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

Intervention of computer-assisted cognitive training combined with occupational therapy in people with mild cognitive impairment: a randomized controlled trial

Objective

Investigate the impact of combined computerized cognitive training and occupational therapy on individuals with mild cognitive impairment (MCI).

Methods

We randomly assigned 118 MCI patients into two groups: a combined intervention group (n = 37) and a control group (n = 81), the latter receiving standard nursing care. The intervention group additionally underwent 12 weeks of computerized cognitive training and occupational therapy. Blind assessors evaluated cognitive performance, anxiety, depression, and daily living activities before the intervention, post-intervention, and at a 3-month follow-up.

Results

Repeated-measures analysis of variance showed that the sMoCA scores, HAMA scores, and ADL scores of the experimental group at T2 (post-intervention) and T3 (3-month follow-up) were higher than those of the control group, and the difference was statistically significant (p < 0.001, p < 0.001, p = 0.026).

Conclusion

Computerized cognitive training combined with occupational therapy can improve patients' cognitive status, enhance their compliance with continuing care, and maintain their anxiety and self-care ability at a stable level.

Clinical trial registration

https://www.chictr.org.cn/index.html, identifier ChiCTR2200065014.

A Scoping Review of Personal, Financial, and Environmental Determinants of Mobility Among Older Adults

OBJECTIVE

To synthesize available evidence of factors comprising the personal, financial, and environmental mobility determinants and their association with older adults' self-reported and performance-based mobility outcomes.

DATA SOURCES

PubMed, EMBASE, PsychINFO, Web of Science, AgeLine, Sociological Abstract, Allied and Complementary Medicine Database, and Cumulative Index to Nursing and Allied Health Literature databases search for articles published from January 2000 to December 2021.

STUDY SECTION

Using predefined inclusion and exclusion criteria, multiple reviewers independently screened 27,293 retrieved citations from databases, of which 422 articles underwent full-text screening, and 300 articles were extracted.

DATA EXTRACTION

The 300 articles' information, including study design, sample characteristics including sample size, mean age and sex, factors within each determinant, and their associations with mobility outcomes, were extracted.

DATA SYNTHESIS

Because of the heterogeneity of the reported associations, we followed Barnett et al's study protocol and reported associations between factors and mobility outcomes by analyses rather than by article to account for multiple associations generated in 1 article. Qualitative data were synthesized using content analysis. A total of 300 articles were included with 269 quantitative, 22 qualitative, and 9 mixed-method articles representing personal (n=80), and financial (n=1), environmental (n=98), more than 1 factor (n=121). The 278 quantitative and mixed-method articles reported 1270 analyses; 596 (46.9%) were positively and 220 (17.3%) were negatively associated with mobility outcomes among older adults. Personal (65.2%), financial (64.6%), and environmental factors (62.9%) were associated with mobility outcomes, mainly in the expected direction with few exceptions in environmental factors.

CONCLUSIONS

Gaps exist in understanding the effect of some environmental factors (eg, number and type of street connections) and the role of gender on older adults' walking outcomes. We have provided a comprehensive list of factors with each determinant, allowing the creation of core outcome set for a specific context, population, or other forms of mobility, for example, driving.

Social Support and Unmet Needs for Personal Assistance Among Community-Dwelling U.S. Chinese Older Adults: Does the Source of Support Matter?

This study examines the relationship between social support sources and unmet needs among U.S. Chinese older adults. Data were from the Population Study of Chinese Elderly in Chicago. Unmet needs were assessed by indexes of activities of daily living (ADL) and instrumental activities of daily living (IADL). Three specific sources of social support (spouse, family members, and friends) were included. Multivariable logistic regression models were conducted. Approximately 17% of the 3,157 respondents reported having unmet ADL/IADL needs. U.S. Chinese older adults with less overall social support were more likely to have unmet ADL needs (odds ratio [OR]=0.91, 95% CI=0.83-0.99) and IADL needs (OR=0.84, 95% CI=0.81-0.88). Family and friend support were associated with a lower likelihood of having unmet ADL needs. Support from spouse, family, and friends was associated with a lower likelihood of having unmet IADL needs. The findings highlight the importance of informal social support in addressing unmet needs        .

Effect of Exercise Cognitive Combined Training on Physical Function in Cognitively Healthy Older Adults: A Systematic Review and Meta-Analysis

This study aimed to evaluate the effects of exercise cognitive combined training (ECCT) compared with non-ECCT on physical function in cognitively healthy older adults. Databases were searched for randomized controlled trials from inception to December 2, 2021, and 22 studies (1,091 participants, Mage = 74.90) were included in the meta-review. The Cochrane Risk of Bias and Grading of Recommendations Assessment, Development, and Evaluation tools were used for quality assessments. ECCT improved gait speed (mean difference: 0.06 m/s, 95% CI [confidence interval] [0.02, 0.11]; 446 participants, 11 studies) and balance (standardized mean difference: 0.38, 95% CI [0.14, 0.61]; 292 participants, seven studies). Simultaneous ECCT, but not nonsimultaneous ECCT, improved gait speed (mean difference: 0.11 m/s, 95% CI [0.07, 0.15]), balance (standardized mean difference: 0.40, 95% CI [0.16, 0.64]), and functional mobility (mean difference: -0.85 s, 95% CI [-1.63, -0.07]; 327 participants, nine studies). Future research should focus on the duration and form of ECCT intervention optimal for improving the functional activities of older individuals.

