Activities Of Daily Living Disability Research Articles

Changes in the prevalence of chronic disability in China: evidence from the China Health and Retirement Longitudinal Study

ObjectivesChinese adults are the biggest users of healthcare services, and understanding current trends in disability profiles is relevant to planning healthcare workforce infrastructure. We investigated the trends over time for disability and physical functional limitations from 2011 to 2015 among Chinese adults and identified the factors associated with these limitations. Study designWe used nationally representative data from the China Health and Retirement Longitudinal Study (CHARLS); the CHARLS participants were followed up every 2 years as they moved from work to retirement with an emphasis on their health status and functional abilities. MethodsParticipants aged ≥50 years from three waves of the CHARLS were included. Data were collected on physical functioning limitations, disabilities in activities of daily living (ADLs) and disabilities in instrumental activities of daily living (IADLs). Multilevel logistic regression models were used to test for changes and factors associated with limitations and disabilities between 2011 and 2015 adjusting for sociodemographic, medical history and health measures. ResultsThere were 44,447 eligible participants (mean age: 63 years; standard deviation [SD], 9 years; 51% female). After adjustment, there was no significant increase in reporting of ADLs or IADLs in the 2015 survey compared with the 2011 survey. After adjustment, there was a 26% significant increase in reporting of physical functioning limitations in the 2015 survey compared with the 2011 survey (odds ratio: 1.26; 95% confidence interval, 1.17 to 1.35). Factors associated with ADL disability were being female, being older, minimal education, no alcohol intake in the previous year, falls, fractured hip, feeling depressed and being obese. Factors associated with IADL disabilities were being female, being older, minimal education and feeling depressed. ConclusionsChinese health agencies should consider the growing need for sufficient community services infrastructure to maximise independence, particularly in the context of ageing populations.

Does self-reported hearing difficulty decrease older adults’ cognitive and physical functioning? The mediating role of social isolation

ObjectivesWe used longitudinal cohort data to explore the association between self-reported hearing difficulty (SHD) and cognitive as well as physical functioning, and whether the association is mediated by social isolation. Study design16,786 observations from participants aged 65 and older in two waves of the Chinese Longitudinal Healthy Longevity Survey, a community‐based cohort study, were analyzed. Main outcome measuresCognitive impairment was assessed using the Chinese version of the Mini Mental State Examination (MMSE). Activities of daily living (ADL) and instrumental activities of daily living (IADL) were used as indicators of physical functioning. ResultsGeneralized structural equation modelling (GSEM) analysis showed that SHD increased the risk cognitive impairment (odds ratio [OR] = 2.93, 95 % confidence intervals [CI] 2.61–3.30), ADL disability (OR = 2.10, 95 % CI 1.86–2.38), and IADL disability (OR = 2.39, 95 % CI 2.12–2.68). Social isolation mediated the association of SHD with cognitive functioning, but not with physical functioning. SHD was positively associated with social isolation (OR = 1.23, 95 % CI 1.07–1.42), and social isolation was significantly associated with cognitive impairment (OR = 2.09, 95 % CI 1.74–2.50). Indirect effects of SHD explained 12.3 % of the variance in cognitive impairment via social isolation. ConclusionsSHD was associated with adverse cognitive and physical functioning in older adults. Cognitive but not physical functioning was indirectly influenced by SHD via social isolation.

Leisure activities and disability in activities of daily living among the oldest-old Chinese population: evidence from the Chinese Longitudinal Healthy Longevity Study.

Introduction: To investigate the independent and joint effects of leisure activities on disability in activities of daily living (ADL) among the oldest-old Chinese population (aged ≥ 80 years).Results: A total of 3696 participants with ADL disability were identified during the median follow-up period of 3.1 years. Compared to the participants who “never” watched TV or listened to the radio and who “never” kept domestic animals or pets, those who engaged in these activities “almost every day” had a significantly lower ADL disability risk (adjusted hazard ratios were 0.74 and 0.66, respectively; both P < 0.001). Furthermore, participants engaging in multiple leisure activities showed a reduced risk of ADL disability (P for trend < 0.001).Conclusions: Frequently watching TV or listening to the radio and keeping domestic animals or pets was associated with a lower risk of ADL disability among the oldest-old Chinese population.Methods: We included 12,331 participants (aged ≥ 80 years) (mean [SD] age: 89.5 [7.0] years) who managed to perform ADL independently at baseline in the Chinese Longitudinal Healthy Longevity Survey 1998-2014 waves. Cox proportional hazards models were used to examine whether leisure activities were associated with ADL disability.

