Psychosocial influences in onset and progression of late life disability

Effect of eating alone and depression symptoms on incident disability among community-dwelling older adults

OBJECTIVES

The intent of the present study was to elucidate the association of eating alone and depressive symptoms with the development of disability among community-dwelling older adults, using a longitudinal study.

METHOD

Participants included 4648 Japanese older adults (mean age 73.8 ± 5.4 years; 44.3% men) aged ≥ 65 years at the time of the examination. Eating status was divided into two categories: "Eating with others at least once a day" and "Other." The 15-item Geriatric Depression Scale was used to measure depressive symptoms. Incident disability was certified by long-term care insurance (median duration: 36 months).

RESULTS

During a median follow-up at 36 months, 8.0% of the participants developed an incident disability. Adjusted for covariates, the participants who ate alone were associated with a higher hazard ratio of incident disability compared to those who ate with others (hazard ratio: 1.36, 95% confidence interval: 1.05-1.75). However, adjusted for the covariate depressive symptoms, eating alone was not significantly associated with incident disability. Structural equation models revealed that the indirect model confirmed eating alone habits were associated with disability via depressive symptoms.

CONCLUSIONS

This study confirmed that eating alone was associated with an incident disability after adjusting for the covariates. Furthermore, the present study suggests an indirect relationship between eating alone and incident disability via depressive symptoms, the result of the structural equation model.

Network Types and Functional Health in Old Age: It is Not Just the Size of the Network That Matters

OBJECTIVES

Findings on the effect of network size and support on functional health are mixed. We examine whether network types, that simultaneously incorporate multiple network characteristics, are associated with functional health in late life.

METHODS

Data are from the National Social Life, Health, and Aging Project (N = 3005). We estimated the longitudinal effect of membership in five multidimensional network types on disability in six activities of daily living using negative binomial regression, and on mobility (assessed using a timed walk test) using a generalized linear mixed model.

RESULTS

Compared to those in the large without strain network, older adults in the small, restricted, high contact network had fewer disabilities but worse mobility, while those in the large network with strain also had worse mobility.

DISCUSSION

Care plans focusing on function and mobility should consider multiple aspects of older adults' social networks including network size, diversity, and relationship strain.

Social Frailty and Functional Status in Japanese Older Adults: The Mediating Role of Subjective Cognitive Function

OBJECTIVE

This study aimed to explore the direct and indirect effects of social frailty on functional state trajectories mediated by subjective cognitive function in older adults.

DESIGN

Longitudinal study.

SETTING AND PARTICIPANTS

Overall, 514 adults aged ≥65 years living in a suburban area of central Japan were included in this study.

METHODS

Five-item social frailty index (going out, visiting, feeling helpful, living alone, and talking to others), subjective cognitive function from the Kihon Checklist, and instrumental activities of daily living disability. Latent growth curve models were applied to examine the longitudinal relations among the variables.

RESULTS

During the 6-year follow-up in latent growth curve models, the initial level of social frailty in older adults was negatively associated with that of functional status (β = -0.53, P < .001), and the rate of change in social frailty was negatively associated with that in functional status (β = -0.78, P < .001). In the mediation model, the indirect effect from the social frailty level to functional status level through subjective cognitive function level was significant (β = -0.14, 95% CI -0.29, -0.09); the rates of change in subjective cognitive function mediated the relationship between those in social frailty and functional status (β = -0.35, 95% CI -0.46, -0.25).

CONCLUSIONS AND IMPLICATIONS

This study found that there is an association between social frailty and functional status in Japanese older adults. Subjective cognitive function mediated this relationship. Hence, additional research is required to investigate additional potential factors linking social frailty and functional status in order to gain a better understanding of the underlying mechanisms.

Relationship between unmet needs for assistance and healthy aging among disabled older adults in China

Background

Although there is a growing consensus around the world that long-term care services and supports are important to help the aged population with disabilities achieve healthy aging, a misallocation of care resources and inefficiency in care delivery still exist in China. The absence or inadequate provision of long-term care services and supports among older adults with disabilities results in a range of adverse health consequences. However, the negative influence of unmet needs for assistance on healthy aging, based on functional perspectives including physiological, psychological, and societal domains, has been underestimated. This study aimed to measure healthy aging based on a person-centered approach and examine the relationship between unmet needs for assistance and healthy aging among older adults with disabilities in China.

Methods

Based on the data from the Chinese Longitudinal Healthy Longevity Survey 2018, we used the latent profile analysis with three indicators to uncover distinctive types of older adults experiencing distinct levels of healthy aging, and applied the ordered logit regression to analyze the correlation between unmet needs for assistance and different levels of healthy aging. To further address the endogeneity bias, the robust test was conducted by the two-stage least-squares instrumental variable estimation and the conditional mixed process instrumental variable estimation.

Results

Three ordered latent classes were identified: a low level of healthy aging (42.83%), a middle level of healthy aging (47.27%), and a high level of healthy aging (9.90%). Disabled older adults with unmet needs had a lower probability of achieving the higher level of healthy aging (OR = 0.57, SE = 0.04, CI = 0.48-0.66, p < 0.001).

Conclusions

This study highlights the need to increase awareness among gerontological practitioners with respect to long-term care services and supports for disabled older adults as a potential for enhancing their healthy aging, and that unmet needs could be a basis for risk assessment and a means for determining the efficacy of long-term care interventions on maintaining health.

