Activities Of Daily Living Limitations Research Articles

Active aging, autonomy, and mental health among older adults with chronic illness - focus on optimism

Abstract Background In the active aging framework, the focus has shifted to the quality of life of the elderly, where autonomy plays an important role. Chronic illnesses often lead to autonomy limitations, impacting activities of daily living (ADL) and increasing the risk of depression. Fostering an optimistic outlook can mitigate depression’s severity and promote healthy aging. Methods The data is from a cross-sectional survey in Hungary (n = 832). 60,1% of the sample had at least one chronic illness. Measurements included the EQ-5D-5L, Mental Health Continuum-SF, Life Orientation Test, and the Geriatric Depression Scale. Results We found worse mental health (p = 0,024), lower levels of optimistic outlook (p = 0,002), and higher levels of depression (p < 0,001) among those who reported ADL limitations. ADL limitations (ß = -0,27, p < 0,001) showed the strongest association with perceived health status, followed by mobility (ß = -0,22, p <; 0,001) and self-care (ß =-0,14, p < 0,001). Considering mental health, only ADL limitations (ß = -0,15, p < 0,001) were a significant predictor from the above-mentioned dimensions. Additional analysis showed that depression affected mental health both directly (effect = -1,90, p < 0,001) and indirectly, mediated by an optimistic outlook (effect = -0,88). Conclusions 1. Limitations in autonomy were negatively linked to perceived health status and mental health. 2. The optimistic orientation toward life can mediate the association between depression and mental health among the elderly with chronic conditions. 3. The Implications of the results could enlighten the necessity of preventive initiatives on autonomy preservation and enhance an optimistic outlook to maintain healthy aging and a favorable quality of life. Key messages • Preventive interventions focusing on health-preserving behaviors could be designed for specific groups with a higher risk of ADL limitations in the future. • Optimism could mediate depression’s impact on the mental health of the elderly with chronic illnesses, suggesting that interventions should target enhancing optimism for improving active aging.

Exploring the Relationship Between Health and Out-of-Pocket Health Expenditures: Evidence for Middle-Aged and Older Adults in China.

With population aging, disability and chronic conditions are increasingly prevalent among middle-aged and older adults in China. Using panel data from the China Health and Retirement Longitudinal Study (CHARLS) from 2011 to 2018, this paper explores the effects of Activities of Daily Living limitations, Instrumental Activities of Daily Living limitations, and chronic conditions on Out-of-Pocket Expenditures (OOPEs) among middle-aged and older adults in China. A first-difference model and a system-generalized method of moment model (GMM) are used. The system-GMM model for the first time addresses unobserved heterogeneity and produces unbiased estimates of the effects of health and OOPEs. Additionally, this paper assesses the heterogeneity of the results across the demographic and socioeconomic groups. These findings can be used to inform policymakers on improving medical resource allocation and ensure better financial protection for those living with a disability and chronic diseases.

Activities of daily living limitation and functional decline during hospitalization predict 180-day readmission and mortality in older patients with pneumonia: A single-center, retrospective cohort study

BackgroundThe role of activities of daily living (ADL) as a predictor of adverse outcomes in patients with pneumonia is unclear. This study aimed to assess the association between ADL, including physical and cognitive function, and death or readmission in older inpatients with pneumonia. MethodsThis retrospective, single-center, observational study included consecutive older inpatients with pneumonia between October 2018 and December 2019. ADL was assessed using the Functional Independence Measure (FIM). Functional decline during hospitalization was defined as a decrease of at least 1 point in FIM at discharge from admission. The primary outcome was the time to composite 180-day mortality and readmission from any cause after discharge. ResultsIn total, 363 patients (median [interquartile range] age: 80 [73–86] years, male: 68 %) were divided according to the median FIM scores (≥100, n = 183 and < 100, n = 180). Among the patients, 25 experienced functional decline during hospitalization, 69 were readmitted, and 17 died. In the Kaplan–Meier analysis, both the lower FIM group and the functional decline group had significantly lower event-free rates than the higher FIM groups and the non-functional decline groups (log-rank test, p < 0.001), respectively. After multivariate analysis, both the lower FIM (adjusted HR, 2.11; 95 % CI, 1.24–3.58; p = 0.006) and functional decline (adjusted HR, 3.18; 95 % CI, 1.44–7.05; p = 0.005) were significantly associated with the primary outcome. ConclusionsIn older patients hospitalized with pneumonia, ADL limitations at discharge and a decline in ADL were associated with poor outcomes.

