Trends in Disability and Limitations among U.S. Adults Age 18-44, 2000-2018.

Understanding disability trends is critical for health care and social policy. Although trends in disability and limitations have been studied extensively among older and middle-aged adults, little is known about trends in younger Americans, despite their importance for current and future population health. We present the first comprehensive evidence on disability trends among U.S. adults age 18-44. We analyze 20 measures of disability and limitations collected in the nationally representative National Health Interview Survey 2000-2018 (N=261,505). Robust Poisson models estimate age- and sex-adjusted trends and their covariates. Over one quarter (27.4%) reported at least one disability or limitation; the age-adjusted prevalence increased by 5% from 2000 to 2018. However, trends for specific disabilities and limitations varied tremendously. ADL and IADL limitations, cognitive, and social disabilities increased steeply (by 65-89% over the study period). Mobility limitations were generally unchanged or increased modestly. Hearing and 'other' limitations decreased significantly (25-48% decrease). The trends are only partly explained by education, health behaviors, chronic conditions, and other covariates. Disability trends research must not be limited to older adults. Researchers and policy makers interested in health care policy, planning, and caregiving should pay attention to disability trends among young adults in the United States.

Factors associated with self-reports of limitations in activities of daily living among Medicare Fee-for-Service recipients.

BACKGROUND: Physical function is an important indicator of physical health and predicts mortality. This study identified characteristics associated with limitations in Medicare recipients' activities of daily living. METHODS: 2019 Consumer Assessment of Healthcare Providers and Systems Fee-for-Service Medicare Survey data: 79,725 respondents (34% response rate) who were 65 and older and 53% female; 7% Black, 5% Hispanic, 4% Asian American, Native Hawaiian, or other Pacific Islander, 2% Multiracial, 1% American Indian/Alaskan Native; 35% with high school education or less. Walking, getting in and out of chairs, bathing, dressing, toileting, and eating (scored as having no difficulty versus being able to do with difficulty or unable to do) and a scale of these items were regressed on patient characteristics. RESULTS: After adjustment for all characteristics, function limitations were found for those who smoked (effect sizes of significant associations range .04-.13), had chronic health conditions (.02-.33), were 85 years or older (.09-.46), needed assistance completing the survey (.32-1.29), were female (.05-.07), and had low income and assets (.15-.47). CONCLUSIONS: These nationally representative U.S. estimates of physical function characteristics are useful for interventions for vulnerable population subgroups.

Factors influencing functional recovery after limb-salvage surgery for lower extremity musculoskeletal tumours: a qualitative study combining patients' and healthcare professionals' perspectives.

PURPOSE: Survival rates of lower extremity musculoskeletal tumours (LEMTs) have been increasing. However, patients continue to experience functional limitations after LEMT followed by limb-salvage surgery (LSS). This study aimed to identify factors influencing functional recovery after LSS for LEMT. METHODS: A qualitative study was conducted using semi-structured interviews with a purposive sample of adult patients who underwent LSS for LEMT (n=7) and healthcare professionals (HCPs) with expertise in orthopaedic oncology (n=7). Recruitment continued until data saturation. A combination of deductive and inductive qualitative content analysis was performed to analyse the transcribed data, producing subthemes under the main International Classification of Functioning, disability and health (ICF)-model domains. RESULTS: Four themes were described: (1) bodily functions and structures, (2) activities and participation, (3) environmental factors, and (4) expectations. Physical aspects such as larger resection size and complications negatively affected recovery. The importance of communication strategies of tertiary HCPs and the unfamiliarity of the primary physical therapists with the disease, its surgical treatment, and related consequences were emphasised by both the interviewed patients and HCPs. CONCLUSIONS: Functional recovery after LSS for LEMT is a multifactorial process. To improve patient care, improving (intercollegiate) communication strategies on treatment details and expectations about functional outcomes is warranted.Implications for rehabilitationHealthcare professionals should be aware some patients experience limited functional recovery after limb-salvage surgery (LSS) for lower extremity musculoskeletal tumours.Healthcare professionals should use multiple communication strategies to bridge the gap between the information provided and what the patient recalls.Knowledge exchange and communication between primary and tertiary care should be more extensive.Multidisciplinary consultations and/or case managers are needed to address all aspects of the individual's functional recovery after LSS.

