Disability and Care Needs Among Older Americans

Context

The cost of late-life dependency is projected to grow rapidly as the number of older adults in the United States increases in the coming decades. To provide a context for framing relevant policy discussions, we investigated activity limitations and assistance, care resources, and unmet need for a national sample of older adults.

Methods

We analyzed the 2011 National Health and Aging Trends Study, a new national panel study of more than 8,000 Medicare enrollees.

Findings

Nearly one-half of older adults, or 18 million people, had difficulty or received help in the last month with daily activities. Altogether, 1 in 4 older adults receiving help lived in either a supportive care (15%) or a nursing home (10%) setting. Nearly 3 million received assistance with 3 or more self-care or mobility activities in settings other than nursing homes, and a disproportionate share of persons at this level had low incomes. Nearly all older adults in settings other than nursing homes had at least 1 potential informal care network member (family or household member or close friend), and the average number of network members was 4. Levels of informal assistance, primarily from family caregivers, were substantial for older adults receiving help in the community (164 hours/month) and living in supportive care settings (50 hours/month). Nearly all of those getting help received informal care, and about 3 in 10 received paid care. Of those who had difficulty or received help in settings other than nursing homes, 32% had an adverse consequence in the last month related to an unmet need; for community residents with a paid caregiver, the figure was nearly 60%.

Conclusions

The older population—especially those with few economic resources—has substantial late-life care needs. Policies to improve long-term services and supports and reduce unmet need could benefit both older adults and those who care for them.     

Association Between Disability Trajectory and Health Care Service Utilization Among Older Adults in China

ObjectivesThis study aimed to identify the heterogeneous disability trajectories among older Chinese adults and examine the association between disability trajectories and health care service utilization.DesignProspective cohort study.Setting and ParticipantsA community-based study including older adults aged ≥65 years from the Chinese Longitudinal Healthy Longevity Survey.MethodsDisability was assessed by the difficulties in activities of daily living and instrumental activities of daily living between 2002 and 2018. Health care utilization was measured by the expenditures on outpatient and inpatient services in 2018. Growth mixture modeling was conducted to estimate heterogeneous disability trajectories. A 2-part model was used to analyze the association of disability trajectories and health care utilization. Covariates were included based on Andersen's behavioral model.ResultsThree classes of disability trajectories were identified: the progressive (7.9%), late-onset (13.7%), and normal classes (78.4%). Older adults who followed the late-onset trajectory of disability were more likely to use inpatient services compared with the normal class (odds ratio = 1.47, P < .010), after controlling potential confounders. Compared with the normal class, the progressive class on average spent US$145.94 more annually (45.2% higher) on outpatient services (P < .010) and $738.99 more annually (72.6% higher) on inpatient services (P < .001); the late-onset class reported higher annual expenditures on outpatient and inpatient services of $215.94 (66.9% higher) and $1405.00 (138.0% higher), respectively (all P < .001).Conclusions and ImplicationsHeterogeneous disability trajectories exhibited distinct health care service utilization patterns among older Chinese adults. Older adults affected by late-onset disability incurred the highest health care needs. These findings provide valuable policy-relevant evidence for reducing health care burden among older adults.     

Effect of Sarcopenia Status on Disability Incidence Among Japanese Older Adults

ObjectivesThe updated definition of sarcopenia by the European Working Group on Sarcopenia in Older People (EWGSOP2) recommends both low muscle mass and quality to diagnose sarcopenia; concurrent poor physical performance is considered indicative of severe sarcopenia; however, the relationship between the revised definition and disability incidence among Japanese older adults is unclear. Therefore, we aimed to examine the associations between EWGSOP2-defined sarcopenia and disability incidence among community-dwelling older Japanese adults.DesignNationwide study.Setting and participantsWe included 4561 individuals aged ≥65 years and enrolled in the National Center for Geriatrics and Gerontology–Study of Geriatric Syndromes (NCGG-SGS).MethodsSkeletal muscle mass was assessed using a bioimpedance analysis device; handgrip strength and walking speed were measured as physical performance indicators. We used the Asian Working Group for Sarcopenia cutoffs to define low muscle mass and poor physical performance. We stratified all participants into nonsarcopenia, sarcopenia, and severe sarcopenia groups. Disability incidence was prospectively determined over 49 months using data extracted from the Japanese long-term care insurance system.ResultsThe prevalence of sarcopenia and severe sarcopenia was 3.4% and 1.7%, respectively. Participants with any form of sarcopenia were at a higher risk of disability [hazard ratio (HR) 1.78, 95% confidence interval (CI) 1.27-2.49]. Although participants with severe sarcopenia showed a higher risk of disability (HR 2.00, 95% CI 1.32-3.02), there was no significant disability risk in the sarcopenia group (HR 1.54, 95% CI 0.97-2.46). Grip strength (HR 0.96, 95% CI 0.94-0.98) and walking speed (HR 0.19, 95% CI 0.12-0.30) negatively correlated with disability incidence.Conclusions and implicationsSevere sarcopenia, involving low muscle mass and poor physical performance, might increase disability risk in older adults, as opposed to low muscle mass alone. Further studies are needed to determine whether sarcopenia without poor physical performance increases disability risk.     

