Associations of body mass index, waist circumference and the weight-adjusted waist index with daily living ability impairment in older Chinese people: A cross-sectional study of the Chinese Longitudinal Healthy Longevity Survey.

AIM: To investigate the associations of body mass index (BMI), waist circumference (WC) and the weight-adjusted waist index (WWI) with the impairment of activities of daily living (ADL) in older Chinese people. METHODS: A total of 13 260 participants aged 65 years and older from the 2018 Chinese Longitudinal Healthy Longevity Survey were included in this cross-sectional study. BMI, WC and the WWI were calculated from measurements of height, weight and WC. Binary logistic regression was used to estimate odds ratios (ORs) and 95% confidence intervals (95% CIs). Non-linear correlations were investigated using restricted cubic spline curves. RESULTS: In multivariate logistic regression fully adjusted for confounding variables, our analyses revealed significant associations between WC and WWI and ADL impairment, with adjusted ORs (95% CI) of 1.01 (1.00, 1.01) and 1.08 (1.03, 1.12), respectively. Meanwhile, participants with a high WWI had a higher risk of ADL impairment compared with those with a low WWI, with an adjusted OR (95% CI) of 1.12 (1.02, 1.23). Subgroup analyses showed that only the association between WWI and ADL impairment did not differ in any of the different populations. In addition, we found that BMI, WC and WWI were non-linearly associated with ADL impairment. CONCLUSIONS: There are significant associations between WC and WWI and ADL impairment in older Chinese people. The findings show the ability of the WWI to serve as a comprehensive and effective indicator of obesity in older Chinese people and emphasize the importance of assessing WWI in screening and preventing ADL impairment in older people.

Housework participation and mortality in Japanese male patients undergoing cancer surgery: A propensity score-matched study.

BACKGROUND: Participation in housework and meal preparation are instrumental activity of daily living (IADL) evaluation items that is known to predict prognosis and complications in cancer care. However, these items are often assessed only for females, not for males, in IADL. METHODS: We examined the impact of habit of housework and meal preparation on overall survival (OS) in 1025 Japanese male patients who underwent elective urologic cancer surgery at our institution. The study also used a cohort that was matched by propensity score. RESULTS: We found that patients who did not prepare meals or do housework had significantly shorter OS (hazard ratio [HR] = 3.34, P = 0.005; HR = 5.01, P < 0.001, respectively). Even in the cohort of 448 patients matched by propensity score and adjusted for age, body mass index, comorbidities, performance status, living status, cancer type, stage groups of cancer, and surgical approach, lack of participation in housework was associated with shorter OS (HR = 2.92, P = 0.04) and was an independent predictor of worse OS in multivariable analysis (HR = 5.13, P = 0.008). CONCLUSIONS: Males who did not regularly do household chores before elective cancer surgery had worse life outcomes. Doing more daily physical activities, such as household chores like making the bed and cleaning the room, might have a positive impact on survival when fighting cancer.

Facilitating clinical use of the Amsterdam Instrumental Activities of Daily Living Questionnaire: Normative data and a diagnostic cutoff value.

OBJECTIVE: The Amsterdam Instrumental Activities of Daily Living Questionnaire (A-IADL-Q) is well validated and commonly used to assess difficulties in everyday functioning regarding dementia. To facilitate interpretation and clinical implementation across different European countries, we aim to provide normative data and a diagnostic cutoff for dementia. METHODS: Cross-sectional data from Dutch Brain Research Registry (N = 1,064; mean (M) age = 62 ± 11 year; 69.5% female), European Medial Information Framework-Alzheimer's Disease 90 + (N = 63; Mage = 92 ± 2 year; 52.4% female), and European Prevention of Alzheimer's Dementia Longitudinal Cohort Study (N = 247; Mage = 63 ± 7 year; 72.1% female) were used. The generalized additive models for location, scale, and shape framework were used to obtain normative values (Z-scores). The beta distribution was applied, and combinations of age, sex, and educational attainment were modeled. The optimal cutoff for dementia was calculated using area under receiver operating curves (AUC-ROC) and Youden Index, using data from Amsterdam Dementia Cohort (N = 2,511, Mage = 64 ± 8 year, 44.4% female). RESULTS: The best normative model accounted for a cubic-like decrease of IADL performance with age that was more pronounced in low compared to medium/high educational attainment. The cutoff for dementia was 1.85 standard deviation below the population mean (AUC = 0.97; 95% CI [0.97-0.98]). CONCLUSION: We provide regression-based norms for A-IADL-Q and a diagnostic cutoff for dementia, which help improve clinical assessment of IADL performance across European countries.

