, or caregiver health status alone did not have a significant effect on depressive symptoms of the caregiver. Conclusions In a Mexican American familistic culture, disability and cognitive impairment might be better tolerated by families but neuropsychiatric behavioral symptoms related to dementia may take an increased toll on family member caregivers. The need to provide respite services, mental health resources and community services for caregivers of care recipients with neuropsychiatric symptoms is of paramount importance to alleviate depressive symptoms and burden among caregivers.

Potential associated factors of functional disability in Chinese older inpatients: a multicenter cross-sectional study

BackgroundThere is still controversy about the relationship between aging and changes in functional ability. This study aims to describe the level of basic activities of daily living (ADL) and higher-level instrumental activities of daily living (IADL) in different age groups and explore the factors associated with functional disability in Chinese older inpatients.MethodsThis cross-sectional study surveyed 9996 older inpatients aged 65 years and older from six tertiary hospitals in China from October 2018 to February 2019. The levels of ADL and IADL were measured by scores of the Barthel index and Instrumental Activities of Daily Living Scale. A mixed-effect generalized linear model was used to examine the association between functional disability and covariates.ResultsThe average ADL score was 89.51 ± 19.29 and the mean IADL score 6.76 ± 2.01 for all participants. There was a trend of decreasing scores along with aging, and significant differences between age groups were also observed (P < 0.001). The most affected ADL and IADL was stair climbing and shopping, respectively. Sociodemographic characteristics (such as age), physical health variables (frailty, emaciation, hearing dysfunction, urinary dysfunction, defecation dysfunction, falling accidents in the past 12 months), and mental health variables (cognitive dysfunction, depression) were associated with functional disability. Patients from the emergency department or transferred from other hospitals and former alcohol drinkers are at risk of ADL disability. Former smoking is a risk factor for IADL disability, whereas current drinking, higher-level education, and residing in a building without elevators were likely to maintain a better IADL performance.ConclusionsFunctional ability declines with aging, older inpatients are low dependency upon ADL and IADL. There are several associated factors among the participants derived from this investigation of a large-scale, multicenter, nationally representative Chinese older inpatient population. These findings potentially have major importance for the planning of hospital services, discharge planning, and post-discharge care.Trial registrationChinese Clinical Trial Registry, ChiCTR1800017682, registered August 9, 2018.

Back pain trajectories from midlife to retirement as a predictor of old age mobility and disability

Abstract Background Low back pain (LBP) is a leading cause for mobility limitations and disability at older age. However, little is known about the developmental pathways of LBP and its associations with old age mobility and disability. We studied trajectories of LBP from midlife to retirement (16-years follow-up) and assessed the association after 12 years with mobility limitations and disability in activities of daily living (ADL) at old age. Methods Finnish municipal employees were studied at baseline in 1981 and followed for 28 years. A total of 6257 persons aged 44-58 years, answered a questionnaire on health, work ability, and working conditions. Follow-up data on frequency of LBP (never, occasionally, consistently) was collected similarly at four waves. The study population consisted of persons who answered questions about LBP at baseline and at least in one of the follow-up waves and had information about ADL disability (n = 2787) and mobility limitations (n = 2723) at the 28-year follow-up. Latent class growth curve analysis was used to study LBP trajectories. Odds ratios (OR) with their 95% confidence intervals (CIs) for associations of LBP trajectory with ADL disability and mobility limitations were estimated using multivariable logistic regression. Results We identified two trajectories of LBP: high (77%) and low (23%). People in the high trajectory group had 2.35 times higher odds (95% CI 1.88- 2.97) of ADL disability and 1.86 times higher odds (95% CI 1.56-2.22) of mobility limitations as compared to the low trajectory group. Effects were attenuated by adjustment for lifestyle factors and chronic conditions but remained statistically significant for both outcomes [OR 1.74 (95% CI 1.37-2.24) and 1.44 (1.18-1.77), respectively]. Conclusions High LBP experienced during midlife may have far reached consequences on well-being at old age. Prevention of LBP during mid-life could reduce mobility limitations and disability at old age and promote a healthy ageing. Key messages Our results show that low back pain experienced during midlife is associated with mobility limitations and disability in activities of daily living at old age. Our results suggest that emphasis should be put on promotion of musculoskeletal health in midlife as this may help to reduce disability and mobility limitations at old age.

Incidence Rates of Disability and Its Associated Factors among Korean Community-Dwelling Older Adults.

