Premium
Environmental toxicity exposure and ability to perform instrumental activities of daily living in several U.S. geographic locations
Author(s) -
Feger Danielle M,
Corrigan Anne E,
Crane Breanna M,
Carlson Michelle C
Publication year - 2020
Publication title -
alzheimer's and dementia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 6.713
H-Index - 118
eISSN - 1552-5279
pISSN - 1552-5260
DOI - 10.1002/alz.042258
Subject(s) - activities of daily living , logistic regression , toxicity , univariate , multivariate analysis , multivariate statistics , univariate analysis , odds , psychology , medicine , gerontology , statistics , physical therapy , mathematics
Background Instrumental activities of daily living (IADLs) are complex tasks important for independent living, such as cooking, shopping, and managing finances. Older adults may report difficulty performing IADLs in preclinical dementia or mild cognitive impairment (MCI). Cognitive function has been shown to be lower in individuals with increased environmental toxicity exposure. However, little is known about an individual’s environmental toxicity exposure in relation to their ability to perform IADLs. We hypothesize that older adults with greater environmental toxicity exposure will be more likely to report difficulty performing IADLs. Method Participant data (N=3578) were from the baseline year (1990) of the Cardiovascular Health Study (CHS). Average environmental toxicity exposure was estimated for each participant using 1990 data from the US Environmental Protection Agency Risk‐Screening Environmental Indicators (RSEI) model. Six IADLs were measured; IADL performance was discretized as 1 = proficient (no self‐reported difficulty performing any IADLs), and 0 = not proficient (any self‐reported difficulty). Average toxicity exposure was base‐10 log transformed to aid in model fitting. Univariate and multivariate logistic regression models estimated the relationship between environmental exposure and IADL proficiency; multivariate models were adjusted for participant age, sex, race, education, income, baseline Modified Mini‐Mental State score, and cohort recruitment site. Result In the univariate model, higher toxicity concentration was associated with decreased odds of IADL proficiency (OR=0.79, p<0.001). After adjustment, no significant relationship between toxicity exposure and IADL difficulty was observed (OR=0.929, p=0.553); however, individuals in North Carolina were less likely to report being proficient in all IADLs relative to those in California (OR=0.657, p=0.013), and individuals in Maryland were marginally less likely to report full IADL proficiency relative to those in California (OR=0.736, p=0.098). Conclusion Individuals in North Carolina and Maryland were less likely to successfully perform all IADLs, even after adjustment for possible confounders. Ability to perform IADLs is critical for maintaining older adults’ independence, yet geographic location is rarely considered as a potential risk factor for IADL difficulty. It is unclear what factors beyond socioeconomic status contributed to observed regional disparities.