A longitudinal study shows stress proliferation effects from early childhood adversity and recent stress on risk for depressive symptoms among older adults

Objectives: We evaluated whether the effects of recent stressful life events (SLEs) and early childhood adversities (ECAs) on depressive symptoms are consistent between men and women and across older age, and whether there was evidence for the following: stress sensitization, whereby the psychological impact of SLEs is greater for individuals with ECAs compared with those without; or stress proliferation effect, whereby those with ECAs are more likely to report more SLEs than those without ECAs to effect depressive symptoms.Method: ECAs, SLEs in the past two years, and current depressive symptoms through a modified CES-D were obtained from 11,873 individuals participating in a population representative study of older adults, yielding 82,764 observations. Mixed-effects regression models on depressive symptoms were constructed to control for multiple observations per participant and evaluate within-person effects over time, thereby reducing bias from reverse causation.Results: Results suggest a stress proliferation effect and do not support stress sensitization. ECAs contribute to vulnerability for depressive symptoms, with a dosage effect for each additional ECA. Recent SLEs result in greater depressive symptom risk, with stable effects over age and dosage effects for each additional SLE that were smaller than the effects of ECAs among men, but not women. Belonging to an ethnic minority group, having less education, and less household income at baseline were associated with greater depressive symptom risk.Conclusions: Findings suggest the importance of addressing early childhood adversity and sociodemographic factors, among at-risk older adults to mitigate life-course stress proliferative processes and thereby reduce disparate risk for depression in older age.

Propósito de vida e desempenho de atividades avançadas de vida diária em idosos mais velhos

Resumo Objetivo Verificar a associação entre propósito de vida (PV) e a realização de atividades avançadas e instrumentais de vida diária (AAVD e AIVD) em idosos. Método Estudo de corte transversal com participantes da avaliação de seguimento do estudo FIBRA (Fragilidade em Idosos Brasileiros) nas cidades de Campinas e Ermelino Matarazzo (SP), Brasil, nos anos de 2016 e 2017. Participaram 187 idosos com 80 anos e mais recrutados em domicílios familiares. O protocolo incluiu a aplicação de um teste de rastreio de deficit cognitivo sugestivo de demência, escala para avaliação das AAVD, a Escala de Lawton e Brody avaliando AIVD, a Escala de Depressão Geriátrica e a Escala de Propósito de Vida de Ryff e Keyes (1995). Resultados Os participantes tinham em média 83,81 (±3,60) anos, 4,38 (±3,76) anos de escolaridade e tinham renda mensal média de 3,49 salários mínimos (±2,61) e 125 (66,8%) eram mulheres. Análises de regressão hierárquica mostraram associações estatisticamente significativas entre PV, sintomas depressivos e pontuação mais alta em AAVD (p=0,003) e sem associação significativa com AIVD (0,580), em modelo ajustado para variáveis sociodemográficas, avaliação subjetiva de saúde, desempenho cognitivo e depressão. Conclusões Os idosos com maior escore de PV e menor número de sintomas depressivos foram mais propensos a realizar AAVD, mas não AIVD, que se associaram à idade, sexo, sintomas depressivos e desempenho cognitivo. PV pode colaborar para a manutenção do estado funcional no idoso, contribuindo para um envelhecimento saudável.

Purpose in life and performance of advanced activities of daily living among the oldest old

Abstract Objective To verify the association between purpose in life (PL) and the performance in advanced (AADL) and instrumental (IADL) activities of daily living. Methods Cross-sectional community-based study which analyzed data from the follow-up assessment of the FIBRA Study (Frailty in Elderly Brazilians) in the cities of Campinas and Ermelino Matarazzo (SP), Brazil, in 2016 and 2017. Participants were 187 community dwelling persons aged 80 years and older. The protocol included the application of a cognitive deficit screening test suggestive of dementia, an inventory assessing AADL, the Lawton and Brody scale (IADL), the Geriatric Depression Scale and the Ryff and Keyes’ (1995) Purpose in Life Scale. Results Participants had an average of 83.81 (±3.60) years, 4.38 (± 3.76) years of schooling, 3.49 minimum wages (±2.61) of income, 125 (66.8%) being women. Hierarchical linear regression analyzes showed that PV and depressive symptoms were significantly associated with a higher number of AADL (p=0.003) and no significant association with IADL scores (0.580), in a model adjusted for sociodemographic variables, self-rated health, cognitive performance and depression. Conclusions The results suggest that older adults with higher PL and lower number of depression symptoms are more likely to perform a higher number of AADL. This association was not observed for IADL, which were associated with age, sex, depression and cognitive performance. PL may have an impact on complex levels of functional status in the elderly, thus contributing to healthy aging.

Social care-related outcomes in Finland. Construct validity and structural characteristics of the Finnish ASCOT measure with older home care users

The Adult Social Care Outcomes Toolkit four response-level interview schedule (ASCOT INT4) for service users was translated into Finnish. The aim of this paper was to investigate the construct validity and structural characteristics of the Finnish ASCOT. We used data from a face-to-face interview survey of older people receiving publicly funded home care services, which was conducted in 2016-2017 (n = 493), excluding missing values and proxy respondents (n = 334). Chi-square tests, adjusted residuals and analyses of variance were used to examine hypothesised associations between each attribute and a number of relevant variables regarding health and well-being, disabilities, living arrangements, social contact and support, experience of service use, and the nature of the locality and environment. Structural characteristics were explored using exploratory factor analysis and Cronbach's alpha test. The EQ-5D-3L and ASCOT were moderately correlated (r = 0.429; p < 0.001). The ASCOT attributes were statistically positively related to the overall quality of life. For other tested variables, we found a high number of significant associations with the control over daily life, occupation, social participation, and personal cleanliness attributes, but fewer significant associations with the other attributes. Cronbach's alpha was 0.697 and a single factor was extracted. This assessment provides evidence to support the construct validity of the Finnish ASCOT. The results support the introduction of the Finnish ASCOT into Finland for use in practical applications. Future research on its reliability would be useful.

Biometric indicators can be early signs of declines in activities of daily living functioning among the Indonesian elderly

BACKGROUND

Signs associated with the onset of disability can be useful in disability projection and have significant implications in elderly care policy.

