Instrumental Activities Of Daily Living Difficulties Research Articles

Using cardiorespiratory fitness to operationalize vitality: a path analysis on the hierarchical structure of intrinsic capacity

BackgroundThere is a lack of consensus about the operationalization of vitality, which is one of the intrinsic capacity (IC) domains. In particular, no study has investigated whether cardiorespiratory fitness (CRF) can be considered a vitality indicator. ObjectiveTo examine whether vitality is the upstream domain of IC, and establish the validity of CRF as a vitality indicator, using maximal oxygen consumption (VO2 max) as a representative. Methods561 older adults from a longitudinal cohort study were included. Variables under consideration were VO2 max, other IC domains, instrumental activities of daily living (IADL), and handgrip strength, which was considered an already validated indicator of vitality. Using handgrip strength as the reference point, path analyses were performed to examine whether VO2 max followed a similar hierarchical structure in predicting change in IADL difficulty through other IC domains. ResultsThe mean age of the participants was 75.5 years. The path model in which vitality was measured by VO2 max demonstrated adequate fit, which was similar to the model in which vitality was measured by handgrip strength. Regarding the path coefficients, the model using VO2 max demonstrated significant total and indirect effects. Notably, the indirect effect was due to the locomotor domain (standardized coefficient = −0.148, p < .001), but not the cognitive or psychological domain. ConclusionVitality is the upstream domain of IC. VO2 max can be considered an indicator to operationalize the vitality concept.

Abstract PO1-03-06: Older patients with Early Stage Triple Negative Breast Cancer: The Memorial Sloan Kettering Cancer Center experience

Abstract INTRODUCTION Approximately 15% cases of TNBC are diagnosed in individuals over the age of 70. Older patients remain under-represented in clinical trials. We conducted a retrospective review of patients 70 years of age and older with stage I-III TNBC who were treated at Memorial Sloan Kettering Cancer Center (MSKCC), with the goal of describing the clinical practice patterns and outcomes. MATERIAL AND METHODS A retrospective record review of patients 70 years of age and older with a diagnosis of stage I-III TNBC between January 2015-December 2019 was performed. We report the data on the utilization of systemic chemotherapy and survival analyses. We compared patient characteristics by chemotherapy type using Wilcoxon rank sum test, Pearson’s Chi-squared test, and Fisher’s exact test. Overall Survival (OS), Breast Cancer Specific Survival (BCSS), and Recurrence Free BCSS (RF-BCSS) were examined using Cox proportional hazards models. All statistical analyses were conducted using R. RESULTS A total of 147 patients were included. The median age was 75 years (range 70-96). The number of patients with stage I, II, and III disease was 64 (44%), 66 (45%), 17 (12%), respectively. Twenty-five (18%) patients underwent comprehensive geriatric assessment. Out of total patients, 93 (63%) patients received systemic Chemotherapy (C) while 54 (37%) received no chemotherapy (NC). Patients receiving C were younger (median age 74 years with C vs. 78 years with NC, p&amp;lt; 0.001) and had a higher disease stage (Stage II-III: 66% (C) vs. 41% (NC), p=0.005). There were no significant differences in Activities of Daily Living (ADL) difficulty between both arms. Amongst, Instrumental ADL (IADL) assessment, patients in the NC group reported statistically significant greater difficulty with meal preparation (17% in NC and 4.3% in C, p=0.016). The most common reasons for not receiving chemotherapy were low-risk disease i.e. pT1aN0 or microinvasive (33%), patient preference (29%), and frailty per the treating oncologist (19%). Rate of mastectomy was higher in the NC group (35% in NC vs. 20% in C, p=0.029). Among the 32 patients who had radiation data, breast irradiation rates were higher in the C group (70% in C and 17% in NC, p=0.003). Thirty patients (20%) received neoadjuvant chemotherapy (NAC) and 65 (44%) received adjuvant chemotherapy. Anthracycline-based chemotherapy was the most common NAC (n=17, 57%). Patients who received Cyclophosphamide-Methotrexate-5-Fluorouracil (CMF) were older (age ≥75 years: 51% (CMF) vs. 17% (ACT),p=0.010), more likely treated in an adjuvant setting (87% CMF vs. 61% ACT, p=0.017), had earlier-stage disease (Stage 1: 54% (CMF) vs. 26% (ACT), p=0.028), and reported more ADL (31% in CMF vs. 0% in ACT, p=0.002) and IADL difficulties (31% CMF vs 4.3% in ACT, p=0.021). The use of Docetaxel/Cyclophosphamide (TC) and platinum-based regimens was low (8% and 5%, respectively). In the univariate analysis between the C and NC groups, there was no difference in OS (Hazard Ratio (HR) 0.78, 95% Confidence Interval (CI) 0.42-1.43; p=0.4), BCSS (HR 1.39, 95% CI 0.57-3.39; p=0.5), and RF-BCSS (HR 1.60, 95% CI 0.67-3.83; p=0.3). There was no difference in OS (HR 0.60, 95% CI 0.23-1.55; p=0.3), BCSS (HR 0.48, 95% CI 0.17-1.32; p=0.2), and RF-BCSS (HR 0.71, 95% CI 0.30-1.73; p=0.5) in patients receiving CMF vs. ACT. CONCLUSIONS In our single institutional experience, we observed that two-thirds of older patients with early-stage TNBC received systemic polychemotherapy. A third of patients with NC were very low risk (pT1a or microinvasive disease) which could explain lack of chemotherapy benefit in our study population. Use of CMF was more prevalent in patients aged ≥75, stage I disease, ADL/IADL difficulties, and in the adjuvant setting. We observed no difference in survival outcomes between the two chemotherapy regimens. CMF remains an efficacious option and a potentially viable alternative to ACT in TNBC, especially in the setting of early stage and advanced age. Citation Format: Jasmeet Singh, Diana Lake, West Dente-Ferguson, Yuan Chen, Fiona Erlich, Beatriz Korc-Grodzicki, Mark Robson, Larry Norton, W. Iris Zhi. Older patients with Early Stage Triple Negative Breast Cancer: The Memorial Sloan Kettering Cancer Center experience [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO1-03-06.

