Mediating Role of Physical Capabilities in the Association Between Perceived Physical Fatigability and Cognitive Frailty in Older Adults.

BackgroundThis study aimed to investigate the relationship between cognition, Alzheimer's disease (AD) biomarkers, and instrumental activities of daily living (IADL) performance among cognitively normal (CN) older adults, to identify key predictors of IADL performance. A better understanding of the combined influence of cognitive function and AD pathology on IADL performance in CN older adults could lead to the development of more precise functional screening tools for preclinical AD, improved functional outcome measures for AD and aging, and the development of interventions designed to maintain or improve IADL performance.MethodCN older adults (n = 173) performed three IADL tasks (shopping, checkbook balancing, medication management) from the Performance Assessment of Self‐Care Skills in their home. Cognitive and AD biomarker assessments were completed in an academic medical center. Amyloid and tau positron emission tomography (PET) were used to measure AD pathology. IADL performance was transformed into one composite score and dichotomized (better vs. worse, split at median). Cognitive assessments were transformed to create composites: Global, Episodic Memory, Semantic Memory, Attention & Processing, Working Memory, and Visuospatial. Logistic regression models were used to examine cognitive and biomarker predictors of IADL performance while controlling for demographic covariates.ResultCognitive domains, particularly the Global composite (OR=0.34, p < 0.001) and Attention & Processing (OR=0.40, p = 0.001), emerged as strong predictors of IADL performance. Higher amyloid burden (OR=1.82, p = 0.015) was associated with worse IADL performance and tauopathy (OR=1.61, p = 0.060) demonstrated a trend toward association. Comparison of predictive models identified additive influences of cognition and amyloid in predicting IADL performance.ConclusionThese findings suggest that cognitive function, particularly Global and Attention & Processing domains, and AD pathological burden play significant, complementary roles in IADL performance among CN older adults. Findings may be used to inform the development of sensitive functional assessments in preclinical AD that focus on key deficits, and later to develop interventions targeting important modifiable factors and compensatory rehabilitative methods to improve IADL performance in everyday life.

BackgroundIndividuals with mild cognitive impairment (MCI) experience challenges in maintaining independence in their instrumental activities of daily living (IADLs). The memory support system (MSS) is a paper‐based planner intervention to train individuals with MCI to complete personal goals and IADLs independently. As more individuals use electronic calendar systems, the MSS will need to adapt. This project aimed to develop and test an electronic prototype of the MSS (eMSS).MethodDrawing on the MSS, an eMSS prototype intended for phone/tablet use was developed in Axure, allowing participants to interact with the planner and its sections (calendar, notes, to do list). The prototype was evaluated with MSS trainers and individuals with MCI and their partners using a computer or tablet over a virtual platform. Participants were asked to go through fictional ‘planning’ scenarios which were assessed using cognitive task analysis (CTA). The scenarios were designed to evaluate overall ease of use, and specifics such as navigation between pages/sections and developing schedules and task lists. During sessions, participants were encouraged to 'think aloud,' providing insight into their eMSS experience.ResultTo date, CTA has been conducted with 6 MSS trainers, and 2 patient/partner dyads that completed the MSS training program. Early results provide insight on strengths, challenges and opportunities to optimize the eMSS. Participants could identify and use key features (e.g., menus) and found the symbols and language consistent. However, participants didn’t notice some features (e.g., interactive arrows to navigate across dates) and requested more ‘cueing’ or ‘interactive prompts.’ Participants would prefer to see all information entered on individual pages (which is possible with the MSS) to support better situation awareness.ConclusionTo respond to the everyday planning needs of individuals with MCI in a digital age, an eMSS was developed, drawing on a clinically trialed hardcopy version (MSS). Positive feedback from MSS trainers and patients with MCI and their partners suggests promise for the overall design. Improvements for the next iteration include designing cues to help users know actions have been completed or when to attend to important information, as well as providing more fulsome information on pages to support awareness of daily tasks.

