The urgent need for disability studies among midlife 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.

Factors Associated With Shifts in Caregiving During COVID-19

The COVID-19 pandemic disrupted many aspects of life, including care arrangements of older adults. Using nationally representative data on 2501 U.S. adults who reported providing care to a family member or friend age 50 or older either prior to or during the pandemic, we examined factors associated with pandemic-related changes in caregiving. Logistic regression models were used to compare caregivers who stopped or started providing care due to the pandemic to those who continued on a variety of types of factors (i.e., caregiver characteristics, care recipient characteristics, or caregiving contextual factors). Individuals who stopped providing care had significantly weaker contextual attachments to the care recipient than those who continued. Ceasing care was significantly associated with living further away from the care recipient, being a more distant relative, and being a newer caregiver compared to continuing care. Many different types of factors were significantly associated with becoming a new caregiver.

Cross-sectional associations between patterns and composition of upright and stepping events with physical function: insights from The Maastricht Study

INTRODUCTION

Age-related declines in physical functioning have significant implications for health in later life. Physical activity (PA) volume is associated with physical function, but the importance of the pattern in which PA is accumulated is unclear. This study investigates associations between accelerometer-determined daily PA patterns, including composition and temporal distribution (burstiness) of upright and stepping events, with physical function.

METHODS

Data was from participants who wore an activPAL3 accelerometer as part of The Maastricht Study. Exposures included a suite of metrics describing the composition and the temporal distribution (burstiness) of upright and sedentary behaviour. Physical function outcomes included the six-minute walk test (6MWT), timed chair-stand test (TCST), grip strength (GS), and SF-36 physical functioning sub-scale (SF-36pf). Multivariable linear regression models were used to assess associations, adjusting for covariates including overall PA volume (daily step count).

RESULTS

Participants(n = 6085) had 6 or 7 days of valid data. Upright and stepping event metrics were associated with physical function outcomes, even after adjusting PA volume. Higher sedentary burstiness was associated with better function (6MWT, TCST, and SF-36pf), as was duration and step volume of stepping events (6MWT, TCST, GS, and SF-36pf), step-weighted cadence (6MWT, TCST, and SF-36pf). Number of stepping events was associated with poorer function (6MWT, GS, and SF-36pf), as was upright event burstiness (SF-36pf). Associations varied according to sex.

CONCLUSION

Our study reveals that diverse patterns of physical activity accumulation exhibit distinct associations with various measures of physical function, irrespective of the overall volume. Subsequent investigations should employ longitudinal and experimental studies to examine how changing patterns of physical activity may affect physical function, and other health outcomes.

Mediators of Functional Disability at Mid- and Late-Life

As the number and proportion of older adults living in the U.S. increases, growing evidence shows that people are entering late life with more functional disability than in previous generations. Using data from the 2020 Behavioral Risk Factor Surveillance System survey, we sought to identify the contributions of demographic variables and health conditions to functional disability. Specifically, we tested the associations among age, sex, race, chronic physical health conditions, depression, and functional ability among 243,693 adults, ages 45 years and older. Model testing, implemented in AMOS 29.0.0, resulted in an acceptable fit of the model to the data, Χ2 (DF = 18, N = 243,693) = 19,512.64, p < .001; CFI = 0.909; TLI = 0.774; RMSEA = 0.066; R 2 Function = .267. The findings from the present study replicate previous research that age, sex, and racial background differences influence functional disability. We extend the literature to examine physical and emotional health as potential pathways to intervene in midlife.

Subjective social status and functional and mobility impairments among older adults: life satisfaction and depression as mediators and moderators

BACKGROUND

While functional and mobility impairments (FMIs) have garnered the attention of health researchers in low and middle-income countries (LMICs), including India, research has yet to explore whether and to what extent the perception of one's social status is associated with FMIs. We fill this gap in the literature by examining (1) the association between subjective social status (SSS) and FMIs among older adults in India and (2) whether this association between SSS and FMIs is mediated and moderated by life satisfaction and depression.

