Association of unmet need with self-rated health in a community dwelling cohort of disabled seniors 75 years of age and over

The Consequences of Unmet Needs for Assistance With Daily Life Activities Among Older Adults: A Systematic Review

Many older adults are experiencing unmet needs for assistance with the activities of daily living (ADLs) and instrumental activities of daily living (IADLs). Such unmet needs might threaten their physical and psychosocial well-being. We conducted a systematic review to provide a comprehensive picture of the health consequences of unmet ADL/IADL needs among older adults. Twenty-eight published articles were included for qualitative synthesis. We found that unmet ADL/IADL needs were consistently associated with higher health care utilization (e.g., hospitalization, medical spending) and adverse psychosocial consequences (e.g., anxiety, depression), while the findings of falls and mortality remain inconsistent. More studies are needed to draw firm conclusions and to allow for quantitative synthesis. This review advocates for more coordinated and comprehensive long-term care services for older adults. Future studies should explore how the adverse health outcomes identified in this review can be prevented or improved by adequately meeting older adults' needs for assistance.

Trajectories of Self-Rated Health Among Industrially Disabled Individuals: A Latent Class Growth Analysis

BACKGROUND

Understanding the self-rated health of industrially disabled individuals is an important variable that significantly affects their quality of life, satisfaction, and return to work after an industrial accident. Since the health of people with industrial disabilities is affected by various environments and variables, interventions and policies that are suitable for their characteristics are needed.

OBJECTIVES

This study aimed to identify changes in self-rated health among industrially disabled individuals, distinguish between different latent classes, and verify predictive factors for each latent class.

METHODS

Four time-point datasets from the 2018-2021 panel study of Korean workers' compensation insurance were used. Using the latent growth curve model, an overall trajectory of self-rated health of industrially disabled individuals was confirmed, and the number and characteristics of different trajectories were identified using the latent class growth model. Multinomial logistic regression analysis was used to identify the predictive factors for each class.

RESULTS

Four classes of self-rated health trajectories were identified: low-decreasing (21.7%), moderate-increasing (15.7%), high-decreasing (56.1%), and low-stable (6.5%) classes. A multinomial logistic regression analysis revealed that significant determinants (age, capacity, type of industrial accident, grade of disability, mental activity, outdoor activity, and social relationships) were different for each latent class. Capacity level affected all potential class classifications.

CONCLUSIONS

To improve the self-rated health of industrially disabled individuals, it is necessary to develop an appropriate strategy that considers the characteristics of the latent class.

Prevalence and correlates of disability among urban-rural older adults in Southwest China: a large, population-based study

Background

As one of the challenges of aging, older adults with disabilities are often overlooked in remote areas of many developing countries, including southwest China. Similar populations would undoubtedly benefit from a representative, high-quality survey of large samples, which would also enrich global disability data. This study aims to assess the prevalence of disability and associated factors among urban and rural older adults in a typical representative region.

Method

A large-scale baseline survey was conducted between March and September 2020 using face-to-face interviews with a multistage stratified random sample of 16,536 participants aged ≥ 60 years. Disability was assessed using the BI scale, with a score of 100 representing normal status, 65–95 as mild disability, 45–60 as moderate disability, and 0–40 as severe disability. The prevalence of disability was estimated by demographics and health characteristics, and their associations were explored by robust Poisson regression analysis.

Results

The prevalence of disability among older adults was 19.4%, and the prevalence of mild, moderate, and severe disability was 16.8%, 1.5%, and 1.1%, respectively. All variables, including older age, residence in a rural area, higher number of hospitalizations, comorbidities, poor self-rated health, falls, cognitive impairment, mental impairment, and alienation from friends and relatives, were shown to be associated with a higher adjusted prevalence of disability. Only formal education can reduce the risk of disability.

Conclusion

The prevalence of disability among older adults is high in both urban and rural settings in southwest China, and a number of important factors associated with disability have been identified. In addition to increased attention to the health status of older adults, further research on scientific management and effective disability interventions is needed.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12877-022-03193-2.

The impact of unmet needs for assistance with activities of daily living on the self-rated health and life satisfaction of Chinese community-dwelling older adults

OBJECTIVES

This study examined the associations of change in unmet needs for assistance with Activities of Daily Living (ADLs) with the self-rated health and life satisfaction of community-dwelling Chinese older adults.

