Discrimination and Risk of Incident Disability in Older African Americans

Abstract Discrimination is linked to poor health outcomes, but most studies examine young or midlife populations. We assessed associations between discrimination and disability in African Americans. The Detroit Areas Study Everyday Discrimination Scale quantified experiences of interpersonal mistreatment. Separate Cox-proportional hazards models tested the associations between baseline discrimination and incident mobility, activities of daily living (ADLs), and instrumental activities of daily living (IADLs) disability, adjusting for age, sex, education, BMI, smoking, depressive symptoms, and vascular diseases. At baseline, 441, 674, and 469, participants were initially free of mobility, ADL, and IADL disability, respectively, and 257, 185, and 269 new cases of mobility, ADL, and IADL disability were observed over approximately 8.5 years. Discrimination was associated with higher risk of ADL disability (hazard ratio: 1.03 per 1-point higher discrimination score, 95% confidence interval: 1.00-1.06) but no other disability type. Everyday discrimination is associated with risk of ADL disability.

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P1565THE COMBINATION OF MALNUTRITION-INFLAMMATION AND LIMITATIONS IN FUNCTIONAL STATUS IS ASSOCIATED WITH A HIGH RISK OF MORTALITY IN HEMODIALYSIS PATIENTS: RESULTS FROM THE DIALYSIS OUTCOMES AND PRACTICE PATTERNS STUDY

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfaa142.p1565 ◽

2020 ◽

Vol 35 (Supplement_3) ◽

Author(s):

Eiichiro Kanda ◽

Marcelo Lopes ◽

Angelo Karaboyas ◽

Brian Bieber ◽

Kazuhiko Tsuruya ◽

...

Keyword(s):

Activities Of Daily Living ◽

Functional Status ◽

Daily Living ◽

Proportional Hazards ◽

Practice Patterns ◽

Reference Group ◽

Strong Predictor ◽

High Serum ◽

Cox Proportional Hazards ◽

Dialysis Outcomes

Abstract Background and Aims The malnutrition-inflammation-complex (MIC) is a risk factor for mortality and lower quality of life in haemodialysis (HD) patients. The identification of MIC and its risk factors, which include the limited ability to perform functional status (FS), is key to improve the patient experience on HD. Our study investigates the association of MIC and FS combinations with mortality in HD patients. Method We analysed data from a cohort of 5465 HD patients from Australia, France, Germany, Italy, Japan, New Zealand, Spain, Sweden, and United Kingdom, enrolled in the Dialysis Outcomes and Practice Patterns Study phases 4 (2009-2011) and 5 (2012-2015). MIC syndrome was defined as low serum albumin (<3.8 g/dL) and high serum C-reactive protein (>3mg/L in Japan; >10 mg/L elsewhere). Poor functional status was defined as the sum of scores from the self-reported limitations in the Katz Index of Independence in Activities of Daily Living (score ranges from 0 to 5) and the Lawton-Brody Instrumental Activities of Daily Living Scale (score ranges from 0 to 8) less than 11. We investigated the association between combinations of MIC (+/-) and FS (low/high) with death, using Cox proportional hazards models adjusted for possible confounders including patient demographics, comorbidity history, catheter use, serum creatinine, phosphorus levels, WBC count, haemoglobin level, and time on dialysis therapy. Results The prevalence of different combinations were: MIC-/High FS 57%, MIC-/Low FS 24%, MIC+/High FS 9%, and MIC+/Low FS 10%. Patients with MIC-/high FS were younger, better nourished, and had lower prevalence of comorbidities. Compared to this reference group, the adjusted hazard ratios [HR (95% CI)] for all-cause mortality were 1.56 (1.24-1.98) for MIC-/ low FS, 1.75 (1.32-2.32) for MIC+/ high FS, and 2.97 (2.31-3.82) for MIC+/ low FS groups. The adjusted HRs for infection-related mortality were 1.57 (0.91, 2.71) for MIC-/low FS, 1.67 (0.84, 3.31) for MIC+/High FS, and 5.45 (3.15, 9.45) for MIC+/low FS groups. Conclusion The combination of MIC and low FS is a strong predictor of mortality, and infectious mortality in particular, in HD patients. Identification of patients with MIC and FS status may plausibly help to direct interventions to improve patients’ experiences and lessen adverse clinical outcomes in the HD setting.