What factors preventing the older adults in China from living longer: a machine learning study.

BACKGROUND: The fact that most older people do not live long means that they do not have more time to pursue self-actualization and contribute value to society. Although there are many studies on the longevity of the elderly, the limitations of traditional statistics lack the good ability to study together the important influencing factors and build a simple and effective prediction model. METHODS: Based on the the data of Chinese Longitudinal Healthy Longevity Survey (CLHLS), 2008-2018 cohort and 2014-2018 cohort were selected and 16 features were filtered and integrated. Five machine learning algorithms, Elastic-Net Regression (ENR), Decision Tree (DT), Random Forest (RF), K-Nearest Neighbor (KNN), and eXtreme Gradient Boosting (XGBoost), were used to develop models and assessed by internal validation with CLHLS 2008-2018 cohort and temporal validation with CLHLS 2014-2018 cohort. Besides, the best performing model was explained and according to the variable importance results, simpler models would be developed. RESULTS: The results showed that the model developed by XGBoost algorithm had the best performance with AUC of 0.788 in internal validation and 0.806 in temporal validation. Instrumental activity of daily living (IADL), leisure activity, marital status, sex, activity of daily living (ADL), cognitive function, overall plant-based diet index (PDI) and psychological resilience, 8 features were more important in the model. Finally, with these 8 features simpler models were developed, it was found that the model performance did not decrease in both internal and temporal validation. CONCLUSIONS: The study indicated that the importance of these 8 factors for predicting the death of elderly people in China and built a simple machine learning model with good predictive performance. It can inspire future key research directions to promote longevity of the elderly, as well as in practical life to make the elderly healthy longevity, or timely end-of-life care for the elderly, and can use predictive model to aid decision-making.

Predictors of basic and instrumental activities of daily living among older adults with multiple chronic conditions.

BACKGROUND: Understanding the predictors of functional status can be useful for improving modifiable predictors or identifying at-risk populations. Researchers have examined the predictors of functional status in older adults, but there has not been sufficient study in this field in older adults with multiple chronic conditions, especially in Iran. Consequently, the results of this body of research may not be generalizable to Iran. Therefore, this study was conducted to determine the predictors of functional status in Iranian older adults with multiple chronic conditions. METHODS: In this cross-sectional study, 118 Iranian older adults with multiple chronic conditions were recruited from December 2022 to September 2023. They were invited to respond to questionnaires inquiring about their demographic and health information, basic activities of daily living (BADL) and instrumental activities of daily living (IADL), depression and cognitive status. The predictors included age, gender, marital status, education, number of chronic conditions, and depression. Descriptive and analytical statistical tests (univariate and multiple regression analysis) were used to analyze the data. RESULTS: The majority of participants were married (63.9%) and women (59.3%). Based on the results of the multiple regression analysis, age (B=-0.04, P = 0.04), depression (B=-0.12, P = 0.04), and IADL (B = 0.46, P < 0.001) were significant predictors for functional status in terms of BADL. Also, marital status (B=-0.51, P = 0.05), numbers of chronic conditions (B=-0.61, P = 0.002), and BADL (B = 0.46, P < 0.001) were significant predictors for functional status in terms of IADL. CONCLUSION: The findings support the predictive ability of age, marital status, number of chronic diseases, and depression for the functional status. Older adults with multiple chronic conditions who are older, single, depressed and with more chronic conditions number are more likely to have limitations in functional status. Therefore, nurses and other health care providers can benefit from the results of this study and identify and pay more attention to the high risk older adult population.

