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Originally published by 2 Minute Medicine® (view original article). Reused on AccessMedicine with permission.

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1. Functional impairment in activities of daily living (ADLs) and/or instrumental ADL (IADL), functional decline, and shifts between independence and functional impairment are all common in middle age.

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2. Risk factors for functional impairment include health status, behaviors related to health, and sociodemographics.

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Evidence Rating Level: 1 (Excellent)

Study Rundown:

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Independent living requires the ability to carry out basic ADLs, which includes activities such as dressing or bathing. Functional impairment, which is difficulty performing ADLs, is often associated with the elderly. Although such impairment often also occurs in middle age, there is very limited information for this demographic regarding this issue. This cohort study evaluated the epidemiology and clinical course of functional impairment in middle age. Researchers used longitudinal data to evaluate adults 50 to 56 years of age who were not functionally impaired at the start of the study. For up to 20 years of follow-up, participants were assessed for functional impairment (defined as difficulty in performing at least one ADL or IADL) every 2 years. The authors found that all of the following were common in middle age: functional impairment, functional decline, and shifts back and forth between independence and impairment. Greater understanding about functional impairment in middle age may assist in developing prevention and management strategies for this demographic.

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A strength of the study is the use of a sizable, nationally representative sample of adults from the Health and Retirement Study (HRS). One limitation is the use of self-reported data for functional status. In addition, considering that participants were assessed every 2 years, functional impairment may have been underestimated if shorter periods of impairment were not included.

In-Depth [prospective cohort]:

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This study used nationally representative longitudinal data from the HRS, which enrolls new participants every 6 years, to study 6 874 adults who were 50 to 56 years of age at the time of study enrollment (1992, 1998, or 2004). Every 2 years until 2014, participants were assessed for difficulty in performing any of 5 ADLs or 5 IADLs. The ADLs studied included bathing, dressing, eating, getting out of a bed or chair, and toileting. The IADLs studied included making telephone calls, managing medications, managing money, shopping for groceries, and making meals. By age 64, 22% of participants reported ADL impairment. Within two years of the first impairment incident, 37% of participants had recovered ADL independence, 50% were either stable or had improved to a level that was below full recovery of independence, 9% had functionally worsened, and 4% were deceased. Within 10 years of the first impairment, 28% had recovered, 37% were stable or improved, 16% had worsened, and 19% were deceased. By age 64, 19% of participants reported IADL impairment. Other findings were similar to that of ADLs. Risk factors for functional impairment include health status (e.g. chronic medical conditions), behaviors related to health (e.g. low physical activity), and sociodemographics (e.g. low income).

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