The disability process: is there a place for frailty?

2020 ◽  
Vol 49 (5) ◽  
pp. 764-770
Author(s):  
Alfonso Zamudio-Rodríguez ◽  
Luc Letenneur ◽  
Catherine Féart ◽  
José Alberto Avila-Funes ◽  
Hélène Amieva ◽  
...  
Keyword(s):  
Activities Of Daily Living ◽  
Daily Living ◽  
Time Window ◽  
Intermediate Stage ◽  
Frailty Phenotype ◽  
Risk Of Death ◽  
Disablement Process ◽  
Cox's Regression ◽  
Adl Disability ◽  
The Continuum

Abstract Background frailty and disability are very common in older adults; they share some risk factors and pathophysiological mechanisms. Yet, they are different clinical entities. Objectives this study aimed to explore a potential hierarchical relationship between frailty and disability along the continuum of the disablement process. Design prospective cohort study. Setting the French Three-City (3C) study. Subjects the sample included 943 participants aged 75 and older. Methods the Fried frailty phenotype, Instrumental Activities of Daily Living (IADL) and basic Activities of Daily Living (ADL) were used. We distinguished between four mutually excluding groups: (i) robust (no frailty and no disability); (ii) pure frailty (no disability); (iii) frailty with IADL disability (no ADL disability) and (iv) frailty with IADL and ADL disabilities. We used Cox’s regression models to study the 4-year mortality risk associated with each status. Results Eight-two per cent of participants were classified according to the assumed hierarchy: 61.3% was robust, 5.4% frail, 10.5% frail and IADL-disabled and 4.8% frail, IADL and ADL-disabled. An extra group of 17% was identified with IADL-disabled individuals without frailty. This extra group was similar to pure frailty in terms of characteristics and risk of death, placing them along the continuum at an intermediate stage between robustness and the two most disabled sub-groups. Conclusions our findings suggest that including frailty along the continuum could be relevant to describe the whole disablement process. Frailty would occur upstream of the process and might be relevant to identify an opportune time window, where specific monitoring and clinical interventions could be implemented in order to interrupt the process at a potentially more reversible stage.

scholarly journals Vision and Hearing Impairments Affecting Activities of Daily Living among Malaysian Older Adults by Gender

2021 ◽  
Vol 18 (12) ◽  
pp. 6271
Author(s):  
Yee Mang Chan ◽  
Norhafizah Sahril ◽  
Ying Ying Chan ◽  
Nor’ Ain Ab Wahab ◽  
Norliza Shamsuddin ◽  
...  
Keyword(s):  
Older Adults ◽  
Gender Differences ◽  
Activities Of Daily Living ◽  
Hearing Impairment ◽  
Daily Living ◽  
Hearing Impairments ◽  
Cross Sectional ◽  
Middle Income ◽  
Middle Income Countries ◽  
Adl Disability

Vision and hearing impairments are common among older adults and can cause undesirable health effects. There are limited studies from low- and middle-income countries exploring gender differences between vision and hearing impairment with Activities of Daily Living (ADL) disability. Therefore, this study aimed to investigate gender differences between vision and hearing impairments with ADL disability among older adults in Malaysia. Cross-sectional data from 3977 respondents aged 60 and above from the Malaysian National Health and Morbidity Survey 2018 were used. We used logistic regression analysis to measure associations between vision and hearing impairments with ADL disability, adjusted for covariates. The prevalence of ADL disability was higher among females than males (p < 0.001). The adjusted associations between vision impairment and ADL disability were significant among males (aOR 3.79; 95%CI 2.26, 6.38) and females (aOR 2.66; 95%CI 1.36, 5.21). Similarly, significant adjusted associations were found between hearing impairment and ADL disability among males (aOR 5.76; 95%CI 3.52, 9.40) and females (aOR 3.30; 95%CI 1.17, 9.33). Vision and hearing impairments were significantly associated with ADL disability, with no gender differences identified. Early detection and effective management of vision and hearing impairments are important to prevent ADL disability and improve older adults’ level of independence.

scholarly journals Effect of Aspirin on Activities of Daily Living Disability in Community-Dwelling Older Adults

2020 ◽  
Author(s):  
Robyn L Woods ◽  
Sara Espinoza ◽  
Le T P Thao ◽  
Michael E Ernst ◽  
Joanne Ryan ◽  
...  
Keyword(s):  
Older Adults ◽  
Activities Of Daily Living ◽  
Daily Living ◽  
Low Dose ◽  
Community Dwelling ◽  
Dose Aspirin ◽  
Low Dose Aspirin ◽  
Adl Disability ◽  
Community Dwelling Older Adults ◽  
Aspirin Group

