Increase In Functional Limitations Research Articles

Social connectedness, functional capacity, and longevity: A focus on positive relations with others

RationaleA large literature links social connectedness to health, but there is growing recognition of considerable nuance in the ways social connectedness is defined, assessed, and associated with health. ObjectiveThis study centers on positive relations with others – a measure derived from philosophical notions of the components of a “good life” – and the extent to which it predicts functional limitations and mortality using data from the national, longitudinal Mid-Life in the United States (MIDUS) study. We also assess whether these associations are independent of two common measures of social connectedness: social integration and social support. MethodsData on social connectedness came from the first wave of MIDUS (1994–1996), self-reported functional limitations were from the first (MIDUS 1) and third (MIDUS 3; 2013–2014) waves, and mortality data through 2022 were obtained from the National Death Index. ResultsLinear regression analyses showed that higher scores on positive relations with others predicted significantly less increase in functional limitations over time, and logistic regression models showed reduced probability of onset of functional limitations between MIDUS 1 and MIDUS 3 in those scoring higher on positive relations with others. Mortality was also significantly lower in those with higher scores on positive relations with others. All models adjusted for demographic and health characteristics, and all associations were robust to the inclusion of social integration and social support in the models. ConclusionsThese results show that positive relations with others, a component of a well-lived life that describes sustained investment in social relationships that are mutual and trusting, is associated with two key health outcomes in aging adults: functional limitations and longevity. That these associations are independent of social integration and social support suggests a unique role for this formulation of social connectedness in the health of aging adults.

THE TRAJECTORIES OF COGNITION AND FUNCTIONAL LIMITATIONS OF CENTENARIAN SURVIVORS

Abstract The purpose of this study is to explore cohort differences in the trajectories of cognition and functional limitations among oldest-old adults. Using 1992-2018 data from the Health and Retirement Study, participants included those who survived to at least 98 years (N=494). The study included three cohorts (i.e., 1890-1900, 1901-1910, and 1911-1920) predicting intercept and slope of cognition and functional limitations. Two separate latent growth curve models were computed, and models of cognition, χ2(5)=6.935, p=.226 and functional limitation, χ2(7)=7.743, p=.35 fit the data well. There was a significant decline in cognition levels and a significant increase in functional limitation over time. When adding cohort, results indicated that older cohorts were more likely to have a decrease in cognition and increase in functional limitations compared with the younger cohort. Future research should investigate trajectories of other health variables for a better understanding of health changes of centenarians.

Association Between Long-Term HbA1c Variability and Functional Limitation in Individuals Aged Over 50 Years: A Retrospective Cohort Study.

BackgroundAs mean HbA1c provides incomplete information regarding glycemic variability, there has been considerable interest in the emerging association between glycemic variability and macrovascular events and with microvascular complications and mortality in adults with and without diabetes. However, the association between long-term glycemic variability, represented by visit-to-visit HbA1c variability, and functional limitations has not been clarified in previous literature. The present study aimed to explore the longitudinal association between long-term glycemic variability, represented by visit-to-visit HbA1c variability and functional limitations.MethodsThis cohort study included adults aged over 50 years who participated in the 2006 to 2016 waves of the Health and Retirement Study. Physical functions, including mobility, large muscle function, activities of daily living (ADLs), and instrumental ADLs (IADLs), were assessed at baseline and every 2 years, and HbA1c levels were assessed at baseline and every 4 years. Visit-to-visit HbA1c variability was calculated using the HbA1c variability score (HVS) during the follow-up period. Generalized estimating equation models were used to evaluate the longitudinal association between HbA1c variability and functional limitations with adjustment for a series of confounders.ResultsA total of 5,544 participants having three HbA1c measurements from 2006 to 2016, having two or more physical function measures (including one at baseline), and age over 50 years were included in this analysis. The mean age at baseline was 66.13 ± 8.39 years. A total of 916 (16.5%) participants had an HVS = 100, and 35.1% had an HVS = 50. The highest HVS category (HVS =100) was associated with increased functional status score (β = 0.093, 95% CI: 0.021–0.165) in comparison with the lowest HVS category (HVS = 0). Sensitivity analyses using the CV and SD of HbA1c as measures of variability showed similar associations between HbA1c variability and functional limitation. An incremental increase in HbA1c-CV (β = 0.630, 95% CI: 0.127–1.132) or HbA1c-SD (β = 0.078, 95% CI: 0.006–0.150) was associated with an increase in functional limitation in the fully adjusted model. ConclusionsHbA1c variability was associated with heightened difficulty in performing functional activities over time after adjusting for mean HbA1c levels and multiple demographics and comorbidities. This study provides further evidence regarding the detrimental effect of HbA1c variability and highlights the significance of steady glycemic control.

