Health-protective and adverse effects of the apolipoprotein E epsilon2 allele in older men

OBJECTIVES: To reexamine a health‐protective role of the common apolipoprotein E (APOE) polymorphism focusing on connections between the APOE?2—containing genotypes and impairments in instrumental activities of daily living (IADLs) in older (≥65) men and women and to examine how diagnosed coronary heart disease (CHD), Alzheimer's disease, colorectal cancer, macular degeneration, and atherosclerosis may mediate these connections. DESIGN: Retrospective cross‐sectional study. SETTING: The unique disability‐focused data from a genetic subsample of the 1999 National Long Term Care Survey linked with Medicare service use files. PARTICIPANTS: One thousand seven hundred thirty‐three genotyped individuals interviewed regarding IADL disabilities. MEASUREMENTS: Indicators of IADL impairments, five geriatric disorders, and ?2‐containing genotypes. RESULTS: The ?2/3 genotype is a major contributor to adverse associations between the ?2 allele and IADL disability in men (odds ratio (OR)=3.09, 95% confidence interval (CI)=1.53–6.26), although it provides significant protective effects for CHD (OR=0.55, 95% CI=0.33–0.92), whereas CHD is adversely associated with IADL disability (OR=2.18, 95% CI=1.28–3.72). Adjustment for five diseases does not significantly alter the adverse association between ?2‐containing genotypes and disability. Protective effects of the ?2/3 genotype for CHD (OR=0.52, 95% CI=0.27–0.99) and deleterious effects for IADLs (OR=3.50, 95% CI=1.71–7.14) for men hold in multivariate models with both these factors included. No significant associations between the ?2‐containing genotypes and IADL are found in women. CONCLUSION: The ?2 allele can play a dual role in men, protecting them against some health disorders, while promoting others. Strong adverse relationships with disability suggest that ?2‐containing genotypes can be unfavorable factors for the health and well‐being of aging men.     

The combined effect of visual impairment and cognitive impairment on disability in older people

OBJECTIVES: To determine the risk of disability in individuals with coexisting visual and cognitive impairment and to compare the magnitude of risk associated with visual impairment, cognitive impairment, or the multimorbidity. DESIGN: Prospective cohort. SETTING: North Carolina. PARTICIPANTS: Three thousand eight hundred seventy-eight participants in the North Carolina Established Populations for the Epidemiologic Studies of the Elderly with nonmissing visual status, cognitive status, and disability status data at baseline MEASUREMENTS: Short Portable Mental Status Questionnaire (cognitive impairment defined as > or =4 errors), self reported visual acuity (visual impairment defined as inability to see well enough to recognize a friend across the street or to read newspaper print), demographic and health-related variables, disability status (activities of daily living (ADLs), instrumental activities of daily living (IADLs), mobility), death, and time to nursing home placement. RESULTS: Participants with coexisting visual and cognitive impairment were at greater risk of IADL disability (odds ratio (OR)=6.50, 95% confidence interval (CI)=4.34-9.75), mobility disability (OR=4.04, 95% CI=2.49-6.54), ADL disability (OR=2.84, 95% CI=1.87-4.32), and incident ADL disability (OR=3.66, 95%, CI=2.36-5.65). In each case, the estimated OR associated with the multimorbidity was greater than the estimated OR associated with visual or cognitive impairment alone, a pattern that was not observed for other adverse outcomes assessed. No significant interactions were observed between cognitive impairment and visual impairment as predictors of disability status. CONCLUSION: Individuals with coexisting visual impairment and cognitive impairment are at high risk of disability, with each condition contributing additively to disability risk. Further study is needed to improve functional trajectories in patients with this prevalent multimorbidity. When visual or cognitive impairment is present, efforts to maximize the other function may be beneficial.     

