Instrumental Activities Of Daily Living Limitations Research Articles

Rural-urban disparities in Geriatric Assessment (GA) impairments and mortality among older adults with cancer: Results from the Cancer and Aging Resilience Evaluation (CARE) Registry.

12012 Background: Rural-urban disparities persist in cancer incidence and mortality, despite improvement in cancer screening and treatment. Older adults are at increased risk for cancer, represent the majority of cancer cases, and are more likely to reside in rural areas than younger adults are. GAs are recommended in clinical management of older adults with cancer, in part to identify aging-related impairments predictive of adverse outcomes; few studies have explored rural-urban disparities in GA impairments and mortality among older patients with cancer. Methods: We included 937 older adults (≥60y) from the CARE registry recently diagnosed with cancer who underwent GA at their first pre-chemotherapy visit to the UAB oncology clinic. Rural-urban status using Rural-Urban Commuting Area (RUCA) codes, classified the cohort by residence in metropolitan, micropolitan, and rural/small town areas. We included self-rated performance status (PS) (≥2 on Eastern Cooperative Oncology Group PS), instrumental activities of daily living (IADL) [≥1 impairment], physical and mental health-related quality of life (HRQoL) [t-score < 40 on PROMIS 10-item Global Health], and overall survival as outcomes. Logistic regression evaluated the association between rural-urban status and each outcome (except overall survival, where we used Cox regression analyses). Micropolitan residence was chosen as the reference category due to similar high risk in both rural and urban areas. Results: Median age at study participation was 69.0y (Interquartile range: 64.0-74.0); 12.4% resided in rural, 14.8% in micropolitan and 72.8% in urban areas; 22.5% were diagnosed with colorectal cancer, 19.0% with pancreatic, and 12.4% with hepatobiliary; 74.7% were Stage III/IV. Participants in rural areas were more likely to be white and less educated. After adjustment for age, sex, race, education and cancer type/stage, rural residence was associated with increased odds of impaired PS (OR = 1.93, 95% CI: 1.10-3.40), limitations in IADLs (OR = 1.79, 95% CI: 1.03-3.10), and impaired physical HRQoL (OR = 1.84, 95% CI: 1.05-3.22) compared to micropolitan residence. Urban residence was not significantly associated with any GA outcomes compared to micropolitan residence. Rural residence was associated with higher hazard of death compared to micropolitan residence (HR = 1.88, 95% CI: 1.09-3.24) as well as urban residence (HR = 1.67, 95% CI: 1.13-2.45). Conclusions: Among older adults with newly diagnosed cancer, rural residence was associated with impaired PS, limitations in IADLs, impaired physical HRQoL, and reduced overall survival. Implementation of routine GA among older adults in rural areas may aid in early identification and intervention on GA impairments to improve cancer outcomes.

Long-Term High Dietary Diversity Maintains Good Physical Function in Chinese Elderly: A Cohort Study Based on CLHLS from 2011 to 2018.

(1) Objective: This study aimed to explore the correlation between dietary factors and physical function in Chinese elderly. (2) Methods: A cohort study was conducted on the association of long-term dietary intake status with physical function in older people based on the Chinese Longitudinal Healthy Longevity Survey (CLHLS) from 2011 to 2018. The physical function of the subjects was judged according to the scores of basic activities of daily living (BADL) and instrumental activities of daily living (IADL). The dietary diversity score was established according to the intake frequency of the food groups, and the dietary pattern score was obtained by factor analysis. The associations between dietary factors and functional impairment was investigated by logistic regressions. (3) Results: A total of 2282 subjects were included in our cohort study, 458 and 1439 of whom had BADL limitation and IADL limitation, respectively. The risk of functional impairment decreased in the consistent high dietary diversity groups compared with the consistent low dietary diversity group (p < 0.05). The fruit-egg-milk pattern, vegetable-meat-fish pattern, and condiment and tea pattern reduced the risk of functional impairment (p < 0.05). (4) Conclusions: Long-term maintenance of high dietary diversity and increasing total dietary intake can help maintain good physical function of Chinese elderly.