Gender differences in motor and non-motor symptoms in individuals with mild-moderate Parkinson's disease

BACKGROUND

Parkinson's disease (PD) affects both men and women with documented gender differences across functional domains, with findings varying among reports. Knowledge regarding gender differences in PD for different geographic locations is important for further understanding of the disease and for developing personalized gender-specific PD assessment tools and therapies.

OBJECTIVE

This study aimed to examine gender differences in PD-related motor, motor-cognitive, cognitive, and psychosocial function in people with PD from the southern United States (US).

METHODS

199 (127 men and 72 women; M age: 69.08±8.94) individuals with mild-moderate idiopathic PD (Hoehn &Yahr (H&Y) Median = 2, stages I-III) from a large metro area in the southeastern US were included in this retrospective, cross-sectional study. Motor, motor-cognitive, cognitive, and psychosocial data were obtained using standardized and validated clinical tests. Univariate analyses were performed, adjusting for age and housing type.

RESULTS

After adjustment for age, housing, PD duration and fall rate, men exhibited statistically significantly greater motor (Movement Disorders Society (MDS)-Unified Parkinson Disease Rating Scale (UPDRS)-II) and non-motor (MDS-UPDRS-I) impact of PD, and more severe motor signs (MDS-UPDRS-III). Men exhibited worse PD-specific health-related quality of life related to mobility, activities of daily living, emotional well-being, cognitive impairment, communication, and more depressive symptoms. Men performed worse on a subtraction working memory task. Women had slower fast gait speed.

CONCLUSIONS

In the southeastern United States, men may experience worse PD-related quality of life and more depression than women. Many non-motor and motor variables that are not PD specific show no differences between genders in this cohort. These findings can contribute to the development of gender-sensitive assessment and rehabilitation policies and protocols for people with PD.

Indicators and Instruments to Assess Components of Disability in Community-Dwelling Older Adults: A Systematic Review

The epidemiological demands of aging point to the need for characterizing older adults regarding health and disability. This systematic review aims to summarize the indicators (instruments) identifying different components of disability as a result of aging exposition in community-dwelling older adults, considering the International Classification of Functioning, Disability, and Health framework. Taking the PRISMA 2020 recommendations as a reference, studies with community-dwelling older adults, reporting the development and/or age disability modifications were included. Two reviewers analyzed the observational studies searched in the MEDLINE, CINAHL, Web of Science, Scopus, and Embase databases. Of the 137 potentially eligible studies, 49 were included in this review. Several indicators (instruments) demonstrated older adults' disabilities according to the different domains of the ICF. Objective measures assessed Body Structures, Body Functions, and Environmental Factors and included handgrip strength (dynamometry, n = 8), cognitive function (Mini-Mental State examination, n = 7), gait speed (walk test, n = 6), and endurance (Chair stand-test, n = 4). Self-reported measures assessed Activities and Participation, but not the Body Structures, and included the basic and instrumental activities of daily living (ADL) (the Katz Index of ADL, n = 4 studies, the Lawton and Brody Instrumental ADL, n = 4 studies). The summary of the measures gathered can guide researchers and health professionals to select indicators (instruments) to assess and monitor older adults' disabilities resulting from aging exposition, to support the development of new wearables, and to provide improvements to the existing ones, allowing the tailored assessment of different health and disability dimensions.

Depressive Symptoms and ADL/IADL Disabilities Among Older Adults from Low-Income Families in Dalian, Liaoning

Purpose

This study aimed to assess the prevalence of depressive symptoms and ADL/IADL disabilities and explore their correlation and associated factors for depressive symptoms among community-dwelling older adults from low-income families in Dalian, Liaoning Province, China.

Methods

This cross-sectional study included 522 participants aged 60 years and older from low-income families in Dalian. The 30-Item Geriatric Depression Scale was employed to measure depressive symptoms. The Katz ADL Scale and IADL Scale were used to evaluate the performance of activities necessary for independent life. SPSS 22.0 was employed to analyze the data. Logistic regression was used to estimate the relationship between depressive symptoms and ADL/IADL disabilities in five models.

Results

The prevalence of depressive symptoms among older people from low-income families in Dalian was 57.3%. A total of 19.0% had difficulties performing ADLs, and 40.2% had difficulties performing IADLs. Logistic regression analysis revealed that ADL/IADL disabilities were associated with depressive symptoms even after controlling for people’s sociodemographic characteristics, welfare, health conditions and informal care. The following factors were associated with depressive symptoms: education, self-reported health, number of chronic diseases, and emotional support from families.

Conclusion

Given that older people from low-income families in Dalian have a notable prevalence rate of depressive symptoms, and ADL/IADL disabilities were independently associated with these symptoms, it is crucial to give priority to this particular group in geriatric health services due to economic and health disparities.

Caregiving and Care Receiving Experiences Among Older Chinese Immigrants and Their Home Health Aide

INTRODUCTION

There is limited information about how racial and cultural similarities or differences between patient and caregiver may affect quality care. The purpose of this study was to explore caregiving and receiving experiences among older Chinese immigrants and their home health aides by using in-depth interviews in culturally concordant dyads in a community setting.

