The burden and patterns of disability in activities of daily living among community-living older persons

Exploring trajectories of functional decline and recovery among older adults: a data-driven approach

Independently performing activities of daily living (ADLs) is vital for maintaining one's quality of life. Losing this ability can significantly impact an individual's overall health status, including their mental health and social well-being. Aging is an important factor contributing to the loss of ADL abilities, and our study focuses on investigating the trajectories of functional decline and recovery in older adults. Employing trajectory analytics methodologies, this research delves into the intricate dynamics of ADL pathways, unveiling their complexity, diversity, and inherent characteristics. The study leverages a substantial dataset encompassing ADL assessments of nursing home residents with diverse disability profiles in the United States. The investigation begins by transforming these assessments into sequences of disability combinations, followed by applying various statistical measures, indicators, and visual analytics. Valuable insights are gained into the typical disability states, transitions, and patterns over time. The results also indicate that while predicting the progression of ADL disabilities presents manageable challenges, the duration of these states proves more complicated. Our findings hold significant potential for improving healthcare decision-making by enabling clinicians to anticipate possible patterns, develop targeted and effective interventions that support older patients in preserving their independence, and enhance overall care quality.

Relationship between walking speed, respiratory muscle strength, and dynamic balance in community-dwelling older people who required long-term care or support and used a daycare center

Background

Focusing on the relationship between frail older people and gait speed is vital to minimize the need for long-term care or increased support. The relationship between gait speed, respiratory muscle strength, and dynamic balance, is not well understood in older people requiring long-term care or support. Therefore, this study aimed to provide new insights into the relationship between gait speed, respiratory muscle strength, and dynamic balance in community-dwelling older people who required long-term care or support and used a daycare center.

Methods

This was a cross-sectional study of 49 community-dwelling older people (21 men, 28 women) aged ≥65 years who were certified as requiring long-term care or support under the Japanese system. The participants' maximal inspiratory pressure (PImax), maximal expiratory pressure (PEmax), walking speed (maximal and normal walking speed), and maximal double-step length test (MDST) results were recorded. The measurement data were evaluated using Pearson's correlation coefficient and multiple regression analysis.

Results

Pearson's correlation coefficient revealed correlations between PImax and the following: maximal walking speed (r = 0.606, p < 0.001), normal walking speed (r = 0.487, p < 0.001), and MDST (r = 0.435, p = 0.002). Correlations were also observed between PEmax and the following: maximal walking speed (r = 0.522, p < 0.001), normal walking speed (r = 0.467, p < 0.001), and MDST (r = 0.314, p = 0.028). Moreover, a correlation was found between MDST and both maximal walking speed and (r = 0.684, p < 0.001) and normal walking speed (r = 0.649, p < 0.001). The effect size was 0.379. Multiple regression analysis using a forced entry method with maximal walking speed as the dependent variable showed that maximal walking speed was significantly associated with MDST (p < 0.001) and PEmax (p = 0.036), with an effect size of 0.272. The model's adjusted coefficient of determination was 0.593 (p < 0.001). Multiple regression analysis using a forced entry method with normal walking speed as the dependent variable showed that normal walking speed was significantly associated with MDST (p < 0.001) and PEmax (p = 0.021), with an effect size of 0.272. The model's adjusted coefficient of determination was 0.497 (p < 0.001). Multiple regression analysis using a forced entry method with MDST as the dependent variable showed that MDST was significantly associated with PImax (p < 0.025), with an effect size of 0.243. The model's adjusted coefficient of determination was 0.148 (p = 0.017).

Conclusions

Respiratory muscle strength and dynamic balance were related to walking speed in older people requiring long-term care or support.

The Associations of Individual and Subclasses of Nonesterified Fatty Acids With Disability, and Mobility Limitation in Older Adults: The Cardiovascular Health Study

BACKGROUND

We sought to determine the associations between individual nonesterified fatty acids (NEFAs) and disability and mobility limitation.

METHODS

We studied 1 734 participants in the Cardiovascular Health Study (CHS), an ongoing population-based cohort study of community-living older American adults. We measured 35 individual NEFA species in fasting serum samples obtained at the 1996-1997 clinic visit. Using yearly assessments of activities of daily living and self-reported mobility, we identified participants with incident disability or mobility limitation during 15 years of follow-up. Cox proportional hazards regression models were used to determine the associations between per SD increment in the individual NEFAs and incident disability and mobility limitations with adjustment for potential confounding factors.

RESULTS

Higher concentrations of total and a broad range of individual NEFA species were associated with risk of disability and mobility limitation (disability: HR per SD of total NEFA [SD = 174.70] = 1.11, 95% CI = 1.04-1.18, p = .001; mobility limitation: HR per SD of total NEFA = 1.09, 95% CI = 1.02-1.16, p = .01). Among individual saturated NEFAs (SFAs), myristic (14:0) and palmitic (16:0) acids were significantly associated with higher risk of both disability and mobility limitations, but longer-chain FAs were not. Most individual monounsaturated (MUFA), n-6 polyunsaturated fatty acids (PUFAs), and trans FAs were positively significantly associated with higher risks of both disability and mobility limitation. In contrast, most n-3 PUFA species were not associated with disability or mobility limitation.

CONCLUSIONS

Higher risks of disability and mobility limitation were observed for proinflammatory intermediate-chain SFAs, MUFAs, n-6 PUFAs, and trans FAs. Our findings indicated no significant association for anti-inflammatory n-3 PUFAs.

Prevalence of activity limitation and its associated predictor among the elderly in Tamil Nadu, India: A community-based cross-sectional study

BACKGROUND

Functional disability develops in a dynamic and progressive manner. As people age, their health problems worsen and they lose the ability to perform activities of daily living (ADLs) such as dressing, using the toilet, bathing, and eating. With a better understanding of the underlying risk factors and the related mechanisms of the disablement process, it is possible to make more effective and more efficient programs to prevent or delay the onset of disability in older people.

MATERIALS AND METHODS

A community-based, descriptive, cross-sectional study was carried out among 453 elderly from Tamil Nadu, India. A door-to-door interview was used to administer the Katz Index of Independence on ADL. Simple random selection was employed to select the study individuals. To determine the association for particular risk factors, Chi-squared test and binary logistic regression were used.

RESULTS

First, our study findings show the prevalence of activity limitation among the elderly using the The Katz Index of Independence. This study shows that the prevalence of activity limitation was 23% among the elderly. Seventy-seven percent had no significant limitations: they are independent. There is a statistically significant association between activity limitation as opposed to gender, visual impairment, depression, urinary incontinence, unintentional injury in the past year, and alcohol consumption.

CONCLUSION

The study found that the self-reported prevalence of activity limitation was 23% among the elderly and 77% had no significant limitations. The Katz Index of Independence in activities of daily living may be used as a handy tool to identify the activity limitation in community-based checkups.

Recurrent but not single report of fear of falling predicts cognitive decline in community-residing older adults

OBJECTIVES

Literature regarding the association of fear of falling (FOF), a common concern in aging, and cognition is scarce. Moreover, whether frequency of FOF endorsement influences age-related cognitive decline has not been reported. Here we determined whether FOF status (no FOF, single-report FOF, recurrent FOF), predicted decline in global cognitive function (GCF), memory, and attention/executive functions.

