Disability Trajectories Research Articles

Structural and Clinical Correlates of a Periventricular Gradient of Neuroinflammation in Multiple Sclerosis.

ObjectivesTo explore in vivo innate immune cell activation as a function of the distance from ventricular CSF in patients with multiple sclerosis (MS) using [18F]-DPA714 PET and to investigate its relationship with periventricular microstructural damage, evaluated by magnetization transfer ratio (MTR), and with trajectories of disability worsening.MethodsThirty-seven patients with MS and 19 healthy controls underwent MRI and [18F]-DPA714 TSPO dynamic PET, from which individual maps of voxels characterized by innate immune cell activation (DPA+) were generated. White matter (WM) was divided in 3-mm-thick concentric rings radiating from the ventricular surface toward the cortex, and the percentage of DPA+ voxels and mean MTR were extracted from each ring. Two-year trajectories of disability worsening were collected to identify patients with and without recent disability worsening.ResultsThe percentage of DPA+ voxels was higher in patients compared to controls in the periventricular WM (p = 6.10e-6) and declined with increasing distance from ventricular surface, with a steeper gradient in patients compared to controls (p = 0.001). This gradient was found in both periventricular lesions and normal-appearing WM. In the total WM, it correlated with a gradient of microstructural tissue damage measured by MTR (rs = −0.65, p = 1.0e-3). Compared to clinically stable patients, patients with disability worsening were characterized by a higher percentage of DPA+ voxels in the periventricular normal-appearing WM (p = 0.025).ConclusionsOur results demonstrate that in MS the innate immune cell activation predominates in periventricular regions and is associated with microstructural damage and disability worsening. This could result from the diffusion of proinflammatory CSF-derived factors into surrounding tissues.

Menopause does not modify disability trajectories in a longitudinal cohort of women with clinically isolated syndrome and multiple sclerosis followed from disease onset.

To evaluate the effect of menopause on disability accumulation in women followed from their clinically isolated syndrome (CIS). We examined the longitudinal changes in Expanded Disability Status Scale (EDSS) scores from CIS until the last follow-up in women belonging to the Barcelona CIS prospective cohort, followed through their menopausal transition. The analysis is based on 13,718 EDSS measurements, with an average of 28 EDSS measurements per patient. Differences in EDSS trajectories between menopausal and nonmenopausal women, controlling for age and disease duration, were evaluated. We performed two sensitivity analyses in women with confirmed MS and in those experiencing early menopause. From 764 eligible women, 496 (65%) responded to the questionnaire, and 74 (14.9%) reached menopause over the follow-up. We did not find a significant inflection point in EDSS trajectories around menopause (slope change -0.009; 95% CI -0.066; 0.046). The annual increase in EDSS over the complete course of the disease was significantly higher in menopausal women (0.049; 95% CI, 0.026-0.074) versus nonmenopausal (0.019; 95% CI, 0.008-0.031; interaction p value 0.025). This difference was lost when controlling for age and disease duration (EDSS annual increase of 0.059; 95% CI, 0.025-0.094 vs. 0.038; 95% CI, 0.021-0.057, respectively; interaction p value 0.321). No inflection point was detected when the analysis was restricted to women with confirmed MS or with earlier menopause. Menopause is not associated with an increased risk of disability in a CIS population, considering EDSS trajectories throughout the course of the disease together with age and disease duration.

Association among multimorbidity, physical disability and depression trajectories: a study of urban\u2013rural differences in China

PurposeThe purpose of this study was to analyse the trajectories of depression in urban and rural areas, and to analyse the relationship among multimorbidity, disability and other variables and trajectories.MethodsData from the China Health and Retirement Longitudinal Study were used. A latent class growth model was used to characterise the trajectories of urban and rural depression symptoms. Chi-square test was used to test the differences in respondents’ characteristics among depression trajectories groups within urban and rural areas. The relationships among multimorbidity, disability and depression symptom trajectories were analysed via multinomial logistic regression.ResultsUrban and rural depression trajectories were divided into three categories. Respondents in urban areas were divided into rising, remaining-low and declining group, and those in rural areas were divided into rising, remaining-low and remaining-high group. The depression scores of respondents with multimorbidity were more likely to rise, and this result was similar for the disabled respondents. Respondents who need help on activities of daily living and instrumental activities of daily living in urban areas were more likely to decline in depression scores. In rural areas, however, the values were consistently high. In urban and rural areas, the relationships among marital status, education and age and depression trajectories were different.ConclusionsThe depression trajectories are different in urban and rural China. Improving the quality of medical services, promoting the distribution of rural social resources and implementing more recreational activities could be beneficial for the promotion of mental health in rural areas.

