Disability In Community-dwelling Older Adults Research Articles

Heart Failure and Disability in Community-Dwelling Older Adults in the United States-1999 to 2018: Data From National Health and Nutrition Examination Survey.

To examine the associations of heart failure (HF) with five domains of disability while controlling for covariates. Subjects with HF and aged ≥ 50 years were selected from the 1999 to 2018 National Health and Nutrition Examination Survey data. Five domains of disability were measured with 19 physical tasks. Logistic regression with adjustment for covariates was conducted. The prevalence of HF in 27,185 adults aged ≥ 50 years was 6.37%. After controlling for demographics and smoking, logistic regression showed that HF was associated with 2.8 to 3.4 times increased odds of all domains of disability compared to adults without HF, but with additional adjustments of covariates, the association was attenuated indicating the mediating effects of covariates. The future study may examine the mediating effects of covariates when intervening difficulties with lower extremity mobility and activities of daily living while considering in community-dwelling older adults with HF.

Frailty and driving status associated with disability: a 24-month follow-up longitudinal study

ObjectivesTo examine the relationship of driving status and frailty with disability in older adults.DesignA prospective study.Setting and participantsThe study included 8533 participants (mean age: 72.0±6.1 years (range: 60–98 years), women:...

Effect of Aspirin on Activities of Daily Living Disability in Community-Dwelling Older Adults.

Cerebrovascular events, dementia, and cancer can contribute to physical disability with activities of daily living (ADL). It is unclear whether low-dose aspirin reduces this burden in aging populations. In a secondary analysis, we now examine aspirin's effects on incident and persistent ADL disability within a primary prevention aspirin trial in community-dwelling older adults. The ASPREE (ASPirin in Reducing Events in the Elderly) trial of daily 100 mg aspirin versus placebo recruited 19 114 healthy adults aged 70+ years (65+ years if U.S. minority) in Australia and the United States. Six basic ADLs were assessed every 6 months. Incident ADL disability was defined as inability or severe difficulty with ≥1 ADL; persistence was confirmed if the same ADL disability remained after 6 months. Proportional hazards modeling compared time to incident or persistent ADL disability for aspirin versus placebo; death without prior disability was a competing risk. Over a median of 4.7 years, incident ADL disability was similar in those receiving aspirin (776/9525) and placebo (787/9589) with walking, bathing, dressing, and transferring the most commonly reported. Only 24% of incident ADL disability progressed to persistent. Persistent ADL disability was lower in the aspirin group (4.3 vs 5.3 events/1000 py; hazard ratio [HR] = 0.81, 95% confidence interval [CI]: 0.66-1.00), with bathing and dressing the most common ADL disabilities in both groups. Following persistent ADL disability, there were more deaths in the aspirin group (24 vs 12). Low-dose aspirin in initially healthy older people did not reduce the risk of incident ADL disability, although there was evidence of reduced persistent ADL disability.

Longitudinal trajectory of disability in community-dwelling older adults: An observational cohort study in South Korea

BackgroundDisability, which is considered a health-related condition, increases care demands and socioeconomic burdens for both families and communities. To confirm the trend of dynamic longitudinal changes in disability, this study aims to explore how disability is divided by the trajectory method, which deals with time-sequenced data. Additionally, this study examines the differences in demographics, geriatric conditions, and time spent at home among the trajectory groups in community-dwelling older adults. Home time is defined as the period during which the patient was not in a hospital or health care facility during their lifetime.MethodsRecords of 786 community-dwelling older participants were analyzed from the Aging Study of PyeongChang Rural Area, a population-based cohort study that took place over three years. Using 7 domains of activities of daily living and 10 domains of instrumental activities of daily living, participants were grouped into no dependency (0 disabled domain), mild (1 disabled domain), and severe (2 or more disabled domains) disability groups. The longitudinal trajectory group of disability was calculated as a trajectory method. Three distinct trajectory groups were calculated over time: a relatively-stable group (78.5%; n = 617), a gradually-aggravated group (16.0%; n = 126), and a rapidly-deteriorated group (5.5%; n = 43).ResultsThe average age of 786 participants was 73.3 years (SD: 5.8), and the percentage of female was 52.7%. It was found that 78.5% of patients showed relatively no dependence and 5.5% of older adults in a rural area showed severe dependence. Through applying the trajectory method, it was shown that the Short Physical Performance Battery (SPPB) score was 10.2 points in the relatively-stable group and 3.1 points in the rapidly-deteriorating group by the 3rd year. Additionally, by the trajectory method, the rate of decrease in home time was 3.33% in the rapidly-deteriorated group compared to the relatively-stable group.ConclusionsThis study shows the difference in demographics and geriatric conditions (such as SPPB) through the examination of longitudinal trajectory groups of disability in community-dwelling older adults. Significant differences were also found in the amount of home time among the trajectory groups.

