Disability Incidence and Functional Decline among Older Adults with Major Chronic Diseases

2019 ◽  
Author(s):  
Joelle H. Fong
Keyword(s):  
Older Adults ◽  
Chronic Diseases ◽  
Functional Decline

scholarly journals Age, gender, and residence differences in prevalence and patterns of multimorbidity among older Chinese: Evidence from Chinese Longitudinal Healthy Longevity Survey

2022 ◽  
Author(s):  
Siyue Han ◽  
Guangju Mo ◽  
Tianjing Gao ◽  
Qing Sun ◽  
Huaqing Liu ◽  
...  
Keyword(s):  
Older Adults ◽  
Chronic Diseases ◽  
Functional Decline ◽  
Self Report ◽  
Care Utilization ◽  
Rule Mining ◽  
Demographic Differences ◽  
Healthy Longevity ◽  
Older Chinese ◽  
Multimorbid Patients

Abstract Background With the dramatic acceleration of ageing in China, multimorbidity among the older adults has become increasingly common，which are associated with more functional decline and higher health care utilization and mortality. Understanding demographic differences of patterns of multimorbidity is in favor of making targeted intervention strategies. The purpose of this study was to reveal age- specific, gender- specific, and residence- specific prevalence and patterns of multimorbidity among older adults in China. Methods The present analysis is based on the 2018 wave of Chinese Longitudinal Health Longevity Survey (CLHLS). We selected 13 chronic diseases from the CLHLS survey, and information was collected based on self-report. Multimorbidity was defined as the coexistence of two or more chronic diseases from 13 chronic diseases in the same individual. Descriptive statistical analysis was used to examine multimorbidity according to age, sex, and residence. Patterns and trends of chronic disease pairs and multimorbidity were explored using association rule mining. Results 9,660 individuals aged 65-117 years in the CLHLS were analyzed in this study. Overall, 74.4% of all participants had one or more morbidities, and 42.4% were multimorbid. The prevalence of individual chronic diseases ranged from 1.5% for cancer to 41.8% for hypertension, and each disease was often accompanied by one or more other chronic diseases. The prevalence of multimorbidity does not always increase with age. The subgroups with the highest prevalence of multimorbidity was 80-89 years old (48.2%), female (45.0%) and urban (47.2%) group. Prevalence of the hypertension- diabetes pattern decreases with age and is higher in women than in men. The prevalence of hypertension- depression pattern was at the highest among the 90-117 years and rural older adults, while the other groups were hypertension-heart disease. Moreover, it was noteworthy that the multimorbidity rate of dyslipidemia is the highest at 95.5% among the 13 chronic diseases. Conclusions The prevalence of multimorbidity among older Chinese was substantial, and patterns of multimorbidity differed in age, sex, and residence. Future efforts are needed to identify possible prevention strategies and guidelines targeted demographic differences of multimorbid patients to promote health in older adults.

scholarly journals Disability incidence and functional decline among older adults with major chronic diseases

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Joelle H. Fong
Keyword(s):  
Older Adults ◽  
Chronic Diseases ◽  
Chronic Care ◽  
Comparison Group ◽  
Oldest Old ◽  
Functional Decline ◽  
Chronically Ill ◽  
Noncommunicable Diseases ◽  
Functional Loss ◽  
Early Loss

