The severity and associated factors of participation restriction among community-dwelling frail older people: an application of the International Classification of Functioning, Disability and Health (WHO-ICF)

Effect of pain on activity and participation in individuals with unilateral lower-extremity amputation based on the International Classification of Functioning, Disability, and Health

BACKGROUND

Amputation is a major life-changing event and is regarded as one of the loading causes of permanent disability. However, amputation often causes changes in painful and nonpainful sensory experiences. Pain after amputation has been shown to increase functional limitations caused by limb loss and lower quality of life.

OBJECTIVE

This study aimed to examine the effect of pain on activity and participation in individuals with unilateral below-knee amputations according to the International Classification of Functioning, Disability, and Health.

STUDY DESIGN

Cross-sectional study.

METHODS

In the study, 64 individuals were divided into 2 groups: those who experienced pain and those who did not. Group 1 included 33 below-knee amputees who experienced pain (27 males, mean age 43.9 ± 12.6 years) and Group 2 included 31 below-knee amputees who did not experience pain (25 males, mean age 47.4 ± 12.1 years). The McGill Pain Questionnaire and visual analog scale were used to assess pain, the Prosthetic Limb Users Survey of Mobility was used to assess activity, and the Reintegration to Normal Living Index was used to assess participation.

RESULTS

Demographic characteristics of the 2 groups were statistically insignificant ( P > 0.05). The nonpainful group had significantly higher activity and participation scores than the painful group ( P < 0.001).

CONCLUSIONS

It was found that phantom pain and stump pain in below-knee amputees limited activity and participation. It was also shown that phantom pain has a more negative effect on the activity level of individuals than stump pain.

Evidence-based exercise recommendations to improve functional mobility in older adults - A study protocol for living systematic review and meta-analysis

Background and objectives

This is a protocol for a living systematic review and meta-analysis.This review will assess the effects of state-of-the-art exercise interventions designed to promote functional mobility. Therefore, after identifying all potential interventions, we will use the F.I.T.T. principles (frequency, intensity, time, type) as well as the physical and health status of the participants as moderators to analyse the mechanisms for the positive benefits of exercise interventions.The main research questions are:Which exercise types are most beneficial for improving functional mobility in various populations of older adults?Which physical exercise characteristics in terms of frequency, intensity, time and duration will achieve the greatest benefit in terms of the defined outcomes, i.e, the functional mobility of older adults?

Methods

The systematic literature research according to PRISMA guidelines will search databases like MEDLINE, APA Psych-Info and Web of Science.Inclusion criteria are: healthy older people ≥ 50 years, randomized-controlled trials including exercise intervention and a walking or mobility assessments (eg., TUG, SPPB) as an outcome measure. A preliminary search revealed more than 33,000 hits that will be screened by pairs of independent reviewers. The results will be summarized according to the effects regarding functional mobility and potential dose-response relations via respective meta-analysis.

Conclusion

The systematic review will comprise the knowledge of the existing literature with regards to the effects of the physical activity interventions compared to an active or inactive control group.We will summarize the effects with respect to the F.I.T.T.. They provide a foundation for structuring an optimal exercise training program. If possible, we will also compare interventions from the different categories (eg. cardiovascular, resistance, motor-coordinative, multicomponent or mind-body exercise) as a network analysis and report the influence of moderator variables. Based on the results evidence-based guidelines following GRADE for physical exercise interventions to improve functional mobility in older adults will be provided.

Activity and Participation Are Associated With Future Falls, Hospitalizations, and Emergency Visits in Community-Dwelling Older Adults

OBJECTIVE

Activity and participation are important for older adults as they are associated with well-being and quality of life. Falls, emergency department (ED) visits, and hospitalizations are adverse health outcomes that impact older adults. Limited research has investigated whether measurement of activity and participation are related to adverse health events in community dwelling older adults. This study sought to examine the association between activity and participation with falls, ED visits, and hospitalization over 1 year in community dwelling older adults.

METHODS

A secondary analysis of a longitudinal clinical trial of 341 community dwelling older adults was conducted. The sample mean age was 80.9 (SD = 7.7) years and 83% were female. One-year risk of falls was associated with baseline Late Life Function and Disability Instrument (LLFDI) components of overall function and disability (frequency and limitations dimensions). Incident rate ratios (IRRs) and 95% CIs were calculated.

RESULTS

For each five-point higher score (clinically meaningful difference) in activity as measured by LLFDI-overall function (adjusted for age, race, sex, comorbidities and fall history), there was an 18% lower rate of falls (IRR = 0.82, 95% CI = 0.74-0.92), 12% reduction in hospitalizations (IRR = 0.88; 95% CI = 0.77-0.99), and 11% lower rate of emergency room visits (IRR = 0.89, 95% CI = 0.81-0.98). Greater participation as measured by the LLFDI limitations dimension was related to fewer falls (IRR = 0.93, 95% CI = 0.87-1.00) and hospitalizations (IRR = 0.91, 95% CI = 0.83-0.99).

CONCLUSION

Greater activity and participation are associated with a lower incidence of falls, ED visits, and hospitalizations representing an important consideration for targeted physical therapist interventions.

IMPACT STATEMENT

Physical therapists are uniquely positioned to identify and address reduced activity and participation. If activity and participation are specifically targeted and improved through physical therapy, undesirable distal health outcomes might be prevented or minimized.