Independent and Combined Relationships of Perceived Neighborhood Social Cohesion and Physical Frailty on Functional Disability in Community-Dwelling Older Adults.

Functional disability and physical frailty (PF) are debilitating geriatric conditions. Previous studies have suggested both perceived neighborhood social cohesion (PNSC) and PF can influence functional disability and may have an interactive effect too. This cross-sectional study aims to examine the independent and combined relationships of PF and PNSC on functional disability in community-dwelling older adults in Shanghai, China. A total of 1616 older adults aged ≥ 75 years were recruited using multistage sampling. Results showed that prefrailty, frailty (using the modified frailty phenotype criteria), and low PNSC (measured by the Neighborhood Cohesion Scale) were independently associated with increased likelihood of functional disability after adjustment of covariates. To evaluate the combined relationships of PF and PNSC, participants were classified into six groups based on their levels of PF and PNSC. The probability of frail older adults with low PNSC having functional disability stood out compared with the robust older adults with high PNSC. Our findings suggest the importance of high PNSC as a protective factor of maintaining functional ability. Future longitudinal studies are needed to identify the role of PNSC in the development of functional disability among frail older adults.

Effects of comorbid physical frailty and low muscle mass on incident disability in community-dwelling older adults: A 24-month follow-up longitudinal study

ObjectivesLow muscle mass frequently precedes or coexists with physical frailty in late life. This study aimed to examine whether comorbid physical frailty and low muscle mass increase the risk of incident disability in community-dwelling older adults. Study designA prospective cohort study. MethodsParticipants were 9229 community-dwelling older Japanese adults (≥65 years). Longitudinal data on incident disability were collected for up to a maximum of 24 months from baseline. Physical frailty was defined as experiencing three or more of the following five symptoms: slowness, weakness, exhaustion, low activity, and weight loss. Low muscle mass was identified based on the AWGS definition (<7.0 kg/m2 for men and <5.7 kg/m2 for women). ResultsDuring the follow-up period, 460 (5.0%) individuals had incident disability. The prevalence rates of low muscle mass, physical frailty, and comorbid physical frailty and low muscle mass were 12.0% (n = 1104), 6.8 % (n = 624), and 1.8 % (n = 167), respectively. Compared with non-physical frailty/normal muscle mass, physical frailty (hazard ratio (HR) 2.50, 95% confidential interval (CI) 1.97−3.18) and comorbid physical frailty and low muscle mass (HR 4.03, 95% CI 2.85−5.70) were significantly associated with incident disability after adjusting for the covariates. ConclusionsAlthough low muscle mass alone may not be associated with an increased risk of incident disability in community-dwelling older adults, comorbid physical frailty and low muscle mass had a significant impact on disability. Low muscle mass was a risk factor for disability in older adults with physical frailty.

Plasma Soluble αKlotho, Serum Fibroblast Growth Factor 23, and Mobility Disability in Community-Dwelling Older Adults.

ContextαKlotho is a hormone and co-receptor for fibroblast growth factor 23 (FGF23), a hormone that downregulates active vitamin D synthesis and promotes phosphate excretion. Low αKlotho and high FGF23 occur in chronic kidney disease (CKD).ObjectiveWe aimed to assess the relationships of αKlotho and FGF23 with mobility disability in community-dwelling older adults.Design and SettingWe estimated associations of plasma-soluble αKlotho and serum FGF23 concentrations with mobility disability over 6 years. Additional analyses was stratified by CKD.ParticipantsParticipants included 2751 adults (25.0% with CKD), aged 71 to 80 years, from the 1998 to 1999 Health, Aging, and Body Composition Study visit.Main Outcome MeasuresWalking disability and stair climb disability were defined as self-reported “a lot of difficulty” or an inability to walk a quarter mile and climb 10 stairs, respectively.ResultsMedian (interquartile range [IQR]) serum FGF23 and plasma soluble αKlotho concentrations were 46.6 (36.7, 60.2) pg/mL and 630.4 (478.4, 816.0) pg/mL, respectively. After adjustment, higher αKlotho concentrations were associated with lower walking disability rates (Rate Ratio [RR] highest vs. lowest tertile = 0.74; 95% confidence interval l [CI] = 0.62, 0.89; P = 0.003). Higher FGF23 concentrations were associated with higher walking disability rates (RR highest vs. lowest tertile = 1.24; 95%CI = 1.03, 1.50; P = 0.005). Overall, higher αKlotho combined with lower FGF23 was associated with the lowest walking disability rates (P for interaction = 0.023). Stair climb disability findings were inconsistent. No interactions with CKD were statistically significant (P for interaction > 0.10).ConclusionsHigher plasma soluble αKlotho and lower serum FGF23 concentrations were associated with lower walking disability rates in community-dwelling older adults, particularly those without CKD.