Cognitive, physical and disability trajectories in community-dwelling elderly people

Backgrounds and aimsHealth trajectories in aging, rather than single time-point assessments, could be early indicators of the onset of conditions such as dementia. The aim of this study was to identify different aging trajectories and to investigate their influence on the cumulative incidence of dementia.MethodsWe evaluated data referring to 993 elders from the InveCe.Ab study cohort. All subjects were free from dementia at baseline and re-assessed on at least one other occasion thereafter. Cognitive function was assessed using the Mini-Mental State Examination (MMSE), physical function using the Walking Speed Test (WST), and disability on the basis of the Activities of Daily Living (ADL) score. To describe the different courses of the three outcomes combined, the Group-Based Trajectory Model (GBTM) method was applied. We looked for differences in age, gender, education, ApoE-e4 carrier status and obesity, and then investigated the influence of the observed trajectories on the incidence of dementia.ResultsThree trajectories were identified: a “good” scenario was observed in 703 (70.2%) individuals, who showed substantially stable cognitive and physical function and no disability; an “intermediate” scenario in 248 subjects (25.5%), who recorded a longer walking time, lower MMSE score, and a one-point higher ADL score; and a “severe” scenario in 42 elders (4.3%), who recorded declines in all the outcomes. Female gender, obesity and low education were most represented in the “severe” group. ApoE-e4 carrier status showed no difference between groups. The estimated cumulative incidence of dementia was higher in the “severe” (37%) than in the “intermediate” (7%) and “good” (< 1%) scenarios.ConclusionsUsing simple measurements, we built different aging trajectories, and observed that the worst performers had the highest incidence of dementia. Better knowledge of trajectories of aging would be useful for preventive interventions aimed at promoting healthier aging.

Association Between Disability Trajectory and Health Care Service Utilization Among Older Adults in China

ObjectivesThis study aimed to identify the heterogeneous disability trajectories among older Chinese adults and examine the association between disability trajectories and health care service utilization. DesignProspective cohort study. Setting and ParticipantsA community-based study including older adults aged ≥65 years from the Chinese Longitudinal Healthy Longevity Survey. MethodsDisability was assessed by the difficulties in activities of daily living and instrumental activities of daily living between 2002 and 2018. Health care utilization was measured by the expenditures on outpatient and inpatient services in 2018. Growth mixture modeling was conducted to estimate heterogeneous disability trajectories. A 2-part model was used to analyze the association of disability trajectories and health care utilization. Covariates were included based on Andersen's behavioral model. ResultsThree classes of disability trajectories were identified: the progressive (7.9%), late-onset (13.7%), and normal classes (78.4%). Older adults who followed the late-onset trajectory of disability were more likely to use inpatient services compared with the normal class (odds ratio = 1.47, P < .010), after controlling potential confounders. Compared with the normal class, the progressive class on average spent US$145.94 more annually (45.2% higher) on outpatient services (P < .010) and $738.99 more annually (72.6% higher) on inpatient services (P < .001); the late-onset class reported higher annual expenditures on outpatient and inpatient services of $215.94 (66.9% higher) and $1405.00 (138.0% higher), respectively (all P < .001). Conclusions and ImplicationsHeterogeneous disability trajectories exhibited distinct health care service utilization patterns among older Chinese adults. Older adults affected by late-onset disability incurred the highest health care needs. These findings provide valuable policy-relevant evidence for reducing health care burden among older adults.

