Functional Ability In Older Adults Research Articles

The effect of long chain n-3 fatty acid supplementation on muscle strength in older adults: A systematic review and meta-analysis

Muscle strength and mass decline as we age, typically starting around 35–40 years, and can eventually lead to the development of sarcopenia(1). There are currently no effective drug treatments available for either the prevention or treatment of this condition(2) and whilst resistance exercise has efficacy(3) its effectiveness is limited due to issues with uptake and adherence(4). However, emerging research suggests that nutrition may offer a potentially effective approach to delay the age-related decline in muscle mass and function among older individuals(5), with LCn-3 PUFA emerging as a strong candidate.The main objective of the current study was to perform a systematic literature review with the purpose of exploring the impact of long-chain n-3 polyunsaturated fatty acid (LCn-3 PUFA) relative to control oil supplementation on muscle strength, with secondary outcomes of muscle mass and physical function in older individuals under conditions of habitual physical activity/exercise.The review protocol was registered with PROSPERO (CRD42021267011) and followed the guidelines outlined in the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) statement(6). The search for relevant studies was performed utilizing databases such as PubMed, EMBASE, CINAHL, Scopus, Web of Science, and the Cochrane Central Register of Controlled Trials (CENTRAL) up to June 2023. Randomized controlled trials (RCTs) in older adults comparing the effects of LCn-3 PUFA with a control oil supplement on muscle strength were included.Five studies(7,8,9,10,11) involving a total of 488 participants (348 females and 140 males) were identified that met the specified inclusion criteria and were included. Upon analyzing the collective data from these studies, it was observed that supplementation with LCn-3 PUFA did not have a significant impact on grip strength (standardized mean difference (SMD) 0.61, 95% confidence interval [−0.05, 1.27]; p = 0.07) in comparison to the control group. However, there was a considerable level of heterogeneity among the studies (I2 = 90%; p < 0.001). As secondary outcomes were only measured in a few studies, with significant heterogeneity in methods, meta-analyses of muscle mass and functional abilities were not performed. Papers with measures of knee extensor muscle mass as an outcome (n = 3) found increases with LCn-3 PUFA supplementation, but studies measuring whole body lean/muscle mass (n = 2) and functional abilities (n = 4) reported mixed results.With a limited number of studies, our data indicate that LCn-3 PUFA supplementation has no effect on muscle strength or functional abilities in older adults but may increase muscle mass, although, with only a few studies and considerable heterogeneity, further work is needed to confirm these findings.

Trajectory of intrinsic capacity among community-dwelling older adults in China: The China health and retirement longitudinal study

BackgroundsIntrinsic capacity (IC), the sum of individual mental and physical capabilities, as well as living environment and behavior, jointly determine the functional ability of older adults, shifting the focus from disease to function. At the population level, IC in older adults is associated with adverse health outcomes, such as disability, falls, and death. At the individual level, IC changes dynamically. However, studies on the longitudinal IC trajectory and the factors influencing IC deterioration are limited. We aimed to analyze the IC trajectory and explore the risk factors for IC deterioration in Chinese older adults. MethodsData were obtained from the baseline (2011–2012) and 4-year follow-up (2015) CHARLS surveys, including 1906 people aged 60 years and older. IC comprises six dimensions: locomotion, vitality, hearing, vision, cognition, and psychology. IC trajectory was categorized into three groups: improved, maintained, and deteriorated. Logistic regression analysis was used to analyze factors influencing the trajectory of IC deterioration. ResultsAfter 4 years, 32.1 % had deteriorated, 38.5 % remained stable, and 29.4 % had improved. Age, low level of education, widowed were independently associated with IC deterioration. ConclusionsDynamic IC monitoring supports the development of individualized intervention policies to delay or prevent IC deterioration.

Home-based supportive and health care services based on functional ability in older adults in Iran.