Food Insecurity and Functional Disability Among Older Adults in Ghana: The Role of Sex and Physical Activity

ObjectivesWe examined the associations between food insecurity and functional disability among older adults in Ghana and, the roles of sex and physical activity on the relationship.DesignA cross-sectional study design was employed.Setting and participantsA total of 4446 older adults (50+ years of age) from the Study on Global Aging and Adult Health Ghana Wave 2, a countrywide study, was completed in 2015.MethodsLogistic regression models were used to examine the associations between measures of food insecurity and functional disability using data from Study on Global Aging and Adult Health Ghana Wave 2. Functional disability was assessed using World Health Organization Disability Assessment Schedule 2.0 composed of 12 items in 6 domains of cognition, mobility, self-care, getting along, life activities, and participation in society. Food insecurity was assessed from 12-month food sufficiency and experience of hunger over the last 12 months.ResultsApproximately 11% were identified as having functional disability. The prevalence of food insecurity was 23.8% for insufficient food intake and 18.3% for hunger. Adjusting for all variables, older adults who reported consuming insufficient food (OR 2.27; 95% CI 1.57, 3.28), and those who experienced hunger (OR 2.35; 95% CI 1.59, 3.46) had higher odds of functional disability, compared with those not reporting these issues. Sex differences modified the association between hunger and functional disability. Physical activity served as a protective factor (OR 0.60; 95% CI 0.38, 0.95) on the association implying that older adults who engaged in physical activity were 40% less likely to experience food insecurity-induced functional disability.Conclusions and ImplicationsFood insecurity is associated with functional disability among older adults. Results highlight the usefulness of tackling the social determinants of health and promoting financial/social security in older age in a changing Ghanaian society.     

A New Functional Classification Based on Frailty and Disability Stratifies the Risk for Mortality Among Older Adults: The FRADEA Study

ObjectivesThe aim of the current study was to investigate whether a new functional classification, based on basic (BADL) and instrumental (IADL) activities of daily living and frailty, is associated with mortality in older adults during 10 years of follow-up.DesignCohort study, with a follow-up of 10 years.Setting and participantsA total of 924 participants aged 70 and older from the Frailty and Dependence in Albacete (FRADEA) study, a population-based sample of Spanish older adults.MeasuresAt baseline, a new functional classification of 8 categories was constructed with limitations in BADL using the Barthel Index, limitations in IADL using the Lawton IADL Index, and the criteria of the frailty phenotype. Associations with 10-year mortality were assessed using Kaplan-Meier curves and Cox proportional hazard models.ResultsThe risk of mortality gradually increased toward the less functionally independent end of the classification. The presence of mild, moderate, or severe BADL impairment was associated with mortality, in models adjusted for age, sex, comorbidity and institutionalization. The analyses also revealed that those who were BADL independent, IADL dependent and prefrail [hazard ratio (HR) = 2.27, 95% confidence interval (CI) = 1.22-4.20], and those who were BADL independent and frail (HR = 3.74, 95% CI = 1.88-7.42) had an increased risk of mortality.Conclusions/implicationsA new functional classification composed of BADL, IADL, and frailty representing the functional continuum is effective in stratifying the risk for mortality in older adults. Frailty is a high-mortality-risk state close to subjects with mild disability in BADL, needing an intensive specialized approach. Prefrailty with any impairment in IADL has an intermediate mortality risk and should be offered primary care interventions.     

Social Frailty Predicts Incident Disability and Mortality Among Community-Dwelling Japanese Older Adults

Objective

To determine the prevalence of social frailty and its relation to incident disability and mortality in community-dwelling Japanese older adults.

