Links across disabilities: unveiling associations between functional domains

BACKGROUND

Persons with disabilities experience higher risks of mortality as well as poorer health as compared to the general population. The aim of this study is to estimate the correlations between functional difficulties across several domains in six countries.

METHODS

National census data with questions on disability from six countries (Mauritius, Morocco, Senegal, Myanmar, Vietnam, and Uruguay) was used in this study. We performed logistic regressions to assess the extent to which having a functional difficulty in one domain is correlated with having a functional difficulty in each of the other domains and report weighted odds ratios (ORs) overall and within age-groups ('18-44' years and '45+' years). Models adjust for age, sex, and location (rural or urban). Sensitivity analyses around different choices of predictors and response variables were conducted.

FINDINGS

For all countries, reporting a functional difficulty in one domain was consistently and significantly positively correlated with reporting a functional difficulty in other domains (overall) and for each of the two age-groups considered - '18-44' years and '45+' years. All ORs were greater than one. Cognition, mobility, and hearing were the domains that were the most correlated ones with other domains. The highest pairwise correlations were for i/ hearing and cognition; ii/ mobility and cognition. Results were robust to changing the severity thresholds for functional difficulties. Across countries, Uruguay, the only high-income country among the six countries under study, had the lowest correlations between functional domains.

CONCLUSIONS

There are consistent positive associations in the experience of functional difficulties in various domains in the six countries under study. Such correlations may reflect barriers to social services including healthcare services and resources (e.g. assistive devices) that may lead to an avoidable deterioration of functioning across domains. Further research is needed on the trajectories of functional difficulties and on structural barriers that people with functional difficulties may experience in their communities and in healthcare settings in particular. This is important as some functional difficulties may be preventable.

Anxiety and Depression Signs Among Adolescents in 26 Low- and Middle-Income Countries: Prevalence and Association With Functional Difficulties

PURPOSE

The aim of this study is to describe the occurrence of signs of depression and anxiety among adolescents from 26 low- and middle-income countries and explore the extent to which these are associated with difficulties across other functional domains.

METHODS

We analyzed randomly selected, nationally representative data from 26 countries with a total sample size of 123,975 adolescents aged 10-17 years. Data on functional difficulties, including signs of depression and anxiety, were collected by the Child Functioning Module, an instrument validated to identify the population of children with disabilities through household surveys. We estimated percentages and 95% confidence intervals of adolescents with difficulties across 11 domains of functioning, and of signs of depression and/or anxiety. We used multinomial regressions to estimate the association between difficulties in the different domains and having signs of depression only, signs of anxiety only, and signs of both depression and anxiety, relative to not presenting signs of depression or anxiety.

RESULTS

In total, 5.5% of adolescents were reported to have had signs of anxiety, 3.1% signs of depression, and 2.3% co-occurring signs of anxiety and depression. Compared to adolescents without functional difficulties, those with difficulties in one or more domains were three times more likely to have signs of depression and anxiety. The likelihood of presenting signs of depression only or signs of both depression and anxiety was significantly higher across all domains, and the highest among adolescent with difficulties to self-care and communicating. The likelihood of presenting signs of anxiety only was significantly higher across all domains except seeing and hearing, and the highest among adolescent with difficulties communicating and accepting changes.

DISCUSSION

Adolescents with functional difficulties in all domains analyzed, across different contexts, are more likely to experience depression and anxiety signs than those without such difficulties. Increasing the availability of population-level data on adolescent functional difficulties, including those related to depression and anxiety, is important in promoting inclusivity, participation, and the right of children to equal opportunities.

COVID-Related Functional Difficulties and Concerns Among University Students During COVID-19 Pandemic: A Binational Perspective

The COVID-19 pandemic has created a sense of threat, and stress that has surged globally at an alarming pace. University students were confronted with new challenges. This study examined university students’ functional difficulties and concerns during COVID-19 pandemic in two countries: Israel and Ukraine. Additionally, it examined the similarities and differences in prediction of COVID-related concerns in both countries. Two large samples of university students were drawn from both countries. Results showed that students’ main functional difficulties in both countries were: worries about their family health status and their learning assignments. In both countries, COVID-related functional difficulties and stress associated with exposure to the media added a significant amount of the explained variance of COVID-related concerns after controlling for background variables. In conclusion—while the level of exposure and difficulties may differ by country and context, their associations with students’ concerns seem robust. Additionally, repeated exposure to media coverage about a community threat can lead to increased anxiety.

Factors influencing attrition in 35 Alzheimer's Disease Centers across the USA: a longitudinal examination of the National Alzheimer's Coordinating Center's Uniform Data Set

OBJECTIVE

A lack of understanding of the causes of attrition in longitudinal studies of older adults may lead to higher attrition rates and bias longitudinal study results. In longitudinal epidemiological studies of Alzheimer's disease and related dementias, high rates of attrition may cause a systematic underestimation of dementia prevalence and skew the characterization of the disease. This can compromise the generalizability of the study results and any inferences based on the surviving sample may grossly misrepresent the importance of the risk factors for dementia. The National Institute on Aging outlined a National Strategy for Recruitment and Participation in Alzheimer's Disease Clinical Research to address this problem, providing evidence of the magnitude of this problem.

METHOD

To explore predictors of attrition, this study examined the National Alzheimer's Coordinating Center (NACC) Uniform Data Set, a repository of observations of older adults spanning 11 years, using survival analysis. Four samples were examined: the full sample (n = 30,433), the alive subsample excluding those who died (n = 24,231), the MRI sample [participants with complete MRI data (n = 1104)], and the alive MRI subsample [participants with MRI data excluding those who died (n = 947)].

RESULTS

Worsening cognitive impairment, neuropsychiatric symptoms, and difficulty with functional activities predicted attrition, as did lower hippocampal volume in the MRI subsample. Questionable co-participant reliability and an informant other than a spouse also increased risk of attrition.

DISCUSSION

Special considerations exist in recruiting and retaining older adults in longitudinal studies, and results of baseline psychological, functional, and cognitive functioning should be used to identify targeted retention strategies.

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

OBJECTIVE

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

PRACTICE IMPLICATIONS

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