Prevalence of functional disability in activities of daily living (ADL), instrumental activities of daily living (IADL) and associated factors, as predictors of morbidity and mortality

doi:10.1016/j.archger.2009.04.017

Archives of Gerontology and Geriatrics

Volume 50, Issue 3, May–June 2010, Pages 306-310

https://doi.org/10.1016/j.archger.2009.04.017 Get rights and content

Abstract

The aim of this study is to establish the existing relationship among variables referred to the person, specifically age and gender, and the functional dependence in basic ADL and in IADL, as well as the possible relationship it has with the increase of morbidity and mortality in a random sample of 598 individuals older than 65 years. Of these individuals, 34.6% were categorized as dependent for at least one ADL, and 53.5% if we refer to IADL. Regarding the ADL, the risk of dependence increases (odds ratio = OR = 1.089) per year of age, (OR = 2.48) in women's case; while there is an IADL correlation between age and the score (r = −0.527; p < 0.001). A relationship exists between dependence and the days of hospitalization (for ADL: r = −0.12, p = 0.018 and IADL: r = −0.97, p = 0.003), the number of visits to the doctor (ADL: r = −0.27, p < 0.001; IADL: r = −0.25, p < 0.001) or the presence of concomitant pathologies such as dementia (ADL: p < 0.001; IADL: p < 0.001). There is a significant association between age, gender and dependence, as well as between dependence and morbidity and mortality, so that dependence could be used as a predictor of both.

Introduction

Functional capacity refers to the possibility and ability to carry out the daily activities in a normal or accepted way (Millán-Calenti, 2006). Maintenance of functional capacity is an important indicator of health in the elderly; the loss of this capacity leads to a rise in morbidity and mortality (Stuck et al., 1999).

Disability refers to the negative aspects of the interaction between the individual and the environment, i.e., deficits, limitations in the activity and restrictions in his/her social participation (WHO, 2001). We consider it as dependence when the adaptation of the environment or the use of technical aids cannot compensate disability and the help of a third person is needed to carry out activities of daily living (Conseil de l’Europe, 1998). Dependence is the main impact factor on health and quality of life, not only for the elderly but also for the caregiver and relatives (Millán-Calenti et al., 2000).

Generally, disability in old people is assessed based on their difficulty to carry out the activities of daily living, or those activities everybody does everyday in order to live independently and integrated within the environment (WHO, 2001). The International Classification of Functioning, Disability and Health (ICF) (WHO, 2001) tries to establish a consensus in its understanding, by establishing a difference between the basic ADL and the IADL. The first ones (ADL), are defined as those activities essential for an independent life, while carrying out the IADL is more complex, requires a higher level of personal autonomy. These IADL-scores refer to tasks implying enough capacity as to make decisions as well as a greater interaction with the environment. Based on these differences, deficits in the IADL normally precede deficits in the ADL (Judge et al., 1996).

Prevalence of disability has been associated with different factors apart from age and sex (Avlund et al., 1993, Dunlop et al., 1997); thus, a relation has been found with the presence of heart diseases, strokes and diabetes mellitus (Barberger-Gateau and Fabrigoule, 1997, Fried and Guralnik, 1997), with the patient institutionalization and with an increase in morbidity and mortality (Ferrucci et al., 1991, Bavazzano et al., 1998).

Based on the above arguments, and due to the clear impact disability has on the socio-sanitary system, it is essential to study the prevalence, reasons and effects of disability in the old population in order to draw up a plan for a suitable public health policy (Chalise et al., 2008).

The main purpose of this study was to establish the existing relationship among different variables referred to the person, specifically age and sex, and the functional dependence in basic ADL and IADL; as well as its possible relationship as predictors of morbidity and/or mortality.

Section snippets

Materials and methods

The representative sample (n = 598) consisted of people over 65 years from Narón Council (A Coruña), randomly selected, stratified by quinquennia of age and sex, from the council census. The level of confidence was 95%; accuracy ±4% and estimation for data losses 10% (Table 1).

Professionals in charge of doing and collecting data were trained to unify criteria. Participants were individually assessed in a Health Center or at home, in the case of people with mobility difficulties. Before the data

Results

The average age of the studied population was 75.09 ± 7.54 years, which was representative of the sample age group. Regarding sex, women predominated over men (57.2%), being significantly older (p = 0.008) than men (75.9 years vs. 73.9 years).

Regarding the marital status, 62.1% were married and 26.1% were widowers. Among men, 80.8% were married while only 47.9% of women were married; men who had widowed represented 10.2% of the total men and 38.8% of the women had widowed from the total number of

Discussion

Marital status could be associated with functional disability in the elderly. In our study, as in that made by Tang et al. (1999), married people had less dependence ratios than single people. Nevertheless, it is necessary to go deeper in this aspect before reaching more accurate conclusions.

Regarding the functional capacity and based on our results, approximately 2/3 (65.4%) of participants are categorized as independent to carry out ADL, decreasing to 46.5% when referring to IADL. This data

Conclusion

Advanced age and female gender are important factors in the development of the disability that leads to dependence. At the same time, an important relation has been observed among health indicators and dependence, being possible to use the last one as predictor of morbidity and mortality in the elder population. Deeper research is needed to determine the relationship among dependence, morbidity and mortality.

Conflict of interest statement

None.

Acknowledgement

We sincerely thank Narón Council for giving us access to their elderly people.

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Prevalence of functional disability in activities of daily living (ADL), instrumental activities of daily living (IADL) and associated factors, as predictors of morbidity and mortality

Abstract

Introduction

Section snippets

Materials and methods

Results

Discussion

Conclusion

Conflict of interest statement

Acknowledgement

Arch. Gerontol. Geriatr. Suppl.

Ann. Epidemiol.

Arch. Gerontol. Geriatr.

Arch. Gerontol. Geriatr.

Soc. Sci. Med.

Arch. Gerontol. Geriatr.

Dementia is the major cause of functional dependence in the elderly: 3-year follow-up data from a population-based study

Am. J. Public Health

Unmet health care needs and mortality among Spanish elderly

Am. J. Public Health

Healthy aging and functional disability among the elderly inhabitants of the Canary Islands (Spain)

Rev. Esp. Salud Pública

A multiple state model for disability using the decomposition of death probabilities and cross-sectional data

Commun. Stat. Theory Methods

Factors related to perceived poor health conditions or poor quality of life among those over 65 years of age

Rev. Esp. Salud Pública

The measurement of instrumental ADL: content validity and construct validity

Aging Clin. Exp. Res.

Disability and cognitive impairment in the elderly

Disabil. Rehabil.

Dependencia funcional y enfermedades crónicas en ancianos mexicanos

Salud Publica Mex.

La salud y las incapacidades funcionales. Elaboración de un modelo casual

Rev. Gerontol.

Predictors of functional status in older people living at home

Age Ageing

Cognitive and functional decline in adults aged 75 and older

J. Am. Geriatr. Soc.

Chronic conditions that lead to functional limitation in the elderly

J. Gerontol.

Development and validation of a functional morbidity index to predict mortality in community dwelling elders

J. Gen. Intern. Med.

Functional disability in activities of daily living and instrumental activities of daily living among Nepalese Newar elderly

Public Health

Predicting in-hospital mortality. The importance of functional status information

Med. Care

Disability in activities of daily living; patterns of change and a hierarchy of disability

Am. J. Public Health