METHODS

Data come from the 2017-18 wave 1 of the Longitudinal Aging Study in India (LASI) with a sample of 31,464 older adults aged 60 years and above. FMIs were assessed using established scales on impairments in activities of daily living (ADLs), instrumental activities of daily living (IADLs), and mobility. SSS was assessed using the Macarthur scale. Life satisfaction was measured using responses to five statements gauging respondent's overall satisfaction with life. Depression was calculated using the shortened version of the Composite International Diagnostic Interview (CIDI-SF). Multivariable regression was employed to examine the association between variables, and the interaction terms and Karlson-Holm-Breen (KHB) method were used separately to test the mediation and moderation effects.

RESULTS

39.11% of the sample had a low SSS, 8.26% were depressed, and 32.07% reported low life satisfaction. A total of 8.74%, 10.91%, and 8.45% of the study population reported at least one impairment in ADL, IADL, and mobility, respectively. Older adults in the higher SSS group were less likely to have ADL impairment (beta: -0.017, CI: -0.030, -0.0032) and mobility impairment (beta: -0.044, CI: -0.076, -0.013). Depression moderated the association between SSS and mobility impairment (p-value: 0.025), and life satisfaction moderated the association between SSS and ADL impairments (p-value: 0.041) and SSS and IADL impairments (p-value: 0.037). Depression mediated 20.28%, 31.88%, and 18.39% of the associations of SSS with ADL, IADL, and mobility impairments, respectively. Similarly, life satisfaction mediated 23.24%, 52.69%, and 27.22% of the associations of SSS with ADL, IADL, and mobility impairments.

CONCLUSIONS

That SSS is associated with FMIs among older Indians, even after considering their objective socioeconomic status (SES), suggests that the use of SSS is relevant to the study of health inequalities in India. The finding that life satisfaction and depression mediate and moderate this association is crucial in pinpointing those older Indians at risk of the functional and mobility-related repercussions of lower SSS.

Trends in Activity Limitations From an International Perspective: Differential Changes Between Age Groups Across 30 Countries

Objectives: Examine trends in limitations among young (15-39), middle-aged (40-64) and older age-groups (>=65) and their socioeconomic differences. Methods: Population-based European Social Survey data (N = 396,853) were used, covering 30 mostly European countries and spanning the time-period 2002-2018. Limitations were measured using a global activity limitations indicator. Results: Age-differential trends in limitations were found. Activity limitations generally decreased in older adults, whereas trends varied among younger and middle-aged participants, with decreasing limitations in some countries but increasing limitations in others. These age-differential trends were replicated across limitation severity and socioeconomic groups; however, stronger limitation increases occurred regarding less-severe limitations. Discussion: Functional health has improved in older adults. Contrarily, the increasing limitations in younger and middle-aged individuals seem concerning, which were mostly observed in Western and Northern European countries. Given its public health importance, future studies should investigate the reasons for this declining functional health in the young and middle-aged.

Multimorbidity increases the risk of dementia: a 15 year follow-up of the SHARE study

AIMS

the literature regarding the association between multimorbidity and dementia is still unclear. Therefore, we aimed to explore the potential association between multimorbidity at the baseline and the risk of future dementia in the SHARE (Survey of Health, Ageing and Retirement in Europe) study, a large European research survey, with a follow-up of 15 years.

METHODS

in this longitudinal study, multimorbidity was defined as the presence of two or more chronic medical conditions, among 14 self-reported at the baseline evaluation. Incident dementia was ascertained using self-reported information. Cox regression analysis, adjusted for potential confounders, was run and hazard ratios (HRs), with their 95% confidence intervals (CIs), that were estimated in the whole sample and by 5 year groups.

RESULTS

among 30,419 participants initially considered in wave 1, the 23,196 included participants had a mean age of 64.3 years. The prevalence of multimorbidity at baseline was 36.1%. Multimorbidity at baseline significantly increased the risk of dementia in the overall sample (HR = 1.14; 95% CI: 1.03-1.27) and in participants younger than 55 years (HR = 2.06; 95% CI: 1.12-3.79), in those between 60 and 65 years (HR = 1.66; 95% CI: 1.16-2.37) and in those between 65 and 70 years (HR = 1.54; 95% CI: 1.19-2.00). In the overall sample, high cholesterol levels, stroke, diabetes and osteoporosis increased the risk of dementia, particularly if present among participants between 60 and 70 years of age.

CONCLUSIONS

multimorbidity significantly increases the risk of dementia, particularly in younger people, indicating the need for early detection of multimorbidity for preventing cognitive worsening.