METHODOLOGY

A purposive sample of 10 dyads of older Chinese immigrants and their home health aides were recruited using a snowball sampling method (N = 20). All interviews were audio recorded, transcribed, and coded for qualitative content analysis.

RESULTS

The majority of older adults were female (n = 8) and their average age was 76.8 years. The following themes emerged: companionship and rapport, reconciling the need for care services with the expectations of family, the value of matched gender, language, and ethnic foodculture, assisting with daily routines, and experiencing caregiving burden due to a dual role.

DISCUSSION

This study elucidated the dynamics between care recipients and their caregivers with shared cultural backgrounds.

Understanding Racial/Ethnic Disparities in Physical Performance in Midlife Women: Findings From SWAN (Study of Women's Health Across the Nation)

OBJECTIVES

Evaluate degree to which racial/ethnic differences in physical performance are mediated by sociodemographic, health, behavioral, and psychosocial factors.

METHODS

Physical performance was evaluated using a decile score derived from grip strength, timed 4 m walk, and timed repeat chair stand in 1,855 African American, Caucasian, Chinese, Hispanic, and Japanese women, mean age = 61.8 (SD = 2.7) in the Study of Women's Health Across the Nation. Mediators included education, financial strain, comorbidities, pain, body mass index (BMI), physical activity, and perceived stress. Structural equation models provided estimates of the total difference in physical performance between Caucasians and each race/ethnic groups and differences due to direct effects of race/ethnicity and indirect effects through mediators.

RESULTS

The mean decile score for Caucasian women was 16.9 (SD = 5.6), 1.8, 2.6, and 2.1 points higher than the model-estimated scores in African Americans, Hispanics and Chinese, respectively, and 1.3 points lower than the Japanese. Differences between Caucasians and the Chinese and Japanese were direct effects of race/ethnicity whereas in African Americans and Hispanics 75% or more of that disparity was through mediators, particularly education, financial strain, BMI, physical activity, and pain.

DISCUSSION

Addressing issues of poverty, racial inequality, pain, and obesity could reduce some racial/ethnic disparity in functional limitations as women age.

Predementia constructs: Mild cognitive impairment or mild neurocognitive disorder? A narrative review

BACKGROUND

Predementia is a heuristic umbrella concept to classify older adults with cognitive impairment who do not suffer dementia. Many diagnostic entities have been proposed to address this concept, but most of them have not had widespread acceptance.

AIMS

To review clinical definitions, epidemiologic data (prevalence, incidence) and rate of conversion to dementia of the main predementia constructs, with special interest in the two most frequently used: mild cognitive impairment (MCI) and minor neurocognitive disorder (miNCD).

METHODS

We have selected in three databases (MEDLINE, Web of Science and Google scholar) the references from inception to 31 December 2019 of relevant reviews, population and community-based surveys, and clinical series with >500 participants and >3 years follow-up as the best source of evidence.

MAIN RESULTS

The history of predementia constructs shows that MCI is the most referred entity. It is widely recognized as a clinical syndrome harbinger of dementia of several etiologies, mainly MCI due to Alzheimer's disease. The operational definition of MCI has shortcomings: vagueness of its requirement of "preserved independence in functional abilities" and others. The recent miNCD construct presents analogous difficulties. Current data indicate that it is a stricter predementia condition, with lower prevalence than MCI, less sensitivity to cognitive decline and, possibly, higher conversion rate to dementia.

CONCLUSIONS

MCI is a widely employed research and clinical entity. Preliminary data indicate that the clinical use of miNCD instead of MCI requires more scientific evidence. Both approaches have common limitations that need to be addressed.

Association between physical function and perceived stress among U.S. Chinese older adults

Objectives

Physical function impairment can cause great stress to older adults. The purpose of the study is to investigate the association between self-reported and directly-observed physical function on perceived stress among U.S. Chinese older adults.

Methods

Data were from the Population Study of Chinese Elderly in Chicago (PINE) of 3,157 Chinese older adults who were 60 and above in the Greater Chicago Area. Self-reported and directly-observed physical function measures, and Perceived Stress Scale were used.

Results

Participants had a mean age of 72.8 ± 8.3 years old (range 60–105). Higher scores of Katz activities of daily living impairments (odds ratio [OR]=1.77), Lawton instrumental activities of daily living impartments (OR=1.10, p<0.01), Rosow–Breslau index of mobility scale (OR=1.39, p<0.05), and Nagi index of basic physical activities scale (OR=1.19, p<0.001) were associated with higher levels of perceived stress. In addition, higher scores of directly-observed physical function measurements, including chair stand (OR=0.93), tandem stand (OR=0.71, p<0.05), timed walk (OR=0.73, p<0.001), and the overall measurement (OR= 0.87, p<0.01) were associated with lower level of perceived stress.

Discussion

Findings suggested that poor physical function was associated with perceived stress among U.S. Chinese older adults. Longitudinal studies are needed to obtain a more comprehensive understanding of the pathways between physical function and perceived stress.

Implications for practice

Health care professionals could provide personalized physical activity interventions to encourage older adults to engage in regular exercise in order to maintain and promote older adults’ physical function and psychological well-being.