Lay Meanings of Health Among Rural Older Adults in Appalachia

Purpose: Self‐perceptions of health vary depending on one's social and cultural context. Rural residents have been characterized as having a distinct culture, and health differences by residence have been well documented. While there is evidence of poor health among rural older adults, little research has examined how they perceive and define health. Qualitative methods may help capture these lay meanings of health. The purpose of our study was to use a qualitative approach to examine what perceptions community‐dwelling rural older adults have regarding their health. Methods: The study involved thirteen 90‐minute focus groups and short self‐administered surveys with community‐dwelling persons aged 60 years or older residing in 6 rural West Virginia communities. A total of 101 participants were asked questions about their personal definitions of health. With professional transcribed tapes from the focus group discussions, we used a systematic text analysis approach. Findings: Discussions included 4 themes on the meaning of health: (1) health as a value, (2) dimensions of life, (3) holistic nature of health, and (4) health care use and adherence. Conclusion: Our results expand on previous studies and demonstrate that health is a subjective, multidimensional construct deeply embedded in the everyday experience of rural older adults. We found that older adults’ perceptions about health contain components which most medical professionals would not take into account. Health care providers may consider supplementing traditional medical approaches with a more contextually sensitive recognition of rural elders’ desired health goals and outcomes.     

Combined Impact of Traditional and Nontraditional Healthy Behaviors on Frailty and Disability: A Prospective Cohort Study of Older Adults

ObjectivesTo assess the short- and long-term association of 6 healthy behaviors (not smoking, vigorous to moderate physical activity, healthy diet, adequate sleeping duration, not being sedentary, and daily social interaction) with incident frailty and disability.DesignProspective population-based study.Settings and ParticipantsIn 2001, 4008 community-dwelling individuals aged ≥60 years in Spain were recruited. Participants were followed up until 2003, when a short-term phone interview of the remaining 3235 individuals was performed. Then, the participants were followed up until 2009, when a long-term phone interview was conducted with 1309 participants.MeasuresAt baseline, a home interview and a physical examination were conducted to assess healthy behaviors. At baseline and at follow-ups, we ascertained frailty and 4 domains of disability: limitation in instrumental activities of daily living, restriction in daily activities, limitation in mobility, and self-care limitation.ResultsIn the short-term analyses, vigorous to moderate physical activity and not being sedentary were associated with a reduction in frailty, multivariable odds ratios (OR) (95% confidence interval) 0.55 (0.35-0.85) and 0.43 (0.26-0.72). Vigorous to moderate physical activity and adequate sleeping duration decreased instrumental activities of daily living limitation OR 0.63 (0.44–0.91) and 0.69 (0.53–0.89) as well as self-care limitation OR 0.62 (0.41–0.92) and 0.65 (0.45-0.94). Adequate sleep duration and not being sedentary decreased restriction in daily activities OR 0.67 (0.49–0.90) and 0.57 (0.36–0.91). Vigorous to moderate physical activity and healthy diet decreased limitation in mobility OR 0.58 (0.35–0.96) and 0.73 (0.54–0.97). Considering these 5 healthy behaviors, participants who scored 5 (vs ≤ 2) in the combined score had a lower risk of frailty and disability. In the long-term analyses, results showed the same direction as in short-term analyses.Conclusions and ImplicationsThe combination of healthy behaviors is associated with a substantial reduction in the risk of frailty and of most disability outcomes in older adults.     

Impairments in Individual Autonomous Living Tasks and Time to Self-Care Disability in Middle-Aged and Older Adults

