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Yu R, Lai D, Leung G, Tam LY, Cheng C, Kong S, Tong C, Woo J. Transitions in intrinsic capacity among community-dwelling older people and their associated factors: a multistate modelling analysis. J Nutr Health Aging 2024; 28:100273. [PMID: 38833766 DOI: 10.1016/j.jnha.2024.100273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2024] [Revised: 05/08/2024] [Accepted: 05/18/2024] [Indexed: 06/06/2024]
Abstract
OBJECTIVES Trajectory of intrinsic capacity (IC) can be non-linear and discontinuous, which traditional linear models may not be able to handle. This study thus aimed to model the trajectory of IC as transitions between different IC states and examine their associated factors. METHODS Longitudinal data from a sample of community-dwelling older people aged 60 years or above (n = 1,588) was analysed. A set of 14 self-reported items representing different domains of IC were administered annually to measure IC at four time points. Based on the number of impaired IC domains (i.e., cognitive, locomotor, vitality, sensory, and psychological), participants at each time point were classified into one of three IC states, namely state 1 (0 impaired domain), state 2 (1-2 impaired domains), and state 3 (3-5 impaired domains). Multistate modelling was used to identify factors associated with the transitions from one state to another. RESULTS The mean age of participants was 75.0 years, and 77.4% of them were female. At baseline, 12.4% were in state 1, 51.8% were in state 2, and 35.8% were in state 3. 62.8% of participants experienced at least one transition between states, among which 12% experienced a transition every year. The transitions occurred mostly between adjacent IC states and could take place back and forth. Age, sex, marital status, perceived financial adequacy, number of chronic diseases, and self-rated health were the factors associated with the transitions. CONCLUSION Findings may serve as a valuable reference for guiding future policies to optimize IC and promote healthy ageing using a person-centred approach.
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Affiliation(s)
- Ruby Yu
- The Chinese University of Hong Kong, Hong Kong.
| | - Derek Lai
- The Chinese University of Hong Kong, Hong Kong
| | - Grace Leung
- The Chinese University of Hong Kong, Hong Kong
| | - Lok-Yan Tam
- The Chinese University of Hong Kong, Hong Kong
| | - Clara Cheng
- The Chinese University of Hong Kong, Hong Kong
| | - Sara Kong
- The Chinese University of Hong Kong, Hong Kong
| | | | - Jean Woo
- The Chinese University of Hong Kong, Hong Kong
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Schmucker AM, Reyes-Farias D, Nicosia FM, Xu E, B Potter M, Karliner LS, Brown RT. Caring for Patients with Functional Impairment in Middle Age: Perspectives from Primary Care Providers and Geriatricians. J Gen Intern Med 2024:10.1007/s11606-024-08701-1. [PMID: 38489004 DOI: 10.1007/s11606-024-08701-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 02/23/2024] [Indexed: 03/17/2024]
Abstract
BACKGROUND The prevalence of functional impairment is increasing among middle-aged adults and is associated with adverse health outcomes. Primary care providers (PCPs) and geriatricians may have important insights about optimal approaches to caring for these patients, but little is known about their perspectives. OBJECTIVE To examine PCPs' and geriatricians' perspectives on clinical needs and optimal approaches to care for middle-aged patients with functional impairment. DESIGN Qualitative study using semi-structured interviews. PARTICIPANTS PCPs and geriatricians from outpatient practices in the San Francisco Bay area. APPROACH Interviews focused on characteristics and care needs of middle-aged patients with functional impairment and models of care to address these needs. We analyzed interviews using hybrid deductive-inductive qualitative thematic analysis. KEY RESULTS Clinicians (14 PCPs, 15 geriatricians) described distinct characteristics of functional impairment in middle-aged versus older adults, such as different rates of onset, but similar clinical needs. Despite these similar needs, clinicians identified age-specific barriers to delivering optimal care to middle-aged patients. These included system-level challenges such as limited access to insurance and social services; practice- and clinician-level barriers including inadequate clinician training; and patient-level factors including less access to family caregivers and perceptions of stigma. To overcome these challenges, clinicians suggested clinical approaches including addressing health-related social needs within healthcare systems; implementing practice-based models that are multi-disciplinary, team-based, and coordinated; training clinicians to effectively manage functional impairment; and expanding community-based services and supports to help patients navigate the medical system. Identified needs, challenges, and solutions were generally similar across geriatricians and PCPs. CONCLUSIONS Clinicians face challenges in delivering optimal care to middle-aged patients who have functional impairments similar to their older counterparts but lack access to services and supports available to older people. These findings suggest the importance of increasing access to care models that address functional impairment regardless of age.
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Affiliation(s)
- Abigail M Schmucker
- Department of Internal Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA, USA.
| | - David Reyes-Farias
- Division of Geriatric Medicine, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA, USA
| | - Francesca M Nicosia
- Geriatrics, Palliative, and Extended Care, San Francisco VA Health Care System, San Francisco, CA, USA
- Division of Geriatrics, University of California, San Francisco, San Francisco, CA, USA
| | - Edison Xu
- Division of General Internal Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Michael B Potter
- Department of Family and Community Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Leah S Karliner
- Division of General Internal Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Rebecca T Brown
- Division of Geriatric Medicine, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA, USA
- Geriatrics and Extended Care Program, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA, USA
- Center for Health Equity Research and Promotion, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA, USA
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA
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Chen J, Li H, Zhou B, Li X, Zhu Y, Yao Y. Interaction between visual impairment and subjective cognitive complaints on physical activity impairment in U.S. older adults: NHANES 2005-2008. BMC Geriatr 2024; 24:167. [PMID: 38368377 PMCID: PMC10874547 DOI: 10.1186/s12877-024-04739-2] [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: 08/14/2023] [Accepted: 01/23/2024] [Indexed: 02/19/2024] Open
Abstract
BACKGROUND/AIM To investigate the independent relationships of visual impairment (VI) and Subjective cognitive complaints (SCC) with physical function impairment (PFI) and the interaction effect between VI and SCC on PFI in American older adults. METHODS The data of this cross-sectional study was obtained from the 2005-2008 National Health and Examination Survey (NHANES) conducted in the United States. The VI criterion included both subjective self-reported eyesight conditions and objective visual acuity test results. The self-reported questionnaires were utilized to determine PFI and SCC. According to the survey design of NHANS, original data were weighted to produce nationally representative estimates. Both the unweighted original data and weighted estimates underwent analysis. Crude and adjusted logistic models were employed to assess the pairwise associations among VI, SCC, and PFI. To assess the interactive effect, measures such as the relative excess risk due to interaction (RERI), attributable proportion due to interaction (AP), and synergy index (S) were calculated. RESULTS A total of 2,710 subjects (weighted n = 38,966,687) aged 60 years or older were included. Compared with subjects without subjective visual impairment (SVI), those with SVI had a significant positive association with PFI [weighted OR (95%CI): 3.11 (2.25, 4.31)]. After multi-variable adjusting, the relationship remained significant [weighted OR (95%CI): 1.90 (1.32, 2.72)]. Similarly, those with objective visual impairment (OVI) were positively associated with the risk of PFI in the crude model [weighted OR (95%CI): 2.35 (1.53, 3.61)] and adjusted model [weighted OR (95%CI): 1.84 (1.07, 3.17)]. Moreover, we found the association of SCC with an increased risk of FPI [crude weighted OR (95%CI): 5.02 (3.40, 7.40); adjusted weighted OR (95%CI): 3.29 (2.01, 5.38)]. Ultimately, the additive interaction showed there was a significant positive interaction term between SVI and SCC on PFI, while OVI and SCC did not. CONCLUSION Both VI and SCC were significantly associated with PFI in elder adults. Besides, there was a significant synergistic interaction between SVI and SCC on PFI, which indicated the improvement of SVI and SCC may be beneficial for the prevention of PFI. For the elderly, especially those with multiple disabilities, comprehensive and targeted approaches are imperative to foster their overall well-being and health.
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Affiliation(s)
- Jinyuan Chen
- Department of Ophthalmology, the First Affiliated Hospital, Fujian Medical University, Fuzhou, China
- Department of Ophthalmology, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, China
- Clinical Research Center for Eye Diseases and Optometry of Fujian Medical University, Fuzhou, China
| | - Haoyu Li
- Department of Ophthalmology, The Second Xiangya Hospital, Central South University, Changsha, P. R. China
- Hunan Clinical Research Centre of Ophthalmic Disease, Changsha, P. R. China
| | - Biting Zhou
- Department of Ophthalmology, the First Affiliated Hospital, Fujian Medical University, Fuzhou, China
- Department of Ophthalmology, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, China
- Clinical Research Center for Eye Diseases and Optometry of Fujian Medical University, Fuzhou, China
| | - Xian Li
- Manchester Royal Eye Hospital, Manchester University NHS Foundation Trust, Manchester, UK
- Division of Pharmacy and Optometry, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - Yihua Zhu
- Department of Ophthalmology, the First Affiliated Hospital, Fujian Medical University, Fuzhou, China.
- Department of Ophthalmology, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, China.
- Clinical Research Center for Eye Diseases and Optometry of Fujian Medical University, Fuzhou, China.
| | - Yihua Yao
- Department of Ophthalmology, the First Affiliated Hospital, Fujian Medical University, Fuzhou, China.
- Department of Ophthalmology, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, China.
- Clinical Research Center for Eye Diseases and Optometry of Fujian Medical University, Fuzhou, China.
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van der Ploeg T, Gobbens RJJ. Disability transitions in Dutch community-dwelling older people aged 75 years or older. Arch Gerontol Geriatr 2024; 116:105165. [PMID: 37639841 DOI: 10.1016/j.archger.2023.105165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Revised: 08/10/2023] [Accepted: 08/18/2023] [Indexed: 08/31/2023]
Abstract
BACKGROUND Recent world population predictions show that the world population aged >=65 years will increase from 10% in 2022 to 16% in 2050. Population aging is accompanied by an increase in people with disability. It is important to pay special attention to people with disability, as these people are at high risk of adverse outcomes. Our study aimed to investigate the transitions of disability among Dutch community-dwelling older people aged 75 years or older, using a follow-up of nine years. We used socio-demographic factors gender, age, marital status, education, and income, but also lifestyle, diseases, and life events to predict the disability transitions over time. METHODS We used a sample of 484 people that was randomly drawn from the municipality of Roosendaal (the Netherlands), a municipality with 78,000 inhabitants. A subset of people who completed part A of the Tilburg Frailty Indicator (TFI) at baseline and the Groningen Activity Restriction Scale (GARS) questionnaires was used with a nine-year follow-up. Paired Wilcoxon tests were used to compare the consecutive measurements. Socio-demographic factors gender, age, marital status, education, and income, but also lifestyle, diseases, and life events were included to predict the disability transitions over time. For the univariable and multivariable analysis of the measurements over time with the predictor variables, we used generalized estimation equations (GEE). A p-value <0.05 was considered significant. R version 3.4.4 was used for all analyses. RESULTS Of the participants, 65% were younger than 80 years, 50% were married or cohabiting, 87% reported a healthy lifestyle, and 63% had no diseases or chronic disorders. Each year, more participants changed from status not disabled to disabled than vice versa. The GEE analyses showed that lifestyle ('not healthy') and diseases or chronic disorders ('two or more') were significant in the multivariable analysis for the disability score and only diseases or chronic disorders ('two or more') was significant in the multivariable analysis for the dichotomous disability score. CONCLUSIONS The transition of the disability score is strongly influenced by lifestyle and diseases or disorders. This applies to a lesser extent to the dichotomous disability score. There, only diseases or disorders are an important predictor. For health care professionals our study provides starting points for interventions focused on the prevention of worsening disability and for community-dwelling older people >= 75, the most important recommendation is: live healthy!