LAY SUMMARY

Greater activity and participation were found to be related to lower rate of falls, ED visits, and hospitalizations in a sample of 341 older adults who lived in the community.

Relationship between chronic pain, depressive symptoms, and functional disability in community-dwelling older adults: mediating role of frailty

BACKGROUND

Borim et al. showed that older adults with chronic pain exhibited more depressive symptoms and frailty components. Depressive symptoms were associated with more frailty components, and those with more depressive symptoms and frailty faced greater limitations in IADL performance. Frailty appears to mediate the pathway from chronic pain to functional impairment Chronic pain is directly associated with depressive symptoms and frailty. Chronic pain is not directly associated with functional disability. Depression and frailty are both directly associated with functional disabilities. Frailty mediates the association between chronic pain and functional disability. Depression; Disability evaluation; Frailty; Frail elderly.

OBJECTIVE

To evaluate the direct and indirect effects of chronic pain, depressive symptoms, frailty components, and functional disability through a pathway analysis approach in a sample of community-dwelling older adults.

METHODS

Data of 419 participants were cross-sectionally evaluated for the presence of depressive symptoms (Geriatric Depression Scale [15 items]), physical frailty components (phenotype criteria), chronic pain, and limitations in performing instrumental activities of daily living (functional disability scale by Lawton and Brody). Structural equation modeling via path analysis was used to explore the direct and indirect effects among these four variables. Statistical significance was set at p<0.05.

RESULTS

Of the total participants, 69.8% were women and 59.3% had low education (1-4 years); the mean age was 80.3±4.6 years. Chronic pain and depressive symptoms were directly related and were associated to frailty. The number of frailty components and depressive symptoms were directly associated with functional disability. Frailty had an indirect effect on the association between chronic pain, depressive symptoms, and functional disabilities.

CONCLUSION

The pathway from chronic pain and depressive symptoms to functional disability is potentially mediated by the number of frailty components.

Mediating effects of depression on sleep disturbance and frailty in older adult type 2 diabetes patients in the community

Introduction

With the progressive aging of the population, frailty is now a significant challenge in geriatrics research. A growing amount of evidence suggests that sleep disturbance and depression have independent effects on frailty, although the underlying mechanisms are not yet clear. This study aimed to investigate the mediating role of depression in the relationship between sleep disturbance and frailty in older adult patients with type 2 diabetes (T2DM) in the community.

Method

Purposive sampling was used to collect face-to-face data from 342 community-dwelling T2DM patients in Chengdu, Sichuan Province, China, between February and May 2023. The Pittsburgh Sleep Quality Index (PSQI) scale was used to evaluate sleep quality, the Simple Geriatric Depression Scale (GDS-15) was used to evaluate depressive symptoms, and the FRAIL Scale (FRAIL) was used to evaluate frailty. Linear regression equation and bootstrap self-sampling were used to verify the mediating role of depressive symptoms in sleep disturbance and frailty.

Result

The study found that sleep disturbance had a direct positive effect with frailty [β = 0.040, 95% CI: (0.013, 0.069)]. Additionally, depression had a direct positive effect on frailty [β = 0.130, 95% CI: (0.087, 0.173)], and depression was found to partially mediate the relationship between sleep disturbance and frailty.

Conclusion

Poor sleep quality and frailty are common in patients with T2DM. To reduce the frailty of older adult T2DM patients, all levels of society (government, medical institutions, and communities) must pay more attention to mental health. A variety of interventions should be considered to improve sleep quality and depression, which in turn may prevent or control frailty.

International Classification of Functioning, Disability, and Health-based rehabilitation program promotes activity and participation of post-stroke patients

Background

The International Classification of Functioning, Disability, and Health (ICF) model has been applied in post-stroke rehabilitation, yet limited studies explored its clinical application on enhancing patients' Activity and Participation (ICF-A&P) level.

Purpose

This study gathered evidence of the effects of an ICF-based post-stroke rehabilitation program (ICF-PSRP) in enhancing community reintegration in terms of ICF-A&P of post-stroke patients.

Methods

Fifty-two post-stroke patients completed an 8 to 12 weeks multidisciplinary ICF-PSRP after setting personal treatment goals in an outpatient community rehabilitation center. Intake and pre-discharge assessments were administered for primary outcomes of Body function (ICF-BF; e.g., muscle strength) and ICF-A&P (e.g., mobility), and secondary outcomes of perceived improvements in ability (e.g., goal attainment and quality of life).

Results

There were significantly higher levels in the ICF-BF and ICF-A&P domains, except cognitive function under the ICF-BF. Improvements in the primary outcomes predicted corresponding secondary outcomes. Firstly, expressive and receptive functions (ICP-BF) were mediated by the everyday language (ICF-A&P) which predicted patients' satisfaction with the language-related quality of life. Secondly, upper extremity function (ICP-BF) was mediated by the lower extremity mobility (ICF-A&P) predicting work and productivity-related quality of life. Content analyses showed that combined ICF-BF and ICF-A&P contents throughout the ICF-PSRP contributed to the positive treatment effects.