ObjectivesImpairments in specific tasks that are necessary for independent living may identify future self-care limitations, and the use of time-varying covariates can better capture the fluidity in functional capacity trajectories over time. The purpose of this study was to determine the associations between individual instrumental activities of daily living (IADL) impairments and time to activities of daily living (ADL) disability for middle-aged and older adults in the United States.DesignLongitudinal panel.SettingDetailed interviews that included physical, biological, and psychosocial measures were completed in person. The core interview was typically completed over the telephone.ParticipantsA nationally representative sample of 15,336 adults aged at least 50 years from the 2006 wave of the Health and Retirement Study was followed for 8 years.MeasuresAbility to perform IADL and ADL were self-reported at each wave. Separate covariate-adjusted Cox models were used to examine the time-varying associations between individual IADL impairments and time to ADL disability.ResultsThe presence of each IADL impairment was associated with a higher hazard ratio for an ADL disability for the following functions: 2.52 [95% confidence interval (CI) 2.35, 2.70] for grocery shopping, 1.91 (CI 1.77, 2.06) for preparing hot meals, 1.55 (CI 1.37, 1.76) for taking medications, 1.48 (CI 1.36, 1.61) for managing money, 1.41 (CI 1.27, 1.57) for using a telephone, and 1.38 (CI 1.29, 1.48) for using a map.Conclusions/ImplicationsOur findings provide insights into the disabling process by revealing how impairments in each IADL are differentially associated with time to ADL disability. Interventions aiming to retain function during aging should be informed by fluctuations in IADL performance and how specific IADL impairments may exacerbate functional capacity declines more so than others.     

Prevalence of Hospital-Associated Disability in Older Adults: A Meta-analysis

ObjectivesHospital-associated disability (HAD), defined as loss of independence in activities of daily living (ADL) following acute hospitalization, is observed among older adults. The study objective is to determine overall prevalence of HAD among older adults hospitalized in acute care, and to assess the impact of study initiation year in moderation of prevalence.DesignMeta-analysis of data collected from randomized trials, quasi-experimental, and prospective cohort studies. English-language searches to identify included studies were completed February 2018 and updated May 2018 of electronic databases and reference lists of studies and reviews. Included studies were human subjects investigations that measured ADL ≥2 time points before or during and after hospitalization and reported prevalence of ADL decline among older adults.SettingAcute care hospital units.ParticipantsAdults aged ≥65 years hospitalized in medical-surgical acute care; total sample size across all included studies was 7375.MethodsIndependence in ADL was assessed using the Katz Index of Independence in Activities of Daily Living and Barthel Index of Independence in Activities of Daily Living.ResultsRandom effects meta-analysis across included studies identified combined prevalence of HAD as 30% (95% CI 24%, 33%; P < .001). The effect of study initiation year on the prevalence rate was minimal. A large amount of heterogeneity was observed between studies, which may be due in part to nonstandardized measurement of ADL impairment or other methodological differences.Conclusions and implicationsHospitalization in acute care poses a significant risk to functional independence of older adults, and this risk is unchanged despite shorter lengths of stay. The evidence supports the continued need for hospital-based programs that provide assessment of functional ability and identification of at-risk older adults in order to better treat and prevent HAD.     

Frailty,Disability, and Ambulatory Blood Pressure in Older Adults

Background and objective

Frailty and disability are associated with cardiovascular risk factors, including hypertension, in older people; however, little is known about their association with ambulatory blood pressure (BP). Thus, we assessed the relationship of frailty and disability with ambulatory BP in older adults.

Does Laughter Predict Onset of Functional Disability and Mortality Among Older Japanese Adults? The JAGES Prospective Cohort Study

BackgroundWhile laughter is broadly recognized as a good medicine, a potential preventive effect of laughter on disability and death is still being debated. Accordingly, we investigated the association between the frequency of laughter and onset of functional disability and all-cause mortality among the older adults in Japan.MethodsThe data for a 3-year follow-up cohort including 14,233 individuals (50.3% men) aged ≥65 years who could independently perform the activities of daily living and participated in the Japan Gerontological Evaluation Study were analyzed. The participants were classified into four categories according to their frequency of laughter (almost every day, 1–5 days/week, 1–3 days/month, and never or almost never). We estimated the risks of functional disability and all-cause mortality in each category using a Cox proportional hazards model.ResultsDuring follow-up, 605 (4.3%) individuals developed functional disability, identified by new certification for the requirement of Long-Term Care Insurance, and 659 (4.6%) deaths were noted. After adjusting for the potential confounders, the multivariate-adjusted hazard ratio of functional disability increased with a decrease in the frequency of laughter (P for trend = 0.04). The risk of functional disability was 1.42 times higher for individuals who laughed never or almost never than for those who laughed almost every day. No such association was observed with the risk of all-cause mortality (P for trend = 0.39).ConclusionsLow frequency of laughter is associated with increased risks of functional disability. Laughter may be an early predictor of functional disability later on in life.Key words: laughter, long-term care, death, cohort study, Japan     

Consumption of Sugar-and Fat-Modified Foods Among Rural Older Adults

Abstract

This study examines the levels of and factors associated with consumption of sugar-and fat-reduced foods in sample of rural, ethnically diverse older adults. Data were collected from 122 older adults, including demographic and health characteristics and six 24-hour recalls over 16-month period. About one-quarter of sweetened foods were modified, while intake of fat-modified foods ranged from 4.4 to 76.1%. Few differences in intake of modified foods were observed by gender and ethnic groups. Diabetes status was associated with higher use of sugar-modified foods. This study shows high level of acceptance of sugar-and fat-modified foods among rural older adults across variety of demographic and health characteristics.     

