Patterns of instrumental activities of daily living and association with predictors among community-dwelling older women: A latent class analysis

Social capital and well-being of the elderly 'left-behind' by their migrant children in India

BACKGROUND

The study aims to examine the association between individual forms of social capital and the well-being of the elderly 'left-behind' parents and to determine if there is a gender difference within the possible relationship.

METHODS

This study applied the first wave of the Longitudinal Ageing Study in India (LASI, 2017-18) data. In this study, the respondents were 4,736 older parents 'left-behind' by their migrant adult sons. We employed descriptive statistics and bivariate analysis to assess the study sample's characteristics. The proportion test was performed to examine if there was a significant gender difference among older adults regarding depression, ADL, and IADL impairments. In addition, binary logistic regression was utilized to investigate the associations between social capital and elderly parents' health outcomes.

RESULTS

This study found a significant gender difference in depression (male: 8.26%; female:11.32%; P < 0.001), ADL (male:20.23%; female:25.75%; P = 0.032), and IADL (male: 33.97% female: 54.13%; P < 0.001) limitations. Elderly parents who did not participate in any social activity had a higher odd of ADL (aOR: 2.44; 95%CI: 1.882-3.171; P = < 0.001) and IADL (aOR: 1.22; 95%CI: 1.034-1.766 ; P = < 0.001) limitations. Networking with friends through phone/email conversations has a substantial impact on lowering depression in older parents. Older adults with good personal social capital were less likely to have depression, ADL, and IADL limitations.

CONCLUSION

Personal social capital is closely associated with the well-being of left-behind older parents. More efforts should be in place to increase the stock of social capital in this group with focused gender disparity.

Active and productive ageing in India: evidence from the time use pattern of ageing adults

BACKGROUND

With the increasing proportion of older adults in India, it becomes essential to get an insight into the various influencing factors of successful ageing. However, the literature on successful ageing is minuscule in the Indian context. The present study attempted to understand successful ageing in terms of active and productive ageing by exploring their determining factors.

METHODS

The data were extracted from the Longitudinal Ageing Study in India (LASI) Wave-1 (2017-2018). We utilized self-reported time use information from the experimental module of the LASI. A total of 7837 ageing adults were included in the study. We employed descriptive statistics, bivariate analysis and a multinominal logistic regression model to examine the prevalence and the determinants of active and productive ageing.

RESULTS

The prevalence of inactive ageing was higher among the Indian ageing population (57.47%), followed by active ageing (29.59%) and productive ageing (12.94%). Poor sleep quality and the prevalence of morbidity and disability limited the ageing population from attaining active and productive ageing. Engagement in physical activity was significantly associated with active and productive ageing (β = 0.83, 99% CI: -0.72-0.94 and β = 0.82, 99% CI: 0.66-0.98), respectively. Rural ageing adults were more likely to attain active ageing and less likely to attain productive ageing.

CONCLUSION

Engagement in physical activities among the ageing population shall be promoted to attain active and productive ageing. Since the rural ageing population were less likely to attain productive ageing than their urban counterparts, opportunities to participate in more formal economic activities in rural areas could be promoted for the wellbeing of the second demographic dividend.

Determinants of functional disability trajectories: An assessment of the disablement model and life-course perspective

AIM

Functional disability is a widespread challenge faced by the older population in China, where those with functional disabilities demand greater healthcare and geriatric services. This study performs a longitudinal analysis examining the effects of physiological conditions, intra-, and extra-individual factors, and life-course socioeconomic status risk factors on the disability levels and change rates of functional disability trajectories in old age.

METHODS

Data for this study came from the four waves of the China Health and Retirement Longitudinal Survey. A latent growth model was used to analyze the functional disability of 5044 older adults aged 60 and over in 2011 who survived to 2018.

RESULTS

Pathologies are closely associated with functional disability trajectories, and higher numbers of comorbidities relate to more disabilities. Risk factors and intra- and extra-individual factors affect functional disability trajectories and work through independent and shared mechanisms. The effects of risk factors can be traced to childhood conditions, and higher childhood and adulthood socioeconomic status is related to fewer functional disabilities.

CONCLUSION

Functional disability trajectories are dynamic processes related to pathologies, intra-, and extra-individual factors, and life-course risk factors, and thus prevention and control measures should focus on both childhood and adulthood. Promoting working in later life and improving childhood socioeconomic status deserve prompt attention. Geriatr Gerontol Int 2023; 23: 817-829.