Trends and Factors Affecting Functional Limitations on Activities of Daily Living Performance Among Korean Adults With Disabilities, 2008-2020: A Longitudinal Study.

Loss of the ability to perform activities of daily living (ADLs) leads to negative health outcomes such as reduced quality of life, institutionalization, and mortality. In Korea, the proportion of older adults with disabilities is increasing along with rapid population aging. Therefore, providing a comprehensive approach to the prevention and management of ADL limitations in people with disabilities is necessary. This can be accomplished by understanding the trends and factors affecting these limitations over time. This study was developed to examine the longitudinal trend and factors affecting ADL limitations over time among people with disabilities in Korea. Data from 346 people with disabilities in the 2008-2020 Korean Welfare Panel Study were used. Bivariate analysis and a Kendall trend test were performed to determine the longitudinal trends for ADL limitations, and multiple logistic regression was used to evaluate whether relevant variables could predict these limitations. The prevalence of ADL limitations among people with disabilities increased by 16.5% over the 12 years of the study. The highest rate of increase in these limitations over time was found in people with mental disorders (27.8%), those over 65 years of age (27.3%), and those with depression (25.6%). In multiple logistic regression, the odds ratios of the variables were slightly different at each survey wave. However, severe disability and low educational level were consistently found to be associated with ADL limitations over time. The findings provide evidence of a significant relationship between level of disability and/or educational status and ADL limitations in people with disabilities in Korea. To prevent the development of ADL limitations in people with disabilities, comprehensive identification of longitudinal trends and factors affecting ADL limitations is necessary. Early intervention, including integrated services such as home rehabilitation services to prevent ADL limitations, especially for disabled people with severe disabilities and low educational levels, has the potential to delay ADL limitations.

Impacts of Acculturation on Depressive Symptoms and Activities of Daily Living of U.S. Older Chinese Immigrants.

Acculturation is a critical aspect of social experience for immigrants, including Asian immigrants. Existing literature has shown mixed findings on the health impacts of acculturation and largely relied on cross-sectional studies, preventing drawing definitive conclusions. This study aimed to examine the long-term effects of acculturation on depressive symptoms and activities of daily living (ADL) limitations in a large sample of older Chinese immigrants in the United States. Data were drawn from 2,811 older Chinese immigrants from the Population Study of Chinese Elderly in Chicago. Acculturation was assessed at baseline, and questionnaires on depressive symptoms and ADL limitations were completed at 4 assessments. Overall, results showed that acculturation was not associated with depressive symptoms at baseline but was associated with a faster decline in depressive symptoms over time. No associations were found between acculturation and ADL limitations. Stratified analyses showed that the significant relationship between acculturation and a faster decline in depressive symptoms was only evident among female participants. Also, acculturation was associated with a lower risk of reporting ADL limitations at baseline in female participants but a higher risk of reporting ADL limitations in male participants. This study indicates the long-term benefits of acculturation on mental health among older Chinese immigrants in the United States, particularly among females. Initiatives supporting the acculturation process need to consider sex disparities and individual preferences, aiming to foster sustained benefits for healthy aging in this population.

Analysis of the effect of BMI on depression and anxiety among older adults in China: the mediating role of ADL and IADL.

