The research, published in Cancer Causes & Control by Hülya Bulut of the Health Sciences University Izmir Dr Suat Seren Chest Diseases and Surgery Training and Research Hospital and Kader Mert of Bakırçay University, was conducted as a cross-sectional investigation between March 1 and May 31, 2025. The team recruited 410 older adults diagnosed with lung cancer who were hospitalized at a training and research hospital in İzmir, interviewing each participant face to face. The cohort had a mean age of 70.79 years, with a standard deviation of 4.26 years, and 76.3 percent of the participants were male—a distribution that mirrors the well-documented male predominance in lung cancer epidemiology, driven historically by patterns of tobacco exposure.

What makes the study technically interesting is the trio of validated instruments the researchers deployed. Functional status was measured with the Katz Activities of Daily Living Scale, a classic 1963 instrument that scores a patient’s independence in fundamental self-care tasks such as bathing, dressing, toileting, transferring, continence, and feeding. Frailty was assessed with the Edmonton Frail Scale, a multidimensional screen covering cognition, general health status, functional independence, social support, medication use, nutrition, mood, continence, and physical performance. Care dependency—the outcome of primary interest—was quantified with the Care Dependency Scale developed by Dijkstra and colleagues, which evaluates how much support a patient requires across domains ranging from eating and drinking to mobility, hygiene, communication, and daily activities.

The statistical architecture of the analysis was deliberately conservative. Rather than examining simple correlations, the researchers used multiple regression modeling to determine whether activities of daily living and frailty each contributed independently to care dependency, controlling for the other. The results were striking in both their strength and their symmetry. Higher scores on the Katz scale—indicating greater functional independence—were independently associated with higher scores on the Care Dependency Scale, which reflects lower dependency, with an unstandardized coefficient of 2.344, a standardized beta of 0.309, and a p-value below 0.001. Conversely, higher scores on the Edmonton Frail Scale—indicating greater frailty—were independently associated with lower care dependency scores, meaning greater dependency, with an unstandardized coefficient of −2.391, a standardized beta of −0.652, and again a p-value below 0.001.

The most eye-catching number in the entire analysis is the proportion of variance explained. The regression model accounted for 81.5 percent of the variability in care dependency, with an adjusted R-squared of 0.815 and a p-value below 0.001. In clinical research, where models explaining 20 or 30 percent of an outcome’s variance are often considered respectable, a figure above 80 percent is remarkable. It suggests that for hospitalized older adults with lung cancer, the physics of daily dependence is largely governed by just two forces: how much physical function the patient retains and how deeply frailty has eroded their physiological reserves. Notably, the standardized beta for frailty was roughly twice as large as that for functional status, hinting that the multidimensional syndrome of frailty—including its cognitive, nutritional, and psychological dimensions—may be an even more powerful driver of care needs than the mechanics of self-care alone.

These findings land in a clinical landscape that is changing rapidly. Global cancer statistics from the GLOBOCAN 2022 estimates, cited in the paper’s bibliography, document lung cancer as one of the leading causes of cancer incidence and mortality worldwide across 185 countries. Survival trends tracked by the CONCORD-3 surveillance program, which analyzed records for more than 37 million patients diagnosed with 18 cancers across 71 countries, show gradual improvements that translate into a growing population of older adults living with and beyond lung cancer. As that population expands, the burden of care—delivered by nurses, family caregivers, and formal support systems—becomes a central concern of oncogeriatric medicine rather than an afterthought.

The concept of frailty itself has matured considerably since Clegg and colleagues framed it in The Lancet as a state of heightened vulnerability resulting from cumulative decline across multiple physiological systems. Subsequent work by Hoogendijk and colleagues has emphasized that frailty is not merely a synonym for old age or comorbidity; it is a measurable, potentially modifiable syndrome with real prognostic consequences. Prior research has already demonstrated bidirectional relationships between activities of daily living and frailty in general aging populations, including a large Chinese nationwide cohort study published in Frontiers in Public Health showing that functional decline and frailty reinforce one another over both short- and long-term follow-up. The new lung cancer study extends this framework into a specific oncology context, where tumor burden, treatment toxicity, and cancer-related symptoms such as fatigue can accelerate the frailty spiral.

