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Shen T, Wang J, Fu Y. Exploring the relationship between home environmental characteristics and restorative effect through neural activities. Front Hum Neurosci 2023; 17:1201559. [PMID: 37799189 PMCID: PMC10548391 DOI: 10.3389/fnhum.2023.1201559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 08/17/2023] [Indexed: 10/07/2023] Open
Abstract
As society and the economy have advanced, the focus of architectural and interior environment design has shifted from practicality to eliciting emotional responses, such as stimulating environments and innovative inclusive designs. Of particular interest is the home environment, as it is best suited for achieving restorative effects, leading to a debate between interior qualities and restorative impact. This study explored the relationships between home characteristics, restorative potential, and neural activities using the Neu-VR. The results of the regression analysis revealed statistically significant relationships between interior properties and restorative potential. We examined each potential characteristic of the home environment that could have a restorative impact and elucidated the environmental characteristics that should be emphasized in residential interior design. These findings contribute evidence-based knowledge for designing therapeutic indoor environments. And combining different restorative potential environments with neural activity, discussed new neuro activities which may predict restorativeness, decoded the new indicators of neuro activity for environmental design.
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Affiliation(s)
- Tao Shen
- College of Design and Innovation, Tongji University, Shanghai, China
| | - JunYao Wang
- Academy of Art and Design, GongQing Institute of Science and Technology, Gongqing City, China
- Integrated Design Studies, Universiti Putra Malaysia, Putrajaya, Malaysia
| | - Yingfan Fu
- School of Arts, Universiti Sains Malaysia, Gelugor, Malaysia
- Arts College, Wuyi University, Nanping, China
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Social Interaction, Lifestyle, and Depressive Status: Mediators in the Longitudinal Relationship between Cognitive Function and Instrumental Activities of Daily Living Disability among Older Adults. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19074235. [PMID: 35409918 PMCID: PMC8998450 DOI: 10.3390/ijerph19074235] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/26/2022] [Revised: 03/29/2022] [Accepted: 03/31/2022] [Indexed: 12/04/2022]
Abstract
(1) Background: Cognitive decline is associated with instrumental activities of daily living (IADL) disability. Intervention targeting the mediators of this association will provide a path to avoid cognition-related IADL disability. (2) Methods: This study used data of wave 2008 (baseline) and wave 2014 of Chinese Longitudinal Healthy Longevity Surveys. Structural equation modeling was conducted to examine the mediating effect of social interaction, lifestyle (fruit and vegetable intake; exercise habits), and depressive status on the association between four baseline cognitive function dimensions (measured by the Chinese version of the Mini-Mental State Examination) and five (2014) IADL dimensions (visiting neighbors, shopping, preparing meals, washing clothes, and taking public transportation). (3) Results: Among 1976 older adults, 29.1% developed IADL disability 6 years later. The cognition−disability association was completely mediated by social interaction (estimate = −0.095, p < 0.001), lifestyle (estimate = −0.086, p < 0.001), and depressive status (estimate = −0.017, p = 0.003). The mediating effects of social interaction (46.3% variances explained) and lifestyle (42.0% variances explained) were both larger than that of depressive status (8.3% variances explained). (4) Conclusions: The development of interventions aimed at improving social interaction, depression, and lifestyle could be of value to prevent cognition-related IADL disability.
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Antiaging Potential of Peptides from Underused Marine Bioresources. Mar Drugs 2021; 19:md19090513. [PMID: 34564175 PMCID: PMC8466736 DOI: 10.3390/md19090513] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Revised: 08/26/2021] [Accepted: 09/07/2021] [Indexed: 12/28/2022] Open
Abstract
Aging is a biological process that occurs under normal conditions and in several chronic degenerative diseases. Bioactive natural peptides have been shown to improve the effects of aging in cell and animal models and in clinical trials. However, few reports delve into the enormous diversity of peptides from marine organisms. This review provides recent information on the antiaging potential of bioactive peptides from underused marine resources, including examples that scavenge free radicals in vitro, inhibit cell apoptosis, prolong the lifespan of fruit flies and Caenorhabditis elegans, suppress aging in mice, and exert protective roles in aging humans. The underlying molecular mechanisms involved, such as upregulation of oxidase activity, inhibition of cell apoptosis and MMP-1 expression, restoring mitochondrial function, and regulating intestinal homeostasis, are also summarized. This work will help highlight the antiaging potential of peptides from underused marine organisms which could be used as antiaging foods and cosmetic ingredients in the near future.
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Deutsch A, Sandel ME, Houtrow AJ, Dillingham TR. Margaret Grace Stineman, MD: Distinguished physiatrist, researcher, and proponent of "empowerment medicine". PM R 2021; 13:1296-1303. [PMID: 34490748 DOI: 10.1002/pmrj.12704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 08/18/2021] [Accepted: 09/01/2021] [Indexed: 11/09/2022]
Affiliation(s)
- Anne Deutsch
- Shirley Ryan AbilityLab, Northwestern University Feinberg School of Medicine, RTI International, Chicago, Illinois, USA
| | - M Elizabeth Sandel
- Department of Physical Medicine and Rehabilitation, University of California/Davis Health System, Sacramento, California, USA
| | - Amy J Houtrow
- Department of Physical Medicine & Rehabilitation, University of Pittsburgh School of Medicine, Philadelphia, Pennsylvania, USA
| | - Timothy R Dillingham
- Department of PM&R, The University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Qin W, Wang Y, Cho S. Neighborhood Social Cohesion, Physical Disorder, and Daily Activity Limitations Among Community-Dwelling Older Adults. Arch Gerontol Geriatr 2020; 93:104295. [PMID: 33242733 DOI: 10.1016/j.archger.2020.104295] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 10/28/2020] [Accepted: 11/08/2020] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Although extensive factors have been examined for limitations in activities of daily living (ADL) and instrumental activities of daily living (IADL), it remains unclear as to the impacts of neighborhood-level factors on ADL and IADL limitations. Thus, we aim to examine whether neighborhood characteristics are predictive of limitations in ADL and IADL. METHODS A total of 7,407 participants were selected from the National Health and Aging Trend Study. We used data from round 1 (2011) to round 8 (2018). Neighborhood characteristics were measured as social cohesion and physical disorder. Daily activity limitations were counted based on the domains of ADL and IADL. Mixed-effects negative binomial regression analyses were performed to estimate the effects of neighborhood features on ADL and IADL limitations. RESULTS Better neighborhood social cohesion significantly predicted less limitations in ADL (incidence rate ratio [IRR] = 0.98, 95% confidence interval [CI] = 0.96 - 0.99) and IADL (IRR=0.96, 95% CI = 0.95 - 0.98). More physical disorder predicted more IADL limitations (IRR=1.04, 95% CI = 1.01 - 1.06), but was not associated with ADL limitations. CONCLUSION Neighborhood social cohesion is essential in enabling older adults to perform both basic self-care activities and more complex tasks, while neighborhood physical disorder is significant to older adults' capability in performing more complex sets of activities so as to age in place. The study findings underscore the importance of improving both social and physical aspects of neighborhood environment to facilitate older adults' daily activity performance.
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Affiliation(s)
- Weidi Qin
- Jack, Joseph, and Morton Mandel School of Applied Social Sciences, Case Western Reserve University.
| | - Yi Wang
- School of Social Work, University of Iowa.
| | - Seungjong Cho
- Department of Sociology, Anthropology, and Social Work, Texas Tech University.
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Umiastowska D, Kupczyk J. Factors Differentiating the Level of Functional Fitness in Polish Seniors. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17051699. [PMID: 32150937 PMCID: PMC7084830 DOI: 10.3390/ijerph17051699] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 02/23/2020] [Accepted: 02/29/2020] [Indexed: 12/13/2022]
Abstract
In this study, functional fitness is defined as the level of independence and self-sufficiency of an elderly person, which facilitates leading an independent life, without the need for assistance from other people. A decrease in functional fitness among older adults is influenced by a variety of factors. In addition to changes occurring in the human body in accordance with the laws of ontogenetic development, they can also be analyzed in terms of somatic parameters and the age of the subjects. The aim of this research was to find the factors differentiating the level of functional fitness of older adults. It involved 509 people divided into a group of people involved in regular physical activity and an inactive group. The Fullerton Functional Fitness Test was used to measure the level of physical fitness, and anthropometric measurements (body weight and height) were also performed. The level of functional fitness of Polish seniors was compared with the American standards established by R. E. Rikli and C. J. Jones. The results of our research confirm a higher level of functional fitness in active older adults, both women and men. In this group, BMI-(Body Mass Index is a measure of body fat based on height and weight) showed a greater correlation with shoulder girdle and back muscles strength, complex coordination, balance, agility, and endurance in women than in men. Finally, the surveyed Polish seniors exhibited a higher level of functional fitness than their American peers.
