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Terrell J, Campbell JA, Thorgerson A, Bhandari S, Egede LE. Understanding the relationship between social risk factors and functional limitation among stroke survivors in the US. J Stroke Cerebrovasc Dis 2024; 33:107583. [PMID: 38242184 PMCID: PMC10939811 DOI: 10.1016/j.jstrokecerebrovasdis.2024.107583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 01/08/2024] [Accepted: 01/15/2024] [Indexed: 01/21/2024] Open
Abstract
BACKGROUND Stroke is the fifth leading cause of death and disability in the United States. Social risk factors contribute to recovery from stroke, however the relationship between social risk factors and functional limitation among stroke survivors remains unknown. METHODS Data on 2,888 adults with stroke from the National Health Interview Survey from 2016-2018 was analyzed. The primary independent variables included six social risk factors: economic instability, lack of community, educational deficit, food insecurity, social isolation, and inadequate access to care. The outcome measure was functional limitation count. Negative binomial regression models were run to test the relationship between the independent and dependent variables adjusting for covariates. RESULTS Overall, 56% of the study participants were aged 65+, 70% were Non-Hispanic White, and 95% had at least one comorbidity. The mean functional limitation count was 1.8. In the unadjusted model, each social risk factor was significantly associated with functional limitation. In the fully adjusted model, significant association with functional limitation was found in individuals reporting economic instability (Incidence rate ratio [IRR] 1.65, 95% CI 1.33, 2.06), food insecurity (IRR 1.28, 95% CI 1.15, 1.42), and social isolation (IRR 1.64, 95% CI 1.48, 1.82). CONCLUSIONS Social risk factors such as economic instability, food insecurity and social isolation are significantly associated with functional limitation in adults with stroke. Interventions designed to address both social and medical needs have the potential to improve physical functioning and other clinical outcomes in stroke survivors.
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Affiliation(s)
- Jennifer Terrell
- Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Jennifer A Campbell
- Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, WI, USA; Division of General Internal Medicine, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Abigail Thorgerson
- Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Sanjay Bhandari
- Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, WI, USA; Division of General Internal Medicine, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Leonard E Egede
- Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, WI, USA; Division of General Internal Medicine, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA.
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Fonseca C, Ramos A, Morgado B, Quaresma P, Garcia-Alonso J, Coelho A, Lopes M. Long-term care units: a Portuguese study about the functional profile. FRONTIERS IN AGING 2023; 4:1192718. [PMID: 37214776 PMCID: PMC10192701 DOI: 10.3389/fragi.2023.1192718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 04/21/2023] [Indexed: 05/24/2023]
Abstract
Aim: In this study, we analyze the relationship between the functional profile of older people admitted to long-term care units in Portugal and some demographic variables such as education level, sex, and age as well as the emotional state of mind. Methods: A sample of 59,516 older people from the National Network of Integrated Continuous Care of Portugal were analyzed in this longitudinal study. All the retrospective data of the older people were collected during the period of hospitalization at the long-term care units. The database records of these units were analyzed, and a functional profile spanning the period of hospitalization was calculated. Results: Activities of daily living and cognitive states improved, in the first 90 days of hospitalization, while mobility and instrumental activities of daily living worsened for the same period of 90 days. Generally, there was a decline in all domains after 450 days of hospitalization. The older women that did not attend school, those over 85 years old, and those who suffered from anxiety were pre-dominantly placed in the group of those with greater dependence (severe/complete dependence). Conclusion: The participants hospitalized between 90 and 360 days presented the best results in the long-term care units of the National Network of Integrated Continuous Care of Portugal. With this study, we highlight the importance of evaluating the functional status of persons in long-term hospitalizations and the influence exerted by the level of education on the recovery and rehabilitation of dependence.