For nursing science, the study carries particular weight. Care dependency is fundamentally a nursing outcome—it determines staffing intensity, discharge planning, rehabilitation referrals, and the strain placed on family caregivers. Earlier work by the same research group has explored related territory, including the relationship between mental health continuum and care dependency in individuals with chronic obstructive pulmonary disease, and the levels of caregiving burden experienced by family caregivers of lung cancer patients. The current findings give those threads a unified quantitative backbone: if a clinician can measure a patient’s Katz score and Edmonton Frail score at admission, the model suggests those two numbers alone will predict the bulk of the care dependency picture, allowing resources to be targeted before a crisis of dependence unfolds on the ward.

The authors are careful about the study’s design limitations, which are inherent to cross-sectional research. Because all data were collected at a single point in time from a single hospital, the analysis can establish association but not causation—it cannot determine whether frailty causes care dependency, whether emerging dependency accelerates frailty, or whether both are driven by a third factor such as advanced disease stage. The hospitalized setting also means the findings may not generalize to outpatients, community-dwelling patients, or those in palliative care at home. Nevertheless, the magnitude and consistency of the associations, together with the use of internationally validated and Turkish-adapted instruments, lend the results substantial credibility.

The practical implication the authors draw is straightforward and potentially transformative: routine frailty screening and functional assessment should be integrated into oncogeriatric care from the moment of diagnosis. In an era when comprehensive geriatric assessment is often skipped due to time constraints, the study suggests that two brief, inexpensive instruments could identify high-risk patients early enough for targeted interventions—nutritional support, structured exercise, cognitive engagement, medication review, and anticipatory discharge planning—to preserve independence rather than react to its loss. For a disease that will touch millions of older adults in the coming decades, that shift from reactive to proactive care could redefine what growing old with lung cancer looks like, turning a trajectory of escalating dependence into one of preserved autonomy for as long as possible.

Subject of Research: Associations between activities of daily living, frailty, and care dependency in older adults with lung cancer

Article Title: The relationship between activities of daily living, frailty, and care dependency in older adults with lung cancer

Article References: Bulut, H., & Mert, K. (2026). The relationship between activities of daily living, frailty, and care dependency in older adults with lung cancer. Cancer Causes & Control, 37(10), Article 172. https://doi.org/10.1007/s10552-026-02259-5

Image Credits: AI Generated

DOI: 10.1007/s10552-026-02259-5

Keywords: lung cancer, older adults, frailty, activities of daily living, care dependency, geriatric oncology, Katz ADL Scale, Edmonton Frail Scale, nursing, functional status, cross-sectional study, oncogeriatric care

The study, led by Johannes Riis of Aalborg University and Aalborg University Hospital in Denmark, together with colleagues including Dorte Melgaard, Victoria Gunmalm, Martin Grønbech Jørgensen, and Stig Andersen, set out to identify independent prognostic factors associated with decline in activities of daily living, commonly abbreviated ADL. These activities span the essential tasks of self-care, from eating and grooming to toileting and transferring, and their loss marks the point at which dementia shifts from a cognitive condition to a disabling one. Functional decline drives caregiver burden, predicts nursing home admission, and shapes the timing of difficult decisions about long-term care, which is why reliable prognostic markers have long been sought.

To assemble the evidence, the team searched five major databases—PubMed, EMBASE, Cochrane CENTRAL, CINAHL, and PsycINFO—from their inception through October 2025. The eligibility criteria were strict: only longitudinal studies following community-dwelling adults aged 65 or older with an established dementia diagnosis qualified. The screening process was enormous in scale. The researchers sifted through 6,915 records, examined 100 full-text articles in detail, and ultimately included 19 reports derived from 13 distinct studies covering a combined 9,490 participants. Two reviewers independently screened studies, extracted data, and judged risk of bias, following the PRISMA 2020 reporting framework and registering the protocol in advance with PROSPERO under identifier CRD42024502839.

Methodological rigor was central to the design. Risk of bias was assessed with the Quality in Prognostic Studies tool, a validated instrument developed specifically for prognostic factor research, and the certainty of the pooled evidence was graded using the GRADE system, which rates confidence in findings from high to very low. Meta-analyses were only attempted for predictors reported in at least three studies with sufficient homogeneity to justify statistical pooling. That constraint proved decisive, because although the included studies reported a remarkably wide range of candidate prognostic factors, only a handful had been examined consistently enough to combine: age, sex, educational attainment, living alone, and global cognitive function measured with the Mini-Mental State Examination.

