Multivariate analysis of independent determinants of ADL/IADL and quality of life in the elderly

Relationship Between Visual Functions and Independence in ADLs and IADLs Among Community-Dwelling Older Adults

IMPORTANCE

Examining an older adult cohort to determine how different types of visual impairment affect independence in activities of daily living (ADLs) and instrumental activities of daily living (IADLs) is an important first step to better understand how to support older adults with specific types of visual dysfunction and enhance their functional abilities.

OBJECTIVE

To examine the relationship between distance visual acuity, near visual acuity, and contrast sensitivity and individual ADLs (dressing, toileting, bathing, eating) and IADLs (laundry, shopping, making hot meals, money management, self-management of medications) among community-dwelling older adults.

DESIGN

A retrospective, cross-sectional design was used to analyze the relationship between visual function and independence in ADLs and IADLs.

PARTICIPANTS

We retrieved data for 4,947 people included in the National Health and Aging Trends Study in 2022.

OUTCOMES AND MEASURES

We used a series of multivariable logistic regression analyses and estimated the relationship between visual function and independence in specific ADLs and IADLs.

RESULTS

Near visual acuity and contrast sensitivity were statistically associated with specific ADLs and IADLs. Distance visual acuity was significantly associated with specific IADLs but was not significantly associated with any ADLs.

CONCLUSIONS AND RELEVANCE

Certain visual impairments were associated with specific ADLs and IADLs and therefore should be considered in the care of community-dwelling older adults. Plain-Language Summary: Normal aging can cause vision to decline. Visual impairment and blindness are expected to nearly double by 2050. Vision is a key component of independence for specific activities of daily living (ADLs; such as dressing, toileting, bathing, eating) and instrumental activities of daily living (IADLs; such as laundry, shopping, making hot meals, money management, self-management of medications). This study examined the relationship between visual impairments and individual ADLs and IADLs among community-dwelling older adults. The study found that certain visual impairments were associated with specific ADLs and IADLs and therefore should be considered in the care of community-dwelling older adults. This study also provides evidence that specific visual impairments are closely linked to older adults' ability to perform ADLs and IADLs. The findings confirm the importance of addressing visual function in occupational therapy practice to support the independence of community-dwelling older adults.

Examine a factor structure for the World Health Organization quality of life measure among adults with ADL limitations in underserved neighborhoods in the United States

BACKGROUND

The extent of the impact of Activity of daily living (ADL) limitations on Quality of Life is well documented. However, the validity of the World Health Organization's Quality of Life-BREF (WHOQOL-BREF) rarely focuses of residents living in underserved settings and on minority inclusion.

OBJECTIVE

to examine the structural validity of WHOQOL-BREF among adults with long-term ADL limitations residing in underserved communities.

METHODS

A cross-sectional survey of patients from underserved communities in the Midwestern United States was conducted between March 2019 and February 2021. Inclusion criteria included a minimum age of 19 years, ADL limitations for more than 5 years, English proficiency, and residence in the targeted zip code areas. A confirmatory factor analysis was conducted to determine the factor structure of the WHOQOL-BREF. The International Statistical Classification of Diseases and Related Health Problems 10 was used to identify individuals with ADL limitations.

RESULTS

A total of 290 people met the criteria. Four latent factors were extracted. However, compared to the original conceptual relationships between variables and latent factors, Physical health to leisure activities, social relationships to self-satisfaction, and environmental health to acceptance of body appearance were additional leadings beyond their conceptual group. This CFA final model fit the data well (ꭓ2 (df = 228) = 320.30, p < 0.001; RMSEA = 0.06; CFI = 0.95; TLI = 0.94).

CONCLUSIONS

These findings underscored the need for accessible environments in their communities. In addition, supportive intra- and interpersonal relationships are needed to improve the QOL for adults with long-term ADL limitations.

Predictors of independence in older people: A longitudinal, population-based study using the CARE75 + cohort

BACKGROUND

The ability to predict older people's functional independence has implications for the development and provision of services to improve individual sense of self and wellbeing.

METHODS

Using linear regression analyses we identified predictors of independence, measured using the Nottingham Extended Activities of Daily Living (NEADL) scale, at 12 and 24-months from baseline. Data were obtained from 1277 community-dwelling people aged ≥ 75. Multivariable models included predictors that were selected through review of existing literature, perspectives of older people, and univariable analyses. Multiple imputation was used to account for missing data.

RESULTS

Participants' mean age was 84.61 years (SD 4.95) and just over half were female (n = 655, 51.29%). At baseline, participants had a mean NEADL score of 53.82 (SD 13.19). Younger age, fewer hours of informal help received, no registered visual impairment, lower frailty, living alone, higher cognitive function, greater physical function, absence of depression, and higher baseline NEADL were significant predictors of greater independence at 12-months. Younger age, higher baseline NEADL score, living alone, less frailty, higher cognitive function, alcohol consumption, greater physical function, and absence of depression predicted greater independence at 24-months.

CONCLUSION

Depression and frailty are important predictors of an older person's independence with other variables such as activities of daily living, age, cognitive function, alcohol consumption, and living status also having an impact over a prolonged period. Refining understanding of the mechanisms within frailty and depression is likely to improve targeting of support and interventions, which will have a lasting impact on older people's independence.

Epidemiological Assessment of Depression, Activities of Daily Living and Associated Factors in Elderly Individuals Aged 65 Years and Older: Evidence from a Population-Based Study

Background: It is a well-established fact that late-life depression represents a significant public health issue, particularly in low- and middle-income countries experiencing rapid demographic aging. Although its clinical and societal impacts are well-recognized, data on the interplay between depressive symptoms and functional status in older populations remain limited for Türkiye. This study aimed to estimate the prevalence of depression among individuals aged 65 years or older, examine its associations with instrumental and basic activities of daily living, and identify key sociodemographic and behavioral correlates. Methods: In this study, data obtained from a population-based survey in 2264 clusters by the Turkish Statistical Institute (TUIK) were used, and weighted data were yielded from 6,036,396 adults aged 65 and over. Depression was measured using the Geriatric Depression Scale (GDS), categorizing participants as "not depressed", "mildly depressed", or "severely depressed". Functional status was evaluated using the Lawton-Brody Instrumental Activities of Daily Living (IADL) Scale and the Katz Activities of Daily Living (ADL) Scale. Logistic regression models, adjusted for age and body mass index (BMI), were used to determine the associations of depression with functional impairment and various covariates, including gender, education, marital status, chronic disease, physical activity, smoking, and alcohol use. Results: Overall, the prevalence of depression in this cohort was 49.9% [95% CI = 48.7-51%], with 36.0% [95% CI = 34.8-37.0%] classified as mild and 13.9% [95% CI = 13.1-14.7%] as severe depression. IADL and ADL scores were negatively correlated with GDS scores (r = -0.416 and r = -0.321, respectively; p < 0.001). In logistic models, lower IADL scores were linked to higher odds of mild (OR = 0.797, 95% CI = [0.796-0.798], p < 0.001) and severe depression (OR = 0.689, 95% CI = [0.688-0.690], p < 0.001). Being semi-dependent or dependent in ADL further escalated depression risk. Female gender, lower education, single/divorced status, chronic disease, and inactivity also emerged as strong predictors. Conclusions: The findings of this study suggest that depression is highly prevalent among older adults in Türkiye, with functional impairment, unfavorable health behaviors, and sociodemographic vulnerabilities heightening risk. Integrating depression screening into geriatric care-alongside interventions to maintain functional independence-may help mitigate the burden of late-life depression in similar contexts.

