老年女性日常生活照料需求及影响因素分析

目的分析山东省老年女性日常生活照料资源需求现状及其影响因素,探讨适合老年女性的日常生活照料资源。 方法采用问卷调查收集378名老年女性的人口学资料、经济状况、躯体健康、心理健康、社会健康及日常生活照料资源需求状况,采用t检验、 χ²检验、方差分析和逐步回归方法进行统计分析。结果老年女性日常生活依靠自身照料者256人,占67.72%,依靠家庭照料者119人,占31.48%,其中依靠配偶照料者87人,占23.02%,靠子女及其他亲属照料者32人,占8.47%,依靠社会照料者仅为3人,占0.79%;无论单因素分析还是多因素分析,年龄、居住状况、健康自评、日常生活能力(ADL)、功能性日常生活能力(IADL)及认知功能均为老年女性日常生活照料资源需求的主要影响因素。结论自身照料是老年女性日常生活照料的主要资源,配偶是来自家庭照料资源的主要力量;关注并提高老年女性ADL、IADL及认知功能,有助于老年女性的健康老龄化。     

老年人抑郁症状与慢性病及日常生活活动能力的关联性研究

目的 分析老年人慢性病、抑郁症状及日常生活活动能力三者之间的相互关系,探讨老年人抑郁症状和老年人日常生活活动能力受限的危险因素.方法 采用多阶段整群抽样方法,应用老年抑郁短量表、Katz日常生活活动量表（Katz-ADL）和Lawton工具性日常生活活动量表（Lawton-IADL）,对济宁市部分县区≥65岁的504例老年人进行问卷调查.结果 济宁市部分县区老年人总患病率为74.01％,抑郁症状阳性率为7.14％,ADL、IADL功能受限率分别为19.05％和66.67％,男性老年人抑郁症状阳性率及ADL、IADL功能受限率低于女性（x2分别为18.15、12.31、30.18,P均＜0.05）;老年人现患有慢性病的种类数是抑郁症状和ADL受限的危险因素（OR分别为1.71、1.53）,ADL和IADL受限也是老年人抑郁症状的危险因素（OR分别为3.15、9.36）;控制性别、年龄因素后,患有慢性病种类数对老年人抑郁症状、ADL、IADL的影响以及ADL和IADL受限对老年人抑郁症状的影响均无统计学意义.结论 性别、年龄是老年人抑郁症状、ADL和IADL受限的最根本的危险因素,家庭和社会在对老年人照护时,应积极锻炼提高老年人的日常生活活动能力,提升老年人的正性情绪,减少抑郁症状的发生.     

Impact of mental health on daily living activities of Japanese elderly

OBJECTIVE: We investigated the impact of mental health on the decline in higher activities of daily living (ADL) defined in terms of social role performance (SR, the highest ADL), intellectual activity (IA), and instrumental ADL (IADL), as well as the onset of basic ADL disability. METHODS: Six hundred older adults were randomly selected from Yamanashi prefecture, Japan. An interview survey collected baseline information from 581 people (97%) in 2003. Of those, 93% were followed for 25 months by mail. Cox's proportional hazard model was used. RESULTS: Among people aged 75+ years, those with severe depressive symptoms had a relative risk (95% confidence intervals) of 3.22 (1.35-7.71), 3.11 (1.38-6.98), and 2.41 (1.07-5.40) for subsequent decline in SR, IA, and IADL, respectively, compared to those without depressive symptoms. The excess risk of IADL decline among people aged 65-74 years was also statistically significant. Social inactivity partly explained the excess risk. CONCLUSIONS: Severe depressive symptoms in older adults may accelerate the progression of higher ADL decline. The adverse effect of depressive symptoms is more pronounced in senior elderly. By screening depressive symptoms and higher ADL, and promoting social activities of people at high risk, their risk for basic ADL disability could be reduced.     

