The prevalence of functional disability in activities of daily living and instrumental activities of daily living among elderly Beijing Chinese

Cohort profile: Beijing Healthy Aging Cohort Study (BHACS)

The Beijing Healthy Aging Cohort Study (BHACS) was established to supplement the limited data of a large representative cohort of older people based on the general population and was designed to evaluate the prevalence, incidence, and natural history of cognitive decline, functional disability, and conventional vascular risk factors. The aim was to determine the evolution of these conditions by estimating the rates and determinants of progression and regression to adverse outcomes, including dementia, cardiovascular events, cancer, and all-cause death. It can therefore provide evidence to help policy makers develop better policies to promote healthy aging in China. BHACS consisted of three cohorts (BLSA, CCHS-Beijing, and BECHCS) in Beijing with a total population of 11 235 (6281 in urban and 4954 in rural areas) and an age range of 55 years or older (55-101 years) with a mean age of 70.35 ± 7.71 years (70.69 ± 7.62 years in urban and 69.92 ± 7.80 years in rural areas). BHACS-BLSA conducted the baseline survey in 2009 with a multistage stratification-random clustering procedure for people aged 55 years or older; BHACS-CCHS-Beijing conducted the baseline survey in 2013-2015 with a stratified multistage cluster random sampling method for people aged 55 years or older; and BHACS-BECHCS conducted the baseline survey in 2010-2014 with two-stage cluster random sampling method for people aged 60 years or older. Data were collected through questionnaires, physical measurements, and laboratory analyses. Topics covered by BHACS include a wide range of physical and mental health indicators, lifestyles and personal, family, and socio-economic determinants of health. There are no immediate plans to make the cohort data freely available to the public, but specific proposals for further collaboration are welcome. For further information and collaboration, please contact the corresponding author Yao He (e-mail: yhe301@x263.net).

Functional Disability Among Middle-Aged and Older Adults in China: The Intersecting Roles of Ethnicity, Social Class, and Urban/Rural Residency

This study explores how ethnicity, family income, and education level differentiate patterns of functional limitations among urban and rural Chinese (aged 45 ≥ years). Based on the 2018 China Family Panel Studies (CFPS) (n = 16,589), this nationwide study employed binary/multinomial logistic regression analyses, stratified by urban/rural residency, to estimate the likelihood of instrumental activities of daily living (IADLs) disability (0/1-2/≥3 limitations) by social determinants of health (SDoH). The estimated overall prevalence of IADLs disability was 14.3%. The multivariable analyses did not find significant ethnic disparity in IADLs disability in urban China, while in rural China, ethnic minorities were 44% more likely to have IADLs disability than Han Chinese. Among rural residents, Mongolians, Tibetans, and Yi minority more than tripled the odds of having ≥3 limitations than Han Chinese; and the intersections of ethnicity and social class were associated with functional limitations. Long-term care and anti-poverty programs should target minority aging populations in rural China.

Motoric cognitive risk syndrome as a predictor of incident disability: A 7 year follow-up study

Background

Though motoric cognitive risk syndrome (MCR) share risk factors with disability, whether it predict disability remains understudied.

Objectives

This study aims to examine the association between MCR and incident disability.

Design

Longitudinal study.

Methods

MCR was defined as subjective cognitive complaints and objective slow gait speed. Two subtypes of MCR were defined by whether memory impairment (MI) was also present, MCR-MI and MCR-non-MI. Incident activities of daily living (ADL) disability and instrumental activities of daily living (IADL) disability were outcome measures. Multiple logistic regression analysis was used to assess the independent effect of MCR at baseline on the odds of ADL/IADL disability at a 7 year follow-up.

Results

Among the subjects who were not disabled at baseline and followed for 7 years, 34.66% reported incident ADL disability, and 31.64% reported incident IADL disability. Compared with participants without MCR at baseline, those with MCR had 58% increased odds of incident ADL disability (OR=1.58, 95% CI: 1.19–2.09) and 46% increased odds of incident IADL disability (OR=1.46, 95% CI: 1.13–1.88) after 7 years. MCR-non-MI was associated with a 56.63% increased risk of ADL disability and a 34.73% increased risk of IADL disability. MCR-MI was associated with an even higher risk of IADL disability (OR = 2.14, 95% CI: 1.18–3.88).

Conclusions

MCR is an independent risk factor for both incident ADL and IADL disability. MCR-MI predicts a higher risk for disability than MCR-non-MI. Early identification of MCR among older adult is recommended and may decrease future risk of disability.

Engaging With Aging: A Qualitative Study of Age-Related Changes and Adaptations

Background and Objectives

In the context of global aging, there is a need to better understand how older adults adapt to their changing health status. Engaging with aging (EWA) is an emerging framework proposed by Carnevali, which provides a new lens to understand an active, conscious daily-living process of managing age-related changes (ARCs) taken on by older adults. Study aims were to (a) describe the ARCs experienced by community-dwelling older adults and (b) identify the strategies and resources used by older adults to accommodate the daily-living challenges caused by the associated ARCs.

Research Design and Methods

We conducted semistructured interviews using a virtual card sort to gather qualitative data about ARCs and strategies to manage ARCs. Interviews were conducted virtually due to coronavirus disease 2019 (COVID-19) restrictions.

Results

Participants included 19 females and 10 males. The mean age was 77.45 years old (range from 64 to 98). Sixteen ARCs (e.g., changes in hearing, changes in stability, changes in sleep, etc.) were mentioned by participants, and their corresponding adaptations were discussed. Participants linked their adaptations to their ARCs based on their changing capacities and needs. Examples of commonly used adaptations included, for example, conserving energy, utilizing tools or technology, and being more conscious before and while taking actions. The challenges caused by COVID-19 in implementing the adaptations were also discussed.

Discussion and Implications

Findings from this study demonstrate how older adults explore, generate, and utilize adaptive behaviors to address their ARCS. This study substantiates the EWA framework by showing common patterns among older adults in linking ARCs with adaptations. Implications for clinicians include using EWA to help older adults identify personalized health solutions that fit their capacities. Researchers may use EWA to design and test interventions by considering the specific ARCs older adults encounter and the attitudes they hold towards the ARCs.

Anthropometric data of an elderly Iranian population provides insights for system design

BACKGROUND

Anthropometric data should be considered for each major population age category, specifically because of the dimension changes occurring during ageing. In elderly subjects, the physical activities and their capabilities become limited. Therefore anthropometric reference data for equipment and system designs is necessary.

OBJECTIVES

The aim of the study was to collect data for the body dimensions of an elderly Iranian population and evaluate the related gender and age correlations.

METHODS

Nineteen body dimensions were manually measured on a sample size of 317 subjects (167 male and 150 female) from four provinces of Iran. A pilot preliminary test for assessing test-retest reliability on ten body dimensions using the Intraclass Correlation Coefficient (ICC2 :1)  was performed. Descriptive statistics were reported based on gender and independent samples t-tests to compare the anthropometric dimensions of both genders and age.

RESULTS

Results indicated higher dimensions in males, except for hip-breadth (p = 0.87). In all subjects, increasing age corresponded with: decreased standing shoulder height, eye height, and elbow height; and with sitting height and sitting knee height; while hip-breadth increased. Reliability was acceptable (ICC2.1 >0.88). In the elderly, as with adult subjects, there are significant gender differences in body dimensions, and this should be considered in equipment and system design. Furthermore, this study demonstrated both genders differences and the consequences of aging.

CONCLUSIONS

From this pilot data, product designers can consider the anthropometric characteristics for elderly Iranian subjects for equipment and system design.

Prevalence of Disability among the Chinese Older Population: A Systematic Review and Meta-Analysis

BACKGROUND

Disability is an important problem in aging societies globally. However, the research findings of the prevalence of disability have been inconsistent. This study aims to estimate the prevalence of disability and its influencing factors among the Chinese older population from 1979 to 31 July 2021.

METHODS

A systematic review and meta-analysis were conducted using both international (PubMed, Web of Science, CBMdisc, PsycINFO, the Cochrane Library, and EMBASE) and Chinese (CNKI, CQVIP, and WanFang) databases. Meta-analysis was performed using a random-effects model to account for heterogeneity. Subgroup analyses were also done.

