Impairment of activities of daily living and its relationship with chronic diseases in the elderly aged ≥60 years in communities: a prospective cohort study in 6 provinces in China

Objective To explore the prevalence of impairment of activities of daily living (ADL) in the elderly aged ≥60 years in communities in China, and analyze the impact of chronic diseases on impaired ADL.

Methods The data from the Project of Prevention and Intervention on Neurodegenerative Disease for Elderly in China (2015−2018) were used. By multi-stage stratified cluster random sampling method, about 24,000 people aged ≥60 years in 6 provinces (municipalities and autonomous regions) of China were selected for a baseline survey in 2015, and the follow-up visits were conducted in 2017 and 2018, respectively. Katz index scale was used to assess ADL in the elderly. The trend of ADL impairment rate in different years was analyzed by Joinpoint regression model, and the relationship between chronic diseases and the ADL impairment was analyzed by logistic regression model.

Results Valid data were collected from 20 180 persons with a mean age of (69.99±6.65), men accounted for 43.90%. Joinpiont regression analysis showed a gradual increase in the rate of ADL impairment over time, with the total impairment rate of 4.49% in 2015 and 9.99% in 2018, showing an upward trend annual change percentage (APC) =30.53%, t=446.00, P=0.001. After three years of follow-up, a total of 1,642 new ADL impairments were observed in 19,273 study participants, with a cumulative incidence of 8.52% 95% confidence interval (CI): 8.13–8.91. The differences in the incidence of impaired ADL between men and women, between urban residents and rural residents, among people in different age groups and among people with different marital status, education levels, residence status and occupations were significant (P<0.001). Logistic regression analyses showed that the prevalence of impaired ADL was 1.30 times higher in the elderly with 1 disease odds ratio (OR)=1.30, 95%CI: 1.13–1.49 and 2.06 time higher in those with 2 or more diseases (OR=2.06, 95%CI: 1.80–2.35) than in the elderly without disease; the incidence of impaired ADL was 1.30 times higher (OR=1.30, 95%CI: 1.16–1.44), 1.22 times higher (OR=1.22, 95%CI: 1.02–1.45), and 1.60 times higher (OR=1.60, 95%CI: 1.34–1.90) in the elderly with cardiovascular system disease, diabetes mellitus and respiratory disease than in the elderly without these diseases. Further analysis found that having stroke and chronic bronchitis (or emphysema) were strongly associated with impaired ADL with OR of 2.87 (95%CI: 2.36–3.49) and 1.57 (95%CI: 1.30–1.90), respectively.

Conclusion The prevalence of impaired ADL in the elderly aged ≥60 years in communities in China increased over time. Cardiovascular and cerebrovascular diseases, chronic respiratory diseases, or co-morbidities all significantly increased the risk for developing impaired ADL. Chronic disease management should be further strengthened for the elderly in communities.