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Affiliation(s)
- Tjeerd van der Ploeg
- Faculty of Health, Sports and Social Work, Inholland University of Applied Sciences, Amsterdam, The Netherlands.
| | - Robbert J J Gobbens
- Faculty of Health, Sports and Social Work, Inholland University of Applied Sciences, Amsterdam, The Netherlands; Zonnehuisgroep Amstelland, Amstelveen, The Netherlands; Department Family Medicine and Population Health, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium; Tranzo, Tilburg University, Tilburg, The Netherlands
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Yin L, Rong T, Zhang Y, Gao J. The relationship between sleep quality and anxiety and depression among older caregivers of centenarians in China: A cross-sectional study. Geriatr Nurs 2023; 54:302-309. [PMID: 37918038 DOI: 10.1016/j.gerinurse.2023.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 10/05/2023] [Accepted: 10/05/2023] [Indexed: 11/04/2023]
Abstract
To explore the relationship between sleep quality and anxiety and depression in older caregivers. From April 2020 to November 2022, GAD-7, GDS-15, and PSQI were used to measure anxiety, depression, and sleep quality. The correlation of each variable was explored by regression analysis. Among 442 caregivers ≥ 65 years old, the prevalence of sleep disorders, anxiety, and depression was 40.5 %, 20.2 %, and 26.4 %. After adjustment for multiple potential confounders, anxiety (OR1.1; 95 % CI 1-1.2) and depression (OR 1.29; 95 % CI 1.21-1.38) were associated with sleep disorders. Daytime dysfunction components of PSQI measurements were associated with anxiety(P < 0.05). Meanwhile, sleep efficiency, sleep medication use, and daytime dysfunction components of PSQI measurements were associated with depression(P < 0.05). Therefore, the sleep quality of older caregivers is strongly related to anxiety and depression. It is necessary to provide sleep guidance or professional intervention for older caregivers to reduce anxiety and depression.
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Affiliation(s)
- Lanxin Yin
- Medical School of Nantong University, Nantong 226001, China; Research Center of Clinical Medicine, Affiliated Hospital of Nantong University, Nantong University, Nantong 226001, China; Research Center of Gerontology and Longevity, Affiliated Hospital of Nantong University, Nantong 226001, China
| | - Ting Rong
- Research Center of Clinical Medicine, Affiliated Hospital of Nantong University, Nantong University, Nantong 226001, China; Research Center of Gerontology and Longevity, Affiliated Hospital of Nantong University, Nantong 226001, China; School of Public Health, Nantong University, Nantong 226001, China
| | - Yi Zhang
- Medical School of Nantong University, Nantong 226001, China; Research Center of Clinical Medicine, Affiliated Hospital of Nantong University, Nantong University, Nantong 226001, China; Research Center of Gerontology and Longevity, Affiliated Hospital of Nantong University, Nantong 226001, China
| | - Jianlin Gao
- Medical School of Nantong University, Nantong 226001, China; Research Center of Clinical Medicine, Affiliated Hospital of Nantong University, Nantong University, Nantong 226001, China; Research Center of Gerontology and Longevity, Affiliated Hospital of Nantong University, Nantong 226001, China.
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Cabib I, Olea-Durán B, Villalobos Dintrans P, Browne Salas J. Long-term functional ability trajectories and mental health among older people before and after the COVID-19 pandemic onset in Chile. Aging Ment Health 2023; 27:1534-1543. [PMID: 36907589 DOI: 10.1080/13607863.2023.2188170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Accepted: 02/21/2023] [Indexed: 03/14/2023]
Abstract
OBJECTIVES Despite the advances in understanding the complex association between functional abilities and mental health in old age, studies have overlooked two important aspects. First, traditionally, research has employed cross-sectional designs, measuring limitations at a single time point. Second, most gerontological studies on this field have been conducted before the COVID-19 pandemic onset. This study aims to explore the association between diverse long-term functional ability trajectories across late adulthood and old age, and older people's mental health in Chile, before and after the COVID-19 pandemic onset. METHODS We use data from the population-representative and longitudinal 'Chilean Social Protection Survey', sequence analysis to reconstruct functional ability trajectory types from 2004 to 2018, and bivariate and multivariate analyses to measure their association with depressive symptoms in early 2020 (N = 891) and late 2020 (N = 672). We analyzed four age groups defined by their age at baseline (2004): people aged 46-50, 51-55, 56-60, and 61-65. RESULTS Our findings indicate that erratic or equivocal patterns of functional limitations across time (with people transiting back and forth between low and high levels of limitations) show the worst mental health outcomes, both before and after the pandemic onset. Prevalence of people with depression increased after the COVID-19 onset in most groups, being particularly high among those with previous equivocal functional ability trajectories. CONCLUSIONS The relationship between functional ability trajectories and mental health calls for a new paradigm, moving away from age as the main policy guide, and highlighting the need to adopt strategies to improve population-level functional status as an efficient policy to address the challenges of population aging.
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Affiliation(s)
- Ignacio Cabib
- Instituto de Sociología & Departamento de Salud Pública, Pontificia Universidad Católica de Chile, Santiago, Chile
- Centro UC Estudios de Vejez y Envejecimiento, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Bastián Olea-Durán
- Centro UC Estudios de Vejez y Envejecimiento, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Pablo Villalobos Dintrans
- Programa Centro Salud Pública, Facultad de Ciencias Médicas, Universidad de Santiago, Santiago, Chile
- Millennium Institute for Care Research (MICARE), Santiago, Chile
| | - Jorge Browne Salas
- Millennium Institute for Care Research (MICARE), Santiago, Chile
- Sección de Geriatría, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
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Yang J, Zhang Y, Shen S, Yu H, Yang L, Zhao Y, Xiong Y, Su J, Wang L, Lei X. 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. Front Public Health 2023; 11:1165753. [PMID: 37206872 PMCID: PMC10189058 DOI: 10.3389/fpubh.2023.1165753] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 04/05/2023] [Indexed: 05/21/2023] Open
Abstract
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.
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Affiliation(s)
- Jialu Yang
- School of Public Health and Management, Chongqing Medical University, Chongqing, China
- Research Center for Medicine and Social Development, Chongqing Medical University, Chongqing, China
- The Innovation Center for Social Risk Governance in Health, Chongqing Medical University, Chongqing, China
| | - Yangchang Zhang
- School of Public Health and Management, Chongqing Medical University, Chongqing, China
- Research Center for Medicine and Social Development, Chongqing Medical University, Chongqing, China
- The Innovation Center for Social Risk Governance in Health, Chongqing Medical University, Chongqing, China
- Research Center for Public Health Security, Chongqing Medical University, Chongqing, China
| | - Shisi Shen
- The First School of Clinical Medicine, Chongqing Medical University, Chongqing, China
| | - Han Yu
- The Second School of Clinical Medicine, Chongqing Medical University, Chongqing, China
| | - Luran Yang
- The First School of Clinical Medicine, Chongqing Medical University, Chongqing, China
| | - Yao Zhao
- The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yang Xiong
- The West China Hospital, Sichuan University, Chengdu, China
| | - Jiayi Su
- The Jiang Jin Central Hospital of Chongqing, Chongqing, China
| | - Lianlian Wang
- Department of Reproductive Center, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
- State Key Laboratory of Maternal and Fetal Medicine of Chongqing Municipality, Chongqing Medical University, Chongqing, China
- *Correspondence: Lianlian Wang, ; Xun Lei,
| | - Xun Lei
- School of Public Health and Management, Chongqing Medical University, Chongqing, China
- Research Center for Medicine and Social Development, Chongqing Medical University, Chongqing, China
- The Innovation Center for Social Risk Governance in Health, Chongqing Medical University, Chongqing, China
- Research Center for Public Health Security, Chongqing Medical University, Chongqing, China
- *Correspondence: Lianlian Wang, ; Xun Lei,
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Assessing Relationships between Physically Demanding Work and Late-Life Disability in Italian Nonagenarian Women Living in a Rural Area. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19148880. [PMID: 35886729 PMCID: PMC9319548 DOI: 10.3390/ijerph19148880] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 07/11/2022] [Accepted: 07/20/2022] [Indexed: 02/04/2023]
Abstract
As more and more persons live into their 90s and beyond, investigating causes of disability in the oldest-old population is relevant for public health implications to plan preventive strategies and rehabilitation interventions. A negative association between physically demanding work and midlife physical function has been shown, but there is a paucity of longitudinal studies investigating possible work-related long-term effects in the oldest old. This study investigates the relationship between physically demanding work exposure and late-life physical performances, disability, general health status, and quality of life in a sample of women aged 90 years and over inside the Mugello Study. Sociodemographic data, cognitive and functional status, lifestyle, medical history, drug use, and work history were collected from 236 participants. Farmers had a lower percentage of individuals with preserved independence in basic activities of daily living compared to other occupations. However, in the multivariate analysis, only a higher cognitive function remained associated with functional independence. While confirming the well-known association between cognitive and functional decline in very old age, our results do not support the hypothesis that the negative effects of physical work exposure observed in midlife are relevant to predict disability in nonagenarian women.
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Verbeek E, Drewes YM, Gussekloo J. Visual impairment as a predictor for deterioration in functioning: the Leiden 85-plus Study. BMC Geriatr 2022; 22:397. [PMID: 35524168 PMCID: PMC9074345 DOI: 10.1186/s12877-022-03071-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Accepted: 04/19/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Visual impairment frequently occurs amongst older people. Therefore, the aim of this study was to investigate the predictive value of visual impairment on functioning, quality of life and mortality in people aged 85 years. METHODS From the Leiden 85-plus Study, 548 people aged 85 years were eligible for this study. Visual acuity was measured at baseline by Early Treatment Diabetic Retinopathy Study charts (ETDRS). According to the visual acuity (VA) three groups were made, defined as no (VA > 0.7), moderate (0.5 ≤ VA ≤ 0.7) or severe visual impairment (VA < 0.5). Quality of life, physical, cognitive, psychological and social functioning were measured annually for 5 years. For mortality, participants were followed until the age of 95. RESULTS At baseline, participants with visual impairment scored lower on physical, cognitive, psychological and social functioning and quality of life (p < 0.001). Compared to participants with no visual impairment, participants with moderate and severe visual impairment had an accelerated deterioration in basic activities of daily living (respectively 0.27-point (p = 0.017) and 0.35 point (p = 0.018)). In addition, compared to participants with no visual impairment, the mortality risk was 1.83 (95% CI 1.43, 2.35) for participants with severe visual impairment. DISCUSSION In very older adults, visual impairment predicts accelerated deterioration in physical functioning. In addition, severely visually impaired adults had an increased mortality risk. A pro-active attitude, focussing on preventing and treating visual impairment could possibly contribute to the improvement of physical independence, wellbeing and successful aging in very old age.
