title: Use of community support services and activity limitations among older adults with chronic kidney disease.
abstract: BACKGROUND
  There is a lack of population-based data on associations between chronic kidney disease (CKD) and the functional status/independence of older adults. We assessed prospective associations between CKD and (a) use of community support services and/or reliance on nonspouse family/friend support and (b) activities of daily living measures among older adults.
  
  
  METHODS
  A total of 1,952 participants from the Blue Mountains Eye Study aged 50 years or older at baseline were examined between 1992-1994 and 2002-2004. CKD was defined as Modification of Diet in Renal Disease Study estimated glomerular filtration rate of less than 60mL(.)min(-1)·1.73·m(-2). Use of services and nonspouse family/friend support was self-reported at baseline and follow-up. Functional status was determined by the Older Americans Resources and Services activities of daily living scale.
  
  
  RESULTS
  After adjusting for age, sex, education level, receipt of pension, living status, poor self-rated health, hypertension, diabetes, number of hospital admissions, walking disability, and visual impairment, participants with CKD had increased odds of using community support services, odds ratio, 1.75 (95% confidence interval: 1.06-2.89). With increasing severity of CKD at baseline, the likelihood of using community support services 10 years later increased significantly, p trend = .02. After multivariable adjustment, participants with CKD had a greater likelihood of incident impaired instrumental activities of daily living after 10 years, odds ratio, 2.02 (95% confidence interval: 1.15-3.57). Increasing severity of CKD at baseline was associated with increased likelihood of incident impaired instrumental activities of daily living, p trend = .02.
  
  
  CONCLUSIONS
  CKD could be a potential barrier to independent living for older adults, as shown by the increased need for formal home care services.
authors.affiliation: Centre for Vision Research, Department of Ophthalmology and Westmead Millennium Institute, University of Sydney, New South Wales, Australia.
authors.forename: Bamini
authors.initials: B
authors.lastname: Gopinath
authors.forename: David C
authors.initials: DC
authors.lastname: Harris
authors.forename: George
authors.initials: G
authors.lastname: Burlutsky
authors.forename: Paul
authors.initials: P
authors.lastname: Mitchell
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D015415:Biomarkers / Q000097:blood; D003153:Community Health Services / Q000706:statistics & numerical data*; D003404:Creatinine / Q000097:blood; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate; D006301:Health Services Needs and Demand; D006801:Humans; D057187:Independent Living; D008297:Male; D009517:New South Wales; D011446:Prospective Studies; D051436:Renal Insufficiency, Chronic / Q000175:diagnosis / Q000503:physiopathology; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D012944:Social Support; D014786:Vision Disorders
chemical_list: D015415:Biomarkers; D003404:Creatinine