Activities Of Daily Living Disability Research Articles

Three Year Functional Trajectories Among Old Age Survivors and Decedents: Dying Eliminates a Racial Disparity.

Long-term trajectories of disability comparing decedents and survivors and differences by race have not been assessed. To examine self-reported difficulty in walking a quarter mile and the need for assistance with activities of daily living (ADL) beginning 3years before death among decedents and age- and gender-matched survivors. A case-control sample drawn from the Health, Aging and Body Composition Study (Health ABC). Data were collected between 1997 and 2015. Of the 1991 participants who died by the end of the study, 1410 were interviewed for 3years prior to death, including an interview 6months before dying. Of these, 1379 decedents were successfully matched by age and gender with 1379 survivors and tracked over the same 3-year period. Self-reported difficulty walking a quarter mile and the ability to perform activities of daily living without assistance (bathing, dressing, transferring). Decedents (mean age at death, 84) increased in mobility disability from 44.1% 3years before death to 69.4% 6months before death and in ADL disability from 32.9% to 58.4%. Among survivors, mobility disability increased from 31.4% to 40.7% and ADL disability from 17.4% to 31.4%. The proportion of decedents and survivors with mobility disability differed significantly in adjusted models at all assessment points (p < 0.0001). African-American survivors were significantly more disabled than White survivors at all points (p < 0.0001), but trajectories of disability among decedents did not differ by race in the last 18months of life (p = 0.35). Trajectories of self-reported disability differ between survivors and decedents. Older adults who died were more disabled 3years before death and also had a greater risk of increasing disability over each subsequent 6-month assessment. The gap in disability between African Americans and Whites was erased in the final 1 to 1.5years before death.

Association between biomarkers and activities of daily living in the elderly ≥65 years old from longevity areas in China

Objective: To explore the association between biomarkers and activities of daily living (ADL) in the elderly over 65 years old from longevity areas in China. Methods: A total of 2 439 people from 8 longevity areas were included in our baseline survey in 2012. Using questionnaires, body measurements, and blood biochemical examinations, information on demographics characteristic, life style, ADL, blood pressure and biomarkers were collected. Based on these six items of ADL (bathing, dressing, indoor activities, toileting, eating, bowel and bladder control), we constructed a dichotomous indicator for ADL. A respondent was defined as ADL disabled if any difficulty in one or more of the above six activities was reported. Information were collected in the follow-up in 2014 using the same questionnaires and examinations. We excluded information on the elderly who lacked ADL or biomarkers test results or with ADL disability at baseline study. Finally 938 elderly people over 65 years old were included in this analysis. Multivariate logistic regression model was used to analyze the influence factors of ADL disability. Results: During the 2-year follow-up, 100 (10.7%) participants developed into ADL disability, with a rate at 10.7%. Multivariate logistic regression analysis indicated that each year increase in age or each 1 mmHg (1 mmHg=0.133 kPa) increase in systolic blood pressure (SBP) would cause the risk of ADL disability to increase 9% or 1%, whose OR (95%CI) were separately 1.09 (1.06-1.12), 1.01 (1.00-1.02). Han nationality or cognitive impairment increased the risk of ADL disability, whose OR (95%CI) values were separately 4.90 (1.13-21.24), 2.47 (1.44-4.25), while increased lymphocyte count (>1.60×10(9)/L), being married, or participating in recreational activities decreased the risk of ADL disability, whose OR (95%CI) values were separately 0.51 (0.31-0.82), 0.52 (0.28-0.96), 0.43 (0.23-0.80). Conclusion: In the elderly elevated lymphocyte count was associated with lower risk of ADL disability. In addition, incresed age, increased SBP, unmarried, Han nationality or cognitive impairment were associated with the increasing risk of ADL disability in older people, while participating in recreational activities would reduce the risk.

Factors Associated with Activities of Daily Life Disability among Centenarians in Rural Chongqing, China: A Cross-Sectional Study.