The mediating effect of pain on the association between multimorbidity and disability and impaired physical performance among community-dwelling older adults in southern China

AIM

To investigate the association between multimorbidity and disability and impaired physical performance, and to further evaluate the mediating effect of physical pain in this association.

METHODS

1321 community-dwelling older adults, who were over 60 years old in southern China, were regarded as participants in this cross-sectional study. Subjects completed a multi-instrument questionnaire including essential characteristics and physical function assessments. Physical function was assessed by activities of daily living (ADL), instrumental activities of daily living (IADL), index of mobility scale (NAGI), index of basic physical activities scale (RB), and short physical performance battery (SPPB). Multimorbidity was defined as the simultaneous presence of two or more chronic conditions. Multivariable regression and mediation analyses were conducted and gender differences were explored.

RESULTS

The prevalence of multimorbidity was 44.6% in our study. In gender stratification analysis, multimorbidity was significantly associated with ADL disability (OR = 2.16), IADL disability (OR = 1.97), NAGI disability (OR = 2.84), RB disability (OR = 2.65) and lower SPPB score (β = - 0.83) in women. The rate of pain increased with the number of chronic diseases and the multimorbidity patients with higher pain prevalence. Moreover, the presence of pain was also significantly associated with disability and impaired physical performance. Mediation analysis illustrated that pain was accounted for 16.5% to 22.1% of the adverse effects of multimorbidity on disability and impaired physical performance in women.

CONCLUSIONS

Multimorbidity was significantly associated with disability and impaired physical performance, and pain might be a mediating factor for adverse effects of multimorbidity on disability and impaired physical performance in women.

Cross-cultural adaptation and validation of the Groningen Frailty Indicator in Chinese nursing home residents

BACKGROUND

Frail older people are more likely to develop negative health outcomes. Previous studies have indicated that the Groningen Frailty Indicator is a practical frailty screening instrument with good psychometric properties; however, it has never been implemented in Chinese nursing homes.

AIMS

To cross-culturally adapt and validate the Groningen Frailty Indicator in Chinese nursing home residents.

METHODS

The participants were 192 residents from nursing homes. Reliability was analyzed by internal consistency and test-retest methods. Convergent validity was assessed using Spearman rank correlations between the GFI domains and activities of daily living, the mini nutritional assessment, the Mini-mental state examination, the Social Support Rating Scale, the 20-item Epidemiologic Studies Depression Scale and the Short Form 36 mental component summary. Criterion validity was investigated by performing a receiver operating characteristics curve analysis.

RESULTS

The Chinese GFI achieved semantic, idiomatic, and experiential equivalence. It had a high response rate among nursing home elders. It also showed good internal consistency (ICC = 0.712) and excellent test-retest reliability. Regarding construct validity, it presented good known-group divergent validity based on age. The correlations between the GFI domains and their corresponding measures were consistent as hypothesized, demonstrating convergent validity of the GFI. Using the Fried frailty phenotypes as reference criteria, the Chinese GFI showed satisfactory diagnostic accuracy for frailty (AUC = 0.823) and prefrailty (AUC = 0.791). The optimal cutoff point was 4 for frailty and 3 for prefrailty.

CONCLUSIONS

The GFI was successfully adapted for Chinese nursing home residents and presented acceptable validity and reliability.

Analyzing functional status and its correlates in Chinese centenarians: A cross-sectional study

Factors affecting independence in basic and instrumental activities of daily living have been established in older adults, but not centenarians. The purpose of this study was to examine the state and factors affecting activities of daily living independence in centenarians who resided in Guangxi Province, China. A cross-sectional design was used. Activities of daily living, physical activity, mobility, and physical performance were measured by the Population Study of ChINese Elderly study instruments, and demographics and cognition were assessed. Of the 228 participants, 57% were independent in basic activities of daily living and 5.7% in instrumental activities of daily living. Stepwise regression showed physical activity, cognition, calf circumference, and self-reported health were associated with basic activities of daily living. Physical activity, mobility, cognition, and physical performance were correlated with instrumental activities of daily living. In conclusion, the Chinese centenarians showed impaired instrumental activities of daily living but mostly maintained basic functioning. Physical activity and cognition were associated with activities of daily living independence.

Cross-cultural adaptation and validation of the FRAIL-NH scale for Chinese nursing home residents: A methodological and cross-sectional study

BACKGROUND

Frailty is a common condition in older adults, and has a particularly high prevalence among nursing home residents. Therefore, it is essential to assess frailty in nursing homes. The FRAIL-NH scale is a brief, quick-to-complete, and user-friendly measurement tool. However, it has not been used in China, and further cross-cultural adaptation and validation need to be undertaken.

OBJECTIVES

To cross-culturally adapt and validate the FRAIL-NH scale for Chinese nursing home residents.

DESIGN

Methodological and cross-sectional study.

SETTING

Twenty-seven nursing homes in Jinan, China.

PARTICIPANTS

Older Chinese nursing home residents (n = 353, age ≥60 years, 197 women; 156 men).

METHODS

Interviewers obtained data on frailty, demographics, comorbidity, physical function, nutritional status, and self-rated health. The Chinese FRAIL-NH scale version was generated using the translation-backward translation method. Psychometric properties, including internal consistency, test-retest reliability, convergent validity, criterion validity, and diagnosis accuracy were evaluated.

