Functional Limitations In Older Adults Research Articles

The phenotypic and genotypic association of grip strength with frailty, physical performance and functional limitations over time in older adults.

To replicate the phenotypic associations of grip strength with frailty, physical performance and functional limitations in older adults for longer follow-up periods and to examine whether these associations are due to shared genetic factors. In total 2,262 participants 55years and older with follow-up data up to 23years (Nobservations = 8,262) from the Longitudinal Aging Study Amsterdam were included. Weighted polygenic risk scores for grip strength (PRS-GS) were built using the genome-wide meta-analysis results from UK Biobank as reference. Grip strength was measured two times on each hand using a dynamometer. Frailty index (FI) and frailty phenotype were operationalised following standard procedures. Performance tests included a timed walk test, a repeated chair stands test and put on-take off cardigan test. Functional limitations were assessed using a questionnaire with six items. Higher grip strength was phenotypically associated with lower FI (b = -0.013, 95% CI (-0.016, -0.009)), better physical performance (b = 0.040, 95% CI (0.026, 0.054)) and less functional limitations (OR = 0.965, 95% CI (0.954, 0.977)) over time for follow-up periods up to 23years. However, PRS-GS was not associated with any of the traits. The phenotypic associations between grip strength, frailty, physical performance and functional limitations were replicated for follow-up periods up to 23years. However, the associations between the traits could not be explained by shared genetics potentially indicating a more relevant involvement of non-genetic factors.

Association Between Personality Traits and Functional Limitations in Older Adults with Affective Disorders: A Cross Sectional Study

ABSTRACT Objectives Personality traits and affective disorders are both related to functional limitations. It is unknown whether personality traits have an additional effect on functioning in older adults with affective disorders. We studied the association between personality traits and functioning within this group. Methods We performed a cross-sectional study of 180 older patients referred to outpatient specialized geriatric mental health care centers with a depressive, anxiety and/or somatic symptom disorder according to DSM-criteria. We studied the association between the Big Five personality traits and functional limitations assessed with the WHO-DAS II, adjusting for potential confounders, including the severity of various affective disorders. Results The 180 patients (57.1% female, mean age 69.2 years) had an average WHO-DAS II score of 31.3 (SD 15.1). Lower scores on Conscientiousness were associated with more overall functional limitations (p = .001), particularly limitations in self-care (p = .001) and household activities (p = .001). Lower Extraversion scores were associated with more limitations in getting along with others (p = .001). Conclusions Personality traits are related to functional limitations independent of the severity of affective disorders in older adults. Clinical implications Personality traits may be used as predictive factors for functioning in older adults with affective disorders.

The longitudinal associations of sarcopenia definitions with functional deterioration: a comparative study.

Probable sarcopenia is a predictor of functional limitation in older adults. However, whether standard thresholds recommended by guides, or population-specific thresholds better predict impairment in functionality is an issue that needs to be enlightened. We aimed to study the associations of probable sarcopenia identified by the use of EWGSOP2 and population-specific thresholds with deterioration in functionality at follow-up and give prevalences of probable sarcopenia with different thresholds in older outpatients admitted to a tertiary health center. In this retrospective, longitudinal follow-up study, we assessed handgrip strength (HGS) at the admission with a Jamar hand-dynamometer and diagnosed probable sarcopenia with standard and population-specific thresholds, i.e., 27kg/16kg, and 35kg/20kg in males/females, respectively. We evaluated activities of daily living (ADL) and instrumental ADL (IADL), with Katz and Lawton scales, at the admission and follow-up. To study whether probable sarcopenia was a predictor of impaired functionality, we defined two models for Cox regression analysis. We performed adjustments for age, sex, and nutritional status (assessed by Mini-Nutritional Assessment-Short Form) in Model 1 and defined Model 2 by adding low gait speed and frailty to the variables in Model 1. Among a total of 1970 patients, 195 had follow-up of median 560days. The mean age was 75.5 ± 5.5, and 142 (72.8%) were female. In the basal evaluation, the prevalences of probable sarcopenia defined by the standard cut-offs and by population-specific cut-offs were 8.7% and 35.4%, respectively. In univariate analyses (Kaplan-Meier log-rank test), probable sarcopenia by population-specific cut-offs, but not EWGSOP2-cut-offs, was associated with deteriorations in both ADL (p = 0.04) and IADL (p < 0.001). In multivariate analyses, only the probable sarcopenia identified by population-specific cut-offs was independently associated with impairment in IADL in both models [HR (95%CI) = 1.88 (1.07-3.30), and 1.9 (1.04-3.6); for Model 1 and Model 2, respectively)]. Our findings suggested that the definition of probable sarcopenia identified by not standard, but population-specific thresholds more reliably predicted longitudinal deterioration of functionality in older outpatients. This finding might be considered as evidence supporting the use of population-specific cut-offs when the concern is sarcopenia diagnosis.