What Level of Alcohol Consumption Is Hazardous for Older People? Functioning and Mortality in U.S. and English National Cohorts

OBJECTIVES: To estimate disability plus mortality risks in older people according to level of alcohol intake. DESIGN: Two population-based cohort studies. SETTING: The Health and Retirement Study (United States) and the English Longitudinal Study of Aging (England). PARTICIPANTS: Thirteen thousand three hundred thirty-three individuals aged 65 and older followed for 4 to 5 years. MEASUREMENTS: Difficulties with activities of daily living (ADLs), instrumental activities of daily living (IADLs), poor cognitive function, and mortality. RESULTS: One-tenth (10.8%) of U.S. men, 28.6% of English men, 2.9% of U.S. women, and 10.3% of English women drank more than the U.S. National Institute on Alcohol Abuse and Alcoholism recommended limit for people aged 65 and older. Odds ratios (ORs) of disability, or disability plus mortality, in subjects drinking an average of more than one to two drinks per day were similar to ORs in subjects drinking an average of more than none to one drink per day. For example, those drinking more than one to two drinks per day at baseline had an OR of 1.0 (95% confidence interval (CI)=0.8-1.2) for ADL problems, 0.7 (95% CI=0.6-1.0) for IADL problems, and 0.8 (95% CI=0.6-1.1) for poor cognitive function. Findings were robust across alternative models. The shape of the relationship between alcohol consumption and risk of disability was similar in men and women. CONCLUSION: Functioning and mortality outcomes in older people with alcohol intakes above U.S. recommended levels for the old but within recommendations for younger adults are not poor. More empirical evidence of net benefit is needed to support screening and intervention efforts in community-living older people with no specific contraindications who drink more than one to two drinks per day.     

Effect of exercise on ease in performing activities of daily living and instrumental activities of daily living from age 70 to 77: the Jerusalem longitudinal study

OBJECTIVES: To determine the prevalence of independence and ease of performance in activities of daily living (ADLs) and instrumental activities of daily living (IADLs) at ages 70 and 77 in a well-characterized cohort and to measure the effect of regular exercise at age 70 on independence and ease of performance 7 years later. DESIGN: Two stages of a longitudinal study of an age-homogeneous cohort employing extensive interview data, physical examination, and clinical laboratory investigation. SETTING: Home-based interviews and examinations in Jerusalem. PARTICIPANTS: Two hundred eighty-seven west Jerusalem residents, born between June 1920 and May 1921, who participated fully in two phases of an ongoing longitudinal cohort study. Subjects were culled from a larger study population of 605 in the first phase and 1,021 in the second phase. MEASUREMENTS: Two-stage comprehensive demographic, social, and economic profile; medical history and examination; cognitive and affective assessment; and clinical laboratory studies performed in 1990-91 and 1997-98. The investigation questionnaire included details of ADL and IADLs and voluntary exercise. RESULTS: Most aspects of personal and social life did not change from age 70 to 77. Independence in ADLs remained high, as did self-reliance in IADLs for women. A more-sensitive marker of diminished function was reported ease in performance, which declined for use of the toilet, dressing, and all spheres of IADLs. For nearly every task, subjects who reported exercising 4 days a week at age 70 were more likely to report ease in performance at age 77. In a logistic regression accounting for the presence of diabetes mellitus, hypertension, obesity, chronic back pain, loneliness, and performance with ease at age 70 and deterioration in self-assessed health from age 70 to 77, ease of performance in at least three of four ADL tasks was independently related to exercise at age 70 for women (odds ratio (OR) = 8.5, 95% confidence interval (CI) = 2.0-36.2) and for men (OR = 4.3, 95% CI = 1.1-17.1). Ease of independent function in at least four of five IADL tasks also correlated to exercise for men in this regression (OR = 3.7, 95% CI = 1.1-12.2) but not for women (OR = 2.0, 95% CI = 0.6-6.3). Ease in shopping, alternatively, correlated with physical activity for men (OR = 4.3, 95% CI = 1.5-12.0) and women (OR = 2.6, 95% CI = 1.1-6.1). CONCLUSIONS: Subjects remained active and independent at age 77. Reported ease of performance declined and revealed changes in function. Exercise at least four times a week at age 70 preserved ease of performance at age 77 independent of the influence of specific disease or general self-assessed health.     

Disability in the oldest old: "can do" or "do do"?

