Instrumental Activities Of Daily Living Disability Research Articles

Abstract P149: Association Between Disabilities And Cardiovascular Disease Mortality In Diabetic Men And Women

The associations of physical disabilities with cardiovascular disease (CVD) mortality in diabetic patients remains less explored. Purpose: We investigated the associations of activities of daily living (ADL), instrumental ADL (IADL), and functional limitation (FL) disabilities with CVD mortality among diabetic men and women in the National Health and Nutrition Examination Surveys. Methods: Cox proportional hazards regressions were used to examine the associations of ADL, IADL, and FL disabilities with CVD mortality in men and women after adjustment for covariates. We followed 2,255 men and women, aged 20 to 90 years, who participated in the National Health and Nutrition Examination Surveys (1988-1994, 199-2014). All participants completed baseline demographics and health factors, including blood lipid profiles. Diabetes mellitus was defined as fasting glucose level ≥126 mg/dL, a nonfasting glucose level ≥200 mg/dL, use of hypoglycemic agents, or a history of physician-diagnosed diabetes mellitus. ADL disability was defined as those who had any difficulties in dressing, eating, getting out of bed, or walking a room to another room. IADL disability was defined as those who had any difficulties in preparing meals, managing money, or doing chores around the house. FL disability was defined as those who had any limitations in mobility performance (walking 0.25 mile, climbing 10 stairs, lifting/carrying 10 pounds, or standing from a chair). Results: During an average of 15.5 years of follow-up (34,939 person-years), there were a total of 382 CVD deaths. There were direct relationships between the number of ADL, IADL, and FL with CVD mortality after adjustment for age, sex, race, and other CVD risk covariates (All P<0.007). After adjustment for multiple risk factors, the risks of CVD mortality for ADL, IADL, and FL disabilities were (95% CI) 2.01 (1.60, 2.51), 1.99 (1.60, 2.48), and 1.97 (1.59, 2.44), respectively, compared with their counterparts. After further adjustment for chronic medical conditions (personal history of coronary heart disease, stroke, or cancer), diabetic persons with ADL disability had 1.94 times (1.5, 2.43), with IADL disability had 1.93 times (1.54, 2.41), and with FL disability had 1.94 times (1.56, 2.40) the risk of CVD mortality as compared with their counterparts, respectively. The associations remained but were attenuated after further excluding these patients with chronic diseases. The risks of CVD mortality in diabetic persons with ADL, IADL, and FL disabilities were (95% CI) 1.78 (1.30, 2.43), 1.66 (1.22, 2.27), and 1.43 (1.09, 1.89), respectively, compared with their counterparts, after excluding these chronic disease patients. Conclusion: Diabetic persons with ADL, IADL, and FL disabilities had a greater risk of CVD mortality. The American Heart Association should establish exercise and dietary guidelines for diabetic persons with physical disabilities.

Individual and population level impact of chronic conditions on functional disability in older adults

BackgroundIt is unknown if the relationship between multimorbidity and disability differs by combinations of chronic conditions. The objective of our study was to elucidate how joint effect of different combinations of chronic conditions impact the five year risk of functional disability at the population level.MethodsParticipants ≥65 years from the Canadian Study of Health and Aging were assessed for functional disability measured using activities of daily living (ADL) and instrumental ADL (IADL), and the presence of conditions in five disease domains; cardiometabolic, neurological, sensory, musculoskeletal, and respiratory. Logistic regression was used to assess the relationship between each disease domain and incident ADL and IADL measured at five years of follow up and population attributable risk (PAR) was modeled for diseases domains that were significantly associated with disability. Results were stratified by sex and age (65–74 years, ≥75 years).ResultsThere were 6272 participants free of ADL disability and 4571 participants free from IADL disability at baseline. For incident ADL, the greatest PAR values were 21.3 (9.8–32.8) for the cardiometabolic domain in males 65–74 years, 22.7 (4.7–40.8) for the musculoskeletal domain for females aged 65–74 years, and 11.2 (2.8–19.7) for the musculoskeletal domain in males ≥75 years. The PAR for the musculoskeletal, sensory, and neurological domains were similar in females ≥75 years(9.3–9.9). PAR values were lower but followed similar patterns for IADL disability.ConclusionThe chronic disease domains which most strongly predicted incident ADLs and IADLs did not account for the greatest amount of disability at the population level.