Instrumental Activities of Daily Living in Neurocognitive Disorders: Determinants and Clinical Implications for Health Promotion

Background/Objectives: Instrumental Activities of Daily Living (IADL) are the key indicators of the autonomy and functional ability in older adults with neurocognitive disorders (NCDs). However, the specific predictors of IADL performance across the NCD spectrum remains insufficiently characterized. This study aimed to identify the cognitive, motor, and caregiver-related determinants of the IADL in individuals with minor and major NCDs. Methods: A cross-sectional study was conducted involving 117 participants referred from a university-based dementia clinic. Standardized tools were administered to evaluate their IADL performance (Lawton IADL Scale), cognition [Addenbrooke's Cognitive Examination III (ACE-III)], Functional Cognitive Assessment Scale (FUCAS)], motor functions, balance, and mobility [Tinetti Test, Timed Up and Go (TUG)], emotional status [Geriatric Depression Scale (GDS)], neuropsychiatric symptoms [Neuropsychiatric Inventory (NPI)], and caregiver burden [Zarit Burden Interview (ZBI)]. Multiple regression analyses were performed to identify the significant predictors of IADL performance. Results: In the total sample (n = 117), the IADL performance was significantly predicted via ACE-III, FUCAS, and Tinetti-balance (adjusted R2 = 0.729). In the minor NCD group (n = 41), the significant predictors included sex, FUCAS, GDS, Tinetti-balance, and TUG (adjusted R2 = 0.725). In the major NCD group (n = 76), ACE-III, FUCAS, and Tinetti-balance remained the significant predictors (adjusted R2 = 0.634). Female sex and a worse profile on the other variables were associated with lower IADL scores. Conclusions: Global cognitive decline, executive dysfunction in everyday problem-solving situations, and balance impairment are the key determinants of IADL performance across both minor and major NCDs. Female sex and depressive symptoms further predicted the IADL performance in the minor NCD group. These findings highlight the need for multidisciplinary assessment and intervention strategies to promote health and autonomy and preserve the functional independence in older adults with NCDs.

Psychometric Properties Under Exploratory Factor Analysis, Confirmatory Factor Analysis, Measurement Invariance, and Item Response Theory Models of Functional Activities Questionnaire (10-Items) Among Iranian Older Adults

BACKGROUND/OBJECTIVE

This study aims to evaluate the Functional Activities Questionnaire (FAQ; 10 items) for assessing the quality of daily living activities among older adults in Iran.

METHODS

A total of 680 participants completed the Persian version of FAQ. We used the Rasch partial credit model, exploratory factor analysis, confirmatory factor analysis, and receiver operating characteristic analysis to evaluate the psychometric properties of the FAQ among Iranian older adults.

RESULTS

The findings from exploratory factor analysis, confirmatory factor analysis, and item response theory analysis supported the usefulness of the Persian version of the FAQ to be used in Iran. The one-factor model of the FAQ exhibited strong internal consistency, as evidenced by McDonald's omega (≥0.75), Factor Determinacy Index (≥0.8), and Overall Reliability of Fully-Informative prior Oblique Nonequivalent Anchor Parameter scores index (≥0.8). In addition, we observed measurement invariance and consistent response patterns for all items in a logical sequence, indicating the good internal consistency of the FAQ relevance.

CONCLUSION

Persian version of FAQ-10 items is a valid and reliable instrument for measuring daily living activities among Iranian older adults. Significance/Implications: The FAQ will be a practical tool for measuring activities of daily living in community-based settings as part of comprehensive geriatric assessment in older adults.

The impact of information technology applications on the quality of life of disabled older adults in nursing homes in China: a qualitative study

Objective

China's smart aging policy system has been evolving to become more comprehensive, continuously promoting the application of information technology in nursing homes. This study explores the adaptation process and experiences of disabled older adults with the use of information technology in nursing homes from four perspectives: physiological, psychological, social, and environmental, and examines its impact on their quality of life.

Methods

An interpretative phenomenological approach was adopted, with purposive sampling used to recruit participants. Semi-structured interviews were conducted with 14 disabled older adults, and the data were analyzed using Van Manen's phenomenology of practice method.

Results

Four main themes and 16 sub-themes were identified: Physical Health and Functional Capacity: subjective health perception, physical functioning, chronic disease management, sleep quality, and nutritional status; Psychological Wellbeing and Emotional Support: attitudes toward aging, negative emotions, emotional companionship, and sense of meaning in life; Social Relationships and Social Engagement: interactions with family and friends, participation in social activities, social roles, and social support; and Environmental Adaptation and Digital Challenges: safety and comfort of the living environment, ease of independent mobility, the 'digital divide', and protection of personal privacy and data.

Conclusion

The application of information technology in nursing homes in China has partially resolved longstanding issues in traditional older adults care, such as inaccurate health management, lack of personalized and diverse services, and inefficient resource allocation. These advancements have contributed to improving the quality of life for older adults in nursing homes. However, new challenges have emerged, including the 'digital divide,' data misuse, and privacy breaches. To fully leverage the benefits of information technology, it is crucial to enhance the digital literacy of disabled older adults, provide robust technical support during implementation, and prioritize data security and privacy protection. These measures will help maximize the positive effects of information technology on the quality of life of disabled older adults.

Interaction effect between sleep duration and dynapenic abdominal obesity for predicting functional disability: A longitudinal study

OBJECTIVE

To assess the interaction of dynapenic abdominal obesity (DAO) and sleep duration on the risk of functional disability among middle-aged and older Chinese individuals.

METHODS

Data were extracted from the China Health and Retirement Longitudinal Study conducted in 2011, 2013, 2015, 2018, and 2020. A total of 6,343 participants were enrolled in this retrospective cohort study. Sleep duration was obtained through face-to-face interviews. Dynapenia (D) and abdominal obesity (AO) were defined by handgrip strength and waist circumference, respectively. Functional disability was assessed according to activities of daily living scales. Cox proportional hazard models analyzed the interactions of DAO and sleep duration on functional disability.

RESULTS

Over a mean follow-up of 10 years, 3,879 (61.2%) participants reported functional disability. Individuals with short sleep duration and D/AO (appropriate but short: RR = 1.42, 95% CI = 1.10-1.82, too short sleep: RR = 1.54, 95% CI = 1.16-2.06), long sleep duration and D/AO (appropriate but long: RR = 1.61, 95% CI = 1.11-2.33; too long: RR = 1.63, 95% CI = 1.15-2.32), were more likely to develop functional disability than those with normal sleep duration and ND/NAO in the fully adjusted model. The multiplicative interaction between the short sleep group and D/NAO or ND/AO were both significant. Middle-aged individuals and females were more susceptible to the effects of short sleep and DAO, while elderly individuals and males were more susceptible to the effects of long sleep and DAO.

