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.     

Relationship between body mass index and different domains of disability in older persons: the 3C study

OBJECTIVE: To study the relationships between body mass index (BMI) and different domains of disability in elderly subjects from the French 3C study. SETTING: Three cities in France: Bordeaux (South-West), Dijon (North-East) and Montpellier (South-East). DESIGN: Cross-sectional study. SUBJECTS: A sample of 8966 elderly community dwellers (age: 65-101 y). MEASUREMENTS: Main outcome measures: BMI, continence, basic and Instrumental Activities of Daily Living (ADL and IADL) and mobility. Adjustment variables: age, educational level, lifestyle, cognitive functioning, smoking and drinking history, depression, dyspnea, diabetes and indicator of cardiovascular disease. RESULTS: Obesity (BMI> or =30 kg/m2) was significantly associated with disability in each domain for women. The relationship tended to be linear for ADL and for continence; whereas for IADL, underweight women (BMI <21 kg/m2) were also at higher risk of disability. In men, relationships were weaker since BMI was only associated with mobility restriction, with a higher risk for both underweight and obese subjects. CONCLUSION: These results are in favor of a strong association between obesity and the three domains of disability and incontinence. Weaker relationships between underweight and disability were observed. Results suggest that maintaining a BMI in the healthy range could contribute to independence in activities of daily living.     

Association between executive attention and physical functional performance in community-dwelling older women.

OBJECTIVES: Executive functions supervise the contents of working memory, where information from long-term memory is integrated with information in the immediate present. This study examined whether executive attentional abilities were uniquely associated with the performance of complex, instrumental activities of daily living (IADLs) in cognitively intact and physically high-functioning older women. METHODS: Participants were 406 community-residing, older women aged 70-80 years in the Women's Health and Aging Study (WHAS) II, screened to be physically high functioning and cognitively intact using the Mini-Mental State Exam. Hierarchical regression models, adjusted for demographic and disease variables, were used to evaluate the association of cognitive domains, including executive attention, memory, psychomotor speed, and spatial ability with summary measures of IADL (e.g., looking up and dialing a telephone number) and mobility-based ADL (e.g., walking 4 meters) function. RESULTS: Tests of executive attention were associated with performance on IADLs (6.6%) and, to a lesser degree, mobility-based ADLs (1%), adjusting for demographic and disease variables. In particular, the mental flexibility component of the Trail Making Test accounted for the majority of attentional variance in IADL performance. Older age, lower education, and African American race were also associated with poorer physical test performances. DISCUSSION: Executive difficulties in flexibly planning and initiating a course of action were selectively associated with slower performance of higher-order IADL tests, relative to other domains of cognition, in a high-functioning, community-based older cohort. These results suggest that executive functions may be important in mediating the onset and progression of physical functional declines.     

Transitions in health status among community-dwelling elderly people with arthritis. A national, longitudinal study

We used the Longitudinal Study on Aging, a national study of community-dwelling elderly people, to 1) estimate the number of elderly persons with arthritis, with and without other chronic conditions, living in the community in 1984, who reported limitations in physical activities, activities of daily living (ADL), and instrumental activities of daily living (IADL); 2) enumerate the population of the elderly with arthritis who were receiving help or paid help with ADL or IADL; and 3) estimate the number of such persons experiencing a change in health status in the ensuing 2 years. In 1984, 14% of all 15.6 million community-dwelling elderly people had arthritis and no other chronic conditions; 41% had arthritis concurrently with other chronic conditions. Of the former group, 66% experienced limitations in physical activities, but only approximately 25% reported limitations in ADL or IADL in 1984. Among the group with arthritis and other chronic conditions, 82% were limited in at least 1 physical activity, and 41% were limited in ADL. With the passage of 2 years, 2% of elderly persons with arthritis and no other conditions had entered a nursing home, 7% had died, and the percentage reporting no limitation declined significantly. Among elderly persons with arthritis and other conditions, 4% entered a nursing home, 12% died, and the rates of all forms of limitation increased. It is essential to gather data such as these, on the prevalence and incidence of limitation among the elderly with arthritis, to ensure adequate long-term care services for an increasing aged population.     

