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Burns SD, Ailshire JA, Crimmins EM. Functional limitation among middle age and older adults: Exploring cross-national gender disparities. Arch Gerontol Geriatr 2024; 123:105410. [PMID: 38503129 DOI: 10.1016/j.archger.2024.105410] [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: 12/11/2023] [Revised: 02/28/2024] [Accepted: 03/10/2024] [Indexed: 03/21/2024]
Abstract
OBJECTIVE Functional limitations are prevalent among aging demographics, especially women. Structural and health factors, which vary worldwide, influence rates of functional limitations. Yet, gender disparities in functional limitation remain unclear in a global context. METHODS We use 2018 data from the Health and Retirement Study (HRS) international family of studies with respondents ages 50-64 and (n = 87,479) and 65-89 (n = 92,145) to investigate gender disparities in large muscle functional limitation (LMFL) across 10 countries/regions using mixed effects logistic regression, with special attention to structural indicators of inequality and health. RESULTS Among both women and men, LMFL was generally higher in China, India, Mexico, United States, and Baltic States than in England, Scandinavia, Southern Europe, Eastern Europe, and Western Europe. The gender disparity in LMFL gradually declined at older ages in India, China, Mexico, and United States, while this disparity gradually increased at older ages throughout Europe. Among middle age respondents, the greater risk of LMFL for women in countries/regions with a high GII was no longer observed after accounting for comorbidities. Among older respondents, a lower risk of LMFL for women in countries/regions with a high GII was not observed until accounting for comorbidities. DISCUSSION Our findings suggest that rates of LMFL are higher in middle-income countries than high-income countries, especially among women, and in countries with a higher GII. In addition, consideration of comorbidities was integral to these relationships. Thus, national/regional contexts inform differential rates of functional limitation, particularly as it relates to gender.
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Affiliation(s)
- Shane D Burns
- Population Studies Center, University of Michigan, 426 Thompson St., Room 2098, Ann Arbor, MI 48109, United States.
| | - Jennifer A Ailshire
- Leonard Davis School of Gerontology, University of Southern California, United States
| | - Eileen M Crimmins
- Leonard Davis School of Gerontology, University of Southern California, United States
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Ren Z, Xu Y, Sun J, Han Y, An L, Liu J. Chronic diseases and multimorbidity patterns, their recent onset, and risk of new-onset Parkinson's disease and related functional degeneration in older adults: a prospective cohort study. EClinicalMedicine 2023; 65:102265. [PMID: 37855021 PMCID: PMC10579290 DOI: 10.1016/j.eclinm.2023.102265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 09/18/2023] [Accepted: 09/25/2023] [Indexed: 10/20/2023] Open
Abstract
Background Certain chronic diseases contribute to increased risks of Parkinson's disease (PD), but the association between time-varying multimorbidity patterns and new-onset PD remains underexplored. Methods Data were from the Survey of Health, Ageing and Retirement in Europe (SHARE) waves 5-8 conducted between January 2013 and March 2020. Eleven chronic diseases were included, with ≥2 denoting multimorbidity. Three multimorbidity patterns were further defined: somatic multimorbidity (SMM), neuropsychiatric multimorbidity (NPM), and cardiometabolic multimorbidity (CMM). PD-related function degeneration included functional limitations, mobility limitations, depressive symptoms, and cognitive decline. Time-dependent analyses, competing-risk analyses, and mixed-effect models were utilised. Findings In this prospective cohort study, 557 developed new-onset PD during follow-ups among 64,273 participants included at baseline, as defined by participants' self-reported physician diagnoses. Participants with (vs. without) multimorbidity, SMM, NPM, and CMM were at 1.40-2.70 times higher PD risk after considering the competing role of all-cause death, which remained significant in all sensitivity analyses and were more pronounced in lower-income participants (P for interaction <0.05). Similarly, they tended to develop functional degeneration faster than those without these multimorbidity patterns (P < 0.05). Participants with recent-onset (newly diagnosed in 2015) multimorbidity patterns were at 1.45-3.72 times higher risk of PD than those never diagnosed. Interestingly, they were at comparable or even higher (though P values for >0.05) PD risk compared to participants with multimorbidity patterns diagnosed in 2013 or before. Furthermore, recent-onset (vs. prior diagnosed) NPM exhibited faster functional deterioration and cognitive decline (P for difference <0.05). Interpretation Our findings suggest that promoting early prevention of multimorbidity, especially recent-onset multimorbidity and NPM, could prevent some subsequent cases of PD and related functional degeneration among older adults. However, further studies are needed to confirm this association. Funding The National Key Research and Development Program, Ministry of Science and Technology, China; Zhongnanshan Medical Foundation of Guangdong Province; Major Project of the National Social Science Fund of China; Fundamental Research Funds for the Central Universities.
