Author Information
Cai Wen, Fudan University, ChinaYe Ruan, Shanghai Municipal Center for Disease Control and Prevention, China
Qi Zhao, Fudan University, China
Abstract
Background: Activities of daily living (ADL), including basic (BADL) and instrumental (IADL) activities, are key indicators of functional independence in older adults. This study aimed to identify and describe the determinants of distinct BADL and IADL trajectory patterns among adults aged 60 and above.
Methods: Data were collected from a community-based cohort across six waves from 2015 to 2022 and analyzed using group-based multi-trajectory modeling (GBMTM) to identify BADL and IADL trajectories. Binary logistic regression was subsequently used to examine the relationships between these multi-trajectories and their potential determinants.
Results: A total of 2,968 older adults aged 60 years and above were included. Two distinct trajectory groups for BADL and IADL were identified: a "stable low impairment" group (n=2,314, 77.96%) and a "rapid decline" group (n=654, 22.04%). Multivariate analysis revealed that female sex (OR=1.65, 95% CI: 1.16–2.36), advanced age (OR=1.24, 95% CI: 1.21–1.27), rural residence (OR=1.44, 95% CI: 1.02–2.04), depressive symptoms (OR=1.88, 95% CI: 1.35–2.63), cognitive impairment (OR=1.75, 95% CI: 1.11–2.73), and multimorbidity (OR=1.45, 95% CI: 1.04–2.02) increased the risk of being assigned to the rapid decline trajectory group. Notably, higher educational attainment (OR=0.66, 95% CI: 0.49–0.89), prior healthcare utilization (OR=0.39, 95% CI: 0.17–0.86), regular physical exercise (OR=0.74, 95% CI: 0.56–0.99), and reading habits (OR=0.61, 95% CI: 0.40–0.93) emerged as significant protective factors.
Conclusions: While most older adults maintained functional stability, a significant subgroup showed pronounced deterioration over time. Targeted interventions focusing on modifiable factors may help delay functional decline and improve the quality of life in aging populations.
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