Association between disability and social capital among community-dwelling elderly

Social Determinants of Quality of Life in the Last Year of Life Among Community-Dwelling Older Adults with Multimorbidity

Quality of life (QOL) at the end of life often declines in relation to various determinants, yet the role of social determinants, including social capital, in end-of-life care is frequently overlooked. This study aims to examine the association between social determinants and QOL in the last year of life and to test the mediating role of social capital in the relationship between social determinants and QOL among older adults with multimorbidity (MM). We used secondary data from the National Health and Aging Trends Study (NHATS) in Rounds 10 and 11, involving 3,085 adults aged 65 and older. The final analysis comprised 230 participants. Multiple linear regression was conducted to assess the associations between social determinants and QOL, and path analysis was used to evaluate the mediating effect of social capital. The regression model showed that social capital was positively and significantly associated with QOL (β = 0.378, 95% CI [0.099, 0.657], SE = 0.139), as were mental conditions (β = 0.614, 95% CI [0.167, 1.062], SE = 0.194). The mediation analysis demonstrated that social capital functioned as a complementary mediator, partially mediating the relationship between mental conditions and QOL in the last year of life. These findings underscore the potential role of social capital in enhancing QOL at the end of life, particularly through its influence on mental health. The study highlights the need for healthcare practices and policies that promote social support systems and community-based care for older adults with MM. By addressing social capital, end-of-life care could be improved, resulting in better overall well-being for individuals facing the last stages of life.

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.

Preventive role of community-level social capital in the need for long-term care and impairment in instrumental activities of daily living: a multilevel analysis

BACKGROUND

Individual-level social capital is an important determinant of older adults' long-term care needs; however, there is scant evidence regarding community-level social capital. Therefore, we investigated the association between community-level social capital and the prevalence of the need for long-term care among older adults.

METHODS

Between January and February 2018, a cross-sectional survey was conducted among all older adults (n = 13,558) aged 65 to 74 years in a rural municipality in Japan (total population, n = 72,833). A self-reported questionnaire was used to identify community-level social capital, comprising civic participation, social cohesion, and reciprocity. A multilevel logistic regression analysis was performed to estimate the odds ratios of the need for long-term care and a decline in social activity competence as assessed by instrumental activities of daily living. For the analysis, the community levels were divided into 76 voting districts and adjusted for daily life, lifestyle, socioeconomic status, health conditions, and the three social capital subscale scores at the individual level.

RESULTS

After adjusting for the covariates, we observed a tendency that a higher community level of reciprocity was associated with a lower prevalence of long-term care needs (OR: 0.86, 95% confidence interval: 0.75-1.00), whereas a high community level of social cohesion was associated with a significantly reduced decline in instrumental activities of daily living (OR per standard deviation increase: 0.87, 95% confidence interval: 0.79-0.96). No significant association was found with civic participation. Similarly, individual-level social capital was associated with the need for long-term care and decline in instrumental activities of daily living.

CONCLUSIONS

Our findings suggest that good community-level reciprocity or social cohesion as well as good individual social capital status may help prevent the need for long-term care among older adults.

[Longitudinal association between social capital and functional disability in a cohort of community dwelling older adults]

This study aimed to investigate the association between social capital and functional disability, based on a longitudinal perspective, using data from the cohort of older adults from Bambuí, Minas Gerais State, Brazil. The baseline of this study was composed of all surviving and disability-free - up until the seventh year of follow-up (2004) - older adults who were followed up until 2011. The outcome variable was functional disability for basic activities of daily living (ADL) and instrumental activities of daily living (IADL), separately analyzed. Social capital was the exposure of interest, measured through its cognitive (cohesion and social support) and structural (social participation and satisfaction with the neighborhood) components. Sociodemographic variables, health conditions, and lifestyle habits were used for adjustment purposes, and the occurrence of death was considered a competitive event. The hypothesis of association between social capital and functional disability was tested using the competing risk model, which provides hazard ratios (HR) and a 95% confidence interval (95%CI). After multivariate analysis, social capital - in its structural component - was associated with functional disability. Older adults who were dissatisfied with the neighborhood had a higher risk of developing functional disability for IADL (HR = 2.36; 95%CI: 1.31-4.24), in relation to their counterparts. This study results suggest that functional disability is associated with aspects other than health, evidencing the need for the development of policies and interventions that support aspects related to the physical and social environment in which older adults live.