OBJECTIVE: To investigate the discrepancies between outcomes for competence (can do) and actual performance (do do) in activities of daily living (ADLs). DESIGN: Baseline measurements of a population-based follow-up study. SETTING: Leiden 85-Plus Study, the Netherlands. PARTICIPANTS: Five hundred and ninety-nine persons, age 85. The response rate was 86%. MEASUREMENTS: Face-to-face interviews. Measurements of competence and actual performance were based on the Groningen Activity Restriction Scale. Help received was assessed for several domains. Prevalence rates for disability were assessed according to the concepts of both competence and actual performance. Analysis was performed separately for basic activities of daily living (BADLs) and instrumental activities of daily living (IADLs). RESULTS: Seventy-seven percent of the oldest old were competent to perform all the BADLs and performed them regularly. Fifteen percent were not competent to perform certain BADLs independently but performed them regularly with help from others. The prevalence of disability defined as inability in one or more BADLs was 22% for women and 10% for men. The prevalence of disability defined as inactivity in one or more BADLs was 16% for women and 17% for men. Only 5% of the oldest old were competent to perform all IADLs and performed them regularly. In spite of being competent, 70% did not perform certain IADLs regularly. The prevalence of disability defined as inability in one or more IADLs was 64% for women and 55% for men. The prevalence of disability defined as inactivity in one or more IADLs was 92% for women and 98% for men. CONCLUSION: The structural discrepancies between the outcomes of competence and actual performance have important consequences when estimating disability in old people. Promoting actual performance in IADLs may reduce disability.     

Physical activity is associated with incident disability in community-based older persons

OBJECTIVES: To examine the association between physical activity and the risk of incident disability, including impairment in activities of daily living (ADLs) and instrumental activities of daily living (IADLs), in community-based older persons free of dementia. DESIGN: Prospective, observational cohort study. SETTING: Approximately 40 retirement communities across the Chicago metropolitan area. PARTICIPANTS: More than 1,000 older persons from the Rush Memory and Aging Project, an ongoing longitudinal clinical-pathological study of common chronic conditions of old age. MEASUREMENTS: All participants underwent detailed annual clinical evaluations that included assessments of physical activity, ADLs, IADLs, and gait performance. The associations between physical activity, mortality, and incident disability were examined using a series of Cox proportional hazards models controlled for age, sex, education, and baseline gait. RESULTS: At baseline, participants spent a mean+/-standard deviation of 3.0+/-3.5 hours per week engaging in physical activity (range 0-35). In a proportional hazards model, the risk of death decreased 11% (hazard ratio (HR)=0.89, 95% confidence interval (CI)=0.83-0.95) for each additional hour of physical activity per week. For those who were not disabled at baseline, the risk of developing disability in ADLs decreased 7% (HR=0.93, 95% CI=0.88-0.98) for each additional hour of physical activity per week. Similarly, the risk of disability in IADLs decreased 7% (HR=0.93, 95% CI=0.89-0.99) for each additional hour of physical activity. CONCLUSION: For community-based older persons without dementia, physical activity is associated with maintenance of functional status, including a reduced risk of developing impairment in ADLs and IADLs.     

Mild cognitive impairment and 10-year trajectories of disability in the Iowa Established Populations for Epidemiologic Studies of the Elderly cohort

OBJECTIVES: To apply diagnostic criteria for mild cognitive impairment (MCI) to a geographically representative sample, to estimate the prevalence of MCI, and to estimate 10-year trajectories of incident disability for cognitively intact participants and subgroups with MCI. DESIGN: Prospective cohort; 10 years of follow-up. SETTING: Community-based survey of noninstitutionalized population aged 65 and or older in two rural Iowa counties (Washington and Iowa). PARTICIPANTS: Iowa Established Populations for Epidemiologic Studies of the Elderly (aged > or = 65; N = 3,673; 61.3% female; 99.9% white). MEASUREMENTS: Age, sex, education, Short Portable Mental Status Questionnaire (SPMSQ), 20-item word recall, activities of daily living (ADLs), instrumental activities of daily living (IADLs), chronic medical conditions. RESULTS: MCI was prevalent in 24.7% of participants at baseline. Most participants in the overall cohort remained stable or changed slowly (< or = 1 new limitations) over 10 years (63.1% for SPMSQ, 89.3% for word recall, and 61.7% for ADL disability). For MCI/no prevalent IADL disability (Stage 1 MCI), disability progression was similar to that in the cognitively intact subgroup (median = 0.08 vs 0.05 disabilities per year). For MCI plus prevalent IADL disability (Stage 2 MCI), the median rate of change was equivalent to that of the severely impaired (0.23 disabilities per year; interquartile range = 0.12-0.36). CONCLUSION: Unlike participants with MCI who reported no IADL limitations, those with such limitations were more likely to develop ADL disability--a prerequisite for a diagnosis of dementia.     

