Functional Status and Adaptation: Measuring Activities of Daily Living and Device Use in the National Health and Aging Trends Study

Objective: The objective of this study is to evaluate the functional status and adaptation of older Americans and discover the factors that contribute to device use. Method: Using the community participants’ portion of the first round of National Health and Aging Trends Study (NHATS), we demonstrate the prevalence of device use and reduction in activities, creating a multilevel measure of activities of daily living (ADL) functionality as compared with Katz’s dichotomous measure. In determining whether adaptation is universal irrespective of age, sex, race, living arrangement, and income, or dependent on these variables, we create a measure of device use, performing a path analysis of the device use measure and sociodemographic variables, with disability score as an intervening measure. Results: ADL functionality becomes more nuanced between the Katz-ADL and NHATS-ADL. Age, sex, and living arrangement were predictors of device use; income was indirectly, whereas race was not. Discussion: When assessors design service plans, consideration should be given to older adults’ ability, capacity, and resources to adapt.

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The association of polypharmacy with functional status impairment, frailty, and health-related quality of life in older adults with gastrointestinal malignancy: Results from the Cancer and Aging Resilience Evaluation (CARE) registry.

Journal of Clinical Oncology ◽

10.1200/jco.2020.38.29_suppl.118 ◽

2020 ◽

Vol 38 (29_suppl) ◽

pp. 118-118

Author(s):

Darryl Alan Outlaw ◽

Chen Dai ◽

Mustafa Al-Obaidi ◽

Smith Giri ◽

Smita Bhatia ◽

...

Keyword(s):

Quality Of Life ◽

Older Adults ◽

Activities Of Daily Living ◽

Functional Status ◽

Daily Living ◽

Cancer Type ◽

Health Related Quality ◽

Related Quality ◽

Health Related

118 Background: The majority of new cancer diagnoses occur in adults greater than 65 years of age. Polypharmacy is a common and potentially devastating problem amongst older adults; however, its prevalence and impact in older adults with gastrointestinal (GI) malignancy is poorly understood. Our objective was to examine the prevalence of polypharmacy and its association with functional status impairments, frailty, and health-related quality of life (HRQoL) in older adults with GI malignancy. Methods: The Cancer and Aging Resilience Evaluation (CARE) registry at the University of Alabama at Birmingham (UAB) is an ongoing prospective cohort study that uses a brief geriatric assessment (CARE survey) in older adults with cancer. We evaluated older adults diagnosed with GI malignancy prior to starting cancer therapy. Our primary outcomes of interest were functional status impairments, including dependence in activities of daily living (ADL) and instrumental activities of daily living (IADL), frailty (as defined by a frailty index derived using the principles of deficit accumulation), and HRQoL (assessed via PROMIS 10 global that includes physical and mental scores). Patients were dichotomized into those taking ≥9 vs. < 9 medications. Multivariable analyses examined associations between polypharmacy and the above-listed outcomes, adjusted for age, sex, race, cancer type, cancer stage, and comorbidities. Results: Overall, 357 patients met eligibility criteria; mean age: 70.1 years; primary diagnoses: colorectal (33.6%), pancreatic (24.6%), hepatobiliary (16.2%), gastroesophageal (10.9%), other (14.6%). Patients reported taking a mean of 6.2 medications: 27.7% with 0-3 medications, 48.2% with 4-8 medications, and 24.1% with ≥ 9 medications. Patients taking ≥ 9 medications were more likely to report limitations in ADL (adjusted odds ratio [aOR] 3.29, 95% CI 1.72-6.29) and IADL (aOR 2.86, 95% CI 1.59-5.14). Polypharmacy was also associated with frailty (aOR 3.06, 95% CI 1.73-5.41) and lower physical (aOR 2.82, 95% CI 1.70-4.69) and mental (aOR 1.73, 95% CI 1.03-2.91) HRQoL. Conclusions: Independent of comorbid conditions, polypharmacy was associated with functional status limitations, frailty, and reduced HRQoL in older adults with GI malignancy. Further study of specific medications and interactions is warranted in order to reduce the negative consequences of polypharmacy in this growing and vulnerable population.

