Impairment in mid-life raises risk of hospitalization and death

Photo: Anne Worner via Flickr

Adults in their 50s and 60s who have trouble with basic activities of daily living (ADLs) such as bathing and dressing are more likely to be hospitalized or end up in a nursing home compared with unimpaired adults the same age, according to a study in JAMA Internal Medicine.

Factors such as chronic disease, depression and obesity can contribute to functional impairment; intervention strategies are needed to prevent adverse outcomes and delay struggles with daily activities that affect health and quality of life.

Researchers at the University of Pennsylvania and the University of California, San Francisco, wanted to find out how middle-aged adults became functionally impaired and if their impairments posed the same risks as similar impairments in older adults. Previous studies confirm older adults with multiple ADLs are more likely to be hospitalized or admitted to a nursing home.

Nearly 15% of adults 55 to 64 reported functional impairment, struggling to perform one or more of six basic ADLs: bathing, dressing, transferring (such as from a bed to a chair), toileting, eating and walking across a room.

Researchers analyzed health data for 5,540 adults, 50 to 56, (median age 53.7), from the nationally representative Health and Retirement Study (HRS). None was functionally impaired when they entered the HRS but 1,097 of them (19.8%) reported developing an impairment in at least one ADL by age 64. Sociodemographic characteristics were assessed at the start of the study enrollment, including self-reported age, sex, race/ethnicity, marital status and education level; other variables were assessed when functional impairment was first reported.

Self-reported health status included any chronic health conditions, visual, or hearing impairments, as well as health behaviors including smoking, alcohol use and physical activity. Other factors included insurance status, income level and self-reported neighborhood safety.

Researchers examined data reported every two years through 2014. They found that functionally impaired participants had a significantly higher risk of hospitalization and nursing home admission than participants their age without functional impairment. The risk of death in the two groups were about the same after adjusting health status and health behaviors.

The study found similar risks for hospitalization and nursing home admission, as well as for death, in the 857 HRS participants (15.5%) who developed trouble performing at least one instrumental ADL. Instrumental ADLs include managing money, managing medications, shopping for groceries, preparing meals, and making telephone calls.

Not all functional impairments are permanent; sometimes they are temporary or disappear and then recur. Participants with functional impairments were more likely to be women, racial or ethnic minorities, unmarried, and to have lower socioeconomic status. They also had poorer health status and were more likely to smoke, exercise infrequently, and lack health insurance.

The authors pointed out that function is seldom routinely assessed in U.S. primary care settings. “This disconnect highlights the need to change how we approach function in our patients, from a concept on the sidelines of medical care to a measure as central as chronic illnesses.” As in older adults, functional impairment in middle-aged adults can affect health and quality of life.

Several study limitations were noted including exclusion of participants with pre-existing disabilities, self-reported health status, and those who had been admitted to a hospital or nursing home prior to the start of the study.

Journalists may want to take a deeper dive into the issues of ADLs and IADLs and whether any community programs exist that help older adults remain independent. Are there programs for those younger than 65 struggling with ADLs?

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