Not Seeing Double: Discordance in Disease, Function, and Their Longitudinal Associations in Monozygotic Twins

Prior research on the causality and directionality between disease and functional limitations is ambiguous. The current study used longitudinal monozygotic twin data to test both directions linking disease burden and functional limitations in middle-aged and older adults, controlling for genetic and familial factors. We also examined potential moderation by psychological well-being. The Twins sub-sample from the first two waves of the longitudinal Midlife in the United States (MIDUS) study was used (Wave 1: 1995-1996, Wave 2: 2004-2006). Only monozygotic twins (N = 713) were included in analyses. In separate multi-level models, we examined disease burden at MIDUS 2 predicted by functional limitations at MIDUS 1 and MIDUS 2 functional limitations predicted by disease burden at MIDUS 1. Disease burden and functional limitations at MIDUS 2 varied substantially within families. There was no within-family association of earlier functional limitations with change in later disease burden (b = .40, p = .39), but there was a within-family association such that the twin with higher baseline disease burden had a greater increase in functional limitations than his/her co-twin (b = .06, p = .02). Well-being was not a moderator in either model. We found support for a potentially causal association between earlier disease burden and later increases in functional limitations, consistent with the Disablement Process Model. Sensitivity analyses confirm the detected within-family effect. Possible mechanisms linking disease burden and functional limitations are discussed as potential targets for future research.

Not Seeing Double: Discordance in Disease, Function, and Their Longitudinal Associations in Monozygotic Twins.

Prior research on the causality and directionality between disease and functional limitations is ambiguous. The current study used longitudinal monozygotic twin data to test both directions linking disease burden and functional limitations in middle-aged and older adults, controlling for genetic and familial factors. We also examined potential moderation by psychological well-being. The twin subsample from the first two waves of the longitudinal Midlife in the United States (MIDUS) study was used (wave 1, 1995-1996; wave 2, 2004-2006). Only monozygotic twins (n = 713) were included in analyses. In separate multilevel models, we examined disease burden at MIDUS 2 predicted by functional limitations at MIDUS 1 and MIDUS 2 functional limitations predicted by disease burden at MIDUS 1. Disease burden and functional limitations at MIDUS 2 varied substantially within families. There was no within-family association of earlier functional limitations with change in later disease burden (b = 0.40, p = .39), but there was a within-family association such that the twin with higher baseline disease burden had a greater increase in functional limitations than his/her co-twin (b = 0.06, p = .02). Well-being was not a moderator in either model. We found support for a potentially causal association between earlier disease burden and later increases in functional limitations, consistent with the Disablement Process Model. Sensitivity analyses confirm the detected within-family effect. Possible mechanisms linking disease burden and functional limitations are discussed as potential targets for future research.