METHODS

Participants were community-residing older adults (n = 421; mean age = 76.29 ± 6.48; %female = 56.06). FOF was assessed bimonthly through yes/no responses to "do you have a fear of falling?" during the first year of the study. Recurrent status required two or more FOF endorsements. GCF was assessed using Repeatable Battery for the Assessment of Neuropsychological Status (RBANS); composite scores were used to assess memory as well as attention/executive functions. Cognitive measures were administered annually for up to six years.

RESULTS

Stratification of the cohort by FOF status showed that 81 participants reported recurrent FOF, 60 participants endorsed FOF once and 280 participants reported no FOF. Linear mixed effects models revealed that compared to no FOF, recurrent FOF was associated with worse declines in GCF (estimate=-0.03, p=.006), memory (estimate=-0.04, p=.012) and attention/executive functions (estimate=-0.04, p=.006). Comparisons between single-report FOF and no FOF, however, were not significant.

CONCLUSIONS

These findings demonstrate that recurrent but not single-report FOF is a risk factor for cognitive decline in community-residing older adults.

Long Term Implications of Home Healthcare Management on Mortality in Older Adults with Functional Difficulties in the Saudi Community

Background: This study aims to investigate whether certain demographic factors of patients receiving home healthcare (HHC) interventions have any positive impact on mortality. Methods: the study included all patients who were enrolled in the HHC program in a referred medical complex, Jeddah, Saudi Arabia between the years 2017 and 2020 (593 patients). Results: A total of 6548 HHC visits were received during the study period. From the total number of visits, 3592 (54.9%) HHC visits were scheduled in the year 2020 compared to 157 (2.4%) scheduled HHC visits in 2017 (p < 0.001). The most successful HHC visits were provided in 2020 compared with the year 2017 (2193 vs. 132; p < 0.001). The cancelled HHC visits were observed to be the lowest (194) in 2019. Three explanatory variables of mortality [age, having a major diagnosis (diabetes mellitus, cerebrovascular diseases, and bedridden), and having more cancelled visits] made a statistically significant contribution to the logistic regression model after controlling for other variables. Suffering from cerebrovascular diseases and/or bedridden were the strongest predictor of death in patients receiving HHC. Conclusions: During the 2020 pandemic, there was a sharp increase in HHC compared to previous years. Three significant explanatory variables of mortality [age, having a major diagnosis (diabetes mellitus, cerebrovascular diseases, and bedridden), and having more cancelled visits] were reported.

Frailty transitions and cognitive function among South Korean older adults

Frailty is considered a multidimensional geriatric syndrome, manifested by the accumulation of age-associated deficits. The consequences of frailty transitions are still understudied. This study evaluated the influence of frailty transitions on cognitive function in the older adult population. We used data derived from the Korean Longitudinal Study of Aging (KLoSA) (2008–2018) on older adults aged ≥ 65 years. Frailty was assessed using a validated Korean frailty measure known as the frailty instrument (FI), and cognitive function was measured using the Korean version of the Mini-Mental State Examination (K-MMSE). Transitions in frailty and their relationship with cognitive function were investigated using lagged generalized estimating equations (GEE), t-tests, and ANOVA. Respondents who experienced frailty transitions (those with ameliorating frailty), those who developed frailty, and whose frailty remained constant, were more likely to have a lower cognitive function than those who were consistently non-frail. Older age, activities of daily living (ADL) disability, and instrumental ADL disability were more negatively associated with declining cognitive function, especially in the “frail → frail” group. Changes in all individual components of the frailty instrument were significantly associated with impaired cognitive function. The results suggest an association between frailty transitions and cognitive impairment. Over a 2-year span, the remaining frail individuals had the highest rate of cognitive decline in men, while the change from non-frail to frail state in women was significantly associated with the lowest cognitive function values. We recommend early interventions and prevention strategies in older adults to help ameliorate or slow down both frailty and cognitive function decline.

Impact of current or past physical activity level on functional capacities and body composition among elderly people: a cross-sectional analysis from the YMCA study

Background

Physical activity (PA) is recognized as important predictor of healthy aging. However, the influence of the type of voluntary PA as well as age or sex in this relationship is unclear. Thus, we assess the association between current and past PA level and physical performances among voluntary active older adults.

Methods

Functional capacities (timed Up and Go, sit-to-stand, alternate step test, unipodal balance, grip strength, knee extension strength, estimated muscle power and VO2 max) as well as body composition (DXA: total and appendicular lean masses (LM; kg), fat mass (FM; %)) were measured. Current and last 5-years PA level (time spent on total, aerobic, resistance and body & mind activities) were assessed using an interview. Multiple regressions, adjusted on age, sex and BMI, were performed to assess the relationship between current or past PA level and physical performances. Sub-group analysis, according to the sex (men/women) or age (< 65 yrs. vs. ≥65 yrs) were performed.

Results

525 subjects (age:61.7 ± 8.1 yrs.; women:68.9%; BMI:26.4 ± 4.8 kg/m²) were enrolled in this study. After adjustment on confounding factors, total current PA level has positive impact on total FM (β = − 2.09, p = 0004) and balance (β = 0.10; p = 0.05). Moreover, current body & mind activities influence total LBM (β = − 0.22, p = 0.02) and balance (β = 0.17; p = 0.001) whereas resistance activities influence total LBM (β = 0.17; p = 0.05), FM (β = − 0.16; p = 0.04) and sit-to-stand capacities (β = − 0.10; p = 0.05). Globally, these results were more pronounced in women than in men and among people aged over 65 years. Past level of PA has low impact on functional capacities and body composition, regardless of sex. Among people < 65 years, there is no relationship between time spent on total PA and functional capacities or body composition. However, a significant correlation was found between past total PA and balance (r=` 0.19; p = 0.01), alternate-step test (r = 0.24; p = 0.02) and VO2max (r = 0.19; p = 0.02) in people aged over 65 years. More precisely, the past time spent on aerobic and resistance activities influence balance (r = 0.16; p = 0.03 and r = 0.15; p = 0.04, respectively) after 65 yrs. old.

Conclusion

Even if physical activity history has little influence on physical aging process, being active is associated with body composition and functional capacities, especially among women aged 65 years and over.

Glycine and N-acetylcysteine (GlyNAC) supplementation in older adults improves glutathione deficiency, oxidative stress, mitochondrial dysfunction, inflammation, insulin resistance, endothelial dysfunction, genotoxicity, muscle strength, and cognition: Results of a pilot clinical trial

BACKGROUND

Oxidative stress (OxS) and mitochondrial dysfunction are implicated as causative factors for aging. Older adults (OAs) have an increased prevalence of elevated OxS, impaired mitochondrial fuel-oxidation (MFO), elevated inflammation, endothelial dysfunction, insulin resistance, cognitive decline, muscle weakness, and sarcopenia, but contributing mechanisms are unknown, and interventions are limited/lacking. We previously reported that inducing deficiency of the antioxidant tripeptide glutathione (GSH) in young mice results in mitochondrial dysfunction, and that supplementing GlyNAC (combination of glycine and N-acetylcysteine [NAC]) in aged mice improves naturally-occurring GSH deficiency, mitochondrial impairment, OxS, and insulin resistance. This pilot trial in OA was conducted to test the effect of GlyNAC supplementation and withdrawal on intracellular GSH concentrations, OxS, MFO, inflammation, endothelial function, genotoxicity, muscle and glucose metabolism, body composition, strength, and cognition.