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Affiliation(s)
- Erj Verbeek
- Department of Internal Medicine, section Gerontology and Geriatrics, Leiden University Medical Center, Leiden, the Netherlands
| | - Y M Drewes
- Department of Internal Medicine, section Gerontology and Geriatrics, Leiden University Medical Center, Leiden, the Netherlands. .,Department of Internal Medicine, section Gerontology and Geriatrics, Leiden University Medical Center, Leiden, the Netherlands.
| | - J Gussekloo
- Department of Internal Medicine, section Gerontology and Geriatrics, Leiden University Medical Center, Leiden, the Netherlands.,Department of Public Health and Primary Care and Department of Internal Medicine, section Gerontology and Geriatrics, Leiden University Medical Center, Leiden, the Netherlands
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Gonot-Schoupinsky F, Garip G, Sheffield D. The Engage-Disengage Model as an Inclusive Model for the Promotion of Healthy and Successful Aging in the Oldest-old. ACTIVITIES, ADAPTATION & AGING 2022. [DOI: 10.1080/01924788.2021.1970892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Freda Gonot-Schoupinsky
- College of Health, Psychology, and Social Care, University of Derby Online Learning, University of Derby, Enterprise Centre, Derby, UK
| | - Gulcan Garip
- College of Health, Psychology, and Social Care, University of Derby Online Learning, University of Derby, Enterprise Centre, Derby, UK
| | - David Sheffield
- College of Health, Psychology, and Social Care, University of Derby Online Learning, University of Derby, Enterprise Centre, Derby, UK
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Marchesi G, De Luca A, Squeri V, De Michieli L, Vallone F, Pilotto A, Leo A, Casadio M, Canessa A. A Lifespan Approach to Balance in Static and Dynamic Conditions: The Effect of Age on Balance Abilities. Front Neurol 2022; 13:801142. [PMID: 35265025 PMCID: PMC8899125 DOI: 10.3389/fneur.2022.801142] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2021] [Accepted: 01/05/2022] [Indexed: 11/23/2022] Open
Abstract
Postural control is a complex sensorimotor skill that is fundamental to our daily life. The abilities to maintain and recover balance degrade with age. However, the time decay of balance performance with age is not well understood. In this study, we aim at quantifying the age-dependent changes in standing balance under static and dynamic conditions. We tested 272 healthy subjects with ages ranging from 20 to 90. Subjects maintained the upright posture while standing on the robotic platform hunova®. In the evaluation of static balance, subjects stood on the fixed platform both with eyes open (EO) and eyes closed (EC). In the dynamic condition, subjects stood with eyes open on the moving foot platform that provided three different perturbations: (i) an inclination proportional to the center of pressure displacements, (ii) a pre-defined predictable motion, and (iii) an unpredictable and unexpected tilt. During all these tests, hunova® measured the inclination of the platform and the displacement of the center of pressure, while the trunk movements were recorded with an accelerometer placed on the sternum. To quantify balance performance, we computed spatio-temporal parameters typically used in clinical environments from the acceleration measures: mean velocity, variability of trunk motion, and trunk sway area. All subjects successfully completed all the proposed exercises. Their motor performance in the dynamic balance tasks quadratically changed with age. Also, we found that the reliance on visual feedback is not age-dependent in static conditions. All subjects well-tolerated the proposed protocol independently of their age without experiencing fatigue as we chose the timing of the evaluations based on clinical needs and routines. Thus, this study is a starting point for the definition of robot-based assessment protocols aiming at detecting the onset of age-related standing balance deficits and allowing the planning of tailored rehabilitation protocols to prevent falls in older adults.
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Affiliation(s)
- Giorgia Marchesi
- Spinal Cord Italian Lab (SCIL), Unità Spinale Unipolare, Santa Corona Hospital, Pietra Ligure, Italy.,Department of Informatics, Bioengineering, Robotics, and Systems Engineering (DIBRIS), University of Genoa, Genoa, Italy
| | | | | | | | - Francesco Vallone
- Department of Geriatric Care, Orthogeriatrics and Rehabilitation, Galliera Hospital, Genoa, Italy
| | - Alberto Pilotto
- Department of Geriatric Care, Orthogeriatrics and Rehabilitation, Galliera Hospital, Genoa, Italy
| | - Alessandra Leo
- Unità Spinale Unipolare, Ospedale Metropolitano Niguarda, Milan, Italy
| | - Maura Casadio
- Spinal Cord Italian Lab (SCIL), Unità Spinale Unipolare, Santa Corona Hospital, Pietra Ligure, Italy.,Department of Informatics, Bioengineering, Robotics, and Systems Engineering (DIBRIS), University of Genoa, Genoa, Italy
| | - Andrea Canessa
- Spinal Cord Italian Lab (SCIL), Unità Spinale Unipolare, Santa Corona Hospital, Pietra Ligure, Italy.,Department of Informatics, Bioengineering, Robotics, and Systems Engineering (DIBRIS), University of Genoa, Genoa, Italy
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12
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Gardeniers MKM, van Groenou MIB, Meijboom EJ, Huisman M. Three-year trajectories in functional limitations and cognitive decline among Dutch 75+ year olds, using nine-month intervals. BMC Geriatr 2022; 22:89. [PMID: 35105338 PMCID: PMC8805337 DOI: 10.1186/s12877-021-02720-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Accepted: 12/03/2021] [Indexed: 11/29/2022] Open
Abstract
Background Using longitudinal panel data, we aimed to identify three-year trajectories in cognitive and physical functioning among Dutch older adults, and the characteristics associated with these trajectories. Methods We used Group-based Trajectory Modelling with mortality jointly estimated to identify trajectories, using a scale composed of 6 Activities of Daily Living (ADL) as a measure of physical functioning, and the short mini mental status examination (sMMSE) or the Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE) as a measure of cognitive functioning. Data came from 574 Dutch adults aged 75+, collected in five nine-month measurement waves (2015–2018) for the Longitudinal Aging Study Amsterdam. Results For physical functioning five trajectories were identified: ‘high’, ‘moderate’, ‘steeply declining’, ‘gradually declining’, and ‘continuously low’; and for cognitive functioning: ‘high’, ‘moderate’, ‘declining’, and ‘low’. Living in an institution, and being lower educated increased the probability of the two continuously low functioning trajectories, whereas old age and multimorbidity increased the probability of low physical functioning, but multimorbidity decreased the probability of low cognitive functioning. Associations for steeply declining physical functioning were absent. Being older and having multimorbidity increased the probability of gradually declining physical functioning and declining cognitive functioning. A higher prevalence of lung- and heart disease, cancer, and rheumatic disease was found in the gradually declining physical functioning group; and a higher prevalence of diabetes, cerebrovascular accidents, and cancer was found in the declining cognitive functioning group. High and moderate physical functioning and high cognitive functioning were characterized by being younger, community-dwelling, and higher educated. Having multimorbidity negatively predicted high and moderate physical functioning, but was not associated with high and moderate cognitive functioning. Conclusions This study identified trajectories comparable to studies that used longer time intervals, showing the consistent presence of heterogeneity in both physical and cognitive trajectories. Co-modelling mortality resulted in bigger group sizes for the more adverse trajectories. The favourable trajectories, containing most of the participants, were mostly characterized by absence of disease. The prevalence of chronic diseases differed between the declining trajectories, suggesting that certain diseases tend to induce cognitive decline rather than physical decline, and vice versa. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-021-02720-x.
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Affiliation(s)
| | | | - Erik Jan Meijboom
- Department of Sociology, Vrije Universiteit Amsterdam, De Boelelaan, 1081, Amsterdam, The Netherlands
| | - Martijn Huisman
- Department of Epidemiology & Biostatistics, Amsterdam Public Health research institute, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan, 1117, Amsterdam, Netherlands
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13
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Neumann JT, Thao LTP, Callander E, Carr PR, Qaderi V, Nelson MR, Reid CM, Woods RL, Orchard SG, Wolfe R, Polekhina G, Williamson JD, Trauer JM, Newman AB, Murray AM, Ernst ME, Tonkin AM, McNeil JJ. A multistate model of health transitions in older people: a secondary analysis of ASPREE clinical trial data. THE LANCET. HEALTHY LONGEVITY 2022; 3:e89-e97. [PMID: 35224525 PMCID: PMC8880962 DOI: 10.1016/s2666-7568(21)00308-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
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14
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Chiu CJ, Li ML, Chang CM, Wu CH, Tan MP. Disability trajectories prior to death for ten leading causes of death among middle-aged and older adults in Taiwan. BMC Geriatr 2021; 21:420. [PMID: 34246236 PMCID: PMC8272348 DOI: 10.1186/s12877-021-02300-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 05/26/2021] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Prolonged life expectancy is associated with increased prevalence of chronic diseases. The aim of this study was to determine the different disability trajectories for the top ten leading causes of death in Taiwan . METHODS A total of 2,431 participants aged 50-96 in 1996 from the Taiwan longitudinal study on aging (TLSA) who died from 1996 to 2016 were analyzed. Integration of Cause of Death Data and TLSA helped sort out participants who had died from the ten leading causes of death. The level of physical disability was evaluated with the Activities of Daily Living Scale (ADLs), ranging from 0 to 6 points, in 1996, 1999, 2003, 2007, and 2011. A multilevel model was used to investigate the levels and rates of change in disability development before death. RESULTS The outcome of the research showed that the earliest group to experience physical limitation was individuals living with diabetes. The groups with the highest ADL scores were participants with diabetes, cerebrovascular disease, and hypertension-related diseases. Most groups reach ADL scores ≥ 1 (mild-level) during 4-6 years before death except chronic hepatitis and cirrhosis and injury. CONCLUSIONS People who had died from the ten leading causes of death experienced different disability trajectories before death. The trajectory of the participants who had died from diabetes showed a unique pattern with the earliest occurrence and more severe deterioration in terms of development of disabilities. Disability trajectories provide a prediction of survival status for middle-aged and older adults associated with the ten leading causes of death.