The health consequences of returning to work after retirement: Evidence from a Japanese longitudinal survey.

Prolonged and active old age provides individuals with more chances to work again after full retirement. Returning to work is an increasingly common form of the retirement process and influences the sustainability of social security systems. Previous studies show a beneficial relationship between returning to work and health; however, little is known about the causal effect of returning to work on health. This study used data from men and women aged 50 and older (11,991 individuals) in the Longitudinal Survey of Middle-aged and Older Adults, conducted annually from 2005 to 2019 in Japan. The effects of three types of labor force transitions (continued work, full retirement, and return to work) on physical and mental health were examined. To obtain the causal effects, an instrumental variable approach was used by exploiting the Japanese pension reform and labor market settings as instruments. Compared with full retirement, returning to work showed significantly worse mental health but no significant difference in physical health. The negative effect of returning to work was pronounced among men, former nonmanual workers, and low-wealth individuals. Contrary to the findings in previous studies, insignificant or detrimental effects of returning to work were found in this study. The rigorous causal analysis adds new evidence to the literature. The findings provide important implications for labor and health policy in aging societies.

Smoking may compromise physical function long before it kills you.

Introduction: Although prior research has demonstrated an association between smoking and worse physical function, most of those studies are based on older people and do not evaluate whether the age-related increase in physical limitations differs by smoking history. We quantify how the magnitude of the smoking differential varies across age. Methods: This cohort study comprised a national sample of Americans aged 20-75 in 1995-1996, who were re-interviewed in 2004-2005 and 2013-2014. Our analysis was restricted to respondents who completed the self-administered questionnaires at Wave 1 (N = 6,325). Follow-up observations for those respondents were included if they completed the self-administered questionnaires at Wave 2 (N = 3,929) and/or Wave 3 (N = 2,849). The final analysis sample comprised 13,103 observations over a follow-up period of up to 19 years (1995-2014). We used a linear mixed model to regress physical limitations on smoking status at baseline adjusted for sex, age, race, socioeconomic status, alcohol abuse, drug abuse, and obesity with an interaction between age and smoking to test whether the age pattern of physical limitations differed by smoking history. Additional models incorporated measures of smoking duration and intensity. Results: In the fully-adjusted model, smokers exhibited a steeper age-related increase in physical limitations than never smokers. Thus, the disparities in physical limitations by smoking status widened with age but were evident even at young ages. The estimated differential between heavy smokers and never smokers rose from 0.24 SD at age 30 to 0.49 SD at age 80. At younger ages, heavy smokers who quit recently fared worse than current light smokers and not much better than current heavy smokers. Discussion: We know smoking is bad for our health, but these results reveal that differences in physical limitations by smoking history are evident even at ages as young as 30. Physical limitations that emerge early in life are likely to have an especially large impact because they can jeopardize health for decades of remaining life. Smoking probably will not kill you at young age, but it may compromise your physical function long before it kills you. Just do not do it.

Telehealth During COVID-19 for Adults with Multiple Chronic Conditions: Associations with Self-Reported Food Insecurity and with Physical Limitations.

Background: Adults with chronic medical conditions complicated by food insecurity or physical limitations may have higher barriers to accessing telehealth implemented during the COVID-19 pandemic. Objective: To examine the relationships of self-reported food insecurity and physical limitations with changes in health care utilization and medication adherence comparing the year before (March 2019-February 2020) and the first year of the COVID-19 pandemic (April 2020-March 2021) among patients with chronic conditions insured by Medicaid or Medicare Advantage. Methods: A prospective cohort study of 10,452 Kaiser Permanente Northern California members insured by Medicaid and 52,890 Kaiser Permanente Colorado members insured by Medicare Advantage was conducted. Difference-in-differences (DID) between the pre-COVID and COVID years in telehealth versus in-person health care utilization and adherence to chronic disease medicines by food insecurity and by physical limitation status were measured. Results: Food insecurity and physical limitations were each associated with small but significantly greater shifts from in-person to telehealth. Medicare Advantage members with physical limitations also had significantly greater decline in adherence to chronic medications from year to year compared with those without physical limitations (DID from pre-COVID year to COVID year ranged from 0.7% to 3.6% greater decline by medication class, p < 0.01). Conclusions: Food insecurity and physical limitations did not present significant barriers to the transition to telehealth during the COVID pandemic. The greater decrease in medication adherence among older patients with physical limitations suggests that care systems must further address the needs of this high-risk population.

