The Burden of Functional Disability

This overview of the published epidemiological evidence of migraine helps to identify the size of the public–health problem that migraine represents. It also highlights the need for further epidemiological studies in many parts of the world to gain full understanding of the scale of clinical, economic and humanistic burdens attributable to it. This paper presents some of the work on migraine undertaken by the World Health Organization (WHO) in the Global Burden of Disease study conducted in 2000 and reported in the World Health Report 2001. Migraine was not included in the first Global Burden of Disease 1990. The paper also discussed the measurement of disability attributable to headache disorders using WHO ICF Classification. Using disabilityadjusted life years (DALYs) as a summary measure of population health (which adds disability to mortality), WHO have shown that mental and neurological disorders collectively account for 30.8% of all years of healthy life lost to disability (YLDs) whilst migraine, one amongst these, alone accounts for 1.4% and is in the top 20 causes of disability worldwide. This information is combined with the increasingly widely accepted belief that disability and functioning are relevant parameters for monitoring the health of nations and that there is an increasing need to measure them. WHO's Classification of Functioning, Disability and Health (ICF) provides a model of human functioning and disability, as well as a classification system, that allows us to highlight and measure all dimensions of disability. ICF applied to headache disorders allows comparability with other health conditions as well as evaluation of the role of the environment as a cause of disability amongst people with headache. Migraine causes a large propotion of the non–fatal disease–related burden worldwide.Our kowledge of headache related burden is incomplete and it is necessary to add to it epidemiological studies in many parts of the world and to combine this with measurements of disability using both DALYs and WHO ‘s ICF Classification. The work described here has been the base for the Global Campaign against Headache disorders: "Lifting the Burden", launched in 2004 jointly by WHO, IHS (International Headache Society), WHA (World Headache Alliance) and EHF (European Headache Federation).

ObjectivesUnderstanding the role of functional capacity on longevity is important as the population in the United States ages. The purpose of this study was to determine the burden of instrumental activities of daily living (IADL) and activities of daily living (ADL) disabilities for a nationally-representative sample of middle-aged and older adults in the United States.DesignLongitudinal-Panel.SettingCore interviews were often performed in person or over the telephone.ParticipantsA sub-sample of 31,055 participants aged at least 50 years from the 1998–2014 waves of the Health and Retirement Study who reported having a functional disability were included.MeasurementsAbility to perform IADLs and ADLs were self-reported at each wave. The National Death Index was used to ascertain date of death. The number of years of life that were lost (YLLs) and years lived with a disability (YLDs) were summed for the calculation of disability-adjusted life years (DALYs). Sampling weights were used in the analyses to make the DALYs nationally-representative. The results for YLLs, YLDs, and DALYs are reported in thousands.ResultsOf the participants included, 14,990 had an IADL disability and 13,136 had an ADL disability. Men and women with an IADL disability had 236,037 and 233,772 DALYs, respectively; whereas, there were 178,594 DALYs for males and 253,630 DALYs for females with an ADL disability. Collectively, there were 469,809 years of healthy life lost from IADL impairments, and 432,224 years of healthy life lost from ADL limitations.ConclusionsThese findings should be used to inform healthcare providers and guide interventions aiming to preserve the functional capacity of aging adults. Prioritizing health-related resources for mitigating the burden of functional disabilities may help aging adults increase their quality of life and life expectancy over time.

OBJECTIVES Functional disability is a common consequence of the ageing process and can lead to poor health outcomes due to the inability to perform activities of daily living (ADL) and instrumental activities of daily living (IADL) independently. However, the prevalence of functional disability among older adults in the Association of Southeast Asian Nations (ASEAN) region is poorly documented. This study aimed to assess the prevalence of functional disability and its impact on older adults in the ASEAN region. METHODS A systematic literature search was performed on 4 databases from inception until March 2021 to identify studies examining individuals aged 60 years and above reporting functional disabilities in the ASEAN region. Information on the prevalence and impact of functional disability was extracted, assessed for bias, summarised, and analysed using a random-effects meta-analysis. RESULTS Thirty-four studies with 59,944 participants were included. The pooled prevalence of ADL disability was 21.5% (95% confidence interval [CI], 16.2 to 27.3) and that of IADL disability was 46.8% (95% CI, 35.5 to 58.3). Subgroup analyses showed higher prevalence among those of advanced age and women. Adverse impacts included increased years of life with disability and poor health-related quality of life. CONCLUSIONS Nearly a quarter of the older adult population in the ASEAN region experience functional disability. These findings highlight the need for further research on the burden and impact of functional disability within this region to allow decision-makers to gauge the severity of the issue, develop policies to reduce the risk of developing functional disabilities, and foster healthy ageing.

… burden, and disability. However, in logistic regressions, Mini-Cog score and disease burden, but … Functional disability was best predicted by a Mini-Cog cutoff score of 1 out of 5. Overall, …

… The results of this study demonstrate that the burden of functional disability on government-reimbursed health care services is substantial. In this community-based sample of older …

… functional status among elderly Hong Kong Chinese aged 70 years and over was carried out to estimate the current burden of disability. … of the old age and disability allowance schemes …

Introduction Older adults are always at a greater risk of physical and functional health challenges. These complications result into morbidity, disability and death making them more vulnerable at later ages. Therefore, this paper will examine the functional health status among older adults and its gender perspective, along with associated risk factors. Materials and methods Using the first round of Longitudinal ageing survey of India (2017–18). Functional disability was computed based on general and instrumental activities of daily living (ADL and IADL) (n = 20910). Functional disability was coined with individual having at least one of the limitations of these activities. Applying bivariate and multivariate analysis the present paper studied the association, gender perspective and risk factors of functional disability among older adults aged 50 and above in India. Results Our results clearly showed the gender bias in functional disability, with greater proportion of women (52%) at risk for functional disability then men (35%). Factors like multimorbidity, depression and life satisfaction are key risk factors identified by this study that increase the likelihood of disability. Conclusion Functional disability is key to healthy ageing and needs immediate attention given its greater concentration among the elderly, particularly women. The results reflect the substantial burden of functional disability than self-care among older adults in India and therefore indicates some significant policy interventions to reduce the likely impact of functional disability.

Introduction: The risk of developing chronic diseases and general disability increases with aging, resulting in loss of functioning ability and decrease in performing optimally. Early diagnosis of impairment and disability may improve the quality of life of elderly and enable them to lead a full and productive life. The study is a part of a larger study done in an urban area of Delhi. Materials and Methods: Systematic random sampling was used to select a cross-sectional sample of the study subjects >20 years and above. Locomotor, Visual Hearing and Speech were assessed using the guidelines given in gazette of India, extraordinary, part II section. Visual disability was measured by the presenting visual acuity in the field area using Snellens chart using WHO guidelines. Result and Conclusion: A total of 120 study subjects out of 1300 screened were in geriatric age group. The overall magnitude of the physical disability was 43.3% among elderly. aVisual disability was most common form of disability (60%). Many study subjects were suffering from >1 disability, but treatment was sought only in 50% of disabilities. Treatment seeking for disabilities is an important and neglected issue leading to severe degree of disabilities that would be prevented if taken care of, in due time. A multidimensional approach for prevention is the need of the hour.

Caregivers of patients with late‐life major depressive disorder experience a significant level of general caregiver burden. Disability in patients is possibly one of the origins of caregiver burden. Frontal lobe dysfunction might be the source of disability. This study investigated if frontal lobe dysfunction (body level) of patients with late‐life major depressive disorder was associated with their disability (individual level), and if it led to a high level of caregiver burden (societal level). Thirty‐four unselected pairs of caregivers and their family members with late‐life major depressive disorder were recruited. Frontal Assessment Battery and Timed Instrumental Activities of Daily Living (TIADL) were used to assess patients' frontal function and disability, and Caregiver Burden Inventory was used to measure caregiver burden. Frontal Assessment Battery correlated with TIADL (r= −0.47; p<0.006). TIADL score was also associated with two subscales of the Caregiver Burden Inventory: social (r = 0.38, p=0.026) and time‐dependent (r= 0.37, p= 0.033). This study supported the hypothesis that frontal lobe dysfunction in elderly patients with depression is associated with their disability in instrumental activities of daily living. Disability is related to social and time‐dependent aspects of caregiver burden. Further studies to examine proposed cognitive interventions are suggested to reduce patient disability and caregiver burden.

Singapore is one of the fastest-aging populations due to increased life expectancy and lowered fertility. Lifestyle changes increase the burden of chronic diseases and disability. These have important implications for social protection systems. The goal of this paper is to model future functional disability and healthcare expenditures based on current trends. To project the health, disability and hospitalization spending of future elders, we adapted the Future Elderly Model (FEM) to Singapore. The FEM is a dynamic Markov microsimulation model developed in the US. Our main source of population data was the Singapore Chinese Health Study (SCHS) consisting of 63,000 respondents followed up over three waves from 1993 to 2010. The FEM model enables us to investigate the effects of disability compounded over the lifecycle and hospitalization spending, while adjusting for competing risk of multi-comorbidities. Results indicate that by 2050, 1 in 6 elders in Singapore will have at least one ADL disability and 1 in 3 elders will have at least one IADL disability, an increase from 1 in 12 elders and 1 in 5 elders respectively in 2014. The highest prevalence of functional disability will be in those aged 85 years and above. Lifetime hospitalization spending of elders aged 55 and above is US$24,400 (30.2%) higher among people with functional disability compared to those without disability. Policies that successfully tackle diabetes and promote healthy living may reduce or delay the onset of disability, leading to potential saving. In addition, further technological improvements may reduce the financial burden of disability.

… Individuals with cognitive frailty were likely at higher risk of developing functional disability and incurring higher disability burden than robust individuals, but evidence remains limited for …

Functional disability in older adults refers to difficulties in performing daily activities. It is usually evaluated based on an individual’s ability to carry out basic activities of daily living and instrumental activities of daily living. Although existing studies provide valuable insights, comprehensive global data on functional disability in basic and instrumental activities of daily living among older adults remain limited. This study aims to review existing research worldwide to estimate the overall pooled prevalence of functional disability in these areas. Systematic searches were conducted across EMBASE, Scopus, PubMed/MEDLINE, and Google Scholar from May 5 to July 11, 2024. Cross-sectional studies worldwide on functional disability in basic and instrumental activities of daily living among adults aged 60 and older, published in English up to July 11, 2024 were included. Studies were excluded if they did not report the outcomes of interest, were inaccessible, case reports, low quality, review articles, or published in languages other than English. Data extraction and cleaning were performed using Microsoft Excel, and STATA version 17 was used to compute the pooled effect size with 95% confidence intervals (CIs) for functional disability in both basic activities of daily living and instrumental activities of daily living among older adults. To derive these estimates, we used weighted averages, where each study’s prevalence was weighted by the inverse of its variance. Study heterogeneity was assessed using the Cochrane I² statistic and its associated p-value. Subgroup analysis and meta-regression were conducted to identify sources of heterogeneity. Sensitivity analysis was used to evaluate the impact of individual studies on the overall results. Publication bias was assessed with Egger’s test and funnel plots, and was addressed through trim-and-fill analysis. This review includes 35 studies with a total of 133,827 participants. The pooled prevalence of functional disability in basic activities of daily living was estimated at 26.07% (95% CI: 19.04–32.74), while on instrumental activities of daily living, it was estimated at 45.15% (95% CI: 36.02–54.29). After applying the trim-and-fill method, the adjusted overall prevalence of disability in basic activities of daily living was 15.12%, (a 95% CI: 11.25–19.13%). Subgroup analysis showed highest prevalence in Africa (BADL: 42.91%, IADL: 69.34%) and lowest in Asia (BADL: 19.15%, IADL: 32.66%). Participants aged 65 and above, those in institutional settings, and studies with smaller sample sizes tended to report higher levels of functional disability. Nearly one-fourth of the study participants had functional disability related to basic activities of daily living, while about half experienced disability in instrumental activities of daily living. This emphasizes the need for continued effort in improving the quality of life and support systems for individuals facing functional disability, particularly in instrumental activities.

