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Patterns of intrinsic capacity among community-dwelling older adults: Identification by latent class analysis and association with one-year adverse outcomes
Abstract
Objective
To identify patterns of intrinsic capacity (IC) and determine the association between these patterns with incident one-year outcomes.
Methods
A total of 756 older adults aged ≥ 60 years were followed up after 1 year. IC was assessed using the revised integrated care for older people screening tool, and its patterns were examined by the latent class analysis. Logistic regression models were conducted to compare the risk of adverse outcomes.
Results
Three IC patterns were identified. Both “sharp declines in sensory domain” (Class 2) and “sharp declines in locomotion, psychological, cognition and vitality domains” (Class 3) were at greater risk of disabilities and poor physical quality of life than “relatively healthy” (Class 1). The Class 3 was twice as likely to be hospitalized as Class 1.
Discussion
Assessment of IC could provide valuable information on stratifying older adults into heterogeneous groups, promoting targeted interventions to delay the adverse outcomes.
... The prevalence of IC impairment in this study was common (69.6%) and comparable to 73.7% as reported by a systematic review in Chinese older adults [39]. To date, some data-driven studies [40][41][42][43](using LCA/cluster analysis) have been performed. Although the number or characters of the IC impairment patterns vary between these studies because of different designs or methods, there is increasing evidence for three IC impairment patterns. ...
... Our study provides a new insight to understand the public-health framework for health aging. Yu et al. also identified three IC impairment patterns, including "relatively healthy", "sharp declines in sensory domain" and "declines in locomotion, psychological, cognition and vitality domains" [41]. But Gonzalez-Bautista et al. explored the natural history of intrinsic capacity impairment over a period of 4-5 years and identified four latent statuses as follows: "high IC", "low deterioration with impaired locomotion", "high deterioration without cognitive impairment", and "high deterioration with cognitive impairment" [42]. ...
... Underlying of intrinsic capacity lie physiological reserves, and a decline in intrinsic capacity progressively leads to frailty and ultimately to dependency [44]. Previous studies have demonstrated that older adults with lower intrinsic capacity have a higher risk of frailty, disability, poor quality of life and falls [40,41,45]. Therefore, it is crucial to take measures to prevent or reverse IC impairment and thus reduce adverse health outcomes. ...
Background
Intrinsic capacity (IC) is proposed by the World Health Organization (WHO) to promote healthy aging. Although some studies have examined the factors influencing IC, few studies have comprehensively confirmed lifestyle factors on IC, especially IC impairment patterns. The present study aimed to identify the patterns of IC impairment and explore the lifestyle and other factors associated with different patterns of IC impairment.
Methods
This cross-sectional study was conducted in a Chinese geriatric hospital. IC was evaluated in five domains according to the recommendations of WHO: cognition, locomotion, vitality, sensory and psychological domains. The sociodemographic and health-related characteristics of participants were assessed.The health promoting lifestyle was evaluated using the Health-Promoting Lifestyle Profile-II scale, including nutrition, health responsibility, interpersonal relationships, physical activity, spiritual growth and stress management. We applied latent class analysis to identify IC impairment patterns and compared basic activities of daily living, instrumental activities of daily living, frailty, quality of life and falls among different IC impairment patterns. Multinomial logistic regression analysis was conducted to identify factors influencing the IC impairment patterns.
Results
Among 237 participants included, the latent class analysis identified three patterns of IC impairment: 44.7% high IC (Class 1), 31.2% intermediate IC mainly locomotor impairment (Class 2) and 24.1% low IC mainly cognitive impairment (Class 3). Older adults in class 1 had the best function ability and quality of life, while class 3 had the highest levels of disability and frailty, the poorest quality of life and a higher prevalence of falls. Compared with class 1, older adults with advanced age (OR = 22.046, 95%CI:1.735-280.149), osteoporosis (OR = 3.377, 95%CI:1.161–9.825), and lower scores in physical activity (OR = 0.842, 95%CI:0.749–0.945), stress management (OR = 0.762, 95%CI:0.585–0.993) and social support (OR = 0.897, 95%CI:0.833–0.965) were more likely to belong to the class 2. Simultaneously, compared with class 1, older adults with advanced age (OR = 104.435, 95%CI:6.038-1806.410), stroke (OR = 3.877, 95%CI:1.172–12.823) and lower scores in physical activity (OR = 0.784, 95%CI:0.667–0.922) and social support (OR = 0.909, 95%CI:0.828–0.998) were more likely to be class 3. In addition, compared with class 2, older adults with a lower score in nutrition (OR = 0.764, 95%CI:0.615–0.950) were more likely to belong to the class 3.
Conclusions
This study provides evidence that there are heterogeneous IC impairment patterns in older adults and identifies various associated factors in each pattern, including age, stroke, osteoporosis, social support and lifestyle behaviors such as nutrition, physical activity and stress management. It informs stakeholders on which modifiable factors should be targeted through public health policy or early intervention to promote IC and healthy aging in older adults.
... (64) APOE+4 Genotype (26) Housing index (7) Diet quality index (DQI) (98) fragility fracture and functional ability (99) Sleep health (21), Having emotional disorders (21) GDF-15 (59, 60) Residence (urban have better IC) (23,64) BMI (100) Nursing home stay (35), Sarcopenia (18) Hospitalization (27,90) Hospitalassociated complications (95) CRP (60) social activities (7) LSM (30). Dementia (87) IF1 (61) Subjective social status (66) Perceived stress, health-promoting behaviour (101) Higher transition to frailty for those with lower IC (88) Cardiovascular mortality (17) Respiratory disease mortality (16) Social engagement (32) Falls (24) (24,28,73,96) Balance (20,23,28,66,67,71,86,98,109) Dehydroepiandrosterone (DHEA(S)) (20) CES-D/Modified (20,25,26,28,29,35,55,56,67,71,72,75,97,109) Self-reported/rated hearing capacity (20, 23-25, 28, 55, 62, 74-76, 82, 85, 94, 105, 106, 109-111) Verbal fluency/semantic verbal fluency (6,20,23,70,97) Muscle Strength/ Hand grip strength (7,20,31,112) FEV1 (7,20,67,72) Sleep/Sleep Score (16,17,20,67) Insulin-like growth factor 1 (IGF-1) (20) little interest or pleasure in doing things (ICOPE item) (58,76,83,91,108,110,(114)(115)(116)(117) Weber and Rinne test of hearing loss (32) Trail making (part-A processing speed) (70) Timed up and go test (TUG) (7,30,69,113) Exhaustion (23,30,111) Goldberg anxiety scale ( ...
... IC predicted functional difficulty parameters, including the future incidence of ADL (20,24,27,35,(74)(75)(76)(77)(78)(79)(80)(81), IADL (20,24,27,31,66,74,76,78,82,83), Frailty (24,(84)(85)(86)(87)(88), disability/ functional decline/dependence (6,28,65,75), and have shown cross-sectional associations with ADL (7,23,25,69), frailty (7,25,63) and IADL (7,23,25,63). Moreover, IC was associated with fragility fracture (99), nursing home stay (35), life-space mobility (30), falls (24), incontinence (64,82), and sarcopenia (18). ...
... IC predicted functional difficulty parameters, including the future incidence of ADL (20,24,27,35,(74)(75)(76)(77)(78)(79)(80)(81), IADL (20,24,27,31,66,74,76,78,82,83), Frailty (24,(84)(85)(86)(87)(88), disability/ functional decline/dependence (6,28,65,75), and have shown cross-sectional associations with ADL (7,23,25,69), frailty (7,25,63) and IADL (7,23,25,63). Moreover, IC was associated with fragility fracture (99), nursing home stay (35), life-space mobility (30), falls (24), incontinence (64,82), and sarcopenia (18). ...
In 2015, the World Health Organization (WHO) introduced the concept of intrinsic capacity (IC) to define healthy aging based on functional capacity. In this scoping review, we summarized available evidence on the development and validation of IC index scores, the association of IC with health-related factors, and its biological basis. The review specifically focused on identifying current research gaps, proposed strategies to leverage biobank datasets, and opportunities to study the genetic mechanisms and gene-environment interactions underlying IC.
The literature search was conducted across six databases, including PubMed, CINAHL, Web of Science, Scopus, AgeLine, and PsycINFO, using keywords related to IC.
This review included 84 articles, and most of them (n=38) adopted the 5-domains approach to operationalize IC, utilizing correlated five factors or bifactor structures. Intrinsic capacity has consistently shown significant associations with socio-demographic and health-related outcomes, including age, sex, wealth index, nutrition, exercise, smoking, alcohol use, ADL, IADL, frailty, multimorbidity, and mortality. While studies on the biological basis of the composite IC are limited, with only one study finding a significant association with the ApoE gene variants, studies on specific IC domains — locomotor, vitality, cognitive, psychological, and sensory suggest a heritability of 20–85% of IC and several genetic variants associated with these subdomains have been identified. However, evidence on how genetic and environmental factors influence IC is still lacking, with no available study to date.
Our review found that there was inconsistency in the use of standardized IC measurement tools and indicators, but the IC indices had shown good construct and predictive validity. Research into the genetic and gene-to-environment interactions underlying IC is still lacking, which calls for the use of resources from large biobank datasets in the future.
... Multidomain interventions could be designed and planned to target the most common patterns. So far, studies have reported clusters of IC domain impairments only cross-sectionally and circumscribed to one country [21,22]. Examination of data from the global north and the global south could expand our knowledge of the natural history of IC impairments in older adults. ...
... Our results are congruent with previous studies which applied the latent class model to IC [21,22]. For example, Yu et al. [21] who also identified a group of healthy participants and two strata of deterioration. ...
... Our results are congruent with previous studies which applied the latent class model to IC [21,22]. For example, Yu et al. [21] who also identified a group of healthy participants and two strata of deterioration. Interestingly, in their study, the nutrition, psychological and sensory domains also 'move in block'. ...
Background
intrinsic capacity (IC) is a construct encompassing people’s physical and mental abilities. There is an implicit link amongst IC domains: cognition, locomotion, nutrition, sensory and psychological. However, little is known about the integration of the domains.
Objectives
to investigate patterns in the presentation and evolution of IC domain impairments in low-and-middle-income countries and if such patterns were associated with adverse outcomes.
Methods
secondary analyses of the first two waves of the 10/66 study (population-based surveys conducted in eight urban and four rural catchment areas in Cuba, Dominican Republic, Puerto Rico, Venezuela, Peru, Mexico and China). We applied latent transition analysis on IC to find latent statuses (latent clusters) of IC domain impairments. We evaluated the longitudinal association of the latent statuses with the risk of frailty, disability and mortality, and tested concurrent and predictive validity.
Results
amongst 14,923 participants included, the four latent statuses were: high IC (43%), low deterioration with impaired locomotion (17%), high deterioration without cognitive impairment (22%), and high deterioration with cognitive impairment (18%). A total of 61% of the participants worsened over time, 35% were stable, and 3% improved to a healthier status.