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Affiliation(s)
- Danuta Umiastowska
- Faculty of Physical Culture and Health, Institute of Physical Culture Sciences, University of Szczecin, 71-521 Szczecin, Poland
- Correspondence:
| | - Joanna Kupczyk
- Faculty of Tourism and Health Sciences, The Jacob of Paradies University, 66-400 Gorzow Wielkopolski, Poland;
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Abstract
South Africa represents one of the most rapidly aging countries in sub-Saharan Africa with a rising burden of age-related psychological morbidities. Despite having one of the highest human development scores in the region, the country faces serious poverty and food insecurity related challenges. Previous studies have shown a positive association between food insecurity and poor mental health among the adult population, however there is no systematic evidence on this association among the elderly population in an African setting. In the present study, we aimed to address this research gap by analyzing cross-sectional data (n = 931) on the over-50 population (>50 years) from the SAGE (Study on global AGEing and adult health) Well-Being of Older People Study (WOPS) of the World Health Organization, conducted between 2010 and 2013. The outcome variable was perceived depression and the explanatory variables included several sociodemographic factors including self-reported food insecurity. The independent associations between the outcome and explanatory variables were measured using multivariable regression analysis. Results showed that close to a quarter of the population (22.6%, 95% CI = 21.4, 24.7) reported having depression in the last 12 months, with the percentage being markedly higher among women (71.4%). In the multivariable regression analysis, self-reported food insecurity was found to be the strongest predictor of depression among both sexes. For instance, severe food insecurity increased the odds of depression by 4.805 [3.325, 7.911] times among men and by 4.115 [2.030, 8.341] times among women. Based on the present findings, it is suggested that national food security programs focus on promoting food security among the elderly population in an effort to improve their mental health status. Nonetheless, the data were cross-sectional and the associations can’t imply causality.
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Bernal OA, McClintock HF, Kurichi JE, Kwong PL, Xie D, Streim JE, Pezzin LE, Bogner HR. Patient Satisfaction and Perceived Quality of Care Among Younger Medicare Beneficiaries According to Activity Limitation Stages. Arch Phys Med Rehabil 2019; 100:289-299. [PMID: 30316959 DOI: 10.1016/j.apmr.2018.09.114] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Revised: 07/19/2018] [Accepted: 09/02/2018] [Indexed: 10/28/2022]
Abstract
OBJECTIVE To examine the association between activity limitation stages and patient satisfaction and perceived quality of medical care among younger Medicare beneficiaries. DESIGN Cross-sectional study. SETTING Medicare Current Beneficiary Survey (MCBS) for calendar years 2001-2011. PARTICIPANTS A population-based sample (N=9323) of Medicare beneficiaries <65 years of age living in the community. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES MCBS questions were categorized under 5 patient satisfaction and perceived quality dimensions: care coordination and quality, access barriers, technical skills of primary care physician (PCP), interpersonal skills of PCP, and quality of information provided by PCP. Persons were classified into an activity limitation stage (0-IV) which was derived from self-reported difficulty performing activities of daily living (ADL) and instrumental activities of daily living (IADL). RESULTS Compared to beneficiaries with no limitations at ADL stage 0, the adjusted odds ratios (95% confidence intervals) for stage I (mild) to stage IV (complete) for satisfaction with access barriers ranged from 0.62 (0.53-0.72) at stage I to a minimum of 0.31 (0.22-0.43) at stage IV. Similarly, compared to beneficiaries at IADL stage 0, satisfaction with access barriers ranged from 0.66 (0.55-0.79) at stage I to a minimum of 0.36 (0.26-0.51) at stage IV. Satisfaction with care coordination and quality and perceived quality of medical care were not associated with activity limitation stages. CONCLUSIONS Younger Medicare beneficiaries with disabilities reported decreased satisfaction with access to medical care, highlighting the need to improve access to health care and human services and to enhance workforce capacity to meet the needs of this patient population.
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Affiliation(s)
- Olivia A Bernal
- Center for Public Health Initiatives, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Heather F McClintock
- Department of Public Health, College of Health Sciences, Arcadia University, Glenside, PA
| | - Jibby E Kurichi
- Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Pui L Kwong
- Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Dawei Xie
- Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Joel E Streim
- Geriatric Psychiatry Section of the Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania and VISN 4 Mental Illness Research Education and Clinical Center, Philadelphia VA Medical Center, Philadelphia, PA
| | - Liliana E Pezzin
- Department of Medicine, Medical College of Wisconsin, Milwaukee, WI
| | - Hillary R Bogner
- Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA; Department of Family Medicine and Community Health, Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.
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Salman Roghani R, Delbari A, Asadi-Lari M, Rashedi V, Lökk J. Neuropathic Pain Prevalence of Older Adults in an Urban Area of Iran: A Population-Based Study. PAIN RESEARCH AND TREATMENT 2019; 2019:9015695. [PMID: 30719350 PMCID: PMC6334371 DOI: 10.1155/2019/9015695] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Revised: 11/02/2018] [Accepted: 11/22/2018] [Indexed: 11/17/2022]
Abstract
BACKGROUND Pain prevalence would increase as the population grows older, but the exact prevalence rate is not apparent in Iran. OBJECTIVES This study, therefore, set out to reveal the prevalence of pain, especially neuropathic type and explore its associated comorbidities among Iranian older adults in a large urban population-based survey. METHODS 5326 older people, aged ≥ 60 years, were randomly chosen by a multistage, cluster sampling method. The selected people then were interviewed by using the following instruments: a standard questionnaire about pain, questions of interview part of Douleur Neuropathique 4 Questions (DN4) and its comorbidities, GHQ-28, and a sociodemographic checklist. Descriptive statistics and multiple regression analysis were conducted to analyze the gathered data. RESULTS The average of the participants' age was 68.92 ± 7.02 years. Of 5326 participants, 2529 (47.5%) of participants were male. About one-third of this population had chronic pain. Chronic neuropathic pain prevalence was 13.7% and nociceptive in 30%. Knee pain (20.6%) and feet dysesthesia (7.8%) were the most common sites of nociceptive and neuropathic pain, respectively. Results of multiple regression analysis revealed that the major comorbidities of chronic pain were osteoporosis, disability, diabetes mellitus, and stroke. Neuropathic pain experiences were significantly associated with GHQ-28 scores (t=-11.42, P<0.001). CONCLUSIONS In addition to neuropathic pain, other subtypes of pain prevalence and the comorbidities are determined in the community-dwelling elder adults. This study highlights the importance of neuropathic pain and its adverse consequences and can be used to manage this populations' needs in Iran effectively.
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Affiliation(s)
- Reza Salman Roghani
- Department of Neurobiology, Care Sciences and Society, Division of Clinical Geriatrics, Karolinska Institute, Stockholm, Sweden
- Physical Medicine and Rehabilitation Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Ahmad Delbari
- Department of Neurobiology, Care Sciences and Society, Division of Clinical Geriatrics, Karolinska Institute, Stockholm, Sweden
- Iranian Research Center on Aging, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Mohsen Asadi-Lari
- Department of Epidemiology, School of Public Health, Oncopathology Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Vahid Rashedi
- School of Behavioral Sciences and Mental Health (Tehran Institute of Psychiatry), Iran University of Medical Sciences, Tehran, Iran
| | - Johan Lökk
- Department of Neurobiology, Care Sciences and Society, Division of Clinical Geriatrics, Karolinska Institute, Stockholm, Sweden
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Gulley SP, Rasch EK, Bethell CD, Carle AC, Druss BG, Houtrow AJ, Reichard A, Chan L. At the intersection of chronic disease, disability and health services research: A scoping literature review. Disabil Health J 2018; 11:192-203. [PMID: 29396271 PMCID: PMC5869152 DOI: 10.1016/j.dhjo.2017.12.012] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2017] [Revised: 12/23/2017] [Accepted: 12/27/2017] [Indexed: 01/14/2023]
Abstract
BACKGROUND There is a concerted effort underway to evaluate and reform our nation's approach to the health of people with ongoing or elevated needs for care, particularly persons with chronic conditions and/or disabilities. OBJECTIVE This literature review characterizes the current state of knowledge on the measurement of chronic disease and disability in population-based health services research on working age adults (age 18-64). METHODS Scoping review methods were used to scan the health services research literature published since the year 2000, including medline, psycINFO and manual searches. The guiding question was: "How are chronic conditions and disability defined and measured in studies of healthcare access, quality, utilization or cost?" RESULTS Fifty-five studies met the stated inclusion criteria. Chronic conditions were variously defined by brief lists of conditions, broader criteria-based lists, two or more (multiple) chronic conditions, or other constructs. Disability was generally assessed through ADLs/IADLs, functional limitations, activity limitations or program eligibility. A smaller subset of studies used information from both domains to identify a study population or to stratify it by subgroup. CONCLUSIONS There remains a divide in this literature between studies that rely upon diagnostically-oriented measures and studies that instead rely on functional, activity or other constructs of disability to identify the population of interest. This leads to wide ranging differences in population prevalence and outcome estimates. However, there is also a growing effort to develop methods that account for the overlap between chronic disease and disability and to "segment" this heterogeneous population into policy or practice relevant subgroups.
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Affiliation(s)
- Stephen P Gulley
- The Heller School for Social Policy and Management, Brandeis University, Waltham, MA, USA; National Institutes of Health, Clinical Research Center, Rehabilitation Medicine Department, Bethesda, MD, USA.
| | - Elizabeth K Rasch
- National Institutes of Health, Clinical Research Center, Rehabilitation Medicine Department, Bethesda, MD, USA
| | | | - Adam C Carle
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | | | - Amy J Houtrow
- University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | | | - Leighton Chan
- National Institutes of Health, Clinical Research Center, Rehabilitation Medicine Department, Bethesda, MD, USA
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Clari M, Ivziku D, Casciaro R, Matarese M. The Unmet Needs of People with Chronic Obstructive Pulmonary Disease: A Systematic Review of Qualitative Findings. COPD 2018; 15:79-88. [PMID: 29308932 DOI: 10.1080/15412555.2017.1417373] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
The complexity of chronic obstructive pulmonary disease (COPD) can negatively impact the lives of people with the condition and compromise their capacity to take care of their needs. Unmet needs can then lead to significant morbidity, unpleasant emotional experiences and a poor quality of life; thus this systematic review aimed to identify, evaluate and synthesise the qualitative literature on the unmet needs of people with COPD. A qualitative meta-synthesis was performed according to the Joanna Briggs Institute method. A systematic search of five databases was conducted, searching for articles published from January 1995 to May 2017. Eight papers were identified. Two researchers extracted the data and independently assessed their quality. The total sample of people with COPD included was 108. Nine categories were derived from 49 findings, and aggregated into three synthesised findings: (1) people with COPD have unmet needs regarding information about the disease; (2) people with COPD have unmet physical, emotional and social needs, due to the disease symptoms and treatments; and (3) people with COPD have unmet care needs. This review showed qualitative evidence regarding the dimensions in which people with COPD express their unmet needs. The needs that are mainly unsatisfied include physical, psychosocial, informational and practical aspects, as well as the need for healthcare professional care. A global approach, which includes the areas identified by our findings, could lead to an improvement in the care of people with COPD and could improve the self-care management of those individuals who do not correctly identify their needs.