Home-based care is affordable due to population aging, increased chronic disease, and higher hospitalization costs. The objective was to evaluate home-based supportive and health care services provided to older adults and identify possible associations between activities of daily living (ADLs), instrumental ADL (IADLs) classifications, sociodemographic variables, clinical characteristics, and perceived social support among older adults. In this cross-sectional study, 700 people aged 60 years and older were selected by stratified cluster sampling. Areas of Tabriz City were selected as clusters, and 55 comprehensive urban health centers were selected as stratifies. Chi-square, Pearson's and Spearman's tests, and multiple linear regression were used for statistical analyses. Statistical analysis was performed using the Statistical Package for Social Sciences (SPSS 24.0, SPSS Inc., Chicago, USA). The study instrument included demographic characteristics of older adults and caregivers, health services provided at home, and two valid questionnaires, including the KATZ index of independence in (instrumental) activities of daily living and a multidimensional scale of perceived social support. Scores on scales and demographic variables were collected during telephone interviews. The study lasted from April 25, 2022, to October 30, 2022. A high level of perceived social support was 56.6%. The study found that 51.3% of participants had family caregivers. Most participants had ADL independence (85.4%), while 22.9% and 24.3% were dependent and needed assistance with IADL, respectively. Women had a lower ADL score and a higher IADL score than men (P < 0.05). The obtained results of multiple regression analysis revealed a negative and significant association between unemployment, illiteracy, increasing age, five and more medications, and ADL and IADL dependency (P < 0.05). Empowering older adults to reduce dependency, and designing a formal home-based care system is recommended.

ICOPE Evaluations and Promoting Health in Older Adults: A Chinese Medicine Perspective

The Integrated Care for Old People (ICOPE) guidelines were developed by the World Health Organization. These guidelines address functional abilities in older adults in six intrinsic capacity domains, including cognitive decline, limited mobility, malnutrition, visual impairment, hearing loss, and depressive symptoms with the goal of improving their assessment and management. In this article, aging is interpreted from the perspective of Chinese medicine and guided by the theory of Yin Yang, the five elements, the six ICOPE domains, and the five organs (liver, heart, spleen, lungs, and kidneys). Huang Di Nei Jing's concept of disease prevention is proposed in a manner that corresponds to the three-stage preventive public health strategy for promoting health, delaying the effects of aging, and improving quality of life in older adults.

1709 Comparative performance of six multimorbidity indices to discriminate intrinsic capacity impairments among older adults

Abstract Introduction Optimal intrinsic capacity (IC) is crucial for preserving the functional abilities of older adults. The presence of multimorbidity is closely associated with IC impairments. Various multimorbidity indices have been developed for diverse health outcomes. This study aimed to compare the performance of six commonly used multimorbidity indices to discriminate IC impairments among community-dwelling older adults. Method We used data from a multidimensional geriatric assessment program including 627 community-dwelling older adults in five cities of Hunan, China. Six multimorbidity indices were extracted from the data, including disease counts, Functional Comorbidity Index (FCI), the Deyo Charlson comorbidity index, two indices (total score and comorbidity index) derived from the Cumulative Illness Rating Scale-Geriatric (CIRS-G), and medication counts. The IC was measured with five individual domains, i.e., locomotion, vitality, sensory, cognition, and psychological capacity. Individuals were regarded as having IC impairments if they had impairments in one or more domains. Associations between multimorbidity indices and IC impairments were examined using logistic regression analyses. The discriminative ability of multimorbidity indices for IC impairments was compared using the c-statistics. Results A total of 374 (59.6%) participants had IC impairments. All multimorbidity indices were significantly associated with IC impairments after adjusting for confounding factors. All indices showed acceptable discriminative power (c-statistic ranged from 0.711 to 0.759) for IC impairments. The comorbidity index derived from CIRS-G resulted in the highest c-statistic, followed by the total score of CIRS-G and FCI. Conclusions Our study results suggest that multimorbidity indices differed in their ability to discriminate IC impairments. The comorbidity index derived from CIRS-G performed better than other multimorbidity indices included in this study. The comorbidity index has the potential as a simple proxy measure of indicating the need for interventions to optimise IC for older adults in community settings.