Participants with deteriorated IC had a significantly higher risk of frailty, disability and dementia than people with high IC. There was strong concurrent and predictive validity. (Mortality Hazard Ratio = 4.60, 95%CI 4.16; 5.09; Harrel’s C = 0.73 (95%CI 0.72;0.74)).
Conclusions
half of the study population had high IC at baseline, and most participants followed a worsening trend. Four qualitatively different IC statuses or statuses were characterised by low and high levels of deterioration associated with their risk of disability and frailty. Locomotion and cognition impairments showed other trends than psychological and nutrition domains across the latent statuses.
... Their results identified four classes sharing similar longitudinal IC trajectories: "high-stable" (20.13%), "normal-stable" (40.58%), "sensory dysfunction" (29.53%), and "all dysfunction" (9.76%). However, three IC patterns ("sharp declines in sensory domain", "sharp declines in locomotion, psychological, cognition, and vitality domains", and "relatively healthy") were identified in Yu et al.'s study [31]. Regarding the size of the trajectory groups in our study, the stable high IC group was the largest (71.8%), which was followed by the mediumlevel increasing IC, medium-level decreasing IC, and low-level IC. ...
Background: Previous studies have shown that intrinsic capacity changes over time and can independently predict adverse outcomes such as mortality and care dependence in older adults. However, explorations of the heterogeneity in the developmental trajectories of intrinsic capacity are limited. Aim: This study aimed to identify potential intrinsic capacity trajectory groups and the factors impacting different trajectory groups among older adults. Methods: We utilized data from 2454 older adults aged 60 and above, sourced from the Chinese Longitudinal Healthy Longevity Survey. Our analyses were conducted using growth mixture modeling, chi-square tests, and multinomial logistic regression analysis. Results: We identified four intrinsic capacity trajectory groups among older adults in China: low-level intrinsic capacity (3.2%), medium-level increasing intrinsic capacity (13.0%), medium-level decreasing intrinsic capacity (12.0%), and stable high intrinsic capacity (71.8%). Age was an influencing factor of the medium-level increasing intrinsic capacity, medium-level decreasing intrinsic capacity, and stable high intrinsic capacity trajectory groups. Compared to individuals in the low-level intrinsic capacity trajectory group, individuals in the medium-level decreasing intrinsic capacity group were more likely to regularly exercise and participate in social activity, and those in the stable high intrinsic capacity group were more likely to be male, drink, participate in social activity, and have good self-rated health. Conclusions: Understanding the developmental trajectories of the intrinsic capacity of the older adults can contribute to formulating personalized intervention planning. We identified four intrinsic capacity trajectories in a cohort of older adults in China, which highlights significant heterogeneity in intrinsic capacity development. Our findings suggest that age, gender, exercise, drinking, social activity, and self-rated health of older adults have important effects on different intrinsic capacity development trajectories.
... For example, a longitudinal aging study analysis has indicated that higher IC is associated with reduced risk of falls [9]. Other studies have found that a decrease in IC is associated with a decrease in quality of life, an increased risk of disability [10], an increased risk of hospitalization [11], an increased incidence of frailty [12], and an increased mortality rate [13], consistent with cohort studies from Hong Kong [14]. It can be seen that improving IC is crucial for the health and life of the older adults, and how to maintain and improve IC in the older adults has become an increasingly important factor in nursing practices. ...
Objectives
This study aimed to examine Intrinsic Capacity (IC) subgroups and the association of IC subgroups with IC predictors in Chinese urban empty nesters.
Methods
A convenient sample of 385 older adults aged 60 and above in Community Health Service Center was recruited from Hei Longjiang Province, China, between June 2023 and December 2023. Latent class Analysis (LCA) was conducted to explore IC subgroups using the sensory, cognition, locomotion, psychological, and vitality domains of IC as input variables. Multinomial logistic regression was performed to explore the association between latent subgroups and the IC predictors.
Results
We identified three IC subgroups: "Low IC level—Low locomotion domain"(33.5%), "Medium IC level—Low sensory domain" (16.9%) and "High IC level" (49.6%). Being young, married, without multimorbidity, receiving visits from children ≥ 1 time per week, a low score of self-neglect, a high score of social networking, and a low score of loneliness were closely correlated to the "High IC level" subgroup of empty-nest older adults in communities.
Conclusion
The potential subgroups of the IC of empty-nest older adults in communities can be identified through five IC domains. The older empty-nesters should pay extra attention to their critical IC predictors. Community medical staff and other workers should provide intervention measures for different subgroups of older adults to improve their IC in an effective and individualized manner.
... Yu at al, 2022 47 Yu at al, 2023 46 Beard at al, 2022 21 Yu at al, 2021 48 Yu at al, 2021 49 Tay at al, 2023 44 Beard at al, 2019 20 ...
Background: Together with environmental factors, intrinsic capacity (the composite of all the physical and mental capacities of an individual) has been proposed as a marker of healthy ageing. However, whether intrinsic capacity predicts major clinical outcomes is unclear. We aimed to explore the association of intrinsic capacity with functional decline and mortality in older adults.
Methods: In this systematic review and meta-analysis, we conducted a systematic search in MEDLINE (via PubMed), Scopus, and Web of Science from database inception to Feb 14, 2024, of observational longitudinal studies conducted in older adults (age ≥60 years) assessing the association of intrinsic capacity with impairment in basic activities of daily living (BADL) or instrumental activities of daily living (IADL) or risk of mortality. Estimates were extracted by two reviewers (JLS-S and W-HL) and were pooled using three-level meta-analytic models. The quality of each study was independently assessed by two authors (JLS-S and PLV) using the Newcastle-Ottawa Scale for longitudinal studies. Heterogeneity was evaluated using the I2 indicator at two levels: within-study (level 2) and between-study (level 3) variation. For associations between intrinsic capacity and IADL and BADL, we transformed data (standardised β coefficients and odds ratios [ORs]) into Pearson product moment correlation coefficients (r) using Pearson and Digby formulas to allow comparability across studies. For associations between intrinsic capacity and risk of mortality, hazard ratios (HRs) with 95% CIs were extracted from survival analyses. This study is registered with PROSPERO, CRD42023460482.
Findings: We included 37 studies (206 693 participants; average age range 65·3-85·9 years) in the systematic review, of which 31 were included in the meta-analysis on the association between intrinsic capacity and outcomes; three studies (2935 participants) were included in the meta-analysis on the association between intrinsic capacity trajectories and longitudinal changes in BADL or IADL. Intrinsic capacity was inversely associated with longitudinal impairments in BADL (Pearson's r -0·12 [95% CI -0·19 to -0·04]) and IADL (-0·24 [-0·35 to -0·13]), as well as with mortality risk (hazard ratio 0·57 [95% CI 0·51 to 0·63]). An association was also found between intrinsic capacity trajectories and impairment in IADL (but not in BADL), with maintained or improved intrinsic capacity over time associated with a lower impairment in IADL (odds ratio 0·37 [95% CI 0·19 to 0·71]). There was no evidence of publication bias (Egger's test p>0·05) and there was low between-study heterogeneity (I2=18·4%), though within-study (I2=63·2%) heterogeneity was substantial.
Interpretation: Intrinsic capacity is inversely associated with functional decline and mortality risk in older adults. These findings could support the use of intrinsic capacity as a marker of healthy ageing, although further research is needed to refine the structure and operationalisation of this construct across settings and populations.
... Prior research has shown that elderly individuals who experience visual or auditory impairments exhibit a higher propensity for restricted physical movement [19]. In their study, Yu [20] employed latent category analysis to investigate the trajectory of intrinsic capacity decline. Their findings revealed a distinct pattern characterized by a pronounced decrease in sensory domains and a moderate reduction in locomotor domains. ...
Background
Intrinsic capacity (IC) can better reflect the physical functioning of older adults. However, few studies have been able to systematically and thoroughly examine its influencing factors and provide limited evidence for the improvement of intrinsic capacity. The objective of this study was to provide a comprehensive description of the overall decline in intrinsic capacity among older persons in the community. Additionally, the study aimed to analyze the composition of the five domains of reduction, compare the rate of decline among older adults and investigate the factors that influence this decline.
Methods
This was a cross-sectional study conducted in the Chinese community. The self-designed general characteristics questionnaire was created based on the healthy aging framework and a systematic review. Intrinsic capacity was assessed with the Mini-Mental State Examination (MMSE), Geriatric Depression Scale (GDS-15), Community Health Record Management System (CHRMS), Mini Nutritional Assessment Brief Form (MNA-SF), and Short Physical Performance Battery (SPPB). The influencing factors of intrinsic capacity were investigated using stepwise logistic regression.
Results
A total of 968 older adults with a mean age of 71.00 (68.00, 76.75) were examined, and 704 older adults (72.7%) showed a decline in intrinsic capacity. There was a decline in at least one domain in 39.3% of older adults, with reductions in each domain ranging from 5.3% (psychological) to 52.4% (sensory). The study examined the composition of domains that experienced a decline in intrinsic capacity. It was found that a combination of sensory and locomotor domains showed the most significant decrease in 44.5% (n = 106) of individuals who experienced a decline in the two domains. Furthermore, a combination of sensory, cognitive, and locomotor domains exhibited a significant decrease in 51.3% (n = 44) of individuals who experienced a reduction in three domains. Lastly, a combination of sensory, vitality, cognitive, and locomotor domains showed the most significant decline in four domains, accounting for 60.0% (n = 15) of the population. Older adults had a higher risk of intrinsic capacity decline if they were older (95% CI:1.158–2.310), had lower education, lived alone (95% CI: 1.133–3.216), smoked (95% CI: 1.163–3.251), high Charlson Comorbidity Index (95% CI: 1.243–1.807) scores, did not regular exercise (95% CI:1.150–3.084), with lower handgrip strength (95% CI: 0.945–0.982).
Conclusions
We found a relatively high prevalence of intrinsic capacity; more attention should be paid to older adults who are older, less educated, live alone, and have more comorbidities. It is imperative to prioritize a healthy lifestyle among older persons who exhibit smoking habits, lack regular exercise, and possess inadequate handgrip strength.
... Although demographic ageing is an inevitable result of social development, it poses new challenges for health systems, health policies, and healthcare providers [3]. As individuals age, their intrinsic capacity, which is the sum of their physical and mental abilities, tends to decline, and health issues become more chronic and complex [4]. Multimorbidity, which refers to the presence of multiple chronic conditions simultaneously, is increasingly prevalent with age [5], as is the development of geriatric syndromes, including frailty [6], urinary incontinence [7], and propensity to fall [8]. ...