METHODS

A 36-week open-label clinical trial was conducted in eight OAs and eight young adults (YAs). After all the participants underwent an initial (pre-supplementation) study, the YAs were released from the study. OAs were studied again after GlyNAC supplementation for 24 weeks, and GlyNAC withdrawal for 12 weeks. Measurements included red-blood cell (RBC) GSH, MFO; plasma biomarkers of OxS, inflammation, endothelial function, glucose, and insulin; gait-speed, grip-strength, 6-min walk test; cognitive tests; genomic-damage; glucose-production and muscle-protein breakdown rates; and body-composition.

RESULTS

GlyNAC supplementation for 24 weeks in OA corrected RBC-GSH deficiency, OxS, and mitochondrial dysfunction; and improved inflammation, endothelial dysfunction, insulin-resistance, genomic-damage, cognition, strength, gait-speed, and exercise capacity; and lowered body-fat and waist-circumference. However, benefits declined after stopping GlyNAC supplementation for 12 weeks.

CONCLUSIONS

GlyNAC supplementation for 24-weeks in OA was well tolerated and lowered OxS, corrected intracellular GSH deficiency and mitochondrial dysfunction, decreased inflammation, insulin-resistance and endothelial dysfunction, and genomic-damage, and improved strength, gait-speed, cognition, and body composition. Supplementing GlyNAC in aging humans could be a simple and viable method to promote health and warrants additional investigation.

"Longing to be independent again" - A qualitative study on older adults' experiences of life after hospitalization

It is important to support older adults' independence after hospitalization and, thus, to increase their perceived quality of life. The present descriptive study took a qualitative approach and aimed to describe older adults' experiences of their life situation after hospital discharge. Fifteen individuals (≥65 years) from two regional hospitals in central Sweden were interviewed between October 2015 and January 2016 in their own home following hospital discharge. The interview data were analyzed using manifest and latent qualitative content analysis. The analysis revealed one theme: "Longing to be independent again" based on four categories: `Dependent on other people and aids´, `Obstacles, impediments and limitations in daily life´, Adapt to the situation´ and `Psychological and physical values´. Understanding older adults' experiences of life after hospitalization is also a prerequisite for being able to provide person-centered care.

Recovery from physical limitations among older Mexican adults

OBJECTIVES

This paper examines the key determinants of the likelihood of recovery from a physical disability among older adults.

METHODS

Data come from the Mexican Health and Aging Study (MHAS), a national sample of adults born in 1951 or earlier, including a baseline survey in 2001 and follow-ups in 2003, 2012 and 2015. At baseline, we divided our sample of older adults aged 60+ by dimensions of physical limitations (ADLs, IADLs, mobility) and classified respondents as having physical limitations in zero, one, two or three dimensions. Each respondent was then categorized as "same", "worse", "improved" or "died" depending on the number of physical dimensions with a limitation in a 2-year span (2001-2003) and again, separately, in a 3-year span (2012-2015). We then used a multinomial logistic regression to analyze the relative risk of transitioning from one category to another.

FINDINGS

Around 21 % of our sample exhibited some recovery in 2003 and around 20 % recovered in 2015. Age, gender, poor self-rated health, depression and some chronic conditions were significant for shifting the relative risk from staying the same to getting worse, dying or even improving.

CONCLUSIONS

Disability from a physical limitation is a reversible and dynamic process. Our results reflect the importance of considering the dimensions of physical ability while analyzing recovery, and illustrate that the presence of a chronic condition or depressive symptoms does not necessarily imply permanent disability.

Do factors across the World Health Organisation's International Classification of Functioning, Disability and Health framework relate to caregiver availability for community-dwelling older adults in Ghana?

Introduction

In Ghana, the care needs of older adults in the later years has become a critical issue given population ageing and increased proportions of older adults with difficulties with functional abilities. However, factors related to caregiver availability is unknown. The purpose of this study was to examine how the World Health Organisation’s International Classification of Functioning, Disability and Health (WHO-ICF) framework relates to caregiver availability for community-dwelling older adults in Ghana. This evidence will strengthen our understanding of the perceived unmet care needs of older adults in Ghana in Africa.

Materials and methods

A hospital-based survey was conducted among 400 consecutively recruited older adult in-patients using a questionnaire at Komfo Anokye Teaching Hospital in southern Ghana. Multivariate logistic regression tested associations between caregiver availability and other factors as related to the WHO-ICF conceptual framework.

Results

Eighty-six per cent of the participants reported having an available caregiver. In the final parsimonious model, the environmental factors were highly related to caregiver availability, seconded by personal factors, and then health conditions. Body function and structure, activity, and participation variables were not statistically significant. Overall, the variables that were associated with caregiver availability were age, being a widow, having a single chronic condition, being hardly understood by friends and family, receiving no neighbourhood support, and having 2–4 children. Interaction existed between being a widow and living as a couple in relation to caregiver availability.

Conclusions

Caregiver availability is associated with variables under the personal, health and environmental components of the WHO-ICF. Increased effort to strengthen the current and future welfare programs, including the health of older adults and their caregivers is relevant.

Age-specific physical and mental health status in Italian patients with hidradenitis suppurativa: a comparison with the general population

Hidradenitis suppurativa (HS) has a considerable impact on quality of life. Despite comparisons of health status between HS patients and the general population have been done, there is a need to make more meaningful comparisons, such as age-specific ones. The objective of the study was to compare age-specific physical and mental health status in Italian patients with HS to that of a representative sample of the Italian general population. We conducted a cross-sectional, observational study on consecutive HS patients. Patients' health status was measured using the 36-item Short Form Health Survey (SF-36) and in the general population using the 12-item version (SF-12). The mean scores of the physical component summary (PCS) and the mental component summary (MCS) from the two instruments were graphically compared in different age categories according to sex and clinical severity. Data were complete for 298 HS patients. Young patients with HS reported a physical and mental health status similar to that of elderly people from the general population. Even HS patients with mild-to-moderate clinical severity had a consistently worse health status than the reference population. In conclusion, HS deeply affects patients' physical and mental status, starting from a very young age. An early intervention is advisable, not only with pharmacological treatment, but also with an appropriate discussion and interaction with the patient to focus on the aspects that would reduce the psychosocial impact of their condition.

Self-rated eyesight and handgrip strength in older adults

BACKGROUND

The aim of this study was to investigate the association between self-rated eyesight and handgrip strength in a large, representative population of older adults.

METHODS

Data were from 7433 older adults (≥52 years) participating in the English Longitudinal Study of Ageing. Linear regression was used to analyze the association between self-rated eyesight and handgrip strength cross-sectionally in 2004/2005, and longitudinally over 4‑year follow-up, adjusting for a range of sociodemographic and health-related variables.

RESULTS

In cross-sectional and prospective models, poor eyesight was strongly associated with lower handgrip strength after adjustment for age, sex, ethnicity, socioeconomic status and body mass index (BMI, cross-sectional B = -1.39 kg, 95% confidence interval, CI -1.84 to -0.94, p < 0.001, prospective B = -0.68 kg, 95% CI -1.14 to -0.22, p = 0.004). The association was attenuated but remained statistically significant when health behaviours were included in the model (cross-sectional B = -0.93 kg, 95% CI -1.42 to -0.44, p < 0.001, prospective B = -0.50, 95% CI -0.99 to -0.02, p = 0.044).

CONCLUSION

Older adults in England with poor self-rated eyesight have lower levels of physical function compared with those with good eyesight. This association can be predominantly explained by differences in age, sex, ethnicity, socioeconomic status, BMI, and health behaviours, as well as chronic conditions, disability and depression.

