Incident Activities Of Daily Living Disability Research Articles

Physical performance and negative events in very old adults: a longitudinal study examining the ilSIRENTE cohort

BackgroundDeclining physical performance in old age is associated with a wide range of negative health-related outcomes. However, it is unclear which physical capabilities should be prioritized to obtain prognostic information in older adults.AimsTo examine the associations between the performance on several physical function tests and falls, disability, and death in a well-characterized sample of very old Italian adults.MethodsThis was a prospective cohort study of older adults who lived in the mountain community of the Sirente geographic area in Central Italy. Physical performance was assessed using isometric handgrip strength (IHG), walking speed (WS) at a usual and fast pace, 5-time sit-to-stand test (5STS), and sit-to-stand power measures. Appendicular skeletal muscle mass was estimated from calf circumference using a validated equation. History of falls, incident falls, and disability status according to basic Activities of Daily Living (ADLs) were recorded over two years. Survival status was obtained from the participants’ general practitioners and was confirmed by the National Death Registry over 10 years from enrolment. Linear, binary, and Cox regressions were performed to evaluate the association between physical performance measures and health outcomes.ResultsThe mean age of the 255 participants was 84.2 ± 5.1 years, and 161 (63.1%) were women.Logistic regression indicated that IHG was significantly associated with incident ADL disability, whereas specific sit-to-stand muscle power was an independent predictor of death. No significant associations were observed between physical function and falls.ConclusionsOur findings indicate selective associations between physical function tests and the occurrence of negative events in very old adults, with poor IHG predicting disability and specific sit-to-stand muscle power being longitudinally associated with death.

The association of dietary antioxidants and the inflammatory potential of the diet with poor physical function and disability in older Australian men: the Concord Health and Ageing in Men Project.

Our objective was to evaluate the association of antioxidant intake and the inflammatory potential of the diet with functional decline in older men. A diet history questionnaire was used to collect dietary intake data from men aged ≥ 75 years (n 794) participating in the Concord Health and Aging in Men Project cohort study. Intake of vitamins A, C, E and Zn were compared with the Australian Nutrient Reference Values to determine adequacy. The Energy-adjusted Dietary Inflammatory Index (E-DIITM) was used to assess the inflammatory potential of the diet. Physical performance data were collected via handgrip strength and walking speed tests, and activities of daily living (ADL) and instrumental activities of daily living (IADL) questionnaires, at baseline and 3-year follow-up (n 616). Logistic regression analysis was used to identify associations between diet and incident poor physical function and disability. Both poor antioxidant intake and high E-DII scores at baseline were significantly associated with poor grip strength and ADL disability at 3-year follow-up. No significant associations with walking speed or IADL disability were observed. Individual micronutrient analysis revealed a significant association between the lowest two quartiles of vitamin C intake and poor grip strength. The lowest quartiles of intake for vitamins A, C, E and Zn were significantly associated with incident ADL disability. The study observed that poor antioxidant and anti-inflammatory food intake were associated with odds of developing disability and declining muscle strength in older men. Further interventional research is necessary to clarify the causality of these associations.

SOCIAL PARTICIPATION AND DEPRESSIVE SYMPTOMS ON THE RELATIONSHIP BETWEEN COGNITIVE FRAILTY AND DISABILITY

Abstract To explore the multiple mediating effects of social participation and depressive symptoms on the relationship between cognitive frailty and functional disability. A total of 6122 participants from four waves of the China Health and Retirement Longitudinal Study (CHARLS) were included. Functional status was assessed by activities of daily living (ADL) and instrumental ADL (IADL). Analyses were restricted to middle-aged and older adults free of functional disability at baseline. Competing-risks regression and multiple mediation effects analysis adjusted for covariates were conducted. Cognitive frailty (hazard ratio [HR] 1.27, 95% confidence interval [CI] 1.09, 1.48), social participation (HR 0.87, 95%CI 0.79, 0.97), and depressive symptoms (HR 1.75, 95%CI 1.56, 1.95) were associated with the incidence of ADL disability. These factors were also found to predict the occurrence of IADL disability. Cognitive frailty was found to be associated with ADL disability, not only through the pathways of social participation (β = 0.009, 95% CI 0.001, 0.018) and depressive symptoms (β = 0.094, 95% CI 0.062, 0.131) separately, but also through social participation and depressive symptoms sequentially (β = 0.002, 95% CI 0.001, 0.003). Similar findings were also observed for the outcome of IADL disability. Cognitive frailty has been associated with functional disability, wherein social participation and depressive symptoms partially mediate the association. To prevent functional disability, it’s suggested to implement integrated and comprehensive intervention measures, including preventing and managing cognitive frailty, promoting social participation, and improving depressive symptoms.