Effects of peri-traumatic stress experienced during Hurricane Sandy on functional limitation trajectories for older men and women

Background and methodsAlthough the short-term effects of disasters on the physical health of mid-life and older people have been documented, little is understood about the long-term effects that disasters have on the physical health of these people. Based on the environmental docility hypothesis and research regarding gender effects on functional limitations and disaster, our analyses examined the effects of peri-traumatic stress experienced during Hurricane Sandy using longitudinal data from 5688 people aged 50 and older collected over six waves (2006–2019). ResultsWe found that functional limitations follow three trajectories, with people in each group having a significant linear increase over time and all but the highest functioning people also having a significant quadratic effect, indicating that the linear increase peaked post-Hurricane and then slowed in later waves. ConclusionConsistent with the environmental docility hypothesis, peri-traumatic stress had its greatest impact on people with more functional limitations before the hurricane. Men experiencing peri-traumatic stress during Hurricane Sandy were more likely to experience an increase in functional limitations than women. These findings, which identify people most likely to experience long-term health effects following a disaster, can be used to inform health policies before, during, and after disaster strikes.

Brain amyloid, cortical thickness, and changes in activities of daily living.

ObjectiveTo examine the association of baseline elevated brain amyloid and neurodegeneration with changes in activities of daily living in participants without dementia (ND; i.e., cognitively unimpaired and participants with mild cognitive impairment) at baseline in the population‐based Mayo Clinic Study of Aging.MethodsWe included 1747 ND participants with 11C‐PiB PET and MR imaging in the study, with data on activities of daily living (as assessed by the Functional Activities Questionnaire (FAQ) and the Clinical Dementia Rating scale Sum of Boxes for functional domains (CDR‐SOB (functional)), with a median (range) of 4.3 (0.0–12.7) years of follow‐up. Abnormal (elevated; A+) 11C‐PiB‐PET retention ratio was defined as standardized uptake value ratio ≥ 1.48, and abnormal (reduced) AD signature cortical thickness as ≤ 2.68 mm (neurodegeneration; N+). Associations were examined with mixed effects models, adjusting for age, sex, education, apolipoprotein E ε4 allele carrier status, and global cognitive z‐score.ResultsMean age (SD) was 71.4 years (10.1), 46.7% were females, 195 (11.2%) had A+N‐, 442 (25.3%) had A‐N+, and 339 (19.4%) had A+N+ biomarkers. The A+N+ group had the largest annualized change in the FAQ score from baseline (difference in annual change A+N+ vs. A‐N‐; ß (SE): 0.80 (0.07)); associations were substantially attenuated when a time‐varying global cognitive composite was included in the model (A+N+ vs. A‐N‐; ß (SE): 0.31 (0.05)). CDR‐SOB (functional) findings partly agreed with FAQ score findings.InterpretationThe longitudinal increase in functional limitations is greater for individuals with abnormal neuroimaging biomarkers, especially for those with both elevated brain amyloid and neurodegeneration.

Effect of Anodal Transcranial Direct Current Stimulation of the Motor Cortex on Elbow Flexor Muscle Strength in the Very Old.

Muscle weakness predisposes older adults to a fourfold increase in functional limitations and has previously been associated with reduced motor cortex excitability in aging adults. The purpose of this study was to determine whether a single session of anodal transcranial direct current stimulation (tDCS) of the motor cortex would increase elbow flexion muscle strength and electromyographic (EMG) amplitude in very old individuals. Eleven very old individuals-85.8 (4.3) years-performed 3 maximal isometric elbow flexion contractions before and after 20 minutes of sham or anodal tDCS on different days. Order of stimulation was randomized, and the study participants and investigators were blinded to condition. In addition, voluntary activation capacity of the elbow flexors was determined by comparing voluntary and electrically evoked forces. Anodal tDCS did not alter muscle strength or EMG activity in comparison to sham stimulation. Elbow flexion voluntary activation capacity was very high among the study participants: 99.3% (1.8%). Contrary to our hypothesis, we observed no effect of anodal tDCS and no impairment in elbow flexor voluntary activation capacity in the very old. Whether anodal tDCS would exert a positive effect and support our initial hypothesis in another muscle group that does exhibit impairments in voluntary activation in older adults is a question that is still to be addressed.