Anxiety and depression are serious psychological and public health issues among the older adults. Currently, there is a lack of understanding of the relationship between Body Mass Index (BMI) and anxiety or depression symptoms in the older adult population in China. Therefore, the purpose of this study is to investigate the impact of BMI on anxiety and depression through correlation analysis in different subgroups and to examine the potential chain mediating effects of Activities of Daily Living (ADL) and Instrumental Activities of Daily Living (IADL) between BMI and symptoms of anxiety and depression. From the CLHLS database conducted in 2017-2018, data regarding height, weight, anxiety symptoms, depression symptoms, as well as demographic, socioeconomic, behavioral, and health-related characteristics were collected. Multivariate logistic regression analysis was used to explore the impact of BMI on anxiety and depression symptoms. Finally, the SPSS macro process was utilized to test the multiple mediating effects of ADL and IADL between BMI and anxiety or depression symptoms. After screening, a final sample of 9,098 Chinese older adult individuals aged 65 and above was selected. Among them, 1,074 cases (11.8%) exhibited anxiety symptoms, 1,458 cases (16.0%) exhibited depressive symptoms. Compared to normal BMI, the adjusted analysis showed that underweight in Chinese older adult individuals was significantly associated with anxiety (OR = 1.316, p = 0.004) and depression (OR = 1.232, p = 0.013). This relationship was found to be more significant in males, individuals aged 80 and above, unmarried individuals, and those residing in town. ADL and IADL played a chain-mediated role between BMI and anxiety symptoms in the older adult. BMI not only had a direct effect on anxiety symptoms in the older adult (effect = -0.0159; SE = 0.0066; 95%CI: LL = -0.0288, UL = -0.0031), but also influenced them indirectly through two pathways: the independent mediating role of IADL (effect = -0.0010; SE = 0.0005; 95%CI: LL = -0.0018, UL = -0.0003) and the chain-mediated role of ADL and IADL (effect = -0.0012; SE = 0.0004; 95%CI: LL = -0.0020, UL = -0.0006). In the older adult individuals in China, underweight is associated with an increased risk of anxiety and depression symptoms. Improving the underweight condition of Chinese older adult individuals can reduce their ADL and IADL limitations, thereby benefiting their mental health.

Crosswalk Algorithms for Cognitive and Functional Outcomes Among 2013–2018 Medicare Beneficiaries With Dementia

ObjectiveBefore 2019, the Minimum Data Set (MDS) and Outcome and Assessment Information Set (OASIS) had incongruent response categories for rating cognitive impairment and activities of daily living (ADLs), hindering direct comparisons between nursing facilities and home health. We devised rule-based algorithms to compare cognitive impairment and ADL limitations between these 2 care settings among people with Alzheimer's disease and Alzheimer's disease–related dementias (ADRD). DesignA retrospective cohort study. Setting and ParticipantsIncluded fee-for-service Medicare beneficiaries (2013–2018) transitioning from nursing facilities to home health, with 1-year of continuous enrollment, aged ≥65 years, diagnosed ADRD, and with complete MDS discharge and OASIS admission assessments (N = 398,496). MethodsWe identified target phenotypes using the Cognitive Function Scale (CFS) and ADL items from the MDS discharge assessment as reference standards. We compared 6 OASIS-based algorithms for cognitive impairment and 1 for each ADL limitation by estimating sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV). ResultsThe average age was 83.5 (SD = 7.5) years and 82.3% transitioned from nursing to home health within 3 days. In the MDS discharge assessment, 42.2% had moderate-to-severe cognitive impairment. ADL limitations ranged from 71.4% for feeding to 97.8% for bathing. Compared with the moderate-to-severe cognitive impairment (CFS ≥3) on the MDS, the OASIS cognitive assessment indicating “considerable assistance to total dependence in routine situations” had 24% sensitivity, 94% specificity, 75% PPV, and 63% NPV. The ADL limitation algorithms exhibited high sensitivities (>96%) and PPVs (>94%) except for feeding (Sensitivity: 82%; PPV: 74%). Despite the short time frame between the 2 assessments, the OASIS admission assessment showed a higher prevalence of ADL limitations than the MDS discharge assessment. Conclusions and ImplicationsWe highlighted differences in patient function between post-acute care settings. Our algorithms can help researchers, clinicians, and policymakers standardize patient-centered outcomes for comparative effectiveness research or quality initiatives.

Prestroke Physical Activity Matters for Functional Limitations: A Longitudinal Case-Control Study of 12,860 Participants.

