Racial/ethnic differences in the prevalence of disability based on self-reported activities of daily living (ADLs) exist in older Americans, particularly in Hispanic adults. Such studies have relied on large data sets in which disability is measured across a broad range of functional tasks. While useful in generating a global measure of disability, it precludes an ability to differentiate, for example, deficits in upper versus lower extremity function which can provide useful information in targeting therapeutic interventions. Despite known age-related declines in hand function and concomitant ADLs, racial/ethnic differences in hand-related ADL limitations have not been addressed. Using 2011-2018 data from the National Health and Nutrition Examination Survey (NHANES), we identified 3,189 non-Hispanic White and Hispanic adults aged 65 and older, and classified responses based on perceived difficulty to five self-reported tasks requiring hand dexterity. Compared to non-Hispanic Whites, Hispanic males reported 2.2 times higher rates of difficulty for dressing tasks (p<0.01) and 3.3 times higher rates for difficulties preparing meals (p<0.01). Similar rates of difficulty were also observed in females. Additionally, Hispanic females reported 4.6 times higher rates of difficulty in tasks requiring grasping small objects (p<0.01). Deficits in hand function are often under-reported in older adults despite the role of dexterity in maintaining functional independence. The results presented here indicate that difficulties in hand-related ADLs are more prevalent in the Hispanic population and warrant greater attention in health care settings. Future work will include identifying factors contributing to these observed differences in self-reported difficulties in hand-related ADLs.
Upper extremity function, particularly the hand, declines with aging and is predictive of executive ability and independence. Standard assessments typically focus on strength partly due to a lack of easily administered functional tasks requiring multi-joint coordination and precision grasp. This study aimed to determine the feasibility of using an inexpensive board game to assess upper extremity function in older adults. Six healthy older adults (77 +/- 5.1 years) completed reaching tasks using the Connect4® game that requires grasping and placing small discs into a vertical board. Tasks included different hand configurations (unilateral, bilateral), and two dual-task conditions (serial subtraction by 7s and placing colored discs to match specific color patterns). The time to complete each task was recorded. For comparison purposes, participants completed a standardized pegboard test (Purdue Pegboard) using one or both hands. Connect4 results were similar to age-normative findings reported for the Purdue Pegboard. Dominant versus non-dominant hand performance did not differ while bilateral coordination tasks were slower than unilateral tasks for both the Purdue Pegboard (p<0.05) and Connect4 (p<0.01). Pegboard and Connect4 times were moderately to strongly correlated for all hand configurations. Dual-task conditions using Connect4 led to longer completion times (p<0.05). Preliminary results support the use of Connect4 as a functional upper extremity assessment tool for older adults. It is inexpensive, engaging, easy to use, and allows for cognitive-motor assessment using dual-task protocols, a critical factor in maintaining functional independence in older individuals. Further research will include a formal validation study across a wider age range.
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