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Affiliation(s)
- Ching-Ju Chiu
- Institute of Gerontology, College of Medicine, National Cheng Kung University, No. 1 University Road, 701, Tainan, Taiwan.
| | - Meng-Ling Li
- Department of Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
| | - Chia-Ming Chang
- Division of Geriatrics and Gerontology, Department of Internal Medicine, National Cheng Kung University Hospital, Tainan City, Taiwan
| | - Chih-Hsing Wu
- Institute of Gerontology, College of Medicine, National Cheng Kung University, No. 1 University Road, 701, Tainan, Taiwan
- Department of Family medicine, College of Medicine, National Cheng Kung University Hospital, National Cheng Kung University, Tainan, Taiwan
| | - Maw Pin Tan
- Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
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15
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Du Puy RS, Poortvliet RKE, Mooijaart SP, den Elzen WPJ, Jagger C, Pearce SHS, Arai Y, Hirose N, Teh R, Menzies O, Rolleston A, Kerse N, Gussekloo J. Outcomes of Thyroid Dysfunction in People Aged Eighty Years and Older: An Individual Patient Data Meta-Analysis of Four Prospective Studies (Towards Understanding Longitudinal International Older People Studies Consortium). Thyroid 2021; 31:552-562. [PMID: 33012278 DOI: 10.1089/thy.2020.0567] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Background: Subclinical and overt thyroid dysfunction is easily detectable, often modifiable, and, in younger age groups, has been associated with clinically relevant outcomes. Robust associations in very old persons, however, are currently lacking. This study aimed to investigate the associations between (sub-)clinical thyroid dysfunction and disability in daily living, cognitive function, depressive symptoms, physical function, and mortality in people aged 80 years and older. Methods: Four prospective cohorts participating in the Towards Understanding Longitudinal International older People Studies (TULIPS) consortium were included. We performed a two-step individual participant data meta-analysis on source data from community-dwelling participants aged 80 years and older from the Netherlands, New Zealand, United Kingdom, and Japan. Outcome measures included disability in daily living (disability in activities of daily living [ADL] questionnaires), cognitive function (Mini-Mental State Examination [MMSE]), depressive symptoms (Geriatric Depression Scale [GDS]), physical function (grip strength) at baseline and after 5 years of follow-up, and all-cause five-year mortality. Results: Of the total 2116 participants at baseline (mean age 87 years, range 80-109 years), 105 participants (5.0%) were overtly hypothyroid, 136 (6.4%) subclinically hypothyroid, 1811 (85.6%) euthyroid, 60 (2.8%) subclinically hyperthyroid, and 4 (0.2%) overtly hyperthyroid. Participants with thyroid dysfunction at baseline had nonsignificantly different ADL scores compared with euthyroid participants at baseline and had similar MMSE scores, GDS scores, and grip strength. There was no difference in the change of any of these functional measures in participants with thyroid dysfunction during five years of follow-up. Compared with the euthyroid participants, no 5-year survival differences were identified in participants with overt hypothyroidism (hazard ratio [HR] 1.0, 95% confidence interval [CI 0.6-1.6]), subclinical hypothyroidism (HR 0.9 [CI 0.7-1.2]), subclinical hyperthyroidism (HR 1.1 [CI 0.8-1.7]), and overt hyperthyroidism (HR 1.5 [CI 0.4-5.9]). Results did not differ after excluding participants using thyroid-influencing medication. Conclusions: In community-dwelling people aged 80 years and older, (sub-)clinical thyroid dysfunction was not associated with functional outcomes or mortality and may therefore be of limited clinical significance.
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Affiliation(s)
- Robert S Du Puy
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
| | - Rosalinde K E Poortvliet
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
| | - Simon P Mooijaart
- Department of Gerontology and Geriatrics, and Leiden University Medical Center, Leiden, The Netherlands
| | - Wendy P J den Elzen
- Department of Clinical Chemistry and Laboratory Medicine, Leiden University Medical Center, Leiden, The Netherlands
| | - Carol Jagger
- Campus for Ageing and Vitality, Newcastle University Institute for Ageing, Newcastle upon Tyne, United Kingdom
| | - Simon H S Pearce
- Institute of Translational and Clinical Medicine, Newcastle University, Newcastle upon Tyne, United Kingdom
- Endocrine Unit, Royal Victoria Infirmary, Newcastle upon Tyne, United Kingdom
| | - Yasumichi Arai
- Center for Supercentenarian Medical Research, Keio University School of Medicine, Tokyo, Japan
| | - Nobuyoshi Hirose
- Center for Supercentenarian Medical Research, Keio University School of Medicine, Tokyo, Japan
| | - Ruth Teh
- School of Population Health, University of Auckland, Auckland, New Zealand
| | - Oliver Menzies
- School of Population Health, University of Auckland, Auckland, New Zealand
| | - Anna Rolleston
- School of Population Health, University of Auckland, Auckland, New Zealand
| | - Ngaire Kerse
- School of Population Health, University of Auckland, Auckland, New Zealand
| | - Jacobijn Gussekloo
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
- Department of Gerontology and Geriatrics, and Leiden University Medical Center, Leiden, The Netherlands
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16
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Luo MS, Chui EWT, Li LW. The Longitudinal Associations between Physical Health and Mental Health among Older Adults. Aging Ment Health 2020; 24:1990-1998. [PMID: 31429303 DOI: 10.1080/13607863.2019.1655706] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVES This study examines the lead-lag relationship between physical and mental health among older adults. METHOD Data are collected from 16,417 older adults aged 50 years and older participating in the biannual Health and Retirement Study (HRS). Participants were assessed on up to 11 measurement points over a 21-year period from 1994 to 2014. Physical health was measured as a composite of chronic diseases, functional limitations, and difficulties in basic and instrumental activities of daily living. Mental health was measured with the modified CES-D. Bivariate latent change score models (BLCSM) were estimated. RESULTS Both physical and mental health declined in the observed years, with slower declining rates over time. A reciprocal relationship emerged, with the prior level of physical health acting as the leading indicator of subsequent change in mental health, and the prior mental health state acting as the leading indicator of subsequent changes in physical health. Additionally, the influence of physical health on mental health changes was larger than the corresponding effect of mental health on subsequent physical health. CONCLUSION This study demonstrates the reciprocal relationship between physical and mental health in later adulthood and highlights the need to pay attention to the mental health of older people with physical health problems.
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Affiliation(s)
- Meng Sha Luo
- Department of Social Work and Social Administration, The University of Hong Kong, Pokfulam, Hong Kong
| | - Ernest Wing Tak Chui
- Department of Social Work and Social Administration, The University of Hong Kong, Pokfulam, Hong Kong
| | - Lydia W Li
- School of Social Work, University of Michigan, Ann Arbor, MI, USA
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17
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Brown RT, Covinsky KE. Moving prevention of functional impairment upstream: is middle age an ideal time for intervention? Womens Midlife Health 2020; 6:4. [PMID: 32695430 PMCID: PMC7366897 DOI: 10.1186/s40695-020-00054-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Accepted: 07/13/2020] [Indexed: 12/20/2022] Open
Abstract
To live independently, individuals must be able to perform basic activities of daily living (ADLs), including bathing, dressing, and transferring out of a bed or chair. When older adults develop difficulty or the need for help performing ADLs, they experience decreased quality of life and an increased risk of acute care utilization, nursing home admission, and death. For these reasons, slowing or preventing the progression to functional problems is a key focus of the care of older adults. While preventive efforts currently focus mainly on older people, difficulty performing basic ADLs (“functional impairment”) affects nearly 15% of middle-aged adults, and this prevalence is increasing. People who develop functional impairment in middle age are at increased risk for adverse outcomes similar to those experienced by older adults. Developing ADL impairment in middle age also impacts work force participation and health expenditures, not just in middle age but also older age. Middle-aged adults have a high capacity for recovery from functional impairment, and many risk factors for developing functional impairment in middle and older age have their roots in mid-life. Taken together, these findings suggest that middle age may be an ideal period to intervene to prevent or delay functional impairment. To address the rising prevalence of functional impairment in middle age, we will need to work on several fronts. These include developing improved prognostic tools to identify middle-aged people at highest risk for functional impairment and developing interventions to prevent or delay impairment among middle-aged people. More broadly, we need to recognize functional impairment in middle age as a problem that is as prevalent and central to health outcomes as many chronic medical conditions.
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Affiliation(s)
- Rebecca T Brown
- Division of Geriatric Medicine, Perelman School of Medicine at the University of Pennsylvania, 3615 Chestnut Street, Philadelphia, PA 19104 USA.,Geriatrics and Extended Care, Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, PA USA.,Center for Health Equity and Research Promotion, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA USA
| | - Kenneth E Covinsky
- Division of Geriatrics, University of California, San Francisco, CA USA.,San Francisco Veterans Affairs Medical Center, San Francisco, CA USA
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18
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Understanding Health Deterioration and the Dynamic Relationship between Physical Ability and Cognition among a Cohort of Danish Nonagenarians. J Aging Res 2020; 2020:4704305. [PMID: 32655951 PMCID: PMC7323846 DOI: 10.1155/2020/4704305] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Accepted: 04/15/2020] [Indexed: 11/18/2022] Open
Abstract
This study aims to determine how demographics, socioeconomic characteristics, and lifestyle affect physical and cognitive health transitions among nonagenarians, whether these transitions follow the same patterns, and how each dimension affects the transitions of the other. We applied a multistate model for panel data to 2262 individuals over a 2-year follow-up period from the 1905 Danish Cohort survey. Within two years from baseline, the transition probability from good to bad physical health-ability to stand up from a chair-was higher than dying directly (29% vs. 25%), while this was not observed for cognition (24% vs. 27%) evaluated with Mini-Mental State Examination-a score lower than 24 indicates poor cognitive health. Probability of dying either from bad physical or cognitive health condition was 50%. Health transitions were associated with sex, education, living alone, body mass index, and physical activity. Physical and cognitive indicators were associated with deterioration of cognitive and physical status, respectively, and with survivorship from a bad health condition. We conclude that physical and cognitive health deteriorated differently among nonagenarians, even if they were related to similar sociodemographic and lifestyle characteristics and resulted dynamically related with each other.
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19
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Gontijo Guerra S, Berbiche D, Vasiliadis HM. Changes in instrumental activities of daily living functioning associated with concurrent common mental disorders and physical multimorbidity in older adults. Disabil Rehabil 2020; 43:3663-3671. [PMID: 32255362 DOI: 10.1080/09638288.2020.1745303] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
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.
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Affiliation(s)
- Samantha Gontijo Guerra
- Centre de recherche Charles-Le Moyne - Saguenay-Lac-Saint-Jean sur les innovations en santé (CR-CSIS), Longueuil, QC, Canada.,Faculty of Medicine and Health Sciences, Université de Sherbrooke, Campus Longueuil, Longueuil, QC, Canada
| | - Djamal Berbiche
- Centre de recherche Charles-Le Moyne - Saguenay-Lac-Saint-Jean sur les innovations en santé (CR-CSIS), Longueuil, QC, Canada.,Faculty of Medicine and Health Sciences, Department of Community Health Sciences, Université de Sherbrooke, Longueuil, QC, Canada
| | - Helen-Maria Vasiliadis
- Centre de recherche Charles-Le Moyne - Saguenay-Lac-Saint-Jean sur les innovations en santé (CR-CSIS), Longueuil, QC, Canada.,Faculty of Medicine and Health Sciences, Department of Community Health Sciences, Université de Sherbrooke, Longueuil, QC, Canada
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20
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Patterns of social participation among older adults with disabilities and the relationship with well-being: A latent class analysis. Arch Gerontol Geriatr 2020; 86:103933. [DOI: 10.1016/j.archger.2019.103933] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Revised: 07/18/2019] [Accepted: 08/06/2019] [Indexed: 11/20/2022]
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21
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Edjolo A, Pérès K, Guerchet M, Pilleron S, Ndamba-Bandzouzi B, Mbelesso P, Clément JP, Dartigues JF, Preux PM. Development of the Central Africa Daily Functioning Interference Scale for Dementia Diagnosis in Older Adults: The EPIDEMCA Study. Dement Geriatr Cogn Disord 2019; 47:29-41. [PMID: 30630171 DOI: 10.1159/000492782] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Accepted: 08/08/2018] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND There are a few validated tools capable of assessing the dimensions essential for the diagnosis of dementia and cognitive disorders in sub-Saharan Africa. OBJECTIVES Our aim was to develop an adapted tool, the Central African - Daily Functioning Interference (DFI) scale. METHODS An initial 16-item scale of activity limitations and participation restrictions was completed by 301 participants with low cognitive performances to assess their level of DFI. A psychometric evaluation was performed using Item Response Theory. RESULTS A unidimensional 10-item scale emerged with a reasonable coverage of DFI (thresholds range: -1.067 to 1.587) with good item discrimination properties (1.397-4.076) and a high reliability (Cronbach's al pha = 0.92). The cutoff for detecting 96% of those with dementia was with a latent score ≥0.035 that corresponds to the LAUNDRY limitation. CONCLUSIONS These results provide valuable support for the reliability and internal validity of an operational 10-item scale for DFI assessment used in Central Africa for the diagnosis of dementia in the elderly.
