Quality-adjusted life years (QALYs) associated with limitations in activities of daily living (ADL) in a large longitudinal sample of the U.S. community-dwelling older population

The efficiency of activities of daily living (ADLs) skills in late adulthood: A mediational approach

The term "Activities of Daily Living" (ADLs) refers to a set of fundamental tasks (i.e., toileting, bathing, personal care, eating, grooming, and getting dressed) considered necessary for living and being autonomous in everyday life. Although in the clinical setting ADLs efficiency is a marker to diagnose dementia, limited evidence on the mechanism implicating muscular function and cognitive alterations in ADLs skills in late adulthood exists. This study primarily intended to determine the extent to which executive functions mediate between muscular strength, as assessed through handgrip strength (HGS) measurement, and ADLs skills of older community-dwellers. A further goal was to explore the impact of gender and cognitive status on ADLs and HGS scores, using education as a covariate. Three hundred and thirty-four older participants, 199 females and 135 males (Mage = 77.5 years, SD = 5.6 years, age range = 63-93 years) completed a battery of tests assessing ADLs, HGS, and executive functions. The results showed that 34-56% of the variance in the ADLs condition was explained by HGS and executive functioning. Furthermore, cognitively healthy participants exhibited better ADLs skills, whereas cognitively impaired individuals, both males and females, exhibited poorer HGS efficiency. In conclusion, in clinical settings, the concurrent evaluation of ADLs skills, motor, and higher-order cognitive processes should be encouraged to detect individuals needing a person-tailored intervention to boost their quality of life.

The association between sarcopenia and functional disability in older adults

OBJECTIVES

Sarcopenia is associated with functional disability in older adults. However, no consistent conclusions have been reached considering the differences in the measurement and criteria of sarcopenia. We aimed to examine the association between sarcopenia status and functional disability based on China Health and Retirement Longitudinal Study (CHARLS).

DESIGN

A nationally representative longitudinal study.

SETTING AND PARTICIPANTS

Participants aged at least 60 years old from the CHARLS 2015y were included.

MEASUREMENTS

Sarcopenia was assessed according to the Asian Working Group for Sarcopenia 2019 algorithm. The outcomes of this study were basic activities of daily living (ADLs) and instrumental activities of daily living (IADLs). The logistic regression model was conducted to analyze the cross-sectional and longitudinal associations between sarcopenia status and ADLs and IADLs disability.

RESULTS

In the cross-sectional study, 37.2% of the 6893 participants were defined as having sarcopenia. Any form of sarcopenia was associated with ADLs and IADLs disability. During three years of follow-up, 786 (16.5%) participants developed new-onset ADLs disability, and 980 (22.5%) participants developed new-onset IADLs disability. Compared with the no-sarcopenia, participants with possible sarcopenia (OR: 1.62, 95%CI: 1.34-1.95), sarcopenia (OR: 1.58, 95%CI: 1.18-2.11), or total sarcopenia (OR: 1.58, 95%CI: 1.34-1.88) had a higher risk of ADLs disability. While, the risk of IADLs disability for participants with possible sarcopenia (OR: 1.68, 95%CI: 1.41-2.00), sarcopenia (OR: 1.87, 95%CI: 1.40-2.51), or total sarcopenia (OR: 1.71, 95%CI: 1.45-2.00) was still significantly increased. With statistical interaction between sarcopenia status and residence or sex in ADLs and IADLs disability, older adults in urban, with ORs ranging from 2.14 to 2.44, were at a higher risk of functional disability than those in rural. Possible sarcopenia was associated with a much higher risk of ADLs disability (OR: 1.68, 95%CI: 1.26-2.25) in males and a higher risk of IADLs disability (OR: 1.98, 95%CI: 1.56-2.52) in females.

CONCLUSIONS

Sarcopenia was associated with an increased risk of ADLs and IADLs disability among older Chinese adults. Even possible sarcopenia still significantly impacted ADLs and IADLs disability, and this association varied by sex and residence.

Socioeconomic Disparities in Individual-Level Quality-Adjusted Life Years throughout Remaining Lifetimes: A National Representative Longitudinal Survey in China

Socioeconomic disparities in health within and across low- and middle-income countries pose a significant global public health concern. While prior research has demonstrated the importance of socioeconomic status on health outcomes, few studies have employed comprehensive measures of individual-level health such as quality-adjusted life years (QALYs) in exploring the quantitative relationship. In our study, we employed QALYs to measure individual-level health, using health-related quality of life scores based on the Short Form 36 and predicted remaining life years through individual-specific Weibull survival analysis. We then constructed a linear regression model to explore the socioeconomic factors that influence QALYs, providing a predictive model of individual-level QALYs throughout remaining lifetimes. This practical tool can help individuals predict their remaining healthy life years. Using data from the China Health and Retirement Longitudinal Study between 2011 and 2018, we found that education and occupation were the primary factors influencing health outcomes among individuals aged 45 and above, while income appeared to have less of an impact when education and occupation were simultaneously controlled for. To promote the health status of this population, low- and middle-income countries should prioritize the long-term advancement of their population's education while controlling unemployment rates in the short term.