Conclusion

The ICF-PSRP was effective in promoting body function, and activity and participation levels of post-stroke patients. Positive treatment effects are characterized by goal-setting process, cross-domain content design, and community-setting delivery.Clinical trial registration: https://clinicaltrials.gov/study/NCT05941078?id=NCT05941078&rank=1, identifier NCT05941078.

Examining the factors associated with functional capacity of community-dwelling older adults using the ICF framework: a cross-sectional study from the Frailty in Brazilian Older Adults Study (FIBRA)

BACKGROUND

There are many factors associated with functioning and disability in older adults and these relationships are not clear.

OBJECTIVE

To explore the factors associated with functional capacity of older adults using the framework of the International Classification of Functioning, Disability, and Health (ICF).

METHODS

This is a cross-sectional study with a dataset from a survey of 1 377 community-dwelling older adults (≥ 65 years) in a middle-income country. Three functional outcomes were selected to represent the functioning domains: 1) muscle strength for body function; 2) walking speed for activity; and 3) advanced activities of daily living (ADL) for participation. Demographic, clinical, and social information was selected to represent the domains of health conditions and contextual factors (i.e. personal and environmental factors). Multivariate models tested the impact of these factors on each outcome.

RESULTS

Depressive symptoms, age, and physical activity were associated with the three outcomes. Muscle strength was also associated with urinary incontinence, visual deficits, female sex, and employment. Walking speed was also associated with urinary incontinence, obesity, fractures due to falls, female sex, health professionals' visits, and walking aid devices. Advanced ADL were also associated with stroke, visual deficits, education, employment, health perception, social support, and walking aid devices.

CONCLUSION

Functional capacity of older adults is associated with some non-modifiable factors, such as age and sex. The modifiable factors must be addressed by health professionals and policymakers in the geriatric area, especially depression, obesity, physical inactivity, and social support.

Transitions in robust and prefrail octogenarians after 1 year: the influence of activities of daily living, social participation, and psychological resilience on the frailty state

BACKGROUND

Knowledge opportunities lie ahead as everyday activities, social participation, and psychological resilience might be important predictors for frailty state transitioning in the oldest old. Therefore, this article aims to examine whether changes in basic-, instrumental-, advanced- activities of daily living (b-, i-, a-ADLs), social participation, and psychological resilience predict both a transition from robustness to prefrailty or frailty and vice versa among community-dwelling octogenarians over a follow-up period of one year.

METHODS

To evaluate worsened and improved frailty transitions after one year in 322 octogenarians (Mage = 83.04 ± 2.78), the variables sex, ADLs (b-ADL-DI, i-ADL-DI, a-ADL-DI as baseline and as difference after 6 months values), the CD-RISC (Connor-Davidson Resilience Scale, as baseline and as difference after 6 months), the social participation variables (total participation score, being a member, total number of memberships, level of social participation, being a board member, volunteering, and formal participation as baseline and as difference after 6 months values), were included in a logistic regression analysis.

RESULTS

Limitations in a-ADLs at baseline (OR: 1.048, 95% confidence interval, 1.010-1.090) and an increment of limitations in a-ADLs after 6 months (OR: 1.044, 95% confidence interval, 1.007-1.085) were predictors to shift from robust to a worsened frailty state after one year follow-up. Additionally, being a woman (OR: 3.682, 95% confidence interval, 1.379-10.139) and social participation, specifically becoming a board member in 6 months (OR: 4.343, 95% confidence interval, 1.082-16.347), were protectors of robustness and thus related to an improved frailty transition after one year.

CONCLUSIONS

Encouraging healthy lifestyle behaviors to help the maintenance of ADLs, possibly leading to more social participation, could be promising in the prevention of frailty.

Relation of environmental factors with activity limitations and participation restrictions in older adults with diabetes mellitus over time: an international classification of functioning framework perspective

BACKGROUND

Activity limitations and participation restrictions were observed in patients with diabetes, which may impact their quality of life. Environmental factors such as seasonal effects, resources and perceived stress may play important role in activity limitations and participation restrictions. In this study, a variant of International Classification of Functioning (ICF) model was used to clarify the associations of function/structure factors, personal factors and environmental factors with activity limitations and participation restrictions.

METHODS

This was a longitudinal design with 1 year follow-up. The Mini-Mental State Examination (MMSE), Geriatric Depression Scale- short form, Perceived Stress Scale, and Instrumental Activities of Daily Living assessments were measured at 3-month intervals for long-term follow-up in 110 patients with diabetes aged ≥ 65 years.

RESULTS

Hierarchical linear regression models revealed that age (p = 0.001), perceived health status, MMSE scores (p < 0.01), and positive perceived stress (p < 0.001) were predictors of activity limitations (adjusted R2 = 53%). GDS-S (p < 0.05) and positive perceived stress (p < 0.01) were predictors of participation restrictions (adjusted R2 = 30%). Generalized estimating equation analysis indicated that seasonal effects, age, perceived health status, MMSE predicted the changes of slopes in activity limitations. Seasonal effects and GDS-S were predictors of the changes of slopes for participation restrictions (all p < 0.001).

CONCLUSIONS

The ICF can be used to identify the risk factors for activity limitations and participation restrictions in older adults with diabetes. Practitioners should provide individualized interventions with consideration of these risk factors.