Association between postural tremor and risk of disability in community-dwelling older people.

The prevalence of postural tremor increases with age and the tremor has been found to be associated with aging-related physiological decline. However, whether postural tremor in older adults is associated with adverse outcomes such as disability is unclear. This study investigated the association between postural tremor and the risk of disability in activities of daily living (ADL) among community-dwelling older people. Data were derived from a population-based study of Chinese adults aged ≥55 years. Postural tremor was assessed at baseline using a two-step method (i.e., tremor screening followed by examination of positive cases). ADL disability was determined using an 8-item questionnaire, which covered the mobility and self-care domains of ADL. Participants free of ADL disability at baseline were followed for up to 4 years. The prospective analyses included 5868 participants. Participants with postural tremor were at greater risk of incident ADL disability, particularly disability in the mobility domain of ADL. After multivariate adjustment, postural tremor was not significantly associated with incident ADL disability (multivariate-adjusted relative risk [RR]=1.05, 95% confidence interval [CI]=0.77-1.43), and was marginally associated with incident disability in the mobility domain of ADL (multivariate-adjusted RR=1.36, 95% CI=0.98-1.88). The risk of mobility-related ADL disability was significantly increased among men, but not women, with postural tremor (multivariate-adjusted RR=1.84, 95% CI=1.11-3.05). Older age and an increased number of chronic comorbidities mainly explained the higher risk of ADL disability in older people with postural tremor. Postural tremor in older adults is associated with greater incidence of ADL disability, particularly mobility-related ADL disability. The association is largely due to older age and a higher prevalence of chronic comorbidities in older people with postural tremor. Postural tremor is not a strong independent predictor of ADL disability in older people.

Associations of source-specific PM2.5 and incident disability in older U.S. adults: the Health Retirement Study

Keywords: Air Pollution, emission sources, Activities of Daily Living, PM2.5 Background and Aims: Late-life disability is a common endpoint of the chronic health conditions that affect people as they age. Although fine particulate matter (PM2.5) is associated with chronic conditions that contribute to disability, associations with disability itself are understudied, and the most toxic emission sources have yet to be identified. We evaluated the association between long-term exposure to PM2.5 from specific emission sources and disability. Methods: We used biennial survey data between 2006 and 2016 on Activities of Daily Living (ADL) from participants >65 years of the Health and Retirement Study. Using a spatiotemporal prediction model, we estimated 10-year PM2.5 concentrations at participants' residences and multiplied these values by spatially-resolved fractions of PM2.5 from sources including agriculture, energy production, industry, transportation, fires, and windblown dust, derived from a chemical transport model. We used Cox models to estimate the risk of incident ADL disability per 1-µg/m³ source-specific PM2.5, adjusting for individual- and area-level confounders, time, geography, and sampling weights. Results: Among 11,782 adults (72±6.8 years), 37% reported a new disability during follow-up. Overall, both total PM2.5 and source-specific PM2.5 were associated with increased incident of ADL disability. A 1-µg/m³ increment in total PM2.5 corresponded to a 2% (95% CI: 1.00, 1.04) greater hazard of ADL. In single-sector models, PM2.5 from each source was also positively associated with incident ADL. After adjusting for PM2.5 from other sources, associations with agriculture, non-road and road transportation, non-coal energy production, and windblown dust PM2.5 remained, whereas no associations were observed for the other sources. Conclusions: We found evidence that higher levels of PM2.5 from some but not all sources were associated with increased risk of disability, suggesting that selective interventions could be effective at improving health and function in late-life.

Motoric cognitive risk syndrome as a predictor of incident disability: A 7 year follow-up study.