CONCLUSIONS

Short and long sleep durations combined with DAO increase the risk of functional disability. Managing waist circumference and improving grip strength in middle-aged and older adults with abnormal sleep durations may help prevent functional disability.

Advances in hemiplegia rehabilitation: modern therapeutic interventions to enhance activities of daily living

Hemiplegia severely impairs patients' abilities to perform activities of daily living (ADL), thus affecting their overall quality of life and independence. Often caused by stroke or other forms of brain injury, hemiparesis causes long-term impairment of upper and lower limb function, hindering the patient's ability to manage self-care. With advances in modern rehabilitation medicine, emerging therapeutic interventions such as electrophysiological feedback, virtual reality, and robot-assisted therapy are increasingly being applied to the rehabilitation of hemiplegic patients. These interventions, combined with precise technical support through individualized training, have been shown to be effective in improving upper and lower limb function as well as enhancing ADL abilities of hemiplegic patients. This paper reviews recent advances in modern hemiplegic rehabilitation therapeutic interventions, assesses their impact on improving ADL performance, and examines their effectiveness in improving functional outcomes and quality of life for patients. These findings suggest that modern rehabilitation approaches have significant clinical potential to provide more personalized and effective treatment strategies for people with hemiplegia.

Trends of impairment of the activities of daily living in Chinese older adults: an age-period-cohort analysis

BACKGROUND

Based on age, period, and cohort, this study aimed to understand the trend of impairment of activities of daily living (ADL) and its influencing factors in older adults in China and to provide a basis for the development of appropriate interventions.

METHODS

This longitudinal follow-up study was conducted on a sample of 40,748 cases aged ≥ 60 years from the China Family Panel Studies (CFPS) database of 6 periods, using the six-item ADL scale to measure impaired ability to perform daily activities in older adults. Incorporating independent variables affecting ADL impairment in older adults based on the health ecology theory, a stratified age-period-cohort mixed-effects model was used to analyze the factors influencing impaired ADL in older adults.

RESULTS

Age, different periods, and birth cohort had an independent effect on females suffering from chronic diseases, having lower life satisfaction (dissatisfied, very dissatisfied), living in the western region, residing in rural areas, having per capita household income levels of middle-high, middle-low, lower-middle, lower-middle, and going to specialized and general hospitals were risk factors for ADL impairment in older adults. Smoking, drinking alcohol, exercising, having high life satisfaction (satisfied), being married, having higher education, and having urban/rural/rural residents' health insurance and employee health insurance were protective factors for ADL impairment in older adults.

CONCLUSIONS

It is important to pay further attention to the current situation of ADL impairment in older adults from the perspective of the whole life cycle and the whole population and to take timely and targeted intervention strategies and preventive measures to improve the health of older adults in different dimensions from the individual to the macro level.

How does social support mediate the relationship between functional status and mental health among older adults in China? An exploration of the role of children's visits

OBJECTIVE

To examine the mediating role of social support, as outlined in the Convoy Model of Social Relations, in the association between functional status and mental health, with a focus on those with disabilities.

METHODS

The study included 15,498 participants aged 65 to 105 years old from the 2018 wave of the Chinese Longitudinal Healthy Longevity Survey (CLHLS). Spearman analysis and mediation analysis were performed.

RESULTS

Social support was significantly positively correlated with mental health (p < 0.001), except for financial aid. Social support partially mediated the effect of functional status on mental health. Among those with disabilities, the frequency of children's visits mediated this relationship (effect = -0.009, 95 % CI:0.016 to -0.004).

CONCLUSIONS

Social support mediated the relationship between functional status and mental health, with children's visits emerging as a more potent mediating factor compared to other types of support, particularly for those with disabilities.

Prevalence and sociodemographic characteristics of functional impairment in community-dwelling older adults in China: a cross-sectional study

OBJECTIVES

Functional impairment is an early stage of disability, and timely identification and intervention are critical for the health of older adults. However, little is known about the functional impairment of Chinese older adults due to the absence of specialised assessment tools. This study aimed to explore the prevalence and socio-demographic characteristics of functional impairment in Chinese community-dwelling older adults using the Function Impairment Screening Tool (FIST), which was previously developed based on the Delphi method.

DESIGN

Cross-sectional study.

SETTING

Community-based.

PARTICIPANTS

The study included 6444 community-dwelling older adults from the China Comprehensive Geriatric Assessment Study.

RESULTS

The FIST identified functional impairment in 31.3% of Chinese community-dwelling older adults. The prevalence was higher among women and individuals in rural areas and increased with age. Illiteracy, no spouse, living alone, poor self-reported health, low income, limited meat intake, less exercise, chronic diseases and geriatric syndromes were associated with functional impairment. Furthermore, after adjusting for related variables, functional impairment was independently associated with disability (OR=138.5, 95% CI 70.0 to 273.9), frailty (OR=13.7, 95% CI 10.3 to 18.3), immobility (OR=6.9, 95% CI 5.4 to 8.9), fractures (OR=2.2, 95% CI 1.5 to 3.3) and falls (OR=2.6, 95% CI 1.8 to 3.7).

CONCLUSION

Approximately one-third of Chinese community-dwelling older adults experienced functional impairment, and its prevalence was associated with socio-psychological characteristics, lifestyle, chronic diseases and geriatric syndromes.

Impact of Comorbidities on Prognosis and Treatment Outcomes in Elderly Patients with Hodgkin Lymphoma

Background/Objectives: Hodgkin lymphoma (HL) primarily affects young adults, but about 20% of cases occur in patients over the age of 60 years. Older individuals often have comorbidities and poorer functional status, which can affect treatment choices. Methods: We retrospectively analyzed data from HL patients over 60 years old who were treated at our institution between January 2010 and December 2023. We examined various factors, such as blood parameters (e.g., platelet count, lactate dehydrogenase (LDH), C-reactive protein (CRP)), PET/CT results and comorbidities (e.g., hypertension, diabetes, cardiovascular diseases), to assess their impact on overall survival (OS) and progression-free survival (PFS). Diagnostic efficiency was determined via receiver operating characteristic analysis, while the survival outcomes were evaluated using the Cox proportional hazards model. Results: A total of 35 patients with a median age of 68 were treated. The most common subtype was nodular sclerosis, and 72% of patients were in advanced stages at diagnosis. Treatment varied by age, with younger patients receiving ABVD and older patients (80-89) receiving brentuximab vedotin with dacarbazine. The survival of older patients, when analyzed by age groups, did not show a significant difference in the OS (p = 0.16) and PFS (p = 0.11). Comorbidities significantly worsened survival, with patients who scored > 7 on the Charlson Comorbidity Index (CCI) showing a 5-year PFS of 41.3%, compared to 91.3% for those who scored ≤ 7. Among the tested laboratory parameters, a platelet count over 310.5 G/L and an absolute lymphocyte count below 0.47 G/L were found to be independent risk factors for OS. Patients with neither or only one of these risk factors demonstrated a 5-year OS of 81.7%, whereas those presenting with both risk factors experienced a reduced 5-year OS of 70%. For PFS, a white blood cell count > 8.48 G/L, a platelet count > 310.5 G/L, and advanced age (>73.5 years) were identified as significant adverse prognostic factors. Patients with none of these risk factors had a 5-year PFS of 100%, whereas those with ≥ 1 risk factor had a 5-year PFS of 35.6%. Conclusions: Comorbidities play a greater role in prognosis than chronological age, emphasizing the need for personalized treatment approaches.

