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Functional impairment in middle age increases risk of adverse outcomes

Impairment in activities of daily living was associated with a higher risk of hospitalization, nursing home admission and death among middle-aged adults, according to findings published in JAMA Internal Medicine.

“Difficulty performing daily activities such as bathing and dressing (‘functional impairment’) affects nearly 15% of middle-aged adults,” Rebecca T. Brown, MD, MPH, from the Perelman School of Medicine at the University of Pennsylvania, and colleagues wrote. “Older adults who develop such difficulties, often because of frailty and other age-related conditions, are at increased risk of acute care use, nursing home admission, and death. However, it is unknown if functional impairments that develop among middle-aged people, which may have different antecedents, have similar prognostic significance.”

Brown and colleagues analyzed data from the Health and Retirement Study to assess whether functional impairment is associated with hospitalization, nursing home admission and death among middle-aged adults (n = 5,540; 2,739 women; median age, 53.7 years).

Participants did not have functional impairment at enrollment. Those who developed functional impairment between 50 and 64 years were matched to those without impairment by age, sex and survey wave.

Impairment in activities of daily living (ADLs) was defined as self-reported difficulty performing one or more of the following: bathing, dressing, transferring, toileting, eating and walking across a room. Impairment in instrumental ADLs was defined as self-reported difficulty performing one or more of the following: managing money, managing medications, shopping for groceries, preparing meals and making telephone calls.

Follow-up assessments were performed biennially through 2014.

Overall, 19.8% of participants (n = 1,097) developed ADL impairment and 15.5% (n = 857) developed instrumental ADL impairment between ages 50 and 64 years over the study duration.

Compared with patients without impairment, those with ADL impairment demonstrated an elevated risk for hospitalization (subhazard ratio = 1.97; 95% CI, 1.77-2.19), nursing home admission (subhazard ratio = 2.62; 95% CI, 1.99-3.45) and death (HR = 2.06; 95% CI, 1.74-2.45). Patients with ADL impairment still had significantly higher risks of hospitalization (subhazard ratio = 1.54; 95% CI, 1.36-1.75) and nursing home admission (subhazard ratio = 1.73; 95% CI, 1.24-2.43), but not death (HR = 1.06; 95% CI, 0.85-1.32) after multivariable adjustment.

In both adjusted and unadjusted analyses, there was an increased risk of hospitalization, nursing home admission and death among patients with instrumental ADL.

“Our findings suggest that even among relatively young people, functional impairment has important clinical implications,” Brown and colleagues conclude. “Interventions commonly used to improve and delay functional impairment among older adults may hold promise for improving function and reducing adverse outcomes among middle-aged adults with functional impairment.” – by Alaina Tedesco

Disclosures: The authors report no relevant financial disclosures.