Recovery in instrumental activities of daily living (IADLs): findings from the Medical Research Council Cognitive Function and Ageing Study (MRC CFAS).
ABSTRACT to provide evidence for predictors of recovery in instrumental activities of daily living (IADLs) among disabled older people living in the community.
MRC CFAS recruited a sample of 13,004 individuals aged 65 years and above from five communities in the UK. Participants underwent a baseline interview between 1990 and 1994 and were re-assessed 2 years later.
the participants who reported that they were unable to perform any IADL without difficulty or help at baseline ('disabled') were included in the analysis.
logistic regression was used to estimate odds ratios (OR) for improvement from disabled to non-disabled state at follow-up ('recovery').
at baseline, 50% reported disability of whom 9% reported independent function at follow-up. Women (OR = 0.4) and participants aged > or =75 years (OR = 0.2) were least likely to recover, followed by those with poor self-rated health (OR = 0.5), using at least one medication (OR = 0.6) and having more than or equal to two co-morbidities (OR = 0.6).
a minority of participants reporting disability at baseline then reported independent function at 2 years. It may be important to focus on those who seem least likely to recover once they have become disabled. Several factors that have been shown to increase the risk of disability were inversely associated with recovery, suggesting that intervention programmes could target these same factors.
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ABSTRACT: Although functional ability decreases with age and is associated with poor health outcomes, decline in functional ability is reversible. The aim of this study is to describe the rate of recovery of functional ability and to identify factors associated with it over a two-year period among older Mexican Americans. 245 functionally disabled older Mexican Americans were included in a two-year prospective cohort study. Data are from the Hispanic Established Population for the Epidemiological Study of the Elderly (H-EPESE), a population-based study of non-institutionalized Mexican Americans in the South-western United States. Activities of daily living (ADL), lower body mobility (tandem balance, eight-foot walk, and repeated chair stands), depressive symptomatology, body mass index, and self-reported medical conditions were obtained. Over a two-year period, of the 245 subjects at baseline who reported functional disability in at least 1 of 7 ADLs, 83 totally recovered their ADL ability, 108 remained disabled, 36 died, and 18 were lost to follow-up. Factors significantly associated with recovery included younger age (65-74) (OR 2.18, 95% CI 1.08-4.42), higher summary performance measure of lower body function (OR 1.19, 95% CI 1.05-1.34), few depressive symptoms (OR 2.84, 95% CI 1.39-5.78), and a BMI > or = 30 Kg/m2 (OR 3.08, 95% CI 1.17-8.07). Higher numbers of ADL limitations at baseline were associated with lower odds of ADL recovery. Two-year recovery from ADL disability among older Mexican Americans was high (33.9%). Factors independently associated with recovery include younger age, few depressive symptoms, good lower body function, and high BMI.Aging clinical and experimental research 09/2003; 15(4):315-20. · 1.01 Impact Factor
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ABSTRACT: The clinico-epidemiologic relevance of the reduction in the frequency of going outdoors in older adults has not been well characterized. This study examined whether the frequency of going outdoors has predictive values for incident physical disability and recovery among community-dwelling elderly. One thousand, two hundred and sixty-seven persons aged 65+ years who lived in a rural community in Niigata, Japan, and participated in the baseline survey were assessed again 2 years later in terms of mobility, and instrumental and basic activities of daily living (IADL and BADL). We compared the incident disability and recovery at follow-up among three subgroups classified by the baseline frequency of going outdoors: once a day or more often, once per 2-3 days, and once a week or less often. Multivariate analyses tested associations between the frequency of going outdoors and functional transition, independent of potential confounders. A lower frequency of going outdoors at baseline was associated with a greater incident disability, and a lower recovery at the two-year follow-up. Even after adjustment, the effects of going outdoors remained significant. Adjusted risks of incident mobility and IADL disabilities were significantly higher (odds ratio[OR]=4.02, 95% confidence interval [CI]: 1.77-9.14 and OR=2.65, 95% CI: 1.06-6.58), respectively, and recovery from mobility disability was significantly lower (OR=0.29, 95% CI: 0.08-0.99) for "once a week or less often" subgroup compared with "once a day or more often" subgroup. The frequency of going outdoors is a good predictor for incident physical disability and recovery among community-living elderly. Public health nurses and clinicians should pay more attention how often their senior clients usually go outdoors.Journal of Epidemiology 12/2006; 16(6):261-70. · 2.11 Impact Factor
Article: The disablement process.[show abstract] [hide abstract]
ABSTRACT: Building on prior conceptual schemes, this article presents a sociomedical model of disability, called The Disablement Process, that is especially useful for epidemiological and clinical research. The Disablement Process: (1) describes how chronic and acute conditions affect functioning in specific body systems, generic physical and mental actions, and activities of daily life, and (2) describes the personal and environmental factors that speed or slow disablement, namely, risk factors, interventions, and exacerbators. A main pathway that links Pathology, Impairments, Functional Limitations, and Disability is explicated. Disability is defined as difficulty doing activities in any domain of life (from hygiene to hobbies, errands to sleep) due to a health or physical problem. Feedback effects are included in the model to cover dysfunction spirals (pernicious loops of dysfunction) and secondary conditions (new pathology launched by a given disablement process). We distinguish intrinsic disability (without personal or equipment assistance) and actual disability (with such assistance), noting the scientific and political importance of measuring both. Disability is not a personal characteristic, but is instead a gap between personal capability and environmental demand. Survey researchers and clinicians tend to focus on personal capability, overlooking the efforts people commonly make to reduce demand by activity accommodations, environmental modifications, psychological coping, and external supports. We compare the disablement experiences of people who acquire chronic conditions early in life (lifelong disability) and those who acquire them in mid or late life (late-life disability). The Disablement Process can help inform research (the epidemiology of disability) and public health (prevention of disability) activities.Social Science [?] Medicine 02/1994; 38(1):1-14. · 2.73 Impact Factor