The results of the pooled analyses upend several common assumptions. Age, often assumed to accelerate functional deterioration in dementia, showed no significant effect, with a standardized mean difference of 0.0 and a 95 percent confidence interval of 0.0 to 0.1, at moderate certainty. Years of education fared no better: the pooled estimate was 0.00 with a confidence interval of −0.02 to 0.02, also at moderate certainty. In other words, neither being older nor having spent fewer years in school meaningfully changed how quickly daily functioning declined once dementia was established. The finding challenges the intuitive notion that chronological age is a reliable yardstick for disease progression in this population.

Baseline cognition, by contrast, emerged as the single dependable predictor. Better global cognitive function at the start of follow-up, as measured by the MMSE, was associated with slower subsequent decline in activities of daily living, with a standardized mean difference of −0.05 and a 95 percent confidence interval of −0.06 to −0.04, rated at moderate certainty. Although the effect size appears modest in statistical terms, its consistency across studies gives it practical weight: a patient who scores higher on cognitive testing at diagnosis can be expected to retain functional independence longer than a patient with equivalent diagnosis but poorer cognition. This aligns with a broader literature linking cognitive and functional trajectories in dementia, but the new analysis is the first to establish the association through a formally graded synthesis of longitudinal community-based studies.

Two further factors—sex and living alone—could not be interpreted with confidence. The evidence for both was rated as very low certainty and inconsistent across studies, meaning the pooled data could not determine whether men and women, or people living alone versus with others, decline at different rates. The authors conclude that only baseline cognition can currently be recommended for predicting functional decline in dementia, while age and sex may be of limited importance, and that substantially more research is needed to improve person-centered prognostication.

The review is as notable for what it exposes about the research field as for what it confirms. Risk of bias was frequently judged high for participant selection, in 16 of 19 reports, and for attrition, in 14 of 19, often because of poor reporting rather than demonstrable flaws. This pattern matters because prognostic studies are particularly vulnerable to selection effects: cohorts recruited from memory clinics may differ systematically from the broader population of people with dementia living at home, and loss to follow-up is rarely random, since the sickest participants are often the first to drop out. The authors’ transparent accounting of these weaknesses, and their decision to grade certainty rather than simply pool everything, models the approach that prognostic factor research has been urged to adopt under frameworks such as PROGRESS.

The heterogeneity problem also deserves attention. Studies measured functional decline with different instruments, over different follow-up periods, and adjusted for different covariates, which is precisely why only five factors could be meta-analyzed at all. Candidate predictors that clinicians might consider important—comorbidities, polypharmacy, behavioral symptoms, physical performance measures such as balance, caregiver characteristics, and treatment effects—appeared in individual studies but could not be synthesized. The Danish team’s conclusion that the evidence base is limited and heterogeneous is a call to action: without standardized measurement and better reporting, the field cannot build the multivariable prediction models that would allow genuinely individualized forecasting.

For clinicians, caregivers, and health planners, the practical message is nonetheless actionable. When counseling a family after a dementia diagnosis, the strongest available evidence supports using baseline cognitive performance, not age or education, to gauge the likely pace of functional loss. That information can inform realistic planning for home support, respite care, and eventual transitions in care arrangements, while avoiding the fatalism that an advanced age alone might invite. At the same time, the review tempers expectations: with moderate certainty for only one predictor and very low certainty for others, prognostication in dementia remains an inexact science. The 9,490 participants whose data underpin this analysis have clarified what is known, and just as importantly, mapped the terrain of what remains unknown. Closing those gaps will require the kind of high-quality, well-reported longitudinal research that this review shows is still too rare.