METHODS

Using national longitudinal data from the Chinese Longitudinal Healthy Longevity Study, we examined the associations of change in unmet ADL needs with self-rated health and life satisfaction from baseline (T1) to a 3-year follow-up (T2) among 1,914 ADL-limited older adults. Change in unmet ADL needs was categorized into 'Persistently Unmet,' 'Unmet at T1 Only,' 'Unmet at T2 Only,' and 'Never Unmet.' Self-rated health and life satisfaction were rated by 5-point Likert scales. Linear mixed models were performed to examine the associations, controlling for sociodemographics, health conditions, and social support.

RESULTS

Older adults whose ADL needs were 'Persistently Unmet,' 'Unmet at T2 Only,' or 'Never Unmet,' showed a significant decline in self-rated health, but those whose ADL needs were 'Unmet at T1 Only' exhibited a significant rise at follow-up. While life satisfaction was stable among older adults with 'Persistently Unmet' or 'Never Unmet' ADL needs, it significantly decreased among those with 'Unmet at T2 Only' ADL needs and increased among those with 'Unmet at T1 Only' ADL needs.

CONCLUSION

Unmet needs may play an even more significant role in negatively impacting life satisfaction than the ADL limitation itself. Unmet ADL needs' effects on self-rated health and life satisfaction appeared to be short-term rather than long-term. Thus, it is never too late to adequately meet older adults' ADL needs.

Supplemental data for this article is available online at http://dx.doi.org/10.1080/13607863.2022.2045563.

Effects of healthcare access and financial status on self-rated health among adults living alone in South Korea

Assessments of the overall health status of people living alone are important for developing health promotion programs and delivering appropriate health services. In the context of universal social health insurance system of South Korea, the relationship between failure to access health-care and self-rated health among adults living alone has given little attention. In addition, the influence of objective financial status on self-rated health in adults living alone has not explored so far. The sample of the present study comprised 4,852 adults who participated in the cross-sectional 2015 Korea National Health and Nutrition Examination Survey. The main finding was that the unmet health-care needs resulting from the inability to access health-care services during the previous 12 months was independently associated with fair or poor self-rated health, especially for women living alone. Having an income below the subsistence level was significantly associated with fair or poor self-rated health among women living alone. The findings of this study demonstrate the need for policies enabling appropriate delivery of health-care services, especially for women living alone. It is necessary to provide community-based monitoring programs related to general health for women living alone with a household income below the minimum cost-of-living.

Association of employment status and income with self-rated health among waged workers with disabilities in South Korea: population-based panel study

OBJECTIVE

This study aimed to examine the association of employment status and income with self-rated health among waged workers with disabilities in South Korea.

METHODS

This study used the Panel Survey of Employment for the Disabled from 2011 to 2015. A total of 951 waged workers with disabilities were selected as baseline subjects in 2011 and were followed up for 5 years. This study used a generalised linear mixed model after adjusting for covariates.

RESULTS

Among 951 waged workers with disabilities, the results showed that 39.3% of workers with disabilities reported poor self-rated health. Workers with disabilities with a precarious employment status and lower income were 1.22 (95% CI 1.21 to 1.23) and 1.81 (95% CI 1.80 to 1.83) times more likely to have poor self-rated health than those with permanent employment and higher income, respectively. A subgroup analysis found that precarious workers with disabilities in lower income households had higher possibilities of poor self-rated health.

CONCLUSION

This study suggests that precarious employment and lower income of waged workers with disabilities are significantly associated with poor self-rated health compared with those with permanent jobs or higher income.