The Effect of Dual Sensory Impairment and Multimorbidity Patterns on Functional Impairment: A Longitudinal Cohort of Middle-Aged and Older Adults in China.

ObjectiveThere is an urgent need to evaluate the contribution of several co-existing diseases on health. This study aims to explore the combined effect of dual sensory impairment (DSI) and multimorbidity patterns on functional impairment among middle-aged and older adults in China.MethodsData were from 10,217 adults aged 45 or older from four waves of the China Health and Retirement Longitudinal Study (CHARLS). Sensory impairments were self-reported measures. Multimorbidity patterns were identified by using k-means cluster analyses. Functional impairment was defined using activities of daily living (ADL) scale and instrumental activities of daily living (IADL) scale. Generalized estimating equation models were estimated to assess the effect of co-occurring DSI and multimorbidity on functional impairment.ResultsDSI prevalence was 50.4%, and multimorbidity prevalence was 37.7% at the baseline. The simultaneous presence of DSI and multimorbidity was associated with increased odds of ADL limitations (OR = 2.27, 95% CI: 2.11–2.43) and IADL limitations (OR = 1.89, 95% CI: 1.77–2.02). Five multimorbidity patterns were identified: the cardio-cerebrovascular pattern, the stomach-arthritis pattern, the respiratory pattern, the hepatorenal pattern, and the unspecified pattern. Compared to DSI only, DSI plus the hepatorenal pattern was most strongly associated with functional impairment (for ADL: OR = 2.70, 95% CI: 2.34–3.12; for IADL: OR = 2.04, 95% CI: 1.77–2.36).ConclusionMiddle-aged and older adults with co-occurrence of DSI and multimorbidity are at increased risk of functional impairment, especially those with multimorbidity characterized by the hepatorenal pattern. These findings imply that integrated care for DSI and multimorbidity may be a potent pathway in improving functional status.

Prevalence and Social Risk Factors of Functional Limitations Among Slum-Dwelling Older Adults: Findings From the Nairobi Urban Health and Demographic Surveillance System.

Objective: In this study, we investigate the patterns and the risk factors of functional limitations in a sample of 1323 slum-dwelling older adults in Kenya who participated in the Nairobi Urban Health and Demographic Surveillance Systems. Methods: We conducted crude and adjusted logistic regression analyses to evaluate the associations. Results: The prevalence of activities of daily living (ADL) and instrumental ADL (IADL) limitations were approximately 5% and 8%, respectively; some 4.5% reported both limitations. Estimates varied significantly between sexes and age (p < .001). After adjustments, age, female, and Garre ethnic group were associated with ADL and IADL limitations. ADL decline was determined by co-residence (aOR = 0.93, 95% CI = 0.34–0.95), household size (aOR = 1.19, 95% CI = 1.04–1.37) and educational level (aOR = 0.45, 95% CI = 0.05–0.72). Conclusions: Older slum-dwellers in Nairobi experience functional impairments with marked age and sex differences. These findings may encourage salient policy planning and public health interventions to promote healthy aging in informal settlements.

Functional disabilities and changes in sleep quality and duration among older adults: results from a longitudinal study in China, 2005-2014.

We examined the associations of activities of daily living (ADL) and instrumental activities of daily living (IADL) with changes in sleep-related measurements among Chinese older adults from 2005 to 2014. Four waves of longitudinal data from the Chinese Longitudinal Healthy Longevity Survey (CLHLS; 2005-2014; n = 42,417) were used. Two sleep-related measurements were included: sleep quality and meeting the recommended daily sleep duration (7-8h). We used Cox two-state regression models to examine the different states of sleep quality and duration. Approximately 43.6% of observations were between 81 and 95years old, and 35.9% were between 65 and 80years old. Around 54.8% of observations were female. Older adults with more ADL and IADL limitations had a higher risk of experiencing declines in sleep quality and the transition from meeting to not meeting the recommended sleep duration over time (all p < 0.01). ADL and IADL limitations are significant risk factors for the development of sleep-related issues over time among Chinese older adults. Functional limitations need to be included in intervention strategies focused on sleep hygiene and studies examining changes in sleep patterns over time.