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Affiliation(s)
- Marco Clari
- a Department of Biomedicine and Prevention , University of Rome 'Tor Vergata', Rome , Italy
| | - Dhurata Ivziku
- a Department of Biomedicine and Prevention , University of Rome 'Tor Vergata', Rome , Italy
| | | | - Maria Matarese
- c Research Unit of Nursing Science , Campus Bio-Medico University of Rome , Rome , Italy
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Abstract
ABSTRACTUnderstanding the nature and extent of unmet need for social care among older people is a critical policy priority in the United Kingdom and beyond, as national governments juggle the provision of adequate social care for a growing older population with competing funding priorities. Several factors can heighten the experience of unmet need among older people, for instance their family environment, and their health and socio-economic status. This paper contributes empirical evidence on the patterns of unmet need for social care among older people in England today, focusing on the individual characteristics associated with experiencing unmet need in relation to mobility tasks, activities of daily living (ADLs) and instrumental activities of daily living (IADLs). The results show that about 55 per cent of older individuals with an ADL difficulty had unmet need, compared to 24 per cent of those with an IADL difficulty and 80 per cent of those with a mobility difficulty. Characteristics reflecting greater vulnerability were more strongly associated with the risk of experiencing unmet need for ADLs, and such vulnerability was greater for particular ADLs (e.g. bathing), and for a higher number of ADLs. The findings reaffirm the complexity of conceptualising and empirically investigating unmet need in later life, and add to our understanding of the challenges of providing adequate and appropriate social care to older people.
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Bal S, Kurichi JE, Kwong PL, Xie D, Hennessy S, Na L, Pezzin LE, Streim JE, Bogner HR. Presence of Vision Impairment and Risk of Hospitalization among Elderly Medicare Beneficiaries. Ophthalmic Epidemiol 2017; 24:364-370. [PMID: 28346032 DOI: 10.1080/09286586.2017.1296961] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
PURPOSE To examine the association between vision impairment and all-cause hospitalization among elderly Medicare beneficiaries. METHODS A population-based study (N = 22,681) of community-dwelling Medicare beneficiaries aged 65 years and older who participated in the Medicare Current Beneficiary Survey for the years 2001-2007. Beneficiaries were classified into self-reported presence of vision impairment versus no vision impairment. Inpatient hospitalizations were identified using Medicare claims data. A multivariable Cox proportional hazard model examined the association between presence of vision impairment and time to first hospitalization within 3 years of survey entry after adjusting for sociodemographics, comorbidities, hearing impairment, and activity limitation stages derived from difficulty performing the activities of daily living. RESULTS Medicare beneficiaries who self-reported the presence of vision impairment were significantly more likely to be hospitalized over 3 years compared to beneficiaries without vision impairment even after adjustment for potentially influential covariates (hazard ratio = 1.14 and 95% confidence interval: 1.05-1.23). CONCLUSIONS Medicare beneficiaries with self-reported vision impairment were at higher risk of hospitalization during a 3-year period. Further research may identify reasons that are amenable to policy interventions.
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Affiliation(s)
- Sila Bal
- a Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania , Philadelphia , PA , USA
| | - Jibby E Kurichi
- a Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania , Philadelphia , PA , USA
| | - Pui L Kwong
- a Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania , Philadelphia , PA , USA
| | - Dawei Xie
- a Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania , Philadelphia , PA , USA
| | - Sean Hennessy
- a Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania , Philadelphia , PA , USA.,b Center for Pharmacoepidemiology Research and Training, Perelman School of Medicine, University of Pennsylvania , Philadelphia , PA , USA
| | - Ling Na
- a Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania , Philadelphia , PA , USA
| | - Liliana E Pezzin
- c Department of Medicine , Medical College of Wisconsin , Milwaukee , WI , USA
| | - Joel E Streim
- d Geriatric Psychiatry Section of the Department of Psychiatry , Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, and VISN 4 Mental Illness Research, Education and Clinical Center (MIRECC), Corporal Michael J. Crescenz VA Medical Center , Philadelphia , PA , USA
| | - Hillary R Bogner
- a Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania , Philadelphia , PA , USA.,e Department of Family Medicine and Community Health, Perelman School of Medicine , University of Pennsylvania , Philadelphia , PA , USA
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Na L, Streim JE. Psychosocial Well-Being Associated With Activity of Daily Living Stages Among Community-Dwelling Older Adults. Gerontol Geriatr Med 2017; 3:2333721417700011. [PMID: 28540343 PMCID: PMC5433668 DOI: 10.1177/2333721417700011] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2016] [Revised: 01/02/2017] [Accepted: 02/14/2017] [Indexed: 11/28/2022] Open
Abstract
Objectives: Activity of daily living (ADL) stages demonstrated ordered associations with risk of chronic conditions, hospitalization, nursing home use, and mortality among community-living elderly. This article explores the association of stages with psychosocial well-being. We hypothesized that higher ADL stages (greater ADL limitation) are associated with more restricted social networks, less perceived social support, greater social isolation, and poorer mental health. Methods: Cross-sectional data from the National Social Life, Health, and Aging Project (N = 3,002) were analyzed in regression models and latent factor models. Results: Although ADL stages had a nearly monotonic relationship with most mental health measures (e.g., Center for Epidemiologic Studies Depression Scale [CES-D]), only the complete limitation stage (Stage IV) showed significant disadvantage in the majority of social network measures. Discussion: The study may aid clinicians and policy makers to better understand the social and mental health needs of older adults at different ADL stages and provide well-planned social and mental health care.
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Affiliation(s)
- Ling Na
- Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA
| | - Joel E Streim
- Geriatric Psychiatry Section, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Bleijenberg N, Zuithoff NPA, Smith AK, de Wit NJ, Schuurmans MJ. Disability in the Individual ADL, IADL, and Mobility among Older Adults: A Prospective Cohort Study. J Nutr Health Aging 2017; 21:897-903. [PMID: 28972242 DOI: 10.1007/s12603-017-0891-6] [Citation(s) in RCA: 60] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To examine the risk of disability in 15 individual ADL, IADL, and mobility in older adults by age; and to assess the association of multimorbidity, gender, and education with disability. DESIGN AND SETTING A prospective cohort study. The sample included 805 community-dwelling older people aged 60+ living in the Netherlands. MEASUREMENTS Disability was assessed using the Katz-15 Index of Independence in Basic Activities of Daily Living (ADL), Instrumental Activities of Daily Living (IADL) and one mobility item. Disability in any of these activities was defined as the inability to perform the activity without assistance. The risk of disability by age for each individual ADL, IADL, and for mobility was assessed using Generalized mixed models. RESULTS Disability in activities as household tasks, traveling, shopping, and continence had the highest risk and increased rapidly with age. The risk traveling disability among people aged 65 with two comorbidities increase from 9% to 37% at age 85. Disability in using the telephone, managing medications, finances, transferring, and toileting, had a very low risk and hardly increased with age. Compared to those without chronic conditions, those with ≥ 3 chronic conditions had a 3 to 5 times higher risk of developing disability. Males had a higher risk of disability in managing medication (P=0.005), and preparing meals (P=0.019), whereas females had a higher risk of disability with traveling (P=0.001). No association between education and disability on the individual ADL, IADL, and mobility was observed. CONCLUSIONS Older adults were mostly disabled in physical related activities, whereas disability in more cognitive related activities was less often experienced. The impact of multimorbidity on disability in each activity was substantial, while education was not.
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Affiliation(s)
- N Bleijenberg
- Nienke Bleijenberg, RN, PhD. Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht Str. 6.131 P.O. Box 85500, 3508 GA Utrecht, The Netherlands. Telephone: +31(0) 88 75 68094; Fax: +31 (088) 75 680 99.
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Zhou Y, Xu Q, Dong Y, Zhu S, Song S, Sun S. Supplementation of Mussel Peptides Reduces aging Phenotype, Lipid Deposition and Oxidative Stress in D-Galactose-Induce Aging Mice. J Nutr Health Aging 2017; 21:1314-1320. [PMID: 29188895 DOI: 10.1007/s12603-016-0862-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVES Aging is associated with glucose and lipid metabolism disorder. We aimed to examine the effects of mussel peptides on protecting against aging by regulating glucose and lipid metabolism. METHODS For the aging model, d-galactose (200 mg/kg) was administered subcutaneously to 8-month-old mice for 8 weeks. Mussel peptides (1,000 mg/kg) were simultaneously administered by intragastric gavage. The glucose and lipid metabolism profiles, aging phenotype and peroxisome proliferator-activated receptors (PPARs) expression in the liver and adipose tissue of ICR mice were measured. RESULTS D-galactose-treated mice showed pronounced fat deposition and impaired glucose and lipid homeostasis, along with increased oxidative damage and aging. Mussel peptides improved metabolic status by reducing serum glucose and triglyceride levels, insulin resistance and hepatic free fatty acid, as well as enhancing serum high-density lipoprotein (HDL) level and hepatic glycogen content, accompanied with amelioration of aging phenotype and fat deposition. Moreover, mussel peptides ameliorated oxidative stress in aged liver tissues and promoted expression of peroxisome proliferator activated receptors alpha (PPARα) and gamma (PPARγ) in liver and adipose tissues. CONCLUSIONS These results indicate that mussel peptides protect against lipid metabolic disorders associated with aging via maintaining oxidative stress homeostasis and elevated expression levels of PPARs.