Physical activity, functional limitations, and disability in older adults

OBJECTIVES: To explore initially how low levels of physical activity influence lower body functional limitations in participants of the Longitudinal Study of Aging. Changes in functional limitations are used subsequently to predict transitions in the activities of daily living/instrumental activities of daily living (ADL/IADL) disability, thus investigating a potential pathway for how physical activity may delay the onset of ADL/IADL disability and, thus, prolong independent living. DESIGN: Analysis of a complex sample survey of US civilian, noninstitutionalized population aged 70 years and older in 1984, with repeated interviews in 1986, 1988, and 1990. SETTING AND PARTICIPANTS: Analyses concentrated on 5151 men and women targeted for interview at all four LSOA interviews. MEASUREMENTS: Characteristics used in analyses: gender, age, level of physical activity, comorbid conditions including the presence of hypertension, diabetes, arthritis, and atherosclerotic heart disease, levels of functional limitations, and ADL/IADL disability. RESULTS: Transitional models provide evidence that older adults who have varying levels of disability and who report at least a minimal level of physical activity experience a slower progression in functional limitations (OR = .45, P < .001 for severe vs less severe limitations). This low level of physical activity, through its influence on changes in functional limitations, is shown to slow the progression of ADL/IADL disability. CONCLUSIONS: Results from analyses provide supporting evidence that functional limitations can mediate the effect that physical activity has on ADL/IADL disability. These results contribute further to the increasing data that seem to suggest that physical activity can reduce the progression of disability in older adults.     

COPD, chronic bronchitis and capacity for day-to-day activities: negative impact of illness on the health-related quality of life

The aim of this study was to investigate the negative impact of illness on health-related quality of life (HRQoL) of people with chronic obstructive pulmonary disease (COPD) or chronic bronchitis. The study population consisted of the participants (N = 8028) of a health examination survey conducted in Finland. The sample in the present substudy was composed of 4718 participants who had complete information about spirometry. Variables age, gender, body mass index (BMI), illnesses, smoking in lifetime, education, FEV1% and incomes were entered in blockwise bivariate regression analysis to examine the relationships between capability for day-to-day activities (physical, psychological and social functioning) of those with COPD. Also, COPD (n = 277) and chronic bronchitis (n = 630) were compared with the general population (n = 3817). Study results showed that women with COPD had worse HRQoL than men, regarding the activities in daily living (ADL; odds ratio [OR] 2.63, 95% confidence interval [Cl] 1.15-5.99), instrumental activities of daily living (IADL; OR 4.23, 95% Cl 1.92-9.29) and exercise (OR 2.66, 95% Cl 1.21-5.84). Compared with the general population, people with chronic bronchitis were associated with poor ADL, IADL and exercise, (OR 1.58, 95% Cl 1.32- 1.92). Those with COPD, had difficulties managing in ADL (OR 4.02, 95% Cl 2.98-5.44), IADL (OR 3.27, 95% Cl 2.43-4.39), exercise (OR 3.35, 95% Cl 2.47 to 4.53). In this representative population-based sample, COPD and chronic bronchitis mean a significantly poor capability in physical functioning. People with chronic bronchitis experienced their daily life to be worse compared with the general population. Reductions in physical functioning for women and especially with COPD were also noteworthy.     

Predictors of functional status in older people living at home.

OBJECTIVE: to describe changes in functional status of community-dwelling Spanish elderly people, followed for 2 years, and to identify socio-demographic and health characteristics that predict functional change. METHOD: we have analysed data from the first two waves of the longitudinal study, Ageing in Leganés, from a representative sample of community-dwelling people aged 65 and over (n=1273). Functional status was categorized according to a hierarchical scale as: completely functional, with functional limitations, with instrumental activities of daily living (IADL) disability, with activities of daily living (ADL) disability or deceased. Multinomial logistic regression was used to estimate the predictive value of selected 1993 socio-demographic and health status variables on 1995 functional status. RESULTS: prevalence of disability based on dependency in any of seven ADL items was 15.5%. Half of the respondents were disabled in at least one of 10 IADLs. Some improved functionally, others deteriorated. Men were more likely to recover function while women were more likely to enter and to remain in the IADL state. Socioeconomic factors were associated to baseline functional status and to functional status change on bivariate analysis. Number of chronic diseases, presence of cognitive problems and depressive symptoms predicted transitions, even after controlling for baseline functional status. CONCLUSION: although estimates of prevalence of disability among people over 65 are higher in Spain than in other European and North American countries, the pattern of functional changes, both in the direction of improvement and decline, seems to be similar.     