Black/White Differences in Nutritional Risk Among Rural Older Adults

Abstract

In order to examine race differences in nutritional risk among participants in rural home-delivered meals programs, we conducted a secondary analysis using routinely collected data on 245 participants from two rural North Carolina counties. After constructing three categories of High Nutritional Risk from the putative High Risk category of the Nutrition Screening Initiative's (NSI) DETERMINE Checklist and using adjusted logistic regression, we found black participants 3.7 times more likely than white participants to be at the highest level of nutritional risk, with a further increase in odds when economic need was present. This underscores the importance of understanding racial and cultural differences in the development and delivery of targeted and tailored nutritional services to older adults.     

Health-Related Quality of Life Among Older Adults With and Without Functional Limitations

Objectives. We examined factors that influence health-related quality of life (HRQOL) among individuals aged 50 years and older with and without functional limitations.Methods. We analyzed data from the 2009 Behavioral Risk Factor Surveillance System to assess associations among demographic characteristics, health care access and utilization indicators, modifiable health behaviors, and HRQOL characterized by recent physically and mentally unhealthy days in those with and those without functional limitations. We defined functional limitations as activity limitations owing to physical, mental, or emotional health or as the need for special equipment because of health.Results. Age, medical care costs, leisure-time physical activity, and smoking were strongly associated with both physically and mentally unhealthy days among those with functional limitations. Among those without functional limitations, the direction of the effects was similar, but the size of the effects was substantially smaller.Conclusions. The availability of lower cost medical care, increasing leisure-time physical activity, and reducing rates of cigarette smoking will improve population HRQOL among older adults with and without functional limitations. These factors provide valuable information for determining future public health priorities.Disability affects a substantial portion of the population, and the prevalence of disabilities increases with age. Adults with disabilities represent 31% of those aged 55–64 years and 52% of those aged 65 years and older.1 Annual disability-associated health care expenditures have been estimated at almost $400 billion, or 27% of all US adult health care expenditures in 2006,2 making this an important economic issue for public health.Disability definitions have evolved over the past 2 centuries because of the medical profession’s changing attitudes regarding health care treatment of individuals with disabilities and changing societal perspectives, including the destigmatization of attitudes and beliefs regarding disability and increased support for designing environments that encourage independent living.3,4 Recently, advocates for a social model of disability5,6 have argued that disability results from functional impairment and limitations that are the result of social, cultural, and environmental factors. Expanding this more integrated conceptualization of disability, the World Health Organization published the International Classification of Functioning Disability and Health (ICF) in 2001.7 The ICF depicts disability as resulting from the interaction of a person’s functional impairment with environmental factors to create limitations. The ICF provides a framework for considering health and disability at the individual and population level across the entire lifespan and provides an important step forward for assessing the relationships among disability, environment, and health outcomes.The shift in focus in public health to health promotion and quality of life is advancing quickly because of increases in life expectancy and the increasing number of individuals living with chronic diseases. Furthermore, as the population of the United States continues to age, the public health community has become more focused on understanding how to improve health-related quality of life (HRQOL) among individuals with multiple chronic conditions and disabilities.8 HRQOL is a multidimensional population health outcome that supplements more traditional measures of mortality and morbidity and is useful because it provides broad summary measures of perceived health.9,10 HRQOL constructs include measures of physical health, mental health, and social functioning.11,12 These measures have the potential to bridge boundaries between disciplines and among social, mental, and medical services. For example, Health and Human Services’ Healthy People 2020 initiative has provided overarching goals that emphasize the desire to create high quality lives for individuals with disabilities, including the creation of social and physical environments that promote optimal health, and has recommended the use of HRQOL measures to assess progress in this area.13When depicting the nature of the relationships among disability, functional limitations, and HRQOL, it is important to consider the perspective of the individual evaluating the health outcome. Previous studies have shown significant differences between self-report and proxy reports for individuals with disabilities.14,15 For example, 1 study found that more than 50% of adults with serious and persistent disabilities reported good or excellent HRQOL despite living a daily life that other individuals might regard as less than optimal.15 This