Demographic ageing has emphasized the need to adapt current healthcare systems to the comorbidity profile of older adults. In 2004, the World Health Organization (WHO) developed the Age-Friendly Principles, but the approach to their implementation in the health systems still remains uncertain. This article intends to address this gap by assessing how the Principles are perceived and implemented in the Portuguese National Health Service (NHS), where this topic has recently been placed on the political agenda. A questionnaire survey was administered to primary care directors and hospital administrators, covering a total of 173 health units. Findings show that most respondents are unaware of the WHO Principles (71%) and do not identify the current organizational structure of care as a problem for the provision of care (80%). However, the implementation of the WHO Principles is lower than desired, especially regarding professional training and the management system (50%
and 28% of the criteria are implemented, respectively). These criteria defined by the WHO are implemented in a reduced number of health units, as opposed to the physical environment where implementation is more widespread (64%). Accordingly, further dissemination and implementation support in the national territory are needed in order to improve the health outcomes of older adults and increase the performance of health units.
Introduction: Intrinsic capacity is a new concept driven by functional medicine. Unplanned readmission is one of the most common and expensive adverse outcomes after percutaneous coronary intervention (PCI), and its predictors are complex. Whether the baseline intrinsic capacity level or longitudinal intrinsic capacity trajectories could predict unplanned readmission remains unclear. Methods Intrinsic capacity was assessed at discharge, 1 month, and 6 months after PCI. Latent class growth analysis was used to determine heterogeneous intrinsic capacity trajectories. We used logistic regression to explore the effect of intrinsic capacity on unplanned readmission. Results A total of 300 participants (mean ± SD age: 67.02 ± 9.42 years; 226 [75.3%] male) were included in the analysis. The unplanned readmission incidence was 24%. Unplanned readmission could be predicted by the baseline intrinsic capacity level (OR = 1.72, 95%CI: 1.23–2.39), NT-proBNP (OR = 0.24, 95%CI: 0.10–0.54), LVEF% (OR = 0.95, 95%CI: 0.91–0.98), CRP (OR = 1.04, 95%CI: 1.01–1.07), Ty-G index (OR = 2.08, 95%CI: 1.16–3.74) and chronic disease resource utilization (OR = 1.06, 95%CI: 1.00-1.11). At the prospective level, two intrinsic capacity trajectory classes were identified: “low then drop” and “high and stable”. Patients in the “low then drop” group have a higher risk of unplanned readmission (OR = 2.12, 95%CI: 1.10–4.10). Conclusions The findings capture two intrinsic capacity trajectories in middle-aged and older patients after PCI. Both the baseline intrinsic capacity level and intrinsic capacity trajectories could effectively predict unplanned readmission. The longitudinal association between cardiovascular markers and unplanned readmission requires further evidence.
This prospective cohort study assessed the impact of intrinsic capacity on hospital admissions among older adults after an Emergency Department (ED) visit. Assessing 1132 patients according to WHO’s Integrated Care for Older People guidelines between March 1 and August 30, 2022, we found that 784 (69.26%) were admitted. The admission group demonstrated significantly lower intrinsic capacity scores (mean ± SD, 2.92 ± 1.29) compared to the discharge group (3.44 ± 1.23; p < .001). Multivariable logistic regression showed that higher intrinsic capacity scores were associated with lower odds of admission (adjusted odds ratio [aOR] = 0.81; 95% CI: 0.71–0.92; p < .001). Notably, patients with malnutrition had significantly higher odds of admission (OR = 3.12; 95% CI: 2.16–4.50; p < .001). These findings underscore the importance of integrating the intrinsic capacity assessment with traditional clinical indicators in the emergency care of older adults.
Background:
Intrinsic capacity (IC) is defined as "all the physical and mental attributes possessed by the older person." This concept has gained momentum in recent years because it provides insights into the changes in the functional capacity of individuals during their life. This study examined common factors associated with IC decline among older adults in Mexico and Colombia.
Methods:
This cross-sectional, correlational study included 348 community-dwelling older adults. Sociodemographic, clinical, and family conditions were assessed as possible associated factors, and IC was analyzed across five domains: cognitive, locomotor, psychological, vitality (malnutrition through deficiency and excess), and sensory (visual and auditory). Parametric and non-parametric statistical analyses were performed.
Results:
The common factors associated with impairment according to domain were family dysfunctionality (cognitive domain); myocardial infarction, family dysfunctionality, age >80 years, home occupation, and not having a partner (locomotor domain); dysfunctional family and risk of falls (psychological domain); age >80 years and not having a partner (malnutrition by deficiency domain); age 60-79 years, walking <7,500 steps/day, and peripheral vascular disease (malnutrition by excess domain); risk of falling and being female (visual sensory domain); risk of falling (auditory sensory domain); and dysfunctional family and risk of falling (total intrinsic capacity).
Conclusion:
Both populations had common sociodemographic, clinical, and familial factors that directly affected total IC stocks and their domains.
Introduction
In 2015, the term ‘intrinsic capacity’ (IC) was proposed by the World Health Organisation to promote healthy aging. However, the factors associated with IC are still discrepant and uncertain.
Aim
We aim to synthesise the factors connected with IC.
Methods
This scoping review followed the five‐stage framework of Arksey and O'Malley and was reported using PRISMA‐ScR guidelines.
Results
In all, 29 articles were included. IC of older adults is associated with demographic characteristics, socioeconomic factors, disease conditions, behavioural factors, and biomarkers. Age, sex, marital status, occupation status, education, income/wealth, chronic diseases, hypertension, diabetes, disability, smoking status, alcohol consumption, and physical activity were emerged as important factors related to the IC of older adults.
Conclusions
This review shows that IC is related to multiple factors. Understanding these factors can provide the healthcare personnel with the theoretical basis for intervening and managing IC in older adults.
Relevance to Clinical Practice
The influencing factors identified in the review help to guide older adults to maintain their own intrinsic capacity, thereby promoting their health and well‐being. The modifiable factors also provide evidence for healthcare personnel to develop targeted intervention strategies to delay IC decline.
No Patient or Public Contribution
As this is a scoping review, no patient or public contributions are required.
Different types of community-based intervention activities may have differential effects in improving the intrinsic capacity (IC) of older people. This study aims to (i) identify subgroups of older people based on their IC impairments, (ii) examine the differential associations between different types of activity participations and change in IC across subgroups, and (iii) assess whether the activity participation patterns of older people align with the way that would benefit them the most.
Participants were community-dwelling older people aged 60 years or above. They were screened for IC impairments at baseline, and their participation records of different types (cognitive, physical, nutritional, mental, and social) of intervention activities were collected for one year. An aggregated IC score was created based on four IC domains including cognitive (self-rated memory), locomotor (self-rated difficulties in walking), vitality (self-rated weight loss), and psychological (subjective well-being). Cluster analysis was used to group homogenous participants. Mixed-effects regression was used to examine the associations between activity counts (i.e., number of sessions participated) and change in IC. Activity participation patterns were also compared across subgroups.
Data were obtained from 7,357 participants (mean age = 74.72 years). Four clusters were identified, including those who were relatively robust (cluster 1, N = 4,380, 59.5%), those who had cognitive decline (cluster 2, N = 2,134, 29.0%), those who had impaired mobility and vitality (cluster 3, N = 319, 4.3%), and those with poor psychological well-being (cluster 4, N = 524, 7.1%). Overall, activity count was associated with IC improvement (β = 0.073, 95% CI [0.037, 0.108]). However, as regards the cluster-specific results, different types of activities were associated with IC improvement for different specific clusters. For instance, cognitive activity count was associated with IC improvement only for cluster 2 (β = 0.491, 95% CI [0.258, 0.732]). Notably, none of the activity types were associated with IC improvement for cluster 1. Regarding the activity participation patterns, there were no significant differences across the four clusters (Wilk’s Λ = 0.997, F = 1.400, p =.138).
IC improvement depended on the activity types and IC status of older people. In view of this, a people-centred and targeted approach should be adopted to maximize the overall benefits of intervention activities.
Objectives
This review summarizes the measurements of intrinsic capacity in 5 domains across different studies and evaluates the quality of research papers.
Design
Scoping review of papers written in English and Chinese published in peer-reviewed journals.
Setting and Participants
The intrinsic capacity of older adults was assessed using the multidomain structure (Cognition, Locomotion, Psychological, Sensory and Vitality) proposed by the World Health Organization.
Methods
We searched PubMed, MEDLINE, and Web of Science for papers in English, and CNKI, CBM for papers written in Chinese published until September 13, 2022. Both cross-sectional and cohort studies of multidomain measurements of intrinsic capacity were included. Three independent reviewers appraised the quality of studies, and Cohen’s kappa was calculated to determine interrater reliability. Data were listed by author, year, setting, country, age range and number of participants, measurement and calculation of intrinsic capacity, and data acquisition method.
Results
We included 53 studies. Twenty-one studies were of high quality, 31 studies were of moderate quality, and 1 study was of low quality. Measurements of intrinsic capacity and derivation of the summative index score were heterogeneous. Intrinsic capacity was usually assessed in 4 or 5 domains. Sensory was the most frequently overlooked domain or subdivided into vision and hearing in some studies. Indicators of vitality were the most heterogeneous. We also found consistency in heterogeneous measurements. The most common measurements of cognition, locomotion, and psychological capacity were the Mini-Mental State Examination, Short Physical Performance Battery, and Geriatric Depression Scale respectively. Self-reported questionnaires were commonly adopted in sensory domain. The Mini-Nutritional Assessment and grip strength were the most measured indicators of vitality.
Conclusions and Implications
The focus on capacity and disease should be balanced to better promote healthy aging in older adults. Heterogeneity of intrinsic capacity measurements underscores the need for consensus about standardized measurements and calculation procedures.
Aim
This study aimed to elucidate whether malnutrition is associated with cognitive impairment in an older Chinese population.
Methods
A cross‐sectional study was conducted in 2365 participants aged 60 years or older from January 2013 to September 2019. Nutritional status was measured by using the Mini Nutritional Assessment Short Form (MNA‐SF). Cognitive function was assessed with the Mini‐Mental State Examination (MMSE). The relationship between malnutrition or each Mini Nutritional Assessment Short Form domain and cognitive impairment was examined with univariate and multivariate logistic regression analysis.
Results
The prevalence of malnutrition, risk of malnutrition, and cognitive impairment was 5.54%, 33.45%, and 36.74%, respectively. The prevalence was higher in those 80 years and older: 7.88%, 40.75%, and 53.65%, respectively. The Mini‐Mental State Examination score was positively correlated with the Mini Nutritional Assessment Short Form score (r = 0.364, P < 0.001). After adjustment for age, gender, education, marital status, and living alone, malnutrition (odds ratio (OR) = 3.927, 95% confidence interval (CI): 2.650–5.819), anorexia (OR = 1.454, 95%CI: 1.192–1.774), weight loss (OR = 1.697, 95%CI: 1.406–2.047), impaired mobility (OR = 4.156, 95%CI: 3.311–5.218), and psychological stress (OR = 1.414, 95%CI: 1.070–1.869) were significantly associated with an increased risk of cognitive impairment.
Conclusions
Our results suggest that the prevalence of malnutrition and cognitive impairment is relatively high and increases with age. Malnutrition, anorexia, weight loss, impaired mobility, and psychological stress are significantly associated with an increased risk of cognitive impairment. Therefore, clinicians should assess the nutritional and cognitive status of the elderly regularly to improve early detection and timely intervention.