Health disparities, and health behaviours of older immigrants & native population in Norway.

We aimed to investigate and compare activities of daily living (ADL), instrumental ADL (IADL), poor self-rated health and the health behaviours among immigrants and the native population in Norway. We present results from analysis of two Norwegian surveys, (Living Conditions Survey on Health from 2015, Living Conditions Survey among Immigrants 2016). Using logistic regression models, odds ratios were estimated for functional ability, self-reported health, and health behavior among immigrants, with Norwegian born being the reference category. The first model was controlled for age and gender and the second model was additionally adjusted for educational level. Our analysis included 5343 participants, 2853 men (913 immigrants), and 2481 women (603 immigrants), aged 45-79 years. The age-group 45-66 years includes n = 4187 (immigrants n = 1431, men n = 856; women n = 575) and 67-79 years n = 1147 (immigrants n = 85, men n = 57; women n = 28). The percentage of Norwegians having ≥ 14 years of education was 86%, as compared to 56% among immigrants. The percentage of immigrants with no education at all was 11%. The employment rate among the Norwegian eldest age group was nearly double (14%) as compared to the immigrant group. Adjusted for age, gender and education, immigrants had higher odds than Norwegian of ADL and IADL, chronic diseases and overweight. There were no differences between immigrants and Norwegians in prevalence of poor self-reported health and smoking. Overall elderly immigrants are worse-off than Norwegians in parameters of health and functioning. Knowledge about health and functioning of elderly immigrants can provide a basis for evidence-based policies and interventions to ensure the best possible health for a growing number of elderly immigrants. Furthermore, for a better surveillance, planning of programs, making policies, decisions and improved assessment and implementation, ADL and IADLs limitations should be included as a variable in public health studies.

Can Social Resources Explain the Limitations in the Activities of Daily Living of Older Adults Classified by the Phenotype of Physical Frailty?

The objective is to investigate the mediating roles of living alone and personal network in the relationship between physical frailty and activities of daily living (ADL) limitations among older adults. 2271 individuals were classified as vulnerable (pre-frail or frail) or robust. Mediating variables were living alone and personal network. Katz Index and Lawton-Brody scale were used to assess ADL. Mediating effects were analyzed with beta coefficients from linear regression models using the bootstrapping method. Mediation analysis showed significant mediating effects of living alone (β = .011; 95% CI = .004; .018) and personal network (β = .005; 95% CI = .001; .010) on the relationship between physical frailty and basic ADL limitations. Mediation effects of living alone and personal network on the relationship between physical frailty and instrumental ADL limitations were β = -.074 (95% CI=-.101; -.046) and β = -.044 (95% CI = -.076; -.020), respectively. Physically vulnerable older adults who lived alone or had poor personal network were more dependent on basic and instrumental ADL.

The Role of Social Connection/engagement Predicts Changes in Depressive Symptoms and IADL in Stroke

Social connections/engagement have been found to be potentially protective against depression and declines in physical functioning. We examined whether social connection/engagement was protective against depression and functional decline after stroke. Participants were 898 individuals with incident stroke from the Health and Retirement Study between 1998-2012. Multilevel modeling was used to examine how social connection/engagement were associated with trajectories of depressive symptoms and limitations with instrumental activities of daily living (IADLs). Models controlled for age, gender, education, and race. In addition, analyses with depressive symptoms as outcome controlled for functional limitations with ADLs. Participants who were lonely and did not have friends in their neighborhood pre-stroke had more depressive symptoms at the time of stroke. Participants with close children pre-stroke showed less increase in depressive symptoms over time. Within-person increase in loneliness and within-person decline in providing help were related to more depressive symptoms post-stroke. Participants who felt lonely and did not provide help pre-stroke had more IADL limitations at the time of stroke. Smaller pre-stroke household size and pre-stroke volunteering were associated with less increase in IADL limitations with stroke. Within-person increase in having friends and providing help after stroke were associated with fewer IADL limitations post-stroke. Taken together, these findings suggest that social connection/engagement may buffer the negative psychological and physical outcomes of a stressful event such as stroke.