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Affiliation(s)
- Y Zhou
- Ying Dong, Jiangsu University, China,
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Na L, Pan Q, Xie D, Kurichi JE, Streim JE, Bogner HR, Saliba D, Hennessy S. Activity Limitation Stages Are Associated With Risk of Hospitalization Among Medicare Beneficiaries. PM R 2016; 9:433-443. [PMID: 27664405 DOI: 10.1016/j.pmrj.2016.09.008] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2016] [Revised: 08/21/2016] [Accepted: 09/12/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND Activity limitation stages based on activities of daily living (ADLs) and instrumental activities of daily living (IADLs) are associated with 3-year mortality in elderly Medicare beneficiaries, yet their associations with hospitalization risk in this population have not been studied. OBJECTIVE To examine the independent association of activity limitation stages with risk of hospitalization within a year among Medicare beneficiaries aged 65 years and older. DESIGN Cohort study. SETTING Community. PARTICIPANTS A total of 9447 community-dwelling elderly Medicare beneficiaries from the Medicare Current Beneficiary Survey for years 2005-2009. METHODS Stages were derived for ADLs and IADLs separately. Associations of stages with time to first hospitalization and time to recurrent hospitalizations within a year were assessed with Cox proportional hazards models, with which we accounted for baseline sociodemographics, smoking status, comorbidities, and the year of survey entry. MAIN OUTCOMES Time to first hospitalization and time to recurrent hospitalizations within 1 year. PRINCIPLE FINDINGS The adjusted risk of first hospitalization increased with greater activity limitation stages (except stage III). The hazard ratios (95% confidence intervals) for ADL stages I-IV compared with stage 0 (no limitations) were 1.49 (1.36-1.63), 1.61 (1.44-1.80), 1.54 (1.35-1.76), and 2.06 (1.61-2.63), respectively. The pattern for IADL stages was similar. For recurrent hospitalizations, activity limitation stages were associated with the risk of the first hospitalization but not with subsequent hospitalizations. CONCLUSION Activity limitation stages are associated with the risk of first hospitalization in the subsequent year among elderly Medicare beneficiaries. Stages capture clinically interpretable profiles of ADL and IADL functionality and describe preserved functions and activity limitation in an aggregated measure. Stage can inform interventions to ameliorate disability and thus reduce the risk of a subsequent hospitalization in this population. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Ling Na
- Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA(∗)
| | - Qiang Pan
- Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA(†)
| | - Dawei Xie
- Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA(‡)
| | - Jibby E Kurichi
- Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA(§)
| | - Joel E Streim
- Geriatric Psychiatry Section of the Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA(¶)
| | - Hillary R Bogner
- Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA(‖)
| | - Debra Saliba
- U.S. Department of Veterans Affairs, Geriatrics Research Education and Clinical Center, Los Angeles, CA; Borun Center, UCLA Department of Medicine, University of California, Los Angeles, CA; RAND, Santa Monica, CA(#)
| | - Sean Hennessy
- Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia; Center for Pharmacoepidemiology Research and Training, University of Pennsylvania, 803 Blockley Hall, 423 Guardian Drive, Philadelphia, PA 19104-6021(∗∗).
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Bogner HR, de Vries McClintock HF, Kurichi JE, Kwong PL, Xie D, Hennessy S, Streim JE, Stineman MG. Patient Satisfaction and Prognosis for Functional Improvement and Deterioration, Institutionalization, and Death Among Medicare Beneficiaries Over 2 Years. Arch Phys Med Rehabil 2016; 98:1-10. [PMID: 27590442 DOI: 10.1016/j.apmr.2016.07.028] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2016] [Accepted: 07/19/2016] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To examine how patient satisfaction with care coordination and quality and access to medical care influence functional improvement or deterioration (activity limitation stage transitions), institutionalization, or death among older adults. DESIGN National representative sample with 2-year follow-up. SETTING Medicare Current Beneficiary Survey from calendar years 2001 to 2008. PARTICIPANTS Community-dwelling adults (N=23,470) aged ≥65 years followed for 2 years. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES A multinomial logistic regression model taking into account the complex survey design was used to examine the association between patient satisfaction with care coordination and quality and patient satisfaction with access to medical care and activities of daily living (ADL) stage transitions, institutionalization, or death after 2 years, adjusting for baseline socioeconomics and health-related characteristics. RESULTS Out of 23,470 Medicare beneficiaries, 14,979 (63.8% weighted) remained stable in ADL stage, 2508 (10.7% weighted) improved, 3210 (13.3% weighted) deteriorated, 582 (2.5% weighted) were institutionalized, and 2281 (9.7% weighted) died. Beneficiaries who were in the top quartile of satisfaction with care coordination and quality were less likely to be institutionalized (adjusted relative risk ratio [RRR], .68; 95% confidence interval [CI], .54-.86). Beneficiaries who were in the top quartile of satisfaction with access to medical care were less likely to functionally deteriorate (adjusted RRR, .87; 95% CI, .79-.97), be institutionalized (adjusted RRR, .72; 95% CI, .56-.92), or die (adjusted RRR, .86; 95% CI, .75-.98). CONCLUSIONS Knowledge of patient satisfaction with medical care and risk of functional deterioration may be helpful for monitoring and addressing disability-related health care disparities and the effect of ongoing policy changes among Medicare beneficiaries.
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Affiliation(s)
- Hillary R Bogner
- Department of Family Medicine and Community Health, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA; Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.
| | - Heather F de Vries McClintock
- Department of Family Medicine and Community Health, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA; Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Jibby E Kurichi
- Department of Family Medicine and Community Health, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Pui L Kwong
- Department of Family Medicine and Community Health, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Dawei Xie
- Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Sean Hennessy
- Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA; Center for Pharmacoepidemiology Research and Training, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Joel E Streim
- Geriatric Psychiatry Section of the Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA; Veterans Integrated Service Network 4 Mental Illness Research, Education and Clinical Center, Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, PA
| | - Margaret G Stineman
- Department of Physical Medicine and Rehabilitation, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
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Schüssler-Fiorenza Rose SM, Stineman MG, Pan Q, Bogner H, Kurichi JE, Streim JE, Xie D. Potentially Avoidable Hospitalizations among People at Different Activity of Daily Living Limitation Stages. Health Serv Res 2016; 52:132-155. [PMID: 26990312 DOI: 10.1111/1475-6773.12484] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE To determine whether higher activity of daily living (ADL) limitation stages are associated with increased risk of hospitalization, particularly for ambulatory care sensitive (ACS) conditions. DATA SOURCE Secondary data analysis, including 8,815 beneficiaries from 2005 to 2006 Medicare Current Beneficiary Survey (MCBS). STUDY DESIGN ADL limitation stages (0-IV) were determined at the end of 2005. Hospitalization rates were calculated for 2006 and age adjusted using direct standardization. Multivariate negative binomial regression, adjusting for baseline demographic and health characteristics, with the outcome hospitalization count was performed to estimate the adjusted rate ratio of ACS and non-ACS hospitalizations for beneficiaries with ADL stages > 0 compared to beneficiaries without limitations. DATA COLLECTION Baseline ADL stage and health conditions were assessed using 2005 MCBS data and count of hospitalization determined using 2006 MCBS data. PRINCIPAL FINDINGS Referenced to stage 0, the adjusted rate ratios (95 percent confidence interval) for stage I to stage IV ranged from 1.9 (1.4-2.5) to 4.1 (2.2-7.8) for ACS hospitalizations compared with from 1.6 (1.3-1.9) to 1.8 (1.4-2.5) for non-ACS hospitalizations. CONCLUSIONS Hospitalization rates for ACS conditions increased more dramatically with ADL limitation stage than did rates for non-ACS conditions. Adults with ADL limitations appear particularly vulnerable to potentially preventable hospitalizations for conditions typically manageable in ambulatory settings.
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Affiliation(s)
- Sophia Miryam Schüssler-Fiorenza Rose
- Department of Veterans Affairs Palo Alto Health Care System, Spinal Cord Injury and Disorders Center, Palo Alto, CA.,Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA
| | - Margaret G Stineman
- Department of Physical Medicine and Rehabilitation, University of Pennsylvania, Philadelphia, PA.,Perelman School of Medicine University of Pennsylvania, Philadelphia, PA
| | - Qiang Pan
- Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, PA
| | - Hillary Bogner
- Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, PA
| | - Jibby E Kurichi
- Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, PA
| | - Joel E Streim
- Department of Psychiatry, University of Pennsylvania, Philadelphia, PA.,Mental Illness Research Education and Clinical Center Philadelphia Veterans Affairs Medical Center, Philadelphia, PA
| | - Dawei Xie
- Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, PA
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Ward BW, Ridolfo H, Creamer L, Gray C. The 1994-1995 National Health Interview Survey on Disability (NHIS-D): A Bibliography of 20 Years of Research. REVIEW OF DISABILITY STUDIES 2015; 11:1-22. [PMID: 26640424 PMCID: PMC4666019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
The 1994-1995 National Health Interview Survey on Disability (NHIS-D) has been one of the most unique and important data sources for studying disability, impairment, and health in the United States. In celebration of the NHIS-D's twenty-year anniversary, we created an extensive bibliography (n=212) of research that has used these data.