Background:
Hearing loss is highly prevalent and associated with reduced well-being in older adults. But little is known about the role of social factors in the association of hearing difficulty and its health consequences. This study aims to examine the association between self-reported hearing loss and health-related quality of life (HRQoL, consisted of physical and mental component summary, PCS and MCS), and to investigate whether social engagement mediates this association.
Method:
Data on 4035 older adults aged 60 years or above from a cross-sectional nationally representative database in China were obtained to address this study. HRQoL was measured by the Short Form 12 Health Survey (SF-12). Hearing loss was defined by a dichotomized measure of self-reported hearing difficulty, which has been proved to be sensitive and displayed moderate associations with audiometric assessment in elderly population. Social engagement was measured by the Index of Social Engagement Scale. Bootstrap test was applied to test for the significance of the mediating role of social engagement.
Results:
Self-reported hearing loss was found negatively associated with HRQoL in older adults, and hearing loss was much more related to reduced mental well-being. Social engagement played a partial mediating role in the association of hearing loss and HRQoL. Social engagement account for 4.14% of the variance in the change of PCS scores and 13.72% for MCS, respectively.
Conclusion:
The study lends support to the hypothesis that hearing loss is associated with aging well beings, and the use of hearing aid or proper social engagement intervention may improve the quality of life among the elderly.
Introduction
Hearing loss (HL) is a frequent problem among the elderly and has been studied in many cohort studies. However, pure tone audiometry—the gold standard—is rather time-consuming and costly for large population-based studies. We have investigated if self-reported hearing loss, using a multiple choice question, can be used to assess HL in absence of pure tone audiometry.
Methods
This study was performed within 4,906 participants of the Rotterdam Study. The question (in Dutch) that was investigated was: ‘Do you have any difficulty with your hearing (without hearing aids)?’. The answer options were: 'never', 'sometimes', 'often' and 'daily'. Mild hearing loss or worse was defined as PTA0.5-4(Pure Tone Average 0.5, 1, 2 & 4 kHz) ≥20dBHL and moderate HL or worse as ≥35dBHL. A univariable linear regression model was fitted with the PTA0.5–4 and the answer to the question. Subsequently, sex, age and education were added in a multivariable linear regression model. The ability of the question to classify HL, accounting for sex, age and education, was explored through logistic regression models creating prediction estimates, which were plotted in ROC curves.
Results
The variance explained (R²) by the univariable regression was 0.37, which increased substantially after adding age (R² = 0.60). The addition of sex and educational level, however, did not alter the R² (0.61). The ability of the question to classify hearing loss, reflected in the area under the curve (AUC), was 0.70 (95% CI 0.68, 0.71) for mild hearing loss or worse and 0.86 (95% CI 0.85, 0.87) for moderate hearing loss or worse. The AUC increased substantially when sex, education and age were taken into account (AUC mild HL: 0.73 (95%CI 0.71, 0.75); moderate HL 0.90 (95%CI 0.89, 0.91)).
Conclusion
Self-reported hearing loss using a single question has a good ability to detect hearing loss in older adults, especially when age is accounted for. A single question cannot substitute audiometry, but it can assess hearing loss on a population level with reasonable accuracy.
Background
Activities of daily living (ADLs) and instrumental activities of daily living (IADLs) are essential for independent living and are predictors of morbidity and mortality in older populations. Older adults who are dependent in ADLs and IADLs are also more likely to have poor muscle measures defined as low muscle mass, muscle strength, and physical performance, which further limit their ability to perform activities. The aim of this systematic review and meta‐analysis was to determine if muscle measures are predictive of ADL and IADL in older populations.
Methods
A systematic search was conducted using four databases (MEDLINE, EMBASE, Cochrane, and CINAHL) from date of inception to 7 June 2018. Longitudinal cohorts were included that reported baseline muscle measures defined by muscle mass, muscle strength, and physical performance in conjunction with prospective ADL or IADL in participants aged 65 years and older at follow‐up. Meta‐analyses were conducted using a random effect model.
Results
Of the 7760 articles screened, 83 articles were included for the systematic review and involved a total of 108 428 (54.8% female) participants with a follow‐up duration ranging from 11 days to 25 years. Low muscle mass was positively associated with ADL dependency in 5/9 articles and 5/5 for IADL dependency. Low muscle strength was associated with ADL dependency in 22/34 articles and IADL dependency in 8/9 articles. Low physical performance was associated with ADL dependency in 37/49 articles and with IADL dependency in 9/11 articles. Forty‐five articles were pooled into the meta‐analyses, 36 reported ADL, 11 reported IADL, and 2 reported ADL and IADL as a composite outcome. Low muscle mass was associated with worsening ADL (pooled odds ratio (95% confidence interval) 3.19 (1.29–7.92)) and worsening IADL (1.28 (1.02–1.61)). Low handgrip strength was associated with both worsening ADL and IADL (1.51 (1.34–1.70); 1.59 (1.04–2.31) respectively). Low scores on the short physical performance battery and gait speed were associated with worsening ADL (3.49 (2.47–4.92); 2.33 (1.58–3.44) respectively) and IADL (3.09 (1.06–8.98); 1.93 (1.69–2.21) respectively). Low one leg balance (2.74 (1.31–5.72)), timed up and go (3.41 (1.86–6.28)), and chair stand test time (1.90 (1.63–2.21)) were associated with worsening ADL.
Conclusions
Muscle measures at baseline are predictors of future ADL and IADL dependence in the older adult population.
Objectives
To assess the validity of the WHO concept of intrinsic capacity in a longitudinal study of ageing; to identify whether this overall measure disaggregated into biologically plausible and clinically useful subdomains; and to assess whether total capacity predicted subsequent care dependence.
Design
Structural equation modelling of biomarkers and self-reported measures in the English Longitudinal Study of Ageing including exploratory factor analysis, exploratory bi-factor analysis and confirmatory factor analysis. Longitudinal mediation and moderation analysis of incident care dependence.
Settings
Community, United Kingdom.
Participants
2560 eligible participants aged over 60 years.
Main outcome measures
Activities of daily living (ADL) and instrumental activities of daily living (IADL).
Results
One general factor (intrinsic capacity) and five subfactors emerged: locomotor, cognitive; psychological; sensory; and ‘vitality’. This structure is consistent with biological theory and the model had a good fit for the data (χ ² =71.2 (df=39)). The summary score of intrinsic capacity and specific subfactors showed good construct validity. In a causal path model examining incident loss of ADL and IADL, intrinsic capacity had a direct relationship with the outcome—root mean square error of approximation ( RMSEA ) =0.02 ( 90% CI 0.001 to 0.05 ) and RMSEA=0.008 ( 90% CI0.001 to 0.03 ) respectively— and was a strong mediator for the effect of age, sex, wealth and education. Multimorbidity had an independent direct relationship with incident loss of ADLs but not IADLs, and also operated through intrinsic capacity. More of the indirect effect of personal characteristics on incident loss of ADLs and IADLs was mediated by intrinsic capacity than multimorbidity.
Conclusions
The WHO construct of intrinsic capacity appears to provide valuable predictive information on an individual’s subsequent functioning, even after accounting for the number of multimorbidities. The proposed general factor and subdomain structure may contribute to a transformative paradigm for future research and clinical practice.
The number of older adults with vision and/or hearing loss is growing world-wide, including in China, whose population is aging rapidly. Sensory loss impacts on older people's ability to participate in their communities and their quality of life. This study investigates the prevalence of vision loss, hearing loss, and dual sensory loss (combined vision and hearing loss) in an older adult Chinese population and describes the relationships between these sensory losses and demographic factors, use of glasses and hearing aids, unmet needs, and impacts on social participation. The China Health and Retirement Longitudinal Study is a population-based longitudinal survey conducted since 2011. The 2013 dataset for people aged 60 and over was used in this study. Items analyzed included demographic data (age, gender, education, rurality, and SES), self-reported ratings of vision (including legally blind, excellent-poor long, and short distance vision and the use and frequency of wearing glasses), hearing (excellent-poor hearing and the use of hearing aids), dual sensory loss (both poor/fair vision and hearing), and social participation. Of the sample, 80.2% reported poor/fair vision, 64.9% reported poor/fair hearing, and 57.2% had poor/fair vision and hearing. Few respondents (10%) wore glasses regularly and 20.1% wore glasses from time to time. Only 0.8% of respondents wore hearing aids although the proportion with hearing loss was high (64.9%). The proportion of unmet needs for glasses and hearing aids was 54.9 and 63.9%, respectively. Low socio-economic status (SES), poor education, and rurality were significantly associated with the prevalence of poor/fair vision and hearing, the use of glasses and hearing aids and the unmet needs of glasses/hearing aids. Poor/fair vision and/or hearing, and the unmet needs for glasses/hearing aids were significantly and negatively associated with social participation. Sensory loss is a significant health issue for older Chinese people that impacts on their social participation. Training primary care health professionals in identification and rehabilitation approaches is needed as well as increasing the numbers of vision and hearing specialists working in the field. Providing information on sensory loss and the use of aids to older adults will also help improve older adult's quality of life.
In most countries, a fundamental shift in the focus of clinical care for older people is needed. Instead of trying to manage numerous diseases and symptoms in a disjointed fashion, the emphasis should be on interventions that optimize older people’s physical and mental capacities over their life course and that enable them to do the things they value. This, in turn, requires a change in the way services are organized: there should be more integration within the health system and between health and social services. Existing organizational structures do not have to merge; rather, a wide array of service providers must work together in a more coordinated fashion. The evidence suggests that integrated health and social care for older people contributes to better health outcomes at a cost equivalent to usual care, thereby giving a better return on investment than more familiar ways of working. Moreover, older people can participate in, and contribute to, society for longer. Integration at the level of clinical care is especially important: older people should undergo comprehensive assessments with the goal of optimizing functional ability and care plans should be shared among all providers. At the health system level, integrated care requires: (i) supportive policy, plans and regulatory frameworks; (ii) workforce development; (iii) investment in information and communication technologies; and (iv) the use of pooled budgets, bundled payments and contractual incentives. However, action can be taken at all levels of health care from front-line providers through to senior leaders - everyone has a role to play.
Background
This study sought to identify multimorbidity patterns and determine the association between these latent classes with several outcomes, including health, functioning, disability, quality of life and use of services, at baseline and after 3 years of follow-up. Methods
We analyzed data from a representative Spanish cohort of 3541 non-institutionalized people aged 50 years old and over. Measures were taken at baseline and after 3 years of follow-up. Latent Class Analysis (LCA) was conducted using eleven common chronic conditions. Generalized linear models were conducted to determine the adjusted association of multimorbidity latent classes with several outcomes. Results63.8% of participants were assigned to the “healthy” class, with minimum disease, 30% were classified under the “metabolic/stroke” class and 6% were assigned to the “cardiorespiratory/mental/arthritis” class. Significant cross-sectional associations were found between membership of both multimorbidity classes and poorer memory, quality of life, greater burden and more use of services. After 3 years of follow-up, the “metabolic/stroke” class was a significant predictor of lower levels of verbal fluency while the two multimorbidity classes predicted poor quality of life, problems in independent living, higher risk of hospitalization and greater use of health services. Conclusions
Common chronic conditions in older people cluster together in broad categories. These broad clusters are qualitatively distinct and are important predictors of several health and functioning outcomes. Future studies are needed to understand underlying mechanisms and common risk factors for patterns of multimorbidity and to propose more effective treatments.