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Central and Peripheral Adiposity Had Different Effect on Disability in Centenarians

Frontiers in Endocrinology ◽

10.3389/fendo.2021.635205 ◽

2021 ◽

Vol 12 ◽

Author(s):

Shanshan Yang ◽

Shengshu Wang ◽

Penggang Tai ◽

Wangping Jia ◽

Ke Han ◽

...

Keyword(s):

Activities Of Daily Living ◽

Educational Level ◽

Daily Living ◽

Central Obesity ◽

Household Survey ◽

Continuous Variable ◽

Calf Circumference ◽

Full Sample ◽

Iadl Disability ◽

Adl Disability

PurposeTo explore the correlations between waist circumference, body mass index, calf circumference (CC), and waist-calf circumference ratio (WCR) and activities of daily living (ADLs) and instrumental activities of daily living (IADLs) in Hainan centenarians.Patients and MethodsA total of 1,002 Hainan centenarians were selected by full sample household survey. ADLs and IADLs were used to investigate the ability of activity and instrumental activity in daily living. The possible non-linear associations were further analyzed using restricted cubic spline.ResultsAfter adjusting for demographic characteristics (gender, age, ethnicity, marital status, educational level, and type of residence) and lifestyle (smoking, drinking, and exercise), the odds ratio (OR) of CC (continuous variable) on ADL disability in centenarians was 0.90 (95% CI: 0.85–0.96), while high WCR (continuous variable) was related with high risk of ADL disability (OR=1.73; 95% confidence interval[CI], 1.07–2.80). The ORs of CC and WCR for IADL severe disability were 0.86 (95% CI, 0.82–0.91) and 2.23 (95% CI, 1.52–3.28), respectively.ConclusionCentral (WCR) and peripheral (CC) adiposity had different effects on disability (ADL and IADL) in centenarians. Even in centenarians, maintaining muscle mass (with higher calf circumference) and avoiding central obesity are of positive significance for the prevention of ADL/IADL disability.

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Different Combinations of Mobility Metrics Derived From a Wearable Sensor Are Associated With Distinct Health Outcomes in Older Adults

The Journals of Gerontology Series A ◽

10.1093/gerona/glz160 ◽

2019 ◽

Vol 75 (6) ◽

pp. 1176-1183 ◽

Cited By ~ 8

Author(s):

Aron S Buchman ◽

Robert J Dawe ◽

Sue E Leurgans ◽

Thomas A Curran ◽

Timothy Truty ◽

...

Keyword(s):