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Affiliation(s)
- César Fonseca
- São João de Deus Higher School of Nursing, University of Évora, Évora, Portugal
- Comprehensive Health Research Centre (CHRC), Universidade de Évora, Évora, Portugal
| | - Ana Ramos
- Nursing Research, Innovation and Development Centre of Lisbon (CIDNUR), Nursing School of Lisbon (ESEL), Lisbon, Portugal
| | | | - Paulo Quaresma
- Department of Computer Science, University of Évora, Évora, Portugal
- Centro de Investigação e Desenvolvimento em Ciências Humanas e Sociais (CIDEHUS), University of Évora, Évora, Portugal
| | - José Garcia-Alonso
- Department of Computer and Telematics Systems, University of Extremadura, Badajoz, Spain
| | - Anabela Coelho
- São João de Deus Higher School of Nursing, University of Évora, Évora, Portugal
- Comprehensive Health Research Centre (CHRC), Universidade de Évora, Évora, Portugal
- Global Health and Tropical Medicine, Instituto de Higiene e Medicina Tropical, Universidade NOVA de Lisboa, Lisbon, Portugal
| | - Manuel Lopes
- São João de Deus Higher School of Nursing, University of Évora, Évora, Portugal
- Comprehensive Health Research Centre (CHRC), Universidade de Évora, Évora, Portugal
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Gao Y, Du L, Cai J, Hu T. Effects of functional limitations and activities of daily living on the mortality of the older people: A cohort study in China. Front Public Health 2023; 10:1098794. [PMID: 36743188 PMCID: PMC9895937 DOI: 10.3389/fpubh.2022.1098794] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 12/22/2022] [Indexed: 01/22/2023] Open
Abstract
Introduction Prevalence of functional limitations (FLs) and disabled activities of daily living (ADL) cause heavy burdens to the health of the older people. Stratified by gender, this study aimed to explore the effects of FL and ADL on the mortality of the older people in China, and the mechanism was then discussed. Methods We used survey data of a prospective 10-year cohort (2008-2018), from the China Longitudinal Healthy Longevity Survey (CLHLS). The primary outcome was all-cause mortality, and Independent variables included FL, basic ADL (BADL), and instrumental ADL (IADL). Covariates involved socio-demographic characteristics, health-related behaviors, and health status of the participants in the CLHLS project. Results There were 967 (19.20%) male and 2,235 (32.36%) female older people performed functional limitations, and their survival time was 60.98 (SE = 0.66) and 55.19 (SE = 0.55) months, respectively. Old adults with FL had significantly poorer survival than the ones without (Log-rank test, P < 0.001). Weibull regression suggested that FL (P < 0.001), abnormal BADL (P < 0.001) and IADL (P < 0.001) were negatively associated with the survival of the older people. Further analysis showed that BADL and IADL performed significantly mediating roles in the relation of FL and survival time in old adults; additionally, for female older people, BADL also exhibited a significant moderating role in the effect of FL on survival. Conclusions Prevalence of FL was serious among the older people in China, especially for the women. Disabilities of BADL and IADL and FL were negatively associated with the survival time of the older people in China. Regarding the effect of FL on survival, BADL and IADL performed significantly mediating roles, and the moderating role of BADL existed only for the female. These suggested evidence to implement strategies to maintain health in the older people.
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Affiliation(s)
- Yumeng Gao
- Department of Medical Insurance, Jinshan Hospital of Fudan University, Shanghai, China,*Correspondence: Yumeng Gao ✉
| | - Liang Du
- School of Public Health, Fudan University, Shanghai, China
| | - Jianping Cai
- Department of Medical Insurance, Jinshan Hospital of Fudan University, Shanghai, China
| | - Tingfa Hu
- Department of Medical Insurance, Jinshan Hospital of Fudan University, Shanghai, China
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Trends in activities of daily living disability among Chinese older adults from 1998 to 2018: an age-period-cohort analysis. Eur J Ageing 2022; 19:1167-1179. [PMID: 36692744 PMCID: PMC9729626 DOI: 10.1007/s10433-022-00690-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/17/2022] [Indexed: 01/26/2023] Open
Abstract
This study aims to investigate the age, period, and cohort effects on trends in activities of daily living (ADL) disability among Chinese older adults; and to explore these three temporal effects on gender and residence disparities in disability. We utilized multiple cross-sectional waves of the Chinese Longitudinal Healthy Longevity Survey data (1998-2018), including 89,511 participants aged above 65 years old. Our measurement of disability is the number of ADL items (dressing, bathing, indoor transferring, toileting, eating, and continence) participants can't perform independently. Hierarchical age-period-cohort cross-classified random effects models were conducted to investigate age, period and cohort trends in ADL disability. Results showed that ADL disability increased with age at an increasing rate. A V-shaped cohort trend and a fluctuated period trend were identified. Females and urban residents were associated with more ADL limitations. When age increased, the gender and residence gaps in disability further increased. The cohort-based gender and residence inequalities in ADL limitations converged with successive cohorts. The period-based residence gap in ADL limitations diverged throughout the 20-year period, while the corresponding period-based change in gender disparity was not significant. These findings suggested that age, period, and cohort had different and independent effects on ADL disability among Chinese older adults. The age effect on trends in ADL is stronger compared to period and cohort effects. The gender and residence disparities in disability increased with age and decreased with successive cohorts. These patterns might help inform healthcare planning and the priorities for medical resource allocation accordingly.
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Laborde C, Ankri J, Cambois E. Environmental barriers matter from the early stages of functional decline among older adults in France. PLoS One 2022; 17:e0270258. [PMID: 35731807 PMCID: PMC9216542 DOI: 10.1371/journal.pone.0270258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Accepted: 06/07/2022] [Indexed: 11/19/2022] Open
Abstract
Background
The adaptation of living environments can preserve functional independence among older people. A few studies have suggested that this would only benefit the most impaired. But conceptual models theorize that environmental pressure gradually increases with functional decline.
Objectives
We examined (1) how far different environmental barriers increased difficulties and favoured resort to assistance; (2) at what stage in functional decline environmental barriers begin to matter.
Methods
We used the French cross-sectional survey CARE (2015), including 7,451 participants (60+) with at least one severe functional limitation (FL). Multinomial logistic regressions models were used to compare predicted probabilities for outdoor activities of daily living (OADL) difficulties (no OADL difficulties; difficulties but without assistance; use of assistance) among individuals with and without environmental barriers (self-reported or objective), in relation to the number of FLs.