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Affiliation(s)
- Brian W Ward
- Division of Health Interview Statistics, National Center for Health Statistics
| | - Heather Ridolfo
- National Agricultural Statistics Service, U.S. Department of Agriculture
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Bogner HR, de Vries McClintock HF, Hennessy S, Kurichi JE, Streim JE, Xie D, Pezzin LE, Kwong PL, Stineman MG. Patient Satisfaction and Perceived Quality of Care Among Older Adults According to Activity Limitation Stages. Arch Phys Med Rehabil 2015; 96:1810-9. [PMID: 26119464 PMCID: PMC4758213 DOI: 10.1016/j.apmr.2015.06.005] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2015] [Revised: 05/14/2015] [Accepted: 06/02/2015] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To examine whether patient satisfaction and perceived quality of medical care are related to stages of activity limitations among older adults. DESIGN Cross-sectional study. SETTING Medicare Current Beneficiary Survey (MCBS) for calendar years 2001 to 2011. PARTICIPANTS A population-based sample (N=42,584) of persons aged ≥65 years living in the community. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES MCBS questions were categorized under 5 patient satisfaction and perceived quality dimensions: care coordination and quality, access barriers, technical skills of primary care physicians, interpersonal skills of primary care physicians, and quality of information provided by primary care physicians. Persons were classified into a stage of activity limitation (0-IV) derived from self-reported difficulty levels performing activities of daily living (ADL) and instrumental ADL. RESULTS Compared with older beneficiaries with no limitations at ADL stage 0, the adjusted odds ratios (ORs) for stage I (mild) to stage III (severe) for satisfaction with care coordination and quality ranged from .85 (95% confidence interval [CI], .80-.92) to .79 (95% CI, .70-.89). Compared with ADL stage 0, satisfaction with access barriers ranged from OR=.81 (95% CI, .76-.87) at stage I to a minimum of OR=.67 (95% CI, .59-.76) at stage III. Similarly, compared with older beneficiaries at ADL stage 0, perceived quality of the technical skills of their primary care physician ranged from OR=.87 (95% CI, .82-.94) at stage I to a minimum of OR=.81 (95% CI, .72-.91) at stage III. CONCLUSIONS Medicare beneficiaries at higher stages of activity limitation, although not necessarily the highest stage of activity limitation, reported less satisfaction with medical care.
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Affiliation(s)
- Hillary R Bogner
- Department of Family Medicine and Community Health, University of Pennsylvania, Philadelphia, PA; Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.
| | - Heather F de Vries McClintock
- Department of Family Medicine and Community Health, University of Pennsylvania, Philadelphia, PA; Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Sean Hennessy
- Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA; Center for Pharmacoepidemiology Research and Training, University of Pennsylvania, Philadelphia, PA
| | - Jibby E Kurichi
- Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Joel E Streim
- Geriatric Psychiatry Section of the Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA; VISN 4 Mental Illness Research Education and Clinical Center, Philadelphia VA Medical Center, Philadelphia, PA
| | - Dawei Xie
- Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Liliana E Pezzin
- Department of Medicine, Medical College of Wisconsin, Milwaukee, WI
| | - Pui L Kwong
- Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Margaret G Stineman
- Department of Physical Medicine and Rehabilitation, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
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Hennessy S, Kurichi JE, Pan Q, Streim JE, Bogner HR, Xie D, Stineman MG. Disability Stage is an Independent Risk Factor for Mortality in Medicare Beneficiaries Aged 65 Years and Older. PM R 2015; 7:1215-1225. [PMID: 26003869 DOI: 10.1016/j.pmrj.2015.05.014] [Citation(s) in RCA: 68] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2015] [Revised: 05/11/2015] [Accepted: 05/14/2015] [Indexed: 11/28/2022]
Abstract
BACKGROUND Stages of activity limitation based on activities of daily living (ADLs) and instrumental activities of daily living (IADLs) have been found to predict mortality in persons aged 70 years and older but have not been examined in Medicare beneficiaries aged 65 years and older using data that are routinely collected. OBJECTIVE To examine the association between functional stages based on items of ADLs and IADLs with 3-year mortality in Medicare beneficiaries aged 65 years and older, accounting for baseline sociodemographics, health status, smoking, subjective health, and psychological well-being. DESIGN A cohort study using the Medicare Current Beneficiary Survey (MCBS) and associated health care utilization data. SETTING Community administered survey. PARTICIPANTS The study included 9698 Medicare beneficiaries aged 65 years and older who participated in the MCBS in 2005-2007. MAIN OUTCOME MEASURES Death within 3 years of cohort entry. RESULTS The overall mortality rate was 3.6 per 100 person years, and 3-year cumulative mortality was 10.3%. Unadjusted 3-year mortality was monotonically associated with both ADL stage and IADL stage. Adjusted 3-year mortality was associated with ADL and IADL stages, except that in some models the hazard ratio for stage III (which includes persons with atypical activity limitation patterns) was numerically lower than that for stage II. CONCLUSION We found nearly monotonic relationships between ADL and IADL stage and adjusted 3-year mortality. These findings could aid in the development of population health approaches and metrics for evaluating the success of alternative economic, social, or health policies on the longevity of older adults with activity limitations.
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Affiliation(s)
- Sean Hennessy
- Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, 803 Blockley Hall, 423 Guardian Dr, Philadelphia, PA 19104-6021.,Center for Pharmacoepidemiology Research and Training, University of Pennsylvania, Philadelphia, PA
| | - Jibby E Kurichi
- Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Qiang Pan
- Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Joel E Streim
- Geriatric Psychiatry Section of the Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.,VISN 4 Mental Illness Research Education and Clinical Center, Philadelphia VA Medical Center, Philadelphia, PA
| | - Hillary R Bogner
- Department of Family Medicine and Community Health, University of Pennsylvania, Philadelphia, PA
| | - Dawei Xie
- Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Margaret G Stineman
- Department of Physical Medicine and Rehabilitation, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
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Bates BE, Xie D, Kwong PL, Kurichi JE, Cowper Ripley D, Davenport C, Vogel WB, Stineman MG. Development and Validation of Prognostic Indices for Recovery of Physical Functioning Following Stroke: Part 1. PM R 2015; 7:685-698. [PMID: 25633632 DOI: 10.1016/j.pmrj.2015.01.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2014] [Revised: 01/21/2015] [Accepted: 01/22/2015] [Indexed: 01/04/2023]
Abstract
OBJECTIVE To develop a prognostic index using Functional Independence Measure grades and stages that would enable clinicians to determine the likelihood of achieving a level of minimum assistance with physical functioning after a stroke. Grades define varying levels of physical function, and stages define varying levels of cognitive functioning. DESIGN Retrospective cohort study. SETTING Veterans Affairs Medical Centers throughout the United States. PARTICIPANTS Veterans with a diagnosis of a new stroke discharged between October 1, 2006, and September 30, 2008, who were below physical grade IV (requiring minimal assistance) at initial rehabilitation assessment. MAIN OUTCOME MEASURE Achievement of physical grade IV or above at final rehabilitation assessment. RESULTS Physical grade IV was reached by 25.8% of participants who were initially below this grade. Seven variables remained independently predictive of physical grade IV after adjustment. These variables were assigned the following points: age, ≤69 years = 2, 70-79 years = 1, ≥80 years = 0; initial physical grade, I = 0, II = 3, III = 4; initial cognitive stage, I or II = 0, III = 2, IV or V = 3, VI or VII = 4; absence of renal failure = 1; no serious nutritional compromise = 3; the type of rehabilitation services received, consultative = 0, comprehensive = 4; and recovery time between admission and discharge physical grade assessment, 1-2 days = 0, 3-7 days = 4, and ≥8 days = 5. The area under the receiver operating characteristic curve was 0.84 and 0.83 for the point system in the derivation and validation cohorts, respectively. The Hosmer-Lemeshow statistic was not significant (P = .93) in the derivation cohort, indicating that the regression model demonstrated adequate fit. The proportions of patients recovered to physical grade IV in the first (score ≥9), second (score = 10-12), third (score = 13-15), and fourth (score >15) score quartiles were 2.72%, 11.38%, 28.96%, and 60.34%, respectively. CONCLUSION By using a simple tool, clinicians can forecast the likelihood of recovery to or above the physical grade IV benchmark by the conclusion of rehabilitation services during the acute stroke hospitalization.