Definitions of primary-progressive multiple sclerosis trajectories by rate of clinical disability progression

BackgroundPatients with primary progressive multiple sclerosis (PPMS) vary in the rate of disability progression. ObjectiveTo classify clinical disability trajectories by rate of disability progression and evaluate predictive variables in PPMS patients. MethodsWe analyzed the cumulative incidence of progression to disability and in accordance defined clinical PPMS disability trajectories. Correlation was performed with age, gender and disability at first presentation. Estimated onset was calculated and validated by the mathematical slope of disability progression. ResultsThe cohort included 304 PPMS patients, 146 (48%) were females, the mean age at first visit was 41.1 years, and the median follow up was 18.9 years. Median time to reach moderate and severe disability was 4.5 years (95%CI 3.8–5.2) and 12.6 years (95%CI 10.1–14.2), respectively. Extremely fast patients (3.3%) progressed to severe disability within 2-years, while very slow patients (4.7%) did not progress to moderate disability even 20 years after first presentation. Age and gender were not associated with progression. Moderate disability at first visit was associated with faster progression to severe disability. Mean estimated range of disease onset was between 4.3 to 9.9 years prior to first presentation. ConclusionsMajority of PPMS patients progressed to moderate disability within 5-years and to severe disability within 15-years from first presentation. Clinical disability progression trajectories can help treatment-related decisions.

Long-term disability trajectories in relapsing multiple sclerosis patients treated with early intensive or escalation treatment strategies.

Background and aims:No consensus exists on how aggressively to treat relapsing–remitting multiple sclerosis (RRMS) nor on the timing of the treatment. The objective of this study was to evaluate disability trajectories in RRMS patients treated with an early intensive treatment (EIT) or with a moderate-efficacy treatment followed by escalation to higher-efficacy disease modifying therapy (ESC).Methods:RRMS patients with ⩾5-year follow-up and ⩾3 visits after disease modifying therapy (DMT) start were selected from the Italian MS Registry. EIT group included patients who received as first DMT fingolimod, natalizumab, mitoxantrone, alemtuzumab, ocrelizumab, cladribine. ESC group patients received the high efficacy DMT after ⩾1 year of glatiramer acetate, interferons, azathioprine, teriflunomide or dimethylfumarate treatment. Patients were 1:1 propensity score (PS) matched for characteristics at the first DMT. The disability trajectories were evaluated by applying a longitudinal model for repeated measures. The effect of early versus late start of high-efficacy DMT was assessed by the mean annual Expanded Disability Status Scale (EDSS) changes compared with baseline values (delta-EDSS) in EIT and ESC groups.Results:The study cohort included 2702 RRMS patients. The PS matching procedure produced 363 pairs, followed for a median (interquartile range) of 8.5 (6.5–11.7) years. Mean annual delta-EDSS values were all significantly (p < 0.02) higher in the ESC group compared with the EIT group. In particular, the mean delta-EDSS differences between the two groups tended to increase from 0.1 (0.01–0.19, p = 0.03) at 1 year to 0.30 (0.07–0.53, p = 0.009) at 5 years and to 0.67 (0.31–1.03, p = 0.0003) at 10 years.Conclusion:Our results indicate that EIT strategy is more effective than ESC strategy in controlling disability progression over time.

Restoration of Population Disability Trajectory During Hundreds of Years - China, 1896-2006.

What is already known about this topic? A previous study found that the size of population with disability was 52.7 million and 84.6 million in 1987 and 2006, with the weighted disability rate of 4.9% and 6.5%, respectively. What is added by this report? This study restored the prevalence of disability and its change trajectory in China during 110 years from 1896 to 2006 across 3 centuries. What are the implications for public health practice? This study realized the innovation of cross-sectional data utilization methods and the expansion of the theory of morbidity transformation while making up for the lack of historical data.

Trajectory of excess healthcare consultations, medication use, and work disability in newly diagnosed knee osteoarthritis: a matched longitudinal register-based study

To estimate the excess healthcare use and work disability attributable to knee osteoarthritis (OA) in the first 5years following diagnosis. Among individual aged 40-80 years who resided in Skåne on 31st December 2008, we identified those with a main diagnosis of knee OA during 2009-2014 and no previous diagnosis of any OA from 1998 (n=16,888). We created a comparison cohort matched (1:1) by sex, age, and municipality from individuals with no OA diagnosis (at any site) during 1998-2016. We compared healthcare use and net disability days for 60 months following diagnosis between the two groups. We applied a survival-adjusted regression technique controlling for sociodemographic characteristics as well as pre-diagnosis outcome and comorbidity. The estimated 5-year incremental effects of knee OA per-patient were 16.8 (95% CI: 15.8, 17.7) healthcare consultations, 0.7 (0.4, 1.1) inpatient days, 420 (372, 490) defined daily dose of prescribed medications, and 21.8 (15.2, 30.0) net disability days. Primary care consultations constituted about 73% of the excess healthcare consultations. Most of these incremental effects occurred in the first year after diagnosis. Better survival in the knee OA group accounted for 0.7 (95% CI: 0.5, 0.8) and 1.4 (0.7, 2.6) of the excess healthcare consultations and net disability days, respectively. Both estimated total and incremental resources use were generally greater for women than men with knee OA. Knee OA was associated with considerable excess healthcare use and work disability independent of pre-diagnosis resources use, comorbidity, and sociodemographic characteristics.