Identification of Subgroups of Activity Participation in Group of Community-Dwelling Older Adults

Occupational therapy in public health is advancing for groups of older adults, but few studies have focused on measuring population-based activity engagement. This study aimed to identify subgroups based on the daily activity pattern of community-dwelling older adults. Japanese older adults aged ≥65 years responded to a 128-activity-item questionnaire. Sparse principal component analysis was applied to summarize the activities, and k-means clustering was used to identify subgroups. Respondents were divided into three subgroups (subgroup 1: n = 39, high instrumental/leisure and social/cognitive activity; subgroup 2: n = 51, high instrumental/leisure and low social/cognitive activity; subgroup 3: n = 44, low instrumental/leisure and social/cognitive activity). The three subgroups were associated with sociodemographics (sex, area, education, and activity level) (p < .05). This study highlighted the activity-based subgroups of older adults and provided a novel viewpoint regarding occupation-based community assessments in addition to previous community occupational therapy practice.

Comparison between the General Assessment of Hospitalised Patient Tool and the Barthel Index: A Retrospective Study

Among hospitalised patients, functional decline and increased dependence on others are common health problems. Identifying critical needs is an important starting point to empower patients to improve their own health and behaviour. Once these needs are determined, the most relevant goals for addressing patients' needs and health potential can be established. This study aimed to test a model for profiling patients using the General Assessment of Hospitalised Patients (ASGO) compared to the Barthel Index (BI) as the gold standard. A retrospective approach was conducted by reviewing administrative data recorded between 2017 and 2020 at the University of Padova, Italy. Data from patients (a) older than 18 years, (b) admitted to a local hospital, and (c) with a stay of at least three days were included in the study. The ASGO and the BI were both used on patients' admission and discharge from the ward. Data were analysed using STATA software (v.16) (StataCorp. 2019. Stata Statistical Software: Release 16. College Station, TX: StataCorp LLC). The database used for the analysis consisted of 842 patient records, with more than 50% over 75 years of age and consisting mainly of men. The results of the ASGO and the BI were more correlated at discharge (rho = -0.79) than at admission (rho = -0.59). Furthermore, sensitivity and specificity, calculated with reference to the optimal cut-off point (Youden index), demonstrated the highest reliability of the test at discharge (sensitivity: 0.87; specificity: 0.78) compared to admission (sensitivity: 0.77; specificity: 0.72). This result was confirmed by the analysis of the ROC curve: The area under the curve was greater at discharge (89%) than at admission (82%). Analysis of the results obtained from assessments created with the ASGO demonstrates the applicability of this model in the context of hospital care and how well it can represent functional dependence. This study was not registered.

Cognitive Function and Depressive Symptoms among Chinese Adults Aged 40 Years and Above: The Mediating Roles of IADL Disability and Life Satisfaction

The purpose of this study was to investigate the relationship between cognitive function and depressive symptoms among Chinese adults aged 40 years and above, as well as the series of multiple mediating effects of Instrument Activities of Daily Living disability and life satisfaction on this relationship. The data was obtained from the China Health and Retirement Longitudinal Study (CHARLS, 2013-2018), including 6466 adults aged 40 years and above. The mean age of the adults was 57.7 ± 8.5. The SPSS PROCESS macro program was conducted to examine the mediating effects. The results indicated that there was a significant association between cognitive function and depressive symptoms five years later (B = -0.1500, 95%CI: -0.1839, -0.1161), which could also be demonstrated through three mediation pathways: (1) the mediating pathway through IADL disability (B = -0.0247, 95%CI: -0.0332, -0.0171); (2) the mediating pathway through life satisfaction (B = 0.0046, 95%CI: 0.0000, 0.0094); and (3) the chain mediation pathway through IADL disability and life satisfaction (B = -0.0012, 95%CI: -0.0020, -0.0003). Both IADL disability and life satisfaction have been proven to be crucial mediators for the relationship between cognitive function and depressive symptoms five years later. It is necessary to improve individuals' cognitive function and reduce the negative impact of disability on them, which is important to enhance their life satisfaction and prevent depressive symptoms.

Instrumental activities of daily living trajectories and risk of mild cognitive impairment among Chinese older adults: results of the Chinese longitudinal healthy longevity survey, 2002-2018

Background

The association between the instrumental activities of daily living (IADL) score and the risk of initial cognitive function impairment is inconclusive. We aimed to identify distinctive IADL trajectories and examine their relationship with the onset of mild cognitive impairment (MCI) among Chinese older people.

