Risk of functional decline among well elders

doi:10.1016/0895-4356(89)90103-0

Journal of Clinical Epidemiology

Volume 42, Issue 9, 1989, Pages 895-904

https://doi.org/10.1016/0895-4356(89)90103-0 Get rights and content

Abstract

Active lifestyles may delay the onset of the functional consequences of chronic disease, potentially increasing active life expectancy. We analyzed the Longitudinal Study of Aging (LSOA) to test the hypothesis that elders' participation in an active lifestyle prevents loss of function. Focusing on the cohort aged 70–74 who reported being able to carry 25 lb, walk $14$ mile, climb 10 steps and do heavy housework without help and without difficulty at baseline, decline was defined as no longer being able to perform these tasks independently and without difficulty 2 years later. Using multivariate logistic regression, results reveal that those who did not report regularly exercising or walking a mile were 1.5 times more likely to decline than those who did, controlling for reported medical conditions and demographic factors. Similar findings (with different models) were observed for both men and women. Findings suggest the potential value of programs oriented toward the primary prevention of functional decline.

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Aging is the primary risk factor for functional decline; thus, understanding and preventing disability among older adults has emerged as an important public health challenge of the 21st century. The science of gerontology – or geroscience - has the practical purpose of “adding life to the years.” The overall goal of geroscience is to increase healthspan, which refers to extending the portion of the lifespan in which the individual experiences enjoyment, satisfaction, and wellness. An important facet of this goal is preserving mobility, defined as the ability to move independently. Despite this clear purpose, this has proven to be a challenging endeavor as mobility and function in later life are influenced by a complex interaction of factors across multiple domains. Moreover, findings over the past decade have highlighted the complexity of walking and how targeting multiple systems, including the brain and sensory organs, as well as the environment in which a person lives, can have a dramatic effect on an older person's mobility and function. For these reasons, behavioral interventions that incorporate complex walking tasks and other activities of daily living appear to be especially helpful for improving mobility function. Other pharmaceutical interventions, such as oxytocin, and complementary and alternative interventions, such as massage therapy, may enhance physical function both through direct effects on biological mechanisms related to mobility, as well as indirectly through modulation of cognitive and socioemotional processes. Thus, the purpose of the present review is to describe evolving interventional approaches to enhance mobility and maintain healthspan in the growing population of older adults in the United States and countries throughout the world. Such interventions are likely to be greatly assisted by technological advances and the widespread adoption of virtual communications during and after the COVID-19 era.
Relationship between Chronic Conditions and Disability in African American Men and Women
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Citation Excerpt :
Logistic regression was conducted to estimate the independent effect of each demographic and medical condition on odds of disability. Because of the documented sex differences in disability56-58 all analyses were stratified by sex. P-values <0.05 were considered statistically significant and all tests were two-tailed.
Race differences in chronic conditions and disability are well established; however, little is known about the association between specific chronic conditions and disability in African Americans. This is important because African Americans have higher rates and earlier onset of both chronic conditions and disability than white Americans.
We examined the relationship between chronic conditions and disability in 602 African Americans aged 50 years and older in the Baltimore Study of Black Aging. Disability was measured using self-report of difficulty in activities of daily living (ADL). Medical conditions included diagnosed self-reports of asthma, depressive symptoms, arthritis, cancer, diabetes, cardiovascular disease (CVD), stroke, and hypertension.
After adjusting for age, high school graduation, income, and marital status, African Americans who reported arthritis (women: odds ratio (OR)=4.87; 95% confidence interval(CI): 2.92–8.12; men: OR=2.93; 95% CI: 1.36–6.30) had higher odds of disability compared to those who did not report having arthritis. Women who reported major depressive symptoms (OR=2.59; 95% CI: 1.43–4.69) or diabetes (OR=1.83; 95% CI: 1.14–2.95) had higher odds of disability than women who did not report having these conditions. Men who reported having CVD (OR=2.77; 95% CI: 1.03–7.41) had higher odds of disability than men who did not report having CVD.
These findings demonstrate the importance of chronic conditions in understanding disability in African Americans and how it varies by gender. Also, these findings underscore the importance of developing health promoting strategies focused on chronic disease prevention and management to delay or postpone disability in African Americans.
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Validation of Katz index of independence in activities of daily living in Turkish older adults
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Katz Index of Independence in Activities of Daily Living Scale (Katz ADL) is a widely used tool to assess the level of independency in older adults. The objective of this study was to assess the validity and reliability of the Turkish version of the six item Katz ADL in geriatric patients aged 65 years and older.
The participants were recruited in a geriatric medicine outpatient clinic (n = 211). The Katz ADL was translated to Turkish and it was administered with the Barthel index (BI) and SF-36 physical functioning subscale (SF-36 PF) which are already validated in Turkish. Reliability was assessed by internal consistency, interrater and test–retest analysis. Construct validity was assessed by Spearman correlations between the Katz ADL and other functional status indices.
