Activities Of Daily Living Disability Research Articles

Low hemoglobin A1c and low body mass index are associated with dementia and activities of daily living disability among Japanese nursing home residents with diabetes.

To investigate associations between glycemic control and dementia, activities of daily living (ADL), falls and fractures in Japanese older adults with type 2 diabetes mellitus living in nursing homes. A total of 384 older residents with diabetes aged ≥65 years from 95 out of 132 facilities in Hiroshima Prefecture were studied in a cross-sectional study in 2016. Primary outcomes were differences in severity of dementia and ADL among three glycosylated hemoglobin level groups. Secondary end-points included differences in falls, fragility fracture and severe hypoglycemia. Approximately 67.6% of patients receiving any diabetes treatment received dipeptidyl peptidase-4 inhibitors, and 26.0% received sulfonylureas. Patients with glycosylated hemoglobin <7.0% had a significantly higher severity of dementia compared with those with glycosylated hemoglobin 7.0-7.9% (beta ± SE, 0.55 ± 0.26; 95% CI 0.04-1.06) in multivariable ordinal logistic regression analysis. This tendency was observed particularly in patients using insulin (1.91 ± 0.91; 95% CI 0.13-3.69) or both sulfonylureas and dipeptidyl peptidase 4 (2.14 ± 0.88; 95% CI 0.41-3.87). Low body mass index was significantly associated with dementia (-0.08 ± 0.03; 95% CI -0.14 - -0.03) and ADL impairment (-0.15 ± 0.03; 95% CI -0.20 - -0.09), and fractures (odds ratio OR 0.89 per kg/m2 ; 95% CI 0.84-0.96). Tight glycemic control was related to dementia in residents treated with insulin and sulfonylureas, and low body mass index was associated with dementia, ADL disability and fractures. Optimization of glycemic control and weight for people with diabetes in long-term care facilities could be important for the maintenance of cognitive and physical function. Geriatr Gerontol Int 2019; 19: 854-860.

Dairy consumption and risk of functional disability in an elderly Japanese population: the Hisayama Study

Little is known about the association between dairy intake and risk of functional disability in the elderly. We examined the influence of dairy intake on the development of declining functional capacity and activities of daily living (ADL) in a prospective cohort study of an elderly population. A total of 859 community-dwelling Japanese residents, aged ≥65 y without functional disability, were followed up for 7 y. Functional capacity impairment was defined as a Tokyo Metropolitan Institute of Gerontology Index of Competence score of ≤12, and ADL disability was defined as a Barthel Index score of ≤95. Dairy intake was evaluated using a 150-item semiquantitative food frequency questionnaire, grouped into quartiles. The RR of dairy intake on incident functional disability was computed using a Poisson regression model. The multivariable-adjusted RR of impaired functional capacity decreased significantly with increasing dairy intake levels (RR [95% CI]: quartile 1, 1.00 [reference]; quartile 2, 0.85 [0.71, 1.02]; quartile 3, 0.81 [0.68, 0.98]; and quartile 4, 0.74 [0.61, 0.90]; P-trend=0.001). Regarding the three subscales of functional capacity, the inverse association between dairy intake and risk for impairment of intellectual activity and social role remained significant (P-trend=0.0009 and 0.02, respectively), but such an association was not observed for instrumental ADL. The multivariable-adjusted risk of ADL disability also decreased weakly but significantly with elevating dairy intake (P-trend=0.04). A similar association was seen for severity of functional disability (P-trend=0.002). However, the magnitude of these associations was attenuated after further adjustment for protein intake. Our findings suggest that higher dairy intake is associated with a lower risk of functional disability and its progression in the elderly, probably via an increase in protein intake.

Association between visual problems, insufficient emotional support and urinary incontinence with disability in elderly people living in a poor district in Rio de Janeiro, Brazil: A six-year follow-up study.