Results
Poor-quality pedestrian areas and lack of places to rest were associated with a higher probability of experiencing OADL difficulties, whatever the number of FLs; the association increased with the number of FLs. Up to 6 FLs, individuals with these barriers were more likely to report difficulties without resorting to assistance, with a decreasing association. Living in cities/towns with high diversity of food outlets was associated with a lower probability of reporting assistance, whatever the number of FLs, but with a decreasing association.
Discussion
Overall, the results suggest that environmental barriers increasingly contribute to OADL difficulties with the number of FLs. Conclusions differed as to whether they tended to favour resort to assistance, but there was a clear association with food outlets, which decreased with impairment severity. The adaptation of living environments could reduce difficulties in performing activities from the early stages of decline to the most severe impairment. However, the most deteriorated functional impairments seem to generate resort to assistance whatever the quality of the environment.
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Affiliation(s)
- Caroline Laborde
- Université Paris-Saclay, UVSQ, Inserm, CESP, Echappement aux anti-infectieux et pharmaco-épidémiologie, Montigny-le-Bretonneux, France
- Observatoire régional de santé Île-de-France, Département de l’Institut Paris Région, Paris, France
- * E-mail:
| | - Joël Ankri
- Université Paris-Saclay, UVSQ, Inserm, CESP, Echappement aux anti-infectieux et pharmaco-épidémiologie, Montigny-le-Bretonneux, France
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Fuchs J, Gaertner B, Prütz F. Limitations in activities of daily living and support needs - Analysis of GEDA 2019/2020-EHIS. JOURNAL OF HEALTH MONITORING 2022; 7:6-25. [PMID: 35434501 PMCID: PMC9009067 DOI: 10.25646/9570] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Accepted: 03/04/2022] [Indexed: 11/16/2022]
Abstract
Being able to perform activities of daily living is an important component of a person's ability to function. If these activities are impaired, support is needed. Using data from GEDA 2019/2020-EHIS, we present how many people aged 55 and older living in private households in Germany experience limitations in activities of daily living. Severe limitations in basic (fundamental) activities (e.g. food intake) are reported by 5.8% of women and 3.7% of men. The proportion increases with age as 13.4% of women and 9.0% of men aged 80 and older experience limitations. Severe limitations of instrumental activities of daily living (e.g. grocery shopping) are rather rare in participants less than 80 years of age. But at age 80 and older the proportion rises to 35.9% of women and 21.0% of men. A total of 68.1% of afflicted women and 57.5% of men receive help and support related to limitations of basic activities. Women are also more likely to report a lack of support (48.8% vs. 43.2%). The situation is slightly better with regard to instrumental activities. The results of GEDA 2019/2020-EHIS show in which areas of daily life older and very old people are impaired, give an impression of who is affected particularly strongly and indicate where support services are insufficient. As such, these results provide clues as to where support can be provided to enable older people to keep living in their own homes for a long time.
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Affiliation(s)
- Judith Fuchs
- Corresponding author Dr Judith Fuchs, Robert Koch Institute, Department of Epidemiology and Health Monitoring, General-Pape-Str. 62–66, 12101 Berlin, Germany, E-mail:
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Nóbrega JCL, Medeiros JB, da Silva Freitas JLG, Silva JMM, Simões RFM, Olinda R, de Ferreira Santos JL, Menezes TN, de Oliveira Duarte YA, Zatz M, Matheson D, Santos S. Psychosocial aspects and support networks associated with disability in two longevous populations in Brazil: a cross-sectional study. BMC Geriatr 2022; 22:110. [PMID: 35139805 PMCID: PMC8826700 DOI: 10.1186/s12877-022-02810-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 02/03/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Among the oldest old, aged 80 years and over, the prevalence of disability is higher than in other age groups and can be considered a predictor of mortality. OBJECTIVE To evaluate how psychosocial aspects and support networks influence the disability of these oldest-old individuals, performing a comparison between two longevous populations, one living in one of the poorest regions of Brazil, in the backlands of Paraíba, and another living in one of the largest urban centres in Latin America. METHOD A cross-sectional study in which 417 oldest-old persons aged 80 years and older were interviewed, with data collected through the "Health, Welfare and Ageing" survey conducted in two Brazilian cities. Disability was assessed by reporting the need for assistance in Activities of Daily Living (ADLs) and Instrumental Activities of Daily Living (IADLs). Bivariate and multiple analyses were performed using R statistical software. RESULTS Food insufficiency in the first years of life had negative repercussions on the disability of oldest old people living in the northeast. On the other hand, in this region, older people have a higher rate of support and live longer with their peers, which may contribute to reducing feelings of loneliness, depressive symptoms, and worse self-perception of health. In the Southeast, financial constraints, subjective poverty, and unmet needs may favour the development of functional limitations between long-lived people. CONCLUSION Our findings indicate that regional differences in Brazil may influence the disability of older people aged 80 and older. In northeast Brazil, having no partner may contribute to disability for ADLs and IADLs; while, in the longevous population of São Paulo, having a worse self-rated health may contribute to disability for IADLs.