Optimizing the Design of Clinical Trials to Evaluate the Efficacy of Function-Promoting Therapies.

Several candidate molecules that may have application in treating physical limitations associated with aging and chronic diseases are in development. Challenges in the framing of indications, eligibility criteria, and endpoints and the lack of regulatory guidance have hindered the development of function-promoting therapies. Experts from academia, pharmaceutical industry, National Institutes of Health (NIH), and Food and Drug Administration (FDA) discussed optimization of trial design including the framing of indications, eligibility criteria, and endpoints. Mobility disability associated with aging and chronic diseases is an attractive indication because it is recognized by geriatricians as a common condition associated with adverse outcomes, and it can be ascertained reliably. Other conditions associated with functional limitation in older adults include hospitalization for acute illnesses, cancer cachexia, and fall injuries. Efforts are underway to harmonize definitions of sarcopenia and frailty. Eligibility criteria should reconcile the goals of selecting participants with the condition and ensuring generalizability and ease of recruitment. An accurate measure of muscle mass (eg, D3 creatine dilution) could be a good biomarker in early-phase trials. Performance-based and patient-reported measures of physical function are needed to demonstrate whether treatment improves how a person lives, functions, or feels. Multicomponent functional training that integrates training in balance, stability, strength, and functional tasks with cognitive and behavioral strategies may be needed to translate drug-induced muscle mass gains into functional improvements. Collaborations among academic investigators, NIH, FDA, pharmaceutical industry, patients, and professional societies are needed to conduct well-designed trials of function-promoting pharmacological agents with and without multicomponent functional training.

Longitudinal associations of concurrent falls and fear of falling with functional limitations differ by living alone or not.

Falls and fear of falling (FOF) are independent risk factors for functional limitations in older adults. However, the combined effect of falls and FOF on functional limitations and the moderating role of living alone or not is unclear. We aimed to examine (1) the independent and combined effect of falls and FOF on functional limitations in older adults and (2) whether living alone moderates these associations. We used data from the National Health and Aging Trends Study (NHATS) and included 5,950 U.S. community-dwelling older adults aged 65 and older from Round 1 (Year 2011) and Round 2 (Year 2012). Falls and FOF were ascertained by asking participants whether they had any falls in the last year and whether they had worried about falling in the previous month at R1. Assessed functional limitations included any difficulties with mobility, self-care, or household activities at R2. Poisson regression models were used to examine the longitudinal associations of falls and FOF with functional limitations and the moderation effects of baseline living alone. Of the 5,950 participants, 16.3% had falls only; 14.3% had FOF only; 14.3% had both, and 55.1% had neither at baseline. In the adjusted model, those who experienced concurrent falls and FOF in R1 had a higher risk of functional limitations at R2 than those with neither (Mobility: Incidence risk ratio [IRR] = 1.34, 95% CI: 1.24-1.45; Self-care: IRR = 1.18, 95% CI: 1.11-1.26; Household: IRR = 1.20, 95% CI: 1.11-1.30). Moreover, living alone significantly moderated the longitudinal associations of concurrent falls and FOF with mobility activity limitations. The findings suggest that strategies to improve falls and FOF together could potentially help prevent functional limitations. Older adults who live with others and have falls or FOF should receive interventions to promote their mobility activities.