In the chronic phase after a stroke, limitations in basic activities of daily living (ADLs) and instrumental activities of daily living (IADLs) initially plateau before steadily increasing. The benefits of prestroke physical activity on these limitations remain unclear. To clarify this relationship, the effect of physical activity on the long-term evolution of functional limitations in a cohort of people with stroke compared to a cohort of matched adults without stroke was examined. Longitudinal data from 2143 people with stroke and 10,717 adults without stroke aged 50years and older were drawn from a prospective cohort study based on the Survey of Health, Ageing and Retirement in Europe (2004-2022; eight data collection waves). Physical activity was assessed in the prestroke wave. Functional limitations were assessed in the poststroke waves. Each person with stroke was matched with five adults without stroke who had similar propensity scores computed on the basis of key covariates, including baseline age, sex, body mass index, limitations in ADLs and IADLs, chronic conditions, and country of residence, before any of the participants from either cohort had experienced a stroke. Results showed an interaction between stroke status and physical activity on ADL limitations (b = -0.076; 95% CI = -0.142 to -0.011), with the beneficial effect of physical activity being stronger in people with stroke (b = -0.345; 95% CI = -0.438 to -0.252) than in adults without stroke (b = -0.269; 95% CI = -0.269 to -0.241). The beneficial effect of prestroke physical activity on ADL limitations after stroke is stronger than its effect in matched adults without stroke followed for a similar number of years. Physical activity, an intervention within the physical therapist's scope of practice, is effective in reducing the risk of functional dependence after stroke. Moreover, prestroke levels of physical activity can inform the prognosis of functional dependence in people with stroke.

Trends over time in the deficit of (instrumental) activities of daily living in the Austrian population aged 65years and older : Results from the Austrian Health Interview Survey series.

Difficulties in activities of daily living (ADL) and instrumental activities of daily living (IADL) in older adults are associated with diminished quality of life and increased demand for long-term care. The present study examined the prevalence of disability among individuals aged 65years and older in Austria, using data from the Austrian Health Interview Surveys (ATHIS). The ATHIS 2014 and 2019 surveys were used (N = 5853) for the analysis. Binary logistic regression was performed to measure the association between disability in at least one ADL or IADL limitation and independent variables adjusted for sociodemographic, health-related behavior and survey year. The prevalence of ADL or IADL limitations increased in both sexes during the 5‑year follow-up period. For ADL limitations, the prevalence rose from 12.8% to 17.9% in men (p < 0.001) and from 19.2% to 25.7% in women (p < 0.001). The IADL limitations increased from 18.9% to 35.1% in men (p < 0.001) and from 38.2% to 50.8% in women (p < 0.001). Women reported significantly higher odds for ADL (odds ratio [OR]: 1.08, 95% confidence interval [CI]: 0.93-1.26) and IADL limitations (OR: 1.74, 95% CI: 1.53-1.98). In both sexes, participants aged 80years and older reported higher odds for ADL (OR: 4.37, 95% CI:3.77-5.07) and IADL limitations (OR: 4.43, 95% CI: 3.86-5.09) compared to the younger group. Participants with at least one chronic disease reported higher odds for ADL (OR: 4.00, 95% CI: 3.41-4.70) and IADL limitations (OR: 4.37, 95% CI: 3.85-4.96). Primary education, single status, being born in non-EU/EFTA countries, and residing in Vienna were associated with higher odds of ADL and IADL limitations. Gender, age, education, country of birth, residence, partnership status, number of chronic diseases, noncompliance with physical activity, and nutrition recommendations had astrong association with increased vulnerability to disability. Public health policy must address these factors for disability prevention strategies.

Facility-Level and Racial Disparities in Access to Inpatient Psychiatric Occupational Therapy Services in the Veterans Health Administration.

