Supported By: This investigation was supported by NIA grant RO1AG21055. OBJECTIVE: To report the level of dependence in Activities of Daily Living (ADLs) and Instrumental Activities of Daily Living (IADLs) in non-demented community dwelling ninety year-olds. BACKGROUND: Little is known about the functional abilities of community-residing oldest-old, the fastest growing segment of the population. METHODS: Eighty nine men and women from the 90+ Study, a population-based investigation of individuals 90 years or older residing in Southern California. Subjects were excluded if they had a Mini-Mental State Examination (MMSE) score of less than 24, or were missing data on any of the relevant variables. Five ADLs (moving about indoors, bathing, eating, continence, and dressing) and five IADLs (doing finances, shopping, traveling out of the neighborhood, preparing meals, and using the telephone) were assessed by self-report from each subject. Each of the ten items was scored as: 0 (independent), 1 (difficult), 2 (needs some assistance), or 3 (dependent). Subjects were considered independent if they had scores of 0 or 1, and dependent if they had scores of 2 or 3 on an item. RESULTS: Sixty seven percent of subjects were women. Fifty six percent lived alone, 20% had a college degree or higher, and mean age was 93.7 years (range 90 to 100). Seventy eight subjects (87.6%) were independent in all five ADLs. Of the 12.4% who needed help with ADLs, assistance was required most frequently for bathing (73%). Sixty two (69.7%) were independent in all five IADLs. Of the 30.3% who needed help on IADLs, assistance was required most frequently for shopping (85%), traveling (48%), and doing finances (37%). CONCLUSION: Most community-residing non-demented 90+ year olds in this study were independent in all ADLs and IADLs. Dependency frequently involved activities that appeared to have a mobility or visual acuity component. Further research is needed to investigate the determinants of functional loss in the oldest-old.

Purpose:To describe the level of function in Activities of Daily Living (ADLs) and Instrumental Activities of Daily Living (IADLs) in those aged 90 and over, the fastest growing segment of the population. Methods:Subjects in The 90+ Study, a population-based study, were rated on ADLs, IADLs, and the Dementia Severity Rating Scale (DSRS) by informants.Six ADLs (transfer, eat, bath, dress, toileting, and continence) and 10 IADLs (bills, finances, shop, games, make coffee, prepare meals, current events, understand television, remember appointments, travel) were scored from 0 (independent) to 3 dependent). Summation ADL scores from 0 (independent) to 18 (dependent) and IADL scores from 0 (independent) to 30 (dependent) were calculated. Memory scores from the DSRS were rated 0 (normal) to 3 (severe loss).We used non-parametric ANOVA to test differences in median scores by gender, age, memory score, and living situation.Results:The sample of 530 was 77% women, average age 94 (range=90-106), and 71% post-high school education. The distribution of IADL scores was bimodal with peaks at 0 (20%) and 30 (11%).The distribution of ADL scores had only one peak at 0 (25%).ADL and IADL scores were significantly related to all variables examined.Conclusion:In addition to age, memory, and living situation, gender appears to be strongly related to functional status.Furthermore, the bimodal distribution of the IADL scores suggests 2 distinct levels of ability.Additional research is needed to further understand the shape and determinants of the functional abilities distributions in the oldest-old.

Background

Atrial fibrillation (AF) adversely impacts health-related quality of life (hrQoL). While some patients demonstrate improvements in hrQoL, the factors associated with large improvements in hrQoL are not well described.

Methods

We assessed factors associated with a 1-year increase in the Atrial Fibrillation Effect on Quality-of-Life score of 1 SD (≥18 points; 3× clinically important difference), among outpatients in the Outcomes Registry for Better Informed Treatment of Atrial Fibrillation I registry.

Results

Overall, 28% (181/636) of patients had such a hrQoL improvement. Compared with patients not showing large hrQoL improvement, they were of similar age (median 73 versus 74, P=0.3), equally likely to be female (44% versus 48%, P=0.3), but more likely to have newly diagnosed AF at baseline (18% versus 8%; P=0.0004), prior antiarrhythmic drug use (52% versus 40%, P=0.005), baseline antiarrhythmic drug use (34.8% versus 26.8%, P=0.045), and more likely to undergo AF-related procedures during follow-up (AF ablation: 6.6% versus 2.0%, P=0.003; cardioversion: 12.2% versus 5.9%, P=0.008). In multivariable analysis, a history of alcohol abuse (adjusted OR, 2.41; P=0.01) and increased baseline diastolic blood pressure (adjusted OR, 1.23 per 10-point increase and >65 mm Hg; P=0.04) were associated with large improvements in hrQoL at 1 year, whereas patients with prior stroke/transient ischemic attack, chronic obstructive pulmonary disease, and peripheral arterial disease were less likely to improve (P<0.05 for each).

Conclusions

In this national registry of patients with AF, potentially treatable AF risk factors are associated with large hrQoL improvement, whereas less reversible conditions appeared negatively associated with hrQoL improvement. Understanding which patients are most likely to have large hrQoL improvement may facilitate targeting interventions for high-value care that optimizes patient-reported outcomes in AF. Registration: URL: http://www.clinicaltrials.gov. Unique identifier: NCT01165710.