BackgroundThough motoric cognitive risk syndrome (MCR) share risk factors with disability, whether it predict disability remains understudied.ObjectivesThis study aims to examine the association between MCR and incident disability.DesignLongitudinal study.MethodsMCR was defined as subjective cognitive complaints and objective slow gait speed. Two subtypes of MCR were defined by whether memory impairment (MI) was also present, MCR-MI and MCR-non-MI. Incident activities of daily living (ADL) disability and instrumental activities of daily living (IADL) disability were outcome measures. Multiple logistic regression analysis was used to assess the independent effect of MCR at baseline on the odds of ADL/IADL disability at a 7 year follow-up.ResultsAmong the subjects who were not disabled at baseline and followed for 7 years, 34.66% reported incident ADL disability, and 31.64% reported incident IADL disability. Compared with participants without MCR at baseline, those with MCR had 58% increased odds of incident ADL disability (OR=1.58, 95% CI: 1.19–2.09) and 46% increased odds of incident IADL disability (OR=1.46, 95% CI: 1.13–1.88) after 7 years. MCR-non-MI was associated with a 56.63% increased risk of ADL disability and a 34.73% increased risk of IADL disability. MCR-MI was associated with an even higher risk of IADL disability (OR = 2.14, 95% CI: 1.18–3.88).ConclusionsMCR is an independent risk factor for both incident ADL and IADL disability. MCR-MI predicts a higher risk for disability than MCR-non-MI. Early identification of MCR among older adult is recommended and may decrease future risk of disability.

Association Between Mediterranean Diet and Functional Status in Older Adults: A Longitudinal Study Based on the Washington Heights-Inwood Columbia Aging Project.

Current evidence on the association between Mediterranean diet (MeDi) intake and activities of daily living (ADL) is limited and inconsistent in older adults. This study included 1 696 participants aged ≥65 years in the Washington Heights-Inwood Community Aging Project study. The MeDi score was calculated based on data collected from the Willett's semiquantitative food frequency questionnaire. The multivariable-adjusted Cox regression model was applied to examine the association of MeDi score with risks of disability in basic (BADL) and instrumental ADL (IADL), as well as the overall ADL (B-IADL). Eight hundred and thirty-two participants with incident ADL disability were identified over a median follow-up of 5.39 years. The continuous MeDi score was significantly associated with decreased risk of disability in B-IADL (hazard ratio = 0.95, 95% confidence interval = 0.91-0.99, p = .018) in a model adjusted for age, sex, race/ethnicity, educational level, and dietary calories intake but was no longer significant after additionally adjusted for multiple comorbidities and physical activities (0.97 [0.93, 1.01], p = .121). The continuous MeDi score was significantly associated with decreased risk of disability in B-IADL (0.92 [0.85, 1.00], p = .043) and BADL (0.90 [0.82, 0.99], p = .030) in non-Hispanic Whites, but not in non-Hispanic Blacks and Hispanics (p > .05 for all). Higher MeDi score was associated with decreased risk of ADL disability, particularly in non-Hispanic Whites.

Intrinsic Capacity vs. Multimorbidity: A Function-Centered Construct Predicts Disability Better Than a Disease-Based Approach in a Community-Dwelling Older Population Cohort.

Objective: This study aimed to assess the status of intrinsic capacity (IC)—a novel function-centered construct proposed by the WHO and examine whether impairment in IC predicts subsequent 1-year activities of daily living (ADL) disability better than a disease-based approach, i. e., multimorbidity status.Methods: This study included data of community-dwelling older adults from the Beijing Longitudinal Study on Aging II aged 65 years or older who were followed up at 1 year. Multivariate logistic regressions were performed to estimate the odds of ADL disability at baseline and 1-year follow-up.Results: A total of 7,298 older participants aged 65 years or older were included in the current study. About 4,742 older adults were followed up at 1 year. At baseline, subjects with a higher impairment in IC domains showed higher odds of ADL disability [adj. odds ratio (OR) = 9.51 for impairment in ≥3 domains, area under the curve (AUC) = 0.751] compared to much lower odds of ADL disability in subjects with a higher number (≥3) of chronic diseases (adj. OR 3.92, AUC = 0.712). At 1-year follow-up, the overall incidence of ADL disability increased with the impairment in IC domains higher than the increase in multimorbidity status. A higher impairment in IC domains showed higher odds of incidence ADL disability for impairment in 2 or ≥3 IC domains (adj. OR 2.32 for impairment in ≥3 domains, adj. OR 1.43 for impairment in two domains, AUC = 0.685). Only subjects who had ≥3 chronic diseases had higher odds of 1-year incident ADL disability (adj. OR 1.73, AUC = 0.681) that was statistically significant.Conclusion: Our results imply that a function-centered construct could have higher predictability of disability compared to the multimorbidity status in community older people. Our results need to be confirmed by studies with longer follow-up.