The association of health care access and utilization with self-perceived health in South Korea: the significance of age

Even though South Korea's universal health care system was established in 1989, many South Koreans continue to encounter obstacles in their attempts to access health care. Previous studies have not investigated the relationship between health care access and utilization and perceived health in the context of a universal health care system that implements a mandatory social health insurance policy. The objective of this study was to evaluate the influence of health care access and use of preventive health care services on self-rated health among young and middle-aged adults in Korea. The sample consisted of 1242 young adults aged 20-39 years and 2389 middle-aged adults aged 40-64 years who had participated in the cross-sectional 2015 Korea National Health and Nutrition Examination Survey. Using multiple logistic regression analysis, the association between health care access and use of preventive health care services and perceived poor health among young adults and middle-aged adults was assessed. The main finding was that a history of unmet health care requirements during the past 12 months was strongly associated with fair and poor self-rated health, especially among young adults. Additionally, middle-aged adults who had attended medical check-ups during the preceding 2 years reported poorer self-rated health. This study's findings suggest that, despite South Korea's universal public insurance system, there remains the need to improve access to health care services, especially among young adults. As a health improvement strategy, it is imperative that measures be taken to promote the availability of health care services when they are required and to solve any of the various individual accessibility problems, such as cost, particularly with young adults in mind.

Prevalence of Convergence Insufficiency-Type Symptomatology in Parkinson's Disease

BACKGROUND

Individuals with Parkinson's disease (PD) often present with visual symptoms (e.g., difficulty in reading, double vision) that can also be found in convergence insufficiency (CI). Our objective was to estimate the prevalence of CI-type visual symptomatology in individuals with PD, in comparison with controls.

METHODS

Participants ≥50 years with (n=300) and without (n=300) PD were recruited. They were administered the Convergence Insufficiency Symptom Survey (CISS-15) over the phone. A score of ≥21 on the CISS-15, considered positive for CI-type symptomatology, served as the cutoff. Data from individuals (n=87 with, n=94 without PD) who were approached but who reported having a known oculovisual condition were analysed separately. Student's t test and chi-square at the 0.05 level were employed for statistical significance.

RESULTS

A total of 29.3% of participants with versus 7.3% without PD presented with a score of ≥21 on the CISS-15 (p=0.001). Of the participants having a known oculovisual condition, 39.1% with versus 19.1% without PD presented with a score of ≥21 on the CISS-15 (p=0.01).

CONCLUSIONS

The prevalence of CI-type visual symptoms is higher in individuals with versus without PD whether or not they have a coexisting oculovisual condition. These results suggest that PD per se places individuals with the disease at greater risk of visual symptomatology. These results further underline the importance of providing regular eye exams for individuals with PD.

Associations of Generalized Trust and Social Participation at the Individual Level with Unmet Healthcare Needs in Communities with High Mortality

BACKGROUND

The aim of this study was to investigate whether generalized trust and/or social participation at an individual level have negative associations with unmet healthcare needs.

METHODS

Door-to-door interviews were conducted by trained interviewers to collect information. The 8,800 study participants included 220 adults sampled systematically using the resident registration database from 40 sub-municipal-level administrative units in Korea. Unmet healthcare needs were measured subjectively by the following question: "During the past 12 months, was there ever a time when you felt that you needed healthcare (excluding dental care) but did not receive it?" The responses were classified as either "yes" or "no."

RESULTS

The adjusted odds ratios (ORs) for unmet healthcare needs based on one positive response, two positive responses, and three positive responses to the three items of generalized trust compared to no positive responses were 0.92 (95% confidence interval [CI], 0.77-1.09), 0.90 (95% CI, 0.74-1.09), and 0.73 (95% CI, 0.61-0.87), respectively. The adjusted ORs for unmet healthcare needs based on social participation only in informal organizations, only in formal organizations, and in both informal and formal organizations compared to no social participation were 0.83 (95% CI, 0.71-0.98), 0.97 (95% CI, 0.77-1.21), and 0.97 (95% CI, 0.82-1.15), respectively. The covariates included in the multiple logistic regression were sociodemographic variables (gender, age, marital status, educational level, occupation, food security, and administrative unit), self-rated health, and perceived stress.

CONCLUSION

Therefore, generalized trust and social participation in informal organizations can decrease the incidence of unmet healthcare needs.

Older Adults in Rural Appalachia: Preference and Expectations for Future Care

Little is known about how rural-dwelling older adults anticipate and plan for future care needs. Using a mixed-method explanatory design, structural equation modeling ( n = 535) revealed significant associations between concerns about using services on preference for type of help; preference was associated with likelihood of using future services. Content analysis of interview data from 19 older adults who needed but were not receiving help revealed how they conceptualize their need for assistance and anticipated future care arrangements. Nine older adults were not thinking about future care needs. While most older adults articulated preferences for informal help, they indicated some openness to formal assistance. Preferences did not always align with expectations for the future. Rather, concerns about burdening family and friends outweighed concerns about community services and influenced expectations of using formal services. Understanding rural older adults' expectations for future care arrangements is necessary for advancing policy and implementing successful services options.