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Affiliation(s)
- Ziyang Ren
- Institute of Reproductive and Child Health/National Health Commission Key Laboratory of Reproductive Health, Peking University, Beijing, China
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
| | - Yunhan Xu
- Department of Maternal and Child Health, School of Public Health, Peking University, Beijing, China
| | - Jinfang Sun
- Office of Epidemiology, Chinese Centre for Disease Control and Prevention, Beijing, China
| | - Yanqing Han
- Department of Neurology, Cardiovascular Affiliated Hospital of Shanxi Medical University, Taiyuan, China
| | - Lin An
- Department of Maternal and Child Health, School of Public Health, Peking University, Beijing, China
| | - Jufen Liu
- Institute of Reproductive and Child Health/National Health Commission Key Laboratory of Reproductive Health, Peking University, Beijing, China
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
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Fonseca C, Ramos A, Morgado B, Quaresma P, Garcia-Alonso J, Coelho A, Lopes M. Long-term care units: a Portuguese study about the functional profile. FRONTIERS IN AGING 2023; 4:1192718. [PMID: 37214776 PMCID: PMC10192701 DOI: 10.3389/fragi.2023.1192718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 04/21/2023] [Indexed: 05/24/2023]
Abstract
Aim: In this study, we analyze the relationship between the functional profile of older people admitted to long-term care units in Portugal and some demographic variables such as education level, sex, and age as well as the emotional state of mind. Methods: A sample of 59,516 older people from the National Network of Integrated Continuous Care of Portugal were analyzed in this longitudinal study. All the retrospective data of the older people were collected during the period of hospitalization at the long-term care units. The database records of these units were analyzed, and a functional profile spanning the period of hospitalization was calculated. Results: Activities of daily living and cognitive states improved, in the first 90 days of hospitalization, while mobility and instrumental activities of daily living worsened for the same period of 90 days. Generally, there was a decline in all domains after 450 days of hospitalization. The older women that did not attend school, those over 85 years old, and those who suffered from anxiety were pre-dominantly placed in the group of those with greater dependence (severe/complete dependence). Conclusion: The participants hospitalized between 90 and 360 days presented the best results in the long-term care units of the National Network of Integrated Continuous Care of Portugal. With this study, we highlight the importance of evaluating the functional status of persons in long-term hospitalizations and the influence exerted by the level of education on the recovery and rehabilitation of dependence.