Objectives
To identify patterns of multimorbidity in the general population and examine how these patterns are related to socio-demographic factors and health-related quality of life.
Study design and setting
We used latent class analysis to identify subgroups with statistically distinct and clinically meaningful disease patterns in a nationally representative sample of Danish adults (N = 162,283) aged 16+ years. The analysis was based on 15 chronic diseases.
Results
Seven classes with different disease patterns were identified: a class with no or only a single chronic condition (59% of the population) labeled “1) Relatively Healthy” and six classes with a very high prevalence of multimorbidity labeled; “2) Hypertension” (14%); “3) Musculoskeletal Disorders” (10%); “4) Headache-Mental Disorders” (7%); “5) Asthma-Allergy” (6%); “6) Complex Cardiometabolic Disorders” (3%); and “7) Complex Respiratory Disorders” (2%). Female gender was associated with an increased likelihood of belonging to any of the six multimorbidity classes except for class 2 (Hypertension). Low educational attainment predicted membership of all of the multimorbidity classes except for class 5 (Asthma-Allergy). Marked differences in health-related quality of life between the seven latent classes were found. Poor health-related quality of life was highly associated with membership of class 6 (Complex Cardiometabolic Disorders) and class 7 (Complex Respiratory Disorders). Despite different disease patterns, these two classes had nearly identical profiles in relation to health-related quality of life.
Conclusion
The results clearly support that diseases tend to compound and interact, which suggests that a differentiated public health and treatment approach towards multimorbidity is needed.
This 3-year longitudinal study among older adults showed that declining muscle mass, strength, power, and physical performance are independent contributing factors to increased fear of falling, while declines of muscle mass and physical performance contribute to deterioration of quality of life. Our findings reinforce the importance of preserving muscle health with advancing age.
The age-associated loss of skeletal muscle quantity and function are critical determinants of independent physical functioning in later life. Longitudinal studies investigating how decrements in muscle components of sarcopenia impact fear of falling (FoF) and quality of life (QoL) in older adults are lacking.
Twenty-six healthy older subjects (age, 74.1 ± 3.7; Short Physical Performance Battery (SPPB) score ≥10) and 22 mobility-limited older subjects (age, 77.2 ± 4.4; SPPB score ≤9) underwent evaluations of lower extremity muscle size and composition by computed tomography, strength and power, and physical performance at baseline and after 3-year follow-up. The Falls Efficacy Scale (FES) and Short Form-36 questionnaire (SF-36) were also administered at both timepoints to assess FoF and QoL, respectively.
At 3-year follow-up, muscle cross-sectional area (CSA) (p < 0.013) and power decreased (p < 0.001), while intermuscular fat infiltration increased (p < 0.001). These decrements were accompanied with a longer time to complete 400 m by 22 ± 46 s (p < 0.002). Using linear mixed-effects regression models, declines of muscle CSA, strength and power, and SPPB score were associated with increased FES score (p < 0.05 for each model). Reduced physical component summary score of SF-36 over follow-up was independently associated with decreased SPPB score (p < 0.020), muscle CSA (p < 0.046), and increased 400 m walk time (p < 0.003).
In older adults with and without mobility limitations, declining muscle mass, strength, power, and physical performance contribute independently to increase FoF, while declines of muscle mass and physical performance contribute to deterioration of QoL. These findings provide further rationale for developing interventions to improve aging muscle health.
Objectives
This paper aims to systematically review observational studies that have analysed whether depressive symptoms in the community are associated with higher general hospital admissions, longer hospital stays and increased risk of re-admission.
Methods
We identified prospective studies that looked at depressive symptoms in the community as a risk factor for non-psychiatric general hospital admissions, length of stay or risk of re-admission. The search was carried out on MEDLINE, PsycINFO, Cochrane Library Database, and followed up with contact with authors and scanning of reference lists.
Results
Eleven studies fulfilled our inclusion and exclusion criteria, and all were deemed to be of moderate to high quality. Meta-analysis of seven studies with relevant data suggested that depressive symptoms may be a predictor of subsequent admission to a general hospital in unadjusted analyses (RR = 1.36, 95% CI: 1.28–1.44), but findings after adjustment for confounding variables were inconsistent. The narrative synthesis also reported depressive symptoms to be independently associated with longer length of stay, and higher re-admission risk.
Conclusions
Depressive symptoms are associated with a higher risk of hospitalisation, longer length of stay and a higher re-admission risk. Some of these associations may be mediated by other factors, and should be explored in more details.
Visual impairment (VI) affects physical, psychological, and emotional well-being, and social life as well. The purpose of this exploratory study was to assess the psycho-social impact of VI on health-related quality of life (HRQoL) among nursing home residents.
This cross-sectional study involved 272 residents of 60 years or older residing in seven nursing homes of the Kathmandu Valley, Nepal. Comprehensive ocular examinations, including near and distance vision assessment and refractions were carried out. VI was defined as visual acuity (VA) less than 6/18 in the better eye. Residents were divided into two groups: one group did not have VI (in whom VA was greater than or equal to 6/18 in the better eye), and the other had VI (in whom VA was worse than 6/18 in the better eye).
Face-to-face interviews were conducted filling out a 36-item The Medical Outcomes Study Short-Form (SF-36) questionnaire. The SF-36 questionnaire was scored according to the scoring algorithm SF-36 subscales.
The mean age of residents was 74.68 ± 8.19 years (range, 60–99 years) and the majority were female (78.68%). The mean composite score of SF-36 was 46.98 ± 13.08. VI detrimentally affected scores of both the physical and the mental components, but the impact of VI was slightly greater for the physical component than that for the mental component. There was a trend towards a lower composite score as well as each subscale score of the SF-36 in participants with VI than in those without VI.
VI has a negative effect on HRQoL. HRQoL is reduced among nursing home residents and the reduction in the HRQoL bears a positive association with VI.
Mixture modeling is a widely applied data analysis technique used to identify unobserved heterogeneity in a population. Despite mixture models' usefulness in practice, one unresolved issue in the application of mixture models is that there is not one commonly accepted statistical indicator for deciding on the number of classes in a study population. This article presents the results of a simulation study that examines the performance of likelihood-based tests and the traditionally used Information Criterion (ICs) used for determining the number of classes in mixture modeling. We look at the performance of these tests and indexes for 3 types of mixture models: latent class analysis (LCA), a factor mixture model (FMA), and a growth mixture models (GMM). We evaluate the ability of the tests and indexes to correctly identify the number of classes at three different sample sizes (n D 200, 500, 1,000). Whereas the Bayesian Information Criterion performed the best of the ICs, the bootstrap likelihood ratio test proved to be a very consistent indicator of classes across all of the models considered.
A systematic review was conducted to identify and quality assess how studies published since 1999 have measured and reported the usage of hearing aids in older adults. The relationship between usage and other dimensions of hearing aid outcome, age and hearing loss are summarised.
Articles were identified through systematic searches in PubMed/MEDLINE, The University of Nottingham Online Catalogue, Web of Science and through reference checking. Study eligibility criteria: (1) participants aged fifty years or over with sensori-neural hearing loss, (2) provision of an air conduction hearing aid, (3) inclusion of hearing aid usage measure(s) and (4) published between 1999 and 2011.
Of the initial 1933 papers obtained from the searches, a total of 64 were found eligible for review and were quality assessed on six dimensions: study design, choice of outcome instruments, level of reporting (usage, age, and audiometry) and cross validation of usage measures. Five papers were rated as being of high quality (scoring 10-12), 35 papers were rated as being of moderate quality (scoring 7-9), 22 as low quality (scoring 4-6) and two as very low quality (scoring 0-2). Fifteen different methods were identified for assessing the usage of hearing aids.
Generally, the usage data reviewed was not well specified. There was a lack of consistency and robustness in the way that usage of hearing aids was assessed and categorised. There is a need for more standardised level of reporting of hearing aid usage data to further understand the relationship between usage and hearing aid outcomes.
Depression is highly common throughout the life course and dementia is common in late life. Depression has been linked with dementia, and growing evidence implies that the timing of depression may be important in defining the nature of this association. In particular, earlier-life depression (or depressive symptoms) has consistently been associated with a more than twofold increase in dementia risk. By contrast, studies of late-life depression and dementia risk have been conflicting; most support an association, yet the nature of this association (for example, if depression is a prodrome or consequence of, or risk factor for dementia) remains unclear. The likely biological mechanisms linking depression to dementia include vascular disease, alterations in glucocorticoid steroid levels and hippocampal atrophy, increased deposition of amyloid-β plaques, inflammatory changes, and deficits of nerve growth factors. Treatment strategies for depression could interfere with these pathways and alter the risk of dementia. Given the projected increase in dementia incidence in the coming decades, understanding whether treatment for depression alone, or combined with other regimens, improves cognition is of critical importance. In this Review, we summarize and analyze current evidence linking late-life and earlier-life depression and dementia, and discuss the primary underlying mechanisms and implications for treatment.
The benefits of fitness for cognitive performance in healthy older adults have repeatedly been demonstrated. Animal studies, however, have revealed differential relationships between physical and motor fitness and brain metabolism. We therefore investigated whether for older humans different dimensions of fitness are differentially associated with cognitive performance and brain activation patterns. Seventy-two participants (mean age 68.99 years, SD = 3.66; 52 females) completed four psychometric tests reflecting two primary abilities of higher cognitive functioning (executive control, perceptual speed) and a battery of fitness tests comprising two fitness dimensions (physical and motor fitness). We found that not only physical fitness indexed by cardiovascular fitness and muscular strength, but also motor fitness including movement speed, balance, motor coordination and flexibility showed a strong association with cognitive functioning. Additionally, functional brain imaging data revealed that physical and motor fitness were differentially related to cognitive processes. Results are discussed with regard to the compensation hypothesis and potential consequences for intervention work.
Several epidemiological studies have shown that self-reported vision and hearing impairments are associated with adverse health outcomes (AHOs) in older populations; however, few studies have used objective sensory measurements or investigated the role of gender in this association. Therefore, we examined the association of vision and hearing impairments (as measured by objective methods) with AHOs (dependence in activities of daily living or death), and whether this association differed by gender.
