Abstract / Summary
Older adults with diabetes are at high risk of functional decline, but functional status is dynamic and may involve both worsening and improvement. Evidence remains limited on whether home- and community-based services (HCBS) use is associated with transitions into and out of concurrent limitations in activities of daily living (ADL) and instrumental activities of daily living (IADL). This study examined these two directions of dual functional limitation transition. This longitudinal cohort study used 2018 and 2020 data from the China Health and Retirement Longitudinal Study (CHARLS). Among 1,227 adults aged ≥ 60 years with diabetes, dual functional limitation was defined as concurrent ADL and IADL limitation. HCBS use was assessed in 2018. Modified Poisson regression with robust sandwich variance estimated risk ratios (RRs) for transitions into and out of dual functional limitation. Overall, 288 participants (23.5%) used HCBS. HCBS use was not significantly associated with transition into dual functional limitation (RR, 1.01; 95% CI, 0.72–1.41). In contrast, HCBS use was associated with a higher probability of transition out of dual functional limitation (RR, 1.45; 95% CI, 1.05–1.99). In a more detailed analysis, the association was observed for transition to single-domain limitation (RR, 1.84; 95% CI, 1.16–2.93) but not for complete transition to no ADL or IADL limitation (RR, 1.01; 95% CI, 0.52–1.97). Among older adults with diabetes, HCBS use was associated with transition out of dual functional limitation, but not with transition into dual functional limitation. The association primarily reflected improvement from dual- to single-domain limitation rather than complete restoration of functional independence. Not applicable