CHALLENGES IN 21ST CENTURY INPATIENT GERIATRIC PSYCHIATRY AND LONG TERM CARE PRACTICE.: Session 112

With the increase in life span, there has been a rise in the number of older adults. In 2010, approximately 40 million persons aged 65 years and older lived in the United States and this statistic is projected to increase to 88.5 million by 2050, accounting for 20.2% of the population. The number of older adults with psychiatric disorders is also expected to increase to 15 million by 2030. A significant proportion of these older adults will also have co-morbid medical issues, which may pose challenges. In this session, we will provide an overview of how nursing home facilities and inpatient geriatric psychiatry units are adapting to changes and challenges to provide care for this vulnerable population. In the last 20 years, the number of elderly patients cared for in nursing homes has increased, with facilities expanding to include more beds to respond to this need. The average resident age has also increased, with a corresponding increase in functional limitations, disabilities, cognitive and mental disorders requiring advanced care. Additionally, policy and industry changes over the years have affected the way we provide care for these residents. There has been rapid growth in assisted living facilities in order to provide an alternative care setting for these individuals who require more assistance with activities of daily living. This has led to the development of specialized units that will meet the needs of these residents. Since the implementation of the minimum data set (MDS) system, many prevalence reports have relied on either recorded diagnoses or scales derived from MDS to identify residents with psychiatric conditions. These have also been used as screening tools to identify residents in need of treatment. Available data indicates that there are an inadequate number of geriatric psychiatrists in the USA to care for these older adults with mental illness. The unfortunate consequence has been providers without specialist training or oversight attempting to provide care for residents. This often includes prescribing multiple psychotropic medications that are inappropriate for their symptoms and their age, which can ultimately lead to substantial psychological and functional morbidity. Additionally, these medication side effects and undertreated psychiatric disorders have a significantly negative impact on the residents’ quality of life, disability, and cost of care. Approximately 75-80% of residents in long- term care have a neurocognitive disorder. Although most major neurocognitive disorders are incurable, appropriate comprehensive treatment can substantially improve the quality of life of a resident, their family, and their caregivers. Routine provision of evidence-based care by a mental health care team with expertise in long-term care is essential for maintaining dignity and reducing suffering for these patients. This includes ongoing staff education, discontinuation of inappropriate medications, optimal use of appropriate psychotropic medications and other behavioral interventions. We will review how the geriatric psychiatrist, along with other allied health care professionals, can work as a team in today's highly regulated environment of long term care to improve patient outcomes. With the projection that the older adult population will swell over the next several decades, inpatient geriatric psychiatry facilities have arisen to address the need to provide acute services for these patients. These units appear to have distinct clinically relevant assessment and treatment advantages. They are more comprehensive in their diagnostic assessment of patients, are more likely to provide cognitive assessments and are more cognizant of potential side effects of psychotropic medications. They are also more likely to provide more age-specific aftercare recommendations, which is important in maintaining success after the hospitalization. However these specialized units are limited, expensive, and may encounter a unique set of challenges as the landscape changes for healthcare delivery, reimbursement and managed care. In this session, we will describe key characteristics of a typical geriatric psychiatry unit, discuss advantages of such a unit over a general psychiatry unit, discuss different models of geriatric psychiatry facilities, outline standard admission screening criteria for appropriate patient selection, address treatment challenges associated with the need for rapid improvement in patient psychopathologies and discuss the increased pressures in providing high quality care in the context of reduced length of stays with scarce resources for aftercare. At the end of our presentation, we will briefly showcase the unique characteristics of our inpatient geriatric psychiatry unit.