Higher Adherence to the Dietary Approaches to Stop Hypertension (DASH) Dietary Pattern Is Inversely Associated with Incidence of Disability Among Puerto Rican Adults

Abstract Objectives Emerging evidence suggests that overall dietary quality is important for the prevention of disability, which maybe be due to protective effects on cardiovascular risk factors. Few studies have investigated adherence to a DASH diet and disability and muscle strength prospectively, particularly among Puerto Rican adults. This study examined the relationship between a DASH dietary index and incidence of disability and change in muscle strength over 5 years of follow up. Methods Data are from the Boston Puerto Rican Health Study, a prospective cohort of Puerto Rican adults aged 45 to 75 y (n = 1408). The DASH dietary quality index (DASH) was derived from averaged dietary data assessed by validated food frequency questionnaire at baseline and 2-y follow up. Self-reported disability included activities of daily living (ADL) and instrumental ADL assessed at baseline, 2-y and 5-y follow up. Hand grip measures were obtained using a hand dynamometer at baseline, 2-y and 5-y follow up. Cox Proportional Hazards models were adjusted for sex, age, cardiovascular disease, smoking status, educational attainment, alcohol consumption, physical activity, hypertension, diabetes, cholesterol concentration, C-reactive protein and body mass index. Multivariable linear regression was used to model changes in handgrip. Interactions by sex, age and diabetes status were examined. Results The prevalence of ADL and IADL disability at baseline was 70.8% and 48.6%. Mean change in handgrip from baseline to 5 y was −2.19 kg. Interactions by age, sex and diabetes status were not significant. Participants with higher adherence to the DASH diet had lower incidence of impaired ADL (HR = 0.95, 95% CI: 0.92, 0.99) and IADL disability (HR = 0.96, 95% CI: 0.93, 0.98). The relationship between the DASH dietary index and change in handgrip measures from baseline to 5-y follow up approached significance (β = 0.14 ± 0.08, P = 0.07). Conclusions These findings suggest that higher adherence to a DASH diet may reduce risk of disability and mitigate muscle strength loss among Puerto Rican adults. This may be an important intervention strategy for prevention of disability in this population. Funding Sources National Institutes of Health, National Institute of Arthritis and Musculoskeletal and Skin Diseases.

Muscle Mass Assessed by the D3-Creatine Dilution Method and Incident Self-reported Disability and Mortality in a Prospective Observational Study of Community-Dwelling Older Men.

Whether low muscle mass is a risk factor for disability and mortality is unclear. Associations between approximations of muscle mass (including lean mass from dual-energy x-ray absorptiometry [DXA]), and these outcomes are inconsistent. Muscle mass measured by deuterated creatine (D3Cr) dilution and appendicular lean mass (ALM, by DXA) were assessed at the Year 14 Visit (2014-2016) of the prospective Osteoporotic Fractures in Men study (N = 1,425, age 77-101 years). Disability in activities of daily living (ADLs), instrumental ADLs, and mobility tasks was self-reported at the Year 14 visit and 2.2 years later; deaths were centrally adjudicated over 3.3 years. Relative risks and 95% confidence intervals (CI) were estimated per standard deviation decrement with negative binomial, logistic regression, or proportional hazards models. In age- and clinical center-adjusted models, the relative risks per decrement in D3Cr muscle mass/wgt was 1.9 (95% CI: 1.2, 3.1) for incident self-reported ADL disability; 1.5 (95% CI: 1.3, 1.9) for instrumental ADL disability; and 1.8 (95% CI: 1.5, 2.2) for mobility disability. In age-, clinical center-, and weight-adjusted models, the relative risks per decrement in D3Cr muscle mass was 1.8 (95% CI: 1.5, 2.2) for all-cause mortality. In contrast, lower DXA ALM was not associated with any outcome. Associations of D3Cr muscle mass with these outcomes were slightly attenuated after adjustment for confounding factors and the potentially mediating effects of strength and physical performance. Low muscle mass as measured by D3Cr dilution is a novel risk factor for clinically meaningful outcomes in older men.

