Disability in the Oldest Old: “Can Do” or “Do Do”?

Wiel, A. van de; Gussekloo, Jacobijn; Craen, Anton Jm de; Exel, Eric van; Knook, D.L.; Lagaay, A. M.; Westendorp, Rudi G.J.

doi:10.1046/j.1532-5415.2001.49181.x

Cited by 54 publications

(17 citation statements)

References 34 publications

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“…Moreover, since IADL disability is highly prevalent among the very elderly (Bootsma-van der Wiel et al 2001), it is less likely that the oldest old fully recover to a non-disabled state. Therefore, the transition from BADL disability to no disability was too uncommon to include in the multistate model.…”

Section: Discussionmentioning

confidence: 99%

“…The BADL items included the following: walk inside the house, get up and out of bed, get in and out of a chair, visit the toilet, wash hands and face, wash body, dress and undress, eat and drink, and prepare breakfast (Bootsma-van der Wiel et al 2001). The IADL items included the following: light housework, heavy cleaning, wash and iron clothes, clean and make the bed, prepare a hot meal, climbing/descending stairs, get around outdoors, do the groceries, and attend to feet and toenails (Bootsma-van der Wiel et al 2001).…”

Section: Methodsmentioning

confidence: 99%

“…The IADL items included the following: light housework, heavy cleaning, wash and iron clothes, clean and make the bed, prepare a hot meal, climbing/descending stairs, get around outdoors, do the groceries, and attend to feet and toenails (Bootsma-van der Wiel et al 2001). Questions were phrased “ Can you fully independently …?” We dichotomized the answers into a score of 0 (cannot or only with help from others) or 1 (yes fully independently, with or without difficulty).…”

Section: Methodsmentioning

confidence: 99%

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Disability transitions in the oldest old in the general population. The Leiden 85-plus study

Houwelingen

Cameron

Gussekloo

et al. 2013

AGE

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Transitions between disability states in older people occur frequently. This study investigated predictors of disability transitions in the oldest old and was performed in the Leiden 85-plus study, a population-based prospective cohort study among 597 participants aged 85 years. At baseline (age 85 years), data on sociodemographic characteristics and chronic diseases were obtained. Disabilities in basic activities of daily living (BADL) and instrumental activities of daily living (IADL) were measured annually for 5 years with the Groningen Activities Restriction Scale (GARS). Mortality data were obtained. A statistical multi-state model was used to assess the risks of transitions between no disabilities, IADL disability, BADL disability, and death. At baseline, 299 participants (50.0 %) were disabled in IADL only, and 155 participants (26.0 %) were disabled in both BADL and IADL. During 5-year follow-up, 374 participants (62.6 %) made >1 transition between disability states, mostly deterioration in disability. Males had a lower risk of deterioration [hazard ratio (HR), 0.75 (95 % CI, 0.58–0.96)] compared to females. No gender differences were observed for improvement [HR, 0.64 (95 % CI, 0.37–1.11)]. Participants with depressive symptoms were less likely to improve [HR, 0.50 (95 % CI, 0.28–0.87)]. Participants with depressive symptoms [HR, 1.46 (95 % CI, 1.12–1.91)], >1 chronic disease [HR, 1.60 (95 % CI, 1.27–2.01)], and with cognitive impairment [HR, 1.60 (95 % CI, 1.20–2.13)] had the highest risk of deteriorating. Disability is a dynamic process in the oldest old. Deterioration is more common than improvement. Older men are less likely to deteriorate than women. The presence of depressive symptoms, chronic disease, and cognitive impairment predicts deterioration.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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Disability transitions in the oldest old in the general population. The Leiden 85-plus study

Houwelingen

Cameron

Gussekloo

et al. 2013

AGE

View full text Add to dashboard Cite

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“…Disability in basic ADL was determined with the Groningen Activity Restriction Scale, which assesses an individual's competence in the following nine basic activities: walk inside, get up out of bed, get into and out of a chair, visit the toilet, wash hands and face, wash body, dress and undress, eat and drink and make breakfast [17, 18]. Questions are phrased: “ Can you, fully independently , … ?”.…”