INTRINSIC CAPACITY OF OLDER ADULTS IN SINGAPORE USING WHO INTEGRATED CARE FOR OLDER PEOPLE (ICOPE) FRAMEWORK

Abstract The World Health Organization (WHO) proposed the Integrated Care for Older People (ICOPE) approach to guide health systems in better supporting the intrinsic capacity and functional ability of older adults to enable healthy aging (Briggs et al., 2018; de Carvalho et al., 2019). This approach is aligned with Singapore’s Healthier SG initiative, which aims to build a good healthcare system that promotes better health and quality of life for everyone. Recent studies have shown that older adults experience intrinsic capacity decline in various countries, including Singapore, highlighting the importance of targeted interventions to maintain functionality and quality of life in old age (Beard et al., 2019; Liu et al., 2021; Tay et al., 2022). In this cross-sectional study, 367 participants were assessed by 43 ICOPE assessors, of whom 77.4% (n=284) had impairments in intrinsic capacity. The three most prevalent intrinsic capacity impairments were visual impairment (42%), hearing loss (33.5%), and cognitive decline (31.3%), followed by limited mobility (24.3%), malnutrition (16.1%), and depressive symptoms (16.1%). Furthermore, 22.6% of participants were unaware of any elderly care services available in the community, and 8.2% did not know where to seek help in case of problems. These findings emphasize the need for ICOPE assessments at the community level to promote early detection of intrinsic capacity impairments and interventions. More discussion of the care pathway, together with health professionals, older adults, and caregivers, should be the next step to offer diagnostic assessment and guide self-management of intrinsic capacity impairment for among older adults.

The Effects of Cognitive Ability, Mental Health, and Self-Quarantining on Functional Ability of Older Adults During the COVID-19 Pandemic: Results From the Canadian Longitudinal Study on Aging.

Determine whether levels of anxiety and depression, cognitive ability, and self-quarantining during and prior to the pandemic predict decreases in perceived functional ability. Longitudinal data collected from the Canadian Longitudinal Study on Aging (CLSA) COVID-19 Questionnaire Study (2020) and core CLSA study (Follow-Up 1; 2014-2018). 17541 CLSA participants. Self-quarantining behaviours from questionnaires administered at Baseline (April 2020), Monthly, and Exit (December 2020) time points of the CLSA COVID-19 Questionnaire Study, levels of anxiety and depression at Baseline, perceived change in functional ability at Exit, and performance on neuropsychological tests (Rey Auditory Verbal Learning Task, Mental Alternation Task, Animal Fluency Test) and functional ability (Older Americans Resources and Services [OARS] Multidimensional Assessment Questionnaire) from the core CLSA study. Greater cognitive ability pre-pandemic (B = -.003, P < .01), higher levels of anxiety (B = -.024, P < .01) and depressive symptoms (B = -.110, P < .01) at Baseline, and higher frequency of engaging in self-quarantining throughout the COVID-19 survey period (B = -.098, P < .01) were associated with perceived loss in functional ability at Exit. Self-quarantining behaviour was associated with perceived loss in functional ability only at average and high levels of depressive symptoms (B = -.013, P < .01). Older adults with higher cognitive and lower functional ability prior to the pandemic were at greater risk of decreased perceived functional ability during the first year of the pandemic, as were those who experienced greater levels of anxiety and depressive symptoms during the pandemic. Strategies/interventions to preserve functional ability in older adults with cognitive independence prior to future pandemics are warranted.

Cross‐cultural adaptation, validity and reliability of the Everyday Cognition Scale in Mexico M‐ECog in Older Adults with Subjective Cognitive Decline, Mild Cognitive Impairment and Alzheimer’s Dementia

AbstractBackgroundThe Everyday Cognition (ECog) scale was created to assess the functional abilities of older adults across a wide range of abilities between normal aging and dementia. The original ECog was shown to have convergent and divergent external validity. Developed in 2008 by Farias et al and updated in 2021. This scale screens early cognitive alterations such as Subjective Cognitive Decline (SCD), Mild Cognitive Impairment (MCI) and Alzheimer’s dementia (AD) through the decline of basic activities and instruments of daily life (DLA)To establish validity, reliability, and cross‐cultural adaptation of the ECog in Spanish (M‐ECog) to identify: SCD, MCI, and Alzheimer’s‐type dementia in older Mexican adults.Method200 patients and 200 informants in a memory clinic of a third level hospital in Mexico City. Four groups were formed: 50 cognitively healthy (CH), 50 SQD, 50 MCI and 50 AD. The clinical evaluation included: sociodemographic aspects, cognitive status by the Mini‐Mental State Evaluation (MMSE) and Montreal Cognitive Evaluation Spanish version (MoCA‐E). The informants rated the functional status measured through the KATZ and Lawton &amp; Brody scales, as well as the ECog Spanish version (M‐ECog).ResultThe internal consistency of the overall function of the M‐ECog (Cronbach’s alpha) was 0.881. The intraclass correlation coefficient was 0.877 (95% CI, 0.850‐0.902; p&lt;0.001). M‐ECog was significantly correlated with DLA 0.40 (95% CI, 0.320‐0.471; p&lt;0.001), MMSE 0.68; (95% CI, 0.650‐0.710; p&lt;0.001) and MoCA‐E 0.70 (95% CI, 0.620‐0.892; p&lt;0.001). And it differentiated patients with SCD, MCI and AD from CH (p &lt; 0.002). The area under the curve (AUC) for SQD was 0.70 (95% CI, 0.58‐0.82), p &lt; 0.005 with a cut‐off value of 46 points, (Sensitivity (S) 99%, and Specificity (E) of 96%; the AUC for MCI was 0.94 (95% CI, 0.89‐0.99), p &lt; 0.001 with a cut‐off point of 52 points, (S: 97%, E: 27%); and for the dementia group, the AUC was 0.86 (95% CI, 0.79‐0.92), p &lt;0.001 with a cut‐off value of 85 points, with (S: 97%, E: 51%).ConclusionM‐ECog is a valid, reliable, useful instrument that measures daily skills mediated by cognition in older Mexican adults, self‐applicable (patients and informants) with SCD, MCI and Alzheimer’s Dementia

