Back to Life, Back to Reality: Participation and Function After Acute Hospitalization in Older Adults

Abstract This study aims to describe and compare functional trajectories (i.e., participation versus basic daily function) from pre-hospitalization period to one and three-months post-discharge, among older adults hospitalized for acute medical illness, of two age groups: ages 65-75, n=39, >75, n=38. A Prospective longitudinal study was conducted, starting during hospitalization in internal ward and followed by home visits (1 month) and telephone interviews (3 months). Participation was measured by the Activity Card Sort (ACS) that queries about instrumental (e.g. shopping), leisure (e.g. physical activity), and social activities. Basic daily function was measured by the Modified Barthel Index (mBI). Wilcoxon test was used to compare between the ACS and mBI total retained scores within age groups. A mixed model repeated measures ANCOVA was used to compare time by group effects in ACS total scores. The results showed that basic function in both age groups was preserved, and both groups experienced a significantly greater decrease in participation level compared with basic function at one month (z=-4.1, p=.001, z=-4.5, p=.001) and at three months (z=-4.1, p=.001, z=-4.1, p=.001) in the "younger" and "older" groups, respectively. Participation trajectories were similar among age groups, however, the "older" group experienced a significantly greater decrease in participation (F(1)=(4.3), p=.042, η2= .056). Findings indicate that the traditional measure of basic function does not capture the broad spectrum of older adults’ full life and overshadows the reduced participation in meaningful activities. Health care professionals should adopt a comprehensive approach toward functional assessment to encompass participation beyond basic daily function.

and immune systems, but the extent to which they are related to the risk of developing COVID-19-like symptoms remains unclear.We aimed to explore these associations among Swedish older adults.We analyzed data from 904 individuals aged ≥68 years from the population-based Swedish National study on Aging and Care in Kungsholmen.COVID-19-like symptoms were assessed by phone interview (March-June 2020) and included fever, cough, sore throat and/or a cold, headache, pain in muscles, legs and joints, loss of taste and/ or odour, breathing difficulties, chest pain, gastrointestinal symptoms and eye inflammation.Muscle strength, mobility, and physical activity were objectively examined in 2016-2018.Data were analyzed using logistic regression models and stratifying by age.During the first outbreak of the pandemic, 325 (36%) individuals from our sample developed COVID-19-like symptoms.Those with longer time to perform the chair stand test had an odds ratio (OR) of 1.5 (95% confidence interval [CI] 1.1-2.1)for presenting with COVID-19-like symptoms compared to those with a faster time to perform the test, after adjusting for potential confounders.The risk was even higher among people aged ≥80 years (OR: 2.6; 95% CI 1.5-4.7).No significant associations were found for walking speed or moderate-to-vigorous physical activity.A weaker muscle strength, especially among the oldest-old adults, may contribute to higher odds of developing COVID-19-like symptoms, emphasizing the need to maintain sufficient levels of muscle strength in old age.

BACK TO LIFE, BACK TO REALITY: PARTICIPATION AND FUNCTION AFTER ACUTE HOSPITALIZATION IN OLDER ADULTS
Maya Arieli, 1 Racheli Kizony, 1 Efrat Gil, 2 and Maayan Agmon, 3 1.Department of Occupational Therapy, University of Haifa,Israel,Haifa,HaZafon,Israel,2. Clalit health services,Haifa and West Galilee,Israel,Haifa,HaZafon,Israel,3. The Cheryl Spencer Department of Nursing,University of Haifa,Israel,Haifa,HaZafon,Israel This study aims to describe and compare functional trajectories (i.e., participation versus basic daily function) from pre-hospitalization period to one and three-months postdischarge, among older adults hospitalized for acute medical illness, of two age groups: ages 65-75, n=39, >75, n=38.A Prospective longitudinal study was conducted, starting during hospitalization in internal ward and followed by home visits (1 month) and telephone interviews (3 months).Participation was measured by the Activity Card Sort (ACS) that queries about instrumental (e.g.shopping), leisure (e.g.physical activity), and social activities.Basic daily function was measured by the Modified Barthel Index (mBI).Wilcoxon test was used to compare between the ACS and mBI total retained scores within age groups.A mixed model repeated measures ANCOVA was used to compare time by group effects in ACS total scores.The results showed that basic function in both age groups was preserved, and both groups experienced a significantly greater decrease in participation level compared with basic function at one month (z=-4.1,p=.001, z=-4.5, p=.001) and at three months (z=-4.1,p=.001, z=-4.1, p=.001) in the "younger" and "older" groups, respectively.Participation trajectories were similar among age groups, however, the "older" group experienced a significantly greater decrease in participation (F(1)=(4.3),p=.042, η2= .056).Findings indicate that the traditional measure of basic function does not capture the broad spectrum of older adults' full life and overshadows the reduced participation in meaningful activities.Health care professionals should adopt a comprehensive approach toward functional assessment to encompass participation beyond basic daily function.