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Affiliation(s)
| | | | | | - Jaíza M M Silva
- Public Health Program, Universidade Estadual da Paraíba (UEPB), Campina Grande, Brazil
| | | | - Ricardo Olinda
- Department of Statistics, Universidade Estadual da Paraíba (UEPB), Campina Grande, Brazil
| | | | - Tarciana Nobre Menezes
- Public Health Program, Universidade Estadual da Paraíba (UEPB), Campina Grande, Brazil.,Department of Physical Therapy, Universidade Estadual da Paraíba (UEPB), Campina Grande, Brazil
| | | | - Mayana Zatz
- Human Genome Studies Center, Universidade de São Paulo (USP), São Paulo, Brazil
| | - David Matheson
- Faculty of Education, Health and Wellbeing, University of Wolverhampton, Wolverhampton, UK
| | - Silvana Santos
- Public Health Program, Universidade Estadual da Paraíba (UEPB), Campina Grande, Brazil. .,Department of Biology, Universidade Estadual da Paraíba (UEPB), Campina Grande, Brazil.
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Fontes AP. Are there still sex differences in the functioning of the elderly? FISIOTERAPIA EM MOVIMENTO 2022. [DOI: 10.1590/fm.2022.35103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Abstract Introduction: Sex is one of the demographic characteristics that better differentiates the independence of the elderly, despite this distinction not being consensual. Objective: To know the differences in functioning associated with sex in elderly people aged ≥ 65 years according to the International Classification of Functioning, Disability, and Health (ICF). Methods: This was an analytical and cross-sectional observational study with a sample of 451 subjects. The instruments were a sociodemographic questionnaire identical to a ICF checklist and the Biopsychosocial Assessment Method. The student t, Mann-Whitney, chi-square, and Spearman correlation tests were used considering p < 0.05. Results: The average age was between 79.5 ± 7.5 years with a female prevalence (62.1%). Of the 43 variables studied, sex differences were found in 17 (39.5%). In the personal factors, women showed greater vulnerability in conjugality (p ≤ 0.001), cohabitation (p = 0.037), and economic income (p = 0.002). Nonetheless, they showed healthier behaviors in all health-related habits. As for environmental factors and body functions, greater fragility was once again observed in women: the need for assistive devices (p ≤ 0.001) and urinary incontinence (p = 0.021). In activities/participation, differences were found in mobility, where women experienced more restrictions, whereas men were more dependent on washing/drying clothes in domestic life (p = 0.022). Conclusion: Women are more unprotected in social and economic areas, while men showed more vulnerability in habits related to health. These differences are linked to demographic issues related to longevity, cultural differences, and socialization, and differences regarding activities/participation tend to dilute between sexes.
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Affiliation(s)
- Ana Paula Fontes
- Universidade Nova de Lisboa, Portugal; Universidade do Algarve, Portugal
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Hamulka J, Frackiewicz J, Stasiewicz B, Jeruszka-Bielak M, Piotrowska A, Leszczynska T, Niedzwiedzka E, Brzozowska A, Wadolowska L. Socioeconomic, Eating- and Health-Related Limitations of Food Consumption among Polish Women 60+ Years: The 'ABC of Healthy Eating' Project. Nutrients 2021; 14:nu14010051. [PMID: 35010925 PMCID: PMC8746491 DOI: 10.3390/nu14010051] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 12/20/2021] [Accepted: 12/22/2021] [Indexed: 12/13/2022] Open
Abstract
The study aimed at identifying the socioeconomic, eating- and health-related limitations and their associations with food consumption among Polish women 60+ years old. Data on the frequency of consumption of fruit, vegetables, dairy, meat, poultry, fish, legumes, eggs, water and beverages industrially unsweetened were collected with the Mini Nutritional Assessment (MNA®) and were expressed in the number of servings consumed per day or week. Three indexes: the Socioeconomic Status Index (SESI), the Eating-related Limitations Score (E-LS) and the Health-related Limitations Score (H-LS) were developed and applied. SESI was created on the base of two variables: place of residence and the self-reported economic situation of household. E-LS included: difficulties with self-feeding, decrease in food intake due to digestive problems, chewing or swallowing difficulties, loss of appetite, decrease in the feeling the taste of food, and feeling satiety, whereas H-LS included: physical function, comorbidity, cognitive function, psychological stress and selected anthropometric measurements. A logistic regression analysis was performed to assess the socioeconomic, eating-, and health-related limitations of food consumption. Lower socioeconomic status (vs. higher) was associated with a lower chance of consuming fruit/vegetables ≥ 2 servings/day (OR = 0.25) or consuming dairy ≥ 1 serving/day (OR = 0.32). The existence of multiple E-LS limitations (vs. few) was associated with a lower chance of consuming fruit/vegetables ≥ 2 servings/day (OR = 0.72), consuming dairy ≥ 1 serving/day (OR = 0.55) or consuming water and beverages industrially unsweetened ≥6 cups/day (OR = 0.56). The existence of multiple H-LS limitations was associated with a lower chance of consuming fruit/vegetables ≥ 2 servings/day (OR = 0.79 per 1 H-LS point increase) or consuming dairy ≥ 1 serving/day (OR = 0.80 per 1 H-LS point increase). Limitations found in the studied women were related to insufficient consumption of selected groups of food, which can lead to malnutrition and dehydration. There is a need for food policy actions, including practical educational activities, to eliminate barriers in food consumption, and in turn to improve the nutritional and health status of older women.