Multimorbidity patterns and functional disability in elderly Brazilians: a cross-sectional study with data from the Brazilian National Health Survey

The presence of multimorbidity patterns has been related to functional disability in basic activities (BADLs) and instrumental activities of daily living (IADLs), which are essential for elder individuals' self-care and autonomy. The study thus aimed to estimate the association between multimorbidity patterns and presence of functional disability in elderly Brazilians. This was a cross-sectional study using data from the Brazilian National Health Survey (PNS 2013) in a sample of elderly Brazilians (≥ 60 years). The measures of functional disability were from self-completed questionnaires, categorized in basic activities of daily living (BADLs) and instrumental activities of daily living (IADLs). The multimorbidity patterns analyzed here were: (1) cardiorespiratory; (2) vascular-metabolic; and (3) mental-musculoskeletal. The adjustment variables included age, sex, schooling, and region of Brazil. Multivariate logistic regression analyses were performed, estimating crude and adjusted odds ratios (OR) with Stata 16.0. Elderly individuals classified in the mental-musculoskeletal patterns showed the highest odds of disability in BADLs (OR = 2.72; 95%CI: 2.33; 3.18), while those with the cardiopulmonary pattern showed the highest odds of disability in IADLs (OR = 2.65; 95%CI: 1.95; 3.60), compared to those without the same patterns. All the multimorbidity patterns analyzed here were associated with disability in BADLs and IADLs and should thus be considered when planning measures to prevent disabilities in elderly individuals with multimorbidity.

Why Do Older Korean Adults Respond Differently to Activities of Daily Living and Instrumental Activities of Daily Living? A Differential Item Functioning Analysis.

ObjectivesCulture-based gender norms regarding who performs daily activities can bias the assessment of instrumental activities of daily living (IADL). This study evaluated item-response biases in the activities of daily living (ADL) and IADL among community-living Korean older adults.MethodsThe subjects included older Korean participants of the Korean Longitudinal Study of Ageing baseline survey (n=4,164). We performed differential item functioning (DIF) analysis of these data using the Mantel–Haenszel method. ResultsWe observed different reported levels of disability for eight IADL items among gender, age, and educational level subgroups. After matching for overall functional disability, men were more likely to report limitations in performing various household activities, compared to cognitive activities in women.ConclusionsCross-national comparisons of ADL and IADL disabilities need to consider item response bias stemming from culture-based gender norms regarding who performs different household activities.

Disabilities in activities of daily living and in instrumental activities of daily living among older adults in China, 2011–15: a longitudinal cohort study

BackgroundWith global population ageing, the population of older adults (aged ≥60 years) is rapidly growing, and most such individuals are in need of health care and assistance. We aimed to assess changes in disability in basic activities of daily living (ADL), and in instrumental activities of daily living (IADL) among older Chinese individuals. MethodsWe used data from three surveys of the China Health and Retirement Longitudinal Study, conducted in 2011 (n=7380), 2013 (n=8328), and 2015 (n=9594). Data on six ADL measures (dressing, bathing, eating, walking, toileting, and urination and defecation) and six IADL measures (doing housework, shopping, cooking, managing money, taking medicine, and telephoning) were collected through interviews. We defined disability as need of assistance or inability to perform any of the ADLs or IADLs. Generalised estimating equation models were used to assess the time trend in the prevalence of disabilities in ADL and IADL. FindingsThe prevalence of disability in IADLs increased from 1496 (20·96%, weighted) of 7330 participants in 2011 to 2584 (26·51%, weighted) of 9348 in 2015, with a relative annual increase of 1·92% in the total sample (ptrend<0·0001). The trend was statistically significant (ptrend<0·001) in all subgroups by age, sex, and living region. The prevalence of disability in ADLs showed little change from 2011 (759 [11·40%, weighted] of 7354) to 2015 (983 [10·03%, weighted] of 9554), with a relative annual change of 0·12% in the total sample (ptrend=0·2429), and in all subgroups by age, sex, and living region (ptrend>0·10). After controlling for various confounding factors, functional capacities in ADLs and IADLs were substantially worse in women than in men. InterpretationThe prevalence of IADL disability increased among older Chinese adults during 2011–15, whereas the prevalence of ADL disability remained stable. Improvements in lifestyle, socioeconomics, and health care might reduce disabilities in ADL, but lifespan extension might expand IADL disability as more frail and older individuals survive with health problems. FundingNational Natural Science Foundation of China (grant number 81573262).