67 Cognitive Reserve, Depressive Symptoms, and Functional Ability in Older Adults

Objective:Cognitive reserve has been linked to functional ability, and depression has been shown to be associated with more functional impairment in older adults. While cognitive reserve and depression are associated and have each been shown to impact functional impairment, the independent impact of cognitive reserve on functional ability after accounting for depressive symptoms has not been explored. For the purpose of this study, years of education served as a proxy for cognitive reserve, which is consistent with the literature. It was predicted that higher levels of education would be associated with better functional ability regardless of age and severity of depressive symptoms.Participants and Methods:Participants (ages 55 to 90) were drawn from the Alzheimer’s Disease Neuroimaging Initiative (N=3407); participants with major depression were not included. Subsyndromal depressive symptoms were measured using the Geriatric Depression Scale (GDS &lt; 6) and functional impairment was assessed using the Functional Activities questionnaire. A three-stage hierarchical regression was conducted with functional ability as the dependent variable.Results:Age, entered at stage one of the regression model, was a significant predictor (F(1,1427) =49.75, p&lt;.001) and accounted for 3.4% of the variance in functional ability. Adding depressive symptoms to the regression model led to a significant increase in variance explained (F(1,1426) = 64.57, p&lt;.001), accounting for an additional 4.2% of the variance in functional ability. Adding years of education to the regression model explained an additional 1.4% of variance in functional ability and this increase in variance explained was significant (F(1,1425) = 22.53, p&lt;.001).Conclusions:Cognitive reserve (operationalized as higher levels of education) was associated with higher functional ability even after accounting for age and depressive symptoms.

Functional ability of older adults based on the World Health Organization framework of healthy ageing: a scoping review

Functional ability of older adults based on the World Health Organization framework of healthy ageing: a scoping review

Impact of age-friendly living environment and intrinsic capacity on functional ability in older adults: a cross-sectional study

BackgroundThe World Health Organization (WHO) has proposed healthy aging framework, supposing that intrinsic capacity (IC), environment and their interaction may have influence on functional ability (FA). It was still unclear how the IC level and age-friendly living environment impact on FA. This study aims to confirm the relationship between the IC level and age-friendly living environment with FA, especially in older adults with low IC.MethodsFour hundred eighty-five community-dwelling residents aged ≥ 60 years were enrolled. IC constructed by locomotion, cognition, psychological, vitality, and sensory domains was assessed using full assessment tools recommended by WHO. Age-friendly living environment was measured with 12 questions adapted from the spatial indicators framework of age-friendly cities. FA was assessed using activities of daily living (ADL) and one question about mobile payment ability. Multivariate logistic regression was used to explore the association between IC, environment and FA. The influence of the environment on electronic payment and ADL under the IC layer was assessed.ResultsOf 485 respondents, 89 (18.4%) had ADL impairment, and 166 (34.2%) had mobile payment function impairment. Limited IC (odds ratio [OR] = 0.783, 95% confidence interval [CI] = 0.621–0.988) and poor environment (OR = 0.839, 95% CI = 0.733–0.960) were associated with mobile payment ability impairment. Our results suggested that a supportive age-friendly living environment influenced FA was more prominent in older adults with poor IC (OR = 0.650, 95% CI = 0.491–0.861).ConclusionsOur results confirmed IC and the environment had an impact on mobile payment ability. The relationship between environment and FA showed differences according to IC level. These findings suggest that an age-friendly living environment is important to maintain and enhance elders’ FA, especially in those with poor IC.