Methods

The study used six-wave longitudinal data from the Chinese Longitudinal Healthy Longevity Survey conducted between 2002 and 2018. It included a total of 11,044 Chinese people aged 65 years or older. A group-based trajectory model was used to identify distinctive trajectories of the IADL score, and the Cox proportional hazards model was used to explore the hazard ratio of various trajectories at the onset of MCI. Interaction analysis was used to analyze individual modification between the IADL trajectories and the onset of MCI. Finally, we adopted four types of sensitivity analysis to verify the robustness of the results.

Results

During a median follow-up of 16 years, the incidence of MCI was 6.29 cases per 1,000 person-years (95% confidence interval [CI] 5.92-6.68). Three distinct IADL trajectory groups were identified: a low-risk IADL group (41.4%), an IADL group with increasing risk (28.5%), and a high-risk IADL group (30.4%). Using the Cox proportional hazards model after adjusting for covariates, we found that compared with the low risk IADL group, the hazard ratio of the IADL group with increasing risk was 4.49 (95% CI = 3.82-5.28), whereas that of the high-risk IADL group was 2.52 (95% CI 2.08-3.05). Treating the IADL group with increasing risk as the reference, the hazard ratio for the high-risk IADL group was 0.56 (95% CI 0.48-0.66). Interaction analyses showed that age and residence were significant moderators (P for interaction <0.05).

Conclusion

A group-based trajectory model was developed to classify older people into three distinct trajectory groups of the IADL score. The IADL group with increasing risk had a greater risk of MCI than the high-risk IADL group. In the IADL group with increasing risk, city residents of ≥80 years were the most likely to develop MCI.

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

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

Labor Participation of Retirement-Aged Workers: Understanding the Influencing Mechanism of Health Status and Social Pension Insurance Participation

BACKGROUND

Delayed retirement initiative is taken as one of the proposed solutions to population aging. Rare research attention has been paid to determinants in decisions-making of late retirement.

METHOD

This study applies data from CHARLS survey (2018) that traces the health status among older adults in China, and implements the stepwise multiple regression analysis adjusted with robust standard errors on individual level.

RESULTS

The difficulty in instrumental activities of daily living (IADLs) and chronic conditions could increase the intention of retirement-aged workers to withdraw from late career participation; and the overlay of both would interact to reinforce such intention. Besides, the employment-related social pension participation could further strengthen the jointly contributing effect of both on withdrawal from late career participation.

CONCLUSION

The triple interaction mechanism in retirement-aged workers' decisions of late retirement needs considering in the policy formulation of delayed retirement initiative.

Quality of Life and Activities of Daily Living among Patients with Complete Cervical Spinal Cord Injury and Surgical Treatment in Vietnam

Spinal cord injury (SCI) is defined as temporary or permanent changes in spinal cord function and reflex activity. The objective of this study is to evaluate health-related quality of life (HRQoL) and activities of daily living (ADL) among postoperative surgery patients with complete cervical SCI in Vietnam and to explore the factors associated with these indices. A cross-sectional study was conducted on 88 adults in Vietnam from June 2018 to June 2019. The EQ-5D-5L, ADL, and instrumental activities of daily living (IADL) were applied. Multivariate Tobit regression was adopted to determine factors that were associated with HRQOL, ADL, and IADL. Results: Participants who were in American Spinal Cord Injury Association (ASIA) scale group A (ASIA-A) had the lowest ADL, IADL index, and HRQOL score (p < 0.001). HRQoL and ADL were affected by health insurance coverage, occupation, type of fracture, and IADL. Meanwhile, IADL was significantly associated with living areas and ASIA. Low HRQoL among patients suffering from SCI was observed. Attention should be given to outcomes related to a disability during clinical treatment and should be treated effectively in the recovery.

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

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

The mediating and moderating effects of depression on the relationship between cognitive function and difficulty in activities of daily living among postmenopausal women

OBJECTIVE

Cognitive function and depression impact critically the daily functioning of menopausal women. This study aimed to explore the mediating and moderating effects of depressive symptoms on the association between cognitive function and activities of daily living (ADL) difficulty in postmenopausal women.

METHODS

A total of 2,596 postmenopausal women from the China Health and Retirement Longitudinal Study completed the Chinese version of the Mini-Mental State Examination, basic ADL (BADL) and instrumental ADL (IADL) scales, and 10-item Short-Form Center for Epidemiological Studies Depression. We constructed structural equation modeling to examine the association between cognitive function, depressive symptoms, and BADL/IADL difficulty.

RESULTS

The prevalence of BADL/IADL difficulty in postmenopausal women was 22.5% and 31.5%, respectively. After adjustments for demographic and health-related covariates, cognitive decline (contributed by four cognitive dimensions with different weights) was significantly associated with BADL/IADL difficulty (contributed by six-item daily activities with different weights). Depressive symptoms mediated and explained 28.8% and 23.2% of cognitive function associations with BADL and IADL difficulty, respectively. The Johnson-Neyman technique identified a threshold of eight and four for depressive symptoms, beyond which the protective effect of cognitive function on BADL and IADL emerged.