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Affiliation(s)
- César Fonseca
- São João de Deus Higher School of Nursing, University of Évora, Évora, Portugal
- Comprehensive Health Research Centre (CHRC), Universidade de Évora, Évora, Portugal
| | - Ana Ramos
- Nursing Research, Innovation and Development Centre of Lisbon (CIDNUR), Nursing School of Lisbon (ESEL), Lisbon, Portugal
| | | | - Paulo Quaresma
- Department of Computer Science, University of Évora, Évora, Portugal
- Centro de Investigação e Desenvolvimento em Ciências Humanas e Sociais (CIDEHUS), University of Évora, Évora, Portugal
| | - José Garcia-Alonso
- Department of Computer and Telematics Systems, University of Extremadura, Badajoz, Spain
| | - Anabela Coelho
- São João de Deus Higher School of Nursing, University of Évora, Évora, Portugal
- Comprehensive Health Research Centre (CHRC), Universidade de Évora, Évora, Portugal
- Global Health and Tropical Medicine, Instituto de Higiene e Medicina Tropical, Universidade NOVA de Lisboa, Lisbon, Portugal
| | - Manuel Lopes
- São João de Deus Higher School of Nursing, University of Évora, Évora, Portugal
- Comprehensive Health Research Centre (CHRC), Universidade de Évora, Évora, Portugal
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Xi JY, Zhong SR, Zhou YX, Lin X, Hao YT. Effects of family multi-generational relationship on multimorbidity and healthy life expectancy for second generations: insight from the China Health and Retirement Longitudinal Study. BMC Geriatr 2023; 23:100. [PMID: 36800942 PMCID: PMC9938571 DOI: 10.1186/s12877-022-03714-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 12/23/2022] [Indexed: 02/19/2023] Open
Abstract
OBJECTIVE In the context of aging, Chinese families consisting of more than three generations (grandparents, parents, children) are the norm. The second generation (parents) and other family members may establish a downward (contact only with children) or two-way multi-generational relationship (contact with children and grandparents). These multi-generational relationships may have the potential effect on multimorbidity burden and healthy life expectancy in the second generation, but less is known about the direction and intensity of this effect. This study aims to explore this potential effect. METHODS We obtained longitudinal data from the China Health and Retirement Longitudinal Study from 2011 to 2018, which included 6,768 people. Cox proportional hazards regression was used to assess the association between multi-generational relationships and the number of multimorbidity. The Markov multi-state transition model was used to analyze the relationship between multi-generational relationships and the severity of multimorbidity. The multistate life table was used to calculate healthy life expectancy for different multi-generational relationships. RESULTS The risk of multimorbidity in two-way multi-generational relationship was 0.830 (95% CIs: 0.715, 0.963) times higher than that in downward multi-generational relationship. For mild multimorbidity burden, downward and two-way multi-generational relationship may prevent aggravation of burden. For severe multimorbidity burden, two-way multi-generational relationship may aggravate the burden. Compared with two-way multi-generational relationship, the second generations with downward multi-generational relationship has a higher healthy life expectancy at all ages. CONCLUSION In Chinese families with more than three generations, the second generations with severe multimorbidity burden may aggravate the condition by providing support to elderly grandparents, and the support provided by offspring to the second generations plays a vital positive role in improving the quality of life and narrowing the gap between healthy life expectancy and life expectancy.
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Affiliation(s)
- Jun-Yan Xi
- grid.12981.330000 0001 2360 039XDepartment of Medical Statistics, School of Public Health, Sun Yat-Sen University, 74Th Zhongshan 2Nd Rd, Yuexiu District, Guangzhou, 510080 China
| | - Si-Rui Zhong
- grid.12981.330000 0001 2360 039XDepartment of Medical Statistics, School of Public Health, Sun Yat-Sen University, 74Th Zhongshan 2Nd Rd, Yuexiu District, Guangzhou, 510080 China
| | - Yu-Xiao Zhou
- grid.12981.330000 0001 2360 039XDepartment of Medical Statistics, School of Public Health, Sun Yat-Sen University, 74Th Zhongshan 2Nd Rd, Yuexiu District, Guangzhou, 510080 China
| | - Xiao Lin
- Department of Medical Statistics, School of Public Health, Sun Yat-Sen University, 74Th Zhongshan 2Nd Rd, Yuexiu District, Guangzhou, 510080, China.
| | - Yuan-Tao Hao
- Department of Medical Statistics, School of Public Health, Sun Yat-Sen University, 74Th Zhongshan 2Nd Rd, Yuexiu District, Guangzhou, 510080, China. .,Peking University Center for Public Health and Epidemic Preparedness & Response, Xueyuan Road, Haidian District, 100191, Beijing, China. .,Sun Yat-Sen Global Health Institute, Sun Yat-Sen University, Guangzhou, 510080, China. .,Center for Health Information Research, Sun Yat-Sen University, Guangzhou, 510080, China.