LONGITUDINAL IMPLICATIONS OF SOCIAL INTEGRATION FOR AGE AND GENDER DIFFERENCES IN LATE-LIFE PHYSICAL FUNCTIONING

Aging adults may face limitations in physical functioning which can influence their quality of life. Though previous research has documented potential benefits of social integration (SI) for late-life physical functioning, it is not well understood how those benefits may vary over time among women and men of different ages. The present study examined potential age and gender differences in the longitudinal associations between SI and physical functioning by constructing a two-level hierarchical linear model with three waves of data collected over four years from a sample of 403 adults (baseline age of 60 to 98). Whereas age and SI predicted functional limitations, findings also indicated multiple interactions of age, gender, and SI on levels and trajectories of functional limitations. Older people with low SI appeared to experience greater increase in functional limitations than those with high SI, a pattern not found among younger people. Levels and trajectories of functional limitations also differed between genders. Older women showed greater increases in functional limitations than older men in contrast to relatively similar trajectories between younger women and men. In addition, having high levels of SI was associated with fewer functional limitations among men as compared to women. These findings suggest that SI may be more protective for late-life physical functioning among men as well as older cohorts of both genders. This study highlights future directions for longitudinal research on SI in late-life. Moreover, this study highlights the need to explore practical implications for focusing on promoting SI among the oldest old.

Weak Grip Strength and Cognition Predict Functional Limitation in Older Europeans

To estimate the effects of baseline grip strength and cognition on the trajectory of functional limitation over time. Longitudinal study of older adults participating in the Survey of Health, Ageing and Retirement in Europe (SHARE). Urban and rural households in 11 European countries and Israel. Individuals aged 50 and older from SHARE (2004-2015) (N=14,073; 52.5% female). Outcomes were functional limitation scores from five panel wave. Main exposure variables were grip strength and cognitive measures including memory, verbal fluency, and numeracy at baseline. Basic demographic characteristics, life habits, and health status were considered as potential confounders. Mixed-effect linear regression models were fitted. Functional limitation increased significantly over time (follow-up range 0.9-11.6 years) (β = 0.051, P < .001). Mixed-effect linear regression models identified significant interactions between grip strength (β = -0.001, P < .001), numeracy (β = -0.012, P < .001), verbal fluency (β = -0.003, P < .001), word recall (β = -0.006, P < .001) and time on functional limitation. Stronger baseline grip strength and better cognition predicted a slower rate of increase in functional limitation over time in older adults. Grip strength and cognitive function appeared to be useful indicators of the functional limitation process and attested to their value in monitoring functional change in European older adults. J Am Geriatr Soc 67:93-99, 2019.

The Effectiveness of a PRoactive Multicomponent Intervention Program on Disability in Independently Living Older People: A Randomized Controlled Trial.

There is an increase in functional limitations and a decline in physical and mental well-being with age. Very few effective lifestyle interventions are available to prevent adverse outcomes such as disability in (pre-) frail older people. The effectiveness of an interdisciplinary multicomponent intervention program to prevent disability in older people in the community was tested. A randomized controlled trial (RCT) with a one-year follow-up was conducted in the Netherlands. Community-dwelling pre-frail older people aged 65 years and over were invited to participate. Frailty was measured with the Groningen Frailty Indicator (GFI) and categorized into non-frail (GFI=0), pre-frail (GFI = 1-3) and frail (GFI ≥ 4). The intervention program consisted of four components: a medication review, physical fitness, social skills, and nutrition. The primary outcome was activity of daily living (ADL) measured with the Katz-6. Secondary outcomes were quality of life (SF-12) and healthcare consumption such as hospital admission, nursing home admission and primary care visits. Additional outcomes measured in the intervention group were physical fitness, Instrumental Activities of Daily Living (IADL), muscle strength, walking speed, functional capacity, mobility, feelings of depression and loneliness and nutritional status. The data were collected at baseline, after each intervention component and at a 12-month follow-up. An intention to treat analysis was used. In total, there were 290 participants, and 217 (74.8%) completed the study. The mean age was 74 (SD: 7.2), most were pre-frail (59.9%), the majority were female (55.2%), and the individuals were not living alone (61.4%). After the 12-month follow-up, the median Katz-6 score did not change significantly between the two groups; adjusted Odds Ratio (OR) = 0.96 (95% Confidence Interval (CI): 0.39-2.35, p-value 0.92). No statistically significant differences were observed between the groups for quality of life and healthcare consumption. Among the participants in the intervention group, IADL (Friedman's test p <=0.04, X2 =6.50), walking speed (Friedman's test p <0.001, X2 =19.09) and functional capacity (Friedman's test p <0.001, X2 =33.29) improved significantly after the one-year follow-up. Right-hand grip strength improved immediately after completion of the intervention (Wilcoxon signed-rank test p=0.00, z= -3.39) but not after the 12-month follow-up. The intervention program did not significantly improve daily functioning, quality of life and healthcare consumption among (pre) frail community-dwelling older persons at the one-year follow-up. Participants in the intervention group experienced improvements in walking speed, functional capacity and instrumental activities of daily living. More research is needed to better understand why may benefit and how to identify the target population.