BackgroundAlzheimer's disease progression is typically staged using cognitive tests. This study aimed to define clinical stages measured by Instrumental Activities of Daily Living (IADL) using a crosswalk with Montreal Cognitive Assessment (MoCA) scores.MethodPatients with mild cognitive impairment (MCI) or Alzheimer's dementia (AD) were identified from the Veteran's Affairs Healthcare System (VAHS) database from 2020 – 2024. Paired MoCA and Lawton‐Brody IADL scores were analyzed to generate IADL score means, standard deviations (SD), medians, and ranges. Linear and repeated measures mixed effects analysis was performed adjusting for patient demographics.ResultThe study sample (N = 1,327) had a mean age of 80.1 years (97.4% men, 18.4% Black, and 12.0% Hispanic). MoCA cut‐offs for Normal, MCI, Mild, Moderate, and Severe AD stages were ≥29, 26,18, 11 and ≤10, respectively. Corresponding mean (SD) and median IADL score cutoffs separating disease stages were: normal (n = 14), 7.0 (1.8) and 8; MCI (n = 96), 6.4 (2.3) and 8; mild (n = 666) 5.9 (2.5) and 7; moderate (n = 393) 4.0 (2.9) and 3; severe (n = 158), 2.4 (2.6) and 1. IADL tests resulted in ranges of 3‐8 for normal, 1‐8 for MCI, and 0‐8 for other stages. The IADL linear least squares (LS) means were distributed as >7.6, 6.9‐7.6, 5.1‐6.9, 3.5‐5.1, <3.5 for normal, MCI, mild, moderate, and severe stages projected by MoCA cutoffs, respectively (adjusted R‐squared=0.25). The LS means from categorical regression were 7, 6.5, 6.0, 4.2, and 2.6 for normal, MCI, mild, moderate and severe stages, respectively (adjusted R‐squared=0.23). Similarly, LS means from repeated measures analysis found IADL score ranges for normal to severe AD were >7.3, 6.7‐7.3, 5.1‐6.7, 3.6‐5.1, and <3.6.ConclusionThis study identified IADL score thresholds corresponding to clinical stages from normal to severe AD according to a regressional crosswalk with MoCA. The findings from categorial regression allowed greater spread of the IADL cut‐offs from mild to severe AD stages compared to linear and repeated measures regressions, accommodating nonlinearity in the cut‐off score distribution.

BackgroundPopulation aging and increasing life expectancy raised concerns about functional dependency (FD) and multimorbidity. However, the impact of FD on later-life multimorbidity remains poorly understood.MethodParticipants from the China Health and Retirement Longitudinal Study (CHARLS) and the Survey of Health, Ageing and Retirement in Europe (SHARE) with complete baseline FD and 7-year follow-up data on multimorbidity were included, excluding those with multimorbidity or missing specific chronic diseases at baseline. FD levels, measured by inability to perform basic activities of daily living (ADLs) and instrumental activities of daily living (IADLs) at baseline wave, were categorized into five cumulative-score groups. Multimorbidity was defined as the presence of two or more chronic diseases. Logistic regression was employed to analyze the association of FD with incident multimorbidity and individual chronic diseases in each cohort. Cohort-specific estimates were combined using random-effects meta-analysis. Stratified analyses and interaction tests assessed modifications of associations.ResultsCompared to individuals without dependency, the risk of developing incident multimorbidity at 7-year follow-up with 2 FDs were significantly increased (2.13 [1.33–3.42] for ADL, 1.30 [1.02–1.66] for IADL), nearly doubling among patients with ≥ 4 FDs (1.52 [1.37–1.69] for ADL, 1.78 [1.18–2.69] for IADL). Significant associations between FDs and incident multimorbidity were observed across various subgroups, demonstrating dose-response relationships. Both cohorts exhibited positive interaction effects of age, gender, residential area, marital status, and social isolation on the associations between ADL dependency and incident multimorbidity.ConclusionsFD emerged as a significant risk factor for later-life multimorbidity, displaying interactions with demographic and social factors. This underscores the urgency for tailored interventions, integrated care models, and a reorientation of healthcare services to mitigate potential adverse health outcomes.Supplementary InformationThe online version contains supplementary material available at 10.1186/s12889-025-25259-7.

