Hostname: page-component-76fb5796d-45l2p Total loading time: 0 Render date: 2024-04-29T05:37:42.381Z Has data issue: false hasContentIssue false
  • English
  • Français

Unmet Need for Assistance to Perform Activities of Daily Living and Psychological Distress in Community-Dwelling Elderly Women*

Published online by Cambridge University Press:  31 October 2011

Jacqueline M. Quail ,
Christina Wolfson  and
Abby Lippman
Jacqueline M. Quail*
Affiliation:
Department of Epidemiology and Biostatistics and Occupational Health, McGill University Saskatchewan Health Quality Council
Christina Wolfson
Affiliation:
Department of Epidemiology and Biostatistics and Occupational Health, McGill University Research Institute, McGill University Health Centre
Abby Lippman
Affiliation:
Department of Epidemiology and Biostatistics and Occupational Health, McGill University
*
†Correspondence and requests for offprints should be sent to / La correspondance et les demandes de tirés-à-part doivent être adressées à: Jacqueline Quail, Ph.D. Saskatchewan Health Quality Council 241-111 Research Drive Saskatoon, Saskatchewan Canada S7N 3R2 (jacqueline.quail@gmail.com)
Get access Rights & Permissions [Opens in a new window]

Abstract

Community-dwelling seniors increasingly require physical assistance to perform the activities of daily living (ADL). To examine the possible association of this need with psychological distress, we conducted a prospective cohort study of community-dwelling people age 75 and older in Montreal, Canada. We report the results for women only (n = 530). Multivariable linear regression was used to examine the association between met and unmet need in instrumental ADL (IADL) and personal ADL (PADL) with concomitant psychological distress. Unmet IADL need was associated with elevated psychological distress [β = 0.42 (95% CI: 0.26, 0.60)], as was met IADL need [β = 0.19 (95% CI: 0.06, 0.33)], but not met and unmet PADL need. The full model explained 32.8 per cent of the total variance in psychological distress. Receiving assistance to meet IADL needs is associated with elevated psychological distress. Not receiving assistance, however, is associated with even greater distress.

Résumé

De plus en plus, les aînés vivant dans les communautés ont besoin d’une assistance physique pour les activités de la vie quotidienne (AVQ). L’association de ce besoin, que ce soit atteint ou non satisfaits, avec la détresse psychologique est inconnue. Nous avons mené une étude prospective des cohortes sur des résidents vivant dans les communautés âgées de 75 ans et plus à Montreal, au Canada. Nous rapportons les résultats pour les femmes seulement (n = 530). On a utilisé une régression lineaire multivariable pour examiner l’association entre les besoins satisfaits et ceux qui restent insatisfaits dans les activités déterminantes de la vie quotidienne (ADVQ) et les activités personnelles de la vie quotidienne (APVQ) et la détresse psychologique concomitante. Alors que les besoins ADVQ non satisfaits ont été associés à une détresse psychologique élevée, [β = 0.19 (95% CI: 0.06, 0.33)], comme cela a été avec les besoins ADVQ satisfaits [β = 0.42 (95% CI: 0.26, 0.60)], les besoins APVQ satisfaits et non satisfaits ne l’étaient pas. Le modèle complet explique 32,8 pour cent de la variance totale de la détresse psychologique. Recevoir de l’aide pour répondre aux besoins ADVQ est associé à une détresse psychologique élevée. Ne pas recevoir d’aide, cependant, est associé à une détresse encore plus élevée.

Keywords

vieillissementbesoin non satisfaithandicapaînésanté mentaleaging/vieillissmentunmet needdisabilityelderlymental health
Type
Articles
Information
Canadian Journal on Aging / La Revue canadienne du vieillissement , Volume 30 , Issue 4 , December 2011 , pp. 591 - 602
Copyright
Copyright © Canadian Association on Gerontology 2011

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Footnotes

*

We thank the study participants who generously gave their time and who were a constant motivation to everyone involved with the study. We also acknowledge Louise Levesque, a co-primary investigator for the Montreal Unmet Needs Study, as well as the MUNS study coordinator and all of the interviewers for working on various aspects of the study. Sources of funding for this research include Le Fonds de la Recherche en Santé du Quebec; l’Institut universitaire de gériatrie de Montreal; Ministère de la Santé et des Services Sociaux; Neuroinflammation CIHR Strategic Training Program; Canadian Health Services Research Foundation; and the Canadian Institutes of Health Research.