Objective: This study aims to ascertain the health and lifestyle factors associated with the activities of daily living (ADL) disability of centenarians in rural Chongqing, China. Method: 564 centenarians living in rural Chongqing were selected for this cross-sectional study. Demographic characteristics and self-reported lifestyle factors were obtained from face-to-face interviews. ADL disability was measured using the Katz Activities of Daily Living Scale. Result: Among the respondents, 65.7% were considered ADL disability centenarians. Multivariable logistic regression analysis showed that preference for salt, drinking habits, social activities, physical activity, and failure to follow good diet habits were significantly associated with the ADL disability of centenarians. Conclusion: ADL disability of centenarians was associated with certain lifestyle habits. This outcome suggested that target intervention may help maintain ADL independence even among the oldest of the elderly population.

Age, Race, and Gender Factors in Incident Disability.

Incident disability rates enable the comparison of risk across populations. Understanding these by age, sex, and race is important for planning for the care of older adults and targeting prevention. We calculated incident disability rates among older adults in the Cardiovascular Health Study, a study of 5,888 older adults aged ≥ 65 years over 6 years of follow-up. Disability was defined in the following two ways: (i) self-report of disability (severe difficulty or inability) in any of six Activities of Daily Living (ADL), and (ii) mobility difficulty (any difficulty walking half a mile or climbing 10 steps). Incident disability rates were calculated as events per 100 person years for age, gender, and race groups. The incidence of ADL disability, and mobility difficulty were 2.7 (2.5-2.8), and 9.8 (9.4-10.3) events per 100 person years. Women, older participants, and blacks had higher rates in both domains. Incidence rates are considerably different based on the domain examined as well as age, race, and gender composition of the population. Prevention efforts should focus on high risk populations and attempt to ameliorate factors that increase risk in these groups.

Predicting activities of daily living for cancer patients using an ontology-guided machine learning methodology

BackgroundBio-ontologies are becoming increasingly important in knowledge representation and in the machine learning (ML) fields. This paper presents a ML approach that incorporates bio-ontologies and its application to the SEER-MHOS dataset to discover patterns of patient characteristics that impact the ability to perform activities of daily living (ADLs). Bio-ontologies are used to provide computable knowledge for ML methods to “understand” biomedical data.ResultsThis retrospective study included 723 cancer patients from the SEER-MHOS dataset. Two ML methods were applied to create predictive models for ADL disabilities for the first year after a patient’s cancer diagnosis. The first method is a standard rule learning algorithm; the second is that same algorithm additionally equipped with methods for reasoning with ontologies. The models showed that a patient’s race, ethnicity, smoking preference, treatment plan and tumor characteristics including histology, staging, cancer site, and morphology were predictors for ADL performance levels one year after cancer diagnosis. The ontology-guided ML method was more accurate at predicting ADL performance levels (P < 0.1) than methods without ontologies.ConclusionsThis study demonstrated that bio-ontologies can be harnessed to provide medical knowledge for ML algorithms. The presented method demonstrates that encoding specific types of hierarchical relationships to guide rule learning is possible, and can be extended to other types of semantic relationships present in biomedical ontologies. The ontology-guided ML method achieved better performance than the method without ontologies. The presented method can also be used to promote the effectiveness and efficiency of ML in healthcare, in which use of background knowledge and consistency with existing clinical expertise is critical.

Gender, childhood and adult socioeconomic inequalities in functional disability among Chinese older adults

BackgroundGender difference and life-course socioeconomic inequalities in functional disability may exist among older adults. However, the association is less well understood among Chinese older population. The objective is to provide empirical evidences on this issue by exploring the association between gender, childhood and adult socioeconomic inequalities in functional disability.MethodsData from the 2013 wave of the China Health and Retirement Longitudinal Study (CHARLS) was utilized. Functional disability was assessed by the activities of daily living (ADL) and instrumental activities of daily living (IADL). Childhood socioeconomic status (SES) was measured by birthplace, father’s education and occupation. Adult SES was measured in terms of education and household income. Multivariate logistic regressions were conducted to assess the association between gender, childhood and adult SES and functional disability.ResultsBased on a sample of 18,448 older adults aged 45 years old and above, our results showed that the prevalence of ADL and IADL disability was higher among women than men, but gender difference disappeared after adult SES and adult health were controlled. Harsh conditions during childhood were associated with functional disability but in multivariate analyses only father’s education was associated with IADL disability (OR for no education = 1.198; 95% CI = 1.062–1.353). Current SES such as higher education and good economic situation are protective factors of functional disability.ConclusionsChildhood and adult SES were both related to functional disability among older adults. Our findings highlight the need for policies and programs aimed at decreasing social inequalities during childhood and early adulthood, which could reduce socioeconomic inequalities in functional disability in later life.