A chain mediation model reveals the association between depression and cognitive function in the elderly

The purpose of this study was to explore the relationship between depression, cognitive function, social activities and activities of daily living ( ADL ), and verify whether social activities and ADL have a chain mediating effect between depression and cognitive function. Using the data of the fourth phase of the China Health and Retirement Longitudinal Study ( CHARLS ), 7547 elderly samples were studied. Correlation analysis and Bootstrap method were used to analyze the data to test whether social activities and ADL played a chain mediating role between depression and cognitive function in the elderly. In this study, the direct effect of depression on the cognitive function of the elderly accounted for 36.85% of the total effect. The indirect effects of social activities and ADL on depression and cognitive function of the elderly accounted for 15.99% and 44.64% of the total effects, respectively. At the same time, the chain mediating effect of social activities and ADL was significant, accounting for 2.44% of the total effect. The effect of depression on the cognitive function of the elderly is achieved through social activities, ADL and the chain mediating effect of social activities and ADL.

Disparities in Vision-Related Functional Impairments Among Adults in the United States

PURPOSE

To investigate the relationships between vision-related functional impairment (VFI) with sociodemographic and healthcare access factors in a representative sample of the United States population.

METHODS

Data from the 2017 National Health Interview Survey (NHIS) were used. The NHIS involves responses from the U.S. civilian, non-institutionalized population aged 18 years or older. It provides self-reported data on demographic characteristics, socioeconomic factors, health status, and healthcare access. NHIS participants who responded to at least one of our target questions about VFI were included in the study. VFI was defined for participants based on their 'yes' or 'no' responses to target questions about experiencing a VFI. Data analysis was performed through univariable and multivariable logistic regression.

RESULTS

Overall, 26,711 participants were included, of which 6926 (25.9%) participants reported experiencing a VFI. In univariable analysis, there were greater odds of VFI among females (OR: 1.16, 95% CI: 1.07-1.26, p < 0.001), and participants with less than a high school degree compared to those with an advanced degree (OR: 1.17, 95% CI: 1.02-1.33, p = 0.02). Among economic and healthcare access factors, greater odds of VFI was associated with public health insurance versus private coverage (OR: 1.19, 95% CI: 1.07-1.32, p = 0.001), having delayed medical care due to costs (OR: 1.86, 95% CI: 1.86-2.10, p < 0.001), and being unemployed (OR: 1.39, 95% CI: 1.26-1.53, p < 0.001). Participants whose incomes were lower than the poverty threshold (OR: 1.54, 95% CI: 1.32-1.80, p < 0.001) had higher odds of VFI than those with income >5× poverty threshold.

CONCLUSIONS

Several demographic and economic factors are associated with VFI in a representative sample of the U.S. population. These results highlight the importance of addressing social and economic factors that are associated with the development of VFI.

Aging Well? Exploring Self-Reported Quality of Life in the Older Austrian Population Based on Repeated Cross-Sectional Data

Increase in life expectancy around the world puts aging societies with all their challenges on the Global Public Health agenda. In Austria, additional years of life gained are not spent in good health, as healthy life expectancy is far below the European average. Using repeated cross-sectional data from three waves of the Austrian Health Interview Survey (2006, 2014 and 2019), including a total of 10,056 participants aged 65 years and above, this study examined the change in self-reported quality-of-life (QoL) over time and explored associated factors. QoL, estimated by domain scores of the WHOQOL-BREF questionnaire, increased over time but decreased with age in all survey waves. Observed mean scores were significantly higher in males than in females in all QoL domains except the social domain but sex differences disappeared in most domains in the multivariable regression analyses. Instead, factors associated with significantly higher QoL scores included younger age, higher socioeconomic status, living in Western Austria and having no chronic conditions. Statistically significant observed sex differences in QoL in the older-aged Austrian population disappeared when adjusting for income and education. Strategies and measures to increase financial capabilities may have a significant impact on QoL and well-being in this age group.

Nutritional Status and Quality of Life: Urban-Rural Disparities and the Impact of Obesity

The shift in dietary habits has reshaped the population's health profile, leading to a rise in overweight individuals and a subsequent decline in health-related quality of life (HRQoL). This study evaluated the correlations between demographic, social, and health-related factors and HRQoL in rural and urban areas of Bahia, Brazil. The cross-sectional study included 124 participants aged 18-60 who underwent interviews, anthropometric measurements, and laboratory tests. The WHOQol-BREF instrument assessed the HRQoL. The results showed that rural participants had lower educational levels, income, and access to sanitation. Despite these challenges, rural residents reported better HRQoL in psychological, social relations, and health satisfaction domains, although differences diminished after age adjustment. Urban participants, who had higher rates of obesity and related metabolic risks experienced a negative correlation between BMI and HRQoL, especially in the social relationships domain. The study highlights that environmental and social factors, such as weight-related stigma and social connections, significantly influence HRQoL in urban areas, emphasizing the need for public health interventions that address both nutritional status and urban-specific challenges.

Activities of Daily Living Disability Transition Patterns in Older Adults with Chronic Diseases: A Four-Year Cohort Study in China

BACKGROUND

Older adults with chronic diseases often experience higher rates of Activities of Daily Living (ADL) disability, with research primarily examining the transition between states of ADL disability and non-disability. The current study aims to analyze the patterns and factors of mutual transitions between multiple different ADL disability states in older adults with chronic diseases.

METHODS

This longitudinal study utilized data from the Shanghai Elderly Care Unified Needs Assessment (SECUNA) spanning 2014 to 2017, with 2014 being the baseline. The study included older adults aged 60 years and older with chronic diseases. Using the Markov model, individuals were classified into three states: no ADL disability, mild ADL disability, and severe ADL disability. Transition patterns were analyzed by calculating the frequency, intensity, and probability of transition, and the influencing factors of six transition scenarios were evaluated.

RESULTS

Older adults with mild ADL disability were more likely to experience improvement (transition intensity: 0.4731) rather than deterioration (transition intensity: 0.2226) in their ADL disability states. However, those with severe ADL disability faced challenges in improving their states (transition intensities: 0.0068 and 0.1204). Among the six ADL disability transition scenarios, place of residence was associated with four scenarios, age and economic sources were associated with three scenarios, sex was associated with two scenarios, and other factors were associated with one scenario.

CONCLUSIONS

The transition patterns and factors differ among individuals with varying ADL disability states. It is essential for relevant agencies to implement tailored preventive healthcare strategies to effectively manage the health status of older adults with chronic diseases.