Background and purpose Stroke affects mortality, functional ability, quality of life and incurs costs. The primary objective of this study was to estimate the costs of stroke care in Sweden by level of disability and stroke type (ischemic (IS) or hemorrhagic stroke (ICH)). Method Resource use during first and second year following a stroke was estimated based on a research database containing linked data from several registries. Costs were estimated for the acute and post-acute management of stroke, including direct (health care consumption and municipal services) and indirect (productivity losses) costs. Resources and costs were estimated per stroke type and functional disability categorised by Modified Rankin Scale (mRS). Results The results indicated that the average costs per patient following a stroke were 350,000SEK/€37,000–480,000SEK/€50,000, dependent on stroke type and whether it was the first or second year post stroke. Large variations were identified between different subgroups of functional disability and stroke type, ranging from annual costs of 100,000SEK/€10,000–1,100,000SEK/€120,000 per patient, with higher costs for patients with ICH compared to IS and increasing costs with more severe functional disability. Conclusion Functional outcome is a major determinant on costs of stroke care. The stroke type associated with worse outcome (ICH) was also consistently associated to higher costs. Measures to improve function are not only important to individual patients and their family but may also decrease the societal burden of stroke.

BackgroundSeverity of illness is not only depending on the symptom load, but also on the burden in life. Mental disorders are among those illnesses, which in particular cause suffering to the individual and society.MethodTo study burden of disease for mental in comparison to somatic disorders, 2099 patients from 40 general practitioners filled in (a) the Burvill scale which measures acute and chronic illnesses in ten different body systems and (b) the IMET scale which measures impairment in ten different areas of life.ResultsPatients were suffering on average from acute and/or chronic illness in 3.5 (SD: 2.0) body systems and 56.6% of patients complained about acute and/or chronic mental disorders. The most significant negative impact on the IMET total score have acute and chronic mental disorders, followed by chronic neurological and musculoskeletal and acute respiratory and gastrointestinal disorders, while cardiovascular, metabolic, urogenital, haematological and ear/eye disorders have no greater impact. Acute as well as chronic mental disorders cause impairment across all areas of life and most burden of disease (functional burden of disease 1.69), followed by musculoskeletal disorders (1.62).ConclusionMental disorders are among the most frequent health problems with high negative impact across all areas of life. When combining frequency and impairment mental disorders cause most burden of disease in comparison to other illnesses. This should be reflected in the organization of medical care including family medicine.

Background: Old age is often associated with functional decline and physical dependence, thus compromising the ability to carry out basic tasks required for daily living. There are very few community-based studies on functional disability among elderly, especially in India. This study was done to find out the prevalence of functional disability and associated risk factors among the elderly in urbanized villages of Delhi. Methods: A cross-sectional study was conducted in two urbanized villages of East Delhi. A semi-structured interview schedule was used to record the socio-demographic and relevant personal details of the elderly (>60 years). Functional disability was defined as a disability in activities of daily living (ADL) or blindness or bilateral hearing impairment or a combination of these. Statistical analysis included simple descriptive analysis and tests of significance like Chi-square test. The multiple logistic regression was used to identify predictors of functional disability. Results: Data were collected from 360 study participants. Around one-fourth (25.6%) of the study participants were having a functional disability. Older age, presence of chronic disease, and having possible malnutrition were found to be significant predictors of functional disability among the elderly by applying the multiple logistic regression. Conclusions: Functional disability needs to be identified at an early stage using appropriate tools so that proper interventions can be directed to those who need it to ensure healthy aging.

… for at least one ADL, and 53.5% if we refer to IADL. Regarding the ADL, the risk of … OR = 2.48) in women's case; while there is an IADL correlation between age and the score (r = −0.527; …

Background: Instrumental activities of daily living (IADL) are neuropsychological-driven tasks that are linked to cognitive dysfunction. Examining population-based IADL deficits may reveal insights for the presence of these impairments in the United States. Objective: This investigation sought to evaluate the prevalence and trends of IADL impairments in Americans. Methods: A secondary analysis of data from the 2006–2018 waves of the Health and Retirement Study was conducted. The overall unweighted analytic sample included 29,764 Americans aged≥50 years. Respondents indicated their ability to perform six IADLs: manage money, manage medications, use a telephone, prepare hot meals, shop for groceries, and use a map. Persons reporting difficulty or an inability to complete an individual IADL were considered as having a task-specific impairment. Similarly, those indicating difficulty or an inability to perform any IADL were classified as having an IADL impairment. Sample weights were utilized to generate nationally-representative estimates. Results: Having an impairment in using a map (2018 wave: 15.7% (95% confidence interval (CI): 15.0–16.4) had the highest prevalence in individual IADLs regardless of wave examined. The overall prevalence of IADL impairments declined during the study period (p < 0.001) to 25.4% (CI: 24.5–26.2) in the 2018 wave. Older Americans and women had a consistently higher prevalence of IADL impairments compared to middle-aged Americans and men, respectively. The prevalence of IADL impairments was also highest among Hispanics and non-Hispanic Blacks. Conclusion: IADL impairments have declined over time. Continued surveillance of IADLs may help inform cognitive screening, identify subpopulations at risk of impairment, and guide relevant policy.

To live independently, people must be able to perform basic activities of daily living (ADLs), such as bathing, dressing, and transferring out of a bed or chair. Older adults who have difficulty performing these activities, or functional impairment, have decreased quality of life and increased risk for acute care use, nursing home admission, and death (13). For these reasons, slowing or preventing the progression to functional impairment is a key focus of care for older adults. Many people think of functional impairment as a problem affecting adults aged 65 years and older, especially the oldest old. Yet, functional impairment also is common in middle age. About 15% of community-dwelling adults aged 55 to 64 years have difficulty performing basic daily activities (4), compared with 20% to 25% of those aged 65 years and older (5). Despite the high prevalence of functional impairment in middle-aged adults, little is known about its epidemiology or clinical course in this younger age group, including the extent to which it shares common features with functional impairment in older adults. Some have hypothesized that midlife functional impairments may be more transient and related to acute injuries or single diseases compared with those that develop later in life (6), which often result from a gradual, multifactorial process without a clear precipitating event (7, 8). However, previous studies in middle-aged adults often focused on prevalent functional impairment and did not distinguish between long-standing deficits due to congenital conditions or trauma and those that are newly acquired in middle age and may have different risk factors and characteristics (912). Understanding the epidemiology and course of functional impairment in middle age is key in developing appropriate strategies to manage this condition in our aging population and address the rising societal costs of long-term care (1). If loss of function in middle age has a clinical course and risk factors similar to those of late-life functional impairment, existing interventions to address functional loss in older adults might potentially be adapted for this younger age group. Conversely, different risk factors and progression may require a different clinical approach. We used nationally representative longitudinal data to determine the incidence of functional impairment in adults aged 50 to 64 years, explore the course of functional decline in this age group, and identify risk factors for functional impairment in middle age. Supplement. Study Protocol and Statistical Code Methods Participants We analyzed data from participants in the Health and Retirement Study (HRS), a nationally representative longitudinal study of changes in the health and wealth of Americans older than 50 years (13). New participants have been enrolled every 6 years since the study began in 1992, so it remains representative of the U.S. population older than 50 years. Participants are interviewed every 2 years by telephone; face-to-face interviews are conducted for those unable to access a telephone or too ill to participate by phone. Our analytic cohort included participants who were aged 50 to 56 years when they enrolled in the 1992, 1998, or 2004 survey waves. Of 8430 participants aged 50 to 56 years at enrollment, we excluded 1280 who reported difficulty performing either ADLs or instrumental ADLs (IADLs) at the baseline interview, 252 who did not complete any follow-up interviews, and 24 who had missing ADL or IADL information at baseline. We analyzed data from the remaining 6874 participants at intervals of approximately 2 years until 2014. The institutional review boards of the University of California, San Francisco, and the San Francisco Veterans Affairs Medical Center approved the study. Measures Functional Impairment We first examined 2 outcomes: the cumulative incidence of the first episode of ADL impairment in middle age and cumulative incidence of the first episode of IADL impairment. To assess cumulative incidence, we determined the proportion of participants who developed ADL or IADL impairment between the ages of 50 to 64 years, accounting for death as a competing risk (14, 15). At baseline and each follow-up assessment, participants reported whether they had difficulty performing each of 5 ADLs (bathing, dressing, transferring, toileting, and eating) and 5 IADLs (managing money, managing medications, shopping for groceries, preparing meals, and making telephone calls). Those who reported difficulty in performing an activity were asked whether they required help from another person to perform that activity. We defined ADL impairment as difficulty in performing 1 or more ADLs; we defined IADL impairment similarly. For participants enrolled in 1992, we considered 1994 as the baseline assessment, because ADL and IADL measures in 1992 differed from those used subsequently. We determined date of death from the National Death Index and interviews with family members. Functional Trajectories Studies in older adults suggest that functional status is dynamic and follows complex trajectories. Although some persons have persistent functional impairment after an initial episode, many others improve but are at high risk for recurrence (7, 16). Moreover, both groups are subject to worsening functional status over time (7, 16, 17). To evaluate trajectories of functional change in participants who had incident ADL impairment, we examined several functional outcomes during follow-up. At 2-year follow-up, we examined 4 outcomes: recovery of functional independence, persistent functional impairment, further functional decline, and death. We defined ADL recovery as returning to ADL independence, persistent ADL impairment as having similar or improved function relative to the initial episode of impairment, and ADL decline as having worsened function relative to the initial episode of impairment. Using the same categories, we also examined the worst functional outcomes during the 10 years after the initial impairment. Other Measures Sociodemographic characteristics included self-reported age, sex, race/ethnicity, marital or partnership status, educational attainment, household income, and household net worth. Income for the previous 12 months was based on a comprehensive list of before-tax income. Net worth was calculated by summing assets and subtracting debts. Measures of health status included self-reported medical conditions. We defined visual impairment as self-rated fair or poor eyesight despite best correction and hearing impairment as self-rated fair or poor hearing or use of a hearing aid. Other measures included cognitive impairment, assessed by using a modified version of the Telephone Interview for Cognitive Status (with impairment defined as a score of <5 on a scale of 0 to 35) (18); depression, assessed by using the 8-item Center for Epidemiologic Studies Depression Scale (with clinically significant depressive symptoms defined as a score of 3 on a scale of 0 to 8) (19, 20); and body mass index, calculated from self-reported weight and height. Measures of health-related behaviors included self-reported alcohol use (21), smoking status, and frequency of physical activity (with infrequent activity defined as participation in activity once a week or less) (22). Measures of access to health care included health insurance and financial barriers to health care (defined as delay in filling a prescription or taking a medication because of cost). Measures of the physical environment included the self-reported condition of one's housing and safety of one's neighborhood. Statistical Analysis We used descriptive statistics to examine the characteristics of participants as well as those of functional impairment episodes. These analyses included the prevalence of impairment in 1, 2, 3, 4, or 5 ADLs and the most common pairings of ADL deficits in participants with 2 impairments; analyses for IADLs were performed similarly. These and the following analyses were adjusted for the complex HRS survey design to provide nationally representative estimates. To calculate the cumulative incidence of the first ADL impairment episode between the ages of 50 and 64 years, we used a survival analysis framework. We defined the baseline as age 50 and the event time as the age of onset of ADL impairment. Participants who enrolled after age 50 were considered to have a delayed entry time. Because assessments occurred every 2 years, the date of onset of ADL impairment could not be observed exactly. We estimated the event time to be midway between the date when impairment was first reported and the date of the previous assessment. We censored participants who ended their observation period or were lost to follow-up; those who missed the first follow-up but had a subsequent assessment were retained in analyses (Appendix, Approach to Missing Data). To account for the competing risk for death, we used competing-risks survival analysis (23). We applied a similar analytic framework to determine the cumulative incidence of IADL impairment and impairments in individual ADLs and IADLs. To determine the predicted trajectories of functional impairment over time, we used multistate survival modeling. In brief, multistate models describe the probability that participants transition among 3 or more states and may be used to characterize longitudinal trajectories in data sets in which participants enroll at different ages and are followed for different periods (24). We used a 6-state Markov model to examine the probability of transitioning between different states of functional impairment, by using the SPACE (Stochastic Population Analysis for Complex Events) programs for SAS (SAS Institute) (25). We defined states by using a summed ADL score. For each ADL, the score could take a value of 0 (independent), 1 (difficulty performing that ADL), or 2 (need for help performing that ADL). The maximum score for all 5 ADLs there

