Instrumental activities of daily living trajectories and risk of mild cognitive impairment among Chinese older adults: results of the Chinese longitudinal healthy longevity survey, 2002–2018

Abstract

BackgroundThe association between the instrumental activities of daily living (IADL) score and the risk of initial cognitive function impairment is inconclusive. We aimed to identify distinctive IADL trajectories and examine their relationship with the onset of mild cognitive impairment (MCI) among Chinese older people.MethodsThe study used six-wave longitudinal data from the Chinese Longitudinal Healthy Longevity Survey conducted between 2002 and 2018. It included a total of 11,044 Chinese people aged 65 years or older. A group-based trajectory model was used to identify distinctive trajectories of the IADL score, and the Cox proportional hazards model was used to explore the hazard ratio of various trajectories at the onset of MCI. Interaction analysis was used to analyze individual modification between the IADL trajectories and the onset of MCI. Finally, we adopted four types of sensitivity analysis to verify the robustness of the results.ResultsDuring a median follow-up of 16 years, the incidence of MCI was 6.29 cases per 1,000 person-years (95% confidence interval [CI] 5.92–6.68). Three distinct IADL trajectory groups were identified: a low-risk IADL group (41.4%), an IADL group with increasing risk (28.5%), and a high-risk IADL group (30.4%). Using the Cox proportional hazards model after adjusting for covariates, we found that compared with the low risk IADL group, the hazard ratio of the IADL group with increasing risk was 4.49 (95% CI = 3.82–5.28), whereas that of the high-risk IADL group was 2.52 (95% CI 2.08–3.05). Treating the IADL group with increasing risk as the reference, the hazard ratio for the high-risk IADL group was 0.56 (95% CI 0.48–0.66). Interaction analyses showed that age and residence were significant moderators (P for interaction <0.05).ConclusionA group-based trajectory model was developed to classify older people into three distinct trajectory groups of the IADL score. The IADL group with increasing risk had a greater risk of MCI than the high-risk IADL group. In the IADL group with increasing risk, city residents of ≥80 years were the most likely to develop MCI.

Effect of social participation on the trajectories of activities of daily living disability among community-dwelling older adults: a 7-year community-based cohort

“…The findings of this study are in line with earlier studies that have classified IADL disability trajectories into three categories [ 16 , 31 ]. However, a previous analysis of CHARLS data from 2011 to 2018 using group-based modeling identified three typical BADL disability trajectories [ 35 ].…”

“…To determine the best-fitting discrete number and pattern of ADL score trajectories, we used group-based trajectory modeling (GBTM), which is increasingly applied in healthy aging research [ 30 , 31 ]. The time metric was the years since baseline (2015–2022), and six waves of ADL scores were used to estimate the trajectory.…”

Identifying Predictive Risk Factors for Future Cognitive Impairment Among Chinese Older Adults: Longitudinal Prediction Study

“…A plethora of modifiable and nonmodifiable risk factors that are associated with cognitive impairment among Chinese older adults have been identified. Previous studies have found that increased age, limited functional independence, alcohol consumption, hypertension, and depression are significantly associated with cognitive impairment [ 3 9-12 undefined undefined undefined ]. Protective factors have also been identified, namely, good sleep quality, sleeping sufficiently for many hours per night, exercise, and increased social participation [ 3 9 13-17 undefined undefined undefined undefined ].…”

Latent transition analysis of instrumental activities of daily living in Chinese elderly: based on the 2014–2018 wave of the Chinese Longitudinal Healthy Longevity Survey

“…Importantly, a study identified three combined profiles of BADL and IADL employing latent profile analysis (LPA) among elderly individuals in China [ 6 ]. Another study using a group-based trajectory model demonstrated the dynamic changes of IADL over time, which could be divided into three trajectories [ 20 ]. Both studies demonstrated the differences in IADL among elderly individuals based on latent variable modeling, which may be attributed to various demographic characteristics such as age [ 12 ], health conditions [ 13 ], and their changes over time.…”

“…Second, most studies have been cross-sectional in nature. Although longitudinal studies have demonstrated the existence of three distinct developmental trajectories for IADL [ 20 ], the probability of transitions in the state of IADL over time remains unclear. To address these limitations, latent transition analysis (LTA) may offer a promising solution.…”