Participation Among Community-Dwelling Older Adults During the COVID-19 Pandemic: A Cross-Sectional Analysis

OBJECTIVE

Participation in life situations is a critical aspect of health recognized by the World Health Organization. Guidelines to prevent spreading of COVID-19 place older adults at risk of worsening participation. The purpose of this study was to identify the factors associated with participation during the COVID-19 pandemic among community-dwelling older adults living in Hamilton, Ontario, Canada.

METHODS

Participants were recruited from identified census dissemination areas in Hamilton. Participants completed surveys either by phone or online during the months of May to August 2020. Measures were organized into factors related to body functions and structures, activities, participation, as well as personal and environmental contextual factors using the International Classification of Functioning, Disability, and Health (ICF) framework. Multivariable regression analysis was conducted to identify factors associated with participation as measured by the Late-Life Disability Instrument's (LLDI) frequency and limitations scales.

RESULTS

A total of 272 older adults completed the survey (78 [7.3] years; 70% female). Use of a walking aid, driving status, perceived mental health status, nutrition risk, and physical function explained 48.2% of the variance observed in the LLDI-frequency scale scores. Use of a walking aid, driving status, perceived mental health status, receiving health assistance, and physical function explained 38.5% of the variance observed in the LLDI-limitation scale scores.

CONCLUSION

Results highlighted factors across multiple ICF domains that are associated with participation restriction among a sample of community-dwelling older adults during the pandemic. Participation during the pandemic was greatest in those that were able to walk without needing to use a walking aid, being a licensed and current driver, perceiving good to excellent mental health, and having greater physical function.

IMPACT

Our findings contribute to the literature on older adult participation during lockdowns, restrictions, pandemics, and/or other similar circumstances.

Gender specific cut-off points of age for disability among rural elderly in Anhui Province, China

Objective

The purpose of this study was to determine the optimal cut-off values of age for disability in order to predict the risk of disability for older adults in rural areas.

Methods

WHO Disability Assessment Schedule 2.0 was used to assess disability. The cut-off values of age for disability were obtained by ROC curve analysis.

Results

The cut-off points of age for cognition restriction, mobility restriction, self-care restriction, getting along with people restriction, life activities restriction, and social participation restriction for men were 70.5, 68.5, 72.5, 70.5, 71.5, and 68.5 years old, respectively. The cut-off points of age for cognition disability, mobility restriction, self-care disability, getting along with people disability, life activities disability, and social participation disability for women were 72.5, 71.5, 70.5, 70.5, 71.5, and 71.5 years old, respectively. Over the cut-off values of age was an independent risk factor for disability (P < 0.05).

Conclusion

Presenting first disability symptoms were different between men and women. Preventive efforts to prevent future disability should be different for men and women.

Social participation of community-dwelling older adults in western China: A latent profile analysis

Objective

Social participation has become a policy framework to address population aging. However, little is known about the social participation of older adults in western China, and extensive, multicenter, regional research is lacking. This research investigated the profiles of social participation of older adults in western China and explored the characteristics and factors influencing social participation.

Method

This cross-sectional study was conducted in 3 provinces (Chongqing, Sichuan, and Inner Mongolia) in western China from March 2021 to December 2021 and included 3,456 participants aged 60 years or older. Social participation was assessed using the Chinese version of the Impact on Participation and Autonomy Questionnaire (IPA). Latent profile analysis (LPA) was performed to extract latent classes of social participation among older adults in western China. The chi-square test and multinomial regression analyses were used to identify differences between these classes.

Results

Three social participation classes were identified by LPA: high social participation (25.2%), moderate social participation (55.1%), and low social participation (19.7%). Being older, having a primary school education level, having mobility or speaking impairment, using assistive devices, and having a chronic disease were highly associated with the low social participation class (P < 0.05). Furthermore, older adults with no dependence (OR = 0.018, 95% CI = 0.005-0.062) or mild dependence (OR = 0.039, 95% CI = 0.011-0.139) in activities of daily living (ADLs) were less likely to be in the low social participation class. Older adults who were cared for by non-spouse primary caregivers were more likely to be assigned to the moderate social participation group (OR = 2.097, 95% CI = 1.501-2.930) than to the high social participation group.

Conclusions

Most older adults in western China have a moderate level of social participation. Advanced age, reduced ADL ability, reduced speech ability, reduced mobility, and non-spouse care are related to the level of social participation. Healthcare professionals should pay attention to the predictors for different classes, identifying high-risk groups as early as possible.

Factors of Functional Disability in the Social Participation of Older Adults Living Alone With Fall Experience

The fall experiences of older adults living alone lead to restrictions in their social participation. This study aimed to examine the factors that influence functional disability in social participation (FSP) among older adults who live alone and have experienced falls. This study used secondary data of 493 older adults living alone who experienced a fall, which were collected from the 2017 National Survey of Older Koreans. Multiple linear regression analyses were performed. Factors, such as old age, sex, economic status, frequency of drinking, and number of acquaintances, significantly related to functional disability in terms of social participation. In addition, poor muscle strength, depression, and cognitive decline comprised predictors of FSP. The findings of this study revealed that it is important to comprehensively evaluate the social participation of older adults who live alone and have experienced falls.

Health Insurances and the Health-Related Work Capacity of Retirement-Aged Workers: A Comparative Investigation

OBJECTIVE

This study is to investigate the health-related work capacity of retirement-aged workers under the beneficiary status of different health insurance schemes in China.