Understanding Transitions in IADL and Their Consequences for Cognitive Impairment Among Older Mexican Americans

Mexican Americans tend to live longer lives than other ethnic groups, but it remains unclear how this trend influences the trajectory of disability and its consequences for cognitive frailty. Building on previous research, we assess transitions in IADL among the oldest old. We use data from three waves of the Hispanic Established Population of the Epidemiologic Study of the Elderly (H-EPESE) to investigate trajectories of IADL disability as individuals’ age into their 80s and 90s, a period of the life course with much higher rates of morbidity and decreasing socioeconomic resources. The H-EPESE is a benchmark longitudinal cohort study based on an original sample of 3,050 Mexican-Americans aged 65 and older in the Southwestern United States. Our modeling approach estimates transitions in patterns of IADL employing the Latent Transition Analysis (LTA). Results revealed three heterogeneous latent classes: high IADLs, difficulty in transportation and mobility, and low IADLs. Those with high IADLs tended to remain in the same class over time. Individuals having difficulty in transportation and mobility tended to stay in the same class or transfer to high IADLs, whereas those with overall low IADLs transferred to either the same class or to difficulty in transportation and mobility. Additional analysis revealed that cognitive impairment was a significant predictor of instrumental disability over time. Furthermore, females were more likely than males to belong to difficulty in transportation or mobility class than to the low IADL class. Our results highlight the long term consequences of cognitive decline on IADL limitations.

Functional Disability in the Context of Cancer Diagnosis: Examining the Within- and Between-Person Associations

Physical functioning is essential for independent living and aging in place among older adults. Although older adults show a general trend of increasing functional disability, it was unclear how cancer diagnosis, which also has an increased incidence rate among older adults, may potentially aggravate the progress of functional decline at the within- and between-person levels. Using 3 waves of the China Health and Retirement Longitudinal Study (CHARLS, 2011-2015), the current study examined the trajectory of functional disability and associated factors over 5 years among older adults with (n = 139) and without cancer (n = 212), who were matched on key demographic characteristics. We considered four contributing factors to disability as specified in the Disablement Process model as covariates, in the context of cancer diagnosis timing at both the within- and between-person levels. These factors were psychological (i.e., depressive symptoms), physical limitations (i.e., pain, fall, and frailty), cognitive impairment (i.e., self-reported memory problems and word recall), and environmental constraints (i.e., social contact and availability of support). Consistent with the literature, there was a general trend of increasing functional disability among all participants over time. At the within-person level, although cancer diagnosis timing was associated with higher levels of functional difficulty, we found a slower increasing rate over time. At the between-person level, functional disability trajectory was not associated with cancer diagnosis timing. These findings suggest that maintenance of physical functioning should be considered at the within-person level, and personalized care is recommended for Chinese older adults with cancer.

Growth Curve of Disability of Older Adults Over a 12-Year Period: Can It Be Modified by Age or Engaging in Activities?

Adopting a growth curve model, this study aims to fit a growth trajectory of disability of older adults over a 12-year period, and to investigate whether such a trajectory is modified by initial age and level of engagement in activities. The data are from the Chinese Longitudinal Healthy Longevity Survey, which includes 16,064 individuals aged 60 or above in the first wave in 2002 who were followed-up in four more waves until 2014. Disability in this study is measured by having any difficulty in performing six activities of daily living. Activities include physical exercise and eight leisure activities. To rigorously test the causal effect of engaging in activities on disability, we adopted a time-lagged growth curve model. In addition, disability status in the initial wave was controlled at baseline and an array of health status measures, such as physical functioning and cognitive performance, were included as time-varying covariates. We introduced a random effect to control for unobserved heterogeneity between individuals. The results show a quadratic curve of disability over time with an accelerating pace in later waves. While initial age shows a moderate modifying effect, engaging in leisure activities substantially modified the trajectory: The probability of being disabled increased from 6.7% to 45.8% between the first and fourth follow-up for those inactive individuals. For those active older adults, it only increased from 3.1% to 18.0%. This study demonstrates that engaging in leisure activities can significantly reshape the trajectory of developing disability among older adults.