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Affiliation(s)
- Arlette Edjolo
- Univ. Bordeaux, Inserm, Bordeaux Population Health Research Center, UMR 1219, Bordeaux, France, .,INSERM UMR 1094, Tropical Neuroepidemiology, Faculty of Medicine, Limoges, France,
| | - Karine Pérès
- Univ. Bordeaux, Inserm, Bordeaux Population Health Research Center, UMR 1219, Bordeaux, France
| | - Maëlenn Guerchet
- University Limoges, School of Medicine, Institute of Neuroepidemiology and Tropical Neurology, CNRS FR 3503 GEIST, Limoges, France.,INSERM UMR 1094, Tropical Neuroepidemiology, Faculty of Medicine, Limoges, France.,King's College London, Centre for Global Mental Health, Institute of Psychiatry, Health Service and Population Research Department, London, United Kingdom
| | - Sophie Pilleron
- University Limoges, School of Medicine, Institute of Neuroepidemiology and Tropical Neurology, CNRS FR 3503 GEIST, Limoges, France.,INSERM UMR 1094, Tropical Neuroepidemiology, Faculty of Medicine, Limoges, France
| | | | - Pascal Mbelesso
- University Limoges, School of Medicine, Institute of Neuroepidemiology and Tropical Neurology, CNRS FR 3503 GEIST, Limoges, France.,INSERM UMR 1094, Tropical Neuroepidemiology, Faculty of Medicine, Limoges, France.,Department of Neurology, Brazzaville University Hospital, Brazzaville, Congo
| | - Jean-Pierre Clément
- University Limoges, School of Medicine, Institute of Neuroepidemiology and Tropical Neurology, CNRS FR 3503 GEIST, Limoges, France.,INSERM UMR 1094, Tropical Neuroepidemiology, Faculty of Medicine, Limoges, France.,Hospital and University Federation of Adult and Geriatric Psychiatry, Limoges, France
| | - Jean-François Dartigues
- Univ. Bordeaux, Inserm, Bordeaux Population Health Research Center, UMR 1219, Bordeaux, France
| | - Pierre-Marie Preux
- University Limoges, School of Medicine, Institute of Neuroepidemiology and Tropical Neurology, CNRS FR 3503 GEIST, Limoges, France.,INSERM UMR 1094, Tropical Neuroepidemiology, Faculty of Medicine, Limoges, France.,CHU, Department of Medical Information and Evaluation, Clinical Research and Biostatistics Unit, Limoges, France
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22
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Bonneuil N, Kim Y. Socio-economic and health determinants of transitions to adult dependency in South Korea, 2008-2014. Public Health 2019; 173:130-137. [PMID: 31280096 DOI: 10.1016/j.puhe.2019.05.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Revised: 04/29/2019] [Accepted: 05/04/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVES The aim of this study is to identify the determinants of transitions to and possibly back from dependence. STUDY DESIGN The Korean Longitudinal Study of Aging, 2006-2014. METHODS The transitions between non-dependence and difficulties in activities of daily living -instrumental (IADL) or not (ADL)-are distinguished between stability, deterioration, death, or recovery in multilevel logistic regressions. RESULTS Controlling for other covariates, women are more likely to remain without difficulty than men, dependants are more likely out of the labor force or unemployed, city dwellers are more likely dependent. Subjective health helps predict health two years later, as grip power, score of cognition, depression, cardiac and cerebrovascular diseases, and the number of difficulties in IADL (but not in ADL). Dependants with difficulties in IADL reporting no caregiver survive longer but are less likely to recover. Difficulties in ADL overwhelm any other available determinant. The Gompertz-like increase in the death rate with age no longer holds true for ADL dependants. Cardiac and cerebrovascular pathologies and smoking and drinking favor the transition to disability. CONCLUSIONS Socio-economic and medical factors identify a multifactorial determination of the risk to dependence and changes in dependence status, controlling for each effect and selection bias.
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Affiliation(s)
- N Bonneuil
- Institut national d'études démographiques, 133, bld Davout, 75980, Paris cedex 20, France; École des hautes études en sciences sociales, Paris, France.
| | - Y Kim
- Korea Labor Institute, 622, C Bldg, Sejong National Research Complex 370, Sicheong-daero, Sejong-si, 30147 South Korea.
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Sex differences in healthy life expectancy among nonagenarians: A multistate survival model using data from the Vitality 90+ study. Exp Gerontol 2018; 116:80-85. [PMID: 30590122 DOI: 10.1016/j.exger.2018.12.015] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Revised: 12/18/2018] [Accepted: 12/20/2018] [Indexed: 11/22/2022]
Abstract
OBJECTIVES Little is known about sex differences in healthy life expectancy among the oldest old, the fastest growing segment of the older population. This study examines sex differences in total, healthy and unhealthy life expectancy among nonagenarians. METHODS Longitudinal data of 884 older adults aged 90 and over participating in the Vitality 90+ study (Tampere, Finland) were used, including 2501 observations (health or death states) from 5 measurement waves between 2001 and 2014. Using the MSM and ELECT packages in R, multistate survival models were performed to estimate the transition probabilities of older adults through the different health states and to calculate life expectancies. The analyses were done separately for two health indicators (disability and multimorbidity) to see whether patterns were consistent. RESULTS Women had higher total life expectancies than men (about 8 months), but also higher unhealthy life expectancies. Men had a higher disability-free life expectancy between the age of 90 and 95 compared to women. For multimorbidity, no sex differences in healthy life expectancy were found. CONCLUSIONS This study showed that the male-female health-survival paradox remains at very old age. Women aged 90+ live longer than men, and spend more time in poor health.
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Gobbens RJ. Associations of ADL and IADL disability with physical and mental dimensions of quality of life in people aged 75 years and older. PeerJ 2018; 6:e5425. [PMID: 30123720 PMCID: PMC6087617 DOI: 10.7717/peerj.5425] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Accepted: 07/22/2018] [Indexed: 12/21/2022] Open
Abstract
Background Quality of life is an important health outcome for older persons. It predicts the adverse outcomes of institutionalization and premature death. The aim of this cross-sectional study was to determine the influence of both disability in activities of daily living (ADL) and instrumental activities of daily living (IADL) on physical and mental dimensions of quality of life. Methods A total of 377 Dutch people aged 75 years and older completed a web-based questionnaire. This questionnaire contained the Groningen Activity Restriction Scale (GARS) for measuring ADL and IADL and the Short-Form Health Survey (SF-12) for measuring quality of life. The SF-12 distinguishes two dimensions of quality of life, a physical and mental dimension. Results All ADL disability items combined and all IADL disability items combined explained a significant part of the variance of the physical and the mental dimension of quality of life. Only ADL item "stand up from sitting in a chair", and IADL items "do "heavy" household activities" and "do the shopping" were negatively associated with both quality of life dimensions after controlling for all the variables in the model. Discussion This study showed that disability in ADL and IADL is negatively associated with quality of life in older people. Therefore, it is important for health care professionals to carry out interventions aimed to prevent and diminish disability or the adverse outcomes of disability such as a lower quality of life. In order to be effective these interventions should be inexpensive, feasible, and easy to implement.
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Affiliation(s)
- Robbert J Gobbens
- Faculty of Health, Sports and Social Work, Inholland University of Applied Sciences, Amsterdam, The Netherlands.,Zonnehuisgroep Amstelland, Amstelveen, The Netherlands.,Department of Primary and Interdisciplinary Care, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
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Siemonsma PC, Blom JW, Hofstetter H, van Hespen ATH, Gussekloo J, Drewes YM, van Meeteren NLU. The effectiveness of functional task exercise and physical therapy as prevention of functional decline in community dwelling older people with complex health problems. BMC Geriatr 2018; 18:164. [PMID: 30016948 PMCID: PMC6050649 DOI: 10.1186/s12877-018-0859-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2017] [Accepted: 07/09/2018] [Indexed: 12/05/2022] Open
Abstract
Background A physically active lifestyle in older people contributes to the preservation of good health. We assessed the influence of physiotherapy on daily functioning among community dwelling older people (75+) with complex health problems identified with screening, versus usual care. We also compared functional task exercise (FTE), with problems prioritized by older people, trained in the home environment, versus usual preventive physical therapy (PPT). Methods Design: FTE and PPT were compared in a randomized controlled trial (RCT). Both interventions were compared with daily functioning in an observational study: control group. Setting/Participants: Community-dwelling persons aged ≥75 years with daily activity limitations enlisted in 83 general practices (n = 155). Interventions: Both intervention groups (FTE, n = 76 and PPT, n = 79) received individual, 30 min treatments. The control group (n = 228) did not get any experimental intervention offered. Measurements: Groningen Activities of Daily Living Restriction Scale (GARS). Statistical analyses: Linear Mixed Model analysis, correcting for age, sex, baseline scores and clustering by physiotherapist were used to compare the different groups. Results At baseline, 74% percent of the intervention trial group was female vs 79% in the control group. Median ages were 83.9 and 84.7 respectively. The median baseline GARS-score for the control group was 41.0 (25 and 75 percentile): 35.0; 48.0) and 40.0 (25 and 75 percentile: 32.3; 46.0) for the intervention group (FTE + PPT). The mean change over time was 3.3 (2.5; 4.1) for the control group. Mean difference in change over time between the intervention (FTE + PPT) and the control group was − 2.5 (− 4.3; − 0.6) (p = .009). Between FTE and PPT the difference in change was − 0.4 (95% CI: -2.3; 3.0, p = 0.795). Conclusion An exercise intervention led by physiotherapists may slow down decline in self-reported daily functioning in older persons with daily activity limitations, identified by pro-active case finding. Trial registration Netherlands trial register (NTR2407). Registered 6th of July 2010. Electronic supplementary material The online version of this article (10.1186/s12877-018-0859-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Petra C Siemonsma
- TNO Healthy Living, Leiden, Schipholweg 77-89, 2316, ZL, Leiden, The Netherlands
| | - Jeanet W Blom
- Department of Public Health and Primary Care (V0-P), Leiden University Medical Center, Postbox 9600, 2300, RC, Leiden, The Netherlands.