Subject of Research: Prognostic factors for functional decline in community-dwelling older adults with dementia

Article Title: Prognostic factors for functional decline in community-dwelling older adults with dementia: a systematic review and meta-analysis

Article References: Riis, J., Melgaard, D., Gunmalm, V., Petersen, K. S., Jørgensen, M. G., & Andersen, S. (2026). Prognostic factors for functional decline in community-dwelling older adults with dementia: a systematic review and meta-analysis. European Geriatric Medicine. https://doi.org/10.1007/s41999-026-01613-9

Image Credits: AI Generated

DOI: 10.1007/s41999-026-01613-9

Keywords: dementia, functional decline, activities of daily living, prognosis, systematic review, meta-analysis, older adults, cognition, MMSE, geriatrics, community-dwelling, risk of bias

The research, led by occupational therapist Rina Juel Kaptain of University College of Northern Denmark and colleagues at the Parker Institute in Copenhagen and the University of Southern Denmark, took an exploratory cross-sectional approach. The team recruited 30 adults diagnosed with Long COVID who were enrolled in an interdisciplinary, municipality-based rehabilitation program between April and December 2022. All had been referred from a clinic for long-term sequelae of COVID-19 at a county university hospital after their symptoms had persisted for at least six weeks. Of 53 people invited to take part, 57 percent agreed to share clinical data collected as part of their routine care.

The study’s central innovation lies in the assessment tool it deployed. Rather than relying on coarse questionnaires that simply ask whether a person can or cannot perform a task, the researchers used the ADL Interview, or ADL-I, a validated occupational therapy instrument that probes the quality of task performance across 47 activities: 31 personal ADL tasks such as eating, grooming, and dressing, and 16 instrumental ADL tasks such as cooking, shopping, and cleaning. For each task, respondents describe whether they perform it without extra time or effort, with added time, with added effort or fatigue, with risk of injury, with partial assistance, or not at all. These ratings are then converted, through a Rasch rating scale model, into an overall interval-level measure of self-reported ADL ability, adjusted for the difficulty of each task.

The results reveal a striking and consistent pattern. Nearly every participant reported degraded performance quality in both personal and instrumental domains, but the dominant problems were not outright dependence. Instead, they were subtler: extra time consumed and extra effort expended. Within the personal ADL domain, between 60 and 97 percent of participants reported communication difficulties, including taking part in conversation, using the phone, reading, and writing by hand or word processor. Roughly half reported similar time-and-effort burdens when walking between floors or moving about the neighborhood, and nearly half reported the same when washing or bathing. Almost a third reported added effort simply to wash their hair.

The instrumental domain showed even broader disruption. More than half of the participants reported decreased quality of performance across transportation, cooking, shopping, and cleaning tasks. Sixteen participants had trouble riding a bicycle or moped, and 21 reported problems driving a car, again mostly because of increased time or effort, though a smaller group described safety risks, a need for help, or inability to complete the task. Cooking a hot meal, making shopping plans, and both small- and large-quantity shopping were each affected in more than half the sample. By contrast, nearly all participants remained competent at heating up liquid or prepared food and preparing a cold meal, suggesting that simpler, shorter tasks remained within reach while complex, multi-step activities did not.

Statistically, the picture sharpened further. Using Spearman’s rho and point biserial correlations, the researchers examined whether ADL ability was linked to a range of health-related, social, and personal factors: age, sex, cohabitation, comorbidity, symptom presence, and work status. Only one factor rose above weak association. Fatigue, measured with the Modified Fatigue Impact Scale, showed a moderate negative correlation with ADL ability (r = −0.50, p = 0.01), meaning that the more severely participants were affected by fatigue, the poorer their rated quality of everyday task performance. None of the remaining variables, including age, showed meaningful relationships, a finding the authors describe as surprising given that ADL ability typically declines with age in the general population. Long COVID, they suggest, may disrupt typical age-related patterns of function.

The centrality of fatigue is consistent with a broader literature. Previous research has found that more than 70 percent of people with Long COVID report fatigue as their worst symptom, and that physical activity, stress, and disturbed sleep can all exacerbate it. Fatigue is also a well-documented driver of functional limitation in other chronic conditions, including heart failure, fibromyalgia, chronic pain, hypertension, and stroke, and self-reported fatigue in older adulthood has been shown to predict the need for ADL assistance years later. The Danish findings extend this pattern to Long COVID, reinforcing the idea that energy dysregulation lies at the heart of the condition’s functional toll.