Age trajectories of disability in instrumental activities of daily living and disability-free life expectancy among middle-aged and older adults in Taiwan: an 11-year longitudinal study

BackgroundThis study aims to identify the age trajectories of disability in instrumental activities of daily life (IADLs) over 11 years and their correlates, and to estimate disability-free life expectancy for identified trajectory groups in middle-aged and older adults.MethodsWe included 3118 participants aged 50 and over without IADL limitations at baseline from the Taiwan Longitudinal Study in Aging, followed across 1996–2007. We used group-based trajectory models to identify age trajectories of IADL disability, and multiple logistic regressions to examine their correlates. Sullivan method was used to compute IADL disability-free life expectancy for trajectory groups at different ages.ResultsWe identified two trajectories groups: 67.7% of participants classified as the late-onset group and 32.3% as the early-onset group. Female (adjusted odds ratio [aOR]: 1.93, 95% confidence interval [95% CI]: 1.54, 2.41), not being employed (aOR: 1.30, 95% CI: 1,08, 1,56), poor/fair self-rated health (aOR: 1.31, 95% CI:1.09, 1.58), hypertension (aOR: 1.32, 95% CI: 1.07, 1.63), diabetes mellitus (aOR: 2.29, 95% CI: 1.72, 3.07), arthritis (aOR: 1.42, 95% CI: 1.11, 1.81), stroke (aOR: 2.21, 95% CI: 1.04, 4.70), and one-point increase in a 10-item depression scale (aOR: 1.04, 95% CI: 1.02, 1.06) were associated with early-onset of disability, whereas higher education (aOR: 0.59, 95% CI: 0.42, 0.81), regular exercise (aOR: 0.76, 95% CI: 0.62, 0.93), and participating voluntary or club activities (aOR: 0.78, 95% CI: 0.65, 0.93) related to the late-onset. IADL disability-free life expectancies at 65 years old in the late-onset group were 15.6 years for women and 14.4 for men, respectively, comprising 56.6 and 64.2% of their remaining life, whereas those of the early-onset group were 4.8 and 4.6 years for women and men respectively, comprising 22.5 and 27.2% of remaining life.ConclusionsEarly-onset of IADLs disability may correlate to chronic conditions, and engagement in employment, exercise, and social participation were associated with a reduced risk of early disability in IADLs.

Predictors for functional decline after an injurious fall: a population-based cohort study

BackgroundThe functional consequences of injurious falls are well known. However, studies of the factors that can modify trajectories of disability after an injury from a fall are scarce.AimsWe aimed to investigate whether sociodemographic and health-related factors may impact this association.MethodsThe study population consisted of 1426 community-dwelling older adults (≥ 60 years) from the SNAC-K cohort study in Stockholm, Sweden. Functional status over 12 years of follow-up was assessed using the number of limitations in basic and instrumental activities of daily living. Sex, cohabitation status, physical activity, and self-rated health were assessed at baseline. Injurious falls were defined as falls requiring healthcare and were assessed over 3 years starting at baseline. Data were analyzed using linear-mixed effects models.ResultsThe fastest increase in the number of disabilities was observed in those who had endured an injurious fall and were living alone (β coefficient = 0.408; p < 0.001), been physically inactive (β coefficient = 0.587; p < 0.001), and had poor self-rated health (β coefficient = 0.514; p < 0.001). The negative impact of these factors was more pronounced among fallers compared to non-fallers.DiscussionLiving alone, being physically inactive, and having poor self-rated health magnifies the negative effect of an injurious fall on functional status. Among individuals who endure an injurious fall, the heterogeneity in long-term functional status is substantial, depending on the individuals’ characteristics and behaviors.ConclusionsThese findings emphasize the need for a person-centered approach in care provision and can guide secondary prevention within health care.

