In the Journals

Difficulty with basic daily activities in middle age often progresses to further decline, death

Among middle-aged patients, functional impairment was common and 35% of those with impaired function died or progressed to further decline over the next 10 years, according to research published in Annals of Internal Medicine.

“Difficulties with daily functioning are common in middle-aged adults,” Rebecca T. Brown, MD, MPH, from the University of California, San Francisco, and colleagues wrote. “However, little is known about the epidemiology or clinical course of these problems, including the extent to which they share common features with functional impairment in older adults.”

To address this gap in knowledge, Brown and colleagues examined data from the Health and Retirement Study of 6,874 community-dwelling adults aged 50 to 56 years who did not have functional impairment at enrollment.

The researchers assessed the cumulative incidence of the first episode of impairment in basic activities of daily living (ADLs), including bathing, dressing and transferring out of a bed or chair, toileting and eating as well as instrumental ADLs (IADLs), including managing money, managing medications, shopping for groceries, preparing meals and making telephone calls. ADL and IADL impairment were defined as having difficulty performing one or more ADLs or IADLs, respectively. Impairment was evaluated every 2 years and follow-up was performed at a maximum of 20 years.

Data showed that 22% of participants aged 50 to 64 years developed ADL impairment. Two years following the initial episode of functional impairment, 37% (95% CI, 35-39%) of participants fully recovered independence, while 4% (95% CI, 3-5%) died, 9% (95% CI, 8-11%) had worse ADL functional status and 50% (95% CI, 48%-52%) had persistent impairment.

During the 10 years after the initial impairment, 19% died (95% CI, 16-21%), 16% (95% CI, 14%-18%) of participants had one or more episodes of functional decline, 37% (95% CI, 35-39%) had one or more episodes of stable or improved functional impairment and 28% (95% CI, 26-30%) recovered and regained independent.

Findings were similar for IADLs, with 19% (95% CI, 18-20%) of participants experiencing IADL impairment by age 64 years.

Low income, health status and health-related behaviors were independently associated with new impairment.

“These findings challenge traditional thinking that functional impairment in middle age is merely a transient phenomenon and point to common features between functional impairment in middle-aged adults and that in older persons,” Brown and colleagues concluded. “At the same time, functional impairments in middle age have characteristics distinct from those in older age, including a relatively lower cumulative incidence of IADL versus ADL impairment and differing patterns of impairment in individual ADLs.”

“Taken together, these findings suggest that interventions commonly used to prevent functional decline in older adults may hold promise for adults in middle age but must be tailored to meet their unique needs,” they added.

In an accompanying editorial, Thomas M. Gill, MD, from Yale School of Medicine, noted that impairment incidence may be even higher than Brown and colleagues reported because they did not assess walking or housework and shorter periods of impairment may have been missed if they were resolved between intervals.

“Future studies would benefit from collection of a more comprehensive array of potential risk factors, including slow gait speed (as the best single indicator of physical frailty); shorter assessment intervals and improved strategies for ascertaining the occurrence of disability between widely spaced assessments; and consideration of intervening illnesses and injuries, many of which may be amenable to prevention or improved management,” he added. – by Alaina Tedesco

Disclosure: Brown and Gill report no relevant financial disclosures. Please see study for all other authors’ relevant financial disclosures.

 

Among middle-aged patients, functional impairment was common and 35% of those with impaired function died or progressed to further decline over the next 10 years, according to research published in Annals of Internal Medicine.

“Difficulties with daily functioning are common in middle-aged adults,” Rebecca T. Brown, MD, MPH, from the University of California, San Francisco, and colleagues wrote. “However, little is known about the epidemiology or clinical course of these problems, including the extent to which they share common features with functional impairment in older adults.”

To address this gap in knowledge, Brown and colleagues examined data from the Health and Retirement Study of 6,874 community-dwelling adults aged 50 to 56 years who did not have functional impairment at enrollment.

The researchers assessed the cumulative incidence of the first episode of impairment in basic activities of daily living (ADLs), including bathing, dressing and transferring out of a bed or chair, toileting and eating as well as instrumental ADLs (IADLs), including managing money, managing medications, shopping for groceries, preparing meals and making telephone calls. ADL and IADL impairment were defined as having difficulty performing one or more ADLs or IADLs, respectively. Impairment was evaluated every 2 years and follow-up was performed at a maximum of 20 years.

Data showed that 22% of participants aged 50 to 64 years developed ADL impairment. Two years following the initial episode of functional impairment, 37% (95% CI, 35-39%) of participants fully recovered independence, while 4% (95% CI, 3-5%) died, 9% (95% CI, 8-11%) had worse ADL functional status and 50% (95% CI, 48%-52%) had persistent impairment.

During the 10 years after the initial impairment, 19% died (95% CI, 16-21%), 16% (95% CI, 14%-18%) of participants had one or more episodes of functional decline, 37% (95% CI, 35-39%) had one or more episodes of stable or improved functional impairment and 28% (95% CI, 26-30%) recovered and regained independent.

Findings were similar for IADLs, with 19% (95% CI, 18-20%) of participants experiencing IADL impairment by age 64 years.

Low income, health status and health-related behaviors were independently associated with new impairment.

“These findings challenge traditional thinking that functional impairment in middle age is merely a transient phenomenon and point to common features between functional impairment in middle-aged adults and that in older persons,” Brown and colleagues concluded. “At the same time, functional impairments in middle age have characteristics distinct from those in older age, including a relatively lower cumulative incidence of IADL versus ADL impairment and differing patterns of impairment in individual ADLs.”

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“Taken together, these findings suggest that interventions commonly used to prevent functional decline in older adults may hold promise for adults in middle age but must be tailored to meet their unique needs,” they added.

In an accompanying editorial, Thomas M. Gill, MD, from Yale School of Medicine, noted that impairment incidence may be even higher than Brown and colleagues reported because they did not assess walking or housework and shorter periods of impairment may have been missed if they were resolved between intervals.

“Future studies would benefit from collection of a more comprehensive array of potential risk factors, including slow gait speed (as the best single indicator of physical frailty); shorter assessment intervals and improved strategies for ascertaining the occurrence of disability between widely spaced assessments; and consideration of intervening illnesses and injuries, many of which may be amenable to prevention or improved management,” he added. – by Alaina Tedesco

Disclosure: Brown and Gill report no relevant financial disclosures. Please see study for all other authors’ relevant financial disclosures.