Disability Trajectories Research Articles

Patterns of intrinsic capacity trajectory and onset of activities of daily living disability among community-dwelling older adults.

Global population ageing has brought about new challenges for elderly care. Exploring intrinsic capacity (IC) over time, which is designed as a composite measure of an individual's physical and mental capabilities, is essential for promoting healthy ageing and preventing dependency, such as that emerging from disability in activities of daily living (ADL). We aimed to identify and examine the differences between classes of IC trajectory and onset of ADL disability. We conducted an observational study using data from three waves (2011-15) of the China Health and Retirement Longitudinal Study, comprising 2609 participants with 6034 observations. IC was measured by five domains, including locomotion, cognition, psychological, sensory capacities, and vitality. We used joint latent class modelling to identify distinct classes with similar patterns of IC trajectory and onset of ADL disability, as well as to explore the variation in IC trajectory and predict five-year risks of ADL disability considering the heterogeneity in the elderly population. The average baseline IC score was 7.15 (range: 0-15). We observed that IC scores slowly decreased with age, with 17.25% of participants developing ADL disability. We identified three classes of IC, which could be described as moderate health (class 1: n = 1634, 62.63%), at-risk (class 2: n = 716, 27.44%; had the highest risk of ADL disability), and optimal health (class 3: n = 259, 9.93%; had the lowest baseline risk of ADL disability). The probability of being in the moderate health class was decreased the most by emotional problems (odds ratio (OR) = 0.219; P < 0.001). Having a self-rated poor standard of living substantially reduced the chances of moderate (OR = 0.308; P = 0.001) and optimal health (OR = 0.110; P < 0.001). Observing IC trajectories and the onset of ADL disability can stratify the elderly into heterogeneous groups, as well as provide data for implementing person-centred care plans to reverse the trend and delay the adverse outcomes in clinical practice.

Blast Exposure, Tinnitus, Hearing Loss, and Postdeployment Quality of Life in U.S. Veterans: A Longitudinal Analysis.

Examine the association between military blast exposure and functional status among veterans with a focus on functional disability as a proxy for quality of life and explore the potential modifying effect of hearing loss on this association. Prospective cohort. Multi-institutional tertiary referral centers. 540 veterans. Self-reported military blast exposure with and without tinnitus; high-frequency hearing loss (yes/no). WHO Disability Assessment Schedule 2.0 questionnaires at baseline and annually over 5 years. The odds of membership into three functional disability trajectory groups: low functional disability, moderate functional disability, and high functional disability. Of 540 veterans, 197 (36.5%) self-reported a blast exposure history, and 106 of 197 (53.8%) reported tinnitus as a direct result of the blast. Blast exposure without tinnitus increased the odds of moderate functional disability compared with low functional disability (odds ratio [OR] = 1.5; 95% confidence interval [CI], 0.92-2.51), which strengthened among those with blast with tinnitus (OR, 3.6; 95% CI, 2.1-6.1). Blast exposure without tinnitus also increased the odds of membership to high functional disability versus low functional disability (OR, 2.2; 95% CI, 1.1-4.8). Hearing loss further increased the odds of reporting functional disability. The probability of low functional disability was approximately 60% if there was no history of blast or hearing loss, dropping to 20% if there was blast, tinnitus, and hearing loss history. Blast exposure negatively affects the quality of life of veterans, especially when compounded with tinnitus and hearing loss.

Disability trajectories individuals with spinal cord injury in mainland China: do psychosocial resources and diseases factors predict trajectories?