ObjectivesThis study aimed to explore the relationship between selected motor performance tests and indicators of cognitive impairment in older adults. Specifically, it examined associations with the Mini-Mental State Examination (MMSE) and the Lawton Instrumental Activities of Daily Living (IADL) scale. A secondary aim was to assess whether these motor tests correlate more strongly with cognitive and functional status than with chronological age.MethodsSixty-two institutionalized adults aged 60 years and older were evaluated. Motor performance was measured using tasks from the Vienna Test System (MLS), including pin insertion, tapping, targeting, tremor control, and line tracking. Handgrip strength was also assessed as a reference. Pearson’s correlation coefficients were calculated to examine relationships among motor test scores, MMSE, IADL, and age.ResultsMost fine motor tests showed moderate to strong correlations with MMSE and IADL scores, but not with chronological age. Pin insertion, tracking, and tremor control were especially indicative of cognitive and functional status. Handgrip strength, by contrast, was significantly associated with age but not with MMSE or IADL.ConclusionFine motor tasks, particularly pin insertion and tracking, show significant associations with cognitive and functional performance in older adults. These findings suggest that such tasks may hold potential as practical indicators for identifying individuals at risk of decline; however, longitudinal studies are needed to confirm their predictive value and causal relationships.

The health effect produced by a contributing factor alone may be different from the effect when other interacting factors are present. The effects of a set of contributors, estimated by regression coefficients, may be invalid or inappropriate if some of the predictors are correlated or the model has interaction and nonlinear terms. The net effect (NE) of a given contributing factor is the effect produced by the factor alone, not by other factors due to their correlations with the factor of interest. This study estimated NE of selected determinants of health for U.S. older adults. Participants, aged ≥ 65 years, were from the baseline 2020 Medicare Health Outcome Survey (N = 196,641). We examined the NE of each explanatory variable from five specified categories on four health outcomes: physical component summary scores (PCS), mental component summary scores (MCS), health utilities (SF-6D), and 2-year mortality. The five categories of explanatory variables included: six difficulties in activities of daily living (ADLs), three difficulties in instrumental activities of daily living (IADLs), five geriatric syndromes, five demographics, and fifteen chronic conditions. The NE for a given factor was calculated as the average of the factor's marginal effect over all possible values of other factors. After adjusting for age, race, and sex, difficulty in walking contributed the greatest decrement in PCS (NE= -7.4) among the 6 ADLs. Other ADL decrements were 4.5-points for bathing, 4.4-points for getting in/out of chairs, 2.7-points for dressing, 1.5-points for using the toilet, and 1.3-points for eating. For MCS, difficulty in eating contributed the greatest decrement (-4.9), followed by bathing (-3.9) and walking (-3.2). For the SF-6D, difficulty in walking had a NE of -0.078 while difficulty in bathing had the greatest increment for 2-year mortality (8.1%). The NEs for the explanatory variables in the other categories are presented. This study introduced NE as a measure of effect produced by each determinant of health and demonstrated how to estimate the net effect for various types of data. Our results highlight how the net effect varies within a given category, and differs according to physical and mental health and mortality.