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Affiliation(s)
- Barbara E Bates
- Physical Medicine and Rehabilitation, Samuel S. Stratton Veterans Affairs Medical Center, 113 Holland Ave, Albany, NY 12208.,Physical Medicine and Rehabilitation, Albany Medical College, Albany, NY
| | - Dawei Xie
- Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, PA
| | - Pui L Kwong
- Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, PA
| | - Jibby E Kurichi
- Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, PA
| | - Diane Cowper Ripley
- VA Center for Innovation on Disability and Rehabilitation Research, North Florida/South Georgia Veterans Health System, Gainesville, FL
| | - Claire Davenport
- Physical Medicine and Rehabilitation, Albany Medical College, Albany, NY
| | - W Bruce Vogel
- VA Center for Innovation on Disability and Rehabilitation Research, North Florida/South Georgia Veterans Health System, Gainesville, FL.,Department of Health Outcomes and Policy, University of Florida, College of Medicine, Gainesville, FL
| | - Margaret G Stineman
- Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, PA.,Department of Physical Medicine and Rehabilitation, University of Pennsylvania, Philadelphia, PA
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Hsu B, Cumming RG, Naganathan V, Blyth FM, Le Couteur DG, Seibel MJ, Waite LM, Handelsman DJ. Longitudinal relationships of circulating reproductive hormone with functional disability, muscle mass, and strength in community-dwelling older men: the Concord Health and Ageing in Men project. J Clin Endocrinol Metab 2014; 99:3310-8. [PMID: 24628559 DOI: 10.1210/jc.2014-1124] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
CONTEXT The relationship between functional disability and reproductive hormones and whether it is mediated by muscle mass and strength in older men are unclear. OBJECTIVES The objective of the study was to identify the relationships between hormones and change in functional disability over a 2-year follow-up and to examine whether muscle mass and strength explain any of the observed relationships. DESIGN, SETTING, AND PARTICIPANTS A total of 1318 men aged 70 years and older from the Concord Health and Ageing in Men Project study were assessed at both baseline and 2-year follow-up. T, DHT, estradiol (E2), and estrone (E1) were measured by liquid chromatography-tandem mass spectrometry and SHBG, LH, and FSH by immunoassay. OUTCOME MEASURES Functional disability was measured by basic Activities of Daily Living scale at both time points. Grip and quadricep strength were measured using dynamometers and lean (muscle) mass was determined by dual X-ray absorptiometry. RESULTS All hormones were significantly associated with functional decline in univariate analyses. Only T, E2, E1, and calculated free T remained associated in multivariate analyses. Men in the lowest T quartile (vs the highest quartile) had an increased risk functional decline (odds ratio 1.96, 95% confidence interval 1.01-3.82). Similar associations were observed in E2, E1, and calculated free T. When muscle variables were added into the multivariate model, the associations between these hormones and functional decline were no longer statistically significant. CONCLUSION Low T, E2, and E1 were significantly associated with prospective functional decline over 2 years. This relationship was no longer significant when muscle mass or strength were added, suggesting that the hormonal associations are mediated through their sequential effect on muscle mass and strength.
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Affiliation(s)
- Benjumin Hsu
- School of Public Health (B.H., R.G.C.), University of Sydney, Sydney 2006, New South Wales, Australia; Centre of Education and Research on Ageing (B.H., R.G.C., V.N., F.M.B., D.G.L.C., L.M.W.) and ANZAC Research Institute (R.G.C., D.G.L.C, M.J.S., D.J.H.), University of Sydney and Concord Hospital, Sydney 2139, New South Wales, Australia
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Lee JH, Kim SJ, Lam J, Kim S, Nakagawa S, Yoo JW. The effects of shared situational awareness on functional and hospital outcomes of hospitalized older adults with heart failure. J Multidiscip Healthc 2014; 7:259-65. [PMID: 25061316 PMCID: PMC4085298 DOI: 10.2147/jmdh.s62269] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Functional decline of hospitalized older adults is common and triggers health care expenditures. Physical therapy can retard the functional decline that occurs during hospitalization. This study aims to examine whether shared situational awareness (SSA) intervention may enhance the benefits of physical therapy for hospitalized older persons with a common diagnosis, heart failure. METHOD An SSA intervention that involved daily multidisciplinary meetings was applied to the care of functionally declining older adults admitted to the medicine floor for heart failure. Covariates were matched between the intervention group (n=473) and control group (n=475). Both intervention and control groups received physical therapy for ≥0.5 hours per day. The following three outcomes were compared between groups: 1) disability, 2) transition to skilled nursing facility (SNF, post-acute care setting), and 3) 30-day readmission rate. RESULTS Disability was lower in the intervention group (28%) than in the control group (37%) (relative risk [RR] =0.74; 95% confidence interval [CI], 0.35-0.97; P=0.026), and transition to SNF was lower in the intervention group (22%) than in the control group (30%) (RR =0.77; 95% CI, 0.39-0.98; P=0.032). The 30-day readmission rate did not significantly differ between the two groups. CONCLUSION SSA intervention enhanced the benefits of physical therapy for functionally declining older adults. When applied to older adults with heart failure in the form of daily multidisciplinary meetings, SSA intervention improved functional outcomes and reduced transfer to SNFs after hospitalization.
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Affiliation(s)
- Joo H Lee
- Department of Media and Communication, Hanyang University College of Social Sciences, Seoul, Korea
| | - Sun J Kim
- Department of Public Health, Yonsei University College of Medicine, Seoul, Korea ; Institute of Health Services Research, Yonsei University College of Medicine, Seoul, Korea
| | - Julia Lam
- University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Sulgi Kim
- Department of Epidemiology and Biostatistics, Case Western Reserve University, Cleveland, OH, USA
| | - Shunichi Nakagawa
- Department of Medicine, Columbia University College of Physicians and Surgeons, New York, NY, USA
| | - Ji W Yoo
- Center for Senior Health and Longevity, Aurora Health Care, Milwaukee, WI, USA ; Department of Medicine, University of Wisconsin School of Medicine and Public Health, Milwaukee, WI, USA
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Hermsen LA, Leone SS, Smalbrugge M, Dekker J, van der Horst HE. Frequency, severity and determinants of functional limitations in older adults with joint pain and comorbidity: Results of a cross-sectional study. Arch Gerontol Geriatr 2014; 59:98-106. [DOI: 10.1016/j.archger.2014.02.006] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2013] [Revised: 02/13/2014] [Accepted: 02/20/2014] [Indexed: 10/25/2022]
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Stineman MG, Streim JE, Pan Q, Kurichi JE, Schüssler-Fiorenza Rose SM, Xie D. Activity Limitation Stages empirically derived for Activities of Daily Living (ADL) and Instrumental ADL in the U.S. Adult community-dwelling Medicare population. PM R 2014; 6:976-87; quiz 987. [PMID: 24798263 DOI: 10.1016/j.pmrj.2014.05.001] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2013] [Revised: 04/23/2014] [Accepted: 05/01/2014] [Indexed: 11/30/2022]
Abstract
BACKGROUND Stages quantify severity like conventional measures but further specify the activities that people are still able to perform without difficulty. OBJECTIVE To develop Activity Limitation Stages for defining and monitoring groups of adult community-dwelling Medicare beneficiaries. DESIGN Cross-sectional. SETTING Community. PARTICIPANTS There were 14,670 respondents to the 2006 Medicare Current Beneficiary Survey. METHODS Stages were empirically derived for the Activities of Daily Living (ADLs) and the Instrumental Activities of Daily Living (IADLs) by profiling the distribution of performance difficulties as reported by beneficiaries or their proxies. Stage prevalence estimates were determined, and associations with demographic and health variables were examined for all community-dwelling Medicare beneficiaries. MAIN OUTCOME MEASUREMENTS ADL and IADL stage prevalence. RESULTS Stages (0-IV) define 5 groups across the separate ADL and IADL domains according to hierarchically organized profiles of retained abilities and difficulties. For example, at ADL-I, people are guaranteed to be able to eat, toilet, dress, and bathe/shower without difficulty, whereas they experience limitations getting in and out of bed or chairs and/or difficulties walking. In 2006, an estimated 6.0, 2.9, 2.2, and 0.5 million beneficiaries had mild (ADL-I), moderate (ADL-II), severe (ADL-III), and complete (ADL-IV) difficulties, respectively, with estimates for IADL stages even higher. ADL and IADL stages showed expected associations with age and health-related concepts, supporting construct validity. Stages showed the strongest associations with conditions that impair cognition. CONCLUSIONS Stages as aggregate measures reveal the ADLs and IADLs that people are still able to do without difficulty, along with those activities in which they report having difficulty, consequently emphasizing how groups of people with difficulties can still participate in their own lives. Over the coming decades, stages applied to populations served by vertically integrated clinical practices could facilitate large-scale planning, with the goal of maximizing personal autonomy among groups of community-dwelling people with disabilities.
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Affiliation(s)
- Margaret G Stineman
- Department of Biostatistics and Epidemiology, The Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA; and Department of Physical Medicine and Rehabilitation, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA∗
| | - Joel E Streim
- Geriatric Psychiatry Section of the Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA; and VISN 4 Mental Illness Research Education & Clinical Center, Philadelphia Veterans Affairs Medical Center, Philadelphia, PA†
| | - Qiang Pan
- Department of Biostatistics and Epidemiology, The Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA‡
| | - Jibby E Kurichi
- Department of Biostatistics and Epidemiology, The Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA; 423 Guardian Drive, 907 Blockley Hall, Philadelphia, PA 19104-6021§.
| | - Sophia Miryam Schüssler-Fiorenza Rose
- Mental Illness Research Education & Clinical Center, Philadelphia Veterans Affairs Medical Center, Philadelphia, PA; and VA Healthcare System Palo Alto, Spinal Cord Injury Service‖
| | - Dawei Xie
- Department of Biostatistics and Epidemiology, Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA¶
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Liu Y, Croft JB, Anderson LA, Wheaton AG, Presley-Cantrell LR, Ford ES. The association of chronic obstructive pulmonary disease, disability, engagement in social activities, and mortality among US adults aged 70 years or older, 1994-2006. Int J Chron Obstruct Pulmon Dis 2014; 9:75-83. [PMID: 24477269 PMCID: PMC3896280 DOI: 10.2147/copd.s53676] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
PURPOSE To assess associations among chronic obstructive pulmonary disease (COPD), disability as measured by activities of daily living (ADL) and instrumental ADL (IADL), engagement in social activities, and death among elderly noninstitutionalized US residents. MATERIALS AND METHODS A nationally representative sample of 9,415 adults who were aged ≥70 years and responded to the Second Supplement on Aging survey in 1994-1996 and mortality follow-up study through 2006 were assessed. Multiple logistic regression analyses were performed to assess the risk of all-cause mortality in participants with COPD after accounting for age, sex, race/ethnicity, and smoking status. RESULTS At baseline, approximately 9.6% of study participants reported having COPD. Compared with participants without COPD, those with COPD were significantly more likely (P<0.05) to have difficulty with at least one ADL (44.3% versus [vs] 27.5%) and with at least one IADL (59.9% vs 40.2%), significantly less likely to be engaged in social activities (32.6% vs 26.3%), and significantly more likely to die by 2006 (70.7% vs 60.4%; adjusted risk ratio 1.15, P<0.05). The association between COPD and risk for death was moderately attenuated by disability status. CONCLUSION COPD is positively associated with disability and mortality risk among US adults aged ≥70 years. The significant relationship between COPD and mortality risk was moderately attenuated, but was not completely explained by stages of ADL and IADL limitations and social activities.