Projections of functional dependence among the late middle-aged and older population from 2018-2048 in China: a dynamic microsimulation

BackgroundThe population of China is aging rapidly. However, the long-term trajectories of functionally dependent late middle-aged and older Chinese people are currently absent. The present study aimed to estimate the population size and proportion of late middle-aged and older adults with difficulties and dependence on activities of daily living (ADL) and instrumental activities of daily living (IADL) in China from 2018 to 2048.MethodsWe constructed a dynamic microsimulation model to project the population size and proportions of late middle-aged and older Chinese people who have difficulty and dependence in ADL and IADL from 2018-2048. The model was populated with a representative sample of the target population and allowed individual-level interaction between risk factors, diseases, and health outcomes. Analyses by socioeconomic subgroups were also conducted.ResultsAlmost 25% and 38% of late middle-aged and older people in China will become ADL- and IADL-dependent by 2048, respectively. Also, 17% of the target population will be severely ADL-disabled by 2048. The inequity in functional status across subgroups by sex, educational level, and urban/rural residency will become substantial.ConclusionsThe numbers and percentages of China's functionally difficult and dependent late middle-aged and older population will increase by magnitudes as of the mid-21st century, the pressure of which is compounded by its disproportionate distribution across subgroups. To alleviate the overwhelming challenge, efforts to improve the functional status of the underserved subpopulation should also be iterated.

EMPLOYMENT AS A FORM OF SOCIAL PARTICIPATION AMONG OLDER ADULTS: LINKS TO COGNITIVE AND FUNCTIONAL HEALTH

Abstract Within the active aging literature, studies on social participation and health concur that people who are better socially integrated and engage in social activities tend to have better physical, mental, and cognitive health. This study revisits the literature by aiming to address three primary knowledge gaps in prior literature: 1) we explicitly examine the change within the 5-year-interval in cognition, activities of daily living (ADL), instrumental activities of daily living (IADL) associated with social participation five years prior; 2) we examine diversity in participation’s association with not only cognitive function, but also ADL and IADL, which we lack knowledge of; 3) we conceptualize employment in later life as a kind of social participation, a part of older adults’ lives that is overlooked in the social participation literature. We also examine whether the relationship between social participation and cognition, ADL, and IADL is the same for men and women, and for those employed and those not employed. The study finds that neighborhood participation at a high level indicates worse cognitive, ADL, and IADL outcomes 5 years later, and a higher level of neighborhood participation is more indicative of worse cognitive outcomes for men than for women. Full-time employment predicts better cognitive, ADL, and IADL outcomes 5 years later. We also find evidence that full-time work creates a stronger buffer against cognitive decline, developing ADL difficulties, and IADL difficulties, even among older adults who socialize with family and friends, participate in the community, and the neighborhood at a high level, respectively.

