Stroke-associated differences in rates of activity of daily living loss emerge years before stroke onset.

TitleStroke-associated differences in rates of activity of daily living loss emerge years before stroke onset.
Publication TypeJournal Article
Year of Publication2013
AuthorsCapistrant, BD, Wang, Q, Liu, SY, M. Glymour, M
JournalJ Am Geriatr Soc
Date Published2013 Jun
ISSN Number1532-5415
KeywordsActivities of Daily Living, Age of Onset, Aged, Aged, 80 and over, Bayes Theorem, Disability Evaluation, Disabled Persons, Female, Follow-Up Studies, Geriatric Assessment, Humans, Male, Middle Aged, Morbidity, Prospective Studies, Risk Assessment, Risk Factors, Socioeconomic factors, Stroke, Stroke Rehabilitation, Survival Rate, Survivors, Time Factors, United States

OBJECTIVES: To compare typical age-related changes in activities of daily living (ADLs) independence in stroke-free adults with long-term ADL trajectories before and after stroke.

DESIGN: Prospective, observational study.

SETTING: Community-dwelling Health and Retirement Study (HRS) cohort.

PARTICIPANTS: HRS participants who were stroke free in 1998 and were followed through 2008 (average follow-up 7.9 years) (N = 18,441).

MEASUREMENTS: Strokes were assessed using self- or proxy-report of a doctor's diagnosis and month and year of event. Logistic regression was used to compare within-person changes in odds of self-reported independence in five ADLs in those who remained stroke free throughout follow-up (n = 16,816), those who survived a stroke (n = 1,208), and those who had a stroke and did not survive to participate in another interview (n = 417). Models were adjusted for demographic and socioeconomic covariates.

RESULTS: Even before stroke, those who later developed stroke had significantly lower ADL independence and were experiencing faster independence losses than similar-aged individuals who remained stroke free. Of those who developed a stroke, survivors experienced slower pre-stroke loss of ADL independence than those who died. ADL independence declined at the time of stroke and decline continued afterwards.

CONCLUSION: In adults at risk of stroke, disproportionate ADL limitations emerge well before stroke onset. Excess disability in stroke survivors should not be entirely attributed to effects of acute stroke or quality of acute stroke care. Although there are many possible causal pathways between ADL and stroke, the association may be noncausal. For example, ADL limitations may be a consequence of stroke risk factors (e.g., diabetes mellitus) or early cerebrovascular ischemia.

User Guide Notes

Endnote Keywords

Gerontology And Geriatrics/ADL and IADL Impairments/Stroke/Self assessed health/risk Factors

Endnote ID


Alternate JournalJ Am Geriatr Soc
Citation Key7814
PubMed ID23668393
PubMed Central IDPMC4312665
Grant ListR21 AG034385 / AG / NIA NIH HHS / United States
R24 HD050924 / HD / NICHD NIH HHS / United States
T32 HD007168 / HD / NICHD NIH HHS / United States
R21-AG034385 / AG / NIA NIH HHS / United States