Residential greenness, activities of daily living, and instrumental activities of daily living: A longitudinal cohort study of older adults in China.

We included older adults 65 years of age or older from the Chinese Longitudinal Healthy Longevity Survey. Our exposure was Normalized Difference Vegetation Index in 500 m radius around residence. Our outcome was ADL and IADL. We used binary logistic regression and mixed-effects logistic regression to estimate the odds of ADL and IADL disabilities. A total of 36,803 and 32,316 participants were included for the analysis of ADL and IADL, with 71.6% free of ADL disability and 47.3% free of IADL disability. In the logistic regression model, compared with the participants living in the lowest quartile of residential greenness, those in the highest quartile had a 28% (odds ratio [OR] = 0.72; 95% confidence interval [CI] = 0.65, 0.79) lower odds of ADL disability and a 14% (OR = 0.86; 95% CI = 0.77, 0.95) lower odds of IADL disability. A similar association was found in the mixed-effects logistic regression models. During the follow-up period, 5,004 and 4,880 healthy participants developed ADL and IADL disabilities. Per 0.1-unit increase in baseline annual average Normalized Difference Vegetation Index (NDVI) was related to an OR of 0.95 of developing ADL disability (95% CI = 0.93, 0.98) and IADL disability (95% CI = 0.91, 0.98). Our study suggests that increasing green space is associated with lower odds of ADL and IADL disabilities, which may reduce caregiver burden of long-term care for Chinese older adults.

The mediating effect of pain on the association between multimorbidity and disability and impaired physical performance among community-dwelling older adults in southern China.

To investigate the association between multimorbidity and disability and impaired physical performance, and to further evaluate the mediating effect of physical pain in this association. 1321 community-dwelling older adults, who were over 60years old in southern China, were regarded as participants in this cross-sectional study. Subjects completed a multi-instrument questionnaire including essential characteristics and physical function assessments. Physical function was assessed by activities of daily living (ADL), instrumental activities of daily living (IADL), index of mobility scale (NAGI), index of basic physical activities scale (RB), and short physical performance battery (SPPB). Multimorbidity was defined as the simultaneous presence of two or more chronic conditions. Multivariable regression and mediation analyses were conducted and gender differences were explored. The prevalence of multimorbidity was 44.6% in our study. In gender stratification analysis, multimorbidity was significantly associated with ADL disability (OR = 2.16), IADL disability (OR = 1.97), NAGI disability (OR = 2.84), RB disability (OR = 2.65) and lower SPPB score (β = - 0.83) in women. The rate of pain increased with the number of chronic diseases and the multimorbidity patients with higher pain prevalence. Moreover, the presence of pain was also significantly associated with disability and impaired physical performance. Mediation analysis illustrated that pain was accounted for 16.5% to 22.1% of the adverse effects of multimorbidity on disability and impaired physical performance in women. Multimorbidity was significantly associated with disability and impaired physical performance, and pain might be a mediating factor for adverse effects of multimorbidity on disability and impaired physical performance in women.