Hand-grip strength predicts incident disability in non-disabled older men.

OBJECTIVES: To verify if hand-grip performance in older men is a predictor of disability. DESIGN: Population-based prospective study. SETTING: A sample from the Italian rural cohorts of the FINE study (Finland, Italy, Netherlands Elderly), representative of the general population of elderly men surveyed in 1991 and 1995. PARTICIPANTS: 140 men aged 71-91 years who reported no disability in performing activities of daily living (ADLs), instrumental activity of daily living (IADLs) and mobility activities at baseline examination and provided information on their functional status at follow-up 4 years later. MEASUREMENTS: Disability was defined as needing help in performing ADLs, IADLs and mobility. Hand-grip strength was evaluated at baseline by a mechanical dynamometer. RESULTS: After adjusting for potential confounding variables, a lower concentration of high-density lipoprotein cholesterol was the only factor predicting disability in men aged 76 years or younger and only reduced hand-grip strength predicted incident disability in men 77 years or older. CONCLUSION: Poor hand strength as measured by hand-grip is a predictor of disability in older people. The hand-grip test is an easy and inexpensive screening tool to identify elderly people at risk of disability.     

Urinary incontinence and its association with death, nursing home admission, and functional decline

OBJECTIVES: To determine whether urinary incontinence (UI) is an independent predictor of death, nursing home admission, decline in activities of daily living (ADLs), or decline in instrumental activities of daily living (IADLs). DESIGN: A population-based prospective cohort study from 1993 to 1995. SETTING: Community-dwelling within the United States. PARTICIPANTS: Six thousand five hundred six of the 7,447 subjects aged 70 and older in the Asset and Health Dynamics Among the Oldest Old study who had complete information on continence status and did not require a proxy interview at baseline. MEASUREMENTS: The predictor was UI, and the outcomes were death, nursing home admission, ADL decline, and IADL decline. Potential confounders considered were comorbid conditions, baseline function, sensory impairment, cognition, depressive symptoms, body mass index, smoking and alcohol, demographics, and socioeconomic status. RESULTS: The prevalence of UI was 14.8% (18.5% in women; 8.5% in men). At 2-year follow-up, subjects incontinent at baseline were more likely to have died (10.9% vs 8.7%; unadjusted odds ratio (OR)=1.29, 95% confidence interval (CI)=1.02-1.64), be admitted to a nursing home (4.4% vs 2.6%, OR=1.77; 95% CI=1.18-2.63), and to have declined in ADL function (13.6% vs 8.1%; OR=1.78, 95% CI=1.36-2.33) and IADL function (21.2% vs 13.8%; OR 1.69, 95% CI 1.39-2.05). However, after adjusting for confounders, UI was not an independent predictor of death (adjusted OR (AOR)= 0.90, 95% CI=0.67-1.21), nursing home admission (AOR=1.33, 95% CI=0.86-2.04), or ADL decline (AOR=1.24, 95% CI=0.92-1.68). Incontinence remained a predictor of IADL decline (AOR=1.31; 95% CI=1.05-1.63), although adjustment markedly reduced the strength of this association. CONCLUSION: Higher levels of baseline illness severity and functional impairment appear to mediate the relationship between UI and adverse outcomes. The results suggest that, although UI appears to be a marker of frailty in community-dwelling elderly, it is not a strong independent risk factor for death, nursing home admission, or functional decline.     

Abdominal fat distribution and functional limitations and disability in a biracial cohort: the Atherosclerosis Risk in Communities Study