Associations of Long-term Air Pollution Exposure and Incident Late-Life Disability in Older U.S. Adults: The Health Retirement Study

BACKGROUND AND AIM: Late-life disability is of critical concern to older adults and can reflect the cumulative burden of chronic disease over the lifespan. Although air pollution has been associated with many common chronic conditions, associations with disability are understudied. We aimed to quantify associations between long-term exposures to air pollution and late-life disability. METHODS: We used biennial data between 2000 and 2016 on self-reported Activities of Daily Living (ADL) from participants 65 years from the nationally representative Health and Retirement Study. Using a spatiotemporal prediction model, we estimated 10-year PM2.5, PM10-2.5, NO2, and O3 concentrations at participant residences. We then estimated the risk of incident ADL disability as a function of time-varying air pollution, adjusting for individual and area-level confounders and sampling weights in a Cox model. We fitted single- and two-pollutant models. RESULTS:Our study population of 16,927 adults (70+6.4 years) was predominantly non-Hispanic White (76%), Non-Hispanic Black (14%), and Hispanic White (8%) and 32% reported a new disability during follow-up. Overall, we found some evidence that air pollution was associated with an increased risk of ADL disability. After adjustment for place and PM2.5, we found that interquartile increases in PM10-2.5 and NO2 were associated with 8% (HR: 1.08 per 5 µg/m3, 95% CI: 1.01, 1.17) and 9% (HR: 1.09 per 6 ppb, 95% CI: 1.00, 1.19) greater hazards of ADL, respectively, with similar findings in the single pollutant models. PM2.5 and O3 were not associated with higher hazards of ADL in single or multipollutant models after detailed adjustment for place. CONCLUSIONS:This prospective study in a nationally representative sample of older adults found some evidence that higher levels of some but not all long-term air pollutants assessed are associated with increased risk of late-life disability. KEYWORDS: Air Pollution, Long-Term Exposure, Activities of Daily Living

Cognitive frailty predicting death and disability in Chinese elderly

ABSTRACT Objective: Although multiple sclerosis (MS) is known to be an immune-mediated disease, very little is known about its etiopathogenesis. MicroRNAs (miRNAs) are small non-coding proteins involved in the regulation of gene expression. T-cell activation potential in neurodegenerative diseases has been a research topic of interest in recent years Cytokines play an important role in the course and pathogenesis of MS, The aim of the present study was to analyze expression levels of miR-20, miR-21, miR-26, miR-155, and Let-7, which target the cytokines interleukin IL-17 and IL-23, in order to evaluate the relationship between MS and miRNAs that modulate the expression of cytokines involved in the autoimmune pathway. Methods:The study included 20 relapsing-remitting multiple sclerosis (MS) patients who were at least 18 years of age and were undergoing outpatient immunomodulatory therapy and 20 healthy, unrelated individuals who had no systemic disease and were not taking any medication as a control group. Peripheral blood samples were collected from all participants into EDTA-containing tubes and plasma was isolated for cDNA synthesis . From these cDNA samples, miRNA expression levels were quantitatively analyzed via melting curve analysis using the miScript SYBR Green kit in real-time PCR device. Results: Comparison of miRNA expression levels in the peripheral blood samples and MS patients and healthy subjects revealed that the MS patients had significant upregulation of miR-20 and downregulation of miR-26 and miR-155 compared to the control group (p<0.005). Conclusions:Dysregulation of miRNA expression may play a role in the pathogenesis of MS.

Metabolic syndrome predicts incident disability and functional decline among Chinese older adults: results from the China Health and Retirement Longitudinal Study.