BackgroundThe extension of the life span has led to an increase in the number of older people and an increase in the prevalence of disability in people over 60 years of age. The aim of this study was to assess the prevalence of ADL and IADL disability and to analyze its determinants among people aged 60 and older living in southeastern Poland.MethodsThis cross-sectional study was carried out among a randomly selected, representative population of people aged 60 and older living in southeastern Poland. Disability was assessed using the Katz Index of Independence in Basic Activities of Daily Living and Instrumental Activities of Daily Living. Logistic regression models were used to identify the factors related to ADLs and IADLs. For the variables that were included in the above models, their clustered influence on the increase in the odds ratio for the occurrence of an ADL or IADL limitation was also examined.ResultsThe research results show that 35.75% of the participants reported at least one problem with IADLs. At least one problem with ADLs was reported by 17.13% of the participants. The most significant modifiable factors influencing the occurrence of disability were the presence of barriers in the participant’s environment, poor relations with relatives, a lack of social contacts, multimorbidity and pain. A multiple increase in the odds ratio of disability was found with the presence of pairs of analyzed factors. The highest odds ratio of at least one ADL limitation was observed for the combination of barriers in the participant’s environment with multimorbidity (OR 74.07). With regard to IADL disability, the highest odds ratio was observed for the combination of pain on the VAS scale ≥3 points with older age (OR 19.47).ConclusionsThe study showed a high prevalence of ADL and IADL disability in older people living in southeastern Poland. It also indicated the extent to which modifiable factors influenced the occurrence of disability and the extent to which the risk of disability increased with the presence of pairs of factors, especially those that included environmental barriers in the participant’s environment.

… Though HRS collects data longitudinally, we used a serial cross-sectional design to estimate changes in prevalence of ADL and IADL limitations overall and within sociodemographic …

This study aims to evaluate the instrumental activities of daily living (iADLs) limitations in Europe and its association with socio-demographic characteristics, economic parameters and physical and mental health status. We used data from the wave 6 of SHARE database. Individuals were classified as having either none or one or more limitations on iADLs. Participants aged 65 or more years who answered all questions for the variables included in this work were selected. A total of 54.8% of participants were female and had a mean age of 74.37 (SD = 7.08) years. A global prevalence of 1 or more iADLs in Europe was shown to be 23.8% and more prevalent in women than in men (27.1% vs. 17.6%) and in people aged 85 years or more (51.5%). Older age, female gender, lower education, physical inactivity, frailty, having two or more chronic diseases, presence of depression, polypharmacy, poor self-perception of health and lower network satisfaction were found to be factors associated with the presence of 1 or more iADLs limitation. This study highlights the burden of iADLs limitations at the European level. These are based on a multidimensional biopsychosocial model and are associated with both health conditions and environmental factors. This intersection between the physical and social world underscores its potential as a health indicator and can, to some extent, explain some of the pronounced differences seen among European countries. Different inter-tasks can also stress different dimensions of health indicators in distinct and specific groups of individuals. Minimizing the impact of iADL limitations can improve the quality and sustainability of public health systems.

… in addition to IADL ability, or die within 3 years. We could not access ADL or IADL disability … The prevalence of ADL disabilities was very low at baseline in this cohort of community-…

OBJECTIVE Older adults make up the fastest growing segment of the population, and disability rates increase with age. There is much debate whether later born cohorts of 85-year-olds will face the same disability rates as earlier born cohorts. This study aimed to examine ADL and IADL disability in three birth cohorts of Swedish 85-year-olds born three decades apart, examined in 1986-87, 2008-10 and 2015-16, as well as potential factors associated with ADL and IADL disability in these birth-cohorts. METHODS Systematically selected population-based birth cohorts of 85-year-olds (n = 1,551) from the Gothenburg H70 Birth Cohort studies, Sweden, born in 1901-02 (n = 494), 1923-24 (n = 571) and 1930 (n = 486) and examined with identical methods. Disability was defined as a need for assistance in any ADL/IADL activities. RESULTS ADL/IADL disability decreased between cohorts in both men and women (from 76.7% in 1986-87, to 58.4% in 2008-10, and 48.4% in 2015-16, P-value trend <.001). Factors associated with ADL/IADL disability varied between cohorts, although dementia and depression increased the odds of disability in all three birth cohorts. CONCLUSION Later born cohorts of 85-year-olds face less ADL/IADL disability compared to earlier born cohorts. As disability poses a significant financial burden on healthcare services, our findings might contribute to a more positive view on global ageing and the demographic challenges ahead. However, it might also be that in later born cohorts, ADL/IADL disability affects people at later ages, but due to increased longevity, the total number of years in late-life with a functional disability will remain the same.

Background: Population-level surveillance of the prevalence and trends of basic self-care limitations will help to identify the magnitude of physical disablement in the rapidly growing older American demographic. We sought to evaluate the prevalence and trends of activities of daily living (ADL) limitations in the United States. Methods: The analytic sample included 30,418 Americans aged ≥50 years from the 2006–2018 waves of the Health and Retirement Study. ADLs were self-reported. Weighted prevalence estimates were presented, and trends analyses were performed. Results: Although overall ADL disability prevalence was 16.5% (95% confidence interval: 15.8–17.2) in 2018, there were no changes in limitations during the study period (p = 0.52). Older adults had a greater ADL disability prevalence than middle-aged adults (p < 0.001). While older persons experienced a declining trend of ADL limitations (p < 0.001), middle-aged persons had an increasing trend (p < 0.001). Males had a lower ADL limitation prevalence than females (p < 0.001). Hispanic and non-Hispanic Black had a higher ADL disability prevalence than non-Hispanic White (p < 0.001). Conclusions: This investigation revealed that while the estimated prevalence of ADL limitations in the United States was substantial, changes in such limitations were not observed. Our findings can help guide ADL screening, target sub-populations with an elevated ADL limitation prevalence, and inform interventions.

ObjectivesTo examine the risk of disability in 15 individual ADL, IADL, and mobility in older adults by age; and to assess the association of multimorbidity, gender, and education with disability.Design & SettingA prospective cohort study. The sample included 805 community-dwelling older people aged 60+ living in the Netherlands.MeasurementsDisability was assessed using the Katz-15 Index of Independence in Basic Activities of Daily Living (ADL), Instrumental Activities of Daily Living (IADL) and one mobility item. Disability in any of these activities was defined as the inability to perform the activity without assistance. The risk of disability by age for each individual ADL, IADL, and for mobility was assessed using Generalized mixed models.ResultsDisability in activities as household tasks, traveling, shopping, and continence had the highest risk and increased rapidly with age. The risk traveling disability among people aged 65 with two comorbidities increase from 9% to 37% at age 85. Disability in using the telephone, managing medications, finances, transferring, and toileting, had a very low risk and hardly increased with age. Compared to those without chronic conditions, those with ≥ 3 chronic conditions had a 3 to 5 times higher risk of developing disability. Males had a higher risk of disability in managing medication (P=0.005), and preparing meals (P=0.019), whereas females had a higher risk of disability with traveling (P=0.001). No association between education and disability on the individual ADL, IADL, and mobility was observed.ConclusionsOlder adults were mostly disabled in physical related activities, whereas disability in more cognitive related activities was less often experienced. The impact of multimorbidity on disability in each activity was substantial, while education was not.

Stages quantify severity like conventional measures but further specify the activities that people are still able to perform without difficulty.