Reverse total shoulder arthroplasty pain and function: new perspectives from a 10-year multicenter study at the 7-year follow-up

BACKGROUND

Reverse total shoulder arthroplasty (RTSA) can decrease shoulder pain and improve function. However, results reportedly deteriorate as patients approach mid-term follow-up and little is known about how this impacts physical health-related quality of life (PHRQOL) and mental health-related quality of life (MHRQOL). The study hypothesis was that shoulder function, pain, and medication use for pain would influence PHRQOL and MHRQOL.

METHODS

This prospective cohort study involving subjects from 6 orthopedic clinics and 12 fellowship-trained surgeons evaluated the influence of RTSA on PHRQOL, MHRQOL, shoulder function, pain, instability, and medication use over the initial 7 years of a 10-year study, and device survivorship and revision rates. Clinical examination, the American Shoulder and Elbow Surgeons (ASES) score, Short Form (SF)-12 PHRQOL and MHRQOL assessments, the single assessment numeric shoulder function evaluation (SANE), visual analog scale (VAS) shoulder pain and instability scores, shoulder pain, medication use for pain, surgery satisfaction, survivorship and revision rate data were collected pre-RTSA, and at 6-week, 6-month, 1-year, 2-year, 3-year, 5-year, and 7-year follow-ups.

RESULTS

Two hundred participants (108 female) of 69 ± 8.3 years of age, with gross rotator cuff deficiency (poor tissue quality or impaired dynamic stability) (n = 92), glenohumeral joint osteoarthritis (n = 88), failed primary total shoulder arthroplasty (n = 8), non-united humeral head fracture (n = 6) or 3-4 section comminuted humeral head fracture (n = 6) underwent pre-RTSA evaluation. Device survivorship was 94%. Friedman two-way ANOVA and Wilcoxon test pairwise comparisons revealed that compared to pre-RTSA, median active shoulder flexion (+ 25°) and external rotation (+ 10°) mobility improved by 6 months (p < 0.0001) and remained improved. Shoulder flexion (+ 1 grade), abduction, external rotation (+ 0.5 grade), and internal rotation strength (+ 1 grade) also improved by 6 months (p < 0.0001) and remained improved. ASES (+ 26.8), SANE (+ 17.5) and VAS pain (- 5.7) scores improved by 6 weeks (p < 0.0001) and remained improved, as medication use for shoulder pain decreased (- 24.6%) (p < 0.0001). SF-12 PHRQOL scores improved by 6 months (+ 11.5) and remained improved (p < 0.0001). Significant Spearman Rho correlations were observed between shoulder function (ASES or SANE) and SF-12 PHRQOL (r ≥ 0.52) and MHRQOL (r ≥ 0.20) scores (p < 0.0001) supporting the relationship between shoulder function and quality of life. Trend analysis revealed changing shoulder function, pain, and PHRQOL relationships between 2 and 3 years, and 5 and 7 years post-RTSA (Chi-Square, p < 0.05).

CONCLUSION

Excellent device survival and good-to-excellent perceived shoulder function, and PHRQOL improvements were observed. Secondary objectives of improved shoulder mobility, strength, pain and instability were also achieved. In contrast to previous reports, subjects did not display shoulder mobility or perceived function deterioration by the 7-year follow-up. Following chronic pain relief at 6 weeks post-RTSA, subjects appear to balance PHRQOL and shoulder pain relationships at the 6-month and 1-year post-RTSA follow-ups. Careful evaluation at this time may help patients with higher pain levels and lower function expectations reverse these trends, or patients with lower pain levels and higher function expectations to optimize RTSA use and longevity.

Association of multimorbidity patterns with incident disability and recovery of independence among middle-aged and older adults

OBJECTIVE

to identify multimorbidity patterns among middle-aged and older adults in China and examine how these patterns are associated with incident disability and recovery of independence.

METHODS

data were from The China Health and Retirement Longitudinal Study. We included 14,613 persons aged ≥45 years. Latent class analysis (LCA) was conducted to identify multimorbidity patterns with clinical meaningfulness. Multinomial logistic models were used to determine the adjusted association between multimorbidity patterns and incident disability and recovery of independence.