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Affiliation(s)
- Yong Liu
- Epidemiology and Surveillance Branch, CDC and Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Janet B Croft
- Epidemiology and Surveillance Branch, CDC and Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Lynda A Anderson
- Healthy Aging Program, Division of Population Health, CDC and Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Anne G Wheaton
- Epidemiology and Surveillance Branch, CDC and Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Letitia R Presley-Cantrell
- Program Development and Services Management, Division of Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Earl S Ford
- Epidemiology and Surveillance Branch, CDC and Rollins School of Public Health, Emory University, Atlanta, GA, USA
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Ghinescu M, Olaroiu M, van Dijk JP, Olteanu T, van den Heuvel WJA. Health status of independently living older adults in Romania. Geriatr Gerontol Int 2013; 14:926-33. [PMID: 24299334 DOI: 10.1111/ggi.12199] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/17/2013] [Indexed: 12/01/2022]
Abstract
AIM Aging is affecting health care all over Europe, but it is expected to have a much greater impact in Eastern Europe. Reliable data on various indicators of health of older adults in Eastern Europe are lacking. The objectives of the present study were to describe the health of older Romanian adults, and to examine its relationship with sociodemographic, psychological and social factors. METHODS This cross-sectional study used a stratified sample of 600 independent-living older Romanian adults from the great metropolitan area of Bucharest; 549 citizens aged ≥ 65 years participated. Data were collected by a mailed questionnaire and interviews. Measurements included self-rated health, the number of chronic conditions, the Short Form-20, the Eysenck Personality Questionnaire and Social support. RESULTS Romanian older adults rate their health as "fair". On average, they report three chronic conditions. They more frequently have problems in executing daily activities as compared with older adults from other European countries. Three components of health are identified: independent functioning, suffering from chronic diseases and psychological health. Regression analysis shows that age, education and social support are related to each component, and neuroticism and extraversion to two components of health. CONCLUSIONS A comparison with international data shows various indicators of health of older Romanian adults to be relatively worse. The three identified components of health offer opportunities for an integrated approach to deal with the health care needs of older citizens.
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Affiliation(s)
- Minerva Ghinescu
- Department of Primary Health Care, Titu Maiorescu University, Bucharest, Romania
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Gerrard P. Prognosis for Functional Deterioration and Functional Improvement in Late Life Among Community-Dwelling Older Persons. PM R 2013; 5:372-3. [DOI: 10.1016/j.pmrj.2013.03.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2013] [Accepted: 03/28/2013] [Indexed: 10/26/2022]
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Stineman MG, Zhang G, Kurichi JE, Zhang Z, Streim JE, Pan Q, Xie D. Prognosis for functional deterioration and functional improvement in late life among community-dwelling persons. PM R 2013; 5:360-71. [PMID: 23454447 DOI: 10.1016/j.pmrj.2013.02.008] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2012] [Revised: 01/30/2013] [Accepted: 02/21/2013] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To examine how health-related, socioeconomic, and environmental factors combine to influence the onset of activity of daily living (ADL) limitations or prognosis for death or further functional deterioration or improvement among elderly people. DESIGN A national representative sample with 2-year follow-up. SETTING Community-dwelling people. PARTICIPANTS Included were 9447 persons (≥70 years of age) in the United States from the Second Longitudinal Study of Aging who were interviewed in 1994, 1995, or 1996. METHODS Self- or proxy-reported health conditions, ADLs expressed as 5 stages describing severity and pattern of limitations, and other baseline characteristics were obtained. A multinomial logistic regression model was used to predict stage transitions. Because of incomplete follow-up (17.7% of baseline sample), primary analyses were determined by multiple imputation to address potential bias associated with loss to follow-up. MAIN OUTCOME MEASUREMENT ADL stage transitions in 2 years (death, deteriorated, stable, and improved ADL function). RESULTS In the imputed-case analysis, the percentages for those who died, deteriorated, were stable, and improved were 12.6%, 32.7%, 48.4%, and 6.2%, respectively. Persons at a mild stage of ADL limitation were most likely to deteriorate further. Persons at advanced stages were most likely to die. Married people and high school graduates had a lower likelihood of deterioration. The risk of mortality and functional deterioration increased with age. Certain conditions, such as diabetes, were associated both with mortality and functional deterioration; other conditions, such as cancer, were associated with mortality only, and arthritis was associated only with functional deterioration. CONCLUSIONS Although overlap occurs, different clinical traits are associated with mortality, functional deterioration, and functional improvement. ADL stages might aid physical medicine and rehabilitation clinicians and researchers in developing and monitoring disability management strategies targeted to maintaining and enhancing self-care among community-dwelling older people.
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Affiliation(s)
- Margaret G Stineman
- Department of Biostatistics and Epidemiology, Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, and Department of Physical Medicine and Rehabilitation, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
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den Ouden MEM, Schuurmans MJ, Mueller-Schotte S, van der Schouw YT. Identification of high-risk individuals for the development of disability in activities of daily living. A ten-year follow-up study. Exp Gerontol 2013; 48:437-43. [PMID: 23403381 DOI: 10.1016/j.exger.2013.02.002] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2012] [Revised: 01/16/2013] [Accepted: 02/03/2013] [Indexed: 11/18/2022]
Abstract
Independence in activities of daily living (ADL) is important in an aging population. ADL disability is a multifactorial problem, therefore a multifactorial approach is needed in the prediction of ADL disability. Our objective is to identify predictors for the development of ADL disability over a course of ten years in middle-aged and older persons. In a prospective cohort study, 478 middle-aged and older persons (61.2 years, range 40-78 years) without ADL disability at baseline were included. ADL disability was measured using the Katz-questionnaire. We included the following candidate predictors: number of chronic diseases, MMSE, Short Physical Performance Battery, leg strength, handgrip strength, physical activity, cholesterol/HDL ratio, BMI, pulse wave velocity, the degree of urbanization, age, gender and socioeconomic status. Associations between candidate predictors and ADL disability were examined using Poisson regression analysis. Performance of the prediction model was assessed with calibration and discrimination measures. The number of chronic diseases, muscle strength, age, gender and socioeconomic status were predictors of ADL disability at ten-year follow-up. The model showed a good calibration and discrimination (c-statistic: 0.83) between persons who will and will not develop ADL disability. In conclusion, the present study showed that using a multifactorial prediction model - based on easily and readily available measurements - individuals who are at high risk of developing ADL disability could be identified. The prediction model could be used as a screening tool to identify which persons most likely benefit from preventive strategies and interventions.
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Schüssler-Fiorenza CM, Xie D, Pan Q, Stineman MG. Comparison of complex versus simple activity of daily living staging: validation of simple stages. Arch Phys Med Rehabil 2013; 94:1320-7. [PMID: 23313353 DOI: 10.1016/j.apmr.2012.11.046] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2012] [Revised: 11/16/2012] [Accepted: 11/28/2012] [Indexed: 10/27/2022]
Abstract
OBJECTIVE To compare activities of daily living (ADL) staging based on 2-level responses to ADL difficulty questions (simple ADL stages) with ADL staging based on 4-level ADL question responses (complex ADL stages). DESIGN Analysis of the Second Longitudinal Study of Aging, a prospective cohort study, using descriptive statistics and logistic regression. SETTING Participants' homes. PARTICIPANTS Community-dwelling persons (N=9447) aged ≥70 years in 1994. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES (1) Agreement and face validity: baseline simple ADL stage; (2) construct validity: baseline health, difficulty, and need characteristics; (3) prognostic comparison (determined at the Wave 2 interview): primary-nursing home use and/or death; secondary-death. RESULTS The systems showed good agreement (κ=.75). The simple ADL stages stratified people into distinct groups and reflected the expected stepwise increases from stage 0 to stage IV in health and need characteristics, such as the prevalence of home-related challenges (2.9%-84.5%) and perceived need for home modifications (2.1%-33.6%). In comparing the prognostic ability using the primary outcome, the complex system model demonstrated slightly increased discrimination between milder stages and a slightly higher C statistic (.666 vs .664). CONCLUSIONS Although complex staging appears slightly better at classifying people into distinct prognostic strata with respect to nursing home use and/or death at Wave 2, simple ADL stages demonstrate strong, clinically relevant associations with health and need characteristics.