IntroductionDisability follows the rapid rate of population ageing, imposing a huge burden on society. Functional assessment in older people can identify predictors of disability.ObjectiveAnalyze the incidence and the risk factors for disability in activities of daily living (ADL) and instrumental activities of daily living (IADL) in older adults over six years.MethodsSix year-follow up study initiated in 2010. The baseline non-probabilistic sample consisted of 180 independent community dwelling individuals aged 60 and over. The procedures comprised an interview with sociodemographic data, questions about falls, urinary incontinence, self-rated health, and assessment of ADL, IADL, mobility, depression, vision, hearing, cognition, nutrition, grip strength and social support. The second research was carried out by telephone and assessed ADL and IADL. Logistic regression models calculated the odds of disability in ADL and IADL according to the age, sex and all other variables.ResultsAt six-year follow-up, 118 participants were still alive (65.6%), 31 died (17%) and other 31 were missed (17%). The incidence of disability to performADL and IADL were 25.4% and 32.3%, respectively. The regression logistic models revealed thaturinary incontinence (OR = 3.2; P = 0.03) and insufficient emotional support (OR = 3.8; P = 0.04) were associated with ADL disability, while visual problems (OR: 2.9; P = 0.03) and insufficient emotional support (OR: 5.6; P = 0.01) were associated with IADL disability.ConclusionThe current study has identified that insufficient emotional support, visual problems and urinary incontinence are associated with disability in older adults. The routine assessment of these problems in the primary care clinics enable the implementation of strategies aimed at reducing or postponing disability. Educating patients and families will also enable better choices to reduce the risk of functional decline.

Prevalence of chronic diseases and associate factors on daily activities in male oldest-olds

Objective: To investigate the prevalence of chronic diseases in aged ≥80 oldest-olds and related factors influencing their daily activities. Methods: This survey was conducted in the retired cadres in Beijing from 2012 to 2014. A unified questionnaire was used to investigate the general characteristics of the oldest-olds and the activities of daily living (ADL). Information on chronic diseases was extracted from related medical records. Results: A total of 4 472 male oldest- olds, with an average age as (87.1±3.9) years (80-102 years), were included. Nearly half of the elderly people were suffering from 5 or more kinds of chronic diseases, with 43.9% of them having disability on basic daily activities (BADL) with 13.4% of those classified as moderate or severe cases. 38.8% of them had instrumental activities of daily living (IADL) disability, with 28.7% of them were moderate or severe cases. The ADL disability showed an increasing trend along with the increase number of chronic diseases. The proportion of BADL disability increased from 40.5% to 50.6%. Compared with the ones having fewer chronic diseases (≤2 kinds), those with more (≥7 kinds) had an increase of 50.5% risk on BADL disability and 199.4% on IADL disability. Conclusion: We noticed that the male oldest-olds suffered from multiple chronic diseases. The impairment of ADL was higher than the younger elderly. Comorbidity showed heavier impact on ADL, especially on the instrumental activities of daily living.

Role of physical performance measures for identifying functional disability among Chinese older adults: Data from the China Health and Retirement Longitudinal Study.

BackgroundFunctional disability is a common health burden in older adults and follows a hierarchical pattern. Physical performance measures are useful for the objective estimation of functional disability. This study primarily aimed to compare the validity of handgrip strength and gait speed, alone and in combination, for recognizing the functional disability among Chinese older adults. This study also aimed to stratify the functional disability according to the criterion-referenced values of handgrip strength and gait speed.MethodsWe selected 6127 respondents from the 2011 wave of the China Health and Retirement Longitudinal Study. Here, we defined functional disability as needing any help in any items of activities of daily living (ADL) and instrumental activities of daily living (IADL). To assess the validity of physical performance measures alone and in combination for the recognition of functional disability, we conducted the receiver operating characteristic analysis.ResultsCompared with handgrip strength, the gait speed could better discriminate ADL disability and showed a satisfactory discriminant validity (area under the curve ≥ 0.7) in men. However, this finding was not found in the recognition of IADL disability. When combining these two measures, the parallel test showed a high sensitivity with a poor specificity, whereas the serial test showed a perfect specificity with a poor sensitivity.ConclusionWe developed the hierarchical cut-off values of handgrip strength and gait speed for identifying and stratifying the functional disability among Chinese adults over 60 years old. The speed test was superior to handgrip strength in identifying ADL disability. The parallel tests of those with high sensitivity perhaps could help identify the functional disability. Further work on cost-utility analysis is warranted.