Observational cohort study. To identify classes of disability trajectories from 1 month post-injury (acute hospital) to 6 months post-injury (individuals with SCI individuals who stay in rehabilitation setting or back in the community), and to investigate whether psychosocial resources and disease factors can predict disability trajectory. Spinal surgery in three Class III hospitals. Hospitals in China are divided into three classes (Class I, II and III). All the participants were submitted to WHO Disability Assessment Schedule (WHO-DAS 2.0) at three times; and personal data anamnesis, level of hope, level of PTSD, level of social support were recorded at first time. All the data collected by the master's students who participated in this study. Two disability trajectories were identified using the latent class growth model: the continuous high disability group (N = 196, 93.3%) and the low starting point stabilization group (N = 14, 6.7%). Complete injury(ASIA-A) with SCI and more depression in the stable condition after SCI surgery were more likely to be classified as having higher disability than those with a lower disability trajectory. Occupation, annual family income, hope, social support, and Post-traumatic Stress Disorder (PTSD) cannot predict individuals belonging to trajectory classes. These findings emphasize the importance of ASIA and depression in the early recovery stage after SCI and support the opinion that strengthening psychological nursing and rehabilitation management at an early stage after SCI will benefit individuals with a lower disability trajectory.

Trajectories of work disability and unemployment before and after a common mental disorder diagnosis among young private sector employees in Sweden-a register-based longitudinal study.

To identify trajectory groups of work disability (WD), including sick leave and disability pension, and unemployment three years before and sixyears (from Y-3 to Y + 6) after a common mental disorder (CMD) diagnosis and to investigate associations of socio-demographic, work-related and clinical factors with trajectory membership. A longitudinal nationwide register-based study was conducted including individuals aged 22-29 years, gainfully employed in the private sector, with a CMD diagnosis in specialised healthcare or prescribed antidepressant (N = 12,121) in 2014 (Year 0/Y0), with follow-up from Y-3 to Y + 6. Group-based trajectory analyses identified groups of individuals who followed similar trajectories of months of WD and unemployment, respectively. Multinomial logistic regression determined associations between socio-demographic, work-related and clinical factors and trajectory membership. In the CMD group, we identified three trajectory groups, each for WD and unemployment. Only 7% individuals belonged to a 'Fluctuant high' trajectory group with four months of WD in Y0, which peaked at 7months in Y + 3 and reduced to 5months in Y + 6. For unemployment, 15% belonged to an 'Increasing medium' trajectory group that steadily increased from 1.3months in Y0 to 2.6months in Y + 6. Sex, educational level and musculoskeletal disorders for WD, and educational level, living area and occupational class for unemployment, influentially determined the variance across the CMD trajectory groups. Specific vulnerable groups regarding unfavourable WD (women, low education and musculoskeletal disorders) and unemployment (manual work, low education and rural residence) trajectories require special attention regarding their return-to-work process following a CMD diagnosis.

Outcome prediction following lumbar disc surgery: a longitudinal study of outcome trajectories, prognostic factors, and risk models.

This study aimed to 1) describe the 2-year postoperative trajectories of leg pain and overall clinical outcome after surgery for radiculopathy, 2) identify the preoperative prognostic factors that predict trajectories representing poor clinical outcomes, and 3) develop and internally validate multivariable prognostic models to assist with clinical decision-making. This retrospective cohort study included patients enrolled in the Canadian Spine Outcomes and Research Network who were diagnosed with lumbar disc pathology and radiculopathy and had undergone lumbar discectomy at one of 18 spine centers. Potential outcome predictors included preoperative demographic, health-related, and clinical prognostic factors. Clinical outcomes were 1) 2-year univariable latent trajectories of leg pain intensity (numeric pain rating scale) and 2) overall outcomes comprising multivariable trajectories showing the combined postoperative courses of leg and back pain intensity (numeric pain rating scale) together with pain-related disability (Oswestry Disability Index). Each outcome model identified a subgroup of patients classified as experiencing a poor outcome based on minimal change in their clinical status after surgery. Multivariable risk model performance and internal validity were evaluated with discrimination and calibration statistics based on bootstrap shrinkage with 500 resamplings. The authors included data from 1142 patients (47.6% female). The trajectory models identified 3 subgroups based on the patients' postoperative courses of pain or disability: 88.6% of patients in the leg pain model and 71.9% in the overall outcome model experienced a good-to-excellent outcome. The models classified 11.4% (leg pain outcome) and 28.2% (overall outcome) of patients as experiencing a poor clinical outcome, which was defined as minimal improvement in pain or disability after surgery. Eleven individual demographic, health, and clinical factors predicted patients' poor leg pain and overall outcomes. The performance of the multivariable risk model for leg pain was inadequate, while the overall outcome model had acceptable discrimination, calibration, and internal validity for predicting a poor surgical outcome. Patients with lumbar radiculopathy experience heterogeneous postoperative trajectories of pain and disability after lumbar discectomy. Individual preoperative factors are associated with postoperative outcomes and can be combined within a multivariable risk model to predict overall patient outcome. These results may inform clinical practice but require external validation before confident clinical implementation.