RESULTS

The pooled prevalence of disability across all 97 studies was 26.2% (95% CI: 23.7-28.6%). The estimates varied according to the types of activities of daily living (ADL), gender, age, and region. Studies based on the identification of cases by using the complete ADL scale showed a higher prevalence than those using the basic ADL scale. The prevalence was slightly higher among female older individuals than among male older individuals. The highest rates were seen in older individuals aged 80 years or older. Elders in central China, southwest China, and northwest China were more likely to be BADL-disabled.

CONCLUSION

Prevalence of disability among the Chinese older population is high, around 26%. Using standardized diagnostic systems to correctly estimate the prevalence of disability would be helpful for public health professionals in China.

Longitudinal validity of self-rated health: the presence and impact of response shift

Objective: This paper aimed to examine the longitudinal validity of self-rated health (SRH) and whether it would be affected by possible changes in evaluation standards (i.e., response shift) over time.Design: Data are from a longitudinal survey of a nationally representative sample in China. Analytical sample was restricted to respondents aged 45 and above (n = 15,893). Individual fixed effects models were used to analyze changes in ratings on health anchoring vignettes and self-rated health over time.Main outcome measures: SRH at two time points with a -two-year span.Results: Both SRH and anchoring vignettes ratings displayed changes over a two-year span for all the studied age groups. Compared with the self-assessed change in health ("How would you rate your health as compared to that of last year?"), changes in SRH reported over time displayed a more stable and optimistic pattern. SRH responded to doctor diagnosed chronic disease and changes in functional limitation, before and after adjusting for evaluation standards.Conclusion: SRH is responsive to the newly diagnosed chronic disease and functional limitation, regardless of whether we consider response shift within the same respondents over time.

Do response styles affect the predictive validity of self-rated health among Chinese older men and women?

PURPOSE

This study intended to examine whether correcting for response styles of the widely used self-rated health (SRH) question would affect its predictive validity in estimating respondents' mortality risks.

METHODS

We used data on a sample of 3319 men and 3250 women aged 60 and above from a nationally representative survey in China. Response styles were estimated with both ratings on two health anchoring vignettes and self-rated items in domains unrelated to health. Gender-stratified logistic regressions were used to estimate the effects of SRH on 4-year mortality risks. We compared the results before and after adjusting for response styles.

RESULTS

In the unconditional model, the effects of the five-point SRH on 4-year mortality risks were significant in both older women and men, and stronger among Chinese older men based on discrete change in probabilities of mortality at means. Gender difference was observed in response styles. Men assigned lower ratings to the vignettes than women, reflecting their higher standards in defining good health. Women presented higher proportions of extreme responses and lower proportions of midpoint responses. Correcting for response styles had no effect on the predictive validity of SRH for Chinese older men, but had some positive effects for Chinese older women when no other covariates were included.

CONCLUSION

Adjusting for response styles contributed to a small improvement in predicting mortality risks only among Chinese older women under restricted conditions, but not men.

Predicting Functional Dependence in Mild Cognitive Impairment: Differential Contributions of Memory and Executive Functions

BACKGROUND AND OBJECTIVES

Diagnostic criteria for mild cognitive impairment (MCI) exclude functional deficits, yet recent studies suggest that older adults with MCI can exhibit impairment in instrumental activities of daily living (IADL). To assist health care providers in detecting functional vulnerabilities that often precipitate loss of independence, we: (a) compared IADL dependence in MCI to older adults without cognitive impairment and those with dementia, (b) estimated the odds of dependence on specific IADLs in MCI, and (c) investigated the differential contributions of memory and executive functions to IADL dependence.

RESEARCH DESIGN AND METHODS

Participants were older adults (Mage = 77.58 ± 11.05) in Maryland, USA (N = 512) community and postacute rehabilitation settings. Analysis was performed on Brief Cognitive Assessment Tool (BCAT) and the Functional Activities Questionnaire (FAQ) data that assessed participants' cognitive functioning and IADL dependence, respectively.

RESULTS

61.04% of participants with MCI were dependent on one or more IADLs. MCI was associated with significantly greater odds of dependence than normal cognition on 7 of the 10 IADLs (odds ratios = 2.62-4.66). Impairment in memory and executive functions significantly predicted IADL dependence (18.52% of variance beyond demographics); executive functions were the stronger predictor, particularly for complex finances, complex cooking, and remembering events.

DISCUSSION AND IMPLICATIONS

IADL dependence can occur even in MCI. Testing suggestive of MCI should alert clinicians to further investigate the older adult's profile of cognitive and functional limitations to highlight targets for caregiver support and promote independence by "right-sizing" community or facility resources.

The Prevalence and Clinical Characteristics of Essential Tremor in Elderly Chineses: A Population-Based Study

OBJECTIVES

To investigate the prevalence and the clinical feature of essential tremor (ET) in a community cohort in Beijing.

METHODS

Using a door-to-door, two-phase approach, we investigated 2,835 residents aged ≥55 years old from rural, urban, and mountain areas.

RESULTS

The prevalence rate of ET was 4.29%, 2.85%, and 2.29% in rural, urban, and mountain areas, respectively. The overall age- and sex-adjusted prevalence was 3.29%. Among those aged ≥75 years, the prevalence rate in the urban area was higher than those in the rural and mountain areas. The prevalence rate increased with age, and the prevalence was higher among men (6.0%) than among women (3.6%). There was a correlation of ET prevalence with age, sex, and habitation area, but not with alcohol, tea drinking, and occupation. Women (25%) with ET were more likely to have head tremor than men (16.9%).

CONCLUSIONS

The ET prevalence in the elderly of Beijing was 3.29% which is higher in the urban area and in men.

Sex differences in the relative heterogeneity of frailty in relation to age, frailty, health protection, and five-year mortality

BACKGROUND

Previous studies have suggested that the relative heterogeneity of frailty declines with increases in age and the level of the frailty index (FI). In this study, we investigated the sex difference in the relative heterogeneity of frailty and its response to health-protective factors, in a Chinese community sample.

METHODS

Data used for this secondary analysis were obtained from the Beijing Longitudinal Study of Aging that involved 3257 community-dwelling Chinese people aged 55 years and older at baseline. An FI was constructed for each indicial using 35 variables assessing health-related problems. A protection index (PI) consisting of 27 variables assessing lifestyle and social engagement was also built. The relative heterogeneity of frailty, as measured by the coefficient of variation (CV) of the FI, was calculated as the ratio of the standard deviation to the mean FI for different age, FI, and PI groups, and for the five-year survival status.

RESULTS

The CV decreased with the increase in age (F = 20.60, P = .006) and the FI (F = 57.59, P = .001), consistent in both sexes. In each age group, the CV was higher in men than in women (t = 3.25, P = .018). A great level of protection was associated with a significantly reduced mortality, and an increased CV (t = 2.91, P = .027).

CONCLUSIONS

Our data demonstrate that a gender difference exists in the relative heterogeneity of frailty, which is negatively related to age and frailty as well as positively associated with health protection and the five-year survival.

Suicide ideation, suicide attempts, their sociodemographic and clinical associates among the elderly Chinese patients with schizophrenia spectrum disorders

BACKGROUND

It is still unknown whether many well-identified risk factors of suicide could be applied to the elderly Chinese patients with schizophrenia.

METHODS

1-month suicidal ideation and lifetime suicide attempts together with their sociodemographic and clinical associates were analyzed by retrospective data on 263 elderly patients with schizophrenia spectrum disorders at the Kangning Hospital, Shenzhen, China. T-tests and Chi-square tests were used to examine the differences between patients with and without suicidality. Backward stepwise logistic regression was performed to identify the associated factors.

RESULTS

Among the selected patients, 17.87% had 1-month suicide ideation and 7.60% had lifetime suicide attempts. It was further observed that the elderly patients with schizophrenia who had 1-month suicide ideation were more likely to report lifetime suicide attempts, suffer from severe hopelessness and negative symptoms, and have no pension. However, the backward stepwise logistic regression analyses revealed that lifetime suicide attempts and negative symptoms were most significantly associated with 1-month suicide ideation. In contrast, lifetime suicide attempters were more likely to be men, receive a pension, display symptoms of hopelessness, have longer duration of illness and poor family relationships. The regression analyses also indicated that only hopelessness, relatively long duration of schizophrenia, and poor family relationships were the most significantly associated with lifetime suicide attempts.