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Association of providing/receiving support on the mortality of older adults with different living arrangements in Taiwan: a longitudinal study on ageing

Ageing and Society ◽

10.1017/s0144686x17000484 ◽

2017 ◽

Vol 38 (10) ◽

pp. 2082-2096 ◽

Cited By ~ 4

Author(s):

MIAO-YU LIAO ◽

CHIH-JUNG YEH ◽

SHU-HSIN LEE ◽

CHUN-CHENG LIAO ◽

MENG-CHIH LEE

Keyword(s):

Older Adults ◽

Longitudinal Study ◽

Activities Of Daily Living ◽

Family Support ◽

Living Arrangements ◽

Daily Living ◽

Cox Regression ◽

Economic Status ◽

Living Arrangement ◽

Health Status Measures

ABSTRACTThis longitudinal study evaluated the direct effects of providing/receiving family support on mortality in older adults with different living arrangements in Taiwan. All data analysed were obtained from the Taiwan Longitudinal Study on Aging, 1996–2007, of residents aged ⩾67 years (1,492 men and 1,177 women) and Taiwan's National Death Register. Living arrangements were divided into living alone, living only with spouse, living with family and living with others. Support was mainly defined as family support divided into two categories: providing and receiving. The effect of providing/receiving family support on the mortality of older adults was evaluated using Cox regression analysed by living arrangement. Participants living with their families had lower educational levels (illiterate or elementary school) and more disability in both activities of daily living and instrumental activities of daily living. However, they provided more family support than those in other living arrangements. After adjusting for several potentially confounding variables, including background characteristics, economic status and various health status measures, results showed that older adults living with their families and providing support had an 11 per cent lower mortality rate (Hazard ratio = 0.89; 95 per cent confidence interval = 0.83–0.96; p = 0.0018). In conclusion, we found that, when living with family, the lives of older adults can be extended by providing support, clearly supporting the old adage ‘it is more blessing to give than to receive’. Older adults wanting to extend their lives can be encouraged to provide more help to their families.

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Gait Speed and Instrumental Activities of Daily Living in Older Adults After Hospitalization: A Longitudinal Population-Based Study

The Journals of Gerontology Series A ◽

10.1093/gerona/glab064 ◽

2021 ◽

Author(s):

Juraj Sprung ◽

Mariana Laporta ◽

David S Knopman ◽

Ronald C Petersen ◽

Michelle M Mielke ◽

...

Keyword(s):

Older Adults ◽

Activities Of Daily Living ◽

Functional Status ◽

Gait Speed ◽

Daily Living ◽

Functional Limitations ◽

Parameter Estimate ◽

Population Based ◽

Instrumental Activities

Abstract Background Hospitalization can impair physical and functional status of older adults, but it is unclear whether these deficits are transient or chronic. This study determined the association between hospitalization of older adults and changes in long-term longitudinal trajectories of two measures of physical and functional status: gait speed (GS) and Instrumental Activities of Daily Living measured with Functional Activities Questionnaire (FAQ). Methods Linear mixed effects models assessed the association between hospitalization (non-elective vs. elective, and surgical vs. medical) and outcomes of GS and FAQ score in participants (>60 years old) enrolled in the Mayo Clinic Study of Aging who had longitudinal assessments. Results Of 4,902 participants, 1,879 had ≥1 hospital admission. Median GS at enrollment was 1.1 m/s. The slope of the annual decline in GS before hospitalization was -0.015 m/s. The parameter estimate [95%CI] for additional annual change in GS trajectory after hospitalization was -0.009 [-0.011 to -0.006] m/s, P<0.001. The accelerated GS decline was greater for medical vs. surgical hospitalizations (-0.010 vs. -0.003 m/s, P=0.005), and non-elective vs. elective hospitalizations (-0.011 vs -0.006 m/s, P=0.067). The odds of a worsening FAQ-score increased on average by 4% per year. Following hospitalization, odds of FAQ-score worsening further increased (multiplicative annual increase in odds ratio per year [95%C] following hospitalization was 1.05 [1.03, 1.07], P<0.001). Conclusions Hospitalization of older adults is associated with accelerated long-term decline in GS and functional limitations, especially after non-elective admissions and those for medical indications. However, for most well-functioning participants these changes have little clinical significance.