Functional Outcomes After Hip Fracture in Independent Community‐Dwelling Patients

To determine predictors of new activities of daily living (ADLs) disability and worsened mobility disability and secondarily increased daily care hours received, in previously independent hip fracture patients. Retrospective cohort study. Academic hospital with ambulatory follow-up. Community-dwelling adults 65 years or older independent in ADLs undergoing hip fracture surgery in 2015 (n = 184). Baseline, 3- and 6-month ADLs, mobility, and daily care hours received were ascertained by telephone survey and chart review. Comorbidities, medications, and characteristics of hospitalization were extracted from patient charts. Models for each outcome used logistic regression with a backward elimination strategy, adjusting a priori for age, sex, and race. Predictors of new ADL disability at 3 months were dementia (odds ratio [OR] = 11.81; P = .001) and in-hospital delirium (OR = 4.20; P = .002), and at 6 months were age (OR = 1.04; P = .014), dementia (OR = 9.91; P = .001), in-hospital delirium (OR = 3.00; P = .031) and preadmission opiates (OR = 7.72; P = .003). Predictors of worsened mobility at 3 months were in-hospital delirium (OR = 4.48; P = .001) and number of medications (OR = 1.13; P = .003), and at 6 months were age (OR = 1.06; P = .001), preadmission opiates (OR = 7.23; P = .005), in-hospital delirium (OR = 3.10; P = .019), and number of medications (OR = 1.13; P = .013). Predictors of increased daily care hours received at 3 and 6 months were age (3 months: OR = 1.07; P = .014; 6 months: OR = 1.06; P = .017) and number of medications (3 months: OR = 1.13; P = .004; 6 months: OR = 1.22; P = .013). The proportion of patients with ADL disability and care hours received did not change from 3 to 6 months, yet there were significant improvements in mobility. Age, dementia, in-hospital delirium, number of medications, and preadmission opiate use were predictors of poor outcomes in independent older adults following hip fracture. Further investigation is needed to identify factors associated with improved mobility measures from 3 to 6 months to ultimately optimize recovery.

Process of Decline in Activities of Daily Living of Older Chinese People Prior to Death: Evidence From Three Cohorts.

The study analyzes the decline in activities of daily living (ADL) prior to death among three cohorts of older Chinese. With data from the Chinese Longitudinal Healthy Longevity Survey, the process of decline in ADL in older people born during the periods 1899-1908, 1909-1918, and 1919-1928 is analyzed using the hierarchical linear model with mixed effects. The remaining survival time has a stronger effect on changes in ADL than chronological age, and there is significant heterogeneity among the older adults in ADL. Decline in ADL is delayed by extending life span. Older people with healthy behaviors, good living conditions in childhood, and age-friendly living environment have long-lasting good ADL during their remaining life span; socioeconomic resources help the older adults with ADL disabilities to survive. Selective effects of mortality and protective effects of socioeconomic resources explain the heterogeneity in ADL and its changes over time.

Healthy eating index-2010 and physical activity and disabilities of old age

BACKGROUND: Consuming a poor diet and being physically inactive may increase the risk of developing disabilities of old age. OBJECTIVE: To investigate correlations between Healthy Eating Index-2010 (HEI-2010) scores, physical activity levels, and disabilities of old age in a large biracial cohort. METHODS: The ARIC Study is a prospective cohort aged 45–64 years at baseline. Overall diet quality was assessed using the HEI-2010. A physical activity score was the sum of work, sports, and leisure. Activities of daily living (ADL), instrumental activities of daily living (IADL), and functional abilities were compared with HEI-2010 and physical activity by logistic regression 9 years after the baseline examination. RESULTS: Compared with the lowest quartile, quartile 4 healthier HEI-2010 scores showed an odds ratios of 0.76 (95% confidence interval 0.67–0.87) for functional disability, 0.89 (95% CI 0.75–1.07) for ADL disabilities, and 0.88 (95% CI 0.76–0.1.03) for IADL disabilities.Compared with the lowest tertile, tertile 3 of physical activity showed an odds ratios of 0.60 (95% CI 0.54– 0.67) for functional disability, 0.68 (95% CI 0.60–0.78) for ADL disabilities, and 0.53 (95% CI 0.47–0.60) for IADL disabilities. CONCLUSIONS: Healthier diet and higher physical activity were associated with lower levels of the disabilities of aging, particularly functional disability, at follow up.

