Preventive Strategies for Functional Dependency among Older Adults with Disabilities

Study Objectives:

While previous research has demonstrated the significance of physical activities for healthy adults, little attention has been paid to examine the effect of self-directed health promotion activities among community-dwelling older adults with disabilities and chronic health conditions. The purpose of this study is to identify risk indicators (i.g., health challenges and physical and social activities) to prevent functional declines among older adults with disabilities.

Methods:

The sample was drawn from 2004 National Long-Term Care Survey, a nationally representative survey of Medicare beneficiaries aged 65 or over who experience chronic functional disabilities (N= 3258).

The outcome variable, functional dependency (FD), was measured as a three level group variable. After combining six items from the Activities of Daily Living (ADL) scale and nine items from the Instrumental Activities of Daily Living (IADL) scale, the FD variable consisted of the following: Low level of FD group, only having IADL difficulties; medium level of FD group, having one to three ADL difficulties with or without IADL difficulties; and, high level of FD group, having four to six ADL difficulties with or without IADL difficulties. Demographic variables used in the present analysis included gender (male=1), age, race (White=1), marital status (Married=1), education, and employment (employed=1). Major chronic health conditions considered in this analysis were diabetes, cancer, obesity, hypertension, and any heart problem in the past 12 months. Dichotomous dummy coding was used for three types of physical activities including light or moderate activity, light and moderate activity, and vigorous only or with other activity. Two types of social activity consisted of frequency of relative visit and friend visit.

Multinomial logistic regression was performed to identify risk factors, including chronic health conditions, physical activities, and social activities, comparing three levels of FD. The base outcome used was the low level of FD group (IADL only group).

Results:

Older adults who have regular physical activities were less likely to have severe FD. The effect of physical activities was more evident for both high-level and medium-level FD groups, compared to low-level FD group. Three indicators of chronic condition predictive of FD were obesity, diabetes, and heart-related problems. Older adults with medium-level FD were likely to be obese compared to the low-level group. However, diabetes and heart-related problem were identified as risk factors within the high-level FD group compared to the low level FD group. Having less friends' visits also was an indicator to be more likely in the high-level FD group compared to the low-level FD group. Age and higher level of education were more likely to have severe FD (X2=674.73, p=.0000).

Implications: Our findings suggest that physical and social activity should be encouraged for seniors with chronic conditions and be considered a primary or adjunctive therapy. When developing and implementing community-based programs targeting older adults with functional dependency, practitioners and policy makers should be aware of obesity, diabetes, and heart-related problems as risk factors. Other implications for practice, policy, and research will be discussed.