Background:We aimed to identify incidence rates of disability and its associated factors among Korean community-dwelling older adults.Methods:The sample included 1,739 Koreans aged over 65 yr from the Korean Longitudinal Study of Aging (2006–2016) who reported no limitations in activities of daily living (ADL) or instrumental activities of daily living (IADL) at baseline (2006) and had complete data for other covariates. ADL, IADL, socio-demographic, lifestyle, and health-condition data were collected and analyzed using multiple logistic regression models.Results:The 10-yr incidence rates of ADL and IADL disability in subjects with no disability at baseline were 11.6% and 21.6%, respectively. After adjusting for socio-demographic, lifestyle, and health-condition factors, the incidence of ADL disability was higher in women (odds ratio [OR] =1.418, 95% confidence interval [CI]=1.102–2.613) and increased with age (OR=1.170, 95% CI=1.133–1.208), multi-morbidity (OR=1.194, 95% CI=1.015–1.406), and obesity (OR=1.563, 95% CI=1.057–2.311). It decreased in subjects living alone (OR=0.531, 95% CI=0.328–0.856). The incidence of IADL disability increased with age (OR=1.131, 95% CI=1.102–1.161), multi-morbidity (OR=1.199, 95% CI=1.054–1.365), and cognitive disability (OR=1.422, 95% CI=1.083–1.866) and decreased for subjects living alone (OR=0.484, 95% CI=0.328–0.715) and with overweight (OR=0.725, 95% CI=0.532–0.988).Conclusion:Incidence rates of disability differed considerably based on socio-demographic, lifestyle, and health-condition factors. These results suggest the importance of identifying factors that can decrease the risk of disability in this group and of prevention efforts in populations with a higher disability risk.

Self-Efficacy, Pain Intensity, Rheumatic Disease Duration, and Hand Functional Disability on Activities of Daily Living.

Knowledge regarding the possible influence of self-efficacy, pain intensity and disease duration on hand functional disability could promote new intervention strategies for activities of daily living (ADLs) in patients with rheumatic disease (RD). These approaches could prevent the health problems and socioeconomic costs associated with these diseases. The aims of this study were to evaluate if there are differences between the levels of perceived self-efficacy, pain intensity and disease duration among people with RD and non-RD diseases, and to analyze if hand functional disability in ADLs is related to self-efficacy, pain intensity and disease duration in a sample of patients with RD. A multicenter, observational, cross-sectional study was conducted on a total sample of 335 participants over 50 years old (176 patients with RD and 159 individuals with non-RD). The Duruöz Hand Index, the General Perceived Self-Efficacy Scale, the Rheumatic Diseases Self-Efficacy Scale (RDS-ES), the Visual Analog Scale (VAS), and the mean time of evolution in years of the disease (disease duration) were used to analyze the possible relationships surrounding hand functional disability in ADLs. The comparison analysis showed significant differences between the RD/non-RD sample for the General Perceived Self-Efficacy Scale, RDS-ES, and VAS scores (p < .001). The multiple regression results showed that age, General Perceived Self-Efficacy Scale scores, RDS-ES scores, VAS scores, and disease duration (or a combination of some of them) explained the variability of hand functional disability in almost 68% of kitchen tasks, 44% of dressing tasks, 46% of hygiene and other tasks, and 47% of office tasks. Our study shows that general and domain-specific self-efficacy, pain intensity, and disease duration are predictors of the dimensions of hand functional disability in patients with RD. Early evaluation of these components with an interdisciplinary approach would help to manage hand disability properly.

Social Isolation and Loneliness as Risk Factors for Grip Strength Decline Among Older Women and Men in China

ObjectiveThe purpose of this study was to examine the relationships of social isolation and loneliness, both individually and simultaneously, on changes in grip strength among Chinese older adults and whether these relations vary by gender. DesignA 4-year prospective observational study. Setting and ParticipantsThis study used data from the China Health and Retirement Longitudinal Study (CHARLS). Analyses were conducted with data from 2 waves (2011 and 2015) and were restricted to those respondents aged 50 and older [n = 7025, mean age (SD) = 61.46 (7.59); male, 48.4%]. MethodsSocial isolation, loneliness, and grip strength were measured at baseline. Follow-up measures of grip strength were obtained 4 years later. Multiple linear regression was used to evaluate the associations among baseline isolation, loneliness, and decline of grip strength between 2 waves after adjustment for age, gender, education, body mass index, chronic diseases, smoking and drinking status, activities of daily living (ADL) and instrumental ADL disabilities, and depressive symptoms. ResultsFor women, baseline loneliness (β = 0.04, P = .035) rather than isolation (β = 0.03, P = .110) significantly predicted grip strength decline after 4 years when other confounding variables were taken into account. For men, baseline isolation (β = 0.05, P = .005) rather than loneliness (β = 0.01, P = .570) significantly predicted grip strength decline. No synergistic effect of isolation and loneliness on grip strength was found for either women or men. Conclusions and ImplicationsIn this prospective study, gender differences were found for the associations of social isolation and loneliness with grip strength decline. Our results suggest that older women and men may benefit from different social enhancement strategies for prevention of physical function decline.