Relationships between stroke, depression, generalized anxiety disorder and physical disability: some evidence from the Canadian Community Health Survey-Mental Health

The objective of this study is to evaluate associations between stroke, depression, anxiety and physical disability. The sample of 19,159 participants aged ≥30 was obtained from the 2012 Canadian Community Health Survey–Mental Health. Depression or anxiety was defined as major depressive disorder (MDD) or generalized anxiety disorder (GAD) within the past 12 months. The history of anxiety was defined as GAD at any time point during the respondent's lifetime. Physical disability was assessed by the past 14-day disability in daily-living activities. For statistical analysis, two logistic regression models (crude and adjusted models) were presented. The results showed that subjects with stroke had greater likelihoods of MDD-GAD comorbidity and GAD only compared those without stroke. People with GAD only had higher likelihood of physical disability than those with neither of the two conditions. Among participants with stroke, lifetime GAD was associated with a greater likelihood of MDD. In conclusion, individuals with stroke may be vulnerable to comorbid depression-anxiety as well as anxiety only. Additionally, subjects with anxiety were more likely to have physical disability. The history of anxiety increased the risk for developing post-stroke depression.

The disability process: is there a place for frailty?

frailty and disability are very common in older adults; they share some risk factors and pathophysiological mechanisms. Yet, they are different clinical entities. this study aimed to explore a potential hierarchical relationship between frailty and disability along the continuum of the disablement process. prospective cohort study. the French Three-City (3C) study. the sample included 943 participants aged 75 and older. the Fried frailty phenotype, Instrumental Activities of Daily Living (IADL) and basic Activities of Daily Living (ADL) were used. We distinguished between four mutually excluding groups: (i) robust (no frailty and no disability); (ii) pure frailty (no disability); (iii) frailty with IADL disability (no ADL disability) and (iv) frailty with IADL and ADL disabilities. We used Cox's regression models to study the 4-year mortality risk associated with each status. Eight-two per cent of participants were classified according to the assumed hierarchy: 61.3% was robust, 5.4% frail, 10.5% frail and IADL-disabled and 4.8% frail, IADL and ADL-disabled. An extra group of 17% was identified with IADL-disabled individuals without frailty. This extra group was similar to pure frailty in terms of characteristics and risk of death, placing them along the continuum at an intermediate stage between robustness and the two most disabled sub-groups. our findings suggest that including frailty along the continuum could be relevant to describe the whole disablement process. Frailty would occur upstream of the process and might be relevant to identify an opportune time window, where specific monitoring and clinical interventions could be implemented in order to interrupt the process at a potentially more reversible stage.

A Cross-Sectional Study of the Prevalence of and Risk Factors for Suicidal Ideation Among the Elderly in Nursing Homes in Hunan Province, China.

Our study aims to explore the risk factors for suicidal ideation and their interaction among the elderly in nursing homes in Hunan province, China. A cross-sectional study was conducted among the elderly in nursing homes in Hunan Province. Twenty-four nursing homes were selected by multistage cluster random sampling, and 817 elderly residents were investigated using a set of structured questionnaires. The main outcome measures included general information, suicidal ideation, depression symptoms, social support, activities of daily living (ADL), stressful life events, and sleep quality. Multivariate binary logistic regression was performed to explore the risk factors for suicidal ideation among the elderly in nursing homes, and additive interaction was used to analyze the interaction between risk factors. The prevalence of suicidal ideation among the elderly in nursing homes in Hunan province was 17.9% (95% confidence interval(CI): 15.2%, 20.6%). Living in a rural area (odds ratio(OR)=1.88, 95% CI: 1.03, 3.44), infrequent visits from relatives (OR=2.61, 95% CI: 1.42, 4.78), history of chronic disease (OR=2.34, 95% CI: 1.09, 5.01), depression symptoms (OR=8.11, 95% CI: 4.52, 14.54), lower social support (OR=3.85, 95% CI: 1.94, 7.61), and ADL disability status (OR=4.38, 95% CI: 2.10, 9.14) increased the risk of suicidal ideation. Additive interactions were detected between depression symptoms and ADL status, with a relative excess risk due to interaction (RERI) of 8.73 (95% CI: 2.04, 15.43), and between depression symptoms and social support, with an RERI of 5.98 (95% CI: 0.86, 11.10). The prevalence of suicidal ideation among the elderly in nursing homes is relatively high. Both physical conditions and psychosocial factors were associated with suicidal ideation among the elderly. These findings have significant implications for the prediction and prevention of suicidal behaviors.