From 2005 to 2006, a total of 801 residents (337 men and 464 women) aged 65 years or older of Kurabuchi Town, Gunma, Japan, participated in a baseline examination that included vision and hearing assessments; they were followed up through September 2008. Vision impairment was defined as a corrected visual acuity of worse than 0.5 (logMAR = 0.3) in the better eye, and hearing impairment was defined as a failure to hear a 30 dB hearing level signal at 1 kHz in the better ear. Information on outcomes was obtained from the town hall and through face-to-face home visit interviews. We calculated the risk ratios (RRs) of AHOs for vision and hearing impairments according to gender.
During a mean follow-up period of 3 years, 34 men (10.1%) and 52 women (11.3%) had AHOs. In both genders, vision impairment was related to an elevated risk of AHOs (multi-adjusted RR for men and women together = 1.60, 95% CI = 1.05-2.44), with no statistically significant interaction between the genders. In contrast, a significant association between hearing impairment and AHOs (multi-adjusted RR = 3.10, 95% CI = 1.43-6.72) was found only in the men.
In this older Japanese population, sensory impairments were clearly associated with AHOs, and the association appeared to vary according to gender. Gender-specific associations between sensory impairments and AHOs warrant further investigation.
It has been well established that increasing age is associated with decreasing functional ability in older adults. It is important to understand the specific factors that affect instrumental activities of daily living (IADL) and functional independence among older adults with sensory disabilities.
Nationally representative sample of adults aged 55 years and older with seeing or hearing disabilities were categorised into three sensory classifications: "Seeing Disabled but Hearing Abled" (SD-HA), "Hearing Disabled but Seeing Abled" (HD-SA), and both "Seeing and Hearing Disabled" (SD-HD). The additional category of "Seeing Disabled and/or Hearing Disabled" (SD and/or HD) was created to calculate the total of all individuals from the above categories who either had a seeing or hearing disability or both sensory disabilities. Respondents were asked to indicate whether they received assistance in performing seven IADL and their level of functional independence.
The most common factors that affect IADL were heavy chores, grocery shopping and housework. Individuals with both seeing and hearing disabilities (SD-HD) reported having the most IADL restrictions, followed by individuals with only seeing disabilities (SD-HA) and only hearing disabilities (HD-SA). Individuals with severe sensory disabilities were generally more likely to report IADL restrictions and less likely to have decision-making control and be happy with their lives. In each sensory classification, females aged 55-64 years and 65 years and older reported more IADL restrictions than males.
Both seeing and hearing disabilities have a significant impact on restricting an individual's IADL.
Objective:
To examine the predictive value of intrinsic capacity on one-year incident adverse outcomes among community-dwelling older adults.
Methods:
A total of 756 community-dwelling older adults aged ≥ 60 years were followed up after 1 year. Intrinsic capacity was assessed using the revised integrated care for older people screening tool. Adverse outcomes included incident disability, recurrent falls, hospitalization, emergency department visits, and poor quality of life. Multivariate logistic regression models were performed to evaluate the predictive value of intrinsic capacity domains on adverse outcomes.
Results:
Cognitive decline, limited mobility, visual impairment and depressive symptoms predicted incident disability. Visual impairment predicted recurrent falls. Cognitive decline and limited mobility predicted emergency department visits. Limited mobility predicted poor quality of life.
Discussion:
Intrinsic capacity could predict incident adverse outcomes among community-dwelling older adults. Assessing intrinsic capacity would facilitate early identification of older adults at high risk of adverse outcomes and prompt targeted interventions.
Background:
Intrinsic capacity (IC) is a novel view focusing on healthy aging. The effect of IC on adverse outcomes in older hospitalized Chinese adults is rarely studied.
Objectives:
This study focused on investigating the impact of IC domains on the adverse health outcomes including new activities of daily living (ADL) dependency, new instrumental activities of daily living (IADL) dependency, and mortality over a 1-year follow-up.
Methods:
In a retrospective observational population-based study, a total of 329 older hospitalized patients from Zhejiang Hospital in China were enrolled and completed 1-year follow-up. The 5 domains of IC including cognition, locomotion, sensory, vitality, and psychological capacity were assessed at admission. The IC composite score was calculated based on these domains, and the higher IC composite score indicated the greater amount of functional capacities reserved. Multivariate logistic regression models were used to explore the association between IC at baseline and 1-year adverse outcomes.
Results:
During the 1-year follow-up, 69 patients (22.5%) experienced new ADL dependency, 103 patients (33.6%) suffered from new IADL dependency, and 22 patients (6.7%) died. After adjusting for age, sex, education level, comorbidities, and polypharmacy, low Mini-Mental State Examination (MMSE) scores at admission predicted 1-year new ADL dependency (odds ratio [OR] = 2.31, 95% confidence interval [CI]: 1.12-4.78) and new IADL dependency (OR = 2.15, 95% CI: 1.14-4.04) among older hospitalized patients, but no significance was obtained between IC domains and mortality. Higher IC composite score at admission was associated with decreased risks of 1-year new ADL dependency (OR = 0.53, 95% CI: 0.40-0.70) and new IADL dependency (OR = 0.76, 95% CI: 0.61-0.95), and 1-year mortality (OR = 0.48, 95% CI: 0.31-0.74) after adjustment for the possible confounders.
Conclusions:
Loss of ICs at admission predicted adverse health outcomes including new ADL and IADL dependency and mortality 1 year after discharge among older hospitalized patients.
Background and purpose:
Mobility is a basic human need, and its limitation compromises health status, especially in older adults from developing countries and residing in nursing homes. This study aims to determine the prevalence and factors associated with mobility limitation in older adults residing in nursing homes.
Methods:
A cross-sectional study was conducted with 305 older adults (≥60 years) residing in 10 nursing homes in Northeast Brazil. Mobility limitation was evaluated using the "walking" item of the Barthel index. Sociodemographic/economic data concerning the participants and institutions, as well as conditions that could influence the mobility state of the older adults, were collected. The χ2 test and multiple logistic regression were performed using a significance level of 5%.
Results and discussion:
The prevalence of mobility limitation was 65.6% (95% confidence interval [CI], 59.6-70.4). Walking dependence was identified in 39.7% of the sample (26.9% wheelchair users and 12.8% bedridden), while 25.9% walked with assistance (16.7% with maximal assistance and 9.2% with minimal assistance). Mobility limitation was significantly associated with malnutrition/risk of malnutrition (1.86, 95% CI, 1.54-2.26, P < .001) and age ≥81 years (1.35, 95% CI, 1.12-1.63, P = .002).
Conclusion:
Mobility limitation has a high prevalence among older adults residing in nursing homes in Brazil, and is associated with advanced age and poor nutritional status. Health professionals should advocate for the maintenance of mobility and adequate nutritional support.
Latent class analysis is a probabilistic modeling algorithm that allows clustering of data and statistical inference. There has been a recent upsurge in the application of latent class analysis in the fields of critical care, respiratory medicine, and beyond. In this review, we present a brief overview of the principles behind latent class analysis. Furthermore, in a stepwise manner, we outline the key processes necessary to perform latent class analysis including some of the challenges and pitfalls faced at each of these steps. The review provides a one-stop shop for investigators seeking to apply latent class analysis to their data.
Ageing well involves individuals continuing participating in personal, social and civic affairs even in older age. From this standpoint, limitations in individual's functioning (beyond the mere absence of disease) may drastically impact on how well people becoming older. This study aimed to identify functional status profiles in a nationally representative sample of older adults, using latent class analysis methods. Moreover, it intended to study the how identified classes would be related to health‐related outcomes later in life, as a way to provide some evidence on predictive validity. Data from a nationally representative sample of Spanish older adults (N = 2,118; 56.18% women; M = 71.50 years, SD = 7.76), were used. Profiles were identified according to a large set of functioning indicators from multiple domains using latent class analysis. Outcomes were studied over a 3‐year follow‐up, considering both the individual (quality of life, well‐being and mortality) and institutional level (health service utilisation). As a result, seven profiles were identified: normative profile (showed by most participants), limited cognitive functioning class, limited global functioning class, limited mental and mobility functioning class, poor self‐reported health class, limited sensory functioning class and limited objective functioning class. All the profiles with limitations across domains showed poor outcomes. Multidimensional limitations were related to the worst outcomes, especially when psychosomatic complaints and high feelings of loneliness were reported. To sum up, latent class analysis constitutes a suitable alternative to study population heterogeneity, providing relevant evidence to help making decision in public and community health.
Centenarians are remarkable not only because of their prolonged life, but also because they compress morbidity until the very last moments of their lives, thus being proposed as a model of successful, extraordinary ageing. From the medical viewpoint, centenarians do not escape the physiological decline or the age-related diseases or syndromes (i.e. frailty), but the rate of such processes is slow enough to be counterbalanced by their increased intrinsic capacity to respond to minor stresses of daily life (i.e. resilience). These new concepts are reviewed in this paper. Allostatic stresses lead to a chronic low-grade inflammation that has led to the proposal of the "inflammaging" theory of ageing and frailty. The biology of centenarians, described in this review, provides us with clues for intervention to promote healthy ageing in the general population. One of the major reasons for this healthy ageing has to do with the genetic signature that is specific for centenarians and certainly different from octogenarians who do not enjoy the extraordinary qualities of centenarians.
Objective:
Prospective studies on obesity incidence specifically among young adults have not been reported. This study examined risks of obesity incidence over 19 years among young women without obesity at baseline.
Methods:
Women aged 18 to 23 years at baseline (N = 8,177) were followed up every 2 to 3 years to ages 37 to 42 using the Australian Longitudinal Study on Women's Health. A latent class analysis identified obesity-risk classes based on time-dependent measures of income, education, physical activity, sleep quality, dietary behavior, depression, stressful events, and social functioning. Cox proportional hazards regression models examined associations between incident obesity and latent classes, controlling for covariates.
Results:
Four latent classes were identified, including a lower-risk referent class and classes characterized by poor exercise and diet, stress and low income, and multiple intermediate-level risks. Compared with the referent, all three risk classes had significantly higher obesity risk, with the highest risk in the stress and low-income group (hazard ratio = 2.22; 95% CI: 1.92-2.56). Individual risks associated with obesity included lower education, stressful life events, and lower vigorous physical activity.
Conclusions:
Young women without baseline obesity were at risk of developing obesity when they experienced co-occurring behavioral, socioeconomic, and psychosocial risks. Both latent classes and individual risk indicators offer insights into prevention strategies.
Background:
This study aimed to evaluate the predictive value of the domains of intrinsic capacity (i.e. cognition, locomotion, sensory, vitality and psychosocial) proposed by the WHO on the 3-year adverse health outcomes of nursing home residents.
Methods:
A 3-year incidence of mortality, falls, repeated falls and autonomy decline (i.e. a one-unit increase in the Katz score) was assessed in a cohort of Belgian nursing home residents. Cognition was assessed using the MMSE. For locomotion, balance, gait speed and chair stand performance were evaluated by the SPPB test. The sensory domain was measured using the Strawbridge questionnaire for audition and vision. For vitality, abdominal circumference, BMI, nutritional status (by MNA) and handgrip strength were assessed. Psychosocial status was evaluated by the EQ-5D and the CES-D scale. Missing data were handled by multiple imputations. Cox proportional hazard models, logistic regressions and ANOVA were used for the analyses.