OBJECTIVE: To examine the associations of abdominal fat and obesity with functional limitations and disability in late adulthood. DESIGN: Longitudinal, cohort study. PARTICIPANTS: African American and white men and women aged 45-64 y at baseline with measured waist circumference, waist-to-hip ratio (WHR), and body mass index (BMI) who participated in the Atherosclerosis Risk in Communities (ARIC) Study (n = 9416). OUTCOME MEASURES: Self-reported functional limitations, activities of daily living (ADLs), and instrumental activities of daily living (IADLs) at ages 52-75 y. RESULTS: Waist circumference, WHR, and BMI were positively associated with functional limitations and ADL and IADL impairment approximately 9 y later among African American and white men and women. For example, in African American women the odds ratios (95% CI) associated with a one standard deviation (s.d.) increment in waist circumference (13.3 cm) for severe functional limitations and ADL and IADL impairment were 2.36 (2.00-2.79), 1.41 (1.25-1.58), and 1.49 (1.34-1.66), respectively. In white women, the odds ratios (95% CI) were 2.66 (2.39-2.96), 1.60 (1.47-1.74), and 1.42 (1.31-1.53), respectively. Similar associations were found in men. A 1 s.d. increment in WHR (0.08 U) and BMI (5.06 kg/m2) produced similar results. The associations of waist circumference and WHR with functional limitations and ADL and IADL impairment were attenuated but, in general, remained statistically significant when BMI was added to the models. CONCLUSIONS: Maintaining a healthy body weight and avoiding increases in abdominal fat should be investigated for their potential to reduce the risk of functional limitations and disability in an aging population.     

Association of urgency symptoms with self-rated health, mood and functioning in an older population

BACKGROUND AND AIMS: Lower urinary tract symptoms (LUTS) with comorbidities are common in old age. The aim here was to investigate the associations of urgency symptoms with self-rated health, mood and functioning in a random older population adjusted for comorbid conditions. METHODS: A population-based cross-sectional survey was made involving 343 people (159 men and 184 women) aged 70 years and over. LUTS were categorized as symptoms with or without urgency. Perceived inconvenience from LUTS, self-rated health, mood, social activity and activities of daily living (ADL), instrumental activities of daily living (IADL) and mobility disability were the outcome measures. Ageand gender-adjusted and multivariate logistic regression models were constructed in order to examine the associations of urgency and non-urgency symptoms with the outcomes. The covariates were age, gender, and self-reported cardiovascular, musculoskeletal, neurological and other chronic diseases. RESULTS: Perceived inconvenience from urgency symptoms was more frequent than that from non-urgency symptoms (64% vs 20%, p<0.001). In the age- and gender-adjusted logistic regression models, LUTS with urgency were associated with poor self-rated health (OR [odds ratio] 2.35; 95% CI [confidence interval] 1.06-5.20), depressive mood (OR 7.29; 95% CI 2.91-18.30), ADL (OR 2.33; 95% CI 1.10-4.92), IADL (OR 2.16; 95% CI 1.19-3.92) and mobility disability (OR 2.44; 95% CI 1.37-4.36). LUTS without urgency were associated with depressive mood (OR 5.02; 95% CI 1.97-12.82) and mobility disability (OR 1.97; 95% CI 1.10-3.53). In the multivariate analyses in which comorbid conditions were added to the model, the associations of non-urgency and urgency symptoms persisted only with depressive mood (OR 4.00; 95% CI 1.52-10.53 and OR 6.16; 95% CI 2.39-15.84, respectively). CONCLUSION: Urgency symptoms are associated with poor self-rated health, depressive mood and disability in older people. There is an independent association between both urgency and non-urgency LUTS and depressive mood. A careful assessment of the mental state of older individuals with LUTS is warranted.     

Disparities between black and white patients in functional improvement after hospitalization for an acute illness

The aim of this study was to determine whether older black and white patients experience different rates of improvement in functioning after being acutely hospitalized. Of the 2,364 community-living patients in this prospective cohort study, 25% self-reported their race/ethnicity to be black. The outcomes were improvement in basic activities of daily living (ADLs) and instrumental activities of daily living (IADLs) from admission to discharge and 90 days postdischarge. Multivariable models that included statistical adjustment for age, illness severity, in-hospital social service referral, dementia, admission level of functioning, and change in functioning from 2 weeks before admission were computed to determine whether black and white patients experienced significantly different rates of recovery at discharge and 90 days after discharge in ADL and IADL functioning. Black patients were as likely as white patients to improve in ADL functioning by discharge (odds ratio (OR)=0.97, 95% confidence interval (CI)=0.76-1.24) or by 90 days after discharge (OR=0.95, 95% CI=0.73-1.24) but significantly less likely to improve IADL functioning by discharge (OR=0.72, 95% CI=0.56-0.93) or by 90 days after discharge (OR=0.68, 95% CI=0.51-0.90). The findings suggest that differential rates of recovery in functioning after an acute hospitalization may contribute to racial/ethnic disparities in IADL functioning, which has implications for the setting of future interventions oriented toward reducing these disparities.     