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Changes in Functional Status Among Clusters of Older Adults After Hospitalization for Pneumonia

Innovation in Aging ◽

10.1093/geroni/igab046.2276 ◽

2021 ◽

Vol 5 (Supplement_1) ◽

pp. 595-596

Author(s):

Chan Mi Park ◽

Hye Chang Rhim ◽

Eun Sik Lee ◽

Wonsock Kim ◽

Jong Hun Kim ◽

...

Keyword(s):

Social Support ◽

Older Adults ◽

Activities Of Daily Living ◽

Functional Status ◽

Functional Recovery ◽

Daily Living ◽

Social Deprivation ◽

Group A ◽

Group B ◽

Group D

Abstract Little is known about how social determinants, comorbidity, and disability status are associated with functional recovery after an acute illness. A prospective cohort study was conducted between 2019-2020 at a university hospital in Korea, to investigate functional recovery after hospitalization for pneumonia in older adults with different degrees of social deprivation, disabilities, and comorbidities. K-means cluster analysis was used to identify groups of patients based on social deprivation score, activities of daily living, instrumental activities of daily living, physical limitation score, and Gagne comorbidity index. Four groups were identified: Group A: non-disabled group with limited social support (n=61 [30.3%]); Group B: multimorbid but non-disabled group with social support (n=45 [22.4%]); Group C: multimorbid and disabled group with social support (n=38 [18.9%]); Group D: multimorbid and disabled group with limited social support (n=57 [28.4%]). Functional status, defined as ability to perform 21 activities and physical tasks independently, was measured via telephone interviews at 1, 3, and 6 months after discharge. Group-based trajectory model identified four functional status trajectories: excellent (n=29 [14.4%]), good (n=51 [25.4%]), fair (n=58 [28.9%]) and poor (n=63 [31.3%]). The most common functional trajectory by four groups was good trajectory (59%) in Group A, excellent trajectory (48.9%) in Group B, fair (50%) and poor trajectory (50%) in Group C, and poor trajectory (77.2%) in Group D. Our results suggest that most patients without disability recover functional status after pneumonia, despite multimorbidity or limited social support. Social support seems to be more important for those with multimorbidity and disability.

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Geriatric Syndromes and Atrial Fibrillation: Prevalence and Association with Anticoagulant use in a National Cohort of Older Americans

10.1101/2020.05.04.20091025 ◽

2020 ◽

Author(s):

Sachin J. Shah ◽

Margaret C. Fang ◽

Sun Y. Jeon ◽

Steven E. Gregorich ◽

Kenneth E. Covinsky

Keyword(s):