Cohort Profile: The Precipitating Events Project (PEP Study)

The Precipitating Events Project (PEP Study) is an ongoing longitudinal study of 754 nondisabled community-living persons age 70 years or older who were members of a large health plan in greater New Haven, Connecticut, USA. The study was established to rigorously evaluate the epidemiology of disability in older persons and to elucidate the role of intervening illnesses and injuries on the disabling process. Of the eligible members, 75.2% agreed to participate and were enrolled between March 1998 and October 1999. Participants have completed comprehensive home-based assessments at 18-month intervals and have been interviewed monthly over the phone with a completion rate of 99%. Detailed participant-level data on health care utilization are obtained annually through linkages with Medicare claims. Through June 2019, 702 (93.1%) participants have died after a median of 109 months, while 43 (5.7%) have dropped out of the study after a median of 27 months. Death certificates are available for all decedents. To date, 117 original reports have been published using data from the PEP Study, including many focusing on other high priority areas such as end of life, frailty, depressive symptoms, aging stereotypes, pain, sleep, and methodologic research. The PEP Study welcomes proposals to access data for meritorious analyses from qualified investigators.

Socio-economic and health determinants of transitions to adult dependency in South Korea, 2008-2014

OBJECTIVES

The aim of this study is to identify the determinants of transitions to and possibly back from dependence.

STUDY DESIGN

The Korean Longitudinal Study of Aging, 2006-2014.

METHODS

The transitions between non-dependence and difficulties in activities of daily living -instrumental (IADL) or not (ADL)-are distinguished between stability, deterioration, death, or recovery in multilevel logistic regressions.

RESULTS

Controlling for other covariates, women are more likely to remain without difficulty than men, dependants are more likely out of the labor force or unemployed, city dwellers are more likely dependent. Subjective health helps predict health two years later, as grip power, score of cognition, depression, cardiac and cerebrovascular diseases, and the number of difficulties in IADL (but not in ADL). Dependants with difficulties in IADL reporting no caregiver survive longer but are less likely to recover. Difficulties in ADL overwhelm any other available determinant. The Gompertz-like increase in the death rate with age no longer holds true for ADL dependants. Cardiac and cerebrovascular pathologies and smoking and drinking favor the transition to disability.

CONCLUSIONS

Socio-economic and medical factors identify a multifactorial determination of the risk to dependence and changes in dependence status, controlling for each effect and selection bias.

A Longitudinal Study Examining the Change in Functional Independence Over Time in Elderly Individuals With a Functioning Kidney Transplant

Background:

Functional disability is defined as the need for assistance with self-care tasks.

Objective:

To document changes in functional status over time among older prevalent renal transplant recipients.

Design:

Single center, prospective, follow-up study.

Setting:

Single center, tertiary care transplant center.

Patients:

Patients, with a functioning kidney transplant, aged 65 years or older who underwent assessment of functional status approximately 12 months previously.

Measurements:

Validated tools used included Barthel Index, the Lawton-Brody Scale of Instrumental Activities of Daily Living, the Timed Up and Go test, the Veterans Specific Activity Questionnaire, the Mini-Cog, and dynamometer handgrip strength.

Methods:

Outpatient assessment by a trained observer.

Results:

Of the 82 patients previously studied, 64 (78%) patients participated in the follow-up study (mean age 70.5 ± 4.4 years, 58% male, 55% diabetic). Among those completing functional status measures, 32 (50%) had functional disability at baseline. Over the 1-year period, 11 (17%) of these patients experienced progressive functional decline, 6 (9%) exhibited no change, and 15 (23%) had functional recovery. Eleven patients (17%) initially independent, developed new-onset disability. One of the strongest predictors of progressive functional decline was having 1 or more falls in the previous year.

Limitations:

Assessments were performed only on 2 occasions separated by approximately 1 year.

Conclusions:

Fluctuations in disability states are common among older adults living with renal transplants. Episodes of functional disability may place individuals at higher risk of persistent and/or progressive disability.

The Heterogeneity of Disability Trajectories in Later Life: Dynamics of Activities of Daily Living Performance Among Nursing Home Residents

Objective: This study investigated the variability in activities of daily living (ADL) trajectories among 6,155 nursing home residents using unique and rich observational data. Method: The impairment in ADL performance was considered as a dynamic process in a multi-state framework. Using an innovative mixture model, such states were not defined a priori but inferred from the data. Results: The process of change in functional health differed among residents. We identified four latent regimes: stability or slight deterioration, relevant change, variability, and recovery. Impaired body functions and poor physical performance were main risk factors associated with degradation in functional health. Discussion: The evolution of disability in later life is not completely gradual or homogeneous. Steep deterioration in functional health can be followed by periods of stability or even recovery. The current condition can be used to successfully predict the evolution of ADL allowing to set and target different care priorities and practices.

Functional Impairment and Decline in Middle Age: A Cohort Study

BACKGROUND

Difficulties with daily functioning are common in middle-aged adults. However, little is known about the epidemiology or clinical course of these problems, including the extent to which they share common features with functional impairment in older adults.

OBJECTIVE

To determine the epidemiology and clinical course of functional impairment and decline in middle age.

DESIGN

Cohort study.

SETTING

The Health and Retirement Study.

PARTICIPANTS

6874 community-dwelling adults aged 50 to 56 years who did not have functional impairment at enrollment.

MEASUREMENTS

Impairment in activities of daily living (ADLs), defined as self-reported difficulty performing 1 or more ADLs, assessed every 2 years for a maximum follow-up of 20 years, and impairment in instrumental ADLs (IADLs), defined similarly. Data were analyzed by using multistate models that estimate probabilities of different outcomes.

RESULTS

Impairment in ADLs developed in 22% of participants aged 50 to 64 years, in whom further functional transitions were common. Two years after the initial impairment, 4% (95% CI, 3% to 5%) of participants had died, 9% (CI, 8% to 11%) had further ADL decline, 50% (CI, 48% to 52%) had persistent impairment, and 37% (CI, 35% to 39%) had recovered independence. In the 10 years after the initial impairment, 16% (CI, 14% to 18%) had 1 or more episodes of functional decline and 28% (CI, 26% to 30%) recovered from their initial impairment and remained independent throughout this period. The pattern of findings was similar for IADLs.

LIMITATION

Functional status was self-reported.

CONCLUSION

Functional impairment and decline are common in middle age, as are transitions from impairment to independence and back again. Because functional decline in older adults has similar features, current interventions used for prevention in older adults may hold promise for those in middle age.

PRIMARY FUNDING SOURCE

National Institute on Aging and National Center for Advancing Translational Sciences through the University of California, San Francisco, Clinical and Translational Sciences Institute.

Situation Model for Situation-Aware Assistance of Dementia Patients in Outdoor Mobility

BACKGROUND

Dementia impairs spatial orientation and route planning, thus often affecting the patient's ability to move outdoors and maintain social activities. Situation-aware deliberative assistive technology devices (ATD) can substitute impaired cognitive function in order to maintain one's level of social activity. To build such a system, one needs domain knowledge about the patient's situation and needs. We call this collection of knowledge situation model.

OBJECTIVE

To construct a situation model for the outdoor mobility of people with dementia (PwD). The model serves two purposes: 1) as a knowledge base from which to build an ATD describing the mobility of PwD; and 2) as a codebook for the annotation of the recorded behavior.