Are frailty components associated with disability in specific activities of daily living in community-dwelling older adults? A multicenter Canadian study

Current studies show the relevance of geriatric prevention and rehabilitation programs to slow down the development of disability in community-dwelling older adults who are becoming frail. This evidence reveals the importance of improving knowledge on how individual components of frailty and specific disability in basic and instrumental activities of daily living (ADL) are related, to offer early, targeted, and tailored interventions. The objective was to examine the association between each of the five frailty phenotype components (weakness, slowness, exhaustion, low physical activity, weight loss) and disability in specific ADL pertaining to physical aspects (bathing, dressing, cutting toe nails, transportation, shopping, housekeeping, food purchasing, food preparation) and cognitive aspects (finances, telephone, medication). A cross-sectional design involving 1643 community-dwelling older adults (65+) from the longitudinal multi-center FRéLE study was used. Disability was defined as needing help or being unable to perform specific ADL. Multiple logistic regressions were adjusted for socio-demographic characteristics, clinical variables, and for 4 other frailty components. Results showed that low physical activity and slowness were significantly linked to disability in all physical and cognitive aspects of ADL (OR: 1.71–9.42; p<0.05), except using the telephone. Notably, all frailty components except weight loss were associated with disability in the physical aspects of instrumental ADL (transportation, shopping, housekeeping, food purchasing, food preparation) (OR: 1.73–9.42; p<0.05). This study helped identify the relevant frailty components as targets in community-based prevention and rehabilitation programs. Easily imbedded interventions in daily routines should be promoted earlier in the frailty process to delay or reduce disability.

Muscle Weakness and Physical Disability in Older Americans: Longitudinal Findings from the U.S. Health and Retirement Study.

Muscle weakness is an important indicator of disability, chronic disease and mortality. While we recently proposed sex/race specific grip strength cutpoints for clinical muscle weakness in a diverse, nationally representative sample of older Americans, the extent to which these cutpoints predict physical disability remains unknown. To examine whether sex/race specific muscle weakness cutpoints predict physical disability status in a nationally representative sample of Americans age 65+. We used data from the 2006-2010 Health and Retirement Study. Fully-adjusted, weighted multinomial logistic regression models were used to quantify the odds of experiencing the onset, progression or persistence of disability in activities of daily living (ADL) among weak versus non-weak individuals over a 2-year period. General community, nationally representative sample of older Americans. Population-based, community dwelling sample of older American adults aged 65-years+; 57 percent were women, 91% were White and the mean age was 75 years. Main Outcome(s) and Measure(s): The primary outcome of interest was disability dynamics, defined by changes in ADL status across at 2- year period. The primary exposure was clinical muscle weakness as defined by previously identified cutpoints. Hypotheses were formulated before analyses were conducted. In this nationally representative sample (n= 8,725), 44% of individuals were classified as weak at baseline. At follow-up, 55% remained independent with no change in their ADL status, 11% had an onset of disability and 4% progressed in their disability status. The odds of experiencing an onset of ADL disability was 54% higher among weak individuals compared those who were not weak at baseline (OR= 1.54, 95% CI= 1.54, 1.5, p<.0001); the odds of experiencing a progression in physical disability status was 2.16 times higher among those who were weak at baseline compared to non-weak individuals (OR= 2.16, 95% CI= 2.15, 2.16, p<.0001). This is the first study to use grip strength weakness cut-points to identify those who may be at greatest risk for experiencing physical disability in later life. Results underscore the importance of using population-specific cutpoints for clinical weakness in order to identify individuals at greatest risk for adverse health outcomes.

Trends of Activities of Daily Living Disability Situation and Association with Chronic Conditions among Elderly Aged 80 Years and Over in China.