The Association Between Parents’ Physical Function and Adult Children’s Caregiving Burden

Using data from 544 older parents-adult children Chinese American dyads, this study aims to understand the association between older parents’ physical function and their adult children’s perceived caregiving burden. Parents’ physical function was assessed by the Katz Index of Activities of Daily Living (ADL) and the Lawton Instrumental ADL (IADL), with higher scores indicating more functional limitations. Adult children’s caregiving burden was assessed in five dimensions, including time dependence, developmental, physical, social, and emotion burden. Logistic regression was used to examine the association. More ADL limitations were associated with a higher likelihood of developmental burden (OR:1.14 (1.06-1.23)) and physical burden (OR:1.14 (1.06-1.23)) burden. More IADL limitations was associated with a higher likelihood of time dependence burden (OR:1.08 (1.03-1.12)), developmental burden (OR:1.06 (1.03-1.09)), and physical burden (OR:1.08 (1.04-1.12)). Parents’ physical function was not related to children’s social and emotional burdens. Practice and research implications will be discussed.

Prevalence and Impact of Comorbid Cancer and Dementia on Health Outcomes in Older Adults: A Longitudinal Study

Dementia and cancer are two common chronic conditions in older adults. However, there are few studies examining the prevalence of comorbid cancer and dementia and the longitudinal impact of these comorbid conditions on health outcomes. This study investigated the prevalence and longitudinal impact on health outcomes in older adults with comorbid cancer and dementia. This is a secondary analysis, using data from the 2010 and 2016 waves of the Health and Retirement Study (HRS). The health outcomes of the study included nursing home stay, hospital stay, home care use, activities of daily living (ADL) limitations, instrumental activities of daily living (IADL), self-rated health status, mortality, and the out-of-pocket medical expenditure in older adults with cancer and dementia. Data were analyzed using descriptive statistics, logistic regression, and linear regression analyses. The results revealed that the prevalence of comorbid cancer and dementia ranged from 2.6% to 2.8% over the 6-year period. Older adults with comorbid cancer and dementia demonstrated higher likelihood of nursing home stay, ADL and IADL limitations, and mortality; but a decreased likelihood of homecare use and hospital stay compared to older adults with cancer only or dementia only (some outcomes were not significant for dementia only group). Findings point out the risk of increased functional decline and mortality in older adults with comorbid cancer and dementia. Future research is needed to explore the contributing factors of the risk and identify interventions to promote physical function and reduce mortality for this population.

Sex differences in functional limitations and the role of socioeconomic factors: a multi-cohort analysis

SummaryBackgroundWomen are more likely to have functional limitations than are men, partly because of greater socioeconomic disadvantage. However, how sex differences vary by severity of functional limitations remains unclear. We examined sex differences in functional limitations, with attention to socioeconomic factors and severity of limitations.MethodsLongitudinal data on limitations in basic activities of daily living (ADL) and instrumental activities of daily living (IADL) and mobility activities were drawn from 62 375 participants from 14 countries. For ADL, IADL, and mobility, participants were categorised based on number of limited activities (0, 1, 2, or ≥3). Sex differences in limitations in four birth cohorts (1895–1929, 1930–38, 1939–45, and 1946–60) were analysed before and after adjustment for socioeconomic factors (education and labour force status).FindingsThe prevalence of IADL and ADL limitations was higher in women than in men. After adjustment for socioeconomic factors, this sex difference was attenuated. The sex difference in IADL limitations at age 75 years (in the 1895–1929 cohort) was 3·7% before adjustment for socioeconomic factors (95% CI 2·6–4·7) and 1·7% (1·1–2·2) after adjustment. For ADL, the sex difference in limitations at age 75 years (in the 1895–1929 cohort) was 3·2% (2·3–4·1) before adjustment for socioeconomic factors and 1·4% (0·9–1·8) after adjustment. Sex differences in mobility limitations (16·1%, 95% CI 14·4–17·7) remained after adjustment for socioeconomic factors (14·3%, 12·7–15·9). After age 85 years, women were more likely to have three or more IADL or mobility limitations and men were more likely to have one or two limitations.InterpretationSocioeconomic factors largely explain sex differences in IADL and ADL limitations but not mobility. Sex differences in mobility limitations in midlife are important targets for future research and interventions.FundingNational Institute on Aging, UK National Institute for Health Research, European Commission, and US Social Security Administration.