METHODS

We perform systematic knowledge elicitation to obtain the relevant knowledge. The OBO Edit tool is used for implementing and validating the situation model. The model is evaluated by using it as a codebook for annotating the behavior of PwD during a mobility study and interrater agreement is computed. In addition, clinical experts perform manual evaluation and curation of the model.

RESULTS

The situation model consists of 101 concepts with 11 relation types between them. The results from the annotation showed substantial overlapping between two annotators (Cohen's kappa of 0.61).

CONCLUSION

The situation model is a first attempt to systematically collect and organize information related to the outdoor mobility of PwD for the purposes of situation-aware assistance. The model is the base for building an ATD able to provide situation-aware assistance and to potentially improve the quality of life of PwD.

Foundations of Activity of Daily Living Trajectories of Older Americans

OBJECTIVES

The disablement process can be viewed conceptually as a progression from disease to impairment to functional limitation and finally disability (frequently operationalized as activity limitation). This article assesses the extent to which early phases of the process are associated with individual-level disability trajectories by age.

METHOD

We use data from seven waves of the Health and Retirement Study, 1998 to 2010, to investigate for individuals aged 65-84 years how baseline sociodemographic characteristics and self-reported disease, pain, and functional limitation (physical, cognitive, or sensory) are related to the dynamics of limitations in activities of daily living (ADLs). Our modeling approach jointly estimates multiperiod trajectories of ADL limitation and mortality and yields estimates of the number of, shapes of, and factors associated with the most common trajectories.

RESULTS

Individual probability of ADL limitation can best be described by three common trajectories. In comparison with disease, pain, and functional limitation, sociodemographic characteristics have weak associations with trajectory group membership. Notably, neither sex nor education is strongly associated with group membership in multivariate models.

DISCUSSION

The analysis confirms the importance of the early phases of the disablement process and their relationships with subsequent trajectories of activity limitation.

Assessment of geriatric syndromes and physical function in people living with HIV

As the number of older adults living with HIV continues to increase, understanding how to incorporate geriatric assessments within HIV care will be critical. Assessment of geriatric syndromes and physical function can be useful tools for HIV clinicians and researchers to help identify the most vulnerable older adults and to better understand the aging process in people living with HIV (PLWH). This review focuses on the assessment of falls, frailty, and physical function, first in the general population of older adults, and includes a specific focus on use of these assessments in older adults living with HIV.

Factors associated with patient activation in an older adult population with functional difficulties

OBJECTIVE

Patient activation, the patient's knowledge, skill, and confidence to manage his or her health, is an important indicator of future health and use of health care resources. Understanding factors associated with patient activation in an older population with functional difficulties may inform care in this population. This study aimed to determine whether patient activation is associated with depression, chronic conditions, family support, difficulties with activities of daily living (ADLs) and instrumental activities of daily living (IADLs), hospitalizations, education, and financial strain.

METHODS

(N=277), We administered surveys measuring patient activation, financial strain, depressive symptoms, family support, and chronic conditions to an older adult population. We tested association through multivariate linear regressions controlling for race, sex, and age.

RESULTS

Patient activation is significantly (p<0.05), positively associated with family support and self-rated overall health, and significantly (p<0.05), negatively associated with depressive symptoms and difficulties with ADLs and IADLs. We found no association between patient activation and financial stress, hospitalizations, and education.

CONCLUSIONS

Older age, depressive symptoms, and difficulties with ADLs and IADLs were associated with decreased patient activation.

PRACTICE IMPLICATIONS

Developing interventions tailored to older adults' level of patient activation has the potential to improve outcomes for this population.

Functional Independence in Late-Life: Maintaining Physical Functioning in Older Adulthood Predicts Daily Life Function after Age 80

BACKGROUND

We examined physical functioning (PF) trajectories (maintaining, slowly declining, and rapidly declining) spanning 15 years in older women aged 65-80 and protective factors that predicted better current levels and less decline in functional independence outcomes after age 80.

METHODS

Women's Health Initiative extension participants who met criteria (enrolled in either the clinical trial or observational study cohort, >80 years at the data release cutoff, PF survey data from initial enrollment to age 80, and functional independence survey data after age 80) were included in these analyses (mean [SD] age = 84.0 [1.4] years; N = 10,478). PF was measured with the SF-36 (mean = 4.9 occasions). Functional independence was measured by self-reported level of dependence in basic and instrumental activities of daily living (ADLs and IADLs) (mean = 3.4 and 3.3 occasions).

RESULTS

Maintaining consistent PF in older adulthood extends functional independence in ADL and IADL in late-life. Protective factors shared by ADL and IADL include maintaining PF over time, self-reported excellent or very good health, no history of hip fracture after age 55, and no history of cardiovascular disease. Better IADL function is uniquely predicted by a body mass index less than 25 and no depression. Less ADL and IADL decline is predicted by better self-reported health, and less IADL decline is uniquely predicted by having no history of hip fracture after age 55.

CONCLUSIONS

Maintaining or improving PF and preventing injury and disease in older adulthood (ages 65-80) has far-reaching implications for improving late-life (after age 80) functional independence.

Common trajectories of physical functioning in the Doetinchem Cohort Study

PURPOSE

to describe common trajectories of physical functioning and their determinants among an adult cohort, followed over a period of 15 years.

METHODS

the study sample consisted of 4,123 participants (initial ages 26-70 years) from the Doetinchem Cohort Study, who participated in three or four measurement cycles. Physical functioning was measured with the Dutch version of the SF-36. Using a group-based modelling strategy, trajectories of physical functioning were determined. Weighted multinomial logistic regression analyses were performed to identify socio-demographic, lifestyle and health characteristics that differentiate between the trajectories at baseline.

RESULTS

five common physical functioning trajectories were distinguished, labelled as 'stable not limited' (27% of the population), 'stable slightly limited' (54%), 'slightly limited substantial deterioration' (7%), 'moderately limited gradual improvement' (9%) and 'stable severely limited' (3%). The characteristics that differentiate between the trajectories with limitations and the trajectory 'stable not limited' were being female, older, physically inactive, overweight or obese, having one or more chronic conditions, poor mental health and poor self-perceived health at baseline. Being younger, physically active, less obese, living with a partner and a good perceived health were characteristics of the trajectory 'moderately limited gradual improvement' compared with 'stable severely limited'.

CONCLUSION

five common trajectories of physical functioning were distinguished in an adult cohort, with most individuals following a stable but slightly limited course of physical functioning. Some early risk indicators were found that in the future might be used to early identify those with limitations in physical functioning.

Factors associated with ADL/IADL disability in community dwelling older adults in the Irish longitudinal study on ageing (TILDA)

PURPOSE

To identify the factors associated with disability across many domains using a large powered sample in the activities of daily living (ADL) and instrumental activities of daily living (IADL).

METHODS

Those aged ≥65 years from the Irish longitudinal study on ageing (TILDA) were included in this cross sectional analysis. Three logistic regression models were used to examine the relationships between 25 health, psychological and sociodemographic variables and difficulties in ADL, IADL and ADL/IADL combined.

RESULTS

The proportion of those reporting combined ADL/IADL difficulties was 18%. More individuals reported difficulty with ADLs (13%) than IADLS (11%). The main model showed that after age, the top three factors associated with difficulty in ADL/IADL combined were pain, taking five or more medications and depression. After age, the factors with the highest impact on ADL disability were pain, taking five or more medications and body mass index (BMI); the factors with the highest impact on IADL were being separated or divorced, living with others (non-spouse) and self-rated memory.