The role of age, sex, and multimorbidity in 7-year change in prevalence of limitations in adults 60–94 years

Recent data suggest a temporal trend in decline in functional limitations in older adults but whether this trend extends to the period after the 8th decade of life remains unclear. We examined change in prevalence of limitations in activities and instrumental activities of daily living (ADL and IADL) between 2008 and 2015 among adults of 60–94 years and the role of age, sex, multimorbidity; we also examined changes in severity of limitations. Data were drawn from two nationally representative surveys in 2008 (n = 13,593) and 2015 (n = 13,267). The 6-item scales of ADL and IADL were each categorized first as ≥ 1 limitations, and then to examine severity as 0, 1–2, and ≥ 3 limitations. Weighted logistic and multinomial regressions were used to estimate prevalence of limitations; the difference between surveys were extracted every 5 years between 60 and 90 years. The prevalence of ≥ 1 ADL declined between 2008 and 2015, from age 75 (− 1.2%; 95%CI = − 2.0, − 0.4%) to age 90 (− 8.8%; 95%CI = − 12.7, − 5.0%). This decline was more pronounced in men than women (p-value for interaction = 0.05) and observed primarily in those with multimorbidity (p-value for interaction = 0.06). Up to 2 ADL limitations declined from age 75 (− 1.0; 95%CI = − 1.7, − 0.3) to 90 (− 6.7; 95%CI = − 9.9, − 3.6) and from age 80 (− 0.6; 95%CI = − 1.1, 0.1) to 85 (− 1.2; 95%CI = − 2.2, − 0.1) for ≥ 3 ADL limitations. There was no substantial change in IADL limitations. These data from a high-income country with universal health care show improvement in ADL even after the 8th decade of life despite increase in multimorbidity.

Secondhand Tobacco Smoke and Functional Impairments in Older Adults Living in the Community.

There has been no comprehensive examination of the potential association of SHS with broad functional limitation assessment in older adults, where functional limitations are burdensome and challenging. We examined 2258 community-dwelling non-smoking older adults from the Seniors-Enrica-2-cohort. At baseline (2017) and follow-up (2019) grip strength was measured with a Jamar dynamometer, lower-extremity performance with the Short Physical Performance Battery (SPPB), overall physical function using the physical component summary (PCS) of the Spanish version of the SF-12, frailty with a Deficits Accumulation Index (DAI), and mobility limitations with the Rosow-Breslau scale. Baseline exposure to SHS was assessed by serum cotinine, and past exposure was self-reported. Cross-sectional analyses were performed using linear and logistic regression models, whereas functional performance changes were examined using repeated measures models with robust SE estimates. Overall, the median (IQR) serum cotinine concentration was 0.079 (0.035-0.175) ng/ml, with 20 participants presenting concentrations ≥3 ng/ml. Compared to the unexposed, fully-adjusted models showed that the highest exposure group (≥0.239 ng/ml) presented lower grip strength (mean difference: -1.05 kg; 95% CI = -1.80, -0.31) and higher DAI scores (1.52; 95% CI = 0.38, 2.66) at baseline. Similarly, in models of self-reported past exposure, never-smokers who had lived with ≥2 smokers or been exposed to higher SHS cumulative doses showed lower baseline SPPB values, higher DAI scores, and higher prevalence of mobility limitations. In prospective analyses, those in the highest quartile of baseline cotinine presented harmful SPPB [-0.24 (-0.46, -0.02)] and DAI [1.28 (0.00, 2.55)] changes, and higher risk of mobility limitations [hazard ratio: 1.64; 95% CI = 1.01, 2.68] than the unexposed. SHS exposure over the life-course and during old age may accelerate functional decline. This manuscript provides a comprehensive examination of the relationship between secondhand smoke exposure and a broad range of functional limitations in older adults. Results show that: (i) non-smokers who had been exposed to higher cumulative doses of SHS in adulthood show worse physical function than non-exposed. (ii) Exposure to SHS during old age, as measured with cotinine concentrations, is associated with accelerated short-term functional declines. (iii) The effects of SHS are stronger among older adults with chronic morbidities. (iv) Results suggest that more efforts are needed to protect older adults from passive smoking, especially to those with chronic conditions because of their potential greater vulnerability to the effects of SHS.

The relationship between multimorbidity, obesity and functional impairment in older adults.