Background: Stroke incidence remains high in South Africa. Access to rehabilitation services is critical for stroke survivors to successfully reintegrate back into the community. This study aimed to explore the factors that influence stroke survivors' reintegration into the community to inform contextually relevant rural rehabilitation processes. Methods: A sequential, explanatory mixed-method research design was used. Quantitative data were collected through a file audit of 15 participants. The qualitative data were sourced through semi-structured interviews with 15 purposively selected stroke survivors and three rehabilitation team members. The five themes identified were stroke survivors' meaningful occupations, enablers for community reintegration, barriers to community reintegration, stroke survivors' and caregivers' perceptions on rehabilitation processes for improved stroke rehabilitation. Work was the most affected occupation reported, followed by socialisation and the least affected was Basic Activities of Living (BADL) and Instrumental Activities of Daily Living (IADL). Facilitators included accessibility to assistive devices, positive attitude and community support of the rehabilitation team. Main barriers were residual impairments and limited hospital resources. Conclusion: Early intervention, provision of assistive devices and continued community interventions strengthen the stroke survivors' reintegration into the community. Implications for practice: Work is the most affected occupation in stroke survivors, followed by socialisation and the least affected were BADLs and IADLs Continued support to the stroke survivors and caregivers through support groups in the community is needed to increase awareness of stroke sequelae, caregiver relief and fostering social participation Return to work rehabilitation for stroke survivors should include a routine vocational rehabilitation programme that is individually structured to assist the stroke survivors to adapt to the work routine Occupational therapist should also initiate vocational training such as entrepreneurial skills and subsistence agriculture in collaboration with other sectors such as the Department of Agriculture, to assist the stroke survivors and their caregivers to support their families.

Cognitive deficits are common in older persons with seizures (PWS). Cognitive disorders are often characterized by impairment in Instrumental Activities of Daily Living (IADL). Despite the high occurrence of cognitive decline in older PWS, their effects on IADL remain unexplored. This study examined the associations between active versus remote seizures on the baseline IADL impairment and longitudinal decline of IADLs in older adults with and without cognitive impairment. This prospective study is based on 42 US Alzheimer's Disease Research Centers from 9/2005 to 3/2024. Participants were classified into active seizures (within the past 12 months), remote seizures (prior history but none in the past 12 months), and no seizures (controls). IADLs were measured using the Pfeffer Functional Activities Questionnaire (FAQ). ANOVA compared individual and total baseline FAQ scores by seizure status and cognitive categories. Multivariable linear regression adjusted FAQ for seizure status, age, sex, and education. The rate of FAQ decline (follow-up minus baseline score/time interval) was compared across seizure groups using ANOVA. Posthoc Tukey tests identified significant group differences. Among 20486 cognitively normal participants (average age=69.7 years, female=65%[N=13,370]), IADLs were worse among active seizure participants (adjusted-mean-difference [95% confidence interval (CI)]: active vs remote=0.69(0.23,1.14), p=0.0011 and active vs controls=0.85(0.46,1.24), p<0.001). Among 30,238 cognitively impaired participants (average age=72.2 years, female=52%[N=15,632]), IADLs were worse among active seizure participants (adjusted-mean-difference (95%-CI): active vs. remote=6.85(5.59,8.10), p<0.001 and active vs. controls=8.93(8.06,9.80), p<0.001). Longitudinally, IADLs in cognitively normal adults declined faster in those with active seizures compared to controls (p=0.0396). The impairment in IADLs among active seizure participants was disproportionately higher than their level of cognitive abilities. The worst functions in active seizure participants were in the ability to assemble tax records, travel out of the neighborhood, pay bills, and, to a lesser degree, remember dates or appointments. Active seizures are associated with worse IADL performance regardless of cognitive status. Active seizures are also associated with a significantly faster rate of decline in IADLs in cognitively normal individuals. These findings suggest the need to assess IADLs in routine clinical care in older PWS to identify those needing assistance and for aggressive seizure management to preserve independence in at-risk populations.