Handgrip Strength Asymmetry and Weakness Together Are Associated With Functional Disability in Aging Americans.

Evaluating handgrip strength (HGS) asymmetry may help to improve the prognostic value of HGS. This study sought to determine the associations of HGS asymmetry and weakness on future activities of daily living (ADL) disability in a national sample of aging Americans. The analytic sample included 18,468 Americans aged ≥50 years from the 2006-2016 waves of the Health and Retirement Study. A handgrip dynamometer measured HGS. Those with HGS >10% stronger on either hand were considered as having any HGS asymmetry. Individuals with HGS >10% stronger on their dominant hand were considered as having dominant HGS asymmetry, while those with HGS >10% stronger on their nondominant hand were classified as having nondominant HGS asymmetry. Men with HGS <26 kg and women with HGS <16 kg were considered weak. ADLs were self-reported. Generalized estimating equations were used for analyses. Relative to those with symmetric HGS and no weakness, each HGS asymmetry and weakness group had increased odds for future ADL disability: 1.11 (95% confidence interval [CI]: 1.02-1.20) for any HGS asymmetry alone, 1.42 (CI: 1.16-1.74) for weakness alone, and 1.81 (CI: 1.52-2.16) for both any HGS asymmetry and weakness. Most weakness and HGS asymmetry dominance groups had increased odds for future ADL disability: 1.30 (CI: 1.13-1.50) for nondominant HGS asymmetry alone, 1.42 (CI: 1.16-1.74) for weakness alone, 1.72 (CI: 1.29-2.29) for both weakness and nondominant HGS asymmetry, and 1.86 (CI: 1.52-2.28) for both weakness and dominant HGS asymmetry. HGS asymmetry and weakness together may increase the predictive utility of handgrip dynamometers.

Eating and communication difficulties as mediators of the relationship between tooth loss and functional disability in middle-aged and older adults

ObjectivesPrevious cohort studies have reported the significant association between tooth loss and functional disability in aging adults. This study aimed to examine whether eating and communication difficulties mediate this association. MethodsData from wave 7 (2014–2015) to wave 8 (2016–2017) of the English Longitudinal Study of Ageing (ELSA) were analyzed. Severe tooth loss was defined as “< 20 teeth remaining” at baseline. Eating and communication difficulties were assessed through a questionnaire. Onset of functional disability 2-year later was assessed by activities of daily living (ADL) scale and instrumental ADL (IADL) scale. Baron and Kenny’s causal steps and Karlson/Holm/Breen (KHB) method were used to examine the mediating effect. ResultsAt baseline, 7,830 participants had no ADL disability and 7,678 participants had no IADL disability. The 2-year cumulative incidence of ADL disability and IADL disability were 7.5 % and 9.0 %, respectively. Severe tooth loss was associated with both incidence of ADL disability (OR = 1.40; 95 % CI = 1.13–1.74) and incidence of IADL disability (OR = 1.24; 95 % CI = 1.01–1.52). The mediating effect of eating difficulty on the association between severe tooth loss and ADL disability was 1.04 (95 % CI: 1.01, 1.06). The mediating effect of communication difficulty on the association between severe tooth loss and IADL disability was 1.05 (95 % CI: 1.02, 1.07). ConclusionSevere tooth loss is associated with incidence of functional disability in middle-aged and older English adults. Eating and communication difficulties play the role as mediators in these associations. Clinical SignificanceThis prospective study contributes to elucidating parts of biological mechanism underlying tooth loss and functional disability in middle-aged and older adults. It suggests that oral health strategies aimed to protect teeth may be important in reducing the risk of functional disability.

Decomposing Inequality in Long-Term Care Need Among Older Adults with Chronic Diseases in China: A Life Course Perspective.

