Variability in measuring (instrumental) activities of daily living functioning and functional decline in hospitalized older medical patients: a systematic review

Objective

To study instruments used and definitions applied in order to measure (instrumental) activities of daily living (I [ADL]) functioning and functional decline in hospitalized older medical patients.

Study Design

We systematically searched Medline, Embase, and the Cochrane Database of Systematic Reviews from 1990 to January 2010. Articles were included if they (1) focused on acute hospitalization for medical illness in older patients; (2) described the instrument used to measure functioning; and (3) outlined the clinical definition of functional decline. Two reviewers independently extracted data.

Results

In total, 28 studies were included in this review. Five different instruments were used to measure functioning: the Katz ADL index, the IADL scale of Lawton and Brody, the Barthel index, Functional Independence Measure, and Care Needs Assessment. Item content and scoring between and within the instruments varied widely. The minimal amount for decline, as defined by the authors, referred to a decrease in functioning between 2.4% and 20.0%.

Conclusion

This review shows there is a large variability in measuring (I)ADL functioning of older hospitalized patients and a large range of clinical definitions of functional decline. These conceptual and clinimetric barriers hamper the interpretation and comparison of functional outcome data of epidemiological and clinical studies.     

中国社会经济状况与老年人工具性日常生活能力关系的研究

在中国老年人口规模快速增长的同时,残疾人老年化和老年人残疾化的问题突显~([1]).社会经济状况(SES)是研究健康的重要视角,国外文献也总结出了两者之间的梯度关系,即SES越好,健康状况越好,反之亦然~([2,3]).     

社区老年人健康功能多维评价及影响因素

目的 评价福州市社区老年人的健康状况，并探讨影响健康的有关因素。方法 对1767名65岁及以上的老年人进行问卷调查，从日常生活功能、躯体健康、精神健康、社会健康和经济状况等5个基本方面对老年人健康功能状况进行多维评价。结果 研究对象中综合健康状况优良、一般和较差分别占总人数的47．1％，44．6％和8．3％。5项单维健康损害发生率介于37．7％和74％之间，其中躯体健康损害发生率最高。影响老年人健康水平的主要慢性病为高血压、心脏病和糖尿病。结论 慢性病防治、婚姻家庭生活、适度体育锻炼、科学膳食营养以及参与社会活动等均有益于社区老年人健康水平的提高。     

营养不足在社区老人社会隔离与能力下降间的中介效应

目的 探究营养不足在社区老人社会隔离与能力下降间的中介效应。方法 于2017年3-8月,在辽宁省沈阳市、大连市、鞍山市、锦州市便利抽取社区居住老人1 028名,运用一般资料调查表,社会网络量表(Lubben Social Network Scale 6,LSNS-6)、微型营养评定表(mini-nutritional assessment,MNA)和工具性日常生活能力量表(instrumental activities of daily living scale,IADL)进行问卷调查,通过SPSS21.0 和AMOS21.0软件,采用分层回归分析与Bootstrap 法进行营养不足中介效应的检验与验证。结果 （1）社会隔离得分为15.47±5.02分,营养不足得分为23.79±3.73分,能力下降得分为10.28±3.83分;（2）能力下降得分与社会隔离、营养不足得分呈负相关( r =-0.64,P<0.001; r =-0.70,P<0.001),营养不足与社会隔离呈正相关( r =0.68,P<0.001);（3）社会隔离不仅可以直接影响社区老人日常生活能力,还可以通过营养不足的中介作用间接影响社区老人的日常生活能力,且中介效应占总效应的43.71%。结论 营养不足在社会隔离与能力下降间起部分中介作用。     

Nutritional Status of Functionally Dependent and Nonfunctionally Dependent Elderly in Taiwan

Objective: The purpose of this study was to measure and compare nutritional status of the functionally dependent elderly with those nonfunctionally dependent elderly by assessing nutrient intake, anthropometric measurements, hematological and biochemical parameters, and the nutritional risk index (NRI).

Methods: Ninety-six volunteers (42 functionally dependent elderly, 54 nonfunctionally dependent elderly) participated in this study. The items of activity of daily living (ADL) were assessed to determine functional status. Demographic and health data were collected at the time of interview. Subjects completed 24-hour diet recall and food frequency questionnaires. Height, weight and skinfold thickness measurements were taken. Hematological and biochemical parameters were measured. The NRI was then calculated.