Older Adults ◽

Health Outcomes ◽

Activities Of Daily Living ◽

Gait Speed ◽

Daily Living ◽

Proportional Hazards ◽

Cox Proportional Hazards ◽

Adverse Health Outcomes ◽

Backward Elimination ◽

Cox Proportional Hazards Models

Abstract Background Gait speed is a robust nonspecific predictor of health outcomes. We examined if combinations of gait speed and other mobility metrics are associated with specific health outcomes. Methods A sensor (triaxial accelerometer and gyroscope) placed on the lower back, measured mobility in the homes of 1,249 older adults (77% female; 80.0, SD = 7.72 years). Twelve gait scores were extracted from five performances, including (a) walking, (b) transition from sit to stand, (c) transition from stand to sit, (d) turning, and (e) standing posture. Using separate Cox proportional hazards models, we examined which metrics were associated with time to mortality, incident activities of daily living disability, mobility disability, mild cognitive impairment, and Alzheimer’s disease dementia. We used a single integrated analytic framework to determine which gait scores survived to predict each outcome. Results During 3.6 years of follow-up, 10 of the 12 gait scores predicted one or more of the five health outcomes. In further analyses, different combinations of 2–3 gait scores survived backward elimination and were associated with the five outcomes. Sway was one of the three scores that predicted activities of daily living disability but was not included in the final models for other outcomes. Gait speed was included along with other metrics in the final models predicting mortality and activities of daily living disability but not for other outcomes. Conclusions When analyzing multiple mobility metrics together, different combinations of mobility metrics are related to specific adverse health outcomes. Digital technology enhances our understanding of impaired mobility and may provide mobility biomarkers that predict distinct health outcomes.

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Trends in the Incidence of Activities of Daily Living Disability Among Chinese Older Adults From 2002 to 2014

The Journals of Gerontology Series A ◽

10.1093/gerona/glz221 ◽

2019 ◽

Vol 75 (11) ◽

pp. 2113-2118 ◽

Cited By ~ 4

Author(s):

Zhi-Hao Li ◽

Yue-Bin Lv ◽

Virginia Byers Kraus ◽

Zhao-Xue Yin ◽

Si-Min Liu ◽

...

Keyword(s):

Risk Factors ◽

Older Adults ◽

Cardiovascular Risk ◽

Older People ◽

Activities Of Daily Living ◽

Cardiovascular Risk Factors ◽

Daily Living ◽

Cox Proportional Hazards ◽

Adl Disability ◽

Chinese Older People

Abstract Background Evidence of the trend of the incidence of activities of daily living (ADL) disability among Chinese older people is limited. We aimed to investigate the time trends and potential risk factors for the incidence of ADL disability among Chinese older people (≥65 years). Methods We established two consecutive and nonoverlapping cohorts (6,857 participants in the 2002 cohort and 5,589 participants in the 2008 cohort) from the Chinese Longitudinal Healthy Longevity Survey. ADL disability was defined as the need for assistance with at least one essential activity (dressing, bathing, toileting, eating, indoor activities, and continence). Cox proportional hazards models were used to identify factors associated with the trend in the incidence of ADL disability from 2002 to 2014. Results The incidence (per 1,000 person-years) of ADL disability decreased significantly from 64.2 in the 2002 cohort to 46.6 in the 2008 cohort (p < .001), and decreasing trends in the incidence of ADL disability were observed for all sex, age, and residence subgroups (all p < .001), even after adjusting for multiple potential confounding factors. Moreover, we found that adjustment for sociodemographic, lifestyle information, and cardiovascular risk factors (hypertension, diabetes, heart disease, and stroke) explained less of the decline in ADL disability during the period from 2002 to 2014. Conclusion The incidence of ADL disability among the older adults in China appears to have decreased during the study period, and this finding cannot be explained by existing sociodemographic and lifestyle information and cardiovascular risk factors.

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INCIDENT DIFFICULTY IN INSTRUMENTAL ACTIVITIES OF DAILY LIVING: WHICH COMES FIRST?

Innovation in Aging ◽

10.1093/geroni/igz038.1924 ◽

2019 ◽

Vol 3 (Supplement_1) ◽

pp. S522-S522

Author(s):

Danielle L Feger ◽

George W Rebok ◽

Sherry Willis ◽

Alden L Gross

Keyword(s):