apparent contradiction between self-reported health and assessment of health by others was named “the disability paradox.” This paradox emphasizes the importance of self-report for determining HRQOL. The disability paradox can be explained, in part, by the fact that quality of life and well-being do not involve merely the absence of illness and disability. Indeed, many people with disabilities or illness experience a fine quality of life, and, conversely, many who are not ill or infirm still do not flourish. Furthermore, although self-report is generally the preferred method for measuring HRQOL,10,16 another concern in measuring HRQOL among people with longstanding functional limitations is that some popular measures of HRQOL include function domains in their summary measures of HRQOL. Consequently, these measures will reduce scores of HRQOL related to functional limitations among those who may otherwise perceive their HRQOL to be very good, resulting in an HRQOL score that is artificially low.17,18 This concern has been documented for the Rand Medical Outcomes Study Short Form–36 health survey as a measure of HRQOL19 derived from differential item analyses. These differential item analysis estimates appear to be smaller for the Centers for Disease Control and Prevention (CDC) Healthy Days measures of HRQOL.20In a seminal article on understanding the structure of perceived health (more recently referred to as HRQOL) among older Americans, Johnson and Wolinsky21 developed a conceptual and statistical model to understand the relationships among 4 primary components of health: disease, disabilities, functional limitations, and perceived health. As part of their causal model, functional limitations are considered, in part, to result from disabilities and are a useful way for classifying how a particular disability has affected an individual.22Measuring HRQOL can assist in determining the burden of disabilities and chronic diseases and can provide valuable new insights into the relationships between HRQOL and risk factors. We investigated which risk factors and public health policies should be considered for improving HRQOL among those with and those without functional limitations. On the basis of the conceptual definitions the ICF presented, the theoretical model presented by Johnson and Wolinsky,21 and the health services model of Andersen,23,24 we assessed the associations between HRQOL and predisposing factors (age, race/ethnicity, and marital status), enabling factors (health care coverage, medical care cost issues, and health care utilization), and modifiable health behaviors (smoking, nutrition, and leisure-time physical activity) among individuals aged 50 years and older with and without functional limitations. We derive our definition for functional limitations from Healthy People 2010 surveillance objectives. The definition represents the standard questions and classifications used for the CDC Behavioral Risk Factor Surveillance System (BRFSS). This definition combines general limitations in function owing to disability or health conditions and adds the use of assistive technology to capture those who may not report limitations because these aids obviate the body limitation. Asking respondents about attribution to disability and health conditions especially helps include older adults with disability, who might otherwise ascribe their limitations to aging. We hypothesized that poor HRQOL would be associated with lower rates of health care coverage, difficulties with cost for medical care, higher smoking rates, poor nutrition, and less leisure-time physical activity. We also hypothesized that the factors that influence HRQOL would differ for those with functional limitations from those without. On the basis of the results of these analyses, we have identified promising future directions for public health prevention and research.     

Coexistence of Chronic Musculoskeletal Pain and Depressive Symptoms and Their Combined and Individual Effects on Onset of Disability in Older Adults: A Cohort Study

ObjectivesCoexistence of chronic musculoskeletal pain and depressive symptoms is common, and their combined effect on adverse events warrants investigation. The purpose of this study was to investigate the individual and combined effect of chronic musculoskeletal pain and depressive symptoms on the onset of disability, which is a crucial outcome in older adults.DesignA 1-year cohort study.Setting and participants1251 community-dwelling older adults.MeasurementsThe number of chronic musculoskeletal pain sites was measured using a self-reported questionnaire. Depressive symptoms were assessed using the Geriatric Depression Scale–15. Disability was self-reported as any difficulty in basic activities of daily living. Incidence of disability was defined as any difficulty in performing 1 or more tasks at the follow-up assessment, that was absent at baseline.ResultsOlder adults with more chronic musculoskeletal pain sites tend to have depressive symptoms at baseline (P for trend < .001). Compared to older adults without both chronic musculoskeletal pain and depressive symptoms, older adults with both chronic multisite musculoskeletal pain and depressive symptoms have the higher risk for development of disability (adjusted odds ratio: 6.84, 95% confidence interval: 3.72 to 12.58), followed by older adults with chronic multisite musculoskeletal pain and without depressive symptoms (adjusted odds ratio: 2.13, 95% confidence interval: 1.35 to 3.37).Conclusions/ImplicationsSimultaneous assessment of both chronic musculoskeletal pain and depressive symptoms may be useful for accurate prognosis and preventing disability in older adults.     