Veterans receiving inpatient psychiatric services with limitations in activities of daily living (ADLs) benefit from occupational therapy, yet disparities in access are unknown. To investigate whether ADL limitations, an indicator of occupational therapy need, was associated with inpatient psychiatric occupational therapy utilization in the Veterans Health Administration (VHA) and whether this relationship differs by facility characteristics. Secondary analysis of VHA data. Modified Poisson regression modeled occupational therapy utilization as a function of ADL limitations, facility characteristics, and covariates. Interactions estimated whether the relationship between ADL limitations and occupational therapy utilization differed across facility characteristics. VHA inpatient psychiatric setting. Veterans receiving VHA inpatient psychiatric care from 2015 to 2020 (N = 133,844). Occupational therapy utilization. Veterans with ADL limitations were more likely to receive occupational therapy. Veterans receiving care in facilities with higher complexity and greater inpatient psychiatric care quality were more likely to receive occupational therapy. Additionally, Black veterans were less likely to receive occupational therapy relative to their White, non-Hispanic counterparts. Interactions indicated that the extent to which ADL limitations drove access to occupational therapy utilization was weaker within facilities with higher complexity and care quality. Veterans with ADL limitations were more likely to access inpatient psychiatric occupational therapy, suggesting that such services are generally allocated to veterans in need. However, findings indicate disparities in access across patient-level (e.g., Black race) and facility-level (e.g., facility complexity) factors, informing efforts to eliminate barriers to accessing these valuable services. Plain-Language Summary: This is the first study, to our knowledge, to examine disparities in access to inpatient psychiatric occupational therapy in the Veterans Health Administration (VHA). The study findings show that access to inpatient psychiatric occupational therapy is partly driven by the needs of the patient. However, nonclinical factors, such as a patient's race and the characteristics of the facility at which they receive care (complexity, number of psychiatric beds available, and the quality of psychiatric care), are also important drivers of access. Identifying factors influencing access to these valuable services is the first step in developing strategies that reduce barriers to access for veterans in need.

Limitations and determinants of Activities of Daily Living among older adults in Assam: LASI (Wave-1) analysis

BackgroundThe entire concept of aging gracefully involves maintaining the independence and quality of life among the older adults, with a particular emphasis on the ability to perform Activities of Daily Living (ADL). The number of older adults in the country has grown subsequently, with their dependence on care-givers which has also increased. ObjectivesThe study attempts to understand the prevalence and determinants of the limitations of Activities of Daily Living (ADL) among older adults aged 60 and over living in Indian state of Assam. MethodsThe study use the Longitudinal Ageing Study in India (LASI, 2017–18) Assam data, and information was sought from 816 older adults aged 60 years and above. An index of ADL was created on a scale of two levels, having no levels of ADL and having ADL limitation. ResultsAround 18 % of the older adults reported ADL disability. Females had higher prevalence of ADL than males (22 % v/s 14 %). Those aged 70 plus were also more likely to have ADL functional limitation (OR = 1.78, CI = 1.61–1.96) than those aged 60–69 years. Older adults not involved in any physical activity were more likely to report ADL limitation (OR = 1.50, CI = 1.34–1.68) than their counterparts. ConclusionThe findings of the study call for action to have geriatric care centres as the need of the hour, to promote exercise and other recreational activities that will help the old keep physically active and increase social-participation.

Depression and associated factors among older people in Vietnam: Findings from a National Aging Survey.

Depression is one of the most common mental health disorders among older people. Depressive symptoms are often overlooked and untreated in primary care settings. This study aims to assess the prevalence of depressive symptoms and associated factors among older people in Vietnam. The study analyzed data from the Vietnam National Aging Survey (VNAS) conducted in 2022 with a nationally representative sample of 3,006 older people aged 60 and over in 12 provinces. The 15-item Geriatric Depression Scale (GDS-15) was used to assess depressive symptoms. Bivariate and multiple logistic regression analyses were used to explore the association between depressive symptoms and other related factors such as sociodemographic and economic characteristics, social support, health status, Activities of Daily Living (ADL) and Instrumental Activities of Daily Living (IADL) limitations, chronic diseases, cigarette smoking status, alcoholic drinking, and domestic violence. The prevalence of depressive symptoms among older people was 20.2%. The associated factors that increase the odds of having depression among older people were female gender (OR = 2.21, 95% CI 1.34-3.62), living in rural areas (OR = 1.83, 95% CI 1.15-2.89), the poorest quintile (OR = 2.26, 95% CI 1.39-3.66), self-rated poor health (OR = 11.68, 95% CI 4.96-27.49), ADL limitations (OR = 2.12, 95% CI 1.51-2.99), IADL limitation (OR = 1.61 95% CI 1.16-2.25), and experiencing domestic violence in the last 12 months (OR = 6.66, 95% CI 4.00-11.05). Depression symptoms were prevalent among older people in Vietnam. Depression screening for older people should be included in primary care settings for early identification and treatment of depression.

