Association Between Activities of Daily Living and Mortality Among Institutionalized Elderly Adults in Japan

Abstract

BackgroundWe assessed the association between activities of daily living (ADL) and mortality among nursing home residents in Japan.MethodsThis 1-year prospective cohort study investigated 8902 elderly adults in 140 nursing homes. Baseline measurements included age, sex, height, weight, body mass index (BMI), ADL, and dementia level. ADL levels were obtained by caregivers, using the Barthel Index (BI), after which total BI scores were calculated (higher scores indicate less dependence). Information on dates of discharge and mortality was also obtained to calculate person-years. The Cox proportional hazards model was used to estimate hazard ratios (HRs).ResultsMean age was 84.3 years, and mean total BI score was 38.5. The HRs of mortality adjusted for sex, age, BMI, and type of nursing home were 7.6 (95% CI: 3.3–17.8) for those with a BI score of 0 (totally dependent), 3.9 (1.7–9.0) for those with a score of 1 to 10, 3.5 (1.4–8.7) for those with a score of 11 to 40, 2.7 (1.4–5.1) for those with a score of 41 to 70, and 1.3 (0.7–2.4) for those with a score of 71 to 99 (P for trend <0.001), as compared with those with a score of 100. Multivariate analysis revealed that BI, sex, age, and BMI were significantly associated with mortality rate.ConclusionsThere was a clear inverse association between ADL level and mortality. In conjunction with other risk factors, ADL level might effectively predict short-term mortality in institutionalized elderly adults.

Longevity: Big Data Comparison of Mortality in Older Adults Receiving Care in Nursing Homes or Their Own Home in Andalusia (Spain)

“…We found an elevated mortality of institutionalized older adults [2], and the greater risk of death in the residential care setting compared to home-based care [8,9]. The results also confirm that ADL level is a very powerful predictive mortality factor [3].…”

“…The Activities of Daily Living (ADL) level [3], cognitive impairment [4], hip fracture [5], cancer [6] and Chronic Obstructive Pulmonary Disease [7] are important risk factors of mortality in this population. Recent studies have also found an increased risk of death among institutionalized older adults than those that live within the community, adjusting for age, gender and clinical conditions [8,9].…”

A Prevalence Study of the Activities of Daily Living (ADL) Dependency among the Elderly in Four Districts in Selangor, Malaysia

“…On the other hand, institutionalization in the developed countries is closely related to disability in terms of ADL [31] and lack of family support. For example, a study done among institutionalized older people in nursing homes in Japan found the ADL dependency prevalence at 38.5% [2]. Therefore, the higher prevalence of ADL dependency in our study may be due to the lower number of publicly institutionalized elderly in Malaysian population as these government funded institutions are strictly reserved for the elderly without homes, heirs or family.…”

“…For example, in many developing countries, the elderly is defined as those who are 60 years old and above. This definition was based on the decision made in the World Assembly on Aging held in Vienna in 1982 [1,2]. This differs from the definition used by most developed countries that choose the cutoff-point of 65 years and above.…”

“…These disabilities can be assessed through the activities of daily living (ADL), which are routine tasks performed by each individual on a daily basis that are essential to independent living without any assistance, and involves self-care [10]. A person's ability in performing ADL is important in determining their long term care and coverage of their needs [2,11,12]. An individual with disability will have dependency that requires more help to do house chore, as well as higher needs during nursing care and hospitalization.…”