Cardiovascular disease is an important cause of disability in activities of daily living (ADL) through its effect on physical functioning. However, it is unclear whether subclinical vascular abnormalities and rate of change in subclinical vascular abnormalities is also associated with an impaired physical ability and with ADL disability. In a longitudinal study, 490 middle-aged and older persons were included. Physical ability was measured using the Short Physical Performance Battery and ADL disability using a questionnaire on self-reported basic and instrumental ADL. Subclinical vascular abnormalities were measured by pulse wave velocity (PWV) and carotid intima media thickness (CIMT, in men only). Longitudinal associations between baseline markers of subclinical vascular abnormalities, their rate of change, and change in physical ability or ADL disability were assessed using generalized estimation equation models. After adjustment for confounders, higher baseline PWV, change in PWV, baseline CIMT (in men) and change in CIMT (in men) were associated with a higher rate of change in physical ability (regression coefficients 0.035, 95% CI [0.018; 0.052]; 0.047, 95% CI [0.024; 0.069]; 0.214, 95% CI [0.070; 0.358] and 0.148, 95% CI [0.019; 0.277], respectively). No relations were found for change in ADL disability. In subjects with incident cardiovascular disease, higher change in PWV was associated with a higher rate of change in ADL disability (regression coefficient 0.054, 95% CI [0.001; 0.106]). The present study showed that subclinical vascular abnormalities and rate of change were associated with higher rate of change in physical ability. The association between (change in) subclinical vascular abnormalities and ADL disability tended to be stronger in persons with incident and prevalent cardiovascular disease. These data may suggest that ADL decline is more a direct effect of experienced clinically manifest vascular events rather than the effect of progression of subclinical vascular abnormalities.
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Background. Quality of life is an important health outcome for older persons. It predicts the adverse outcomes of institutionalization and premature death. The aim of this cross-sectional study was to determine the influence of both disability in activities of daily living (ADL) and instrumental activities of daily living (IADL) on physical and mental dimensions of quality of life. Methods. A total of 377 Dutch people aged 75 years and older completed a web-based questionnaire. This questionnaire contained the Groningen Activity Restriction Scale (GARS) for measuring ADL and IADL and the Short-Form Health Survey (SF-12) for measuring quality of life. The SF-12 distinguishes two dimensions of quality of life, a physical and mental dimension.
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Objective: To predict mortality by disability in a sample of 479 Dutch community-dwelling people aged 75 years or older. Methods: A longitudinal study was carried out using a follow-up of seven years. The Groningen Activity Restriction Scale (GARS), a self-reported questionnaire with good psychometric properties, was used for data collection about total disability, disability in activities in daily living (ADL) and disability in instrumental activities in daily living (IADL). The mortality dates were provided by the municipality of Roosendaal (a city in the Netherlands). For analyses of survival, we used Kaplan–Meier analyses and Cox regression analyses to calculate hazard ratios (HR) with 95% confidence intervals (CI). Results: All three disability variables (total, ADL and IADL) predicted mortality, unadjusted and adjusted for age and gender. The unadjusted HRs for total, ADL and IADL disability were 1.054 (95%-CI: [1.039;1.069]), 1.091 (95%-CI: [1.062;1.121]) and 1.106 (95%-CI: [1.077;1.135]) with p-values <0.001, respectively. The AUCs were <0.7, ranging from 0.630 (ADL) to 0.668 (IADL). Multivariate analyses including all 18 disability items revealed that only “Do the shopping” predicted mortality. In addition, multivariate analyses focusing on 11 ADL items and 7 IADL items separately showed that only the ADL item “Get around in the house” and the IADL item “Do the shopping” significantly predicted mortality. Conclusion: Disability predicted mortality in a seven years follow-up among Dutch community-dwelling older people. It is important that healthcare professionals are aware of disability at early stages, so they can intervene swiftly, efficiently and effectively, to maintain or enhance the quality of life of older people.
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