Background: China has the largest number of aging people in need of long-term care, among whom 70% have chronic diseases. For policy planners, it is necessary to understand the different levels of needs of long-term care and provide long-term care insurance to ensure the long-term care needs of all people can be met. Methods: This study combines the 2013 wave of CHARLS survey and the Life Course Survey of 2014. The combination allows us to factor in both childhood and adulthood data to provide life-course analysis. We identified 7,734 older adults with chronic diseases for analysis. The need for long-term care is defined by the presence of functional limitations based on the performance of basic activities of daily living (ADLs) and of instrumental activities of daily living (IADLs). Two dummy variables, ADLs disability and IADLs disability, and two count variables, ADLs score and IADLs score, were defined to measure incidence and severity of long-term care need, respectively. The concentration index was used to capture the inequality in long-term care need, and a decomposition method based on Probit Regression and Negative Binomial Regression was exploited to identify the contribution of each determination. Results: At least a little difficulty was reported in ADLs and IADLs in 20.44% and 19.25% of respondents, respectively. The concentration index of ADLs disability, ADLs score, IADLs disability, IADLs score were −0.085, −0.109, −0.095 and −0.120, respectively, all of which were statistically significant, indicating the pro-poor inequality in the incidence and severity of long-term care need. Decomposition analyses revealed that family income, education attainment, aging, and childhood experience played a significant role in explaining the inequalities. Conclusions: The long-term care need among older adults with chronic disease is high in China and low socioeconomic groups had a higher probability of needing long-term care or need more long-term care. It is urgent to implement long-term care insurance, especially for the individuals from lower socioeconomic groups.

Association of Frailty with recovery from disability among community-dwelling Chinese older adults: China health and retirement longitudinal study

BackgroundsLittle is known about the role of frailty in the recovery process of disability among older adults. We examined the association between frailty and recovery from activities of daily living (ADL) and instrumental ADL (IADL) disability among community-dwelling Chinese older adults.MethodsData were from the China Health and Retirement Longitudinal Study. Three waves were used. Participants ≥60 years, had frailty assessment at baseline, and had incident disability in ADL or IADL in 2013, and had disability assessment in 2015 were included. Recovery from ADL and IADL disability were used as outcome measure. Multivariable logistic regression was used to evaluate the potential association between frailty and recovery from ADL or IADL.ResultsWe included 516 and 598 participants in the ADL and IADL analysis, respectively. In total, 237 participants recovered from ADL disability and 293 recovered from IADL disability. Nearly half of the non-frail persons recovered from ADL disability, while less than one-quarter of the frail persons had recovery. Over half of the non-frail persons had IADL disability recovery, while only 30% of the frail recovered. After adjustment, the odds of recovery from ADL disability were 59% (95% confidence interval [CI]: 1, 83%) lower among frail participants than those who were non-frail; the odds of recovery from IADL disability were 52% lower among frail persons than those who were non-frail and the association did not reach statistical significance.ConclusionsFrailty is an independent predictor of poor recovery from disability among nondisabled community-dwelling older adults in China.

Abstract P149: Association Between Disabilities And Cardiovascular Disease Mortality In Diabetic Men And Women

The associations of physical disabilities with cardiovascular disease (CVD) mortality in diabetic patients remains less explored. Purpose: We investigated the associations of activities of daily living (ADL), instrumental ADL (IADL), and functional limitation (FL) disabilities with CVD mortality among diabetic men and women in the National Health and Nutrition Examination Surveys. Methods: Cox proportional hazards regressions were used to examine the associations of ADL, IADL, and FL disabilities with CVD mortality in men and women after adjustment for covariates. We followed 2,255 men and women, aged 20 to 90 years, who participated in the National Health and Nutrition Examination Surveys (1988-1994, 199-2014). All participants completed baseline demographics and health factors, including blood lipid profiles. Diabetes mellitus was defined as fasting glucose level ≥126 mg/dL, a nonfasting glucose level ≥200 mg/dL, use of hypoglycemic agents, or a history of physician-diagnosed diabetes mellitus. ADL disability was defined as those who had any difficulties in dressing, eating, getting out of bed, or walking a room to another room. IADL disability was defined as those who had any difficulties in preparing meals, managing money, or doing chores around the house. FL disability was defined as those who had any limitations in mobility performance (walking 0.25 mile, climbing 10 stairs, lifting/carrying 10 pounds, or standing from a chair). Results: During an average of 15.5 years of follow-up (34,939 person-years), there were a total of 382 CVD deaths. There were direct relationships between the number of ADL, IADL, and FL with CVD mortality after adjustment for age, sex, race, and other CVD risk covariates (All P&lt;0.007). After adjustment for multiple risk factors, the risks of CVD mortality for ADL, IADL, and FL disabilities were (95% CI) 2.01 (1.60, 2.51), 1.99 (1.60, 2.48), and 1.97 (1.59, 2.44), respectively, compared with their counterparts. After further adjustment for chronic medical conditions (personal history of coronary heart disease, stroke, or cancer), diabetic persons with ADL disability had 1.94 times (1.5, 2.43), with IADL disability had 1.93 times (1.54, 2.41), and with FL disability had 1.94 times (1.56, 2.40) the risk of CVD mortality as compared with their counterparts, respectively. The associations remained but were attenuated after further excluding these patients with chronic diseases. The risks of CVD mortality in diabetic persons with ADL, IADL, and FL disabilities were (95% CI) 1.78 (1.30, 2.43), 1.66 (1.22, 2.27), and 1.43 (1.09, 1.89), respectively, compared with their counterparts, after excluding these chronic disease patients. Conclusion: Diabetic persons with ADL, IADL, and FL disabilities had a greater risk of CVD mortality. The American Heart Association should establish exercise and dietary guidelines for diabetic persons with physical disabilities.