Associations between Disability in Activities of Daily Living and Social Capital aspects among older adults: a scoping review

Social capital aspects are playing an important role in activities of daily living (ADL) performance, thus on independent living. This paper was aimed to present an overview of the associations and adverse effects between social capital aspects and disability in ADL and health-related quality of life (HRQoL) in an older population aged 65 years old and over. Α scoping review was designed following the guidelines of PRISMA Extension for Scoping Reviews (PRISMA-ScR) and the review was conducted by 3 authors. A total of 185 primary studies were extracted and, finally, 40 studies did meet the inclusion criteria and critically appraised in two main categories; Category 1(29 studies) 'social capital and disability in ADL' deducing that as greater a social capital as better ADL performance and Category 2 (11 studies) 'Social capital and HRQoL' concluding that people 65 years old and over with lower social capital were presented with a poor HRQoL. Study synthesis highlights the impact of social capital suggesting that nurses caring for older people must focus on their engagement in terms of social diversity and trust in the community.

Dependence in instrumental activities of daily living and its implications for older adults' oral health

We aimed to assess the association between dependence in instrumental activities of daily living (IADL) and oral health in older adults. We conducted a cross-sectional study of 280 people aged ≥60 years served at public primary health care centers in Northeastern Brazil. Sociodemographic, oral discomfort and general health data were collected. The Lawton and Brody scale were used to assess IADL. This research adheres to the STROBE checklist. Most participants were married (n = 139; 49.6%), women (n = 182; 65.0%) and retired (n = 212; 75.7%). A total of 37 (13.2%) older adults had some degree of dependence in IADL. Dependence in IADL was associated with: retirement (p<0.040), poor general health (p = 0.002), speech problems (p = 0.014), use of medications (p = 0.021), difficulty chewing and swallowing food (p = 0.011), voice changes (p = 0.044), edentulism (p = 0.011), use of toothbrush (p<0.001), use of toothpaste (p<0.001), and visit to the dentist in the previous year (p = 0.020). Functional disability was associated with older age, cardiovascular diseases, speech problems, chewing and swallowing difficulties, use of medication and brushing deficiency. The functional dependence in IADL can be considered an indicator of oral health status in older adults.

Functional difficulties and toileting among older adults in Ghana: evidence from the World Health Organization Study on global AGEing and adult health (SAGE) Ghana Wave 1

Ghana's older population is projected to increase in coming decades and as a result will see increasing care needs. Understanding the functional difficulties older adults experience, and the associated factors, will help identify relevant intervention to assist older adults in meeting their care needs. This study aimed to analyse the prevalence of functional difficulties among older adults in Ghana, and examine how the World Health Organization International Classification of Functioning, Disability and Health (WHO-ICF) conceptual framework can relate to toileting difficulty to understand the factors that increase older adults’ care needs. Data were for 5,096 adults aged ⩾50 years from the WHO Study on global AGEing and adult health (SAGE) Ghana Wave 1. Difficulties were assessed using self-reported difficulty on 22 functional items, including toileting. Multivariate logistic regression tested associations between toileting and other factors as related to the WHO-ICF conceptual framework. Older adults reported climbing one flight of stairs without resting as a common functional difficulty. Difficulty eating was the item least identified. Toileting difficulty was ranked second among five total activities of daily living difficulties. Age, marital status, self-reported health, memory, bodily pain, short- and far-distance vision, obesity, stroke, chronic lung disease, trust at individual and neighbourhood level, toilet facility type, socialising with co-workers, and public and religious meeting attendance were statistically significantly associated with toileting difficulty in the final parsimonious model. Post-hoc analysis testing interaction revealed that interaction existed between female sex and never married marital status (p = 0.04), and obesity and widowed marital status (p = 0.01), with toileting as the outcome. A significant level of functional difficulty existed among Ghanaian older adults in this sample. Toileting difficulty was associated with factors across different components in the WHO-ICF, emphasising functional, social and environmental factors related to this fundamental human activity.

Cross-sectional association of residential greenness exposure with activities of daily living disability among urban elderly in Shanghai

AIM

Residential greenness exposure is associated with many health outcomes, including obesity, cardiovascular disease, and mental disorders. However, few studies have assessed the effects of greenness exposure on activities of daily living (ADL). This study evaluated the relationship between greenness and ADL among elderly residents with long-term care insurance (LTCI) in Shanghai, China.