Abstract Background Cerebrovascular events, dementia and cancer can contribute to physical disability with activities of daily living (ADL). It is unclear whether low-dose aspirin reduces this burden in aging populations. In a secondary analysis, we now examine aspirin’s effects on incident and persistent ADL disability within a primary prevention aspirin trial in community-dwelling older adults. Methods The ASPREE (ASPirin in Reducing Events in the Elderly) trial of daily 100mg aspirin versus placebo recruited 19,114 healthy adults aged 70+ years (65+ years if U.S. minority) in Australia and the U.S. Six basic ADLs were assessed every six months. Incident ADL disability was defined as inability or severe difficulty with ≥1 ADL; persistence was confirmed if the same ADL disability remained after six months. Proportional hazards modelling compared time to incident or persistent ADL disability for aspirin versus placebo; death without prior disability was a competing risk. Results Over a median 4.7 years, incident ADL disability was similar in those receiving aspirin (776/9525) and placebo (787/9589) with walking, bathing, dressing and transferring the most commonly reported. Only 24% of incident ADL disability progressed to persistent. Persistent ADL disability was lower in the aspirin group (4.3 versus 5.3 events/1000py; HR=0.81, 95% CI:0.66-1.00), with bathing and dressing the most common ADL disabilities in both groups. Following persistent ADL disability there were more deaths in the aspirin group (24 versus 12). Discussion Low-dose aspirin in initially healthy older people did not reduce risk of incident ADL disability, although there was evidence of reduced persistent ADL disability.

scholarly journals Predictor of Activities of Daily Living (ADL) Disability in Patients Undergoing Cardiovascular Surgery

2019 ◽  
Vol 48 (5) ◽  
pp. 299-304
Author(s):  
Shinji Mizuta ◽  
Shinya Takahashi ◽  
Mayo Oshita ◽  
Miwa Arakawa ◽  
Akira Katayama
Keyword(s):  
Activities Of Daily Living ◽  
Daily Living ◽  
Cardiovascular Surgery ◽  
Adl Disability

scholarly journals Association between cognitive declines and disability in activities of daily living in older adults with COPD: evidence from the China health and retirement longitudinal study

BMJ Open ◽  
2020 ◽  
Vol 10 (10) ◽  
pp. e040098
Author(s):  
Bingyan Gong ◽  
Shaomei Shang ◽  
Chao Wu
Keyword(s):  
Older Adults ◽  
Regression Analysis ◽  
Longitudinal Study ◽  
Cognitive Function ◽  
Activities Of Daily Living ◽  
Daily Living ◽  
Visuospatial Ability ◽  
Cross Sectional ◽  
Adl Disability

ObjectivesThis study aimed to investigate the relationship between disability and domain-specific cognitive function in older adults with chronic obstructive pulmonary disease (COPD).DesignCross-sectional analyses combined with retrospective longitudinal analyses.SettingWe included 450 communities in China.ParticipantsIn this study, 1022 (mean age: 68.6±6.3; 612 males) and 152 (mean age: 67.0±5.2; 83 males) older adults with COPD from the China Health and Retirement Longitudinal Study were included in a cross-sectional multivariate linear regression analysis and a longitudinal logistic regression analysis, respectively.Outcome measuresDisability was determined by the difficulty or inability to complete 1 of the 12 activity items in basic activities of daily living (ADL) and instrumental ADL. The cognitive dimensions of episodic memory, attention/numerical ability, orientation to time, and visuospatial ability were assessed via the immediate/delayed recall task, serial sevens task, naming the current date and pentagon-figure-drawing tasks, respectively.ResultsOf 1022 older respondents with COPD at wave-4, 48.5% had ADL disability. Declines in the global cognitive function (β (95% CI)=−0.627 (−1.214 to –0.040)), orientation to time (β (95% CI)=−0.207 (−0.364 to –0.050)) and visuospatial ability (β (95% CI)=−0.068 (−0.127 to –0.009)) were significantly associated with the presence of ADL disability, when demographic and health-related variables were adjusted. Of 152 older participants with COPD and without ADL disability in wave-2, 61 (40.1 %) developed disability over a 2-year follow-up. Relative to the participants without a decline in orientation to tine, those with the condition had greater odds of incidence of ADL disability increased by a factor of about 1.46 over a 2-year follow-up.ConclusionsIn older adults with COPD, orientation to time and visuospatial inability are vulnerable to the presence of a disability. Prevention of a decline in orientation to time might help prevent disability in older people with COPD.