Cognitive function and its influencing factors in chinese with advanced age: An observational study based on comprehensive geriatric assessment

AbstractBackgroundCognitive impairment is an age‐related clinical problem that has a significant negative impact on the quality of life of elderly individuals. Hence, it is necessary to identify and intervene the factors affecting cognitive impairment early. Comprehensive geriatric assessment (CGA) is a multidimensional, multidisciplinary diagnostic and therapeutic process used to evaluated the medical, psychosocial, and functional abilities of older adults. This study aimed to evaluated the cognitive function and to explored the risk factors in the old elderly in Chongqing, southwest China by analyzing the CGA assessment data.MethodA cross‐sectional study was conducted in 551 inpatients aged 80 years or older of Department of Geriatrics in The First Affiliated Hospital of Chongqing Medical University from July 2017 to August 2018. Participants were measured with CGA to assess the physical condition, cognition, mental health status, fatigue, nutrition, and presence of geriatric syndromes. Cognitive function was assessed with the Mini‐Mental State Examination (MMSE). The factors associated with cognitive function were analyzed with independent sample t‐test, chi‐square test, and rank‐sum test. The relationship between cognitive impairment and risk factors was examined with logistic regression analysis.ResultAmong the 551 subjects, 313 (56.8%) had different degrees of cognitive impairment. The cognition function was obviously correlated with literacy (z = ‐3.294,P&lt; 0.001), diabetes (x² = 6.862,P&lt; 0.009), nutrition (z = ‐3.466, P&lt;0.001), GDS‐5 (x² = 25.955, P&lt;0.000). Furthermore, logistic regression analysis showed that age (odds ratio (OR) = 1.117, 95% confidence interval (CI): 1.1048–1.190), no diabetes (OR = 0.628, 95% CI:0.400–0.984), normal GDS‐5 (OR = 2.417, 95%CI: 1.568–3.000), and malnourished (OR = 2.481, 95%CI:1.159–5.313) were significantly associated with cognitive function.ConclusionOur results suggest that age, poor literacy, diabetes, depression and malnutrition are significantly associated with an increased risk of cognitive impairment. Therefore, improving nutritional status, controlling blood glucose and regulating emotions have positive regulatory effects on cognitive function of the older elderly.

Constructing the concept of healthy ageing and examining its association with loneliness in older adults

BackgroundWorld Health Organization (WHO) has defined healthy ageing by highlighting five functional ability domains to (meet basic needs, make decisions, be mobile, build and maintain relationships, and contribute to society), which also emphasized the importance of addressing loneliness as priorities within United Nations Decade of Healthy Ageing initiative. However, the level and determinants of healthy ageing and its association with loneliness are rarely examined. This study aimed to construct a healthy ageing index to verify the WHO healthy ageing framework, measure five domains of functional ability of older adults and examine the relationship between functional ability domains and loneliness.MethodsA total of 10,746 older adults from the 2018 China Health and Retirement Longitudinal Study (CHARLS) were included. A healthy ageing index ranging from 0 to 17 was constructed using 17 components related to functional ability domains. Univariate and multivariate logistic regression analyses were utilized to determine the association between loneliness and healthy ageing. The STROBE guidelines with the RECORD statement for observational studies using routinely collected health data were observed.ResultsThe factor analysis verified the five functional ability domains for healthy ageing. After adjusting for confounders, being mobile, building and maintaining relationships, and learning, growing and making decisions were significantly associated with lesser loneliness among participants.ConclusionsThe healthy ageing index of this study can be utilized and further modified with respect to large-scale research with relevant healthy ageing topics. Our findings will support healthcare professionals to provide patient-centered care when identifying their comprehensive abilities and needs.