The study also documented a heavy occupational cost. Only 10 percent of participants were able to maintain their regular working hours; more than half worked reduced hours, and one third were on full-time sick leave. This aligns with earlier research showing that only a minority of previously employed people with Long COVID return to their pre-illness working hours. Notably, the tasks that most often deteriorated, communication, planning, transportation, and household management, are precisely the capacities that underpin employment and social participation. The authors point out that difficulty with conversation, reading, and writing is particularly consequential, and cite prior work showing that 73 percent of Long COVID patients report difficulties socializing.

For rehabilitation practice, the findings carry concrete implications. Because most participants retained independence but lost efficiency, the authors argue that rehabilitation planning should assess not just whether patients can perform a task, but how much time, effort, and risk the performance involves. They highlight the role of occupational therapy in energy management interventions, teaching patients to understand the factors that influence their energy levels and to apply strategies such as pacing, prioritizing activities, planning ahead, and modifying their environment. Evidence suggests such interventions can be delivered effectively both in person and remotely, and recent data show meaningful improvements in fatigue, energy-management competence, and ADL performance, a flexibility that matters given the fluctuating nature of Long COVID symptoms.

The authors are careful to note the study’s limits. The sample of 30 participants was small and drawn retrospectively from people who had completed municipal rehabilitation, so the findings may not generalize to those with milder symptoms or limited healthcare access. Still, the heterogeneity of the sample, spanning ages 28 to 73, both sexes, varied symptom profiles, and different times since diagnosis, strengthens the correlational analyses. And the use of a standardized, task-specific instrument administered by a certified occupational therapist gives the study a granularity that binary assessments cannot match. The conclusion is sobering but actionable: Long COVID does not merely make people unable to do things; it makes the doing of ordinary life slower, costlier, and more fragile, and rehabilitation that targets energy and efficiency, not just independence, may be key to restoring it.

Subject of Research: Quality of activities of daily living task performance and fatigue in adults with Long COVID

Article Title: Activities of daily living following Long COVID: An exploratory cross-sectional study

Article References: Kaptain, R. J., Jensen, K. E. B., Nielsen, K. T., & Wæhrens, E. E. (2025). Activities of daily living following Long COVID: An exploratory cross-sectional study. Scandinavian Journal of Occupational Therapy, 32(1), Article 2597212. https://doi.org/10.1080/11038128.2025.2597212

Image Credits: AI Generated

DOI: 10.1080/11038128.2025.2597212

Keywords: Long COVID, activities of daily living, ADL-I, fatigue, occupational therapy, rehabilitation, functional disability, post-acute sequelae of COVID-19, energy management, cross-sectional study, personal ADL, instrumental ADL

The research team assessed functional disability using a two-component framework that distinguishes between basic and instrumental domains of daily living. The Physical Self-Maintenance Scale, or PSMS, captures fundamental self-care capacities such as bathing, dressing, toileting, continence, feeding, and grooming, which together define basic activities of daily living. The Instrumental Activities of Daily Living scale, known as IADL, probes more complex and cognitively demanding tasks, including the ability to use a telephone, shop, prepare food, manage housework, do laundry, travel independently, take medications, and handle finances. This layered architecture matters clinically because instrumental disability typically emerges earlier in the trajectory of functional decline, often signaling a window during which intervention can still preserve independence, whereas basic ADL impairment marks a deeper erosion of autonomy that usually demands intensive support.

The headline numbers are striking. The overall prevalence of functional disability in the sample stood at 36.41 percent, a figure that underscores how widespread functional limitation already is among middle-aged and older residents of this mountainous, multi-ethnic province. Breaking the composite measure into its components, the researchers found that 35.58 percent of participants experienced disability in instrumental activities, while 4.27 percent had lost capacity in basic self-care activities. The large gap between these two figures is itself informative: it suggests that the early stages of functional decline in these populations manifest primarily as difficulty with the complex, socially embedded tasks of independent living rather than as an inability to perform elementary self-maintenance, a pattern consistent with the established natural history of disability progression.