Declining mortality rates and an aging population have contributed to increasing rates of multimorbidity (MM) in the United States. MM is strongly associated with a decline in physical function. Obesity is an important risk factor for the development of MM, and its prevalence continues to rise. Our study aimed to evaluate the associations between obesity, MM, and rates of functional limitations in older adults. We analyzed body mass index (BMI) and self-reported comorbidity data from 7261 individuals aged ≥60 years from the National Health and Nutrition Examination Surveys 2005-2014. Weight status was defined based on standard BMI categories. MM was defined as 2 or more comorbidities, while functional limitations were self-reported. Adjusted logistic regression quantified the association between standard BMI categories and MM. We also examined the difference in the prevalence of limitations between those with and without MM. The overall proportion of individuals with concomitant MM and obesity was 27.0%. Compared to a normal BMI, older adults with obesity had higher odds of MM (Prevalence odds ratio 1.79, 95% CI 1.49, 2.12). Overall, 67.5% of patients with MM also reported a functional limitation, with rates of functional limitation increasing with increasing BMI. When evaluating functional limitations in those with MM by BMI class, 90% of patients classified as severely obese (BMI ≥40 kg/m2 ) with MM also had a concomitant functional limitation. Compared to normal weight status, obesity is associated with an increased burden of MM and functional limitation among older adults. Our results underscore the importance of identifying and addressing obesity, MM, and functional limitation patterns and the need for evidence-based interventions that address all three conditions in this population.

Roles of Social Isolation and Rurality on Functional Limitations in Older Adults Living in the US

Homebound vulnerable adults 65+ are at an increased risk for social isolation and loneliness. The adverse consequences of loneliness are profound – including increased health care utilization, burden of dementia, chronic diseases, and mortality. Meals on Wheels (MOW) is a familiar source of nutritional support for homebound individuals who wish to stay in their homes and has additional important benefits. A growing body of evidence demonstrates that MOW provides mental and social health benefits beyond nutrition, but less is known about the interplay between MOW, social cohesion, and health services use. This project will address this gap in the literature using data from the 2013-2020 National Health and Aging Trends Study (NHATS), a nationally-representative panel study of 65+ Medicare enrollees. Using matching and longitudinal multivariate techniques, the risks of hospitalization and permanent nursing home entry are compared between MOW users and non-users. Our longitudinal dataset includes 11,266 observations. Of those, 12.8% rely on MOW or other food assistance (N= 1,488) and 16.6% experience low social cohesion (N= 1,936). Some 6.6% of participants are nursing home residents (N= 748) and the 39.1% report an overnight hospital stay in the prior year (N= 4,560). MOW is a comparatively low-cost intervention to help homebound older adults retain their independence and limit costlier healthcare utilization. This work extends our understanding of MOW services beyond simple nutrition benefits to its potential impact on social health.

Dual Effects of Hearing Loss and Dementia on Functional Limitations in Older Adults

Age-related hearing loss (HL) is both common and associated with elevated risk for cognitive decline and poorer health. To care for an aging population, it is critical to understand the effect of coexisting HL and dementia on functional activities. The effect of co-existing dementia and self-reported HL on daily functioning were assessed. A cross-sectional analysis was performed using nationally-representative data from the 2015 National Health and Aging Trends Study consisting of U.S. adults 65+. The sample included 1,829 adults with HL (22.8%) and 5,338 adults without HL. Multivariable Poisson regression was used to model the independent effects and interaction of self-reported HL and dementia status on three validated functional activity scales (self-care, mobility, and household). All analyses adjusted for sociodemographic and medical factors. HL participants were more likely to be white, older, male, less educated (p <0.01). 8.4% had possible dementia and 6.5% had probable dementia. Respondents with HL or possible or probable dementia had significantly lower mobility, self-care, and household activity scores (p<.001 for all comparisons) compared to their peers. A small yet significant interaction was present in all models, suggesting that HL respondents with co-occurring dementia had lower mobility, self-care, and household activity scores than predicted by the independent effects of dementia and self-reported HL (p<.001 for all comparisons). Older adults with co-occurring dementia and HL are at increased risk for poor functioning and should be screened by healthcare providers. Future work should consider the impact of intervention in this vulnerable/at-risk population.

Black-White Disparities in Social and Behavioral Determinants of Health Index and Their Associations with Self-rated Health and Functional Limitations in Older Adults.