Older Adults ◽

Activities Of Daily Living ◽

Daily Living ◽

Independent Living ◽

Proportional Hazards ◽

Cox Proportional Hazards ◽

Phone Call ◽

Proportional Hazards Regression ◽

Instrumental Activities ◽

Household Cleaning

Abstract Background: Instrumental activities of daily living (IADLs) are necessary for successful independent living. Older adults may develop difficulty completing IADLs as they become physically and/or cognitively frail. The relative ordering in which IADLs deteriorate, and the importance of this ordering, is not well understood. Methods: Participants from the Advanced Cognitive Training for Independent and Vital Elderly (ACTIVE) study who reported no difficulty with IADLs at baseline were included. Individuals were followed up to 10 years for incidence of self-reported difficulty in 19 specific IADLs. The outcome of interest was time to any incident difficulty. We used Cox proportional hazards regression to estimate the hazard ratio (HR) of incident IADL difficulty for each IADL. Results: Of N=1,273 participants who contributed 6,144 person-years to the analysis, 887 developed difficulty with at least 1 IADL during the study period. The tasks in which participants reported difficulty earliest included giving self-injections (HR=5.69, [4.77, 6.79]), balancing checkbooks (HR=5.56, [4.32-7.16]), remembering often called numbers without having to look them up (HR=5.47, [4.55-6.59]), and household chores (HR=4.18, [3.43-5.11]). The last tasks to become difficult included keeping household expenses balanced (HR=0.07, [0.04-0.14]) and hanging up at the end of a phone call (HR=0.23, [0.09-0.56]). Conclusion: Independent older adults reported earlier difficulty with balancing checkbooks, remembering often called phone numbers, and doing household cleaning. Recognizing these early difficult tasks may facilitate early planning for family members and adoption of compensatory strategies.

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Sarcoscore: A Novel Approach for Assessing Sarcopenia and Functional Disability in Older Adults

Journal of Clinical Medicine ◽

10.3390/jcm9030692 ◽

2020 ◽

Vol 9 (3) ◽

pp. 692

Author(s):

Yosuke Osuka ◽

Hunkyung Kim ◽

Hisashi Kawai ◽

Yu Taniguchi ◽

Yuri Yokoyama ◽

...

Keyword(s):

Activities Of Daily Living ◽

Daily Living ◽

Functional Disability ◽

Proportional Hazards ◽

Handgrip Strength ◽

Principal Component ◽

Population Based ◽

Cox Proportional Hazards ◽

Cross Sectional ◽

Skeletal Muscle Index

Sarcopenia is associated with instrumental activities of daily living (IADL) and basic activities of daily living (BADL) disabilities. We developed an index for assessing sarcopenia degree (sarcoscore) and compared it to the Asian Working Group for Sarcopenia (AWGS) criteria. Principal component analyses of walking speed, handgrip strength, and skeletal muscle index were performed to develop a sarcoscore using 3088 Japanese population-based cross-sectional data. During the nine-year follow-up, 278 of 2571 and 88 of 2341 participants developed IADL and BADL disabilities, respectively. Adjusted Cox proportional hazards regression models showed that the sarcoscore criteria, defined as proportional to the sarcopenia prevalence diagnosed by the AWGS criteria, had higher hazard ratios (HRs) and 95% confidence interval (CI) for disability onset than the AWGS criteria (IADL disability: 2.19 (1.64–2.93) vs. 1.79 (1.32–2.43), BADL disability: 4.28 (2.63–6.96) vs. 3.22 (1.97–5.27)). The adjusted HRs for IADL and BADL disabilities were reduced by 4% and 8% per point increase in the sarcoscore, respectively. The sarcoscore assessed the degree of sarcopenia and had a satisfactory performance for predicting functional disabilities in older Japanese adults, suggesting its usefulness as a complementary composite marker for clinical diagnosis.

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Association of Brain Natriuretic Peptide With Mortality in Exceptionally Long-Lived Families

Innovation in Aging ◽

10.1093/geroni/igaa057.681 ◽

2020 ◽

Vol 4 (Supplement_1) ◽

pp. 211-211

Author(s):

Allison Kuipers ◽

Robert Boudreau ◽

Mary Feitosa ◽

Angeline Galvin ◽

Bharat Thygarajan ◽

...