OBJECTIVE

To explored the associations between biometric screening indicators and declines in activities of daily life (ADLs) functioning among the Indonesian elderly.

METHODS

This is a prospective longitudinal cohort study. The Indonesian Family Life Survey (IFLS) 4 conducted in 2007-2008, and IFLS 5 conducted in 2014-2015 were used to assess the association between biometric indicators and ADLs at baseline and follow-up.

RESULTS

Findings revealed that 22.3% of participants surveyed in 2007-2014 had become disabled in terms of ADLs. Anemia status, stage 2 hypertension, lung capacity, and a longer sit-to-stand time were associated with ADLs.

CONCLUSION

These findings are important to help early detection and potentially help the prevention of ADLs in elderly people in the future. Accuracy of disability estimation could possibly be improved if including biometric parameters.

Effects of social network diversity in the disablement process: a comparison of causal inference methods and an outcome-wide approach to the Indonesian Family Life Surveys, 2007-2015

BACKGROUND

Social networks (SN) have been proven to be instrumental for healthy aging and function as important safety nets, particular for older adults in low and middle-income countries (LMICs). Despite the importance of interpreting health outcomes in terms of SN, in many LMICs - including Indonesia - epidemiological studies and policy responses on the health effects of SN for aging populations are still uncommon. Using outcome-wide multi-method approaches to longitudinal panel data, this study aims to outline more clearly the role of SN diversity in the aging process in Indonesia. We explore whether and to what degree there is an association of SN diversity with adult health outcomes and investigate potential gender differences, heterogeneous treatment effects, and effect gradients along disablement processes.

METHODS

Data came from the fourth and fifth waves of the Indonesian Family Life Survey fielded in 2007-08 and 2014-15. The analytic sample consisted of 3060 adults aged 50+ years. The primary exposure variable was the diversity of respondents' SN at baseline. This was measured through a social network index (SNI), conjoining information about household size together with a range of social ties with whom respondents had active contact across six different types of role relationships. Guided by the disablement process model, a battery of 19 outcomes (8 pathologies, 5 impairments, 4 functional limitations, 2 disabilities) were included into analyses. Evidence for causal effects of SN diversity on health was evaluated using outcome-wide multivariable regression adjustment (RA), propensity score matching (PSM), and instrumental variable (IV) analyses.

RESULTS

At baseline, 60% of respondents had a low SNI. Results from the RA and PSM models showed greatest concordance and that among women a diverse SN was positively associated with pulmonary outcomes and upper and lower body functions. Both men and women with a high SNI reported less limitations in performing activities of daily living (ADL) and instrumental ADL (IADL) tasks. A high SNI was negatively associated with C-reactive protein levels in women. The IV analyses yielded positive associations with cognitive functions for both men and women.

CONCLUSIONS

Diverse SN confer a wide range of strong and heterogeneous long-term health effects, particularly for older women. In settings with limited formal welfare protection, intervening in the SN of older adults and safeguarding their access to diverse networks can be an investment in population health, with manifold implications for health and public policy.

Social vulnerability underlying disability amongst older adults: A systematic review

BACKGROUND

Older adults face radical changes in their social life during ageing, dealing with several age-related social adaptations. The aim of this review is to systematically explore the literature on social vulnerability (SV) and its association with functional decline activity of daily living (ADL)/instrumental activities of daily living (IADL) as an endpoint in older adults.

METHODS

We searched for relevant studies in three different databases: PubMed, Ovid Medline and PsychInfo. Inclusion criteria included: prospective cohort studies assessing SV correlation; studies in English, Italian, French and Spanish to the end of March 2018; a general population aged >65 years living in a community setting and/or studies including younger participants if the mean age was >65 years; and basic ADL and/or IADL by Katz and Lawton, respectively, as functional decline and clinical outcomes.

RESULTS

We identified 65 manuscripts that assessed the role of SV in functional decline. Our systematic analysis showed that 26, 36 and 19 studies observed a correlation between Basic Social Needs, Social Resources and Social Behaviour and Activity, respectively, and the onset of ADL/IADL functional decline. Twenty-six studies explored the correlation between General Social Resources and the onset of ADL/IADL functional decline.

CONCLUSIONS

When examining a wide set of social variables, the "quality," rather than just structure, and "type" of social relationship represents the core feature of SV that predicts functional decline in older adults. By defining individual SV, its measurement and evaluation, we can plan effective social interventions aimed at preventing or delaying functional decline or death.

Patient-Reported Quality of Hospital Discharge Transitions: Results from the SILVER-AMI Study

BACKGROUND

Transitions from hospital to home in older patients are a high-risk period for adverse outcomes in a population that may have more challenges navigating the healthcare system. There is little information about the association of patient-reported quality of hospital discharge processes with clinical outcomes.

OBJECTIVES

We evaluated whether patient-reported quality of hospital discharge processes was associated with emergency department utilization and rehospitalization within 30 days of discharge after hospitalization for acute myocardial infarction (AMI) in older adults.

DESIGN

Multi-center, prospective cohort study.

PATIENTS

The ComprehenSIVe Evaluation of Risk Factors in Older Patients with Acute Myocardial Infarction (SILVER-AMI) study was a longitudinal study of 3006 adults age 75 and older hospitalized with AMI recruited from 94 academic and community hospitals from across the USA.

INTERVENTION

N/A MAIN MEASURES: Patients answered a subset of questions from the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey. Readmissions and emergency department utilization within 30 days of discharge were ascertained through medical record review.

KEY RESULTS

A total of 2132 patients were included in the study. Patients' median age was 81 years and the response rate to the survey of discharge quality was 87%. Patients who reported being asked about having the help they needed at home were significantly less likely to have emergency room utilization within 30 days of discharge in both the unadjusted (0.65, 95% CI 0.43-0.99) and adjusted (0.65, 95% CI 0.42-0.997) models, though there was no significant association with readmission.