References

Reference List

Adelmann, P.K. (1993). Psychological well-being and homemaker vs. retiree identity among older women. Sex Roles, 29, 195–212.CrossRefGoogle Scholar
Allen, S.M., & Mor, V. (1997). The prevalence and consequences of unmet need. Contrasts between older and younger adults with disability. Medical Care, 35, 1132–1148.CrossRefGoogle ScholarPubMed
Aronson, J. (2002). Elderly people’s accounts of home care rationing: Missing voices in long-term care policy debates. Ageing and Society, 22, 399–418.CrossRefGoogle ScholarPubMed
Bond, T.G., & Fox, C.M. (2007). Applying the Rasch model: Fundamental measurement in the human sciences (2nd ed.). Mahwah, NJ: Lawrence Erlbaum Associates.Google Scholar
Bruce, M.L. (2000). Depression and disability. In Williamson, G.M., Shaffer, D.R., & Parmelee, P.A. (Eds.), Physical illness and depression in older adults: A handbook of theory, research, and practice (pp. 11–29). New York: Kluwer Academic/Plenum.Google Scholar
Canadian Institutes for Health Research. (2010). Gender, sex and health research guide: A tool for CIHR applicants. Retrieved February 4, 2011, fromhttp://www.cihr-irsc.gc.ca/e/32019.htmlGoogle Scholar
Couture, M., Lariviere, N., & Lefrancois, R. (2005). Psychological distress in older adults with low functional independence: A multidimensional perspective. Archives of Gerontology and Geriatrics, 41, 101–111.CrossRefGoogle ScholarPubMed
Covic, T., Pallant, J.F., Conaghan, P.G., & Tennant, A. (2007). A longitudinal evaluation of the Center for Epidemiologic Studies-Depression scale (CES-D) in a rheumatoid arthritis population using Rasch analysis. Health and Quality of Life Outcomes, 5, 41.CrossRefGoogle Scholar
Desai, M.M., Lentzner, H.R., & Weeks, J.D. (2001). Unmet need for personal assistance with activities of daily living among older adults. The Gerontologist, 41, 82–88.CrossRefGoogle ScholarPubMed
Gustafsson, K., Andersson, I., Andersson, J., Fjellstrom, C., & Sidenvall, B. (2003). Older women’s perceptions of independence versus dependence in food-related work. Public Health Nursing, 20, 237–247.CrossRefGoogle ScholarPubMed
Hays, J.C., Kasl, S., & Jacobs, S. (1994). Past personal history of dysphoria, social support and psychological distress following conjugal bereavement. Journal of the American Geriatrics Society, 42, 712–718.CrossRefGoogle ScholarPubMed
Hsueh, I.P., Wang, W.C., Sheu, C.F., & Hsieh, C.L. (2004). Rasch analysis of combining two indices to assess comprehensive ADL function in stroke patients. Stroke, 35, 721–726.CrossRefGoogle ScholarPubMed
Kaplan, L., & Boss, P. (1999). Depressive symptoms among spousal caregivers of institutionalized mates with Alzheimer’s: Boundary ambiguity and mastery as predictors. Family Process, 38, 85–103.CrossRefGoogle ScholarPubMed
Kempen, G.I., Jelicic, M., & Ormel, J. (1997). Personality, chronic medical morbidity, and health-related quality of life among older persons. Health Psychology, 16, 539–546.CrossRefGoogle ScholarPubMed
Kempen, G.I., van Heuvelen, M., van Sonderen, E., van den Brink, R., Kooijman, A., & Ormel, J. (1999). The relationship of functional limitations to disability and the moderating effects of psychological attributes in community-dwelling older persons. Social Science and Medicine, 48, 1161–1172.CrossRefGoogle ScholarPubMed
Kennedy, G.J. (2001). The dynamics of depression and disability. American Journal of Geriatric Psychiatry, 9, 99–101.CrossRefGoogle ScholarPubMed
Krause, N., & Jay, G. (1991). Stress, social support, and negative interaction in later life. Research on Aging, 13, 333–363.CrossRefGoogle Scholar
Lahelma, E., Martikainen, P., Rahkonen, O., & Silventoinen, K. (1999). Gender differences in ill health in Finland: Patterns, magnitude and change. Social Science and Medicine, 48, 7–19.CrossRefGoogle Scholar