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Affiliation(s)
- Jadwiga Hamulka
- Department of Human Nutrition, Institute of Human Nutrition Sciences, Warsaw University of Life Sciences (WULS-SGGW), Nowoursynowska 159C, 02-776 Warsaw, Poland; (M.J.-B.); (A.B.)
- Correspondence: (J.H.); (J.F.)
| | - Joanna Frackiewicz
- Department of Human Nutrition, Institute of Human Nutrition Sciences, Warsaw University of Life Sciences (WULS-SGGW), Nowoursynowska 159C, 02-776 Warsaw, Poland; (M.J.-B.); (A.B.)
- Correspondence: (J.H.); (J.F.)
| | - Beata Stasiewicz
- Department of Human Nutrition, Faculty of Food Science, University of Warmia and Mazury in Olsztyn, Sloneczna 45F, 10-718 Olsztyn, Poland; (B.S.); (E.N.); (L.W.)
| | - Marta Jeruszka-Bielak
- Department of Human Nutrition, Institute of Human Nutrition Sciences, Warsaw University of Life Sciences (WULS-SGGW), Nowoursynowska 159C, 02-776 Warsaw, Poland; (M.J.-B.); (A.B.)
| | - Anna Piotrowska
- Department of Functional and Organic Food, Institute of Human Nutrition Sciences, Warsaw University of Life Sciences (SGGW-WULS), Nowoursynowska 159C, 02-776 Warsaw, Poland;
| | - Teresa Leszczynska
- Department of Human Nutrition and Dietetics, Faculty of Food Technology, University of Agriculture in Krakow, Balicka 122, 30-149 Krakow, Poland;
| | - Ewa Niedzwiedzka
- Department of Human Nutrition, Faculty of Food Science, University of Warmia and Mazury in Olsztyn, Sloneczna 45F, 10-718 Olsztyn, Poland; (B.S.); (E.N.); (L.W.)
| | - Anna Brzozowska
- Department of Human Nutrition, Institute of Human Nutrition Sciences, Warsaw University of Life Sciences (WULS-SGGW), Nowoursynowska 159C, 02-776 Warsaw, Poland; (M.J.-B.); (A.B.)
| | - Lidia Wadolowska
- Department of Human Nutrition, Faculty of Food Science, University of Warmia and Mazury in Olsztyn, Sloneczna 45F, 10-718 Olsztyn, Poland; (B.S.); (E.N.); (L.W.)
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Ramos A, Fonseca C, Pinho L, Lopes M, Oliveira H, Henriques A. Functional Profile of Older Adults Hospitalized in Convalescence Units of the National Network of Integrated Continuous Care of Portugal: A Longitudinal Study. J Pers Med 2021; 11:jpm11121350. [PMID: 34945822 PMCID: PMC8704872 DOI: 10.3390/jpm11121350] [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: 10/07/2021] [Revised: 11/22/2021] [Accepted: 12/07/2021] [Indexed: 11/29/2022] Open
Abstract
Aim: To evaluate the evolution of the functional profile of older adults admitted to a health unit in Portugal; to relate the functional profile of these individuals with age, sex, education level and emotional state; and to evaluate the probability of the degree of dependence as a function of age and sex. Methods: longitudinal, retrospective study with a sample of 59,013 older adults admitted to convalescence units of the National Network of Integrated Continuous Care of Portugal. Results: In the first 75 days of hospitalization, activities of daily living, mobility and cognitive state improved, but there was a decline after 75 days of hospitalization. The ability to perform instrumental activities of daily living improved in the first 15 days of hospitalization, stabilized until 45 days and then began to worsen. Women had a higher probability of having a severe/complete dependence three years earlier than men (88 years to 91 years). A higher education level and stable emotional state were protective factors against functional decline. Conclusions: The functional profile of older adults improved during the length of stay recommended for hospitalization in convalescence units (30 days). It is critical for health systems to adopt strategies to prevent declines in the emotional state of frail individuals.
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Affiliation(s)
- Ana Ramos
- Nursing Research, Innovation and Development Centre of Lisbon (CIDNUR), Nursing School of Lisbon (ESEL), 1600-096 Lisbon, Portugal; (A.R.); (A.H.)
| | - César Fonseca
- Escola Superior de Enfermagem de São João de Deus, Universidade de Évora, 7000-801 Evora, Portugal; (C.F.); (M.L.)
- Comprehensive Health Research Centre (CHRC), Universidade de Évora, 7000-801 Evora, Portugal
| | - Lara Pinho
- Escola Superior de Enfermagem de São João de Deus, Universidade de Évora, 7000-801 Evora, Portugal; (C.F.); (M.L.)
- Comprehensive Health Research Centre (CHRC), Universidade de Évora, 7000-801 Evora, Portugal
- Correspondence:
| | - Manuel Lopes
- Escola Superior de Enfermagem de São João de Deus, Universidade de Évora, 7000-801 Evora, Portugal; (C.F.); (M.L.)