Plasma proteomic signature of the risk of developing mobility disability: A 9-year follow-up.

IntroductionMobility disability is a powerful indicator of poor health in older adults. The biological and pathophysiological mechanism underlying the development of mobility disability remains unknown. This study conducted a data‐driven discovery phase investigation to identify plasma proteins that predict the incidence of mobility disability in community‐dwelling older adults without mobility disability at baseline.MethodsWe investigated 660 women and men, aged 71.9 ± 6.0 (60–94) years, who participated in the Invecchiare in Chianti, “Aging in the Chianti Area” study and completed the 400‐m walk at fast pace (400‐m walk) at enrollment. Median follow‐up time was 8.57 [interquartile, 3.20–9.08] years. SOMAscan technology was used to measure 1,301 plasma proteins at enrollment. The incident of mobility disability was defined as inability to complete the 400‐m walk. Protein‐specific Cox proportional hazard model was adjusted for sex, age, and other important covariates.ResultsPlasma levels of 75 proteins predicted mobility disability (p < .05). Significant proteins were enriched for the KEGG “PI3K‐Akt signaling,” “phagosomes,” and “cytokine–cytokine receptor interaction” pathways. After multiple comparison adjustment, plasma cathepsin S (CTSS; hazard ratio [HR] 1.33, 95% CI: 1.17, 1.51, q = 0.007), growth/differentiation factor 15 (GDF15; HR: 1.45, 95% CI: 1.23, 1.72, q = 0.007), and thrombospondin‐2 (THBS2; HR: 1.44, 95% CI: 1.22, 1.69, q = 0.007) remained significantly associated with high risk of losing mobility.ConclusionCTSS, GDF15, and THBS2 are novel blood biomarkers associated with new mobility disability in community‐dwelling individuals. Overall, our analysis suggests that cellular senescence and inflammation should be targeted for prevention of mobility disability.

Association of Nutritional Status with Physical Function and Disability in Community-Dwelling Older Adults: A Longitudinal Data Analysis

Objective: To investigate how change in nutritional status is associated with physical function and disability among community-dwelling older adults.Methods: Baseline and 1-year follow-up data of 593 community-dwelling older adults were obtained from the Population Health Index survey in Singapore. The Mini Nutritional Assessment was used to assess nutritional status; the Late-Life Function and Disability Instrument was used to measure physical function and disability. Multivariate linear regression was applied to examine the association of change in nutritional status with physical function and disability.Results: Compared to older adults with normal nutritional status at both baseline and 1-year follow-up, those who became undernourished or remained undernourished reported poorer physical function (B = –6.36 and –5.96, respectively; both P < 0.01), and had less frequent involvement (B = –3.95 and –2.84, respectively; both P < 0.01) and more limitation in performing life tasks (B = –13.24 and –16.02, respectively; both P < 0.01) at 1-year follow-up. However, older adults with improved nutritional status did not differ in physical function and frequency of involvement in life tasks compared to those with normal nutrition.Conclusion: Undernutrition is associated with poorer physical function and disability in community-dwelling older adults regardless of whether it developed or was persistent over one year. Improving nutritional status could be an effective strategy to improve physical function in older adults.

Effects of a water-based exercise program on disability prevention in older Japanese adults.