METHOD

Using the data from CHARLS program, we investigate the health-related work capacity of retirement-aged workers in China (more than 60/55 years-old for men/women respectively). Multivariate regressions and robustness checks (Heckman two-stage procedures, chronological design, etc) are conducted.

RESULTS

(1) Late-life career participation could reduce the risk of declining work capacity due to health problems; (2) different social health insurances affect health-related work capacity among retirement-aged workers differently; (3) social health insurances influence the role of late-life career participation in reducing the risk of health-related work capacity, with different schemes displaying different effects (mitigate or strengthen).

CONCLUSIONS

Systematic inequity in benefit across health insurances may result in contrasting health outcomes of retirement-aged workers.

The Contribution of Frailty to Participation of Older Adults

Background: Participation, which is involvement in life situations, is an important indicator of human health and well-being of older adults. Frailty is known to be related to difficulties in activities of daily living (ADL) but the association with participation restriction has not been sufficiently researched. Therefore, we aimed to (1) to assess the correlations between frailty, ADL, and participation; and (2) to identify the contribution of frailty to explaining the participation restriction of older adults. Methods: A cross-sectional study included home visits to community-dwelling older adults aged 75 and older. The Reintegration to Normal Living Index (RNL-I) assessed participation, PRISMA-7 assessed frailty, and the Functional Independence Measure and IADL questionnaire assessed the basic and instrumental ADL. Cognition, which may explain participation, was also assessed (The Montreal Cognitive Assessment) and demographic information was collected. Results: Older adults (N = 121, 60 women), aged 75 to 91 years (mean (SD)—79.6 (3.1)), were included. Older adults demonstrated full to restricted participation (RNL-I-mean (SD)—78.2 (18.0)/100). Frailty was identified in 39 (32%) older adults (mean (SD) PRISMA-7—2.9 (1.4)/7points). A negative moderate significant correlation was found between participation and frailty (r = −0.634, p < 0.001). The variance of participation was significantly explained by frailty, 31.5%, and basic ADL, 5.6% (after controlling for age and cognition); the total model explained 44.6% (F = 23.29, p < 0.001). Conclusions: Frailty is significantly associated with participation restriction. Since participation has many health benefits, understanding which factors are associated to participation is central to developing interventions for older adults. These findings may help health professionals in the future develop interventions for maintaining and promoting the participation of older adults.

Incapacidade, desempenho físico-funcional e ambiente de vizinhança: avaliação de idosos comunitários com base na Classificação Internacional de Funcionalidade, Incapacidade e Saúde

RESUMO A Classificação Internacional de Funcionalidade, Incapacidade e Saúde (CIF) ainda é uma ferramenta distante e muitas vezes temida na área da saúde do idoso. Diante disso, o objetivo deste estudo foi descrever a incapacidade nas atividades da vida diária (AVDs), as limitações no desempenho físico-funcional e a percepção do ambiente de vizinhança em idosos comunitários do extremo sul de Santa Catarina, classificando-os segundo os domínios e qualificadores propostos pela CIF. Tratou-se de estudo transversal realizado com idosos de ambos os sexos. As variáveis analisadas foram categorizadas de acordo com os domínios da CIF: (1) funções e estruturas do corpo: testes de desempenho físico-funcional; (2) atividade e participação: instrumento de autoavaliação das AVDs; e (3) fatores ambientais: autopercepção do ambiente de vizinhança. Foram avaliados 308 idosos, sendo a maioria mulheres (57,8%) e com idade entre 60 e 69 anos (54,7%). Considerando os qualificadores da CIF, verificou-se maior dificuldade moderada/grave para o teste de sentar e levantar da cadeira de 5 repetições (TSLC5R) (66,2%) no domínio “função e estrutura do corpo”, enquanto para o domínio “atividade e participação” observou-se a prevalência de incapacidade moderada/grave para a tarefa de cortar as unhas dos pés (21,2%). No domínio “fatores ambientais”, verificou-se o predomínio de ausência de locais para a prática de atividade física no ambiente de vizinhança (72,5%).

Disability, physical-functional performance, and neighborhood environment: evaluation of community-dwelling older adults based on the International Classification of Functioning, Disability, and Health

ABSTRACT The International Classification of Functioning, Disability, and Health (ICF) is still a distant and often feared tool in the area of older adults health. This study aimed to describe the inabilities to perform activities of daily living (ADLs), limitations in the physical-functional performance, and the perception of the surrounding environment in community-dwelling older adults from the extreme South of Santa Catarina, classifying them according to the domains and qualifiers proposed by the ICF. This is a cross-sectional study, with older adults of both sexes. The analyzed variables were classified and categorized according to the ICF: (1) Body Functions and Structures: physical-functional performance tests; (2) Activity and Participation: ADL self-assessment instrument; and (3) Environmental factors: self-perception of the surrounding environment. A total of 308 older adults were evaluated, most of them were women (57.8%) and aged 60-69 years (54.7%). There were higher prevalence of moderate/severe difficulty in the 5-times sit-to-stand test (5TSTS) (66.2%), of moderate/severe disability in the activity of cutting toenails (21.2%), and no reports of places for the practice of physical activity near the residence (72.5%). As for the ICF qualifiers, there was greater “moderate/severe difficulty” for the 5TSTS in the “Body Function and Structure” categories and in the task of cutting toenails in the “Activity and Participation” categories. In the category “Environmental factors,” there was a higher prevalence of lack of places for physical activity in the neighborhood.