Depression by gender and associated factors among older adults in India: implications for age-friendly policies

Inspite of implementing policies to control mental health problems, depression remains a severe health concern among older adults in India. We examined self-reported differences in the depression among older men and women in India and examined associated factors for gender differences in depression at the population level. We utilized nationally representative data from the Longitudinal Aging Study in India (LASI) wave I, for years 2017–2019. Our analytical sample comprised of 30,637 older adults ages 60 years and above (14,682 men and 15,655 women). We conducted descriptive statistics and Chi-Square tests followed by binary logistic regression and multivariate decomposition analyses to examine our study objectives. Depression was reported in − 7.4% (95% CI 7.0, 7.8) of older men and 9.5% (CI 9.1, 10.0) of older women. Poor self-rated health, multimorbidity status, physical activity, difficulty in activities of daily living (ADL) and instrumental ADL (IADL) were the significant health-related factors associated with depression among older men and women. Not being satisfied with one’s life, not being satisfied with their present living arrangement, receiving any type of ill-treatment, and being widowed were the significant factors associated with depression among older men and women. We found gender disparity in self-reported depression. Marital status contributed-to 36.7% of the gender gap in depression among older adults. Additionally, ADL and IADL difficulties among men and women contributed to 17.6% and 34.0%, gender gap, self-rated health contributed to 18.8% gap, whereas not having equal social participation (4.4%) and not satisfied in present living arrangements (8.1%) were other factors that contributed to gender gap for depression in India. Depression is a critical and persistent public health problem among—older females in India. Our findings provide a broader framework for policymakers and health practitioners to focus on gender-specific strategies to mitigate this highly emergent problem.

Prevalence and correlates of loneliness in the later life-insights from Longitudinal Ageing Study in India (LASI) Wave-1.

Loneliness is a psychosocial problem that can affect anyone at any age in any circumstances, but it has become a serious issue of concern among the elderly. The present study aims to examine the overall and state and union-territories-wise prevalence of loneliness among India's elderly population and exploring the correlates of loneliness in old age. The study is based on secondary data from Longitudinal Ageing Study in India (LASI) Wave-1 (2017-2018) data collected from a total of 30,394 older adults aged 60 and above excluding missing responses. Frequent loneliness was measured using a single question asking how often you feel alone. Descriptive statistics, the Chi-square test, and bivariate logistic regression were used to meet the objectives. The statistical significance was set at <0.05. 13.4% of elderly reported frequent loneliness. The prevalence of loneliness among elderly was found to be maximum in Andaman and Nicobar Island and minimum in Tripura. Age, current marital status, region, religion, MPCE quintile, number of chronic conditions, number of Activities of Daily Living (ADL), and Instrumental Activities of Daily Living (IADL) difficulties, involvement in physical activity, involvement in yoga/meditation, number of social networks, participation in social activities, and involvement in leisure activities like reading books, watching TV, or using computer were found to be significantly associated with loneliness. Not being in a marital union, having more than two chronic conditions, more than two ADL and IADL difficulties, being physically inactive, non-involvement in Yoga/Meditation, and small social network are associated with higher loneliness.

Associations between intrinsic capacity, functional difficulty, and fall outcomes among older adults in India

The construct of intrinsic capacity (IC) in the context of integrated care for older adults emphasizes functional assessment from a holistic perspective. It provides reliable and comparable insights on subsequent functioning and disability. Given the paucity of research on IC and health outcomes in low- and middle-income countries (LMICs), the present study examined the association of IC with geriatric conditions of functional limitations and multiple fall outcomes among older adults in India. The data used for analysis come from the first wave of the Longitudinal Aging Study in India (LASI), 2017–2018. The final sample size contains 24,136 older adults (11,871 males and 12,265 females) age 60 years or above. Multivariable binary logistic regression is employed to examine the association of IC and other explanatory factors with outcome variables of difficulty in activities of daily living (ADL) and instrumental activities of daily living (IADL), falls, fall injury, and multiple falls. Of the total sample, 24.56% of older adults were observed to be in the high IC category. The prevalence of ADL difficulty, IADL difficulty, falls, multiple falls and fall-related injury is estimated to be 19.89%, 45.00%, 12.36%, 5.49% and 5.57%, respectively. Older adults who reported high IC had a significantly lower prevalence of ADL difficulty (12.26% vs 22.38%) and IADL difficulty (31.13% vs 49.52%) than those who reported low IC. Similarly, a lower prevalence of falls (9.42% vs 13.34%), fall-related injury (4.10% vs 6.06%) and multiple falls (3.46% vs 6.16%) were reported among those who had high IC. After adjusting for a large number of confounders such as age, sex, health-related attributes and lifestyle behaviors, older adults with high IC had significantly lower odds of ADL difficulty [aOR: 0.63, CI: 0.52–0.76], IADL difficulty [aOR: 0.71, CI: 0.60–0.83], falls [aOR: 0.80, CI: 0.67–0.96], multiple falls [aOR: 0.73, CI: 0.58–0.96] and fall-related injury [aOR: 0.78, CI: 0.61–0.99]. That a high IC was independently associated with a lower risk of functional difficulty and fall outcomes in later life is of enormous value in predicting subsequent functional care needs. More specifically, the findings here imply that because regular IC monitoring can predict poor health outcomes in older adults, improvements in IC should be prioritized while formulating disability and fall prevention strategies.

