Factors Associated With Functional Limitations in Daily Living Among Older Adults in Korea: A Cross-Sectional Study

Prevalence of functional disability and associated factors among older people in Vietnam: a secondary data analysis

OBJECTIVES

To explore the prevalence of functional disabilities and associated factors among older people in Vietnam.

DESIGN

A cross-sectional survey of older people aged 60 years and over in Vietnam using a multistage sampling method.

SETTING

The study used weighted data from the Vietnam Ageing Survey in 12 provinces in Vietnam.

PARTICIPANTS

The study sample consists of 3183 men and women aged 60 years and over.

OUTCOME MEASURES

The study used the Katz Index of Independence in Basic Activities of Daily Living (ADL) and the Instrumental Activities of Daily Living (IADL) to assess functional disabilities. Bivariate analyses and multivariate logistic regressions were used to explore the association between functional disability indicators and associated factors such as sociodemographic, health status, health behaviours and social participation.

RESULTS

The prevalence of ADL limitation, IADL limitation and both ADL/IADL limitations among older people were 44.6%, 35.2% and 26.3%, respectively. After adjustment, the associated factors for ADL limitation, including age (OR=1.04, 95% CI: 1.02 to 1.06), lower education (secondary school vs high school and above: OR=2.11, 95% CI: 1.34 to 3.33), lower wealth quintiles (lowest vs highest quintile: OR=2.36, 95% CI: 1.57 to 3.56), fair/poor/very poor self-rated health (vs good/very good: OR=5.40, 95% CI: 3.42 to 8.52), number of chronic diseases (OR=1.41, 95% CI: 1.24 to 1.62), depressive symptoms (OR=2.58, 95% CI: 1.84 to 3.67), receiving financial support (OR=1.47, 95% CI: 1.021 to 2.12) and lack of social participation (OR=1.97, 95% CI: 1.38 to 2.81). The associated factors for IADL limitation included age (OR=1.07, 95% CI: 1.05 to 1.09), lower education (no schooling/incomplete primary education vs high school and above: OR=2.29, 95% CI: 1.29 to 4.05), lower wealth quintiles (poorest vs wealthiest: OR=2.82, 95% CI: 1.76 to 4.52), not working (OR=3.24, 95% CI: 2.36 to 4.44), did not drink alcohol in the last 6 months (OR=1.56, 95% CI: 1.05 to 2.30), number of chronic diseases (OR=1.23, 95% CI: 1.05 to 1.44), depressive symptoms (OR=2.05, 95% CI: 1.53 to 2.75) and lack of social participation (OR=3.88, 95% CI: 2.64 to 5.71). The associated factors for both ADL/IADL limitations were age, lower education, lower wealth quintiles, not working, fair/poor/very poor self-rated health, number of chronic diseases, depressive symptoms, receiving financial support, and lack of social participation.

CONCLUSION

The prevalence of functional disabilities among older people in Vietnam was high. Functional disabilities were multifactorial, and the multicomponent interventions and policies for older people should focus on improving health literacy, preventing and managing depression and chronic diseases, and encouraging social participation.

Characteristics associated with activities of daily living (ADL), instrumental activities of daily living (IADL), functional, or other activity limitation among United States adults with asthma

OBJECTIVE

The objective of this study was to explore the characteristics associated with having a limitation, which included any activities of daily living (ADL), instrumental activities of daily living (IADL), functional, or other activity limitations, among adults with asthma in the United States (US).

METHODS

This cross-sectional study included US adults (≥18 years) with asthma in the 2021 Medical Expenditure Panel Survey. A multivariable logistic regression model assessed the association between the following characteristics and the dependent variable (having a limitation, which included ADL, IADL, functional, or other activity limitation): age, sex, race, ethnicity, education, employment, income, marriage, exercise, smoking, pain, overall health, and mental health.

RESULTS

The sample included 2325 (limitation n = 940, no limitation n = 1385) US adults with asthma, which represented an estimated weighted population of 37 210 236 (limitation n = 11 104 087, no limitation n = 26 106 149). In this analysis, characteristics associated with having a limitation (versus no limitation) included: age ≥65 versus 18-39 years (odds ratio (OR)=6.6, 95% confidence interval (CI)=3.8-11.4), age 40-64 versus 18-39 years (OR = 2.4, 95% CI = 1.5-3.9), unemployed versus employed (OR = 2.6, 95% CI = 1.7-4.0), low versus middle/high income (OR = 1.5, 95% CI = 1.0-2.2), not married versus married (OR = 1.8, 95% CI = 1.2-2.7), smoker versus nonsmoker (OR = 3.0, 95% CI = 1.7-5.3), quite a bit/extreme versus little/moderate pain (OR = 2.8, 95% CI = 1.8-4.3), fair/poor versus good overall health (OR = 3.3, 95% CI = 2.0-5.3), and fair/poor versus excellent/very good overall health (OR = 6.3, 95% CI = 3.5-11.4).