RESULTS

we identified four multimorbidity patterns: 'low morbidity' (67.91% of the sample), 'pulmonary-digestive-rheumatic' (17.28%), 'cardiovascular-metabolic-neuro' (10.77%) and 'high morbidity' (4.04%). Compared to the 'low morbidity' group, 'high morbidity' (OR = 2.63, 95% CI = 1.97-3.51), 'pulmonary-digestive-rheumatic' (OR = 1.89, 95% CI = 1.63-2.21) and 'cardiovascular-metabolic-neuro' pattern (OR = 1.61, 95% CI = 1.31-1.97) had higher odds of incident disability in adjusted multinomial logistic models. The 'cardiovascular-metabolic-neuro' (OR = 0.60, 95% CI = 0.44-0.81), 'high morbidity' (OR = 0.68, 95% CI = 0.47-0.98) and 'pulmonary-digestive-rheumatic' group (OR = 0.75, 95% CI = 0.60-0.95) had lower odds of recovery from disability than the 'low morbidity' group. Among people without disability, the 'cardiovascular-endocrine-neuro' pattern was associated with the highest 2-year mortality (OR = 2.42, 95% CI = 1.56-3.72).

CONCLUSIONS

multimorbidity is complex and heterogeneous, but our study demonstrates that clinically meaningful patterns can be obtained using LCA. We highlight four multimorbidity patterns with differential effects on incident disability and recovery from disability. These studies suggest that targeted prevention and treatment approaches are needed for people with multimorbidity.

Association between self-reported body mass index and active life expectancy in a large community-dwelling sample of older U.S. adults

Background

Obesity may have a protective effect (greater survival) in older adults, a finding known as the “obesity paradox.” This study examined the association between self-reported body mass index (BMI) and active life expectancy (ALE) among older U.S. adults.

Methods

Using the Medicare Health Outcomes Survey Cohort 15 (2012 baseline, 2014 follow-up), we estimated life expectancy and ALE by participants’ baseline BMI and age using multi-state models. A participant was classified as in an active state if this person reported having no difficulty for any of these six activities of daily living (ADLs).

Results

Small differences in life expectancy were noted among persons in normal weight (BMI 18.5–24.9 kg/m²), overweight (BMI 25–29.9 kg/m²), and obesity ranges (BMI 30 kg/m² and higher). However, persons with obesity had a significantly lower ALE. ALE at age 65 was 11.1 (11.0–11.2) years for persons with obesity, 1.2 (1.1–1.3) years less than that for the normal weight and overweight persons (12.3 years for both, 12.2–12.4). Persons with class III obesity had a significantly lower life expectancy and ALE than normal weight persons. Although persons with class I or II obesity had a similar life expectancy as normal weight persons, they have a shorter ALE.

Conclusions

Although older adults with obesity have a similar life expectancy as normal weight persons, they have a significantly shorter ALE. Given the complex relationship of BMI and ALE, a “one size fits all” approach to weight management is not advisable.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12877-022-03021-7.

Self-Care Capacity and Its Relationship to Age, Disability, and Perceived Well-Being in Medicare Beneficiaries

BACKGROUND

Self-care is a multicomponent set of capacities that influence beliefs about health and well-being.

OBJECTIVES

We examined the relationship between self-care capacity, age, and disability status with two perceptions of well-being in a cohort of Medicare beneficiaries.

METHODS

The current study is part of a multisite research project to determine factors associated with cross-sectional and longitudinal morbidity and mortality trajectories observed in Medicare beneficiaries. Variable selection was informed by the health disparities and outcomes model. Using data from the 2013 Medicare Current Beneficiary Survey and logistic regression models, we determined associations between self-care capacity, including indicators of self-care ability and self-care agency and two perceptions of well-being. Participants were divided into four groups based on how they qualified for Medicare: (a) over 65 years of age, and below 65 years of age and disabled because of (b) physical or (c) mental disorder, or (d) disabled and could not be classified as physically or mentally disabled as the primary cause of eligibility.

RESULTS

Self-care ability limitations in activities of daily living (ADL), instrumental activities of living (IADL), and social activity participation were associated with both health perceptions. Those with physical disabilities reported more ADL and IADL limitations when compared with the other eligibility groups and were significantly more likely to have negative health perceptions. Those with serious mental illness were most likely to report the most severe IADL limitations. The over 65 years of age group reported less self-care incapacity than the other three eligibility types. Other components of self-care, including health literacy, agency, and health behaviors, significantly influenced perceptions of health. Women and people identifying as non-Whites were more likely to have negative health perceptions.