Incidence of activities of daily living disability and related factors in community-dwelling older adults in China

Objective: To analyze the decline of activities of daily living (ADL) ability and influencing factors over a period of 2 years in community-dwelling older adults in China. Methods: The study subjects were from the project of Prevention and Intervention on Neurodegenerative Disease for Elderly in China of 2015-2017 to select the samples. In 2015, a total of 23 803 community- dwelling residents adults, aged ≥60 years old, came from both urban and rural areas, were selected through a stratified multi-stage cluster sampling in 6 provinces and joint baseline survey. The follow-up was conducted in 2017 to collect the related information using the same questionnaires and examinations. Finally, 18 785 elderly people were included in this analysis after excluding those who were died, failed to follow up, had incomplete data cases or defined as ADL disability at baseline survey. The post-stratification weight on the sample data was done by using the 6(th) national population census data as the standard, the rates of ADL/basic activities of daily living (BADL)/instrumental activities of daily living (IADL) disabilities over 2 years were calculated and compared among the elderly with different characteristics. Multiple logistic regression models were used to analyze the factors associated with BADL/IADL disabilities. Results: During the 2-year follow-up, ADL disability developed in 1 959 participants with a rate of 12.0% (1.6% for BADL disability and 10.4% for IADL disability only). Multivariate logistic regression analysis showed that the risk factors for BADL disability included increased age, obesity, comorbidity and cognitive impairment. The risk factors for only IADL disability included increased age, being female, lower weight and cognitive impairment. Compared with illiterates, the educated had lower risk for only IADL disability. Compared with those with normal weight, overweight and obese old people had lower risk for only IADL disabilities. Conclusion: Increased age and cognitive impairment were associated with the increased risk for BADL and IADL disabilities. Older people with comorbidities had higher risk for BADL disability. Obesity increased the risk of BADL disability, but decreased the risk for IADL disability in older people. Women had a higher risk for IADL disability compared with men. Being educated was associated with lower risk of IADL disability.

Objective physical measures and their association with subjective functional limitations in a representative study population of older Thais

BackgroundIn this study, we analyzed elderly people in Thailand to identify the validity of suggested cutoff points of physical measures, handgrip strength, usual walking speed, and a composite score of both measures to predict functional limitations. Moreover, we examined whether these physical performance measures are accurate indicators of the investigated health outcomes.MethodsUsing Receiver Operating Characteristics (ROC) analysis, we investigated a sample of 8272 respondents aged 60 to 79 years. All data were based on the 2009 National Health Examination Survey (NHES IV) of Thailand.ResultsFor males aged 60 to 69 years, handgrip strength was used as an indicator of functional limitations. The cutoff point for disabilities in the activities of daily living (ADLs) was 29.5 kg, while in other limitations it ranged from 28.7 to 31.3 kg. In contrast, usual walking speed was able to indicate ADL disabilities at 0.7 m per second (m/s). As one might expect, the cutoff points for males aged 70 to 79 years were lower than for males in the 60 to 69 age group. For females, handgrip strength was able to indicate ADL disabilities at 16.5 kg for both the 60 to 69, and 70 to 79 age groups. Likewise, walking speed was indicative of ADL disabilities at 0.6 m/s for both age groups. Interestingly, the composite measure increases the ability to detect ADL disabilities in the younger group but not in the older group. The area under the curve (AUC) of cutoffs measuring the detection power of a diagnostic test was varied, ranging from 0.535 to 0.7386.ConclusionsThe cutoff points of three measures varied according to sex and type of functional limitations. Our findings also showed that physical performance measures were useful for identifying people with an increased risk of functional limitations, particularly for ADL disabilities. However, although the AUC of the cutoffs of other functional limitations were relatively low, they should be considered with caution.

Prevalence and Risk Factors for Frailty among Community-Dwelling Older People in China: A Systematic Review and Meta-Analysis.