Section: Methodsmentioning

confidence: 99%

The effect of cognitive impairment on the predictive value of multimorbidity for the increase in disability in the oldest old: the Leiden 85-plus Study

et al. 2011

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Background: prevention of disability is an important aim of healthcare for older persons. Selection of persons at risk is a first crucial step in this process.Objectives: this study investigates the predictive value of multimorbidity for the development of disability in the general population of very old people and the role of cognitive impairment in this association.Design: the Leiden 85-plus Study (1997–2004) is an observational prospective cohort study with 5 years of follow-up.Setting: general population of the city of Leiden, the Netherlands.Subjects: population based sample of 594 participants aged 85 years.Methods: disability in activities of daily living (ADL) was measured annually for 5 years with the Groningen Activity Restriction Scale (range 9–36, 9 = optimal). Multimorbidity is defined as the presence of two or more chronic diseases at age 85 years. Cognitive function was measured at baseline with the mini-mental state examination (MMSE).Results: at baseline participants with multimorbidity had higher ADL disability scores compared with those without [median 11 inter-quartile range (IQR 9–16) versus 9 (IQR 9–13) ADL points, Mann–Whitney U test P < 0.001]. Stratified into four MMSE groups, ADL disability increased over time in all groups, even in participants without multimorbidity (P trend <0.001). Multimorbidity predicted accelerated increase in ADL disability in participants with MMSE of 28–30 points (n = 205, 0.67 points/year, P < 0.001), but not in participants with lower MMSE scores (all P > 0.100).Conclusion: the predictive value of multimorbidity for the increase in ADL disability varies with cognitive function in very old people. In very old people with good cognitive function, multimorbidity predicts accelerated increase in ADL disability. This relation is absent in very old people with cognitive impairment.

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“…In Europe and North America a handful of studies have begun to document the changing disability and dependency profiles of the oldest old [4-11]. Such profiles have been used in planning health and social care provision and the projection of future needs for services [12-14].…”

Section: Introductionmentioning

confidence: 99%

Capability and dependency in the Newcastle 85+ cohort study. Projections of future care needs

et al. 2011

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BackgroundLittle is known of the capabilities of the oldest old, the fastest growing age group in the population. We aimed to estimate capability and dependency in a cohort of 85 year olds and to project future demand for care.MethodsStructured interviews at age 85 with 841 people born in 1921 and living in Newcastle and North Tyneside, UK who were permanently registered with participating general practices. Measures of capability included were self-reported activities of daily living (ADL), timed up and go test (TUG), standardised mini-mental state examination (SMMSE), and assessment of urinary continence in order to classify interval-need dependency. To project future demand for care the proportion needing 24-hour care was applied to the 2008 England and Wales population projections of those aged 80 years and over by gender.ResultsOf participants, 62% (522/841) were women, 77% (651/841) lived in standard housing, 13% (106/841) in sheltered housing and 10% (84/841) in a care home. Overall, 20% (165/841) reported no difficulty with any of the ADLs. Men were more capable in performing ADLs and more independent than women. TUG validated self-reported ADLs. When classified by 'interval of need' 41% (332/810) were independent, 39% (317/810) required help less often than daily, 12% (94/810) required help at regular times of the day and 8% (67/810) required 24-hour care. Of care-home residents, 94% (77/82) required daily help or 24-hour care. Future need for 24-hour care for people aged 80 years or over in England and Wales is projected to increase by 82% from 2010 to 2030 with a demand for 630,000 care-home places by 2030.ConclusionsThis analysis highlights the diversity of capability and levels of dependency in this cohort. A remarkably high proportion remain independent, particularly men. However a significant proportion of this population require 24-hour care at home or in care homes. Projections for the next 20 years suggest substantial increases in the number requiring 24-hour care due to population ageing and a proportionate increase in demand for care-home places unless innovative health and social care interventions are found.

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Disability in the Oldest Old: “Can Do” or “Do Do”?

Cited by 54 publications

References 34 publications

Disability transitions in the oldest old in the general population. The Leiden 85-plus study

Disability transitions in the oldest old in the general population. The Leiden 85-plus study

The effect of cognitive impairment on the predictive value of multimorbidity for the increase in disability in the oldest old: the Leiden 85-plus Study

Capability and dependency in the Newcastle 85+ cohort study. Projections of future care needs

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