| | - Hedwig Hofstetter
- TNO Healthy Living, Leiden, Schipholweg 77-89, 2316, ZL, Leiden, The Netherlands
| | | | - Jacobijn Gussekloo
- Department of Gerontology and Geriatrics, Leiden University Medical Center, Leiden, The Netherlands
| | - Yvonne M Drewes
- Department of Gerontology and Geriatrics, Leiden University Medical Center, Leiden, The Netherlands
| | - Nico L U van Meeteren
- TNO Healthy Living, Leiden, Schipholweg 77-89, 2316, ZL, Leiden, The Netherlands.,Topsector Life Sciences and Health (Health~Holland), The Hague, the Netherlands.,CAPHRI, Maastricht University, Maastricht, the Netherlands
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van Blijswijk SCE, Blom JW, de Craen AJM, den Elzen WPJ, Gussekloo J. Prediction of functional decline in community-dwelling older persons in general practice: a cohort study. BMC Geriatr 2018; 18:140. [PMID: 29898672 PMCID: PMC6001140 DOI: 10.1186/s12877-018-0826-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Accepted: 05/25/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND A first step to offer community-dwelling older persons proactive care is to identify those at risk of functional decline within a year. This study investigates the predictive value of registered information, questionnaire and GP-opinion on functional decline. METHODS In this cohort study, embedded within the ISCOPE-trial, participants (≥75 years) completed the ISCOPE-screening questionnaire on four health domains. GPs gave their opinion on vulnerability of participants. Functional status was measured at baseline and 12 months (Groningen Activities Restriction Scale [GARS]). The outcome was functional decline (death, nursing home admission, 10% with greatest functional decline). The predictive value of pre-selected variables (age, sex, polypharmacy, multimorbidity, living situation; GPs' opinion on vulnerability, number of domains with problems [ISCOPE-score]) was compared with the area under the curves (AUC) for logistic regression models. RESULTS 2018 of the 2211 participants (median age 82.1 years [IQR 78.8-86.5], 68.0% female, median GARS 31 [IQR 24-41]) were visited at 12 months (median GARS 34 [IQR 26-44]). 394 participants (17.8%) had functional decline (148 died, 45 nursing home admissions, 201 with greatest functional decline). The AUC for age and sex was 0.602, increasing to 0.620 (p = 0.029) with polypharmacy, multimorbidity and living situation. The GPs' opinion added more (AUC 0.672, p < 0.001) than the ISCOPE-score (AUC 0.649, p = 0.007). AUC with all variables was 0.686 (p = 0.016), and 0.643 for GPs' opinion alone. CONCLUSIONS The GPs' opinion and ISCOPE-score improve this prediction model for functional decline based on readily available variables. GPs could identify older patients for further assessment with their clinical judgement. TRIAL REGISTRATION Netherlands trial register, NTR1946 . Registered 10 August 2009.
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Affiliation(s)
- Sophie C E van Blijswijk
- Department of Public Health and Primary Care, Leiden University Medical Center, PO Box 9600, 2300 RC, Leiden, The Netherlands
| | - Jeanet W Blom
- Department of Public Health and Primary Care, Leiden University Medical Center, PO Box 9600, 2300 RC, Leiden, The Netherlands.
| | - Anton J M de Craen
- Department of Gerontology and Geriatrics, Leiden University Medical Center, PO Box 9600, 2300 RC, Leiden, The Netherlands
| | - Wendy P J den Elzen
- Department of Clinical Chemistry and Laboratory Medicine, Leiden University Medical Center, PO Box 9600, 2300 RC, Leiden, The Netherlands
| | - Jacobijn Gussekloo
- Department of Public Health and Primary Care, Leiden University Medical Center, PO Box 9600, 2300 RC, Leiden, The Netherlands.,Department of Gerontology and Geriatrics, Leiden University Medical Center, PO Box 9600, 2300 RC, Leiden, The Netherlands
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27
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Pathways to death: The co-occurrence of physical and mental health in the last years of life. DEMOGRAPHIC RESEARCH 2018. [DOI: 10.4054/demres.2018.38.53] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Abstract
Top themes of international research on disability in the past three decades are discussed: disability dynamics, buffers and barriers for disability, disability trends, and disability among very old persons. Each theme is highlighted by research examples. Turning to measurement, I discuss traditional measures of disability, new longer and shorter ones, and composites like disability-free life expectancy, noting their merits. Contemporary models of disability are presented, ranging from visual images to formal theories. The article ends on how scientists can facilitate movement of disability science into health care practice and policy.
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Botes R, Vermeulen KM, Correia J, Buskens E, Janssen F. Relative contribution of various chronic diseases and multi-morbidity to potential disability among Dutch elderly. BMC Health Serv Res 2018; 18:24. [PMID: 29334922 PMCID: PMC5769323 DOI: 10.1186/s12913-017-2820-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Accepted: 12/28/2017] [Indexed: 11/16/2022] Open
Abstract
Background The amount of time spent living with disease greatly influences elderly people’s wellbeing, disability and healthcare costs, but differs by disease, age and sex. Methods We assessed how various single and combined diseases differentially affect life years spent living with disease in Dutch elderly men and women (65+) over their remaining life course. Multistate life table calculations were applied to age and sex-specific disease prevalence, incidence and death rates for the Netherlands in 2007. We distinguished congestive heart failure, coronary heart disease (CHD), breast and prostate cancer, colon cancer, lung cancer, diabetes, COPD, stroke, dementia and osteoarthritis. Results Across ages 65, 70, 75, 80 and 85, CHD caused the most time spent living with disease for Dutch men (from 7.6 years at age 65 to 3.7 years at age 85) and osteoarthritis for Dutch women (from 11.7 years at age 65 to 4.8 years at age 85). Of the various co-occurrences of disease, the combination of diabetes and osteoarthritis led to the most time spent living with disease, for both men (from 11.2 years at age 65 to 4.9 -years at age 85) and women (from 14.2 years at age 65 to 6.0 years at age 85). Conclusions Specific single and multi-morbid diseases affect men and women differently at different phases in the life course in terms of the time spent living with disease, and consequently, their potential disability. Timely sex and age-specific interventions targeting prevention of the single and combined diseases identified could reduce healthcare costs and increase wellbeing in elderly people.
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Affiliation(s)
- Riaan Botes
- Clinical Epidemiology, University Medical Centre Groningen, University of Groningen, Groningen, the Netherlands.
| | - Karin M Vermeulen
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Janine Correia
- Department of Medical Biosciences, University of the Western Cape, Bellville, South Africa
| | - Erik Buskens
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Fanny Janssen
- Population Research Centre, University of Groningen, Groningen, the Netherlands.,The Netherlands Interdisciplinary Demographic Institute, The Hague, the Netherlands
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30
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Nascimento CDM, Oliveira CD, Firmo JO, Lima-Costa MF, Peixoto SV. Prognostic value of disability on mortality: 15-year follow-up of the Bambuí cohort study of aging. Arch Gerontol Geriatr 2018; 74:112-117. [DOI: 10.1016/j.archger.2017.10.011] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2017] [Revised: 08/04/2017] [Accepted: 10/13/2017] [Indexed: 11/30/2022]
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31
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de Dieuleveult AL, Siemonsma PC, van Erp JBF, Brouwer AM. Effects of Aging in Multisensory Integration: A Systematic Review. Front Aging Neurosci 2017; 9:80. [PMID: 28400727 PMCID: PMC5368230 DOI: 10.3389/fnagi.2017.00080] [Citation(s) in RCA: 93] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2016] [Accepted: 03/14/2017] [Indexed: 11/13/2022] Open
Abstract
Multisensory integration (MSI) is the integration by the brain of environmental information acquired through more than one sense. Accurate MSI has been shown to be a key component of successful aging and to be crucial for processes underlying activities of daily living (ADLs). Problems in MSI could prevent older adults (OA) to age in place and live independently. However, there is a need to know how to assess changes in MSI in individuals. This systematic review provides an overview of tests assessing the effect of age on MSI in the healthy elderly population (aged 60 years and older). A literature search was done in Scopus. Articles from the earliest records available to January 20, 2016, were eligible for inclusion if assessing effects of aging on MSI in the healthy elderly population compared to younger adults (YA). These articles were rated for risk of bias with the Newcastle-Ottawa quality assessment. Out of 307 identified research articles, 49 articles were included for final review, describing 69 tests. The review indicated that OA maximize the use of multiple sources of information in comparison to YA (20 studies). In tasks that require more cognitive function, or when participants need to adapt rapidly to a situation, or when a dual task is added to the experiment, OA have problems selecting and integrating information properly as compared to YA (19 studies). Additionally, irrelevant or wrong information (i.e., distractors) has a greater impact on OA than on YA (21 studies). OA failing to weigh sensory information properly, has not been described in previous reviews. Anatomical changes (i.e., reduction of brain volume and differences of brain areas' recruitment) and information processing changes (i.e., general cognitive slowing, inverse effectiveness, larger time window of integration, deficits in attentional control and increased noise at baseline) can only partly explain the differences between OA and YA regarding MSI. Since we have an interest in successful aging and early detection of MSI issues in the elderly population, the identified tests form a good starting point to develop a clinically useful toolkit to assess MSI in healthy OA.
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Affiliation(s)
- Alix L de Dieuleveult
- Predictive Health Technologies, Netherlands Organisation for Applied Scientific ResearchLeiden, Netherlands; Perceptual and Cognitive Systems, Netherlands Organisation for Applied Scientific ResearchSoesterberg, Netherlands
| | - Petra C Siemonsma
- Predictive Health Technologies, Netherlands Organisation for Applied Scientific ResearchLeiden, Netherlands; Thim van der Laan, University for PhysiotherapyNieuwegein, Netherlands; Faculty of Health, University of Applied Sciences LeidenLeiden, Netherlands
| | - Jan B F van Erp
- Perceptual and Cognitive Systems, Netherlands Organisation for Applied Scientific ResearchSoesterberg, Netherlands; Human Media Interaction, Electrical Engineering, Mathematics and Computer Science, University of TwenteEnschede, Netherlands
| | - Anne-Marie Brouwer
- Perceptual and Cognitive Systems, Netherlands Organisation for Applied Scientific Research Soesterberg, Netherlands
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Verbrugge LM, Brown DC, Zajacova A. Disability Rises Gradually for a Cohort of Older Americans. J Gerontol B Psychol Sci Soc Sci 2017; 72:151-161. [PMID: 26968638 PMCID: PMC5156489 DOI: 10.1093/geronb/gbw002] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2015] [Accepted: 01/06/2016] [Indexed: 01/25/2023] Open
Abstract
OBJECTIVES We study changes in average disability over nearly two decades for a large epidemiological cohort of older Americans. As some people exit by mortality, do average disability levels for the living cohort rise rapidly, rise gradually, stay steady, or decline? METHOD Data are from the Study of Asset and Health Dynamics Among the Oldest Old (AHEAD) cohort for 1993-2010. Cohort members are aged 70+ in 1993 (mean = 77.5 years), and the survivors are aged 87+ in 2010 (mean = 90.2 years). Personal care disability (activities of daily living), household management disability (instrumental activities of daily living), and physical limitations are studied. We study average disability for the living cohort over time and the disability histories for decedent and survivor groups. RESULTS Average disability rises gradually over time for the living cohort. Earlier decedent groups have higher average disability than later ones. Near death, disability rises sharply for all decedent groups. Longer surviving groups have less average disability, and slower disability increases, than shorter surviving groups. All results are repeated for younger cohort members (baseline age = 70-79 years), older ones (baseline age = 80+ years), women, and men. DISCUSSION As a cohort ages, average disability among living members increases gradually, signaling behavioral, psychological, and biological fitness in very old persons.
