Disability in the Individual ADL, IADL, and Mobility among Older Adults: A Prospective Cohort Study

The Moderating Effect of Age on the Association Between Circadian Syndrome and Instrumental Activities of Daily Living Disability in People With Diabetes: A Cross-Sectional Study

PURPOSE

To examine the association between circadian syndrome (CircS) and instrumental activities of daily living (IADL) disability in middle-aged and older adults with diabetes, as well as the moderating effect of age on CircS and IADL disability.

METHOD

Participants included 939 individuals with diabetes. IADL disability was defined as having trouble finishing specific tasks. CircS was defined as having four or more specific symptoms. Binary logistic regression analysis was used to examine associations among CircS, age, and IADL disability.

RESULTS

Of total participants, 29.3% had IADL disability. CircS and age were associated with IADL disability (CircS: odds ratio [OR] = 1.898, 95% confidence interval [CI] [1.370, 2.630]; age: OR = 1.045, 95% CI [1.027, 1.063]; both p < 0.001). The interaction effect of age on CircS and IADL disability was significant (OR = 1.047, 95% CI [1.004, 1.092], p = 0.032).

CONCLUSION

Individuals with diabetes and CircS had a higher risk of IADL disability than those without CircS, and the difference in predicted probabilities of IADL disability between the two groups increased with age. [Journal of Gerontological Nursing, xx(xx), xx-xx.].

Social factors associated with everyday functioning in older Black adults

OBJECTIVE

Independence in everyday functioning has been associated with successful aging and declines in functioning may be indicative of pathological cognitive decline. Social determinants of health, like economic status and access to health care, a]lso play a role in everyday functioning. Understanding these factors are of particular importance for older Black adults who have had long-standing disparate access to care, education, and treatments. The current study aimed to evaluate social determinants of health, more specifically social engagement, as moderators of the association between cognition and everyday functioning.

METHOD

A sample of 930 older Black adults from Rush University: The Memory and Aging Project, African American Clinical Core, and Minority Adult Research Study were used. Participants completed a battery of neuropsychological testing as well as questionnaires about their everyday functioning and social behaviors. Hierarchical linear regressions were utilized to determine to what extent social factors moderated the relationship between cognition and everyday functioning.

RESULTS

Late life social activity reduced the effect of global cognition on everyday functioning and was independently associated with everyday functioning. Social network size was associated with increased impairment.

CONCLUSION

Results from the current study provide novel information regarding the role of social interaction on cognition in an older Black adult sample. Future interventions may benefit from an emphasis on increasing social engagement.

Association between frailty and subsequent disability trajectories among older adults: a growth curve longitudinal analysis from the Survey of Health, Ageing and Retirement in Europe (2004-19)

Frailty is associated with adverse health outcomes in ageing populations, yet its long-term effect on the development of disability is not well defined. The study examines to what extent frailty affects disability trajectories over 15 years in older adults aged 50+. Using seven waves of data from the Survey of Health, Ageing and Retirement in Europe (SHARE), the study estimates the effect of baseline frailty on subsequent disability trajectories by multilevel growth curve models. The sample included 94 360 individuals from 28 European countries. Baseline frailty was assessed at baseline, using the sex-specific SHARE-Frailty-Instrument (SHARE-FI), including weight loss, exhaustion, muscle weakness, slowness, and low physical activity. Disability outcomes were the sum score of limitations in activities of daily living (ADL) and Instrumental ADL (IADL). Analyses were stratified by sex. Over 15 years, baseline frailty score was positively associated with disability trajectories in men [βADL = 0.074, 95% confidence interval (CI) = 0.064; P = .083; βIADL = 0.094, 95% CI = 0.080; P = 0.107] and women (βADL = 0.097, 95% CI = 0.089; P = .105; βIADL = 0.108, 95% CI = 0.097; P = .118). Frail participants showed higher ADL and IADL disability levels, independent of baseline disability, compared with prefrail and robust participants across all age groups. Overall, participants displayed higher levels of IADL disability than ADL disability. Study findings indicate the importance of early frailty assessment using the SHARE-FI in individuals 50 and older as it provides valuable insight into future disability outcomes.

Improved functional status from people with disabilities discharged from day medical care homes from 2017-2023 in Poland

This study aimed to assess changes in the functional status of 956 patients with disabilities covered by day care in Day Medical Care Homes in Poland between 2017 and 2023. Medical records (admission reports and discharge reports) of patients admitted to seven Day Medical Care Homes managed by the Medical and Diagnostic Centre (Poland) were analyzed. The functional status of the patients was assessed using the Barthel Index and the Instrumental Activities of Daily Living (IADL) tool. Out of 956 patients, 77.4% were females, and the mean age was 74.4 (SD=8.6) years. The average Barthel Index score was 59.4 (SD=5.8; 40-65) on admission and 72.6 (SD=10.2; 25-100) on discharge (p<0.001). The average IADL score was 19.2 (SD=3.2; 8-24) on admission and 20.6 (SD=3.0; 8-24) on discharge (p<0.001). Significant improvement (p<0.001) in functional status defined with both the Barthel Index and IADL scale was observed in all demographic groups and facilities.

Provider Perspectives, Barriers, and Improvement Strategies for Hospital Discharge Support Programs: A Focus Group Interview Study in Korea

OBJECTIVES

Transitional periods, such as patient discharge, are notably challenging. This study aimed to explore the perceptions of providers involved in hospital discharge support programs, identify the primary obstacles, and propose strategies for improvement.

METHODS

In this qualitative cross-sectional study, we interviewed 49 healthcare professionals, comprising doctors, nurses, and social workers, who participated in two pilot programs. We organized focus group interviews with 3-6 participants per group, segmented by the type of discharge support program and profession. For data analysis, we employed phenomenological analysis, a qualitative method.

RESULTS

Participants recognized the importance of the discharge support program and anticipated its benefits. The Rehabilitation Hospital Discharge Patient Support program saw more active involvement from doctors than the Establishment of a Public Health-Medical Collaboration System program. Both programs highlighted the critical need for more staff and better compensation, as identified by the doctors. Nurses and social workers cited the heavy documentation burden, uncooperative attitudes from patients and local governments, and other issues. They also anticipated that program improvements could be achieved through the standardization of regional welfare services and better coordination by local governments serving as welfare service regulators. All groups-doctors, nurses, and social workers-underscored the significance of promoting these programs.

CONCLUSIONS

Discharge support programs are crucial for patients with functional impairments and severe illnesses, particularly in ensuring continuity of care. Policy support is essential for the successful implementation of these programs in Korea.

Timed instrumental activities of daily living tasks in adults with irreversible vision impairment: validation to visual function and self-report

BACKGROUND

Instrumental activities of daily living (IADL) are typically self-reported ability to perform complex tasks vital for independent living. There is a need for a complementary objective, performance-based approach especially in tracking outcomes in visual rehabilitation for patients with irreversible vision impairment ("low vision"). Our goals are: (1) To describe the validity of timed performance of instrumental activities of daily living (timed IADL or TIADL) tasks in individuals with irreversible vision impairment, by examining its association with visual function (visual acuity, contrast sensitivity, visual field), (2) To explore the correlation between TIADL and self-reported IADL.

METHODS

Twenty TIADL tasks were administered to 88 patients (median age 63.3 years, IQR 37.4-78.0) recruited from the UAB Department of Ophthalmology, Callahan Eye Hospital Clinics. An average Z-score incorporating time and accuracy of task completion was constructed. Minor accuracy errors were penalized 1 standard deviation from their calculated Z-score and major accuracy errors were assigned maximum allotted time. Linear regression was used to analyze the association between TIADL score and measured visual acuity (Early Treatment Diabetic Retinopathy Study, ETDRS chart), contrast sensitivity (Pelli-Robson), and binocular visual field (Esterman) with an unadjusted model and an adjusted model accounting for age, comorbidities, and depression scale (Center for Epidemiological Studies Depression, CES-D). Pearson correlation was used to estimate the correlation between TIADL and IADL.

RESULTS

Increased time to task completion was associated with decreased visual function. Each decreased line of ETDRS read was associated with an increase of 0.002 (95% CI 0.001, 0.002) Z-score (P < 0.01). A decreased ability to discern each Pelli-Robson letter was associated with an increase of 0.26 (95% CI 0.19, 0.33) Z-score (P < 0.01). For each less Esterman target identified, there was an increase of 0.01 (95% CI 0.003, 0.02) Z-score. Self-reported IADL and TIADL were correlated for reading tasks such as newspapers, nutrients on food can, and microwave timer (P < 0.05).

CONCLUSIONS

Longer time to perform TIADL is associated with decreased visual acuity, contrast sensitivity, and binocular visual field. TIADL and self-reported IADL are significantly correlated for reading tasks providing an accurate, complementary outcome measure in clinical practice and research.

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

BACKGROUND

Difficulties in activities of daily living (ADL) and instrumental activities of daily living (IADL) in older adults are associated with diminished quality of life and increased demand for long-term care. The present study examined the prevalence of disability among individuals aged 65 years and older in Austria, using data from the Austrian Health Interview Surveys (ATHIS).

METHODS

The ATHIS 2014 and 2019 surveys were used (N = 5853) for the analysis. Binary logistic regression was performed to measure the association between disability in at least one ADL or IADL limitation and independent variables adjusted for sociodemographic, health-related behavior and survey year.

