Functional Impairment and Decline in Middle Age

Abstract

Background Difficulties with daily functioning are common in middle-aged adults. However, little is known about the epidemiology or clinical course of these functional problems, including the extent to which they share common features with functional impairment in older adults. Objective To determine the epidemiology and clinical course of functional impairment and decline in middle age. Design Cohort study. Setting The Health and Retirement Study. Participants 6874 community-dwelling adults aged 50–56 who did not have functional impairment at enrollment. Measurements Impairment in activities of daily living (ADLs), defined as self-reported difficulty performing 1 or more ADLs, assessed every 2 years over a maximum follow-up period of 20 years, and impairment in instrumental ADLs (IADLs), defined similarly. Data were analyzed using multi-state models which estimate probabilities of different outcomes. Results Twenty-two percent of participants developed ADL impairment between ages 50 and 64. Among these individuals, further functional transitions were common. Two years after the initial impairment, 4% (95% CI, 3%–5%) of participants had died, 9% (CI, 8%–11%) had experienced further ADL decline, 50% (CI, 48%–52%) had persistent impairment, and 37% (CI, 35%–39%) had recovered independence. In the 10 years following the initial impairment, 16% (CI, 14%–18%) had one or more episodes of functional decline, and 28% (CI, 26%–30%) recovered from their initial impairment and remained independent throughout. The pattern of findings was similar for IADLs. Limitations Functional status was self-reported. Conclusions Functional impairment and decline are common in middle age, as are transitions from impairment to independence and back again. Because functional decline in older adults has similar features, interventions currently used to prevent functional decline among older adults may hold promise for adults in middle age. Primary Funding Source National Institute on Aging and the National Center for Advancing Translational Sciences through the UCSF-Clinical and Translational Sciences Institute

The importance of physical function as a clinical outcome: Assessment and enhancement

“…It is estimated that over 22% of those over age 75 years and over 40% of those over 85 years struggle to perform their basic ADLs . Additionally, ADL impairment is a strong predictor of outcome, predicting longer length of stay in hospital, functional decline, increased risk of institutionalization and death, thus important to assess Cognitive function : A brief screening for cognitive impairment is another important component of the assessment of function as cognition has enormous bearing on physical activity, exercise, as well as activities of daily living .…”

“…Nonetheless, the majority of older adults are predominantly sedentary and fall short of physical activity recommendations, contributing to patterns of premature onset of illness, disease, functional decline, and mortality . Deficits in physical function have also been associated with increased risk of falls, diminished ability to live independently, and poorer self‐reported health . Thus emphasis of physical function in older adults stands out as an important opportunity to identify deficiencies, initiate solutions, and improve health.…”

“…13 Deficits in physical function have also been associated with increased risk of falls, diminished ability to live independently, and poorer self-reported health. 14 Thus emphasis of physical function in older adults stands out as an important opportunity to identify deficiencies, initiate solutions, and improve health.…”

Clinical Features of Geriatric Syndromes in Older Koreans with Diabetes Mellitus

“…Physician-diagnosed Alzheimer disease was also categorized as cognitive impairment. Functional status in the older adults was assessed on the basis of 7 categories of activities of daily living (ADLs) and 10 categories of instrumental activities of daily living (IADLs), 14,16,17) with functional impairment defined as the presence of one or more difficulties in ADL and IADL. 14) Visual and hearing status was assessed via a structured questionnaire, with impairment defined as any inconvenience in daily life such as watching TV, reading the newspaper, talking on the phone, and talking with a person or the need for assistance due to visual and hearing impairment.…”

Do the Tenets of Late-Life Disability Apply to Middle Age?

“…(3) Whether these findings apply to middle-aged persons is uncertain, but is the focus of the study by Brown and colleagues. (4) Using longitudinal data from a large, nationally representative sample of nondisabled persons aged 50 to 56 who were interviewed every two years for up to 20 years, the authors demonstrate relatively high cumulative rates of disability, with more than one out of every five persons reporting new difficulty in one or more self-care activities by the age of 64 and only a slightly lower rate for instrumental activities. Within two years of developing disability, more than a third of participants had recovered, while 10% declined further and 4% died.…”