Population-Based Screening for Functional Disability in Older Adults

Author:

Ankuda Claire K1,Freedman Vicki A2,Covinsky Kenneth E34,Kelley Amy S15

Affiliation:

1. Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA

2. Institute for Social Research, University of Michigan, Ann Arbor, USA

3. Division of Geriatrics, University of California, San Francisco, USA

4. Division of Geriatrics, Veterans Affairs Medical Center, San Francisco, California, USA

5. Geriatric Research Education and Clinical Center, James J. Peters Veterans Affairs Medical Center, Bronx, New York, USA

Abstract

Abstract Background and Objectives Screening for functional disability is a promising strategy to identify high-need older adults. We compare 2 disability measures, activities of daily living (ADLs), and life space constriction (LSC), in predicting hospitalization and mortality in older adults. Research Design and Methods We used the nationally representative National Health and Aging Trends Study of 30,885 observations of adults aged 65 years and older. Outcomes were 1-year mortality and hospitalization. Predictors were ADLs (receiving help with bathing, eating, dressing, toileting, getting out of bed, walking inside) and LSC (frequency of leaving home). Results Of respondents, 12.4% reported 3 or more ADLs and 10.8% reported rarely/never leaving home. ADL disability and LSC predicted high rates of 1-year mortality and hospitalization: of those with 3 or more ADLs, 46.4% died and 41.0% were hospitalized; of those who never/rarely left home, 40.7% died and 37.0% were hospitalized. Of those with both 3 or more ADLs and who never/rarely left home, 58.4% died. ADL and LSC disability combined was more predictive of 1-year mortality and hospitalization than either measure alone. ADL disability and LSC screens identified overlapping but distinct populations. LSC identified more women (72.6% vs 63.8% with ADL disability), more people who live alone (40.7% vs 30.7%), fewer who were White (71.7% vs 76.2%) with cancer (27.6% vs 32.4), and reported pain (67.1% vs 70.0%). Discussion and Implications LSC and ADLs both independently predicted mortality and hospitalization but using both screens was most predictive. Routine screening for ADLs and LSC could help health systems identify those at high risk for mortality and health care use.

Funder

National Palliative Care Research Center

National Institute on Aging

Publisher

Oxford University Press (OUP)

Subject

Life-span and Life-course Studies,Health Professions (miscellaneous),Health (social science)

Reference47 articles.

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3. Caregiving, recovery and death after incident ADL/IADL disability among older adults in the United States;Ankuda;Journal of Applied Gerontology,2020

4. Validation of PHQ-2 and PHQ-9 to screen for major depression in the primary care population;Arroll;Annals of Family Medicine,2010

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