Examining transitions in loneliness for people without and with moderate and severe disabilities

Purpose To investigate how disability affects the levels of loneliness reported by people living in Germany. In particular, we are interested in analysing the transitions into and out of loneliness but incorporating a dynamic approach of disability (i.e., disability trajectories). Method Drawing data from the German Socio-Economic Panel for the years 2013 and 2017 and using a three-item version of the UCLA Loneliness Scale, we construct a balance panel of individuals and estimate linear regression models on loneliness, and probit models to predict the likelihood to become lonely or exit from loneliness. Results We find a positive association between disability and loneliness (especially for those people who are severely limited). The frequency of contacts with family, friends, etc., the number of close friends and the participation in volunteering, sports, cultural and religious events reduce loneliness. Furthermore, we find that those individuals making the transition into a moderate/severe disability and also those recovering totally from a severe disability are more likely to become lonely in 2017. Conclusions From a public health policy perspective, it is necessary to undertake the design and implementation of instrumental, emotional and social support for people with disabilities. A higher engagement in social activities (e.g., social gatherings, cultural and leisure activities) and the elimination of barriers (e.g., structural and environmental) may become key elements to preventing loneliness. IMPLICATIONS FOR REHABILITATION Loneliness has become an important social problem in most countries with a significant impact on individuals’ health status (mental and physical). Loneliness strongly affects individuals who experience important levels of discrimination and social exclusion (e.g., people with disabilities). Transitions of disabilities and loneliness must be taken into account to investigate the relative position of people with disabilities (especially those with severe disabilities). People with severe disabilities report the highest levels of loneliness, especially if this disability status remains over time. Rehabilitation professionals must promote social relations and support among people with disabilities and help them exit from permanent loneliness.

Longitudinal trajectory of disability in community-dwelling older adults: An observational cohort study in South Korea

BackgroundDisability, which is considered a health-related condition, increases care demands and socioeconomic burdens for both families and communities. To confirm the trend of dynamic longitudinal changes in disability, this study aims to explore how disability is divided by the trajectory method, which deals with time-sequenced data. Additionally, this study examines the differences in demographics, geriatric conditions, and time spent at home among the trajectory groups in community-dwelling older adults. Home time is defined as the period during which the patient was not in a hospital or health care facility during their lifetime.MethodsRecords of 786 community-dwelling older participants were analyzed from the Aging Study of PyeongChang Rural Area, a population-based cohort study that took place over three years. Using 7 domains of activities of daily living and 10 domains of instrumental activities of daily living, participants were grouped into no dependency (0 disabled domain), mild (1 disabled domain), and severe (2 or more disabled domains) disability groups. The longitudinal trajectory group of disability was calculated as a trajectory method. Three distinct trajectory groups were calculated over time: a relatively-stable group (78.5%; n = 617), a gradually-aggravated group (16.0%; n = 126), and a rapidly-deteriorated group (5.5%; n = 43).ResultsThe average age of 786 participants was 73.3 years (SD: 5.8), and the percentage of female was 52.7%. It was found that 78.5% of patients showed relatively no dependence and 5.5% of older adults in a rural area showed severe dependence. Through applying the trajectory method, it was shown that the Short Physical Performance Battery (SPPB) score was 10.2 points in the relatively-stable group and 3.1 points in the rapidly-deteriorating group by the 3rd year. Additionally, by the trajectory method, the rate of decrease in home time was 3.33% in the rapidly-deteriorated group compared to the relatively-stable group.ConclusionsThis study shows the difference in demographics and geriatric conditions (such as SPPB) through the examination of longitudinal trajectory groups of disability in community-dwelling older adults. Significant differences were also found in the amount of home time among the trajectory groups.

Disability in Basic Activities of Daily Living Is Associated With Symptom Burden in Older People With Advanced Cancer or Chronic Obstructive Pulmonary Disease: A Secondary Data Analysis