Examining the Association of Pain and Pain Frequency With Self-Reported Difficulty in Activities of Daily Living and Instrumental Activities of Daily Living Among Community-Dwelling Older Adults: Findings From the Longitudinal Aging Study in India.

We examined the prevalence and associations of self-reported difficulty in activities of daily living (ADL) and instrumental activities of daily living (IADL) with pain among community-dwelling older adults in India. We also explored the interaction effects of age and sex in these associations. We used the Longitudinal Ageing Study in India (LASI) Wave 1 data (2017-2018). Our unweighted sample included 31,464 older adults aged 60 years and above. Outcome measures were having difficulty in at least 1 ADL/IADL. We conducted multivariable logistic regression analyses to examine the association of pain with functional difficulties controlling for selected variables. A total of 23.8% of older adults reported ADL and 48.4% reported IADL difficulty. Among older adults who reported pain, 33.1% reported difficulty in ADL and 57.1% reported difficulty in IADL. The adjusted odds ratio (aOR) for ADL was 1.83 (confidence interval [CI]: 1.70-1.96) and for IADL was 1.43 (CI: 1.35-1.51) when respondents reported pain compared with those without pain. Older adults who reported frequent pain had 2.28 and 1.67 times higher odds of ADL (aOR: 2.28; CI: 2.07-2.50) and IADL difficulty (aOR: 1.67; CI: 1.53-1.82) compared with those with no pain. Additionally, age and sex of the respondents significantly moderated the associations of pain and difficulty in ADL and IADL. Given the higher prevalence and likelihood of functional difficulties among older Indian adults who experienced frequent pain, interventions to mitigate pain in this vulnerable population are needed to ensure active and healthy aging.

Migration status, physical limitations and associated self-rated health: a study of older Indian adults

BackgroundMigrant status with mobility impairment becomes a double burden for health and wellbeing of older adults. This study examined the independent relationships and multitude effects between migrant status, functional and mobility impairments and poor self-rated health (SRH) among older Indian adults.MethodsThis study utilised nationally representative Longitudinal Ageing Study in India wave-1 (LASI) data, including a sample of 30,736 individuals aged 60 years and above. The main explanatory variables were migrant status, difficulty in activities of daily living (ADL), difficulty in instrumental activities of daily living (IADL) and mobility impairments; and the outcome variable was poor-SRH. Multivariable logistic regression and stratified analyses were used to fulfil the study objectives.ResultsOverall, about 23% of older adults reported poor-SRH. Reporting poor-SRH was more prevalent (28.03%) among recent migrants (less than ten years). The prevalence of reporting poor-SRH was significantly higher among older adults who had mobility impairment (28.65%), difficulty in ADL or IADL (40.82% & 32.57%). Migrant older adults (regardless of duration) who had mobility impairment had significantly greater odds of reporting poor-SRH compared with non-migrant older adults who did not have mobility impairment. Similarly, older respondents who had problems in ADL and IADL with migration status had higher odds of reporting poor-SRH than their non-migrant counterparts with no such problems.ConclusionsThe study revealed the vulnerability of migrant older adults with functional and mobility disability, as well as those with limited socioeconomic resources and suffering from multimorbidity on rating their perceived health. The findings can be utilised to target outreach programmes and provision of services for migrating older individuals with mobility impairments and enhance their perceived health and ensure active ageing.

Undiagnosed Cognitive Impairment and Impact on Instrumental Activities of Daily Living Among People With HIV Infection in Primary Care.