- Comprehensive Health Research Centre (CHRC), Universidade de Évora, 7000-801 Evora, Portugal
| | | | - Adriana Henriques
- Nursing Research, Innovation and Development Centre of Lisbon (CIDNUR), Nursing School of Lisbon (ESEL), 1600-096 Lisbon, Portugal; (A.R.); (A.H.)
- Instituto de Saúde Ambiental (ISAMB), Faculdade de Medicina, Universidade de Lisboa, 1649-028 Lisbon, Portugal
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Cachioni M, Cipolli GC, Borim FSA, Batistoni SST, Yassuda MS, Neri AL, Paúl C. Factors Associated With Positive Self-Rated Health: Comparing Older Adults in Brazil and in Portugal. Front Public Health 2021; 9:650294. [PMID: 33869133 PMCID: PMC8044971 DOI: 10.3389/fpubh.2021.650294] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Accepted: 03/01/2021] [Indexed: 01/22/2023] Open
Abstract
Introduction: Self-rated health is a multidimensional health indicator and a predictor of adverse events in old age. Answers to this assessment are influenced by social, cultural and personality factors. Aim: Exploring common and distinctive characteristics of Brazilian and Portuguese older adults aged 70 and over regarding positive self-rated health according to sociodemographic variables, to functional capacity, to independent performance of basic activities of daily living and to neuroticism, as well as analyzing associations between positive self-rated health and these variables. Methods: The present paper is a comparative and cross-sectional study based on secondary data contained in the databases of the FIBRA (Frailty in Brazilian Older Adults) follow-up study, with 418 Brazilian older adults, and of the DIA (From Disability to Activity: The Challenge of Aging) study, with 380 Portuguese older adults. Both samples had higher percentages of women: 68.4% for Portugal and 69.9% for Brazil. The Brazilian sample had a higher average age (80.31 ± 4.67) than the Portuguese sample (76.80 ± 5.28). Results: The Portuguese older adults had better overall cognition scores, higher handgrip strength and higher neuroticism values than the Brazilian older adults. In the simple and multiple logistic regression analyses, it was found that among Brazilian older adults, subjects with higher scores in the MMSE (OR 1.16; 95% CI 1.08-1.24), regardless of ADL performance (OR 2.13; 95% CI 1.31-3.47) and with scores 24-29 (OR 1.92; 95% CI 1.07-3.43) or 11-23 (OR 2.09; 95% CI 1.15-3.79) in neuroticism were more likely to assess their health as very good/good. On the other hand, the Portuguese older adults with intermediate 24-9 (OR 2.38; 95% CI 1.31-4.33) or low 11-23 (OR 5.31; 95% CI 2.69-10.45) scores in neuroticism were more likely to evaluate their health as very good/good. Conclusion: Based on the findings of the present study and on the existing literature, it may be said that it is possible for people to age while keeping a positive perception of their own health, even in advanced old age; comparisons between the above-mentioned countries, however, point to the need for investments in healthcare systems so that older adults may enjoy greater physical independence and improved mental health.
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Affiliation(s)
- Meire Cachioni
- University of São Paulo, São Paulo, São Paulo, Brazil.,Institute of Biomedical Sciences Abel Salazar (ICBAS), Center for Research in Health Technologies and Services (CINTESIS), University of Porto, Porto, Portugal
| | | | | | | | | | - Anita Liberalesso Neri
- Graduate Studies in Gerontology, State University of Campinas, Campinas, São Paulo, Brazil
| | - Constança Paúl
- Institute of Biomedical Sciences Abel Salazar (ICBAS), Center for Research in Health Technologies and Services (CINTESIS), University of Porto, Porto, Portugal
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Lee J, Meijer E, Phillips D, Hu P. Disability Incidence Rates for Men and Women in 23 Countries: Evidence on Health Effects of Gender Inequality. J Gerontol A Biol Sci Med Sci 2021; 76:328-338. [PMID: 33216874 PMCID: PMC7812438 DOI: 10.1093/gerona/glaa288] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Inequality in gender varies across social contexts, which may influence the health of both men and women. Based on theories of gender as a social system, we examine whether systematic gender inequality at the macro-level influences health of men and women. METHOD Using harmonized panel data from the Gateway to Global Aging Data in 23 high- and middle-income countries (N = 168 873), we estimate disability prevalence and incidence for men and women ages 55-89 (2000-2016). Within each country or geographic region, we also investigate gender differences in age gradients of the probability of disability onset. We, then, pool data from all countries and test the hypothesis that gender inequality increases the probability of disability onset. RESULTS We found substantial cross-country variation in disability incidence rates, and this variation is greater for women than for men. Among ages 65-69, disability incidence rates ranged from 0.4 to 5.0 for men and from 0.5 to 9.4 for women. Our within-country analysis showed significant gender differences in age gradients of the probability of disability onset in the United States, Korea, Southern Europe, Mexico, and China, but not in Northern, Central, and Eastern Europe, England, and Israel. Testing hypothesized effects of gender inequality, we find that gender inequality is significantly associated with the probability of disability onset for women, but not for men. CONCLUSIONS Macro-level societal gender inequality is significantly associated with the probability of disability onset for women. Reducing and eliminating gender inequality is crucial to achieving good health for women.