Results: Osteoporosis and hypertension were the most frequently reported chronic diseases. A small proportion of the elderly with functional dependence (9.5%) and with nonfunctional dependence (13%) had a body mass index (BMI) (≤21 kg/m²), indicating they were underweight. There were no significant differences in nutrient intake between the two groups. However, a higher percentage of the functionally dependent elderly had a nutrient intake of less than 75% of the Taiwan Recommended Daily Nutrient Allowance (RDNA). The functionally dependent group had a higher prevalence of malnutrition than the nonfunctionally dependent group (44.7% vs. 25%) based on the NRI.

Conclusions: These functionally dependent elderly people exhibited a poorer nutritional status than the nonfunctionally dependent elderly. The elderly with functional dependence were at risk for inadequate iron intake and abnormal serum triglyceride concentrations; they were also at greater risk for chronic diseases and had a greater need for medications.     

中国65岁及以上老年人日常生活活动能力与死亡的关系

目的  探讨老年人日常生活活动能力(activities of daily living, ADL)与中短期死亡之间的关系。方法  本研究使用了来自中国老年健康影响因素跟踪调查(Chinese Longitudinal Healthy Longevity Survey, CLHLS)的数据。分析样本包括37 173名CLHLS项目历次调查中的新人群,生存结局来自研究对象2~4年后首次跟踪随访调查结果。失能情况是通过ADL能力量表进行测量。计算ADL总分并进行分组之后,本研究通过多种统计建模策略,探讨不同失能水平对老年人死亡的影响。结果  调整人口学、健康行为、膳食摄入特征等混杂因素后,ADL总分人群死亡风险存在着统计学关联(RR=1.09, 95% CI：1.08~1.09, P < 0.001)。以6分组作对照,得分高于6分组的人群发生死亡的风险增加69%(RR=1.69, 95% CI：1.65~1.74, P < 0.001)。以正常组作为对照组,低级失能组和高级失能组的人群发生死亡的风险分别增加52%和92%(RR=1.52, 95% CI：1.47~1.56, P < 0.001; RR=1.92, 95% CI: 1.86~1.97, P < 0.001)。结论  基于CLHLS样本发现,失能会增加老年人发生死亡的风险,短期随访、低年龄段的失能老年人发生死亡的风险更大。     

湖南省赫山区老年人失能现况及影响因素分析

目的调查湖南省赫山区65岁以上老年人日常生活活动能力现状及影响因素,为制定干预措施、养老服务规划提供理论依据。方法采用多阶段随机抽样的原则,分别抽取赫山区2个街道(村)共460名65岁以上老年人,对其进行问卷调查。评估基本生活自理能力(basicactivities of daily living,BADL)和工具性日常生活活动能力(instrumental activities of daily living,IADL)。使用χ^(2)检验分析不同特征老年人群失能率差异,采用多因素logistic回归模型分析老年人BADL和IADL失能的影响因素。结果赫山区65岁以上BADL总体失能率为13.76%,IADL总体失能率47.82%。BADL损失率排前3位的项目依次是洗澡、穿衣、上厕所;IADL损失中搭乘公共交通受损率最高(34.06%),其次是使用电话、食物烹调。多因素分析结果显示:年龄越大,BADL、IADL损失的可能性越高;近1年未跌倒(OR=0.429,95%CI:0.182~1.010)、无慢性病(OR=0.136,95%CI:0.056~0.332)是BADL发生的保护因素,而初中以上文化程度(OR=0.418,95%CI:0.217~0.806)、近1年未跌倒(OR=0.313,95%CI:0.137~0.717)、无慢性病(OR=0.250,95%CI:0.141~0.443)是IADL失能的保护因素。结论湖南省益阳市赫山区65岁以上老年人失能率较高。高龄、跌倒、患有慢性病是BADL损失发生的危险因素,高龄、较低的文化程度、跌倒、患慢性病是IADL损失的危险因素,对该地区老年人日常生活活动能力进行有针对性地干预十分必要。     

