Activities of daily living

Physical and cognitive functioning of people older than 90 years: a comparison of two Danish cohorts born 10 years apart.

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Background

A rapidly increasing proportion of people in high-income countries are surviving into their tenth decade. Concern is widespread that the basis for this development is the survival of frail and disabled elderly people into very old age. To investigate this issue, we compared the cognitive and physical functioning of two cohorts of Danish nonagenarians, born 10 years apart.

Methods

People in the first cohort were born in 1905 and assessed at age 93 years (n=2262); those in the second cohort were born in 1915 and assessed at age 95 years (n=1584). All cohort members were eligible irrespective of type of residence. Both cohorts were assessed by surveys that used the same design and assessment instrument, and had almost identical response rates (63%). Cognitive functioning was assessed by mini-mental state examination and a composite of five cognitive tests that are sensitive to age-related changes. Physical functioning was assessed by an activities of daily living score and by physical performance tests (grip strength, chair stand, and gait speed).

Findings

The chance of surviving from birth to age 93 years was 28% higher in the 1915 cohort than in the 1905 cohort (6·50% vs 5·06%), and the chance of reaching 95 years was 32% higher in 1915 cohort (3·93% vs 2·98%). The 1915 cohort scored significantly better on the mini-mental state examination than did the 1905 cohort (22·8 [SD 5·6] vs 21·4 [6·0]; p<0·0001), with a substantially higher proportion of participants obtaining maximum scores (28—30 points; 277 [23%] vs 235 [13%]; p<0·0001). Similarly, the cognitive composite score was significantly better in the 1915 than in the 1905 cohort (0·49 [SD 3·6] vs 0·01 [SD 3·6]; p=0·0003). The cohorts did not differ consistently in the physical performance tests, but the 1915 cohort had significantly better activities of daily living scores than did the 1905 cohort (2·0 [SD 0·8] vs 1·8 [0·7]; p<0·0001).

Interpretation

Despite being 2 years older at assessment, the 1915 cohort scored significantly better than the 1905 cohort on both the cognitive tests and the activities of daily living score, which suggests that more people are living to older ages with better overall functioning.

Source: Lancet

 

Cognitive Function and Daily Independence in Nonagenarians Are Improving.

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People born in 1915 scored higher than those born a decade earlier, despite no significant improvement in physical performance.
Elders increasingly are living past age 90, raising concerns that their illnesses and infirmities will burden society. However, data are scarce regarding the health status of nonagenarians. To explore this issue, researchers surveyed nonagenarians in two Danish cohorts born 10 years apart. In 1998, 2262 Danish residents who were born in Denmark in 1905 were interviewed (directly or by proxy) and underwent physical and cognitive tests. Twelve years later, investigators used the same methods to survey 1584 Danish residents born in Denmark in 1915.

Although the 1915 cohort was about 2 years older than the 1905 cohort when it was studied (mean age, 95 vs. 93), members of the 1915 cohort scored significantly higher on the Mini-Mental State Examination (mean score, 22.8 vs. 21.4) and were significantly more likely to achieve maximum scores of 28 to 30 (23% vs. 13%); the 1915 cohort also scored higher on activities of daily living. No consistent differences were observed between cohorts on measures of physical performance or depression.

COMMENT

Even without an improvement in physical performance, Danish nonagenarians seem to have become more independent in their activities of daily living, probably, as the authors suggest, because of improved cognitive function and better living accommodations. Whether these findings can be generalized to the U.S. is unclear, because economic conditions and social services are different in the two countries.

Source: NEJM

Unhealthy behaviours and disability in older adults: Three-City Dijon cohort study.

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Abstract

Objectives To examine the individual and combined associations of unhealthy behaviours (low/intermediate physical activity, consuming fruit and vegetables less than once a day, current smoking/short term ex-smoking, never/former/heavy alcohol drinking), assessed at start of follow-up, with hazard of disability among older French adults and to assess the role of potential mediators, assessed repeatedly, of these associations.

Design Population based cohort study.

Setting Dijon centre of Three-City study.

Participants 3982 (2410 (60.5%) women) French community dwellers aged 65 or over included during 1999-2001; participants were disability-free at baseline when health behaviours were assessed.

Main outcome measure Hierarchical indicator of disability (no, light, moderate, severe) combining data from three disability scales (mobility, instrumental activities of daily living, basic activities of daily living) assessed five times between 2001 and 2012.

Results During the 12 year follow-up, 1236 participants (861 (69.7%) women) developed moderate or severe disability. Interval censored survival analyses (adjusted for age, sex, marital status, and education) showed low/intermediate physical activity (hazard ratio 1.72, 95% confidence interval 1.48 to 2.00), consuming fruit and vegetables less than once a day (1.24, 1.10 to 1.41), and current smoking/short term ex-smoking (1.26, 1.05 to 1.50) to be independently associated with an increased hazard of disability, whereas no robust association with alcohol consumption was found. The hazard of disability increased progressively with the number of unhealthy behaviours independently associated with disability (P<0.001); participants with three unhealthy behaviours had a 2.53 (1.86 to 3.43)-fold increased hazard of disability compared with those with none. Reverse causation bias was verified by excluding participants who developed disability in the first four years of follow-up; these analyses on 890 disability events yielded results similar to those in the main analysis. 30.5% of the association between the unhealthy behaviours score and disability was explained by body mass index, cognitive function, depressive symptoms, trauma, chronic conditions, and cardiovascular disease and its risk factors; the main contributors were chronic conditions and, to a lesser extent, depressive symptoms, trauma, and body mass index.

Conclusions An unhealthy lifestyle is associated with greater hazard of incident disability, and the hazard increases progressively with the number of unhealthy behaviours. Chronic conditions, depressive symptoms, trauma, and body mass index partially explained this association.

Source: BMJ