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

INTRODUCTION: Studies examining the effects of social participation on activities of daily living (ADL) disability are still scarce. AIM: To assess the reciprocal relationship between ADL disability trajectories and social participation among older Chinese people aged ≥ 60 years. METHODS: This study included 2976 participants aged ≥ 60 years in six waves of a community-based survey from 2015 to 2022. Basic activities of daily living (BADL) and instrumental activities of daily living (IADL) were used to assess the ADL disability in each survey. Social participation was assessed by involvement in four social activities and an extensive social participation score. Group-based trajectory modeling was used to identify potential heterogeneity in longitudinal changes over 7 years and explore associations between baseline predictors of group membership and these trajectories. RESULTS: Two BADL disability trajectories were identified: stable (94.8%) and increase (5.2%). Additionally, three IADL disability trajectories were distinguished: stable (73.2%), moderate (20.2%), and increase (6.6%). After controlling for the potential covariates, each point increase in the extensive social participation score correlated with a 17% decrease in the odds of older individuals belonging to the increase BADL trajectory group (OR = 0.83, 95% CI = 0.68-1.00). For IADL, it decreased the odds of being assigned to the moderate trajectory group by 16% (OR = 0.84, 95% CI = 0.75-0.95) and to the increase trajectory group by 23% (OR = 0.77, 95% CI = 0.64-0.93). CONCLUSIONS: Higher levels of social participation among older individuals were more likely to be classified as stable trajectories in both BADL and IADL. Increased participation in social activities by community-dwelling elderly adults may promote healthy aging.

Environment profiles, social participation patterns, depressive symptoms and quality of life of disabled older adults: a longitudinal investigation.

OBJECTIVES: This study used the World Health Organization's healthy ageing framework to explore longitudinal influences of environment profiles and social participation (SP) patterns on depressive symptoms (DSs) and on quality of life (QOL). METHODS: Data were collected from a sample of community-dwelling older adults in Taiwan in 2018 (T1; N = 1,314) and a follow-up survey in 2020 (T2; N = 831). Latent class analysis was conducted to obtain environment and SP profiles. Multilevel modeling was carried out to explicate the hypothesized associations. RESULTS: Three unique environment profiles, labeled as Highly- (Highly-FE), Moderately- (Moderately-FE) and Weakly-Facilitative Environment (Weakly-FE), were identified from T1 data. The three SP classes that were obtained from T1 and T2 data denoted High-, Moderate- and Low-SP. Participants in the 'Highly-FE' class were more likely to belong to the 'High-SP' and 'Moderate-SP' subgroups and exhibited significantly fewer DSs and better QOL. The associations were confirmed both cross-sectionally and longitudinally. CONCLUSION: Interventions should be developed to promote or maintain preferred SP to maximize the current and future mental health and subjective well-being of disabled older adults.

Multiculturalism and reported cognitive change in Parkinson's disease.

OBJECTIVE: Subjective cognitive decline (SCD) and how much cognitive decline impacts one's ability to perform instrumental activities of daily living (iADLs) are necessary elements of neuropsychological assessment when diagnosing mild cognitive impairment (MCI) and dementia. Though limited, the literature suggests that culture and self-appraisal of cognitive abilities are related. However, it is unclear if differences exist in the subjective elements of neuropsychological assessments between patients born in Anglosphere countries (Canada, the USA, and the UK) versus immigrants born elsewhere (International Group). METHOD: We conducted a retrospective chart review of advanced Parkinson's disease (PD) patients (n = 764). Reports of SCD and iADL difficulties were extracted from neuropsychological reports and coded by two independent raters. We also examined responses on self- and family-rated questionnaires of executive functioning and iADL difficulties. RESULTS: Anglosphere and International patients did not differ on overall, memory, or attention SCD, or overall iADL difficulties based on interviews. Anglosphere patients reported more executive and language SCD during the interview but International care-partners reported more current executive dysfunction on a questionnaire. International patients and care-partners reported more iADL difficulties on a questionnaire, which they ascribed to motor (not cognitive) symptoms. The effects on questionnaires were small and persisted after accounting for depression severity ratings. CONCLUSION: There were no consistent group differences in the number or pervasiveness of SCD or iADL difficulties reported by Anglosphere versus International groups. Immigration status has limited effect on these subjective elements and they should be given significant weight when diagnosing cognitive dysfunction in PD.