Health trajectories across the work exit transition in the 1990s, 2000s, and 2010s: the role of working conditions and policy.

PURPOSE: We examined health trajectories of Dutch older workers across their exit from the workforce in the 1990s, 2000s, and 2010s, testing the hypothesis that pre-post-exit health trajectories of workers with favourable and unfavourable working conditions increasingly diverged over time due to policy measures to extend working life. METHODS: The Longitudinal Aging Study Amsterdam includes baseline samples in 1992/1993, 2002/2003 and 2012/2013 with two 3-year follow-up waves each. Selected respondents were aged 55 years and over who exited from a paid job within the first or second 3-year interval, up to and including the statutory retirement age (N = 522). Pre-post-exit trajectories were modelled using Generalized Estimating Equations with outcomes self-rated health and physical limitations and determinants physical demands, psychosocial demands, and psychosocial resources. RESULTS: Average work exit age rose from 60.7 in the 1990s to 62.9 in the 2010s. On average, self-rated health decreased somewhat over successive periods and did not show pre-post-exit change; average physical limitations increased substantially both over successive periods and from pre- to post-exit. No support is found for our hypothesis. However, regardless of work exposures, we found sharp pre-post-exit increases in physical limitations in the 2010s. CONCLUSION: Although these findings provide no support for our hypothesis of diverging health trajectories over time based on work exposure, they show that exiting at a higher age is linked to poorer pre- and post-exit health and to pre-post-exit increases in physical limitations, suggesting greater health care costs in the near future.

Physical limitations and loneliness: The role of guilt related to self-perception as a burden.

BACKGROUND: Limitations in performing physical activities have been associated with greater loneliness in older adults. This association could be moderated by maladaptive social cognition or feelings, such as guilt related to perceiving oneself as a burden. This study analyzes the effect of guilt related to self-perception as a burden on the relationship between physical limitations and loneliness in older adults. METHODS: Participants were 190 community-dwelling people aged over 60 years who did not show cognitive or functional limitations in daily life activities. We used linear regression to test the influence of guilt related to self-perception as a burden on the association between physical limitations and loneliness. RESULTS: The interaction between physical limitations and guilt related to self-perception as a burden was found to be significant in the explanation of loneliness, explaining 18.10% of the variance. Specifically, the relationship between physical limitations and loneliness was stronger when levels of guilt related to self-perception as a burden were high or medium than when these levels were low. CONCLUSIONS: The findings suggest that feelings of loneliness are more frequent in people who report more physical limitations and, at the same time, report guilt for perceiving themselves as a burden. Guilt related to perceiving oneself as a burden seems to be a relevant modulator variable for understanding the effects of physical limitations on loneliness.

Pain and physical activity levels among Rheumatoid Arthritis patients between the ages of 18 to 50 years in South Africa.