Associations between cardiac arrhythmia, incident disability in activities of daily living and physical performance: the ILSA study.

BackgroundCardiac arrhythmias are common conditions in older people. Unfortunately, there is limited literature on associations between cardiac arrhythmias and physical performance or disability. We therefore aimed to prospectively investigate associations between cardiac arrhythmias and changes in disability and physical performance during 8 years of follow-up, using data from the Italian Longitudinal Study on Aging (ILSA).MethodsCardiac arrhythmias diagnosis was posed through a screening phase, confirmed by a physician. The onset of disability in activities of daily living (ADL) and the changes in several physical performance tests during follow-up were considered as outcomes. Fully-adjusted and propensity-score Cox Proportional Hazard models and mixed models were used for exploring associations between cardiac arrhythmia and the outcomes of interest.ResultsThe prevalence of cardiac arrhythmia at baseline was 23.3%. People reporting cardiac arrhythmia at the baseline were significantly older, more frequently male, smokers and reported a higher presence of all medical conditions investigated (hypertension, heart failure, angina, myocardial infarction, diabetes, stroke), but no difference in dementia, Parkinsonism, cognitive or mood disorder. Cardiac arrhythmia at baseline was significantly associated with the incidence of disability in ADL (HR = 1.23; 95%: CI: 1.01–1.50; P = 0.0478 in propensity score analyses; HR = 1.28; 95% CI: 1.01–1.61; P = 0.0401 in fully adjusted models). Cardiac arrhythmia at baseline was also associated with a significant worsening in balance test (P = 0.0436).ConclusionsThe presence of cardiac arrhythmia at baseline was associated with a significant higher risk of disability and of worsening in some physical performance tests, particularly those relating to balance. Screening and frequently assessing physical performance in older people affected by cardiac arrhythmia can be important to prevent a loss of physical performance, with further, potential, complications of medical management.

Individual and population level impact of chronic conditions on functional disability in older adults

BackgroundIt is unknown if the relationship between multimorbidity and disability differs by combinations of chronic conditions. The objective of our study was to elucidate how joint effect of different combinations of chronic conditions impact the five year risk of functional disability at the population level.MethodsParticipants ≥65 years from the Canadian Study of Health and Aging were assessed for functional disability measured using activities of daily living (ADL) and instrumental ADL (IADL), and the presence of conditions in five disease domains; cardiometabolic, neurological, sensory, musculoskeletal, and respiratory. Logistic regression was used to assess the relationship between each disease domain and incident ADL and IADL measured at five years of follow up and population attributable risk (PAR) was modeled for diseases domains that were significantly associated with disability. Results were stratified by sex and age (65–74 years, ≥75 years).ResultsThere were 6272 participants free of ADL disability and 4571 participants free from IADL disability at baseline. For incident ADL, the greatest PAR values were 21.3 (9.8–32.8) for the cardiometabolic domain in males 65–74 years, 22.7 (4.7–40.8) for the musculoskeletal domain for females aged 65–74 years, and 11.2 (2.8–19.7) for the musculoskeletal domain in males ≥75 years. The PAR for the musculoskeletal, sensory, and neurological domains were similar in females ≥75 years(9.3–9.9). PAR values were lower but followed similar patterns for IADL disability.ConclusionThe chronic disease domains which most strongly predicted incident ADLs and IADLs did not account for the greatest amount of disability at the population level.