Sarcopenic Obesity and Risk of Disability in Community-Dwelling Japanese Older Adults: A 5-Year Longitudinal Study

ObjectivesPrevious studies have indicated that sarcopenic obesity is a risk factor for disability onset. However, these studies had disparities in terms of criteria for sarcopenia, study design, or study population. No longitudinal study has investigated the effect of sarcopenic obesity on disability onset in an Asian population using the Asian Working Group for Sarcopenia 2019 criteria for sarcopenia definition. Herein, we aimed to investigate the longitudinal effect of sarcopenic obesity on disability onset in Japanese older adults and extend the generalizability of results to other populations.DesignLongitudinal cohort study.Setting and ParticipantsA total of 4197 Japanese older adults (mean age 74.6 ± 5.0 years, 54.2% women) formed our study population.MeasurementsSarcopenia was identified using the Asian Working Group for Sarcopenia 2019 algorithm. Obesity was determined when body fat percentage was ≥25%, or when visceral fat content was ≥100 cm² for either sex. Disability onset was defined as a new case of long-term care insurance system certification for 5 years from baseline. Missing values were managed with multi-imputation. Cox proportional hazard regression analysis was used with disability onset as dependent variable and group (nonsarcopenia/nonobesity as a reference, nonsarcopenia/obesity, sarcopenia/non-obesity, possible sarcopenia/obesity, possible sarcopenia/non-obesity, sarcopenic obesity) as explanatory variable, and was adjusted for potential confounding factors.ResultsWhen the nonsarcopenia/nonobesity group was used as the reference category, other groups such as possible-sarcopenia/nonobesity [hazard ratio (HR) 1.38, 95% confidential interval (95% CI) 1.29‒1.47, P < .028], possible-sarcopenia/obesity (HR 1.54, 95% CI 1.46‒1.62 P < .001), sarcopenia/nonobesity (HR 2.09, 95% CI 1.96‒2.23, P < .001), and sarcopenic obesity (HR 2.48, 95% CI 2.24‒2.75, P < .001) showed significantly increased HRs.Conclusions and ImplicationsThe risk of disability onset because of sarcopenic obesity was exceedingly higher compared with sarcopenia alone among community-dwelling older adults in Japan The health providers should consider assessing the co-existence of sarcopenia and obesity to screen for the risk of disability onset in the community-dwelling population.     

Use of Home-Based Clinical Care and Long-Term Services and Supports Among Homebound Older Adults

ObjectivesDescribe use of home-based clinical care and home-based long-term services and supports (LTSS) using a nationally representative sample of homebound older Medicare beneficiaries.DesignCross-sectional study.Setting and ParticipantsHomebound, community-dwelling fee-for-service Medicare beneficiaries participating in the 2015 National Health and Aging Trends Study (n = 974).MethodsUse of home-based clinical care [ie, home-based medical care, skilled home health services, other home-based care (eg, podiatry)] was identified using Medicare claims. Use of home-based LTSS (ie, assistive devices, home modification, paid care, ≥40 hours/wk of family caregiving, transportation assistance, senior housing, home-delivered meals) was identified via self or proxy report. Latent class analysis was used to characterize patterns of use of home-based clinical care and LTSS.ResultsApproximately 30% of homebound participants received any home-based clinical care and about 80% received any home-based LTSS. Latent class analysis identified 3 distinct patterns of service use: class 1, High Clinical with LTSS (8.9%); class 2, Home Health Only with LTSS (44.5%); and class 3, Low Care and Services (46.6% homebound). Class 1 received extensive home-based clinical care, but their use of LTSS did not meaningfully differ from class 2. Class 3 received little home-based care of any kind.Conclusions and ImplicationsAlthough home-based clinical care and LTSS utilization was common among the homebound, no single group received high levels of all care types. Many who likely need and could benefit from such services do not receive home-based support. Additional work focused on better understanding potential barriers to accessing these services and integrating home-based clinical care services with LTSS is needed.