CONCLUSIONS

Awareness of sociodemographics and early interventions for pain and cognitive deficits could reduce ADL/IADL disability and promote successful ageing. Identification of variables that influence ADL/IADLs can be used to inform policy and practice. Implications for rehabilitation After age, pain and taking five or more medications were the strongest factors associated with difficulty in ADL/IADL combined and ADL alone. Practice therefore needs to be cognizant that it is not the disease label but the symptoms of a disease that affect ADL and IADL activities. Given the strong influence of pain on difficulties with ADL and IADL, there is a need for early interventions from a multidisciplinary perspective for pain reduction, control, and self-management. These interventions should include development of pain-coping strategies and exercises to maintain mobility. After age, being separated/divorced or living with non-spouse others are the strongest factors associated with IADL difficulties. Awareness of these social factors can be used to inform support mechanisms, such as development of community services and suitable housing for those with these changing sociodemographics. Unsurprisingly, cognitive impairments were strongly associated with IADL difficulties. Simple cognitive screening assessments could be used for early detection of cognitive changes. In order to maintain optimal cognitive functioning, rehabilitation professionals should facilitate older adults' engagement in activities that are cognitively demanding and socially interactive.

Trajectories of limitations in activities of daily living among older adults in Mexico, 2001-2012

BACKGROUND

Trajectories of disability are an essential component to understand the burden of disability at the societal level. Longitudinal studies, compared to cross-national studies, enable a better analysis of the progression of physical limitations among the elderly. However, information on disability dynamics in developing countries is limited.

OBJECTIVES

This paper examines the changes in activities of daily living (ADLs) in an 11-yr. period in the Mexican elderly population aged 60 or older and identifies how sociodemographic variables alter these trajectories.

METHODS

The data come from the Mexican Health and Aging Study (MHAS), a national sample of adults born in 1951 or earlier, including a baseline survey in 2001 and follow-ups in 2003 and 2012.

RESULTS

The ADL score increased on average by 0.03 for every year respondents aged after 60. In contrast, the ADL score was reduced by 0.06 for every additional year of education.

CONCLUSIONS

Age, gender, and years of education were confirmed to influence the trajectories of ADL limitations. Understanding the patterns of deterioration of functional limitations will help public health policies to better serve the population.

Functional Dependence and Mortality in the International Dialysis Outcomes and Practice Patterns Study (DOPPS)

BACKGROUND

Patients receiving long-term dialysis have among the highest mortality and hospitalization rates. In the nonrenal literature, functional dependence is recognized as a contributor to subsequent disability, recurrent hospitalization, and increased mortality. A higher burden of functional dependence with progressive worsening of kidney function has been observed in several studies, suggesting that functional dependence may contribute to both morbidity and mortality in dialysis patients.

STUDY DESIGN

Prospective cohort study.

SETTING & PARTICIPANTS

7,226 hemodialysis patients from 12 countries in the DOPPS (Dialysis Outcomes and Practice Patterns Study) phase 4 (2009-2011) with self-reported data for functional status.

PREDICTOR

Patients' ability to perform 13 basic and instrumental activities of daily living was summarized to create an overall functional status score (range, 1.25 [most dependent] to 13 [functionally independent]).

OUTCOME

Cox regression was used to estimate the association between functional status and all-cause mortality, adjusting for several demographic and clinical risk factors for mortality. Median follow-up was 17.2 months.

RESULTS

The proportion of patients who could perform each activity of daily living task without assistance ranged from 97% (eating) to 47% (doing housework). 36% of patients could perform all 13 tasks without assistance (functional status = 13), and 14% of patients had high functional dependence (functional status < 8). Functionally independent patients were younger and had many indicators of better health status, including higher quality of life. Compared with functionally independent patients, the adjusted HR for mortality was 2.37 (95% CI, 1.92-2.94) for patients with functional status < 8.

LIMITATIONS

Possible nonresponse bias and residual confounding.

CONCLUSIONS

We found a high burden of functional dependence across all age groups and across all DOPPS countries. When adjusting for several known mortality risk factors, including age, access type, cachexia, and multimorbidity, functional dependence was a strong consistent predictor of mortality.

Sequence of Functional Loss and Recovery in Nursing Homes

PURPOSE OF THE STUDY

This study provides benchmarks for likelihood, number of days until, and sequence of functional decline and recovery.

DESIGN AND METHODS

We analyzed activities of daily living (ADLs) of 296,051 residents in Veteran Affairs nursing homes between January 1, 2000 and October 9, 2012. ADLs were extracted from standard minimum data set assessments. Because of significant overlap between short- and long-stay residents, we did not distinguish between these populations. Twenty-five combinations of ADL deficits described the experience of 84.3% of all residents. A network model described transitions among these 25 combinations. The network was used to calculate the shortest, longest, and maximum likelihood paths using backward induction methodology. Longitudinal data were used to derive a Bayesian network that preserved the sequence of occurrence of 9 ADL deficits.

RESULTS

The majority of residents (57%) followed 4 pathways in loss of function. The most likely sequence, in order of occurrence, was bathing, grooming, walking, dressing, toileting, bowel continence, urinary continence, transferring, and feeding. The other three paths occurred with reversals in the order of dressing/toileting and bowel/urinary continence. ADL impairments persisted without any change for an average of 164 days (SD = 62). Residents recovered partially or completely from a single impairment in 57% of cases over an average of 119 days (SD = 41). Recovery rates declined as residents developed more than 4 impairments.

IMPLICATIONS

Recovery of deficits among those studied followed a relatively predictable path, and although more than half recovered from a single functional deficit, recovery exceeded 100 days suggesting time to recover often occurs over many months.

Formal home-care utilisation by older adults in Ireland: evidence from the Irish Longitudinal Study on Ageing (TILDA)

The aim of this study was to provide a population-based estimate of the utilisation of publicly financed formal home care by older adults in Ireland and to identify the principal characteristics of those utilising formal home care. Data were collected through computer-aided personal interviews from a representative sample of community living older adults in Ireland. The interviews were conducted between 2009 and 2011 as part of the first wave of the Irish Longitudinal Study on Ageing (TILDA). The study is cross-sectional in design and limited to participants aged 65 years and older (n = 3507). Results reveal that 8.2% (95% CI 7.1%-9.3%) of participants utilised publicly financed formal home care in the form of home help and/or personal care. Key determinants of formal home-care utilisation were Instrumental Activity of Daily Living (IADL) difficulty (Adj OR 3.8, 95% CI 2.7-5.3), older age (Adj OR 3.4, 95% CI 2.4-4.8) and living alone (Adj OR 2.6, 95% CI 1.9-3.8). Almost half of those utilising formal care did not self-report an Activity of Daily Living (ADL) difficulty or an IADL difficulty. Government policy aims to reduce the need for long-term residential care by providing formal home care for older adults with low to moderate levels of dependency. This requires an increasing emphasis on personal care provision in the home. No evidence was found in this study to suggest that a shift in emphasis from formal domestic to personal care is taking place in Ireland. The absence of standardised assessment and eligibility criteria are deemed to be barriers to reorientation of the system. From a health services perspective, the current situation is not sustainable into the future and requires a focused policy response.