Dipeptidyl peptidase-4 inhibitors alleviate cognitive dysfunction in type 2 diabetes mellitus.

BACKGROUND: Patients with type 2 diabetes mellitus (T2DM) are commonly at high risk for developing cognitive dysfunction. Antidiabetic agents might be repurposed for targeting cognitive dysfunction in addition to modulation on glucose homeostasis. This study aimed to evaluate the impact of dipeptidyl peptidase-4 inhibitors (DPP-4i) on cognitive function in T2DM. METHODS: PubMed, Embase, Cochrane Library and Web of Science were systematically searched from inception to September 30, 2023. Weighted mean differences were calculated using the Mantel-Haenszel (M-H) fixed or random effects model based on the degree of heterogeneity among studies. Heterogeneity was evaluated using a Chi-squared test and quantified with Higgins I2. Sensitivity analysis was performed with the leave-one-out method, and publication bias was evaluated according to Begg's and Egger's tests. RESULTS: Six clinical trials involving 5,178 participants were included in the pooled analysis. Administration of DPP-4i generally correlated with an increase of Mini-Mental State Examination (MMSE) scores (1.09, 95% CI: 0.22 to 1.96). DPP-4i alleviated cognitive impairment in the copying skill subdomain of MMSE (0.26, 95% CI: 0.12 to 0.40). Treatment with DPP-4i also resulted in an increase of Instrumental Activities of Daily Living (IADL) scores (0.82, 95% CI: 0.30 to 1.34). However, DPP-4i produced no significant effects on Barthel Activities of Daily Living (BADL) scores (0.37, 95% CI: -1.26 to 1.99) or other test scores. CONCLUSIONS: DPP-4i treatment favourably improved cognitive function in patients with T2DM. Further trials with larger samples should be performed to confirm these estimates and investigate the association of different DPP-4i with cognitive function among diabetic patients. TRIAL REGISTRATION IN PROSPERO: CRD42023430873.

Decline of instrumental activities of daily living is a risk factor for nutritional deterioration in older adults: a prospective cohort study.

BACKGROUND: The association between functional capacity and the subsequent risk of nutritional deterioration is yet to be understood. The purpose of this study was to elucidate the relationship between functional capacity, comprising instrumental activities of daily living (IADL), intellectual activity, and social function, and future decline in nutritional status. METHODS: The current study is a two-year prospective cohort study. A total of 468 community-dwelling older adults without nutritional risks were enrolled. We used the Mini Nutritional Assessment Screening Form. Functional capacity, including IADL, intellectual activity, and social function, was assessed using the Tokyo Metropolitan Institute of Gerontology Index of Competence at baseline. The nutritional status was reassessed at a 2-year follow-up. Risk ratios (RR) of functional capacity for the incidence of nutritional decline were estimated. RESULTS: Low functional capacity was significantly associated with future deterioration of nutritional status (RR 1.12, 95% confidence interval [CI] 1.02-1.25). Of the subdomains of functional capacity, IADL decline (adjusted RR 2.21, 95% CI 1.18-4.13) was an independent risk factor for the incidence of nutritional risk. Intellectual and social activities were not significant. CONCLUSION: Decline in functional capacity, especially IADL, is a risk factor for future deterioration in nutritional status. Further studies are required to elucidate the effect of interventions for IADL decline on maintaining nutritional status in older adults.

The impact of social support, physical and psychological performance on sleep outcomes in Iranian older adults: a case-control study.