To systematically assess the prevalence of frailty, including prefrailty, stratified prevalence according to frailty criteria, gender, age, and region, and the risk factors for frailty in China. We conducted a systematic literature review and meta-analysis using articles available in 8 databases including PubMed, Cochrane Library, Web of Science, CINAHL Plus, China Knowledge Resource Integrated Database (CNKI), Wanfang Database, Chinese Biomedical Database (CBM), and Weipu Database (VIP). Cross-sectional and cohort data from Chinese community. Community-dwelling adults aged 65 and older. Two authors independently extracted data based upon predefined criteria. Where data were available we conducted a meta-analysis of frailty parameters using a random-effects model. We screened 915 different articles, and 14 studies (81258 participants) were ultimately included in this analysis. The prevalence of frailty and prefrailty in individual studies varied from 5.9% to 17.4% and from 26.8% to 62.8%, respectively. The pooled prevalence of frailty and prefrailty were 10% (95% CI: 8% to 12%, I2 = 97.4%, P = 0.000) and 43% (95% CI: 37% to 50%, I2 = 98.0%, P = 0.000), respectively. The pooled frailty prevalence was 8% for the Fried frailty phenotype, 12% for the frail index, and 15% for the FRAIL scale. Age-stratified meta-analyses showed the pooled prevalence of frailty to be 6%, 15%, and 25% for those aged 65-74, 75-84, and ≥85 years old, respectively. The pooled prevalence of frailty was 8% for males and 11% for females. The pooled prevalence of frailty in Mainland China, Taiwan, and Hong Kong was 12%, 8%, and 14%, respectively. The pooled frailty prevalence was 10% in urban areas and 7% in rural areas. After controlling for confounding variables, increasing age (OR = 1.28, 95% CI: 1.2 to 1.36, I2 = 98.0%, P = 0.000), being female (OR = 1.29, 95% CI: 1.16 to 1.43, I2 =92.7%, P=0.000), activities of daily living (ADL) disability (OR = 1.72, 95% CI: 1.57 to 1.90, I2 = 99.7%, P = 0.000), and having three or more chronic diseases (OR = 1.97, 95% CI: 1.78 to 2.18, I2 = 97.5%, P = 0.000) were associated with frailty. These findings of this review indicate an overall pooled prevalence of frailty among Chinese community-dwelling older people of 10%. Increasing age, being female, ADL disability, and having three or more chronic diseases were all risk factors for frailty. Further research will be needed to identify additional frailty risk factors in order to better treat and prevent frailty in the community.

Effect of a Biobehavioral Environmental Approach on Disability Among Low-Income Older Adults

Disability among older adults is a strong predictor of health outcomes, health service use, and health care costs. Few interventions have reduced disability among older adults. To determine whether a 10-session, home-based, multidisciplinary program reduces disability. In this randomized clinical trial of 300 low-income community-dwelling adults with a disability in Baltimore, Maryland, between March 18, 2012, and April 29, 2016, 65 years or older, cognitively intact, and with self-reported difficulty with 1 or more activities of daily living (ADLs) or 2 or more instrumental ADLs (IADLs), participants were interviewed in their home at baseline, 5 months (end point), and 12 months (follow-up) by trained research assistants who were masked to the group allocation. Participants were randomized to either the intervention (CAPABLE) group (n = 152) or the attention control group (n = 148) through a computer-based assignment scheme, stratified by sex in randomized blocks. Intention-to-treat analysis was used to assess the intervention. Data were analyzed from September 2017 through August 2018. The CAPABLE group received up to 10 home visits over 5 months by occupational therapists, registered nurses, and home modifiers to address self-identified functional goals by enhancing individual capacity and the home environment. The control group received 10 social home visits by a research assistant. Disability with ADLs or IADLs at 5 months. Each ADL and IADL task was self-scored from 0 to 2 according to whether in the previous month the person did not have difficulty and did not need help (0), did not need help but had difficulty (1), or needed help regardless of difficulty (2). The overall score ranged from 0 to 16 points. Of the 300 people randomized to either the CAPABLE group (n = 152) or the control group (n = 148), 133 of the CAPABLE participants (87.5%) were women with a mean (SD) age of 75.7 (7.6) years; 126 (82.9%) self-identified as black. Of the controls, 129 (87.2%) were women with a mean (SD) age of 75.4 (7.4) years; 133 (89.9%) self-identified as black. CAPABLE participation resulted in 30% reduction in ADL disability scores at 5 months (relative risk [RR], 0.70; 95% CI, 0.54-0.93; P = .01) vs control participation. CAPABLE participation resulted in a statistically nonsignificant 17% reduction in IADL disability scores (RR, 0.83; 95% CI, 0.65-1.06; P = .13) vs control participation. Participants in the CAPABLE group vs those in the control group were more likely to report that the program made their life easier (82.3% vs 43.1%; P < .001), helped them take care of themselves (79.8% vs 35.5%; P < .001), and helped them gain confidence in managing daily challenges (79.9% vs 37.7%; P < .001). Low-income community-dwelling older adults who received the CAPABLE intervention experienced substantial decrease in disability; disability may be modifiable through addressing both the person and the environment. ClinicalTrials.gov identifier: NCT01576133.