贵州某少数民族地区农村留守老年人日常生活功能状况及影响因素分析

目的 了解贵州某少数民族地区农村留守老年人日常生活功能情况及分析影响因素。方法 采取多级整群抽样方法,从贵州省黔南布依族苗族自治州4个县抽取符合要求的1 260名留守老年人,采用面对面问卷调查的方式进行一般情况、健康状况及日常生活功能等相关情况的调查。结果 贵州某少数民族地区农村留守老年人日常生活功能明显障碍率为10.87%。多因素Logistic回归分析结果显示,高龄（OR=2.851, 95% CI:2.233~3.642）、少数民族（OR=1.486, 95% CI:1.029~2.174）、患慢性病（OR=1.246, 95% CI:1.047~1.482）、与家人关系差（OR=1.835, 95% CI:1.397~2.409）等因素是留守老年人日常生活功能明显障碍的危险因素;家庭经济收入高（OR=0.657, 95% CI:0.494~0.876）、文化程度高（OR=0.723, 95% CI:0.559~0.935）是留守老年人日常生活功能明显障碍的保护因素。结论 贵州某少数民族地区农村留守老年人日常生活功能明显障碍率高,少数民族留守老年人为高危人群,建议加强少数民族地区留守老年人的健康教育、慢性病管理、提高健康知识知晓率等预防性措施,延缓或减少其日常生活功能下降或障碍,提高其生活质量。     

老年人慢性病对日常生活功能的影响

目的：研究贵阳市城区老年慢性病人日常生活功能（ＡＤＬ和ＬＡＤＬ）的影响。方法：通过问卷问和体格检查相结合，对贵阳市我９６６名≥６０岁的老年人进行了慢性病和日常生活功能调查。运用非条件Ｌｏｇｉｓｔｉｃ回归分析有关慢性病对老年人日常生活功能损害原作用大小。结果：慢性病患病率为５７．８％，ＡＤＬ损害率为９．４％，ＩＡＤＬ损害率为２３．２％。对ＡＤＬ损害影响显著的疾病依次为脑血管疾病、白内障、慢性阻塞性肺     

An evaluation of transition in functional states among the elderly in Beijing, China

Objectives The goal of the present study was to describe the changes in activities of daily living (ADL) of community-dwelling Beijing elderly people (n=3,257), observed for 8 years, and to identify the demographic characteristic that predict the functional change. Methods Two sets of interview data (1992 and 2000) were used to evaluate changes among the elderly in reports of limitation in ADL management. Results The prevalence of disability increased over 8 years both in IADL and BADL disability. The patterns of ADLs change were bi-directional. A large proportion (74.7%) of the elderly were found to remain active in their functional states, 20.4% of the elderly declined, 3.4% of the elderly remained disabled, and 1.5% showed improvement in functional states. The transition rates from non-disability and disability states to various functional states showed different characteristic, a high disability rate accompanied a high mortality rate. The demographic factors that affected the level of disability among different kinds of population manifested similar trends. Conclusion Age was the most significant predictor for functional limitations. In addition, demographic variables played an important role in estimating functional outcomes. It is recommended that the demarcation factor for the evaluation of ADLs should be 75 years of age.     

中国老年人体质对日常生活活动能力的影响

目的 了解中国老年人日常生活活动能力的受损情况,并探究身体素质与ADL之间的关系。方法 数据来源为2015年中国健康与养老全国追踪调查（CHARLS）,采用 χ²检验比较不同特征老年人日常生活活动能力受损率的差异,采用二分类logistic回归模型探讨身体素质与日常生活活动能力之间的关系。结果 297例（6.6%）老年人存在基本日常生活活动能力受损的情况,1 167例（26.0%）老年人存在工具性日常生活活动能力受损的情况。BMI、肌肉力量、平衡能力和活动能力都与老年人日常生活活动能力存在密切关系,而血压对日常生活活动能力的影响不显著。结论 身体素质与老年人日常生活活动能力的受损情况存在相关关系,BMI值过高或过低、肌肉力量较差、平衡能力和活动能力不佳的老年人发生日常生活活动能力受损的可能性高于身体素质较好的老年人。     

Functional capacity and five-year mortality in a sample of urban community elderly

To assess the validity of a functional status measure in communityelderly, 1317 residents of Barcelona, Spain, aged 65 years orover were interviewed at home in 1986 and their vital statuswas assessed five years later from census data. Functional capacitywas measured by self-reported ability to perform nine basicactivities (ADL) and four instrumental activities (IADL) ofdaily living. Significantly lower survival rates were foundfor males, older age groups, functionally dependent subjectsand for those reporting poor health. Relative risks of death,estimated by Cox's regression controlling for health statusand sociodemographic variables were 3.17 (95% CI=1.98–5.08)for ADL-dependent elderly, and 2.14 (95% CI=1.32–3.46)for IADL-dependent elderly, compared with elderly reportingbeing fully independent. Functional capacity based on ADL stronglypredicts subsequent mortality and provides relevant informationon health status of community elderly. Nevertheless, cross-culturalvalidity of functional capacity based on IADL measures deservesfurther research.     