To characterize cumulative risk scores of social and behavioral determinants of health (SDoH) and examine their association with self-rated general health and functional limitations between non-Hispanic black and white older adults in the United States. We used data from the 2013-2014 National Health and Nutrition Examination Survey (NHANES), with a nationally representative sample of black and white adults aged 65 or older (n = 954 unweighted). We quantified the cumulative risk scores of SDoH (eg, food insecurity, education and poverty), ranging from 0 (no risk at all) to 8 (highest risk), and used multivariable-adjusted logistic and Poisson regression analyses to assess the association of SDoH by racial group with self-rated health and functional limitations, adjusting for other covariates. Black older adults had a higher mean cumulative risk score than white counterparts (2.3 ± 2.1 vs 1.5 ± 1.0; p < .001). Black older adults were more likely to report lower self-rated health than white older adults in each of SDoH domains (p < .01 for each). In multivariable-adjusted analyses, black older adults were more likely to report lower self-rated health than white older adults (p < .01 for all) regardless of SDoH risk factors. However, those with high SDoH risk factors (ie, ≥3 risk factors) were more likely to report functional limitations than those in the low-risk group (ie, <3 risk factors) in both racial groups (p < .01 for all). SDoH-related black-white disparities remain persistent in older age. In particular, SDoH index scores for black and white older adults were differentially associated with functional limitations. Addressing SDoH should be an important consideration in reducing gaps in black-white disparities of functioning.

Dietary Energy Density, Not Caloric Intake, Is Associated with Sedentary Behavior in Older US Adults

Abstract Objectives National surveillance data has demonstrated that fewer than 1 in 5 older adults meet physical activity (PA) guidelines, despite research showing that PA is associated with decreased functional limitations in older adults. Most strategies for healthy eating focus on caloric intake as opposed to overall diet quality. Energy density (ED; kcal/g) is an established indicator of diet quality as well as an established risk factor for chronic disease. Studies in children and adolescents have also demonstrated that dietary ED is associated with physical functioning, however there has been minimal research in older adults. The objective of the present study was to evaluate the association between dietary energy density and physical activity in a nationally representative sample of older adults. Methods Using data from a sample of 4484 adults &amp;gt; 60y who participated in the 2014–2016 NHANES, the association between dietary ED and physical functioning was assessed. During the NHANES, participants were asked to report whether or not they engaged in moderate PA (mPA) and report hours of sedentary behaviors. All data were analyzed using SAS 9.4 survey procedures to account for the unequal sampling probability and complex survey design of the NHANES. Results Energy-dense diets were associated with sedentary behavior and lower physical abilities in older adults. Individuals who reported engaging in mPA had a significantly lower dietary ED than those who did not engage in any mPA; this was observed in men (1.71 vs. 1.87, P = 0.03) and women (1.61 vs. 1.72, P = 0.02) after controlling for age, education, race/ethnicity, and beverage ED. Further, each unit increase in dietary energy density was associated with a 39% decrease in probability of engaging in mPA (P &amp;lt; 0.001). In contrast, there was no association between caloric intake and sedentary behavior in this population Low-ED diets were also lower in saturated fat; higher in vegetable, fiber and micronutrient content, offering additional health benefits. Conclusions These results indicate the energy density of the diet is associated with diet quality and active lifestyle behaviors. Strategies that promote low-ED diets may be effective tools in the promotion of healthy aging in the US population. Funding Sources None.

EXPLORING FUNCTION OVER TIME IN OLDER ADULTS WITH ADVANCED HEART FAILURE

Heart failure contributes to functional limitation in older adults, which is associated with rehospitalization and poorer health. However little is known about the trajectory of function after hospitalization in this population or its’ association with readmission. Objective measurement over time to assess physical function trajectory in older adults with heart failure is needed. Purpose: To explore trajectory of function in older adults with heart failure who have history of hospitalization. Methods: Exploratory longitudinal design. Bi-weekly visits were conducted over 4 months with home-dwelling, ambulatory adults with heart failure (60+ years, NYHA classification III) who had a recent acute hospitalization. Function was assessed by Short Physical Performance Battery (SPPB) test and hand-grip strength (9 time-points). Descriptive analyses across time and groups comparison were performed. Results: Participants (N=10) were 75.3±4.6 years (2 female, 5 African American), with EF(%) 39±10 and 8.2±2.9 comorbidities. Half (n=5) were re-hospitalized during the study period. Those re-hospitalized scored an average 1.3 points lower on SPPB and had 2.03 kg less hand strength over time than those not re-hospitalized. An SPPB score <6 was observed across time in 51% of those re-hospitalized, compared to 31% of those remaining at home. Intra-individual function varied but did not decline over this time period. Conclusions: In a sample of older adults with heart failure, physical function ranged from some level of functional disability to functional dependence, with higher levels of disability observed in those re-hospitalized. A longer study period and larger sample may be needed to adequately assess physical function trajectory.