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Beltz S, Gloystein S, Litschko T, Laag S, van den Berg N. Multivariate analysis of independent determinants of ADL/IADL and quality of life in the elderly. BMC Geriatr 2022; 22:894. [PMID: 36418975 PMCID: PMC9682836 DOI: 10.1186/s12877-022-03621-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 11/14/2022] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND This study evaluated the determinants of disability and quality of life in elderly people who participated at the multi-centred RubiN project (Regional ununterbrochen betreut im Netz) in Germany. METHODS Baseline data of the subjects aged 70 years and older of the RubiN project were used and only subjects with complete data sets were considered for the ensuing analysis (complete case analysis (CCA)). Disability was examined using the concepts of ADL (activities of daily living) and IADL (instrumental activities of daily living). Subjects exhibiting one or more deficiencies in ADL respectively IADL were considered as ADL respectively IADL disabled. Quality of life was assessed using the WHOQOL-BREF and the WHOQOL-OLD. Applying multivariate analysis, sociodemographic factors, psychosocial characteristics as well as the functional, nutritional and cognitive status were explored as potential determinants of disability and quality of life in the elderly. RESULTS One thousand three hundred seventy-five subjects from the RubiN project exhibited data completeness regarding baseline data. ADL and IADL disability were both associated with the respective other construct of disability, sex, a reduced cognitive and functional status as well as domains of the WHOQOL-BREF. Furthermore, ADL disability was related to social participation, while IADL disability was linked to age, education and social support. Sex, ADL and IADL disability, income, social support and social participation as well as the functional status were predictors of the domain 'Physical Health' (WHOQOL-BREF). The facet 'Social Participation' (WHOQOL-OLD) was affected by both ADL and IADL disability, income, social participation, the nutritional and also the functional status. CONCLUSIONS Several potential determinants of disability and quality of life were identified and confirmed in this study. Attention should be drawn to prevention schemes as many of these determinants appear to be at least partly modifiable.
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Affiliation(s)
- Sebastian Beltz
- grid.5603.0Institute for Community Medicine, Section Epidemiology of Health Care and Community Health, University Medicine Greifswald, Greifswald, Germany
| | - Simone Gloystein
- grid.5603.0Institute for Community Medicine, Section Epidemiology of Health Care and Community Health, University Medicine Greifswald, Greifswald, Germany
| | - Thomas Litschko
- grid.5603.0Institute for Community Medicine, Section Epidemiology of Health Care and Community Health, University Medicine Greifswald, Greifswald, Germany
| | - Sonja Laag
- Department for Product Strategy/Development, BARMER Health Insurance, Wuppertal, Germany
| | - Neeltje van den Berg
- grid.5603.0Institute for Community Medicine, Section Epidemiology of Health Care and Community Health, University Medicine Greifswald, Greifswald, Germany
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Ramos A, Fonseca C, Pinho L, Lopes M, Brites R, Henriques A. Assessment of Functioning in Older Adults Hospitalized in Long-Term Care in Portugal: Analysis of a Big Data. Front Med (Lausanne) 2022; 9:780364. [PMID: 35372382 PMCID: PMC8964623 DOI: 10.3389/fmed.2022.780364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Accepted: 01/21/2022] [Indexed: 11/13/2022] Open
Abstract
Background Functioning assessment is a key tool for health professionals to characterize the person's degree of dependence and plan care. Objectives The objectives were: (1) know the functioning components of older adults hospitalized in the National Network of Continuous Integrated Health Care (NNCIHC) in Portugal; and (2) compare the conceptual frameworks used in this network with the International Classification of Functioning, Disability and Health (ICF). Methods A longitudinal retrospective study is made with 171,414 individuals aged 65 years and over. The Principal Components Analysis (PCA) was realized to reduce the number of variables, previously suggested by a scoping review, about the concepts that characterize the functionality. Then, a consensus meeting was held, where the items were matched with the ICF. Results The average age of the sample is 80.17 years old (SD = 7.383), predominantly female (59%), without a spouse (54%), and with <6 years of education (56.4%). Four concepts were grouped: mobility, life daily activities, instrumental activities, and cognitive status that demonstrated good internal consistency. Most items correspond to ICF, except for the item "taking medication." Conclusion Theoretical and conceptual similarities support the use of instruments based on the ICF in Portugal's healthcare network. We suggest that ICF also encompasses a specific dimension related to medication management, given its importance for people's health.