CONCLUSION

Report of an assessment of help needed at home during hospitalization was associated with lower post-discharge emergency department utilization. Efforts to improve outcomes after hospital discharge in older patients may benefit from greater focus on assessing need of help at home.

Association Between Mobility Measured During Hospitalization and Functional Outcomes in Older Adults With Acute Myocardial Infarction in the SILVER-AMI Study

Importance

Many older survivors of acute myocardial infarction (AMI) experience functional decline, an outcome of primary importance to older adults. Mobility impairment has been proposed as a risk factor for functional decline but has not been evaluated to date in older patients hospitalized for AMI.

Objective

To examine the association of mobility impairment, measured during hospitalization, as a risk marker for functional decline among older patients with AMI.

Design, Setting, and Participants

Prospective cohort study among 94 academic and community hospitals in the United States. Participants were 2587 hospitalized patients with AMI who were 75 years or older. The study dates were January 2013 to June 2017.

Main Outcomes and Measures

Mobility was evaluated during AMI hospitalization using the Timed "Up and Go," with scores categorized as preserved mobility (≤15 seconds to complete), mild impairment (>15 to ≤25 seconds to complete), moderate impairment (>25 seconds to complete), and severe impairment (unable to complete). Self-reported function in activities of daily living (ADLs) (bathing, dressing, transferring, and walking around the home) and walking 0.4 km (one-quarter mile) was assessed at baseline and 6 months after discharge. The primary outcomes were worsening of 1 or more ADLs and loss of ability to walk 0.4 km from baseline to 6 months after discharge. The association between mobility impairment and risk of functional decline was evaluated with multivariable-adjusted logistic regression.

Results

Among 2587 hospitalized patients with AMI, the mean (SD) age was 81.4 (4.8) years, and 1462 (56.5%) were male. More than half of the cohort exhibited mobility impairment during AMI hospitalization (21.8% [564 of 2587] had mild impairment, 16.0% [414 of 2587] had moderate impairment, and 15.2% [391 of 2587] had severe impairment); 12.8% (332 of 2587) reported ADL decline, and 16.7% (431 of 2587) reported decline in 0.4-km mobility. Only 3.8% (30 of 800) of participants with preserved mobility experienced any ADL decline compared with 6.9% (39 of 564) of participants with mild impairment (adjusted odds ratio [aOR], 1.24; 95% CI, 0.74-2.09), 18.6% (77 of 414) of participants with moderate impairment (aOR, 2.67; 95% CI, 1.67-4.27), and 34.7% (136 of 391) of participants with severe impairment (aOR, 5.45; 95% CI, 3.29-9.01). Eleven percent (90 of 800) of participants with preserved mobility declined in ability to walk 0.4 km compared with 15.2% (85 of 558) of participants with mild impairment (aOR, 1.51; 95% CI, 1.04-2.20), 19.0% (78 of 411) of participants with moderate impairment (aOR, 2.03; 95% CI, 1.37-3.02), and 24.6% (95 of 386) of participants with severe impairment (aOR, 3.25; 95% CI, 2.02-5.23).

Conclusions and Relevance

This study's findings suggest that mobility impairment assessed during hospitalization may be a potent risk marker for functional decline in older survivors of AMI. These findings also suggest that brief, validated assessments of mobility should be part of the care of older hospitalized patients with AMI to identify those at risk for this important patient-centered outcome.

Individual and Environmental Determinants of Late-Life Community Disability for Persons Aging With Cardiovascular Disease

OBJECTIVE

The aim of the study was to estimate the prevalence of late-life community disability for adults 65 yrs and older with cardiovascular disease versus those without. This study also investigated the contributions of environmental and individual risk factors on late-life community disability for persons with cardiovascular disease.

DESIGN

This is a secondary data analysis of the 2016 round of the National Health and Aging Trends Study. The study sample included community-dwelling Americans with cardiovascular disease (n = 1490) and without (n = 4819). Logistic regression was used to estimate associations between individual risk factors, environmental factors, and community disability for those with cardiovascular disease.

RESULTS

Individuals with cardiovascular disease had a significantly higher prevalence of late-life community disability than those without (44.8% vs. 29.0%). For persons with cardiovascular disease, lack of transportation, home modification, and needing assistance with mobility increased the odds of community disability. Younger age and lower comorbidity were associated with decreased odds of community disability. When accounting for environmental factors in multivariate analyses, sex, race, and education were not significantly associated with community disability.

CONCLUSION

Late-life community disability is highly prevalent for persons aging with cardiovascular disease. Intervention strategies to deter late-life community disablement should focus on improving access to transportation and improving the community environment in which older adults live.

Impact of housing conditions on social behavior, neuroimmune markers, and oxytocin receptor expression in aged male and female Fischer 344 rats

Aging is associated with a substantial decline in social behavior, whereas positive social interaction can improve overall health in aged individuals. In laboratory rodents, manipulations of the social environment across the lifespan have been shown to affect social behavior. Therefore, we examined the effects of long-term (5-6 weeks) housing conditions (alone, with one adult, or with two adults) on social behavior and the expression of neuroinflammation-related genes as well as oxytocin receptor (OXTR) gene expression in brain areas associated with social behavior regulation in aged male and female Fischer (F) 344 rats. Single-housed males and females exhibited increased social investigation, relative to pair-housed rats (one aged and one adult). Triple-housed (one aged and two adults) aged males exhibited lower levels of social investigation, relative to triple-housed aged females. Aged females were more socially active that their male counterparts. Although social housing condition significantly affected social behavior in males, it had no impact on cytokine gene expression in the paraventricular nucleus of hypothalamus (PVN), bed nucleus of the stria terminalis (BNST) or medial amygdala (MeA). However, in triple-housed aged females, who exhibited social behavior comparable to their single- and pair-housed counterparts, there was a significant increase in the expression of IL-1β and IL-6 mRNA in the MeA. No changes in cytokine gene expression were observed in the PVN or BNST, indicating that the increased expression of cytokines in the MeA was not a result of a generalized increase in neuroinflammation. Single-housed males and females exhibited elevated OXTR gene expression in the BNST. Taken together, these data indicate that manipulations of the social environment in late aging significantly influenced social interactions with a novel partner and gene expression in social behavior circuits and that these effects are sex-specific.