Weakness and cognitive impairment are independently and jointly associated with functional decline in aging Americans

Discovering how certain health factors contribute to functional declines may help to promote successful aging. To determine the independent and joint associations of handgrip strength (HGS) and cognitive function with instrumental activities of daily living (IADL) and activities of daily living (ADL) disability decline in aging Americans. Data from 18,391 adults aged 50years and over who participated in at least one wave of the 2006-2014 waves of the Health and Retirement Study were analyzed. A hand-held dynamometer assessed HGS and cognitive functioning was examined with a modified version of the Telephone Interview of Cognitive Status. IADL and ADL abilities were self-reported. Participants were stratified into four distinct groups based on their HGS and cognitive function status. Separate covariate-adjusted multilevel models were conducted for the analyses. Participants who were weak, had a cognitive impairment, and had both weakness and a cognitive impairment had 1.70 (95% confidence interval (CI) 1.57-1.84), 1.97 (CI 1.74-2.23), and 3.13 (CI 2.73-3.59) greater odds for IADL disability decline, respectively, and 2.26 (CI 2.03-2.51), 1.26 (CI 1.05-1.51), and 4.48 (CI 3.72-5.39) greater odds for ADL disability decline, respectively. HGS and cognitive functioning were independently and jointly associated with IADL and ADL disability declines. Individuals with both weakness and cognitive impairment demonstrated substantially higher odds for functional decline than those with either risk factor alone. Including measures of both HGS and cognitive functioning in routine geriatric assessments may help to identify those at greatest risk for declining functional capacity.

Association between chronic obstructive pulmonary disease and activity of daily living among oldest-old in China: based on Chinese Longitudinal Health Longevity Survey.

AimsThis study was designed to investigate the association between COPD and activity of daily living among oldest-old in People's Republic of China.Patients and methodsThe data of Chinese Longitudinal and Health Longevity Study in 2014 was used, and those who were aged more than 80 years old were included. Both basic activity of daily living (BADL) and instrumental activity of daily living (IADL) were measured.ResultsA total of 4621 oldest-old (≥80 years old) were included. 32.1% (1482) of the oldest-old had BADL disability and 79.0% (3129) had IADL disability. The BADL disability and IADL disability rates were higher for participants with COPD than those without, and this difference was more robust among male (31.8% vs 25.6%, p=0.018). The IADL disability rate showed similar trends. Multivariate logistic regression analysis showed that the odds ratios of COPD on BADL disability and IADL disability were 1.261 (95% CI: 1.044–1.525) and 2.014 (95% CI: 1.561–2.598), respectively. The odds ratios of COPD on moderate to severe BADL disability and IADL disability were 1.007 (95% CI: 0.790–1.284) and 1.713 (95% CI: 1.397–2.100), respectively.ConclusionThere were independent associations between COPD and disability among oldest-old in People's Republic of China, and the associations were greater among male population. Besides, COPD had a profound influence on the mild disability of BADL, while had a greater impact on the moderate and severe disability of IADL.

Depressive Symptoms and Onset of Functional Disability Over 2 Years: A Prospective Cohort Study.

This prospective cohort study examined the relationship between depressive symptoms and onset of functional disability over 2 years among US Chinese older adults, a rapidly growing minority older adult population. This study used survey data from 2713 Chinese older adults who completed both baseline (2011-2013) and follow-up (2013-2015) interviews of the Population Study of Chinese Elderly in Chicago. Depressive symptoms were assessed at baseline by the nine-item Patient Health Questionnaire. Functional disability was measured by three validated scales, Katz Index of Independence in Activities of Daily Living (ADLs), the Lawton Instrumental Activities of Daily Living (IADLs) scale, and the Rosow and Breslau mobility scale. Multivariate logistic regression was conducted to examine the relationship between baseline depressive symptoms and the development of functional disability (ADLs, IADLs, mobility) at 2-year follow-up while adjusting for covariates. Of the 2713 participants, 5.2% experienced ADL disability onset, 35.6% experienced IADL disability onset, and 23.3% experienced mobility disability onset over 2 years. After adjusting for covariates, the odds of ADL disability onset (odds ratio [OR] = 1.06; 95% confidence interval [CI] = 1.02-1.11), IADL disability onset (OR = 1.05; 95% CI = 1.01-1.09), and mobility disability onset (OR = 1.05; 95% CI = 1.01-1.09) were consistently higher in US Chinese older adults with higher levels of depressive symptoms than their less-depressed counterparts. Other significant risk factors included older age and more chronic physical conditions. Study findings underscore a significant relationship between depressive symptoms and onset of functional disability. Screening and, subsequently, treating depressive symptoms have the potential to reduce disability among US Chinese older adults. Culturally relevant depressive symptom screening may help identify Chinese older adults who are at greater risks for the development of functional disability. J Am Geriatr Soc 67:S538-S544, 2019.