CONCLUSIONS

In conclusion, these findings offer some insight into having a limitation among US adults with asthma, although a future prospective study is needed to establish evidence of causality.

Determinants of limitations in activities of daily living among community-dwelling persons aged 80 years and older: Longitudinal national evidence from the Health, Aging and Retirement in Thailand study, 2015-2022

AIM

Few studies have longitudinally assessed the determinants of limitations in activities of daily living (LADL) among persons aged ≥80 years. The aim of this study was to estimate the determinants of LADL among persons aged ≥80 years based on 4-wave national longitudinal data from Thailand.

METHODS

Data from the Health, Aging and Retirement in Thailand study from 2015, 2017, 2020 and 2022 were utilized. The sample was restricted to community-dwelling persons aged ≥80 years (analytic sample: n = 3113 observations). For the pooled sample, the average age was 85.4 years (range 80-117 years). Established measurements were used to assess LADL. Linear fixed effects regression was applied to assess the time-varying determinants and outcomes.

RESULTS

Linear fixed effects regressions showed that increasing age, an increase in the number of chronic conditions, an increase in depressive symptoms, higher religious involvement and being underweight increased LADL, whereas increases in exercise frequency and increases in subjective life expectancy decreased LADL. In addition, in subgroup analysis among 60-79-year-olds, transitioning to widowhood and work status decreased LADL. Further differences between ≥80-year-olds and 60-79-year-olds include that an increase in depressive symptoms and increase in chronic conditions only increased LADL among ≥80-year-olds and not among 60-79-year-olds.

CONCLUSIONS

This longitudinal study enhances our understanding of the determinants of LADL among persons aged ≥80 years. Strategies to delay or decrease depressive symptoms and chronic conditions, proper weight management and increasing physical activity might help in reducing LADL. Geriatr Gerontol Int 2025; 25: 403-410.

Mediating Effect of IADL and Depression in the Relationship Between Ability to Perform Movements and Death Preparation in Elderly with Osteoarthritis or Rheumatoid Arthritis

Background/Objectives: This study investigated the mediating effects of instrumental activities of daily living (IADL) and depression on the relationship between the ability to perform movements and death preparation among older adults with osteoarthritis (OA) or rheumatoid arthritis (RA). Methods: This study is a secondary analysis of data from the Ministry of Health and Welfare of Korea's 5th (2020) survey of the elderly. It included 1483 elderly individuals with OA or RA. We measured the ability to perform movements, death preparation, IADL, and depression using validated scales. Hayes' PROCESS Macro for SPSS model 6 was used to determine the mediating effects. Results: Death preparation exhibited significant differences based on satisfaction with economic conditions, fall experiences, and suicidal ideation. A significant correlation existed between the ability to perform movements, death preparation, IADL, and depression. IADL demonstrated a significant mediating effect between the ability to perform movements and death preparation. However, depression did not exhibit a significant mediating effect. Conclusions: IADL significantly mediates the relationship between movement ability and death preparation in elderly individuals with OA or RA. Lower movement ability was associated with higher death preparation and greater IADL dependence. However, contrary to expectations, depression did not show a significant mediating effect. These findings offer significant insights for developing interventions to enhance the quality of life and prepare for dignified death in elderly individuals with OA or RA. Future longitudinal studies are required to clarify the causal relationships and evaluate the efficacy of IADL enhancement programs.

Prevalence and sociodemographic characteristics of functional impairment in community-dwelling older adults in China: a cross-sectional study

OBJECTIVES

Functional impairment is an early stage of disability, and timely identification and intervention are critical for the health of older adults. However, little is known about the functional impairment of Chinese older adults due to the absence of specialised assessment tools. This study aimed to explore the prevalence and socio-demographic characteristics of functional impairment in Chinese community-dwelling older adults using the Function Impairment Screening Tool (FIST), which was previously developed based on the Delphi method.

DESIGN

Cross-sectional study.