LIMITATIONS

The retrospective design do not allow for causal inferences.

CONCLUSIONS

Early interventions designed to decrease hopelessness, control negative symptoms, and improve family relationships may result in reduced risks of suicide among elderly Chinese patients with schizophrenia.

Development of type 2 diabetes mellitus in people with intermediate hyperglycaemia

BACKGROUND

Intermediate hyperglycaemia (IH) is characterised by one or more measurements of elevated blood glucose concentrations, such as impaired fasting glucose (IFG), impaired glucose tolerance (IGT) and elevated glycosylated haemoglobin A1c (HbA1c). These levels are higher than normal but below the diagnostic threshold for type 2 diabetes mellitus (T2DM). The reduced threshold of 5.6 mmol/L (100 mg/dL) fasting plasma glucose (FPG) for defining IFG, introduced by the American Diabetes Association (ADA) in 2003, substantially increased the prevalence of IFG. Likewise, the lowering of the HbA1c threshold from 6.0% to 5.7% by the ADA in 2010 could potentially have significant medical, public health and socioeconomic impacts.

OBJECTIVES

To assess the overall prognosis of people with IH for developing T2DM, regression from IH to normoglycaemia and the difference in T2DM incidence in people with IH versus people with normoglycaemia.

SEARCH METHODS

We searched MEDLINE, Embase, ClincialTrials.gov and the International Clinical Trials Registry Platform (ICTRP) Search Portal up to December 2016 and updated the MEDLINE search in February 2018. We used several complementary search methods in addition to a Boolean search based on analytical text mining.

SELECTION CRITERIA

We included prospective cohort studies investigating the development of T2DM in people with IH. We used standard definitions of IH as described by the ADA or World Health Organization (WHO). We excluded intervention trials and studies on cohorts with additional comorbidities at baseline, studies with missing data on the transition from IH to T2DM, and studies where T2DM incidence was evaluated by documents or self-report only.

DATA COLLECTION AND ANALYSIS

One review author extracted study characteristics, and a second author checked the extracted data. We used a tailored version of the Quality In Prognosis Studies (QUIPS) tool for assessing risk of bias. We pooled incidence and incidence rate ratios (IRR) using a random-effects model to account for between-study heterogeneity. To meta-analyse incidence data, we used a method for pooling proportions. For hazard ratios (HR) and odds ratios (OR) of IH versus normoglycaemia, reported with 95% confidence intervals (CI), we obtained standard errors from these CIs and performed random-effects meta-analyses using the generic inverse-variance method. We used multivariable HRs and the model with the greatest number of covariates. We evaluated the certainty of the evidence with an adapted version of the GRADE framework.

MAIN RESULTS

We included 103 prospective cohort studies. The studies mainly defined IH by IFG_5.6 (FPG mmol/L 5.6 to 6.9 mmol/L or 100 mg/dL to 125 mg/dL), IFG_6.1 (FPG 6.1 mmol/L to 6.9 mmol/L or 110 mg/dL to 125 mg/dL), IGT (plasma glucose 7.8 mmol/L to 11.1 mmol/L or 140 mg/dL to 199 mg/dL two hours after a 75 g glucose load on the oral glucose tolerance test, combined IFG and IGT (IFG/IGT), and elevated HbA1c (HbA1c_5.7: HbA1c 5.7% to 6.4% or 39 mmol/mol to 46 mmol/mol; HbA1c_6.0: HbA1c 6.0% to 6.4% or 42 mmol/mol to 46 mmol/mol). The follow-up period ranged from 1 to 24 years. Ninety-three studies evaluated the overall prognosis of people with IH measured by cumulative T2DM incidence, and 52 studies evaluated glycaemic status as a prognostic factor for T2DM by comparing a cohort with IH to a cohort with normoglycaemia. Participants were of Australian, European or North American origin in 41 studies; Latin American in 7; Asian or Middle Eastern in 50; and Islanders or American Indians in 5. Six studies included children and/or adolescents.Cumulative incidence of T2DM associated with IFG_5.6, IFG_6.1, IGT and the combination of IFG/IGT increased with length of follow-up. Cumulative incidence was highest with IFG/IGT, followed by IGT, IFG_6.1 and IFG_5.6. Limited data showed a higher T2DM incidence associated with HbA1c_6.0 compared to HbA1c_5.7. We rated the evidence for overall prognosis as of moderate certainty because of imprecision (wide CIs in most studies). In the 47 studies reporting restitution of normoglycaemia, regression ranged from 33% to 59% within one to five years follow-up, and from 17% to 42% for 6 to 11 years of follow-up (moderate-certainty evidence).Studies evaluating the prognostic effect of IH versus normoglycaemia reported different effect measures (HRs, IRRs and ORs). Overall, the effect measures all indicated an elevated risk of T2DM at 1 to 24 years of follow-up. Taking into account the long-term follow-up of cohort studies, estimation of HRs for time-dependent events like T2DM incidence appeared most reliable. The pooled HR and the number of studies and participants for different IH definitions as compared to normoglycaemia were: IFG_5.6: HR 4.32 (95% CI 2.61 to 7.12), 8 studies, 9017 participants; IFG_6.1: HR 5.47 (95% CI 3.50 to 8.54), 9 studies, 2818 participants; IGT: HR 3.61 (95% CI 2.31 to 5.64), 5 studies, 4010 participants; IFG and IGT: HR 6.90 (95% CI 4.15 to 11.45), 5 studies, 1038 participants; HbA1c_5.7: HR 5.55 (95% CI 2.77 to 11.12), 4 studies, 5223 participants; HbA1c_6.0: HR 10.10 (95% CI 3.59 to 28.43), 6 studies, 4532 participants. In subgroup analyses, there was no clear pattern of differences between geographic regions. We downgraded the evidence for the prognostic effect of IH versus normoglycaemia to low-certainty evidence due to study limitations because many studies did not adequately adjust for confounders. Imprecision and inconsistency required further downgrading due to wide 95% CIs and wide 95% prediction intervals (sometimes ranging from negative to positive prognostic factor to outcome associations), respectively.This evidence is up to date as of 26 February 2018.

AUTHORS' CONCLUSIONS

Overall prognosis of people with IH worsened over time. T2DM cumulative incidence generally increased over the course of follow-up but varied with IH definition. Regression from IH to normoglycaemia decreased over time but was observed even after 11 years of follow-up. The risk of developing T2DM when comparing IH with normoglycaemia at baseline varied by IH definition. Taking into consideration the uncertainty of the available evidence, as well as the fluctuating stages of normoglycaemia, IH and T2DM, which may transition from one stage to another in both directions even after years of follow-up, practitioners should be careful about the potential implications of any active intervention for people 'diagnosed' with IH.

Assessment of risk factors for cerebrovascular disease among the elderly in Beijing: A 23-year community-based prospective study in China

INTRODUCTION

There are few studies on how lifestyle factors and mental conditions modulate the cerebrovascular diseases (CBVD) mortality risk are rare in the Asian elderly.

AIM

To comprehensively assess the impact of lifestyle factors and mental conditions on the mortality risk of CBVD among the Chinese older adults.

MATERIAL AND METHODS

This community-based prospective cohort study was based on the Beijing Longitudinal Study of Aging. We included 2101 participants aged ≥55 years who were interviewed in August 1992 and followed until December 2015. Baseline sociodemographic variables, lifestyle behaviors, and medical conditions were collected using a standard questionnaire. In addition, biochemical parameters, the Activities of Daily Living (ADL) scale, Center for Epidemiological Studies Depression (CES-D) scale, and Mini-Mental State Examination (MMSE) were performed. Hazard ratio (HR) and 95% confidence intervals (CI) was estimated from the competing risk model.

RESULTS

During the follow-up period, 576 (27.42%) CBVD events were documented. Multivariable analysis showed that hypertension (HR = 2.331, 95% CI = 1.652-3.288,P < 0.001), depression (HR=2.331, 95% CI=1.652-3.288, P < 0.001), cognitive impairment (HR=1.382, 95% CI=1.132-1.689, P < 0.001), and coronary heart diseases (HR=1.360, 95% CI=1.095-1.689, P = 0.005) were independently associated with CBVD, while body mass index, fasting blood glucose, triglycerides, drinking, and smoking were not associated with CBVD (all P > 0.05).