RESULTS

The prevalence of ADL or IADL limitations increased in both sexes during the 5‑year follow-up period. For ADL limitations, the prevalence rose from 12.8% to 17.9% in men (p < 0.001) and from 19.2% to 25.7% in women (p < 0.001). The IADL limitations increased from 18.9% to 35.1% in men (p < 0.001) and from 38.2% to 50.8% in women (p < 0.001). Women reported significantly higher odds for ADL (odds ratio [OR]: 1.08, 95% confidence interval [CI]: 0.93-1.26) and IADL limitations (OR: 1.74, 95% CI: 1.53-1.98). In both sexes, participants aged 80 years and older reported higher odds for ADL (OR: 4.37, 95% CI:3.77-5.07) and IADL limitations (OR: 4.43, 95% CI: 3.86-5.09) compared to the younger group. Participants with at least one chronic disease reported higher odds for ADL (OR: 4.00, 95% CI: 3.41-4.70) and IADL limitations (OR: 4.37, 95% CI: 3.85-4.96). Primary education, single status, being born in non-EU/EFTA countries, and residing in Vienna were associated with higher odds of ADL and IADL limitations.

CONCLUSION

Gender, age, education, country of birth, residence, partnership status, number of chronic diseases, noncompliance with physical activity, and nutrition recommendations had a strong association with increased vulnerability to disability. Public health policy must address these factors for disability prevention strategies.

Adherence to Mediterranean, Dietary Approaches to Stop Hypertension and Healthy Eating Indices are associated with lower risk of disability among Puerto Rican adults from the longitudinal Boston Puerto Rican Health Study

BACKGROUND

Emerging evidence suggests that poor dietary quality is an important risk factor for disability. However, few studies have compared adherence to dietary patterns with disability and none among Puerto Rican adults.

OBJECTIVES

This study was designed to examine relationships between 3 dietary patterns-including Dietary Approaches to Stop Hypertension (DASH), Mediterranean dietary score (MeDS), and Healthy Eating Index (HEI)-2010-and ∼6-y incidence of activities of daily living (ADL) and instrumental activities of daily living (IADL) disability and to assess potential mediation by handgrip strength.

METHODS

Data are from the Boston Puerto Rican Health Study, a longitudinal cohort of Puerto Rican adults aged 45-75 y (N = 1502). Adherence to dietary pattern variables were derived from food frequency questionnaire (FFQ) data averaged at baseline and ∼2 y. Handgrip strength was assessed at baseline. Cox proportional hazards models were used to assess longitudinal associations between DASH, MeDS, and HEI-2010 and incident ∼6-y ADL (and subscales) and IADL disability. Mediation by handgrip strength was also tested.

RESULTS

Participants with higher adherence DASH had lower risk of ADL, ADL mobility, and ADL manual dexterity disabilities (hazards ratio [HR]: 0.96; 95% confidence interval [CI]: 0.91, 0.98; HR: 0.96; 95% CI: 0.92, 0.99; and HR: 0.95; 95% CI: 0.92, 0.98, respectively). Higher adherence to MeDS was associated with lower risk of ADL and ADL mobility disabilities (HR: 0.89; 95% CI: 0.81, 0.98; HR: 0.90; 95% CI: 0.82, 1.00), and higher adherence to HEI with lower risk of ADL manual dexterity (HR: 0.98; 95% CI: 0.97, 0.99) in fully adjusted models. Only DASH tended to be associated with IADL (HR: 0.97; 95% CI: 0.94, 1.00). Baseline handgrip strength was a mediator between HEI and ADL manual dexterity (23.7% of the indirect effect was explained through handgrip strength).

CONCLUSIONS

Higher adherence to a healthy diet pattern may decrease risk of disability and may be an important prevention strategy for ADL and IADL disability associated with aging.

Sex differences in physical functioning among older adults: cross-sectional results from the OUTDOOR ACTIVE study

BACKGROUND

Maintaining good functional ability is a key component of healthy ageing and a basic requirement for carrying out activities of daily living, staying independent, and delaying admission to a nursing home. Even though women have a higher life expectancy and slower age-related muscle mass loss than men, they often show a higher prevalence of limitations in physical functioning. However, the reasons behind these sex differences are still unclear. Therefore, the aims of this study were to investigate sex differences among older adults regarding physical functioning and to study which factors are explaining these sex differences.

METHODS

Cross-sectional data from participants of the OUTDOOR ACTIVE study residing in Bremen, Germany, aged 65 to 75 years, were included in the analyses. Physical functioning was assessed via a self-administered questionnaire using the SF-36 10-item Physical Functioning Scale. Social, lifestyle, and health-related factors were also assessed using the questionnaire. Physical activity was measured objectively using wrist-worn accelerometers over seven consecutive days. Descriptive analyses with absolute and relative frequencies, means and standard deviations, as well as T-tests and chi-square tests were carried out. To test for associations between sex, physical functioning, and several individual factors, linear regressions were performed.

RESULTS

Data of 2 141 participants (52.1% female) were included in the study. Women and men showed statistically significant differences in physical functioning, with men perceiving fewer limitations than women. On average, women had a physical functioning score of 81.4 ± 19.3 and men 86.7 ± 17.0. Linear regression showed a statistically significant negative association between physical functioning score and sex (β: -0.15, 95% CL: -0.19, -0.10). The association remained statistically significant when adding individual factors to the model. All factors together were only able to explain 51% of the physical functioning-sex association with health indicators and the presence of chronic diseases being the most influential factors.

CONCLUSIONS

We found sex differences in physical functioning, with older women having more limitations than older men. The results showed that health-related factors and chronic diseases played the biggest roles in the different physical functioning scores of women and men. These findings contribute to future longitudinal, more in-depth research.

TRIAL REGISTRATION

German Clinical Trials Register DRKS00015117 (Date of registration 17-07-2018).

A Longitudinal Study on the Relationship Between Family Size and Instrumental Activities of Daily Living: The Masking Effect of Depressive Symptoms

PURPOSE

According to use and disuse theory, the decreasing size of families in China may have a considerable influence on older adults' health. However, research on the associations among family size, depression, and instrumental activities of daily living (IADL) in this population is limited. Thus, the current study examined the role of depression on the impact of family size on IADL and explored the differences between urban and rural areas.

METHOD

Mediation analyses were performed with data from 7,290 older adults aged ≥60 years from the Harmonized China Health and Retirement Longitudinal Study in 2011, 2013, 2015, and 2018, using stepwise regression and bootstrap methods.

RESULTS

Family size had a positive impact on IADL limitations of older adults (0.29, p < 0.01), and the masking effects of depressive symptoms had a partial effect of family size on older adults' IADL. However, these effects only exist in rural areas.

CONCLUSION

Providing emotional support through psychological counseling and guiding caregivers to provide moderate care support is crucial, particularly in rural areas, for alleviating depressive symptoms due to changes in family size and maintaining independent living skills among older adults. [Research in Gerontological Nursing, 17(4), 165-175.].

The Effectiveness of Virtual Reality-Based Training on Cognitive, Social, and Physical Functioning in High-Functioning Older Adults (CoSoPhy FX): 2-Arm, Parallel-Group Randomized Controlled Trial

BACKGROUND

Virtual reality (VR) has emerged as a promising technology for enhancing the health care of older individuals, particularly in the domains of cognition, physical activity, and social engagement. However, existing VR products and services have limited availability and affordability; hence, there is a need for a scientifically validated and personalized VR service to be used by older adults in their homes, which can improve their overall physical, cognitive, and social well-being.

OBJECTIVE

The main purpose of the CoSoPhy FX (Cognitive, Social, and Physical Effects) study was to analyze the effects of a VR-based digital therapeutics app on the cognitive, social, and physical performance abilities of healthy (high-functioning) older adults. This paper presents the study protocol and the results from the recruitment phase.

METHODS

A group of 188 healthy older adults aged 65-85 years, recruited at the Medical University of Lodz, Poland, were randomly allocated to the experimental group (VR dual-task training program) or to the control group (using a VR headset app showing nature videos). A total of 3 cognitive exercises were performed in various 360° nature environments delivered via a VR head-mounted display; the participants listened to their preferred music genre. Each patient received 3 sessions of 12 minutes per week for 12 weeks, totaling a minimum of 36 sessions per participant. Attention and working memory (Central Nervous System Vital Signs computerized cognitive battery) were used as primary outcomes, while other cognitive domains in the Central Nervous System Vital Signs battery, quality of life (World Health Organization-5 Well-Being Index), health-related quality of life (EQ-5D-5L), and anxiety (General Anxiety Disorder 7-item questionnaire) were the secondary outcomes. The group-by-time interaction was determined using linear mixed models with participants' individual slopes.

RESULTS

In total, 122 (39%) of the initial 310 participants failed to meet the inclusion criteria, resulting in a recruitment rate of 61% (188/310). Among the participants, 68 successfully completed the intervention and 62 completed the control treatment. The data are currently being analyzed, and we plan to publish the results by the end of September 2024.

CONCLUSIONS

VR interventions have significant potential among healthy older individuals. VR can address various aspects of well-being by stimulating cognitive functions, promoting physical activity, and facilitating social interaction. However, challenges such as physical discomfort, technology acceptance, safety concerns, and cost must be considered when implementing them for older adults. Further research is needed to determine the long-term effects of VR-based interventions, optimal intervention designs, and the specific populations that would benefit most.

TRIAL REGISTRATION

ClinicalTrials.gov NCT05369897; https://clinicaltrials.gov/study/NCT05369897.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/53261.

Low grip strength and gait speed as markers of dependence regarding basic activities of daily living: the FIBRA study

OBJECTIVE

Marincolo et al. showed that older adults without limitations in basic activities of daily living at baseline presented with an 11.7% concomitant presence of functional dependence, slow gait speed, and low muscle strength at follow-up. Slow gait speed remains a predictor of dependence in basic activities of daily living. To determine whether low muscle strength and low gait speed increase the risk of disability related to basic activities of daily living in community-dwelling older adults.

METHODS

A longitudinal study (9 years of follow-up) was conducted with 390 older adults who were independent in basic activities of daily living at baseline and answered the Katz Index at follow-up. Associations were determined using Pearson's χ2 test with a 5% significance level and logistic regression analysis.