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Affiliation(s)
| | - Dustin C Brown
- Department of Sociology and Social Science Research Center, Mississippi State University
| | - Anna Zajacova
- Department of Sociology, University of Wyoming, Laramie
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Residential area characteristics and disabilities among Dutch community-dwelling older adults. Int J Health Geogr 2016; 15:42. [PMID: 27846880 PMCID: PMC5111195 DOI: 10.1186/s12942-016-0070-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2016] [Accepted: 11/03/2016] [Indexed: 02/02/2023] Open
Abstract
Background Living longer independently may be facilitated by an attractive and safe residential area, which stimulates physical activity. We studied the association between area characteristics and disabilities and whether this association is mediated by transport-related physical activity (TPA). Methods Longitudinal data of 271 Dutch community-dwelling adults aged 65 years and older participating in the Elderly And their Neighbourhood (ELANE) study in 2011–2013 were used. Associations between objectively measured aesthetics (range 0–22), functional features (range 0–14), safety (range 0–16), and destinations (range 0–15) within road network buffers surrounding participants’ residences, and self-reported disabilities in instrumental activities of daily living (range 0–8; measured twice over a 9 months period) were investigated by using longitudinal tobit regression analyses. Furthermore, it was investigated whether self-reported TPA mediated associations between area characteristics and disabilities. Results A one unit increase in aesthetics within the 400 m buffer was associated with 0.86 less disabilities (95% CI −1.47 to −0.25; p < 0.05), but other area characteristics were not related to disabilities. An increase in area aesthetics was associated with more TPA, and more minutes of TPA were associated with less disabilities. TPA however, only partly mediated the associated between area aesthetics and disabilities. Conclusions Improving aesthetic features in the close by area around older persons’ residences may help to prevent disability.
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Etman A, Pierik FH, Kamphuis CBM, Burdorf A, van Lenthe FJ. The role of high-intensity physical exercise in the prevention of disability among community-dwelling older people. BMC Geriatr 2016; 16:183. [PMID: 27829369 PMCID: PMC5103399 DOI: 10.1186/s12877-016-0334-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2016] [Accepted: 08/27/2016] [Indexed: 11/11/2022] Open
Abstract
Background Moderate to vigorous physical activity (MVPA) is considered important to prevent disability among community-dwelling older people. To develop MVPA programs aimed at reducing or preventing disability more insight is needed in the contributions of exercise duration and intensity and the interplay between the two. Methods Longitudinal data of 276 Dutch community-dwelling persons aged 65 years and older participating in the Elderly And their Neighbourhood (ELANE) study were used. MVPA exercise (yes/no), duration (hours per two weeks), intensity (Metabolic Equivalent of Task; METs), and energy expenditure (MET-hours per two weeks), and disability in instrumental activities of daily living (range 0–8) were measured twice within 9 months to account for fluctuations over time. Associations between the four exercise measures and disability were tested with longitudinal tobit regression analyses. Results MVPA exercise was associated with fewer disabilities. While exercise duration was not associated with disability, whereas an increase of one MET in exercise intensity was associated with 0.14 fewer disabilities (95 % CI: -0.26 to -0.02). For exercise energy expenditure, an increase of one MET-hour exercise per two weeks was associated with 0.03 fewer disabilities (95 % CI: -0.05 to -0.01). Conclusions Higher-intensity exercise may help to prevent disability among community-dwelling older people. Further investigation is needed to explore the preventive effects in more detail.
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Affiliation(s)
- Astrid Etman
- Department of Public Health, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Frank H Pierik
- Department of Urban Environment and Safety, TNO, Utrecht, The Netherlands
| | - Carlijn B M Kamphuis
- Department of Human Geography and Spatial Planning, Utrecht University, Utrecht, The Netherlands
| | - Alex Burdorf
- Department of Public Health, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Frank J van Lenthe
- Department of Public Health, Erasmus University Medical Centre, Rotterdam, The Netherlands.
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Chen SW, Chippendale T. Factors associated with IADL independence: implications for OT practice. Scand J Occup Ther 2016; 24:109-115. [PMID: 27347768 DOI: 10.1080/11038128.2016.1194464] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND Globally, the population is aging. Instrumental activities of daily living (IADL) are an important component of independent function and impact the ability of older adults to age in place. Therefore, factors associated with IADL independence warrant further study. OBJECTIVE To explore the association of age, depressive symptoms and leisure participation with IADL independence, and the relative importance of these three factors in predicting IADL independence. METHODS A cross-sectional design using an existing data set was employed. Older adults age 60 and older (n = 98) who resided in senior housing or their own home/apartment were included in the study. A hierarchical multiple regression analysis was employed. RESULTS The second model predicting IADL independence using age, depressive symptoms and level of leisure participation was significant (F(3,96) = 15.57, p < 0.001) and explained 31.00% of the variance in IADL independence compared to the first regression model, which included age alone (R2 adjusted = 18.00%). Age was the strongest of the three predictors, accounting for 11.40% of the variance in IADL independence. Depressive symptoms and participation in leisure activities were also significant predictors, their unique contributions being 7.30 and 4.30%, respectively. CONCLUSION AND SIGNIFICANCE Age, depressive symptoms and leisure participation are all significant predictors of IADL independence among older adults. Therefore, according to our preliminary findings, leisure participation and non-pharmacological interventions for depressive symptoms warrant attention in practice in relation to IADL independence.
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Affiliation(s)
- Szu-Wei Chen
- a Department of Occupational Therapy , New York University , New York , NY , USA
| | - Tracy Chippendale
- a Department of Occupational Therapy , New York University , New York , NY , USA
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Herr M, Arvieu JJ, Robine JM, Ankri J. Health, frailty and disability after ninety: Results of an observational study in France. Arch Gerontol Geriatr 2016; 66:166-75. [PMID: 27341649 DOI: 10.1016/j.archger.2016.06.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Revised: 05/09/2016] [Accepted: 06/04/2016] [Indexed: 01/04/2023]
Abstract
BACKGROUND In spite of their increasing demographic weight, health characteristics of the oldest old remain poorly described in epidemiological studies. OBJECTIVE To describe the health of people aged 70 years and over included in the SIPAF study, and to compare the prevalence of health indicators including successful aging, frailty, and disability between three age groups including the oldest old. METHODS The study population is composed of 2350 retired people recruited between 2008 and 2010, of whom 512 are aged 90 and over (21.8%). A comprehensive geriatric assessment was performed at home by trained nurses. The prevalence of health and functional indicators, as well as the distribution of people among successful ageing, frailty, and disability, were described by age group (70-79, 80-89, 90+) and sex. RESULTS Compared to their younger counterparts, people aged 90 years and over were more likely to experience functional limitations, sensory impairment, cognitive impairment, poor mood, and frailty. One third of the nonagenarians needed help in at least one basic activity of daily living and 25% met the frailty criteria. In contrast, the prevalence of most chronic diseases did not increase after ninety. Successful ageing concerned 9% of the oldest old. Women were less likely to experience successful ageing and more likely to be frail or dependent. CONCLUSION This study shows the diversity of health states in very old age and points out that one quarter of the people aged 90 and over said frail are likely to take advantage of preventive actions of disability.
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Affiliation(s)
- M Herr
- INSERM, U1168, VIMA: Aging and Chronic Diseases, Epidemiological and Public Health Approaches, F-94807, Villejuif, France; Univ Versailles St-Quentin-en-Yvelines, UMR-S 1168, F-78180, Montigny le Bretonneux, France; AP-HP, Hôpital Sainte Périne, Département de Santé Publique, Paris, France.
| | - J J Arvieu
- AG2R La Mondiale, Direction des Etudes, Prévoyance Individuelle et IARD, Paris, France
| | - J M Robine
- INSERM U988 et U1198, EPHE, Paris & Montpellier, France
| | - J Ankri
- INSERM, U1168, VIMA: Aging and Chronic Diseases, Epidemiological and Public Health Approaches, F-94807, Villejuif, France; Univ Versailles St-Quentin-en-Yvelines, UMR-S 1168, F-78180, Montigny le Bretonneux, France; AP-HP, Hôpital Sainte Périne, Département de Santé Publique, Paris, France
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Svensson HK, Olofsson EH, Karlsson J, Hansson T, Olsson LE. A painful, never ending story: older women's experiences of living with an osteoporotic vertebral compression fracture. Osteoporos Int 2016; 27:1729-36. [PMID: 26659067 PMCID: PMC4839051 DOI: 10.1007/s00198-015-3445-y] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2015] [Accepted: 11/30/2015] [Indexed: 01/19/2023]
Abstract
UNLABELLED Vertebral compression fractures (VCF) cause pain and decreased physical ability, with no known well-established treatment. The aim of this study was to illuminate the experience of living with a VCF. The results show that fear and concerns are a major part of daily life. The women's initial contact with health-care providers should focus on making them feel acknowledged by offering person-centered and tailored support. INTRODUCTION In the past decade, osteoporotic-related fractures have become an increasingly common and costly public health problem worldwide. Vertebral compression fracture (VCF) is the second most common osteoporotic fracture, and patients with VCF describe an abrupt descent into disability, with a subsequent desire to regain independence in everyday life; however, little is known of their situation. The aim of this study was to illuminate the lived experience of women with an osteoporotic VCF. METHODS Ten women were interviewed during 2012-2013, starting with an open-ended question: could you tell me what it is like to live with a vertebral compression fracture? The verbatim transcribed interviews were analyzed using a phenomenological hermeneutical approach. RESULTS The narrative provided descriptions of living in turmoil and chaos, unable to find stability in their life with little improvement regarding pain and physical function. Shifts from periods of constant pain to periods of fear of constant pain created a loss of confidence and an increased sense of confinement. The structural analysis revealed fear and concerns as the most prominent experience building on five themes: struggling to understand a deceiving body, breakthrough pain fueling fear, fearing a trajectory into isolation, concerns of dependency, and fearing an uncertain future. CONCLUSIONS Until researchers find a successful prevention or medical/surgical treatment for osteoporotic VCFs, health-care providers and society abandon these women to remain in a painful and never ending story.
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Affiliation(s)
- H K Svensson
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, PO Box 457, SE 405 30, Gothenburg, Sweden.