The Role of Information and Communication Technology (ICT) for Older Adults' Decision-Making Related to Health, and Health and Social Care Services in Daily Life-A Scoping Review

Information and communication technology (ICT) can potentially support older adults in making decisions and increase their involvement in decision-making processes. Although the range of technical products has expanded in various areas of society, knowledge is lacking on the influence that ICT has on older adults' decision-making in everyday situations. Based on the literature, we aimed to provide an overview of the role of ICT in home-dwelling older adults' decision-making in relation to health, and health and social care services. A scoping review of articles published between 2010 and 2020 was undertaken by searching five electronic databases. Finally, 12 articles using qualitative, quantitative, and mixed-method designs were included. The articles were published in journals representing biology and medicine, nursing, informatics, and computer science. A majority of the articles were published in the last five years, and most articles came from European countries. The results are presented in three categories: (i) form and function of ICT for decision-making, (ii) perceived value and effect of ICT for decision-making, and (iii) factors influencing ICT use for decision-making. According to our findings, ICT for decision-making in relation to health, and health and social care services was more implicitly described than explicitly described, and we conclude that more research on this topic is needed. Future research should engage older adults and health professionals in developing technology based on their needs. Further, factors that influence older adults' use of ICT should be evaluated to ensure that it is successfully integrated into their daily lives.

Disability among Older People: Analysis of Data from Disability Surveys in Six Low- and Middle-Income Countries

This analysis of surveys from six low- and middle-income countries (LMICs) aimed to (i) estimate the prevalence of disability among older adults and (ii) compare experiences and participation in key life areas among older people with and without disabilities which may show vulnerability during the COVID-19 pandemic. Data were analysed from district-level or national surveys in Cameroon, Guatemala, Haiti, India, Nepal and the Maldives, which across the six databases totalled 3499 participants aged 60 years and above including 691 people with disabilities. Disability was common among adults 60+, ranging from 9.7% (8.0–11.8) in Nepal to 39.2% in India (95% CI 34.1–44.5%). Mobility was the most commonly reported functional difficulty. In each setting, older people with disabilities were significantly less likely to be working and reported greater participation restrictions and environmental barriers in key life areas compared to people in the same age categories without disabilities (p < 0.05). Disability is common in this population, and older people with disabilities may have greater difficulties participating in COVID-19 responses and have high economic vulnerabilities. It is imperative to prioritise the needs of older people with disabilities in the COVID-19 pandemic, including ensuring accessibility of both health services and the community in general.

Functional difficulties and toileting among older adults in Ghana: evidence from the World Health Organization Study on global AGEing and adult health (SAGE) Ghana Wave 1

Ghana's older population is projected to increase in coming decades and as a result will see increasing care needs. Understanding the functional difficulties older adults experience, and the associated factors, will help identify relevant intervention to assist older adults in meeting their care needs. This study aimed to analyse the prevalence of functional difficulties among older adults in Ghana, and examine how the World Health Organization International Classification of Functioning, Disability and Health (WHO-ICF) conceptual framework can relate to toileting difficulty to understand the factors that increase older adults’ care needs. Data were for 5,096 adults aged ⩾50 years from the WHO Study on global AGEing and adult health (SAGE) Ghana Wave 1. Difficulties were assessed using self-reported difficulty on 22 functional items, including toileting. Multivariate logistic regression tested associations between toileting and other factors as related to the WHO-ICF conceptual framework. Older adults reported climbing one flight of stairs without resting as a common functional difficulty. Difficulty eating was the item least identified. Toileting difficulty was ranked second among five total activities of daily living difficulties. Age, marital status, self-reported health, memory, bodily pain, short- and far-distance vision, obesity, stroke, chronic lung disease, trust at individual and neighbourhood level, toilet facility type, socialising with co-workers, and public and religious meeting attendance were statistically significantly associated with toileting difficulty in the final parsimonious model. Post-hoc analysis testing interaction revealed that interaction existed between female sex and never married marital status (p = 0.04), and obesity and widowed marital status (p = 0.01), with toileting as the outcome. A significant level of functional difficulty existed among Ghanaian older adults in this sample. Toileting difficulty was associated with factors across different components in the WHO-ICF, emphasising functional, social and environmental factors related to this fundamental human activity.

Daily Time Use by Activity of Community-Dwelling Older Koreans: Focus on Health Management

This study aimed to examine the daily time use by activity and identified factors related to health management time (HMT) use among 195 older adults (mean age = 77.5, SD = 6.28 years; 70.8% women) attending a Korean senior center. Descriptive statistics were analyzed and gamma regression analyses were performed. Participants used the most time on rest, followed by leisure, health management, daily living activities, and work. The mean duration of HMT was 205.38 min/day. The mean score for the subjective evaluation of health management (SEHM) was 13.62 and the importance score for SEHM was 4.72. Factors influencing HMT included exercise, number of chronic conditions, fasting blood sugar level, low density lipoprotein level, and cognitive function. HMT and frailty significantly predicted SEHM. HMT interventions focus on promoting exercise and acquiring health information to improve health outcomes among older adults in senior centers.