Predicting Mortality and Adverse Outcomes: Comparing the Frailty Index to General Prognostic Indices.

Mortality prediction models are useful to guide clinical decision-making based on prognosis. The frailty index, which allows prognostication and personalized care planning, has not been directly compared with validated prognostic models. To compare the discrimination of mortality, disability, falls, and hospitalization between a frailty index and validated prognostic indices. Secondary Analysis of the National Health and Aging Trends Study. Seven thousand thirty-three Medicare beneficiaries 65years or older. We measured a deficit-accumulation frailty index, Schonberg index, and Lee index at the 2011 baseline assessment. Primary outcome was mortality at 5years. Secondary outcomes were decline in activities of daily living (ADL), decline in instrumental activities of daily living (IADL), fall, and hospitalization at 1year. We used C-statistics to compare discrimination between indices, adjusting for age and sex. The study population included 4146 (44.8%) with age ≥ 75years, with a median frailty index of 0.15 (interquartile range 0.09-0.25). A total of 1385 participants died (14.7%) and 2386 (35.2%) were lost to follow-up. Frailty, Schonberg, and Lee indices predicted mortality similarly: C-statistics (95% confidence interval) were 0.78 (0.77-0.80) for frailty index; 0.79 (0.78-0.81) for Schonberg index; and 0.78 (0.77-0.80) for Lee index. The frailty index had higher C-statistics for decline in ADL function (frailty index, 0.80 [0.78-0.83]; Schonberg, 0.74 [0.72-0.76]; Lee, 0.74 [0.71-0.77]) and falls (frailty index, 0.66 [0.65-0.68]; Schonberg, 0.61 [0.58-0.63]; Lee, 0.61 [0.59-0.63]). C-statistics were similar for decline in IADL function (frailty index, 0.61 [0.59-0.63]; Schonberg, 0.60 [0.59-0.62]; Lee, 0.60 [0.58-0.62]) and hospitalizations (frailty index, 0.68 [0.66-0.70]; Schonberg, 0.68 [0.66-0.69]; Lee, 0.65 [0.63-0.67]). A deficit-accumulation frailty index performs as well as prognostic indices for mortality prediction, and better predicts ADL disability and falls in community-dwelling older adults. Frailty assessment offers a unifying approach to risk stratification for key health outcomes relevant to older adults.

The Influence of Disabilities in Activities of Daily Living on Successful Aging: The Role of Well-Being and Residence Location.

This study aimed to investigate the effect of disability in activities of daily living (ADLs) on successful aging, and the possible moderators between them. Based on data from the Chinese Longitudinal Healthy Longevity Surveys (CLHLS), we used the Cox proportional hazards model of survival analysis and multivariate regression analysis (SPSS 16.0) to test our hypotheses. Mortality or cognition impairment were the dependents variables, and disability in ADLs was the independent variable. Well-being and residence location were the moderators. The results showed that in survey 2005, the Chinese elders with disability in ADLs, after controlling elder's gender, age, residence place, and marital status, often experienced more mortality and cognition impairment risk in the next 3 years. Our findings also showed that the increased mortality risk among elders with disability in ADLs was lower in those with higher well-being or younger age. The increased cognitive impairment risk among elders with disability in ADLs was lower in those living in the city than those living in a rural area or small towns. These findings contribute to a better understanding of the relationship between disability in ADLs and successful aging among Chinese elders. Our findings also expose other elements to consider such as psychological factors (e.g., well-being) and residence location in the relationships between the disability in ADLs and mortality (or cognition impairment), which have a psychological impact in successful aging of the Chinese elders.

Association of Anemia with Activities of Daily Living in Chinese Female Centenarian.