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Affiliation(s)
- Ana Ramos
- Nursing Research, Innovation and Development Centre of Lisbon (CIDNUR), Nursing School of Lisbon (ESEL), Lisboa, Portugal
| | - César Fonseca
- Escola Superior de Enfermagem de São João de Deus, Universidade de Évora, Évora, Portugal.,Comprehensive Health Research Centre (CHRC), Universidade de Évora, Évora, Portugal
| | - Lara Pinho
- Escola Superior de Enfermagem de São João de Deus, Universidade de Évora, Évora, Portugal.,Comprehensive Health Research Centre (CHRC), Universidade de Évora, Évora, Portugal
| | - Manuel Lopes
- Escola Superior de Enfermagem de São João de Deus, Universidade de Évora, Évora, Portugal.,Comprehensive Health Research Centre (CHRC), Universidade de Évora, Évora, Portugal
| | - Rui Brites
- Instituto Superior de Economia e Gestão, Universidade de Lisboa, Lisboa, Portugal
| | - Adriana Henriques
- Nursing Research, Innovation and Development Centre of Lisbon (CIDNUR), Nursing School of Lisbon (ESEL), Lisboa, Portugal.,Faculdade de Medicina, Instituto de Saúde Ambiental (ISAMB), Universidade de Lisboa, Lisboa, Portugal
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Hamid TA, Din HM, Bagat MF, Ibrahim R. Do Living Arrangements and Social Network Influence the Mental Health Status of Older Adults in Malaysia? Front Public Health 2021; 9:624394. [PMID: 34026706 PMCID: PMC8131656 DOI: 10.3389/fpubh.2021.624394] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Accepted: 02/15/2021] [Indexed: 01/07/2023] Open
Abstract
Living arrangement has been reported to have a significant influence on several mental health statuses of older adults, but their social network may confound this association. This study is aimed at examining the interactive effect of living arrangements and social network on the mental health status among older adults in Malaysia. A total of 2,188 Malaysian older adults living nationwide were included in this cross-sectional study. Participants were classified into four groups according to their living arrangements (living alone or not living alone) and social network size (assessed using Lubben's Social Network Scale-6). Poor social network was defined as the lowest quartile (fourth quartile) of the score. Mental health statuses, which include flourishing in life, life satisfaction, cognitive functions, loneliness, depression, and perceived stress, were measured. Multiple linear regression models, adjusted for age, gender, education, and comorbidities, revealed that a good social network was significantly associated with an increase on the flourishing scale scores, regardless of living arrangements. Not living alone and having good social network was significantly associated with increased Montreal Cognitive Assessment scores and decreased loneliness scores. This study found that living arrangements are not always a risk factor for the mental health status of older adults. However, it may be confounded by the level of their social networks. The results suggested that the effects of social network may exceed the impact of living arrangements. It is recommended that health professionals pay more attention to the social networks of older Malaysians to harness its benefits in improving their mental health status.
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Affiliation(s)
- Tengku Aizan Hamid
- Malaysian Research Institute on Ageing, Universiti Putra Malaysia, Serdang, Malaysia
| | - Hazwan Mat Din
- Malaysian Research Institute on Ageing, Universiti Putra Malaysia, Serdang, Malaysia
| | | | - Rahimah Ibrahim
- Malaysian Research Institute on Ageing, Universiti Putra Malaysia, Serdang, Malaysia.,Department of Human Development and Family Studies, Faculty of Human Ecology, Universiti Putra Malaysia, Serdang, Malaysia
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Honarvar B, Gheibi Z, Asadollahi A, Bahadori F, Khaksar E, Rabiey Faradonbeh M, Farjami M. The Impact of Abuse on the Quality of Life of the Elderly: A Population-based Survey in Iran. J Prev Med Public Health 2020; 53:89-97. [PMID: 32268463 PMCID: PMC7142012 DOI: 10.3961/jpmph.19.210] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Accepted: 12/10/2019] [Indexed: 11/10/2022] Open
Abstract