Background: Little epidemiological research on rheumatoid arthritis (RA) has been done in Africa, suggesting that it is an uncommon illness. In rural South Africa, RA has an overall prevalence of 0.07% and a prevalence of 2.5% in urban areas; therefore, it is not as uncommon as perceived by the lack of research. Patient-centred programmes to improve physical function have been lacking and, as a result, the prior assumption was that physical activity should be avoided. Objectives: To determine pain and physical activity levels among RA patients between the ages of 18 to 50 years in South Africa. Methods: A combination of two questionnaires were used, namely, the Global Physical Activity Questionnaire (2002) and the Pain Outcomes Questionnaire (2003). The collated questionnaires were distributed by rheumatologists and on social media platforms to RA patients between the ages of 18 to 50 years old living in South Africa. This study had a sample size of 105 participants, with participation occurring through the online Google forms platform. Results: One hundred and five participants with RA were recruited with an average age of 38±9 years. Most of the participants were females (93.3%). Seventy-two percent of the sample was classified as physically active, where work, leisure and travel activities were considered. No significant correlation between pain and physical activity was evident (r=0.10; p=0.311). Results showed significant correlations between pain and personal grooming (r=0.30; p=0.002), pain and ambulation (r=0.60; p=0.000), and pain and stair climbing (r=0.60; p=0.000). Conclusion: Physical activity has proven to have multiple benefits for those suffering with RA. In this South African sample of RA patients, the majority were classified as physically active, and pain did not affect the activity levels of the involved participants. This study opens further research questions regarding RA prevalence in South Africa, and the type and intensity of physical activity that would be beneficial for RA.

Association between physical limitations and depressive symptoms among Indian elderly: marital status as a moderator.

BACKGROUND: Depression among the elderly is well-documented and associated with socio-economic factors, physical and mental health conditions. Few studies have focused on older adults' physical limitations and depressive symptoms. However, very little is known about marital status' role in such associations, especially in India. The present study examines the association between physical limitations and self-reported depressive symptoms and moderating role of marital status in such association separately for men and women. METHODS: The present study used data from the Longitudinal Ageing Study in India (LASI) wave 1, 2017-2018, a nationally and state representative longitudinal large-scale survey of ageing and health. For the present research, a total sample of 20,806 older adults aged 60+ years was selected after excluding missing values. Along with descriptive statistics, binary logistic regression analysis and interaction effect of marital status were applied to examine the association between physical limitations (functional limitations and mobility difficulty) with the depressive symptoms separately for men and women. RESULTS: About 58, 50, and 45% elderly reported having depressive symptoms and had difficulty in 2+ ADLs, 2+ IADLs, and 2+ mobility difficulties, respectively. By the marital status, the prevalence of depressive symptoms was higher among currently unmarried than currently married, irrespective of type and number of physical limitations. The unadjusted, marital and multivariate-adjusted association suggested that elderly with more than two ADLs, IADLs, and mobility difficulty had higher odds of depressive symptoms. The gender stratified interaction effect of marital status and physical limitations on depressive symptoms indicated that currently unmarried elderly, particularly unmarried older women with 2+ ADLs (OR = 2.85; CI 95% = 1.88-3.09), 2+ IADLs (OR = 2.01; CI 95% = 1.74-2.31) and 2+ mobility difficulty (OR = 2.20; CI 95% = 1.86-2.60) had higher odds of depressive symptoms. However, such association was only valid for unmarried men having mobility difficulty. CONCLUSION: The study highlights that the elderly with physical limitations such as ADLs, IADLs, and mobility difficulty require attention and care. Although married elderly are less likely to have depressive symptoms even with all the mentioned physical limitations, unmarried women are more vulnerable to have depressive symptoms with physical limitations.

Physical functioning and mental health treatment initiation and retention for veterans with posttraumatic stress disorder: a prospective cohort study.