ContextManaging activities of daily living is important to people with advanced cancer or chronic obstructive pulmonary disease (COPD). Understanding disability in activities of daily living may inform service planning. ObjectiveTo identify the prevalence of disability in activities of daily living, associations and change over time, in older people with advanced cancer or COPD. MethodsSecondary analysis of International Access, Rights and Empowerment (IARE) studies in adults aged ≥65 years with advanced disease in the United Kingdom, Ireland, and United States, using cross-sectional (IARE I & II) and longitudinal (IARE II, 3 timepoints over 6 months) data. Measures included disability in activities of daily living (Barthel Index), symptom severity (Palliative Outcome Scale), and assistive device use (self-reported). Logistic regression was used to identify relationships between disability and age, sex, living alone, diagnosis, and symptom burden; visual graphical analysis explores individual disability trajectories. ResultsOne hundred fifty-nine participants were included (140 cancer, 19 COPD). Sixty-five percent had difficulty climbing stairs, 48% bathing, 39% dressing, and 36% mobilizing. Increased disability was independently associated with increased symptom burden (odds ratio, 1.08 [95% CI:1.02–1.15], P = 0.01) and walking unaided (z = 2.35, P = 0.02), but not with primary diagnosis (z = −0.47, P = 0.64). Disability generally increased over time but with wide interindividual variation. ConclusionDisability in activities of daily living in advanced cancer or COPD is common, associated with increased symptom burden, and may be attenuated by use of assistive devices. Individual disability trajectories vary widely, with diverse disability profiles. Services should include rehabilitative interventions, guided by disability in individual activities of daily living.

Trajectories of Late-Life Disability Vary by the Condition Leading to Death.

Previous research suggested that there might be distinct patterns of functional decline in the last years of life depending on the condition leading to death, but the validity of these results and hence the explanatory value of the condition leading to death for late-life disability are uncertain. A total of 636 decedents from a cohort of 754 community-living persons, 70+ years of age (Yale PEP Study) provided 33 700 monthly observations of self-/proxy-reported disability during the last 5 years of life. Nonlinear trajectories and short-term fluctuations of late-life disability by condition leading to death (cancer, organ failure, frailty, severe dementia, sudden death, other) were estimated with flexible mixed spline regression models. Disability trajectories at the end of life varied distinctively by the condition leading to death. Estimated disability trajectories among cancer deaths increased gradually up until about 6 months before death, after which a steep terminal decline set in. Among those with organ failure, frailty, and dementia, in contrast, disability was higher, increased more gradually, and there was no clear-cut terminal phase. Adding the condition leading to death to other known risk factors increased the amount of explained between-person variation in late-life disability from R2 = 0.35 to 0.49. Short-term fluctuations in disability were not specific for decedents with organ failure. The condition leading to death is an important determinant of trajectories of late-life disability. These trajectories follow distinct patterns partially resembling a previously outlined theoretical typology.

Disability trajectories in activities of daily living of elderly Chinese before death

This study aims to analyze the changes in activities of daily living (ADL) of the Chinese elderly before death, and to explore the heterogeneity in this process. Using data from the Chinese Longitudinal Healthy Longevity Survey (CLHLS), we quantify disability trajectories of ADL using a group-based trajectory model and find that there are three types of disability trajectory for ADL. The elderly who differ by socioeconomic status, childhood experiences, health behaviors, ages and birth cohorts show significant differences in their disability trajectories. Long duration of disability is found to be more prevalent in older females and people with high socioeconomic status. Good and stable status of ADL is more common among males and people of low socioeconomic status, while the elderly in an early cohort who died at older ages were more likely to have experienced a long duration of disability. Selective and protective effects contribute to the observed differences in trajectories.

The Association between 25-Hydroxyvitamin D Concentration and Disability Trajectories in Very Old Adults: The Newcastle 85+ Study.

Background: Low vitamin D status is common in very old adults which may have adverse consequences for muscle function, a major predictor of disability. Aims: To explore the association between 25-hydroxyvitamin D [25(OH)D] concentrations and disability trajectories in very old adults and to determine whether there is an ‘adequate’ 25(OH)D concentration which might protect against a faster disability trajectory. Methodology: A total of 775 participants from the Newcastle 85+ Study for who 25(OH)D concentration at baseline was available. Serum 25(OH)D concentrations of <25 nmol/L, 25–50 nmol/L and >50 nmol/L were used as cut-offs to define low, moderate and high vitamin D status, respectively. Disability was defined as difficulty in performing 17 activities of daily living, at baseline, after 18, 36 and 60 months. Results: A three-trajectory model was derived (low-to-mild, mild-to-moderate and moderate-to-severe). In partially adjusted models, participants with 25(OH)D concentrations <25 nmol/L were more likely to have moderate and severe disability trajectories, even after adjusting for sex, living in an institution, season, cognitive status, BMI and vitamin D supplement use. However, this association disappeared after further adjustment for physical activity. Conclusions: Vitamin D status does not appear to influence the trajectories of disability in very old adults.