Objectives The quality of life (QoL) of the elderly and elder abuse are growing public health concerns. This study aimed to evaluate the prevalence of abuse and the association between QoL and abuse in older adults. Methods Multistage random cluster sampling, along with valid QoL (LEIPAD: LEIden, the Netherlands; PADua, Italy; Helsinki, Finland) and abuse questionnaires, were used to assess QoL and elder abuse. Path analysis was performed using Mplus. SPSS and AMOS were used for the other analyses. Results A total of 386 elderly individuals with a mean age of 68.00±6.10 years were interviewed, of whom 200 (51.8%), 289 (74.9%), and 376 (97.4%) were women, educated, and married, respectively. Moreover, 167 (43.2%) had low-to-moderate QoL, and 108 (27.9%) had experienced a moderate level of abuse. QoL and abuse were inversely associated (r=-0.253), with men (β=-0.24) more affected than women (β=-0.21). Musculoskeletal disorders were also strong determinants of QoL in the elderly. QoL was strongly associated with emotional abuse, while abuse was highly related to the social component of QoL. Furthermore, emotional abuse was the type of abuse most significantly associated with the self-care, depression/anxiety, cognitive, and social components of QoL. Sexual abuse, violation of personal rights, and neglect were the main determinants of the physical functioning, life satisfaction, and sexual domains of QoL, respectively. Conclusions Nearly half of the elderly individuals lacked a high QoL, and at least one-fourth had experienced some form of abuse. Elder abuse was correlated inversely with QoL. Therefore, preventive interventions are recommended to decrease elder abuse in the family, community, and other settings.
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Affiliation(s)
- Behnam Honarvar
- Health Policy Research Center, Institute of Health, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Zahra Gheibi
- Health Policy Research Center, Institute of Health, Shiraz University of Medical Sciences, Shiraz, Iran.,Department of Epidemiology, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Abdolrahim Asadollahi
- Department of Healthy Aging, School of Health, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Farzaneh Bahadori
- Department of Healthy Aging, School of Health, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Elahe Khaksar
- Health Policy Research Center, Institute of Health, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Maryam Rabiey Faradonbeh
- Department of Healthy Aging, School of Health, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohammad Farjami
- Department of Biostatistics, Shiraz University of Medical Sciences, Shiraz, Iran
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Ćwirlej-Sozańska A, Wiśniowska-Szurlej A, Wilmowska-Pietruszyńska A, Sozański B. Determinants of ADL and IADL disability in older adults in southeastern Poland. BMC Geriatr 2019; 19:297. [PMID: 31672121 PMCID: PMC6824102 DOI: 10.1186/s12877-019-1319-4] [Citation(s) in RCA: 61] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Accepted: 10/15/2019] [Indexed: 11/26/2022] Open
Abstract
Background The extension of the life span has led to an increase in the number of older people and an increase in the prevalence of disability in people over 60 years of age. The aim of this study was to assess the prevalence of ADL and IADL disability and to analyze its determinants among people aged 60 and older living in southeastern Poland. Methods This cross-sectional study was carried out among a randomly selected, representative population of people aged 60 and older living in southeastern Poland. Disability was assessed using the Katz Index of Independence in Basic Activities of Daily Living and Instrumental Activities of Daily Living. Logistic regression models were used to identify the factors related to ADLs and IADLs. For the variables that were included in the above models, their clustered influence on the increase in the odds ratio for the occurrence of an ADL or IADL limitation was also examined. Results The research results show that 35.75% of the participants reported at least one problem with IADLs. At least one problem with ADLs was reported by 17.13% of the participants. The most significant modifiable factors influencing the occurrence of disability were the presence of barriers in the participant’s environment, poor relations with relatives, a lack of social contacts, multimorbidity and pain. A multiple increase in the odds ratio of disability was found with the presence of pairs of analyzed factors. The highest odds ratio of at least one ADL limitation was observed for the combination of barriers in the participant’s environment with multimorbidity (OR 74.07). With regard to IADL disability, the highest odds ratio was observed for the combination of pain on the VAS scale ≥3 points with older age (OR 19.47). Conclusions The study showed a high prevalence of ADL and IADL disability in older people living in southeastern Poland. It also indicated the extent to which modifiable factors influenced the occurrence of disability and the extent to which the risk of disability increased with the presence of pairs of factors, especially those that included environmental barriers in the participant’s environment.