Atrial Fibrillation ◽

Older Adults ◽

Activities Of Daily Living ◽

Daily Living ◽

Stroke Risk ◽

Geriatric Syndrome ◽

Marginal Effect ◽

Geriatric Syndromes ◽

Cross Sectional ◽

Older Americans

AbstractBackgroundWhile guidelines recommend focusing primarily on stroke risk to recommend anticoagulants in atrial fibrillation (AF), physicians report that geriatric syndromes (e.g., falls, disability) are important when considering anticoagulants. Little is known about the prevalence of geriatric syndromes in older adults with AF or the association with anticoagulant use.MethodsWe performed a cross-sectional analysis of the 2014 Health and Retirement Study, a nationally representative study of older Americans. Participants were asked questions to assess domains of aging, including function, cognition, and medical conditions. We included participants ≥65 years with two years of continuous Medicare enrollment who met AF diagnosis criteria by claims codes. We examined five geriatric syndromes: one or more falls within the last two years, receiving help with activities of daily living (ADL) or instrumental activities of daily living (IADL), experienced incontinence, and cognitive impairment. We determined the prevalence of geriatric syndromes and their association with anticoagulant use adjusting for ischemic stroke risk (i.e., CHA2DS2-VASc score).ResultsIn this study of 779 participants with AF (median age 80 years, median CHA2DS2-VASc score 4), 82% had ≥1 geriatric syndrome. Geriatric syndromes were common: 49% reported falls, 38% had ADL impairments, 42% had IADL impairment, 37% had cognitive impairments, and 43% reported incontinence. Overall, 65% reported anticoagulant use; guidelines recommend anticoagulant use for 97% of participants. Anticoagulant use rate decreased for each additional geriatric syndrome (average marginal effect −3.7%; 95% CI −1.4% to −5.9%). Lower rates of anticoagulant use were reported in participants with ADL dependency, IADL dependency, and dementia.ConclusionMost older adults with AF had at least one geriatric syndrome, and geriatric syndromes were associated with reduced anticoagulant use. The high prevalence of geriatric syndromes may explain the lower than expected anticoagulant use in older adults.

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Factors associated with handgrip strength in older adults residents in Florianópolis, Brazil: EpiFloripa Aging Study

Revista de Nutrição ◽

10.1590/1678-98652018000400004 ◽

2018 ◽

Vol 31 (4) ◽

pp. 385-395

Author(s):

Susana Cararo CONFORTIN ◽

Lariane Mortean ONO ◽

Vandrize MENEGHINI ◽

Anapaula PASTORIO ◽

Aline Rodrigues BARBOSA ◽

...

Keyword(s):

Physical Activity ◽

Older Adults ◽

Activities Of Daily Living ◽

Daily Living ◽

Leisure Time Physical Activity ◽

Handgrip Strength ◽

Living Arrangement ◽

Age Group ◽

Cross Sectional ◽

Instrumental Activities

ABSTRACT Objective To investigate the association between sociodemographic factors, lifestyle, health conditions and low Handgrip Strength in older adults. Methods A cross-sectional study was conducted in a sample of 598 older adults. The Handgrip Strength (first quartile) was verified using a dynamometer. Independent variables included age group, schooling, living arrangement, paid work, alcohol consumption, smoking, leisure-time physical activity and transportation, disability in activities of daily living and instrumental activities of daily living, history of falls and probable cognitive impairment. Logistic regression analyses were performed (crude and adjusted). Results Age group, disability in instrumental activities of daily living and physical inactivity were associated with low Handgrip Strength for women. For men, there was no association. Conclusion Low Handgrip Strength was positively associated with age, disability in instrumental activities of daily living, and negatively associated with the practice of physical activity in women.

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From Snapshots to Movies: The Association Between Retirement Sequences and Aging Trajectories in Limitations to Perform Activities of Daily Living

Journal of Aging and Health ◽

10.1177/0898264318782096 ◽

2018 ◽

Vol 31 (2) ◽

pp. 293-321 ◽

Cited By ~ 5

Author(s):

Ariel Azar ◽

Ursula M. Staudinger ◽

Andrea Slachevsky ◽

Ignacio Madero-Cabib ◽

Esteban Calvo

Keyword(s):

Older Adults ◽

Activities Of Daily Living ◽

Labor Force ◽

Daily Living ◽

Full Time ◽

Conventional Model ◽

Older Americans ◽

Part Time ◽

Matching Models ◽

Retirement Study

Objective: This study analyzes the dynamic association between retirement sequences and activities of daily living (ADLs) trajectories between ages 60 and 70. Method: Retirement sequences previously established for 7,880 older Americans from the Health and Retirement Study were used in hierarchical linear and propensity score full matching models, analyzing their association with ADL trajectories. Results: Sequences of partial retirement from full- or part-time jobs showed higher baseline and slower decline in ADL than sequences characterized by early labor force disengagement. Discussion: The conventional model in which people completely retire from a full-time job at normative ages and the widely promoted new conventional model of late retirement are both associated with better functioning than early labor force disengagement. But unconventional models, where older adults keep partially engaged with the labor force are also significantly associated with better functioning. These findings call attention to more research on potential avenues to simultaneously promote productive engagement and health later in life.