SETTING

Community-based.

PARTICIPANTS

The study included 6444 community-dwelling older adults from the China Comprehensive Geriatric Assessment Study.

RESULTS

The FIST identified functional impairment in 31.3% of Chinese community-dwelling older adults. The prevalence was higher among women and individuals in rural areas and increased with age. Illiteracy, no spouse, living alone, poor self-reported health, low income, limited meat intake, less exercise, chronic diseases and geriatric syndromes were associated with functional impairment. Furthermore, after adjusting for related variables, functional impairment was independently associated with disability (OR=138.5, 95% CI 70.0 to 273.9), frailty (OR=13.7, 95% CI 10.3 to 18.3), immobility (OR=6.9, 95% CI 5.4 to 8.9), fractures (OR=2.2, 95% CI 1.5 to 3.3) and falls (OR=2.6, 95% CI 1.8 to 3.7).

CONCLUSION

Approximately one-third of Chinese community-dwelling older adults experienced functional impairment, and its prevalence was associated with socio-psychological characteristics, lifestyle, chronic diseases and geriatric syndromes.

The prevalence of functional disability and associated factors among older adults living in Bahir Dar City, Northwest, Ethiopia: a community-based cross-sectional study

Background

The limitation of carry out everyday activities independently is a common experience for older adults with functional disabilities, which can hurt their overall well-being. Unfortunately, there is still a dearth of evidence about how common it is among older adults, especially in low-and middle-income countries like Ethiopia. Therefore, the study aimed to assess the prevalence and associated factors of functional disability among older adults living in Bahir Dar city, Northwest, Ethiopia, 2023.

Method

A community-based cross-sectional study was conducted among older adults (≥60 years) living in Bahir Dar city, Northwest, Ethiopia. A total of 598 study participants were included using a multistage sampling technique. Data were collected through interviewer-administered questionnaires. Barthel Index (BI) was used to assess the functional capacity of older adults which comprises 10 items. The total score ranges from 0 to 100. Variables significant in bivariable analysis were entered into multivariable logistic regression analysis. A p < 0.05 was considered statistically significant in the final logistic regression model.

Results

Among the 598 participants studied, the overall prevalence of functional disability was 29.6 (95% CI: 26.0-33.4). Older age (≥70 years) {adjusted odds ratio(AOR: 2.24; 95% CI: 1.03-4.88)}, comorbidity (AOR: 2.96; 95% CI: 1.47-5.94), physically inactive (AOR: 2.42; 95% CI: 1.18-4.96), one and more drug users (AOR: 3.61; 95% CI: 2.12-6.15), cognitive impairment (AOR: 3.66; 95% CI: 2.26-4.93) and depression (AOR: 1.70; 95% CI: 1.08-2.68) were found significant associated factors of functional disabilities among older adults.

Conclusion

This study found that nearly one-third of older adults had functional disabilities. Functional disability was significantly associated with factors such as increasing age, presence of comorbidities, being physically inactive, one and more drug users, who developed cognitive impairment, and having depression symptoms. Proactive measures need to be initiated to ensure proper care and support of functionally disabled individuals, especially targeting vulnerable groups identified in this study.

Cognitive frailty and its association with disability among Chinese community-dwelling older adults: a cross-sectional study

BACKGROUND

There are a variety of determinants that are key to functional disability of older adults. However, little is known regarding the relationship between cognitive frailty and disability among older people. The aims of this study were to examine the associations between cognitive frailty and its six components with instrumental activities of daily living (IADL) functioning in community-dwelling older adults.

METHODS

A total of 313 community-dwelling older adults (aged ≥ 65 years) were recruited from eight community centers in central China. Cognitive frailty was operationalized using the Mini-Mental State Examination for the evaluation of cognitive status and the Fried criteria for the evaluation of physical frailty. The outcome was functional disability assessed by the IADL scale. The association between cognitive frailty, as well as its components, and IADL limitations was identified by conducting binary logistic regression analysis.

RESULTS

The prevalence of cognitive frailty was 8.9% in this study. The results showed that cognitive frailty (OR = 22.86) and frailty without cognitive impairment (OR = 8.15) were associated with IADL limitations. Subdimensions of cognitive frailty, exhaustion, weakness, low physical activity and cognitive impairment components were independently associated with IADL limitations.

CONCLUSION

Cognitive frailty was associated with a higher prevalence of disability. Interventions for improving cognitive frailty should be developed to prevent IADL disability among community-dwelling older adults in China.