METHODS

We conducted a cross-sectional survey using stratified random sampling among elderly residents with LTCI in six districts of Shanghai in August 2018. We quantitatively assessed residential greenness using satellite-derived normalized difference vegetation index (NDVI) values with 250-, 500-, and 1000-m buffers around each participant's residential address. We calculated the walk score to assess neighborhood walkability. Physical function was assessed using basic ADL (BADL) and instrumental ADL (IADL). We performed binary logistic regression and restricted cubic splines with R software.

RESULTS

The study participants were 1067 adults with a mean age of 82.40 years (standard deviation, 7.68 years). The mean NDVI value was 0.311. In the fully adjusted model, being in the highest-tertile NDVI_500-m had a significant protective effect on BADL mild to none disability (odds ratio, 2.143; 95% confidence interval, 1.489-3.084) compared with participants in the lowest-tertile NDVI_500-m. Restricted cubic spline showed a non-linearity association between NDVI values and BADL and IADL mild to none disability.

CONCLUSIONS

Our results indicate the importance of residential greenness exposure to physical function-especially for BADL disability. Well-designed longitudinal studies are needed to confirm our findings and investigate the underlying mechanisms.

Prevalence of Older Adult Disability and Primary Health Care Responsiveness in Low-Income Communities

In Brazil and in most low- and middle-income countries (LMICs), information about how prepared the health care system is for the rapid aging of the population is scarce. We investigated the prevalence of disability and areas of life affected by disability among elders of the public primary health care in São Paulo and Manaus, Brazil. We investigated whether people with disability visited a primary care professional more frequently, the individual characteristics associated with disability, and differences by city. We randomly selected participants aged ≥60 years (n = 1375). The main outcome was disability, evaluated with the 12-item World Health Organization Disability Assessment Schedule (WHODAS 2.0). Exposure variables were consultation with a family physician, sociodemographic characteristics, health status, social support, and lifestyle. The prevalence of global disability was higher in Manaus (66.2% vs. 56.4% in São Paulo). In both cities, participation and mobility were the areas of life most affected by disability. The number of consultations with a family physician was not associated with disability. The high prevalence of disability and associated risk factors indicates that public primary health care is not meeting the needs of elders in both cities. It is warning because most elders in LMICs live in more underserved communities compared to Brazil.

Relationship between Individual Social Capital and Functional Ability among Older People in Anhui Province, China

This study aimed to explore the relationship between individual social capital and functional ability, with a focus on whether there is an interactive relationship that exists among social capital related to functional ability among older people in Anhui province, China. We conducted a cross-sectional study with a multi-stage stratified cluster random sampling method from July to September 2017. Data were collected through questionnaire including demographic characteristics, individual social capital status, and functional capability status. Binary logistic regression analysis model and classification and regression tree model (CART) were utilized. Overall, this study included 1810 elderly people, 43% of whom had functional disability. After the adjustment, subjects with lower social participation (AOR = 1.60; 95% CI: 1.26–2.03) and lower social connection (AOR = 1.74; 95% CI: 1.34–2.25) had an increased risk of functional disability. However, social support (AOR = 0.73; 95% CI: 0.57–0.94) was inversely related to functional ability. We also observed interactive relationship of social capital associated with functional ability, which indicated that special attention and efforts should be paid to older adults with less educational attainment, with multimorbidity, with advanced age, and with lower level of social participation, cohesion for the purpose of maintaining sound functional ability. Our findings may be of salient relevance for devising more targeted and effective interventions to prevent the onset of functional limitations among community-dwelling older adults.

Disability for basic and instrumental activities of daily living in older individuals

AIMS

To know the prevalence, associated factors and temporal trends of disabilities for basic and instrumental activities of daily living in older people in Spain from 2009 to 2017.

BACKGROUND

Disability in older people is associated with health problems, increased health costs and low quality of life. There are no updated data in Spain with a representative sample about disability.

METHODS

Cross-sectional study with 25,465 non-institutionalized older people who participated in the European Health Survey in 2009 and 2014 and the National Health Survey in 2011/12 and 2017 in Spain. The prevalence rates of disability were evaluated using the Katz Scale and Lawton and Brody Scale. Logistic regression was used to determine if there was an association between basic and instrumental activities of daily living and sociodemographic characteristics.