… with disability in specific numbers of ADLs (who generally have IADL disability as well), the percentage with IADL disability only, and the percentage who live in long-term care facilities. …

Background: Physical function is a cornerstone of geriatric medicine. Impairment in physical function may threaten one’s ability to live independently and is associated with multiple negative health outcomes. Although Chinese people is one of the fastest growing populations in the world, there is a limited understanding of the epidemiology of physical function impairment in the global Chinese aging population. Methods: Researchers used the PRISMA statement and performed a comprehensive online search to highlight the global epidemiology of physical function impairment of Chinese older adults in terms of prevalence, incidence, risk and protective factors, and health consequences. Search items include Chinese, older adult, Asian elderly, aging, physical function, physical function impairment, disability, function impairment, functional dependence, functional limitation, mobility, ADL, IADL, Nagi, and Rosow-Breslau. Results: Eighty-two papers met inclusion criteria. Prevalence of ADL impairment ranges from 3.0% to 11.6%, while prevalence of IADL impairment ranges from 7.9% to 50.2%. Common risk factors include older age, female gender, lower education, lower income, rural residences, unmarried status, chronic diseases, depression/depressive symptoms, cognitive impairment, and falls. Health outcomes include suicidal ideation/attempted suicide, depression/depressive symptoms, cognitive impairment, falls, and mortality. Conclusion: The prevalence of physical function impairment among Chinese aging population varies across regions and the number of physical function impairments increases over time. Physical function is influenced by multiple aspects, including socio-demographic characteristics, health conditions, and health behaviors, and can lead to adverse health outcomes. Future longitudinal research is necessary to explore the regional differences, effectiveness of existing intervention programs, as well as the cultural contexts of physical function impairment. Concerted support from caregivers, healthcare and social service providers, and policy makers is necessary to improve physical function and promote healthy aging among Chinese older adults. Xinqi Dong* and Dan Su Rush Institute for Healthy Aging, Rush University Medical Center, Chicago, Illinois, USA *Address for Correspondence Dr. Xinqi Dong, Professor of Medicine, Nursing and Behavioral Sciences Director, Chinese Health, Aging and Policy Program Associate Director, Rush Institute for Healthy Aging, Rush University Medical Center, Chicago, Illinois, USA, Tel: 312 942 3350; Fax: 312 942 2861; E-mail: xinqi_dong@rush.edu Submission: 22 February, 2016 Accepted: 26 April, 2016 Published: 3 May, 2016 Copyright: © 2016 Dong X, et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Reviewed & Approved by: Dr. Quincy Samus, Department of Psychiatry and Behavioral Sciences, Johns Hopkins Bayview Medical Center, Baltimore, USA Research Article Open Access

INTRODUCTION AND OBJECTIVE Demographic changes in Europe have resulted in anincreased demand for healthcare and social care for the elderly. The aim of this study was to analyze the factors related to disability in ADL and IADL among elderly inhabitants of rural areas of southeastern Poland. MATERIAL AND METHODS The study involved 426 subjects aged 71-80 years. To assess their activities of daily living, the Katz ADL Scale was used, and the Lawton IADL Scale was used to assess their instrumental activities in daily living. RESULTS The subjects reported at least one problem with IADL (43.19%) more often than with ADL (36.85%). The strongest factors related to difficulties with ADL were assessment of satisfaction with life, using assistive devices, and having one's home suitably adapted. The strongest factors related to IADL were the assessment of satisfaction with life, education, using assistive devices and performing moderate physical exercise at a minimum of 150 minutes per week. CONCLUSIONS Age, education, pain, falls, household not fully adapted for one's needs, using assistive devices, lack of satisfaction with life, and low assessment of quality of life had a significant impact on the prevalence of ADL and/or IADL disabilities in the elderly inhabitants of rural areas. Most of these factors can be subject to modification. They are also a complex of predictors that allow for identifying and supporting those elderly patients from rural areas who are the most vulnerable.

STUDY OBJECTIVE Instrumental activities of daily living (IADLs) are essential to patient function and quality of life after surgery. In older surgical patients, the incidence of preoperative IADL dependence has not been well characterized in the literature. This systematic review and meta-analysis aimed to determine the pooled incidence of preoperative IADL dependence and the associated adverse outcomes in the older surgical population. DESIGN Systematic review and meta-analysis. SETTING MEDLINE, MEDLINE Epub Ahead of Print and In-Process, In-Data-Review & Other Non-Indexed Citations, Embase/Embase Classic, Cochrane CENTRAL, and Cochrane Database of Systematic Reviews, ClinicalTrials.Gov, the WHO ICTRP (International Clinical Trials Registry Platform) were searched for relevant articles from 1969 to April 2022. PATIENTS Patients aged ≥60 years old undergoing surgery with preoperative IADL assessed by the Lawton IADL Scale. INTERVENTIONS Preoperative assessment. MEASUREMENT The primary outcome was the pooled incidence of preoperative IADL dependency. Additional outcomes included post-operative mortality, postoperative delirium [POD], functional status improvement, and discharge disposition. MAIN RESULTS Twenty-one studies (n = 5690) were included. In non-cardiac surgeries, the pooled incidence of preoperative IADL dependence was 37% (95% CI: 26.0%, 48.0%) among 2909 patients. Within cardiac surgeries, the pooled incidence of preoperative IADL dependence was 53% (95% CI: 24.0%, 82.0%) among 1074 patients. Preoperative IADL dependence was associated with an increased risk of postoperative delirium than those without IADL dependence (44.9% vs 24.4, OR 2.26; 95% CI: 1.42, 3.59; I2: 0%; P = 0.0005). CONCLUSIONS There is a high incidence of IADL dependence in older surgical patients undergoing non-cardiac and cardiac surgery. Preoperative IADL dependence was associated with a two-fold risk of postoperative delirium. Further work is needed to determine the feasibility of using the IADL scale preoperatively as a predictive tool for postoperative adverse outcomes.

Background The increase in life expectancy has proliferated the number of elderly and subsequently increased the prevalence of disability among the elderly. This study assesses the prevalence of Activity of Daily Living (ADL) and Instrumental Activity of Daily Living (IADL) and analyzes determinants of ADL and IADL among elderly aged 60 and over living in India. Methods The study utilized the Longitudinal Ageing Study in India (LASI, 2017–18) data, and information was sought from 31,464 elderly aged 60 years and above. An index of ADL and IADL was created on a scale of three levels, exhibiting no, moderate, or severe levels of ADL/IADL disability. Multinomial logistic regression was used to determine the effect of socio-demographic parameters on ADL and IADL disability among the elderly. Results Around 3% of the elderly reported severe ADL disability, and 6% elderly reported severe IADL disability. Elderly who were not involved in any physical activity than their counterparts were more likely to report severe ADL (RRR = 2.68, C.I. = 1.66–4.32) and severe IADL (RRR = 2.70, C.I. = 1.98–3.67) than no ADL and no IADL, respectively. Conclusion Amidst the study finding, the study emphasizes the importance of setting-up of geriatric care centers in rural and urban areas. It would be feasible to provide geriatric care under the umbrella of already functioning government health facilities in different parts of the country. Community interventions earmarking the elderly with a focus on physical activity, specifically based in group physical exercise and implemented through existing networks, are rewarding for the elderly.

Aims To know the prevalence, associated factors and temporal trends of disabilities for basic and instrumental activities of daily living in older people in Spain from 2009 to 2017. Background Disability in older people is associated with health problems, increased health costs and low quality of life. There are no updated data in Spain with a representative sample about disability. Methods Cross-sectional study with 25,465 non-institutionalized older people who participated in the European Health Survey in 2009 and 2014 and the National Health Survey in 2011/12 and 2017 in Spain. The prevalence rates of disability were evaluated using the Katz Scale and Lawton and Brody Scale. Logistic regression was used to determine if there was an association between basic and instrumental activities of daily living and sociodemographic characteristics. Results More individuals had disability for instrumental activities of daily living (31.9%) than disability for basic activities of daily living (11.1%). The most predominant disability for instrumental activities of daily living was performing severe housework (34%). The prevalence of disabilities decreased from 2009 to 2017. In general, disability was associated with female gender, advanced age, lower education, restricted daily activity, being bedridden and higher pain levels. Conclusion There is a considerable prevalence of disabilities for basic and instrumental activities of daily living in older people in Spain. Although the disability prevalence has decreased slowly from 2009 to 2017, it continues to remain a health problem. Gender may influence the disabilities for basic and instrumental activities of daily living. Health policymakers should establish prevention strategies and effective interventions (e.g., physical exercise) for prevention and reduction of the disabilities for basic and instrumental activities of daily living, particularly in older females.

… [Citation41] The findings of this study show a lower prevalence of ADL/IADL disability in an Irish cohort when compared to other large ageing studies. The proportion of the population in …

BackgroundThe effect of the onset of difficulties with activities of daily living (ADLs) on the health-related quality of life (HRQoL) of older adults is not well understood. We identified strong longitudinal associations between ADL onset and HRQoL changes for older adults in Medicare Advantage Organizations (MAOs).MethodsWe analyzed 473,282 age-eligible MAO beneficiaries in the 2008-2013 Medicare Health Outcomes Surveys (M-HOS) who reported no ADL difficulties at baseline and completed their two-year follow-ups in 2010-2015. The four HRQoL measures were the physical and mental health component scores (PCS and MCS) from the SF-12V, and the CDC’s counts of physically unhealthy and mentally unhealthy days (PUD and MUD) in the past month. Ordinary least squares (OLS) and zero-inflated negative binomial regressions were used.ResultsThe onset of difficulty/inability in bathing, dressing, eating, getting in/out of chairs, walking, and using the toilet significantly reduced PCS scores by 10.84, 11.29, 9.18, 8.98, 9.49 and 10.67 points, and MCS scores by 7.93, 8.72, 10.13, 5.34, 4.37 and 9.00 points, respectively. The onset of difficulty/inability in bathing, dressing, eating, getting in/out of chairs, walking, and using the toilet increased PUD days by 6.24, 6.83, 6.34, 4.93, 4.96 and 6.72 days, and MUD days by 3.00, 3.19, 3.54, 2.26, 2.07 and 3.27 days, respectively.ConclusionsThere is robust evidence that the onset of ADL difficulties/inabilities significantly and substantially reduced age-eligible MAO beneficiaries’ HRQoL. Prevention strategies focused on ADLs would benefit the performance of MAOs.

BackgroundThe purpose was to conduct systematic reviews of the relationship between physical activity of healthy community-dwelling older (>65 years) adults and outcomes of functional limitations, disability, or loss of independence.MethodsProspective cohort studies with an outcome related to functional independence or to cognitive function were searched, as well as exercise training interventions that reported a functional outcome. Electronic database search strategies were used to identify citations which were screened (title and abstract) for inclusion. Included articles were reviewed to complete standardized data extraction tables, and assess study quality. An established system of assessing the level and grade of evidence for recommendations was employed.ResultsSixty-six studies met inclusion criteria for the relationship between physical activity and functional independence, and 34 were included with a cognitive function outcome. Greater physical activity of an aerobic nature (categorized by a variety of methods) was associated with higher functional status (expressed by a host of outcome measures) in older age. For functional independence, moderate (and high) levels of physical activity appeared effective in conferring a reduced risk (odds ratio ~0.5) of functional limitations or disability. Limitation in higher level performance outcomes was reduced (odds ratio ~0.5) with vigorous (or high) activity with an apparent dose-response of moderate through to high activity. Exercise training interventions (including aerobic and resistance) of older adults showed improvement in physiological and functional measures, and suggestion of longer-term reduction in incidence of mobility disability. A relatively high level of physical activity was related to better cognitive function and reduced risk of developing dementia; however, there were mixed results of the effects of exercise interventions on cognitive function indices.ConclusionsThere is a consistency of findings across studies and a range of outcome measures related to functional independence; regular aerobic activity and short-term exercise programmes confer a reduced risk of functional limitations and disability in older age. Although a precise characterization of a minimal or effective physical activity dose to maintain functional independence is difficult, it appears moderate to higher levels of activity are effective and there may be a threshold of at least moderate activity for significant outcomes.