BackgroundAlzheimer's disease and related dementias (ADRD) develop over 20 years with subtle impairments in Instrumental Activities of Daily Living (IADLs). This study aimed to determine whether specific IADLs are associated with risks for cognitive impairment in pre‐ADRD stages.MethodsWe used Gateway to Global Aging Data (g2aging.org) from the US Health and Retirement Study. In adults ≥65 years without an ADRD diagnosis (n = 10, 346), IADL impairments were self‐reported as difficulty in managing money, medication, reading maps, using telephone, shopping for groceries and preparing meals. Memory‐related cognitive impairment was defined as ≥1.5 SD below the study‐specific mean for total recall combined with poor self‐reported memory. Non‐memory‐related cognitive impairment was ≥1.5 SD below the mean in ≥2 cognitive tests including orientation, serial 7s and backward counting. Latent class analysis was performed to identify different groups of IADLs at baseline. Cox proportional hazards models adjusted for age, sex, education, were used to determine the associations between group membership in IADLs and the risk for cognitive impairment. Models were adjusted for post‐stratification sample weights.ResultsWeighted mean age of participants was 74.3 years (SD 6.8), and 58% were women. Three IADL groups were identified: A high functioning group (86%), with low probabilities of difficulty in any IADLs ; a group with moderate difficulty in specific tasks such as managing money, shopping, reading maps and making meals (10%) ; and a low functioning group (4%), with high difficulty across all IADLs. The low functioning group showed increased risk (hazard ratio [HR] 2‐2.5; p <0.001) of developing both types of cognitive impairment compared to the high functioning group (during a mean 10.3 (SD 7.2) years of follow‐up). The moderate functioning group also showed an increased risk for memory‐ (HR 2.0, p = 0.001) and non‐memory‐related impairment (HR 1.6, p <0.001) compared to the high functioning group (Table 1).ConclusionsOur findings suggest that even moderate difficulty in performing specific IADLs (i.e., managing money) is associated with an increased risk for cognitive impairment in older adults. These IADLs may serve as early risk indicators and have the potential to be developed into clinical trial endpoints in pre‐clinical ADRD populations.

BackgroundThe ability to perform instrumental activities of daily living (IADL) is critical for independent living. Impairments in IADL due to cognitive decline is a diagnostic criterion differentiating mild cognitive impairment (MCI) from dementia. Common IADL assessments, such as, subjective questionnaires, are prone to reporting biases, and performance‐based evaluations, are resource‐intensive. Computerised measures of IADL have the potential to be more objective and efficient. The aims of this systematic review are to (1) identify and describe published computerised performance‐based IADL measures, and (2) review and synthesise the psychometric properties of these measures.MethodFollowing the Systematic reviews and Meta‐Analyses (PRISMA) guidelines, two stages of database searches were conducted in PubMed, EMBASE, Cochrane, PsycINFO, and CINAHL: the first to identify instruments and the second to find studies reporting their psychometric properties. The Consensus Based Standards for the Selection of Health Measurement Instruments (COSMIN) checklist was used to assess the quality of the identified computerised performance‐based IADL instruments.ResultStage 1 yielded 28,846 studies and identified 50 computerised IADL instruments. Of these, 26 instruments were evaluated for psychometric properties across 40 studies in stage 2, with 52.2% published in the last 5‐years, reflecting a growing area of research. Twelve of the 26 tools assessed multiple IADL domains, while 14 focused on a single IADL domain. Assessments completion time raged from 2 to 30 minutes. Construct validity, or the ability for a tool to accurately measure the intended construct, was the most frequently assessed psychometric property (24 instruments). However, half of these instruments demonstrated insufficient construct validity with mixed ratings of quality of evidence. Reliability was only assessed in 10 instruments, with five instruments demonstrating indeterminate reliability. Internal consistency was evaluated in only three instruments, and structural validity was reported for a single instrument.ConclusionDespite the growing interest in computerised IADL assessments, significant research gaps remain. Notably, there is a lack of data on psychometric properties such as measurement error, cross‐cultural validity, criterion validity, and responsiveness. Computerised IADL tools have the potential for efficient and accurate assessments but further validation across diverse psychometric domains and populations is needed.

The interactive influences of sleep duration and activities of daily living on low back pain: Insights from CHARLS.