Aging of skeletal muscle fibers

Aging has become an important topic for scientific research because life expectancy and the number of men and women in older age groups have increased dramatically in the last century. This is true in most countries of the world including the Republic of Korea and the United States. From a rehabilitation perspective, the most important associated issue is a progressive decline in functional capacity and independence. Sarcopenia is partly responsible for this decline. Many changes underlying the loss of muscle mass and force-generating capacity of skeletal muscle can be understood at the cellular and molecular levels. Muscle size and architecture are both altered with advanced adult age. Further, changes in myofibers include impairments in several physiological domains including muscle fiber activation, excitation-contraction coupling, actin-myosin cross-bridge interaction, energy production, and repair and regeneration. A thorough understanding of these alterations can lead to the design of improved preventative and rehabilitative interventions, such as personalized exercise training programs.

Effects of emotionally charged auditory stimulation on gait performance in the elderly: a preliminary study

OBJECTIVES

To evaluate the effect of a novel divided attention task-walking under auditory constraints-on gait performance in older adults and to determine whether this effect was moderated by cognitive status.

DESIGN

Validation cohort.

SETTING

General community.

PARTICIPANTS

Ambulatory older adults without dementia (N=104).

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURES

In this pilot study, we evaluated walking under auditory constraints in 104 older adults who completed 3 pairs of walking trials on a gait mat under 1 of 3 randomly assigned conditions: 1 pair without auditory stimulation and 2 pairs with emotionally charged auditory stimulation with happy or sad sounds.

RESULTS

The mean age of subjects was 80.6±4.9 years, and 63% (n=66) were women. The mean velocity during normal walking was 97.9±20.6cm/s, and the mean cadence was 105.1±9.9 steps/min. The effect of walking under auditory constraints on gait characteristics was analyzed using a 2-factorial analysis of variance with a 1-between factor (cognitively intact and minimal cognitive impairment groups) and a 1-within factor (type of auditory stimuli). In both happy and sad auditory stimulation trials, cognitively intact older adults (n=96) showed an average increase of 2.68cm/s in gait velocity (F1.86,191.71=3.99; P=.02) and an average increase of 2.41 steps/min in cadence (F1.75,180.42=10.12; P<.001) as compared with trials without auditory stimulation. In contrast, older adults with minimal cognitive impairment (Blessed test score, 5-10; n=8) showed an average reduction of 5.45cm/s in gait velocity (F1.87,190.83=5.62; P=.005) and an average reduction of 3.88 steps/min in cadence (F1.79,183.10=8.21; P=.001) under both auditory stimulation conditions. Neither baseline fall history nor performance of activities of daily living accounted for these differences.

CONCLUSIONS

Our results provide preliminary evidence of the differentiating effect of emotionally charged auditory stimuli on gait performance in older individuals with minimal cognitive impairment compared with those without minimal cognitive impairment. A divided attention task using emotionally charged auditory stimuli might be able to elicit compensatory improvement in gait performance in cognitively intact older individuals, but lead to decompensation in those with minimal cognitive impairment. Further investigation is needed to compare gait performance under this task to gait on other dual-task paradigms and to separately examine the effect of physiological aging versus cognitive impairment on gait during walking under auditory constraints.

Restricting back pain and subsequent mobility disability in community-living older persons

OBJECTIVES

To evaluate the relationship between back pain severe enough to restrict activity (restricting back pain) and subsequent mobility disability in community-living older persons.

DESIGN

Prospective cohort study.

SETTING

Greater New Haven, Connecticut.

PARTICIPANTS

Community-living men and women aged 70 and older (n = 709).

MEASUREMENTS

Restricting back pain and mobility disability (defined as needing help with or unable to walk one-quarter of a mile, climb a flight of stairs, or lift and carry 10 pounds) were assessed during monthly telephone interviews for up to 159 months. The association between restricting back pain and subsequent mobility disability was evaluated using a recurrent-events Cox model. Secondary analyses evaluated the association between restricting back pain and mobility disability for two or more consecutive months (persistent mobility disability). Additional analyses were repeated in participants without baseline mobility disability.

RESULTS

The event rate for mobility disability was 7.26 per 100-person months (95% confidence interval (CI) = 6.89-7.64). Mobility disability episodes lasted for a median of 2 months (interquartile range (IQR) 1-4). In a recurrent-event Cox regression analysis, after adjusting for 11 covariates, restricting back pain was strongly associated with mobility disability (hazard ratio (HR) = 3.23, 95% CI = 2.87-3.64). The association was maintained when the outcome was defined as persistent mobility disability (adjusted HR = 3.63, 95% CI = 3.15-4.20) and when participants with baseline mobility disability were omitted (adjusted HR = 3.71, 95% CI = 3.22-4.28).

CONCLUSION

Restricting back pain was strongly associated with mobility disability. Interventions that prevent or ameliorate restricting back pain may be effective for reducing the burden of mobility disability in older persons.

Predicting the risk of physical disability in old age using modifiable mid-life risk factors

BACKGROUND

We aimed to investigate the relationship between potentially modifiable risk factors in middle age and disability after 13 years using the Framingham Offspring Study (FOS). We further aimed to develop a disability risk algorithm to estimate the risk of future disability for those aged 45-65 years.

METHODS

FOS is a longitudinal study. We used examination 5 (1991-1995; 'baseline') and examination 8 (2005-2008; 'follow-up'). We included participants aged between 45-65 years at 'baseline' with complete predictor and outcome measures (n=2031; mean age 53.9 years). Predictors considered were body mass index, smoking, hypertension, diabetes and dyslipidaemia. We used multinomial logistic regression to identify predictors of disability or death.We assessed external validity using Australian data.

RESULTS

By examination 8, 156 participants had disability and 198 had died. Disability was associated with smoking (OR (95% CI) 1.81 (1.18 to 2.78)); obesity (2.95 (1.83 to 4.77)); diabetes 1.96 (1.11 to 3.45) and being female (OR 1.67 (1.13 to 2.45). The model performed moderately well in predicting disability and death in an Australian population. Based on our algorithm, a 45-year-old man/woman with the combined risk factors of obesity, diabetes and smoking has similar likelihood of surviving free of disability to a 65-year-old man/woman without any of the same risk factors.

CONCLUSIONS AND RELEVANCE

The derived risk algorithm allows, for the first time, quantification of the substantial combined impact on future disability of key modifiable risk factors in mid-life. Here we demonstrated the combined impact of obesity, diabetes and smoking to be similar to 20 years of aging.

The prediction of disability by self-reported physical frailty components of the Tilburg Frailty Indicator (TFI)

Disability is an important health outcome for older persons; it is associated with impaired quality of life, future hospitalization, and mortality. Disability also places a high burden on health care professionals and health care systems. Disability is regarded as an adverse outcome of physical frailty. The main objective of this study was to assess the predictive validity of the eight individual self-reported components of the physical frailty subscale of the TFI for activities of daily living (ADL) and instrumental activities of daily living (IADL) disability. This longitudinal study was carried out with a sample of Dutch citizens. At baseline the sample consisted at 429 people aged 65 years and older and a subset of all respondents participated again two and a half years later (N=355, 83% response rate). The respondents completed a web-based questionnaire comprising the TFI and the Groningen Activity Restriction Scale (GARS) for measuring disability. Five components together (unintentional weakness, weakness, poor endurance, slowness, low physical activity), referring to the phenotype of Fried et al., predicted disability, even after controlling for previous disability and other background characteristics. The other three components of the physical frailty subscale of the TFI (poor balance, poor hearing, poor vision) together did not predict disability. Low physical activity predicted both total and ADL disability, and slowness both total and IADL disability. In conclusion, self-report assessment using the physical subscale of the TFI aids the prediction of future ADL and IADL disability in older persons two and a half years later.