In China, few studies reported the disability situation and the association between disabilities with chronic conditions in aged people. This study investigates the cross-sectional trends of prevalence and severity of activities of daily living disability (ADL) in Chinese oldest-old people from 1998 to 2008, and identified the potential risk factors of disability. A combination of population-based longitudinal prospective study and probabilistically sampling cross-sectional studies. The Chinese Longitudinal Healthy Longevity Survey (CLHLS) was based on a random sampling of aged people from twenty-two provinces in China. A total of 52,667 participants aged from 80 years old to 105 years old sampled in the year of 1998 (n=8,768), 2000 (n=10,940), 2002 (n=10,905), 2005 (n=10,396) and 2008 (n=11,658) were analyzed respectively. The prevalence of ADL disability decreased from the year of 1998 (18%) to 2008 (12%). The disability prevalence significantly increased in 2002 and decreased in 2008 (P<0.001) in total participants than the year of 1998. The prevalence trends of low ADL disability level were almost identical with that of the total ADL disability. Stroke/cerebrovascular disease (CVD) and cognitive impairment were the strongest risk factors of disability. Vision impairment became less associated with ADL disability (P=0.045), while the association between multimorbidity and ADL disability became stronger (P=0.033). The prevalence of ADL disability declined among the oldest-old population in China from the year of 1998 to 2008 without obeying a linear pattern. Temporal trends of ADL disability mainly attributed to the change of low disability level prevalence. Stroke/CVD and cognitive impairment were the most common risk factors of disability. Vision impairment caused disability has become less common, while risks of multimorbidity related disability increased.

METABOLIC SYNDROME AND DISABILITY IN CHINESE NONAGENARIANS AND CENTENARIANS

AbstractMetabolic syndrome (MetS) increases with aging. Little is known about the relationship between MetS and disability in the elderly population, especially in the oldest old. We therefore conducted this study to investigate the possible association between MetS and disability in a population of Chinese nonagenarians and centenarians. Data were obtained from a face-to-face survey conducted in 870 Chinese adults aged 90 years or older. MetS was diagnosed according to the International Diabetes Federation criteria. Activities of daily living (ADL) and instrumental activities of daily living (IADL) disabilities were evaluated using the physical self-maintenance scale and the Lawton-Brody IADL scale, respectively. The subjects included in the current analyses were 500 women and 225 men (mean age: 93.8 ± 3.1 years). MetS was present 13.0% in women and 9.8% in men. In women, the prevalence of ADL and IADL disabilities was significantly higher in the MetS group compared with the non-MetS group (ADL:43.1% vs. 30.6%, p=0.044; IADL: 73.8% vs. 59.8%, p=0.030). After adjusting for relevant confounders, the MetS group showed significantly increased odds ratios (ORs) for either ADL (1.8, 95% confidence interval [CI] 1.2–3.4) or IADL disability (2.1, 95% CI 1.3–4.7) compared with the non-MetS group. In men, similar results were found with respect to the prevalence of ADL or IADL disability and adjusted ORs between MetS and non-MetS groups, but these results were not statistically significant. In conclusion, in our study population, MetS appeared to be associated with an increased risk of either ADL or IADL disability, especially in women.

Racial/ethnic disparities in disability outcomes among post-acute home care patients.

To examine activities of daily living (ADL) disability outcomes among racially/ethnically diverse elders receiving home care (HC) after hospitalization. We conducted a retrospective cohort analysis of single-agency, 2013-2014 Outcome and Assessment Information Set data from older adults who received post-hospitalization HC ( n = 20,674). We measured overall change in ADL disability by summing the difference of standardized admission and discharge scores from nine individual ADL. Associations between race/ethnicity and overall ADL change scores were modeled using general linear regression, adjusting for covariates consistent with the Disablement Model. Overall, patients experienced improvement in ADL disability from HC admission to discharge. However, Asian, African American, and Hispanic patients experienced significantly less improvement compared with non-Hispanic Whites (all p < .001), even after controlling for covariates. Racial/ethnic disparities exist in ADL disability improvement among HC patients. Research is needed to clarify mechanisms underlying these disparities. Disablement Model factors may be targets for clinical intervention.

Prognostic value of short-term decline of forced expiratory volume in 1s over height cubed (FEV1/Ht3) in a cohort of adults aged 80 and over.