安徽省两城市老年人生活自理能力及其相关因素的研究

目的：了解老年人生自理能力状况及其影响因素,方法：应用整群随机抽样方法,调查安徽省合肥,铜陵两城市老年日常生活活动能力,应用单因素和多因素logistic回归模型分析老年人生活自理能力受损的主要影响因素,结果：老年人日常生活动动（PADL）和日常家务活动功能（IADL）丧失率分别为7．2％和20．9％,女性功能丧失率高于男性,且随年龄的增长,功能丧失率逐渐升高,经多因素分析,活活自理能力功能丧失率与年龄,性别,教育程度,患病,经济和有无工作有关,结论：老年人生活自理能力随年龄增长而下降,女性知活自理能力低于男性,IADL功能丧失率高于PADL,老年人健康状况应引起重视。     

Neighborhood Social Cohesion,Physical Disorder,and Daily Activity Limitations Among Community-Dwelling Older Adults

IntroductionAlthough extensive factors have been examined for limitations in activities of daily living (ADL) and instrumental activities of daily living (IADL), it remains unclear as to the impacts of neighborhood-level factors on ADL and IADL limitations. Thus, we aim to examine whether neighborhood characteristics are predictive of limitations in ADL and IADL.MethodsA total of 7,407 participants were selected from the National Health and Aging Trend Study. We used data from round 1 (2011) to round 8 (2018). Neighborhood characteristics were measured as social cohesion and physical disorder. Daily activity limitations were counted based on the domains of ADL and IADL. Mixed-effects negative binomial regression analyses were performed to estimate the effects of neighborhood features on ADL and IADL limitations.ResultsBetter neighborhood social cohesion significantly predicted less limitations in ADL (incidence rate ratio [IRR] = 0.98, 95% confidence interval [CI] = 0.96 - 0.99) and IADL (IRR=0.96, 95% CI = 0.95 - 0.98). More physical disorder predicted more IADL limitations (IRR=1.04, 95% CI = 1.01 - 1.06), but was not associated with ADL limitations.ConclusionNeighborhood social cohesion is essential in enabling older adults to perform both basic self-care activities and more complex tasks, while neighborhood physical disorder is significant to older adults’ capability in performing more complex sets of activities so as to age in place. The study findings underscore the importance of improving both social and physical aspects of neighborhood environment to facilitate older adults’ daily activity performance.     

Persistent infection, inflammation, and functional impairment in older Latinos

BACKGROUND: The objective of this study was to examine whether cytomegalovirus (CMV), herpes simplex virus type-1 (HSV-1), and C-reactive protein (CRP) are associated with functional impairment in older Latinos. METHODS: A cross-sectional analysis of a cohort study was conducted with a community-dwelling elderly population. The sample was a subset (N = 1559/1789) of participants in the Sacramento Area Latino Study on Aging (SALSA) ages 60-101 with available serum samples and functional impairment measures. Baseline serum samples were assayed for levels of immunoglobulin G antibodies to CMV and HSV-1 and for levels of CRP. Several measures were used to assess functional impairment, including activities of daily living (ADL), instrumental activities of daily living (IADL), and walking pace. RESULTS: CMV and CRP showed statistically significant graded associations with ADL functional impairment, even after controlling for age and gender. The relationship between CMV and ADL was slightly attenuated, and the confidence interval contained the null value when adjusted for total number of health conditions, body mass index, and household income. Only high levels of CRP were significantly related to ADL and IADL impairment even after adjusting for all other covariates. CONCLUSION: Inflammation is clearly linked to physical functioning among aging Latinos. This study also suggests a role for CMV infection in relation to ADL impairment. Further research examining the influence of infection, immune response, and inflammation on longitudinal trajectories of physical functioning is warranted.     

农村老年人群日常生活能力与常见慢性病的相关性

目的了解农村老年人群日常生活能力的现状及其与常见慢性病的关系。方法以陕西省内户口类型为农业型的60周岁以上的老年人3307名为研究对象,采用多阶段分层随机整群抽样法对其进行日常生活活动能力(ADL)量表调查,包括躯体生活自理(PADL)和工具性生活自理(IADL)两部分。运用χ2检验、二元logistic回归分析农村老年人群日常生活能力现状及与常见慢性病的相关性。结果陕西省农村老年人日常生活能力依赖率达34.20%(1131/3307),PADL依赖率为17.00%(526/3307),IADL依赖率为33.78%(1117/3307)。logistic回归显示,慢性病种数≥2种、冠心病、关节疾病、白内障、耳聋是影响陕西省农村老年人PADL依赖的危险因素(P<0.05);高血压、冠心病、慢性阻塞性肺疾病、关节疾病、耳聋是影响农村老年人IADL依赖的危险因素(P<0.05)。结论陕西省农村老年人群日常生活能力依赖率较高。患病种数不是日常生活能力的重要影响因素,应重点关注老年性耳聋、关节疾病、冠心病及慢性阻塞性肺疾病等特定疾病。     

A comparison of correlates of cognitive functioning in older persons in Taiwan and the United States.

