ABSTRACT
BACKGROUND: Population-level surveillance of the prevalence and trends of basic self-care limitations will help to identify the magnitude of physical disablement in the rapidly growing older American demographic. We sought to evaluate the prevalence and trends of activities of daily living (ADL) limitations in the United States. METHODS: The analytic sample included 30,418 Americans aged ≥50 years from the 2006-2018 waves of the Health and Retirement Study. ADLs were self-reported. Weighted prevalence estimates were presented, and trends analyses were performed. RESULTS: Although overall ADL disability prevalence was 16.5% (95% confidence interval: 15.8-17.2) in 2018, there were no changes in limitations during the study period (p = 0.52). Older adults had a greater ADL disability prevalence than middle-aged adults (p < 0.001). While older persons experienced a declining trend of ADL limitations (p < 0.001), middle-aged persons had an increasing trend (p < 0.001). Males had a lower ADL limitation prevalence than females (p < 0.001). Hispanic and non-Hispanic Black had a higher ADL disability prevalence than non-Hispanic White (p < 0.001). CONCLUSIONS: This investigation revealed that while the estimated prevalence of ADL limitations in the United States was substantial, changes in such limitations were not observed. Our findings can help guide ADL screening, target sub-populations with an elevated ADL limitation prevalence, and inform interventions.
ABSTRACT
OBJECTIVES: New absolute and normalized handgrip strength (HGS) cut-points may not yield similar predictive value for cognitive performance. We sought to determine the associations of (1) each absolute and normalized weakness cut-point, and (2) compounding weakness on future cognitive impairment in older Americans. DESIGN: Longitudinal panel. SETTING AND PARTICIPANTS: The analytic sample included 11,116 participants aged ≥65 years from the 2006 to 2018 waves of the Health and Retirement Study. Participants from the Health and Retirement Study completed detailed interviews that included physical measures and core interviews. METHODS: The modified Telephone Interview of Cognitive Status assessed cognitive function and persons scoring <11 were classified as having a cognitive impairment. A handgrip dynamometer measured HGS. Men were considered weak if their HGS was <35.5 kg (absolute), <0.45 kg/kg (body mass normalized), or <1.05 kg (body mass index normalized), whereas women were classified as weak if their HGS was <20.0 kg, <0.337 kg/kg, or <0.79 kg. Compounding weakness included those below 1, 2, or all 3 cut-points. Generalized estimating equations quantified the associations. RESULTS: Persons considered weak under the absolute cut-point had 1.62 (95% CI 1.34-1.96) greater odds for future cognitive impairment, but no significant associations were observed for those classified as weak under the body mass [odds ratio (OR) 1.12, CI 0.91-1.36] and body mass index normalized (OR 1.17, CI 0.95-1.43) cut-points. Older Americans below all 3 weakness cut-points had 1.47 (CI 1.15-1.88) greater odds for future cognitive impairment, but no significant associations were found for persons classified as weak under 1 (OR 1.08, CI 0.83-1.42) or 2 (OR 1.19, CI 0.91-1.55) cut-points. CONCLUSIONS AND IMPLICATIONS: Our findings suggest that each weakness cut-point has differential prognostic value for future cognitive impairment, and aggregating weakness cut-points may improve their predictive utility. Consideration should be given to how weakness categories are uniquely linked to cognitive function.