Prognostic value of disability on mortality: 15-year follow-up of the Bambuí cohort study of aging

BackgroundDisability is a concern in the context of population ageing. The extent of an individual’s disability is a major determinant of whether or not they require long-term care or survival time. We investigated the effect of three disability domains as predictors of all-cause mortality over 15-year follow-up in a Brazilian socioeconomically disadvantaged and multiracial older adult population.MethodsWe estimated Cox proportional hazards models using data from 1333 community-dwelling individuals aged 60 and older from the Bambuí Cohort Study of Ageing. Disability was defined as a great difficulty or not being able to perform one and two or more activities in each domain: mobility, instrumental activities of daily living (IADL) and basic activities of daily living (BADL).ResultsThe overall mortality rate was 46.1 per 1000 person-years at risk (pyrs) and it was higher in men. Among men, the fully adjusted Hazard Ratios (HRs) were 1.92 (95%CI: 1.43-2.58), 2.07 (95%CI: 1.53-2.79) and 1.65 (95%CI: 1.11-2.45), and among women 1.75 (95%CI: 1.38-2.21), 1.43 (95%CI: 1.11-1.84) and 1.43 (95%CI: 1.05-1.95), for two or more disability in mobility tasks, IADLs and BADLs, respectively, compared to those with no difficulty or some difficulty to perform all the tasks.ConclusionA similar risk of death for mobility, IADL and BADL in both genders was found, suggesting that any of these domains can be used to identify risk of all-cause mortality among older adults. The number of activities with limitations in each domain was an important factor.     

What does the medical record reveal about functional status?

OBJECTIVE: Functional status measures are potent independent predictors of hospital outcomes and mortality. The study objective was to compare medical record with interview data for functional status. SUBJECTS AND METHODS: Subjects were 525 medical patients, aged 70 years or older, hospitalized at an academic medical center. Patient interviews determined status for 7 basic activities of daily living (BADLs) and 7 instrumental activities of daily living (IADLs). Medical records were reviewed to assess documentation of BADLs and IADLs. RESULTS: Most medical records contained no documentation of individual BADLs and IADLs (61% to 98% of records lacking documentation), with the exception of walking (24% of medical records lacking documentation). Impairment prevalence was lower in medical records than at interview for all BADLs and IADLs, and agreement between interview and medical record was poor (kappa < 0.40 for individual BADLs and IADLs). Sensitivity of the medical record for BADL and IADL impairment was poor (range 95% to 44%), using the interview as a reference standard. Sensitivity and specificity of the medical record for detection of BADL and IADL impairment changed substantially when records with nondocumentation of functional status were excluded or were assumed to be equivalent to independence. CONCLUSIONS: The results suggest that the medical record is a poor source of data on many functional status measures, and that assuming that nondocumentation of functional status is equivalent to independence may be unwarranted. Given the prognostic importance of functional status measures, the results highlight the importance of developing reliable and efficient means of obtaining functional status information on hospitalized older patients.     

Pulmonary Function and Cognitive Decline in an Older Chinese Population in Singapore

Abstract

Introduction: Various cognitive deficits associated with reduced pulmonary function are reported in different studies, but the pattern of cognitive deficits across multiple domains and its associated everyday functional disability remain unclear. Methods: We analyzed neuropsychological functioning, cognitive impairment and accompanying disability in instrumental activities of daily living (IADL) associated with reduced pulmonary function in community-living middle-aged and older adults in Singapore. Performance on a comprehensive battery of neuropsychological tests, spirometry and cognitively demanding IADLs were assessed in the population-based Singapore Longitudinal Ageing Studies. Results: Consecutive 10% increase in forced expiratory volume in 1 s (FEV1) as percent of predicted was positively associated with 0.18 points increase in Mini-mental state examination (MMSE) and 0.04 points increase in executive function, independent of age, education and other variables. Subjects with moderate-to-severe airway obstruction showed significantly poorer MMSE score (p for linear trend = 0.001), and information processing speed (p for linear trend < 0.001). FEV1 (per 10% of predicted) was significantly associated with lower risk of cognitive impairment (OR = 0.92, 95% CI: 0.87-0.98, P = 0.005) and cognitive IADL disability (OR = 0.86,95% CI:0.79–0.93, P < 0.001). Pulmonary restriction was associated with greater risk of cognitive impairment (OR = 1.98, 95% CI: 1.26-3.11, P = 0.003) and cognitive IADL disability (OR = 2.43, 95% CI: 1.31-4.53, P = 0.005). Moderate-to-severe airway obstruction (OR = 2.04, 95% CI: 1.11–3.74, P = 0.022) was positively associated with cognitive IADL disability. Conclusion: The findings suggest a measurable but modest cognitive effect of low pulmonary function that was accompanied by corresponding disability in living activities. The effect on executive functioning should be further investigated in longitudinal studies.     