Cross-sectional and Longitudinal Associations of Environmental Factors with Frailty and Disability in Older People

PurposeTo determine cross-sectional and longitudinal associations of environmental factors with frailty and disability. MethodsThis study was conducted in a sample of Dutch citizens. At baseline the sample consisted of 429 subjects (aged ≥ 65 years); a subset of this sample participated again two and half years later (N = 355). The participants completed a web-based questionnaire, “the Senioren Barometer”, comprising seven scales for assessing environmental factors, and the Tilburg Frailty Indicator (TFI) and the Groningen Activity Restriction Scale (GARS), for assessing frailty and disability, respectively. Environmental factors of interest were: nuisance; housing; facilities; residents; neighborhood; stench/noise; and traffic. ResultsSequential regression analyses demonstrated that all environmental factors together explained a significant part of the variance of physical and social frailty and disability in performing activities of daily living (ADL) and instrumental activities of daily living (IADL), measured at Time 1 (T1) and Time 2 (T2). These analyses also showed that four of the environmental factors were associated with at least one of the outcome measures: housing, nuisance, residents, and neighborhood. Housing was the only environmental factor associated with three different outcome measures (social frailty, ADL disability, IADL disability), assessed at T1 and T2. ConclusionThe findings offer health-care and welfare professionals and also policymakers starting points for interventions. These interventions should focus, in particular, on housing, nuisance, residents, and neighborhood, because their impact on frailty and/or disability was the largest.

Multidimensional investigation of chronic pain experience and physical functioning following hip fracture surgery: clinical implications.

Older adults experience significant chronic pain after hip fracture, resulting in decreased physical functioning. However, pain investigation in this population is mostly limited to self-reported pain intensity. Detailed pain assessment may identify intervention targets other than pain relief. The aim of this study is to investigate multiple dimensions of pain experience (intensity, sensory, affective, evaluative and miscellaneous dimensions) and to correlate them to lower limb functionality and limitations in daily living activities. We conducted a cross-sectional study of 50 older adults (77.1 ± 8.1 years old) who underwent hip fracture surgery in the past 4 months. We used the Numeric Rating Scale (NRS), the McGill Pain Questionnaire (MPQ) and an algometer to assess pain intensity, pain quality and pressure pain threshold, respectively. Lower limb functionality and limitation in basic (activities of daily living (ADL)) and instrumental activities of daily living (IADL) were assessed using the Short Physical Performance Battery (SPPB) and the Brazilian OARS Multidimensional Functional Assessment Questionnaire. Participants described pain as brief, momentary and transient, especially during weight-bearing activities. Although the pain intensity measured by the NRS was reported as moderate to severe (7.5 ± 1.6 points), it was not correlated with physical functioning. However, we observed a moderate negative correlation between pressure pain threshold, ADL and IADL disability (r = -0.41, p < 0.01). Among pain qualities, the sensory category was moderately negatively correlated to SPPB (r = -0.41, p < 0.01), and the evaluative category was moderately correlated to ADL and IADL disability (r = 0.43, p < 0.01). Pain can be present 4 months after hip fracture surgery, particularly during weight-bearing activities, and it is associated with poor lower limb functionality, as well as ADL and IADL disability. Older adults may benefit from pain assessments that go beyond pain intensity measurements after hip fracture, as this helps clinicians optimise pain management and overall functional recovery.

Association between visual problems, insufficient emotional support and urinary incontinence with disability in elderly people living in a poor district in Rio de Janeiro, Brazil: A six-year follow-up study.