To investigate the longitudinal association of metabolic syndrome (MetS) and its components with disability outcomes. A total of 5875 participants aged 60 and above completed the 2011 and 2015 waves of the China Health and Retirement Longitudinal Study (CHARLS). MetS at baseline was measured by the National Cholesterol Education Program Adult Treatment Panel III criteria. Logistic regressions were conducted to analyze the associations between baseline MetS and incident disability, measured as the onset of limitations regarding instrumental activities of daily living (IADL) and activities of daily living (ADL) 4years later. Linear regression was adopted to analyze the longitudinal impact of baseline MetS on the number of IADL and ADL limitations in 2015. A comprehensive list of baseline covariates was adjusted in all regression analyses. Baseline MetS was related to increased odds of incident IADL disability (OR = 1.28, 95% CI 1.05-1.55) and incident ADL disability (OR = 1.27, 95% CI 1.05-1.53) among disability-free participants at baseline. Baseline MetS was also associated with an increase in the number of IADL (beta = 0.15, 95% CI 0.07-0.23) and ADL limitations (beta = 0.10, 95% CI 0.01-0.18), while adjusting for baseline functional performance. Significant MetS component predictors of disability outcomes include abdominal obesity, high blood pressure, and a low level of high-density lipoprotein cholesterol. Our findings suggest an increased risk of incident disability and deteriorated functional performance over 4years, associated with the presence of MetS and its components.

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

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

Association Between Plasma 25-hydroxyvitamin D Concentrations and Incident Activities of Daily Living Disability: A Longitudinal Community-Based Cohort Study

ObjectivesA few studies of Western populations have found inconsistent results regarding the associations between vitamin D status and physical function. We explored the association between circulating vitamin D status [plasma 25-hydroxyvitamin D, 25(OH)D] and incident activities of daily living (ADL) disability among Chinese older adults. DesignCommunity-based longitudinal cohort study. Setting and ParticipantsA total of 2453 men and women (median age 84.0 years) in 7 Chinese longevity areas were included. MeasuresCox proportional hazards regression models were used to estimate hazard ratios (HRs) with 95% confidence intervals (CIs) for incident ADL, with adjustments for potential sociodemographic, and lifestyle confounders and biomarkers. Because there was a statistically significant interaction between plasma 25(OH)D and sex in relation to incident ADL, men and women were analyzed separately. ResultsThe median concentrations of plasma 25(OH)D were 46.6 nmol/L and 36.4 nmol/L for men and women, respectively. Compared with the lowest quartile in the fully adjusted model, the HR for incident ADL disability for the highest quartile was 0.55 (95% CI 0.36–0.85) for women; for men, a null association was indicated (HRhighest vs lowest 0.61, 95% CI 0.37–1.00). However, when using the recommended circulating 25(OH)D thresholds by the US Institute of Medicine, those with vitamin D sufficiency (≥50 nmol/L) had better ADL disability prognoses than those with vitamin D deficiency (<30 nmol/L) in both sexes (men HR 0.45, 95% CI 0.28–0.72; women HR 0.58, 95% CI 0.37–0.90). Conclusions and ImplicationsThe relationship between plasma 25(OH)D concentration and incident ADL disability was sex-specific among Chinese older adults. However, participants with recommended vitamin D sufficiency may have better disability prognoses in both sexes, suggesting that the recommended 25(OH)D concentration for bone health may extend to functional outcomes such as ADL disability in Chinese older adults.

Incidence Rates of Disability and Its Associated Factors among Korean Community-Dwelling Older Adults.

Background:We aimed to identify incidence rates of disability and its associated factors among Korean community-dwelling older adults.Methods:The sample included 1,739 Koreans aged over 65 yr from the Korean Longitudinal Study of Aging (2006–2016) who reported no limitations in activities of daily living (ADL) or instrumental activities of daily living (IADL) at baseline (2006) and had complete data for other covariates. ADL, IADL, socio-demographic, lifestyle, and health-condition data were collected and analyzed using multiple logistic regression models.Results:The 10-yr incidence rates of ADL and IADL disability in subjects with no disability at baseline were 11.6% and 21.6%, respectively. After adjusting for socio-demographic, lifestyle, and health-condition factors, the incidence of ADL disability was higher in women (odds ratio [OR] =1.418, 95% confidence interval [CI]=1.102–2.613) and increased with age (OR=1.170, 95% CI=1.133–1.208), multi-morbidity (OR=1.194, 95% CI=1.015–1.406), and obesity (OR=1.563, 95% CI=1.057–2.311). It decreased in subjects living alone (OR=0.531, 95% CI=0.328–0.856). The incidence of IADL disability increased with age (OR=1.131, 95% CI=1.102–1.161), multi-morbidity (OR=1.199, 95% CI=1.054–1.365), and cognitive disability (OR=1.422, 95% CI=1.083–1.866) and decreased for subjects living alone (OR=0.484, 95% CI=0.328–0.715) and with overweight (OR=0.725, 95% CI=0.532–0.988).Conclusion:Incidence rates of disability differed considerably based on socio-demographic, lifestyle, and health-condition factors. These results suggest the importance of identifying factors that can decrease the risk of disability in this group and of prevention efforts in populations with a higher disability risk.