应用OARS问卷对社区老年人ADL功能的调查

目的：了解上海城市社区60岁以上老年人的日常活动能力（ADL）并探索其影响因素。方法：应用OARS问卷对上海某城区两个里委902名社区老年人日常活动能力（ADL）进行调查。结果：老年人各项ADL功能均不需帮助者占64．3％，至少有一项ADL功能下降者占34．2％，有7人（0．8％）完全丧失ADL功能。生理性ADL（PADL）中下降率最高的是沐浴（7．2％），最低的是进食（3．0％），PADL下降率随年龄增加而上升，但无性别差异。工具性ADL（IADL）中下降率最高的是打电话（28．5％），最低的是理财（7．5％）。结论：IADL下降率随年龄增加的趋势更加明显，是PADL的3．9倍，且有性别差异，女性下降率显著高于男性。影响ADL功能的因素主要有年龄、性别，ADL评分与老年人社会资源、经济状况、躯体健康及精神健康评分呈正相关，并有显著统计学意义。     

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。     

Impact of morbidity and life events on successful aging

The purpose of this study was to examine the risks of the incidence of chronic conditions and life events on successful aging. Longitudinal data from a 10-year follow-up health survey were used. Successful aging indicators included basic and advanced physical function, depressive symptoms, cognitive function, emotional support, participation in productive activities, and life satisfaction. The stressors included life events and morbidity years of 10 chronic conditions. Loss of offspring increased the risk to physical health, psychological health, and life satisfaction. Being newly widowed was related to depressive symptoms, whereas being newly divorced increased the risk of poor social support. Morbidity years increased the risk of failure in successful aging, especially for stroke, respiratory system disease, diabetes, and cancer. Emotional health of the elderly should be carefully monitored after onset of life events and incidences of chronic conditions.     

The impact of socio-economic factors on functional status decline among community-dwelling older adults in China

The purpose of this paper is to examine the impact of baseline socio-economic factors on functional status decline over a period of 3 years among a sample of Chinese older men and women, using the China Health and Nutrition Surveys of 1997 and 2000. In addition, the study tries to determine whether risk differentials by these socio-economic factors can be explained by other demographic, health-related and nutritional risk factors. The eligible study population was defined as women and men aged 55 years and over who at baseline were free from any form of disablement in activities of daily living (ADLs) or instrumental activities of daily living (IADL) tasks. Among subjects with complete data at followed-up (N = 976), the overall incidence proportions of any functional status decline, IADL only and ADL declines were 25.8%, 18.9% and 6.9%, respectively. Our study found that education is strongly and inversely associated with incidence of combined functional status decline and IADL only but not with the onset of ADL disability. Similarly, household income per capita was inversely associated with functional status decline and IADL disability incidence, with a clear dose-response relationship, even after adjustment for age and gender. However, multivariate analysis demonstrated that the latter association was highly confounded by other demographic factors, especially urban-rural area of residence. Using a combined measure of socio-economic status that includes years of education and household income per capita, the age and gender-adjusted odds ratio for functional status decline and belonging to lower SES class as compared to middle, upper middle and upper classes was 3.82 (95% CI: 2.15, 6.77) and 2.77 (95% CI: 1.52, 5.03) after further adjustment for urban-rural area of residence and living arrangements. Hence, there are wide socio-economic disparities in the functional health of older adults in China, although such disparities are more seen for IADL decline and are almost exclusively attributed to differentials in educational attainment. Finally, nutritional and health-related risk factors do not seem to act as intermediate factors in this association and hence further research should try to uncover other mechanisms by which SES affects changes in functional health among older adults in China.     

功能测量用于农村老年人健康状况评价的研究

利用日常生活活动（ＡＤＬ）、社区日常生活活动（ＩＡＤＬ）和综合功能（ＧＰＦ）测量问卷对中国农村６０岁以上老年人的功能健康状况进行了评价，探讨了国外功能测量问卷在我国老年人功能健康状况评价中的适用性，分析了不同人口特征老年人功能丧失率和各功能项目群功能丧失情况。结果显示，不同年龄、性别老年人的功能健康状况有明显差异，而且功能健康状况随社会经济状况的下降而恶化。ＡＤＬ和ＩＡＤＬ多项同时丧失者占多数，而ＧＰＦ倾向于单项丧失。     

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     

Role of weight history on functional limitations and disability in late adulthood: the ARIC study