RESULTS

Increases in prevalence between baseline and follow-up were observed for low muscle strength (17.5%-38.2%), slow gait speed (26.0%-81.1%), and functional dependence (10.8%-26.6%). At follow-up, 11.7% of the participants had concomitant functional dependence, slow gait speed, and low muscle strength. Slow gait speed remained a predictor of dependence in basic activities of daily living (odds ratio=1.90; 95% confidence interval=1.06-3.41).

CONCLUSION

Slow gait speed is a predictor of functional dependence, constituting an important variable for screening functional decline.

Longitudinal Mediating Effect of Depression on the Relationship between Excessive Daytime Sleepiness and Activities of Daily Living in Parkinson's Disease

OBJECTIVES

Whether depression affects activities of daily living (ADLs) in patients with Parkinson's disease (PD) via excessive daytime sleepiness (EDS) remains unclear; moreover, few longitudinal studies have been conducted.

METHODS

We recruited 421 patients from the Parkinson's Progression Markers Initiative. We constructed a latent growth mediation model to explore the longitudinal mediating effect of depression on the relationship between EDS and ADLs.

RESULTS

EDS (p < .001) and depression scores (p < .001) both increased, and ADL scores (p < .001) decreased. Moreover, EDS was positively correlated with depression, whereas an increase in EDS significantly reduced ADLs. The initial value (95% confidence interval [CI]: 0.026, 0.154) and the rate of change (95% CI: 0.138, 0.514) of self-reported depression measured using the Geriatric Depression Scale(GDS) partially mediated the association between EDS and ADL score.

CONCLUSIONS

The indirect effect of the longitudinal changes of depression on the relationship between EDS and ADLs highlights the importance of depression changes in PD patients with EDS.

CLINICAL IMPLICATIONS

Depression should be considered a mediator by clinicians; preventing the worsening of depression is essential for improving ADLs in patients with PD, especially those with EDS.

Home-based supportive and health care services based on functional ability in older adults in Iran

BACKGROUND

Home-based care is affordable due to population aging, increased chronic disease, and higher hospitalization costs. The objective was to evaluate home-based supportive and health care services provided to older adults and identify possible associations between activities of daily living (ADLs), instrumental ADL (IADLs) classifications, sociodemographic variables, clinical characteristics, and perceived social support among older adults.

MATERIALS AND METHODS

In this cross-sectional study, 700 people aged 60 years and older were selected by stratified cluster sampling. Areas of Tabriz City were selected as clusters, and 55 comprehensive urban health centers were selected as stratifies. Chi-square, Pearson's and Spearman's tests, and multiple linear regression were used for statistical analyses. Statistical analysis was performed using the Statistical Package for Social Sciences (SPSS 24.0, SPSS Inc., Chicago, USA). The study instrument included demographic characteristics of older adults and caregivers, health services provided at home, and two valid questionnaires, including the KATZ index of independence in (instrumental) activities of daily living and a multidimensional scale of perceived social support. Scores on scales and demographic variables were collected during telephone interviews. The study lasted from April 25, 2022, to October 30, 2022.

RESULTS

A high level of perceived social support was 56.6%. The study found that 51.3% of participants had family caregivers. Most participants had ADL independence (85.4%), while 22.9% and 24.3% were dependent and needed assistance with IADL, respectively. Women had a lower ADL score and a higher IADL score than men (P < 0.05). The obtained results of multiple regression analysis revealed a negative and significant association between unemployment, illiteracy, increasing age, five and more medications, and ADL and IADL dependency (P < 0.05).

CONCLUSION

Empowering older adults to reduce dependency, and designing a formal home-based care system is recommended.

Physical performance and negative events in very old adults: a longitudinal study examining the ilSIRENTE cohort

BACKGROUND

Declining physical performance in old age is associated with a wide range of negative health-related outcomes. However, it is unclear which physical capabilities should be prioritized to obtain prognostic information in older adults.

AIMS

To examine the associations between the performance on several physical function tests and falls, disability, and death in a well-characterized sample of very old Italian adults.

METHODS

This was a prospective cohort study of older adults who lived in the mountain community of the Sirente geographic area in Central Italy. Physical performance was assessed using isometric handgrip strength (IHG), walking speed (WS) at a usual and fast pace, 5-time sit-to-stand test (5STS), and sit-to-stand power measures. Appendicular skeletal muscle mass was estimated from calf circumference using a validated equation. History of falls, incident falls, and disability status according to basic Activities of Daily Living (ADLs) were recorded over two years. Survival status was obtained from the participants' general practitioners and was confirmed by the National Death Registry over 10 years from enrolment. Linear, binary, and Cox regressions were performed to evaluate the association between physical performance measures and health outcomes.

RESULTS

The mean age of the 255 participants was 84.2 ± 5.1 years, and 161 (63.1%) were women. Logistic regression indicated that IHG was significantly associated with incident ADL disability, whereas specific sit-to-stand muscle power was an independent predictor of death. No significant associations were observed between physical function and falls.

CONCLUSIONS

Our findings indicate selective associations between physical function tests and the occurrence of negative events in very old adults, with poor IHG predicting disability and specific sit-to-stand muscle power being longitudinally associated with death.

Prevalence of functional dependence and chronic diseases in the community-dwelling Brazilian older adults: an analysis by dependence severity and multimorbidity pattern

BACKGROUND

Despite the advancements in knowledge about health care for older adults, essential gaps persist regarding the effects of chronic diseases as epidemiological markers of the state of functional dependence. This study aimed to identify the prevalence of moderate and severe functional dependence in Brazilian older adults and its association with chronic diseases and verify the multimorbidity patterns by dependence status.

METHODS

This cross-sectional analytical study used data from 11,177 community-dwelling Brazilian older adults from the 2013 National Health Survey conducted in Brazil. The dependent variables were moderate and severe functional dependence in basic activities of daily living (BADLs) and instrumental ADLs (IADLs). The independent variables were defined based on the questions applied to measure each morbidity in a self-reported manner and asked, "Has a doctor ever diagnosed you as having (each disease)? Multimorbidity was simultaneously considered present for older adults with ≥ 2 chronic morbidities. The association between functional dependence on BADLs and IADLs separately by severity and the independent variables was verified from crude and adjusted estimates of the point prevalence ratios and their 95% confidence intervals using the regression model Poisson with robust variance. To group diseases into patterns, exploratory factor analysis was used.

RESULTS

The prevalences of moderate and severe BADL dependence were 10.2% (95% CI, 9.6-10.7) and 4.8% (95% CI, 4.4-5.2), respectively. Moderate and severe IADL dependence prevalences were 13.8% (95% CI, 13.1-14.4) and 15.6% (95% CI, 14.9%-16.2), respectively. When changing the condition from moderate to severe dependence in BADLs, in the presence of other mental illnesses and stroke, the probability of dependence increased more than four times in the case of other mental illnesses and more than five times for stroke. There was a linear trend for dependence severity, both moderate and severe, whereas, for severe dependence on IADLs, this same factor maintained a linear trend toward an increase in probability as the number of diseases simultaneously increased.

CONCLUSIONS

Chronic diseases are associated with functional dependence, with greater emphasis on mental illnesses and stroke in severe disability, considering their acute adverse effects.

Relationship Between Distressing Symptoms and Changes in Disability After Major Surgery Among Community-living Older Persons

OBJECTIVES

To evaluate the relationship between distressing symptoms and changes in disability after major surgery and to determine whether this relationship differs according to the timing of surgery (nonelective vs elective), sex, multimorbidity, and socioeconomic disadvantage.

BACKGROUND

Major surgery is a common and serious health event that has pronounced deleterious effects on both distressing symptoms and functional outcomes in older persons.

METHODS

From a cohort of 754 community-living persons, aged 70 or older, 392 admissions for major surgery were identified from 283 participants who were discharged from the hospital. The occurrence of 15 distressing symptoms and disability in 13 activities were assessed monthly for up to 6 months after major surgery.

RESULTS

Over the 6-month follow-up period, each unit increase in the number of distressing symptoms was associated with a 6.4% increase in the number of disabilities [adjusted rate ratio (RR): 1.064; 95% CI: 1.053, 1.074]. The corresponding increases were 4.0% (adjusted RR: 1.040; 95% CI: 1.030, 1.050) and 8.3% (adjusted RR: 1.083; 95% CI: 1.066, 1.101) for nonelective and elective surgeries. Based on exposure to multiple (ie, 2 or more) distressing symptoms, the adjusted RRs (95% CI) were 1.43 (1.35, 1.50), 1.24 (1.17, 1.31), and 1.61 (1.48, 1.75) for all, nonelective, and elective surgeries. Statistically significant associations were observed for each of the other subgroups with the exception of individual-level socioeconomic disadvantage for the number of distressing symptoms.

CONCLUSIONS

Distressing symptoms are independently associated with worsening disability, providing a potential target for improving functional outcomes after major surgery.

Disability risk prediction model based on machine learning among Chinese healthy older adults: results from the China Health and Retirement Longitudinal Study

Background

Predicting disability risk in healthy older adults in China is essential for timely preventive interventions, improving their quality of life, and providing scientific evidence for disability prevention. Therefore, developing a machine learning model capable of evaluating disability risk based on longitudinal research data is crucial.

Methods

We conducted a prospective cohort study of 2,175 older adults enrolled in the China Health and Retirement Longitudinal Study (CHARLS) between 2015 and 2018 to develop and validate this prediction model. Several machine learning algorithms (logistic regression, k-nearest neighbors, naive Bayes, multilayer perceptron, random forest, and XGBoost) were used to assess the 3-year risk of developing disability. The optimal cutoff points and adjustment parameters are explored in the training set, the prediction accuracy of the models is compared in the testing set, and the best-performing models are further interpreted.