Exercise type and activities of daily living disability in older women: An 8-year population-based cohort study.

Exercise may reduce the risk of disability for activities of daily living (ADL), but the degree of associations between specific exercise types and such a risk remains unclear. This study aimed to examine the longitudinal associations between exercise types and the incidence of ADL disability in older women. This 8-year population-based prospective cohort study enrolled 1003 community-dwelling older Japanese women without ADL disability in the baseline surveys. In the baseline surveys, all participants were asked whether or not they participated in any of 16 exercise types through a face-to-face interview. ADL were assessed using a modified form of the Katz index that comprised five ADL tasks. ADL disability was defined as dependence in at least one ADL task during the 8-year follow-up period. Binary logistic regression analyses were applied to obtain adjusted odds ratios (ORs) and 95% confident intervals (CIs) for the incidence of ADL disability based on participation or non-participation in each exercise type. Activities of daily living disability was noted in 130 participants (13.0%) over the 8-year follow-up period. After adjustment for confounders and other exercise types, participation in dancing, compared to non-participation, was associated with a significantly lower OR (0.27; 95% CI: 0.09-0.75) for incident ADL disability. There were no significant associations between other exercise types and incident ADL disability. Dancing was significantly and independently associated with a lower incidence of ADL disability. Thus, dancing may solely contribute to a reduced risk of ADL disability in older women.

Associations of Hearing Loss and Depressive Symptoms With Incident Disability in Older Adults: Health, Aging, and Body Composition Study.

Depressive symptoms and hearing loss (HL) are independently associated with increased risk of incident disability; whether the increased risk is additive is unclear. Cox Proportional Hazards models were used to assess joint associations of HL (normal, mild, moderate/severe) and late-life depressive symptoms (defined by a score of ≥8 on the 10-item Center for Epidemiologic Studies-Depression scale) with onset of mobility disability (a lot of difficulty or inability to walk ¼ mile and/or climb 10 steps) and any disability in activities of daily living (ADL), among 2,196 participants of the Health, Aging and Body Composition Study, a cohort of well-functioning older adults aged 70-79 years. Models were adjusted for age, race, sex, education, diabetes, hypertension, and body mass index. Relative to participants with normal hearing and without depressive symptoms, participants without depressive symptoms who had mild or moderate/severe HL had increased risk of incident mobility and ADL disability (hazard ratio [HR] for mobility disability, mild HL:1.34, 95% confidence interval [CI]: 1.09, 1.64 and HR for mobility disability, moderate/severe HL: 1.37, 95% CI: 1.08, 1.75 and HR for ADL disability, mild HL: 1.32, 95% CI: 1.08, 1.63, and HR for ADL disability, moderate/severe HL: 1.42, 95% CI: 1.11, 1.82). Among participants with depressive symptoms, mild HL (HR: 1.71, 95% CI: 1.09, 2.70) was associated with increased risk of incident mobility disability. Independent of depressive symptoms, risk of incident disability was greater in older adults with HL, regardless of severity. Further research into HL interventions may delay disability onset.