Prefrailty: The Relationship Between Daily Activities and Social Participation in Older Persons

OBJECTIVES

To analyze prefrailty's relationship with limitations in activities of daily living (ADLs) and restrictions in social participation.

METHOD

Robust (Fried 0/4; n = 214; M_age = 82.3 years [SD ±2.1]) and prefrail (Fried 1-2/4; n = 191; M_age = 83.8 years [SD ±3.2]) community-dwelling older individuals were included. Frailty scores were obtained from weight loss, exhaustion, gait speed, and grip strength. A total disability index (DI) expressed dependency for basic (b-), instrumental (i-), and advanced (a-)ADLs. Total participation score, being a member, total number of memberships, being a board member, level of participation, membership over time, volunteering, and formal participation represented social participation.

RESULTS

Logistic regression retained age (OR = 1.224; 95% CI = [1.122, 1.335]), sex (OR = 3.818; 95% CI = [2.437, 5.982]), and a-ADL-DI (OR = 1.230; 95% CI = [1.018, 1.486]) as variables significantly related to prefrailty (68.3%; χ² = 68.25; df = 3; p < .001).

DISCUSSION

Subtle limitations in a-ADLs, higher age, and being a man were associated with prefrailty, revealing the possible role of personal and culturally related a-ADLs as red flags for (pre)frailty.

The perspectives of healthcare practitioners on fall risk factors in older adults

Background

Accidental falls could have severe and far-reaching consequences for older adults, their families and society at large. Healthcare practitioners’ (HCPs) perspectives on fall risk factors in older adults could assist in reducing and even preventing falls. Currently, no universal tool exists for this purpose. The World Health Organization’s globally accepted International Classification of Functioning, Disability and Health (ICF) was used.

Aim

This study aimed to (1) describe the perspectives of HCPs on fall risk factors in older adults in South Africa and (2) link these factors to the ICF.

Setting

Eighteen HCPs participated in two focus groups.

Methods

Using a qualitative research design, an inductive thematic analysis allowed for the identification of important themes, which were linked to the ICF.

Results

The factors mentioned by participants were categorised into 38 themes, which were linked to 142 ICF codes, of which 43% (n = 61) were linked to the Body Function category, 23% (n = 32) to the Environmental Factors category, 18% (n = 26) to the Body Structure category and 16% (n = 23) to the Activities and Participation category. HCPs revealed two relevant factors that were not captured in existing fall risk assessment tools (FRATs), namely ‘muscle-power functions’ and ‘mobility-of-joint functions’, which directly relate to the ability to execute mobility activities. Combining HCPs’ perspectives with other stakeholders and with literature provides a holistic picture of fall risk factors in older adults.

Functional Independence in the Community Dwelling Older People: a Scoping Review

Ageing potentially poses a threat to independent functioning of older adults. Although clinicians commonly focus on physical factors limiting Functional Independence (FI), it is likely that personal and environmental interactions also seem important to maintain FI. Herewith, FI exceeds several professional borders and calls for a uniform, multidisciplinary interdisciplinary supported definition of FI. This study aims to provide such a definition of FI in community dwelling older people. A scoping review was performed. Pubmed/Medline, Psychinfo and CINAHL were searched for studies describing aspects of FI. A literature-based definition of FI was discussed by experts (n = 7), resulting in a formulated final definition of FI and insight into contributing factors to FI. A multidisciplinairy focusgroup a stakeholder consultation (n = 15) ensured clinical relevance for daily practice. Data from the focusgroup stakeholder consultation were analyzed by using Atlas.ti (version 8). Based on the literature search, 25 studies were included. FI was finally defined as “Functioning physically safely and independent from another person, within one’s own context”. The contributing factors of FI comprised physical capacity combined with coping, empowerment and health literacy. Moreover, the level of FI is influenced by someone’s own context. This study confirms the relevance of the physical aspect of FI, but additionally stresses the importance of psychological factors. In addition, this study shows that one’s context may affect the level of FI as well. This underlines the importance of a holistic view and calls for multidisciplinary interdisciplinary collaboration in community-dwelling older people.

Predictors of participation restriction over a 9-year period in adults with myotonic dystrophy type 1

PURPOSE

For slowly progressive neuromuscular disease, prognostic approach and long-term monitoring of participation is a crucial part of rehabilitation services. To improve the prognostic approach, professionals must identify individuals at risk of having higher participation restriction. This study aimed to identify personal and environmental predictors of participation restriction over nine years in adults with myotonic dystrophy type 1 (DM1).

METHODS

A secondary analysis of a longitudinal design comparing baseline with a follow-up nine years later was used with a multidimensional assessment of participation and personal and environmental factors. Based on theoretical models, multiple linear regressions were used.

RESULTS

One hundred and fourteen adults with DM1 were included in the study (63.2% women; 78.9% adult onset; mean (SD) age of 43.5 (10.4) years). When age, sex, phenotype, and education were controlled for, participation restriction was predicted by a longer time to stand and walk, lower grip strength, higher body mass index, absence of perceived impact of myotonia in daily living, use of adapted transportation from community services, and perception of obstacle in physical environment (p < 0.001, adjusted R² = 0.50).