Effect of physical therapy on the isokinetic performance of knee flexors and extensors and functional balance in older adults with Parkinson's disease, according to severity

ObjectiveTo analyze the effects of a physical therapy intervention on the muscle strength and power of the knee flexors and extensors and functional balance in older adults with Parkinson's disease (PD), according to its clinical severity. MethodsForty older adults diagnosed with PD were evaluated before and after 48-week of a basic exercise program (two 20-min sessions a week) to improve functional balance and quadriceps strength. The variables analyzed were: motor aspects of PD, assessed using the Unified Parkinson's Disease Rating Scale (UPDRS); functional mobility; peak torque (PT) and mean power (MP) at the knee flexors and extensors, evaluated using an isokinetic dynamometer (CYBEX®) on both legs at 60°/s (PT) and 240°/s (P); Timed Up and Go (TUG) test; and Tinetti Index. The participants were divided into three groups (GI, GII, GIII) according to their stage (I–III) of PD on the Hoehn and Yahr (H&Y) scale. ResultsMuscle strength and power were greater in GI (PT: 131.14 N/kg ±61.73; P: 102.29 W/kg ±39.16) than in GII and GIII (PT: 82 N/kg ±38.27 and 89.29 N/kg ±68.78; p = 0.047; P: 56.17 W/kg ±31.99 and 68.14 W/kg ±58.18; p = 0.009). In addition, an improvement in functional balance was shown by higher indices after the intervention (p < 0.05). ConclusionThese findings suggest that training to increase leg strength in the early stages of PD (GI) may benefit this population and this will help in the design of interventions to improve the functional abilities of older adults with PD.

Effects of Physical Activity on Physical Fitness and Functional Ability in Older Adults.

A cross-sectional survey was done to investigate the pathways the physical activity acts in improving physical fitness and functional outcomes of older adults (60 years and above) using 880 community-dwelling older adults in Sri Lanka. Structural Equation Modeling (SEM) was used. The final SEM model included five latent factors and 14 co-variances. Goodness of Fit Index (GFI), Comparative fit index (CFI) and Root Mean Square Error of Approximation (RMSEA) values of the model were 0.95, 0.93, 0.91, and 0.05 respectively, indicating a good model fit. Strength enhances balance (β = .52, p < .01) and reduces the time required to complete physical functions (β = -.65, p < .01). Since strength declines with advancing age, muscle-strengthening activity programs should be promoted to enhance balance and functional performances in older adults in advanced ages. Strength test (hand grip and leg strength) can be used as a screening test to predict potential risk of falls and functional disabilities in older adults.

The efficacy of exergames on balance and reducing falls in older adults: A narrative review

Falls in older adults are a very important health concern worldwide with enormous social and economic ramifications. The advancement of medical technology and the creation and dissemination of exergames has gained more and more ground in recent decades as it combines exercise with a pleasant environment. However, their efficacy over conventional exercise methods is under investigation. The aim of this review is to present recent research data regarding the efficacy of exergames in older adults with balance deficits who experience falls. Method: The PubMed and Google Scholar databases were searched with the following keywords: exergames, elderly falls, balance and Exercise. Articles that were clinical studies and had been published in the last four years were selected. Six clinical studies were found to meet the criteria and were included in the review. The total sample was 287 older adults. Results: Most clinical studies concluded that exergame rehabilitation is effective, enjoyable, and well received by older adults. In two studies, a combination with conventional physical therapy was reported to show better results. Discussion - Conclusions: The results of our review provide evidence that interventions based on virtual reality and exergames are effective in improving balance and reducing the number of falls in older adults. Our review also derives positive results of exergames effects compared to conventional physical therapy. Exergames-based intervention is cost-effective, safe, without adverse effects, and appears able to cause adaptations in balance and functional ability in older adults, thus reducing the risk of falls. Their application is proposed for the training of older adults in future interventions.

Prevalence of Urinary Tract Infection and Health Outcomes in Older Adults Undergoing Hip Surgery: A Prospective Study

Urinary tract infections are complications found mostly in older adults undergoing hip surgery. However, little is known about the impact of urinary tract infections on health at after post-hip fracture surgery, particularly in Thailand. This prospective study investigated the prevalence of urinary tract infections and their impact on length of stay, functional ability, re-admission, surgical site infections, and in-hospital mortality. The participants were 120 older adults undergoing hip surgery at four tertiary care hospitals in Bangkok, Thailand. Instruments for collection the data were the Demographic Data Questionnaire, Health Outcome Data Record Form—length of hospital stays, surgical site infections, re-admission, and in-hospital mortality, and the Hip Disability and Osteoarthritis Outcome Score. Data were analyzed using descriptive statistics and Firth’s logistic regression. Results demonstrated that the prevalence of urinary tract infections was 28.32%. Significantly, older adults who developed urinary tract infections had a 2.88-fold increased the risk of impaired functional ability four weeks after surgery and a 3.21-fold increased the risk of re-admission to the hospital compared to those without urinary tract infections. Findings suggest that nurses should continually evaluate urinary tract infections and related factors from admission to post-discharge, as urinary tract infections profoundly affect health outcomes. Strict compliance with guidelines or strengthening post-acute care services to prevent urinary tract infections and its consequences is recommended to promote and restore health, especially functional ability in older adults undergoing hip surgery.