Forced expiratory volume in 1s over height cubed (FEV1/Ht3) is an FEV1 expression that uses no reference values and is independently associated with adverse outcomes in older adults. No studies have reported on the prognostic value of its decline over time in adults aged 80 and over. To investigate the prognostic value of FEV1/Ht3 decline for adverse outcomes in a cohort of adults aged 80 and over. 328 community-dwelling adults aged 80 and over of the BELFRAIL prospective cohort had two valid FEV1 measurements as part of their comprehensive geriatric assessment at baseline and follow-up (after 1.7 ± 0.21 years). Kaplan-Meier survival curves, Cox and logistic multivariable regression, assessed association of excessive decline of FEV1/Ht3 (lowest quintile of percentage change) with all-cause mortality (3 years after follow-up assessment), time to first hospitalization (1year), and new/ worsened disability in activities of daily living (ADL) at the follow-up assessment. Participants with excessive FEV1/Ht3 decline had increased adjusted hazard ratio for all-cause death 1.61 (95% CI 1.01-2.55) and first hospitalization 1.71 (1.08-2.71) and increased odds ratio for new/worsened ADL disability at follow-up 2.02 (1.10-3.68) compared to the rest of the study population. Excessive, short-term decline in FEV1/Ht3 was independently associated with all-cause mortality, time to first, unplanned hospitalization, and ADL disability in a cohort of adults aged 80 and over. This FEV1 expression should be further investigated in studies of longitudinal FEV1 change in older adults.

The Association Between Handgrip Strength and Diabetes on Activities of Daily Living Disability in Older Mexican Americans.

The aim of this study is to determine the independent and joint effects of muscle weakness and diabetes on incident activities of daily living (ADL) disability in older Mexican Americans. A subsample of 2,270 Mexican Americans aged at least 65 years at baseline were followed for 19 years. Handgrip strength was normalized to body weight (normalized grip strength [NGS]). Weakness was defined as NGS ≤0.46 in males and ≤0.30 in females. Diabetes and ADL disability were self-reported. Compared with participants that were not weak and did not have diabetes, those that had diabetes only, were weak only, and were both weak and had diabetes experienced a 1.94 (95% confidence interval [CI] = [1.89, 1.98]), 1.17 (CI = [1.16, 1.19]), and 2.12 (CI = [2.08, 2.16]) higher rate for ADL disability, respectively. Muscle weakness and diabetes were independently and jointly associated with higher rates for ADL disability in older Mexican Americans.

Correlates of dyspnoea and its association with adverse outcomes in a cohort of adults aged 80 and over.

adults aged 80 and over, a fast growing age-group, with increased co-morbidity and frailty have not been the focus of previous research on dyspnoea. We investigate the correlates of dyspnoea and its association with adverse outcomes in a cohort of adults aged 80 and over. about 565 community-dwelling adults aged 80 and over of the BELFRAIL prospective cohort had assessment of Medical Research Council dyspnoea scale (MRC), forced expiratory volume in 1 s (FEV1), N-terminal pro-brain natriuretic peptide (NT-proBNP), physical performance tests, grip strength, 15 items geriatric depression scale, activities of daily living (ADL), body mass index (BMI) and demographics data. Kaplan-Meier survival curves, Cox and logistic multivariable regression, classification and regression tree (CART) analysis assessed association of dyspnoea (MRC 3-5) with time-to-cardiovascular and all-cause death (5 years), time to first hospitalisation (3 years), new/worsened ADL disability (2 years), and its correlates. participants with dyspnoea MRC 3-5 (29.9%) had increased hazard ratios for cardiovascular mortality 2.85 (95% confidence interval 1.93-4.20), all-cause mortality 2.04 (1.58-2.64), first hospitalisation 1.72 (1.35-2.19); and increased odds ratio for new/worsened disability 2.49 (1.54-4.04), independent of age, sex and smoking status. Only FEV1, physical performance, BMI and NT-proBNP (in order of importance) were selected in the tree-based classification model for dyspnoea. in a cohort of adults aged 80 and over, dyspnoea was common and an independent predictor of adverse outcomes, with cardio-respiratory and physical performance impairments as key independent correlates. Its routine and comprehensive evaluation in primary care could be very valuable in caring for this age-group.

Functional Impairment and Risk of Venous Thrombosis in Older Adults.