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Rural-urban inequalities in poor self-rated health, functional disabilities and depression among Chinese older adults: Evidence from the China Health and Retirement Longitudinal Study 2011 and 2015

10.21203/rs.2.23207/v1 ◽

2020 ◽

Author(s):

Haiting Jiang ◽

Bo Burström ◽

Jiaying Chen ◽

Kristina Burström

Keyword(s):

Older Adults ◽

Longitudinal Study ◽

Health Outcomes ◽

Activities Of Daily Living ◽

Educational Level ◽

Daily Living ◽

Living Arrangement ◽

Chinese Older Adults ◽

Self Rated Health ◽

Functional Disabilities

Abstract Background: The demand for healthcare and social services increases with the aging of the population and functional disabilities among older adults. Rural-urban inequalities in health have not been extensively studied previously from the national perspective, especially after classifying the effects of Hukou (household registration system in China) and residence. This study investigates rural-urban inequalities in prevalence of poor self-rated health, functional disabilities and self-reported depression among Chinese older adults and analyses determinants of rural-urban inequalities in self-reported health outcomes. Methods: The data originate from the China Health and Retirement Longitudinal Study (CHARLS), which started in 2011 and collects data every two years, a representative sample in 28 provinces in China. Older adults aged 60 years and above in CHARLS 2011 and CHARLS 2015 were studied. Sociodemographic factors were studied, including age, sex, marital status, living arrangement, living near children, educational level and income. Self-Rated Health (SRH) was assessed with a single question. Basic Activities of Daily Living (BADLs) and Instrumental Activities of Daily Living (IADLs) were used to measure self-reported functional abilities. The 10-item version of the Center for Epidemiologic Studies Depression Scale was used to measure self-reported depression. Results: Rural respondents had poor socioeconomic status and higher prevalence of poor SRH, functional disabilities and depression than urban respondents. The levels of functional disabilities, both BADLs and IADLs, were similar in 2011 and 2015, while the prevalence of poor SRH and self-reported depression were lower in 2015, both among rural and urban respondents. Impairments increased with age, and appeared at younger age among rural respondents compared to urban respondents. Being female, unmarried, with low educational level and low income increased the odds ratios of reporting poor SRH, functional disabilities and depression. Living arrangement and living near children did not have significant impacts on health outcomes. Conclusions: Rural-urban inequalities in poor SRH, functional disabilities and depression were mainly related to educational level and income.

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PROMIS Physical Function 10-Item Short Form for Older Adults in an Emergency Setting

The Journals of Gerontology Series A ◽

10.1093/gerona/glz163 ◽

2019 ◽

Vol 75 (7) ◽

pp. 1418-1423

Author(s):

G W Conner Fox ◽

Sandra Rodriguez ◽

Laura Rivera-Reyes ◽

George Loo ◽

Ariela Hazan ◽

...

Keyword(s):