Survey of Current Status and Cognition of Activities of Daily Living in Dementia Patients: the 2018 "Il-sang-ye-chan" Campaign.

Background and PurposeDisability associated with activities of daily living (ADL) is the basis of dementia diagnosis and is an important factor in the care of dementia patients. The status of awareness and burden of ADL disability in dementia patients was investigated six years ago and used as an important reference for “Il-sang-ye-chan” campaign. They were re-investigated in six years and compared with previous results.MethodsThe survey included caregivers of 100 dementia patients listed at the four regional dementia centers. Structured open and closed questions about ADL were asked. Assessments included age, sex, education level, economic status, severity of dementia, caregiving pattern, current statues and cognition of ADL, and caregiver needs.ResultsThe cognition of ADL was still very low (43%). Increased stress among caregivers was the biggest burden, and they frequently suffered from outing disability (56%), recent memory loss (48%), and loss of bowel/bladder control (40%). The economic burden has been greatly reduced compared with the burden six years ago and the needs of caregivers were still highly about educational guide lines or programs.ConclusionsContinued interest and further investigation into ADL disability of dementia patients are needed. Korean Dementia Association will further expand the “Il-sang-ye-chan” program: via a multi-domain cognitive intervention program under the Care for ADL in dementia and Relieve symptoms in Dementia Project.

Exercise type and activities of daily living disability in older women: An 8-year population-based cohort study.

Exercise may reduce the risk of disability for activities of daily living (ADL), but the degree of associations between specific exercise types and such a risk remains unclear. This study aimed to examine the longitudinal associations between exercise types and the incidence of ADL disability in older women. This 8-year population-based prospective cohort study enrolled 1003 community-dwelling older Japanese women without ADL disability in the baseline surveys. In the baseline surveys, all participants were asked whether or not they participated in any of 16 exercise types through a face-to-face interview. ADL were assessed using a modified form of the Katz index that comprised five ADL tasks. ADL disability was defined as dependence in at least one ADL task during the 8-year follow-up period. Binary logistic regression analyses were applied to obtain adjusted odds ratios (ORs) and 95% confident intervals (CIs) for the incidence of ADL disability based on participation or non-participation in each exercise type. Activities of daily living disability was noted in 130 participants (13.0%) over the 8-year follow-up period. After adjustment for confounders and other exercise types, participation in dancing, compared to non-participation, was associated with a significantly lower OR (0.27; 95% CI: 0.09-0.75) for incident ADL disability. There were no significant associations between other exercise types and incident ADL disability. Dancing was significantly and independently associated with a lower incidence of ADL disability. Thus, dancing may solely contribute to a reduced risk of ADL disability in older women.

Associations of Hearing Loss and Depressive Symptoms With Incident Disability in Older Adults: Health, Aging, and Body Composition Study.

Depressive symptoms and hearing loss (HL) are independently associated with increased risk of incident disability; whether the increased risk is additive is unclear. Cox Proportional Hazards models were used to assess joint associations of HL (normal, mild, moderate/severe) and late-life depressive symptoms (defined by a score of ≥8 on the 10-item Center for Epidemiologic Studies-Depression scale) with onset of mobility disability (a lot of difficulty or inability to walk ¼ mile and/or climb 10 steps) and any disability in activities of daily living (ADL), among 2,196 participants of the Health, Aging and Body Composition Study, a cohort of well-functioning older adults aged 70-79 years. Models were adjusted for age, race, sex, education, diabetes, hypertension, and body mass index. Relative to participants with normal hearing and without depressive symptoms, participants without depressive symptoms who had mild or moderate/severe HL had increased risk of incident mobility and ADL disability (hazard ratio [HR] for mobility disability, mild HL:1.34, 95% confidence interval [CI]: 1.09, 1.64 and HR for mobility disability, moderate/severe HL: 1.37, 95% CI: 1.08, 1.75 and HR for ADL disability, mild HL: 1.32, 95% CI: 1.08, 1.63, and HR for ADL disability, moderate/severe HL: 1.42, 95% CI: 1.11, 1.82). Among participants with depressive symptoms, mild HL (HR: 1.71, 95% CI: 1.09, 2.70) was associated with increased risk of incident mobility disability. Independent of depressive symptoms, risk of incident disability was greater in older adults with HL, regardless of severity. Further research into HL interventions may delay disability onset.