Association between frailty and subsequent disability trajectories among older adults: a growth curve longitudinal analysis from the Survey of Health, Ageing and Retirement in Europe (2004-19).

Frailty is associated with adverse health outcomes in ageing populations, yet its long-term effect on the development of disability is not well defined. The study examines to what extent frailty affects disability trajectories over 15 years in older adults aged 50+. Using seven waves of data from the Survey of Health, Ageing and Retirement in Europe (SHARE), the study estimates the effect of baseline frailty on subsequent disability trajectories by multilevel growth curve models. The sample included 94360 individuals from 28 European countries. Baseline frailty was assessed at baseline, using the sex-specific SHARE-Frailty-Instrument (SHARE-FI), including weight loss, exhaustion, muscle weakness, slowness, and low physical activity. Disability outcomes were the sum score of limitations in activities of daily living (ADL) and Instrumental ADL (IADL). Analyses were stratified by sex. Over 15 years, baseline frailty score was positively associated with disability trajectories in men [βADL = 0.074, 95% confidence interval (CI) = 0.064; P = .083; βIADL = 0.094, 95% CI = 0.080; P = 0.107] and women (βADL = 0.097, 95% CI = 0.089; P = .105; βIADL = 0.108, 95% CI = 0.097; P = .118). Frail participants showed higher ADL and IADL disability levels, independent of baseline disability, compared with prefrail and robust participants across all age groups. Overall, participants displayed higher levels of IADL disability than ADL disability. Study findings indicate the importance of early frailty assessment using the SHARE-FI in individuals 50 and older as it provides valuable insight into future disability outcomes.

Influence of nationality on the trajectories of pain, disability and health related quality of life in neck and back patients – The Norwegian Neck and Back Registry

PurposeThe aim of the current study was to examine differences in trajectories of pain, disability, and health related quality of life (HRQOL) between non-Norwegian and Norwegian patients with neck and back pain over 12 months. MethodsThe study is based on data from the Norwegian Neck and Back Registry (NNRR). The data include demographics and patient-reported outcome measures such as pain rating, the Oswestry Disability Index and HRQOL. Data were collected at baseline, 6 and 12 months after consultation for neck and back pain in specialist health care. ResultsA total of 5012 patients were included. We found a significant main effect of nationality. Non-Norwegian patients showed higher levels of pain and disability and lower HRQOL than Norwegian patients. Both patient groups exhibited an improvement in all three outcomes at 6- and 12-month follow-ups. The improvement was similar for pain with the greatest improvement taking place during the first 6 months and then slightly flattening out. For disability and HRQOL, we observed a differential effect over time as a function of nationality. Both groups reported an improvement the first 6 months, however, while the Norwegian patients continued their improvement to 12 months, non-Norwegian patients had increasing disability and lower HRQOL at 12 months. ConclusionBoth patient groups improved over the 12-month period. Non-Norwegian patients showed an overall higher level of pain, disability and lower HRQOL compared to Norwegian patients, with a differential effect over time as a function of nationality for disability and HRQOL. Suggesting that future studies should focus on potential systemic barriers that may affect the recovery of neck and back patients based on nationality.