中国社区老年居民日常生活活动能力失能状况调查

目的 调查我国城乡社区老年人失能现状及其流行特征。方法 调查对象来自2015年老年期重点疾病预防和干预项目。采用多阶段分层整群随机抽样,抽取6省市共23 803名≥ 60岁城乡社区老年人,对其进行问卷调查和身体测量,采用日常生活活动能力量表（ADL）评估老年人失能情况。采用χ²检验分析基础性日常生活活动能力量表（BADL）和工具性日常生活活动能力量表（IADL）各项功能受损率及BADL/IADL失能率在不同特征老年人群间的差异,采用多因素logistic回归模型分析失能的影响因素。结果 BADL功能中洗澡受损率最高（1.7%）,吃饭受损率最低（0.6%）;IADL功能中打电话受损率最高（16.6%）,其次是乘公共汽车（5.5%）,吃药受损率最低（1.8%）。社区老年人BADL失能率2.1%,IADL失能率19.1%。BADL失能率在女性、无配偶、文盲、低体重和肥胖老年人中较高（P<0.05）。IADL失能率在女性、农村、无配偶、低文化程度和低体重老年人中较高（P<0.05）。多因素分析显示,BADL失能的危险性随年龄增加而升高,非正常体重也增加其危险性,而文化程度较高的老年人群BADL失能的危险性相对较低。增加IADL失能的危险因素有女性、增龄、农村、无配偶和低体重;而文化程度高和肥胖的老年人群IADL失能的危险性相对比较低。结论 本研究结果显示,受年龄老化和人口学诸多因素影响,我国老年人群失能率仍维持在一个高水平,加强老年人群躯体性的和工具性的日常生活活动能力下降预防和干预工作是非常必要的。     

湖北省老年住院患者营养状况调查及评价

目的 评估湖北省老年住院患者营养状况及其影响因素,为老年住院患者合理营养支持提供依据。方法 采取分层随机抽样方法,对2014年5—12月湖北省黄冈市等5个地区住院治疗的4 946例老年患者进行营养状况评估。结果 城市和农村居民肥胖率分别34.16%和15.44%,差异有统计学意义(χ²=30.47,P<0.05);营养风险筛查(NRS)评分中,老年住院患者营养风险发生率、贫血发生率、血清总蛋白(TP)异常发生率、血清白蛋白(ALB)异常发生率、总淋巴细胞计数(TLC)和红细胞计数(RBC)异常发生率分别为53.62%、44.54%、53.98%、59.12%、43.17%和39.39%,其中,城市和农村老年住院患者贫血发生率、TP异常发生率、ALB异常发生率、RBC异常发生率差异均有统计学意义(χ²=21.72、32.85、38.23、21.07,均P<0.05)。结论 随着年龄的增长,农村地区老年住院患者的营养风险和营养不良发生率高于城市地区,需要社会和家庭更加关注农村老年患者的营养状况,及时调整膳食结构和食物品种搭配,合理补充各类营养素。     

中国城乡老年人群两年内日常生活活动能力受损发生情况及影响因素

目的 了解中国城乡社区老年人群2年内日常生活活动能力（ADL）下降情况及其影响因素。方法 调查对象来自老年期重点疾病预防和干预项目。该调查采用多阶段分层整群随机抽样的方法,于2015年从我国6个省份抽取23 803名研究对象进行基线调查,2017年进行随访,剔除死亡、失访、数据不完整和2015年基线调查ADL受损的研究对象后,共计18 785名≥ 60岁的老年人符合纳入标准。以第6次全国人口普查数据为标准人口对样本数据进行加权后,分析不同特征老年人群2年内ADL、基础性日常生活活动能力（BADL）和工具性日常生活活动能力（IADL）受损发生率,并采用多因素logistic回归模型分析相关影响因素。结果 经过2年的随访,队列人群中共有1 959例发生ADL受损,ADL受损的2年累计发生率为12.0%,其中,BADL受损的2年累计发生率为1.6%,仅IADL受损的2年累计发生率为10.4%。多因素logistic回归模型分析结果显示,增加仅BADL受损发生风险的因素是年龄增加、肥胖、≥ 2种共病以及认知功能异常;增加仅IADL受损发生风险的因素为年龄增加、女性、低体重和认知功能异常。降低仅IADL受损发生风险的因素包括小学或初中及以上文化程度、超重或肥胖。结论 年龄增加、认知功能异常均增加BADL和IADL受损发生的风险。患有≥ 2种疾病的老年人BADL受损风险较高;肥胖增加老年人BADL受损发生风险,但降低IADL受损发生风险;女性比男性发生IADL受损风险高;高文化程度的老年人IADL受损风险低。     