Results

During a 3-year follow-up period, a total of 505 (23.22%) healthy older adult individuals developed disabilities. Among the 43 features examined, the LASSO regression identified 11 features as significant for model establishment. When comparing six different machine learning models on the testing set, the XGBoost model demonstrated the best performance across various evaluation metrics, including the highest area under the ROC curve (0.803), accuracy (0.757), sensitivity (0.790), and F1 score (0.789), while its specificity was 0.712. The decision curve analysis (DCA) indicated showed that XGBoost had the highest net benefit in most of the threshold ranges. Based on the importance of features determined by SHAP (model interpretation method), the top five important features were identified as right-hand grip strength, depressive symptoms, marital status, respiratory function, and age. Moreover, the SHAP summary plot was used to illustrate the positive or negative effects attributed to the features influenced by XGBoost. The SHAP dependence plot explained how individual features affected the output of the predictive model.

Conclusion

Machine learning-based prediction models can accurately evaluate the likelihood of disability in healthy older adults over a period of 3 years. A combination of XGBoost and SHAP can provide clear explanations for personalized risk prediction and offer a more intuitive understanding of the effect of key features in the model.

Evaluation and intention to use the interactive robotic kitchen system AuRorA in older adults

BACKGROUND

The number of older adults in need of care and living at home is increasing in Europe. At the same time, the number of professional caregivers is decreasing. This development reinforces the need for assistive technology to support care recipients in their own homes and promote their independence. One of the main challenges of independent living is the preparation of food. Interactive robots could assist older adults with difficulties performing physically demanding tasks. Within the project AuRorA (full German project title: Wiederverwendbare, interaktive Verhalten für proaktive Roboter im Smart Home), an interactive voice-controlled robot arm was developed as an assistance system in the kitchen.

OBJECTIVE

The aim of the study was to assess how older adults evaluate the AuRorA system and to collect data on actual willingness to use the technology. Older adults were asked to evaluate the system in terms of usefulness, usability, accessibility and intention to use.

MATERIAL AND METHODS

Due to the ongoing coronavirus disease 2019 (COVID-19) pandemic, the older adults evaluated the system via an online survey. The validated questionnaire Technology Usage Inventory (short: TUI) was used in conjunction with self-developed questionnaires to collect data on study population characteristics.

RESULTS

A total of 106 participants were included in the analysis. The acceptance, usability and usefulness of the system were rated as medium, while the intention to use was rated as low. A significant strong correlation was found between the TUI subscales intention to use and usefulness.

CONCLUSION

It can be assumed that the actual need of the individual participant for such a robotic assistive system had an influence on the evaluation of the system. The perceived usefulness may have been a crucial influence on the intention to use and the overall assessment of the system.

Distressing symptoms after major surgery among community-living older persons

BACKGROUND

Relatively little is known about how distressing symptoms change among older persons in the setting of major surgery. Our objective was to evaluate changes in distressing symptoms after major surgery and determine whether these changes differ according to the timing of surgery (nonelective vs. elective), sex, multimorbidity, and socioeconomic disadvantage.

METHODS

From a prospective longitudinal study of 754 nondisabled community-living persons, 70 years of age or older, 368 admissions for major surgery were identified from 274 participants who were discharged from the hospital from March 1998 to December 2017. The occurrence of 15 distressing symptoms was ascertained in the month before and 6 months after major surgery. Multimorbidity was defined as more than two chronic conditions. Socioeconomic disadvantage was assessed at the individual level, based on Medicaid eligibility, and neighborhood level, based on an area deprivation index (ADI) score above the 80th state percentile.

RESULTS

In the month before major surgery, the occurrence and mean number of distressing symptoms were 19.6% and 0.75, respectively. In multivariable analyses, the rate ratios, denoting proportional increases in the 6 months after major surgery relative to presurgery values, were 2.56 (95% confidence interval [CI], 1.91-3.44) and 2.90 (95% CI, 2.01-4.18) for the occurrence and number of distressing symptoms, respectively. The corresponding values were 3.54 (95% CI, 2.06-6.08) and 4.51 for nonelective surgery (95% CI, 2.32-8.76) and 2.12 (95% CI, 1.53-2.92) and 2.20 (95% CI, 1.48-3.29) for elective surgery; p-values for interaction were 0.030 and 0.009. None of the other subgroup differences were statistically significant, although men had a greater proportional increase in the occurrence and number of distressing symptoms than women.

CONCLUSIONS

Among community-living older persons, the burden of distressing symptoms increases substantially after major surgery, especially in those having nonelective procedures. Reducing symptom burden has the potential to improve quality of life and enhance functional outcomes after major surgery.

Prevalence and determinants of self-reported functional status among older adults residing in the largest refugee camp of the world

BACKGROUND

The older adults of refugee camps might be vulnerable to exhibiting limited functional abilities because of the limited resources available to create a supportive environment for older population in the camps. This study aims to explore the prevalence and determinants of self-reported functional status among the older adults residing in the Rohingya refugee camp in Bangladesh.

METHODS

This cross-sectional study was conducted on 864 older adults aged 60 years and above living in five selected sub-camps of Rohingya refugee camp in Cox's Bazar, Bangladesh. Data were collected through face-to-face interviews of the participants between November-December 2021. Functional status was measured using the Barthel Index. Information on participants' sociodemographic characteristics, self-reported chronic diseases and lifestyle characteristics were also collected. A multiple logistic regression model was used to assess the factors associated with self-reported functional abilities among the participants.

RESULTS

The overall percentage of people having limited self-reported functional ability was 26.5% (male: 22.6% and female: 31.5%) with inability most found in grooming (33.2%), bathing (31.8%), stair using (13.2%) and mobility (10.7%). In the final adjusted model, having age of 80 years or more (aOR = 2.01,95% CI: 1.08,3.75), being female (aOR = 1.44, 95% CI: 1.04,2.0), having low memory or concentration (aOR = 1.83, 95% CI: 1.30,2.56), loneliness (aOR = 2.89, 95% CI:1.74,4.80) and living with aid alone (aOR = 2.89, 95% CI: 1.74,4.80) were found to be associated with self-reported limited functional ability.

CONCLUSION

The findings of this study highlight the need for attention from policymakers and public health practitioners on addressing functional limitations among older adults residing in the Rohingya refugee camp. Our findings emphasize the need for the development of comprehensive interventions that can address the wider unmet needs (e.g., ensuring family/caregiver support, engaging in social and physical activities, providing nutritional support packages, etc.) to improve the health and well-being of older Rohingya adults.

The mediating effect of leisure activities in the relationship between depression and cognitive decline in middle age and older adults in Taiwan

BACKGROUND

Depression can affect the development of cognitive functions, and there are many people with depressive symptoms and cognitive decline in the aging population. The role of mediators between depressive symptoms and the subsequent cognitive decline remains unclear. We aimed to investigate whether depressive symptoms can slow down cognitive decline through a mediator.

METHODS

A total of 3,135 samples were collected in 2003, 2007, and 2011. This study used the CES-D10 and SPMSQ (Short Portable Mental State Questionnaire) to measure depression and cognitive functions. The effect of depression trajectory on the subsequent cognitive dysfunction was analyzed using multivariable logistic regression, and the mediating effect was analyzed using the Sobel test.

RESULTS

The results of the multivariable linear regression analysis showed that after including different variables in each model, such as leisure activities and mobility in 2003 and 2007, women had a higher percentage of depressive symptoms in each model, compared to men. The effect of depression in 2003 on cognitive decline in 2011 was mediated by intellectual leisure activities in 2007 in men (Z=-2.01) and physical activity limitation in 2007 in women (Z=-3.02).

CONCLUSIONS

The mediation effect of this study shows that people with depressive symptoms will reduce their participation in leisure activities, which will lead to the degeneration of cognitive function. We suggest that if depressive symptoms are addressed as early as possible, people will have the ability and motivation to delay the decline of cognitive function through participation in leisure activities.

Investigating the Link Between IADL and Depressive Symptoms in Older Adults: A Cross-Sectional Serial Mediation Model

OBJECTIVES

There is a dearth of research on the psychological processes that underlie the negative relation between impaired instrumental activities of daily living (IADL) and depressive symptoms in older adults. Drawing on the stress process model and the resilience framework, we investigated whether purpose in life and resilience serially mediate the relationship between impaired IADL and depressive symptoms.

METHODS

We recruited 111 cognitively healthy community-dwelling older adults (ages 54-85; M = 66.5) who scored a minimum of 25 points on the Mini-Mental State Examination.

RESULTS

We found that purpose in life and resilience serially mediated the relationship between IADL and depressive symptomatology in older adults. This association held true when we controlled for covariates. Additional sensitivity analyses also supported these findings.

CONCLUSIONS

This study extends our understanding of how IADL limitations contribute to depressive symptoms. Using a community-dwelling, cognitively healthy sample, we demonstrate that functional limitations indirectly influence older adults' depressive symptoms through a decreased sense of purpose in life and decreased resilience.

CLINICAL IMPLICATIONS

Our findings have implications for intervention programs that aim to alleviate IADL limitations and mental health issues in an aging population and promote healthy aging by improving psychosocial resources (i.e., purpose in life and resilience).