- Gothenburg Centre for Person-Centred Care (GPCC), University of Gothenburg, Gothenburg, Sweden.
| | - E H Olofsson
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, PO Box 457, SE 405 30, Gothenburg, Sweden
- Gothenburg Centre for Person-Centred Care (GPCC), University of Gothenburg, Gothenburg, Sweden
| | - J Karlsson
- Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - T Hansson
- Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - L-E Olsson
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, PO Box 457, SE 405 30, Gothenburg, Sweden
- Gothenburg Centre for Person-Centred Care (GPCC), University of Gothenburg, Gothenburg, Sweden
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Sánchez-Martínez M, Castell M, González-Montalvo J, De la Cruz J, Banegas J, Otero Á. Transitions in functional status of community dwelling older adults: Impact of physical performance, depression and cognition. Eur Geriatr Med 2016. [DOI: 10.1016/j.eurger.2016.01.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Pinto-Carral A, Fernández-Villa T, Molina de la Torre AJ. Patient-Reported Mobility: A Systematic Review. Arch Phys Med Rehabil 2016; 97:1182-94. [PMID: 26898389 DOI: 10.1016/j.apmr.2016.01.025] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2015] [Revised: 01/28/2016] [Accepted: 01/28/2016] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To identify the self-administered instruments to assess mobility in adults with disability, to link the mobility assessed by these instruments to the International Classification of Functioning, Disability and Health (ICF), and to evaluate their methodological quality. DATA SOURCES Scopus, Science Direct, and Web of Science were systematically searched up to July 2015. STUDY SELECTION Studies on the development and validation of self-administered questionnaires in which at least half of the items were related to movement or mobility were included. DATA EXTRACTION The mobility assessed by the instruments was classified according to the ICF categories. The methodological quality was assessed according to the Consensus-based Standards for the Selection of Health Measurement Instruments checklist. DATA SYNTHESIS Of 5791 articles, 34 studies were eligible for inclusion. Only 10 of the instruments contained items that exclusively assessed mobility. The most frequently linked ICF categories were "changing basic body position" (19.4%), "walking" (14.8%), and "moving around" (13.5%). Measurement properties evaluated included internal consistency (5 studies), reliability (5 studies), measurement error (1 study), content validity (9 studies), structural validity (4 studies), hypotheses testing (6 studies), and responsiveness (1 study). Only content validity obtained the highest quality, probably because the studies included in the review reported the development and initial validation of the instruments. CONCLUSIONS Self-administered mobility questionnaires published in the scientific literature assess mobility activities rather than functions related to movement, and do so from the perspective of disability, frequently including self-care and domestic life as domains for assessment. The instruments that presented the highest methodological quality were the Outpatient Physical Therapy Improvement in Movement Assessment Log, the Movement Ability Measure, and the Mobility Activities Measure for Inpatient Rehabilitation Settings.
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Affiliation(s)
- Arrate Pinto-Carral
- School of Health Science, SALBIS Research Group, University of León, León, Spain.
| | - Tania Fernández-Villa
- Research Group on Gene-Environment Interactions and Health (GIIGAS), University of León, León, Spain
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Haan MN, Lee A, Odden MC, Aiello AE, To TM, Neuhaus JM. Gender Differences in the Combined Effects of Cardiovascular Disease and Osteoarthritis on Progression to Functional Impairment in Older Mexican Americans. J Gerontol A Biol Sci Med Sci 2016; 71:1089-95. [PMID: 26893469 DOI: 10.1093/gerona/glw014] [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: 10/29/2015] [Accepted: 01/18/2016] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Comorbidity (COM) is an important issue in aging. Cardiovascular disease (CVD) and osteoarthritis separately and together may modify the trajectories of functional decline. This analysis examines whether specific and unrelated COMs influence functional change differently and vary by gender. METHODS A cohort study of 1,789 (aged 60 years and older) Mexican Americans was followed annually for up to 10 years. We created four groups of COM (CVD alone, lower body osteoarthritis alone [OA], neither, or both). We employed mixed effects Poisson models with Instrumental Activities of Daily Living (IADL) as the outcome. We tested whether the association between COM and decline in functional status differed by gender. RESULTS IADL impairments in those with CVD, OA, or both were significantly higher at baseline and increased more rapidly over time compared to those with neither condition. Compared to women with no COM, the number of IADL impairments in women with CVD alone were 1.36 times greater, with OA were 1.35 times greater, and both conditions were 1.26 times greater. Compared to men with no COM, IADL impairments in men with CVD alone were 1.15 times greater, OA alone were 1.12 times greater, and both were 1.26 times greater. CONCLUSIONS Over time, the influence of COM on functional decline differs by specific combinations of COM and by gender. Aggregate COM scales obscure the biological and temporal heterogeneity in the effects of COM. Time-dependent-specific COMs better assess the development of impairment. Women experience a higher burden of functional impairment due to COM than men.
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Affiliation(s)
- Mary N Haan
- Department of Epidemiology and Biostatistics, School of Medicine, University of California, San Francisco.
| | - Anne Lee
- Department of Epidemiology and Biostatistics, School of Medicine, University of California, San Francisco
| | - Michelle C Odden
- College of Public Health and Human Sciences, Oregon State University, Corvallis
| | - Allison E Aiello
- Department of Epidemiology, School of Public Health, University of North Carolina, Chapel Hill
| | - Tu My To
- Department of Epidemiology and Biostatistics, School of Medicine, University of California, San Francisco
| | - John M Neuhaus
- Department of Epidemiology and Biostatistics, School of Medicine, University of California, San Francisco
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Edjolo A, Proust-Lima C, Delva F, Dartigues JF, Pérès K. Natural History of Dependency in the Elderly: A 24-Year Population-Based Study Using a Longitudinal Item Response Theory Model. Am J Epidemiol 2016; 183:277-85. [PMID: 26825927 DOI: 10.1093/aje/kwv223] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2014] [Accepted: 08/13/2015] [Indexed: 11/12/2022] Open
Abstract
We aimed to describe the hierarchical structure of Instrumental Activities of Daily Living (IADL) and basic Activities of Daily Living (ADL) and trajectories of dependency before death in an elderly population using item response theory methodology. Data were obtained from a population-based French cohort study, the Personnes Agées QUID (PAQUID) Study, of persons aged ≥65 years at baseline in 1988 who were recruited from 75 randomly selected areas in Gironde and Dordogne. We evaluated IADL and ADL data collected at home every 2-3 years over a 24-year period (1988-2012) for 3,238 deceased participants (43.9% men). We used a longitudinal item response theory model to investigate the item sequence of 11 IADL and ADL combined into a single scale and functional trajectories adjusted for education, sex, and age at death. The findings confirmed the earliest losses in IADL (shopping, transporting, finances) at the partial limitation level, and then an overlapping of concomitant IADL and ADL, with bathing and dressing being the earliest ADL losses, and finally total losses for toileting, continence, eating, and transferring. Functional trajectories were sex-specific, with a benefit of high education that persisted until death in men but was only transient in women. An in-depth understanding of this sequence provides an early warning of functional decline for better adaptation of medical and social care in the elderly.
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Zhou Y, Putter H, Doblhammer G. Years of life lost due to lower extremity injury in association with dementia, and care need: a 6-year follow-up population-based study using a multi-state approach among German elderly. BMC Geriatr 2016; 16:9. [PMID: 26758623 PMCID: PMC4710990 DOI: 10.1186/s12877-016-0184-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2015] [Accepted: 01/04/2016] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Dementia and care need are challenging aging populations worldwide. Lower extremity injury (LEI) in the elderly makes matters worse. Using a multi-state approach, we express the effect of LEI on dementia, care need, and mortality in terms of remaining life expectancy at age 75 (rLE) and years of life lost (YLL). METHODS A population-based random sample of beneficiaries aged 75-95 years was drawn from the largest public health insurer in Germany in 2004 and followed until 2010 (N 62,103; Mean Age ± SD 81.5 ± 4.8 years; Female 71.2%). We defined a five-state model (Healthy, Dementia, Care, Dementia & Care, Dead), and calculated transition-specific hazard ratios of LEI using Cox regression. The transition probabilities as well as the YLL due to LEI were estimated. RESULTS LEI significantly increased the risk for each transition, with a maximum risk for the transition from Healthy to Care (HR: 1.70, 95% CI: 1.63-1.77) and a minimum risk for the transition from Care to Dead (HR: 1.16, 95% CI: 1.10-1.22). If the elderly had LEI-history, their age-specific mortality was generally higher and their probabilities of transient states peaked at younger ages. At age 75, initially dementia-free and care-independent elderly experiencing LEI lost about 2 years of life, of which more than 90% were life years free of dementia or care need. Dementia patients lost about one and a half year, more than 60% were free of long-term care need. CONCLUSIONS LEI not only casts a large health burden on care need, but is also associated with cognitive decline and shortened rLE. LEI plus dementia extend the relative life time in need of care, despite generally shortening rLE. Using the composite measure YLL may help to better convey these results to the elderly, families, and health professionals. This may strengthen preventive measures as well as improve timely and rehabilitative treatment of LEI, not only in cognitive and physically intact elderly.
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Affiliation(s)
- Ying Zhou
- Institute for Sociology and Demography, University of Rostock, Ulmenstrasse 69, 18057, Rostock, Germany.,Rostock Center for the Study of Demographic Change, Konrad-Zuse-Str. 1, 18057, Rostock, Germany
| | - Hein Putter
- Department of Medical Statistics and Bioinformatics, Leiden University Medical Centre, Einthovenweg 20, 2333 ZC, Leiden, Netherlands
| | - Gabriele Doblhammer
- Institute for Sociology and Demography, University of Rostock, Ulmenstrasse 69, 18057, Rostock, Germany. .,Rostock Center for the Study of Demographic Change, Konrad-Zuse-Str. 1, 18057, Rostock, Germany. .,German Center for Neurodegenerative Disease, Ludwig-Erhard-Allee 2, 53175, Bonn, Germany.
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Karvonen-Gutierrez CA. The importance of disability as a health issue for mid-life women. Womens Midlife Health 2015; 1:10. [PMID: 30766697 PMCID: PMC6297968 DOI: 10.1186/s40695-015-0011-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2015] [Accepted: 09/25/2015] [Indexed: 12/17/2022] Open
Abstract
Data suggest that disability prevalence among mid-aged populations is increasing in recent years; current prevalence estimates for mid-aged adults range from 20 to 40 %. The World Health Organization’s International Classification of Functioning (ICF) has provided a multi-dimensional biopsychosocial model to understand disability that is highly relevant to mid-aged populations. Under the ICF framework, mid-aged women experience high levels of work, non-work, and mobility-associated disability but very little difficulty with self care. Despite the high prevalence, evidence suggests that there is a large proportion of non-chronic disability and that mid-aged women can both worsen and improve their functioning. Thus, the mid-life period may represent a critical window during which interventions to improve disability may be most efficacious for the improvement of current and future functioning. Interventions that are initiated during the mid-life are highly relevant as a strategy to reduce disability during this life stage and prevent or forestall the onset of late life disability. Targets for intervention include improvement of depressive symptoms and increasing physical activity levels, both of which have shown to be efficacious in older populations and are correlates of mid-life functioning and disability.
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Affiliation(s)
- Carrie A Karvonen-Gutierrez
- Department of Epidemiology, University of Michigan School of Public Health, 1415 Washington Heights, Room 6618, Ann Arbor, MI 48109 USA
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