… developing and evaluating the Health and Activity Limitation Index (HALex), a generic measure of health that consists of two attributes: perceived health and activity limitation. Using a …

In this minireview, we summarize the research results to date on the progression of functional limitations and the role of physical activity during the life course in preventing risk factor accumulation. In addition, socioeconomic and health disparities play a role in the development process of functional limitation throughout life. We discuss the potential role of physical activity in alleviating this process. Functional limitations usually develop gradually over an extended period of time while the level of physical functioning varies greatly already from midlife onwards. Current research strongly suggests that physical activity has a beneficial effect on functional limitations at different life stages on the population level. However, the potential impact of physical activity in alleviating the effects caused by socioeconomic disparities is inconsistent. Research findings are also conflicting on the extent of the effect of physical activity among certain subsets of the population, such as obese persons. Although the benefits of physical activity on physical impairments and functioning among the adult population have been confirmed, the number of adults who are physically active is too low and, for the majority, physical activity declines with older age. Thus, detailed research evidence is needed for designing effective preventive interventions starting from earlier ages and continuing throughout the lifespan across different subgroups in the population.

… activity to functional limitations and disability, we present only a brief summary of the results of the model used to predict missing outcomes. … missing outcomes. Prior levels of physical …

BackgroundGALI or Global Activity Limitation Indicator is a global survey instrument measuring participation restriction. GALI is the measure underlying the European indicator Healthy Life Years (HLY). Gali has a substantial policy use within the EU and its Member States. The objective of current paper is to bring together what is known from published manuscripts on the validity and the reliability of GALI.MethodsFollowing the PRISMA guidelines, two search strategies (PUBMED, Google Scholar) were combined to identify manuscripts published in English with publication date 2000 or beyond. Articles were classified as reliability studies, concurrent or predictive validity studies, in national or international populations.ResultsFour cross-sectional studies (of which 2 international) studied how GALI relates to other health measures (concurrent validity). A dose-response effect by GALI severity level on the association with the other health status measures was observed in the national studies. The 2 international studies (SHARE, EHIS) concluded that the odds of reporting participation restriction was higher in subjects with self-reported or observed functional limitations. In SHARE, the size of the Odds Ratio’s (ORs) in the different countries was homogeneous, while in EHIS the size of the ORs varied more strongly. For the predictive validity, subjects were followed over time (4 studies of which one international). GALI proved, both in national and international data, to be a consistent predictor of future health outcomes both in terms of mortality and health care expenditure. As predictors of mortality, the two distinct health concepts, self-rated health and GALI, acted independently and complementary of each other. The one reliability study identified reported a sufficient reliability of GALI.ConclusionGALI as inclusive one question instrument fits all conceptual characteristics specified for a global measure on participation restriction. In none of the studies, included in the review, there was evidence of a failing validity. The review shows that GALI has a good and sufficient concurrent and predictive validity, and reliability.

Attenuating the physical decline and increases in disability associated with the aging process is an important public health priority. Evidence suggests that regular physical activity participation improves functional performance, such as walking, standing balance, flexibility, and getting up out of a chair, and also plays an important role in the disablement process by providing a protective effect against functional limitations. Whether these effects are direct or indirect has yet to be reliably established. In this review, the authors take the perspective that such relationships are indirect and operate through self-efficacy expectations. They first provide an introduction to social cognitive theory followed by an overview of self-efficacy’s reciprocal relationship with physical activity. They then consider the literature that documents the effects of physical activity on functional performance and functional limitations in older adults and the extent to which self-efficacy might mediate these relationships. Furthermore, they also present evidence that suggests that self-efficacy plays a pivotal role in a model in which the protective effects conferred by physical activity on functional limitations operate through functional performance. The article concludes with a brief section making recommendations for the development of strategies within physical activity and rehabilitative programs for maximizing the major sources of efficacy information.

Background Metrics based on self-reports of health status have been proposed for tracking population health and making comparisons among different populations. While these metrics have been used in the US to explore disparities by sex, race/ethnicity, and socioeconomic position, less is known about how self-reported health varies geographically. This study aimed to describe county-level trends in the prevalence of poor self-reported health and to assess the face validity of these estimates. Methods We applied validated small area estimation methods to Behavioral Risk Factor Surveillance System data to estimate annual county-level prevalence of four measures of poor self-reported health (low general health, frequent physical distress, frequent mental distress, and frequent activity limitation) from 1995 and 2012. We compared these measures of poor self-reported health to other population health indicators, including risk factor prevalence (smoking, physical inactivity, and obesity), chronic condition prevalence (hypertension and diabetes), and life expectancy. Results We found substantial geographic disparities in poor self-reported health. Counties in parts of South Dakota, eastern Kentucky and western West Virginia, along the Texas-Mexico border, along the southern half of the Mississippi river, and in southern Alabama generally experienced the highest levels of poor self-reported health. At the county level, there was a strong positive correlation among the four measures of poor self-reported health and between the prevalence of poor self-reported health and the prevalence of risk factors and chronic conditions. There was a strong negative correlation between prevalence of poor self-reported health and life expectancy. Nonetheless, counties with similar levels of poor self-reported health experienced life expectancies that varied by several years. Changes over time in life expectancy were only weakly correlated with changes in the prevalence of poor self-reported health. Conclusions This analysis adds to the growing body of literature documenting large geographic disparities in health outcomes in the United States. Health metrics based on self-reports of health status can and should be used to complement other measures of population health, such as life expectancy, to identify high need areas, efficiently allocate resources, and monitor geographic disparities. Electronic supplementary material The online version of this article (doi:10.1186/s12963-017-0133-5) contains supplementary material, which is available to authorized users.

… The main objective of the present study was to describe the changes in outcome … , activity limitation, and participation restriction). We used currently available instruments for outcome …

BackgroundInformation on health-related quality of life is becoming increasingly important in children with cerebral palsy. This study investigated the relationship between activity limitation and health-related quality of life in school-aged children with cerebral palsy.MethodsData were collected from 71 children aged 6–15 years with cerebral palsy. Activity limitations were assessed using functional classification systems, including the Korean-Gross Motor Function Classification System (K-GMFCS) and the Korean-Manual Ability Classification System (K-MACS). Health-related quality of life was assessed using the Korean version of the Childhood Health Assessment Questionnaire. Physical therapists collected the data by interviewing the parents of the subjects.ResultsBoth the K-GMFCS and the K-MACS were significantly positively correlated with the Childhood Health Assessment Questionnaire. The Childhood Health Assessment Questionnaire score differed significantly with respect to the functional classification systems. The differences in the ratings according to the K-GMFCS levels were significant, except those between levels I and II, levels II and III, levels III and IV, and levels IV and V. In the K-MACS, there were no significant differences between levels I and II, levels III and IV, and levels IV and V. The K-GMFCS and the K-MACS were significant predictors of health-related quality of life, demonstrating 75.5% of the variance (p < 0.05).ConclusionComprehensive information on children with cerebral palsy should be gathered to provide professionals with a better understanding of health-related quality of life.

Background Vision impairment is a common disability that poses significant challenges to individuals’ ability to perform activities essential for independent living, including activities of daily living (ADL) and instrumental activities of daily living (IADL). Despite extensive research, the extent and nature of these associations remain unclear, particularly across varying levels and types of vision impairment. Objectives This meta‐analysis aims to estimate associations between vision impairment and difficulties with ADL and IADL. Methods We conducted a systematic review of relevant literature from the inception of the databases to February 2024, using electronic database searches, including PubMed, MEDLINE (Ovid), EMBASE, Cochrane CENTRAL, and CDSR. The articles were screened for title and abstract and then for the full-text reports by two independent reviewers and study quality was appraised. Meta‐analyses were performed using random effects models to calculate the pooled effect size, expressed as odds ratio (OR) with corresponding 95% confidence interval (CI) of each outcome. Results Forty-six studies involving 210,960 participants were included. A positive large correlation between vision impairment and difficulties with ADL (Correlation coefficient [r] = 0.55, 95% CI 0.37–0.68, p = 0.001) and IADL (r = 0.60, 95% CI 0.49–0.69, p = 0.001) was shown. We also found that vision impairment was associated with difficulties in ADL (OR = 1.77, 95% CI 1.56–2.01, p < 0.0001) and IADL (OR = 1.96, 95% CI 1.68–2.30, p < 0.0001). Subgroup analysis revealed that moderate to severe impairment resulted in difficulties in ADL (OR = 1.78, 95% CI 1.43–2.21, p = 0.02) and IADL (OR = 1.86, 95% CI 1.57–2.20, p = 0.0003). Further, there was a significant association between mild to moderate vision impairment and difficulties in IADL (OR = 1.38, 95% CI 1.23–1.55, p < 0.0001). Greater impact was observed in individuals with near vision impairment compared to those with distance vision impairment. Near vision impairment was significantly associated with higher difficulties in ADL (OR = 1.77, 95% CI 1.57–2.01, p < 0.0001) and IADL (OR = 1.79, 95% CI 1.32–2.42, p < 0.0001). In contrast, distance vision impairment showed lower but still significant associations with IADL (OR = 1.19, 95% CI 1.05–1.34, p = 0.005) and a nonsignificant association with ADL (OR = 1.12, 95% CI 0.90–1.40, p = 0.30). Meta-regression analysis indicated that for every one-year increase in age, ADL performance decreased by an average of 0.0147 units (p < 0.001), while IADL performance declined at a slower rate of 0.0047 units/year (p = 0.031). Conclusion The present systematic review and meta-analysis using several statistical methods indicates that vision impairment including near vision impairment, is associated with difficulties in ADL and IADL. Thus, vision impairment remains an urgent and increasingly important public health priority. These findings highlight the need for targeted measures to raise public health awareness to provide rehabilitation and eye care examination strategies to reduce the risk of developing disabilities in adults and the elderly who have vision impairment.

Objectives As the Global Activity Limitation Index (GALI) has only recently been created and it is not yet known whether it adds any additional information to self-rated health (SRH), two …

Background. The number of people surviving into old age is increasing, and it has now become a global phenomenon. Studies on the prevalence and correlates of physical disability and functional limitation among elderly Nigerians are scanty. Methodology. This is a community-based cross-sectional study conducted in 3 local government areas (LGAs) in Nigeria, using a multistage sampling technique. Functional limitations of 1824 elderly persons were tested using Tinetti performance-oriented mobility assessment tool (TPOMAT) and self-reported activities of daily living (ADL). ADL disability of ten, six, and five basic items were compared. Results. The prevalence ratios (PRs) of physical disability using the ten, six, and five basic ADL items were 28.3 (95% CI 25.2–31. 5), 15.7 (95% CI 13.4–19.8), and 12.1 (95% CI 9.8–15.3), respectively, while functional limitation was 22.5 (95% CI 18.1–24.4). Increased risk of disability was independently associated with female gender PR 3.6 (95% CI 1.5–7.4), advanced age ≥75 years; PR 22.2 (95% CI 14.5, 36.8), arthritis PR 3.7 (95% CI 2.6–4.6), stroke PR 4.8 (95% CI 3.7–7.9) and diabetes PR 6.1 (95% CI 4.3–7.1). Conclusions. The findings from this study are pointers to unmet needs of the elderly disabled Nigerians.