Results:
In the multivariable model, a one-unit increase in balance performance and in the nutrition score decreased the probability of death by 12% (HR=0.88; 95% CI 0.78-0.99) and 4% (HR=0.96; 95% CI 0.93-0.99), respectively. The risk of falling decreased when there was a one-unit increase in balance performance (HR=0.87, 95% CI 0.79-0.96) and in the nutrition score (HR=0.96, 95% CI 0.93-0.98). No association was found for intrinsic capacity and repeated falls. Low scores in nutrition (OR=0.86, 95% CI 0.77-0.96) were associated with a higher probability of autonomy decline.
Conclusion:
Some domains of intrinsic capacity predicted health outcomes among nursing home residents. Nutrition and balance should be regularly checked among this population.
Objectives:
To explore whether baseline scores on the Mobility Assessment Tool-short form (MAT-sf), a brief, animated, computer-based means of assessing mobility that predicts mobility disability, are associated with number of hospitalizations and time to first hospitalization over a median follow-up of 2.7 years.
Design:
Post hoc analysis of prospectively gathered data from the Lifestyle Interventions and Independence for Elders (LIFE) Study, a randomized clinical trial of lifestyle interventions to preserve mobility in older adults.
Setting:
Eight U.S. academic medical centers.
Participants:
Of 1,635 sedentary community-dwelling older adults enrolled in LIFE, 1,574 completed baseline physical function screening including the MAT-sf, with baseline scores ranging from 30.2 (low function) to 69.8 (high function) on a scale from 30 to 80.
Measurements:
Number of hospitalizations and time to first hospitalization, adjusted for age, sex, race, living alone, clinical site, baseline comorbidities, number of prescription medications, and cognition.
Results:
Of the 1,557 participants with data regarding hospitalization status, 726 (47%) had at least 1 hospitalization; 78% of these had 1 or 2 hospitalizations. For every 10-point lower MAT-sf score, the rate of all hospitalizations was 19% higher in those with lower scores (adjusted rate ratio=1.20, 95% confidence interval (CI)=1.08-1.32, p<.001). Lower baseline MAT-sf scores were also associated with greater risk of first hospitalization (adjusted hazard ratio=1.20, 95% CI=1.09-1.32, p<.01, per 10-point lower MAT-sf score).
Conclusion:
Low MAT-sf scores identify older adults at risk of hospitalization; further study is needed to test interventions to reduce hospitalizations in these individuals.
Background
Little is known about the effect of persistent depressive symptoms on the trajectory of cognitive decline.
Aims
We aimed to investigate the longitudinal association between the duration of depressive symptoms and subsequent cognitive decline over a 10-year follow-up period.
Method
The English Longitudinal Study of Ageing cohort is a prospective and nationally representative cohort of men and women living in England aged ≥50 years. We examined 7610 participants with two assessments of depressive symptoms at wave 1 (2002–2003) and wave 2 (2004–2005), cognitive data at wave 2 and at least one reassessment of cognitive function (wave 3 to wave 7, 2006–2007 to 2014–2015).
Results
The mean age of the 7610 participants was 65.2 ± 10.1 years, and 57.0% were women. Of these, 1157 (15.2%) participants had episodic depressive symptoms and 525 participants (6.9%) had persistent depressive symptoms. Compared with participants without depressive symptoms at wave 1 and wave 2, the multivariable-adjusted rates of global cognitive decline associated with episodic depressive symptoms and persistent depressive symptoms were faster by –0.065 points/year (95% CI –0.129 to –0.000) and –0.141 points/year (95% CI –0.236 to –0.046), respectively ( P for trend < 0.001). Similarly, memory, executive and orientation function also declined faster with increasing duration of depressive symptoms (all P for trend < 0.05).
Conclusions
Our results demonstrated that depressive symptoms were significantly associated with subsequent cognitive decline over a 10-year follow-up period. Cumulative exposure of long-term depressive symptoms in elderly individuals could predict accelerated subsequent cognitive decline in a dose-response pattern.
Declaration of interest
None.
Malnutrition and depression are of important concern among older adults. We investigated the association between malnutrition and depression among community-dwelling older Chinese adults and how both affect health care costs. Data from 4916 older adults (age ≥60 years) collected as part of 2013-Wave II China Health and Retirement Longitudinal Study (CHARLS) survey were analyzed. Measures of body mass index and weight loss were used as indicators of malnutrition. Malnourished subjects were 31% more likely to be depressed than their non-malnourished counterparts (odds ratio = 1.311, P < .1). Health care–related cost was ¥591.8 higher for malnourished older adult per year compared to a non-malnourished counterpart (P < .1), thus confirming that incidence of depression coupled with malnutrition significantly increases health care–related costs. These results highlight the importance of malnutrition and depression screening and treatment for older Chinese community-dwelling adults, and the importance of community-based nutrition-specific programs that could address the needs of the affected populations.
Healthy ageing can be defined as “the process of developing and maintaining the functional ability that enables wellbeing in older age”. Functional ability (i.e., the health-related attributes that enable people to be and to do what they have reason to value) is determined by intrinsic capacity (i.e., the composite of all the physical and mental capacities of an individual), the environment (i.e., all the factors in the extrinsic world that form the context of an individual’s life), and the interactions between the two. This innovative model recently proposed by the World Health Organization has the potential to substantially modify the way in which clinical practice is currently conducted, shifting from disease-centered towards function-centered paradigms. By overcoming the multiple limitations affecting the construct of disease, this novel framework may allow the worldwide dissemination of a more proactive and function-based approach towards achieving optimal health status.
In order to facilitate the translation of the current theoretical model into practice, it is important to identify the inner nature of its constituting constructs. In this paper, we consider intrinsic capacity. Using the International Classification of Functioning, Disability and Health (ICF) framework as background and taking into account available evidence, five domains (i.e., locomotion, vitality, cognition, psychological, sensory) are identified as pivotal for capturing the individual’s intrinsic capacity (and therefore also reserves) and, through this, pave the way for its objective measurement.
Objectives:
Data for the assessment of frailty in acutely ill hospitalized older adults remains limited. Using the Frailty Index (FI) as "gold standard," we compared (1) the diagnostic performance of 3 frailty measures (FRAIL, Clinical Frailty Scale [CFS], and Tilburg Frailty Indicator [TFI]) in identifying frailty, and (2) their ability to predict negative outcomes at 12 months after enrollment.
Design:
Prospective cohort study.
Participants:
We recruited 210 patients (mean age 89.4 ± 4.6 years, 69.5% female), admitted to the Department of Geriatric Medicine in a 1300-bed tertiary hospital.
Measurements:
Premorbid frailty status was determined. Data on comorbidities, severity of illness, functional status, and cognitive status were gathered. We compared area under receiver operator characteristic curves (AUC) for each frailty measure against the reference FI. Multiple logistic regression was used to examine the independent association between frailty and the outcomes of interest.
Results:
Frailty prevalence estimates were 87.1% (FI), 81.0% (CFS), 80.0% (TFI), and 50.0% (FRAIL). AUC against FI ranged from 0.81 (95% confidence interval [CI] 0.72-0.90: FRAIL) to 0.91 (95% CI 0.87-0.95: CFS). Only FRAIL was associated with higher in-hospital mortality (6.7% vs 1.0%, P = .031). FRAIL and CFS were significantly associated with increased length of hospitalization (10 [6.0-17.5] vs 8 [5.0-14.0] days, P = .043 and 9 [5.0-17.0] vs 7 [4.25-11.75] days, P = .036, respectively). CFS and FI were highly associated with mortality at 12-month (CFS, frail vs nonfrail: 32.9% vs 2.5%, P < .001, and FI, frail vs nonfrail: 30.6% vs 3.7%, P < .001). CFS also conferred the greatest risk of 12-month mortality (odds ratio [OR] 5.78, 95% CI 3.19-10.48, P < .001) and composite outcomes of institutionalization and/or mortality (OR 3.69, 95% CI 2.31-5.88, P < .001), adjusted for age, sex, and severity of illness.
Conclusion:
Our study affirms the utility of frailty assessment tools among older persons in acute care. FRAIL conferred highest risk of in-hospital mortality. However, CFS had greatest risk of mortality and institutionalization within 12 months.
Objectives:
The aim of this study was to assess health economics evidence published to date on malnutrition costs in institutionalized or community-dwelling older adults.
Design:
A systematic search of the literature published until December 2013 was performed using standard literature, international and national electronic databases, including MedLine/PubMed, Cochrane Library, ISI WOK, SCOPUS, MEDES, IBECS, and Google Scholar. Publications identified referred to the economic burden and use of medical resources associated with malnutrition (or risk of malnutrition) in institutionalized or community-dwelling older adults, written in either English or Spanish. Costs were updated to 2014 (€).
Results:
A total of 9 studies of 46 initially retrieved met the preestablished criteria and were submitted to thorough scrutiny. All publications reviewed involved studies conducted in Europe, and the results regarding the contents of all the studies showed that total costs associated with malnutrition in institutionalized and community-dwelling older adults were considerably higher than those of well-nourished ones, mainly due to a higher use of health care resources (GP consultations, hospitalizations, health care monitoring, and treatments). Interventions to reduce the prevalence of malnutrition, such as the use of oral nutritional supplements, showed an important decrease in-hospital admissions and medical visits.
Conclusion:
Malnutrition is associated with higher health care costs in institutionalized or community-dwelling older adults. The adoption of nutritional interventions, such as oral nutritional supplements, may have an important impact in reducing annual health care costs per patient.
Background
This study examines effects of mobility and multimorbidity on hospitalization and inpatient and post-acute care (PAC) facility days among older men.
Methods
Prospective study of 1701 men (mean age 79.3 years) participating in MrOS Study Year 7 (Y7) examination (2007-2008) linked with their Medicare claims. At Y7, mobility ascertained by usual gait speed and categorized as poor, intermediate, or good. Multimorbidity quantified by applying Elixhauser algorithm to inpatient and outpatient claims and categorized as none, mild-moderate, or high. Hospitalizations and PAC facility stays ascertained during 12 months following Y7.
Results
Reduced mobility and greater multimorbidity burden were independently associated with a higher risk of inpatient and PAC facility utilization, after accounting for each other and traditional indicators. Adjusted mean total facility days/year were 1.13 (95% confidence interval [CI] 0.74-1.40) among men with good mobility increasing to 2.43 (95% CI 1.17-3.84) among men with poor mobility, and 0.67 (95% CI 0.38-0.91) among men without multimorbidity increasing to 2.70 (95% CI 1.58-3.77) among men with high multimorbidity. Men with poor mobility and high multimorbidity had a 9-fold increase in mean total facility days/year (5.50, 95% CI 2.78-10.87) compared with men with good mobility without multimorbidity (0.59, 95% CI 0.37-0.95).