BACKGROUND: Most US adults with posttraumatic stress disorder (PTSD) do not initiate mental health treatment within a year of diagnosis. Increasing treatment uptake can improve health and quality of life for those with PTSD. Individuals with PTSD are more likely to report poor physical functioning, which may contribute to difficulty with treatment initiation and retention. We sought to determine the effects of poor physical functioning on mental health treatment initiation and retention for individuals with PTSD. METHODS: We used data for a national cohort of veterans in VA care; diagnosed with PTSD in June 2008-July 2009; with no mental health treatment in the prior year; and who responded to baseline surveys on physical functioning and PTSD symptoms (n = 6,765). Physical functioning was assessed using Veterans RAND 12-item Short Form Health Survey, and encoded as limitations in physical functioning and role limitations due to physical health. Treatment initiation (within 6 months of diagnosis) was determined using VA data and categorized as none (reference), only medications, only psychotherapy, or both. Treatment retention was defined as having ≥ 4 months of appropriate antidepressant or ≥ 8 psychotherapy encounters. RESULTS: In multinomial models, greater limitations in physical functioning were associated with lower odds of initiating only psychotherapy (OR 0.82 [95 % CI 0.68, 0.97] for limited a little and OR 0.74 [0.61, 0.90] for limited a lot, compared to reference "Not limited at all"). However, it was not associated with initiation of medications alone (OR 1.04 [0.85, 1.28] for limited a little and OR 1.07 [0.86, 1.34] for limited a lot) or combined with psychotherapy (OR 1.03 [0.85, 1.25] for limited a little and OR 0.95 [0.78, 1.17] for limited a lot). Greater limitations in physical functioning were also associated with lower odds of psychotherapy retention (OR 0.69 [0.53, 0.89] for limited a lot) but not for medications (e.g., OR 0.96 [0.79, 1.17] for limited a lot). Role limitations was only associated with initiation of both medications and psychotherapy, but there was no effect gradient (OR 1.38 [1.03, 1.86] for limitations a little or some of the time, and OR 1.18 [0.63, 1.06] for most or all of the time, compared to reference "None of the time"). Accounting for chronic physical health conditions did not attenuate associations between limitations in physical functioning (or role limitations) and PTSD treatment; having more chronic conditions was associated with lower odds of both initiation and retention for all treatments (e.g., for 2 + conditions OR 0.53 [0.41, 0.67] for initiation of psychotherapy). CONCLUSIONS: Greater limitations in physical functioning may be a barrier to psychotherapy initiation and retention. Future interventions addressing physical functioning may enhance uptake of psychotherapy.

Low Protein Intakes and Poor Diet Quality Associate with Functional Limitations in US Adults with Diabetes: A 2005-2016 NHANES Analysis.

Type 2 diabetes is associated with an increased risk for sarcopenia. Moreover, sarcopenia correlates with increased risk for falls, fractures, and mortality. This study aimed to explore relationships among nutrient intakes, diet quality, and functional limitations in a sample of adults across levels of glycemic control. Data were examined from 23,487 non-institutionalized adults, 31 years and older, from the 2005-2016 National Health and Nutrition Examination Survey. Hemoglobin A1c (%) was used to classify level of glycemic control: non-diabetes (<5.7%); pre-diabetes (5.7-6.4%); diabetes (≥6.5%). Dietary data were collected from a single 24-h dietary recall. Participants were categorized as meeting or below the protein recommendation of 0.8 g/kg of body weight. Physical functioning was assessed across 19-discrete physical tasks. Adults below the protein recommendation consumed significantly more carbohydrate and had lower diet quality across all glycemic groups compared to those who met the protein recommendation (p < 0.001). Adults with diabetes who did not meet protein recommendations had significantly poorer diet quality and significantly higher mean number of functional limitations. A greater percent of adults with diabetes who did not meet the protein recommendation reported being physically limited for most activities, with more than half (52%) reporting limitations for stooping, crouching, and kneeling. This study underscores the potential for physical limitations associated with low protein intakes, especially in adults with diabetes. In the longer term, low protein intakes may result in increased risk of muscle loss, as protein intake is a critical nutritional factor for prevention of sarcopenia, functional limitations, and falls.

Psychological State after an Acute Coronary Syndrome: Impact of Physical Limitations.

The aim of this study was to investigate how physical limitations after ACS influence patients' quality of life and health perception. This was a longitudinal clinical study. We recruited 146 patients diagnosed with ACS. The patients performed a stress test (Bruce's protocol) for the evaluation of physical limitations and were classified according to the test result: without physical limitations (more than 10 METS), with some physical limitations (7 to 9 METS), and with high physical limitations (less than 6 METS). Significant differences were found between the three groups immediately after the diagnosis of ACS and after a period of three months, regarding health perception, anxiety, depression, sexual relationships, distress, and adjustment to disease. These differences resulted larger between the group with less limitations and the group with higher limitations. After 3 months, however, there was an overall improvement in all variables. In conclusion, physical limitations after ACS seem to influence perceived quality of life determined by measuring general health, vitality, total adaptation, emotional role, social adaptation, depression, and anxiety. Therefore, the highest the physical limitations, the poorer the psychological conditions and vice versa, even 3 months after ACS diagnosis.