Prevalence and health outcomes in community-dwelling older adults with comorbid cancer and dementia: a longitudinal analysis

Objectives To examine health outcomes in community-dwelling older adults with: dementia only, cancer only, and comorbid cancer and dementia. Methods Longitudinal analysis was conducted using data from 2010 to 2016 waves of the Health and Retirement Study. Health outcomes included mortality, limitations in activities of daily living (ADL) and instrumental activities of daily living (IADL), nursing home utilization, hospital stay, homecare use, self-rated health, and out-of-pocket medical expenditure. Panel regression was used for statistical analysis. Results The prevalence of comorbid cancer and dementia ranged from 2.56% to 2.97%. Individuals with comorbid cancer and dementia demonstrated a higher likelihood of nursing home utilization and poorer self-rated health but a lower likelihood of hospital stay, homecare use, and out-of-pocket expenditures, compared to the cancer only or dementia only groups. The differences in mortality and ADL and IADL limitations were not statistically significant. Conclusion Comorbid cancer and dementia predicted longer nursing home utilization and poorer self-rated health. The results help guide care planning for individuals with comorbid cancer and dementia.

Limitations in Activities of Daily Living Among Spanish Women Diagnosed With Endometriosis.

Understanding the impact of endometriosis symptoms on patients' activities of daily living (ADLs) is a priority to establish effective and personalized intervention programs. To explore limitations in ADLs and instrumental ADLs (IADLs) and their association with pelvic pain (PP), chronic fatigue, and pain-catastrophizing thoughts among women with endometriosis. Cross-sectional study. Spain. Two hundred thirty women with endometriosis. Outcomes and Measures: Information regarding performance of ADLs (Barthel Index) and IADLs (Lawton-Brody questionnaire), PP intensity (Numeric Rating Scale), chronic fatigue (Piper Fatigue Scale), and pain-catastrophizing thoughts (Pain Catastrophizing Scale) was gathered. Multivariate regression analyses were created, and mediating effects of fatigue and pain-catastrophizing thoughts on the association between PP and ADL and IADL limitations were assessed. The prevalence of limitations in at least one ADL and one IADL was 22.6% (95% confidence interval [CI] [17.2, 28.1]) and 39.1% (95% CI [32.8, 45.5]), respectively. Limitations in bowel continence, housework, shopping, and meal preparation were reported most frequently. Women reporting severe PP showed higher risk for ADL (odds ratio [OR] = 3.33, 95% CI [1.10, 10.10]) and IADL (OR = 7.99, 95% CI [2.86, 22.34]) limitations. Chronic fatigue and pain-catastrophizing thoughts were also positively related to ADL-IADL limitations, showing a mediating effect on the association between PP and ADL-IADL limitations. This study reveals the widespread presence of difficulties in ADL-IADL performance among women with endometriosis, with some symptoms underlying these difficulties in occupational performance. This study points to the need for cost-effective occupational therapy interventions for affected women. What This Article Adds: This research shows that the occupational performance of women with endometriosis is frequently impaired; therefore, the effectiveness of occupational therapy interventions should be addressed in the near future.

Sex differences in functional limitations and the effect of socioeconomic factors: a retrospective multi-cohort study

