Abstract
Objective
To investigate causal factors of functional impairment in old age in a longitudinal approach.
Design
A population-based prospective cohort study.
Setting
Elderly individuals were recruited via GP offices at six study centers in Germany. They were observed every 1.5 years over six waves.
Participants
Three thousand two hundred fifty-six people aged 75 years and older at baseline.
Measurements
Functional impairment was quantified by the Lawton and Brody Instrumental Activities of Daily Living scale (IADL) and the Barthel-Index (BI).
Results
Fixed effects regressions revealed that functional impairment (IADL; BI) increased significantly with ageing (β=-.2; β=-1.1), loss of a spouse (β=.5; β=-3.1), not living alone in private household (β=-1.2; β=-5.5), depression (solely significant for IADL: β=.6) and dementia (β=-2.3; β=-18.2). The comorbidity score did not affect functional impairment.
Conclusion
Our findings underline the relevance of changes in sociodemographic variables as well as the occurrence of depression or dementia for functional impairment. While several of these causal factors for functional decline in the oldest old are inevitable, some may not be, such as depression. Therefore, developing interventional strategies to prevent depression might be a fruitful approach in order to delay functional impairment in old age.
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These authors contributed equally to this work.
Statistical analysis
To test whether FE regressions are necessary or the more efficient RE models can be used instead, we performed Sargan-Hansen test, resulting in the need to control for unobserved time-constant factors. Thus, FE regressions are the preferred regressions.
Alternate models
We repeated estimates (IADL as criterion) without comorbidity score (assessed from FU 2 upwards) as a covariate. Thus, in- traindividual changes from baseline up to FU wave 5 were used. Findings were almost the same (in terms of significant predictors and effect sizes) and the interaction term between depression and sex was significant (p=.001).
Furthermore, all analyses were repeated with FE poisson models, leading to similar results (in terms of significance) (results of alternate models are not shown, but are available upon request from the authors).
Additional models
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Table S3 Longitudinal Predictors of Functional Impairment (with interaction terms): Results of Fixed Effects Regressions
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Hajek, A., Luck, T., Brettschneider, C. et al. Factors affecting functional impairment among elderly Germans — Results of a longitudinal study. J Nutr Health Aging 21, 299–306 (2017). https://doi.org/10.1007/s12603-016-0771-5
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DOI: https://doi.org/10.1007/s12603-016-0771-5