BACKGROUND: Sleep quality is one of the most important factors to improve the quality of life in older adults and physical and mental health plays an essential role in better sleep quality. This study aimed to determine the impact of social support, and physical and psychological performance on sleep outcomes in Iranian older adults. METHODS: In this case-control study, 400 elder people, who were exposed to sleep problems, and 400 people without sleep problems were randomly selected during 2016-2017 in Amirkola, Iran. Subjects in the case and control groups were matched in terms of gender and age. The demographic characteristics, Duke Social Support Questionnaire (DSSI), Physical Activity Scale for the Elderly (PASE), Activity of Daily Living (ADL), Instrumental Activity of Daily Living (IADL), Mini-Mental State Examination (MMSE), and Pittsburgh Sleep Quality Questionnaire (PSQI) questionnaires were used to collect data. T-test, Chi-square, Pearson Correlation coefficient, and multiple Logistic regression were used for data analysis. RESULTS: The mean score of DSSI and its domains including social interaction (DSSI.Int) and social satisfaction (DSSI.Sat) were 28.15 ± 3.55, 9.31 ± 1.23, and 18.84 ± 2.88 in the case group and 28.87 ± 3.20, 9.48 ± 1.10, and 19.83 ± 2.44 in the control group, respectively. In this study, the mean scores of MMSE, PASE, ADL, and IADL were 25.36 ± 3.95, 101.71 ± 56.99, 13/97 ± 0.37, 20.59 ± 2/79; respectively. There was a significant inverse correlation between poor sleep quality with DSSI score (rho = -0.165, P < 0.0001), DSSI.Int (rho = -0.113, P < 0.001), DSSI.Sat (rho = -0.160, P < 0.0001), PASE (rho=-0.160, P < 0.0001), and IADL (rho = -0.112, P < 0.001) score. Therefore, more social support and physical activity improved the quality of sleep. There was a significant negative relationship between DSSI, and its domains with sleep quality in terms of gender. DSSI (rho = 0.25, P < 0.0001), DSSI.Int (P < 0.0001, rho=-0.18), and DSSI.Sat (P < 0.0001, rho=-0.22) was significant in men but not in women. The results of the adjusted logistic regression revealed a significant association between sleep quality problems and DSSI (p < 0.045, OR = 1.40), the use of hypnotic drugs (p < 0.0001, OR = 7.56), and occupation (p <0.03, OR= 12.66). CONCLUSIONS: The results of the present study suggest that low social support and all its domains, PASE, IADL, and using hypnotic drugs may play a role in the development of sleep problems. It can be used as an effective, safe, and low-cost strategy for promoting sleep quality in older adults.

Social capital and well-being of the elderly 'left-behind' by their migrant children in India.

BACKGROUND: The study aims to examine the association between individual forms of social capital and the well-being of the elderly 'left-behind' parents and to determine if there is a gender difference within the possible relationship. METHODS: This study applied the first wave of the Longitudinal Ageing Study in India (LASI, 2017-18) data. In this study, the respondents were 4,736 older parents 'left-behind' by their migrant adult sons. We employed descriptive statistics and bivariate analysis to assess the study sample's characteristics. The proportion test was performed to examine if there was a significant gender difference among older adults regarding depression, ADL, and IADL impairments. In addition, binary logistic regression was utilized to investigate the associations between social capital and elderly parents' health outcomes. RESULTS: This study found a significant gender difference in depression (male: 8.26%; female:11.32%; P < 0.001), ADL (male:20.23%; female:25.75%; P = 0.032), and IADL (male: 33.97% female: 54.13%; P < 0.001) limitations. Elderly parents who did not participate in any social activity had a higher odd of ADL (aOR: 2.44; 95%CI: 1.882-3.171; P = < 0.001) and IADL (aOR: 1.22; 95%CI: 1.034-1.766 ; P = < 0.001) limitations. Networking with friends through phone/email conversations has a substantial impact on lowering depression in older parents. Older adults with good personal social capital were less likely to have depression, ADL, and IADL limitations. CONCLUSION: Personal social capital is closely associated with the well-being of left-behind older parents. More efforts should be in place to increase the stock of social capital in this group with focused gender disparity.

Virtual reality applications based on instrumental activities of daily living (iADLs) for cognitive intervention in older adults: a systematic review.