Little is known about the prevalence of undiagnosed cognitive impairment and its impact on instrumental activities of daily living (IADL) among people with HIV (PWH) in primary care. PWH were recruited from an integrated health care setting in the United States. PWH were eligible for recruitment if they were ≥50 years old, taking antiretroviral therapy (ie, ≥1 antiretroviral therapy [ART] prescription fill in the past year), and had no clinical diagnosis of dementia. Participants completed a cognitive screen (St. Louis University Mental Status exam) and a questionnaire on IADL (modified Lawton-Brody). Study participants (n = 47) were mostly male (85.1%), 51.1% White, 25.5% Black, 17.0% Hispanic, and the average age (SD) was 59.7 (7.0) years. Overall, 27 (57.5%) participants were categorized as cognitively normal, 17 (36.2%) as having mild cognitive impairment, and 3 (6.4%) as having possible dementia. Of the 20 participants with mild cognitive impairment or possible dementia, 85.0% were men, the average age (SD) was 60.4 (7.1) years; 45.0% were White, 40.0% were Black, 10.0% were Hispanic, and 30.0% reported difficulty with at least 1 IADL. Most (66.7%) attributed difficulty with IADL primarily (33.3%) or in part (33.3%) to cognitive problems. Undiagnosed cognitive impairment is frequent among ART-treated PWH, with possible elevated risk among Black PWH, and may be accompanied by difficulty with IADL. Efforts are needed to optimize identification of factors contributing to cognitive and IADL difficulties among ART-treated PWH in primary care.

Structural equation model of coping and life satisfaction of community-dwelling older people during the COVID-19 pandemic

BackgroundCOVID-19 put older individuals at high risk for morbidity and mortality, isolation, reduced coping, and lower satisfaction with life. Many older adults experienced social isolation, fear, and anxiety. We hypothesized that successful coping with these stressors would maintain or improve satisfaction with life, a crucial psychological outcome during the pandemic. Our study investigated relationships between older people’s coping and life satisfaction during the pandemic and their optimism, sense of mastery, closeness with spouse, family, and friends, and vulnerabilities from frailty, comorbid diseases, memory problems, and dependencies in instrumental activities of daily living (IADL).MethodsThe study was based on a special COVID-19 sample of 1351 community-dwelling older adults who participated in the 2020 Health and Retirement Survey. A comprehensive structural equation modeling was used to test direct and indirect effects, with life satisfaction as the main outcome and coping as a mediator between the other variables and coping.ResultsMost survey respondents were female and between the ages of 65–74 years. They averaged 1.7 chronic conditions, one in seven was frail, about one-third rated their memory as fair or poor, and about one in seven reported one or more difficulties in IADL. As hypothesized—older people with increased sense of mastery and optimism were better able to cope and had greater life satisfaction. In addition, close relationships with friends and with other family members besides the spouse/partner or children contributed to more successful coping, while the interpersonal closeness of all types contributed directly to greater life satisfaction. Finally, older people with more IADL limitations reported greater difficulty coping and lower life satisfaction, and those older people who were frail or had multiple comorbid diseases reported lower life satisfaction.ConclusionsOptimism, sense of mastery and closeness with family/friends promotes coping and life satisfaction, whereas frailty and comorbidities make coping more challenging and lead to lower life satisfaction particularly during a pandemic. Our study improves on prior research because of its nationally representative sample and formal specification and testing of a comprehensive theoretical framework.

UNMET NEEDS AMONG ADULTS AND OLDER ADULTS IN BRAZIL, ELSI-2019

Abstract Many older adults in Brazil struggle to receive adequate assistance in later life. To better understand this issue, this study examines the prevalence and characteristics of unmet needs of adults ages 50 and older with difficulties performing activities of daily living (ADL), instrumental activities of daily living (IADL), the caregiving patterns, and the consequences of unmet needs in Brazil. We use data from the second wave of the Brazilian Longitudinal Study of Aging (ELSI-Brazil) study conducted in 2019-2021 (N=9,949). Results indicate that the prevalence rate of ADL was 8.9% (95% CI 7.6 – 10.5), and the prevalence of IADL was 15.6% (95% CI 13.1 – 18.5). Among those with ADL difficulties, 11.5% (95% CI 8.2 – 16.0) reported having unmet needs. Among those with IADL difficulties, 8.8% (95% CI 6.1 – 12.4) reported having at least one activity with unmet needs. Unmet needs were higher among younger adults, those living alone, Black or mixed race, or the Northeast region. Most of the care (87%) was provided by family members, primarily daughters, and wives. About 20% of caregivers had to stop working or studying to provide the needed care. Those with ADL unmet needs were less likely to visit friends or family, whereas IADL unmet needs were associated with lower odds of visiting a doctor. Our study provides the first glimpse of the characteristics of those with currently unmet needs among adults in Brazil and of caregivers. Unmet needs are associated with social isolation and worse healthcare use.