Comparison of equipment prescriptions in the toilet/bathroom by occupational therapists using home visits and digital photos, for patients in rehabilitation

BACKGROUND/AIM

Home visits, used by occupational therapists to facilitate independence and enhance safety, are effective but costly and time consuming. This research aims to establish the level of agreement in equipment prescribed by occupational therapists using: digital photographs only, and using home visits and digital photographs, respectively.

METHOD

Quasi-experimental methodological design conducted in private dwellings in the community in Adelaide with rehabilitation patients and their family members. The equipment recommended by occupational therapists for the toilet and bathroom using similar methods (both digital photographs from previous data; n = 5) was compared with equipment recommended using different methods (conventional home visits vs. digital photographs; n = 14).

RESULTS

Percent agreement for equipment prescribed between groups, that is digital only and home visit/photography, respectively, were: 72.5/83.9% for toilet; 87.4/88.3% for bathroom and 83/87% for toilet and bathroom. Variability of agreement in the equipment prescribed showed that some items of equipment were incongruently prescribed, by both methods for toilet and bathroom areas.

CONCLUSION

Using digital photographs taken by family members, patient information, and an equipment list is a reliable method of making accurate equipment prescriptions in the toilet and bathroom areas. To enhance accuracy, in-depth patient information via face-to-face interview and measurements of physical environment should be included.

Functional Disability in Older Adults Maintained on Peritoneal Dialysis Therapy

♦

BACKGROUND

Older in-center hemodialysis patients have a high burden of functional disability. However, little is known about patients on home chronic peritoneal dialysis (PD). As patients opting for home dialysis are expected to play a greater role in their own dialysis care, we hypothesized that a relatively low number of PD patients would require help with basic self-care tasks (ADL) and instrumental activities of daily living (IADL). ♦

METHODS

We used a cross-sectional study design to measure the proportion of patients aged 65 years and older undergoing outpatient PD who needed help with day-to-day activities. Patients living in nursing homes were excluded from the study. Functional dependence in ADL and IADL tasks were measured by the Barthel and Lawton Scales. Physical performance measures used included the timed up-and-go (TUG) test, chair stands and Folstein mini-mental score (MMSE). ♦

RESULTS

A total of 74 of 76 (97%) eligible PD patients participated. Patients had a mean age of 76.2 ± 7.5 years. Thirty-six percent had impaired MMSE scores, 69% were unable to stand from a chair without the use of their arms and 51% had abnormal TUG scores. Only 8 patients (11%) were fully independent for both ADL and IADL activities. Dependence in one or more ADL activity was reported by 64% of participants, while 89% reported dependence in one or more IADL. ♦

CONCLUSIONS

Impaired physical and functional performance is common in older patients maintained on PD. Collaborative geriatric-renal programs may be beneficial within the dialysis community.

Trends in hypertension prevalence, awareness, treatment, and control among US adults 80 years and older, 1988-2010

The authors examined trends in systolic blood pressure (SBP) and diastolic blood pressure (DBP) and the prevalence, awareness, treatment, and control of hypertension in 1988-1994 (n=1164), 1999-2004 (n=1,026), and 2005-2010 (n=1048) among US adults 80 years and older in serial National Health and Nutrition Examination Surveys. Hypertension was defined as SBP ≥140 mm Hg, DBP ≥90 mm Hg, or use of antihypertensive medication. Awareness and treatment were defined by self-report and control as SBP/DBP<140/90 mm Hg. Mean SBP decreased from 147.3 mm Hg to 140.1 mm Hg and mean DBP from 70.2 mm Hg to 59.4 mm Hg between 1988-1994 and 2005-2010. The prevalence, awareness, and treatment of hypertension each increased over time. Controlled hypertension increased from 30.4% in 1988-1994 to 53.1% in 2005-2010. The proportion of patients taking 3 classes of antihypertensive medication increased from 7.0% to 30.9% between 1988-1994 and 2005-2010. Increases in awareness, treatment, and control of hypertension and antihypertensive polypharmacy have been observed among very old US adults.

Factors impacting the household and recreation participation of older adults living in the community

PURPOSE

To identify demographic, physical and psychosocial determinants associated with participation in daily activities of community-dwelling older adults.

METHODS

A cross-sectional design of older adults (≥70 years) from Victoria, Australia, residing in their homes was drawn from a convenience sample. The outcomes were recent participation in household and recreational activities as measured by the Phone-FITT. Explanatory variables included demographics, physical and mental health functioning (Short Form-12 version 2, Geriatric Depression Scale 15). Associations were analyzed through linear regression.

RESULTS

There were 244 participants (60% female), with a mean age of 77.5 years (SD 5.7). Higher levels of depression and fewer falls (during the previous year) were independently associated with restrictions in household participation (p < 0.001, p < 0.001). For recreational participation, higher levels of depression were associated with restricted participation (p < 0.001).

CONCLUSION

Screening for depression should be a key component of health assessments with older adults. Untreated depression may lead to lower participation rates in daily activities potentially resulting in social isolation. Fewer falls and restricted household participation were associated, but no association was observed between falls and recreational participation. Further studies are required to explore this association in more detail. Implications for Rehabilitation Depression is significantly correlated with the level of participation in daily activities for older adults. Health professionals need to screen for depression when working with older adults.

Partially ordered mixed hidden Markov model for the disablement process of older adults

At both the individual and societal levels, the health and economic burden of disability in older adults is enormous in developed countries, including the U.S. Recent studies have revealed that the disablement process in older adults often comprises episodic periods of impaired functioning and periods that are relatively free of disability, amid a secular and natural trend of decline in functioning. Rather than an irreversible, progressive event that is analogous to a chronic disease, disability is better conceptualized and mathematically modeled as states that do not necessarily follow a strict linear order of good-to-bad. Statistical tools, including Markov models, which allow bidirectional transition between states, and random effects models, which allow individual-specific rate of secular decline, are pertinent. In this paper, we propose a mixed effects, multivariate, hidden Markov model to handle partially ordered disability states. The model generalizes the continuation ratio model for ordinal data in the generalized linear model literature and provides a formal framework for testing the effects of risk factors and/or an intervention on the transitions between different disability states. Under a generalization of the proportional odds ratio assumption, the proposed model circumvents the problem of a potentially large number of parameters when the number of states and the number of covariates are substantial. We describe a maximum likelihood method for estimating the partially ordered, mixed effects model and show how the model can be applied to a longitudinal data set that consists of N = 2,903 older adults followed for 10 years in the Health Aging and Body Composition Study. We further statistically test the effects of various risk factors upon the probabilities of transition into various severe disability states. The result can be used to inform geriatric and public health science researchers who study the disablement process.

Declining functional status in older women with a history of breast cancer: implications for women's health nurses

Older breast cancer survivors are at risk for a decline in functional status, which is associated with increased risk for disability, increased health care costs and increased risk of nursing home placement. The comprehensive geriatric assessment is a useful tool for identifying women with a history of breast cancer who are at increased risk for decline in functional status. Use of the comprehensive geriatric assessment will allow nurses to identify functional care needs and develop care plans and interventions that are aimed at maintenance of functional status.