A study to assess the health care utilization and the activities of the daily living status amongst the geriatric population residing in urban and rural field practice areas of a medical college in Tamil Nadu

Background: The prevalence of disability in the activities of daily living (ADL), could probably have a significant impact on the healthcare utilization amongst the geriatric population with disability. Methods: A cross-sectional study in the urban and rural field practice areas of a medical college in Tamil Nadu, using a sample size of 402 elderly individuals. Using the pre-tested, semi-structured questionnaire; the socio-demographic variables, healthcare utilization variables and a comprehensive Katz ADL assessment were used. Results: The overall prevalence of ADL limitation amongst the elderly was seen in 49 (12.2%) elderly individuals mostly with a score of 5 (mildest form) was found in 36 (74%) of the elderly. There was an association found between the follow-up care at health centres, frequency of visits, distance from home to health centres and the ADL limitation with a P- value less than 0.05 (C.I.-95%) using the Pearson chi-square test using SPSS v.26.0. Conclusions: The association between ADL limitation and healthcare utilization calls for initiatives at the family and community level.

Moderating Effects of Informal Care on the Relationship Between ADL Limitations and Adverse Outcomes in Stroke Survivors.

Stroke survivors with limitations in activities of daily living (ADL) have a greater risk of experiencing falls, hospitalizations, or physical function decline. We examined how informal caregiving received in hours per week by stroke survivors moderated the relationship between ADL limitations and adverse outcomes. In this retrospective cohort, community-dwelling participants were extracted from the National Health and Aging Trends Study (2011-2020; n=277) and included if they had at least 1 formal or informal caregiver and reported an incident stroke in the prior year. Participants reported the amount of informal caregiving received in the month prior (low [<5.8], moderate [5.8-27.1], and high [27.2-350.4] hours per week) and their number of ADL limitations (ranging from 0 to 7). Participants were surveyed 1 year later to determine the number of adverse outcomes (ie, falls, hospitalizations, and physical function decline) experienced over the year. Poisson regression coefficients were converted to average marginal effects and estimated the moderating effects of informal caregiving hours per week on the relationship between ADL limitations and adverse outcomes. Stroke survivors were 69.7% White, 54.5% female, with an average age of 80.5 (SD, 7.6) years and 1.2 adverse outcomes at 2 years after the incident stroke. The relationships between informal caregiving hours and adverse outcomes and between ADL limitations and adverse outcomes were positive. The interaction between informal caregiving hours per week and ADL limitations indicated that those who received the lowest amount of informal caregiving had a rate of 0.12 more adverse outcomes per ADL (average marginal effect, 0.12 [95% CI, 0.005-0.23]; P=0.041) than those who received the highest amounts. Informal caregiving hours moderated the relationship between ADL limitations and adverse outcomes in this sample of community-based stroke survivors. Higher amounts relative to lower amounts of informal caregiving hours per week may be protective by decreasing the rate of adverse outcomes per ADL limitation.

Sensory impairments and depressive symptoms in Europe: a cross-national cohort study

Objectives To investigate the associations between sensory impairments and the development of depressive symptoms across sex, age, and European regions, and to examine the mediating role of cognitive function, activities of daily living (ADL), and physical activity. Method A cohort study including 56,847 Europeans aged 50+ participating in at least two waves of the Survey of Health, Ageing and Retirement in Europe (SHARE). Associations were analyzed using mixed effects logistic regression models considering several confounders. Results Overall, 17.8% developed depressive symptoms. Compared to participants with good vision and hearing, those with vision impairment (VI) (odds ratio (OR) = 1.35, 95% confidence interval (CI) 1.27–1.44), hearing impairment (HI) OR = 1.32, 95% CI 1.21–1.43, and dual sensory impairment (DSI, i.e. VI and HI) (OR = 1.93, 95% CI 1.75–2.13) had increased odds of depressive symptoms. The associations were consistent across sex and European regions but became stronger with advancing age among men. Dose-response relationships were found for all associations. Mediation analyses revealed that preventing cognitive decline, ADL limitations, and physical inactivity would eliminate 15.0%, 11.5%, and 21.4% of the total effect for VI, HI, and DSI, respectively. Conclusion Our findings emphasize the importance of preventing sensory impairments to avoid depressive symptoms.