Activities of daily living, life orientation, and health-related quality of life among older people in nursing homes: a national cross-sectional study in China.

This study aimed to explore the current status of activities of daily living (ADLs), life orientation, and health-related quality of life (HRQoL) among older people in nursing homes and to further examine the mediating role of life orientation in the impact of ADLs on HRQoL. A national cross-sectional study was conducted among older people aged 60 and above in nursing homes by the randomly stratified cluster sampling method. The status of ADLs, life orientation and HRQoL were measured using an ADL scale, a life orientation scale and the SF-12v2 scale, respectively. Multiple linear regression models were used to identify explanatory factors associated with ADLs, life orientation, and HRQoL. The potential mediating role of life orientation in the relationship between ADL and HRQoL was explored by mediation analysis. The overall prevalence of ADL disability was 52.67%, and 84.37% of older people in nursing homes had a negative life orientation. The mean scores of physical health and mental health among older people in nursing homes were 45.44 ± 6.46 and 42.67 ± 8.48, respectively. Some sociodemographic characteristics were associated with poor physical health and mental health. After adjustments were made for covariates, the life orientation score mediated 13.81% of the total effect of the ADL score on physical component score of HRQoL and mediated 45.33% of the mental component score of HRQoL. A sizeable proportion of older people had ADL disability and negative life orientation, and HRQoL was poor among older Chinese people in nursing homes. Life orientation partially mediates the relationship between ADLs and HRQoL.

Does subjective health matter? Predicting overall and specific ADL disability incidence

BackgroundThe aims of this study were to examine the incidence of activities of daily living (ADL) and instrumental activities of daily living (IADL) disability in a national sample of community‐living older adults, and to evaluate the value of baseline self-rated health (SRH) in predicting these outcomes. Additionally, we investigated whether SRH’s prognostic ability extended to individual ADL/IADL components (e.g. bathing, managing money). MethodsData were obtained from the 2014 and 2016 Korean Longitudinal Study of Aging (N = 3431). Respondents were aged 65+ and non-disabled at baseline. Setting the respondents with “very good” or “good” baseline SRH as the reference group, logistic regression models were applied to analyze the association between SRH and disability risk. ResultsThe overall incidence rates for ADL and IADL were 25.6 and 53.4/1000 person-years, respectively. Disability incidence increased significantly with poorer SRH. In multivariable regressions, subsequent 1 + ADL disability was significantly associated with “bad” (OR 2.86) and “very bad” SRH (OR 4.28). SRH also predicted 1 + IADL disability for respondents who reported “moderate”, “bad”, or “very bad” health (OR 2.01–3.39). SRH was predictive of three out of five ADL components, and seven out of 10 IADL components. ConclusionSRH predicted functional decline after two years in older adults without baseline disabilities, and its prognostic ability extended to individual ADL/IADL components. Patterns of SRH-morbidity associations can help health administrators identify those at risk of subsequent functional decline. Early interventions targeted at those with poor SRH can help alleviate the strain on long-term care support systems.

Serum albumin and activities of daily living in Chinese centenarians: a cross-sectional study

BackgroundObjective deterioration in activities of daily living (ADLs) exists among older population, and particularly worsens with age. Considering the criterion standard of positive aging and longevity, little information focusing on centenarians is available. This study set out to explore the relationship between serum albumin and ADLs among centenarians in long-lived areas.MethodsThis population-based cross-sectional study investigated a full sample of Chinese centenarians in Hainan, the longest-lived area of China (n = 1002). We assessed serum albumin levels and basic and instrumental activities of daily living (BADLs and IADLs).ResultsOf 1002 participants included in the analysis, 287 (28.64%) had BADL disabilities and 648 (64.67%) had IADL disabilities. The median level of serum albumin was 38.5 g/L (interquartile range, 36.2–41.3). The multivariable analyses controlling for socio-demographic characteristics, lifestyle, morbidities, and other influential factors showed that albumin level was associated with the total score of BADL (standard β = 0.335, P < 0.001) and IADL (standard β = 0.206, P < 0.001). With the increasing of albumin level, the risk of ADLs disability decreased (BADL: odds ratios [OR] = 0.835, 95% Confidence interval [CI]: 0.797–0.876; IADL: OR = 0.863, 95%CI: 0.824–0.905). In the stratified analyses, similar results were found in both sex, but were more prominent in women.ConclusionsHigher levels of serum albumin was a protective factor for the decline of ADLs in centenarians. This association can be observed in both genders and is more pronounced in women.