Risk factors for functional decline in older adults with arthritis

Abstract

Objective. Functional limitation is a major factor in medical costs. This study was undertaken to evaluate the prevalence of functional limitation among adults with arthritis and the frequency of functional decline over 2 years, and to investigate factors amenable to public health intervention that predict functional decline.Methods. Longitudinal data (1998-2000) from a cohort of 5,715 adults ages 65 years or older with arthritis from a national probability sample were analyzed. Function was defined based on ability to perform basic activities of daily living (ADL) tasks and instrumental ADL. Adjusted odds ratios (ORs) from a multiple logistic regression model were used to estimate the associations between functional decline and comorbid conditions, health behaviors, and economic factors.Results. Overall, 19.7% of this cohort had functional limitation at baseline, including 12.9% with ADL limitations. Over the subsequent 2 years, function declined in 13.6% of those at risk. Functional decline was most frequent among women (15.0%) and minorities (18.0% Hispanics, 18.7% African Americans) with arthritis. Lack of regular vigorous physical activity, the most prevalent risk factor (64%), almost doubled the odds of functional decline (adjusted OR 1.9, 95% confidence interval 1.5-2.4) after controlling for all risk factors. It was found that if all subjects engaged in regular vigorous physical activity, the expected functional decline could be reduced as much as 32%. Other significant predictors included older age, cognitive impairment, depressive symptoms, diabetes, physical limitations, no alcohol use, stroke, and vision impairment.Conclusion. Lack of regular vigorous physical activity is a potentially modifiable risk factor that could substantially reduce functional decline and associated health care costs. Prevention/intervention programs should include regular vigorous physical activity, weight maintenance, and medical intervention for health needs.High economic, societal, and personal costs from functional limitation among older adults make the prevention of functional problems an important public health issue (1-3). Medical spending among the elderly is related more closely to the presence of functional limitation than to remaining life expectancy (4,5). In 1999, more than 44 million Americans had 1 or more conditions that resulted in a limitation of life activities (6), and in 1996, direct medical costs for persons with disability exceeded $260 billion (6). Arthritis and other rheumatic conditions (hereinafter called arthritis) are leading causes of disability in the US (6). Arthritis affects almost 60% of persons ages 65 years and older (7), of whom more than 1 in 10 report activity limitations (8). By 2010, almost 40 million Americans ages 65 years or older are projected to have arthritis (9), potentially escalating the numbers of older adults with functional impairments.An understanding of risk factors related to functional decline is essential to the development of population-based public health programs to...

Prognostic factors for the two‐year course of activity limitations in early osteoarthritis of the hip and/or knee

“…Associations between activity limitations in knee and/or hip OA and ethnicity (11,34,35), multiplesite joint pain (36,37), morning stiffness (38), comorbidity count (5,39), BMI (8), impaired hip flexion (33), bodily pain (8), general health perception (6), and the pain coping strategy transformation (40) have been identified previously in established OA. Furthermore, the results of the present study confirm earlier observations that radiographic status is not closely associated with physical function in patients with knee or hip OA (41)(42)(43).…”

How Safe is Your Neighborhood? Perceived Neighborhood Safety and Functional Decline in Older Adults

“…Studies have shown that sociodemographic characteristics are linked to neighborhood safety [14][15][16] and to long-term functional outcomes. [23][24][25] Baseline health and functional status can also have an impact on the perception of safety 14,15 and long-term functional status. [23][24][25] Race/ethnicity was categorized by participants' response to two questions (1) "Do you consider yourself primarily white or Caucasian, black or African American, American Indian or Asian or something else?"…”

Health care utilization in patients with spondyloarthropathies

“…Regression analyses were not performed individually in patients with ReA due to small numbers. Potential confounders for multivariate analyses for predicting health care utilization were chosen based on reports in other medical conditions [17][18][19]: (i) demographics: age (in years), gender (male/female), race (white vs other), education level (<8 grade, 8-11 grade, high school graduate or college and beyond), employment status (employed, unemployed, retired, unknown), marital status (married, not married); (ii) comorbidity: sum of comorbidities including asthma/COPD, depression, diabetes, hypertension or heart disease (comorbidity scale ranging from 0 to 5); (iii) current smoking status (smoker vs non smoker; and (iv) ADL limitations, categorized as 'no': 0 ADLs, 'moderate': 1-2 ADLs; or 'severe limitations': !3 ADLs; similar to previous studies [14,20]. All analyses were performed using SPSS version 11.0.1 (Chicago, IL, USA).…”

“…The survey provided data regarding marital status, education level and functional status. Physical function was assessed querying limitations (no, some, unable) in six activities of daily living (ADLs: bathing, dressing, eating, transferring to and from chair, walking and using the toilet)-a validated measure [13], used very commonly in cohort studies [14,15].…”