Combined Effect of Dynapenia (Muscle Weakness) and Low Vitamin D Status on Incident Disability

Background and objectiveThere is little epidemiologic evidence considering the combined effect of dynapenia and low 25-hydroxyvitamin D [25 (OH) D] on incident disability. Our aim was to investigate whether the combination of dynapenia and low 25 (OH) D serum levels increases the risk of activities of daily living (ADL) incident disability. DesignProspective cohort study. SettingsEnglish Longitudinal Study of Aging. ParticipantsA total of 4630 community-dwelling adults aged 50 years and older without ADL disability at baseline. MeasurementsThe baseline sample was categorized into 4 groups (ie, nondynapenic/normal 25 (OH) D, low 25 (OH) D only, dynapenic only, and dynapenic/low 25 (OH) D according to their handgrip strength (<26 kg for men and <16 kg for women) and 25 (OH) D (≤50 nmol/L). The outcome was the presence of any ADL disability 2 years after baseline according to the modified Katz Index. Incidence rate ratios (IRRs) adjusted by sociodemographic, behavioral, and clinical characteristics were estimated using Poisson regression. ResultsThe fully adjusted model showed that older adults with dynapenia only and those with lower serum levels of 25 (OH) D combined with dynapenia had higher incident ADL disability risk compared with nondynapenic and those with normal serum levels of 25 (OH) D. The IRRs for lower 25 (OH) D serum levels combined with dynapenia were higher than for dynapenia only, however, the confidence intervals (CIs) showed similar effect for these 2 groups. The IRRs were 1.31 for low 25(OH) D only (95% CI 0.99–1.74), 1.77 for dynapenia only (95% CI 1.08–2.88), and 1.94 for combined dynapenia and low 25(OH)D (95% CI 1.28–2.94). ConclusionsDynapenia only and dynapenia combined with low 25 (OH) D serum levels were important risk factors for ADL disability in middle-aged individuals and older adults in 2 years of follow-up.

Frailty and cognitive status evaluation can better predict mortality in older adults?

Objectivesto evaluate the improvement in one-year mortality prediction after adding a 2-min cognitive screening to a simple 1-min frailty detection instrument. Secondary outcomes were new activities of daily living (ADL) disability and falls. DesignProspective cohort study. SettingA geriatric day-hospital for intermediate care. ParticipantsA total of 701 older adults with an acute or decompensated disease (79.5 (8.3) years, 64% female). MeasurementsA rapid and simple frailty evaluation was performed using the FRAIL questionnaire. The presence of cognitive impairment was defined by previous diagnosis of dementia or a score of five or less on an education-corrected 10-point cognitive screening tool. ResultsFrail participants with normal (hazard risk [HR] 4.0, 95% confidence interval [CI], 1.73–9.25) and impaired cognition had a higher risk of death (HR 4.38, 95% CI, 1.95–9.87) than robust participants. The presence of cognitive impairment increased the risk of death in prefrail (HR 3.60, 95% CI, 1.55–8.34) and robust participants (HR 3.49, 95% CI, 1.22–9.96). Cognitive impairment was associated with an increased risk of incident ADL disability in all frailty categories. The presence of cognitive impairment was associated with a significantly higher risk of fall in robust seniors. The predictive accuracy of the FRAIL scale was lower than expected (between 0.58 and 0.69), and a small improvement was observed after adding the cognitive screening (between 0.61 and 0.72). ConclusionDespite of significant results in predicting relevant clinical events, the present combination of the FRAIL and 10-CS scales may not be ideal in clinical practice.

Age, Race, and Gender Factors in Incident Disability.

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

Body Mass Index and Waist Circumference as Predictors of Disability in Nonagenarians: The Vitality 90+ Study.

Only scarce data exist on the association between obesity and disability in the oldest old. The purpose of this prospective study is to examine if body mass index and waist circumference (WC) are associated with incident mobility and activities of daily living (ADL) disability in nonagenarians. We used longitudinal data from the Vitality 90+ Study, which is a population-based study conducted at the area of Tampere, Finland. Altogether 291 women and 134 men, aged 90-91 years, had measured data on body mass index and/or WC and did not have self-reported mobility or ADL disability at baseline. Incident mobility and ADL disability was followed-up on median 3.6 years (range 0.6-7.8 years). Mortality was also followed-up. Multinomial logistic regression models were used for the analyses, as death was treated as an alternative outcome. The follow-up time was taken into account in the analyses. Neither low or high body mass index, nor low or high WC, were associated with incident mobility disability. In women, the lowest WC tertile (<82 cm) was associated with an increased probability of incident ADL disability when compared to the middle WC tertile (odds ratio 3.98, 95% CI 1.35-11.77). Obesity is not associated with incident mobility or ADL disability in nonagenarians. Instead, low WC is associated with an increased risk of developing ADL disability in nonagenarian women.