Introduction: Subjective Cognitive Decline (SCD) represents self-perceived cognitive impairment that may precede objective signs of cognitive decline. Exploring the association between cognition, functional ability, and Quality of Life (QoL) among older adults having SCD, will help in identification of at-risk population and tailor interventions. Aim: To investigate the association between cognition, functional ability and QoL among older adults having SCD across different Socioeconomic Status (SES) and gender. Materials and Methods: The present a cross-sectional study included data collected from the Outpatient Department (OPD) of a Rehabilitation Institution in Delhi,India between July 2023 to October 2023. Data from 130 older adults with SCD was taken by random sampling for cognition, functional ability, QoL and SES. Cognition was assessed using Montreal Cognitive Assessment (MOCA) and Addenbrooke's Cognitive Examination III (ACE-III). Functional ability was measured by Lawton Instrumental Activities of Daily Living (L-IADL) Scale, QoL {Health Related Quality of Life (HRQoL)} by SF-36 Health Survey and Kuppuswamy socioeconomic scale was used to measure SES. Descriptive statistics, Pearson product-moment correlations, and chi-square tests were used to explore the association between the variables. Results: SES was not significantly correlated with IADL (r=- 0.098, p=0.267), SF-36 scores (r=0.131, p=0.138), or ACE-III scores (r=0.145, p=0.099). In males, a statistically significant moderate positive correlation was found between MOCA and ACE-III scores (r=0.521, p&lt;0.001), indicating consistency in cognitive assessment tools and no significant correlations were found between SES and MOCA (r=0.137, p=0.221), IADL (r=-0.076, p=0.502), or SF-36 scores (r=0.072, p=0.520). Among females, a statistically significant moderate-to-strong correlation was also observed between MOCA and ACE-III scores (r=0.546, p&lt;0.001). Additionally, a weak but positive, nearly significant correlation was observed between SES and MOCA scores (r=0.255, p=0.078), indicating a possible trend. The correlation between SES and SF-36 was also weak and non-significant (r=0.212, p=0.143). Conclusion: A statistically significant moderate positive correlation was observed between MOCA scores and ACEIII scores. This indicates that participants who scored higher on the MOCA also tended to have higher ACE-III scores. The correlation between SES and MOCA score was weak and not statistically significant. Other variables did not show strong or statistically significant relationships.

The association of cognitive functions with functional outcomes during post-stroke recovery: A cross-sectional study.

This study examines the relationship between ethnicity and daily functional disabilities among older adults, focusing on Activities of Daily Living (ADLs) and Instrumental Activities of Daily Living (IADLs). The analysis uses data from the 2020 National Social Life, Health, and Aging Project (NSHAP) survey, which included a sample of individuals aged 57-85 (n=3,005). Respondents provided information on their demographic background (e.g., income, gender, race, age, health, retirement, and marital status) and socioeconomic characteristics through telephone interviews. The study hypothesized that ethnic differences would be evident in perceived difficulties with ADLs and IADLs in later life. To assess these relationships, both MANOVA and regression analyses were conducted. The results showed that African American and Hispanic older adults reported greater difficulty with ADLs and IADLs compared to their Anglo counterparts, highlighting significant ethnic disparities in daily functional challenges. These findings are consistent with the convoy model, suggesting that ethnicity significantly influences health outcomes and functional abilities in later life. Future research should include a broader range of variables to deepen our understanding of the complex interplay between demographic factors and health outcomes, including daily functional disabilities, among older adults.