Clinical and radiological aspects of the forearm in children with congenital radioulnar synostosis: a cohort study

Introduction The upper limb functional limitations in congenital radioulnar synostosis may significantly affect the daily activities of patients. Classifications of the condition are descriptive and have limited practical application.Purpose Determine a functionally significant quantitative criterion for anatomical changes in the forearm.Material and methods 92 children (136 forearms) with congenital radioulnar synostosis were examined for limitations in activities of daily living (ADL), health-related quality of life measured with PedsQL questionnaire; pronation of the forearm and radiographic parameters. A comparative and correlation analysis, ROC analysis were performed to determine the relationship between the forearm pronation and limitations of ADL.Results Statistically significant correlations were revealed between symptoms and the forearm alignment (p &lt; 0.01, rxy = 0.5); subluxation of the ulnar head and forearm alignment (p &lt; 0.001, rxy = 0.6); bowing deformity of the radius, forearm alignment and subluxation of the ulnar head and between the length of the forearm bones and bowing deformity of the radius (p &lt; 0.05, rxy = 0.4 and rxy = 0.5). A statistically significant inverse correlation was revealed between symptoms and PedsQL scores (p = 0.038, rxy = –0.4). Pronation of 45° was the threshold value of the forearm alignment with a high risk of ADL limitation. The area under the ROC curve corresponding to the relationship between symptoms and the forearm alignment was 0.955 ± 0.021 (95 % CI: 0.915–0.995). There was a statistically significant (p &lt; 0.01) decrease in the lumen of the medullary canal in the middle third of the ulnar shaft with the radius lumen being unchanged. Dorsal subluxation of the ulnar head was detected In 30 % of cases.Discussion The characteristics identified demonstrated changes in the forearm bones with functional impairments being correlated with the forearm pronation.Conclusion The correlation between the patient’s symptoms and the forearm alignment must be taken into account in the classification and when determining indications for surgical treatment distinguishing between functional (&lt; 45° pronation) and dysfunctional (≥ 45° pronation) options.

Abstract P249: Association Between Loneliness and Functionality in an Elderly Population

Background: Functionality plays a pivotal role in the well-being and autonomy of older individuals. Discovering new predictors of functional decline is a pressing concern, with loneliness emerging as an unconventional risk factor for chronic diseases. However, its role in functional limitations remains poorly understood. Hypothesis: Loneliness is an independent predictor of limitations in Activities of Daily Living (ADLs) and Instrumental ADLs (IADLs) among individuals aged 80 or older. Methods: A cross-sectional analysis was conducted using data from Wave 8 of the Survey of Health, Ageing, and Retirement in Europe (SHARE), spanning 28 European countries, for participants aged 80 and above, excluding residents in long-term care institutions. Loneliness was assessed using a reduced version of the R-UCLA Loneliness Scale, including measures of companionship, feeling left out, and isolation on a 3-point Likert scale ("often," "some of the time," "hardly ever or never"). Participants scoring 4 to 9 were categorized as lonely. The outcome was defined as the presence of limitations in one or more of the six ADLs and/or the nine IADLs. Logistic regression models were employed to control for potential confounding factors. Multivariate analysis included covariates with p&lt;0.200 and no multicollinearity. Model quality was evaluated using the area under the ROC curve, and the significance level was set at 5%. The analysis was conducted using IBM SPSS, version 28.0. Results: The study included 7,434 individuals, with 58.2% (n=4,323) being female and a mean age of 84.4 (±3.8) for both genders. A majority of participants (52.5%, n=3,879) had low levels of education (ISCED-97 from 0 to 2). Comorbidities included cardiovascular disease (22%, n=1,634), stroke (7%, n=523), diabetes mellitus (17.2%, n=1,281), cancer (6.6%, n=494), and obesity (16.8%, n=1,180). In the univariate analysis, older adults classified as lonely exhibited an odds ratio (OR) of 2.213 (95% CI: 2.016 - 2.428) for presenting limitations in one or more ADLs/IADLs. The multiple model showed an OR of 1.472 (95% CI: 1.313 - 1.649) for having one or more ADLs/IADLs limitations in the presence of loneliness. This association remained significant even after adjusting for confounders (age, gender, education, chronic diseases, hip fracture, pain and European region). The AUC was 76,4%. Conclusions: Our study reveals an independent link between loneliness and limitations in ADLs and IADLs among individuals aged 80 or older from the SHARE dataset. These findings lend support to interventions aimed at preventing loneliness and preserving functionality in this age group.