Valued activities among individuals with and without functional impairments: Findings from the National Health and Aging Trends study (NHATS)

Using the National Health and Aging Trends Study (NHATS), we examined baseline activity and functional status. Respondents were classified as High (n=1,662), Moderate (n=1,973), or Low (n=989) Function and rated importance of and actual participation in four activities. Transportation and health were also examined. Individuals classified as low function were less likely to engage in valued activities and more likely to report that poor health and transportation limited participation, compared to individuals with no or moderate functional impairments. Data suggest the importance of developing interventions which bridge the gap between activity preferences and participation for older adults with functional limitations.

Mortality Following Trajectories of Mobility Limitations: The Modifying Impact of Social Factors

Objective: How are trajectories of mobility limitations (MLs) among older adults associated with mortality? Do social factors modify these associations? Method: Group-based trajectory modeling was used to identify four trajectories of MLs over a period of 4.5 years among 3,055 older Danes. Mortality analyses were conducted using additive hazard regression models. Results: Compared to older adults without MLs, older adults with high level of MLs who experienced further increase in MLs were associated with the most additional deaths followed by older adults with no MLs at baseline who later experienced limitations and older adults with a medium ML level at baseline who later experienced further increase in limitations. Men and 80-year olds experienced more additional deaths following adverse ML trajectories than women and 75-year olds. Discussion: Trajectories that led to higher ML levels were associated with most additional deaths especially among men and in the oldest age group.

Depressive symptoms, emotional support and activities of daily living disability onset: 15-year follow-up of the Bambuí (Brazil) Cohort Study of Aging

Psychosocial factors appear to be associated with increased risk of disability in later life. However, there is a lack of evidence based on long-term longitudinal data from Western low-middle income countries. We investigated whether psychosocial factors at baseline predict new-onset disability in long term in a population-based cohort of older Brazilians adults. We used 15-year follow-up data from 1,014 participants aged 60 years and older of the Bambuí (Brazil) Cohort Study of Aging. Limitations on activities of daily living (ADL) were measured annually, comprising 9,252 measures. Psychosocial factors included depressive symptoms, social support and social network. Potential covariates included sociodemographic characteristics, lifestyle, cognitive function and a physical health score based on 10 self-reported and objectively measured medical conditions. Statistical analysis was based on competitive-risk framework, having death as the competing risk event. Baseline depressive symptoms and emotional support from the closest person were both associated with future ADL disability, independently of potential covariates wide range. The findings showed a clear graded association, in that the risk gradually increased from low emotional support alone (sub-hazard ratio - SHR = 1.11; 95%CI: 1.01; 1.45) to depressive symptoms alone (SHR = 1.52; 95%CI: 1.13; 2.01) and then to both factors combined (SHR = 1.61; 95%CI: 1.18; 2.18). Marital status and social network size were not associated with incident disability. In a population of older Brazilian adults, lower emotional support and depressive symptoms have independent predictive value for subsequent disability in very long term.

Predicting the Future Need of Walking Device or Assistance by Moderate to Vigorous Physical Activity: A 2-Year Prospective Study of Women Aged 75 Years and Above

Objective

To examine the association between daily moderate to vigorous physical activity (MVPA) and the change in mobility function among community-dwelling Japanese women aged 75 years and above.

Methods

This prospective study included 330 older women aged 75 years and above who could walk without a walking device or assistance. MVPA and light-intensity physical activity (LPA) were assessed using an accelerometer for seven consecutive days. MVPA was defined as an activity with an intensity of >3 metabolic equivalents. The study outcome was a change in mobility function, defined as the need of walking device or assistance, during the two-year period.

Results

The results of the logistic regression analysis showed that MVPA was inversely associated with a decline in mobility function after controlling for LPA and potential confounders (adjusted odds ratio (OR) = 0.93 per 1 min/d, 95% confidence interval (CI) = 0.88-0.99; P = 0.017), whereas LPA was not when adjusted for MVPA and confounders (adjusted OR = 0.99 per 1 min/d, 95% CI = 0.96-1.01; P = 0.245). The receiver operating characteristics analysis identified a 7.9 min/d of MVPA as the cut-off value.

Conclusions

The results of this study suggest the importance of promoting daily MVPA for preventing mobility limitation in older women aged 75 years and above.

The Role of Ethnic and Racial Disparities in Mobility and Physical Function in Older Adults

Objective: To compare estimates of the prevalence of mobility and physical function limitations by race and ethnicity using data from the Medical Expenditure Panel Survey (MEPS). Method: The sample comprised of 28,854 adults aged ≥60 from the MEPS (2004-2013). Physical function (limitations in basic and instrumental activities of daily living [ADL/IADL]) and mobility limitations were assessed by self-report. Results: Non-Hispanic Whites (NHWs) represented the majority of the sample followed by non-Hispanic Blacks (NHBs), Hispanic and non-Hispanic Other (Other). For mobility limitation, NHBs had the highest prevalence followed by NHWs and Hispanics (33.3%, 28.6%, and 26.2%, respectively). Multivariable logistic regression analyses were performed for the primary outcome of mobility limitation. In the adjusted model, Hispanics had lower odds of mobility limitations (prevalence odds ratio [POR]: 0.78; 95% confidence interval [CI] = [0.67,0.91]) compared with NHWs. For ADL limitations, NHBs had higher odds of having ADLs (POR: 1.87; 95% CI = [1.44, 2.44]) when compared with NHWs. Conclusion: This article evaluated the influence of race and ethnicity, on the prevalence of mobility and functional limitations that are not always consistent with expected racial and ethnic differences.