OBJECTIVES: This article compares patterns of association between cognitive functioning and a number of sociodemographic and health correlates among older persons in Taiwan and the United States. METHODS: The study uses data from the 1993 Survey of Health and Living Status of the Elderly in Taiwan and the 1993 Study of Asset and Health Dynamics Among the Oldest Old in the United States. Separate multivariate regression models are employed for each country to examine the effects of sociodemographic and health factors on cognitive functioning, and to examine the marginal impact of cognitive functioning on activities of daily living (ADL) and instrumental ADL (IADL) functioning. RESULTS: Results of the multivariate analyses show similar patterns of association across the two countries and replicate findings from previous studies. Increasing age, female gender, lower education, depression, and selected health conditions are associated with lower cognitive functioning. In addition, although a significant predictor of both ADL and IADL impairments, cognitive functioning is more powerful with respect to explaining IADL impairments. DISCUSSION: Study findings suggest that the cognitive measures are capturing similar dimensions in Taiwan and the United States, and that factors associated with cognitive functioning and its consequences with respect to physical functioning are similar in the two countries.     

Factors associated with ADL and IADL dependency among Korean centenarians: reaching the 100-year-old life transition

This study aims to examine the functional status of Korean centenarians, who have crossed the relatively rare but increasingly common life transition of living for a century. As functional health is one of the essential components of healthy aging, our primary objective is to identify the correlates of two aspects of functioning, activities of daily living (ADL) and instrumental activities of daily living (IADL). Using a census survey conducted by the Korean National Statistical Office (KNSO) in 2005, we documented ADL and IADL limitations and analyzed their relationship to sociodemographic factors, health behaviors, social connectedness, and presence of diseases. The study participants were 796 adults aged 100 years or older. The mean age was 101.5 +/- 1.8, and females were 89.9% of the sample. Both ADL and IADL dependences were more common among females, those who did less physical activity, those who had more diseases, and those who did not participate in social activities. Intervention programs designed to address life-stage issues such as focusing on initiating healthy behaviors from youth, managing chronic diseases in mid-life, and fostering social participation in later life are recommended ways to improve functional independence and promote healthy aging among current and future generations of Korean centenarians.     

The effects of residential mobility on ADL and IADL limitations among the very old living in the community

OBJECTIVES: We attempt to understand the influence of residential mobility on changes in objective activity of daily living (ADL) and instrumental ADL (IADL) limitations, while taking into account the subjective reason for the move. METHODS: We examine noninstitutionalized adults aged 70 and older who are in the Longitudinal Study of Aging. We use bivariate regression to identify differences between nonmovers and various types of movers in 1988 and 1990 ADL and IADL limitations. Multivariate residualized regression models estimate the effect of residential mobility on the changes in limitations between 1984-1988 and 1988-1990. We give particular attention to the timing and reason for the move. RESULTS: Controlling for demographic, social support, health status, and social integration characteristics, we find that residential mobility is associated with a short-term increase in ADL and IADL limitations. However, an additional analysis reveals that this short-term increase in limitations is only experienced by older adults who move for subjective health reasons. Compared with nonmovers, movers do not have significantly different changes in limitations over the long term. DISCUSSION: Older adults and service providers need to be concerned with short-term increases in objective ADL and IADL limitations that accompany residential relocations, especially for those who move for subjective health reasons. However, from a long-term perspective, residential relocation may serve as a mechanism for accommodating age-related changes that threaten effective functioning.     

The association between low vision and function

OBJECTIVE: This study considers the relationship between low vision and function, specifically exploring whether vision loss is differentially associated with activities of daily living (ADL) versus instrumental activities of daily living (IADL) disability. METHODS: Guided by the World Health Organization's International Classification of Functioning, Disability, and Health framework, multinomial logistic regression analyses were performed for IADL and ADL on a sample of 9,115 adults aged 65 years and above from the 1998 Health and Retirement study. RESULTS: The data supports the fact that ADL and IADL disabilities are associated with vision loss, and there is a differential relationship among functions, with IADLs being more challenging and requiring better visual abilities. DISCUSSION: The findings provide evidence that ADL and IADLs require different skills and are associated differently depending on numerous variables. As the incidence of people living with vision loss is increasing to epidemic proportions due to an aging population, understanding the relationship between vision and participation in meaningful activities has important implications.     