CONCLUSIONS

Males were at higher risk of CBVD than females. Age, gender, hypertension, cognitive impairment, and depression were associated with CBVD among the elderly in Beijing, China.

Activities of Daily Living and Determinant Factors among Older Adult Subjects with Lower Body Fracture after Discharge from Hospital: A Prospective Study

Fracture is a type of musculoskeletal injury that contributes to an inability to perform daily activities. The objective of this study was to evaluate activities of daily living (ADL) of older adult patients with lower body fracture and to determine factors influencing ADL. Patient's ADL was assessed at pre-fracture, ward admission and post-discharge phases using the Katz ADL questionnaire. There were 129 subjects at pre-fracture and ward phases and 89 subjects at discharge phase. There were four independent variables; age, gender, type of fracture and ability to walk before fracture. Logistic regression models showed that 'age' and 'ability to walk before fracture' were the determinant factors of dependent for 'bathing', 'dressing' and 'toileting'. The 'ability to walk before fracture' was the determinant factor of dependent for 'transferring'. 'Age' and 'gender' were the determinant factors of dependent for 'continence', while 'age' was the determinant factor of dependent for 'feeding'. The ADL score changes were significant across the phases with a reduction in ADL score in the ward admission phase and partial increment during the post-discharge phase. There were improvements in the health outcomes of subjects aged more than 50 years old after 3 months of being discharged from the hospital. In conclusion, age, being female, having a hip fracture and using a walking aid before fracture were the determinants identified in this study.

Carotid Artery Plaques, Carotid Intima-Media Thickness, and Risk of Cardiovascular Events and All-Cause Death in Older Adults: A 5-Year Prospective, Community-Based Study

We assessed the effect of asymptomatic carotid atherosclerosis (CAS) on the development of cardiovascular diseases (CVDs) in a community-based population aged ≥55 years in China. A total of 1376 residents underwent CAS assessment by ultrasonography in July 2009. New CVD events, including stroke and coronary heart events, were collected at the follow-up survey at the end of 2014. After adjusting for baseline demographic characteristics and traditional CVD risk factors, the risk of CVD in patients with minimal CAS (mean common carotid artery intima-media thickness [CCA-IMT] ≥1 mm and no plaques), nonstenotic plaques (carotid stenosis <50%), and stenotic plaques (carotid stenosis ≥50%) was 0.8 (hazard ratio [HR]: 0.75, 95% confidence interval [CI]: 0.33-1.69), 2.0 (HR: 2.01, 95% CI: 1.24-3.25), and 3.1 (HR: 3.05, 95% CI: 1.62-5.74) times greater, respectively, than that of patients without CAS (CCA-IMT <1 mm and no plaques). Our findings provide direct evidence of the independent predictive value of the severity of asymptomatic CAS for the development of CVD in older Chinese adults.

Frailty in Relation to the Risk of Alzheimer's Disease, Dementia, and Death in Older Chinese Adults: A Seven-Year Prospective Study

OBJECTIVES

To explore the relationship of general health decline assessed by frailty and risk of dementia and Alzheimer's disease (AD).

DESIGN

A seven-year prospective cohort study.

SETTING

Secondary analysis of data from the Beijing Longitudinal Study on Aging.

PARTICIPANTS

Urban and rural community-dwelling people aged 60 and older at baseline.

MEASUREMENTS

Frailty was quantified using the deficit accumulation-based frailty index (FI), constructed from 40 health deficits at baseline. Dementia was diagnosed by DSM-IIIR. AD and vascular dementia (VaD) were diagnosed by NINCDS-ADRDA and NINDS-AIREN. The relationships between frailty and the risk of dementia, AD and death were evaluated through multivariable models.

RESULTS

Of 2788 participants at baseline (1997), 171 (11.1%) reported a history of dementia. In seven years, 351 people developed dementia (13%: 223 AD and 128 other types of dementia) and 813 died (29%). After adjustment for age, sex, education, and baseline cognition, baseline frailty status significantly associated with Alzheimer's disease and dementia and death. For each deficit accumulated, the odds ratio of death increased by 5.7%, and the odds ratio of dementia increased by 2.9% (p < 0.001).

CONCLUSION

Frailty was associated with Alzheimer's disease and dementia over a seven years period. Frailty index might facilitate the identification of older adults at high risk of dementia for the application of the most effective, targeted prevention strategies.

Prediction of the 20-year incidence of diabetes in older Chinese: Application of the competing risk method in a longitudinal study

The competing risk method has become more acceptable for time-to-event data analysis because of its advantage over the standard Cox model in accounting for competing events in the risk set. This study aimed to construct a prediction model for diabetes using a subdistribution hazards model.We prospectively followed 1857 community residents who were aged ≥ 55 years, free of diabetes at baseline examination from August 1992 to December 2012. Diabetes was defined as a self-reported history of diabetes diagnosis, taking antidiabetic medicine, or having fasting plasma glucose (FPG) ≥ 7.0 mmol/L. A questionnaire was used to measure diabetes risk factors, including dietary habits, lifestyle, psychological factors, cognitive function, and physical condition. Gray test and a subdistribution hazards model were used to construct a prediction algorithm for 20-year risk of diabetes. Receiver operating characteristic (ROC) curves, bootstrap cross-validated Wolber concordance index (C-index) statistics, and calibration plots were used to assess model performance.During the 20-year follow-up period, 144 cases were documented for diabetes incidence with a median follow-up of 10.9 years (interquartile range: 8.0-15.3 years). The cumulative incidence function of 20-year diabetes incidence was 11.60% after adjusting for the competing risk of nondiabetes death. Gray test showed that body mass index, FPG, self-rated heath status, and physical activity were associated with the cumulative incidence function of diabetes after adjusting for age. Finally, 5 standard risk factors (poor self-rated health status [subdistribution hazard ratio (SHR) = 1.73, P = 0.005], less physical activity [SHR = 1.39, P = 0.047], 55-65 years old [SHR = 4.37, P < 0.001], overweight [SHR = 2.15, P < 0.001] or obesity [SHR = 1.96, P = 0.003], and impaired fasting glucose [IFG] [SHR = 1.99, P < 0.001]) were significantly associated with incident diabetes. Model performance was moderate to excellent, as indicated by its bootstrap cross-validated discrimination C-index (0.74, 95% CI: 0.70-0.79) and calibration plot.Poor self-rated health, physical inactivity, being 55 to 65 years of age, overweight/obesity, and IFG were significant predictors of incident diabetes. Early prevention with a goal of achieving optimal levels of all risk factors should become a key element of diabetes prevention.

A Novel Risk Score to the Prediction of 10-year Risk for Coronary Artery Disease Among the Elderly in Beijing Based on Competing Risk Model

The study aimed to construct a risk prediction model for coronary artery disease (CAD) based on competing risk model among the elderly in Beijing and develop a user-friendly CAD risk score tool. We used competing risk model to evaluate the risk of developing a first CAD event. On the basis of the risk factors that were included in the competing risk model, we constructed the CAD risk prediction model with Cox proportional hazard model. Time-dependent receiver operating characteristic (ROC) curve and time-dependent area under the ROC curve (AUC) were used to evaluate the discrimination ability of the both methods. Calibration plots were applied to assess the calibration ability and adjusted for the competing risk of non-CAD death. Net reclassification index (NRI) and integrated discrimination improvement (IDI) were applied to quantify the improvement contributed by the new risk factors. Internal validation of predictive accuracy was performed using 1000 times of bootstrap re-sampling. Of the 1775 participants without CAD at baseline, 473 incident cases of CAD were documented for a 20-year follow-up. Time-dependent AUCs for men and women at t = 10 years were 0.841 [95% confidence interval (95% CI): 0.806-0.877], 0.804 (95% CI: 0.768-0.839) in Fine and Gray model, 0.784 (95% CI: 0.738-0.830), 0.733 (95% CI: 0.692-0.775) in Cox proportional hazard model. The competing risk model was significantly superior to Cox proportional hazard model on discrimination and calibration. The cut-off values of the risk score that marked the difference between low-risk and high-risk patients were 34 points for men and 30 points for women, which have good sensitivity and specificity. A sex-specific multivariable risk factor algorithm-based competing risk model has been developed on the basis of an elderly Chinese cohort, which could be applied to predict an individual's risk and provide a useful guide to identify the groups at a high risk for CAD among the Chinese adults over 55 years old.