BACKGROUND: In recent years, the use of virtual reality (VR) as a complementary intervention in treating cognitive impairment has significantly increased. VR applications based on instrumental activities of daily living (iADL-VR) could offer a promising approach with greater ecological validity for intervention in groups with cognitive impairments. However, the effectiveness of this approach is still debated. OBJECTIVE: This systematic review aims to synthesize the effects of iADL-VR interventions to rehabilitate, train, or stimulate cognitive functions in healthy adults and people with mild cognitive impairment (MCI) and different types of dementia. METHODS: A systematic search was performed in the Scopus, PubMed, IEEE Xplore, Web of Science, and APA PsycNet databases until September 2022 and repeated in April 2023. The selected studies met the search terms, were peer-reviewed, included an iADL-VR intervention, and were written in English. Descriptive, qualitative studies, reviews, cognitive assessment, non-intervention studies, those unrelated to VR or iADL, those focused on motor aspects, and non-degenerative disorders were excluded. The PEDro scale was used to assess the methodological quality of the controlled studies. To present and synthesize the results, we organized the extracted data into three tables, including PEDro scores, participant characteristics, and study characteristics. RESULTS: Nineteen studies that met the inclusion and exclusion criteria were included. The total sample reached 590 participants, mostly women (72.67%). Approximately 30% were diagnosed with Alzheimer's disease or dementia, and 20% had mild cognitive impairment. Variables such as authors and year of publication, study design, type of intervention and VR applied, duration of the intervention, main findings, and conclusions were extracted. Regarding demographic characteristics, the sample size, age, sex, years of education, neurological diagnosis, dropouts, and the city and country where the intervention took place were recorded. Almost all studies showed improvements in some or all the outcomes after the intervention, generally greater in the iADL-VR group than in the control group. CONCLUSION: iADL-VR interventions could be beneficial in improving the performance of cognitive functions in older adults and people with MCI and different types of dementia. The ecological component of these tasks makes them very suitable for transferring what has been learned to the real world. However, such transfer needs to be confirmed by further studies with larger and more homogeneous samples and longer follow-up periods. This review had no primary funding source and was registered with PROSPERO under registration ID: 375166.

Role of age and sex in the association between BMI and functional limitations in stroke patients: Cross-sectional analysis in three European and US cohorts.

BACKGROUND: A U- or J-shaped association between BMI and different post-stroke outcomes is suggested. Thus, the aim is to evaluate the association between BMI with ADL, IADL and mobility limitations in the ageing post-stroke population at different ages, as well as the differences in this association by sex. METHODS: A total of 5,468 participants with stroke and 21,872 without stroke over 50 years of age were assessed for the number of limitations in basic or instrumental activities of daily living (ADL/IADL) as well as mobility tasks. The association between BMI at the interview (continuous time-dependent variable) and the level of limitations was assessed using a linear mixed model stratified by sex and stroke status. RESULTS: The association between BMI and ADL/IADL and mobility limitations were found to be significant in both men and women regardless of stroke status (p<0.001 for all). The association differs between those who have suffered a stroke and those who have not (p<0.001 for all). In ADL/IADL limitations, men with stroke showed a transition from an inverted J-shape to a U-shape association with age. In women, the BMI showed a less pronounced association between BMI and ADL/IADL limitations compared to men but with similar trends. A effect of sex was observed in the association between BMI and mobility, with women with and without stroke showing a linear association that differed from the inverted J-shaped or U-shaped association of men. CONCLUSION: Our results suggest that BMI is associated with limitations in ADL, IADL and mobility in stroke patients. In addition, this association differs between men and women and is also influenced by age.

Functional Disability Among Middle-Aged and Older Adults in China: The Intersecting Roles of Ethnicity, Social Class, and Urban/Rural Residency.

This study explores how ethnicity, family income, and education level differentiate patterns of functional limitations among urban and rural Chinese (aged 45 ≥ years). Based on the 2018 China Family Panel Studies (CFPS) (n = 16,589), this nationwide study employed binary/multinomial logistic regression analyses, stratified by urban/rural residency, to estimate the likelihood of instrumental activities of daily living (IADLs) disability (0/1-2/≥3 limitations) by social determinants of health (SDoH). The estimated overall prevalence of IADLs disability was 14.3%. The multivariable analyses did not find significant ethnic disparity in IADLs disability in urban China, while in rural China, ethnic minorities were 44% more likely to have IADLs disability than Han Chinese. Among rural residents, Mongolians, Tibetans, and Yi minority more than tripled the odds of having ≥3 limitations than Han Chinese; and the intersections of ethnicity and social class were associated with functional limitations. Long-term care and anti-poverty programs should target minority aging populations in rural China.

Investigating the Link Between IADL and Depressive Symptoms in Older Adults: A Cross-Sectional Serial Mediation Model.

