Difficulty in middle age performing activities of daily living associated with adverse outcomes

April 08, 2019

Bottom Line: Vital to quality of life and health for older adults is the ability to perform activities of daily living: bathing, dressing, eating, using the toilet, transferring locations to get in bed or sit in a chair, and walking across a room. This study looked at whether difficulty in performing ADLs (called functional impairment) in middle age was associated with increased risk of hospitalization, admission to a nursing home and death. Data for 5,540 adults were analyzed and those who developed functional impairment between the ages of 50 and 64 were at increased risk of hospitalization, nursing home admission and death compared with those without functional impairment, although the risk of death wasn't statistically significant after adjusting for traditional risk factors including health status, health-related behaviors and sociodemographics. Middle-age adults with difficulty performing instrumental ADLs, such as managing money and medicine, shopping for groceries and preparing meals or making phone calls, had increased risk of hospitalization, nursing home admission and death in analyses adjusted, or not, for other risk factors. Limitations of this observational study include results not generalizable to people with longstanding disabilities because those with impairments at the study start were excluded. Study results suggest functional impairment has important clinical implications for even relatively young people in middle age.

Authors: Rebecca T. Brown, M.D., M.P.H., of the University of Pennsylvania, Philadelphia, and coauthors


Editor's Note: The article includes funding/support disclosures. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.
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JAMA Internal Medicine

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