This cross-sectional study examines trends in the prevalence of functional limitation in cancer survivors using data from the National Health Interview Survey.

Introduction Disabilities are a serious public health, social and human rights issue. Few studies address the relationship between disabilities and functioning among older adults. The study aimed to estimate the prevalence of disability and its’ association with comorbidities and functional limitations in Brazilian elderly individuals. Methods Data from the National Health Survey—PNS 2019 was used. Prevalence rates with its corresponding 95% confidence intervals (CI) were estimated for variables of interest. Chi-squared tests and multiple logistic regression were conducted to investigate associations and estimate crude and adjusted odds ratios (OR) using Stata 17.0 software. The critical value (p<0.05) was considered. Results The overall prevalence of disability was 58.3% (95% CI 57.2–59.4). Moderate/severe disabilities accounted for 24.1 (95% CI 23.1–25.1) and was high among elderly people females (27.9%, 95% CI 26.5–29.3), unemployed (28.4%, 95% CI 27.3–29.6), with an income of up to one minimum wage (30.6%, 95% CI 29.1–32.2), lower education (28.7%, 95% CI 27.5–29.9) and not married (28.5%, 95% CI 27.1–29.9). Crude odds ratios of having functional limitations were 4.5 times higher among individuals with three or more comorbidities, and 32.5 times higher among those with two or more disabilities, compared to those without these conditions. Conclusion Having a disability is an important predictor of functional limitations, especially among women, and people with lower income and education. To address this problem, public health policies such as encouraging physical activity among the elderly in Brazil should be implemented.

… All prevalence estimates shown in this paper are based on at … analytic cell to estimate prevalence simultaneously by age, … used to produce national prevalence estimates. The sample …

… ADL disability, functional limitations and self-rated health … declines in ADL disability, functional limitations and poor self-rated … a higher prevalence of disability, functional limitations and …

OBJECTIVES: To estimate the prevalence of neuropsychiatric symptoms and examine their association with functional limitations.

This study aimed to identify the main regional factors associated with variations in the prevalence of functional limitation on the older adult in Colombia adjusted by individual characteristics. This multilevel study used cross-sectional data from 23,694 adults over 60 years of age in the SABE, Colombia nationwide survey. State-level factors (poverty, development, inequity, violence, health coverage, and access to improved water sources), as well as individual health related, socioeconomic and demographic characteristics, were analyzed. The overall prevalence of functional impairment for the basic activities of daily living (ADL) was 22%. The presence of comorbidities, low educational level, physical inactivity, no participation in social groups, mistreatment and being over 75 years old were associated with functional limitation. At the group level, the analysis showed significant differences in the functional limitation prevalence across states, particularly regarding the socioeconomic status measured according to the Human Development Index (median OR = 1.22; 95%CI: 1.13-1.30; p = 0.011). This study provides evidence on the impact of socioeconomic variation across states on FL prevalence in the Colombian elderly once adjusted for individual characteristics. The findings of this study, through a multilevel approach methodology, provide information to effectively address the conditions that affect the functionality in this population through the identification and prioritization of public health care in groups with economic and health vulnerability.

BackgroundThe prevalence and correlates of physical disability and functional limitation among older people have been studied in many developed countries but not in a middle income country such as Malaysia. The present study investigated the epidemiology of physical disability and functional limitation among older people in Malaysia and compares findings to other countries.MethodsA population-based cross sectional study was conducted in Alor Gajah, Malacca. Seven hundred and sixty five older people aged 60 years and above underwent tests of functional limitation (Tinetti Performance Oriented Mobility Assessment Tool). Data were also collected for self reported activities of daily living (ADL) using the Barthel Index (ten items). To compare prevalence with other studies, ADL disability was also defined using six basic ADL's (eating, bathing, dressing, transferring, toileting and walking) and five basic ADL's (eating, bathing, dressing, transferring and toileting).ResultsTen, six and five basic ADL disability was reported by 24.7% (95% CI 21.6-27.9), 14.4% (95% CI 11.9-17.2) and 10.6% (95% CI 8.5-13.1), respectively. Functional limitation was found in 19.5% (95% CI 16.8-22.5) of participants. Variables independently associated with 10 item ADL disability physical disability, were advanced age (≥ 75 years: prevalence ratio (PR) 7.9; 95% CI 4.8-12.9), presence of diabetes (PR 1.8; 95% CI 1.4-2.3), stroke (PR 1.5; 95% CI 1.1-2.2), depressive symptomology (PR 1.3; 95% CI 1.1-1.8) and visual impairment (blind: PR 2.0; 95% CI 1.1-3.6). Advancing age (≥ 75 years: PR 3.0; 95% CI 1.7-5.2) being female (PR 2.7; 95% CI 1.2-6.1), presence of arthritis (PR 1.6; 95% CI 1.2-2.1) and depressive symptomology (PR 2.0; 95% CI 1.5-2.7) were significantly associated with functional limitation.ConclusionsThe prevalence of physical disability and functional limitation among older Malaysians appears to be much higher than in developed countries but is comparable to developing countries. Associations with socio-demographic and other health related variables were consistent with other studies.

… This study explored the prevalence of functional limitations in a Spanish population. Women aged 75 years and older and men starting from 90 years showed great difficulty walking, …

Significance A country’s economic performance depends in large part on the health and productivity of its workforce. This research provides critical insights into the health and functional abilities of American workers. It reveals that a significant proportion of working adults have work-related functional limitations, often due to chronic medical conditions like mental illness, arthritis, and substance use disorder. The findings highlight occupations and industries where health-related factors have the potential to constrain labor force and productivity growth. Policy initiatives designed to support workers with health-related limitations might consider targeting these occupations and industries.

ABSTRACT Introduction: COVID-19 is an emerging global health pandemic causing tremendous morbidity and mortality worldwide. Chronic symptoms progressing to poor functional status have been reported in a substantial proportion of COVID-19 patients worldwide. This study aimed to determine the prevalence of functional limitation in COVID-19 recovered patients using the post-COVID-19 functional status scale. Methods: A descriptive cross-sectional study was conducted at Tribhuvan University Teaching Hospital. COVID-19 recovered patients with reverse transcription-polymerase chain reaction negative status were included and assessed using the post-COVID-19 functional status scale. Data entry and analysis was done in Statistical Package for the Social Sciences version 20.0. Descriptive statistics were performed. Results: A total of 106 patients were included for the final analysis. More than half of the patients (56.6%) reported having no functional limitation (grade 0), while the prevalence of some degree of functional limitation was observed in 46 (43.4%) patients (grade 1 to 4). Conclusions: Some form of functional limitation should be anticipated after COVID-19 infection. Post-COVID-19 functional status scale can be a valuable tool in determining the prevalence of functional limitation in COVID-19 recovered patients in acute health care settings. It can potentially guide in planning rehabilitative measures in post-acute care management of COVID-19 survivors.

… from persons with functional limitations who did not mention … , types of functional limitations, prevalence of comorbid … identified as contributing to functional limitation, frequency of specific …

… Finally, we calculated prevalence ratios for functional limitations, mobility limitations, BADL difficulty, and IADL difficulty for participants with 2, 3, 4, and 5 or more compared with 0–1 …

ABSTRACT This study aimed to calculate the prevalence of the elderly (aged 60 years+) in Turkey who need long-term care for activities of daily living (ADLs) and instrumental activities of daily living (IADLs), and examine factors affecting functional limitation. Data were collected from the Turkey Health Survey conducted by TurkStat in 2019. The individuals’ dependency degree was measured using seven questions on ADLs and six on IADLs in the survey. The chi-squared test was used to compare the dependency levels of the older adults in terms of age groups, and logistic regression to identify factors related to disability. 23.98% of elderly people required long-term care (minimum six months) —11.82% experienced some difficulty (group 1) and 11.91% experienced great difficulty (group 2); 0.25% were completely dependent (group 3). The dependency level was higher for elderly, female, uninsured, and single people living in northeastern Anatolia. There was statistical significance between depression, Alzheimer's, recent hospitalizations, number of chronic diseases, and disability. The prevalence of functional disability is high in the elderly; one out of four elderly people needs long-term care. Additionally, the disability level increases with age and there is an effect of an individual's sociodemographic and health characteristics on disability. Highlights One in four elderly people in Turkey need long-term care. Approximately 2.6–3.1 million elderly people need long-term care in 2021. It is estimated that this number will reach 4.9–5.9 million by 2040 and 6.7–8 million by 2060. Age, sex, marital status, and region affect the dependency level of the elderly.

… Table 3 shows unadjusted and adjusted prevalence rates for each of the 4 functional limitations by age group. Focusing first on the unadjusted estimates, for all 4 functions and all age …

Performance of IADL could be closely related to biological variables such as age and sex. Since women outnumbered men among the sample population, it is hopeful to conclude that elderly women can be relished with functional independence, but in the advancement of their age, they have to suffer a lot. The results of the study showed that the extended life year is accompanied by increased demands on health care delivery systems as more part of life may be spent with some functional limitation. The prevalence of physical disability in elderly persons with functional limitation are, therefore, important for policy development on care of the elderly. The most effective way to reduce the proportion of population with disabilities is to delay the onset of disabilities. Living independently in familiar surroundings surely promotes a better ageing and the development of living environments together with functional ability exert a profound influence on active ageing. In Kerala situation, geriatric care should be focused to the necessities of elderly women since they have to live more years with functional limitation and disability than males.

… First, the prevalence of functional limitations and basic ADL disabilities in the community-… homes had basic ADL disabilities and functional limitations. The 2004 NNHS revealed an …

… life versus QOL as a clinical or geriatric outcome represented by core dimensions of health status or HRQOL. The investigators located 12 studies on physical activity and QOL, and 6 …

… data that include information on geriatric conditions, chronic diseases, disability, and demographic characteristics. We hypothesized that having 1 or more geriatric conditions is strongly …

Background Quality of life is an important health outcome for older persons. It predicts the adverse outcomes of institutionalization and premature death. The aim of this cross-sectional study was to determine the influence of both disability in activities of daily living (ADL) and instrumental activities of daily living (IADL) on physical and mental dimensions of quality of life. Methods A total of 377 Dutch people aged 75 years and older completed a web-based questionnaire. This questionnaire contained the Groningen Activity Restriction Scale (GARS) for measuring ADL and IADL and the Short-Form Health Survey (SF-12) for measuring quality of life. The SF-12 distinguishes two dimensions of quality of life, a physical and mental dimension. Results All ADL disability items combined and all IADL disability items combined explained a significant part of the variance of the physical and the mental dimension of quality of life. Only ADL item “stand up from sitting in a chair”, and IADL items “do “heavy” household activities” and “do the shopping” were negatively associated with both quality of life dimensions after controlling for all the variables in the model. Discussion This study showed that disability in ADL and IADL is negatively associated with quality of life in older people. Therefore, it is important for health care professionals to carry out interventions aimed to prevent and diminish disability or the adverse outcomes of disability such as a lower quality of life. In order to be effective these interventions should be inexpensive, feasible, and easy to implement.