Patterns of change and factors associated with IADL function decline in community-dwelling older adults with arthritis

Arthritis is a major cause of functional decline, which affects the quality of life (QoL) of older adults. This study analyzed instrumental activities of daily living (IADL) patterns in older adults with arthritis and the risk factors of functional decline. Data from the Korean Longitudinal Study of Aging (KLoSA), in which the participants were community-dwelling older adults aged ≥ 65 years and conducted every two years, were used to examine patterns in IADL performance between 2006 and 2016. The participants comprised 1,822 older adults, divided into an arthritis group and a non-arthritis group. A Generalized Estimating Equations (GEE) model and Kaplan–Meier analysis was used for the data analysis. The arthritis groups showed a statistically significant decrease in IADL function in 2012 (β = 1.283, p = 0.026), 2014 (β = 1.323, p = 0.028), and 2016 (β = 1.484, p = 0.014). The GEE model identified psychological conditions (depressive symptoms, cognitive function) and number of chronic diseases in the arthritis group as risk factors for increased IADL dependence. Healthcare providers should develop strategies to manage long-term functional decline, including programs to manage and prevent chronic diseases, cognitive function decline, and keep depressive symptoms under control, beginning within six years of arthritis diagnosis.

Association between multimorbidity trajectories and incident disability among mid to older age adults: China Health and Retirement Longitudinal Study

BACKGROUND

Although multimorbidity is a risk factor for disability, the relationship between the accumulative patterns of multimorbidity and disability remains poorly understood. The objective of this study was to identify the latent groups of multimorbidity trajectories among mid to older age adults and to examine their associations with incident disability.

METHODS

We included 5,548 participants aged ≥ 45 years who participated in the China Health and Retirement Longitudinal Study from 2011 to 2018 and had no multimorbidity (≥ 2 chronic conditions) at baseline. The group-based multi-trajectory modeling was used to identify distinct trajectory groups of multimorbidity based on the latent dimensions underlying 13 chronic conditions. The association between multimorbidity trajectories and incident disability was analyzed using the generalized estimating equation model adjusting for potential confounders.

RESULTS

Of the 5,548 participants included in the current analysis, 2,407 (43.39%) developed multimorbidity during the follow-up. Among participants with new-onset multimorbidity, four trajectory groups were identified according to the combination of newly diagnosed diseases: "Cardiometabolic" (N = 821, 34.11%), "Digestive-arthritic" (N = 753, 31.28%), "Cardiometabolic/Brain" (N = 618, 25.68%), and "Respiratory" (N = 215, 8.93%). Compared to participants who did not develop multimorbidity, the risk of incident disability was most significantly increased in the "Cardiometabolic/Brain" trajectory group (OR = 2.05, 95% CI: 1.55-2.70), followed by the "Cardiometabolic" (OR = 1.96, 95% CI: 1.52 -2.53) and "Digestive-arthritic" (OR = 1.70, 95% CI: 1.31-2.20) trajectory groups.

CONCLUSIONS

The growing burden of multimorbidity, especially the comorbid of cardiometabolic and brain diseases, may be associated with a significantly increased risk of disability for mid to older age adults. These findings improve our understanding of multimorbidity patterns that affect the independence of living and inform the development of strategies for the primary prevention of disability.

[Longitudinal association between social capital and functional disability in a cohort of community dwelling older adults]

This study aimed to investigate the association between social capital and functional disability, based on a longitudinal perspective, using data from the cohort of older adults from Bambuí, Minas Gerais State, Brazil. The baseline of this study was composed of all surviving and disability-free - up until the seventh year of follow-up (2004) - older adults who were followed up until 2011. The outcome variable was functional disability for basic activities of daily living (ADL) and instrumental activities of daily living (IADL), separately analyzed. Social capital was the exposure of interest, measured through its cognitive (cohesion and social support) and structural (social participation and satisfaction with the neighborhood) components. Sociodemographic variables, health conditions, and lifestyle habits were used for adjustment purposes, and the occurrence of death was considered a competitive event. The hypothesis of association between social capital and functional disability was tested using the competing risk model, which provides hazard ratios (HR) and a 95% confidence interval (95%CI). After multivariate analysis, social capital - in its structural component - was associated with functional disability. Older adults who were dissatisfied with the neighborhood had a higher risk of developing functional disability for IADL (HR = 2.36; 95%CI: 1.31-4.24), in relation to their counterparts. This study results suggest that functional disability is associated with aspects other than health, evidencing the need for the development of policies and interventions that support aspects related to the physical and social environment in which older adults live.

Environmental barriers matter from the early stages of functional decline among older adults in France

Background

The adaptation of living environments can preserve functional independence among older people. A few studies have suggested that this would only benefit the most impaired. But conceptual models theorize that environmental pressure gradually increases with functional decline.

Objectives

We examined (1) how far different environmental barriers increased difficulties and favoured resort to assistance; (2) at what stage in functional decline environmental barriers begin to matter.

Methods

We used the French cross-sectional survey CARE (2015), including 7,451 participants (60+) with at least one severe functional limitation (FL). Multinomial logistic regressions models were used to compare predicted probabilities for outdoor activities of daily living (OADL) difficulties (no OADL difficulties; difficulties but without assistance; use of assistance) among individuals with and without environmental barriers (self-reported or objective), in relation to the number of FLs.

Results

Poor-quality pedestrian areas and lack of places to rest were associated with a higher probability of experiencing OADL difficulties, whatever the number of FLs; the association increased with the number of FLs. Up to 6 FLs, individuals with these barriers were more likely to report difficulties without resorting to assistance, with a decreasing association. Living in cities/towns with high diversity of food outlets was associated with a lower probability of reporting assistance, whatever the number of FLs, but with a decreasing association.

Discussion

Overall, the results suggest that environmental barriers increasingly contribute to OADL difficulties with the number of FLs. Conclusions differed as to whether they tended to favour resort to assistance, but there was a clear association with food outlets, which decreased with impairment severity. The adaptation of living environments could reduce difficulties in performing activities from the early stages of decline to the most severe impairment. However, the most deteriorated functional impairments seem to generate resort to assistance whatever the quality of the environment.

Sex Differences in Vitamin D Status as a Risk Factor for Incidence of Disability in Instrumental Activities of Daily Living: Evidence from the ELSA Cohort Study

Vitamin D deficiency compromises elements underlying the disability process; however, there is no evidence demonstrating the association between vitamin D deficiency and the incidence of disability in instrumental activities of daily living (IADL). We investigated the association between vitamin D deficiency and the risk of incidence of IADL disability separately in men and women. A total of 4768 individuals aged ≥50 years from the English Longitudinal Study of Aging (ELSA) and without IADL disability according to the Lawton scale were available. Vitamin D was evaluated at baseline by serum 25(OH)D concentrations and classified as sufficient (>50 nmol/L), insufficient (>30 to ≤50 nmol/L) or deficient serum (≤30 nmol/L). IADL were reassessed after 4 years. Poisson models stratified by sex and controlled by covariates demonstrated that deficient serum 25(OH)D was a risk factor for the incidence of IADL disability in men (IRR: 1.43; 95% CI 1.02, 2.00), but not in women (IRR: 1.23; 95% CI 0.94, 1.62). Men appear to be more susceptible to the effect of vitamin D deficiency on the incidence of IADL disability, demonstrating the importance of early clinical investigation of serum 25(OH)D concentrations to prevent the onset of disability.

Novel subgroups of functional ability in older adults and their associations with adverse outcomes

Background

There is no general agreement on a standard form of functional classification in older adults and is mainly assessed by Activities of Daily Living (ADL) and/or Instrument Activity of Daily Living. A refined classification based on evaluation the limitations of intrinsic capacity, environment and social interaction, could provide a basis to predict the future disability and identify individuals with increased risk of adverse outcomes.

Methods

A new functional classification among older adults aged 60 and over was conducted by latent class analysis and compared with the traditional classifications, based on the China Health and Retirement Longitudinal Study. To further investigate the scientific validity of this new classification, associations with 7-year mortality and ADLs impairments among categories were tested by using Survival curves and Cox proportional hazard models. This was followed by the confirmatory analysis related to the prospective data. Competing risk analysis was also performed to analysis the sensitivity to further support our conclusions.

Results

Five categories were identified among 5,992 older adults which gave the best fitting, yielding a significant Bootstrap Likelihood Ratio Test (p < 0.001) and Lo-Mendell-Rubin adjusted likelihood ratio test (p < 0.001), with an entropy over 0.80. The presence of five categories: “health” (34.0%), “sub-disorder status” (36.6%), “acute diseases” (10.3%), “somatic functional disorder” (7.7%), and “viability disorder” (11.4%), which matched well with the functional independence rates by the international classifications. Among them, those in “sub-disorder status” were considered as an intermediate status between disability and health. The findings also revealed that those who were in “acute disease”, “somatic functional disorders”, “health” and “sub-disorder status” had a significant lower risk of mortality and ADLs limitations than “viability disorder”. And the risks gradually increased towards the less functionally independent end of the classification. However, the distribution of characteristics among five categories were in a synchronous change, indicating a stable classification.

Conclusions

A new classification representing the functional heterogeneity of older adults could effectively stratify the risk of mortality and ADLs limitations. Identifying the clusters of functional decline might be useful in predicting subsequent ageing trends, designing personalized intervention, and delaying the progression of disability and preventing its occurrence.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12877-022-03081-9.

Multivariate decomposition analysis of sex differences in functional difficulty among older adults based on Longitudinal Ageing Study in India, 2017-2018

OBJECTIVES

This study investigates the gender disparities in difficulty in activities of daily living (ADL) and instrumental activities of daily living (IADL) and explores its contributing factors among older adults in India.

DESIGN

A cross-sectional study was conducted using country representative survey data.

SETTING AND PARTICIPANTS

The present study uses the data from the Longitudinal Ageing Study in India, 2017-2018. Participants included 15 098 male and 16 366 female older adults aged 60 years and above in India.

PRIMARY AND SECONDARY OUTCOME MEASURES

Difficulty in ADL and IADL were the outcome variables. Descriptive statistics and bivariate analysis were carried out to present the preliminary results. Multivariate decomposition analysis was used to identify the contributions of covariates that explain the group differences to average predictions.