RESULTS

The FRAIL-NH scale showed acceptable internal consistency (Cronbach's alpha: 0.67) and satisfactory test-retest reliability within a 1- to 2-week interval (intraclass correlation coefficient: 0.84). As expected, the FRAIL-NH scale was correlated to the validated measurements, presenting convergent validity. Using the frailty phenotype as a reference criterion, the area under the curve was 0.79. The optimal cutoff point for frailty was 2 (sensitivity: 69.90% and 77.33%) in Chinese nursing homes. The FRAIL-NH scale was significantly associated with the frailty phenotype (correlation coefficient = 0.61, P < 0.001), but showed fair agreement with it (kappa = 0.46, p < 0.001).

CONCLUSIONS

The FRAIL-NH scale was found to be suitable for frailty measurement with acceptable validity and reliability, and the optimal cutoff point for frailty was 2. The FRAIL-NH scale can be applied in Chinese nursing homes.

Correlates of Emergency Department Service Utilization Among U.S. Chinese Older Adults

Older adults visit emergency departments (EDs) at a disproportionally higher rate than other age groups. Prior studies examining racial disparities in ED utilization focus on African Americans and Hispanics. There is a dearth of information on ED utilization patterns among older Asian Americans despite the evidence that ED expenditures in Asian Americans are comparable to that of Caucasians. To address this knowledge gap, we examined factors associated with ED service utilization in the largest Asian subgroup, U.S. Chinese older adults. Cross-sectional data from the Population Study of Chinese Elderly in Chicago (PINE) (N = 3,157) were used. Multivariate negative binomial regression analyses were conducted to examine significant factors associated with ED use. Higher education (rate ratio [RR] = 1.03, 95% confidence interval [CI] 1.00-1.05) and acculturation levels (RR = 1.02, CI 1.00-1.04), fewer people in the household (RR = 0.94, CI 0.88-0.99), health insurance coverage (RR = 1.34, CI 1.01-1.78), lower income (RR = 0.89, CI 0.80-0.99), poorer perceived health (RR = 0.67, CI 0.58-0.77), more functional limitations (RR = 1.09, CI 1.06-1.13) and depressive symptoms (RR = 1.04, CI 1.02-1.07), and a history of heart disease (RR = 2.28, CI 1.83-2.84), stroke (RR = 1.68, CI 1.20-2.35), cancer (RR = 1.86, CI 1.31-2.63), and hip fracture (RR = 1.42, CI 1.02-1.98) were associated with higher rates of ED visits. Our findings highlight several significant correlates of ED use in U.S. Chinese older adults. Culturally-appropriate interventions modifying these factors have the potential to decrease ED visits and improve care outcomes in this population.

Depressive Symptoms and Onset of Functional Disability Over 2 Years: A Prospective Cohort Study

OBJECTIVES

This prospective cohort study examined the relationship between depressive symptoms and onset of functional disability over 2 years among US Chinese older adults, a rapidly growing minority older adult population.

DESIGN AND SETTING

This study used survey data from 2713 Chinese older adults who completed both baseline (2011-2013) and follow-up (2013-2015) interviews of the Population Study of Chinese Elderly in Chicago. Depressive symptoms were assessed at baseline by the nine-item Patient Health Questionnaire. Functional disability was measured by three validated scales, Katz Index of Independence in Activities of Daily Living (ADLs), the Lawton Instrumental Activities of Daily Living (IADLs) scale, and the Rosow and Breslau mobility scale. Multivariate logistic regression was conducted to examine the relationship between baseline depressive symptoms and the development of functional disability (ADLs, IADLs, mobility) at 2-year follow-up while adjusting for covariates.

RESULTS

Of the 2713 participants, 5.2% experienced ADL disability onset, 35.6% experienced IADL disability onset, and 23.3% experienced mobility disability onset over 2 years. After adjusting for covariates, the odds of ADL disability onset (odds ratio [OR] = 1.06; 95% confidence interval [CI] = 1.02-1.11), IADL disability onset (OR = 1.05; 95% CI = 1.01-1.09), and mobility disability onset (OR = 1.05; 95% CI = 1.01-1.09) were consistently higher in US Chinese older adults with higher levels of depressive symptoms than their less-depressed counterparts. Other significant risk factors included older age and more chronic physical conditions.

CONCLUSION

Study findings underscore a significant relationship between depressive symptoms and onset of functional disability. Screening and, subsequently, treating depressive symptoms have the potential to reduce disability among US Chinese older adults. Culturally relevant depressive symptom screening may help identify Chinese older adults who are at greater risks for the development of functional disability. J Am Geriatr Soc 67:S538-S544, 2019.

Years of life with and without limitation in physical function and in activities of daily living by body mass index among older adults

BACKGROUND

While older adults with pre-obesity and Class I obesity have similar or lower mortality risk versus those with normal weight, a heavier body mass index (BMI) may not translate into more healthy life years. Utilizing longitudinal data on 3452 older (≥60 years) Singaporeans, we assessed the association between BMI and years of remaining life overall with and without limitation in physical function and in activities of daily living (ADLs).