This scoping review aims to explore and map the most frequently reported limitations in activities of daily living (ADLs) among individuals with spinal muscular atrophy (SMA), with the goal of informing clinical assessment and multidisciplinary care strategies. The review followed the Joanna Briggs Institute (JBI) methodology for scoping reviews and adhered to the PRISMA-ScR reporting guidelines. A comprehensive search was conducted across PubMed, Scopus, Web of Science, and Embase up to December 2024. Eligible studies included qualitative, quantitative, and mixed-methods designs that reported ADL limitations in individuals with any SMA subtype. Data were extracted and descriptively synthesized, with additional input from a multidisciplinary rehabilitation team to provide practical clinical recommendations. Sixteen studies were included, encompassing a wide range of methodologies and SMA types. The most frequently reported ADL limitations included mobility (e.g., walking, transferring, climbing stairs) and self-care tasks (e.g., dressing, toileting, feeding). Upper limb function and instrumental ADLs, such as cooking, writing, and technology use, were less frequently assessed but emerged as important in maintaining autonomy, particularly in adults. Recent studies post-gene therapy demonstrates a broader focus on daily functioning and patient-reported outcomes. A multidisciplinary framework outlining domain-specific interventions and professional roles was developed based on the extracted data. While mobility remains central to SMA-related disability, this review highlights the substantial burden of self-care and upper limb limitations. Findings support a shift toward more comprehensive, patient-centered assessment and rehabilitation approaches in SMA care.

The increasing prevalence of locomotive syndrome (LoS) among older adults underscores the necessity of valid and reliable assessment tools to facilitate early diagnosis and intervention. The 25-Question Geriatric Locomotive Function Scale (GLFS-25) is a widely used self-reported measure for evaluating locomotive dysfunction. However, a culturally adapted and validated version for Turkish older adults was lacking. This study aims to translate, culturally adapt, and validate the Turkish version of GLFS-25 to ensure its applicability in clinical and research settings. A cross-sectional study was conducted with 133 community-dwelling older adults (mean age: 75.3 ± 7.2 years) in Turkey. The translation process followed international guidelines, including forward-backward translation, expert panel review, and pilot testing. The psychometric validation involved confirmatory factor analysis (CFA), internal consistency (Cronbach's α), test-retest reliability (intraclass correlation coefficient, ICC), and criterion validity. Correlations with established functional assessment tools such as the Barthel Daily Living Index, Instrumental Activities of Daily Living (IADL), and Activities-Specific Balance Confidence (ABC) Scale were examined. A receiver operating characteristic (ROC) curve analysis was performed to determine the optimal cut off score for detecting locomotive dysfunction. The Turkish GLFS-25 demonstrated excellent internal consistency (Cronbach's α = 0.984) and test-retest reliability (ICC = 0.986). CFA confirmed a four-factor structure, similar to previous adaptations in Iran and China, supporting its construct validity. Strong correlations were observed between GLFS-25 scores and functional assessment tools (Barthel Index: r = -0.78, IADL: r = -0.72, ABC Scale: r = -0.65, p < 0.001), establishing its criterion validity. ROC analysis identified a cut off score of 16 for detecting locomotive dysfunction, with a sensitivity of 85.3% and specificity of 88.7%. The Turkish adaptation of GLFS-25 is a valid, reliable, and culturally appropriate tool for assessing locomotive dysfunction in Turkish older adults. Its strong psychometric properties and high correlation with functional mobility indicators suggest that it can be effectively integrated into geriatric healthcare and rehabilitation programs. Given the rapid aging of Turkey's population, this tool can support early detection, prevention strategies, and policy development to mitigate mobility-related disabilities.

BackgroundStudies suggest that the higher prevalence of functional disability in women could be explained by differences in social and health-related factors. We examined these factors in association with disability among Chinese older adults in Singapore.MethodsWe used data from 13,788 participants who attended the third follow-up interviews in the Singapore Chinese Health Study, when the mean age was 72.86 ± 6.23 years. Participants who had overall scores > 8 on the Lawton Instrumental Activities of Daily Living (IADL) Scale were considered to have functional disability. Multivariable logistic regression models were used to estimate the odds ratio (OR) and 95% confidence interval (CI) for the association with functional disability.ResultsThe age-adjusted OR (95% CI) for the association with functional disability in women compared to men was 1.29 (1.20–1.39). However, after additional adjustment for other determinants of functional disability, this OR (95% CI) was attenuated to 0.96 (0.88–1.05). This association was largely mediated by lack of formal education (45.8%), weak handgrip strength (20.3%), arthritis (15.0%) and abdominal obesity (8.4%). Furthermore, age, lack of education, hypertension, diabetes, coronary artery disease, arthritis and abdominal obesity were associated with significantly higher odds of disability in women than in men (P-values of interactions with gender ≤ 0.042).ConclusionLower educational attainment, musculoskeletal conditions, and abdominal obesity may contribute to a higher likelihood of disability in women. Additionally, abdominal obesity, arthritis and cardiometabolic diseases showed stronger associations with functional disability in women than in men.