CONCLUSIONS

The majority of predictors of participation restriction can be advantageously modified by rehabilitation and environmental changes, such as politics targeting community services provision or physical environment and services accessibility.Implications for rehabilitationPredictors could better inform rehabilitation professional to recognize individuals at risk of higher participation restriction over time and to target specific interventions based on a prognostic approach.Rehabilitation professionals could inform the people living with myotonic dystrophy type 1 and their relatives of the multifactorial nature of occurrence of participation restriction to diminish the "fatality" associated with a genetic progressive disorder.Predictors allow professionals to assess and intervene in the management of specific factors depending on the rehabilitation goal.Identifying individual with myotonic dystrophy with higher risk of participation restriction could help implement a long-term community based rehabilitation intervention plan targeting both personal and environmental factors.

Slip-Fall Predictors in Community-Dwelling, Ambulatory Stroke Survivors: A Cross-sectional Study

BACKGROUND AND PURPOSE

Considering the multifactorial nature and the often-grave consequences of falls in people with chronic stroke (PwCS), determining measurements that best predict fall risk is essential for identifying those who are at high risk. We aimed to determine measures from the domains of the International Classification of Functioning, Disability and Health (ICF) that can predict laboratory-induced slip-related fall risk among PwCS.

METHODS

Fifty-six PwCS participated in the experiment in which they were subjected to an unannounced slip of the paretic leg while walking on an overground walkway. Prior to the slip, they were given a battery of tests to assess fall risk factors. Balance was assessed using performance-based tests and instrumented measures. Other fall risk factors assessed were severity of sensorimotor impairment, muscle strength, physical activity level, and psychosocial factors. Logistic regression analysis was performed for all variables. The accuracy of each measure was examined based on its sensitivity and specificity for fall risk prediction.

RESULTS

Of the 56 participants, 24 (43%) fell upon slipping while 32 (57%) recovered their balance. The multivariate logistic regression analysis model identified dynamic gait stability, hip extensor strength, and the Timed Up and Go (TUG) score as significant laboratory-induced slip-fall predictors with a combined sensitivity of 75%, a specificity of 79.2%, and an overall accuracy of 77.3%.

DISCUSSION AND CONCLUSIONS

The results indicate that fall risk measures within the ICF domains-body, structure, and function (dynamic gait stability and hip extensor strength) and activity limitation (TUG)-could provide a sensitive laboratory-induced slip-fall prediction model in PwCS.Video Abstract available for more insights from the authors (see the Video, Supplemental Digital Content 1, available at: http://links.lww.com/JNPT/A323).

A Pilot Study of the Effects of Chair Yoga and Chair-Based Exercise on Biopsychosocial Outcomes in Older Adults With Lower Extremity Osteoarthritis

This pilot study examined whether chair yoga and chair-based exercise are effective in managing biopsychosocial outcomes for older adults with lower extremity osteoarthritis. Both interventions improved physical function and mobility over time, although no significant differences between the 2 interventions were identified.

Multimorbidity, frailty and functional disability in octogenarians: A structural equation analysis of relationship

Path analysis allows for an understanding of the complex interrelationships between multiple variables and interactions in the octogenarians. The aim of this study was to estimate the isolated and combined prevalence of multimorbidity, frailty and functional disability and the direct and indirect association of these conditions in octogenarians. A cross-sectional study was conducted with 166 community-dwelling individuals aged 80 years or older participating in the FIBRA80+ epidemiological study. Multimorbidity was defined by three or more chronic diseases, frailty according to 3 or more components of physical frailty phenotype and functional disability as aid needed to perform one or more activities of daily living (ADLs). Associations were tested by Pearson's chi-square test; the relationship between the variables of interest and the mediating variables was tested with structural equation (path) analysis. We observed a higher prevalence of seniors with disability and multimordibity/disability. In path analysis, number of chronic diseases mediated the relation between sex and number of frailty components (p = 0.031), and these mediated the relation between number of diseases and disability (p = 0.008). The study points out the relationship between the simultaneous presence and interaction between multimorbidity, functional disability and frailty. Through path analysis, our findings provide characteristics in relation to the health-disease process, mainly mediation and interaction among octogenarians.

Health-Related Quality of Life among People Applying for Housing Adaptations: Associated Factors

Housing adaptations (HA) clients are a heterogeneous group of people with disabilities experiencing restricted performance and participation in everyday life. While health-related quality of life is a common and relevant outcome in health care research, associated factors among HA clients are largely unknown. Thus, the aim of this study was to investigate which factors are associated with health-related quality of life among HA clients in Sweden. The study has a cross-sectional design, using baseline data collected among 224 participants in three municipalities in Sweden. The main outcome was health-related quality of life measured by the EQ-5D. Factors investigated as potentially associated were age, sex, living conditions, cognitive impairment, usability of the home, activities of daily living (ADL) dependence, participation, and fear of falling. The associations were explored using multiple linear regression analysis. Younger age and higher dependence in ADL were associated with lower scores on the EQ-5D. The social aspect of usability in the home had a positive association with the EQ VAS. Results suggest that certain groups of HA clients might be at risk for low health-related quality of life. Knowledge of their characteristics can potentially improve development and implementation of tailored interventions aiming at increasing their health-related quality of life.