Older Adults ◽

Activities Of Daily Living ◽

Functional Status ◽

Physical Function ◽

Daily Living ◽

Short Form ◽

Emergency Setting ◽

General Function ◽

Convenience Sample ◽

Patient Reported

Abstract Background Functional status in older adults predicts hospital use and mortality, and offers insight into independence and quality of life. The Patient-Reported Outcome Measurement Information System (PROMIS) was developed to improve and standardize patient-reported outcomes measurements. The PROMIS Physical Function (PROMIS PF) 10-Item Short Form was not created specifically for older adults. By comparing PROMIS with the Katz Index of Activities of Daily Living (Katz), we evaluated PROMIS for measurement of physical function versus general function in an older adult population seen in the ED. Methods A prospective, convenience sample of ED patients 65 years and older (from January 1, 2015 to June 30, 2015) completed Katz and PROMIS PF. Both were compared for scoring distributions and conventional scoring thresholds for severity of impairment (eg, minimal, moderate, severe). We assessed convergence through Spearman correlations, equivalents of conventional thresholds and ranges of physical function, and item-response frequencies. Results A total of 357 completed both function surveys. PROMIS PF and Katz have a modest positive correlation (r = .50, p < .01). Mean PROMIS PF scores within Katz scoring ranges for minimal (43, SD = 10), moderate (32, SD = 7), and severe (24, SD = 7) impairment fell within respective PROMIS PF scoring ranges (severe = 14–29, moderate = 30–39, mild = 40–45), indicating convergence. PROMIS identified impairment in 3× as many patients as did Katz, as PROMIS assesses vigorous physical function (eg, running, heavy lifting) not queried by Katz. However, PROMIS does not assess select activities of daily living (ADLs; eg, feeding, continence) important for assessment of function in older adults. Conclusions There is a modest correlation between PROMIS and Katz. PROMIS may better assess physical function than Katz, but is not an adequate replacement for assessment of general functional status in older adults.

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Association between baseline geriatric domains and survival in older adults with chronic lymphocytic leukemia (CLL).

Journal of Clinical Oncology ◽

10.1200/jco.2021.39.15_suppl.12041 ◽

2021 ◽

Vol 39 (15_suppl) ◽

pp. 12041-12041

Author(s):

Julia Rice ◽

Ryan David Nipp ◽

Daniel E Lage ◽

Ashley M. Nelson ◽

Richard Newcomb ◽

...

Keyword(s):

Social Support ◽

Older Adults ◽

Nutritional Status ◽

Activities Of Daily Living ◽

Functional Status ◽

Clinical Outcomes ◽

Daily Living ◽

Social Activity ◽

Psychological Status ◽

Timed Up And Go

12041 Background: CLL is a disease that commonly affects older adults. Although the value of geriatric assessment is increasingly being recognized in older adults with cancer, few studies have examined the relationship between baseline geriatric domains and clinical outcomes in older adults with CLL. Methods: We conducted a secondary data analysis of 369 adults diagnosed with CLL and treated in a phase 3 randomized trial of patients age ≥65 with bendamustine plus rituximab versus ibrutinib plus rituximab versus ibrutinib alone. We evaluated geriatric domains of functional status (activities of daily living [ADL], instrumental activities of daily living [IADL], Timed “Up and Go,” and number of falls in last 6 months), psychological status (Mental Health Inventory), social activity (Medical Outcomes Study [MOS] Social Activity Survey), cognition (Blessed Orientation Memory Concentration Test), social support (MOS Social Support Tangible and Emotional/Informational subscales), and nutritional status ( > 5% weight loss in the preceding 6 months). We examined associations among baseline geriatric domains with overall survival (OS) and progression-free survival (PFS) using multivariable Cox regression models. Results: The median age of patients was 71 years (range: 65-89). Most were male (67.1%) and had an ECOG performance status of 0 or 1 (96.9%). In multivariable models, the following geriatric domains were significantly associated with OS: better functional status (ADL score: HR 0.67, p = 0.012; IADL score: HR 0.98, p = 0.007); social activity score (HR 0.97, p = 0.004); and nutritional status (HR 2.58, p = 0.008). Similarly, functional status (ADL score: HR 0.77, p = 0.028; IADL score: HR 0.99, p = 0.007); social activity score (HR 0.97, p < 0.001); and nutritional status (HR 2.87, p < 0.001) were all associated with PFS. Additionally, the number of impaired geriatric domains was also associated with OS (HR 1.50, p = 0.004) and PFS (HR 1.45, p < 0.001). Timed “Up and Go”, number of falls in last 6 months, psychological status, cognition, and social support were not significantly associated with clinical outcomes. Conclusions: Geriatric domains of functional status, social activity, and nutritional status were associated with OS and PFS in this cohort of older adults with CLL. These findings highlight the importance of assessing geriatric domains to identify high-risk patients with CLL who may benefit from additional support during their treatment.

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