Sarcopenia Risk Evaluation in a Sample of Hospitalized Elderly Men and Women: Combined Use of the Mini Sarcopenia Risk Assessment (MSRA) and the SARC-F.

BACKGROUND: SARC-F and Mini Sarcopenia Risk Assessment (MSRA) questionnaires have been proposed as screening tools to identify patients at risk of sarcopenia. The aim of this study is to test the use of SARC-F and MSRA, alone and combined, as a pre-screening tool for sarcopenia in geriatric inpatients. METHODS: 152 subjects, 94 men and 58 women, aged 70 to 94, underwent muscle mass evaluation by dual energy X-ray absorptiometry (DXA), muscle strength evaluation by handgrip, and completed the MSRA, SARC-F and Activity of daily living (ADL) questionnaires. RESULTS: 66 subjects (43.4%) were classified as sarcopenic according to the European Working Group on Sarcopenia in Older People 2 (EWGSOP2) criteria. The 7-item SARC-F and MRSA and 5-item MSRA showed an area under the curve (AUC) of 0.666 (95% confidence interval (CI): 0.542-0.789), 0.730 (95% CI: 0.617-0.842) and 0.710 (95% CI: 0.593-0.827), respectively. The optimal cut-off points for sarcopenia detection were determined for each questionnaire using the Youden index method. The newly calculated cut-off points were ≤25 and ≤40 for MSRA 7- and 5-items, respectively. The ideal cut-off for the SARC-F was a score ≥3. Applying this new cut-off in our study population, sensitivity and specificity of the 7-item MSRA were 0.757 and 0.651, and 0.688 and 0.679 for the 5-item MSRA, respectively. Sensitivity and specificity of SARC-F were 0.524 and 0.765, respectively. The combined use of the 7-item SARC-F and MSRA improved the accuracy in sarcopenia diagnosis, with a specificity and sensitivity of 1.00 and 0.636. CONCLUSION: 7-item SARC-F and MSRA may be co-administered in hospital wards as an easy, feasible, first-line tool to identify sarcopenic subjects.

The Mini Sarcopenia Risk Assessment (MSRA) Questionnaire score as a predictor of skeletal muscle mass loss.

BACKGROUND: Previous studies showed a strong relationship between reduction of appendicular muscle mass and worsening disability; hence, accuracy in assessing muscle mass is considered a key feature for a sarcopenia screening tool. AIM: The aim of the study was to evaluate if the 7 items of Mini Sarcopenia Risk Assessment (MSRA) questionnaire predict muscle mass loss in a population of community-dwelling elderly subjects over a 5.5-y follow-up. METHODS: The study included 159 subjects, 92 women and 67 men aged 71.5 ± 2.2 years and with mean body mass index of 26.7 ± 4.0 kg/m2. Appendicular skeletal muscle mass (ASMM) as measured with Dual-Energy X-ray absorptiometry (DXA), was obtained at baseline and after 2 and 5.5 years of follow-up where the skeletal muscle index (SMI) was calculated. RESULTS: A significant reduction of ASMM and SMI was observed at two and 5.5 years of follow-up, in both, men and women. Repeated-measures analysis of variance (ANOVA) found a significant time effect on ASMM for both subjects with MSRA > 30 and ≤ 30 (P < 0.01 and P < 0.001). The group × time interaction was significant (P < 0.001), after even considering separately subjects with normal muscle mass and low muscle mass at baseline (P < 0.05 and P = 0.005). Similar results were obtained for SMI. Considering only the subjects with normal SMI at baseline, subjects with MSRA questionnaire ≤ 30 showed 5.7 (95% CI 1.73-19.03) higher risk of exceeding the low muscle mass threshold. CONCLUSION: In a population of community-dwelling elderly men and women, MSRA score of 30 is predictive of a steeper decline in ASMM and SMI and of a higher risk of exceeding the low muscle mass EWGSOP threshold.