Associations between sensory impairment and functional limitations among older Chinese adults: mediating roles of social isolation and cognition

BACKGROUND

The high prevalence of sensory impairment and functional limitations in older adults is a significant concern, yet there is limited understanding of the relationship between these two conditions. Therefore, the objective of this study was to investigate the pathways connecting sensory impairment and functional limitations by examining serial multiple mediating effects of social isolation and cognition in older adults.

METHODS

Using the China Health and Retirement Longitudinal Study dataset, a sample of 4871 older adults was selected. The study variables included sensory impairment, functional limitations, social isolation and cognition, and other covariates. A hierarchical multiple linear regression model was used to assess the association between sensory impairment and functional limitations. Mediation analysis was conducted to explore the sequential multiple mediating effects of social isolation and cognitive function in the relationship between sensory impairment and functional limitations.

RESULTS

Our findings revealed a significant and positive association between sensory impairment and functional limitations (B = 0.615, 95% CI: 0.397, 0.834). After adjusting for social isolation and cognitive function, the impact of sensory impairment on functional limitations accounted for 87.19% of the total effect. Additionally, approximately 12.81% of the significant relationship between dual sensory impairment and functional limitations was mediated by social isolation and cognitive function. A serial multiple mediating pathway (sensory impairment → social isolation → cognition → functional limitations) was identified, with a coefficient of 0.013 (95% CI: 0.006, 0.020).

CONCLUSIONS

Our study provides evidence for the mediating effects of social isolation and cognition in the relationship between sensory impairment and functional limitations. Given the prevalence of functional limitations among older adults with sensory impairment, it is crucial to consider social isolation and cognitive function in efforts to reduce the burden of disability care. Future validation of these findings through longitudinal studies is necessary.

A Structural Equation Model for Understanding the Relationship between Cognitive Reserve, Autonomy, Depression and Quality of Life in Aging

In recent years, aging has become a focal point of scientific research and health policies due to the growing demographic trend of an aging worldwide population. Understanding the protective and risk factors that influence aging trajectories is crucial for designing targeted interventions that support healthy aging and improve people's quality of life. The aim of this study was to explore the relationships between variables of aging. A total of 103 Italian participants (55-75 years old) underwent multidimensional assessments that covered cognitive, functional, emotional, and quality of life dimensions. Structural equation modeling was used to analyze the data and elucidate the relationships between depression, quality of life, cognitive reserve, executive functions, and daily autonomy. The findings revealed that a higher quality of life was associated with reduced depressive symptoms. In addition, cognitive reserve emerged as a protective factor positively correlated with both quality of life and daily autonomy. In this study, quality of life was determined using physical health, psychological, social relationships, and environmental domains. Identifying the significant relationships between these variables in a sample of late adults and young-aged people has given us useful elements for designing psycho-educational interventions that can be aimed at preventing frailty in later old age or supporting healthy longevity.

The impact of social activities on mental health among older adults in China

Background

Understand the current situation of social activities among older adults and its impact on mental health, providing policy basis and intervention measures to improve the mental health of the older adult.

Method

Collect relevant data from 8,181 older adults aged ≥ 60 years old from the 2020 China Health and Retirement Longitudinal Study (CHARLS), constructing an analysis framework for social activities of older adults in China from three aspects: participation in social activities, number of social activities, frequency of social activities, and describe them, then analyzing the impact of social activities on their mental health using OLS and 2SLS regression models. This study also discusses the impact of eight social activities on the mental health of older adult people through subgroup.

Result

Among 8,181 older adults aged 60 and above, 3,808 participated in social activities (56.24%), average number of social activities is 0.71, and average frequency of social activities is 1.31 times. The average score of mental health level measured by CES-D is 15.24 points. Participate in social activities can reduce the depression level of the older adult (β = -0.352, 95%CI: -0.547~-0.158); the more social activities the older adult participate in, the lower the depression level of the older adult (β = -0.214, 95%CI: -0.313~-0.115); the higher the frequency of participating in social activities, the lower the depression level of the older adult (β = -0.133, 95%CI: -0.182~-0.083). In summary, social activities can improve the mental health level of the older adults in China. As for different types of social activities, visiting and socializing with friends, participating in club organization activities, playing mahjong, chess, cards, or going to community activity rooms and attending school or training courses can improve the mental health of the older adult.

Discussion

The social activities in three dimensions among older adults in China need to be further improved, and participating in social activities can help improve their mental health. The conclusion provides important policy implications for encouraging and supporting older adults to participate in various social activities, increasing the number and frequency of older adult social activities, then help improving the mental health level of older adults.

The mediating effect of depressive symptoms on the association between childhood friendship and physical function in middle-aged and older adults: Evidence from the China Health and Retirement Longitudinal Study (CHARLS)

BACKGROUND

This study examines the extent to which depressive symptoms mediate the link between childhood friendship (CF) and physical function among middle-aged and older adults in China.

METHODS

China Health and Retirement Longitudinal Study (CHARLS) data were used; specifically, CHARLS life history survey (conducted from June 1-December 31, 2014) and follow-up health survey (conducted from July 1-September 30, 2015) data were used. The Sobel test, Bootstrap test and multivariable logistic regression were performed to examine the mediating role of depressive symptoms (measured by the 10-item Center for Epidemiologic Studies Depression Scale) in the association between CF (measured by a standardized retrospective questionnaire) and physical function, which was measured by basic activities of daily living (BADL) disability, instrumental activities of daily living (IADL) disability, and grip strength.

RESULTS

A total of 12,170 participants aged 45 years or older were included in this cross-sectional study. After controlling for covariates, low-quality CF was associated with an increased prevalence of BADL disability (OR = 1.18; 95 % CI = 1.05-1.32), IADL disability (OR = 1.25; 95 % CI = 1.12-1.40), and low grip strength (OR = 1.21; 95 % CI = 1.09-1.34). The proportion of the mediating effect of depressive symptoms was 48 % for CF and BADL, 40 % for CF and IADL, and 11 % for CF and grip strength. Depressive symptoms and worse CF have a joint effect on BADL disability (OR = 3.30; 95 % CI = 2.82-3.85), IADL disability (OR = 3.52; 95 % CI = 3.03-4.09), and low grip strength (OR = 1.65; 95 % CI = 1.43-1.92).

LIMITATIONS

Not all potential confounding factors (such as childhood behavioural problems, genetic factors, and memory function) were measured in the analysis, and there may have been recall bias in the retrospective collection of CF data.

CONCLUSIONS

Individuals with high-quality CF were more likely to have a decreased prevalence of impaired physical function in later life. Depressive symptoms acted as a mediator associated with the development of CF.

Relationship between social participation and depressive symptoms in patients with multimorbidity: the chained mediating role of cognitive function and activities of daily living

OBJECTIVE

The potential mechanisms linking social participation and depressive symptoms in Chinese individuals with multimorbidity are not yet fully understood. This study aims to explore how cognitive function and activities of daily living (ADLs) mediate the relationship between social participation and depressive symptoms in individuals with multimorbidity.