This study aimed to evaluate the potential preventive effects of a water-based exercise program on disability in community-dwelling older adults. The study design was a propensity score-matched retrospective study. Older adults were contacted through a mail survey carried out by City Hall, and those who scored ≥3 points on the physical domain of the Kihon Checklist were encouraged to participate in the water-based exercise program. The program consisted of aerobic and walking exercises in the water for 1 h, once a week for 6 months. Propensity scores were used to match individuals who participated in the exercise program with control individuals based on age, sex, height, weight, body mass index and Kihon Checklist score. Among matched pairs, the study included 278 participants (control group 139, intervention group 139). The main outcome was the number of participants who received a new long-term care insurance certification during the first follow-up year, which was used to indicate disability. Of the 278, 13 participants (5.5%) required long-term care insurance certification. A significantly smaller proportion of intervention group members required long-term care insurance certification (intervention group 0.7% [1/139 participants] vs control group 8.6% [12/139 participants], P = 0.003). Water-based exercise program appears to effectively prevent disability in community-dwelling older adults. Because water-based exercise program is associated with a minimal burden on joints and lower risk of falling, it might particularly enable the prevention of disability in older adults with chronic pain and restricted mobility. Geriatr Gerontol Int 2019; 19: 1282-1288.

Screening Value of Social Frailty and Its Association with Physical Frailty and Disability in Community-Dwelling Older Koreans: Aging Study of PyeongChang Rural Area.

Population aging is a challenge, therefore efficient frailty screening has been increasingly emphasized for mass older populations. This study aimed to evaluate the prevalence of social frailty and its association with physical frailty, geriatric syndromes and activity of daily living (ADL) disability in community-dwelling older adults. A cross-sectional study was conducted with 408 older adults (mean age, 75 years; 58% female) in the Aging Study of PyeongChang Rural Area. A five-item social frailty index was administered (range: 0–5); (1) going out less frequently; (2) rarely visiting the homes of friends; (3) feeling unhelpful to friends and family; (4) being alone; and (5) not talking with someone every day. Social frailty was defined as ≥2 positive responses. Physical frailty was assessed according to the Cardiovascular Health Study frailty phenotype criteria. We used logistic regression to examine whether social frailty can identify older adults with common geriatric syndromes including ADL disability, independently of age, gender, and physical frailty. Social frailty was present in 20.5% (14.5% in male and 25.0% in female) and 11.5% was not overlapped with physical frailty. Social frailty increased risk of ADL disability (odds ratio, 2.53; 95% confidence interval, 1.26–5.09) and depressed mood (odds ratio, 4.01; 95% confidence interval, 1.30–12.39) independently of age, gender, and physical frailty. The predictive power for disability was maximized by using both frailty indices (C statistic 0.73) compared with either frailty index alone (C statistic: 0.71 for social frailty and 0.68 for physical frailty). Social frailty screening is important as it can identify frail older adults who are not captured by demographic characteristics and physical frailty. Moreover, assessment of both social frailty and physical frailty can better detect disability and geriatric syndromes.

Frail Phenotype and Disability Prediction in Community-Dwelling Older People: A Systematic Review and Meta-Analysis of Prospective Cohort Studies.

ABSTRACTBackground:The World Health Organization has identified frailty as a crucial factor affecting successful aging. Systematic literature reviews have yet to focus on the relationship between stages of frailty and disability in community-dwelling older adults.Purpose:The purpose of this study was to investigate the relationships between various frailty types and disability in community-dwelling older adults and to explore how various frailty criteria have been used to assess disability in this population.Methods:A systematic literature review and meta-analysis were conducted on articles from the following databases: Cochrane Library, CINAHL, PubMed, and Ovid. Database search criteria included articles that were published between January 2001 and July 2017 and study samples that included community-dwelling adults aged 60 years and older. We excluded studies that were conducted in institutions or hospitals and experimental studies on frailty. Two reviewers independently assessed eligibility and extracted data. A random-effects model was used to analyze the literature and to calculate the pooled disability of frailty.Results:In total, nine studies with a total sample of 32,998 participants that recorded 8,666 disabilities and a mean follow-up time of 30.4 months (SD = 29.26) were pooled for the meta-analysis. Using various indicators to predict the risk of disability compared with robust older adults, those with frailty faced a higher risk of disability, followed by older adults at risk of frailty.Conclusions/Implications for Practice:Frailty is a crucial health consideration among older adults. Those who are frail have the highest relative risk of disability, followed by those at risk of frailty. Early assessment of frailty may effectively prevent the occurrence of frailty-induced disability in older adults.