LaPlante, M.P., Kaye, H.S., Kang, T., & Harrington, C. (2004). Unmet need for personal assistance services: Estimating the shortfall in hours of help and adverse consequences. Journals of Gerontology, Series B: Psychological Sciences and Social Sciences, 59, S98–S108.CrossRefGoogle ScholarPubMed
Leger Marketing. (2010). Leger Marketing home page. Retrieved February 8, 2011, fromhttp://legermarketing.com/eng/Google Scholar
McEwan, K.I., Donnelly, M., Roberston, D., & Hertman, C. (1991). Mental health problems among Canada’s seniors: Demographic and epidemiologic consideration. Ottawa, Ontario, Canada: Mental Health Division, Health Services and Promotion Branch, Department of National Health and Welfare.Google Scholar
Moore, E.G., Rosenberg, M.W., & Fitzgibbon, S.H. (1999). Activity limitation and chronic conditions in Canada’s elderly, 1986–2011. Disability and Rehabilitation, 21, 196–210.CrossRefGoogle ScholarPubMed
Mor, V. (1998). A modern lexicon of disability. In Allen, S.M. & Mor, V. (Eds.), Living in the community with disability: Service needs, use, and systems (pp. 353–371). New York, NY: Springer Publishing Company.Google Scholar
National Council of Welfare. (2004). Poverty profile 2001. Ottawa, Ontario, Canada: Minister of Public Works and Government Services Canada.Google Scholar
Newcomer, R., Kang, T., Laplante, M., & Kaye, S. (2005). Living quarters and unmet need for personal care assistance among adults with disabilities. Journals of Gerontology, Series B: Psychological Sciences and Social Science, 60, S205–S213.CrossRefGoogle ScholarPubMed
Otero, A., de Yebenes, M.J., Rodriguez-Laso, A., & Zunzunegui, M.V. (2003). Unmet home care needs among community-dwelling elderly people in Spain. Aging Clinical and Experimental Research, 15, 234–242.CrossRefGoogle ScholarPubMed
Pallant, J.F., & Tennant, A. (2007). An introduction to the Rasch measurement model: An example using the Hospital Anxiety and Depression Scale (HADS). British Journal of Clinical Psychology, 46, 1–18.CrossRefGoogle Scholar
Paul, C., Ayis, S., & Ebrahim, S. (2006). Psychological distress, loneliness and disability in old age. Psychology, Health & Medicine, 11, 221–232.CrossRefGoogle ScholarPubMed
Payette, H., Guigoz, Y., & Vellas, B.J. (1999). Study design for nutritional assessments in the elderly. In Yu, B.P. (Ed.), Methods in Aging Research (pp. 301–320). Boca Raton, FL: CRC Press.Google Scholar
Pearlin, L.I., Lieberman, M.A., Menaghan, E.G., & Mullan, J.T. (1981). The stress process. Journal of Health and Social Behavior, 22, 337–356.CrossRefGoogle ScholarPubMed
Pearlin, L.I., & Schooler, C. (1978). The structure of coping. Journal of Health and Social Behavior, 19, 2–21.CrossRefGoogle ScholarPubMed
Préville, M., Boyer, R., Potvin, L., Perrault, C., & Légaré, G. (1992). La détresse psychologique: Détermination de la fiabilité et de la validité de la mesure utilisée dans l’enquête Santé Québec (Rep. No. ISBN-2-550-22725-5). Québec, Canada: Ministère de la Santé et des Services Sociaux.Google Scholar
Quail, J.M., Addona, V., Wolfson, C., Podoba, J.E., Levésque, L.Y., & Dupuis, J. (2007). Association of unmet need with self-rated health in a community dwelling cohort of disabled seniors aged 75 and over. European Journal of Ageing, 4, 45–55.CrossRefGoogle Scholar
Ridner, S. H. (2004). Psychological distress: Concept analysis. Journal of Advanced Nursing, 45, 536–545.CrossRefGoogle ScholarPubMed
Robinson, S. B. (1999). Transitions in the lives of elderly women who have sustained hip fractures. Journal of Advanced Nursing, 30, 1341–1348.CrossRefGoogle ScholarPubMed