Factors associated with going outdoors frequently: a cross-sectional study among Swiss community-dwelling older adults.

OBJECTIVE: This study examines potential risk and protective factors associated with going outdoors frequently among older persons, and whether these factors vary according to physical limitations. DESIGN: Cross-sectional analysis. SETTING AND PARTICIPANTS: Community-dwelling participants of the Lausanne cohort Lc65+ in 2016, aged 68-82 years (n=3419). METHODS: Associations between going outdoors frequently and physical limitations, sociodemographic, health, psychological and social variables were examined using logistic regression models. Subgroup analyses were performed according to the severity of physical limitations. MAIN OUTCOME MEASURES: 'Going outdoors frequently' was defined as going out ≥5 days/week and not spending most of the time sitting or lying down. RESULTS: Three in four (73.9%) participants reported going outdoors frequently. Limitations in climbing stairs (adjusted OR (AdjOR) 0.61, 95% CI 0.47 to 0.80) and walking (AdjOR 0.24, 95% CI 0.18 to 0.31), as well as depressive symptoms (AdjOR 0.58, 95% CI 0.47 to 0.70), dyspnoea (AdjOR 0.60, 95% CI 0.48 to 0.75), age (AdjORolder age group 0.73, 95% CI 0.59 to 0.92) and fear of falling (AdjOR 0.75, 95% CI 0.62 to 0.91) reduced the odds of going outdoors frequently. In contrast, living alone (AdjOR 1.30, 95% CI 1.08 to 1.56), reporting a dense (AdjOR 1.57, 95% CI 1.26 to 1.96) and a high-quality (AdjOR 1.28, 95% CI 1.06 to 1.53) social network increased the odds of going outdoors frequently. Among participants with severe limitations, 44.6% still went outdoors frequently. Among this subgroup, a new emotional relationship (AdjOR 2.52, 95% CI 1.18 to 5.38) was associated with going outdoors, whereas cognitive complaints (AdjOR 0.66, 95% CI 0.47 to 0.93), urinary incontinence (AdjOR 0.67, 95% CI 0.46 to 0.97), dyspnea (AdjOR:0.67, 95%CI:0.48-0.93), and depressive symptoms (AdjOR 0.67, 95% CI 0.48 to 0.93) lowered the odds of going outdoors. CONCLUSION: Physical limitations are associated with decreased odds of going outdoors frequently. However, social characteristics appear to mitigate this association, even among older persons with severe limitations. Further studies are needed to determine causality and help guide interventions to promote going outdoors as an important component of active ageing.

Recovery from physical limitations among older Mexican adults.

OBJECTIVES: This paper examines the key determinants of the likelihood of recovery from a physical disability among older adults. METHODS: Data come from the Mexican Health and Aging Study (MHAS), a national sample of adults born in 1951 or earlier, including a baseline survey in 2001 and follow-ups in 2003, 2012 and 2015. At baseline, we divided our sample of older adults aged 60+ by dimensions of physical limitations (ADLs, IADLs, mobility) and classified respondents as having physical limitations in zero, one, two or three dimensions. Each respondent was then categorized as "same", "worse", "improved" or "died" depending on the number of physical dimensions with a limitation in a 2-year span (2001-2003) and again, separately, in a 3-year span (2012-2015). We then used a multinomial logistic regression to analyze the relative risk of transitioning from one category to another. FINDINGS: Around 21 % of our sample exhibited some recovery in 2003 and around 20 % recovered in 2015. Age, gender, poor self-rated health, depression and some chronic conditions were significant for shifting the relative risk from staying the same to getting worse, dying or even improving. CONCLUSIONS: Disability from a physical limitation is a reversible and dynamic process. Our results reflect the importance of considering the dimensions of physical ability while analyzing recovery, and illustrate that the presence of a chronic condition or depressive symptoms does not necessarily imply permanent disability.

