Time trends in prevalence of activities of daily living (ADL) disability and survival: Comparing two populations (aged 78+ years) living in a rural area in Sweden

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Abstract

The aim was to study time trends in prevalence of disability in ADL and survival among men and women 78 years and older comparing two cohorts. The study was a time trend study based on two population-based community cohorts, the Nordanstig Project (NP), collected 1995–1998 and the Swedish National Study on Aging and Care in Nordanstig (SNAC-N), collected 2001–2003. The participants were people aged 78 years and older from the NP cohort (N = 303) and from the SNAC-N cohort (N = 406). All were clinically examined by physicians and nurses using standardized protocols. Disability was defined as a need for assistance in one or more ADL activities. The prevalence of disability and survival were compared using logistic and Cox models. The prevalence of ADL disability was stable for men, while women became more disabled in ADL during the time period, OR 2.36 (1.12–4.94). There was no significant difference in survival time between the cohorts in either ADL disabled persons or non-disabled persons. There was a tendency for increased survival for non-disabled persons in SNAC-N compared with NP, although not significant; this was particularly true for women. In general, women survived longer than men did regardless of whether they were ADL disabled or not. The time trends for ADL disability found in the study show that ADL disability had increased in women but not in men. More studies are needed to identify risk factors for ADL disability with a view to preventing it in time.

Introduction

Life expectancy is increasing in many countries and people in old age are living longer (Christensen et al., 2009, Lutz et al., 2008). Three different scenarios can be seen for future morbidity: (1) depiction of a present health, (2) a future where both life expectancy and morbidity are extended, and (3) a future where both the time period after first morbidity and the amount of morbidity are decreased, resulting in compression of morbidity (Fries, Bruce, & Chakravarty, 2011). Studies on time trends in disability in ADL have shown different results. Stability across time in prevalence of ADL disability was found in a study from the US on adults 70 years and older between 1982 and 2009 (Lin, Beck, Finch, Hummer, & Master, 2012) and in a study from Sweden on participants 75 years and older between 1992 and 2002 (Ahacic et al., 2007, Schon et al., 2011) while another study also from the US, using two surveys (1988–1994 and 1999–2004), found mixed results in ADL disability in different ages, an increase in ADL disability in the age range 60–69 years but not in participants 70 years or older (Seeman, Merkin, Crimmins, & Karlamangia, 2010). An increase in ADL disability from 2000 to 2007 was also found in a Spanish population 65 years and older (Palacios-Cena et al., 2012) and in a study from the US looking at the period 2000 to 2005 (Fuller-Thomson, Yu, Nuru-Jeter, Guralnik, & Minkler, 2009). Improvement in ADL disability has been found in four studies: one US study between 1982 and 2005 in persons aged 65 years and older (Manton, Gu, & Lamb, 2006), in the Framingham study between 1970s and 1990s in persons aged 79–88 years (Murabito et al., 2008), in older persons aged 68–88 years in Europe between 1988 and 2001 (Aijanseppa et al., 2005) and in persons 65 years and older in China between 1998 and 2008 (Feng et al., 2013).

Several studies have shown gender differences in disability, mostly that women have a higher prevalence of ADL disability than men do (Guralnik et al., 1997, von Strauss et al., 2000, Zeki Al Hazzouri et al., 2011). One reason may be women's lower mortality rates, i.e. better survival rates from chronic diseases that result in longer duration of disability (Oman, Reed, & Ferrara, 1999). The fact that women have a different disease course was found in a study of disease activity and disability in women and men with early rheumatoid arthritis (RA). During an 8-year period, both men and women gradually worsened in disability, but the women had more disability than the men did (Hallert, Bjork, Dahlstrom, Skogh, & Thyberg, 2012).

To summarize, studies to date have shown different scenarios for ADL disability over time. Given these conflicting results, there is a need for more studies that examine whether and how ADL disability rates change over time, and the best way to approach this is to conduct population-based studies. Therefore, our aim was to study time trends in prevalence of ADL disability, defined as a need for assistance in one or more ADL activities, and survival among men and women 78 years and older comparing two defined cohorts.

Although the literature is unclear as to how morbidity has changed over time, our hypothesis is that ADL disability in the older population has declined.

Section snippets

Study design

The present project is a time trend study comparing the prevalence of disability in ADL between two population-based cohorts in the rural municipality of Nordanstig in Sweden: (1) The Kungsholmen-Nordanstig Project (NP), a study on aging and dementia originating from the Kungsholmen Project (Fratiglioni, Viitanen, Backman, Sandman, & Winblad, 1992), and (2) the Swedish National Study on Aging and Care in Nordanstig (SNAC-N), an ongoing study on aging and care that is part of a larger national

Results

Thirteen percent of the NP cohort had died before examination and 6% refused to participate, as compared to the reverse 3% and 25% respectively in the SNAC-N cohort. There were no significant age or gender differences between participants and non-participants in the two studies.

Sociodemographic characteristics are presented in Table 1. The two study populations had similar age and gender distributions. The mean (SD) age in the NP cohort was 83.1 (4.6) and in the SNAC-N cohort 83.8 (4.9). The

Discussion

The aim of the present study was to study time trends in prevalence of ADL disability and survival among men and women 78 years and older comparing two cohorts. The strength of this study is the use of two population-based cohorts and, in contrast to many other studies, it included all inhabitants in a municipality whether they were living at home or in a residential care. Furthermore, data on ADL disability was collected both through interviews and observations during the interviews. The main

Conclusion

The time trends for ADL disability found in the present study show that ADL disability had increased in women but not in men. More studies are needed to identify risk factors for becoming disabled with a view to preventing disability.

Conflicts of interest statement

Anders Wimo has been a consultant to most pharmaceutical companies engaged in research on drugs for Alzheimer's Disease. Anders Wimo has no shares or employment in these companies. For this study, he has nothing to declare.

All other authors: nothing to declare.

Acknowledgements

This study was supported by grants from the Swedish Brain Power, Center for Gender Medicine at Karolinska Institutet, the Alzheimer Foundation Sweden, and Karolinska Institutet Foundations. The sponsors had no role in the design, methods, participant recruitment, data collection, analysis, or preparation of the manuscript.

We thank all the members of the SNAC-Nordanstig Project Study Group for data collection and management.

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