Development of Clinical Vignettes to Describe Alzheimer's Disease Health States: A Qualitative Study

Aims

To develop clinical descriptions (vignettes) of life with Alzheimer’s disease (AD), we conducted focus groups of persons with AD (n = 14), family caregivers of persons with AD (n = 20), and clinicians who see persons with AD in their practices (n = 5).

Methods

Group participants read existing descriptions of AD and commented on the realism and comprehensibility of the descriptions. We used thematic framework analysis to code the comments into themes and develop three new vignettes to describe mild, moderate, and severe AD.

Results

Themes included the types of symptoms to mention in the new vignettes, plus the manner in which the vignettes should be written. Since the vignette descriptions were based on focus group participants’ first-hand knowledge of AD, the descriptions can be said to demonstrate content validity.

Conclusion

Members of the general public can read the vignettes and estimate their health-related quality-of-life (HRQoL) as if they had AD based on the vignette descriptions. This is especially important for economic evaluations of new AD medications, which require HRQoL to be assessed in a manner that persons with AD often find difficult to undertake. The vignettes will allow the general public to serve as a proxy and provide HRQoL estimates in place of persons with AD.

Participation needs of older adults having disabilities and receiving home care: met needs mainly concern daily activities, while unmet needs mostly involve social activities

BACKGROUND

Participation is a key determinant of successful aging and enables older adults to stay in their homes and be integrated into the community. Assessing participation needs involves identifying restrictions in the accomplishment of daily and social activities. Although meeting participation needs involves older adults, their caregivers and healthcare providers, little is known about their respective viewpoints. This study thus explored the participation needs of older adults having disabilities as perceived by the older adults themselves, their caregivers and healthcare providers.

METHODS

A qualitative multiple case study consisted of conducting 33 semi-structured interviews in eleven triads, each composed of an older adult, his/her caregiver and a healthcare provider recruited in a Health and Social Services Centre (HSSC) in Québec, Canada. Interview transcripts and reviews of clinical records were analyzed using content analysis and descriptive statistics based on thematic saliency analysis methods.

RESULTS

Aged 66 to 88 years, five older adults had physical disabilities, five had mild cognitive impairment and one had psychological problems, leading to moderate to severe functional decline. Caregivers and healthcare providers were mainly women, respectively retired spouses and various professionals with four to 32 years of clinical experience. Participation needs reported by each triad included all domains of participation. Needs related to daily activities, such as personal care, nutrition, and housing, were generally met. Regarding social activities, few needs were met by various resources in the community and were generally limited to personal responsibilities, including making decisions and managing budgets, and some community life activities, such as going shopping. Unmet needs were mainly related to social activities, involving leisure, other community life activities and interpersonal relationships, and some daily activities, including fitness and mobility.

CONCLUSIONS

This study highlights the complexity of older adults' participation needs, involving daily as well as social activities. Properly assessing and addressing these needs is thus necessary to improve older adults' health and well-being. Discrepancies in the various actors' perceptions of participation needs must be further explored. Additional research would help better understand how to optimize the contribution of community organizations and caregivers.

Undermet needs for assistance in personal activities of daily living among community-dwelling oldest old in China from 2005 to 2008

Based on the 2005 and 2008 Chinese Longitudinal Healthy Longevity Survey, this study examined the prevalence of undermet needs for assistance in personal activities of daily living (ADL) and its associated risk factors among the oldest old aged 80+. Multilevel multinomial logistic modeling was used to analyze the risk factors and changes of undermet needs over time. The results show that the prevalence of slightly undermet needs decreased in urban China from 2005 to 2008. However, the prevalence of undermet needs remained high; 50% or more for both rural and urban residents. Compared to 2005, the likelihood of having slightly undermet needs in 2008 significantly decreased by 28% among rural residents and 22% among urban residents. The common risk factors of undermet needs among rural and urban residents included financial dependence, living alone, having unwilling caregivers, more ADL disabilities, and having poor self-rated health.