OBJECTIVE: To examine associations of weight history with functional limitations and disability in white and African-American men and women. RESEARCH METHODS AND PROCEDURES: Data were from the Atherosclerosis Risk in Communities study (n = 11,177). Associations of recalled weight status at age 25 and weight change from age 25 to ages 45 to 64 with functional limitations, activities of daily living (ADLs), and instrumental activities of daily living (IADLs) at follow-up (ages 52 to 75) were examined using logistic regression. RESULTS: Obesity (BMI > or = 30 kg/m2) at age 25 was associated with functional limitations and ADL and IADL impairment at follow-up in white and African-American men and women. For example, obese compared with normal weight (BMI, 18.5 to 24.9 kg/m(2)) white women had higher odds of mild [odds ratio (95% confidence interval), 1.97 (1.18 to 3.29)] and severe [9.81 (5.92 to 16.27)] functional limitations and ADL [3.48 (2.36 to 5.13)] and IADL [2.95 (2.00 to 4.33)] impairment. In African-American women, obesity was associated with higher odds of mild [2.71 (1.14 to 6.41)] and severe [6.01 (2.53 to 14.26)] functional limitations and ADL [1.82 (1.10 to 3.00)] and IADL [2.39 (1.47 to 3.90)] impairment. Similar associations were found in men. Compared with weight maintenance (+/-10 lbs), large weight gain (>30 lbs) from age 25 to ages 45 to 64 was also associated with functional limitations and ADL and IADL impairment in white and African-American men and women. DISCUSSION: Maintenance of a healthy body weight throughout adulthood may play a role in preventing or delaying the onset of functional limitations and disability, resulting in increased quality of life and decreased health care costs.     

Social interaction and mortality: a seven-year longitudinal study of elderly people

OBJECTIVES: This study was designed to clarify the relation between social interaction and seven-year-mortality in a group of elderly people. METHODS: The participants were all 65 years or older living in farming communities near major urban centers in Japan (n = 801). The contents of the questionnaire covered social interaction (using an "Index of Social Interaction" consisting of 18 items), health status, physical function, activities of daily living (ADL), age and gender. RESULTS: A total of 139 subjects died within the seven year period after the baseline survey: 1) baseline age and physical function were related to the seven-year mortality; 2) greater social interaction was positively related to reduced mortality; 3) multiple logistic regression analysis adjusted for baseline age, gender, physical function, health status, and ADL indicated that greater social interaction was related to reduced mortality. DISCUSSION: These findings highlight the importance of social interaction in successful aging.     

Functional impairment as a predictor of depressive symptomatology: the role of race,religiosity, and social support

The study discussed in this article examined the relationship between depression symptomatology and functional impairment among white and African American elderly people and investigated the effect of race, religiosity, and social support on this relationship. Study results indicate that although African American elderly people were more impaired in the performance of activities of daily living (ADL) and instrumental activities of daily living (IADL) than white elderly people, they did not experience higher levels of depression. However, African Americans did report significantly higher levels of religiosity and social support.     

Body Mass Index and Disability in Chinese Nonagenarians and Centenarians

ObjectivesTo examine the potential association between body mass index (BMI) and activities of daily living (ADLs) and instrumental activities of daily living (IADLs) disabilities in a population-based sample of Chinese nonagenarians and centenarians.MethodsThis study analyzed data obtained from a survey conducted in 870 elderly Chinese adults aged 90 years or older in Dujiangyan. The participants were divided into 4 groups according to the World Health Organization (WHO) Asia criteria of underweight, normal weight, overweight, and obesity in BMI (<18.5, 18.5–23.0, 23.0–25.0, ≥25.0 kg/m², respectively) and to BMI quartile (<16.8, 16.8–18.9, 18.9–21.1, ≥21.1 kg/m², respectively). The ADL and IADL disabilities were measured using the physical self-maintenance scale (PSMS) and IADL scale developed by Lawton and Brody, respectively.ResultsThe participants included in the current statistical analyses were 233 men and 505 women. The mean age was 93.5 ± 3.2 years (ranging from 90 to 108 years). Using the WHO Asia criteria, the prevalence of underweight and obesity were 43.9% and 6.6%, respectively. In long-lived women, the prevalence of ADL and IADL disabilities was significantly higher in either the underweight group (39.4% and 72.9%, respectively) or the obesity group (38.1% and 77.7%, respectively) compared with the normal weight group (31.4% and 60.8%, respectively). After adjusting for relevant covariates, the underweight group and obesity group showed significantly increased odds ratios (ORs) for either ADL (1.5 and 1.8, respectively) or IADL disability (1.9 and 1.4, respectively). Similar results were found when using the BMI quartile. However, in long-lived men, no significant difference was found with respect to the prevalence of ADL or IADL disability and adjusted ORs among the different BMI groups.ConclusionsAmong Chinese long-lived adults, the risk of ADL and IADL disability was higher for women with both extremely low and high BMIs, but this pattern was not found in men.     