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Affiliation(s)
| | | | | | - Bernard Sozański
- Center for Innovative Research in Medical and Natural Sciences, University of Rzeszow, Rzeszow, Poland
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Sahar J, Rekawati E, Wati DNK, Rachmawati U. Improved functional status and quality of life among the public institutionalized elderly in Jakarta. ENFERMERIA CLINICA 2019. [DOI: 10.1016/j.enfcli.2019.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Cleret de Langavant L, Bayen E, Yaffe K. Unsupervised Machine Learning to Identify High Likelihood of Dementia in Population-Based Surveys: Development and Validation Study. J Med Internet Res 2018; 20:e10493. [PMID: 29986849 PMCID: PMC6056741 DOI: 10.2196/10493] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2018] [Revised: 05/08/2018] [Accepted: 05/08/2018] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Dementia is increasing in prevalence worldwide, yet frequently remains undiagnosed, especially in low- and middle-income countries. Population-based surveys represent an underinvestigated source to identify individuals at risk of dementia. OBJECTIVE The aim is to identify participants with high likelihood of dementia in population-based surveys without the need of the clinical diagnosis of dementia in a subsample. METHODS Unsupervised machine learning classification (hierarchical clustering on principal components) was developed in the Health and Retirement Study (HRS; 2002-2003, N=18,165 individuals) and validated in the Survey of Health, Ageing and Retirement in Europe (SHARE; 2010-2012, N=58,202 individuals). RESULTS Unsupervised machine learning classification identified three clusters in HRS: cluster 1 (n=12,231) without any functional or motor limitations, cluster 2 (N=4841) with walking/climbing limitations, and cluster 3 (N=1093) with both functional and walking/climbing limitations. Comparison of cluster 3 with previously published predicted probabilities of dementia in HRS showed that it identified high likelihood of dementia (probability of dementia >0.95; area under the curve [AUC]=0.91). Removing either cognitive or both cognitive and behavioral measures did not impede accurate classification (AUC=0.91 and AUC=0.90, respectively). Three clusters with similar profiles were identified in SHARE (cluster 1: n=40,223; cluster 2: n=15,644; cluster 3: n=2335). Survival rate of participants from cluster 3 reached 39.2% (n=665 deceased) in HRS and 62.2% (n=811 deceased) in SHARE after a 3.9-year follow-up. Surviving participants from cluster 3 in both cohorts worsened their functional and mobility performance over the same period. CONCLUSIONS Unsupervised machine learning identifies high likelihood of dementia in population-based surveys, even without cognitive and behavioral measures and without the need of clinical diagnosis of dementia in a subsample of the population. This method could be used to tackle the global challenge of dementia.
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Affiliation(s)
- Laurent Cleret de Langavant
- Service de Neurologie, Hôpital Henri Mondor, Assistance Publique Hôpitaux de Paris, Créteil, France.,Département de Neurologie, Faculté de Médecine, Université de Paris Est, Créteil, France.,Neuropsychologie Interventionnelle U955 EQ1, Institut Mondor de Recherche Biomedicale, Inserm, Créteil, France.,Département d'Études Cognitives, École Normale Supérieure, PSL Research University, Paris, France.,Global Brain Health Institute, Memory and Aging Center, University of California, San Francisco, CA, United States
| | - Eleonore Bayen
- Global Brain Health Institute, Memory and Aging Center, University of California, San Francisco, CA, United States.,Service de Médecine Physique et Réadaptation, Hôpital de la Pitié Salpêtrière, Assistance Publique Hôpitaux de Paris, Paris, France.,Médecine Physique et Réadaptation, Faculté de Médecine, Sorbonne University, Paris, France.,Laboratoire d'Économie et de Gestion des Organisations de Santé, Département d'Économie de la Santé, Université Paris-Dauphine, Paris, France
| | - Kristine Yaffe
- Global Brain Health Institute, Memory and Aging Center, University of California, San Francisco, CA, United States.,Center for Population Brain Health, Department of Psychiatry, Neurology and Epidemiology and Biostatistics, University of California, San Francisco, CA, United States
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