DISCUSSION

Self-care capacity is a complex construct, and its varied elements have differential relationships with perceptions of well-being. Those with physical disabilities reported more self-care limitations, poorer perceived health, and more health worries than the other groups. Still, there were different patterns of self-care capacities in the serious mental illness type-especially in IADL limitations. The study adds empirical evidence to previous research documenting inequities in health outcomes for women and non-Whites. Findings provide empirical support for the health disparities and outcomes model.

Research on the Establishment and Application of the Environmental Health Indicator System of Atmospheric Pollution in China

To understand the health impact represented by exposure to current atmospheric pollution in China, an environmental health indicators (EHIs) system of atmospheric pollution was established. The EHIs were based on comprehensive consideration of environment, population, economy and diseases associated with atmospheric pollution. An EHIs evaluation system of atmospheric pollution, based on corresponding EHIs data collection and weighting coefficients determined using principal component analysis, was applied to major provinces and regions in China to evaluate the environmental health status. Results showed that the EHIs of atmospheric pollution in Central and East China were low, indicating a serious environmental health condition. Prevention and management of atmospheric pollution in these regions should be strengthened and protective measures taken to improve human health. Compared with other methods, the EHIs evaluation system was more intuitive, which facilitated users to identify the environmental health status and provided support for health management and pollution prevention.

Life expectancy and active life expectancy by disability status in older U.S. adults

Objectives

The Medicare Health Outcome Survey (HOS) is the largest longitudinal survey of the U.S. community-dwelling elderly population. This study estimated total life expectancy, active life expectancy (ALE), and disability-free life expectancy (DFLE) by disability status among HOS participants.

Methods

Data were from the Medicare HOS Cohort 15 (baseline 2012, follow-up 2014). We included respondents aged ≥ 65 years (n = 164,597). Participants’ disability status was assessed based on the following six activities of daily living (ADL): bathing, dressing, eating, getting in or out of chairs, walking, and using the toilet. The multi-state models were used to estimate life expectancy, ALE, and DFLE by participants’ baseline disability status and age.

Results

Persons who had higher-level ADL limitations had a shorter life expectancy, ALE, and DFLE. Also persons with disability had greater expected life years with disability than those with no limitations and those with mild limitations. For example, among 65-year old respondents with no limitations, mild limitations, and disability, life expectancy was 19.9, 18.6, and 17.1 years, respectively; ALE was 14.0, 9.5, and 7.2 years, respectively; DFLE was 17.3, 15.2, and 11.4 years, respectively; and expected years with disability was 2.6, 3.4, and 5.7 years, respectively.

Conclusions

This study demonstrated that greater levels of disability adversely impact life expectancy, ALE, DFLE, and expected number of years with a disability among U.S. older adults. Understanding levels of disability, and how these may change over time, would enhance health care quality and planning services related to home care and housing in this community-dwelling population.

Household heating associated with disability in activities of daily living among Chinese middle-aged and elderly: a longitudinal study

Background

The health hazards of indoor air pollution are well-established but studies of the health effects due to pollution from heating are rare. This study investigated the association of heating and disability for activities of daily living among Chinese middle-aged and elderly.

Methods

We used two consecutive surveys in a cohort of over 17,000 adults aged 45 or older, who were interviewed first in 2011–2012 and then in 2013. In these surveys, taking advantage of random survey time, we applied a random effects logit regression model that included an interaction between pollution-producing heating fuel and a dummy variable, which measured interview time based on whether or not it was heating season.

Results

Exposure to pollution-producing heating fuel was associated with a 39.9% (OR 1.399; 95%CI 1.227–1.594) and 71.0% (OR 1.710; 95%CI 1.523–1.920) increase in the likelihood of disability in activities of daily living (DADL) and disability in instrumental activities of daily living (DIADL), respectively. In heating season between year 2011 and 2013, moving from clean heating energy for heating to pollution-producing fuel was linked with an increase in the likelihoods having DADL and DIADL, with the OR of 2.014 (95%CI 1.126–3.600) and 1.956 (95%CI 1.186–3.226), respectively. However, disability increases due to change from clean energy to pollution-producing heating energy did not appear in advantaged education respondents.

Conclusions

We found that exposure to heating by burning of coal, wood, or crop residue was associated with disability in performing daily living activities. Health policymakers should take indoor pollution due to heating into consideration as it is a major determinant of activities of daily living in elderly people; especially, such policy should focus on elderly people who have disadvantaged education.