The impact of socioeconomic status and social deprivation on musculoskeletal limitations.

BACKGROUND: Objective (SES) and subjective socioeconomic status (SSS) affect symptom intensity and magnitude of limitations. Identification of potentially modifiable social risk factors might contribute to additional opportunities for optimizing musculoskeletal health. QUESTIONS/PURPOSES: (1) There are no correlations between magnitude of limitations (as measured with Patient-Reported Outcomes Measurement Information System Physical Function [PROMIS PF computer adaptive test]) and components of SES or SSS in people with musculoskeletal disease; (2) There are no factors (including level of social deprivation) independently associated with PROMIS PF. METHODS: One hundred and fifty-nine patients presenting to clinicians specializing in the treatment of a broad variety of musculoskeletal conditions were prospectively enrolled in the study. We recorded patient demographics and assessed patients' socioeconomic status using the MacArthur Sociodemographic questionnaire and physical disability rating using PROMIS PF. Patients deprivation index was retrieved using their 9-digit ZIP codes. We used bivariate analysis to determine correlations between magnitude of limitations and socioeconomic status. We created a stepwise backward multivariable linear regression model to assess factors independently associated with PROMIS PF. RESULTS: Weak correlations were found on bivariate analysis of PROMIS PF with SSS measured as "Place in community" (r 0.28; P < 0.001) and "Place in the United States of America" (r 0.25; P = 0.002). In the multivariable models, the area deprivation index was not independently associated with physical limitations. Male gender (beta regression coefficient [ß] 4.1; 95% CI 0.71 to 7.5; P = 0.018) and having net worth of $5000 - $19,999 (ß 6.3; 95% CI 0.35 to 12; P = 0.038) or $20,000 - $99,999 (ß 5.8; 95% CI 2.1 to 9.5; P = 0.003) when compared to having net worth of less than $4999 were independently associated with better physical function. Being unemployed or disabled and keeping house, being a student, or retired were independently associated with worse physical function (ß -12; 95% CI -18 to -7.0; P < 0.001; ß -5.6; 95% CI -9.9 to -1.4; P = 0.009, respectively), when compared to working full-time or part-time. CONCLUSIONS: Objective and subjective measures of socioeconomic status are associated with magnitude of physical limitations in patients with musculoskeletal illness. These factors should be considered when developing treatment plans for patients with musculoskeletal conditions. LEVEL OF EVIDENCE: Level II prognostic study.

Health and voting over the course of adulthood: Evidence from two British birth cohorts.

Systematic differences in voter turnout limit the capacity of public institutions to address the needs of under-represented groups. One critical question relates to the role of health as a mechanism driving these inequalities. This study explores the associations of self-rated health (SRH) and limitations in everyday activities with voting over the course of adulthood in the 1958 National Child Development Study and the 1970 British Cohort Study. We used data from participants who reported voting in the last general election at least once between the ages of 23 and 55 in the 1958 cohort and between the ages of 30 and 42 in the 1970 cohort. We examined associations controlling for a range of early-life and adult circumstances using random-effects models. Compared with those in good or better health: those in fair health had 15% and 18% lower odds of voting in the 1958 and 1970 cohorts; those in poor or worse health had 17% and 32% lower odds of voting in the 1958 and 1970 cohorts. These effects varied with age and were most marked among those in poor health at the ages of 23/30 in the 1958 and 1970 cohorts. Controlling for SRH, having limitations in everyday activities was not associated with voting in main models. Examining age-based differences, however, we found that reporting limitations was associated with a higher probability of voting at the age of 55 in the 1958 cohort and at the age of 30 in the 1970 cohort. Building on the qualities of the British birth cohorts, we offer nuanced evidence about the role of health on voting, which involves considerable life-course processes. Future studies need to examine how these findings progress after the age of 55, extend to mental wellbeing and health practices, and contribute to explain social inequalities in voter turnout.