BackgroundWomen are more likely to have functional limitations (ie, limitations in activities of daily living) than men, partly due to sex differences in socioeconomic factors. How changes in sex differences in socioeconomic factors in successive birth cohorts have affected functional limitations is unclear. We aimed to examine sex differences in functional limitations, with attention to the effect of socioeconomic factors. MethodsIn this retrospective multi-cohort study, we analysed data on limitations in activities of daily living, instrumental activities of daily living (IADL), and mobility activities from four longitudinal cohort studies on ageing (the English Longitudinal Study of Ageing; the Irish Longitudinal Study on Ageing; the Survey of Health, Ageing and Retirement in Europe; and the Health and Retirement Study) spanning 1–9 periods of data collection over 17 years. 62 375 participants (including 34 452 [55%] women) aged 50–107 years from 14 countries were included. Sex differences in limitations in four birth cohorts (1895–1929, 1930–38, 1939–45, and 1946–60) were analysed before and after adjustment for socioeconomic factors (education level and work status) using mixed effects ordinal logistic models with an age timescale. FindingsSex differences in mobility increased from age 50 to 70 years and in IADL until age 90 years and decreased thereafter. Sex differences in ADL limitations remained substantially similar with age but varied by birth cohort (sex by birth cohort interaction p<0·0001). Sex differences in IADL and ADL limitations were minor after adjustment for socioeconomic factors. The sex difference in limitations at age 75 (1895–1929 cohort) for IADL was 3·7% (95% CI 2·6–4·7) before and 1·7% (1·1–2·2) after adjustment for socioeconomic factors, and for ADL was 3·2% (2·3–4·1) before and 1·4% (0·9–1·8) after adjustment. Sex differences remained for mobility after adjustment (16·1%, 14·4–17·7) before adjustment versus 14·3% (12·7–15·9) after. InterpretationSocioeconomic factors explained the majority of sex differences in IADL and ADL limitations but not mobility limitations, with women reporting more mobility limitations than men aged 50 years or older. Efforts to reduce sex differences in disability should focus on identifying and targeting drivers of sex disparities in mobility limitations from midlife. FundingNational Institute on Aging, UK National Institute for Health Research, European Commission, US Social Security Administration.

Spousal Concordance in the Development of Functional Limitations Among Married Adults in China

Functional limitation is increasingly common as people age and is often associated with negative consequences. Evidence of the dynamics of functional limitation within couples in China is still inadequate. To examine whether functional limitation was associated within middle-aged and older couples and to explore sex differences in spousal associations. In this nationwide, population-based cohort study performed from January 1, 2011, to December 31, 2018, participants were selected using multistage probability sampling, and 5207 community-dwelling couples (10 414 individuals) 45 years or older were included in the nationally representative China Health and Retirement Longitudinal Study. Data analysis was performed from January 1 to February 28, 2021. The exposure variable was the presence of functional limitation in spouses. Functional limitation was measured by the activities of daily living (ADLs) and instrumental activities‎ of daily ‎living (IADLs) scales and was defined as having difficulty in independently performing at least 1 ADL or IADL item. The main outcome was functional limitation in index participants. Multivariable logistic regression with generalized estimating equations was used to estimate the reciprocal association of functional limitation within couples over time. A total of 5207 married, different-sex couples (mean [SD] age, 59.1 [8.8] years for husbands and 57.0 [8.2] years for wives) were included in the study. For husbands, the number (percentage) of participants classified with baseline functional limitation was 1140 (21.9%), the number (percentage) with ADL limitation was 684 (13.1%), and the number (percentage) with IADL limitation was 834 (16.0%). For wives, the number (percentage) of participants classified with baseline functional limitation was 1502 (28.8%), the number (percentage) with ADL limitation was 887 (17.0%), and the number (percentage) with IADL limitation was 1183 (22.7%). Longitudinal results demonstrated an association in spouses developing functional limitation (adjusted odds ratio [OR], 2.55; 95% CI, 2.41-2.69; P < .001), ADL limitation (adjusted OR, 2.26; 95% CI, 2.11-2.41; P < .001), and IADL limitation (adjusted OR, 2.58; 95% CI, 2.43-2.73; P < .001). Subgroup analyses by sex revealed similar patterns of spousal health concordance in terms of all studied outcomes, indicating no sex specificity. This population-based cohort study suggests that among Chinese middle-aged and older couples there is significant concordance in the development of functional limitation. This study of spousal functional ability from a dyadic perspective may help in the understanding of health risks within a wider familial context and offers novel insights for prioritizing policy focus from individual centered to couple based.