Unmet need and psychological distress predict emergency department visits in community-dwelling elderly women: a prospective cohort study

Background

Unmet need to perform activities of daily living (ADL) is associated with increased use of urgent health services by the elderly. However, the reported associations may be confounded by psychological distress. We examine the independent effects of unmet need and psychological distress upon emergency department (ED) visits.

Methods

We conducted a prospective study of randomly selected community-dwelling adults aged ≥ 75. We report here the results for women only (n = 530). In-person interviews collected data on self-reported unmet need and the 14-item l'Indice de détresse psychologique de Santé Québec psychological distress scale. ED visits were identified from an administrative database. Multivariable logistic regression was used to identify predictors of any ED visit in the 6 months following the baseline interview.

Results

In multivariable analysis, unmet need in instrumental ADL was associated with subsequent ED visits (odds ratio = 1.57, 95% confidence interval = 1.02-2.41), as was psychological distress (odds rate = 1.30, 95% confidence interval = 1.02-1.67). The magnitude of the association between unmet need and ED visits was overestimated in statistical models that did not adjust for psychological distress.

Conclusions

Both unmet need and psychological distress were independent predictors of ED visits. Future investigations of unmet need and health services utilization should include psychological distress to control for confounding and improve the internal validity of statistical models.

Unmet Need for Assistance to Perform Activities of Daily Living and Psychological Distress in Community-Dwelling Elderly Women

De plus en plus, les aînés vivant dans les communautés ont besoin d’une assistance physique pour les activités de la vie quotidienne (AVQ). L’association de ce besoin, que ce soit atteint ou non satisfaits, avec la détresse psychologique est inconnue. Nous avons mené une étude prospective des cohortes sur des résidents vivant dans les communautés âgées de 75 ans et plus à Montreal, au Canada. Nous rapportons les résultats pour les femmes seulement (n = 530). On a utilisé une régression lineaire multivariable pour examiner l’association entre les besoins satisfaits et ceux qui restent insatisfaits dans les activités déterminantes de la vie quotidienne (ADVQ) et les activités personnelles de la vie quotidienne (APVQ) et la détresse psychologique concomitante. Alors que les besoins ADVQ non satisfaits ont été associés à une détresse psychologique élevée, [β = 0.19 (95% CI: 0.06, 0.33)], comme cela a été avec les besoins ADVQ satisfaits [β = 0.42 (95% CI: 0.26, 0.60)], les besoins APVQ satisfaits et non satisfaits ne l’étaient pas. Le modèle complet explique 32,8 pour cent de la variance totale de la détresse psychologique. Recevoir de l’aide pour répondre aux besoins ADVQ est associé à une détresse psychologique élevée. Ne pas recevoir d’aide, cependant, est associé à une détresse encore plus élevée.

Meeting the home-care needs of disabled older persons living in the community: does integrated services delivery make a difference?

BACKGROUND

The PRISMA Model is an innovative coordination-type integrated-service-delivery (ISD) network designed to manage and better match resources to the complex and evolving needs of elders. The goal of this study was to examine the impact of this ISD network on unmet needs among disabled older persons living in the community.

METHODS

Using data from the PRISMA study, we compared unmet needs of elders living in the community in areas with or without an ISD network. Disabilities and unmet needs were assessed with the Functional Autonomy Measurement System (SMAF). We used growth-curve analysis to examine changes in unmet needs over time and the variables associated with initial status and change. Sociodemographic characteristics, level of disability, self-perceived health status, cognitive functioning, level of empowerment, and the hours of care received were investigated as covariates. Lastly, we report the prevalence of needs and unmet needs for 29 activities in both areas at the end of the study.