Conclusions
Among older men, mobility limitations and multimorbidity were independent predictors of higher inpatient and PAC utilization after considering each other and conventional predictors. Marked combined effects of reduced mobility and multimorbidity burden may be important to consider in clinical decision-making and planning health care delivery strategies for the growing aged population.
Background:
Degraded hearing in older adults has been associated with reduced postural control and higher risk of falls. Both hearing loss (HL) and falls have dramatic effects on older persons' quality of life (QoL). A large body of research explored the comorbidity between the two domains.
Purpose:
The aim of the current review is to describe the comorbidity between HL and objective measures of postural control, to offer potential mechanisms underlying this relationship, and to discuss the clinical implications of this comorbidity.
Data collection and analysis:
PubMed and Google Scholar were systematically searched for articles published in English up until October 15, 2015, using combinations of the following strings and search words: for hearing: Hearing loss, "Hearing loss," hearing, presbycusis; for postural control: postural control, gait, postural balance, fall, walking; and for age: elderly, older adults.
Results:
Of 211 screened articles, 7 were included in the systematic review. A significant, positive association between HL and several objective measures of postural control was found in all seven studies, even after controlling for major covariates. Severity of hearing impairment was connected to higher prevalence of difficulties in walking and falls. Physiological, cognitive, and behavioral processes that may influence auditory system and postural control were suggested as potential explanations for the association between HL and postural control.
Conclusions:
There is evidence for the independent relationship between HL and objective measures of postural control in the elderly. However, a more comprehensive understanding of the mechanisms underlying this relationship is yet to be elucidated. Concurrent diagnosis, treatment, and rehabilitation of these two modalities may reduce falls and increase QoL in older adults.
Introduction:
Depression among older people can be associated with limitations in physical mobility.
Method:
The ENSANUT 2012 data set was used. A secondary data analysis was conducted on a total sample of 6,525 Mexicans 60 years and older.
Results:
Findings indicate that depressive symptoms among older people derive from their limitations in mobility rather than from their age.
Conclusion:
In Mexico, the prevalence of major depressive disorders is higher among older adults than among the rest of the adults. Hence, as the prevalence of this problem grows, the need for appropriate mental health attention will increase in Mexico.
Objectives:
To assess the relationship and the directionality between mobility and cognitive performance.
Method:
A cross-sectional analysis of a racially/ethnically diverse sample of 327 community-dwelling adults (mean age=68.9±9.9 y; range, 40 to 100 y) categorized as having no mobility dysfunction, upper-extremity (UE) impairment, lower-extremity (LE) impairment, or mobility limitation (both UE and LE impairments), and compared by global cognition with multiple hierarchical linear regression adjusted for sociodemographic, health, and mood factors. A bootstrapping mediation analysis investigated the directionality of the mobility-cognition association.
Results:
LE (Est.=-2.95±0.77, P=0.001) but not UE impairment (Est.=-1.43±1.05, P=0.175) was associated with a poorer global cognitive performance/impairment. The presence of mobility limitation had the strongest effect on cognition (Est.=-3.78±1.09, P<0.001) adjusting for sociodemographic factors, body composition, comorbidities, and mood. Mediation analysis indicated that the relationship between cognition and mobility likely operates in both directions.
Discussion:
The association between cognitive function and mobility follows a dose-response pattern in which the likelihood of poor global cognition increases with the progression of mobility dysfunction, with evidence that LE impairments may be better indicators of an impaired cognitive status than UE impairments. Using brief, valid tools to screen older patients for early signs of mobility dysfunction, especially when the LE is affected, is feasible, and may provide the first detectable stage of future cognitive impairment and provide actionable steps for interventions to improve performance, reduce burden, and prevent the development of physical disability and loss of independence.
To examine the association between multiple measures of visual impairment (VI) and incident mobility limitations in older adults.
Prospective observational cohort study.
Memphis, Tennessee, and Pittsburgh, Pennsylvania.
Health, Aging and Body Composition study participants aged 70 to 79 without mobility limitations at the Year 3 visit (N = 1,862).
Vision was measured at the Year 3 visit, and VI was defined as distance visual acuity (VA) worse than 20/40, contrast sensitivity (CS) less than 1.55 log Contrast, and stereoacuity (SA) greater than 85 arcsec. Incident persistent walking and stair climbing limitation was defined as two consecutive 6-month reports of any difficulty walking one-quarter of a mile or walking up 10 steps after 1, 3, and 5 years of follow-up.
At Year 3 (baseline for these analyses), 7.4% had impaired VA, 27.2% had impaired CS, and 29.2% had impaired SA. At all follow-up times, the incidence of walking and stair climbing limitations was higher in participants with VA, CS, or SA impairment. After 5 years, impaired CS and SA were independently associated with greater risk of walking limitation (hazard ratio (HR)CS = 1.3, 95% confidence interval (CI) = 1.1-1.7; HRSA = 1.3, 95% CI = 1.1-1.6) and stair climbing limitation (HRCS = 1.4, 95% CI = 1.1-1.8; HRSA = 1.3, 95% CI=1.1-1.7). Having impaired CS and SA was associated with greater risk of mobility limitations (HRwalking limitations = 2.0, 95% CI = 1.6-2.5; HRstair limitation = 2.1, 95% CI = 1.6-2.8).
Multiple aspects of VI may contribute to mobility limitations in older adults. Addressing more than one component of vision may be needed to reduce the effect of vision impairment on functional decline.
© 2014, Copyright the Authors Journal compilation © 2014, The American Geriatrics Society.
The Index of ADL was developed to study results of treatment and prognosis in the elderly and chronically ill. Grades of the Index summarize over-all performance in bathing, dressing, going to toilet, transferring, continence, and feeding. More than 2,000 evaluations of 1,001 individuals demonstrated use of the Index as a survey instrument, as an objective guide to the course of chronic illness, as a tool for studying the aging process, and as an aid in rehabilitation teaching. Of theoretical interest is the observation that the order of recovery of Index functions in disabled patients is remarkably similar to the order of development of primary functions in children. This parallelism, and similarity to the behavior of primitive peoples, suggests that the Index is based on primary biological and psychosocial function, reflecting the adequacy of organized neurological and locomotor response.
Depression is a common mental disorder in older adults. We examined the prevalence and risk factors for depression in older adults in the Beijing area.
We used data from a cross-sectional survey conducted in July 2006 in Beijing. As part of the national survey for older Chinese adults, 2002 older adults were interviewed. The 15-item Geriatric Depression Scale was used to assess depression. Demographics as well as other personal information were also collected.
Among Beijing older adults, 13.01% were categorized as depressed. Prevalence rates of depression in rural and urban older adults were 26.63% and 10.79%, respectively. Poor economic status, high activities of daily living (ADL) score, poor physical health, impious offspring, and feeling old were important predictors of depression in older adults in Beijing. For the urban sample, poor economic status, poor physical health, high ADL score, and impious offspring were risk factors for depression. For the rural sample, depression was significantly associated with poor economic status and poor physical health.
Depression is a common mood disorder among older adults in the Beijing area. Filial piety is a unique predictor for depression in older Chinese adults, compared with findings in Western cultures.
Clinicians whose practice includes elderly patients need a short, reliable instrument to detect the presence of intellectual impairment and to determine the degree. A 10-item Short Portable Mental Status Questionnaire (SPMSQ), easily administered by any clinician in the office or in a hospital, has been designed, tested, standardized and validated. The standardization and validation procedure included administering the test to 997 elderly persons residing in the community, to 141 elderly persons referred for psychiatric and other health and social problems to a multipurpose clinic, and to 102 elderly persons living in institutions such as nursing homes, homes for the aged, or state mental hospitals. It was found that educational level and race had to be taken into account in scoring individual performance. On the basis of the large community population, standards of performance were established for: 1) intact mental functioning, 2) borderline or mild organic impairment, 3) definite but moderate organic impairment, and 4) severe organic impairment. In the 141 clinic patients, the SPMSQ scores were correlated with the clinical diagnoses. There was a high level of agreement between the clinical diagnosis of organic brain syndrome and the SPMSQ scores that indicated moderate or severe organic impairment.
Lower limb mobility disabilities are well understood in older people, but the causes in middle age have attracted little attention.
To estimate the prevalence of mobility disabilities among noninstitutionalized adults in England and to compare the disabling symptoms reported by middle-aged and older people.
Cross-sectional data from the 2002 English Longitudinal Study of Ageing (ELSA). Mobility disability was identified by level of reported difficulty walking a quarter mile.
Eleven thousand two hundred sixteen respondents aged 50 years and older living in private households in 2002.
The prevalence of difficulty walking a quarter mile increases sharply with age, but even in the middle-aged (50 to 64 years age-group) 18% (95% confidence interval [CI]: 16% to 19%) of men and 19% (95% CI: 17% to 20%) of women reported some degree of difficulty. Of the 16 main symptoms reported as causing mobility disability in middle age, 2 dominated: pain in the leg or the foot (43%; 95% CI: 40% to 46%) and shortness of breath/dyspnea (21%; 95% CI: 18% to 23%). Fatigue or tiredness, and stability problems were cited by only 5% and 6%, respectively. These proportions were slightly different from those in the 65 to 79-year age group: 40%, 23%, 6%, and 8%, respectively.
Mobility (walking) disabilities in the middle-aged are relatively common. The symptoms reported as causes in this age group differ little from those reported by older groups, and are dominated by lower limb pain and shortness of breath. More clinical attention paid to disabling symptoms may lead to disability reductions in later life.
To assess the association of decline in physical functioning with number of chronic diseases and with specific comorbidity in different index diseases.
A longitudinal design was employed using data from 2,497 older adults participating in the Longitudinal Aging Study Amsterdam. Logistic regression analyses were used to determine influence of chronic diseases on change in physical functioning, operationalized using the Edwards-Nunnally index.
Decline in physical functioning was associated with number of chronic diseases (adjusted ORs from 1.58 for 1, to 4.05 for > or =3 diseases). Comorbidity of chronic nonspecific lung disease and malignancies had the strongest exacerbating influence on decline. An exacerbating effect was also found for arthritis in subjects with diabetes or malignancies and for stroke in subjects with chronic nonspecific lung disease or malignancies. A weaker effect than expected was observed for diabetes in subjects with stroke, malignancies, cardiac disease, or peripheral atherosclerosis.
Comorbidities involving chronic diseases that share etiologic factors or pathophysiologic mechanisms appear to have a weaker negative influence on decline in physical functioning than expected. Results indicate that combinations of diseases that both influence physical functioning, but through different mechanisms (locomotor symptoms vs. decreased endurance capacity) may be more detrimental than other combinations.
A 12-Item Short-Form Health Survey: construction of scales and preliminary tests of reliability and validity
- Ware
Clinically significant change: Jacobson and Truax (1991) revisited
- Speer
Performance of factor mixture models as a function of model size, covariate effects, and class-specific parameters
- Lubke
Investigation of hearing and related diseases in 381 aged people
- Liu
Balance, Communication
- Ji