A Risk Scoring System for the Prediction of Functional Deterioration, Institutionalization, and Mortality Among Medicare Beneficiaries

Changes in instrumental activities daily living limitations and their associated factors according to gender in community-residing older adults: A longitudinal cohort study

BACKGROUND

Increases in dependence among older adults cause increases in care needs and social care burden. Instrumental activities of daily living (IADL) are often used to assess the independence of older adults residing in communities. Various factors affect IADL limitations, but few studies confirm gender differences in IADL limitations in older adults. This study explored the changes in incidence of IADL limitations across 14 years and identified the factors associated with IADL limitations according to gender among older adults in Korea.

METHOD

This study uses secondary data analysis with 2006-2020 data from the Korean Longitudinal Study of Aging (KLoSA), a longitudinal cohort study. Among the total 10,254 participants, 1,230 adults aged 65 years and over who met the criteria were included in the final analysis. For each IADL item, a limitation was defined when the response was partial or complete dependence. Multivariate logistic regression was performed to identify the factors (in 2006) associated with IADL limitations in 2020.

RESULTS

The mean age of the participants at baseline was 69.64 years (SD 3.93), and 61.0% of participants were female. Total scores for IADL limitations increased gradually across 14 years in all participants, and observed changes were statistically significant. The top three ranked items of IADL limitations differed according to gender in 2020: the top limitations in men were preparing meals, laundry, and using public transportation, and the top limitations in women were using public transportation, going out, and handling money. Factors associated with total IADL limitations were grip strength in men and age, dementia, fear of fall, and grip strength in women. Factors associated with the top three ranked items of IADL limitations differed according to gender.

CONCLUSION

The incidence of IADL limitations gradually increased in all participants over a 14-year period. In older adults in Korea, gender differences were confirmed in the factors associated with IADL limitations, as well as in the main limited activities. To minimize IADL limitations in community-residing older adults, it is necessary to plan tailored interventions.

Prediction models for functional status in community dwelling older adults: a systematic review

Background

Disability poses a burden for older persons, and is associated with poor outcomes and high societal costs. Prediction models could potentially identify persons who are at risk for disability. An up to date review of such models is missing.

Objective

To identify models developed for the prediction of functional status in community dwelling older persons.

Methods

A systematic review was performed including studies of older persons that developed and/or validated prediction models for the outcome functional status. Medline and EMBASE were searched, and reference lists and prospective citations were screened for additional references. Risk of bias was assessed using the PROBAST-tool. The performance of models was described and summarized, and the use of predictors was collated using the bag-of-words text mining procedure.

Results

Forty-three studies were included and reported 167 evaluations of prediction models. The median c-statistic values for the multivariable development models ranged between 0.65 and 0.76 (minimum = 0.58, maximum = 0.90), and were consistently higher than the values of the validation models for which median c-statistic values ranged between 0.6 and 0.68 (minimum = 0.50, maximum = 0.81). A total of 559 predictors were used in the models. The five predictors most frequently used were gait speed (n = 47), age (n = 38), cognition (n = 27), frailty (n = 24), and gender (n = 22).

Conclusions

No model can be recommended for implementation in practice. However, frailty models appear to be the most promising, because frailty components (e.g. gait speed) and frailty indexes demonstrated good to excellent predictive performance. However, the risk of study bias was high. Substantial improvements can be made in the methodology.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12877-022-03156-7.

Physical and behavioural factors, negative emotion and cognitive function among near-centenarians and centenarians in China

OBJECTIVE

To investigate the association among demographic, physical, behavioural parameters, psychosocial and cognitive function in near-centenarians and centenarians.

METHODS

The present study data originated from the 2014 wave of the largest nationwide longitudinal survey of the population aged 95 and above in China (N = 175). The aim of this study was to systematically identify the relationship among physical and behavioural variables, negative emotions and cognitive function. Cognitive function was evaluated by the modified Mini-Mental State Examination (mMMSE) Chinese version. Structured responses were obtained for the analysis of physical and behavioural factors and negative emotions.

RESULTS

The average age of the sample was 98.78 years (SD = 4.00, range: 95-112 years). The average score of the mMMSE was 20.71 (SD = 3.48), average activities of daily living (ADL) total score was 17.21 (SD = 1.72), average instrumental activities of daily living (IADL) total score was 17.90 (SD = 5.57), and average negative emotion score was 8.77 (SD = 2.69). In the combined multiple linear regression model, the quality of sleep, IADL and negative emotion of centenarians were significantly associated with cognitive function (P < 0.05).

CONCLUSION

The cognitive function of centenarians was significantly associated with the quality of sleep, IADL and negative emotion. Improving physical functioning and social resources can help emotional health and improve the overall cognition of centenarians.