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Prediction of severe, persistent activity-of-daily-living disability in older adults.

ABSTRACT: In a prospective cohort of nondisabled adults aged 65 years or more in the Established Populations for Epidemiologic Studies of the Elderly (1981-1987 and 1985-1992), we used a competing risk approach to predict the 5-year risk of severe, persistent activities-of-daily-living (ADLs) disability, defined as dependence in ≥3 ADLs for 2 consecutive annual interviews or for 1 interview followed by death in the subsequent year. During 5 years, 6.8% developed severe, persistent ADL dependence, and 14.6% died without severe, persistent ADL dependence in the derivation cohort (n = 8,301); the corresponding percentages were 6.8% and 15.8% in the validation cohort (n = 4,177). A model based on age, current employment, visual impairment, self-rated health, diabetes mellitus, history of stroke or brain hemorrhage, cognitive function, and self-reported physical function showed good calibration. Discrimination, assessed by C statistics, for <70, 70-74, 75-79, and ≥80 years, was 0.75, 0.74, 0.65, and 0.66 in the derivation cohort and 0.70, 0.72, 0.70, and 0.65 in the validation cohort, respectively. In conclusion, a simple risk score based on routinely available clinical information can predict severe, persistent disability in 5 years. Future studies should examine whether physical performance measures can further improve prediction in the oldest old.

SUBMITTER: Kim DH

PROVIDER: S-EPMC3783096 | biostudies-literature | 2013 Oct

REPOSITORIES: biostudies-literature

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Prediction of severe, persistent activity-of-daily-living disability in older adults.

Kim Dae Hyun DH Newman Anne B AB Lipsitz Lewis A LA

American journal of epidemiology 20130619 7

In a prospective cohort of nondisabled adults aged 65 years or more in the Established Populations for Epidemiologic Studies of the Elderly (1981-1987 and 1985-1992), we used a competing risk approach to predict the 5-year risk of severe, persistent activities-of-daily-living (ADLs) disability, defined as dependence in ≥3 ADLs for 2 consecutive annual interviews or for 1 interview followed by death in the subsequent year. During 5 years, 6.8% developed severe, persistent ADL dependence, and 14.6 ...[more]

PMID: 23785110

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Project description:BackgroundStudies have examined functional disability among older adults by combining Activities of Daily Living (ADL) and Instrumental Activities of Daily Living (IADL). This study adds another dimension to ADL and IADL by combining various impairments such as hearing, vision, walking, chewing, speaking, and memory loss among older adults. This study examines functional disability among older adults in India as measured by ADL, IADL, along with various impairments.MethodsThis study utilized data from Building a Knowledge Base on Population Aging in India (BKPAI), a national-level survey and conducted across seven states of India. The study utilized three outcome variables, namely, ADL, IADL, and Impairments. Descriptive and bivariate analyses were used along with multivariate analysis to fulfil the objectives of the study. The concentration index was calculated for ADL, IADL, and impairments, and further, decomposition analysis was carried out for IADL.ResultsThe results observed that nearly 7.5% of older adults were not fully independent for ADL. More than half (56.8%) were not fully independent for IADL, and nearly three-fourths (72.6%) reported impairments. Overall, ADL, IADL, and impairments were higher among older adult's aged 80+ years, older adults with poor self-rated health, and those suffering from chronic diseases. The likelihood of ADL (AOR = 6.42, 95% CI: 5.1-8.08), IADL (AOR = 5.08, 95% CI: 4.16-6.21), and impairment (AOR = 3.50, 95% CI: 2.73-4.48) were significantly higher among older adults aged 80+ years compared to 60-69 years. Furthermore, older adults who had poor self-rated health and suffered from chronic diseases were more likely to report ADL (AOR = 2.95, 95% CI: 2.37-3.67 and AOR = 2.70, 95% CI: 2.13-3.43), IADL (AOR = 1.74, 95% CI: 1.57-1.92 and AOR = 1.15, 95% CI: 1.04-1.15), and impairment (AOR = 2.36, 95% CI: 2.11-2.63 and AOR = 2.95, 95% CI: 2.65-3.30), respectively compared to their counterparts. Educational status and wealth explained most of the socio-economic inequality in the prevalence of IADL among older adults.ConclusionIt is recommended that the government advise older adults to adopt health-promoting approaches, which may be helpful. Further, there is a pressing need to deliver quality care to older adults suffering from chronic conditions.

