Geriatric conditions and disability

A broad study of adults ages 65 and older has found that half of them have one or more conditions that can affect their ability to participate in activities of daily living, such as bathing and dressing on their own.

Researchers at the University of Michigan Health System analyzed the responses of more than 11,000 participants in the national Health and Retirement Study. They found that 50 percent of older adults had a moderate to severe form of at least one of the following conditions: cognitive impairment, falls, incontinence, low body mass index, dizziness, vision impairment or hearing impairment.

The researchers also studied whether the respondents had difficulty with activities of daily living (bathing, dressing, eating, toileting or transferring) and needed assistance to complete the tasks. They found that people with geriatric conditions had about the same level of dependency when performing activities of daily living as older patients with chronic diseases, including heart disease, chronic lung disease, diabetes, cancer, musculoskeletal conditions, stroke and psychiatric problems.

The study – which appears in the Aug. 7 issue of the Annals of Internal Medicine – fills a major gap in research about older patients. Although conditions such as incontinence and falls have been studied extensively, the total impact of geriatric conditions on health and disability in the older adult population has not been investigated, notes lead author Christine Cigolle, M.D., MPH, lecturer in the U-M Health System Department of Family Medicine and a physician in the Veterans Affairs Ann Arbor Healthcare System's Geriatric Research, Education and Clinical Center (GRECC).

“The focus in medicine has long been on diseases, and how to diagnose and treat them. But that focus often isn't helpful in regard to older adults; they tend to have one or more of these geriatric conditions, which are not considered diseases and can be missed by physicians,” Cigolle says.

“Our study is the first to look at all seven of these common conditions together, and we found that they are very common and increase dramatically in prevalence with age,” she says. “To me, that says that clinicians need to ask patients about these issues. In many situations, they may be able to help manage the condition before it leads to disability.”

In the medical world, experts have debated how to categorize conditions such as the ones in this study. Some are called geriatric syndromes, while others fall outside of categories typically used by physicians.

The lack of consistent terminology has been one obstacle to the appropriate diagnosis and treatment of these conditions, says senior author Caroline Blaum, M.D., M.S., associate professor in the Division of Geriatric Medicine at U-M and a research scientist at the Veterans Affairs Ann Arbor Healthcare System GRECC.

Such obstacles need to be overcome so that older adults can receive the best health care possible, she says. “Geriatric conditions are integral to the health and function of older adults and should be addressed in their care,” Blaum notes.

The researchers found a strong link between the conditions and dependence on others to help with activities of daily living. Just 2.6 percent of survey participants without any of the geriatric conditions were dependent on others for help with activities. That percentage jumped to 8.1 among people with one of the conditions, 19.4 among people with two conditions, and 45 among people with three or more conditions.

All conditions increased in prevalence with advancing age. Among older adults with cognitive impairment, for instance, 55 percent were 80 or older. Overall, 39 percent of people ages 65-69 were found to have one or more of the conditions. The percentage rose to 82 among people ages 90 and older.

Additionally, compared to those with no geriatric conditions, people with increasing numbers of conditions were older, female, from a minority ethnic group, unmarried, and had less education and a lower net worth.

The data used in this study are from the 2000 wave of the Health and Retirement Study (HRS), a biennial longitudinal health interview survey of adults ages 50 years and older in the United States. The HRS is sponsored by the National Institute on Aging and performed by the Institute for Social Research at U-M.

In addition to Cigolle and Blaum, authors of the study were Kenneth M. Langa, M.D., Ph.D., of the U-M Medical School Department of Internal Medicine, the U-M Institute for Social Research and the Ann Arbor VA Center for Practice Management and Outcomes Research; and Mohammed U. Kabeto, M.S., and Zhiyi Tian, M.A., M.S., of the Department of Internal Medicine.

The study was supported by grants from the John A. Hartford Foundation and the National Institute on Aging and by the Ann Arbor VA GRECC.

Reference: Annals of Internal Medicine , Aug. 7, 2007, Vol. 147, pages 156-164. “Geriatric Conditions and Disability: The Health and Retirement Study.”