RESULTS

There was a significant gender differential in difficulty in ADL (difference: 4.6%; p value<0.001) and IADL (difference: 17.3%; p value<0.001). The multivariate analysis also shows significant gender inequality in difficulty in ADL (coefficient: 0.046; p value<0.001) and IADL (coefficient: 0.051; p value<0.001). The majority of the gender gap in difficulty in ADL was accounted by the male-female difference in levels of work status (18%), formal education (15% contribution), marital status (13%), physical activity (9%), health status (8%) and chronic morbidity prevalence (5%), respectively. Equivalently, the major contributors to the gender gap in difficulty in IADL were the level of formal education (28% contribution), marital status (10%), alcohol consumption (9%), health status (4% contribution) and chronic morbidity prevalence (2% contribution).

CONCLUSION

Due to the rapidly increasing ageing population, early detection and prevention of disability or preservation of daily functioning for older adults and women in particular should be the highest priority for physicians and health decision-makers.

Novel physical performance-based models for activities of daily living disability prediction among Chinese older community population: a nationally representative survey in China

Background

Physical performances including upper and lower limb functions have predictive roles in activities of daily living (ADL) disability, but they have rarely been incorporated into prediction models. This study primarily aimed to develop and validate novel physical performance-based models for ADL disability among Chinese older adults. Comparisons of predictive performance across multiple models were performed, and model simplification was further explored.

Methods

Data were obtained from the China Health and Retirement Longitudinal Study in the 2011 and 2015 waves, containing 2192 older adults over 60 years old. Our models were constructed by logistic regression analysis, using a backward stepwise selection. Model performance was internally validated by discrimination, calibration, and clinical utility. Integrated Discrimination Improvement (IDI) and Net Reclassification Improvement (NRI) were used to assess the incremental benefit of the extended models. Moreover, nomograms were built for visualization.

Results

We selected gender, age, smoking, self-report health condition, BMI, depressive symptoms, and cognitive function into the fundamental model (Model 1). Based on Model 1, five novel prediction models were constructed by adding handgrip strength (Model 2), Short Physical Performance Battery (SPPB) (Model 3), gait speed (Model 4), handgrip strength plus SPPB (Model 5), and handgrip strength plus gait speed (Model 6), respectively. Significant improvement in predictive values were observed for all five novel models compared with Model 1 (C-index = 0.693). The lower limb model (Model 3 SPPB model: C-index = 0.731) may play a key role in the prediction of ADL disability, reflecting a comparable predictive value to the comprehensive models combining both upper and lower limbs (Model 5 handgrip strength + SPPB model: C-index = 0.732). When we simplified the lower limb models by replacing SPPB with gait speed, the predictive values attenuated slightly (C-index: Model 3 vs Model 4: 0.731 vs 0.714; Model 5 vs Model 6: 0.732 vs 0.718), but still better than the upper limb model (Model 2 handgrip strength model: C-index = 0.701).

Conclusions

Physical performance-based models, especially lower limb model, provided improved prediction for ADL disability among Chinese older adults, which may help guide the targeted intervention.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12877-022-02905-y.

Longitudinal effects of physical exercise on health-related outcomes based on frailty status in community-dwelling older adults

AIM

To clarify the difference in the longitudinal effects of physical exercise on health-related outcomes according to the baseline frailty status (frail or non-frail) in community-dwelling older adults.

METHODS

Participants included 177 adults aged ≥65 years who carried out multicomponent physical exercises (strength, aerobic, gait and balance) for 40 min, one to three times per week, for 1 year at a day-care center. Bodyweight, comfortable walking speed, 6-min walking distance and Mini-Mental State Examination were measured at baseline and every 3 months. For longitudinal trend, we analyzed the change in scores from baseline for each outcome using the linear mixed effects model. Fixed effects included "group" (frail or non-frail), "time" (4 time points every 3 months, from 3 to 12 months) and "interaction between group and time."

RESULTS

The effect sizes from baseline showed almost all positive values for each outcome. The linear mixed effects model showed significant effects on "interaction between group and time" in changes in bodyweight (P = 0.033), "group" in changes in walking speed (P = 0.013) and "time" in changes in the Mini-Mental State Examination (P < 0.001). Bodyweight showed a decreasing trend in the non-frail group after 3 months, unlike in the frail group. For walking speed, moderate effect sizes (d = 0.67-0.74) were sustained over time in the frail group, as did lesser effect sizes (d = 0.26-0.40) in the non-frail group.

CONCLUSIONS

Exercise-based multicomponent interventions were effective for both groups. The longitudinal effects on walking speed and bodyweight were greater in the frail group. Geriatr Gerontol Int 2022; ••: ••-••.

"The Internal Police Officer Has Not Retired but Has Slowed Down": Israeli Women Reframe Their Aging Experiences in the Second Half of Life

Compared with gains, losses have received a substantial amount of research and public attention. The present study aims to shed light on the positive gains associated with older age from the perspective of older women. Five focus groups with 19 Israeli women over the age of 54 were conducted. Trailers of three different films were used to stimulate discussion about old age and aging and allow for reflections on societal norms in light of personal experiences. Focus group interviews were analyzed thematically. Respondents identified four contexts, characterized by reframing their experiences against societal norms. These included gender stereotypes, physical appearance, interpersonal relations, and employment. This study represents an opening to a different discourse around old age, which is characterized by gains and possibilities brought about by changes in reframing one’s experiences, while distancing oneself and exerting free will vis à vis social norms.

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.

Disability and the risk of subsequent mortality in elderly: a 12-year longitudinal population-based study

Background

Assessment the impact of disability on mortality among the elderly is vital to healthy ageing. The present study aimed to assess the long-term influence of disability on death in the elderly based on a longitudinal study.

Method

This study used the Chinese Longitudinal Healthy Longevity Study (CLHLS) data from 2002 to 2014, including 13,666 participants aged 65 years and older in analyses. The Katz ADL index was used to assess disability status and levels. Cumulative mortality rates were estimated by the Kaplan-Meier method. Cox proportional hazards models were conducted to estimate associations between disability and all-cause mortality for overall participants, two age groups as well as specific chronic disease groups. All reported results were adjusted by survey weights to account for the complex survey design.

Results

During the 12-year follow-up, the death density was 6.01 per 100 person-years. The 3-years’ cumulative mortality rate of nondisabled elderly was 11.9% (95%CI: 10.9, 12.9%). As the level of disability increased, the cumulative mortality rate was from 28.1% (95%CI: 23.0, 33.1%) to 77.6% (95%CI: 63.8, 91.4%). Compared with non-disabled elderly, the multiple-adjusted hazard ratio of death due to disability was 1.68 (95% CI: 1.48, 1.90). The hazard ratios varied from 1.44 (95%CI: 1.23, 1.67) to 4.45 (95%CI: 2.69, 7.38) after classifying the disability levels. The hazard ratios of death in the young-old group (65–79 years) were higher than the old-old group (80 years and over) in both level B (HR = 1.58, 95%CI: 1.25, 2.00 vs. HR = 1.22, 95%CI: 1.06, 1.39, P = 0.029) and level G (HR = 24.09, 95%CI: 10.83, 53.60 vs. HR = 2.56, 95%CI: 1.75, 3.74, P < 0.001). For patients with hypertension, diabetes, heart disease, cerebrovascular disease as well as dementia, disability increases their relative risk of mortality by 1.64 (95%CI: 1.40, 1.93), 2.85 (95%CI: 1.46, 5.58), 1.45 (95%CI: 1.02, 2.05), 2.13 (95%CI: 1.54, 2.93) and 3.56 (95%CI: 1.22, 10.38) times, respectively.

Conclusions

Disability increases the risk of all-cause death in the elderly, especially those with chronic diseases and the young-old group. Further studies are needed to better understand how to effectively prevent disability in the older population.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12877-021-02611-1.

Number of chronic conditions and associated functional limitations among older adults: cross-sectional findings from the longitudinal aging study in India

Background

Chronic conditions reduce the likelihood of physical functioning among older adults. However, the contribution of most prevalent diseases and multimorbidity to different measures of functional limitations is relatively underexplored among Indian older adults. The present study explores the prospective association between number of chronic conditions and limitations in activities of daily living (ADL) and instrumental activities of daily living (IADL) among older adults in India.

Methods

This study utilized data from the nationally representative Longitudinal Ageing Study in India (LASI-2017-18). The effective sample size was 31,464 older adults aged 60 years and above. Descriptive statistics along with cross-tabulation were presented in the study. Additionally, binary logistic regression analysis was used to fulfil the objectives. The outcome variables were dichotomized; high representing no difficulty in ADL/IADL and low representing a difficulty in at least one ADL/IADL. The chronic conditions included hypertension, diabetes, neurological/psychiatric disease, lung disease, heart diseases, stroke, and bone-related disease. The number of chronic diseases was categorized into no disease, single, two and three plus based on number of reported disease.

Results

26.36% of older women and 20.87% of older men had low ADL and the figures for low IADL were 56.86 and 38.84% for older men and women respectively. The likelihood of low ADL (AOR: 1.698, CI:1.544, 1.868) and low IADL (AOR: 1.197; CI: 1.064, 1.346) was higher among womenthan men. With increasing age, the prevalence of low ADL increased among older adults. Respondents with pre-existing chronic conditions had higher likelihood of low ADL and IADL. Older adults with hypertension, psychiatric disease, heart disease, stroke and bone-related disease had significantly higher odds of reporting low IADL. The chances of low ADL and IADL were 2.156 (CI: 1.709, 2.719) and 2.892 (CI: 2.067, 4.047) times respectively higher among older adults with more than three chronic conditions. After controlling for socio-economic and health-related covariates, it was found that men with more than three pre-existing chronic conditions had higher odds of low ADL than women. On the other hand, low IADL were found higher among women with more than three pre-existing chronic conditions.