OBJECTIVES: There is a dearth of research on the psychological processes that underlie the negative relation between impaired instrumental activities of daily living (IADL) and depressive symptoms in older adults. Drawing on the stress process model and the resilience framework, we investigated whether purpose in life and resilience serially mediate the relationship between impaired IADL and depressive symptoms. METHODS: We recruited 111 cognitively healthy community-dwelling older adults (ages 54-85; M = 66.5) who scored a minimum of 25 points on the Mini-Mental State Examination. RESULTS: We found that purpose in life and resilience serially mediated the relationship between IADL and depressive symptomatology in older adults. This association held true when we controlled for covariates. Additional sensitivity analyses also supported these findings. CONCLUSIONS: This study extends our understanding of how IADL limitations contribute to depressive symptoms. Using a community-dwelling, cognitively healthy sample, we demonstrate that functional limitations indirectly influence older adults' depressive symptoms through a decreased sense of purpose in life and decreased resilience. CLINICAL IMPLICATIONS: Our findings have implications for intervention programs that aim to alleviate IADL limitations and mental health issues in an aging population and promote healthy aging by improving psychosocial resources (i.e., purpose in life and resilience).

Health status and associated factors of middle-aged and older adult cancer survivors in India: results from the Longitudinal Ageing Study in India.

BACKGROUND: The number of persons who have survived cancer has been increasing in India as elsewhere due to advances in detection and treatment of this disease. However, evidence on the standardised number of cancer survivors, their characteristics and their complex health challenges on a national level does not exist due to data limitations. This study, therefore, examines the profile of cancer survivors and their health status using the recently released Longitudinal Ageing Study in India (LASI) survey data. METHODS: LASI wave 1 is a cross-sectional nationally representative survey of 65,562 middle and older adults aged 45 and above. We first calculated the socioeconomic, demographic and geographical characteristics of cancer survivors (per 100,000 population). We later estimated the adjusted odds of poor health, sleep problems, depressive symptoms, activities of living limitations (ADL and IADL), and hospitalisation of cancer survivors using multivariable logistic regression analysis. RESULTS: According to LASI estimates, there were 2.1 million cancer survivors in India (95% CI 1.8 million to 2.6 million) in 2017-18. Overall, 440 cancer survivors have been identified in this study, with considerable state variations. The number of cancer survivors per 1,00,000 population was relatively more in non-indigenous groups, people with a history of cancer in their families, those who worked earlier but currently not working and those in the richest quintile categories. As compared to those who never had cancer, the cancer survivors are at higher risk of hospitalisation (adjusted odds ratio (aOR) = 2.61 CI 1.86, 3.67), poor self-rated health (aOR = 3.77, CI 2.55, 5.54), depressive symptoms (aOR = 1.53, CI 1.41, 2.05) and sleep problems (aOR = 2.29, CI 1.50, 3.47). They also reported higher ADL (aOR = 1.61, CI 1.11, 2.34) and IADL (aOR = 1.49, CI 1.07, 2.07) limitations. Cancer survivors who had their cancer diagnosis in the past 2 years or a cancer-related treatment in the past 2 years have significantly higher odds of poor health status than middle-aged and older adults without a cancer history. CONCLUSION: Middle-aged and older cancer survivors, particularly those who underwent cancer diagnosis or treatment in the past 2 years, are at a significantly higher risk of experiencing poor self-reported health and other health challenges, suggesting the need for an integrated healthcare approach.

Multiple Cognitive and Behavioral Factors Link Association Between Brain Structure and Functional Impairment of Daily Instrumental Activities in Older Adults.