A National Profile of Functional Limitations Among Asian Indians, Chinese, and Filipinos.

Asian Americans are the fastest-growing minority group in the United States, yet little is known about their functional mobility. To overcome such a gap, this study examined the association between demographic/economic characteristics and functional limitations for middle-aged and older Asian Indians, Chinese, and Filipinos. This study utilized microdata from the National Health Interview Survey pooled sample (2010-2016 IPUMS NHIS with a sample size of 6,767 Asians). Logit regressions were used to examine factors associated with functional limitations. Measures include age, gender, currently married, education (categorized as less than high school, high school, some college, college, advanced degree), birth and citizenship status, household income, home ownership, types of health insurance (e.g., Medicaid, Medicare, private), and geographic region (i.e., Northeast, Midwest, South, and West). Chinese (odds ratio [OR] 0.57, p < .01) and Filipinos (OR 0.74, p < .05) had lower odds for any functional limitations relative to Asian Indians. Currently married and individuals with a higher income were also associated with reduced odds for limitations in the overall analysis. As for the subgroup analysis, there was a positive association between age and the presence of any functional limitations for Asian Indians (OR 1.05, p < .01), Chinese (OR 1.08, p < .01), and Filipinos (OR 1.03, p < .01). In terms of gender, Asian Indian men were less likely (OR 0.51, p < .01), whereas Filipino men were more likely to have limitations (OR 1.09, p < .05). Asian Indians appeared to have a poorer health profile for limitations in dressing, eating, walking, or working when compared with Chinese and Filipinos. A pronounced difference at older ages was also apparent for Asian Indians by gender and the likelihood of having any limitations increased much faster for Asian Indian women. For Chinese, there was a dramatic increase in functional limitations after age 75 (particularly for women) and the predicted probability for this subgroup approximated 20%. For Filipinos, men were more likely to have limitations. These findings raise interesting questions about the on-set of disability by age and gender for Asian subgroups.

Predictors of functional limitation trajectories after injury in a nationally representative U.S. older adult population

PurposeStudies examining postinjury functional status have demonstrated that individuals with severe injuries often do not return to baseline levels of physical functioning. We sought to investigate the impact injuries have on changes in physical functioning across the life course of older adults. The study's objectives were to (1) identify trajectories of long-term functional limitations after injury in the older adult population to better characterize the recovery process and (2) predict which individuals are most at risk for poor functional trajectories after injury. MethodsA retrospective cohort study was conducted using six waves of data from the Health and Retirement Study, which surveys Americans older than 50 years every two years. A group-based trajectory model was used to identify trajectories of functional limitations in injured participants. Using multivariate regression, we identified significant predictors of each trajectory. ResultsFive distinct trajectories were identified: Trajectory 1—consistently low functional limitations scores (18.9%), Trajectory 2—increase in functional limitations after injury followed by a gradual, incomplete recovery (46.3%), Trajectory 3—increase in functional limitations followed by further decline in functioning (10.5%), Trajectory 4—increase in functional limitations after injury followed by a gradual, complete recovery (13.4%), and Trajectory 5—consistently high functional limitations scores (10.8%). Gender, multiple health conditions, and insurance status predicted trajectory membership. ConclusionsFunctional limitations after injury follow distinct trajectories that can be predicted by baseline individual characteristics.