The Association Between Handgrip Strength and Diabetes on Activities of Daily Living Disability in Older Mexican Americans

2017 ◽  
Vol 30 (8) ◽  
pp. 1305-1318 ◽  
Author(s):  
Ryan P. McGrath ◽  
Brenda M. Vincent ◽  
Soham Al Snih ◽  
Kyriakos S. Markides ◽  
Brad P. Dieter ◽  
...  
Keyword(s):  
Body Weight ◽  
Confidence Interval ◽  
Activities Of Daily Living ◽  
Grip Strength ◽  
Muscle Weakness ◽  
Mexican Americans ◽  
Daily Living ◽  
Handgrip Strength ◽  
Joint Effects ◽  
Adl Disability

Objective: The aim of this study is to determine the independent and joint effects of muscle weakness and diabetes on incident activities of daily living (ADL) disability in older Mexican Americans. Method: A subsample of 2,270 Mexican Americans aged at least 65 years at baseline were followed for 19 years. Handgrip strength was normalized to body weight (normalized grip strength [NGS]). Weakness was defined as NGS ≤0.46 in males and ≤0.30 in females. Diabetes and ADL disability were self-reported. Results: Compared with participants that were not weak and did not have diabetes, those that had diabetes only, were weak only, and were both weak and had diabetes experienced a 1.94 (95% confidence interval [CI] = [1.89, 1.98]), 1.17 (CI = [1.16, 1.19]), and 2.12 (CI = [2.08, 2.16]) higher rate for ADL disability, respectively. Discussion: Muscle weakness and diabetes were independently and jointly associated with higher rates for ADL disability in older Mexican Americans.

scholarly journals Influence of Type II Diabetes and High Depressive Symptoms on the Likelihood for Developing Activities of Daily Living (ADL) Disability and Mortality in Older Puerto Ricans

2017 ◽  
Vol 29 (6) ◽  
pp. 1079-1095 ◽  
Author(s):  
Brian Downer ◽  
Michael Crowe ◽  
Kyriakos S. Markides
Keyword(s):  
Depressive Symptoms ◽  
Activities Of Daily Living ◽  
Puerto Rican ◽  
Type Ii Diabetes ◽  
Daily Living ◽  
Psychiatric Treatment ◽  
Puerto Ricans ◽  
Elderly Health ◽  
Adl Disability

Objective: To examine the development of activities of daily living (ADL) disability and mortality according to diabetes and high depressive symptoms among Puerto Rican adults aged 60 and older. Method: Data came from Wave I and Wave II of the Puerto Rican Elderly: Health Conditions Study ( n = 3,419). Logistic regression was used. Using insulin and receiving psychiatric treatment were proxy measures of disease severity for diabetes and depressive symptoms, respectively. Results: High depressive symptoms at baseline were associated with developing ADL disability (OR = 2.21; 95% CI = [1.68, 2.91]). Diabetes at baseline was associated with mortality at follow-up (OR = 1.72; 95% CI = [1.34, 2.19]). Baseline diabetes was associated with developing ADL disability but only for those who reported using insulin (OR = 1.69; 95% CI = [1.08, 2.61]). Participants with comorbid diabetes and high depressive symptoms had the highest odds for developing ADL disability and mortality. Discussion: Diabetes and high depressive symptoms are risk factors of developing ADL disability and mortality for older Puerto Ricans.

scholarly journals A study on disability in terms of activities of daily living among elderly in Palam village of west Delhi

2019 ◽  
Vol 6 (11) ◽  
pp. 4777
Author(s):  
Devendra Kumar ◽  
S. K. Rasania ◽  
Ranjan Das
Keyword(s):  
Activities Of Daily Living ◽  
Daily Living ◽  
Cross Sectional Study ◽  
Care Needs ◽  
Cross Sectional ◽  
Quality Life ◽  
High Incidence ◽  
Study Population ◽  
Adl Disability ◽  
Elderly Living

Background: Aging, an integral part of living, typically is accompanied by gradual but progressive physiological changes and an increased prevalence of acute and chronic illness. Although neither a disease nor disability per se, aging nonetheless is associated with a high incidence of physical impairment as well.The objective of the present study was to assess the prevalence of activities of daily living (ADL) disability in elderly living in Palam village of Delhi.Methods: A community based cross-sectional study was carried out to assess the prevalence of ADL disability in elderly living in Palam village of Delhi using Barthel ADL index. It uses ten variables describing ADL and mobility. The sample size was estimated to be 350 and systematic random sampling was used to choose the study subjects.Results: The prevalence of ADL disability was found to be 20.3% in the study population. This was found to be 16.3% in males and 23.9% in females.Conclusions: After obtaining adequate data on elderly having difficulty in performing their routine activities of daily living, appropriate steps needs to be taken to mitigate its ill effects which should also address their health care needs and help them to live a healthy and good quality life.

Comprehensive geriatric assessment (CGA) in men age 70 or over with localized prostate cancer.

