Hierarchical structure in the activities of daily living and trajectories of disability prior to death in elderly Chinese individuals

Service robots in caring for older adults: Uncovering the current conceptual and intellectual structures and future research agenda

Service robots have supported human activity, mainly caring for older adults, for many years. However, a new generation of service robots empowered by artificial intelligence and other novel technologies indicates an increasing use of service robots in our society. Thus, this article aims to synthesize and integrate current research on service robots in caring for older adults, identifying its conceptual and intellectual structures and future research opportunities. A total of 390 articles ranging from the year 1997 to 2022 were analyzed with text-mining and visualization methods. We found that this research is composed of six main themes: (i) acceptance and design of robots; (ii) social role and ethical values (iii) obstacles and criticism; (iv) effects, effectiveness, and impact of using robots; (v) therapeutic use of robots and (vi) perceptions of health professionals and services. We also identified future research opportunities which researchers can use to advance the topics of this research. Identifying research clusters and key works in this multidisciplinary research field can assist researchers in understanding the current status of this research and, after that, better positioning their studies and finding avenues to move forward with the use of service robots for caring for older adults.

Dynamic relations between longitudinal morphological, behavioral, and emotional indicators and cognitive impairment: evidence from the Chinese Longitudinal Healthy Longevity Survey

BACKGROUND

We aimed to assess the effects of body mass index (BMI), activities of daily living (ADL), and subjective well-being (SWB) on cognitive impairment and propose dynamic risk prediction models for aging cognitive decline.

METHODS

We leveraged the Chinese Longitudinal Healthy Longevity Survey from 1998 to 2018. Cognitive status was measured using the Chinese Mini-Mental State Examination. We employed repeated measures correlation to assess associations, linear mixed-effect models to characterize the longitudinal changes, and Cox proportional hazard regression to model survival time. Dynamic predictive models were established based on the Bayesian joint model and deep learning approach named dynamic-DeepHit. Marginal structural Cox models were adopted to control for time-varying confounding factors and assess effect sizes.

RESULTS

ADL, SWB, and BMI showed protective effects on cognitive impairment after controlling observed confounding factors, with respective direct hazard ratios of 0.756 (0.741, 0.771), 0.912 (0.902, 0.921), and 0.919 (0.909, 0.929). Dynamic risk predictive models manifested high accuracy (best AUC = 0.89). ADL was endowed with the best predictive capability, although the combination of BMI, ADL, and SWB showed the most remarkable performance.

CONCLUSIONS

BMI, ADL, and SWB are protective factors for cognitive impairment. A dynamic prediction model using these indicators can efficiently identify vulnerable individuals with high accuracy.

Urban-Rural Disparities in the Association Between Home- and Community-Based Service Utilization and Levels of Disability Among Chinese Older Adults With Disabilities

Home- and community-based services (HCBS) are optimal ways to deal with disability problems among older adults. This study aims to analyze urban-rural disparities in the relationship between HCBS utilization and levels of disability among Chinese older adults with disabilities, so as to meet the long-term care needs of them. In applying the Andersen Behavioral Model, bivariate analysis and multivariate regression models were employed using data from 843 older adults with disabilities from the 2018 China Longitudinal Aging Social Survey (CLASS). After adjusting covariates, disability levels among Chinese older adults with disabilities were significantly correlated with HCBS utilization in urban areas but not in rural areas. The urban-rural disparities may be due to the low utilization of HCBS in rural areas (only 11.2%) among older adults with disabilities compared with their urban counterparts (22.7%).

Dynamic changes and lifetime effect of functional disability profiles for stroke patients: real-world evidence from South Korea

PURPOSE

This work aimed to investigate the long-term dynamic changes of functional disabilities and estimate lifetime outcomes of different functional disabilities after a stroke, using real-world data from a nationally representative South Korean cohort.

METHODS

Patients aged 18 and above with ischemic and hemorrhagic strokes were identified from the Korea Health Panel (KHP) data (2008-2018). Functional disabilities were repeatedly measured for patients aged 55 and over for the prevalence of disabilities associated with activities of daily living (ADL), and kernel smoothing means were estimated for each item. The lifetime survival function of stroke patients in Korea was adopted from another study utilizing the National Health Insurance Service of Korea's national sample cohort. By multiplying the disability-free proportion with the survival function throughout life, disability-free life expectancy (DFLE) for each ADL item was estimated. The loss-of-DFLE was calculated by subtracting the DFLE from age-, sex-, and calendar year-matched referents simulated from Korean life tables.

RESULTS

The KHP dataset included 466 stroke patients. The overall functional disability needs increased over time after stroke diagnosis. DFLE was lowest for bathing (10.1 years for ischemic stroke and 12.8 years for hemorrhagic stroke), followed by those for dressing and washing. Loss-of-DFLE was highest for bathing for ischemic and hemorrhagic strokes (7.2 and 10.7 years, respectively), indicating that this task required the most assistance for stroke patients compared with the other tasks. DFLEs were slightly lower than the quality-adjusted life expectancy of stroke patients.

CONCLUSION

Our findings provide valuable insights for resource allocation and policy decisions in long-term stroke care, potentially enhancing the quality of life for stroke survivors and caregivers.

Onset of ADL and IADL limitation among Chinese middle-aged and older adults

It is important to measure the prevalence and onset of limitations for older adults to take critical day-to-day activities in the population. However, too often, only very older people are covered, and too few activities are included in the studies. Using a nationally representative sample from 2011 to 2018 (N = 16, 381), this study characterizes the limitation pattern covering ADL and IADL activities among middle-aged and older adults in China. We use survival models to characterize the limitation transition. We find that half of the population become limited in activities including housekeeping, toileting, managing money, and cooking in their early 70s, followed by shopping, bathing, transferring and dressing in their late 70s, continence, and taking medications in their early 80s, and feeding in their early 90s. In addition, women show significantly younger age of limitation onsets for all activities except continence.

Associations of depressive symptoms and chronic diseases with activities of daily living among middle-aged and older population in China: A population-based cohort study

BACKGROUND

Activities of daily living (ADL) disability is a concern in the aging population and can lead to increased health service demands and lower quality of life. The aim of this longitudinal study was to assess the associations of chronic conditions and depressive symptoms with ADL disability.

METHODS

This prospective cohort study used two waves of data (2011 and 2015) from the China Health and Retirement Longitudinal Study (CHARLS). A total of 10,864 participants aged 45 and older were included for analysis. Chronic diseases were assessed by self-report and depressive symptoms were assessed using the validated 10-item of Center for Epidemiologic Studies Depression Scale at baseline. Incidents of ADL disability during follow-up were assessed using the Katz ADL scales.

RESULTS

After 4 years of follow-up, there were 704 participants incidents of ADL disability. The incident rate was 17.22 per 1,000 person-years. Having at least one chronic disease was independently associated with a 39% increased risk of incident ADL disability (adjusted HR, 1.39; 95%CI: 1.16, 1.67). The presence of depression symptoms was independently associated with a 54% increased risk of incident ADL disability (adjusted HR, 1.54; 95%CI: 1.30, 1.82). However, there was no significant additive interaction effect between chronic diseases and depressive symptoms on ADL disability.

CONCLUSION

Chronic diseases and depressive symptoms are associated with an increased risk of ADL disability in middle-aged and older Chinese adults. Improving chronic diseases and depressive symptoms can prevent ADL disability.