Personality and functional impairment. Evidence from the Survey of Health, Ageing and Retirement in Europe

To date, only a few studies have investigated the association between personality and functional impairment. Therefore, our purpose was to add to this knowledge. Data from wave 7 of the Survey of Health, Ageing and Retirement in Europe (SHARE) were used (70 028 individuals in the analytical sample). Personality was measured using the 10-item Big Five Inventory (BFI-10). Functional impairment was quantified using activities of daily living (ADL) and instrumental activities of daily living (IADL) indices. Multiple linear regressions were conducted. Regressions showed that an increased likelihood of limitations in ADL was associated with higher extraversion, higher agreeableness, lower conscientiousness, higher neuroticism, and higher openness to experience. Similarly, an increased likelihood of limitations in IADL was associated with higher agreeableness, lower conscientiousness, higher neuroticism, and higher openness to experience (only with one IADL index). This knowledge of associations between personality and functional limitations may help in determining individuals at risk for increased functional impairment (e.g., individuals with low conscientiousness or high neuroticism). Future research is needed to clarify the underlying mechanisms.

Secondhand smoke and functional impairments in older adults

BACKGROUND AND AIM: Secondhand smoke (SHS) is a risk factor of coronary heart disease, lung cancer, and stroke. Recent cross-sectional evidence suggests that it may also increase the risk of functional limitations, especially among older adults METHODS: We included data from 2828 community dwelling non-smoking older adults from the Seniors-Enrica-2 cohort (Madrid, Spain). Exposure to SHS was assessed by serum cotinine concentrations. At baseline (2017) and follow-up (2019), overall physical function was evaluated using the Spanish version of the physical component summary (PCS) of the 12-Item Short-Form Health questionnaire, lower-extremity performance with the Short Physical Performance Battery (SPPB), muscle weakness with a dynamometer, frailty with a Deficits Accumulation index (DAI), and disability in instrumental activities of daily living (IADL) with the Lawton-Brody questionnaire. Cross-sectional analyses were performed using linear and logistic regression models. Repeated measures models used robust standard error estimates to account for within-participant correlations induced by repeated measurements RESULTS:The median (IQR) concentrations of serum cotinine was 0.079 (0.035-0.175)ng/mL. After adjustment for potential confounders including sex, age, social class, civil status, tobacco exposure in the past, physical activity and BMI, and compared to participants with cotinine concentrations below the limit of detection (0.05ng/mL), those in the highest quartile of exposure (≥0.239ng/mL) showed baseline mean differences (95%CI) in the PCS, SPPB and muscle strength of -1.43 (-2.68,-0.18) points, -0.26 (-0.47,-0.06) points, and -1.21 (-1.92, -0.49) kilos; as well as a higher mean accumulation of deficits [2.62 (1.51,3.73)] and a higher odds of IADL limitations [1.38 (0.89, 2.14)]. In prospective analyses, the corresponding figures were -1.11 (-2.52,0.21) for PCS, -0.30 (-0.53,-0.07) for SPPB, -1.02 (-1.90,-0.13) for muscle weakness, 1.90 (0.64,3.16) for DAI and 1.15 (0.59,2.23) for IADL disability CONCLUSIONS:These findings suggest that exposure to SHS during old age may influence functional decline. If confirmed, more efforts would be needed to protect older adults from SHS KEYWORDS: Secondhand smoke, functional decline, ageing

Functional limitations in people with multimorbidity and the association with mental health conditions: Baseline data from the Canadian Longitudinal Study on Aging (CLSA).