Benzodiazepine use and physical disability in community-dwelling older adults

OBJECTIVES: To determine whether benzodiazepine use is associated with incident disability in mobility and activities of daily living (ADLs) in older individuals. DESIGN: A prospective cohort study. SETTING: Four sites of the Established Populations for Epidemiologic Studies of the Elderly. PARTICIPANTS: This study included 9,093 subjects (aged > or =65) who were not disabled in mobility or ADLs at baseline. MEASUREMENTS: Mobility disability was defined as inability to walk half a mile or climb one flight of stairs. ADL disability was defined as inability to perform one or more basic ADLs (bathing, eating, dressing, transferring from a bed to a chair, using the toilet, or walking across a small room). Trained interviewers assessed outcomes annually. RESULTS: At baseline, 5.5% of subjects reported benzodiazepine use. In multivariable models, benzodiazepine users were 1.23 times as likely as nonusers (95% confidence interval (CI) = 1.09-1.39) to develop mobility disability and 1.28 times as likely (95% CI = 1.09-1.52) to develop ADL disability. Risk for incident mobility was increased with short- (hazard ratio (HR) = 1.27, 95% CI = 1.08-1.50) and long-acting benzodiazepines (HR = 1.20, 95% CI = 1.03-1.39) and no use. Risk for ADL disability was greater with short- (HR = 1.58, 95% CI = 1.25-2.01) but not long-acting (HR = 1.11, 95% CI = 0.89-1.39) agents than for no use. CONCLUSION: Older adults taking benzodiazepines have a greater risk for incident mobility and ADL disability. Use of short-acting agents does not appear to confer any safety benefits over long-acting agents.     

Self-reported disability and its association with performance-based limitation in elderly men: a comparison of three European countries

OBJECTIVES: To compare self-reported disability and performance-based limitation and their association in elderly men from three European countries. DESIGN: Cross-sectional data from a cohort study collected around 1990. SETTING: Three cohorts from Finland, the Netherlands, and Italy. PARTICIPANTS: One thousand one hundred sixty-one men aged 70 and older. MEASUREMENTS: Disability and functional limitation were measured in a standardized way in three countries. Self-reported disability was estimated by questionnaire, assessing three domains of activities of daily living: instrumental activities of daily living, mobility, and activities of daily living (score 0-3). Functional limitation was measured by performance tests (score 0-16), with 0 indicated the healthiest score. RESULTS: Self-reported disability and performance-based limitation scores differed between countries. Mean self-reported disability score was worse in Italy (0.72) and the Netherlands (0.70) than in Finland (0.54). Italian men scored worst on the performance-based tests (mean 4.80 vs 4.04 for Finland and 3.74 for the Netherlands). Differences in self-reported disability remained after adjusting for performance scores: Dutch men reported more disabilities (odds ratio (OR) = 1.66, 95% confidence interval (CI) = 1.23-2.25) than men in Finland (reference group) and Italy (OR = 1.08, 95% CI = 0.77-1.53). Self-reported disability was positively associated with performance-based score (OR = 1.28, 95% CI = 1.21-1.35) and did not differ between countries. CONCLUSION: Cross-cultural variation was noted in self-reported disability adjusted for performance score. These differences may be due to sociocultural and physical environmental factors. Self-reported disability was consistently associated with performance-based limitation in Finland, the Netherlands, and Italy.     