RESULTS

On average, participants were 83 years old; 62% were women. They had a moderate level of disability and mild cognitive problems. On average, they received 2.07 hours/day (SD = 1.08) of disability-related care, mostly provided by family. The findings from growth-curve analysis suggest that elders living in the area where ISD was implemented and those with higher levels of disability experience better fulfillment of their needs over time. Besides the area, being a woman, living alone, having a higher level of disability, more cognitive impairments, and a lower level of empowerment were linked to initial unmet needs (r2 = 0.25; p < 0.001). At the end of the study, 35% (95% CI: 31% to 40%) of elders with needs living in the ISD area had at least one unmet need, compared to 67% (95% CI: 62% to 71%) in the other area. In general, unmet needs were highest for bathing, grooming, urinary incontinence, walking outside, seeing, hearing, preparing meals, and taking medications.

CONCLUSIONS

In spite of more than 30 years of home-care services in the province of Quebec, disabled older adults living in the community still have unmet needs. ISD networks such as the PRISMA Model, however, appear to offer an effective response to the long-term-care needs of the elderly.

Measuring health-related quality-of-life for Alzheimer's disease using the general public

PURPOSE

Little research exists to indicate whether the general public can provide proxy health-related quality-of-life (HRQoL) estimates for persons with Alzheimer's disease (AD). We investigated (1) whether the general public can differentiate between mild, moderate, and severe AD and (2) whether the general public's proxy HRQoL estimates are correlated with current health status.

METHODS

We conducted computer-assisted personal interviews. The computer randomly assigned each participant to read a vignette describing mild, moderate, or severe AD. Participants answered the EQ-5D-5L and Quality-of-life-Alzheimer's Disease (QoL-AD), while imagining living in the health state described in their assigned vignette. Participants also answered the EQ-5D-5L based on their health state at the time of the interview.

RESULTS

We interviewed 100 participants. EQ-5D-5L utilities were 0.7413 (mild), 0.6159 (moderate), and 0.4456 (severe) (P < 0.001). Mean QoL-AD scores were 32.5 (mild), 24.0 (moderate), and 21.8 (severe) (P < 0.0001 for severe vs. mild, moderate vs. mild; P > 0.05 for severe vs. moderate). Participants' EQ-5D-5L utility scores were weakly correlated (r ≤ 0.28) across both administrations of the instrument.

CONCLUSIONS

The general public can differentiate between the three stages of AD, and their HRQoL estimates for AD are weakly correlated with their current health status.

Telephone-administered cognitive tests as tools for the identification of eligible study participants for population-based research in aging

ABSTRACTAs part of its recruitment process, the Canadian Longitudinal Study on Aging (CLSA) will face the challenge of screening out individuals who are sufficiently impaired in their ability to provide informed consent. In the process of developing the design of the CLSA, a review of the literature was performed with the goal of identifying currently existing telephone cognitive screening tools that can be used to identify eligible study participants for population-based research on aging. We identified 12 telephone screening tools, four of which were based on the Mini-Mental State Exam (MMSE) and eight that were based on other face-to-face screening tools. Characteristics - including the constructs measured, the length of time for administration, the scoring/classification scheme, and any information regarding the validation of each tool - were extracted and summarized.

Frailty and its association with disability and comorbidity in a community-dwelling sample of seniors in Montreal: a cross-sectional study

BACKGROUND AND AIMS

The term frailty is used to describe older persons at high risk for adverse health outcomes. In 2001, Fried et al. proposed a now widely cited definition which suggests that frailty is a clinical entity related to, but distinct from, ADL disability and comorbidity. Frailty status was assessed based on the presence of any three of the following five characteristics: shrinking, weakness, poor endurance, slowness, and low activity. The objectives of the current study are to estimate the prevalence of frailty in a sample of community-dwelling older persons, to identify sociodemographic and health variables associated with frailty, and to examine the complex relationships between frailty and comorbidity, ADL disability and IADL disability.

METHODS

This study is based on cross-sectional analysis of 740 community-dwelling seniors from the Montreal Unmet Needs Study (MUNS). The five characteristics of frailty were operationalised using measures available in MUNS. The Cochran-Mantel-Haenszel test was used to identify variables associated with frailty. Overlaps between frailty, comorbidity and disability were assessed using proportions.

RESULTS

Overall, 7.4% were classified as frail, 49.7% prefrail and 42.8% non-frail. Frailty was associated with age, sex, income, education, number of chronic diseases, ADL disability, and IADL disability. Among those classified as frail, 29.1% had disabilities in ADLs, 92.7% in IADLs and 81.8% had comorbidity.