… The purpose of this study was to analyze the association between functioning and disability and quality of life (QoL) in older individuals with joint contractures in the geriatric care setting…

Purpose: To identify the effect of frailty and geriatric syndromes on the quality of life (QoL), of older adults receiving home care, taking into consideration their socioeconomic and homebound status, including multi-comorbidities. Patients and Methods: This cross-sectional study enrolled elders aged (≥65) years old, registered members of “Help at Home” programs in the Reference Region of Crete, from March to May 2019. Participants were screened using the WHOQOL-BREF for Quality of Life, geriatric syndromes such as frailty using the SHARE-Frailty Index (SHARE-Fi), the Montreal Cognitive Assessment (MoCA), for cognitive function and the Geriatric Depression Scale (GDS), for the assessment of depression. Results: The mean age of the 301 participants was 78.45 (±7.87) years old. The prevalence of frailty was 38.5%, severe depression 13.6%, cognitive dysfunction 87.8% and severe comorbidity 70.6%. Intriguingly, none of the participants (0%) was identified as free of comorbidity (CCI = 0–1). The overall QoL (ranging from 4–20) of the study participants was 13.24 (±4.09). The bivariate analysis showed that overall QoL significantly differed among older adults with frailty (15.91 vs. 11.56, p < 0.001), cognitive dysfunction (15.42 vs. 12.90, p < 0.001), depression (14.90 vs. 9.31, p < 0.001), and disability in Activities of Daily Living (13.67 vs. 10.67, p = 0.002), compared to non-frail, normal cognition and depression, and independent elders, respectively. Multiple linear regression models revealed that frail and depressive elders reported significantly lower QoL (β = −2.65, p < 0.001 and (β = −5.71, p < 0.001), compared to non-frail and older adults with no depressive symptoms, respectively, despite the fact that this association was not significant for older adults with dementia (β = −2.25, p = 0.159), even after adjusting for potential confounding effects (age, gender, comorbidity, homebound status, etc.). Conclusion: frailty and geriatric syndromes including comorbidities are important risk factors for “poor” QoL among older adults receiving home-based healthcare.

Objective To describe the burden of Generalized Anxiety Disorder (GAD), a common anxiety disorder in older adults. Design Cross-sectional. Setting Late-life depression and anxiety research clinic in Pittsburgh, PA. Participants One hundred sixty-four older adults with GAD and 42 healthy comparison participants with no lifetime history of psychiatric disorder were recruited from primary care and mental health settings as well as advertisements. Measurements Participants were evaluated with the Late Life Function and Disability Index to assess disability, the MOS 36-Item Short Form Survey Instrument to assess health-related quality of life (HRQOL), and the Cornell Service Index to assess healthcare utilization. Results Older adults with GAD were more disabled, had worse HRQOL, and had greater healthcare utilization, than nonanxious comparison participants, even in the absence of psychiatric comorbidity. After controlling for medical burden and depressive symptoms, higher severity of anxiety symptoms was associated with greater disability and poorer HRQOL in several domains. The greatest decrements in HRQOL and function were observed in measures assessing role functioning, including social function. Conclusion This study, the largest ever of GAD in older adults, provides evidence of the significant burden of this disorder in late life. Given the high prevalence and chronicity of GAD in the elderly, these data provide a public health imperative for finding and implementing effective management strategies for this typically undiagnosed and untreated disorder.

This article reviews the impact of depressive and anxiety disorders on quality of life (QOL), disability, and economic burden in the lives of older individuals. Distinctions between the terms QOL, disability, and burden are important in understanding the extent of improvement needed in treatment for elderly patients with depression or anxiety. Treatment efforts should be extended to remediate not only signs and symptoms of psychiatric syndromes but QOL and disability as well; increased understanding toward this end is evolving, yet it is clear that these issues need to be the focus of more investigation.

OBJECTIVES: To determine the relative importance of geriatric impairments (in muscle strength, physical capacity, cognition, vision, hearing, and psychological status) and chronic diseases in predicting subsequent functional disability in longitudinal analyses.

To describe geriatric syndromes and their relationships with quality of life in older adults with diabetes.

BackgroundAccurate measurement of quality of life in older ICU survivors is difficult but critical for understanding the long-term impact of our treatments. Activities of daily living (ADLs) are important components of functional status and more easily measured than quality of life (QOL). We sought to determine the cross-sectional associations between disability in ADLs and QOL as measured by version one of the Short Form 12-item Health Survey (SF-12) at both one month and one year post-ICU discharge.MethodsData was prospectively collected on 309 patients over age 60 admitted to the Yale-New Haven Hospital Medical ICU between 2002 and 2004. Among survivors an assessment of ADL's and QOL was performed at one month and one-year post-ICU discharge. The SF-12 was scored using the version one norm based scoring with 1990 population norms. Multivariable regression was used to adjust the association between ADLs and QOL for important covariates.ResultsOur analysis of SF-12 data from 110 patients at one month post-ICU discharge showed that depression and ADL disability were associated with decreased QOL. Our model accounted for 17% of variability in SF12 physical scores (PCS) and 20% of variability in SF12 mental scores (MCS). The mean PCS of 37 was significantly lower than the population mean whereas the mean MCS score of 51 was similar to the population mean. At one year mean PCS scores improved and ADL disability was no longer significantly associated with QOL. Mortality was 17% (53 patients) at ICU discharge, 26% (79 patients) at hospital discharge, 33% (105 patients) at one month post ICU admission, and was 45% (138 patients) at one year post ICU discharge.ConclusionsIn our population of older ICU survivors, disability in ADLs was associated with reduced QOL as measured by the SF-12 at one month but not at one year. Although better markers of QOL in ICU survivors are needed, ADLs are a readily observable outcome. In the meantime, clinicians must try to offer realistic estimates of prognosis based on available data and resources are needed to assist ICU survivors with impaired ADLs who wish to maintain their independence. More aggressive diagnosis and treatment of depression in this population should also be explored as an intervention to improve quality of life.

PURPOSE In the context of geriatric rehabilitation, 2 quality of life (QoL) facets are of particular importance: a behavioral, more objective facet, and an emotional, more subjective facet. This study looked at changes in these 2 QoL facets during rehabilitation, their relationship to each other and potential mediating processes. DESIGN Ninety-two geriatric patients were assessed by the geriatric assessment and a structured face-to-face interview at admission to and discharge from an inpatient geriatric rehabilitation ward. Behavioral QoL was measured in terms of independence in the activities of daily living and mobile abilities, while positive and negative affect represented emotional QoL. As potential mediators, self-perceptions of health (self-rated health, subjective pain, temporal health comparison) were assessed. Statistical analysis comprised repeated-measures (multivariate) analyses of variance as well as regression and mediation analyses based upon a fixed effects-panel model. RESULTS All behavioral and emotional QoL indicators showed significant prepost improvements. During rehabilitation, changes in behavioral QoL were significantly related to changes in emotional QoL. Multiple regression of changes in emotional QoL on changes in behavioral QoL and in self-perceptions of health revealed, however, that only health perceptions significantly predicted emotional QoL. Mediation analysis showed that self-perceptions of health fully mediated the relationship between behavioral and emotional QoL outcomes. CONCLUSIONS During geriatric rehabilitation, significant progress can be made regarding QoL. The results indicate that the influence of physical progress on affective improvements is conveyed through self-perceptions of health, showing the importance of self-perceptions of health for emotional QoL in geriatric rehabilitation. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

BACKGROUND Burden of disease (BoD) using disability-adjusted life years (DALY) is a useful summary measure of population health and estimates are provided for Ireland annually. We hypothesized that BoD may be used as a predictor of frailty prevalence. AIM To examine the correlation between frailty measured by the accumulation of deficits (frailty index, FI) and Fried frailty phenotype (FFP) classifications and BoD, in an Irish context. DESIGN Cross-sectional secondary analysis. METHODS Data were obtained from waves two and three of The Survey of Health, Ageing and Retirement in Europe for Irish adults aged ≥65 in 2007. Frailty was defined by a 70-item FI and the FFP. Years lived with disability (YLD), years of life lost (YLL) and DALY were calculated using adapted equations from the World Health Organization and, where possible, disability weights, sequelae and durations as in the Global BoD (GBD) project (2016). RESULTS Of 1035 participants, 442 were ≥65 years. Mean DALY were significantly higher in those identified as frail (FI: 3.31, P < 0.0001, n = 406; FFP: 2.46, P = 0.005, n = 319). For the FI, stronger correlation was found for DALY (r = 0.5431, P < 0.0001) than for age (r = 0.275, P < 0.0001). Controlling for confounders, DALY were an independent predictor of frailty when measured with the FI (OR 1.17, 95% CI: 1.10-1.24) but not with the FFP (OR 1.079, 95%% CI 1.00-1.17). CONCLUSIONS Frailty correlates significantly with DALY, and more so with the FI than the FFP, reaffirming that these measures are different constructs. GBD data could represent a predictor of population-level frailty estimates, facilitating improved comparisons.

… from premature death to years lived with … disorders remain the dominant causes of disease burden. The rising burden from mental and behavioural disorders, musculoskeletal disorders, …

Stroke is a prototype disorder that disables as well as kills people. The disability-adjusted life years (DALY) metric developed by the World Health Organization to measure the global burden of disease integrates healthy life years lost due to both premature mortality and living with disability. Accordingly, it is well suited to stroke research. The DALY has previously been applied only to large but relatively crude population-level data analyses, but now it is possible to calculate the DALY lost in individual stroke patients. Measuring each patient's stroke outcome with DALY lost has expanded its application to the analysis of treatment effect in acute stroke trials, delineating the poststroke complication impact, the differential weighting of discrete vascular events, and estimating a more refined stroke burden in a specific population. The DALY metric has several advantages over conventional stroke outcome measures: 1) Since the DALY measures the burden of diverse health conditions with a common metric of life years lost, stroke burden and benefits of stroke interventions can be directly compared to other health conditions and their treatments. 2) Quantifying stroke burden or interventional benefits as the life years lost or gained makes the DALY metric more intuitively accessible for public and health system planners. 3) As a continuous, equal-interval scale, the DALY analysis might be statistically more powerful than either binary or ordinal rank outcome analyses in detecting the treatment effects of clinical trials. 4) While currently employed stroke outcome measures take one-time snapshots of disability or mortality and implicitly indicate long-term health impact, the DALY explicitly indicates the burdens of living with disability for an individual's remaining life.