Impairments in Individual Autonomous Living Tasks and Time to Self-Care Disability in Middle-Aged and Older Adults

ObjectivesImpairments in specific tasks that are necessary for independent living may identify future self-care limitations, and the use of time-varying covariates can better capture the fluidity in functional capacity trajectories over time. The purpose of this study was to determine the associations between individual instrumental activities of daily living (IADL) impairments and time to activities of daily living (ADL) disability for middle-aged and older adults in the United States. DesignLongitudinal panel. SettingDetailed interviews that included physical, biological, and psychosocial measures were completed in person. The core interview was typically completed over the telephone. ParticipantsA nationally representative sample of 15,336 adults aged at least 50 years from the 2006 wave of the Health and Retirement Study was followed for 8 years. MeasuresAbility to perform IADL and ADL were self-reported at each wave. Separate covariate-adjusted Cox models were used to examine the time-varying associations between individual IADL impairments and time to ADL disability. ResultsThe presence of each IADL impairment was associated with a higher hazard ratio for an ADL disability for the following functions: 2.52 [95% confidence interval (CI) 2.35, 2.70] for grocery shopping, 1.91 (CI 1.77, 2.06) for preparing hot meals, 1.55 (CI 1.37, 1.76) for taking medications, 1.48 (CI 1.36, 1.61) for managing money, 1.41 (CI 1.27, 1.57) for using a telephone, and 1.38 (CI 1.29, 1.48) for using a map. Conclusions/ImplicationsOur findings provide insights into the disabling process by revealing how impairments in each IADL are differentially associated with time to ADL disability. Interventions aiming to retain function during aging should be informed by fluctuations in IADL performance and how specific IADL impairments may exacerbate functional capacity declines more so than others.

Pretreatment Psychoneurological Symptoms and Their Association With Longitudinal Cognitive Function and Quality of Life in Older Breast Cancer Survivors

ContextSymptoms affect quality of life (QOL), functional status, and cognitive function in cancer survivors, but older survivors are understudied. ObjectivesThe objectives of this study were to identify prototypical presystemic therapy psychoneurological symptom clusters among older breast cancer survivors and determine whether these symptom clusters predicted cognition and QOL over time. MethodsWomen with newly diagnosed nonmetastatic breast cancer (n = 319) and matched noncancer controls (n = 347) aged 60+ years completed questionnaires and neuropsychological tests before systemic therapy and 12 and 24 months later. Latent class analysis identified clusters of survivors based on their pretherapy depression, anxiety, fatigue, sleep disturbance, and pain. Linear mixed-effects models examined changes in objective cognition, perceived cognition, and functional status (Instrumental Activities of Daily Living disability, functional well-being, and breast cancer–specific QOL) by group, controlling for covariates. ResultsNearly one-fifth of older survivors were classified as having high pretherapy symptoms (n = 51; 16%); the remainder had low symptoms (n = 268; 84%); both groups improved over time on all outcomes. However, compared to the low symptom group and controls, survivors with high symptoms had lower baseline objective cognition and lower perceived cognition at baseline and 24 months, lower functional well-being at baseline and 12 months, greater Instrumental Activities of Daily Living disability at baseline, and lower breast cancer–specific QOL at all time points (all P < 0.05). ConclusionNearly one-fifth of older breast cancer survivors had high psychoneurological symptoms at diagnosis, which predicted clinically meaningful decrements in perceived cognition and function in the first 24 months after diagnosis. Pretreatment psychoneurological symptom clusters could identify survivors for monitoring or intervention.

The Burden of Functional Disabilities for Middle-Aged and Older Adults in the United States.