Perhaps the study’s most methodologically important contribution lies in how it handled the problem of comparing disability across ethnic groups whose age structures differ markedly. Crude prevalence rates can mislead when one population is substantially older than another, because age is the single most powerful driver of functional decline. To address this, the investigators calculated standardized prevalence rates for the 11 ethnic minority groups using the age distribution of the Han population as the reference standard. This statistical adjustment, an application of direct standardization, removes age-structure distortion and permits a more honest comparison of the underlying burden. After standardization, the Bulang group showed the highest age-adjusted prevalence of IADL disability at 59.50 percent, while the Nu group recorded the highest age-adjusted rate of basic ADL disability at 9.37 percent, figures that substantially exceed the provincial averages and point to genuine disparities rather than demographic artifacts.

Drilling into specific instrumental tasks revealed further heterogeneity. The Lisu, Nu, and Bulang groups reported the greatest difficulty with transportation, at 51.33, 50.15, and 49.58 percent respectively, meaning that roughly half of older adults in these communities struggle to move beyond their homes. The Bulang group also registered the highest proportion of difficulty using the telephone, at 33.74 percent. These are not trivial deficits. Transportation dependence and communication barriers sever older adults from markets, clinics, social networks, and emergency services, creating a cascading vulnerability in which each loss compounds the next. In a province defined by rugged terrain and geographically dispersed villages, such figures translate into concrete risks of untreated illness and social isolation, and they hint at infrastructure and accessibility deficits that health policy alone cannot remedy without complementary investment in rural connectivity.

To identify the factors associated with disability risk, the team employed multivariable logistic regression, reporting results as odds ratios with 95 percent confidence intervals. Advanced age emerged as a consistent and powerful predictor across all three outcomes: the odds of functional disability, basic ADL disability, and IADL disability all roughly two-and-a-half-fold higher in the oldest categories, with odds ratios of 2.56, 2.81, and 2.52 respectively. Nutritional status, proxied by body mass index, also carried weight. A BMI below 18.50, indicating underweight status, was associated with elevated risk across the board, with odds ratios of 1.41 for overall disability, 2.20 for basic ADL disability, and 1.35 for IADL disability. This association aligns with a substantial literature linking undernutrition, sarcopenia, and frailty, and it flags older underweight adults as a priority group for screening and nutritional support.

Education exerted a robust protective effect that the authors describe in notably strong terms. Higher educational attainment was associated with sharply reduced odds of disability across all outcomes, with odds ratios of 0.32 for overall functional disability, 0.49 for basic ADL disability, and 0.31 for IADL disability. In practical terms, more educated adults carried roughly a two-thirds to nearly seventy percent lower risk of losing functional independence. The mechanisms are plausibly manifold: education correlates with health literacy, higher lifetime earnings, better access to care, cognitively stimulating occupations, and the physical reserve that gerontologists describe as reserve capacity against decline. In Yunnan’s context, where educational access has historically been uneven across ethnic and geographic lines, this finding suggests that the educational gaps of past generations are now being repaid in the currency of functional health.

The sex differences the study uncovered add an instructive wrinkle. Women were more likely to experience overall functional disability, with an odds ratio of 1.41, and instrumental disability, with an odds ratio of 1.40, while men were more likely to experience basic ADL disability, expressed as an odds ratio of 0.64 for women. This divergence likely reflects a combination of longer female longevity, different lifetime occupational and caregiving exposures, and the fact that instrumental tasks are strongly shaped by gendered social roles. Whatever the precise drivers, the pattern implies that effective interventions will need to be gender-sensitive rather than uniform, recognizing that men and women in these communities lose different capacities at different stages of decline.

The authors conclude that functional disability remains disproportionately prevalent among ethnic minority populations in Yunnan, with substantial heterogeneity both between minority groups and the Han majority and among minority groups themselves, and they call for targeted, culturally sensitive interventions addressing health vulnerability to reduce disparities and promote equitable healthy aging. The study was supported by Yunnan Fundamental Research Projects, the Yunnan High-level Talent Introduction Plan, the Yunnan Philosophy and Social Science Innovation Team, and a First-Class Discipline Team grant from Kunming Medical University, and it was approved by the university’s ethics committee with informed consent obtained from all interviewees. As China’s aging population grows and its minority regions continue to lag in health infrastructure, findings of this kind will be essential raw material for the design of long-term care systems that do not leave entire communities behind. What the Yunnan data make clear is that healthy aging is not a uniform target but a mosaic of local realities, each demanding its own calibrated response.