Keyword(s):

Older Adults ◽

Brain Natriuretic Peptide ◽

Natriuretic Peptide ◽

Sex Education ◽

Proportional Hazards ◽

Cox Proportional Hazards ◽

Time To Event ◽

Healthy Older Adults ◽

Secondary Analyses

Abstract Natriuretic peptides are produced within the heart and released in response to increased chamber wall tension and heart failure (HF). N-Terminal prohormone Brain Natriuretic Peptide (NT-proBNP) is a specific natriuretic peptide commonly assayed in persons at risk for HF. In these individuals, NT-proBNP is associated with future disease prognosis and mortality. However, its association with mortality among healthy older adults remains unknown. Therefore, we determined the association of NT-proBNP with all-cause mortality over a median follow-up of 10 years in 3253 individuals free from HF at baseline in the Long Life Family Study, a study of families recruited for exceptional longevity. We performed cox proportional hazards analysis (coxme in R) for time-to event (mortality), adjusted for field center, familial relatedness, age, sex, education, smoking, alcohol, physical activity, BMI, diabetes, hypertension, and cancer. In addition, we performed secondary analyses among individuals (N=2457) within the normal NT-proBNP limits at baseline (<125pg/ml aged <75 years; <450pg/ml aged ≥75 years). Overall, individuals were aged 32-110 years (median 67 years; 44% male), had mean NT-proBNP of 318.5 pg/ml (median 91.0 pg/ml) and 1066 individuals (33%) died over the follow-up period. After adjustment, each 1 SD greater baseline NT-proBNP was associated with a 1.30-times increased hazard of mortality (95% CI: 1.24-1.36; P<0.0001). Results were similar in individuals with normal baseline NT-proBNP (HR: 1.21; 95% CI: 1.11-1.32; P<0.0001). These results suggest that NT-proBNP is a strong and specific biomarker for mortality in older adults independent of current health status, even in those with clinically-defined normal NT-proBNP.

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

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18126271 ◽

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.

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Social isolation, loneliness and functional disability in Chinese older women and men: a longitudinal study

Age and Ageing ◽

10.1093/ageing/afaa271 ◽

2020 ◽

Author(s):

Lizhi Guo ◽

Li An ◽

Fengping Luo ◽

Bin Yu

Keyword(s):

Longitudinal Study ◽

Activities Of Daily Living ◽

Functional Status ◽

Social Isolation ◽

Daily Living ◽

Functional Disability ◽

Iadl Disability ◽

Older Populations ◽

New Onset

Abstract Objective This study investigated whether loneliness or social isolation is associated with the onset of functional disability over 4 years among Chinese older populations. Setting and Subjects This study used data from the China Health and Retirement Longitudinal Study (CHARLS). Functional status was assessed by activities of daily living (ADL) and instrumental activities of daily living (IADL). Analyses were conducted with data from two waves (2011 and 2015) and were restricted to those respondents aged 50 and older and free of functional disability at baseline [n = 5,154, mean age (SD) = 60.72 (7.51); male, 52.3%]. Method Social isolation, loneliness and covariates were measured at baseline. Follow-up measures of new-onset ADL and IADL disability were obtained 4 years later. We stratified the sample by gender, and then used binary logistic regressions to evaluate the associations between baseline isolation, loneliness and new-onset ADL and IADL disability. Results For women, baseline social isolation was significantly associated with new-onset ADL (OR = 1.18, 95% CI = 1.07–1.30) and IADL (OR = 1.11, 95% CI = 1.01–1.21) disability; no significant association between loneliness and ADL or IADL disability was found. For men, neither social isolation nor loneliness was found to be significantly associated with ADL or IADL disability. Conclusion This longitudinal study found that social isolation, rather than loneliness, was significantly associated with functional disability over 4 years among women (but not men) in China. These findings expand our knowledge about the association between social relationships and functional status among non-Western populations.

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

The Journals of Gerontology Series A ◽

10.1093/gerona/glaa316 ◽

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.

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