Conclusions

The present study demonstrates a significant burden of functional limitations among older individuals and that there is a strong association between pre-existing chronic conditions and functional disability. Those with hypertension, diabetes, psychiatric disorders, heart disease, stroke, lung disease or bone-related diseases should be effectively monitored to predict future functional limitations, which may lead to worsening health.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12877-021-02620-0.

Functional decline after surgery in older patients with head and neck cancer

INTRODUCTION

In addition to classical endpoints such as survival and complication rates, other outcomes such as quality of life and functional status are increasingly recognized as important endpoints, especially for elderly patients. However, little is known about the long-term effect of surgery with regard to these other outcomes. Our aim is to investigate the functional status and self-reported health status of patients ≥ 70 years one year after surgery for head and neck cancer.

METHODS

We present one-year follow-up data of patients ≥ 70 year who underwent surgery for HNC. During an interview by telephone, functional status was evaluated by using the Katz-15 Index of Independence questionnaire including six items covering basic Activities of Daily Living (ADL) and nine items covering Instrumental Activities of Daily Living (IADL). Measurements were compared with those obtained preoperatively.

RESULTS

In total, 126 patients were included and eventually we collected follow-up data of 68 patients. There was a statistically significant decrease in functional status on the total Katz-15 and on the IADL questionnaire scores one year after surgery (mean 1.34 versus 2.42,p-value 0.00 and mean 1.21 versus 1.94,p-value 0.00). There was no significant change concerning ADL dependence (p-value 0.18) and cognitive status (p-value 0.11). The self-reported health status improved postoperatively, although not statistically significantly so (mean 67.36 versus 71.25,p-value 0.12).

CONCLUSION

Approximately-one year after surgery for HNC, there is a significant decline in functional status indicating a higher level of dependency.

Impact of organizational context on patient outcomes in a proactive primary care program:a longitudinal observational study

BACKGROUND

The effectiveness of health care interventions is co-determined by contextual factors. Unknown is the extent of this impact on patient outcomes. Therefore, the aim of this study is to explore which characteristics of general practices are associated with patient outcomes in a proactive primary care program, the U-PROFIT 2.0.

METHODS

A longitudinal observational study was conducted from January 2016 till October 2017. Two questionnaires were send out, one to collect characteristics of general practices such as practice neighbourhood socio-economic status, general practice versus healthcare centre (involving multiple primary care professionals), and professional- frail older patient ratio per practice of general practitioners and practice nurses. Regarding delivering the program, the practice or district nurse who delivered the program, number of years since the start of the implementation, and choice of age threshold for frailty screening were collected. Patient outcomes collected by the second questionnaire and send to frail patients were daily functioning, hospital admissions, emergency department visits, and general practice out-of-hours consultations. Linear and generalized linear mixed models were used.

RESULTS

A total of 827 frail older people were included at baseline. Delivery of the program by a district nurse compared to a practice nurse was significantly associated with a decrease in daily functioning on patient-level (β = 2.19; P = < 0.001). Duration since implementation of 3 years compared to 9 years was significantly associated with less out-of-hours consultations to a general practice (OR 0.11; P = 0.001). Applying frailty screening from the age of 75 compared to those targeted from the age of 60 showed a significant increase in emergency visits (OR 5.26; P = 0.03).

CONCLUSION

Three associations regarding the organizational context 1) the nurse who delivered the program, 2) the number of years the program was implemented and 3) the age threshold for defining a frail patient are significant and clinically relevant for frail patients that receive a proactive primary care program. In general, contextual factors need more attention when implementing complex primary care programs which can result in better balanced choices to enhance effective proactive care for older people living in the community.

Self-Assessment of Mobility of People over 65 Years of Age

BACKGROUND AND OBJECTIVES

Nowadays, various clinical scoring systems are used in the medical care of the elderly to assess the quality of mobility. However, people often tend to under- or overestimate themselves in many aspects. Since this can have serious consequences in their treatment and care, the aim of this study was to identify differences in the self and external assessment of mobility of persons over 65 years of age.

MATERIALS AND METHODS

222 participants over 65 years of age and one external, closely-related relative or professional caregiver were interviewed by a unique study assistant using a standardized questionnaire. Participants were divided into people living in nursing homes and independent people living at home, where either the caregivers or the relatives provided the external assessment of mobility, respectively. The questionnaire included demographics, cognitive abilities (Mini Mental Status Test); fall risk (Hendrich 2 Fall Risk Model); as well as the Parker Mobility Score, Barthel Index, and EQ-5D-5L to measure mobility, activities of daily life and quality of life. In each case, the participant and the external person were asked for their assessment to the participants' mobility situation. Statistical significance of the difference between self and external assessment was calculated with a Wilcoxon rank-sum test and assumed with a p-value of ≤ 0.05.

RESULTS

Self-assessment indicated a significantly higher value, when compared to an external assessment for the Parker Mobility Score for females in nursing homes (p ≤ 0.01), as well as for the Barthel Index for females (p ≤ 0.01) and males (p ≤ 0.01) in nursing homes. The EQ-5D-5L received a significantly higher self-assessment value for females (p ≤ 0.01) and males (p ≤ 0.01) living at home and females (p ≤ 0.01) and males (p ≤ 0.05) in nursing homes.

CONCLUSIONS

Persons over 65 years of age tend to overestimate their level of mobility, quality of life and activities of daily life. Especially for people living in nursing homes, these scoring systems should be treated with caution due to the differences between the verbal statements. It is important to properly assess the mobility situation of elderly patients to ensure correct medical treatment and prevention of falls.

A Longitudinal Study of Cognitive and Instrumental Activities of Daily Living Disablement Among the Oldest Mexican Americans

ObjectivesMexican Americans live longer on average than other ethnic groups, but often with protracted cognitive and physical disability. Little is known, however, about the role of cognitive decline for transitions in instrumental activities of daily living (IADL) disability and tertiary outcomes of the IADL disablement for the oldest old (after 80 years old). Methods We employ the Hispanic Established Populations for the Epidemiologic Study of the Elderly (2010-2011, 2012-2013, and 2016, N = 1,078) to investigate the longitudinal patterns of IADL decline using latent transition analysis. Results Three IADL groups were identified: independent (developing mobility limitations), emerging dependence (limited mobility and community activities), and dependent (limited mobility and household and community activities). Declines in cognitive function were a consistent predictor of greater IADL disablement, and loneliness was a particularly salient distal outcome for emerging dependence. Discussion These results highlight the social consequences of cognitive decline and dependency as well as underscore important areas of intervention at each stage of the disablement process.

A comprehensive multidisciplinary care pathway for hip fractures better outcome than usual care?

INTRODUCTION

Hip fracture surgery is among the most performed surgical procedures in elderly patients. Mortality rates are high, however, and patients often fail to live independently following a hip fracture. To improve outcome, multidisciplinary care pathways have been initiated, but longer-term results are lacking. Aim of this study was to compare functional outcome and living situation six months after hip fracture treatment with and without a care pathway.

PATIENTS AND METHODS

A multicentre prospective controlled trial was conducted with three hospitals: in one hospital patients were treated with a care pathway, in the other hospitals patients received usual care. All patients aged ≥ 60 years with a hip fracture were asked to participate. Besides basic characteristics, health-related quality of life (EQ-5D) and performance scores of activities of daily living (Katz Index and Lawton IADL) were assessed. Differences in scores were analysed using linear regression. Propensity score adjustment was used to correct for differences between the care pathway and the usual care group. Missing data were imputed.

RESULTS

No differences in rate of return to prefracture ADL level were found between patients in the care pathway group and the usual care group. The percentage of participants in the same situation as before the fracture was the same in both treatment groups (81%). There were no significant differences in quality of life, activities of daily living or mortality (15% vs 10%, p = 0.17), but hospital stay in the care pathway group was significantly shorter (median 7 vs 10 days).

DISCUSSION

Treatment of elderly patients with a hip fracture is commonly organised in care pathways. Although short-term advantages are reported, positive effects on longer-term functional results could not be proven in our study. This study confirmed a shorter hospital stay in the care pathway group, which potentially may lead to a reduction in costs.

CONCLUSIONS

Functional outcome and living situation six months after a hip fracture is the same for patients treated with or without a care pathway.

Prevalence of function-limiting late effects in Hodgkin lymphoma survivors

BACKGROUND

Hodgkin lymphoma (HL) is highly curable, but survivors often develop function-limiting impairments. Screening guidelines for neuromuscular and musculoskeletal late effects are not as well recognized across medical disciplines. Early identification and management of functional late effects are instrumental in improving the longitudinal care of HL survivors.

OBJECTIVE

To define the prevalence of neuromuscular, musculoskeletal, visceral, oncologic, and other late effects affecting function and quality of life (QOL) in HL survivors.

DESIGN

A retrospective cohort analysis.

SETTING

Outpatient cancer rehabilitation clinic.

PARTICIPANTS

One hundred HL survivors.

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURES

Prevalence of neuromuscular, musculoskeletal, visceral, oncologic, and other late effects contributing to functional impairment and disability in HL survivors.

RESULTS

Among the 100 HL survivors, 43% received chemotherapy, 94% radiation therapy, and 38% a combination of chemo-radiation for their initial cancer treatment. Nearly all HL survivors were diagnosed with myelopathy (83%), radiculoplexopathy (93%), mononeuropathy (95%), and localized myopathy (93%). Musculoskeletal sequelae included dropped head syndrome (83%), cervicalgia (79%), shoulder girdle dysfunction (73%), and dysphagia (42%). Visceral disorders included cardiovascular (70%), pulmonary (44%), endocrine (63%), gastrointestinal (29%), and genitourinary (11%) dysfunction. Lymphedema affected 21% of survivors and 30% had a history of a secondary malignancy. Pain (71%), fatigue (45%), and dyspnea (43%) were major function-limiting impairments. Nearly all (95%) of survivors were referred to at least one therapy discipline including physical therapy, occupational therapy, speech and language pathology, and/or lymphedema therapy.