IntroductionIntrinsic capacity (IC), as defined by the World Health Organization, represents the composite of an individual’s physical and mental capacities and provides a multidimensional framework for assessing older adults’ functional reserve. It includes five domains: locomotion, vitality, cognition, psychological well-being, and sensory function. This study aimed to examine the associations between IC domains and common geriatric syndromes in hospitalized older adults.MethodsIn this retrospective observational study, 245 patients aged ≥ 60 years who underwent comprehensive geriatric assessment were included. IC was evaluated across five domains using standard tools: gait speed, self-reported sensory deficits, Standardized Mini-Mental State Examination (S-MMSE), Euro Quality of Life 5 Domain (EuroQOL-5D) and Mini Nutritional Assessment. The IC score ranges from 0 to 5, with higher scores indicating better intrinsic capacity, and a score ≤ 2 representing moderate–severe decline. Geriatric syndromes assessed were frailty, probable sarcopenia, falls, urinary incontinence, and functional impairments in Activities of Daily Living (ADL) and Instrumental Activities of Daily Living (IADL). Logistic regression models identified predictive IC domains, adjusting for age, sex, polypharmacy, and comorbidity.ResultsNearly 60% of participants had moderate to severe IC decline (score ≤ 2). Vitality and locomotor impairments were the most common. Cognitive and vitality impairments were strongly associated with both ADL and IADL disability (p < 0.001), while locomotor and vitality impairments predicted probable sarcopenia and frailty (p < 0.01). Cognitive impairment was linked to a nearly six-fold increased fall risk (OR = 5.86, 95% CI: 2.51–13.68, p < 0.001). The models showed good discrimination, with an area under the curve value of 0.723 for falls and 0.854 for ADL disability.ConclusionsIC impairments, particularly in cognition, vitality, and locomotion, are prevalent and predictive of major geriatric syndromes in hospitalized older adults. Routine IC assessment may help identify at-risk individuals and inform targeted interventions.

Introduction Stroke is a leading cause of disability and often impairs performance in activities of daily living (ADL). The Activities of Daily Living Inventory (ADLI) assesses basic (BADL), instrumental (IADL), and advanced ADL (AADL). This study aimed to evaluate the psychometric properties of the ADLI in stroke patients. Method Ninety-nine participants were included: 30 in the subacute phase, 18 in the chronic phase post-stroke, and 51 healthy controls, recruited from community, rehabilitation, and hospital settings. Participants completed a semi-structured interview and a neuropsychological assessment protocol, including: Addenbrooke’s Cognitive Examination for neurocognitive screening; Patient Health Questionnaire-9 (PHQ-9) for assessing depressive symptoms; ADLI, Barthel Index, Lawton and Brody Scale for assessing ADL functioning; and Sensory, Emotional, and Cognitive Reserve Inventory. Results The ADLI demonstrated satisfactory acceptability, internal consistency, convergent validity with recognized instruments assessing ADL and IADL, divergent validity between the BADL scale and the PHQ-9, and criterion validity for discriminating between the stroke and control groups. ADLI scores presented a significant positive correlation with cognitive performance and reserve scores. Discussion The results support the ADLI as a useful tool for assessing functionality in ADL after stroke. Future longitudinal studies using a multidimensional neuropsychological assessment protocol are recommended.