METHODS

We selected 3782 participants with multimorbidity from the 2018 China Health and Retirement Longitudinal Study. Data related to social participation, cognitive function, ADLs, and depressive symptoms were extracted. Regression and Bootstrap analyses were used to explore the sequential mediating effects of social participation, cognitive function, ADLs, and depressive symptoms.

RESULTS

(1) There was a significant correlation between social participation, cognitive function, activities of daily living, and depressive symptoms (p < 0.01). (2) Social participation directly affected depressive symptoms (β = -0.205, p < 0.05). (3) Cognitive function (β = -0.070, p < 0.01) and activities of daily living (β = -0.058, p < 0.01) played separate mediating roles in the effect of social participation on depressive symptoms. (4) Cognitive function and activities of daily living had a chain-mediated role in the relationship between social participation and depressive symptoms in patients with multimorbidity (β = -0.020, p < 0.01).

CONCLUSION

A chained mediating effect was found between cognitive function, ADLs, social participation, and depressive symptoms in patients with multimorbidity. Social participation was found to improve the cognitive function of patients with multimorbidity, which in turn enhanced their daily life activities and ultimately alleviated their depressive symptoms.

Multimodal Prehabilitation for Patients with Crohn's Disease Scheduled for Major Surgery: A Narrative Review

Approximately 15-50% of patients with Crohn's disease (CD) will require surgery within ten years following the diagnosis. The management of modifiable risk factors before surgery is essential to reduce postoperative complications and to promote a better postoperative recovery. Preoperative malnutrition reduced functional capacity, sarcopenia, immunosuppressive medications, anemia, and psychological distress are frequently present in CD patients. Multimodal prehabilitation consists of nutritional, functional, medical, and psychological interventions implemented before surgery, aiming at optimizing preoperative status and improve postoperative recovery. Currently, studies evaluating the effect of multimodal prehabilitation on postoperative outcomes specifically in CD are lacking. Some studies have investigated the effect of a single prehabilitation intervention, of which nutritional optimization is the most investigated. The aim of this narrative review is to present the physiologic rationale supporting multimodal surgical prehabilitation in CD patients waiting for surgery, and to describe its main components to facilitate their adoption in the preoperative standard of care.

The relationship between health behaviors and quality of life: the mediating roles of activities of daily living and psychological distress

Objective

The aim of this study is to examine the role of activities of daily living performance (ADLs) and psychological distress in mediating the process by which health behaviors affect QOL.

Methods

A non-probabilistic study was conducted among 1,065 older adult people older than 60 years. Participants were assessed using the Barthel Index, Functional Activities Questionnaire (FAQ), Kessler Psychological Distress Scale (K10), Australian Active Survey, and EQ-VAS score. The SPSS22.0 software was used to analyze the differences in QOL scores among older adults with different demographic characteristics. Pearson correlation analysis was used to analyze the correlation between health behaviors, psychological distress, ADLs, and QOL. Amos23.0 software was used to construct structural equation model (SEM) to analyze the path of health behavior affecting QOL and the mediating role of BADLs, IADLs and psychological distress.

Results

(1) The direct effect of health behaviors on QOL was not significant in the model; (2) ADLs had multiple mediating effects on the relationship between health behaviors and QOL, and the incidence of ADL limitation was negatively correlated with the reported QOL in the older adult; (3) Psychological distress had a significant mediating effect on the relationship between health behaviors and QOL.

Conclusion

The results of this study elucidated the mechanisms of the correlation between health behaviors and QOL, and added to the existing literature. In addition, these mediating factors and indirect pathways have been identified as targets for intervention to improve the QOL of older adult individuals, which is important for achieving healthy aging.

Is patients' activities of daily living self-care score in Norwegian home care a proxy for workers standing at work?

BACKGROUND

Prolonged standing at work may contribute to increased risk of musculoskeletal pain in home care workers. Patients' activities of daily living (ADL) score may be a proxy for home care workers' standing time at work. The objective of the present study was to investigate the association between patients' ADL self-care score, and workers standing time.

METHODS

This cross-sectional study measured time spent standing, sitting and in physical activity for seven days using thigh-worn accelerometers, among 14 home care workers. Patients' ADL self-care scores are routinely adjusted by home care nurses, and time intervals of home care visits are stored in home care services electronic patient journal. We collected ADL self-care scores and start and end time points of visits, and categorized ADL self-care scores as low (ADL ≤ 2.0), medium (ADL > 2.0 to 3.0) or high (ADL > 3.0). Physical behavior data were transformed to isometric log-ratios and a mixed-effect model was used to investigate differences in physical behavior between the three ADL self-care score categories.

RESULTS

We analyzed 931 patient visits and found that high ADL self-care scores were associated with longer standing times relative to sitting and physical activity, compared to low ADL score (0.457, p = 0.001). However, no significant differences in time spent standing were found between high and medium ADL patient visits (0.259, p = 0.260), nor medium and low (0.204, p = 0.288). High ADL score patients made up 33.4% of the total care time, despite only making up 7.8% of the number of patients.

CONCLUSION

Our findings suggest that caring for patients with high ADL self-care score requires workers to stand for longer durations and that this group of patients constitute a significant proportion of home care workers' total work time. The findings of this study can inform interventions to improve musculoskeletal health among home care workers by appropriate planning of patient visits.

Kidney function and other associated factors of sarcopenia in community-dwelling older adults: The SCOPE study

AIM

Sarcopenia is associated with several factors and medical conditions among older adults, though previous research has shown limitations and inconsistencies, especially regarding chronic kidney disease (CKD). We investigated the clinical and laboratory variables associated with sarcopenia and severe sarcopenia in older adults, focusing on kidney function measures.

METHODS

Data from community-dwelling adults aged ≥75 years participating in the SCOPE multicenter prospective cohort study were assessed cross-sectionally. Comprehensive geriatric assessment was conducted; sociodemographic and lifestyle factors, clinical variables and comorbidities, anthropometric and bioelectrical impedance analysis, blood and urine laboratory variables were collected. EWGSOP2 revised criteria were used to define sarcopenia and its severity. Estimated glomerular filtration rate (eGFR) was calculated using creatinine and non-creatinine-based equations, and CKD stages were defined accordingly.

RESULTS

1420 participants were included, prevalence of sarcopenia was 10.6 %, and 6 % had severe sarcopenia. Multivariate logistic regression analysis showed that age [OR =1.14; 95 %CI (1.09-1.19)], body mass index (BMI) [0.83 (0.79-0.88)], disability performing instrumental activities of daily living (IADL) [2.61 (1.69-4.06)], Mini Mental State Examination (MMSE) score <24 [2.75 (1.62-4.67)], osteoporosis [2.39 (1.55-3.67)], and stage 4 CKD defined by CKD-EPIBTP-B2M, a non-creatinine-based eGFR equation [2.88 (1.11-7.49)], were independently associated with sarcopenia; as were specifically with severe sarcopenia, with more pronounced associations.