The internal consistency was high (Cronbach’s α = 0.838). The test–retest reliability and inter-rater reliability were excellent (ICC 0.999 [0.999–1.000 95% CI]). Regarding the convergent validity strong associations between Katz ADL, BI and SF-36 PF were demonstrated (r_s = 0.988, p < 0.001 and r_s = 0.674, p < 0.001).
Validating an instrument, which has originally been developed in a different culture, is a complex but neccessary task. It provides an opportunity for comparison of information across different cultures. To our knowledge, this is the only study to demonstrate reliability and validity of the Katz ADL-six item version in the geriatric population living in Turkey. Turkish version of the Katz ADL is a valid and reliable scale to detect the disability status in the basic activities of daily living in older adults.
Physical fitness is predictive for a decline in the ability to perform instrumental activities of daily living in older adults with intellectual disabilities: Results of the HA-ID study
2015, Research in Developmental Disabilities
The ability to perform instrumental activities of daily living (IADL) is important for one's level of independence. A high incidence of limitations in IADL is seen in older adults with intellectual disabilities (ID), which is an important determinant for the amount of support one needs. The aim of this study was to assess the predictive value of physical fitness for the ability to perform IADL, over a 3-year follow-up period, in 601 older adults with ID. At baseline, an extensive physical fitness assessment was performed. In addition, professional caregivers completed the Lawton IADL scale, both at baseline and at follow-up. The average ability to perform IADL declined significantly over the 3-year follow-up period. A decline in the ability to perform IADL was seen in 44.3% of the participants. The percentage of participants being completely independent in IADL declined from 2.7% to 1.3%. Manual dexterity, balance, comfortable and fast gait speed, muscular endurance, and cardiorespiratory fitness were significant predictors for a decline in IADL after correcting for baseline IADL and personal characteristics (age, gender, level of ID, and Down syndrome). This can be interpreted as representing the predictive validity of the physical tests for a decline in IADL. This study shows that even though older adults with ID experience dependency on others due to cognitive limitations, physical fitness also is an important aspect for IADL, which stresses the importance of using physical fitness tests and physical fitness enhancing programs in the care for older adults with ID.
Predicting disabilities in daily functioning in older people with intellectual disabilities using a frailty index
2014, Research in Developmental Disabilities
Frailty is a state of increased vulnerability to adverse health outcomes compared to others of the same age. People with intellectual disabilities (ID) are more frequently and earlier frail compared to the general population. Frailty challenges much of health care, which will likely further increase due to the aging of the population. Before effective interventions can start, more information is necessary about the consequences of frailty in this, already disabled, population. Here we report whether frailty predicts disabilities in daily functioning. Frailty was measured with a frailty index (FI). At baseline and follow-up activities of daily living (ADL), instrumental activities of daily living (IADL) and mobility were collected by informant report. For 703 older people with ID (≥50 yr) baseline and follow-up measures were known. Multivariate linear regression models were used to predict ADL, IADL and mobility at follow-up. The FI was significantly associated with disabilities in daily functioning independent of baseline characteristics (age, gender, level of ID, Down syndrome) and baseline ADL, IADL or mobility. The FI showed to be most predictive for those with relative high independence at baseline. These results stress the importance for interventions that limit the progression of frailty and, thereby, help to limit further disability.
Physical fitness is predictive for a decline in daily functioning in older adults with intellectual disabilities: Results of the HA-ID study
2014, Research in Developmental Disabilities
A high incidence of limitations in daily functioning is seen in older adults with intellectual disabilities (ID), along with poor physical fitness levels. The aim of this study was to assess the predictive value of physical fitness for daily functioning after 3 years, in 602 older adults with borderline to profound ID (≥50 years). At baseline, physical fitness levels and daily functioning (operationalized as basic activities of daily living [ADL] and mobility) were assessed. After 3 years, the measurements of daily functioning were repeated. At follow-up, 12.6% of the participants were completely independent in ADL and 48.5% had no mobility limitations. More than half of the participants (54.8%) declined in their ability to perform ADL and 37.5% declined in their mobility. Manual dexterity, visual reaction time, balance, comfortable and fast gait speed, muscular endurance, and cardiorespiratory fitness were significant predictors for a decline in ADL. For a decline in mobility, manual dexterity, balance, comfortable and fast walking speed, grip strength, muscular endurance, and cardiorespiratory fitness were all significant predictors. This proves the predictive validity of these physical fitness tests for daily functioning and stresses the importance of using physical fitness tests and implementing physical fitness enhancing programs in the care for older adults with ID.

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^☆: Supported in part by Grant No. HS00011-02 from the National Center for Health Services Research.

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Original articleRisk of functional decline among well elders☆

Abstract

J Chron Dis

J Chron Dis

J Chron Dis

J Chron Dis

J Chron Dis

J Chron Dis

J Chron Dis

Toward an operational definition of health

J Health Soc Behav

Scales for measuring general health perceptions

Health Serv Res

The Framingham Disability Study II. Physical disability among the aging

Am J Public Health

Long term care: current estimates and projections

Active life expectancy

N Engl J Med

Aging, natural death, and the compression of morbidity

N Engl J Med

Prevention of Disability in the Aged

Exercise, functional aerobic capacity and aging

Exercise and aging (Editorial)

Ann Intern Med

The longitudinal study of aging: the 1986 reinterview public-use file

Original article
Risk of functional decline among well elders☆