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Affiliation(s)
- Jinkook Lee
- Dornsife Center for Economic and Social Research, University of Southern California, Los Angeles
- Department of Economics, University of Southern California, Los Angeles
- RAND Corporation, Santa Monica, California
| | - Erik Meijer
- Dornsife Center for Economic and Social Research, University of Southern California, Los Angeles
- RAND Corporation, Santa Monica, California
| | - Drystan Phillips
- Dornsife Center for Economic and Social Research, University of Southern California, Los Angeles
| | - Peifeng Hu
- Division of Geriatric Medicine, David Geffen School of Medicine at University of California, Los Angeles
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13
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Disability prevalence in midlife (aged 55-65 years): Cross-Country comparisons of gender differences and time trends. Womens Midlife Health 2021; 7:1. [PMID: 33386080 PMCID: PMC7777402 DOI: 10.1186/s40695-020-00061-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Accepted: 12/02/2020] [Indexed: 12/02/2022] Open
Abstract
Background Prior literature on disability has centered on disability prevalence among older adults ages 65 and older, providing only limited insight to potential gender differences in disability prevalence in mid-life. Midlife is, however, a critical time to be examined, as it is typically the time in the life course when large inequalities in physical health first emerge. Methods Using the Harmonized data files provided by the Gateway to Global Aging Data, we estimate disability prevalence of nationally representative adults ages 55–65 from 23 countries (N = 79,465). We examine gender differences in two disability indicators, limitations in instrumental activities of daily living (IADLs) and activities of daily living (ADLs) in two time periods, 2004/05 and 2014/15. Results There are substantial cross-country variations in IADL and ADL disability prevalence in midlife. Within countries, we find that women have higher IADL prevalence than men in only one out of five countries. Similarly, for ADL prevalence, women have higher ADL prevalence than men in only one out of ten countries. Further, comparing disability prevalence in two time periods, we observe different country-specific time trends. Conclusions In the majority of mid and high-income countries, there is no significant gender difference in IADL and ADL prevalence, but there are few countries where women show higher prevalence of disability than men in mid-life. This finding calls for future research into what contributes to cross-country variations.
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14
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Scheel-Hincke LL, Möller S, Lindahl-Jacobsen R, Jeune B, Ahrenfeldt LJ. Cross-national comparison of sex differences in ADL and IADL in Europe: findings from SHARE. Eur J Ageing 2019; 17:69-79. [PMID: 32158373 DOI: 10.1007/s10433-019-00524-y] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
Women experience greater longevity than men, but have poorer health, although sex differences vary across health measures and geographical regions. We aim to examine sex differences in Activities of Daily Living (ADL) and Instrumental Activities of Daily Living (IADL) over age across European regions in a cross-sectional setting including 51,292 men and 62,007 women aged 50+ from a pooled sample of waves 1 (2004-2005) to 6 (2015) in the Survey of Health, Ageing and Retirement in Europe. ADL and IADL were dichotomised into no limitations and at least one limitation. Binomial regression models were used to estimate absolute and relative sex differences. Women had higher risk than men of ADL limitations (RR = 1.21, 95% CI 1.16; 1.27) and IADL limitations (RR = 1.54, 95% CI 1.48; 1.60), corresponding to risk differences of 1.3% and 5.7%, respectively. When we stratified by age groups and regions, sex differences in ADL were found in all age groups in Southern Europe, in the age groups 65-79 years and 80+ years in Western and Eastern Europe, and from the age of 80 in Northern Europe. For IADL, sex differences were found in all age groups in the four European regions, except from ages 50-64 in Eastern Europe. The absolute sex differences increased with age in all European regions. In conclusion, our results lend support for the male-female health survival paradox by showing that European women have higher risk of ADL and IADL limitations than European men and that sex differences increase with advancing age.