CONCLUSIONS

Depressive symptoms mediated and moderated the association between cognition and BADL/IADL difficulty in postmenopausal women. Compared with BADL, IADL may be more sensitive to changes in cognitive function. More strength should be put on developing comprehensive intervention techniques focusing on simultaneous intervention of multidimensional cognitive function and depression to maintain and improve the quality of life of postmenopausal women.

The Patterns of Caregiving Activities for Family Caregivers of Older Adults in Hong Kong: An Exploratory Latent Class Analysis

OBJECTIVES

This study identified the classes (i.e., patterns) of caregivers' activities, based on their engagements in caregiving activities, and explored the characteristics and the caregiver burden of these classes.

METHODS

This study was a secondary analysis of a cross-sectional survey on the profiles of family caregivers of older adults in Hong Kong. A latent class analysis approach was adopted to classify family caregivers (N = 932) according to their routine involvements in 17 daily caregiving activities: 6 activities of daily living (ADLs) and 8 instrumental activities of daily living activities (IADLs) in addition to emotional support, decision making, and financial support. Multinomial logistic regression and multiple linear regression illuminated the characteristics of the classes and compared their levels of caregiver burden.

RESULTS

The family caregivers fell into 5 classes: All-Round Care (High Demand, 19.5%), All-Round Care (Moderate Demand, 8.2%), Predominant IADLs Care (High Demand, 23.8%), Predominant IADLs Care (Moderate Demand, 32.5%), and Minimal ADLs and IADLs Care (Low Demand, 16.0%). These classes exhibited different characteristics in terms of care recipients' cognitive statuses and caregiver backgrounds. The levels of caregiver burden differed across classes; the All-Round Care (High Demand) class experienced the highest levels of caregiver burden.

DISCUSSION

This study contributes to existing scholarship by turning away from a predefined category of care tasks to explore the patterns of caregiving activities. By identifying caregiving activity patterns and understanding their associated characteristics and caregiver burden, prioritizing and targeting caregiver support interventions better is possible.

Serum albumin and activities of daily living in Chinese centenarians: a cross-sectional study

BACKGROUND

Objective deterioration in activities of daily living (ADLs) exists among older population, and particularly worsens with age. Considering the criterion standard of positive aging and longevity, little information focusing on centenarians is available. This study set out to explore the relationship between serum albumin and ADLs among centenarians in long-lived areas.

METHODS

This population-based cross-sectional study investigated a full sample of Chinese centenarians in Hainan, the longest-lived area of China (n = 1002). We assessed serum albumin levels and basic and instrumental activities of daily living (BADLs and IADLs).

RESULTS

Of 1002 participants included in the analysis, 287 (28.64%) had BADL disabilities and 648 (64.67%) had IADL disabilities. The median level of serum albumin was 38.5 g/L (interquartile range, 36.2-41.3). The multivariable analyses controlling for socio-demographic characteristics, lifestyle, morbidities, and other influential factors showed that albumin level was associated with the total score of BADL (standard β = 0.335, P < 0.001) and IADL (standard β = 0.206, P < 0.001). With the increasing of albumin level, the risk of ADLs disability decreased (BADL: odds ratios [OR] = 0.835, 95% Confidence interval [CI]: 0.797-0.876; IADL: OR = 0.863, 95%CI: 0.824-0.905). In the stratified analyses, similar results were found in both sex, but were more prominent in women.

CONCLUSIONS

Higher levels of serum albumin was a protective factor for the decline of ADLs in centenarians. This association can be observed in both genders and is more pronounced in women.

Changes in instrumental activities of daily living functioning associated with concurrent common mental disorders and physical multimorbidity in older adults

