@article {7714, title = {Association of chronic diseases and impairments with disability in older adults: a decade of change?}, journal = {Med Care}, volume = {50}, year = {2012}, month = {2012 Jun}, pages = {501-7}, publisher = {50}, abstract = {

BACKGROUND: Little is known about how the relationship between chronic disease, impairment, and disability has changed over time among older adults.

OBJECTIVE: To examine how the associations of chronic disease and impairment with specific disability have changed over time.

RESEARCH DESIGN: Repeated cross-sectional analysis, followed by examining the collated sample using time interaction variables, of 3 recent waves of the Health and Retirement Study.

SUBJECTS: The subjects included 10,390, 10,621 and 10,557 community-dwelling adults aged 65 years and above in 1998, 2004, and 2008.

MEASUREMENTS: : Survey-based history of chronic diseases including hypertension, heart disease, heart failure, stroke, diabetes, cancer, chronic lung disease, and arthritis; impairments, including cognition, vision, and hearing; and disability, including mobility, complex activities of daily living (ADL), and self-care ADL.

RESULTS: Over time, the relationship of chronic diseases and impairments with disability was largely unchanged; however, the association between hypertension and complex ADL disability weakened from 1998 to 2004 and 2008 [odds ratio (OR) = 1.24; 99\% confidence interval (CI), 1.06-1.46; OR = 1.07; 99\% CI, 0.90-1.27; OR = 1.00; 99\% CI, 0.83-1.19, respectively], as it did for hypertension and self-care disability (OR = 1.32; 99\% CI, 1.13-1.54; OR=0.97; 99\% CI, 0.82-1.14; OR = 0.99; 99\% CI, 0.83-1.17). The association between diabetes and self-care disability strengthened from 1998 to 2004 and 2008 (OR = 1.21; 99\% CI, 1.01-1.46; OR = 1.37; 99\% CI, 1.15-1.64; OR = 1.52; 99\% CI, 1.29-1.79), as it also did for lung disease and self-care disability (OR = 1.64; 99\% CI, 1.33-2.03; OR = 1.63; 99\% CI, 1.32-2.01; OR = 2.11; 99\% CI, 1.73-2.57).

CONCLUSIONS: Although relationships between diseases, impairments, and disability were largely unchanged, disability became less associated with hypertension and more with diabetes and lung disease.

}, keywords = {Activities of Daily Living, Aged, Aging, Cardiovascular Diseases, Chronic disease, Cognition Disorders, Cross-Sectional Studies, Diabetes Mellitus, Disabled Persons, Female, Health Surveys, Hearing loss, Humans, Hypertension, Male, Mobility Limitation, Residence Characteristics, Respiratory Tract Diseases, Self Care, Socioeconomic factors, United States, Vision Disorders}, issn = {1537-1948}, doi = {10.1097/MLR.0b013e318245a0e0}, author = {William W. Hung and Joseph S. Ross and Boockvar, Kenneth S and Albert L Siu} } @article {7637, title = {Recent trends in chronic disease, impairment and disability among older adults in the United States.}, journal = {BMC Geriatr}, volume = {11}, year = {2011}, note = {Hung, William W Ross, Joseph S Boockvar, Kenneth S Siu, Albert L K08 AG032886/AG/NIA NIH HHS/United States U01AG009740/AG/NIA NIH HHS/United States Comparative Study Research Support, N.I.H., Extramural Research Support, Non-U.S. Gov{\textquoteright}t England BMC geriatrics BMC Geriatr. 2011 Aug 18;11:47.}, month = {2011 Aug 18}, pages = {47}, publisher = {11}, abstract = {

BACKGROUND: To examine concurrent prevalence trends of chronic disease, impairment and disability among older adults.

METHODS: We analyzed the 1998, 2004 and 2008 waves of the Health and Retirement Study, a nationally representative survey of older adults in the United States, and included 31,568 community dwelling adults aged 65 and over. Measurements include: prevalence of chronic diseases including hypertension, heart disease, stroke, diabetes, cancer, chronic lung disease and arthritis; prevalence of impairments, including impairments of cognition, vision, hearing, mobility, and urinary incontinence; prevalence of disability, including activities of daily living (ADLs) and instrumental activities of daily living (IADLs).