Relationship Between Food Insecurity and Functional Limitations in Older Adults from 2005–2014 NHANES

Background: Food insecurity refers to the physical, social, and economic inability to access and secure sufficient, safe and nutritious food. Food insecurity has been found to be associated with poor health status, obesity, and chronic disease. To date, a relationship between food insecurity and functional limitations has not been described in of older adults.Methods: We examined 9309 adults ≥60 years old from the 2005–2014 National Health and Nutrition Examination Surveys (NHANES). Food security was categorized as full, marginal, low, and very low. Functional limitations were assessed as having difficulty in physical, basic or instrumental activities of daily living.Results: Of adults ≥60 years old (mean age: 70.5 ± 0.08, 51% female), the prevalence of full, marginal, low, or very low food insecurity was 7572 (81%), 717 (7%), 667 (8%), and 353 (4%), respectively. The prevalence of any functional limitations was 5895 (66.3%). The adjusted odds (OR [95%CI]) of having any functional limitation in marginal, low, and very low food security levels compared to full food security are: 1.08 [1.02–1.13], 1.16 [1.10–1.22], 1.14 [1.07–1.21], respectively. The association between levels of food insecurity and functional limitation is modified by race/ethnicity.Conclusions: Functional limitation is significantly associated with increasing food insecurity in older adults.

Moderating effect of depression on the association between pain and activities of daily living in older adults.

Maintaining older adults' ability to function independently in the community is a critically important public health concern. One of the most common symptoms threatening that ability is pain. Depression is a common co-occurring symptom in older adults with pain. In the present study, we determined the moderating effect of depression on the association between pain and functional limitations. Data were from the Healthy Aging Longitudinal Study in Taiwan, a population-based study of community-dwelling older adults in Taiwan (N = 2680). All data were collected by face-to-face interviews. Sociodemographic and health-related factors along with the location and severity of pain were collected. Functional limitation was assessed using the Barthel Index of Activities of Daily Living, whereas depression was assessed using the Center for Epidemiologic Studies Depression Scale. Pain presence was not significantly associated with functional limitation, but overall pain severity and number of pain sites were. Depressive older adults exhibited a stronger association of pain and functional limitation. Depression moderates the relation between pain and functional limitation. This knowledge may be valuable in developing effective public health and clinical management strategies to reduce functional limitation in older adults.

Food insecurity, comorbidity, and mobility limitations among older U.S. adults: Findings from the Health and Retirement Study and Health Care and Nutrition Study

Both food insecurity and comorbidity have been identified as precursors to functional limitation in older adults, yet whether food insecurity modifies the progression from chronic disease to disability has not been assessed. We examined 5986 respondents age 50 and older drawn from the 2012–2014 Health and Retirement Study (HRS) and 2013 Health Care and Nutrition Study (HCNS). Mobility limitations reported in 2014 and change in mobility limitations from 2012 to 2014 were regressed on measures of food insecurity, number of chronic conditions, and their interaction terms using Poisson regression. Around 17.3% of the sample was identified as food insecure. In 2012, respondents reported an average of 1.9 (SD = 1.5) chronic conditions and 2.4 mobility limitations (SD = 3.0). In 2014, individuals reported an average of 2.5 (SD = 3.1) mobility limitations. Food insecurity was associated with a greater number of mobility limitations (IRR = 1.20, 95% CI: 1.11–1.29, p < .001) and more rapid increase in mobility limitations over the two-year observational period (IRR = 1.06, 95% CI: 1.00–1.11, p = .047). Food security status also modified the association between comorbidity and both mobility limitation outcomes, with the food secure exhibiting a stronger positive association between chronic conditions and mobility limitations than the food insecure. The food insecure tended to have more mobility limitations than the food secure when few chronic conditions were reported. Our results suggest that food insecurity is associated with prevalence and change in mobility limitations among older adults.