Subject of Research: Prevalence and determinants of functional disability among middle-aged and older adults across 12 ethnic groups in Yunnan, China

Article Title: Prevalence and associated factors of functional disability among middle-aged and older adults: evidence from 12 ethnic groups in Yunnan, China

Article References: Zhang, J., Bai, H., Li, R., Wang, Y., Ma, J., Li, Y., Gao, Y., Liu, H., Huang, R., Yan, C., Deng, R., & Huang, Y. (2026). Prevalence and associated factors of functional disability among middle-aged and older adults: evidence from 12 ethnic groups in Yunnan, China. International Journal for Equity in Health. https://doi.org/10.1186/s12939-026-03039-y

Image Credits: AI Generated

DOI: 10.1186/s12939-026-03039-y

Keywords: functional disability, ethnic minorities, aging population, activities of daily living, IADL, PSMS, Yunnan China, health equity, logistic regression, prevalence, older adults, disparities

The study, led by Vita Hagelskjær and colleagues from the Parker Institute at Copenhagen University Hospital Bispebjerg-Frederiksberg, the University of Southern Denmark, and VIA University College, evaluated the content and delivery of ABLE 2.0, an eight-week, individualized occupational therapy intervention designed for adults with chronic somatic conditions. The evaluation was conducted alongside a randomized controlled trial in a Danish municipality, with data collected between August 2020 and July 2021. Of 38 clients allocated to the ABLE arm of the trial, 29 completed the program, and the results paint a picture of an intervention that works largely as intended, with goal attainment achieved in 55 of 64 cases—an impressive 86 percent success rate.

ABLE 2.0 is the product of nearly a decade of systematic development within the A Better Everyday research programme, established in 2015 and guided by the United Kingdom Medical Research Council’s framework for developing and evaluating complex interventions. The first version, ABLE 1.0, was developed and feasibility-tested between 2015 and 2018. Feedback from that phase prompted targeted refinements: the mandatory number of sessions was reduced, standardized evaluation of activities of daily living (ADL) ability and collaborative goal setting were emphasized, and recent occupational therapy theory was incorporated to strengthen occupation-centered reasoning. The result was ABLE 2.0, a program structured by the Occupational Therapy Intervention Process Model (OTIPM), which provides a systematic framework for client-centered, occupation-based practice.

The technical architecture of the intervention is worth examining closely because it illustrates how modern rehabilitation science translates theory into practice. In the first session, clients undergo standardized evaluation of both self-reported and observed ADL ability using the ADL Interview (ADL-I) and the Assessment of Motor and Process Skills (AMPS), a validated observational instrument that measures the motor and process skills a person enacts while performing chosen everyday tasks. This session also involves determining any discrepancy between what clients report about their ability and what structured observation reveals. The second session centers on collaborative goal setting using Goal Attainment Scaling (GAS), a measurement approach in which goals are scaled across levels of expected attainment, alongside an analysis of the underlying reasons for task performance problems using the Person-Environment-Occupation model or the Transactional Model of Occupation.

Sessions three through seven then offer an individualized combination of nine intervention components, ranging from changing habits related to task performance and changing attitude, to modifying the physical or social environment, using tools and assistive technology, dividing tasks into smaller steps, and simplifying task processes. The program builds on a compensatory intervention model, applying adaptational strategies—changes to the environment, assistive devices, adjusted routines—rather than attempting to restore impaired performance skills directly. The final session includes re-evaluation of goal attainment. Sessions one, two, and the final session are mandatory, establishing a minimum dose of three contacts, and the program can be delivered face-to-face or by telephone, with homework assigned between sessions in more than 71 percent of cases. Examples of such homework included practicing to vacuum using new body positions, taking out the waste with a walker, and sitting down while dressing.

The process evaluation, structured according to the framework proposed by O’Cathain and colleagues, examined five dimensions: intervention development and components, mechanisms of action, perceived value and unintended consequences, feasibility and acceptability in practice, and fidelity, reach, and dose. Data came from registration forms completed independently by clients and occupational therapists after every session, with clients submitting their forms in sealed envelopes to avoid influence from the treating therapist. All nine intervention components were applied during the study period, with changing habits the most frequently implemented (34 instances), followed by changing attitude (32) and the use of tools, technology, and assistive devices (23). Session duration varied considerably, from a median of 42.5 minutes in session four to 120 minutes in the evaluation-heavy first session, underscoring the individualized nature of the delivery.