Assessing the impact of the built environment on healthy aging: A gender-oriented Hong Kong study

The built environment is widely perceived as crucial in promoting the public health of older adults. Consequently, recent years have seen substantial efforts to explore linear relationships of the built environment on functional ability, a widely adopted indicator for public health of older adults. However, relevant studies highlighting the non-linear relationships and gender differences of older adults are lacking, posing potential challenges to governments for policymaking of building a sustainable and age-friendly society. Thus, this study aims to investigate non-linear relationships between the built environment (distance to transit, design, destination accessibility, density, and diversity) and functional ability of older adults by employing an ecological model of aging for a sample size of 1112 participants aged 60 and above in a typical aging Chinese society of Hong Kong with a specific emphasis on gender differences. Results reveal that non-linear relationships between the built environment and functional ability of older adults generally exist in both gender groups. However, gender differences are also distinctively found regarding the effects of the built environment on the functional ability of older adults. Males' functional ability has been improved with services (≤ 30), road lengths (≥ 6 km), bus stop (≤ 50), population density (≤ 23,000 person/km2), diverse land-use entropy index (≥ 0.4), shorter distances to the nearest hospital (≤ 1.2 km), and a closer MTR station (≤ 500 m). In comparison, females' functional ability has been improved with specific ranges of road lengths (≤ 4 or ≥ 6 km), services (≤ 30), greenery exposure (0.05 to 0.2 or ≥ 0.25), and distances to the nearest MTR (≤ 800 m). This study provides a valuable reference for various governments to implement targeted gender-based urban planning to facilitate healthy aging.

Novel subgroups of functional ability in older adults and their associations with adverse outcomes

BackgroundThere is no general agreement on a standard form of functional classification in older adults and is mainly assessed by Activities of Daily Living (ADL) and/or Instrument Activity of Daily Living. A refined classification based on evaluation the limitations of intrinsic capacity, environment and social interaction, could provide a basis to predict the future disability and identify individuals with increased risk of adverse outcomes.MethodsA new functional classification among older adults aged 60 and over was conducted by latent class analysis and compared with the traditional classifications, based on the China Health and Retirement Longitudinal Study. To further investigate the scientific validity of this new classification, associations with 7-year mortality and ADLs impairments among categories were tested by using Survival curves and Cox proportional hazard models. This was followed by the confirmatory analysis related to the prospective data. Competing risk analysis was also performed to analysis the sensitivity to further support our conclusions.ResultsFive categories were identified among 5,992 older adults which gave the best fitting, yielding a significant Bootstrap Likelihood Ratio Test (p < 0.001) and Lo-Mendell-Rubin adjusted likelihood ratio test (p < 0.001), with an entropy over 0.80. The presence of five categories: “health” (34.0%), “sub-disorder status” (36.6%), “acute diseases” (10.3%), “somatic functional disorder” (7.7%), and “viability disorder” (11.4%), which matched well with the functional independence rates by the international classifications. Among them, those in “sub-disorder status” were considered as an intermediate status between disability and health. The findings also revealed that those who were in “acute disease”, “somatic functional disorders”, “health” and “sub-disorder status” had a significant lower risk of mortality and ADLs limitations than “viability disorder”. And the risks gradually increased towards the less functionally independent end of the classification. However, the distribution of characteristics among five categories were in a synchronous change, indicating a stable classification.ConclusionsA new classification representing the functional heterogeneity of older adults could effectively stratify the risk of mortality and ADLs limitations. Identifying the clusters of functional decline might be useful in predicting subsequent ageing trends, designing personalized intervention, and delaying the progression of disability and preventing its occurrence.

Lower urinary tract symptoms and functional ability in older adults: a community-based cross-sectional study

ObjectivesFunctional ability, or the ability to live actively in older age, is essential for healthy ageing. This study assessed the association between the five types of lower urinary tract symptoms...