CONCLUSIONS

In community-dwelling older adults, sarcopenia is a relevant condition and is associated with severe CKD, older age, IADL, cognitive impairments, osteoporosis and low BMI. These factors should be assessed for proper identification and management of older patients with sarcopenia, and even more so with severe sarcopenia.

Predictors of basic and instrumental activities of daily living among older adults with multiple chronic conditions

BACKGROUND

Understanding the predictors of functional status can be useful for improving modifiable predictors or identifying at-risk populations. Researchers have examined the predictors of functional status in older adults, but there has not been sufficient study in this field in older adults with multiple chronic conditions, especially in Iran. Consequently, the results of this body of research may not be generalizable to Iran. Therefore, this study was conducted to determine the predictors of functional status in Iranian older adults with multiple chronic conditions.

METHODS

In this cross-sectional study, 118 Iranian older adults with multiple chronic conditions were recruited from December 2022 to September 2023. They were invited to respond to questionnaires inquiring about their demographic and health information, basic activities of daily living (BADL) and instrumental activities of daily living (IADL), depression and cognitive status. The predictors included age, gender, marital status, education, number of chronic conditions, and depression. Descriptive and analytical statistical tests (univariate and multiple regression analysis) were used to analyze the data.

RESULTS

The majority of participants were married (63.9%) and women (59.3%). Based on the results of the multiple regression analysis, age (B=-0.04, P = 0.04), depression (B=-0.12, P = 0.04), and IADL (B = 0.46, P < 0.001) were significant predictors for functional status in terms of BADL. Also, marital status (B=-0.51, P = 0.05), numbers of chronic conditions (B=-0.61, P = 0.002), and BADL (B = 0.46, P < 0.001) were significant predictors for functional status in terms of IADL.

CONCLUSION

The findings support the predictive ability of age, marital status, number of chronic diseases, and depression for the functional status. Older adults with multiple chronic conditions who are older, single, depressed and with more chronic conditions number are more likely to have limitations in functional status. Therefore, nurses and other health care providers can benefit from the results of this study and identify and pay more attention to the high risk older adult population.

The bidirectional relationship between activities of daily living and frailty during short-and long-term follow-up period among the middle-aged and older population: findings from the Chinese nationwide cohort study

Objective

Frailty and activities of daily living (ADL) disability are common conditions among older population. Studies on the bidirectional relationship between frailty and ADL are limited. The current study examined the cross-sectional and longitudinal associations between frailty and ADL in middle-aged and older Chinese individuals.

Methods

The data was collected through the China Health and Retirement Longitudinal Study (CHARLS), conducted in 2011, 2013, and 2015, encompassing 17,284 individuals aged ≥45 years. We excluded individuals without follow-up data. 2,631 participants finished the baseline survey. The definition of ADL disability encompasses difficulty in engaging in either basic activities of daily living (BADL) or instrumental activities of daily living (IADL). Frailty was assessed according to the Fried criteria. Logistic regression was utilized to examine odds ratios (ORs) and 95% confidence intervals (CIs) for assessing the cross-sectional relationships between ADL with frailty at baseline. The prediction effects were explored using Cox proportional hazards analysis, testing hazard ratios (HRs) and 95%CIs.

Results

In cross-sectional analysis, BADL [OR = 6.660 (4.519-9.815)], IADL [OR = 5.950 (4.490-7.866)], and ADL [OR = 5.658 (4.278-7.483)] exhibited significant associations with frailty; frailty demonstrated significant associations with BADL [OR = 6.741 (4.574-9.933)], IADL [OR = 6.042 (4.555-8.016)] and ADL [OR = 5.735 (4.333-7.591)]. In longitudinal analysis, IADL and ADL were significantly associated with frailty in participants without baseline frailty in the short-term period [IADL: HR = 1.971 (1.150-3.379), ADL: HR = 1.920 (1.146-3.215)], IADL exhibited a significant association with frailty in the long-term period [HR = 2.056 (1.085-3.895)]. There was no significant link observed between frailty and an elevated risk of disability onset in BADL, IADL and ADL during the short-term period. When considering the long-term perspective, frailty exhibited a significant association with an elevated risk of disability onset in BADL [HR= 1.820 (1.126-2.939)] and IADL [HR = 1.724 (1.103-2.694)].

Conclusion

In middle-aged and older adults, ADL and IADL disability predicted frailty after 2-year follow-up, IADL disability predicted frailty after 4-year follow-up. Moreover, frailty did not predict BADL, IADL and ADL disability after 2-year follow-up. However, frailty predicted BADL and IADL disability after 4-year follow-up.

The Prediction of Quality of Life by Frailty and Disability among Dutch Community-Dwelling People Aged 75 Years or Older

The present study aimed to examine the prediction of quality of life by frailty and disability in a baseline sample of 479 Dutch community-dwelling people aged 75 years or older using a follow-up period of 8 years. Regarding frailty, we distinguish between physical, psychological, and social frailty. Concerning physical disability, we distinguish between limitations in performing activities in daily living (ADL) and instrumental activities in daily living (IADL). The Tilburg Frailty Indicator (TFI) and the Groningen Activity Restriction Scale (GARS) were used to assess frailty domains and types of disability, respectively. Quality of life was determined by the WHOQOL-BREF containing physical, psychological, social, and environmental domains. In our study, 53.9% of participants were woman, and the mean age was 80.3 years (range 75-93). The study showed that psychological frailty predicted four domains of quality of life and physical frailty three. Social frailty was only found to be a significant predictor of social quality of life and environmental quality of life. ADL and IADL disability proved to be the worst predictors. It is recommended that primary healthcare professionals (e.g., general practitioners, district nurses) focus their interventions primarily on factors that can prevent or delay psychological and physical frailty, thereby ensuring that people's quality of life does not deteriorate.

Latent transition analysis of instrumental activities of daily living in Chinese elderly: based on the 2014-2018 wave of the Chinese Longitudinal Healthy Longevity Survey

BACKGROUND

The instrumental activities of daily living (IADL) among the elderly have been found to be heterogeneous, with different trajectories. However, the transition of the IADL over time remains unclear. We aimed to explore the transition probabilities and the predictors of IADL among the elderly.

METHODS

Longitudinal data from the 2014 (T1) and 2018 (T2) waves of the Chinese Longitudinal Healthy Longevity Survey were extracted. A sample of 2,944 participants aged 65 years or older, with complete responses to the IADL scale, was included. Latent profile analysis (LPA) and latent transition analysis (LTA) were employed to identify latent profiles of IADL and investigate the transition probabilities between profiles from T1 to T2. The predictors of latent profiles and transition probabilities were examined using multinomial regression analysis.

RESULTS

The results of LPA at both T1 and T2 supported a 4-profile model solution. They were labeled as the "Normal function profile," "Mildly impaired profile," "Moderately impaired profile," and "Highly impaired profile". The Normal function profile and Highly impaired profile were characterized by maintaining stability rather than transitioning over time, with transition probabilities of 0.71 and 0.68, respectively, for maintaining stability. The Mildly impaired profile and Moderately impaired profile were characterized by a stronger tendency towards transition rather than stability, with transition probabilities of 0.29 and 0.45, respectively, of transitioning to the Highly impaired profile. The transition probabilities from the three impaired function profiles to the Normal function profile ranged from 0.05 to 0.19. Age, gender, place of residence, and social participation were significant predictors of profile attribution at T1 and transition probabilities over time.