Aging Audiences: Association of Live Performance Attendance and Cognitive Decline in a Biracial Sample

OBJECTIVES

To examine if attendance in live performances was associated with change in cognition among African Americans (AAs) and European Americans (EAs).

METHOD

The study consisted of 5,567 older adults with at least follow-up interview and analyzed using a linear mixed effects regression model adjusting for demographic and health variables.

RESULTS

We found that frequent performance attendance was associated with slower decline in composite cognitive function among older AAs and EAs. Attending 10 or more performances per year was associated with 23% slower cognitive decline among AAs and 31% slower cognitive decline among EAs compared with those who never attend any performance. However, this difference was not significant ( p = .56). Attending live performances was also associated with slower decline in individual tests of perceptual speed, episodic memory, and mini-mental state exam (MMSE).

DISCUSSION

Our findings suggest that live performances form a valuable component of arts engagement and should be encouraged for potential cognitive benefits.

Disability Experience and Measurement

Top themes of international research on disability in the past three decades are discussed: disability dynamics, buffers and barriers for disability, disability trends, and disability among very old persons. Each theme is highlighted by research examples. Turning to measurement, I discuss traditional measures of disability, new longer and shorter ones, and composites like disability-free life expectancy, noting their merits. Contemporary models of disability are presented, ranging from visual images to formal theories. The article ends on how scientists can facilitate movement of disability science into health care practice and policy.

Social Frailty Is Associated with Physical Functioning, Cognition, and Depression, and Predicts Mortality

OBJECTIVES

Social frailty is related to adverse health-related outcomes. However, the measurement thereof is controversial and research into the relationship between social frailty and physical functioning remains limited. This study aimed to determine social frailty status via developing a simple self-reported screening tool, termed the HALFT scale, and to examine the association between social frailty and physical functioning, cognition, depression, and mortality among community-dwelling older adults.

DESIGN

Prospective cohort study.

SETTING

Community.

PARTICIPANTS

1697 community-dwelling adults aged ≥60 years from Beijing Longitudinal Study of Aging were included.

MEASUREMENTS

The HALFT scale was developed based on 5 items: unhelpful to others, limited social participation, loneliness, financial difficulty, and not having anyone to talk to. Socioeconomic and demographic data were collected, and physical functioning, frailty index, cognition, and depression were assessed.

RESULTS

The prevalence of social frailty was 7.7% (weighted, 4.5%). Participants with physical frailty, low levels of physical activity, and poor physical functioning had a higher prevalence of social frailty. Social frailty was associated with dementia, subjective memory decline, depression, cognitive impairment, and having experienced a recent significant life event. After adjusting for age and sex, the 8-year mortality hazard ratios were 2.5-4.3 and 1.6-2.3, respectively, for those with social frailty or pre-social frailty. Each component of the HALFT scale predicted 8-year mortality.

CONCLUSIONS

Social frailty is associated with physical functioning, cognition, and depression, and predicts mortality. The HALFT scale could be a useful screening tool for determining social frailty in older adults. Interventions aimed at preventing or delaying social frailty are warranted.

Perceived discrimination and health-related quality-of-life: gender differences among older African Americans

PURPOSE

Emerging data suggest that African-American women may fare worse than African-American men in health-related quality-of-life (HRQOL). Perceived discrimination is an important contributor to poor health overall among African Americans, but few studies examined the intersecting effects of perceived discrimination and gender in explaining HRQOL disparities. We investigated gender differences in HRQOL and tested whether perceived discrimination accounted for these differences.

METHODS

We examined data from the Chicago Health and Aging Project in which 5652 African-American adults aged 65 and older completed structured questionnaires about demographic and socioeconomic characteristics, HRQOL, perceived discrimination, and health-related variables. Logistic regression models were used to identify associations between perceived discrimination and gender differences in poor HRQOL outcomes (defined as 14+ unhealthy days in overall, physical, or mental health over the past 30 days) when controlling for the other variables.

RESULTS

More women reported poor overall HRQOL than men (24 vs. 16% respectively). Higher perceived discrimination was significantly associated with worse overall HRQOL (OR 1.11; 95% CI 1.08, 1.15), with stronger effects for women in overall and mental HRQOL. These gender disparities remained significant until controlling for potentially confounding variables. Perceived discrimination did not account for gender differences in poor physical HRQOL.

CONCLUSIONS

Perceived discrimination is associated with poor HRQOL in older African Americans, with this association appearing stronger in women than men for mental HRQOL. These findings warrant further investigation of effects of perceived discrimination in gender disparities in overall health, and such research can inform and guide efforts for reducing these disparities.

Disentangling the complex relation of disability and depressive symptoms in old age - findings of a multicenter prospective cohort study in Germany

BACKGROUND

Most of the previous studies attempted to disentangle the relationship between disability and depressive symptoms were limited to observation periods of only few years. Moreover, evidence is missing regarding the complex co-occurrence of disability and depressive symptoms in old age in Germany. In order to close the research gap, we aimed at disentangling the complex co-occurrence of disability and depressive symptoms in old age in Germany over a longer time frame.

METHODS

Based on data from a representative survey of the German general population aged 75 years and older, the course of disability as well as depressive symptoms was observed every 1.5 years over six waves. While disability was quantified by the Lawton and Brody Instrumental Activities of Daily Living scale, the Geriatric Depression Scale was used to measure depressive symptoms. Taking into account the complex co-occurrence of depressive symptoms and disability, a panel vector autoregressive model was used. By taking the first differences, unobserved heterogeneity was taken into account.

RESULTS

In the total sample and in both sexes, we revealed a robust positive association between an initial change in depressive symptoms and subsequent changes in disability. No robust association between an initial change in disability and a subsequent change in depressive symptoms was detected.