Abstract Background More than 80% of elderly Americans have at least one chronic disease. While past studies have shown that hierarchical patterns of functional loss may differ by gender and institutional settings, little is known about whether such patterns differ in relation to chronic health condition. The aim of this study is to investigate the pattern of functional loss among older adults with major chronic illnesses, and to compare their onset and ordering of incident ADL disability with those of persons without such conditions. Methods We use a nationally representative sample of persons aged 80+ from the 1998–2014 Asset and Health Dynamics of the Oldest Old survey. The group with major noncommunicable diseases (including cardiovascular disease, cancer, chronic respiratory disease, and diabetes) comprises 3,514,052 subjects, while the comparison group comprises 1,073,263 subjects. Self-reports of having difficulty with six distinct ADLs are used to estimate disability incidence rate. Nonparametric statistical methods are used to derive median onset ages and ADL loss sequence separately for each group. Results Older adults with major chronic diseases have higher rates of incident disability across all ADL items. Estimated median onset ages of ADL disabilities for the full sample range from 91.5 to 95.6. Disability occurs earlier for chronically ill persons (onset ages 91.1–95.0) than for those in the comparison group (onset ages 93.5–98.1). Among those with major chronic diseases, the ADL loss sequence ordered by median ages of disability onset is bathing, walking, dressing, toileting, transferring and eating. The activities are also distinctly separated into an early-loss cluster and a late-loss cluster. Although the loss sequence derived for the comparison group is largely similar, disability progression for those with major chronic diseases is compressed within a shorter timeframe and the timing gaps between adjacent disabilities are smaller. Conclusions Older Americans with major noncommunicable diseases face an earlier and steeper slope of functional decline. Chronic care delivery programs should adapt to dynamic changes in older patients’ functional status. Health interventions to help patients delay disability onset and optimize functional autonomy within emerging models of chronic care should especially target early-loss activities such as bathing, dressing, and walking.

scholarly journals Spontaneous Eye Blinks Predict Executive Functioning in Seniors

2021 ◽  
Author(s):  
Jessika I. V. Buitenweg ◽  
Jaap M. J. Murre ◽  
K. Richard Ridderinkhof
Keyword(s):  
Older Adults ◽  
Working Memory ◽  
Executive Functioning ◽  
Cognitive Training ◽  
Functional Decline ◽  
Future Research ◽  
Blink Rate ◽  
Memory Updating ◽  
Age Related ◽  
Working Memory Updating

AbstractAs the world’s population is aging rapidly, cognitive training is an extensively used approach to attempt improvement of age-related cognitive functioning. With increasing numbers of older adults required to remain in the workforce, it is important to be able to reliably predict future functional decline, as well as the individual advantages of cognitive training. Given the correlation between age-related decline and striatal dopaminergic function, we investigated whether eye blink rate (EBR), a non-invasive, indirect indicator of dopaminergic activity, could predict executive functioning (response inhibition, switching and working memory updating) as well as trainability of executive functioning in older adults. EBR was collected before and after a cognitive flexibility training, cognitive training without flexibility, or a mock training. EBR predicted working memory updating performance on two measures of updating, as well as trainability of working memory updating, whereas performance and trainability in inhibition and switching tasks could not be predicted by EBR. Our findings tentatively indicate that EBR permits prediction of working memory performance in older adults. To fully interpret the relationship with executive functioning, we suggest future research should assess both EBR and dopamine receptor availability among seniors.

scholarly journals Frailty and hospitalization-associated disability after pneumonia: A prospective cohort study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Chan Mi Park ◽  
Wonsock Kim ◽  
Hye Chang Rhim ◽  
Eun Sik Lee ◽  
Jong Hun Kim ◽  
...  
Keyword(s):  
Older Adults ◽  
Primary Outcome ◽  
Long Term Care ◽  
Functional Decline ◽  
Tube Feeding ◽  
Term Care ◽  
Pneumonia Severity ◽  
Frailty Assessment ◽  
Nasogastric Tube Feeding

Abstract Background Pneumonia is a major cause of morbidity and mortality in older adults. The role of frailty assessment in older adults with pneumonia is not well defined. Our purpose of the study was to investigate 30-day clinical course and functional outcomes of pneumonia in older adults with different levels of frailty. Methods A prospective cohort was conducted at a university hospital in Seoul, Korea with 176 patients who were 65 years or older and hospitalized with pneumonia. A 50-item deficit-accumulation frailty index (FI) (range: 0–1; robust < 0.15, pre-frail 0.15–0.24, mild-to-moderately frail 0.25–0.44, and severely frail ≥ 0.45) and the pneumonia severity CURB-65 score (range: 0–5) were measured. Primary outcome was death or functional decline, defined as worsening dependencies in 21 daily activities and physical tasks in 30 days. Secondary outcomes were intensive care unit admission, psychoactive drug use, nasogastric tube feeding, prolonged hospitalization (length of stay > 15 days), and discharge to a long-term care institution. Results The population had a median age 79 (interquartile range, 75–84) years, 68 (38.6 %) female, and 45 (25.5 %) robust, 36 (47.4 %) pre-frail, 37 (21.0 %) mild-to-moderately frail, and 58 (33.0 %) severely frail patients. After adjusting for age, sex, and CURB-65, the risk of primary outcome for increasing frailty categories was 46.7 %, 61.1 %, 83.8 %, and 86.2 %, respectively (p = 0.014). The risk was higher in patients with frailty (FI ≥ 0.25) than without (FI < 0.25) among those with CURB-65 0–2 points (75 % vs. 52 %; p = 0.022) and among those with CURB-65 3–5 points (93 % vs. 65 %; p = 0.007). In addition, patients with greater frailty were more likely to require nasogastric tube feeding (robust vs. severe frailty: 13.9 % vs. 60.3 %) and prolonged hospitalization (18.2 % vs. 50.9 %) and discharge to a long-term care institution (4.4 % vs. 59.3 %) (p < 0.05 for all). Rates of intensive care unit admission and psychoactive drug use were similar. Conclusions Older adults with frailty experience high rates of death or functional decline in 30 days of pneumonia hospitalization, regardless of the pneumonia severity. These results underscore the importance of frailty assessment in the acute care setting.