Habitual Physical Activity in Older Adults Undergoing TAVR: Insights From the FRAILTY-AVR Study

ObjectivesThe authors sought to assess the distribution and prognostic significance of habitual physical activity (HPA) in older adults undergoing transcatheter aortic valve replacement (TAVR). BackgroundLow HPA is associated with mortality and disability in community-dwelling older adults. In the setting of TAVR, it is unclear whether low HPA is a risk factor for downstream morbidity or a byproduct of severe aortic stenosis that improves following its correction. MethodsOlder adults undergoing TAVR in the prospective multicentre FRAILTY-AVR (Frailty in Aortic Valve Replacement) study were interviewed to quantify their HPA in kilocalories/week using a validated questionnaire at baseline and follow-up. The primary endpoint was all-cause mortality at 12 months. ResultsThe cohort consisted of 755 patients with a median age of 84.0 years (interquartile range [IQR]: 80.0 to 87.0 years). At baseline, median HPA was 1,116 kcal/week (IQR: 227 to 2,715 kcal/week) with 73% of patients performing <150 min/week of moderate or vigorous HPA. Sedentary patients were more likely to be older, female, frail, cognitively impaired, depressed, and have multimorbidity, although they had similar left ventricular function and aortic stenosis severity. In the logistic regression model adjusting for these covariates, HPA was found to be associated with mortality at 12 months (odds ratio: 0.84/100 kcal; 95% confidence interval: 0.73 to 0.98). HPA was associated with longer length of stay, discharge to health care facilities, and disability. At 12 months, median HPA among survivors was 933 kcal/week (IQR: 0 to 2,334 kcal/week) with pre-existing frailty being independently predictive of worsening HPA following TAVR. ConclusionsSedentary patients have a higher risk of mortality and functional decline following TAVR.

Study on activities of daily living disability in community-dwelling older adults in China

Objective: To investigate the disability status and its epidemiological characteristics in the elderly in urban and rural communities in China. Methods: The participants were from the project of Prevention and Intervention on Neurodegenerative Disease for Elderly in China conducted in 2015. A total of 23 803 urban and rural residents aged over 60 years were selected through stratified multi-stage cluster sampling in 6 provinces for a set of standardized questionnaire interview and physical examinations. Activities of daily living (ADL) scale was used to assess the disability status of the elderly. χ(2) test was used to analyze the difference in basic activities of daily living (BADL) and instrumental activities of daily living (IADL) disabilities in different elderly populations. Multivariate logistic regression model was used to analyze the influence factors for disability. Results: Taking bath had the highest impairment rate (1.7%) while eating had the lowest impairment rate (0.6%) in BADL. Making phone call had the highest impairment rate (16.6%), followed by taking bus (5.5%) and taking medicine (1.8%) in IADL. The BADL and IADL disability rates in community seniors were 2.1% and 19.1%, respectively. BADL disability rate was higher in females, the widowed, illiterate, the elderly with low body weight or obesity (P<0.05). IADL disability rate was higher in females, rural residents, the widowed, the elderly with lower educational level or lower body weight (P<0.05). Multivariate analysis showed that risk for BADL disability increased with age and abnormal BMI, and decreased with the increase of education level. The risk factors for IADL disability included being female, age, rural residence, being widowed and low BMI. The risk for IADL disability was lower in those with higher education level and overweight or obesity. Conclusion: The present study showed that the disability rate was high in the elderly in China, which was influenced by the aging and multi demographic characteristics of the elderly. It is important to strengthen the prevention of BADL and IADL disabilities and intervention in the elderly.

Disability in Community-Dwelling Older Adults: Exploring the Role of Stroke and Dementia.

Objectives: We sought to determine the relative contributions of stroke, dementia, and their combination to disability and racial differences in disability among community-dwelling older adults. Methods: We performed a cross-sectional study of 6848 community-dwelling older adults. We evaluated the associations of stroke, dementia, and their combination with activities of daily living (ADL) limitations (range 0-7). We then explored the impact of stroke and dementia on race differences in ADL limitations using Poisson regression after accounting for sociodemographics and comorbidities. Results: After full adjustment, ADL limitations differed among older adults with stroke and dementia. Older adults without stroke or dementia had 0.32 (95% CI 0.29-0.35) ADL limitations compared to 0.64 (95% CI 0.54-0.73) with stroke, 1.36 (95% CI 1.20-1.53) with dementia and 1.84 (95% CI 1.54-2.15) with stroke and dementia. Overall, blacks had 0.27 (95%CI 0.19-0.36) more ADL limitations than whites. Models accounting for stroke led to a 3.7% (95%CI 2.98%-4.43%) reduction in race differences, while those for dementia led to a 29.26% (95%CI 28.53%-29.99%) reduction and the stroke-dementia combination −1.48% (95%CI −2.21% to −0.76) had little impact. Discussion: Older adults with stroke and dementia have greater disability than older adults with either of these conditions alone. However, the amount of disability experienced by older adults with stroke and dementia is less than the sum of the contributions from stroke and dementia. Dementia is likely a key contributor to race differences in disability.