IntroductionDisability follows the rapid rate of population ageing, imposing a huge burden on society. Functional assessment in older people can identify predictors of disability.ObjectiveAnalyze the incidence and the risk factors for disability in activities of daily living (ADL) and instrumental activities of daily living (IADL) in older adults over six years.MethodsSix year-follow up study initiated in 2010. The baseline non-probabilistic sample consisted of 180 independent community dwelling individuals aged 60 and over. The procedures comprised an interview with sociodemographic data, questions about falls, urinary incontinence, self-rated health, and assessment of ADL, IADL, mobility, depression, vision, hearing, cognition, nutrition, grip strength and social support. The second research was carried out by telephone and assessed ADL and IADL. Logistic regression models calculated the odds of disability in ADL and IADL according to the age, sex and all other variables.ResultsAt six-year follow-up, 118 participants were still alive (65.6%), 31 died (17%) and other 31 were missed (17%). The incidence of disability to performADL and IADL were 25.4% and 32.3%, respectively. The regression logistic models revealed thaturinary incontinence (OR = 3.2; P = 0.03) and insufficient emotional support (OR = 3.8; P = 0.04) were associated with ADL disability, while visual problems (OR: 2.9; P = 0.03) and insufficient emotional support (OR: 5.6; P = 0.01) were associated with IADL disability.ConclusionThe current study has identified that insufficient emotional support, visual problems and urinary incontinence are associated with disability in older adults. The routine assessment of these problems in the primary care clinics enable the implementation of strategies aimed at reducing or postponing disability. Educating patients and families will also enable better choices to reduce the risk of functional decline.

Prevalence of chronic diseases and associate factors on daily activities in male oldest-olds

Objective: To investigate the prevalence of chronic diseases in aged ≥80 oldest-olds and related factors influencing their daily activities. Methods: This survey was conducted in the retired cadres in Beijing from 2012 to 2014. A unified questionnaire was used to investigate the general characteristics of the oldest-olds and the activities of daily living (ADL). Information on chronic diseases was extracted from related medical records. Results: A total of 4 472 male oldest- olds, with an average age as (87.1±3.9) years (80-102 years), were included. Nearly half of the elderly people were suffering from 5 or more kinds of chronic diseases, with 43.9% of them having disability on basic daily activities (BADL) with 13.4% of those classified as moderate or severe cases. 38.8% of them had instrumental activities of daily living (IADL) disability, with 28.7% of them were moderate or severe cases. The ADL disability showed an increasing trend along with the increase number of chronic diseases. The proportion of BADL disability increased from 40.5% to 50.6%. Compared with the ones having fewer chronic diseases (≤2 kinds), those with more (≥7 kinds) had an increase of 50.5% risk on BADL disability and 199.4% on IADL disability. Conclusion: We noticed that the male oldest-olds suffered from multiple chronic diseases. The impairment of ADL was higher than the younger elderly. Comorbidity showed heavier impact on ADL, especially on the instrumental activities of daily living.

Role of physical performance measures for identifying functional disability among Chinese older adults: Data from the China Health and Retirement Longitudinal Study.

BackgroundFunctional disability is a common health burden in older adults and follows a hierarchical pattern. Physical performance measures are useful for the objective estimation of functional disability. This study primarily aimed to compare the validity of handgrip strength and gait speed, alone and in combination, for recognizing the functional disability among Chinese older adults. This study also aimed to stratify the functional disability according to the criterion-referenced values of handgrip strength and gait speed.MethodsWe selected 6127 respondents from the 2011 wave of the China Health and Retirement Longitudinal Study. Here, we defined functional disability as needing any help in any items of activities of daily living (ADL) and instrumental activities of daily living (IADL). To assess the validity of physical performance measures alone and in combination for the recognition of functional disability, we conducted the receiver operating characteristic analysis.ResultsCompared with handgrip strength, the gait speed could better discriminate ADL disability and showed a satisfactory discriminant validity (area under the curve ≥ 0.7) in men. However, this finding was not found in the recognition of IADL disability. When combining these two measures, the parallel test showed a high sensitivity with a poor specificity, whereas the serial test showed a perfect specificity with a poor sensitivity.ConclusionWe developed the hierarchical cut-off values of handgrip strength and gait speed for identifying and stratifying the functional disability among Chinese adults over 60 years old. The speed test was superior to handgrip strength in identifying ADL disability. The parallel tests of those with high sensitivity perhaps could help identify the functional disability. Further work on cost-utility analysis is warranted.