OBJECTIVE: Functional impairment in daily activity is a cornerstone in distinguishing the clinical progression of dementia. Multiple indicators based on neuroimaging and neuropsychological instruments are used to assess the levels of impairment and disease severity; however, it remains unclear how multivariate patterns of predictors uniquely predict the functional ability and how the relative importance of various predictors differs. METHOD: In this study, 881 older adults with subjective cognitive complaints, mild cognitive impairment (MCI), and dementia with Alzheimer's type completed brain structural magnetic resonance imaging (MRI), neuropsychological assessment, and a survey of instrumental activities of daily living (IADL). We utilized the partial least square (PLS) method to identify latent components that are predictive of IADL. RESULTS: The result showed distinct brain components (gray matter density of cerebellar, medial temporal, subcortical, limbic, and default network regions) and cognitive-behavioral components (general cognitive abilities, processing speed, and executive function, episodic memory, and neuropsychiatric symptoms) were predictive of IADL. Subsequent path analysis showed that the effect of brain structural components on IADL was largely mediated by cognitive and behavioral components. When comparing hierarchical regression models, the brain structural measures minimally added the explanatory power of cognitive and behavioral measures on IADL. CONCLUSION: Our finding suggests that cerebellar structure and orbitofrontal cortex, alongside with medial temporal lobe, play an important role in the maintenance of functional status in older adults with or without dementia. Moreover, the significance of brain structural volume affects real-life functional activities via disruptions in multiple cognitive and behavioral functions.

Disease progression in dementia with Lewy bodies: A longitudinal study on clinical symptoms, quality of life and functional impairment.

BACKGROUND AND OBJECTIVES: Dementia with Lewy Bodies (DLB) is a heterogeneous disease, with variable signs and symptoms across multiple domains. We aimed to identify associations with rate of change in cognition, everyday functioning (IADL) and quality of life (QoL). METHODS: We included 121 DLB patients (69 ± 6 yrs, 14%F, MMSE: 25 ± 3) in our prospective cohort (follow-up 2 ± 1 yrs). We described progression of symptoms and cognitive decline over time. Mixed models were used to investigate whether changes in symptoms were associated to changes in IADL (FAQ), QoL (QoL-AD) and caregiver burden (ZBI). Last, we investigated whether baseline symptoms and biomarkers predicted decline in cognition (MMSE), IADL (FAQ) and QoL (QoL-AD). RESULTS: Parkinsonism and RBD were most frequently present early in the disease course, while hallucinations were more likely to develop in a later stage. MMSE (annual change ß ± SE = -2.06 ± 0.23), QoL-AD (-1.03 ± 0.20), and FAQ (3.04 ± 0.30) declined over time. Increasing severity of clinical symptoms was associated to increases in FAQ, QoL-AD and caregiver burden. Baseline clinical symptoms were not predictive for decline in these outcomes. By contrast, AD co-pathology (CSF pTau/Aß42 ratio) was associated to steeper decline in MMSE (-1.23 ± 0.54). Medial temporal atrophy (-0.81 ± 0.26) and global cortical atrophy (-0.73 ± 0.36) predisposed for decline in QoL-AD. CONCLUSIONS: Our findings imply that underlying disease processes, rather than clinical symptomatology aid in predicting decline. These findings are relevant for treatment strategies and the development of DLB specific outcome measures.

Predicting financial deficits from a standard neuropsychological assessment: preliminary evidence in mild cognitive impairment.

Patients with mild cognitive impairment (MCI) might experience difficulties in numerical and financial abilities of daily living that compromise their autonomy. The aim of the present work was to examine whether specific tests of the standard neuropsychological assessment could be used to predict these deficits in the clinical practice. Thirty-four MCI patients underwent a comprehensive clinical and neuropsychological examination including (1) a complete assessment of financial abilities and (2) a traditional neuropsychological assessment including measures of language, memory, executive functioning, reasoning, attention, and visuospatial abilities. The neuropsychological tests were used as predictors of the performance in everyday financial tasks using logistic regression analysis. Deficits in financial tasks including calculating percentages, using financial concepts and applying financial judgments were significantly predicted by tests of executive functions, language and short-term memory, while deficits in frequently encountered financial tasks activities such as item purchase and reading numbers could not be predicted by standard neuropsychological evaluations. Contingency tables on performance above/below clinical cut-offs evidenced some cases of financial deficits in the absence of cognitive deficits and, vice versa, some patients with cognitive decline did not show financial impairments. These results suggest that while some cognitive functions might be crucial for taking financial decisions, an ad hoc test of financial capacity is essential to make overall inferences about the everyday financial autonomy of MCI patients. This has potential implications for clinical and legal decisions that directly impact the individuals and their families.