Relationships of Low Cognitive Performance and Sleep Disorder With Functional Disabilities Among Older Adults.

ObjectivesThis study examined the relationships of low cognitive performance and sleep disorder with functional disabilities among older adults. Methods: NHANES 2011-2014 data on 3179 individuals [Mage=69.71] were analyzed. Functional domains included: activities of daily living (ADL), instrumental ADL (IADL) and leisure and social activities (LSA). Animal Fluency Test and the Digit Symbol Substitution Test assessed cognitive performance. Participants self-reported having physician-diagnosed sleep disorder. Results: Participants with both low cognitive performance and sleep disorder had 4- to 10-times greater odds for ADL, IADL, and LSA difficulties compared to the participants with no low cognitive performance/sleep disorder. Participants with only low cognitive performance and those with only sleep disorder were two to three times more likely to experience these difficulties. Discussion: Low cognitive performance and sleep disorder together or independently were associated with functional disabilities. Participants with both low cognitive performance and sleep disorder had higher odds of functional disabilities.

Psychosocial and Physical Functioning Predictors of Everyday Functioning in The Kaiser Healthy Aging and Diverse Life Experience (KHANDLE) Study

AbstractBackgroundWhile Alzheimer’s disease and associated cognitive impairments are major contributors to functional decline, other variables including physical functioning and psychosocial variables may also impact functional status. Our study examined how psychosocial factors (depression, loneliness, and emotional support) and physical functioning (gait speed and grip strength) may independently contribute to instrumental activities of daily living (IADL) functioning among a diverse ethnoracial cohort.MethodThe Kaiser Healthy Aging and Diverse Life Experience (KHANDLE) study is a diverse cohort of long‐term members of an integrated healthcare delivery system ages ≥65, without a dementia diagnosis at time of recruitment. At enrollment, participants completed self‐report IADL measure, neuropsychological testing, physical functioning assessment (grip strength and walk speed), and self‐report psychosocial inventories assessing depression, loneliness, and perceived emotional support through the NIH Toolbox. Analytic sample included 1,243 participants (395 Caucasian (32%), 331 African American (27%), 292 Asian (23%), and 225 Latino (18%)). Cumulative logit models adjusting for cognition and demographics were used to determine significant predictors of IADL functioning, both in separate and combined models. Possible effect modification by race/ethnicity were assessed through interaction terms.ResultAverage baseline age was 75.5 and 59% were female. In separate models, gait speed, grip strength, loneliness, and emotional support were significant predictors of IADL functioning after controlling for cognition and demographics. Depression was not a significant predictor. When adding all significant variables into a single model as independent predictors, slower gait and greater loneliness were associated with more IADL difficulty, while stronger grip strength and more emotional support was associated with less IADL difficulty. Emotional support was no longer a significant predictor of IADL functioning. Interaction terms between independent variables and race were not significant.ConclusionVery few studies have simultaneously examined psychosocial factors and physical functioning as predictors of everyday functioning, particularly among a diverse ethnoracial sample. Our results indicate that independent of cognition, slower gait and greater loneliness were independently associated with worse IADL functioning, while stronger grip strength was associated with better IADL functioning. Such findings have important implications for identifying older adults at risk for disability and for treatments that could prevent excess disability.

Digital exclusion and functional dependence in older people: Findings from five longitudinal cohort studies.