Age group differences in depressive symptoms among older adults with functional impairments

This study used data from the 2000 interview wave of the Health and Retirement Study to examine age group differences in the likelihood of self-reported depressive symptomatology among a nationally representative sample of 3,035 adults age 55 years or older who had at least one activities of daily living (ADL) or instrumental activities of daily living (IADL) limitation. Depression was defined as scoring three points or higher on the eight-point Center for Epidemiological Studies Depression Scale. The results show that respondents age 75 years or older with one ADL/IADL impairment or more were significantly less likely to be depressed than were those between ages 55 and 64 with the same degree of functional impairment. It is recommended that doctors, social workers, and other health care and social services providers pay special attention to younger old adults with health problems and functional limitations because they have a greater risk of being depressed.     

Patient-Related Factors Associated With Depressive State in Caregivers of Patients With Dementia at Home

ObjectvesTo identify patient-related factors associated with depressive state in caregivers of patients with dementia, we investigated the caregivers' and patients' characteristics in relation to the depressive state in their caregivers.DesignProspective hospital-based cohort study.SettingTwo memory clinics in Japan.ParticipantsOutpatients with dementia (n = 135) and their caregivers at home.MeasurementsThe outpatients and their caregivers were divided into 2 groups according to the Center for Epidemiologic Studies Depression Scale for caregivers. To identify the patient-related factors that cause depressive state in caregivers, Mini-Mental State Examination (MMSE), the Physical Self-Maintenance Scale for fundamental activities of daily living (ADL), and the instrumental ADL scale (IADL) scores for instrumental ADL and the neuropsychiatric inventory (NPI) subscale score for behavioral and psychological symptoms of dementia were compared between the 2 groups. We used logistic regression to determine the independent predictors of caregiver depressive state.ResultsThere was no significant difference in MMSE score between the 2 groups. Logistic regression analysis revealed that the depressive state in caregivers was related with IADL score and delusion in NPI subscale of patients.ConclusionsDepressive state in caregivers was independent of the decline in cognitive function in patients with dementia but was associated with decline in instrumental ADL and severity of delusion.     

我国老年人临终前的失能发展轨迹固定队列研究

目的 探索我国老年人临终前的失能发展轨迹。方法 利用2002-2018年中国老年人健康长寿影响因素调查中的日常生活活动能力（ADL）数据拟合纵向项目反应理论（LIRT）模型,通过其中的难度阈值参数分析我国老年人ADL失能顺序;进而拟合混合效应模型分析老年人临终前失能水平的变化轨迹。结果 共纳入2002年进入队列的5 817名老年人,其中男性占41.81%,基线年龄为（86.80±12.40）岁,随访时间M（Q₁,Q₃）为4（3,8）年。LIRT分析结果显示,基本日常生活活动能力（BADL）中难度阈值参数最低的是洗澡部分受限（0.41±0.05）、最高的是室内移动完全受限（6.19±0.16）;而工具性日常生活活动能力（IADL）中难度阈值参数最低的是乘坐公共交通工具部分受限（-3.01±0.07）,最高的是探访邻居完全受限（1.51±0.07）。失能发展轨迹中,临终前男性较女性平均失能水平更低（P<0.001）,独居老人较非独居老人失能水平更低（P<0.001）;文盲老人失能水平高于非文盲老人（P<0.001）。失能水平随时间的线性变化率与二次项系数的估计值分别为0.231（P<0.001）与0.002（P<0.001）。结论 我国老年人失能过程存在一定的规律性,IADL失能早于BADL,失能项目中下肢为主的项目比上肢为主的项目易失能,复杂项目比简单项目易失能。失能轨迹的增速会随时间加快,对失能人群的干预重点应放在女性、非独居、文盲老年人上。     