2014 ◽  
Vol 32 (4_suppl) ◽  
pp. 184-184
Author(s):  
Georgina E.C. Osborne ◽  
Duncan Charles Gilbert ◽  
Angus Robinson ◽  
Ashok Nikapota ◽  
Fiona McKinna ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Activities Of Daily Living ◽  
Geriatric Assessment ◽  
Comprehensive Geriatric Assessment ◽  
Daily Living ◽  
Older Men ◽  
Risk Of Death ◽  
Therapeutic Decisions ◽  
Co Morbidity ◽  
Radiotherapy Toxicity

184 Background: There has been a four-fold increase in incidence of prostate cancer (PC) in men age 70 or older in England in the last 30 years. Which treatment (surgery, radiotherapy, or surveillance) is right for which patient depends on a number of factors including the risk of death from competing causes and fitness for the proposed treatment. Objective assessments such as those included in a Comprehensive Geriatric Assessment (CGA) might be helpful in this regard. The primary objective of this study is to describe CGA scores of a cohort of older men with PC. The secondary objectives are to examine if a single score (the Vulnerable Elders Survey [VES-13]), is a suitable screening test for a full CGA and to assess whether scores predict radiotherapy toxicity. Methods: Patients age 70 and older with localised PC completed a CGA prior to commencement of radical radiotherapy. The CGA assessed WHO performance status (PS), activities of daily living (ADL), instrumental activities of daily living (IADL), Charlson co-morbidity index, number of medications, mini-nutritional assessment (MNA), social network index (SNI), G8 score, and VES-13. Participants had acute radiotherapy toxicity assessed 12 weeks post-treatment completion. Results: As of September 2013, 100 patients had been recruited. Median age was 74.5 (range 70 to 82). Ninety five percent of patients had a PS less than two. Using the VES-13 tool, 5.2% scored greater than two. 22.6% scored less than 14 on G8 scoring. Additionally, 13.5% were not fully independent on ADLs, 4.2% were not fully independent on IADLs, 32.3% scored greater than one on the Charlson Index, 12.3% had a history of depression or dementia, and 52.9% were on more than three prescription medications. Fourteen percent were at risk of malnutrition and 2.3% were malnourished according to MNA scores, 25.0% had SNI scores less than three and 9.3% of patients had fallen at least once in the preceding three months. Twelve week follow-up data regarding acute radiotherapy toxicity is currently being collected; these will be correlated with the CGA components and presented at the 2014 ASCO Genitourinary Cancers Symposium. Conclusions: These data demonstrate that many older men with localised prostate cancer are vulnerable according to a CGA. Correlations observed between radiotherapy toxicity and CGA scores would have important implications for therapeutic decisions.

scholarly journals Back pain trajectories from midlife to retirement as a predictor of old age mobility and disability

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
S Kyrönlahti ◽  
C H Nygård ◽  
S Neupane
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Activities Of Daily Living ◽  
Old Age ◽  
Daily Living ◽  
Low Back ◽  
Mobility Limitations ◽  
Trajectory Group ◽  
Adl Disability

Abstract Background Low back pain (LBP) is a leading cause for mobility limitations and disability at older age. However, little is known about the developmental pathways of LBP and its associations with old age mobility and disability. We studied trajectories of LBP from midlife to retirement (16-years follow-up) and assessed the association after 12 years with mobility limitations and disability in activities of daily living (ADL) at old age. Methods Finnish municipal employees were studied at baseline in 1981 and followed for 28 years. A total of 6257 persons aged 44-58 years, answered a questionnaire on health, work ability, and working conditions. Follow-up data on frequency of LBP (never, occasionally, consistently) was collected similarly at four waves. The study population consisted of persons who answered questions about LBP at baseline and at least in one of the follow-up waves and had information about ADL disability (n = 2787) and mobility limitations (n = 2723) at the 28-year follow-up. Latent class growth curve analysis was used to study LBP trajectories. Odds ratios (OR) with their 95% confidence intervals (CIs) for associations of LBP trajectory with ADL disability and mobility limitations were estimated using multivariable logistic regression. Results We identified two trajectories of LBP: high (77%) and low (23%). People in the high trajectory group had 2.35 times higher odds (95% CI 1.88- 2.97) of ADL disability and 1.86 times higher odds (95% CI 1.56-2.22) of mobility limitations as compared to the low trajectory group. Effects were attenuated by adjustment for lifestyle factors and chronic conditions but remained statistically significant for both outcomes [OR 1.74 (95% CI 1.37-2.24) and 1.44 (1.18-1.77), respectively]. Conclusions High LBP experienced during midlife may have far reached consequences on well-being at old age. Prevention of LBP during mid-life could reduce mobility limitations and disability at old age and promote a healthy ageing. Key messages Our results show that low back pain experienced during midlife is associated with mobility limitations and disability in activities of daily living at old age. Our results suggest that emphasis should be put on promotion of musculoskeletal health in midlife as this may help to reduce disability and mobility limitations at old age.

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