Family ties and functional limitation in the elderly: Results from the Survey of Health Ageing and Retirement in Europe (SHARE)

ObjectivesTo examine if family ties are strong predictors of functional limitation in older adults in Europe. MethodsCross sectional data were used and included 14 European countries from the second wave (w2) of the survey on Health, Ageing, and Retirement in Europe. 13,974 adults aged 50+ (45.2% males and 54.8%females) were included in the study. Functional limitation was assessed using activities of daily living (ADL), instrumental activities of daily living (i-ADL) and mobility sensory index. Family ties were based on a customized model of family structural aspects. Multiple logistic regression analyses were used to examine the risk of functional limitations. ResultsFunctional limitation was associated with females, age, self-rated health, and an increased number of chronic conditions, disease symptoms and depressive symptoms but not with few family ties. After controlling for potential confounders, respondents with lower family contacts showed higher risk for functional limitation. Southern and Mediterranean countries have both closer family ties and adults with higher functional limitation. ConclusionFunctional limitation is associated with biological and demographic factors as well as little contact with family members. Further longitudinal research is required in order to determine the association and the causal relationship between functional limitation and family ties.

0702 Sleep Health and Risk of Prevalent and Incident Functional Limitations in Older Adults

0702 Sleep Health and Risk of Prevalent and Incident Functional Limitations in Older Adults

Housing conditions and risk of physical function limitations: a prospective study of community-dwelling older adults.

Poor housing conditions have been associated with an increased risk of morbidity and mortality in old age. Prospective cohort of 1602 older adults followed from 2012 to 2015. Poor conditions were defined as living in a walk-up building, lacking piped hot water or heating, feeling frequently cold at home, lacking a bathtub/shower, a refrigerator, a washing machine, an own room or a landline. Frailty was assessed with the Fried criteria, lower extremities performance with the Short Physical Performance Battery (SPPB), and disability in instrumental activities of daily living (IADL) with the Lawton and Brody questionnaire. During follow-up, 55 individuals (4.2%) developed frailty and 107 (7.2%) IADL disability. Mean (SD) SPPB values at baseline and at follow-up were 8.5 (2.5) and 8.6 (2.4), respectively. After multivariate adjustment, participants who lived in homes with ≥1 poor conditions showed a higher risk of frailty (odds ratio [OR] = 2.02; 95% confidence interval [95% CI]: 1.09-3.75) and transportation disability (OR = 3.50; 95% CI: 1.38-8.88). Lacking heating and feeling frequently cold were associated with an increased risk of exhaustion (OR = 2.34; 95% CI: 1.00-5.48) and transportation disability (OR = 3.31; 95% CI: 1.07-10.2), respectively. Prevention programs targeting functional limitations in older adults should ensure that they live in suitable housing conditions.

Muscle weakness and functional limitations in an ethnically diverse sample of older adults

ABSTRACTObjectives: Muscle weakness is often linked to functional limitations in older adults. However, certain demographic characteristics, such as ethnicity, may differentially impact the association between weakness and functional limitations. This investigation sought to (1) identify sex- and ethnically-specific muscle weakness thresholds associated with functional limitations among older adults, and (2) determine the odds of functional limitations for each ethnicity by sex after identifying older adults below the weakness thresholds.Design: Persons aged ≥60 years from the 2011–2012 to 2013–2014 waves of the National Health and Nutrition Examination Survey identifying as non-Hispanic white, non-Hispanic black, Hispanic, or non-Hispanic Asian were included. Handgrip strength was normalized to each participant's body weight (normalized grip strength (NGS)). Participants responded to 19-items asking them about their ability to perform certain activities of daily living, instrumental activities of daily living, leisure and social activities, lower extremity mobility functions, and general physical activities. Receiver operating characteristic curves identified the optimal NGS thresholds associated with functional limitations. Covariate-adjusted multiple logistic regression models were performed to determine the odds of functional limitations for weak vs. not-weak participants.Results: Of the 3,027 participants, the highest NGS thresholds for functional limitations were in non-Hispanic Asian males (0.41; p < 0.001) and Hispanic females (0.36; p < 0.001); whereas, the lowest NGS thresholds were in Hispanic males (0.25; p < 0.001) and non-Hispanic black females (0.23; p < 0.001). Weak non-Hispanic Asian males (odds ratio (OR): 10.42; 95% confidence interval (CI): 10.24, 10.61) and females (OR: 11.95; CI: 11.71, 12.19) had the highest odds for functional limitations compared to their non-weak counterparts.Conclusion: Preserving muscle strength, especially for certain older adult populations, may help reduce the odds of developing functional limitations. Interventions designed to increase muscle strength to preserve or improve function should consider the role of ethnicity when designing such interventions and identifying at risk populations.