Understanding the role of functional capacity on longevity is important as the population in the United States ages. The purpose of this study was to determine the burden of instrumental activities of daily living (IADL) and activities of daily living (ADL) disabilities for a nationally-representative sample of middle-aged and older adults in the United States. Longitudinal-Panel. Core interviews were often performed in person or over the telephone. A sub-sample of 31,055 participants aged at least 50 years from the 1998-2014 waves of the Health and Retirement Study who reported having a functional disability were included. Ability to perform IADLs and ADLs were self-reported at each wave. The National Death Index was used to ascertain date of death. The number of years of life that were lost (YLLs) and years lived with a disability (YLDs) were summed for the calculation of disability-adjusted life years (DALYs). Sampling weights were used in the analyses to make the DALYs nationally-representative. The results for YLLs, YLDs, and DALYs are reported in thousands. Of the participants included, 14,990 had an IADL disability and 13,136 had an ADL disability. Men and women with an IADL disability had 236,037 and 233,772 DALYs, respectively; whereas, there were 178,594 DALYs for males and 253,630 DALYs for females with an ADL disability. Collectively, there were 469,809 years of healthy life lost from IADL impairments, and 432,224 years of healthy life lost from ADL limitations. These findings should be used to inform healthcare providers and guide interventions aiming to preserve the functional capacity of aging adults. Prioritizing health-related resources for mitigating the burden of functional disabilities may help aging adults increase their quality of life and life expectancy over time.

Handgrip Strength, Function, and Mortality in Older Adults: A Time-varying Approach.

To determine the time-varying associations between 1) decreased handgrip strength and disabilities in each activity of daily living (ADL) function, and 2) disaggregated ADL limitations and time to mortality in older adults. A United States nationally representative sample of 17,747 older adults from the Health and Retirement Study were followed up for 8 yr. Maximal handgrip strength was measured with a hand-held dynamometer. Ability to perform ADL was self-reported. Date of death was identified by the National Death Index and exit interviews. Separate covariate-adjusted hierarchical logit models were used to examine the time-varying associations between decreased handgrip strength and each ADL outcome. Distinct covariate-adjusted Cox models were used to analyze the time-varying associations between disaggregated ADL limitations and time to mortality. Every 5-kg decrease in handgrip strength was associated with increased odds for the following ADL limitations: 20% for eating, 14% for walking, 14% for bathing, 9% for dressing, 8% for transferring, and 6% for toileting. The presence of a bathing, walking, toileting, eating, and dressing ADL disability was associated with a 47%, 43%, 32%, 30%, and 19% higher hazard for mortality, respectively. A transferring ADL disability was not significantly associated with mortality. Decreased handgrip strength was associated with increased odds for each ADL limitation, and in turn, most individual ADL impairments were associated with a higher hazard for mortality in older adults. These findings provide insights into the disabling process by identifying which ADL limitations are most impacted by decreased handgrip strength and the subsequent time to mortality for each ADL disability.

Abdominal Obesity and Mobility Disability in Older Adults: A 4-Year Follow-Up the International Mobility in Aging Study.

Abdominal obesity is related to the disability process in older adults, however, little is known about this relationship when adjusted for important confounders such as depression and physical performance measures in a diverse international aged population. To explore the longitudinal relationship between abdominal obesity and mobility disability controlling for physical performance and depression. Longitudinal observational study using data from the International Mobility in Aging Study (IMIAS) Study. 1104 out of 2002 older adults aged 64-74 years old free of mobility disability at baseline (2012) and then reassessed in 2016. Mobility disability was defined as reporting difficulty in walking 400 m or climbing stairs. Activities of daily living (ADL) disability was based on any self-reported difficulty in five mobility-related ADLs. Abdominal obesity was defined as waist circumference ≥ 88cm for women or ≥ 102 cm for men. Four meters gait speed, handgrip strength and depressive symptoms (CES-D) were assessed. Generalized Estimating Equations (GEE) and multinomial regressions were used to estimate associations between disability and abdominal obesity. 1104 free of disability participants were followed over 4 years, the mean age was 68.9 (±2.9) years among men and 68.7 (±2.6) years among women. Prevalence and incidence rates of mobility disability varied widely across research site and sex. The longitudinal associations between mobility disability and abdominal obesity remained significant even when adjusted by depressive symptoms, handgrip strength, gait speed, age, sex, education and research site. Participants with abdominal obesity had higher mobility disability (OR=1.68, 95% CI 1.23-1.76, p-value=0.01) and also increased risk for ADL disability (OR: 1.47, 95% CI 1.23-1.76, p-value=0.01). Abdominal obesity in baseline was also predictor of mobility disability in 2016 (OR: 1.93, 95% CI 1.17-3.17, p-value <0.01) but not for ADL disability (OR: 1.59, 95% CI 0.93-2.71, p-value =0.09) with accounting mortality. Abdominal obesity is associated longitudinally and predicts mobility disability, even over a short period (4 years) in community-dwelling older adults from different epidemiological contexts.