Healthy eating index-2010 and physical activity and disabilities of old age

BACKGROUND: Consuming a poor diet and being physically inactive may increase the risk of developing disabilities of old age. OBJECTIVE: To investigate correlations between Healthy Eating Index-2010 (HEI-2010) scores, physical activity levels, and disabilities of old age in a large biracial cohort. METHODS: The ARIC Study is a prospective cohort aged 45–64 years at baseline. Overall diet quality was assessed using the HEI-2010. A physical activity score was the sum of work, sports, and leisure. Activities of daily living (ADL), instrumental activities of daily living (IADL), and functional abilities were compared with HEI-2010 and physical activity by logistic regression 9 years after the baseline examination. RESULTS: Compared with the lowest quartile, quartile 4 healthier HEI-2010 scores showed an odds ratios of 0.76 (95% confidence interval 0.67–0.87) for functional disability, 0.89 (95% CI 0.75–1.07) for ADL disabilities, and 0.88 (95% CI 0.76–0.1.03) for IADL disabilities.Compared with the lowest tertile, tertile 3 of physical activity showed an odds ratios of 0.60 (95% CI 0.54– 0.67) for functional disability, 0.68 (95% CI 0.60–0.78) for ADL disabilities, and 0.53 (95% CI 0.47–0.60) for IADL disabilities. CONCLUSIONS: Healthier diet and higher physical activity were associated with lower levels of the disabilities of aging, particularly functional disability, at follow up.

Incidence of activities of daily living disability and related factors in community-dwelling older adults in China

Objective: To analyze the decline of activities of daily living (ADL) ability and influencing factors over a period of 2 years in community-dwelling older adults in China. Methods: The study subjects were from the project of Prevention and Intervention on Neurodegenerative Disease for Elderly in China of 2015-2017 to select the samples. In 2015, a total of 23 803 community- dwelling residents adults, aged ≥60 years old, came from both urban and rural areas, were selected through a stratified multi-stage cluster sampling in 6 provinces and joint baseline survey. The follow-up was conducted in 2017 to collect the related information using the same questionnaires and examinations. Finally, 18 785 elderly people were included in this analysis after excluding those who were died, failed to follow up, had incomplete data cases or defined as ADL disability at baseline survey. The post-stratification weight on the sample data was done by using the 6(th) national population census data as the standard, the rates of ADL/basic activities of daily living (BADL)/instrumental activities of daily living (IADL) disabilities over 2 years were calculated and compared among the elderly with different characteristics. Multiple logistic regression models were used to analyze the factors associated with BADL/IADL disabilities. Results: During the 2-year follow-up, ADL disability developed in 1 959 participants with a rate of 12.0% (1.6% for BADL disability and 10.4% for IADL disability only). Multivariate logistic regression analysis showed that the risk factors for BADL disability included increased age, obesity, comorbidity and cognitive impairment. The risk factors for only IADL disability included increased age, being female, lower weight and cognitive impairment. Compared with illiterates, the educated had lower risk for only IADL disability. Compared with those with normal weight, overweight and obese old people had lower risk for only IADL disabilities. Conclusion: Increased age and cognitive impairment were associated with the increased risk for BADL and IADL disabilities. Older people with comorbidities had higher risk for BADL disability. Obesity increased the risk of BADL disability, but decreased the risk for IADL disability in older people. Women had a higher risk for IADL disability compared with men. Being educated was associated with lower risk of IADL disability.

Study on activities of daily living disability in community-dwelling older adults in China