Prevalence of functional disability among elderly patients with cancer

This study is part of a larger multicenter prospective study conducted in Italy to assess the efficacy of the comprehensive geriatric assessment (CGA) among elderly patients with cancer (i.e. aged 65 years or older). The prevalence of functional limitations, and its association with selected characteristics, was investigated among 303 elderly patients consecutively admitted at the Department of Medical Oncology, IRCCS Centro di Riferimento Oncologico, Aviano (Northeast Italy), between 1995 and 1998. These patients had a median age of 72 years (range, 65-94), and were affected by haematological (n=182) or solid tumours (n=121). At baseline, their physical function was assessed, in addition to performance status (PS), by means of the activity of daily living (ADL) and the instrumental activities of daily living (IADL) scales. Overall, 17% of the patients had a limitation for ADL, and 59% for IADL, the prevalence of functional disabilities increased with age. Specifically, 8% of patients had continence limitations and 13% had limitations in taking the prescribed drugs. By multivariate analysis, a poor PS turned out to be a strong independent determinant of both ADL and IADL disabilities.     

Caregiving arrangements of older disabled women, caregiving preferences, and views on adequacy of care

The role of women in caregiving to elderly people has focused primarily on their involvement as givers of care. In contrast, this article focuses on older women as recipients of caregiving. Data from the WHAS and the WHAS Caregiving Study are used to describe: the relationship of caregiving arrangements among moderately to severely disabled older women to sociodemographic, health and functional status; the characteristics of primary family caregivers and the assistance they provide; preferences for caregiving arrangements among both care recipients and caregivers; and views on adequacy of caregiving among older women cared for by family. Overall, about one quarter of these women had no caregiver, reflecting the inclusion in the WHAS of women with only moderate functional difficulty, but close to two-thirds relied on family members, and 15% on paid help only. Greater reliance on family was associated with being age 80 or older, black, and living with others. Women with poorer functioning--more ADL and IADL difficulties, difficulty taking medications without help, low cognitive functioning, not emotionally vital--also were significantly more likely to be cared for by family. Caregiving preferences varied among older women and their husband and daughter caregivers. Husbands consistently viewed in-home family help as the best caregiving arrangement regardless of levels of need. Older women and daughter caregivers both saw nursing homes as the best option for people with dementia and substantial care needs. One-quarter of elderly women chose in-home paid help as the best arrangement for meeting ADL/IADL needs. Older women generally held positive views of the assistance they received from family members. Younger women and lower income women were more likely to indicate they received less help than needed.     

Functional status and health outcomes in older americans with diabetes mellitus

OBJECTIVES: To determine how baseline functional status affects health outcomes in older adults with diabetes mellitus (DM). DESIGN: Nationally representative cross-sectional and longitudinal health interview survey. SETTING: Waves I (1993) and II (1995) of the Assets and Health Dynamics of the Oldest Old Survey (AHEAD) in the United States. PARTICIPANTS: AHEAD respondents aged 70 and older (n = 7,447, including 995 with DM). MEASUREMENTS: At baseline, the entire sample was divided into three groups: high-functioning group, defined as having no physical limitations or instrumental activities of daily living/activities of daily living (IADL/ADL) disabilities (39%); low-functioning group, having three or more limitations or IADL/ADL disabilities (24%); and intermediate-functioning group, those in the middle (36%). Older adults with and without DM, within each of the functioning groups, were compared at 2-year follow-up with respect to demographic characteristics, weight/body mass index, baseline and incident chronic diseases and conditions, and follow-up functioning. RESULTS: Of people aged 70 and older, 28% with DM and 41% without were high functioning; 38% with DM and 22% without were low functioning (both P <.001). High-functioning people with DM remained high functioning at 2 years but had a significantly higher incidence of heart disease and mortality than high-functioning people without DM. Low-functioning people with DM were significantly more likely to have vascular comorbidities at baseline than low-functioning people without DM, but their 2-year outcomes were similar. The intermediate-functioning group showed the most differences between those with and without DM; those with DM were significantly (P <.01) more likely to have baseline vascular disease, low cognitive performance, increased incident vascular disease, and significantly worse 2-year functioning and to have experienced falls (P <.001). CONCLUSION: Differences in baseline functional status in older adults with DM were associated with outcome differences. High-functioning older people with DM tended to remain high functioning but demonstrated significantly higher incidence of heart disease and mortality than those without DM, whereas low-functioning people with and without DM had similar outcomes. However, intermediate-functioning older diabetics had worse health and functioning outcomes than a similarly impaired group without DM. DM management adjusted to functional status can potentially address the most-relevant outcomes in the heterogeneous older population with DM.     