… Disability adjusted life years (DALYs) have been used to quantify endpoint indicators of the human burden of disease in life cycle assessment (LCA). The purpose of this paper was to …

… Conclusions: Older adults with ADL or IADL dependency had higher risks of unmet healthcare … were related to unmet healthcare needs. Therefore, to reduce unmet healthcare needs, …

Background The rising prevalence of multimorbidity and functional dependence in community-dwelling older adults contribute to the demand for home care services. Evidence on how chronic conditions, especially multimorbidity, affect dependence levels among older adults with functional dependence in a socio-cultural context is much needed to inform policy, workforce, aged care service development to meet the care needs of this population. Objectives This study aimed to determine the association between chronic conditions, multimorbidity and dependence levels among Chinese community-dwelling older adults with functional dependence. Methods A cross-sectional study was conducted with 1,235 community-dwelling older adults with functional dependence in Hunan province, China, from June to October 2018. Data on socio-demographic factors, cognitive function, vision and hearing conditions, activities of daily living (ADLs), and health conditions were collected, and binary logistic regression analyses were used to determine the association between chronic conditions, multimorbidity and dependence levels, with adjustments for relevant covariates. Results Among the participants, 62.9% had multimorbidity. Parkinson’s disease, stroke, COPD, hypertension, mood and psychotic disorders (Anx/Sch/Dep) were significantly associated with high levels of functional dependence. After adjusting for demographic variables, cognitive function, vision, and hearing conditions, we observed a significant relationship between multimorbidity and higher functional dependence, but this association became insignificant when including certain chronic diseases closely associated with high-level dependence. Study revealed that Parkinson’s disease and stroke notably increase dependency risk across seven ADL domains, demonstrating their extensive impact on daily functioning. Conclusion The prevalence of multimorbidity among Chinese community-dwelling older adults with functional dependence is very high. The association of multimorbidity with functional dependence is mediated by specific chronic conditions. These findings highlight the necessity of adopting an integrated care model that combines medical and social care, with a particular emphasis on managing multimorbidity and critical chronic conditions that lead to severe functional dependence to preventing and diminish the onset of disabilities.

This cross-sectional study examines the association between self-assessed difficulty in performing daily tasks and rates of outpatient visits, prescription drug fills, and use of other health services among adults.

… Functionally dependent residents with obesity often require two or more individuals to assist them with transfers and other ADLs. Furthermore, a resident with obesity with a wound or …

Introduction: Population ageing is a worldwide reality that requires attention, and a concern for healthy and functional ageing is increasingly the focus of government policies and programmes. Objective: To identify the prevalence of homebound elderly people, and the influence of sociodemographic and economic characteristics on their functional dependency. Methods: Cross-sectional study with 178 homebound elderly people assisted by a family healthcare unit in Vitoria, ES, Brazil. Functional independence was measured by the Functional Independence Measure (FIM) and the sociodemographic and economic variables were collected by a questionnaire developed by the authors. Binary logistic regression was used to determine the influence of the sociodemographic and economic characteristics on the risk of being functionally dependent. Results: Forty-eight percent of the participants were functional dependents, 80% were female, 72% belonged to the fourth age, 74% were white, 63% were widowed, 78% had retired, 90% had children, 83% had a caregiver, 52% had low education and 40% had low income. Logistic regression indicated that having a caregiver increased by 40 times the chance of being functionally dependent (OR = 40.2; 95%CI 4.8–355.4) and having between one to eight years of education decreased the chance of functional dependency (OR = 0.2; 95%CI 0.04-0.9). Conclusions: The prevalence of functional dependency was very high in this sample, and since the presence of a caregiver was the strongest and significant predictor of functional dependency, we suggest that guidance and support should be offered to caregivers, followed   by a family healthcare strategy,  to make consistent efforts with the objective of improving  functional recovery and independence of homebound elderly.

Aim: Stroke is a leading cause of disability; however, little is known about the outcomes of the utilization of long-term care (LTC) recipients in Taiwan. This study aimed to quantify the burdens of disease of stroke survivors receiving LTC by evaluating the outcomes of their utilization including mortality, readmissions, and re-emergency within 1 year after diagnoses of strokes. Methods: By interlinkages among the national mortality registry, LTC dataset (LTC-CM), and the National Health Insurance Research Dataset (NHIRD), the outcomes and the factors associated with receiving LTC up to 1 year were explored. Patients were aged 50 years and over with an inpatient claim of the first diagnosis of stroke of intracerebral hemorrhage (ICH) and ischemic stroke during 2011–2016. Outcomes of the healthcare utilization include rehospitalization and re-emergency. Results: There were 15,662 patients with stroke who utilized the LTC services in the dataset among the stroke population in NHIRD. Stroke survivors receiving LTC showed no difference in clinical characteristics and their expected years of life loss (EYLL = 7.4 years) among those encountered in NHIRD. The LTC recipients showed high possibilities to be rehospitalized and resent to emergency service within 1 year after diagnosis. Apart from the comorbidity and stroke severity, both the physical and mental functional disabilities and caregiving resources predicted the outcomes of the utilization. Conclusions: For stroke survivors, both severe functional impairments and cognitive impairments were found as important factors for healthcare utilizations. These results regarding reserving functional abilities deserve our consideration in making the decision on the ongoing LTC policy reform in the aged society of Taiwan.

… healthcare utilization could contribute to reduce both older adults’ disability and healthcare … disability and older adults’ primary healthcare utilization and hospitalization over a period of …

RATIONALE Sepsis often leads to long-term functional deficits and increased mortality in survivors. Post-acute rehabilitation can decrease long-term sepsis mortality, but its impact on nursing care dependency, health care use and costs is insufficiently understood. OBJECTIVE To assess the short-term (7-12 months post-discharge) and long-term (13-36 months post-discharge) effect of inpatient rehabilitation within six months after hospitalization on mortality, nursing care dependency, health care use and costs. METHODS Observational cohort study using health claims data from the health insurer AOK (Allgemeine Ortskrankenkasse). Among 24.3 million AOK beneficiaries, we identified adult beneficiaries hospitalized with sepsis in 2013/14 by explicit ICD-10 codes. We included patients who were non-employed pre-sepsis, for whom rehabilitation is reimbursed by the AOK and thus included in the dataset, and who survived at least six months post-discharge. The effect of rehabilitation was estimated by statistical comparisons of patients with rehabilitation (treatment group) and those without (reference group). Possible differential effects were investigated for the subgroup of Intensive Care Unit (ICU)-treated sepsis survivors. We used inverse probability of treatment weighting based on propensity scores to adjust for differences in relevant covariates. Costs for rehabilitation in the six months post-sepsis were not included in the costs analysis. RESULTS Among 41,918 six-months sepsis survivors, 17.2% (n=7,224) received rehabilitation. There was no significant difference in short-term survival between survivors with and without rehabilitation. Long-term survival rates were significantly higher in the rehabilitation group (90.4% vs. 88.7% (odds ratio [OR]=1.2 95% confidence interval [CI], 1.1-1.3) p=0.003)). Survivors with rehabilitation had a higher mean number of hospital readmissions (7-12 months after sepsis, 0.82 vs. 0.76, p=0.014) and were more frequently dependent on nursing care (7-12 and 13-36 months after sepsis, 47.8% vs. 42.3%, OR=1.2 (95% CI, 1.2-1.3), p<0.001, and 52.5% vs. 47.5%, OR=1.2 (95% CI, 1.1-1.3), p<0.001, respectively) compared to those without rehabilitation, while total health care costs 7-36 months did not differ between groups. ICU-treated sepsis patients with rehabilitation had higher short and long-term survival rates (93.5% vs. 90.9%, OR=1.5 (95% CI, 1.2-1.7), p<0.001; 89.1% vs. 86.3%, OR= 1.3 (95% CI, 1.1-1.5), p<0.001, respectively) than ICU-treated sepsis patients without rehabilitation. CONCLUSION Rehabilitation within the first 6 months after ICU- and non-ICU treated sepsis is associated with increased long-term survival within three years after sepsis without added total health care costs. Future work should aim to confirm and explain these exploratory findings.

Background Growing numbers of critically ill patients receive prolonged mechanical ventilation. Little is known about their patterns of care as they transition from the acute hospital to post-acute care facilities or the associated resource utilization. Objectives To describe one-year trajectories of care and resource utilization for prolonged mechanical ventilation patients. Design One-year prospective cohort study. Setting 5 ICUs at Duke University Medical Center. Participants 126 prolonged mechanical ventilation patients as well as their 126 surrogates and 54 ICU physicians were enrolled consecutively during one year. Prolonged mechanical ventilation was defined as ventilation for ≥4 days with tracheostomy placement or ventilation for ≥21 days without tracheostomy. Measurements Patients and surrogates were interviewed in hospital, as well as 3 and 12 months later to determine patient survival, functional status, and facility type and duration of post-discharge care. Physicians were interviewed in-hospital to elicit prognoses. Institutional billing records were used to assign costs for acute care, outpatient care, and inter-facility transportation. We used Medicare claims data to assign costs for post-acute care. Results 103 (82%) hospital survivors experienced 457 separate transitions in post-discharge care location (median 4 [interquartile range 3, 5]), including 68 (67%) patients who were readmitted at least once. Patients spent an average of 74% (CI, 68% to 80%) of all days alive in a hospital, post-acute care facility, or receiving home health care. At one year, 11 (9%) patients had a good outcome (alive with no functional dependency), 33 (26%) had a fair outcome (alive with moderate dependency), and 82 (65%) had a poor outcome (either alive with complete functional dependency (n=4, 21%) or dead (n=56, 44%). Patients experiencing a poor outcome were older, had more comorbidities, and were more frequently discharged to a post-acute care facility than patients with either fair or good outcomes (all p <0.05). Costs per patient were $306,135 (SD $285,467) and total cohort costs totaled $38.1 million, for an estimated $3.5 million per one-year independently functioning survivor. Limitations The results of this single center study may not be applicable to other centers. Conclusions Prolonged mechanical ventilation patients experience multiple transitions of care, resulting in extraordinary health care costs and persistent, profound disability. The optimism of surrogate decision makers should be balanced by discussions of these outcomes when considering a course of prolonged life support.

Cancer‐focused organizations now recommend routine assessment of instrumental activities of daily living (iADLs) for all older patients with cancer, along with assessment of basic activities of daily living (ADLs) if possible. However, little is known regarding the role of iADLs in predicting survival and acute‐care utilization in populations of older adults with different hematologic malignancies.

… worsening health conditions, or rate of change in functional dependency, cognition, behavioral problems, depressive symptoms, social function, or social withdrawal. Thus, these results …