CONCLUSION

Our findings highlight the importance of changes in depressive symptoms for future changes in disability in old age.

Wealth and Disability in Later Life: The English Longitudinal Study of Ageing (ELSA)

We examined wealth inequalities in disability, taking into account the effect of both depression and social support among older English adults using data from 5,506 community-dwelling people aged 50 years and over from the English Longitudinal Study of Ageing (ELSA). Disability was measured as self-reported limitations in the Basic Activities of Daily Living (ADL) and Instrumental Activities of Daily Living (IADL). Depressive symptomatology was measured using the 8-item Center for Epidemiological Studies-Depression (CES-D) scale. Social support was assessed by marital status and frequency of contact with friends, relatives or children. Multinomial logistic regression models were used to assess the role of social support and depressive symptoms on disability by total household wealth, which is a measure of accumulated assets over the course of life. Our findings showed that the poorest men with disability were more likely to live without a partner and have no weekly contact with children, family or friends compared to the wealthiest. Among women with disability, the poorest were more likely to report loneliness and have no partner while the wealthiest and the intermediate groups were more likely to be living with a partner. There was a strong inverse dose-response association between wealth and depressive symptoms among all participants with disability. This study shows a clear wealth gradient in disability among older English adults, especially for those with elevated depressive symptoms.

The Effects of Social Support on Physical Functioning in Older African Americans: Longitudinal Results from the Baltimore Study of Black Aging

INTRODUCTION

Compared with other racial/ethnic groups, African Americans have higher rates of chronic conditions and suffer a disproportionate burden of disability. We aimed to examine the effects of social support on physical functioning among older African Americans.

METHODS

We analyzed a sample of 448 urban, community-dwelling, older African Americans (aged 48-98 years) from the Baltimore Study of Black Aging. Baseline physical functioning was collected between 2006 and 2008 (wave 1), and change in physical functioning was collected between 2009 and 2011 (wave 2), physical functioning was assessed by self-reported limitations in 7 activities of daily living-eating, dressing, grooming, walking, bathing, using the toilet, and transferring in and out of bed-using a binary variable to indicate whether the individual had difficulty performing each specific activity. Social support was measured by how frequently participants provided/received goods and services, financial assistance, transportation, companionship, advice, or encouragement (never [0], rarely [1], sometimes [2], frequently [3]). Negative binomial regression models were used to test the effects of social support given, received, and a ratio (support received/support given) on physical functioning for those who improved and those who declined in physical functioning.

RESULTS

Participants reported physical functioning at wave 1 (1.24, standard deviation [SD] = 1.98) and at wave 2 (0.34, SD = 0.83). Average social support given was 7.49 (SD = 3.26), and average social support received was 7.81 (SD = 3.17). Those who improved in physical function gave less social support and had lower social support ratios; social support received had no effect. Those who remained stable or declined in physical function gave more social support; neither social support received nor social ratio had an effect.

CONCLUSION

Social support given and social support received as well as the ratio should be considered when seeking to understand how physical functioning changes over time among older African Americans.

State of Health and Quality of Life of Women at Advanced Age

Background

Evaluation of the state of health, quality of life, and the relationship between the level of the quality of life and health status in a group of women at an advanced age (90 years of age and older) in Poland.

Material/Methods

The study was conducted in 2014 in an all-Polish sample of 870 women aged 90 years and older. The research instruments were: the authors’ questionnaire and several standardized tests: Katz Index of Independence in Activities of Daily Living (Katz ADL), Abbreviated Mental Test Score (AMTS), and the World Health Organization Quality of Life (WHOQOL)-BREF. The results of the study were statistically analyzed using significant t-test for mean and regression analysis.

Results

The majority of women at an advanced age suffered from chronic pain (76%) and major geriatric problems such as hypoacusis (81%), visual disturbances (69%) and urinary incontinence (60%); the minority of women at an advanced age suffered from falls and fainting (39%), stool incontinence (17%), severe functional impairment (24%), and cognitive impairment (10%).

On a scale of 1 to 5, women at an advanced age assessed positively for overall quality of life (mean 3.3), social relationships (3.5), and environment (3.2), but negatively for general health, physical health, and psychological health (2.7, 2.7, and 2.8, respectively).

The presence of chronic pain and geriatric problems, including urinary and stool incontinences, falls and faint ing, visual disturbances and hypoacusis, significantly decreased overall quality of life; general health, physical health, psychological health, social relationships, and environment.

Overall quality of life, general health, physical health, psychological health, social relationships, and environment was correlated with functional and cognitive impairments.

Conclusions

Quality of life of women at an advanced age decreased if chronic pain, major geriatric problems, or functional or cognitive impairments occurred.

Assessment of Activities of Daily Living, Self-Care, and Independence

Activities of daily living (ADL) comprise the basic actions that involve caring for one's self and body, including personal care, mobility, and eating. In this review article, we (1) review useful clinical tools including a discussion on ways to approach ADL assessment across settings, (2) highlight relevant literature evaluating the relationship between cognitive functioning and ADLs, (3) discuss other biopsychosocial factors affecting ADL performance, (4) provide clinical recommendations for enhancing ADL capacity with an emphasis on self-care tasks (eating, grooming, dressing, bathing and toileting), and (5) identify interventions that treatment providers can implement to reduce the burden of ADL care.

Patterns of social engagement in the transition to later life

As social roles in later life are shaped by significant life events and changes occurring in the late-life transition, examining social engagement in midlife may provide a context for interpreting the ageing social identity. This is particularly important for women, who are heavily dependent on social relationships and are more influenced by social losses and change.

OBJECTIVE

To examine major social changes occurring in the decade prior to late-life, starting from approximately 45-55 years of age.