Trajectories of work disability among individuals with anxiety-, mood/affective-, or stress-related disorders in a primary healthcare setting

Abstract Background Anxiety-, mood/affective-, or stress-related disorders affect up to one-third of individuals during their lives and often impact their ability to work. This study aimed to delineate trajectories of work disability (WD) among individuals diagnosed with anxiety-, mood/affective-, or stress-related disorder in primary healthcare and to examine associations between trajectory group membership and sociodemographic, clinical, and clinical-related factors. Methods The study population included working-age individuals, aged 22–62 years, living in Stockholm County, Sweden, who experienced a new episode of any anxiety-, mood/affective, or stress-related disorder in primary healthcare in 2017 (N = 11,304). Data were obtained from Swedish national and regional registers and were linked using pseudonymised unique personal identification numbers. The primary outcome was days with WD (sum of sickness absence and disability pension days) during the three years before and three years after a diagnosis of anxiety-, mood/affective-, or stress-related disorders in primary healthcare. A zero-inflated Poisson group-based trajectory model was used to identify groups of individuals with similar patterns of WD over the study period, with a multinomial logistic regression used to examine associations of sociodemographic, clinical, and clinical-related factors with trajectory group membership. Results Four distinct trajectory groups were found, high increasing (5.1%), with high levels, from 16 to 80 days of WD in six-monthly intervals during follow-up, peak (11.1%), with a peak in WD, up to 32 days of WD, around the time of the diagnosis, low increasing (12.8%), with an increase in days of WD from 4 to 22 during the study period, and constant low (71.1%), with almost no WD over the study period. In multinomial regression models, diagnostic category, psychotropic medication use, a diagnosis of a psychiatric disorder within secondary healthcare, age at diagnosis, and occupation were associated with WD trajectory groups. Conclusions Around two-thirds of individuals treated for a new episode of any anxiety-, mood/affective-, or stress-related disorder in primary healthcare have an excellent prognosis regarding WD. Several sociodemographic and clinical characteristics were associated with group membership; these factors could identify individuals at risk of long-term welfare dependency and who might benefit from interventions to promote a return to work.

Long-term disability trajectories in multiple sclerosis: a group-based trajectory analysis of the AusLong cohort

BackgroundPrevious natural history studies highlighted a consistent heterogeneity of disability trajectories among individuals with primary or secondary progressive multiple sclerosis (MS). However, evidence on disability progression in relapsing onset MS...

Disability trajectories by progression independent of relapse activity status differ in pediatric, adult and late-onset multiple sclerosis

BackgroundTo compare Expanded Disability Status Scale (EDSS) trajectories over time between Multiple Sclerosis (MS) groups with pediatric (POMS), adult (AOMS) and late (LOMS) onset, and between patients with and without progression independent of relapse activity (PIRA).MethodsPatients with a first visit within 1 year from onset, ≥ 5-year follow-up and ≥ 1 visit every 6 months were selected from the Italian MS Register. Adjusted disability trajectories were assessed by longitudinal models for repeated measures. Comparisons between groups and between patients with and without PIRA in subgroups were performed by evaluating the yearly differences of mean EDSS score changes versus baseline (delta-EDSS).A first CDA event was defined as a 6-months confirmed disability increase from study baseline, measured by EDSS (increase ≥ 1.5 points with baseline EDSS = 0; ≥ 1.0 with baseline EDSS score ≤ 5.0 and ≥ 0.5 point with baseline EDSS > 5.5).PIRA was defined as a CDA event occurring more than 90 days after and more than 30 days before the onset of a relapse.Results3777 MS patients (268 POMS, 3282 AOMS, 227 LOMS) were included. The slope of disability trajectories significantly diverged in AOMS vs POMS starting from the second year of follow-up (Year 2: delta2-EDSS 0.18 (0.05; 0.31), p = 0.0054) and then mean delta2-EDSS gradually increased up to 0.23 (0.07; 0.39, p = 0.004) at year 5. Patients with PIRA had significant (p < 0.0001) steeper increase in EDSS scores than those without PIRA in all groups, although in POMS, the disability trajectories began to diverge later and at a lesser extent with delta-EDSS score of 0.48 vs 0.83 in AOMS and 1.57 in LOMS, at 3 years after the first PIRA.ConclusionsAge is relevant in determining disability progression in MS. POMS shows a less steep increase in EDSS scores over time than older patients. The effect of PIRA in accelerating EDSS progression is less pronounced in POMS than in AOMS and LOMS.