Association Between Kidney Dysfunction and Carotid Atherosclerosis in Community-Based Older Adults in China

We investigated the association between kidney dysfunction and carotid atherosclerosis in community-based older adults. This study consisted of 1257 participants, aged 55 years and older and free of cardiovascular disease. Kidney dysfunction was classified as mild, moderate, and severe (estimated glomerular filtration rate, 45-59, 30-44, and <30 mL/min/1.73 m2, respectively). We found that the mean common carotid artery intima–media thickness (CCA-IMT) progressively increased with decrement in kidney function ( P < .001). Even mild kidney dysfunction was significantly associated with CCA-IMT thickening (CCA-IMT ≥1.0 mm; odds ratio [OR] 1.52; 95% confidence interval [CI] 1.16-1.99) compared to normal kidney function. A significantly increased presence of heterogeneous plaque was observed in relation to decreased kidney function ( P for trend = .011), that is, even a mild kidney dysfunction was a potential independent risk factor for heterogeneous plaque (OR 1.43; 95% CI 1.04-1.98). Mild kidney dysfunction may be a predictor of early or accelerated carotid atherosclerosis in older adults.

Prevalence and correlates of disability among older Ugandans: evidence from the Uganda National Household Survey

Background

Nationally representative evidence on the burden and determinants of disability among older people in sub-Saharan Africa in general, and Uganda in particular, is limited.

Objective

The aim of this study was to estimate the prevalence and investigate the correlates of disability among older people in Uganda.

Design

We conducted secondary analysis of data from a sample of 2,382 older persons from the Uganda National Household Survey. Disability was operationalized as either: 1) having a lot of difficulty on any one question; 2) being unable to perform on any one question; or, 3) having some difficulty with two of the six domains. We used frequency distributions for description, chi-square tests for initial associations, and multivariable logistic regressions to assess the associations.

Results

A third of the older population was disabled. Among all older persons, disability was associated with advancement in age (OR=4.91, 95% CI: 3.38–7.13), rural residence (0.56, 0.37–0.85), living alone (1.56, 1.07–2.27), separated or divorced (1.96, 1.31–2.94) or widowed (1.86, 1.32–2.61) marital status, households’ dependence on remittances (1.48, 1.10–1.98), ill health (2.48, 1.95–3.15), and non-communicable diseases (NCDs) (1.81, 0.80–2.33). Gender was not associated with disability among older persons.

Conclusions

Disability was associated with advancement in age, rural residence, living alone, divorced/separated/widowed marital status, dependence on remittances, ill health, and NCDs. Interventions to improve health and functioning of older people need to focus on addressing social inequalities and on the early preventive interventions and management of NCDs in old age in Uganda.

Physical function assessment in a community-dwelling population of U.S. Chinese older adults

BACKGROUND

This report describes the levels of physical function in U.S. Chinese older adults utilizing self-reported and performance-based measures, and examines the association between sociodemographic characteristics and physical function.

METHODS

The Population Study of Chinese Elderly in Chicago enrolled an epidemiological cohort of 3,159 community-dwelling Chinese older adults aged 60 and older. We collected self-reported physical function using Katz activities of daily living and Lawton instrumental activities of daily living items, the Index of Mobility scale, and the Index of Basic Physical Activities scale. Participants were also asked to perform tasks in chair stand, tandem stand, and timed walk. We computed Pearson and Spearman correlation coefficients to examine the correlation between sociodemographic and physical function variables.

RESULTS

A total of 7.8% of study participants experienced activities of daily living impairment, and 50.2% experienced instrumental activities of daily living impairment. With respect to physical performance testing, 11.4% of the participants were not able to complete chair stand for five times, 8.5% of the participants were unable to do chair stands at all. Older age, female gender, lower education level, being unmarried, living with fewer people in the same household, having fewer children, living fewer years in the United States, living fewer years in the community, and worsening health status were significantly correlated with lower levels of physical function.

CONCLUSIONS

Utilizing self-reported and performance-based measures of physical function in a large population-based study of U.S. Chinese older adults, our findings expand current understanding of minority older adults' functional status.

Risk profiles for metabolic syndrome and its transition patterns for the elderly in Beijing, 1992-2009

There have been few reports on the development of metabolic disorders, especially when they are considered as a cluster. The purpose of this study was to describe risk profiles for metabolic syndrome (MetS) in elderly dwellers in Beijing, and to find their transition patterns over time. Data were derived from Beijing longitudinal study of aging, a community-based cohort study hosted by Xuanwu hospital. There were 3,257 elderly people aged 55 years or over recruited in 1992. MetS was assessed for the years 1992, 2000, and 2009. Finally, 363 subjects with complete information for components of MetS in the three years were included in the study. The criteria of MetS recommended by the joint interim statement criteria were adopted. Latent transition analysis was used to calculate the transition probabilities between adjacent visits. A risk typology consisting of four time-invariant groups was detected based on the components of MetS for all subjects. Low MetS risk group, BP risk group, BP-HDL risk group, and BP-FPG-TG risk group were found. The probability of staying at the same status was higher at the two intervals across 18 years. Four latent groups were extracted based on three assessments for the components of MetS, together with their transition patterns. Findings suggested various trajectories for MetS components. Different combinations of intervention strategy might be needed for MetS risk groups.

Determinants of long-term care services among the elderly: a population-based study in Taiwan

Objectives

The aim of the study was to investigate determinants of long-term care use and to clarify the differing characteristics of home/community-based and institution-based services users.

Design

Cross-sectional, population-based study.

Setting

Utilizing data from the 2005 National Health Interview Survey conducted in Taiwan.

Participants

A national sample of 2,608 people (1,312 men, 1,296 women) aged 65 and older.

Measurements

The utilization of long-term care services (both home/community- and institution-based services) was measured. A χ² analysis tested differences in baseline characteristics between home/community-based and institution-based long-term care users. The multiple-logistic model was adopted with a hierarchical approach adding the Andersen model’s predisposing, enabling, and need factors sequentially. Multiple logistic models further stratified data by gender and age.

Results

Compared with users of home/community-based care, those using institution-based care had less education (p = 0.019), greater likelihood of being single (p = 0.001), fewer family members (p = 0.002), higher prevalence of stool incontinence (p = 0.011) and dementia (P = .025), and greater disability (p = 0.016). After adjustment, age (compared with 65–69 years; 75–79 years, odds ratio [OR] = 2.08, p = 0.044; age ≥80, OR = 3.30, p = 0.002), being single (OR = 2.16, p = 0.006), urban living (OR = 1.68, p = 0.037), stroke (OR = 2.08, p = 0.015), dementia (OR = 2.32, p = 0.007), 1–3 items of activities of daily living (ADL) disability (OR = 5.56, p<0.001), and 4–6 items of ADL disability (OR = 21.57, p<0.001) were significantly associated with long-term care use.

Conclusion

Age, single marital status, stroke, dementia, and ADL disability are predictive factors for long-term care use. The utilization was directly proportional to the level of disability.

Risk factors for cerebrovascular disease mortality among the elderly in Beijing: a competing risk analysis

Objective

To examine the associations of combined lifestyle factors and physical conditions with cerebrovascular diseases (CBVD) mortality, after accounting for competing risk events, including death from cardiovascular diseases, cancers and other diseases.

Methods

Data on 2010 subjects aged over 55 years were finally analyzed using competing risk models. All the subjects were interviewed by the Beijing Longitudinal Study of Aging (BLSA), in China, between 1 January 1992 and 30 August 2009.