METHODS

Difficulty in any of nine tasks involving upper or lower extremities was considered as limitation in physical function, and health-related difficulty in any basic ADL or instrumental ADL as limitation in ADLs. We utilized multistate life tables, including BMI as a time-varying covariate.

RESULTS

At age 60, life expectancy (LE) was similar for those with normal weight, pre-obesity and obesity. However, those with obesity, versus normal weight, had 6.3 [95% confidence interval: 3.4-9.2] more years with limitation in physical function and 4.9 [3.4-6.5] less years without limitation in physical function. Those with pre-obesity, versus normal weight, also had 3.7 [1.9-5.3] more years with limitation in physical function. The same pattern across BMI categories was observed for years of life with and without limitation in ADLs. In stratified analyses, similar associations of BMI with years of life with and without limitation in physical function and in ADLs were observed across gender, ethnicity, and educational status.

CONCLUSIONS

The increasing global prevalence of obesity may result in an increase in years of life with limitation in physical function and in ADLs at older ages. Older adults, their families and healthcare systems should be cognizant of this issue.

Influence of functional, psychological, and environmental factors on falls among community-dwelling older adults in Hong Kong

AIM

The growth of the ageing population has been rapid. However, this ageing population is not homogeneous; individuals have different levels of functionality and psychosocial status, and some are members of at-risk or high-risk groups. As such, studies on the functional, psychological, and environmental factors of falls among community-dwelling older adults are imperative. By investigating the effect of life satisfaction, as well as environmental and functional factors, on falls among community-dwelling older adults in Hong Kong, this study aims to address this concern.

METHODS

The study recruited 249 participants. Both self-reported questionnaires and home safety assessments were administrated.

RESULTS

Logistic regression analysis showed that life satisfaction and instrumental activities of daily living were significant predictors of falls. Significant differences between fallers and non-fallers were found in functional and psychological areas. The presence of home hazards was low and not associated with falls in this population. However, this variable was negatively associated with life satisfaction and predicted by one of its domains, satisfaction of possession.

CONCLUSION

These results can help health-care and social service providers to identify the needs and types of support required for effective fall prevention and to better tailor and target community intervention for older adults.

Health Services Utilization Among Chinese American Older Adults: Moderation of Social Support With Functional Limitation

In this study, we aimed to examine the relationship of social support with hospitalizations and emergency department (ED) visits among older Chinese adults in the United States and its possible mechanism. This was a secondary analysis of data from the Population Study of Chinese Elderly (July 2011-June 2013; N = 3,157). After adjusting for demographic, clinical, and functional covariates in logistic regression analyses, significant interaction between social support from spouse and the number of functional limitations in (instrumental) activities of daily living was related to lower odds of hospitalization (odds ratio [OR] = 0.97 [0.95-0.99]) and ED visits (OR = 0.98 [0.96-0.99]). This finding suggests that among older Chinese American adults with functional limitations, more spousal support was related to lower odds of hospitalizations and ED visits. Future studies should comprehensively measure social support (e.g., content, amount) from other sources and investigate how unnecessary acute health service utilization in this population may be reduced by social support interventions.

Social Support, Social Strain, and Cognitive Function Among Community-Dwelling U.S. Chinese Older Adults

Background

Limited research is available on the relationship between social support, social strain, and cognitive function among community-dwelling U.S. Chinese older adults. This study aims to examine the associations between social support/strain and cognitive outcomes.

Methods

Data were drawn from the Population-Based Study of Chinese Elderly (N = 3,159). Cognitive function was measured by a battery of tests including the East Boston Memory Test, the Digit Span Backwards assessment, and the Symbol Digit Modalities Test. Social support and strain were measured by the scales drawn from the Health and Retirement study. Multiple regression analyses were conducted.

Results

Social support was significantly associated with global cognitive function (β = .11, SE = .02, p < .001), episodic memory (β = .11, SE = .03, p < .001), working memory (β = .18, SE = .08, p < .05), and executive function (β = 1.44, SE = .37, p < .001). Social strain was significantly associated with global cognitive function (β = .23, SE = .05, p < .001), episodic memory (β = .27, SE = .07, p < .001), working memory (β = .34, SE = .17, p < .05), and executive function (β = 2.75, SE = .85, p < .01). In terms of sources of social support/strain, higher support from friends was significantly associated with higher global cognitive function (β = .04, SE = .02, p < .05), higher episodic memory (β = .05, SE = .02, p < .05), and higher executive function (β = .71, SE = .29, p < .05). Higher strain from spouse was significantly associated with higher global cognitive function (β = .10, SE = .03, p < .01), higher episodic memory (β = .11, SE = .04, p < .01), and higher executive function (β = 1.28, SE = .49, p < .01). Higher strain from friends was significantly associated with higher executive function (β = 3.59, SE = 1.17, p < .01).

Conclusions

Social support and strain were associated with cognitive outcomes. Future longitudinal studies should be conducted.

The Associations and Correlations Between Self-reported Health and Neighborhood Cohesion and Disorder in a Community-dwelling U.S. Chinese Population

Purpose of the Study

Characteristics of neighborhood have been found to be associated with physical and psychological health status of older adults, especially in relationship to social dynamics like cohesion and disorder. This study aims to examine correlations and associations between sociodemographic characteristics, self-reported health status, cohesion, and disorder among Chinese older adults in the greater Chicago area.