Role of functional performance in diagnosis of dementia in elderly people with low educational level living in Southern Italy

BACKGROUND AND AIMS: Diagnosis of dementia is often difficult in subjects with low educational level. Our aim was to evaluate the role of functional performance and the possibility of preferring scores of activities of daily living (ADL) and instrumental activities of daily living (IADL) in screening elderly people for diagnosis of dementia in a rural population of Southern Italy with a very high percentage of non-educated subjects. METHODS: a random sample of 300 residents, out of 1089 subjects over 60 years of age living in San Marcellino (Caserta, Campania), received door-to-door visit for information about their medical history, with clinical evaluation of general geriatric conditions, including the cumulative illness rating scale (CIRS). Dementia was diagnosed if subjects had a Clinical Dementia Rating score (CDR) > or = 1 and according to the criteria of DSMIV, but not according to scores on the Mini Mental State Examination (MMSE), ADL and IADL. Two hundred and nineteen normal subjects (NS) and 75 patients with dementia (DP) were evaluated. RESULTS: in NS, their mean age- and education-corrected MMSE score was 22.15 (lower than the normal cut-off value of 23.8) and 12.60 in DP (p<0.0001). In NS, the mean ADL score was higher than in DP (5.53 vs 2.64, p<0.0001); only age was correlated with ADL scores (coeff=-0.44, t=-4.557, p<0.0001). Assuming age as covariate, ADL scores highly differentiated DP from NS (F(1, 289)=26.083, p<0.0001). In both sexes, mean IADL scores were higher in NS than in DP (4.46 vs 1.80 in men, p<0.0001; 6.85 vs 2.31 in women, p<0.0001). Age and education did not influence IADL scores in men, but age greatly affected performance in women. IADL scores clearly differentiated NS from DP. In NS, a positive correlation was evident between ADL and IADL scores (r=0.234, p<0.0005), but neither scores correlated with the MMSE scores, even when correlation was performed separately for men and women. In DP, a strong correlation was observed between ADL and IADL scores (r=0.709, p<0.0001) and significant correlations were also evident between the scores of MMSE and both ADL (r=0.492,p<0.0001) and IADL (r=0.398, p<0.0004). CONCLUSIONS: in a rural community with a high prevalence of non-educated subjects, cognitive impairment is related to education, whereas independent functioning is limited mainly to age and not to cognition, if the latter remains (relatively) unimpaired. These results point to the importance of an "ecological" approach to the evaluation of elderly people, particularly those living in small rural communities, where education and the social environment may give rise to difficulties in diagnosis of dementia. The assessment of functional autonomy by ADL and IADL scales may be a better screening tool in diagnosing dementia than the MMSE scores.     

The relation of peripheral arterial disease to leg force, gait speed, and functional dependence among older adults

BACKGROUND: Atherosclerotic peripheral arterial disease (PAD), common among older adults, is associated with poor low-extremity functioning. In considering functional status, varying domains exist, including activities of daily living (ADL), instrumental activities of daily living (IADL), low-extremity mobility (LEM), and leisure and/or social activities (LSA). However, little is known about how PAD is related to functional status beyond low-extremity functioning. METHODS: A total of 1798 participants 60 years old or older was selected from the population-based National Health and Nutrition Examination Survey 1999-2002 in the United States. ADL, IADL, LSA, LEM, and general physical activities (GPA) were obtained by self-report. Peak leg force was obtained from an isokinetic dynamometer. Habitual gait speed was obtained from a 20-foot timed walk. PAD was defined as an ankle-brachial blood pressure index <0.9 in either leg. RESULTS: After multivariable adjustment, the odds ratios (ORs) for dependence in IADL, LSA, and LEM comparing participants with PAD to those without were 1.60 (95% confidence interval [CI], 1.11-2.29), 1.63 (95% CI, 1.08-2.44), and 2.29 (95% CI, 1.64-3.18), respectively. Additional adjustment of peak leg force and/or habitual gait speed diminished the relations of PAD to dependence in IADL and LSA. PAD was associated with an 18.06 Newton reduction (p =.003) in peak leg force and a 0.05 m/s reduction (p =.002) in habitual gait speed. CONCLUSION: PAD was independently associated with multiple domains of functional dependence. The association between PAD and dependence in IADL and LSA was to a large extent mediated by leg force and gait speed.