Investigating the trajectory of functional disability in systemic sclerosis: group-based trajectory modelling of the Health Assessment Questionnaire-Disability Index.

To identify the trajectories and clinical associations of functional disability in systemic sclerosis (SSc). Australian Scleroderma Cohort Study (ASCS) participants meeting ACR/EULAR criteria for SSc recruited within 5 years of disease onset, with ≥2 Health Assessment Questionnaire-Disability Index (HAQ-DI) scores were included. Group based trajectory modelling (GBTM) was used to identify the number and shape of HAQ-DI trajectories. Between group comparisons were made using the chi-squared test, two-sample t-test or Wilcoxon rank-sum test as appropriate. Multiple logistic regression was used to identify features associated with trajectory group membership. Survival analyses were performed using Kaplan Meier and Cox proportional hazard modelling. We identified two HAQ-DI trajectory groups within 426 ASCS participants with incident SSc: low-stable disability (n=221, 52%), and high-increasing disability (n=205, 48%). Participants with high-increasing disability were older at disease onset, more likely to have diffuse SSc (dcSSc), cardiopulmonary disease, multimorbidity, digital ulcers, and gastrointestinal involvement (all p≤0.01), as was use of immunosuppression (p<0.01). Multimorbidity was associated with high-increasing trajectory group membership (OR3.1, 95%CI1.1-8.8, p=0.04); independently, multiple SSc features were also strongly associated including dcSSc (OR2.3, 95%CI1.3-4.2, p<0.01), proximal weakness (OR7.3, 95%CI2.0-27.1, p<0.01) and joint contractures (OR2.7, 95%CI1.3-5.3, p<0.01). High-increasing physical disability was associated with an almost two-fold increased risk of mortality (HR1.9, 95%CI1.0-3.8, p=0.05), and higher symptom burden. Two trajectories of functional disability in SSc were identified. Those with high-increasing functional disability had a distinct clinical phenotype and worse survival compared to those with low-stable functional disability. These data highlight the pervasive nature of physical disability in SSc, and its prognostic importance.

An investigation of the longitudinal trajectory patterns of health-related quality of life among Australians with disabilities: explaining disability types and properties

BackgroundResearch on health-related quality of life (HRQoL) trajectory patterns for people with disabilities (PwD) is scant. Understanding the HRQoL trajectory patterns for PwDs and investigating their relationship with disability types and socioeconomic factors can have important implications for Australia’s welfare policy.MethodsWe analysed data from waves 11 to 21 of the Household, Income and Labour Dynamics in Australia (HILDA) survey of respondents aged 15 + years of the PwDs. The analytic sample consists of 3724 self-reported disabled individuals and 34,539 observations in total. The SF-6D utility score is our HRQoL measure. Group-based trajectory modelling was utilised to identify trajectory groups, and multinomial logistic regression was employed to determine the baseline factors associated with trajectory group membership.ResultsThe study identified four distinct types of HRQoL trajectories (high, moderate improving, moderate deteriorating and low HRQoL trajectories). Psychosocial disability types followed by physical disability types had a high Relative Risk Ratio (RRR) in the low group compared with high trajectory group membership of PwDs (psychosocial: 6.090, physical: 3.524). Similar, results followed for the moderate improving group albeit with lower RRR (psychosocial: 2.868, Physical: 1.820). In the moderate deteriorating group, the disability types were not significant as this group has a similar profile to high group at the baseline. Compared with males, females had a higher RRR in low and moderate versus high improving HRQoL trajectories (low: 1.532, moderate improving: 1.237). Comparing the richest class to the poorest class, socioeconomic factors (income and education) predicted significantly lower exposure for the richer class to the low and medium HRQoL trajectories groups (RRR < 1).ConclusionDifferent forms of disability, demographic and socioeconomic factors have distinct effects on the HRQoL trajectories of disabled individuals. Healthcare and economic resource efficiency might be improved with targeted government policy interventions based on disability trajectories.