Older people are more likely to be excluded from the digital world, and this has been linked to poor health outcomes. The extent and direction of the influence of digital exclusion on functional dependency is, however, not well understood. We aimed to investigate the association between digital exclusion and functional dependency among older adults from high-income countries (HICs) and low- and middle-income countries (LMICs). In this multicohort study, we pooled individual-level data from five longitudinal cohort studies that included nationally representative samples of older adults across 23 countries, including the Health and Retirement Study (HRS), the English Longitudinal Study of Aging (ELSA), the Survey of Health, Ageing and Retirement in Europe (SHARE), the China Health and Retirement Longitudinal Study (CHARLS), and the Mexican Health and Aging Study (MHAS). The digital exclusion was recorded as an absence from internet use by self-reported. We assessed basic activities of daily living (BADL) and instrumental activities of daily living (IADL), and we used interval-of-need methods to categorize the functional dependency. We applied generalized estimating equations models fitting Poisson model to investigate the association of digital exclusion with difficulties in BADL or IADL and functional dependency, adjusting for the causal-directed-acyclic-graph (DAG) minimal sufficient adjustment set (MSAS), including gender, age level, labour force status, education, household wealth level, marital status, and co-residence with children. We included 108,621 participants recruited between 2010 and 2018 with a median follow-up of 3 phrases. Digital exclusion in older adults varied across countries, ranging from 23.8% in Denmark (SHARE) to 96.9% in China (CHARLS). According to the crude model, digital exclusion was significantly associated with functional dependency. In the MSAS-adjusted model, those associations remained statistically significant: HRS (incidence rate ratio [IRR]=1.40, 95% confidence interval [CI] 1.34-1.48 for BADL; 1.71 [1.61-1.82] for IADL), ELSA (1.31[1.22-1.40] in BADL and 1.37 [1.28-1.46] in IADL), SHARE (1.69 [1.61-1.78] in BADL and 1.70 [1.63-1.78] in IADL), CHARLS (2.15 [1.73-2.67] in BADL and 2.59 [2.06-3.25] in IADL), and MHAS (1.15 [1.09-1.21] in BADL and 1.17 [1.09-1.25] in IADL). In the subgroup analyses, the associations were more pronounced in the oldest-old (aged≥80 years old). There is a substantial proportion of older adults who are excluded from the Internet, especially those in LMIC. Older people excluded from the Internet regardless of whether they live in HICs or LMICs are more likely to develop functional dependency. It should be made a priority to remove barriers to Internet access in order to assist older people in maintaining their independence and, consequently, to reduce the care burden associated with the ageing population worldwide. The National Natural Science Foundation of China (No. 71904004).

Relationship between handgrip strength and self-reported functional difficulties among older Indian adults: The role of self-rated health.

Older individuals' handgrip strength is a predictor of functional health and their self-perceptions of health may influence functional health and disability. Hence, the study explored the associations between handgrip strength and self-reported functional difficulties in activities of daily living (ADL) and instrumental ADL (IADL) among older adults. The study also explored the moderation and mediation effects of self-rated health (SRH) in those associations. Data for the study were drawn from the baseline survey of Longitudinal Ageing Study in India (LASI, 2017-18). This study was conducted on respondents aged 60years and above with a total sample of 27,707 older adults (men-13,199 and women-14,508). The study assessed handgrip strength using a handheld Smedley's Hand Dynamometer with a cut-off of 19.5kg for males and 12.5kg for females. Moderated multivariable regression models and the Karlson-Holm-Breen (KHB) method adjusting for many confounders, were used to explore the moderation and mediation effects of SRH in the association of handgrip strength and functional difficulties. A proportion of 25.80% of men and 26.24% of women of our sample had weak grip strength. A large proportion of older persons experienced difficulty in ADL (23.77%) and IADL (48.36%) in the study. Older adults with weak handgrip strength had higher odds of suffering from functional difficulties in ADL [adjusted odds ratio (aOR): 1.34; 95% confidence interval (CI):1.14-1.57] and IADL [aOR: 1.38; 95%CI: 1.18-1.60] than older adults with strong handgrip. Older adults who had weak handgrip strength and poor SRH had higher odds of difficulty in ADL [aOR: 2.72; 95%CI: 1.61-3.22] and IADL [aOR: 1.87; CI: 1.28-2.74] compared to those with strong handgrip and good SRH. Further, the association between handgrip strength and functional health was mediated by SRH (percent effect mediated: 26% for ADL and 16.84% for IADL). The findings provide further evidence that handgrip strength is connected with the disabling process and moderating and mediating role of SRH in these associations suggest that enhancement of self-perceptions of health among older adults may help prevent ADL and IADL-related issues in the later phase of life.

Socioeconomic and health-related inequalities in major depressive symptoms among older adults: a Wagstaff’s decomposition analysis of data from the LASI baseline survey, 2017–2018

ObjectivesTo find out the association between socioeconomic and health status and depression among older adults and explore the contributing factors in the socioeconomic and health-related inequalities in late-life depression.DesignA cross-sectional...