scholarly journals Changing Educational Gradients in Life Expectancy With and Without Disease Among U.S. Older Adults From 2000 to 2010

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 505-505
Author(s):  
Matthew Farina ◽  
Phillip Cantu ◽  
Mark Hayward
Keyword(s):  
Older Adults ◽  
Life Expectancy ◽  
Chronic Diseases ◽  
Population Aging ◽  
Good Health ◽  
Vital Statistics ◽  
Healthy Life Expectancy ◽  
Healthy Life ◽  
Education Group ◽  
Education Groups

Abstract Recent research has documented increasing education inequality in life expectancy among U.S. adults; however, much is unknown about other health status changes. The objective of study is to assess how healthy and unhealthy life expectancies, as classified by common chronic diseases, has changed for older adults across education groups. Data come from the Health and Retirement Study and National Vital Statistics. We created prevalence-based life tables using the Sullivan method to assess sex-specific life expectancies for stroke, heart disease, cancer, and arthritis by education group. In general, unhealthy life expectancy increased with each condition across education groups. However, the increases in unhealthy life expectancy varied greatly. While stroke increased by half a year across education groups, life expectancy with diabetes increased by 3 to 4 years. In contrast, the evidence for healthy life expectancy provides mixed results. Across chronic diseases, healthy life expectancy decreased by 1 to 3 years for respondents without a 4-year degree. Conversely, healthy life expectancy increased for the college educated by .5 to 3 years. While previous research shows increases in life expectancy for the most educated, trends in life expectancy with chronic conditions is less positive: not all additional years are in lived in good health. In addition to documenting life expectancy changes across education groups, research assessing health of older adults should consider the changing inequality across a variety of health conditions, which will have broad implications for population aging and policy intervention.

scholarly journals Source of Purchased Medications and Its Impact on Medication Mistakes and Hospitalizations: The NHATS 2017

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 793-793
Author(s):  
Martha Coates ◽  
Janeway Granche ◽  
Rose Ann DiMaria-Ghalili
Keyword(s):  
Older Adults ◽  
Hospital Stay ◽  
Chronic Diseases ◽  
Community Dwelling ◽  
Hospital Stays ◽  
Related Harm

Abstract Older adults self-administer prescribed medication regimens to treat chronic diseases which can lead to mismanagement, medication related harm and hospitalizations. We examined the extent to which source of purchased medications influenced the occurrence of self-reported medication mistakes and hospitalizations in community-dwelling participants who managed medications independently (N= 3899). The majority (65%) picked-up medications, 18% had medications delivered, and 17% used both (picked-up and delivery). Compared to those picking up their medications, those using delivery only were less likely to have a hospital stay (OR=0.691 [95% CI 0.507-0.943]) and no difference in odds of medication mistakes (OR=1.051 [95% CI 0.764-1.445]), while those using both methods were more likely to report hospital stays (OR=1.429 [95% CI 1.106-1.846]) and medication mistakes (OR = 1.576[95% CI 1.078-2.304]). Older adults who picked-up medications from a local pharmacy and had medications delivered were more likely to report medication mistakes and hospitalizations.

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