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Factors favoring a degradation or an improvement in activities of daily living (ADL) performance among nursing home (NH) residents: A survival analysis. Arch Gerontol Geriatr 2013; 56:250-7. [DOI: 10.1016/j.archger.2012.09.001] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2012] [Revised: 09/06/2012] [Accepted: 09/07/2012] [Indexed: 11/19/2022]
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Physical functioning is related to both an impaired physical ability and ADL disability: A ten year follow-up study in middle-aged and older persons. Maturitas 2013; 74:89-94. [DOI: 10.1016/j.maturitas.2012.10.011] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2012] [Revised: 10/12/2012] [Accepted: 10/19/2012] [Indexed: 11/19/2022]
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Do elderly people at more severe activity of daily living limitation stages fall more? Am J Phys Med Rehabil 2012; 91:601-10. [PMID: 22561383 DOI: 10.1097/phm.0b013e31825596af] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The aim of this study was to explore how activity of daily living (ADL) stages and the perception of unmet needs for home accessibility features associate with a history of falling. DESIGN Participants were from a nationally representative sample from the Second Longitudinal Survey of Aging conducted in 1994. The sample included 9250 community-dwelling persons 70 yrs or older. The associations of ADL stage and perception of unmet needs for home accessibility features with a history of falling within the past year (none, once, or multiple times) were explored after accounting for sociodemographic characteristics and comorbidities using a multinomial logistic regression model. RESULTS The adjusted relative risk of falling more than once peaked at 4.30 (95% confidence interval, 3.29-5.61) for persons with severe limitation (ADL-III) compared those with no limitation (ADL-0) then declined for those at complete limitation (ADL-IV). The adjusted relative risks of falling once and multiple times were 1.42 (95% confidence interval, 1.07-1.87) and 1.85 (95% confidence interval, 1.44-2.36), respectively, for those lacking home accessibility features. CONCLUSIONS Risk of falling appeared greatest for those whose homes lacked accessibility features and peaked at intermediate ADL limitation stages, presumably at a point when people have significant disabilities but sufficient function to remain partially active.
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Tsai HJ. Cross-sectional and longitudinal associations of functional and health status with institutional care use: results from the Survey of Health and Living Status of the Elderly in Taiwan. Geriatr Gerontol Int 2012; 13:597-606. [PMID: 22994918 DOI: 10.1111/j.1447-0594.2012.00944.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
AIM This study evaluated the cross-sectional and longitudinal associations of functional and health status with institutional care, and examined determinants of institutional care use over time. METHODS Data of this study were obtained from the Survey of Health and Living Status of the Elderly in Taiwan (SHLSET), which was launched in 1989 and involved a nationally representative sample of nearly-old and old Taiwanese. The baseline data in this present study were collected in 1999, and followed in 2003 and 2007. RESULTS Participants with institutional care use had a higher activities of daily living (ADL) score, more self-reported diseases and poorer self-reported health status than participants without institutional care use (all P<0.05). Cross-sectional analysis showed that a higher ADL score, having heart diseases and having a stroke were positively associated with institutional care use (P<0.05); whereas the number of self-reported diseases and poor self-reported health status were not associated with institutional care use. Longitudinal analysis showed that increased ADL scores and the number of self-reported diseases over 4- and 8 years were associated with an increased likelihood of subsequent institutional care use (all P<0.05). Worsening health status over 4 years was associated with an increased likelihood of subsequent institutional care use, but this association did not exist over 8 years. CONCLUSIONS Only ADL and ADL deterioration over time are cross-sectionally and longitudinally associated with increased institutional care use. Declining functional status is a major determinant of institutional care use for Taiwanese aged over 53 years.
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Affiliation(s)
- Hsin-Jen Tsai
- Department of Health Management, I-Shou University, Kaohsiung, Taiwan.
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Depalma G, Xu H, Covinsky KE, Craig BA, Stallard E, Thomas J, Sands LP. Hospital readmission among older adults who return home with unmet need for ADL disability. THE GERONTOLOGIST 2012; 53:454-61. [PMID: 22859438 DOI: 10.1093/geront/gns103] [Citation(s) in RCA: 116] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
PURPOSE This study determined whether returning to the community from a recent hospitalization with unmet activities of daily living (ADL) need was associated with probability of readmission. METHODS A total of 584 respondents to the 1994, 1999, and/or 2004 National Long-Term Care Surveys (NLTCS) who were hospitalized within 90 days prior to the interview and reported ADL disability at the time of the interview were considered for analysis. Medicare claims linked to the NLTCS provided information about hospital episodes, so those enrolled in Health Maintenance Organizations or Veterans Affairs Medical Centers were not included (n = 62), resulting in a total sample size of 522. ADL disability was defined as needing human help or equipment to complete the task. Unmet ADL need was defined as receiving inadequate or no help for one or more ADL disabilities. Disability that began within 90 days of the interview was considered new disability. RESULTS After adjusting for demographic, health, and functioning characteristics, unmet ADL need was associated with increased risk for hospital readmission (HR: 1.37, 95% CI: 1.03-1.82). Risk of readmission was greater for those with unmet need for new disabilities than those with unmet need for disabilities that were present before the index hospitalization (HR: 1.66, 95% CI: 1.01-2.73). IMPLICATIONS Many older patients are discharged from the hospital with ADL disability. Those who report unmet need for new ADL disabilities after they return home from the hospital are particularly vulnerable to readmission. Patients' functional needs after discharge should be carefully evaluated and addressed.
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Affiliation(s)
- Glen Depalma
- Department of Statistics, Purdue University, West Lafayette, Indiana 47907-2069, USA
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Home accessibility, living circumstances, stage of activity limitation, and nursing home use. Arch Phys Med Rehabil 2012; 93:1609-16. [PMID: 22484216 DOI: 10.1016/j.apmr.2012.03.027] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2011] [Revised: 03/02/2012] [Accepted: 03/23/2012] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To explore the influence of physical home and social environments and disability patterns on nursing home (NH) use. DESIGN Longitudinal cohort study. Self- or proxy-reported perception of home environmental barriers accessibility, 5 stages expressing the severity and pattern of activities of daily living (ADLs) limitations, and other characteristics at baseline were applied to predict NH use within 2 years or prior to death through logistic regression. SETTING General community. PARTICIPANTS Population-based, community-dwelling individuals (N=7836; ≥70y) from the Second Longitudinal Study of Aging interviewed in 1994 with 2-year follow-up that was prospectively collected. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURE NH use within 2 years. RESULTS Perceptions of home environmental barriers and living alone were both associated with approximately 40% increased odds of NH use after adjustment for other factors. Compared with those with no limitations at ADL stage 0, the odds of NH use peaked for those with severe limitations at ADL stage III (odds ratio [OR]=3.12; 95% confidence interval [CI], 2.20-4.41), then declined sharply for those with total limitations at ADL stage IV (OR=.96; 95% CI, .33-2.81). Sensitivity analyses for missing NH use showed similar results. CONCLUSIONS Accessibility of home environment, living circumstance, and ADL stage represent potentially modifiable targets for rehabilitation interventions for decreasing NH use in the aging U.S. population.
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Staging activity limitation and participation restriction in elderly community-dwelling persons according to difficulties in self-care and domestic life functioning. Am J Phys Med Rehabil 2012; 91:126-40. [PMID: 22248806 DOI: 10.1097/phm.0b013e318241200d] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE This study aimed to describe the conceptual foundation and development of an activity limitation and participation restriction staging system for community-dwelling people 70 yrs or older according to the severity and types of self-care (activities of daily living [ADLs]) and domestic life (instrumental ADLs (IADLs)) limitations experienced. DESIGN Data from the second Longitudinal Study of Aging (N = 9447) were used to develop IADL stages through the analyses of self- and proxy-reported difficulties in performing IADLs. An analysis of activity limitation profiles identified hierarchical thresholds of difficulty that defined each stage. IADL stages are combined with ADL stages to profile status for independent living. RESULTS IADL stages define five ordered thresholds of increasing activity limitations and a ``not relevant'' stage for those who normally have someone else do those activities. Approximately 42% of the population experience IADL limitations. To achieve a stage, a person must meet or exceed stage-specific thresholds of retained functioning defined for each activity. Combined ADL and IADL stages define 29 patterns of activity limitations expressing the individual's potential for participating in life situations pertinent to self-care and independent community life. CONCLUSIONS ADL and IADL stages can serve to distinguish between groups of people according to both severity and the types of limitations experienced during home or outpatient assessments, in population surveillance, and in research.
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Stineman MG, Xie D, Pan Q, Kurichi JE, Zhang Z, Saliba D, Henry-Sánchez JT, Streim J. All-cause 1-, 5-, and 10-year mortality in elderly people according to activities of daily living stage. J Am Geriatr Soc 2012; 60:485-92. [PMID: 22352414 DOI: 10.1111/j.1532-5415.2011.03867.x] [Citation(s) in RCA: 104] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To examine the independent association between five stages of activities of daily living (ADLs) and mortality after accounting for known diagnostic and sociodemographic risk factors. DESIGN For five stages of ADLs (0 to IV), determined according to the severity and pattern of ADL limitations, unadjusted life expectancies and adjusted associations with mortality were estimated using a Cox proportional hazards regression model. SETTING Community. PARTICIPANTS Nine thousand four hundred forty-seven participants aged 70 and older from the second Longitudinal Study of Aging. MEASUREMENTS One-, 5-, and 10-year survival and time to death. RESULTS Median life expectancy was 10.6 years for participants with no ADL limitations and 6.5, 5.1, 3.8, and 1.6 years for those at ADL stages I, II, III, and IV, respectively. The sociodemographic- and diagnostic-adjusted hazard of death at 1 year was five times as great at stage IV as at stage 0 (hazard ratio = 5.6, 95% confidence interval = 3.8-8.3). The associations between ADL stage and mortality declined over time but remained statistically significant at 5 and 10 years. CONCLUSION ADL stage continued to explain mortality risk after adjusting for known risk factors including advanced age, stroke, and cancer. ADL stages might aid clinical care planning and policy as a powerful prognostic indicator particularly of short-term mortality, improving on current ADL measures by profiling activity limitations of relevance to determining community support needs.
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Affiliation(s)
- Margaret G Stineman
- Department of Biostatistics and Epidemiology, Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania 19104, USA.
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