To determine the role of age-specific risk factors for thrombosis in older age, such as functional impairment. Case-control study. The Age and Thrombosis-Acquired and Genetic risk factors in the Elderly Study, a two-center study conducted in the Netherlands and the United States from 2008 to 2011. Individuals aged 70 and older with a first-time deep venous thrombosis in the leg or pulmonary embolism (n = 401) and controls aged 70 and older (n = 431) without a history of thrombosis. Exclusion criteria were active malignancy and severe cognitive disorders. The thrombotic risk associated with functional impairment, defined as impairment in two or more activities of daily living (ADLs), impaired mobility (inability to walk outside), sedentary lifestyle (≥20 h/d sleeping or sitting), and low handgrip strength (<15th percentile), was assessed. Odds ratios (ORs) adjusted for age, sex, and study center with 95% confidence intervals (95% CI) and population attributable risks (PAR) were calculated. Risk of venous thrombosis was 2.9 times greater (OR = 2.9, 95% CI = 1.6-5.3) in individuals with impairment in ADLs, three times as great (OR = 3.0, 95% CI = 1.9-4.7) in those with impaired mobility, four times as great (OR = 4.0, 95% CI = 2.5-6.3) in those with a sedentary life style, and 2.3 times as great (OR = 2.3, 95% CI = 1.5-3.4) in those with weak handgrip strength. PARs were 8% for ADL disability, 13% for inability to walk outside for 15 minutes, 29% for sedentary lifestyle, and 13% for weak hand grip strength. In individuals aged 70 and older, functional impairments are a major risk factor for venous thrombosis. These findings may help providers caring for older people be more aware of venous thrombosis risk.

Multiple inflammatory markers and 15-year incident ADL disability in admixed older adults: The Bambui-Epigen Study

BackgroundThe ability of inflammatory markers to predict disability in later life has received growing attention. However, the current evidence came predominantly from Caucasians and the role of genomic ancestry has not been investigated. ObjectiveWe investigated the prognostic value of multiple citokynes and chemokines for incident disability in admixed older Brazilians and whether genomic African and Native American ancestry affects the association. DesignPopulation-based longitudinal study. SettingThe Bambui-Epigen (Brazil) Cohort Study of Aging. Subjects1171 males and females aged ≥60 years over 15-year of follow-up. MethodsOutcome examined was incident activity of daily living (ADL) disability assessed annually (10,039 measures were performed). Serum levels of citokynes (IL6, IL12, TNF, IL10, and IL1β) and chemokines (CCL2, CCL5, CXCL8, CXCL9 and CXCL10) were measured at baseline. We used 370,539 Single Nucleotide Polymorphisms (SNPs) to estimate each individual genomic ancestry proportions. Potential confounding variables included a wide range of socio-demographic variables and health indicators. Statistical analyses were based on competing risk framework. ResultsThe incidence rate of disability was 57.9 per 1000 person-years. IL6 level at the highest quartile showed an independent association with ADL disability (SRH=1.32; 95% CI: 1.03, 1.70). Other inflammatory markers showed no statistically significant associations with the outcome. Neither genomic African nor Native American ancestry had an effect modifier on the associations (P for interaction >0.05 for all). ConclusionAmong multi-inflammatory markers, only IL6 had the potential to identify people at increased risk of ADL disability, independently of ethno-racial background.

Is the Association Between Late Life Morbidity and Disability Attenuated Over Time? Exploring the Dynamic Equilibrium of Morbidity Hypothesis.

There is evidence suggesting that the prevalence of disability in late life has declined over time while the prevalence of chronic diseases has increased. The dynamic equilibrium of morbidity hypothesis suggests that these patterns are due to the attenuation of the morbidity-disability link over time. This study aimed to test this assumption empirically. Data were drawn from three repeated cross-sections of SWEOLD, a nationally representative survey of the Swedish population aged 77 years and older. Poisson regression models were fitted to assess the trends in the prevalence of Activities of Daily Living (ADL) disability, Instrumental ADL (IADL) disability, and selected groups of chronic conditions. The changes in the associations between chronic conditions and disabilities were examined on both multiplicative and additive scales. Between 1992 and 2011, the prevalence of both ADL and IADL disabilities decreased whereas the prevalence of nearly all chronic morbidities increased. Significant attenuations of the morbidity-disability associations were found for cardiovascular diseases, metabolic disorders, poor lung function, and psychological distress. In agreement with the dynamic equilibrium of morbidity hypothesis, this study concludes that the morbidity-disability associations among the Swedish older adults largely waned between 1992 and 2011.