Roccaforte, W.H., Burke, W.J., Bayer, B.L., & Wengel, S.P. (1992). Validation of a telephone version of the mini-mental state examination. Journal of the American Geriatrics Society, 40, 697–702.CrossRefGoogle ScholarPubMed
Sands, L.P., Wang, Y., McCabe, G.P., Jennings, K., Eng, C., & Covinsky, K.E. (2006). Rates of acute care admissions for frail older people living with met versus unmet activity of daily living needs. Journal of the American Geriatrics Society, 54, 339–344.CrossRefGoogle ScholarPubMed
SAS Institute Inc. (2007). SAS. Cary, NC: SAS Institute.Google Scholar
Schieman, S. & Turner, H.A. (1998). Age, disability, and the sense of mastery. Journal of Health and Social Behavior, 39, 169–186.CrossRefGoogle ScholarPubMed
Sheehan, T.J., DeChello, L.M., Garcia, R., Fifield, J., Rothfield, N., & Reisine, S. (2001). Measuring disability: Application of the Rasch model to activities of daily living (ADL/IADL). Journal of Outcome Measurement, 5, 839–863.Google ScholarPubMed
Sidenvall, B., Nydahl, M., & Jellstrom, C. (2000). The meal as a gift—The meaning of cooking among retired women. Journal of Applied Gerontology, 19, 405–423.CrossRefGoogle Scholar
Sonn, U. (1996). Longitudinal studies of dependence in daily life activities among elderly persons. Scandinavian Journal of Rehabilitation Medicine, Supplement, 34, 1–35.Google ScholarPubMed
Spector, W.D., Katz, S., Murphy, J.B., & Fulton, J.P. (1987). The hierarchical relationship between activities of daily living and instrumental activities of daily living. Journal of Chronic Disease, 40, 481–489.CrossRefGoogle ScholarPubMed
Statistics Canada. (2003). Population with and without disabilities, and disability rate, by age groups, Canada, 2001. Retrieved February 8, 2011, fromhttp://www.statcan.ca/english/freepub/89-577-XIE/tables/table2.htmGoogle Scholar
Statistics Canada. (2005). Low income cut-offs for 2004 and low income measures for 2002. Retrieved February 8, 2011, fromwww.statcan.ca/english/research/75F0002MIE/75F0002MIE2005003.pdfGoogle Scholar
Statistics Canada. (2008). CANSIM II Table 051-0001: Population projections for 2006, 2011, 2016, 2021, 2026 and 2031, at July 1. Retrieved February 8, 2011, fromhttp://www40.statcan.ca/l01/cst01/demo23a-eng.htmGoogle Scholar
U.S. Census Bureau. (2008). U.S. population projections: State interim projections by age and sex: 2004–2030. Retrieved fromhttp://www.census.gov/population/www/projections/projectionsagesex.htmlGoogle Scholar
von Korff, M., Wagner, E.H., & Saunders, K. (1992). A chronic disease score from automated pharmacy data. Journal of Clinical Epidemiology, 45, 197–203.CrossRefGoogle ScholarPubMed
Walter-Ginzburg, A., Guralnik, J.M., Blumstein, T., Gindin, J., & Modan, B. (2001). Assistance with personal care activities among the old-old in Israel: A national epidemiological study. Journal of the American Geriatrics Society, 49, 1176–1184.CrossRefGoogle Scholar
World Health Organization. (2002). Towards a common language for functioning, disability and health ICF: International Classification of Functioning, Disability and Health. Retrieved from http://www.who.int/classifications/icf/training/icfbeginnersguide.pdfGoogle Scholar
Yang, Y., & George, L.K. (2005). Functional disability, disability transitions, and depressive symptoms in late life. Journal of Aging Health, 17, 263–292.CrossRefGoogle ScholarPubMed
Zarit, S.H., Stephens, M.A., Townsend, A., & Greene, R. (1998). Stress reduction for family caregivers: Effects of adult day care use. Journals of Gerontology, Series B: Psychological Sciences and Social Sciences, 53, S267–S277.CrossRefGoogle ScholarPubMed
Zeiss, A.M., Lewinsohn, P.M., Rohde, P., & Seeley, J.R. (1996). Relationship of physical disease and functional impairment to depression in older people. Psychology and Aging, 11, 572–581.CrossRefGoogle ScholarPubMed