Design and Methods

The Population Study of Chinese Elderly in Chicago is a cross-sectional, population-based study with community-dwelling Chinese older adults aged 60 and older, recruited through a community-based participatory research approach. Cohesion was measured through six questions; disorder was measured through eight questions. Correlation and regression analyses were conducted using SAS.

Results

Among 3,158 participants enrolled in the study, 92.3% reported any neighborhood cohesion; 69.8% reported any neighborhood disorder. After controlling for age, sex, education, income, marital status, living arrangement, number of children, years in the community, years in the United States, country of origin, language preference, and location, a higher level of cohesion is associated with higher quality of life (odds ratio [OR]: 1.25, 95% confidence interval [CI]: 1.13, 1.39) and a higher level of disorder is associated with lower overall health status (OR: 0.97, 95% CI: 0.95, 0.99) and lower quality of life (OR: 0.96, 95% CI: 0.95, 0.98).

Implications

Our findings suggest that neighborhood cohesion and neighborhood disorder are correlated to the health of U.S. Chinese older adults. Future longitudinal research should examine the relationship between community characteristics, both structural and social, and health-related outcomes.

Patterns of instrumental activities of daily living and association with predictors among community-dwelling older women: A latent class analysis

BACKGROUND

The purpose of this study was to classify patterns of instrumental activities of daily living (IADL) among community-dwelling older women, to examine difference in characteristics among the classes, and to explore predictors of class membership.

METHODS

This study was a secondary analysis of nationwide data from the 2014 Actual Living Condition of the Elderly and Welfare Need Survey. A total of 10,451 individuals aged 65 years or older were interviewed for the 2014 dataset, but we only selected the female participants (n = 6095) for this study. For statistical analyses, latent class analysis was applied to identify different latent classes of IADL and then the effects of predictors on IADL patterns were analyzed by using multinomial logistic regression.

RESULTS

The 5-class model was the best fit for the data. The size of class 1was the biggest (n = 5093, 83.6%), followed by class 5 (n = 401, 6.6%), class 3 (n = 308, 5.1%), class 2 (n = 181, 3.0%), and class 4 (n = 113, 1.8%). The largest class had total independency on all items of IADL. In the multinomial regression, members in the classes 2, 3, 4 and 5 were significantly more likely to have older age and decreased cognitive status compared with the class of total independency on all items of IADL (class1).

CONCLUSIONS

The predictors of the classes identified in this study can be used for tailored and targeted interventions to increased old adults' independency on IADL.

Effect of Yang-Style Tai Chi on Gait Parameters and Musculoskeletal Flexibility in Healthy Chinese Older Women

The purpose of the present study was to examine the effect of Yang-style Tai chi (TC) on gait parameters and musculoskeletal flexibility in healthy Chinese female adults. Sixty-six female adults aged >65 years were randomly assigned to either an experimental group (67.9 ± 3.2 years of age) receiving three 90-min simplified 24-form TC sessions for eight weeks, or a control group (67.4 ± 2.9 years of age) who maintained their daily lifestyles. All study participants were instructed to perform a selected pace walking for recording gait parameters (stride length, gait speed, swing cycle time, stance phase, and double support times) at both baseline and after the experiment. Low-limb flexibility and range of motion at specific musculoskeletal regions (hip flexion, hip extension, and plantar flexion, as well as anterior and lateral pelvic tilts, pelvic rotation, and joint range of motion (hip, knee, and ankle)) were also assessed in the present study. Multiple separate 2 × 2 Factorial Analysis of Variance (ANOVA) with repeated measures were used to examine the effects of TC on the abovementioned outcomes between baseline and posttest in the two groups. When compared to those in the control group, older female adults who experienced the 8-week Tai chi intervention demonstrated significant improvements in most of the outcome measures. More specifically, positive changes in the TC group were found, including gait parameter (p < 0.001 for all; stride length (1.12 to 1.24, +8.6%), gait speed (1.06 to 1.21, +13.9%), stance phase (66.3 to 61.8, −5.5%), swing phase (33.7 to 38.4, +10.1%), double support time (0.33 to 0.26, −21.1%)), flexibility-related outcomes (hip flexion (90.0 to 91.9, 22.6%, p < 0.0001), single hip flexor (6.0 to 2.0, −61.5%, p = 0.0386), and plantar flexion (41.6 to 49.7, +17.5%, p < 0.0001)), and range of motion (anterior pelvic tilt (9.5 to 6.2, −34.7%, p < 0.0001), lateral pelvic tilt (6.6 to 8.3, +23.8%, p = 0.0102), pelvic rotation (10.3 to 14.7, 28.2%, p < 0.0001), hip range of motion (29.8 to 32.9, +13.5%, p = 0.001), and ankle range of motion (28.0 to 32.6, +11.1%, p < 0.0001)). The present study supports the notion that the practice of TC has a positive effect on healthy older female adults in improving gait parameters and flexibility, counteracting the normal functional degeneration due to age.

The Decline of Directly Observed Physical Function Performance Among U.S. Chinese Older Adults

BACKGROUND

Physical function decline is a major public health concern and can predict later mortality. This study aims to examine the sociodemographic factors associated with physical function decline among U.S. Chinese older adults through a longitudinal population-based study.