RESULTS

More individuals had disability for instrumental activities of daily living (31.9%) than disability for basic activities of daily living (11.1%). The most predominant disability for instrumental activities of daily living was performing severe housework (34%). The prevalence of disabilities decreased from 2009 to 2017. In general, disability was associated with female gender, advanced age, lower education, restricted daily activity, being bedridden and higher pain levels.

CONCLUSION

There is a considerable prevalence of disabilities for basic and instrumental activities of daily living in older people in Spain. Although the disability prevalence has decreased slowly from 2009 to 2017, it continues to remain a health problem. Gender may influence the disabilities for basic and instrumental activities of daily living. Health policymakers should establish prevention strategies and effective interventions (e.g., physical exercise) for prevention and reduction of the disabilities for basic and instrumental activities of daily living, particularly in older females.

Diversity in the Factors Associated with ADL-Related Disability among Older People in Six Middle-Income Countries: A Cross-Country Comparison

The low- and middle-income countries (LMICs) are experiencing rapid population ageing, yet knowledge about disability among older populations in these countries is scarce. This study aims to identify the prevalence and factors associated with disability among people aged 50 years and over in six LMICs. Cross-sectional data from the World Health Organization (WHO) Study on global AGEing and adult health Wave 1 (2007-2010) in China, Ghana, India, Mexico, the Russian Federation, and South Africa was used. Multivariable logistic regression analyses were undertaken to examine the association between sociodemographic factors, health behaviours, chronic conditions, and activities of daily living (ADL) disability. The prevalence of disability among older adults ranged from 16.2% in China to 55.7% in India. Older age, multimorbidity, and depression were the most common factors related to disability in all six countries. Gender was significant in China (OR = 1.14, 95% CI: 1.01-1.29), Ghana (OR = 1.22, 95% CI: 1.01-1.48) and India (OR = 1.65, 95% CI: 1.37-1.99). Having no access to social capital was significantly associated with ADL disability in China (OR = 2.57, 95% CI: 1.54-4.31) and South Africa (OR = 4.11, 95% CI: 1.79-9.43). Prevalence data is valuable in these six ageing countries, with important evidence on mitigating factors for each. Identifying determinants associated with ADL disability among older people in LMICs can inform how to best implement health prevention programmes considering different country-specific factors.

A longitudinal study of the association between social capital and mortality in community-dwelling elderly Brazilians

The aim of this study was to verify whether social capital is a predictor of all-cause mortality in community-dwelling elderly Brazilians. Participation included 935 surviving elderly from the elderly cohort of the Bambui Project in 2004, who were followed until 2011. The outcome was all-cause mortality and the exposure of interest was social capital, measured in its two components, cognitive (social cohesion and social support) and structural (social participation and neighborhood satisfaction). Sociodemographic variables, health conditions, and smoking were included in the analysis for adjustment purposes. Data analysis was based on the Cox proportional hazards model, providing hazard ratios (HR) and 95% confidence intervals (95%CI). The social participation dimension of social capital's structural component was the only dimension independently associated with mortality: elderly Brazilians that did not participate in social groups or associations showed a two-fold higher risk of death (HR = 2.28; 95%CI: 1.49-3.49) compared to their peers. The study's results reveal the need to extend interventions beyond the specific field of health in order to promote longevity, focusing on environmental and social characteristics.

Association between built environment and the incidence of disability in basic and instrumental activities of daily living in the older adults: Results of a cohort study in southern Brazil

The aim of this study was to evaluate the association between subjective and objective characteristics of the built environment and the incidence of disability in the activities of daily living in the older adults. A cohort study was conducted with 1196 older adults from Florianopolis, Santa Catarina, Brazil. Incidences were evaluated after four years by the difficulty or inability to perform six basic and nine instrumental activities. The subjective built environment was evaluated by the adapted Neighborhood Environment Walkability Scale and the objective for variables related to the characteristics of streets, sidewalks and land uses in the census tracts. Multilevel Logistic Regression analyzes were performed, where significant positive associations were observed between the presence of hills, and negative associations between safety for walking at night, a high proportion of commercial area, intermediate mixed land use and the incidence of disability in basic activities. The built environment characteristics associated with disability point to the need for improvements in urban infrastructure to promote functional independence in the older adults.