CONCLUSIONS

This study employed the LTA to examine the transition probability of IADL among the Chinese elderly. By recognizing the different profiles of IADL and understanding the factors associated with transitions among the elderly, interventions can be tailored to improve their functional independence and successful reintegration into families and society.

The effects of neighborhood socioeconomic status on ADL/IADL among Chinese older adults-neighborhood environments as mediators

Background

There have been few consistencies in the effects and pathways of neighborhood socioeconomic status (SES) on functional limitations. This study aimed to investigate whether neighborhood socioeconomic status influences ADL/IADL in older residents in China through the neighborhood built environment and social environment.

Methods

Activities of daily living/IADL were assessed in a sample of 5,887 Chinese individuals aged 60 or older, utilizing data obtained from the 2011 China Health and Retirement Longitudinal Study (CHARLS 2011). Neighborhood SES was measured by the neighborhood per-capita net income. Neighborhood built environment was measured by the security resources, motion resources, living resources, service resources for older adults, and medical resources of neighborhood. Neighborhood social environment was measured by the organizations, unemployment subsidies, minimum living allowance, subsidies to persons older than 65, and pensions to persons older than 80 of the neighborhood. The two-level logistical regression model and multilevel structural equation model (MSEM) were used.

Results

The rate of ADL/IADL loss among Chinese older adults aged 60 and above in 2011 were 32.17 and 36.87%, respectively. Neighborhood SES was significantly associated with ADL/IADL in older adults. Compared with the respondents living in communities with lower SES, those living in communities with higher SES possessed better ADL (β = -0.33, p < 0.05) and IADL (β = -0.36, p < 0.05) status. The path of neighborhood socioeconomic status on ADL was completely mediated by the neighborhood built environment (β = -0.110, p < 0.05) and neighborhood social environment (β = -0.091, p < 0.05). Additionally, the effect of neighborhood socioeconomic status on IADL was fully mediated by the neighborhood built environment (β = -0.082, p < 0.05) and neighborhood social environment (β = -0.077, p < 0.05).

Conclusion

Neighborhood SES was significantly correlated with ADL/IADL through the neighborhood environment. Improving the ADL/IADL status of older adults residing in low socioeconomic neighborhoods requires enhancing the built and social environment by provisioning additional neighborhood resources.

Aging at home: factors associated with independence in activities of daily living among older adults in Norway-a HUNT study

Background

Maintaining independence in activities of daily living (ADL) is essential for the well-being of older adults. This study examined the relationship between demographic and living situation factors and ADL independence among community-dwelling older adults in Norway.

Methods

Data was collected in Norway between 2017 and 2019 as part of the fourth wave of the ongoing Trøndelag Health Study (HUNT) survey, sent to all citizens in Trøndelag county over 20 years of age, which is considered representative of the Norwegian population. Included in the current cross-sectional study were 22,504 community-living individuals aged 70 years or older who completed the survey and responded to all items constituting the ADL outcome measure. Group differences in ADL independence were examined with Chi Square tests, while crude and adjusted associations with ADL independence were examined with logistic regression analyses. Statistical significance was set at p < 0.05.

Results

The participants reported a high degree of independence in primary ADL and slightly lower in instrumental ADL. In the fully adjusted analyses, ADL independence was associated with lower age, female gender, higher levels of education and income, higher subjective well-being, having no chronic or disabling disease, and having someone to talk to in confidence. Surprisingly, women who were married had higher likelihood of ADL independence than unmarried women, whereas married men had lower likelihood of ADL independence than unmarried men.

Conclusion

In addition to known demographic and disease-related factors, the social context affects independence in ADL even in a society that offers advanced health and homecare services to all older adults equally. Furthermore, the same social setting can have differential effects on men and women. Despite the healthcare system in Norway being well-developed, it does not completely address this issue. Further improvements are necessary to address potential challenges that older adults encounter regarding their social connections and feelings of inclusion. Individuals with limited education and income are especially susceptible to ADL dependency as they age, necessitating healthcare services to specifically cater to this disadvantaged demographic.

Cognitive-motor interventions based on virtual reality and instrumental activities of daily living (iADL): an overview

Non-invasive, non-pharmacological interventions utilizing virtual reality (VR) represent a promising approach to enhancing cognitive function in patients with degenerative cognitive disorders. Traditional "pen and paper" therapies often lack the practical engagement in everyday activities that older individuals encounter in their environment. These activities pose both cognitive and motor challenges, underscoring the necessity of understanding the outcomes of such combined interventions. This review aimed to assess the advantages of VR applications that integrate cognitive-motor tasks, simulating instrumental activities of daily living (iADLs). We systematically searched five databases-Scopus, Web of Science, Springer Link, IEEE Xplore, and PubMed, from their inception until January 31, 2023. Our review revealed that motor movements, coupled with VR-based cognitive-motor interventions, activate specific brain areas and foster improvements in general cognition, executive function, attention, and memory. VR applications that meld cognitive-motor tasks and simulate iADLs can offer significant benefits to older adults. Enhanced cognitive and motor performance can promote increased independence in daily activities, thereby contributing to improved quality of life.

Development and usability of a hospital standardized ADL ratio (HSAR) for elderly patients with cerebral infarction: a retrospective observational study using administrative claim data from 2012 to 2019 in Japan

BACKGROUND

Maintenance of activities of daily living (ADL) during acute hospitalization is an important treatment goal, especially for elderly inpatients with diseases that often leave disabilities, such as cerebral infarction. However, studies assessing risk-adjusted ADL changes are limited. In this study, we developed and calculated a hospital standardized ADL ratio (HSAR) using Japanese administrative claims data to measure the quality of hospitalization care for patients with cerebral infarction.

METHODS

This study was designed as a retrospective observational study using the Japanese administrative claim data from 2012 to 2019. The data of all hospital admissions with a primary diagnosis of cerebral infarction (ICD-10, I63) were used. The HSAR was defined as the ratio of the observed number of ADL maintenance patients to the expected number of ADL maintenance patients multiplied by 100, and ratio of ADL maintenance patients was risk-adjusted using multivariable logistic regression analyses. The c-statistic was used to evaluate the predictive accuracy of the logistic models. Changes in HSARs in each consecutive period were assessed using Spearman's correlation coefficient.

RESULTS

A total of 36,401 patients from 22 hospitals were included in this study. All variables used in the analyses were associated with ADL maintenance, and evaluations using the HSAR model showed predictive ability with c-statistics (area under the curve, 0.89; 95% confidence interval, 0.88-0.89).

CONCLUSIONS

The findings indicated a need to support hospitals with a low HSAR because hospitals with high/low HSAR were likely to produce the same results in the subsequent periods. HSAR can be used as a new quality indicator of in-hospital care and may contribute to the assessment and improvement of the quality of care.