CONCLUSION

Findings on the relationship between frailty and sociodemographic variables, morbidity and disability, support previous studies, providing further evidence that although frailty seems to be a distinct geriatric concept, it also overlaps with other concepts.

A correspondence analysis revealed frailty deficits aggregate and are multidimensional

OBJECTIVE

To examine the relationships among seven frailty domains: nutrition, physical activity, mobility, strength, energy, cognition, and mood, using data from three studies.

STUDY DESIGN AND SETTING

Data from three studies were separately analyzed using multiple correspondence analysis (MCA). The graphical output of MCA was used to assess (1) if the presence of deficits in the frailty domains separate from the absence of deficits on the graph, (2) the dimensionality of the domains, (3) the clustering of domains within each dimension, and (4) their relationship with age, sex, and disability. Results were compared across the studies.

RESULTS

In two studies, presence of deficits for all domains separated from absence of deficits. In the third study, there was separation in all domains except cognition. Three main dimensions were retained in each study; however, assigned dimensionality of domains differed. The clustering of mobility with energy and/or strength was consistent across studies. Deficits were associated with older age, female sex, and disability.

CONCLUSION

Our results suggest that frailty is a multidimensional concept for which the relationships among domains differ according to the population characteristics. These domains, with the possible exception of cognition, appear to aggregate together and share a common underlying construct.

Predictors of nutritional risk in community-dwelling seniors

OBJECTIVES

At any age, good nutrition is important for maintaining good health. Seniors are at risk of declining nutritional status due to the physiological, psychological, economic and social changes that accompany aging. We investigated medical, psychological, social and environmental characteristics as both correlates and predictors of elevated nutritional risk in community-dwelling seniors.

METHODS

Data came from a prospective study of 839 seniors aged 75 and over, in Montreal. Face-to-face interviews were conducted at baseline and at 12 months. The validated Elderly Nutrition Screening (ENS) tool was administered and subjects were assigned a level of "nutritional risk" based on the risk for energy and nutritional intake deficiencies. Using risk factors identified in the literature, analyses were performed to characterize those factors associated with both the level of risk at baseline and a change in risk over 12 months.

RESULTS

At baseline, more than half (60%) of the participants were at elevated nutritional risk. Cross-sectional analyses supported the findings of previous research examining correlates of elevated nutritional risk. Longitudinal results showed that among those at low nutritional risk, only poor self-rated health was found to be a statistically significant predictor of elevated risk at 12 months (OR = 3.30, p < 0.05).

CONCLUSION

Proper nutrition can promote healthy aging by preventing disease and disability, improving health outcomes and maintaining autonomy, resulting in decreased health care utilization and costs. The findings of this research highlight the need for longitudinal studies in order to better understand and target nutritional risk in community-dwelling seniors.

Predictors of nutritional risk in community-dwelling seniors

OBJECTIVES

At any age, good nutrition is important for maintaining good health. Seniors are at risk of declining nutritional status due to the physiological, psychological, economic and social changes that accompany aging. We investigated medical, psychological, social and environmental characteristics as both correlates and predictors of elevated nutritional risk in community-dwelling seniors.

METHODS

Data came from a prospective study of 839 seniors aged 75 and over, in Montreal. Face-to-face interviews were conducted at baseline and at 12 months. The validated Elderly Nutrition Screening (ENS) tool was administered and subjects were assigned a level of "nutritional risk" based on the risk for energy and nutritional intake deficiencies. Using risk factors identified in the literature, analyses were performed to characterize those factors associated with both the level of risk at baseline and a change in risk over 12 months.

RESULTS

At baseline, more than half (60%) of the participants were at elevated nutritional risk. Cross-sectional analyses supported the findings of previous research examining correlates of elevated nutritional risk. Longitudinal results showed that among those at low nutritional risk, only poor self-rated health was found to be a statistically significant predictor of elevated risk at 12 months (OR = 3.30, p < 0.05).

CONCLUSION

Proper nutrition can promote healthy aging by preventing disease and disability, improving health outcomes and maintaining autonomy, resulting in decreased health care utilization and costs. The findings of this research highlight the need for longitudinal studies in order to better understand and target nutritional risk in community-dwelling seniors.