Functional and Nutritional State in Elderly Men With Compensated Hypogonadism

ObjectivesThere are few data investigating the relationship between compensated hypogonadism and functional and nutritional status of elderly individuals. Impairment of functional and nutritional status of elderly men with compensated hypogonadism needs to be investigated. In this study, we tried to evaluate the association of functional and nutritional status with testosterone and LH levels in elderly with compensated hypogonadism.DesignA cross-sectional study was performed.SettingA total of 1124 patients older than 70 years were screened.ParticipantsA total of 250 patients (patient group) with compensated hypogonadism and 250 subjects (control group) with normal hormone levels were allocated in the study.MeasurementsAll parameters were compared in patient and control groups. The correlations between hormone levels and activities of daily living (ADL), instrumental activities of daily living (IADL), Mini Mental State Examination (MMSE), Mini Nutritional Assessment (MNA), and Geriatric Depression Scale (GDS) were evaluated.ResultsADL, IADL, MMSE, and MNA scores were significantly lower in the patient group. Testosterone and LH levels were correlated with ADL (R = 0.221 and R = ?0.262), IADL (R = 0.210 and R = ?0.277), MMSE (R = 0.331 and R = ?0.341), MNA (R = 0.211 and R = ?0.297), and GDS (R = ?0.214 and R = ?0.211) in the patient group independently from age and body mass index.ConclusionsOur study showed that geriatric men with compensated hypogonadism had worse functionality, cognitive function, nutritional status, and mood compared with healthy controls.     

Quality of life: a possible health index for the elderly

To assess whether quality of life (QOL) could be employed as an outcome measure of health programs for elderly populations, we evaluated the relationship between subjective assessment of QOL ("morale scale") and objective constituents of active life such as activities of daily living (ADL), instrumental ADL (IADL) and work status along with determination of active life expectancy (ALE) in a rural district in Japan (n = 13,529). The QOL scale was positively correlated with ADL, IADL and work status but not with age. Validity and test-retest reliability were satisfactory as regards the small subsamples of respondents. ALE of the elderly aged 60 to 64 was 15.2 years, while their life expectancy was 27.1 years. Factors associated with lower ADL included age, lower IADL and joblessness. The QOL measurement and the objective variables can be incorporated into an assessment of the health status of the elderly in addition to conventional indices based on mortality.     

Sarcopenia according to the European Working Group on Sarcopenia in older people (EWGSOP) versus dynapenia as a risk factor for disability in the elderly

Background

Sarcopenia, defined as low muscle mass (LMM), and dynapenia have been associated with adverse outcomes in elderly.

Objective

Contrast the association of sarcopenia versus dynapenia with incidence of disability.

Design p]A four-year prospective study (2006–2010)

Setting

São Paulo, Brazil.

Participants

478 individuals aged 60 and older from the Saúde, Bem-Estar e Envelhecimento (SABE) study who were non-disabled at baseline.

Measurements

Sarcopenia, measured according to the European Working Group on Sarcopenia in Older People (EWGSOP), includes: LMM assessed by skeletal muscle mass index ≤8.90kg/m2 (men) and ≤6.37kg/m2 (women); low muscle strength (LMS) assessed by handgrip strength <30kg (men) and <20kg (women); and low physical performance (LPP) assessed by gait speed ≤0.8m/s. Diagnosis of sarcopenia required LMM plus LMS or LPP. Dynapenia was defined as handgrip strength <30kg (men) and <20kg (women). Covariates included socio-demographic and behavioral variables, medical conditions, hospitalization, depressive symptoms, cognition, perception of vision, hearing and body mass index.

Outcomes

Disability in mobility or instrumental activities of daily living (IADL) or disability in activities of daily living (ADL) and IADL.

Results

The incidence density of mobility or IADL disability was 43.4/1000 person/year and 22.6/1000 person/year for IADL and ADL disability. There was no significant difference in incidence density according sarcopenia or dynapenia status. After controlling for all covariates, sarcopenia was associated with mobility or IADL disability (relative risk ratio = 2.23, 95%Confidence Interval: 1.03–4.85). Dynapenia was not associated with disability.

Conclusions

Sarcopenia according to the EWGSOP definition can be used in clinical practice as a screening tool for early functional decline (mobility or IADL disability).