Effect of Bright Light and Melatonin on Cognitive and Noncognitive Function in Elderly Residents of Group Care Facilities

Cognitive decline, mood, behavioral and sleep disturbances, and limitations of activities of daily living commonly burden elderly patients with dementia and their caregivers. Circadian rhythm disturbances have been associated with these symptoms. To determine whether the progression of cognitive and noncognitive symptoms may be ameliorated by individual or combined long-term application of the 2 major synchronizers of the circadian timing system: bright light and melatonin. A long-term, double-blind, placebo-controlled, 2 x 2 factorial randomized trial performed from 1999 to 2004 with 189 residents of 12 group care facilities in the Netherlands; mean (SD) age, 85.8 (5.5) years; 90% were female and 87% had dementia. Random assignment by facility to long-term daily treatment with whole-day bright (+/- 1000 lux) or dim (+/- 300 lux) light and by participant to evening melatonin (2.5 mg) or placebo for a mean (SD) of 15 (12) months (maximum period of 3.5 years). Standardized scales for cognitive and noncognitive symptoms, limitations of activities of daily living, and adverse effects assessed every 6 months. Light attenuated cognitive deterioration by a mean of 0.9 points (95% confidence interval [CI], 0.04-1.71) on the Mini-Mental State Examination or a relative 5%. Light also ameliorated depressive symptoms by 1.5 points (95% CI, 0.24-2.70) on the Cornell Scale for Depression in Dementia or a relative 19%, and attenuated the increase in functional limitations over time by 1.8 points per year (95% CI, 0.61-2.92) on the nurse-informant activities of daily living scale or a relative 53% difference. Melatonin shortened sleep onset latency by 8.2 minutes (95% CI, 1.08-15.38) or 19% and increased sleep duration by 27 minutes (95% CI, 9-46) or 6%. However, melatonin adversely affected scores on the Philadelphia Geriatric Centre Affect Rating Scale, both for positive affect (-0.5 points; 95% CI, -0.10 to -1.00) and negative affect (0.8 points; 95% CI, 0.20-1.44). Melatonin also increased withdrawn behavior by 1.02 points (95% CI, 0.18-1.86) on the Multi Observational Scale for Elderly Subjects scale, although this effect was not seen if given in combination with light. Combined treatment also attenuated aggressive behavior by 3.9 points (95% CI, 0.88-6.92) on the Cohen-Mansfield Agitation Index or 9%, increased sleep efficiency by 3.5% (95% CI, 0.8%-6.1%), and improved nocturnal restlessness by 1.00 minute per hour each year (95% CI, 0.26-1.78) or 9% (treatment x time effect). Light has a modest benefit in improving some cognitive and noncognitive symptoms of dementia. To counteract the adverse effect of melatonin on mood, it is recommended only in combination with light. controlled-trials.com/isrctn Identifier: ISRCTN93133646.

Short-term Trends in Functional Limitation and Disability Among Older Asians: A Comparison of Five Asian Settings

The objective of this paper is to examine short-term trends in the prevalence of limitation in Activities of Daily Living (ADL), Instrumental Activities of Daily Living (IADL) and Nagi physical functioning tasks among persons age 60 years or older in five Asian settings: Indonesia, the Philippines, Singapore, Taiwan and the Beijing Municipality. The data come from recent panel surveys of older adults that span a period of 3-4 years during the mid to late 1990s. Results suggest a general trend toward an increase in functional limitation in four of the five settings, with the most pronounced increases occurring for the Nagi functioning tasks. Compositional differences in the population accounted for little of the increase. The paper discusses the potential implications of these results and places them in the context of past and current trends in functional limitation observed in the United States.

Weight and Depressive Symptoms in Older Adults: Direction of Influence?