Mild to moderate chronic kidney disease and functional disability in community-dwelling older adults. The Cardiovascular risk profile in Renal patients of the Italian Health Examination Survey (CARHES) study

ObjectivesChronic kidney disease (CKD) negatively impacts aging success. This study evaluates the association between CKD and functional disability, defined as limitations in performing mobility tasks, basic (ADLs) and instrumental activities of daily living (IADLs), in a population-based sample of older adults. In particular, we examined whether such a relationship extended to mild-moderate CKD stages (G1-G3ab).MethodsData from the Cardiovascular risk profile in Renal patients of the Italian Health Examination Survey (CARHES) study were used.Prevalence of CKD was estimated by means of urinary albumin to creatinine ratio (ACR) and eGFR (CKD-EPI equation-enzymatic assay of serum creatinine). A validated questionnaire was used to assess functional limitations. Potentially confounding variables, e.g. socio-demographic features, lifestyles, cardiovascular (CV) risk factors and prevalent CV diseases, were considered.Results1309 participants, age 71.4 ± 4.3 years, 53.8% men, were studied. 15.2% of participants were identified as having CKD. Of these, 11.5% were aware of the condition. Prevalence of CKD increased with age, and was similar between men and women. Mild-moderate CKD was found to be significantly associated with disability in mobility (OR = 1.05, 95%CI =1.01–1.09, p = .014) and ADLs/IADLs (OR = 1.06, 95%CI = 1.02–1.12, p = .011) after multiple simultaneous adjustment including socio-demographic variables, CV risk profile, ACR, cognitive impairment and self-rated health.ConclusionsMild-moderate CKD independently associated with functional disability in a population-based sample of older adults. Evidence-based recommendations for disability prevention in CKD are needed.     

Minority disparities in disability between Medicare beneficiaries

OBJECTIVES: To examine racial and ethnic disparities in mobility limitation, activities of daily living (ADLs), and instrumental activities of daily living (IADLs) in older adults enrolled in Medicare.
DESIGN: Longitudinal national survey.
PARTICIPANTS: Community-dwelling respondents in the Medicare Current Beneficiaries Survey from 1992 to 2004 (10,180–16,788 respondents per year).
MEASUREMENTS: Disability-related outcomes included mobility limitation, difficulty in six ADLs and six IADLs. Explanatory variables included age, sex, racial or ethnic group, living situation, and income level.
RESULTS: From 1992 to 2004, proportions of Medicare beneficiaries with mobility limitations were stable across racial and ethnic groups, improving slightly for ADLs and IADLs. Blacks reported more limitations in all three disability-related measures. In a longitudinal analysis, the probability of developing mobility limitation was consistently higher for blacks, followed by white Hispanics, white non-Hispanics, and Asians, after adjusting for age, sex, socioeconomic status, and living situation. For ADL and IADL difficulties, the number of reported difficulties increased with age for all ethnic and racial groups. At approximately age 75, Asians and white Hispanics reported difficulties with much higher numbers of ADLs and IADLs than the other groups.
CONCLUSION: Across all ethnic and racial groups, self-reported disability has declined in the past decade, but even after adjusting for age, sex, socioeconomic status, and living situation, racial and ethnic disparities in disability outcomes persist. Race and ethnicity may influence the reporting of disability, potentially affecting measures of prevalence. Further research is needed to understand whether these differences are a result of perceptions related to disablement or true differences in disability between racial and ethnic groups.     

Depression after stroke: a prospective epidemiological study

OBJECTIVES: To elucidate the relationship between stroke and depressive symptoms and to determine whether disability or cerebrovascular risk factors mediate that relationship. DESIGN: A prospective longitudinal epidemiological survey. SETTING: The mid-Monongahela Valley, a rural, nonfarm, low-socioeconomic-status community. PARTICIPANTS: Random sample of 1,134 subjects aged 65 and older. MEASUREMENTS: The dependent variable was clinically significant depressive symptoms, as defined by five or more symptoms on the modified Center for Epidemiological Studies Depression scale. The independent variables were demographics (age, sex, education), stroke, number of impaired instrumental activities of daily living (IADLs), diabetes mellitus, hypertension, atherosclerotic heart disease, and smoking. Logistic regression analyses were conducted for cross-sectional and longitudinal models examining whether stroke was associated with or predicted depressive symptoms, with other associated factors included as covariates. RESULTS: Clinically significant depressive symptoms were cross-sectionally associated with stroke (odds ratio (OR)=3.5, 95% confidence interval (CI)=1.4-8.3), diabetes mellitus (OR=2.8, 95% CI=1.7-4.6; P相似文献