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Affiliation(s)
- Lasse Lybecker Scheel-Hincke
- 1Unit of Epidemiology, Biostatistics and Biodemography, Department of Public Health, University of Southern Denmark, J. B. Winsløws Vej 9B, 5000 Odense, Denmark
| | - Sören Möller
- 2OPEN - Odense Patient data Explorative Network, Odense University Hospital, 5000 Odense, Denmark.,3Department of Clinical Research, University of Southern Denmark, 5000 Odense, Denmark
| | - Rune Lindahl-Jacobsen
- 1Unit of Epidemiology, Biostatistics and Biodemography, Department of Public Health, University of Southern Denmark, J. B. Winsløws Vej 9B, 5000 Odense, Denmark
| | - Bernard Jeune
- 1Unit of Epidemiology, Biostatistics and Biodemography, Department of Public Health, University of Southern Denmark, J. B. Winsløws Vej 9B, 5000 Odense, Denmark
| | - Linda Juel Ahrenfeldt
- 1Unit of Epidemiology, Biostatistics and Biodemography, Department of Public Health, University of Southern Denmark, J. B. Winsløws Vej 9B, 5000 Odense, Denmark
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15
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Chen C, Lim JT, Chia NC, Wang L, Tysinger B, Zissimopolous J, Chong MZ, Wang Z, Koh GC, Yuan JM, Tan KB, Chia KS, Cook AR, Malhotra R, Chan A, Ma S, Ng TP, Koh WP, Goldman DP, Yoong J. The Long-Term Impact of Functional Disability on Hospitalization Spending in Singapore. JOURNAL OF THE ECONOMICS OF AGEING 2019; 14:100193. [PMID: 31857943 PMCID: PMC6922027 DOI: 10.1016/j.jeoa.2019.02.002] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Singapore is one of the fastest-aging populations due to increased life expectancy and lowered fertility. Lifestyle changes increase the burden of chronic diseases and disability. These have important implications for social protection systems. The goal of this paper is to model future functional disability and healthcare expenditures based on current trends. To project the health, disability and hospitalization spending of future elders, we adapted the Future Elderly Model (FEM) to Singapore. The FEM is a dynamic Markov microsimulation model developed in the US. Our main source of population data was the Singapore Chinese Health Study (SCHS) consisting of 63,000 respondents followed up over three waves from 1993 to 2010. The FEM model enables us to investigate the effects of disability compounded over the lifecycle and hospitalization spending, while adjusting for competing risk of multi-comorbidities. Results indicate that by 2050, 1 in 6 elders in Singapore will have at least one ADL disability and 1 in 3 elders will have at least one IADL disability, an increase from 1 in 12 elders and 1 in 5 elders respectively in 2014. The highest prevalence of functional disability will be in those aged 85 years and above. Lifetime hospitalization spending of elders aged 55 and above is US$24,400 (30.2%) higher among people with functional disability compared to those without disability. Policies that successfully tackle diabetes and promote healthy living may reduce or delay the onset of disability, leading to potential saving. In addition, further technological improvements may reduce the financial burden of disability.
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Affiliation(s)
- C Chen
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore
- Schaeffer Center for Health Policy and Economics, University of Southern California, USA
| | - JT Lim
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore
| | - NC Chia
- Department of Economics, National University of Singapore, Singapore
| | - L Wang
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore
| | - B Tysinger
- Schaeffer Center for Health Policy and Economics, University of Southern California, USA
| | - J Zissimopolous
- Schaeffer Center for Health Policy and Economics, University of Southern California, USA
| | - MZ Chong
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore
| | - Z Wang
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore
| | - GC Koh
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore
| | - JM Yuan
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
- Division of Cancer Control and Population Sciences, UPMC Hillman Cancer Center, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - KB Tan
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore
- Policy Research and Economics Office, Ministry of Health, Singapore
| | - KS Chia
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore
| | - AR Cook
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore
- Health Services and Systems Research, Duke-NUS Medical School, Singapore
| | - R Malhotra
- Health Services and Systems Research, Duke-NUS Medical School, Singapore
- Centre for Ageing Research and Education, Duke-NUS Medical School, Singapore
| | - A Chan
- Health Services and Systems Research, Duke-NUS Medical School, Singapore
- Centre for Ageing Research and Education, Duke-NUS Medical School, Singapore
| | - S Ma
- Epidemiology & Disease Control Division, Ministry of Health, Singapore
| | - TP Ng
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - WP Koh
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore
- Health Services and Systems Research, Duke-NUS Medical School, Singapore
| | - DP Goldman
- Schaeffer Center for Health Policy and Economics, University of Southern California, USA
| | - J Yoong
- Center for Economic and Social Research, University of Southern California, USA
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Regional differences in the profile of disabled community-dwelling older adults: A European population-based cross-sectional study. PLoS One 2018; 13:e0208946. [PMID: 30533039 PMCID: PMC6289507 DOI: 10.1371/journal.pone.0208946] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Accepted: 11/27/2018] [Indexed: 11/19/2022] Open
Abstract
The main objective of this work was to estimate the prevalence of disability in European community-dwelling older adults, as well as to investigate differences in the profile of disabled older adults between European regions (Northern, Central, Eastern and Southern). A cross-sectional study based on wave 6 (2015) of the Survey of Health, Ageing and Retirement in Europe (SHARE) was conducted. Community-dwelling participants aged 65-84 were selected (n = 33,369). Disability was defined as presenting at least one functional limitation in basic activities of daily living (BADL). Sociodemographic, health services, lifestyle and health-related variables were analyzed. Statistical analysis was carried out through the Chi-square and ANOVA tests for bivariate analysis, and Poisson regression for multivariate analysis. Overall prevalence of disability was 13.8%: 9.4% in the Northern region, 13.1% in the Southern region, 13.6% in the Central region, and 16.6% in the Eastern region. Portugal, Poland, Estonia and Belgium showed the highest prevalence of BADL limitations, while Sweden, Denmark, Greece and Switzerland showed the lowest prevalence. Besides, disabled older adults from East Europe presented the most disadvantaged health profile, followed by the Southern region. On the other hand, disabled older adults living in the Northern region showed the most advantaged characteristics of most variables, except for smoking and polypharmacy.
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