Hypertension combined with limitations in activities of daily living and the risk for cardiovascular disease

ObjectiveThe aim of present study was to evaluate the combined effect of hypertension and activities of daily living (ADL)/instrumental activities of daily living (IADL) with the risk of CVD, stroke and cardiac events.MethodsA total of 14,083 participants aged 45 years or older from the China Health and Retirement longitudinal study were included in current study. Participants were divided into 4 groups according to hypertension and ADL/IADL status. Cox proportional hazards regression model was used to explore the associations between hypertension, ADL/IADL and new-onset CVD, stroke and cardiac events.ResultsDuring the 7-year follow-up, a total of 2,324 respondents experienced CVD (including 783 stroke and 1,740 cardiac events). Individuals with limitations in ADL alone, or with hypertension alone, or with both limitations in ADL and hypertension were associated with increased risk of CVD, with the adjusted hazard ratios (95% confidence intervals) were 1.17(1.00-1.35), 1.36(1.24–1.49) and 1.44(1.23–1.68), respectively. Those with limitations in ADL and hypertension also had higher risk of stroke (hazard ratios = 1.64; 1.26–2.14) and cardiac events (hazard ratios = 1.37; 1.14–1.64). Similarly, individuals with both limitations in IADL and hypertension were associated with increased risk of CVD (hazard ratios = 1.34; 1.15–1.57), stroke (hazard ratios = 1.50; 1.17–1.95) and cardiac events (hazard ratios = 1.27; 1.06–1.53).ConclusionHypertension and limitations in ADL/IADL jointly increased the risk of CVD, stroke and cardiac events.

Longitudinal reciprocal associations between volunteering, health and well-being: evidence for middle-aged and older adults in Europe.

There is substantial evidence on the importance of voluntary activities for the health of middle-aged and older adults. Evidence on the effects of health and well-being on volunteering is more limited. This study examines reciprocal longitudinal associations between voluntary and/or charity activities and 21 indicators related to physical health, well-being, cognitive impairment and daily life functioning among middle-aged and older adults. Longitudinal data were collected between 2011 and 2020 from a sample of 19 821 middle-aged and older adults from 15 countries participating in the Survey of Health, Ageing and Retirement in Europe. An outcome-wide analysis and an exposure-wide analysis were applied and generalized estimating equations were used. Robustness analyses were conducted. Voluntary and/or charity activities almost every week or more often were prospectively associated with greater emotional well-being, reduced risks of limitations in activities of daily living and of being diagnosed with Alzheimer's disease at a 6-year follow-up. Positive reverse associations were found from emotional well-being to volunteering. Limitations in daily life activities, increased loneliness, high blood cholesterol, hypertension and chronic lung disease were found to impede participation in voluntary and/or charity activities over time. Feedback loops between voluntary and/or charity activities and well-being and limitations in daily activities may exist. Understanding the reciprocal nature of the relationship between volunteering and health and well-being can help identify strategies to encourage volunteering among middle-aged and older adults with specific health conditions and to target health promotion efforts towards volunteers.

Interaction between activities of daily living and cognitive function on risk of depression.

There is a lack of literature about the joint effects of activities of daily living (ADL) limitation and cognitive impairment on depression. This study aimed to estimate the association of ADL limitation and cognitive impairment with depression among Chinese older adults aged 65 and above and to test their interaction on both additive and multiplicative scales. Data was drawn from the Chinese Longitudinal Healthy Longevity Survey (CLHLS), including 11,025 eligible participants. Logistic regression models were fitted, and both multiplicative and additive interactions for ADL limitation and cognitive impairment were tested. A total of 3,019(27.4%) participants reported depressive symptoms. After controlling for potential confounding factors, ADL limitation and cognitive impairment were both positively associated with depression. The adjusted additive interaction of basic and instrumental activities of daily living limitation were 2.47 (95%CI:1.92-3.19) and 3.67 (95%CI:2.88-4.66), respectively, but the multiplicative interaction items were both insignificant. ADL limitation and cognitive impairment were both risk factors for depression among Chinese older adults. Moreover, the significant interaction of ADL limitation and cognitive impairment was found in the additive model, suggesting that improving ADL may be helpful in reducing the risk of depression among older people with cognitive impairment.