Perhaps the most striking findings concern the mechanisms of action. Both clients and therapists reported that the standardized ADL evaluations in the first session provided new insights into the client’s ability, clarified the focus of the intervention, and established a solid foundation for the collaborative relationship. This is notable because data from the parallel effectiveness trial showed that clients receiving usual occupational therapy in the municipality were typically not offered standardized evaluations at all, and their goals were usually set by the referral service rather than negotiated with the client. The 86 percent goal attainment rate in the present study also represents a substantial improvement over the 52 percent achieved in the earlier ABLE 1.0 feasibility study, suggesting that the refinements to the manual and the enhanced training—particularly the emphasis on collaborative goal setting—paid off. Occupational therapists themselves reported feeling skilled to a high or very high degree and found delivering the sessions satisfying, and no side effects were reported at all.

The findings do, however, reveal persistent friction points. A small number of deviations from the manual occurred: the AMPS evaluation was omitted for two clients, and one client expressed no goals, making GAS-based goal setting impossible. Therapists noted challenges with goal setting, and one remarked on doubt about whether a client fully understood the discrepancy dialogue. The authors argue these difficulties reflect limited routine in conducting standardized evaluations and collaborative goal setting within Danish municipal practice—a concern echoed by recent Swedish and Danish studies documenting sparse use of standardized assessment tools in primary healthcare and assistive technology services. Because collaborative goal setting was identified in the companion realist evaluation as a core mechanism of change in ABLE, the researchers recommend further refinement of the manual and training course on this specific aspect before wider implementation.

Retention also emerged as a key consideration for future rollout. Five clients dropped out before the first session, mainly due to hospitalization, and four more left before the second session, citing lack of motivation, bereavement, or no perceived need for intervention. Those who dropped out were slightly younger and had somewhat higher baseline ADL motor ability than completers, hinting that the program may be most beneficial for older adults with lower ADL ability—a conclusion supported by the effectiveness trial, which found clinically relevant and statistically significant improvements in observed ADL motor ability at both ten and twenty-six weeks among ABLE recipients, though no significant changes in self-reported ADL ability. The gap between observed and self-reported outcomes remains an intriguing puzzle for the field, but the observed gains translate into clients performing daily tasks with greater efficiency, less physical effort, and improved safety.

Taken together, the process evaluation confirms that ABLE 2.0 is feasible, acceptable, and deliverable with high fidelity within real-world municipal rehabilitation services. Its essential ingredients—standardized evaluation of ADL ability, collaborative goal setting, identification of the reasons behind task performance problems, and client engagement in trying out adaptational strategies at home—form a coherent, evidence-based template for helping people with chronic conditions reclaim their everyday lives. The authors emphasize that future implementation efforts should prioritize embedding standardized evaluation into clinical routines, optimizing training in collaborative goal setting, and treating recruitment as a central uncertainty. With a cost-effectiveness evaluation still in progress and an implementation strategy on the research agenda, the ABLE programme is steadily building the comprehensive evidence base needed to move from promising trial results to routine clinical practice across Danish municipalities and beyond.

Subject of Research: Feasibility and delivery of a home-based, occupation-centred problem-solving occupational therapy intervention for adults with chronic somatic conditions

Article Title: Content and delivery of occupation-centred problem-solving occupational therapy for people with chronic somatic conditions: A process evaluation of ABLE 2.0

Article References: Hagelskjær, V., Nielsen, K. T., Frilev, T. R., von Bülow, C., & Wæhrens, E. E. (2025). Content and delivery of occupation-centred problem-solving occupational therapy for people with chronic somatic conditions: A process evaluation of ABLE 2.0. Scandinavian Journal of Occupational Therapy, 32(1), 1-16. https://doi.org/10.1080/11038128.2026.2619344

Image Credits: AI Generated

DOI: 10.1080/11038128.2026.2619344

Keywords: occupational therapy, ABLE 2.0, activities of daily living, chronic conditions, process evaluation, goal attainment scaling, AMPS, rehabilitation, home-based intervention, adaptational strategies, municipal health services, Denmark