Chronic disease and multimorbidity in the Chinese older adults' population and their impact on daily living ability: a cross-sectional study of the Chinese Longitudinal Healthy Longevity Survey (CLHLS)

BACKGROUND

Owing to an increase in life expectancy, it is common for the older adults to suffer from chronic diseases that can result in disability and a low quality of life. This study aimed to explore the influence of chronic diseases and multimorbidities on activities of daily living (ADLs) and instrumental ADLs (IADLs) in an older Chinese population.

METHODS

Based on the Chinese Longitudinal Healthy Longevity Survey (2018), 9,155 older adults aged 65 years and above were included in the study. A self-administered questionnaire was used to collect information on demographic characteristics, chronic diseases, ADLs, and IADLs. The impact of factors affecting ADL and IADL impairment in older adults was analysed using binary logistic regression.

RESULTS

In total, 66.3% participants had chronic diseases. Hypertension, heart disease, arthritis, diabetes and cerebrovascular disease were among the top chronic diseases. Of these, 33.7% participants had multimorbidities. The most common combination of the two chronic diseases was hypertension and heart disease (11.2%), whereas the most common combination of the three chronic diseases was hypertension, heart disease, and diabetes (3.18%). After categorising the older adults into four age groups, dementia, visual impairment, and hearing impairment were found to be more prevalent with increasing age. The prevalence of hypertension, heart disease, cerebrovascular disease, gastrointestinal ulcers, arthritis and chronic nephritis gradually increased with age until the age of 75 years, peaked in the 75-84 years age group, and then showed a decreasing trend with age. Multimorbidity prevalence followed a similar pattern. Regression analysis indicated that the increase in age group and the number of chronic diseases independently correlated with impairments in ADL as well as IADL. Additionally, gender, physical activity, educational background, obesity, depressive symptoms, and falls also had an impact on ADLs or IADLs.

CONCLUSION

Chronic diseases and multimorbidities are common in older adults, and it is important to note that aging, multimorbidity, obesity, and unhealthy lifestyle choices may interfere with ADLs or IADLs in older adults. Therefore, it is imperative that primary healthcare providers pay special attention to older adults and improve screening for multimorbidity and follow-up needs.

Relationship between multimorbidity, functional limitation, and quality of life among middle-aged and older adults: findings from the longitudinal analysis of the 2013-2020 Survey of Health, Ageing, and Retirement in Europe (SHARE)

PURPOSE

The increased burden of multimorbidity is restricting individuals' ability to live autonomously, leading to a poorer quality of life. This study estimated trajectories of functional limitation and quality of life among middle-aged (ages 50 to 64 years) and older (aged 65 years and older) individuals with and without multimorbidity. We also assessed differences in the relationship between these two trajectories by multimorbidity status and separately for each age cohort.

METHODS

Data originated from the Survey of Health, Ageing, and Retirement in Europe (SHARE). In Luxembourg, data were obtained between 2013 and 2020, involving 1,585 respondents ≥ 50 years of age. Multimorbidity was defined as a self-reported diagnosis of two or more out of 16 chronic conditions; functional limitation was assessed by a combined (Instrumental) Activities of Daily Living (ADL/IADLI) scale; and to measure quality of life, we used the Control, Autonomy, Self-Realization, and Pleasure (CASP-12) scale. Latent growth curve modelling techniques were used to conduct the analysis where repeated measures of quality of life and functional limitation were treated as continuous and zero-inflated count variables, respectively. The model was assessed separately in each age cohort, controlling for the baseline covariates, and the estimates from the two cohorts were presented as components of a synthetic cohort covering the life course from the age of 50.

RESULTS

Middle-aged and older adults living with multimorbidity experienced poorer quality of life throughout the life course and were at a higher risk of functional limitation than those without multimorbidity. At baseline, functional limitation had a negative impact on quality of life. Furthermore, among middle-aged adults without multimorbidity and older adults with multimorbidity, an increase in the number of functional limitations led to a decline in quality of life. These results imply that the impact of multimorbidity on functional limitation and quality of life may vary across the life course.

CONCLUSION

Using novel methodological techniques, this study contributes to a better understanding of the longitudinal relationship between functional limitation and quality of life among individuals with and without multimorbidity and how this relationship changes across the life course. Our findings suggest that lowering the risk of having multimorbidity can decrease functional limitation and increase quality of life.