Late career participation of late retirees in the age of the silver tsunami: understanding the influencing mechanism of health status and employment-based health insurance participation

BackgroundThe delayed retirement initiative and population aging have led to a growing group of late retirees. However, it remains unclear whether the existing employment-based health insurance system can effectively match the recently proposed initiative and support late retirees, especially those with pre-existing function limitations. Thus, this study aims to investigate the influencing mechanism of China’s Urban Employee Basic Medical Insurance (UEBMI), physical functioning limitation (PFL) and difficulty in instrumental activities of daily living (IADLs) on labour participation of late retirees in China.MethodsThis study uses data from the China Health and Retirement Longitudinal Study (CHARLS) survey, which tracks the quality of life among older adults in China (valid sample size = 5560).ResultsEmpirical results show that China’s employment-based health insurance (i.e. UEBMI) and health conditions (i.e. PFL and difficulty in IADLs) are positively associated with late retirees’ withdrawal from late career participation. In addition, a higher level of difficulty in IADLs could strengthen the effect of PFL on late retirees’ withdrawal from late career participation, which could be further buffered by UEBMI beneficiary status.ConclusionIn the formulation of delayed retirement policies, it is necessary to consider the influencing mechanism of the social health insurance system and health conditions on late career participation of older workers to ensure policy effectiveness.

Social support moderates the association of functional difficulty with major depression among community-dwelling older adults: evidence from LASI, 2017–18

BackgroundThis study aimed to examine the potential independent association of functional disability with major depression and moderating effects of social support variables including marital status, living arrangement and social participation in such associations.MethodsData for the study were drawn from the Longitudinal Ageing Study in India (LASI) wave 1 that was collected during 2017–18 including a sample of 31,464 individuals aged 60 years and above. Descriptive statistics and results from bivariate analysis have been reported. Further, moderated multivariable logistic regression models were used to fulfil the study objective. Major depressive disorder was assessed using the scale of the Short Form Composite International Diagnostic Interview (CIDI-SF).ResultsIt was found that 8.67% of older participants were depressed in this study. Older adults who had difficulty in basic activities of daily living (BADL) (15.34%), difficulty in instrumental activities of daily living (IADL) (12.06%), unmarried (10.13%), separate living (9.67%) and socially inactive (10.09) were having higher prevalence of major depression compared to their respective counterparts. The adjusted model-1 revealed that older adults who had difficulty in BADL and IADL were 2.53 times [AOR: 2.53, CI: 2.17—2.95] and 2.27 times [AOR: 2.27, CI: 1.97—2.64] more likely to have major depression than those with no difficulty in BADL and IADL respectively. Further, interaction analyses found that currently unmarried status, separate living and being socially inactive have moderation effects in the observed associations and exacerbate the likelihood of major depression among older adults who are functionally impaired.ConclusionsThe findings highlight the importance of integrating social participation in the daily life of older adults and developing initiatives that promote a healthy surrounding such as social connectedness, co-residential living and special care for those who are physically disabled to protect against late-life depression.

Oral health problems and risk of incident disability in two studies of older adults in the United Kingdom and the United States.

BackgroundPreventing oral health problems can be crucial for maintaining physical independence in older adults. We aimed to examine the associations of a range of oral health problems with incidence of disability in older adults.MethodsWe used prospective data from the British Regional Health Study (BRHS) (N = 2147, 71–92 years), and the Health, Aging and Body Composition (HABC) study (USA) (N = 3075, 71–80 years). Oral health measures included tooth loss, periodontal disease, self‐rated oral health, and self‐reported dry mouth. Participants were followed for onset of disability over a follow‐up period of 3 years. Onset of disability was assessed through new cases of mobility limitations, activities of daily living (ADL), and instrumental activities of daily living (IADL). Logistic regression was performed to calculate the odds of incident disability.ResultsIn the BRHS, tooth loss was associated with greater odds of mobility limitations and ADL difficulties. Periodontal disease was associated with greater incidence of mobility limitations. Self‐report of ≥3 dry mouth symptoms was associated with increased odds of incident mobility limitations and ADL difficulties (OR = 2.08, 95% CI 1.27–3.42; OR = 1.73, 95% CI 1.03–2.90). Fair/poor self‐rated oral health was associated with greater incidence of IADL difficulties. In the HABC study, complete tooth loss was associated with greater incidence of mobility limitations (OR = 1.86, 95% CI 1.13–3.06), and fair/poor self‐rated oral health was associated with increased odds of incident ADL difficulties (OR = 1.42, 95% CI 1.04–1.94).ConclusionsOral health problems in older adults, particularly tooth loss, self‐reported dry mouth and self‐rated oral health were associated with greater incidence of disability. Poor oral health plays a potentially important role in the development of disability in older populations, which in turn is an essential part of quality of life and healthy aging.