METHODS

Data were derived from the Population Study of Chinese Elderly (PINE) at two time points: 2011-2013 and 2013-2015. Physical function was measured by observed physical performance testing, including chair stand, tandem stand, and timed walk. Mixed-effect models were used to analyze the demographic risk factors associated with physical function decline.

RESULTS

Of the 2,713 participants in waves 1 and 2, their average age was 72.6 years old, 58.4% were female, with 8.7 years of education average, and 85.8% had an annual individual income of less than $10,000. Our findings show subjects of older age, female sex, lower education, lower income, and a greater number of medical comorbidities had lower physical function levels at baseline. Older adults experienced a faster decline in physical function for the overall performance measure (β = -.02, p < .001). Additionally, elderly adults with higher education have a faster decline of physical function in the overall performance measure (β = -.03, p < .01).

DISCUSSION

As the first to examine physical function decline among U.S. Chinese older adults, our study finds older age and higher education are two factors associated with a faster rate of physical function decline. In future research, long-term follow up and multiple waves of data are needed to investigate risk or resilience factors for disability or recovering from disability.

Cross-Sectional and Longitudinal Association Between Trust in Physician and Depressive Symptoms Among U.S. Community-Dwelling Chinese Older Adults

BACKGROUND

Depression is a major public health concern among older adults and health care professionals play a vital role in screening and treatment. However, this process may be impeded by issues like lack of trust in physician (TIP). This study aims to examine the cross-sectional and longitudinal relationships between TIP and depressive symptoms among Chinese older adults in the Chicago area.

METHODS

Data were collected through the Population Study of Chinese Elderly (PINE), a longitudinal cohort study of Chinese older adults in the greater Chicago area. A total of 2,713 Chinese older adults completed both waves of data collection. TIP was measured through the Trust in Physician scale from Anderson and Dedrick (Anderson LA, Dedrick RF. Development of the Trust in Physician scale: a measure to assess interpersonal trust in patient-physician relationships. Psychol Rep. 1990;67(3 Pt 2):1091-1100. doi:10.2466/pr0.1990.67.3f.1091) (range: 11-55). Depressive symptoms were measured through Patient Health Questionnaire-9.

RESULTS

Every one point higher in TIP is associated with being 2% less likely to have any depressive symptoms (odds ratio [OR] 0.98, 0.97-0.99) in cross-sectional analysis. Longitudinally, every one-point increase in TIP score was associated with a 2% lower risk of depressive symptoms at Wave 2 (OR 0.98, 0.97-0.99). Improved TIP over 2 years was associated with 25% decreased risk of having any depressive symptoms at Wave 2 (OR 0.75, 0.63-0.89). Additionally, highest tertile of TIP change was associated with a 31% decreased risk of any depressive symptoms compared to lowest tertile (OR 0.68, 0.55-0.84).

DISCUSSION

Improved TIP over 2 years is associated with less risk of experiencing depressive symptoms. Future research should examine possible pathways and routes of intervention to improve mental health among older adults.

The Association between Filial Piety and Perceived Stress among Chinese Older Adults in Greater Chicago Area

BACKGROUND

Perceived stress influences the health and well-being of older adults. This study aims to examine the association between the expectation and the receipt of filial piety and perceived stress among U.S Chinese older adults.

METHODS

Data were drawn from the PINE study, a population-based study of Chinese older adults aged 60 and above in the greater Chicago area. Perceived stress was assessed by the PSS-10 and was the dependent variable. Independent variables were the expectation and the receipt of filial piety examined in six domains. Negative Binomial Regression and Multivariable Logistic Regression analyses were conducted.

RESULTS

Of the 3,159 Chinese older adults interviewed, the mean age was 72.8 (SD=8.3) and 58.9% were female. Compared with older adults who received a high level of filial piety, older adults who received a medium level of filial piety were 1.57 (1.29-1.93) times more likely to perceive stress as high, and older adults who received a low level of filial piety were 2.74 (2.26-3.33) times more likely to perceive stress as high, after controlling for the potential confounding variables. The expectation of filial piety was not significantly associated with perceived stress.

CONCLUSION

A low level of filial piety receipt may be a risk factor for perceived stress. Our findings suggest incorporating cultural contributors into the analyses of perceived stress.

Religiosity among U.S Chinese Older Adults in Greater Chicago Area-Findings from the PINE Study

BACKGROUND

Religiosity influences health and well-being. We assessed religiosity among U.S. Chinese older adults.

METHODS

Data were drawn from the PINE study based on 3,159 community-dwelling U.S. Chinese older adults aged 60+ in the greater Chicago area. Two items retrieved from Duke University Religion Index (DUREL) were used to assess the frequency of participating in religious activities, and a separate item was used to assess the importance of religion.

RESULTS

Overall, 35.4% of participants perceived religion to be important. This study correlated the higher frequency of participation in religious observances with older age groups of the sample, being female, having a higher income, being unmarried, longer duration of residency in the U.S., and not having been born in Mainland China. Higher frequency of participating in organized religious services was correlated with better quality of life.

CONCLUSIONS

Religion is important among U.S Chinese older adults. Future longitudinal research is needed to explore aging and religiosity.