Trajectory of Increasing Disability over Time in Activities of Daily Living (ADLs) and Instrumental Activities of Daily Living (IADLs) Among Older Adults with Epilepsy
Abstract number :
3.152
Submission category :
16. Epidemiology
Year :
2024
Submission ID :
386
Source :
www.aesnet.org
Presentation date :
12/9/2024 12:00:00 AM
Published date :
Authors :
Presenting Author: Julia James Elmer, BS – Brigham Young University
Ricardo Noriega, MPH – Brigham Young University
Anna Johnson, MPH – Brigham Young University
Sidney Moreas, MPH – Brigham Young University
Hyunmi Choi, MD, MS – Columbia University Medical Center
Jose Gutierrez, MD, MPH – Columbia University
W. T. Longstreth, MD, MPH – University of Washington
Mitchell Elkind, MD, MS, MPhil – Columbia University, America Heart Association
Evan Thacker, PhD – Brigham Young University
Rationale: Activities of daily living (ADLs) and instrumental activities of daily living (IADLs) measure an individual's functionality and ability to live independently. ADL and IADL disability tends to increase with age. Previous research on ADLs and IADLs in older adults with epilepsy is limited. To address this gap, we conducted a longitudinal analysis of ADL and IADL disability among older adults with prevalent epilepsy, incident epilepsy, or no epilepsy.
Methods: The Cardiovascular Health Study (CHS) included 5,888 community-dwelling adults 65 years of age and above enrolled from 1989-1992 and assessed annually through 2017 using a six-item questionnaire for physical function (ADLs) and a six-item questionnaire for IADL function. Disability scores range 0-6, higher scores indicating greater disability. Prevalent epilepsy at study entry and incident epilepsy during follow-up were ascertained using an algorithm that included self-report, antiepileptic medication use, and Medicare ICD-9 codes. We used linear mixed models with age as the time scale for longitudinal trajectories of mean ADL and IADL scores by epilepsy status. Incident epilepsy was measured as a time-varying covariate. ADL/IADL scores obtained prior to incident epilepsy were categorized as non-epilepsy. This model was adjusted for predictors of ADL and IADL disability including sex, race, level of education, self-rated health, cognitive function, and history of chronic obstructive pulmonary disease (COPD), stroke, myocardial infarction, atrial fibrillation, and heart failure.
Results: The cohort had a mean age of 73 (5.62) years at study entry and was 58% women. ADL and IADL disability increased exponentially as the cohort aged (Figure 1 panels A-C for ADL; panels D-F for IADL). Covariate-adjusted trajectories of mean ADL and IADL disability increased more steeply among participants with prevalent or incident epilepsy compared with no epilepsy (Figure 2 panel A for ADL; panel B for IADL). In the no epilepsy group, from age 70 to 80 years, mean ADL disability score increased by 0.1 points (95% CI: 0.0 to 0.1), and from age 80 to 90 years, by 1.6 points (95% CI: 1.5 to 1.6). Disability in the prevalent epilepsy group increased more steeply in mean ADL score, from age 70 to 80 by 0.5 points (95% CI: 0.3 to 0.6) and from age 80 to 90 by 1.9 points (95% CI: 1.7 to 2.1), which was 0.4 points faster than in those without epilepsy (95% CI: 0.2 to 0.6; P = 0.0001 vs non-epilepsy). The incident epilepsy group showed an even steeper increase in mean ADL score, by 0.8 points from age 70 to 80 (95% CI: 0.6 to 1.0) and by 2.3 points from age 80 to 90 (95% CI: 2.1 to 2.5), which was 0.7 points more than in no epilepsy (95% CI: 0.5, 1.0; P < 0.0001 vs no epilepsy). The mean IADL score trajectories followed a similar pattern (Figure 2 panel B).
Epidemiology