Introduction: Instrumental activities of daily living (IADL) are key indicators of general functional status that are frequently used to assess the autonomy of older adults living in the community.Aims: To evaluate the changes in IADL in community-living older adults and the role of common mental disorders and physical multimorbidity in predicting these changes.Method: A secondary analysis including participants from the Longitudinal Survey on Senior's Health and Health Services. Self-reported sociodemographic and clinical information on chronic conditions were obtained at baseline interview (n = 1615). Measures of IADL were obtained at two time points, 3 years apart. Administrative data on physician diagnoses of chronic diseases were linked to self-reported information. Logistic and multinomial regression models were used to study the outcomes of interest.Results: More than one-third of participants reported disability. Significant increase in global and specific IADL tasks disability were observed over time. Concurrent mental and physical chronic conditions predicted persistent and future incidence of disability.Conclusions: We draw attention to the synergistic effect of mental and physical co-morbidities on IADL functioning and to the importance of the simultaneous management of these conditions in order to prevent disability, future decline and the associated health and societal burden.Implications for RehabilitationBy establishing the prevalence of global and specific IADL disability, we can better recognize the needs of older adults and inform health and social care planning.Influenced by the morbidity profile, older adults may experience decline, improvement or maintenance of autonomy in IADL over time.The presence of synergistic effect of physical and mental chronic conditions on functioning suggests that their simultaneous management is crucial in delaying or preventing disability.Reports of significant impairment in tasks such as taking medication calls attention to the need for increased accessibility to programs on medication management.The progressive loss of ability to take medication among multimorbid patients emphasize the need for therapeutic plans that circumvent polypharmacy.

Social capital and the health of left-behind older adults in rural China: a cross-sectional study

OBJECTIVE

To examine the association between social capital and the health of male and female left-behind older adults in rural China.

STUDY DESIGN

This cross-sectional study among the left-behind older adults aged 60 and older and with all their children working outside of Hubei, Shaanxi and Guangdong provinces in China was conducted in 2017-2018. A total of 1106 questionnaires were collected (participation rate=100.0%), and questionnaires from 1016 participants were used (effective rate=91.9%).

METHODS

An ordinary least squares model was used to evaluate the association between social capital and health. Social capital included family trust, friend/neighbour trust, stranger trust, social participation, and network size and density. Health outcomes included basic and instrumental activities of daily living (BADL and IADL) and depression.

RESULTS

Elevated family trust, friend/neighbour trust, stranger trust, high-level participation and middle-level network density were associated with reduced depression (b=-3.23, p<0.001; b=-0.41, p<0.001; b=-0.76, p<0.01; b=-1.04, p<0.05; b=-0.74, p<0.05, respectively). High-level participation and network density were also associated with elevated BADL (b=0.16, p<0.05; b=0.24, p<0.05, respectively). Elevated family trust (b=-2.86, p<0.05 in men; b=-3.86, p<0.001 in women), stranger trust (b=-0.68, p<0.05 in men; b=-0.80, p<0.05 in women) and high-level participation (b=-0.92, p<0.05 in men; b=-1.22, p<0.01 in women) were associated with reduced depression in both sexes. By contrast, elevated friend/neighbour trust was associated with reduced depression (b=-0.56, p<0.001) in women, high-level participation was associated with elevated BADL (b=0.19, p<0.05) and IADL (b=0.43, p<0.05) in men, and high-level network density was associated with elevated BADL (b=0.44, p<0.05) and IADL (b=0.57, p<0.05) and reduced depression (b=-1.05, p<0.05) in women.

CONCLUSIONS

Social capital is closely related to left-behind older adults' health in rural China. More attention should be paid to increasing the stock of social capital in this special population, with a particular focus on the sex disparity.

Disability for basic and instrumental activities of daily living in older individuals

AIMS

To know the prevalence, associated factors and temporal trends of disabilities for basic and instrumental activities of daily living in older people in Spain from 2009 to 2017.

BACKGROUND

Disability in older people is associated with health problems, increased health costs and low quality of life. There are no updated data in Spain with a representative sample about disability.

METHODS

Cross-sectional study with 25,465 non-institutionalized older people who participated in the European Health Survey in 2009 and 2014 and the National Health Survey in 2011/12 and 2017 in Spain. The prevalence rates of disability were evaluated using the Katz Scale and Lawton and Brody Scale. Logistic regression was used to determine if there was an association between basic and instrumental activities of daily living and sociodemographic characteristics.

RESULTS

More individuals had disability for instrumental activities of daily living (31.9%) than disability for basic activities of daily living (11.1%). The most predominant disability for instrumental activities of daily living was performing severe housework (34%). The prevalence of disabilities decreased from 2009 to 2017. In general, disability was associated with female gender, advanced age, lower education, restricted daily activity, being bedridden and higher pain levels.

CONCLUSION

There is a considerable prevalence of disabilities for basic and instrumental activities of daily living in older people in Spain. Although the disability prevalence has decreased slowly from 2009 to 2017, it continues to remain a health problem. Gender may influence the disabilities for basic and instrumental activities of daily living. Health policymakers should establish prevention strategies and effective interventions (e.g., physical exercise) for prevention and reduction of the disabilities for basic and instrumental activities of daily living, particularly in older females.