Influence of Type II Diabetes and High Depressive Symptoms on the Likelihood for Developing Activities of Daily Living (ADL) Disability and Mortality in Older Puerto Ricans.

To examine the development of activities of daily living (ADL) disability and mortality according to diabetes and high depressive symptoms among Puerto Rican adults aged 60 and older. Data came from Wave I and Wave II of the Puerto Rican Elderly: Health Conditions Study ( n = 3,419). Logistic regression was used. Using insulin and receiving psychiatric treatment were proxy measures of disease severity for diabetes and depressive symptoms, respectively. High depressive symptoms at baseline were associated with developing ADL disability (OR = 2.21; 95% CI = [1.68, 2.91]). Diabetes at baseline was associated with mortality at follow-up (OR = 1.72; 95% CI = [1.34, 2.19]). Baseline diabetes was associated with developing ADL disability but only for those who reported using insulin (OR = 1.69; 95% CI = [1.08, 2.61]). Participants with comorbid diabetes and high depressive symptoms had the highest odds for developing ADL disability and mortality. Diabetes and high depressive symptoms are risk factors of developing ADL disability and mortality for older Puerto Ricans.

Survival, Functional Status, and Eating Ability After Percutaneous Endoscopic Gastrostomy Tube Placement for Acute Stroke.

To determine the long-term survival and independence of individuals with stroke and percutaneous endoscopic gastrostomy (PEG) tube placement. Retrospective cohort study. A longitudinal nationally representative community-based sample of older adults. Individuals with stroke who had a PEG tube placed (N = 174, mean age 79, 51% female, 29% African American). Functional status before incident stroke was determined based on data from the Health and Retirement Study (HRS), a national longitudinal survey of community-dwelling older adults, from 1993 to 2012. Hospitalizations for stroke and PEG placement were determined according to Medicare claims. HRS participants were interviewed, and outcomes of survivors interviewed in the 2 years after hospitalization are described. Survival and functional and eating ability of the cohort were examined. Groups were compared according to age and prestroke functional disability in activities of daily living (ADLs) because it was hypothesized that ADL disability would predict worse outcomes. In the 2 years after hospitalization, overall mortality was 66%. Fifteen participants survived and regained independent ADL function (9%). Of those who survived to a follow-up interview, 33 (56%) could not eat independently, and 31 (53%) required assistance to walk across the room. Age of 85 and older was associated with worse outcomes (10% vs 29% at 2 years, P < .001), but baseline ADL disability was not. In this community-based sample, individuals who had had a stroke and a PEG tube placed had high mortality, and survivors were unlikely to be functional or mobile or to recover eating ability after hospitalization. A palliative care discussion including goals of care should occur before PEG tube placement is considered.

Caregiving for Older Adults with Obesity in the United States.

To determine the difference in receipt of activity of daily living (ADL) assistance between obese and normal-weight older adults. Retrospective cohort study. National Health and Aging Trends Study, 2011-2015. U.S. adults aged 65 and older with ADL disability and a body mass index (BMI) of 18.5 kg/m2 or greater (N = 5,612) MEASUREMENTS: BMI was classified as normal weight (18.5-24.9 kg/m2 ), overweight (25.0-29.9 kg/m2 ), or obese (≥30.0 kg/m2 ). Primary outcome was self-reported receipt of help with specific ADLs. Models were adjusted for demographic characteristics (age, sex, race), degree of need (self-reported general health, severity of disability), household resources (income, marriage, people in household, number of children), and cognitive status (dementia, proxy respondent). Obese with disabilities had lower rates of receiving assistance with walking inside (odds ratio (OR) = 0.63, 95% confidence interval (CI) = 0.50-0.81), walking outside (OR = 0.76, 95% CI = 0.59-0.97), toileting (OR = 0.68, 95% CI = 0.52-0.89), and getting in and out of bed (OR = 0.67, 95% CI = 0.50-0.87) than normal-weight older adults after adjustment for respondent demographic characteristics. Level of need and cognitive status partially explained the associations. In fully adjusted models, older adults with obesity still had significantly lower odds of receiving assistance in getting in and out of bed than normal weight adults (OR = 0.69, 95% CI = 0.49-0.98). Older adults with obesity are less likely to receive assistance for ADL disabilities than their normal-weight counterparts-an important concern because of ongoing demographic changes in the United States.