我国60岁及以上老年人日常生活活动能力对抑郁状况的影响

目的探究日常生活活动能力(ADL)对老年人抑郁的影响, 并关注社会网络及子女支持在其中的作用。方法使用2018年"中国老年社会追踪调查"资料中年龄≥60岁者作为研究对象。估计样本量10 215人。ADL、社会网络、抑郁状况均使用量表测量, 采用有调节的中介模型对社会网络及子女支持的作用进行分析。采用SPSS 25.0软件进行统计学分析, 使用PROCESS 3.3宏程序进行有调节的中介效应检验。结果共纳入年龄≥60岁老年人10 760人作为研究对象, ADL对老年人抑郁状况存在直接影响(β=-0.090, P<0.01);社会网络在ADL与抑郁关系中发挥了中介作用(β=0.035, P<0.01;β=-0.064, P<0.05), 子女支持发挥调节作用(β=-0.029, P<0.05)。结论社会网络是缓冲老年人ADL下降对抑郁状况影响的重要资源, 子女支持是增强社会网络积极作用、减轻老年人抑郁风险的有力补充, 应充分发挥社会网络和子女支持的协同作用, 减缓老年人ADL下降对其心理健康的影响。     

福州市鼓山镇4237名老年人日常生活能力及影响因素调查

目的探讨福州市鼓山镇老年人日常生活能力状况及影响因素。方法在自愿原则的基础上，采用横断面调查法对该镇≥60周岁老年人进行普查。结果4237名老年人中日常生活能力下降者占17．3％；自然属性、社会经济结构特征、生活习惯、抑郁症状、精神活动、患病种数是影响老年人日常生活能力的主要因素。结论福州市鼓山镇大部分老年人生活基本能够自理，其日常生活能力受多方面因素的影响。采取综合性的措施，改善其日常生活功能，有助于实现健康老龄化。     

Combined Effects of Cognitive Impairment and Nutritional Trajectories on Functional Recovery for Older Patients after Hip-Fracture Surgery

ObjectivesMalnutrition and cognitive impairment are associated with poor functional recovery in older adults following hip-fracture surgery. This study examined the combined effects of cognitive impairment and nutritional trajectories on postoperative functional recovery for older adults following hip-fracture surgery.DesignProspective longitudinal correlational study.Setting and ParticipantsThis study recruited 350 older adults (≥60 years of age) who received hip-fracture surgery at a 3000-bed medical center in northern Taiwan from September 2012 to March 2020.MethodsParticipant data were collected over a 2-year period after surgery for nutritional and cognitive status and activities of daily living (ADLs). Participants were grouped by type of nutritional trajectory using group-based trajectory modeling. Generalized estimating equations analyzed associations between trajectory groups/cognitive status at discharge and performance of ADLs.ResultsNutritional trajectories best fit a 3-group trajectory model: malnourished (19%), at-risk of malnutrition (40%), and well-nourished (41%). Nutritional status for the malnourished group declined from 12 months to 24 months following surgery; nutritional status remained stable for at-risk of malnutrition and well-nourished groups. Interactions for cognitive impairment-by-nutritional status were significant: the malnourished + intact cognition subgroup had significantly better ADLs than the malnourished + cognitive impairment subgroup (b = 27.1, 95% confidence interval = 14.0–40.2; P < .001). For at-risk of malnutrition and well-nourished groups, there were no significant differences between cognitive impairment and intact cognition in ADLs. These findings suggest that nutritional status may buffer the negative effect of cognitive impairment on ADLs.Conclusions and ImplicationsBetter nutritional status over time for older adults following hip fracture can protect against adverse influences of cognitive impairment on ADLs during postoperative recovery. Participants with malnutrition and cognitive impairment had the poorest ADLs. These findings suggest interventions tailored to improving nutritional status may improve recovery for older adults following hip-fracture surgery.