. The purpose of this study was to clarify the direction of the relationship between changes in depressive symptoms and changes in weight in older adults. Methods. The sample included a prospective cohort of individuals aged 53-63 (n = 9,130) enrolled in the Health and Retirement Study. We used separate cross-lagged models for men and women in order to study the impact of weight change on subsequent increases in depressive symptoms 2 years later and vice versa. . Weight gain did not lead to increased depressive symptoms, and weight loss preceded increased depressive symptoms only in unadjusted models among men (odds ratio [OR] = 1.26, 95% confidence interval [CI] = 1.04-1.53). Increased depressive symptoms were not predictive of subsequent weight loss, but they were predictive of subsequent weight gain in unadjusted models only (men: OR = 1.24, 95% CI = 1.00-1.54; women: OR = 1.12, 95% CI = 1.00-1.26). In adjusted models, baseline depressive symptoms predicted both weight loss and weight gain among both men and women. Increase in functional limitations and medical conditions were significant predictors of both weight loss and weight gain. Baseline functional limitations also predicted increased depressive symptoms. Discussion. Based on our findings, it is apparent that researchers need to examine the pathways between changes in weight and increases in depressive symptoms in the context of functional limitations and medical comorbidity.

Changes in functional status among older adults in Japan: successful and usual aging.

This research aimed to chart the trajectories of functional status in old age in Japan and to assess how self-rated health and cognitive functioning differentiate these trajectories and account for interpersonal differences. Data came from a 5-wave panel study of a national sample of 2,200 Japanese older adults between 1987 and 1999. The sample as a whole showed an accelerated increase in functional limitations with age. approximated by a quadratic function. More important, 3 major trajectories of functional change were identified: (a) minimal functional decrement, (b) early onset of functional impairment. and (c) late onset of functional impairment. These findings may serve as useful benchmarks for observations derived from other developed nations.

Older adults and functional decline: a cross-cultural comparison.

The study was conducted to examine the relationships between functional decline, health risk factors, lifestyle practices, and demographic variables in two culturally diverse, community-based samples of White and Japanese American older adults. The study was an analysis of data from two ongoing studies of aging and dementia in King County, Washington. Functional status at baseline was evaluated, and factors associated with functional decline over a 4-year follow-up period were identified. The sample included 1,083 Japanese American and 1,011 White cognitively intact, community-dwelling adults aged 65 and older, who had no functional limitations at baseline and participated in at least one follow-up examination. In 4 years of follow-up, 70% of the subjects reported no increase in functional limitation, and fewer than 5% of subjects declined in five or more activities. Risk factors associated with functional decline included increased age, female gender, medical comorbidity (particularly cerebrovascular disease, arthritis, and hypertension), elevated body mass index, poorer self-perceived health, and smoking. Depression and diabetes were also significant for persons with the greatest functional decline over the 4-year follow-up. Japanese speakers were significantly less likely to decline over the follow-up period than White or English-speaking Japanese American subjects. However, Japanese speakers were more likely to discontinue participation during the follow-up period, and may also have been more likely to underreport symptoms of functional decline. The present study provides further support that healthy lifestyle practices and prevention of chronic disease are important for maintaining functional independence in older adults. Japanese-speaking subjects were less likely to decline over time, although this could be due in part to differential dropout and reporting bias. These findings have important implications for the design and interpretation of longitudinal studies of older adults. Researchers interested in the effects of ethnicity on health and aging should be cognizant of differences in recruitment and enrollment strategies among studies, and the ways in which these affect study findings. This study also demonstrates the importance of devoting adequate resources to minimize dropouts, and of including measures of health and functioning that are culturally equivalent and less reliant on self-report data.

Changes in geographic proximity between parents and their adult children

We examine how characteristics of both parents and their adult children condition the changes in intergenerational geographic proximity. Using panel data from the US National Survey of Families and Households, we employ multinomial logistic regression techniques to examine the impact of the joint effects of each generation's structural characteristics on the likelihood of changes in distance between the target persons. Our results show that an increase in functional limitations is the most consistent predictor of geographic convergence between elderly parents and their adult children. The onset of widowhood during the observation period leads to a greater likelihood of living with an adult child. Furthermore, our analyses show that the economic status and marital status of adult children is associated with changes in geographic proximity. © 1997 John Wiley & Sons, Ltd.