title: Clinically diagnosed infections predict disability in activities of daily living among the oldest-old in the general population: the Leiden 85-plus Study.
abstract: BACKGROUND
  ageing is frequently accompanied by a higher incidence of infections and an increase in disability in activities of daily living (ADL).
  
  
  OBJECTIVE
  this study examines whether clinical infections [urinary tract infections (UTI) and lower respiratory tract infections (LRTI)] predict an increase in ADL disability, stratified for the presence of ADL disability at baseline (age 86 years).
  
  
  METHODS
  the Leiden 85-plus Study. A population-based prospective follow-up study.
  
  
  METHODS
  general population.
  
  
  METHODS
  a total of 154 men and 319 women aged 86 years.
  
  
  METHODS
  information on clinical infections was obtained from the medical records. ADL disability was determined at baseline and annually thereafter during 4 years of follow-up, using the 9 ADL items of the Groningen Activity Restriction Scale.
  
  
  RESULTS
  in 86-year-old participants with ADL disability, there were no differences in ADL increase between participants with and without an infection (-0.32 points extra per year; P = 0.230). However, participants without ADL disability at age 86 years (n = 194; 41%) had an accelerated increase in ADL disability of 1.07 point extra per year (P < 0.001). For UTIs, this was 1.25 points per year (P < 0.001) and for LRTIs 0.70 points per year (P = 0.041). In this group, an infection between age 85 and 86 years was associated with a higher risk to develop ADL disability from age 86 onwards [HR: 1.63 (95% CI: 1.04-2.55)].
  
  
  CONCLUSIONS
  among the oldest-old in the general population, clinically diagnosed infections are predictive for the development of ADL disability in persons without ADL disability. No such association was found for persons with ADL disability.
authors.affiliation: Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, Netherlands. m.a.a.caljouw@lumc.nl
authors.forename: Monique A A
authors.initials: MA
authors.lastname: Caljouw
authors.forename: Saskia J M
authors.initials: SJ
authors.lastname: Kruijdenberg
authors.forename: Anton J M
authors.initials: AJ
authors.lastname: de Craen
authors.forename: Herman J M
authors.initials: HJ
authors.lastname: Cools
authors.forename: Wendy P J
authors.initials: WP
authors.lastname: den Elzen
authors.forename: Jacobijn
authors.initials: J
authors.lastname: Gussekloo
mesh_terms: D000203:Activities of Daily Living; D000367:Age Factors; D000369:Aged, 80 and over; D000375:Aging; D016009:Chi-Square Distribution; D004185:Disability Evaluation; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D009426:Netherlands / Q000453:epidemiology; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D012141:Respiratory Tract Infections / Q000175:diagnosis* / Q000453:epidemiology; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D014552:Urinary Tract Infections / Q000175:diagnosis* / Q000453:epidemiology
keywords: ADL disability; general population; infections; older people; oldest-old