Results

Elderly females were at a lower risk of death from CBVD than elderly males (HR = 0.639, 95% CI = 0.457–0.895). Increasing age (HR = 1.543, 95% CI = 1.013–2.349), poor self-rated health (HR = 1.652, 95% CI = 1.198–2.277), hypertension (HR = 2.201, 95% CI = 1.524–3.178) and overweight (HR = 1.473, 95% CI = 1.013–2.142) or obesity (HR = 1.711, 95% CI = 1.1754–2.490) was associated with higher CBVD mortality risk. Normal cognition function (HR = 0.650, 95% CI = 0.434–0.973) and living in urban (HR = 0.456, 95% CI = 0.286–0.727) was associated with lower CBVD mortality risk. Gray’s test also confirmed the cumulative incidence (CIF) of CBVD was lower in the ‘married’ group than those without spouse, and the mortality was lowest in the ‘nutrition sufficient’ group among the ‘frequent consumption of meat group’ and the ‘medial type group’ (P value<0.001).

Conclusions

CBVD mortality was associated with gender, age, blood pressure, residence, BMI, cognitive function, nutrition and the result of self-rated health assessment in the elderly in Beijing, China.

Sex differences in the limit to deficit accumulation in late middle-aged and older Chinese people: results from the Beijing Longitudinal Study of Aging

Background.

On average, as people age, they accumulate more health deficits and have an increased risk of death. The deficit accumulation–based frailty index (FI) can quantify health and its outcomes in aging. Previous studies have suggested that women show higher FI values than men and that the highest FI score (the “limit to frailty”) occurs at a value of FI ~ 0.7. Even so, gender differences in the limit to frailty have not been reported.

Methods.

Data for this analysis were obtained from the Beijing Longitudinal Study of Aging that involved 3,257 community-dwelling Chinese people, aged 55+ years at baseline. The main outcome measure was 5-year mortality. An FI consisting of 35 health-related variables was constructed. The absolute and 99% FI limits were calculated for different age groups and analyzed by sex.

Results.

The mean level of the FI increased with age and was lower in men than in women (F = 67.87, p < .001). The 99% FI limit leveled off slightly earlier with a relatively lower value in men (60 years; 0.44 ± 0.02) compared with that in women (65 years; 0.52 ± 0.04). The highest absolute FI value was 0.61 in men and 0.69 in women. In both groups, people with an FI greater than or equal to the 99% limit showed close to 100% mortality by 5 years.

Conclusion.

Compared with men, women appeared to better tolerate deficits in health, yielding both relatively lower mortality and higher limit values to the FI. Even so, the FI did not exceed 0.7 in any individual.

Mental health and social support among HIV-positive injection drug users and their caregivers in China

The burden of HIV/AIDS in China is due to injection drug use. Non-clinical caregivers provide much of the care for HIV patients but are often not included in HIV care or research. The objective of this study is to examine the relationships between the caregiver context and mental health of HIV-positive injection drug users and their caregivers. We interviewed 96 patient-caregiver dyads using quantitative methods. A conceptual model was developed as a framework for multivariate linear regression modeling. The strongest predictor of poor patient mental health was lack of social support, which was largely determined by the caregiver's stigma towards HIV/AIDS and caregiver burden. Patient disability and caregiver burden were the primary predictors of poor caregiver mental health. The interrelated nature of caregiver and patient mental health supports the inclusion of caregiver health into the patient's HIV/AIDS treatment to maximize support provision and health for the patient and caregiver.

An evaluation of transition in functional states among the elderly in Beijing, China

OBJECTIVES

The goal of the present study was to describe the changes in activities of daily living (ADL) of community-dwelling Beijing elderly people (n=3,257), observed for 8 years, and to identify the demographic characteristic that predict the functional change.

METHODS

Two sets of interview data (1992 and 2000) were used to evaluate changes among the elderly in reports of limitation in ADL management.

RESULTS

The prevalence of disability increased over 8 years both in IADL and BADL disability. The patterns of ADLs change were bi-directional. A large proportion (74.7%) of the elderly were found to remain active in their functional states, 20.4% of the elderly declined, 3.4% of the elderly remained disabled, and 1.5% showed improvement in functional states. The transition rates from non-disability and disability states to various functional states showed different characteristic, a high disability rate accompanied a high mortality rate. The demographic factors that affected the level of disability among different kinds of population manifested similar trends.

CONCLUSION

Age was the most significant predictor for functional limitations. In addition, demographic variables played an important role in estimating functional outcomes. It is recommended that the demarcation factor for the evaluation of ADLs should be 75 years of age.

Frailty in relation to the risk of falls, fractures, and mortality in older Chinese adults: results from the Beijing Longitudinal Study of Aging

OBJECTIVES

Falls are well known to be associated with adverse health outcomes, especially when complicated by fracture. Falls are more common in people who are frail and readily related to several items in the frailty phenotype. Less is known about the relationship between falls and frailty defined as deficit accumulation. Our objective was to investigate the relationship between falls, fractures, and frailty based on deficit accumulation.

DESIGN

Representative cohort study, with 8 year follow-up.

SETTING

The Beijing Longitudinal Study of Aging (BLSA).

PARTICIPANTS

3,257 Chinese people aged 55+ years at baseline.

MEASUREMENTS

A frailty index (FI) was constructed using 33 health deficits, but excluding falls and fractures. The rates of falls, fractures and death as a function of age and the FI were analyzed. Multivariable models evaluated the relationships between frailty and the risk of recurrent falls, fractures, and mortality adjusting for age, sex, and education. Self or informant reported fall and fracture data were verified against participants' health records.

RESULTS

Of 3,257 participants at baseline (1992), 360 people (11.1%) reported a history of falls, and 238 (7.3%) reported fractures. By eight years, 1,155 people had died (35.3%). The FI was associated with an increased risk of recurrent falls (OR=1.54; 95% confidence interval (CI)=1.34-1.76), fractures (OR=1.07; 95% CI=0.94-1.22), and death (OR=1.50, 95% CI=1.41-1.60). The FI showed a significant effect on mortality in a multivariate Cox regression model (Hazard Rate=1.29, 95% CI=1.25-1.33). When adjusted for the FI, neither falls nor fractures were associated with mortality.

CONCLUSION

Falls and fractures were common in older Chinese adults, and associated with frailty. Only frailty was independently associated with death.

The trajectories and correlation between physical limitation and depression in elderly residents of Beijing, 1992-2009

BACKGROUND

Physical limitation and psychological distress have been reported to be related, but studies describing the change of instrumental activities of daily living (IADLs) and depression syndrome over time or exploring the link pattern for their development are limited. The study was to assess distinctive patterns for the development of physical limitation and depression and to explore their correlation to form a proper prevention strategy.

METHODS

Dual trajectory analysis was conducted using data from the Beijing Longitudinal Study of Aging (BLSA) 1992-2009 hosted by Xuanwu hospital for subjects with full information on depression and physical limitation for all available visits. Physical limitation was measured by the Instrumental Activities of Daily Living (IADL) scale and depression by the Center for Epidemiological Studies Depression scale (CES-D). The covariates were gender, age at baseline and number of chronic conditions.

RESULTS

Three heterogeneous trajectories for physical limitation and two distinct groups for an increase in depression were detected. Among them, 10.13% of subjects experienced an increase in physical limitation, while 13.22% demonstrated a high, stable level of depressive mood. In all, 80.4% of the subjects enjoyed a relatively low, stable level of IADL and CES-D scores. People in the late increase group for IADL score were more likely to have depressive mood when adjusted for gender, age and number of chronic conditions (OR=3.900, 95%CI=1.347-11.290).

CONCLUSIONS

The development of physical limitation among the elderly may significantly increase the risk for depressive symptoms.

Prevalence and causes of functional disability in an elderly general population of Japanese: the Hisayama study

BACKGROUND

There are limited data on the prevalence and causes of disability in the elderly general population in Japan.

METHODS

In a population-based cross-sectional study of 1550 Japanese aged 65 years or older, we examined the prevalence of functional disability (defined as a Barthel Index score of ≤95) and its causes.

RESULTS

A total of 311 of the participants had a disability (prevalence 20.1%). The prevalence of disability increased with age and doubled with every 5-year increment in age. Prevalence was higher in women than in men, especially among those aged 85 years or older. With respect to the cause of functional disability, dementia accounted for 23.5%, stroke for 24.7%, orthopedic disease for 12.9%, and other disease for 38.9% of cases in men; in women, the respective values were 35.8%, 9.3%, 31.0%, and 23.9%. Regarding age, dementia was the most frequent cause of disability in subjects aged 75 years or older, whereas stroke was most common in subjects aged 65 to 74 years. Approximately two-thirds of cases of total dependence were attributed to dementia in both sexes, whereas the main cause of slight or moderate/severe dependence was stroke in men and orthopedic disease in women. Among participants with total dependence, 94.8% resided in a hospital or health care facility.