Mild to moderate chronic kidney disease and functional disability in community-dwelling older adults. The Cardiovascular risk profile in Renal patients of the Italian Health Examination Survey (CARHES) study

ObjectivesChronic kidney disease (CKD) negatively impacts aging success. This study evaluates the association between CKD and functional disability, defined as limitations in performing mobility tasks, basic (ADLs) and instrumental activities of daily living (IADLs), in a population-based sample of older adults. In particular, we examined whether such a relationship extended to mild-moderate CKD stages (G1-G3ab). MethodsData from the Cardiovascular risk profile in Renal patients of the Italian Health Examination Survey (CARHES) study were used.Prevalence of CKD was estimated by means of urinary albumin to creatinine ratio (ACR) and eGFR (CKD-EPI equation-enzymatic assay of serum creatinine). A validated questionnaire was used to assess functional limitations. Potentially confounding variables, e.g. socio-demographic features, lifestyles, cardiovascular (CV) risk factors and prevalent CV diseases, were considered. Results1309 participants, age 71.4 ± 4.3 years, 53.8% men, were studied. 15.2% of participants were identified as having CKD. Of these, 11.5% were aware of the condition. Prevalence of CKD increased with age, and was similar between men and women. Mild-moderate CKD was found to be significantly associated with disability in mobility (OR = 1.05, 95%CI =1.01–1.09, p = .014) and ADLs/IADLs (OR = 1.06, 95%CI = 1.02–1.12, p = .011) after multiple simultaneous adjustment including socio-demographic variables, CV risk profile, ACR, cognitive impairment and self-rated health. ConclusionsMild-moderate CKD independently associated with functional disability in a population-based sample of older adults. Evidence-based recommendations for disability prevention in CKD are needed.

Occupational Performance and Subclinical Disability in Community-Dwelling Older Adults

Occupational Performance and Subclinical Disability in Community-Dwelling Older Adults

HABITUAL PHYSICAL ACTIVITY AND SURVIVAL IN OLDER ADULTS UNDERGOING TRANS CATHETER AORTIC VALVE REPLACEMENT: INSIGHTS FROM THE FRAILTY-AVR STUDY

Sedentary behaviors are associated with mortality and disability in community-dwelling older adults. In patients referred for transcatheter aortic valve replacement (TAVR), it is unclear whether the level of habitual physical activity (HPA) is similarly prognostic or whether it is a by-product of

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.

Symptoms of Apathy Independently Predict Incident Frailty and Disability in Community-Dwelling Older Adults.

Although depressive symptoms are widely recognized as a predictor of functional decline among older adults, little is known about the predictive utility of apathy in this population. We prospectively examined apathy symptoms as predictors of incident slow gait, frailty, and disability among non-demented, community-dwelling older adults. We examined 2 independent prospective cohort studies-the LonGenity study (N = 625, 53% women, mean age = 75.2 years) and the Central Control of Mobility in Aging (CCMA) study (N = 312, 57% women, mean age = 76.4 years). Individuals were recruited from 2008 to 2014. Apathy was assessed using 3 items from the Geriatric Depression Scale. Slow gait was defined as 1 standard deviation or more below age- and sex-adjusted mean values, frailty was defined using the Cardiovascular Health Study criteria, and disability was assessed with a well-validated disability scale. The prevalence of apathy was 20% in the LonGenity cohort and 26% in the CCMA cohort. The presence of apathy at baseline, independent of depressive symptoms (besides apathy), increased the risk of developing incident slow gait (hazard ratio [HR] = 2.10; 95% CI, 1.36-3.24; P = .001), frailty (HR = 2.86; 95% CI, 1.96-4.16; P < .001), and disability (HR = 3.43; 95% CI, 1.73-6.79; P < .001) in the pooled sample. These associations remained significant when accounting for demographics, medical illnesses, and cognitive function. Apathy is associated with increased risk of developing slow gait, frailty, and disability, independent of other established risk factors, in non-demented older adults. Apathy should be screened for as a potentially preventable cause of functional decline in clinical psychiatric settings.