Objective: To investigate the disability status and its epidemiological characteristics in the elderly in urban and rural communities in China. Methods: The participants were from the project of Prevention and Intervention on Neurodegenerative Disease for Elderly in China conducted in 2015. A total of 23 803 urban and rural residents aged over 60 years were selected through stratified multi-stage cluster sampling in 6 provinces for a set of standardized questionnaire interview and physical examinations. Activities of daily living (ADL) scale was used to assess the disability status of the elderly. χ(2) test was used to analyze the difference in basic activities of daily living (BADL) and instrumental activities of daily living (IADL) disabilities in different elderly populations. Multivariate logistic regression model was used to analyze the influence factors for disability. Results: Taking bath had the highest impairment rate (1.7%) while eating had the lowest impairment rate (0.6%) in BADL. Making phone call had the highest impairment rate (16.6%), followed by taking bus (5.5%) and taking medicine (1.8%) in IADL. The BADL and IADL disability rates in community seniors were 2.1% and 19.1%, respectively. BADL disability rate was higher in females, the widowed, illiterate, the elderly with low body weight or obesity (P<0.05). IADL disability rate was higher in females, rural residents, the widowed, the elderly with lower educational level or lower body weight (P<0.05). Multivariate analysis showed that risk for BADL disability increased with age and abnormal BMI, and decreased with the increase of education level. The risk factors for IADL disability included being female, age, rural residence, being widowed and low BMI. The risk for IADL disability was lower in those with higher education level and overweight or obesity. Conclusion: The present study showed that the disability rate was high in the elderly in China, which was influenced by the aging and multi demographic characteristics of the elderly. It is important to strengthen the prevention of BADL and IADL disabilities and intervention in the elderly.

Does Community-Level Social Capital Predict Decline in Instrumental Activities of Daily Living? A JAGES Prospective Cohort Study.

Instrumental activities of daily living (IADL) represent the most relevant action capacity in older people with regard to independent living. Previous studies have reported that there are geographical disparities in IADL decline. This study examined the associations between each element of community-level social capital (SC) and IADL disability. This prospective cohort study conducted between 2010 and 2013 by the Japan Gerontological Evaluation Study (JAGES) surveyed 30,587 people aged 65 years or older without long-term care requirements in 380 communities throughout Japan. Multilevel logistic-regression analyses were used to determine whether association exists between community-level SC (i.e., civic participation, social cohesion, and reciprocity) and IADL disability, with adjustment for individual-level SC and covariates such as demographic variables, socioeconomic status, health status, and behavior. At three-year follow-up, 2886 respondents (9.4%) had suffered IADL disability. Residents in a community with higher civic participation showed significantly lower IADL disability (odds ratio: 0.90 per 1 standard deviation increase in civic participation score, 95% confidence interval: 0.84–0.96) after adjustment for covariates. Two other community-level SC elements showed no significant associations with IADL disability. Our findings suggest that community-based interventions to promote community-level civic participation could help prevent or reduce IADL disability in older people.

The inflammatory potential of diet is related to incident frailty and slow walking in older adults

Certain foods and dietary patterns have been associated with both inflammation and frailty. As chronic inflammation may play a role in frailty and disability, we examined the association of the inflammatory potential of diet with these outcomes. Data were taken from 1948 community-dwelling individuals ≥60 years old from the Seniors-ENRICA cohort, who were recruited in 2008-2010 and followed-up through 2012. Baseline diet data, obtained with a validated diet history, was used to calculate Shivappa's Dietary Inflammatory Index (DII), an "a priori" pattern score which is based on known associations of foods and nutrients with inflammation, and Tabung's Empirical Dietary Inflammatory Index (EDII), an "a posteriori" pattern score which was statistically derived from an epidemiological study. At follow-up, incident frailty was assessed with Fried's criteria, and incident limitation in instrumental activities of daily living (IADL) with the Lawton-Brody index. Statistical analyses were performed with logistic regression, and adjusted for the main confounders. Compared with individuals in the lowest tertile of DII, those in the highest tertile showed higher risk of frailty (odds ratio [OR] 2.48; 95% confidence interval [CI]: 1.42, 4.44, p-trend=0.001) and IADL disability (OR: 1.96; 95% CI: 1.03, 3.86, p-trend=0.035). By contrast, EDII did not show an association with these outcomes. The DII score was associated with slow gait speed, both as a low score in the Short Physical Performance Battery test (OR: 1.82; 95% CI: 1.27, 2.62, p-trend=0.001) and as a positive Fried's criterion (OR: 1.64; 95% CI: 1.08, 2.51, p-trend=0.021), which use different thresholds. DII predicted frailty and IADL while EDII did not. DII is able to measure diet healthiness in terms of physical decline in addition to avoidance of inflammation. ClinicalTrials.gov number, NCT01133093.