CONCLUSIONS

Our findings indicate that functional disability is common among Japanese elderly adults and that its major cause is stroke in men and dementia in women.

Physical Health and Cognitive Function Independently Contributed to Functional Disability among Chinese Older Adults: Data from Two Asian Metropolises

Objective. We aimed to examine the independent contributions of physical health and cognitive function to disability among Chinese older adults living in two Asian metropolises and explore the potential influences of environment. Design and Participants. Cross-sectional analysis based on data from two population-based studies: the Shanghai Survey of Alzheimer's Disease and Dementia (n = 4639) and the Singapore Longitudinal Ageing Study (n = 2397). Disability was defined as needing help in at least one activity of daily living. Results. The prevalence of functional disability was higher in Shanghai sample (5%) than that in Singapore sample (1.8%). Number of chronic diseases, self-rated health status, cognitive function (measured by the Mini-Mental State Examination), and environment (Singapore versus Shanghai) significantly contributed to functional disability independent of each other. The adjusted Odds Ratio was 1.35 (95%CI 1.22-1.50), 2.85 (95% CI 2.36-3.43), 0.89 (95% CI 0.85-0.94), and 0.68 (95% CI 0.48-0.96), respectively. The strength of associations between health variables and disability appeared to be influenced by environment. Conclusion. Physical health and cognitive function independently contributed to functional disability. The associations are modulated by environmental factors.

Prevalence and Correlates of Physical Disability and Functional Limitation among Elderly Rural Population in Nigeria

Background. The number of people surviving into old age is increasing, and it has now become a global phenomenon. Studies on the prevalence and correlates of physical disability and functional limitation among elderly Nigerians are scanty. Methodology. This is a community-based cross-sectional study conducted in 3 local government areas (LGAs) in Nigeria, using a multistage sampling technique. Functional limitations of 1824 elderly persons were tested using Tinetti performance-oriented mobility assessment tool (TPOMAT) and self-reported activities of daily living (ADL). ADL disability of ten, six, and five basic items were compared. Results. The prevalence ratios (PRs) of physical disability using the ten, six, and five basic ADL items were 28.3 (95% CI 25.2–31. 5), 15.7 (95% CI 13.4–19.8), and 12.1 (95% CI 9.8–15.3), respectively, while functional limitation was 22.5 (95% CI 18.1–24.4). Increased risk of disability was independently associated with female gender PR 3.6 (95% CI 1.5–7.4), advanced age ≥75 years; PR 22.2 (95% CI 14.5, 36.8), arthritis PR 3.7 (95% CI 2.6–4.6), stroke PR 4.8 (95% CI 3.7–7.9) and diabetes PR 6.1 (95% CI 4.3–7.1). Conclusions. The findings from this study are pointers to unmet needs of the elderly disabled Nigerians.

Frailty and survival of older Chinese adults in urban and rural areas: results from the Beijing Longitudinal Study of Aging

Differences in frailty between rural and urban older adults have been demonstrated in developed countries. It is not understood how the apparently greater differences in living conditions between different types of regions in China may affect health and outcomes of older Chinese adults. Here, a frailty index (FI) based on the accumulation of health deficits was used to investigate health and survival differences in older Chinese men and women. We studied rural (n=1121) and urban (n=2136) older adults (55-97 years old) in the Beijing Longitudinal Study of Aging (BLSA), of whom 48.9% (rural) and 35.4% (urban) died over 8 years of follow-up. The FI was generated from 35 self-reported health deficits. The mean FI increased exponentially with age (r(2)=0.87) and was higher in women than in men. The death rate increased significantly with increases in the FI, but women showed a lower death rate than did men. The mean FI in urban older adults (0.12±0.10) was lower than that in their rural counterparts (0.14±0.12, p<0.001). Urban dwellers showed better survival compared with their counterparts in the rural areas. Adjusted by age, sex, and education level, the hazard ratio for death for each increment of the FI was 1.28 for urban people and 1.27 for rural people. Chinese urban dwellers showed better health and survival than rural dwelling older adults. The FI readily summarized health and mortality differences among different geographic regions, reflecting the impact of the environment, socioeconomics, and medical services on deficit accumulation and on survival.

Analysis of frailty and survival from late middle age in the Beijing Longitudinal Study of Aging

BACKGROUND

Frailty in individuals can be operationalized as the accumulation of health deficits, for which several trends have been observed in Western countries. Less is known about deficit accumulation in China, the country with the world's largest number of older adults.

METHODS

This study analyzed data from the Beijing Longitudinal Study of Aging, to evaluate the relationship between age and deficit accumulation in men and women and to evaluate the impact of frailty on mortality. Community dwelling people aged 55+ years at baseline (n = 3275) were followed every two to three years between 1992 and 2000, during which time 36% died. A Frailty Index was constructed using 35 deficits, drawn from a range of health problems, including symptoms, disabilities, disease, and psychological difficulties.

RESULTS

Most deficits increased the eight-year risk of death and were more lethal in men than in women, although women had a higher mean level of frailty (Frailty Index = 0.11 ± 0.10 for men, 0.14 ± 0.12 for women). The Frailty Index increased exponentially with age, with a similar rate in men and women (0.038 vs. 0.039; r > 0.949, P < 0.01). A dose-response relationship was observed as frailty increased.

CONCLUSIONS

A Frailty Index employed in a Chinese sample, showed properties comparable with Western data, but deficit accumulation appeared to be more lethal than in the West.

Predictors of the utilization of long-term care (LTC) services among residents in community-based LTC facilities in Taiwan

Identifying the utilization behaviors of LTC residents is necessary in order to forecast the demand and the level of resource use for health services. The purpose of this study is to understand the utilization behaviors and their predictors among residents of community-based LTC facilities in Taiwan. A prospective design was used in this study. Subjects were from six community-based LTC facilities in Beitou district of Taipei, Taiwan. A one-month time sheet was developed comprising subjects' socio-demographic characteristics, health status, and their use of LTC services. Among five types of LTC services examined in this study, assistance with activities of daily living (ADL) were the most commonly used (mean=67.3±46.0). ADL score was the strongest predictor of service utilization, accounting for 40% of the total variation in the utilization of personal assistance services (R2=0.396). The second most commonly used service was skilled-nursing services (mean=13.3±10.3). The most common skilled-nursing activities were administration of medication (mean=5.2±3.9) and measuring vital sign measurement (mean=3.4±2.3). The results provide useful information on how to allocate resources among staff in community-based LTC facilities.

Prevalence and correlates of physical disability and functional limitation among community dwelling older people in rural Malaysia, a middle income country

Background

The prevalence and correlates of physical disability and functional limitation among older people have been studied in many developed countries but not in a middle income country such as Malaysia. The present study investigated the epidemiology of physical disability and functional limitation among older people in Malaysia and compares findings to other countries.

Methods

A population-based cross sectional study was conducted in Alor Gajah, Malacca. Seven hundred and sixty five older people aged 60 years and above underwent tests of functional limitation (Tinetti Performance Oriented Mobility Assessment Tool). Data were also collected for self reported activities of daily living (ADL) using the Barthel Index (ten items). To compare prevalence with other studies, ADL disability was also defined using six basic ADL's (eating, bathing, dressing, transferring, toileting and walking) and five basic ADL's (eating, bathing, dressing, transferring and toileting).

Results

Ten, six and five basic ADL disability was reported by 24.7% (95% CI 21.6-27.9), 14.4% (95% CI 11.9-17.2) and 10.6% (95% CI 8.5-13.1), respectively. Functional limitation was found in 19.5% (95% CI 16.8-22.5) of participants. Variables independently associated with 10 item ADL disability physical disability, were advanced age (≥ 75 years: prevalence ratio (PR) 7.9; 95% CI 4.8-12.9), presence of diabetes (PR 1.8; 95% CI 1.4-2.3), stroke (PR 1.5; 95% CI 1.1-2.2), depressive symptomology (PR 1.3; 95% CI 1.1-1.8) and visual impairment (blind: PR 2.0; 95% CI 1.1-3.6). Advancing age (≥ 75 years: PR 3.0; 95% CI 1.7-5.2) being female (PR 2.7; 95% CI 1.2-6.1), presence of arthritis (PR 1.6; 95% CI 1.2-2.1) and depressive symptomology (PR 2.0; 95% CI 1.5-2.7) were significantly associated with functional limitation.