Project description:BackgroundGlobal population ageing has brought about new challenges for elderly care. Exploring intrinsic capacity (IC) over time, which is designed as a composite measure of an individual's physical and mental capabilities, is essential for promoting healthy ageing and preventing dependency, such as that emerging from disability in activities of daily living (ADL). We aimed to identify and examine the differences between classes of IC trajectory and onset of ADL disability.MethodsWe conducted an observational study using data from three waves (2011-15) of the China Health and Retirement Longitudinal Study, comprising 2609 participants with 6034 observations. IC was measured by five domains, including locomotion, cognition, psychological, sensory capacities, and vitality. We used joint latent class modelling to identify distinct classes with similar patterns of IC trajectory and onset of ADL disability, as well as to explore the variation in IC trajectory and predict five-year risks of ADL disability considering the heterogeneity in the elderly population.ResultsThe average baseline IC score was 7.15 (range: 0-15). We observed that IC scores slowly decreased with age, with 17.25% of participants developing ADL disability. We identified three classes of IC, which could be described as moderate health (class 1: n = 1634, 62.63%), at-risk (class 2: n = 716, 27.44%; had the highest risk of ADL disability), and optimal health (class 3: n = 259, 9.93%; had the lowest baseline risk of ADL disability). The probability of being in the moderate health class was decreased the most by emotional problems (odds ratio (OR) = 0.219; P < 0.001). Having a self-rated poor standard of living substantially reduced the chances of moderate (OR = 0.308; P = 0.001) and optimal health (OR = 0.110; P < 0.001).ConclusionsObserving IC trajectories and the onset of ADL disability can stratify the elderly into heterogeneous groups, as well as provide data for implementing person-centred care plans to reverse the trend and delay the adverse outcomes in clinical practice.

Project description:BackgroundIdentifying factors that affect variation in health care spending among older adults with disability may reveal opportunities to better address their care needs while offsetting excess spending.ObjectiveTo quantify differences in total Medicare spending among older adults with disability by whether they experience negative consequences due to inadequate support with household activities, mobility, or self-care.DesignObservational study of in-person interviews and linked Medicare claims.SettingUnited States, 2015.Participants3716 community-living older adults who participated in the 2015 NHATS (National Health and Aging Trends Study) and survived for 12 months.MeasurementsTotal Medicare spending by spending quartile in multivariable regression models that adjusted for individual characteristics.ResultsNegative consequences were experienced by 18.3% of participants with disability in household activities, 25.6% with mobility disability, and 20.0% with self-care disability. Median Medicare spending was higher for those who experienced negative consequences due to household ($4866 vs. $4095), mobility ($7266 vs. $4115), and self-care ($10 935 vs. $4436) disability versus those who did not. In regression-adjusted analyses, median spending did not differ appreciably for participants who experienced negative consequences in household activities ($338 [95% CI, -$768 to $1444]), but was higher for those with mobility ($2309 [CI, $208 to $4409]) and self-care ($3187 [CI, $432 to $5942]) disability. In the bottom-spending quartile, differences were observed for self-care only ($1460 [CI, $358 to $2561]). No differences were observed in the top quartile.LimitationThis observational study could not establish causality.ConclusionInadequate support for mobility and self-care is associated with higher Medicare spending, especially in the middle and lower ends of the spending distribution. Better support for the care needs of older adults with disability could offset some Medicare spending.Primary funding sourceThe Commonwealth Fund.

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Prediction of severe, persistent activity-of-daily-living disability in older adults.

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Prediction of severe, persistent activity-of-daily-living disability in older adults.

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