CONCLUSION

Neuromuscular, musculoskeletal, visceral, oncologic, and other late effects are extremely common in HL survivors seeking physiatric evaluation. Multiple function-limiting disorders can coexist in HL survivors with the potential to severely compromise function and QOL. Safe and effective rehabilitation may depend on the physiatrist's ability to identify, evaluate, and manage the multitude of complex and often interrelated functional late effects seen in HL survivors.

ADL/ IADL dependencies and unmet healthcare needs in older persons: A nationwide survey

PURPOSE

To determine the impact of overall and component-wise activities for daily living (ADL) as well as instrumental activities of daily living (IADL) dependencies on unmet healthcare needs in older adults.

MATERIALS AND METHODS

Cross-sectional analyses were performed based on a National Survey of Older Koreans. A total of 10,082 participants aged ≥ 65 years were included. All data were collected through standardized, personal interviews with participants and their representatives. Logistic regression was used to analyse the risk of unmet healthcare needs, with or without adjustment.

RESULTS

Amongst all participants, 734 (7.2%) had ADL dependency. Participants with ADL dependency had lower income, education level, and perceived health status (p<0.001). The adjusted odds ratio (aOR) for the risk of unmet healthcare needs was 1.52 (95%, confidence interval [CI] 1.19-1.95) for ADL and 1.54 (95%, CI 1.28-1.86) for IADL. When men have ADL dependency, aOR of unmet healthcare needs was higher than that of women (aOR 1.89, 95% CI 1.15 - 3.11; aOR 1.65, 95% CI 1.15 - 2.36, respectively) and IADL showed the same trend. Any dependency on ADL or IADL was associated with higher risk of unmet healthcare needs, whether adjusted or not (p<0.001).

CONCLUSIONS

Older adults with ADL or IADL dependency had higher risks of unmet healthcare needs than their independent counterparts. In addition to mobility problems, other components were related to unmet healthcare needs. Therefore, to reduce unmet healthcare needs, integration of health and social care that supports ADL or IADL dependency should be considered.

A web-based dynamic Nomogram for predicting instrumental activities of daily living disability in older adults: a nationally representative survey in China

Background

Instrumental Activities of Daily Living (IADL) disability is a common health burden in aging populations. The identification of high-risk individuals is essential for timely targeted interventions. Although predictors for IADL disability have been well described, studies constructing prediction tools for IADL disability among older adults were not adequately explored. Our study aims to develop and validate a web-based dynamic nomogram for individualized IADL disability prediction in older adults.

Methods

Data were obtained from the China Health and Retirement Longitudinal Study (CHARLS). We included 4791 respondents aged 60 years and over, without IADL disability at baseline in the 2011 to 2013 cohort (training cohort) and 371 respondents in the 2013 to 2015 cohort (validation cohort). Here, we defined IADL disability as needing any help in any items of the Lawton and Brody’s scale. A web-based dynamic nomogram was built based on a logistic regression model in the training cohort. We validated the nomogram internally with 1000 bootstrap resamples and externally in the validation cohort. The discrimination and calibration ability of the nomogram was assessed using the concordance index (C-index) and calibration plots, respectively.

Results

The nomogram incorporated ten predictors, including age, education level, social activity frequency, drinking frequency, smoking frequency, comorbidity condition, self-report health condition, gait speed, cognitive function, and depressive symptoms. The C-index values in the training and validation cohort were 0.715 (bootstrap-corrected C-index = 0.702) and 0.737, respectively. The internal and external calibration plots for predictions of IADL disability were in excellent agreement. An online web server was built (https://lilizhang.shinyapps.io/DynNomapp/) to facilitate the use of the nomogram.

Conclusions

We developed a dynamic nomogram to evaluate the risk of IADL disability precisely and expediently. The application of this nomogram would be helpful for health care physicians in decision-making.

The path linking disease severity and cognitive function with quality of life in Parkinson's disease: the mediating effect of activities of daily living and depression

BACKGROUND

Research on quality of life (QOL) with Parkinson's disease (PD) has examined direct influencing factors, not mediators. The study aim was to explore whether PD severity and poor cognitive function may decrease physical and mental QOL by reducing activities of daily living (ADL) and increasing depression in sequence.

METHODS

We conducted a cross-sectional questionnaire study of 150 PD hospital patients in China. PD severity, cognitive function, ADL, depression, and QOL were evaluated. We used structural equation modeling to analyze the mediating effects of ADL and depression on the association between PD severity/cognition and the physical health and mental health component summary scores measured by the SF36 quality of life instrument.

RESULTS

There was a significant mediating effect of PD severity on physical health via ADL and depression (95% CI: - 0.669, - 0.026), and a significant direct effect (p < 0.001). The mediating effect of PD severity on mental health via ADL and depression was significant (95% CI: - 2.135, - 0.726), but there was no direct effect (p = 0.548). There was a significant mediating effect of cognitive function on physical health via ADL and depression (95% CI: 0.025, 0.219) and a significant direct effect (p < 0.001). The mediating effect of cognitive function on mental health via ADL and depression was significant (95% CI: 0.256, 0.645), but there was no direct effect (p = 0.313). The physical health models showed a partial mediation, and the mental health models showed a complete mediation, of ADL and depression.

CONCLUSIONS

PD severity and cognitive function increase depression by reducing ADL, leading to lower QOL, and directly or indirectly affect physical health and mental health through different pathways.

Factors Associated with Independence for Elderly People in Their Activities of Daily Living

Background: Health in the elderly does not merely refer to a condition free from disease but should also have elements regarding functionality and independence. Purpose: This study aimed to measure Activities of Daily Living (ADLs) and to identify the factors affecting ADLs among the elderly population in Sleman District. Methods: A cross-sectional study was carried out using secondary data from the Multidimensional Elderly Care project, nested on the Health Demographic and Surveillance System in Sleman, involving 549 elderly participants. The independence of these elderly people was measured using an Activities of Daily Living Scale questionnaire. Factors measured were cognitive (using the Mini-Mental State Examination questionnaire), psychological (using the Geriatric Depression Scale or Cornell Scale for Depression in Dementia questionnaires), economic (using the Financial Management Behavior Scale questionnaire), and nutritional status (using the Mini Nutritional Assessment questionnaire). The data were analyzed using the chi-square test, Fisher test, and Poisson test for bivariate analysis, while multivariate analysis using a logistic regression test. Results: The prevalence of elderly dependence was 14.03%. Elderly dependence was significantly related to age, job, residence, financial management, dementia, depression, malnutrition, and stroke disease in the bivariate analysis. However, after multivariate analysis, only age (>86 years) (PR = 4.31; 95% CI = 1.91–9.72), malnutrition (PR = 6.62; 95% CI = 3.79–11.57), and stroke (PR = 3.06; 95% CI = 2.03–4.61) were still shown to be related to elderly dependence. Conclusion: Increasing age, malnutrition, and stroke in elderly people lead to higher dependency in their ADLs.

Factors Associated with the Need for Assistance among the Elderly in Malaysia

The need for assistance among the elderly is rising, which poses challenges for healthcare systems. Thus, this study aims to determine the factors associated with the need for assistance in the daily living activities of Malaysia’s elderly population. A total of 1204 elderly individuals, aged 60 years and above, were recruited. An interview was conducted using the Bahasa Malaysia version of the Japan Gerontological Evaluation Study (JAGES-BM) questionnaire. Overall, 7.7% of the elderly participants required assistance. A logistic regression model showed that difficult financial statuses (aOR 4.56), hearing difficulties (aOR 1.78), and severe limitations in daily activity over the past 6 months (aOR 11.99) were associated with a higher likelihood of needing assistance. In addition, daily activities such as an inability to feed (aOR 8.46), stand without support (aOR 2.06), or walk for 15 min without stopping (aOR 1.99) were significantly associated with the need for assistance. Factors associated with the need for assistance are health status, disability, and the financial status of the elderly. Preventive measures should be included in policies to ensure the sustainability of the care provided to the elderly in terms of promoting healthy ageing and a good quality of life.

Bathing and toileting difficulties of older adults in rural China: the role of environment

BACKGROUND

For older adults, difficulties in bathing and toileting are often the most prevalent in the index of Activities of daily living (ADL). This study aims to examine how environmental factors are associated with difficulty of bathing and toileting among older adults in rural China.

METHOD

The data are from the 2014 Thousand-Village Survey (TVS), a national survey of Chinese rural residents of old age. The sample consists of 10,689 subjects, 55 years or older, from 536 villages across all provinces of China. Logistic regressions were applied to examine how difficulty of bathing and toileting was related to environmental factors such as geographic location, neighbourhood amenity, and related facilities of bathing and toileting.

RESULTS

Older adults living in the Southern regions of China had lesser difficulty in bathing and toileting than those living in Northern China, controlling for other confounders. Better neighbourhood conditions also reduced the likelihood of having such disabilities. Persons who bathed indoors without showering facilities, in public facilities, and outdoors were significantly more likely to have bathing disability than those who showered indoors with facility. Rural older adults who used pedestal pans and indoor buckets for toileting were more likely to have toileting disability than those who used indoor squatting facilities.

CONCLUSION

Environmental barriers were associated with functional disability among older adults in rural China, but the disabled individuals may change their environments to adapt to their functional capabilities. Our findings suggest that it is imperative to promote the use of showering facilities and pedestal pans for toileting in rural China.