Although anemia and activities of daily living (ADL) disability in female elderly are common conditions and are more likely to occur as people age, little is known about the association of anemia with ADL in female centenarians. The objective of this study was to examine the relationship between anemia and ADL disability in Chinese female centenarians. We conducted a population-based cross-sectional study of a sample of 822 Chinese female centenarians from 2014 to 2016. Blood analysis, home interview, and physical examination were performed following standard procedures. ADL disability was defined as a Barthel Index total score≤60. The prevalence of anemia and ADL disability were 66.8% and 29.7% respectively in Chinese female centenarians. Multiple logistic regression analyses revealed that inflammation (OR = 2.280, 95% CI, 1.524-3.410), underweight (OR = 1.653, 95% CI, 1.186-2.303), anemia (OR = 1.775, 95% CI, 1.250-2.521), and living with family (OR = 0.518, 95% CI, 0.302-0.888) were significant factors related to ADL disability. Centenarians with severe anemia had an approximately fourfold greater likelihood of ADL disability than those without anemia (OR =3.747; 95% CI 1.525-9.206). An apparent dose-response relationship was found between anemia and ADL disability. These findings may provide some insights into targeted intervention for maintaining ADL independence in female centenarians, especially encouraging the interventions of anemia to improve ADL.

Sarcopenia in Community-Dwelling Oldest Old Is Associated with Disability and Poor Physical Function.

Sarcopenia is an age-related geriatric syndrome and is associated with numerous adverse outcomes. Although there is preponderance of studies on sarcopenia in community setting, few studies focused on the oldest old. We investigated the prevalence of sarcopenia in Chinese community-dwelling oldest old and examined the socio-demographic and lifestyle factors of sarcopenia. We also investigated the association between sarcopenia and disability in activities of daily living (ADL) and physical function among the oldest old. Cross-sectional study. Urban community in Beijing, China. 664 community-dwelling older adults aged 80 years or older. The presence of sarcopenia and the relationship between sarcopenia and physical function and disability were examined in 582 adults aged 80 years and older. we used the backward stepwise logistic regression model to explore socio-demographic and lifestyle correlates of sarcopenia. Sarcopenia was assessed by an algorithm recommended by the Asian Working Group for Sarcopenia (AWGS). The overall prevalence of sarcopenia was 26.6% (female 21.7%; male 33.3%). Age (odds ratio [OR] = 1.14, 95% confidence interval [CI]: 1.06 - 1.22), body mass index (OR = 0.80, 95% CI: 0.73 - 0.89), and Mini-nutritional assessment (MNA) scores (OR = 0.78, 95% CI: 0.64 - 0.96) were independently associated with sarcopenia. The Odds of disability in ADL was approximately two times greater in oldest old with sarcopenia than those without. Sarcopenia was associated with poor lower extremity strength. Oldest old with sarcopenia have higher odds to reported difficulty in stooping, kneeing, or crouching, carrying weights over 5 kilograms, and walking 400 meters. We found over a quartile of the community-dwelling oldest old in China had sarcopenia. Older age, lower BMI, and worse nutritional status were significantly associated with the presence of sarcopenia. Sarcopenia was independently associated with disability and poor physical function.

Long-term exposure to PM2.5 and incidence of disability in activities of daily living among oldest old

Currently the Chinese government has adopted World Health Organization interim target-1 values as the national ambient air quality standards values. However, the population-based evidence was insufficient, especially for the oldest old (aged 80+). We evaluated the association of fine particulate matters (PM2.5) exposure and incidence of disability in activities of daily living (ADL) in 15 453 oldest old in 886 counties/cities in China from 2002 to 2014 using Cox model with penalized splines and competing risk models to evaluate the linear or non-linear association. After adjusting for potential confounders, a J-shaped association existed between PM2.5 exposure with a threshold concentration of 33 μg/m3, and incident disability in ADL. Above this threshold, the risk magnitude significantly increased with increase of PM2.5 concentrations; compared to 33 μg/m3, the hazard ratio ranged from 1.03 (1.00–1.06) at 40 μg/m3 to 2.25 (1.54–3.29) at 110 μg/m3. The risk magnitude was not significantly changed below this threshold. Each 10 μg/m3 increase in PM2.5 exposure corresponded to a 7.7% increase in the risk of disability in ADL (hazard ratio 1.077, 95% CI 1.051–1.104). Men, smokers, and participants with cognitive impairment might be more vulnerable to PM2.5 exposure. The study provided limited population-based evidence for the oldest old and detected a threshold of 33 μg/m3, and supported that reduction to current World Health Organization interim target-1value (35 μg/m3) and Chinese national ambient air quality standards (35 μg/m3) or lower may be associated with lower risk of disability in ADL.