Association between multisite musculoskeletal pain and disability trajectories among community-dwelling older adults

BackgroundPain is linked to disability, but how multisite musculoskeletal pain leads to disability over time is not well elaborated.ObjectiveTo examine the associations of multisite musculoskeletal pain with disability among a nationally representative cohort.DesignWe used data from the National Health and Aging Trends Study (NHATS) 2015-22. Disability was assessed by basic activities of daily living (ADL) and instrumental activities of daily living (IADL).ParticipantsA total of 5557 individuals with multisite musculoskeletal pain dwelling in the community were included in this study.MethodsGroup-based trajectory models were applied to identify distinct profiles of disability in ADL and IADL. Design-based logistic regressions were used to examine associations among multisite musculoskeletal pain, disability, and dual trajectory group memberships, adjusted for sociodemographic, health status, behavioral, and mental characteristics.ResultsPersons who experienced multisite musculoskeletal pain were at higher risk of disability in ADL and IADL. We identified five heterogeneous disability trajectories and named them based on baseline levels and rates of increase over time. Approximately, 52.42% of older adults with multisite musculoskeletal pain were in trajectories with ADL and IADL declines, and 33.60% experienced a rapid decline. Multisite musculoskeletal pain was associated with elevated relative risk for the adverse disability trajectories, which generally increases with multisite musculoskeletal pain frequency and number of sites.ConclusionsPersons with multisite musculoskeletal pain had a higher risk of disability. It is essential to adopt effective pain management strategies to maintain the independent living ability of older adults and to realize active aging.

Effect of social participation on the trajectories of activities of daily living disability among community-dwelling older adults: a 7-year community-based cohort

IntroductionStudies examining the effects of social participation on activities of daily living (ADL) disability are still scarce.AimTo assess the reciprocal relationship between ADL disability trajectories and social participation among older Chinese people aged ≥ 60 years.MethodsThis study included 2976 participants aged ≥ 60 years in six waves of a community-based survey from 2015 to 2022. Basic activities of daily living (BADL) and instrumental activities of daily living (IADL) were used to assess the ADL disability in each survey. Social participation was assessed by involvement in four social activities and an extensive social participation score. Group-based trajectory modeling was used to identify potential heterogeneity in longitudinal changes over 7 years and explore associations between baseline predictors of group membership and these trajectories.ResultsTwo BADL disability trajectories were identified: stable (94.8%) and increase (5.2%). Additionally, three IADL disability trajectories were distinguished: stable (73.2%), moderate (20.2%), and increase (6.6%). After controlling for the potential covariates, each point increase in the extensive social participation score correlated with a 17% decrease in the odds of older individuals belonging to the increase BADL trajectory group (OR = 0.83, 95% CI = 0.68–1.00). For IADL, it decreased the odds of being assigned to the moderate trajectory group by 16% (OR = 0.84, 95% CI = 0.75–0.95) and to the increase trajectory group by 23% (OR = 0.77, 95% CI = 0.64–0.93).ConclusionsHigher levels of social participation among older individuals were more likely to be classified as stable trajectories in both BADL and IADL. Increased participation in social activities by community-dwelling elderly adults may promote healthy aging.

Disability and pain after anterior cervical decompression and fusion: A group-based trajectory analysis.