COMPARISONS OF DIFFERENT MULTIMORBIDITY MEASURES TO PREDICT PHYSICAL FUNCTION AMONG MIDDLE-AGED AND OLDER CHINESE
Hui-wen Xu, 1 Yan Luo, 1 Zi-Ting Huang, 2 zi-shuo Chen, 1 He-Xuan Su, 1 and Beibei Xu, 3  Multimorbidity has been associated with declined physical function.Several methods have been used to measure multimorbidity.However, few studies have compared the associations between different multimorbidity measures and physical function.We aimed to examine and compare the associations between different multimorbidity measures and physical function.We included 16,117 participants aged ≥45 from China Health and Retirement Longitudinal Survey (CHARLS) 2011-2018.Multimorbidity was defined as the co-existence of two or more of fifteen chronic conditions in an individual and measured by condition count at penultimate, multimorbidity patterns at penultimate (examined by exploratory factor analysis) and multimorbidity trajectories from baseline to penultimate living interview (examined by the group-based trajectory model).Physical function was assessed by activities of daily living or instrumental activities of daily living at the last follow-up.Logistic regression models were conducted for establishing prediction models in the training set.We used c-statistic, Integrated Discrimination Improvements (IDI) and Net Reclassification Index (NRI) to compare the performance of different models in the testing set.After adjusting for age and gender, compared with those without any conditions, participants with multimorbidity measured by three methods all had higher risks of poor physical function in the training set.Compared with the model using condition count (c-statistic=0.749),models using multimorbidity trajectory (c-statistic=0.712,IDI=-0.03,NRI=-0.31) and the multimorbidity pattern (c-statistic=0.739,IDI=-0.01,NRI=-0.16)showed poor predictive power (all p<.05).In our study, condition count has the best predictive performance for poor physical function over short time period.It is a simple and useful tool to assess multimorbidity.

GAIT SPEED MAINTENANCE IS ASSOCIATED WITH SENSORIMOTOR AND FRONTOPARIETAL NETWORK CONNECTIVITY AMONG OLDER ADULTS
Chun Liang Hsu, 1 Brad Manor, 2 and Lewis Lipsitz, 3 1.Hinda and Arthur Marcus Institute for Aging Research,Harvard Medical School,Burnaby,British Columbia,Canada,2. Hinda and Arthur Marcus Institute for Aging Research,Harvard Medical School,Boston,Massachusetts,United States,3. Hebrew SeniorLife,Boston,Massachusetts,United States Mobility impairment is a geriatric giant.Particularly, slow gait is associated with elevated risk for cognitive decline, disabilities and dementia.Gait is the product of complex neural network interactions and changes in their connectivity pattern may negatively impact gait speed.However, mechanistic neural correlates for gait speed maintenance and decline remained unclear.As such, the aim of this study is to investigate differences in neural network connectivity in older adults with and without gait speed decline over 24 months.This sub-analysis included 35 community-dwelling older adults age >70 years from the MOBILIZE Boston Study.Baseline assessments included four-meter gait speed test and resting-state fMRI.Gait speed was reassessed at a 24-month follow-up.Participants were stratified to "Maintainer" and "Decliner" groups based upon a cut-off of >0.05 m/s decline in gait speed from baseline to follow-up.A priori selected functional network included sensori-motor network (SMN) and frontoparietal network (FPN).Multivariate analysis of variance was performed to determine between group differences in network connectivity.Discriminant analysis was conducted to identify relative contribution of network connectivity to group classification.Between the 14 Maintainers and 21 Decliners (mean age 83.9 years), Maintainers were younger (p=0.088).After adjusting for age, Maintainers exhibited lower SMN premotor-precentral gyrus connectivity (p=0.023),greater FPN ventral visual-supramarginal gyrus connectivity (p=0.025), and trend level greater SMN-FPN cerebellum-occipital connectivity (p=0.053).Premotorprecentral gyrus connectivity showed greatest contribution to discriminant function.These preliminary findings suggest aberrant connectivity patterns of the SMN and FPN may be predictive of older adults' ability to maintain gait speed.

THE SEX DIFFERENCE IN PHYSICAL FUNCTIONING: HOW DO RISK FACTORS CONTRIBUTE?
Lena Sialino, 1 Susan Picavet, 2 Hanneke Wijnhoven, 1 Anne Loyen, 2 Monique Verschuren, 2 Marjolein Visser, 1 Laura Schaap, 1 and Sandra van Oostrom, 3 1.Vrije Universiteit Amsterdam, Amsterdam, Noord-Holland, Netherlands, 2. National Institute for Public Health and the Environment, Bilthoven, Utrecht, Netherlands, 3. National Institute for Public Health and the Environment, Amsterdam, Noord-Holland, Netherlands This study explores whether sex differences in the sensitivity to risk factors (strength of the association) and/or in the exposure to risk factors (prevalence) contributes to the sex difference in physical functioning, with women reporting more limitations.Data of the Doetinchem Cohort Study was used (n=5971, initial ages 26-70 years), with follow-up measurements every 5 years (up to 20).Physical functioning (subscale SF-36, range:0-100) and a number of socio-demographic, lifestyle and health-related risk factors were assessed.Mixed-model multivariable analysis was used to investigate sex differences in sensitivity (interaction term with sex) and in exposure (change of the sex difference when adjusting) to risk factors.The physical functioning score among women was 6. 75 (95%CL:5.65,7.85,points lower than among men.In general, men and women