IntroductionIncreasing multimorbidity is often associated with declining physical functioning, with some studies showing a disproportionate impact on functioning when mental health conditions are present. More research is needed because most multimorbidity studies exclude mental health conditions.ObjectivesThis study aims to improve our understanding of the association between functional limitation and multimorbidity, including a comparison of those with multimorbidity that includes versus excludes mental health conditions.MethodsThis is a population-based, cross-sectional analysis of data from The Canadian Longitudinal Study on Aging. Functional limitation was defined as the presence of any of 14 activities of daily living (ADLs) or instrumental activities of daily living (IADLs). Multimorbidity, measured by the number of chronic conditions, included mood and anxiety disorders. Logistic regression explored the association between multimorbidity (with and without mental health conditions) and functional limitation. Factor analysis identified common condition clusters to help understand clinical complexity in those with mood/anxiety disorders and the potential influences on functional limitation.ResultsThere were 51,338 participants, with a similar proportion of men and women (49% versus 51%) and 42% age 65 years or older. Fifteen percent (15%) had no chronic conditions and 17% had 5+. Ten percent (10%) reported at least one ADL or IADL limitation. Odds ratios (ORs) for functional limitation increased with multimorbidity and were generally higher for those with versus without mental health conditions (e.g., ORs from 1 to 5+ chronic conditions increased 1.9 to 15.8 for those with mood/anxiety disorders versus 1.8 to 10.2 for those without). Factor analysis showed that mood/anxiety conditions clustered with somatic conditions (e.g., migraines, bowel/gastrointestinal disorders).ConclusionThis study found higher odds of functional limitation for those with multimorbidity that included versus excluded mental health conditions, at all levels of multimorbidity. It highlights the need for concurrent management of mental and physical comorbidities to prevent functional limitations and future decline. This approach is aligned with the NICE clinical assessment and management guidelines for people with multimorbidity.

The association between nutritional status and functional limitations among centenarians: a cross-sectional study

BackgroundAlthough there have been studies on the association between nutritional status and functional limitations, there were few studies on Asian centenarians in community. Therefore, this study aims to identify associations between nutritional status and functional limitations among centenarians in China.MethodsThis cross-sectional study was conducted with the data from the China Hainan Centenarian Cohort Study. These data ultimately included basic characteristics, hematologic indicators, and chronic disease status for 1,002 centenarians. The nutritional status was evaluated using the Mini Nutritional Assessment Short-Form scale. The functional limitations were assessed using the activities of daily living (ADL) scale, namely Barthel Index and Lawton Scale. The association between nutritional status and ADL was assessed using multivariate logistic regression models.ResultsIn this study, the prevalence of malnutrition was 20.8 % among centenarians, basic ADL (BADL) limitation was 28.6 %, and instrumental ADL (IADL) limitation was 64.7 %. As the nutritional status deteriorated, the risk of ADL limitations increased in total population (BADL limitation: OR = 17.060, 95 % CI: 8.093-35.964; IADL limitation: OR = 11.221, 95 % CI: 5.853-21.511; p for trend < 0.001). Similar results were found in both men and women after stratifying sex but were more prominent in women.ConclusionsMalnutrition is associated with functional limitations among centenarians in China and more pronounced among women.

Age trajectories of disability development after 65: A comparison between Japan and Taiwan

IntroductionDisability development using age as the axis was void in the literature. Identification of the age trajectory of disability development across populations enables preparation for aging-related policies when conducting cross-national comparisons. This study compared three indicators of the development of physical disability in populations of Taiwan and Japan. MethodsData comprised two nationally representative panel surveys (1) the Taiwan Longitudinal Study on Aging (N = 3,037) in 1996–2011 and (2) the National Survey of the Japanese Elderly in 1996–2012 (N = 1,974). Older adults (65+) were examined longitudinally. Activities of daily living (ADL), instrumental activities of daily living (IADL), and mobility disability development during aging were analyzed using multilevel models. ResultsAfter age standardization, Japan reported higher prevalence rate of ADL disability (14.95% vs. 9.65%) but lower IADL (19.30% vs. 30.36%) and mobility disability (36.07% vs. 49.82%) as compared with Taiwan. ADL limitation occur (ADL limitation>=1) at the age of 77.9 and 77.2 for populations in Japan and Taiwan, respectively. Populations reached three ADL limitations at the age of 86.7 and 85.0 in Japan and in Taiwan, respectively. IADL limitation occur (IADL limitation>=1) at the age of 79.1 and 74.5 for populations in Japan and Taiwan, respectively. Mobility limitation occur (Mobility limitation>=1) at the age of 70.7 and 65.3 for populations in Japan and Taiwan, respectively. ConclusionsOlder adults generally do not report ADL limitation until 77 and do not face serious disability until 85 or 86 in Taiwan or Japan, respectively. Mobility limitation occurs at a various age in different countries.