Conclusions

The prevalence of physical disability and functional limitation among older Malaysians appears to be much higher than in developed countries but is comparable to developing countries. Associations with socio-demographic and other health related variables were consistent with other studies.

Earning their keep: the productivity of older women and men in rural Bangladesh

In Bangladesh, being active and able to participate in productive activities is often essential to ensure ongoing health and survival. This study aims to describe and explore the patterns of participation in productive activities by older people in Matlab, a rural area of Bangladesh. Data from a cross sectional survey of people over 60 years of age was utilised. Six hundred and twenty five men and women participated in home based interviews providing information about their participation in productive activities including work, domestic activities and community groups. Overall, 94.4% of subjects reported participation in at least one productive activity. Men were the main participants in paid work and community groups, with 62% reporting engagement in paid work and 44% contributing to community groups. Both men (95.4%) and women (91.9%) reported performing at least one domestic activity. Performance of higher numbers of domestic tasks was associated with being younger, female, not requiring any assistance with self care, not married, not living with any children and earning between 100-999 Bangladesh Taka in the past month. Participation in community groups was low with only 26% of the sample reporting any involvement. This study indicates a high level of productivity in the older population in Matlab which benefits the individual, the family and the wider community. The safety and suitability of typical productive activities needs further investigation, in order to inform strategies protecting the older population from the effects of over work and harmful activities.

Stroke and active life expectancy among older adults in Beijing, China

PURPOSE

Increasing stroke prevalence, population ageing and economic change in China necessitate a better understanding of the impact of stroke. This study examines the impact of stroke on disability and trends over time.

METHOD

Data are from longitudinal surveys conducted in the Beijing municipality from 1992 to 1997 and 2000 to 2004. Multi-state life tables constructed from hazard models are used to estimate life expectancy (LE) and active life expectancy (ALE). The active state is defined using six functional tasks and mortality is determined using interviewer follow-ups.

RESULTS

LE and ALE are higher among those without stroke. Population-based estimates for the cohort observed beginning in 1992 indicate LE at age 55 of about 17 for those who have had a stroke and about 21 for others, whereas years of active life are about 14 and 19, respectively. Disability status at baseline is important for determining ALE. For those active, LE and ALE patterns are similar regardless of stroke status. For those inactive, the stroke group lives almost their entire lives inactive. Stroke reduces years of life by 20-40%, but active life by up to 90%.

CONCLUSION

Trends in ALE among those with stroke suggest possible influences of rapid development, concomitant improvement in health care and an increased focus on disease management.

Prevalence of functional disability in activities of daily living (ADL), instrumental activities of daily living (IADL) and associated factors, as predictors of morbidity and mortality

The aim of this study is to establish the existing relationship among variables referred to the person, specifically age and gender, and the functional dependence in basic ADL and in IADL, as well as the possible relationship it has with the increase of morbidity and mortality in a random sample of 598 individuals older than 65 years. Of these individuals, 34.6% were categorized as dependent for at least one ADL, and 53.5% if we refer to IADL. Regarding the ADL, the risk of dependence increases (odds ratio=OR=1.089) per year of age, (OR=2.48) in women's case; while there is an IADL correlation between age and the score (r=-0.527; p<0.001). A relationship exists between dependence and the days of hospitalization (for ADL: r=-0.12, p=0.018 and IADL: r=-0.97, p=0.003), the number of visits to the doctor (ADL: r=-0.27, p<0.001; IADL: r=-0.25, p<0.001) or the presence of concomitant pathologies such as dementia (ADL: p<0.001; IADL: p<0.001). There is a significant association between age, gender and dependence, as well as between dependence and morbidity and mortality, so that dependence could be used as a predictor of both.

Widowhood and self-rated health among Chinese elders: the effect of economic condition

OBJECTIVE

To examine the mediating effect of economic condition (income, work status, self-rated financial situation and financial support) on widowhood and self-rated health in elderly Chinese.

METHODS

The study sample consists of 17,556 married and widowed elders age 60 and older selected from the nationwide 2000 Sample Survey on Aged Population in Urban/Rural China. Path analysis is used to identify the direct and indirect relationships of economic condition between widowhood and self-rated health.

RESULTS

Widowhood has a direct effect on self-rated health for those widowed for more than 4 years. Work status and perceived financial situation mediate that relationship regardless of length of time widowed. Being older, male, less educated, and functionally healthy are associated with better self-rated health among those widowed.

CONCLUSIONS

Work status and perceived financial situation have a more significant effect on widowhood and self-rated health than income and financial support. The findings have cross-cultural implications for developing elder care programs.

Health and life satisfaction of ethnic minority older adults in mainland China: effects of financial strain

China has achieved indisputable economic growth in the past decades but, with it, unbalanced development across region and socio-economic groups. Little is known about how this impacts the lives of minority older adults who tend to live in remote inland areas. This study is the first attempt to examine and compare the relationships between financial strain, health conditions, and life satisfaction among ethnic minority and non-minority older adults in mainland China. Research data was obtained from respondents aged 60 and over who participated in the National Survey of the Aged Population in China (N = 995) in 2000. Hierarchical linear regression revealed financial strain to be significantly associated with life satisfaction and health, however functional health measurements of ADL were only associated for ethnic minority groups after controlling for socio-demographic variables. The impact of underdeveloped socio-economic levels and unfavorable living environments on health and life satisfaction is stronger among minority groups and warrants further attention.

Factors Associated with the Functional Status of Community-dwelling Elderly

PURPOSE

This research sought to answer the following question: To what extent is the functional status of elderly people explained by gender, age, geographical residence, level of cognitive function, and depression?

METHOD

Two hundred randomly selected community-dwelling elderly people aged 65 to 80 years old completed the Mini-Mental State Examination (MMSE), Geriatric Depression Scale (GDS), and Physical Performance Test (PPT).

RESULTS

Correlation analysis and simple linear regression models showed that age, MMSE, GDS, and geographical residence were significantly associated with the functional level, whereas gender was not. In the multiple regression model, MMSE and geographical residence together explained 40% of the variance in functional status; age and GDS did not add to the explanation.

CONCLUSION

Since cognitive function had the strongest association with functional performance to an extent greater than the other variables, adding a treatment regimen that stimulates cognitive function might further enhance functional level or prevent decline of functional status compared with an exercise intervention alone.

Prevalence and Correlates of Functional Disability in Multiethnic Elderly Singaporeans

OBJECTIVES

To make comparative estimates of prevalence of late-life functional disability, examine sociodemographic and health correlates, investigate sex and ethnic differences, and estimate population attributable risk of modifiable risk factors.

DESIGN

Population-based survey.

SETTING

Multiethnic population of Singapore (3 million residents).

PARTICIPANTS

Noninstitutionalized Chinese, Malay, and Indian people aged 60 and older (N=1,079)

MEASUREMENTS

Functional disability was defined as needing help in at least one basic activity of daily living (ADL) task in the 10 items of the Barthel Index. Five basic ADLs (eating, bathing, dressing, transferring, toileting) were used to compare prevalence with those reported from other national surveys and with reported past prevalence within the country.

RESULTS

The prevalence of disability in at least one of five ADL items (6.6% in those aged > or = 65) appeared lower than elsewhere, including China, but higher than reported past prevalence within the country. Functional disability on at least one of the 10 ADL items was independently associated with female sex, Indian ethnicity, older age, poor self-rated health, specific chronic diseases, cognitive impairment, sensory impairment, and living with others. The population attributable risks for leading modifiable factors were arthritis (12%) and cognitive impairment (14%).

CONCLUSION

Lower prevalence of functional disability accompanies rapid aging and health transition in Singapore than in other countries but higher prevalence than reported past prevalence within the country. Associations with sociodemographic and health-related factors were consistent with Western studies, including unexplained sex and ethnic differences.