This study aimed to identify the clusters of patients with different developmental trajectories of pain and disability after anterior cervical decompression and fusion (ACDF). Group-based trajectory analysis among 318 patients undergoing the ACDF. Three developmental trajectories of disability were identified: "Steadily good functioning," "Improved functioning," and "Steadily poor functioning." Three developmental trajectories of neck pain were identified: "Worsened pain," "Pain relief," and "Steadily severe pain." Two developmental trajectories of arm pain were identified: "Decreased arm pain" and "Severe arm pain with only short-term relief." No associations were found between sex, preoperative pain duration, or body weight and probability to be classified into a particular disability trajectory group. Female sex (relative risk ratio (RRR) 1.78) and longer history of preoperative pain (RRR 2.31-2.68) increased the probability to be classified into a group with steadily severe neck pain. Longer history of preoperative pain increased the probability to be classified into group with severe arm pain with only short-term pain relief (RRR 2.68). After the ACDF, dissimilar developmental trajectories of pain and disability were identified between the patient clusters. While sex, preoperative pain duration, and body weight were not associated with differences in improvement in disability level, female sex and longer duration of preoperative pain were correlated with more severe neck and arm pain after surgery.

The association of physical activity and sedentary behaviour with low back pain disability trajectories: A prospective cohort study

BackgroundMultiple factors influence the recovery process of low back pain (LBP). The identification and increased knowledge of risk factors might contribute to a better understanding of the course of LBP. ObjectivesTo investigate the association of habitual physical activity (PA) and sedentary behaviour (SB), measured at baseline, with disability trajectories in adults with LBP. MethodsA prospective cohort study where habitual PA levels were measured using the Short QUestionnaire to ASsess Health enhancing physical activity (SQUASH), SB was calculated as average sedentary hours per day, and LBP disability using the Oswestry Disability Index (ODI). Participants completed the questionnaires at one and a half, three, six, and twelve months. Linear mixed models were estimated to describe the association of habitual PA levels SB measured at baseline with disability trajectories. Other predictors were gender, education level, age, pain, number of previous episodes of LBP, and duration of LBP. ResultsHabitual SB measured at baseline in adults (n = 347) with LBP were not associated with disability trajectories. For PA, participants with one metabolic equivalent of task (MET) hour per day above average recovered 0.04 [95% CI 0.004 to 0.076] points on the ODI per month faster than participants with an average amount of MET hours per day. ConclusionsHabitual SB was not associated with LBP disability trajectories over a one-year follow-up. High levels of habitual PA at baseline were associated with improved recovery in LBP disability trajectory, but the finding is not clinically relevant.

Dynamic Analysis of Loneliness at Older Ages in Europe by Gender

In this article, we analyse loneliness trajectories for older people aged 50 or more in selected European countries by gender. We also focus on the relationship between disability and loneliness trajectories. We use three waves of the longitudinal SHARE database. Loneliness trajectories are non-linear, increasing with age for both genders, and have the same shape irrespective of disability status but with different levels of loneliness. Loneliness persistence increases with disability and disability severity, especially for women. Worsening (improving) disability increases (decreases) the risk of loneliness persistence. We build rankings of the country's effects on loneliness persistence by gender. Mediterranean and Eastern European countries have the highest persistence rates, while the lowest rates are in Northern countries.

Longitudinal trajectories of disability among Chinese adults: the role of cardiometabolic multimorbidity

BackgroundCardiometabolic multimorbidity (CM) has been found to be associated with higher mortality and functional limitations. However, few studies have investigated the longitudinal association between CM and disability in the Chinese population and whether these associations vary by smoking status.MethodsThe study included 16,754 participants from four waves (2011, 2013, 2015, and 2018) of China Health and Retirement Longitudinal Study (CHARLS) (mean age: 59, female: 51%). CM was assesed at baseline and defined as having two or more of diabetes, stroke, or heart disease. Disability was repeatedly measured by summing the number of impaired activities of daily living (ADL) and instrumental activities of daily living (IADL) during the 7-year follow-up. Linear mixed-effects model was used to determine the association of CM and trajectories of disability and to assess the modification effect of smoking status in these associations.ResultsParticipants with CM at baseline had a faster progression of disability compared to those without CM (CM: β = 0.13, 95% CI: 0.05 to 0.21). Current smokers with CM developed disability faster than their counterparts (Pinteraction for smoking=0.011). In addition, there was a significant association between CM and the annual change of disability in current smokers (β = 0.34, 95% CI: 0.17 to 0.50) while no such association was observed in current non-smokers (β = 0.08, 95% CI: -0.02 to 0.17).ConclusionCM was associated with more a rapid disability progression. Notably, being current smokers may amplify the adverse effects of CM on disability progression.