RESULTS: The proportion of older adults reporting no chronic disease decreased from 13.1\% (95\% Confidence Interval [CI], 12.4\%-13.8\%) in 1998 to 7.8\% (95\% CI, 7.2\%-8.4\%) in 2008, whereas the proportion reporting 1 or more chronic diseases increased from 86.9\% (95\% CI, 86.2\%-89.6\%) in 1998 to 92.2\% (95\% CI, 91.6\%-92.8\%) in 2008. In addition, the proportion reporting 4 or more diseases increased from 11.7\% (95\% CI, 11.0\%-12.4\%) in 1998 to 17.4\% (95\% CI, 16.6\%-18.2\%) in 2008. The proportion of older adults reporting no impairments was 47.3\% (95\% CI, 46.3\%-48.4\%) in 1998 and 44.4\% (95\% CI, 43.3\%-45.5\%) in 2008, whereas the proportion of respondents reporting 3 or more was 7.2\% (95\% CI, 6.7\%-7.7\%) in 1998 and 7.3\% (95\% CI, 6.8\%-7.9\%) in 2008. The proportion of older adults reporting any ADL or IADL disability was 26.3\% (95\% CI, 25.4\%-27.2\%) in 1998 and 25.4\% (95\% CI, 24.5\%-26.3\%) in 2008.

CONCLUSIONS: Multiple chronic disease is increasingly prevalent among older U.S. adults, whereas the prevalence of impairment and disability, while substantial, remain stable.

}, keywords = {Activities of Daily Living, Aged, Aged, 80 and over, Chronic disease, Disabled Persons, Female, Health Surveys, Humans, Longitudinal Studies, Male, United States, Visually Impaired Persons}, issn = {1471-2318}, doi = {10.1186/1471-2318-11-47}, author = {William W. Hung and Joseph S. Ross and Boockvar, Kenneth S and Albert L Siu} } @article {7340, title = {Cognitive decline among patients with chronic obstructive pulmonary disease.}, journal = {Am J Respir Crit Care Med}, volume = {180}, year = {2009}, note = {PMID: 19423714}, month = {2009 Jul 15}, pages = {134-7}, publisher = {180}, abstract = {

RATIONALE: Prior research has suggested an association between chronic obstructive pulmonary disease (COPD) and the development of cognitive decline; however, these studies have been cross-sectional or small case series.

OBJECTIVES: To determine whether COPD increases the risk of cognitive decline among older adults surveyed in a large, population-based longitudinal cohort.

METHODS: We included data from the 1996 to 2002 waves of the Health and Retirement Study, a biennial nationally representative survey. We studied respondents who completed cognitive testing in 1996 and at least one subsequent survey, and excluded those with unknown history of COPD. Clinical history of COPD was based on self-report; severity was categorized based on use of oxygen or disease-related activity limitations. Our primary outcome was cognitive performance, measured using a validated 35-point scale. We examined the effect of COPD on cognition using multivariable mixed linear models accounting for repeated measurements, adjusted for sociodemographic and clinical characteristics.

MEASUREMENTS AND MAIN RESULTS: A total of 4,150 adults were included in our study. Among them, 12\% reported a history of COPD (29\% severe, 71\% nonsevere disease). On repeated measurement, mean cognition scores of older adults with both severe and nonsevere COPD were significantly lower when compared with adults without COPD (2.6 points [P < 0.001] and 0.9 points [P < 0.001], respectively). After multivariable adjustment, mean scores of adults with severe COPD remained lower (0.9 point [P < 0.001]), whereas mean score of adults with nonsevere COPD was no longer different (P = 0.39) when compared with adults without COPD.

CONCLUSIONS: Severe COPD was associated with lower cognitive performance on standardized measurement over time.

}, keywords = {Aged, Case-Control Studies, Cognition Disorders, Female, Health Surveys, Humans, Longitudinal Studies, Male, Middle Aged, Pulmonary Disease, Chronic Obstructive, Pulmonary Ventilation, Risk Factors, Severity of Illness Index, Socioeconomic factors, United States}, issn = {1535-4970}, doi = {10.1164/rccm.200902-0276OC}, author = {William W. Hung and Juan P. Wisnivesky and Albert L Siu and Joseph S. Ross} }