STUDY DESIGN

The study accessed data from the longitudinal prospective Women's Healthy Ageing Project (WHAP). Participants were 493 women who had completed at least one assessment in the first 12 years of the study.

RESULTS

Living with a partner was common and stable amongst participants, while the proportion with children still at home decreased markedly (79-44%). Full-time employment also decreased as participants approached the average retirement age (40-13%). Volunteer work was popular throughout the study, increasing slightly with age, and minding grandchildren was common at the end of the study period (80%).

CONCLUSIONS

Taken together, these findings suggest a notable deficit in participants' social lives as they transition into later life, but with some evidence of compensation by increasing other social activities.

Factors associated with disability among middle-aged and older African American women with osteoarthritis

BACKGROUND

Middle-aged and older African American women experience disproportionate rates of functional limitations and disability from osteoarthritis (OA) compared to other racial ethnic groups; however, little is known about what factors contribute to this disparity within African American women.

OBJECTIVE

To examine factors associated with physical function and disability among African American women ages 50-80 with OA using the disablement process model.

METHODS

This descriptive study included 120 African American women with OA from the Southwestern region of the United States. Regression techniques were used to model the correlates of physical function and disability and to test a mediation model.

RESULTS

BMI and pain severity were significantly related to functional limitations. Depressive symptoms mediated the relationship between racial discrimination and disability.

CONCLUSION

Biological, intra-individual, and extra-individual factors are related to disablement outcomes in this sample of African American women, which is consistent with theory suggesting the need for treatment coupled with environmental modifications. This study can inform the development of future bio-behavioral interventions.

Home but still engaged: participation in social activities among the homebound

Purpose

Participation in social and community activities that require leaving one’s home is important to older adults; however, many older adults have difficulty or are unable to leave their dwellings, and little is known from national samples about issues related to remaining active outside the home or the barriers faced by these older adults.

Design and methods

We used the National Health and Aging Trends Study, a nationally representative study of older adults (n = 7197), to understand the following: (1) the importance that homebound and semi-homebound adults place on involvement in social or community activities, (2) their current level of involvement, and (3) reported barriers to participation.

Results

Despite the heavy burden of functional limitations, depression, pain, and falls, homebound adults reported that activities outside the home were important to them ranging from 25.2 % (attend clubs) to 70.0 % (visit family). Similarly, semi-homebound older adults had a strong interest in such participation, including visiting friends and family (81.8 %), attending religious services (72.6 %), and going out for enjoyment (72.5 %). Many homebound adults reported health (42.9–64.1 % depending on the activity) and transportation (12.2–18.2 %) as barriers to participation. Semi-homebound adults also identified health (23.8–41.0 %) and transportation (6.5–10.2 %) as participation barriers.

Implications

This information can be useful in designing community programs that will foster meaningful social and community engagement for older adults, which may improve their quality of life.

Social Frailty in Community-Dwelling Older Adults as a Risk Factor for Disability

OBJECTIVE

To determine social frailty status using simple questions and to examine the association between social frailty and disability onset among community-dwelling older adults.

DESIGN

Prospective cohort study.

SETTING

Japanese community.

PARTICIPANTS

A total of 4304 adults age ≥65 years living in the community participated in a baseline assessment from 2011 to 2012. They were followed monthly for incident certification of care needs during the 2 years after the baseline assessment.

MEASUREMENTS

Care-needs certification in the national long-term care insurance system of Japan; a self-reported questionnaire including 7 items to define social frailty status, adjustment for several potential confounders such as demographic characteristics; and Kaplan-Meier survival curves for disability incidence by social frailty.

RESULTS

During the 2 years, 144 participants (3.3%) were certified as requiring long-term care insurance in accordance with incident disability. Five of the 7 items in the self-reported questionnaire were significantly associated with disability incidence. In the adjusted model including potential covariates, participants who were defined as having social frailty (≥2/5) (hazard ratio 1.66, 95% confidence interval 1.00-2.74) and prefrailty (=1/5) (hazard ratio 1.53, 95% confidence interval 1.02-2.531), based on 5 items at the baseline assessment, had an increased risk of disability compared with nonfrail participants (=0/5).

CONCLUSIONS

Social frailty, assessed using simple questions regarding living alone, going out less frequently compared with the prior year, visiting friends sometimes, feeling helpful to friends or family, and talking with someone every day, has a strong impact on the risk of future disability among community-dwelling older people.

Disability and care needs among older Americans

CONTEXT

The cost of late-life dependency is projected to grow rapidly as the number of older adults in the United States increases in the coming decades. To provide a context for framing relevant policy discussions, we investigated activity limitations and assistance, care resources, and unmet need for a national sample of older adults.

METHODS

We analyzed the 2011 National Health and Aging Trends Study, a new national panel study of more than 8,000 Medicare enrollees.

FINDINGS

Nearly one-half of older adults, or 18 million people, had difficulty or received help in the last month with daily activities. Altogether, 1 in 4 older adults receiving help lived in either a supportive care (15%) or a nursing home (10%) setting. Nearly 3 million received assistance with 3 or more self-care or mobility activities in settings other than nursing homes, and a disproportionate share of persons at this level had low incomes. Nearly all older adults in settings other than nursing homes had at least 1 potential informal care network member (family or household member or close friend), and the average number of network members was 4. Levels of informal assistance, primarily from family caregivers, were substantial for older adults receiving help in the community (164 hours/month) and living in supportive care settings (50 hours/month). Nearly all of those getting help received informal care, and about 3 in 10 received paid care. Of those who had difficulty or received help in settings other than nursing homes, 32% had an adverse consequence in the last month related to an unmet need; for community residents with a paid caregiver, the figure was nearly 60%.

CONCLUSIONS

The older population-especially those with few economic resources-has substantial late-life care needs. Policies to improve long-term services and supports and reduce unmet need could benefit both older adults and those who care for them.