Abstract 2228: Long-term trajectories of functional disability in older adults with cancer

Abstract Background: Older individuals with cancer history have lower risk of developing Alzheimer’s disease (AD). Cognitive impairment is associated with lower functioning in Instrumental Activities of Daily Living (IADL) and Activities of Daily Living (ADL). However, little is known about long-term IADL and ADL trajectories among individuals with cancer, hindering understanding of the underlying biological mechanisms between cancer and AD. We investigated the long-term functional disability trajectories of adults with cancer, comparing them with similarly aged individuals without a cancer diagnosis. Methods: Our study included 16,006 individuals aged 50 and older without a cancer history at baseline from the Health and Retirement Study. Biennial assessments were conducted from 1998 to 2020, including self-reported cancer status, IADL, and ADL. Linear probability models with repeated measures were used to assess IADL and ADL independence probabilities, adjusting for demographic and socioeconomic covariates. Results: Among 16,006 participants (mean [SD] baseline age, 66.1 [9.9] years; 9,169 [57.3%] female), 3,723 (23.3%) reported a cancer diagnosis during follow-up. Before cancer diagnosis, individuals who later developed cancer had a higher probability of IADL independence and experienced a slower decline in independence compared to their similarly aged counterparts who remained cancer-free. Probability of IADL independence was 0.05 lower immediately after cancer diagnosis compared to the pre-cancer phase, followed by accelerated independence losses relative to the pre-cancer period. After diagnosis, the rate of decline in probability of IADL independence remained slower for individuals with cancer than their cancer-free counterparts, but differences in the rate of decline were smaller than prior to cancer diagnosis. Similar trends were observed for ADL independence. Conclusions: We observed a decline in both IADL and ADL independence around the time of cancer diagnosis, possibly attributed to treatments. Overall, individuals with cancer experienced a more gradual loss in functional independence compared to individuals who remained cancer-free, consistent with the documented inverse association between cancer and AD. Funding information: The current research was supported by the National Cancer Institute of the National Institutes of Health (T32CA009142), T32 Training Grants from the NCI/NIH, and the National Institute on Aging (RF1AG059872). Citation Format: Gina E. Nam, Elizabeth Rose Mayeda, Zuo-Feng Zhang. Long-term trajectories of functional disability in older adults with cancer [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 2228.

The association of the STarT Back Screening Tool and type of leg pain with low back pain disability trajectories: a prospective cohort study

BackgroundMultiple factors influence the recovery process of low back pain (LBP). The identification and increased knowledge of prognostic factors might contribute to a better understanding of the course of LBP. The purpose of this study is to investigate the association of the STarT Back Screening Tool (SBST) risk score and the type of leg pain (non-radiating LBP, referred non-radicular, and radicular radiating leg pain) with the disability trajectory (at baseline, the slope, and recovery at one year) in adults with low back pain.MethodsThis is a prospective cohort study in 347 patients with low back pain who sought physiotherapy care at three primary care practices in the Netherlands. Linear mixed models were estimated to describe the association of the SBST risk score and the type of leg pain with disability at baseline, the slope in the disability trajectory, and at twelve months follow-up.ResultsA medium/high risk score on the SBST is associated with higher baseline disability scores on the Oswestry Disability Index (ODI), faster initial recovery, and still a higher disability ODI score at 12 months follow-up. Non-radicular referred and radicular radiating leg pain were associated with worse baseline disability ODI scores in LBP. This association was not present for the initial recovery or at the 12 months follow-up.ConclusionThe SBST is associated with the LBP recovery trajectory. The SBST might be a useful tool to predict the disability trajectory in a heterogeneous group of people with low back pain in primary care and might, therefore, be recommended in future clinical practice guidelines. The type of leg pain was not associated with the recovery trajectory of LBP. Future research might focus on evaluating different types of leg pain.Trial registrationClinicaltrials.gov: 109,643.