Activity of daily living staging, chronic health conditions, and perceived lack of home accessibility features for elderly people living in the community

Abstract

Objective: To examine the cross-sectional associations between activity of daily living (ADL) limitation stage and specific physical and mental conditions, global perceived health, and unmet needs for home accessibility features of community-dwelling adults aged 70 and older.

Design: Cross-sectional.

Setting: Community.

Participants: Nine thousand four hundred forty-seven community-dwelling persons interviewed through the Second Longitudinal Study of Aging (LSOA II).

Measurements: Six ADLs organized into five stages ranging from no difficulty (0) to unable (IV).

Results: ADL stage showed strong ordered associations with perceived health, dementia severe enough to require proxy use, and history of stroke. For example, the relative risks (RRs) defined as risk of being at Stages I, II, III, or IV divided by risk of being at Stage 0 for those with dementia ranged from 3.2 (95% confidence interval (CI)=2.4-4.4) to 41.9 (95% CI=19.6-89.6) times the RRs for those without dementia. The RR ratios (RRR) comparing respondents who perceived unmet need for accessibility features in the home to those without these perceptions peaked at Stage III (RRR=17.8, 95% CI=13.0-24.5) and then declined at Stage IV. All models were adjusted for age, sex, and race.

Conclusions: ADL stages showed clinically logical associations with other health-related concepts, supporting external validity. Findings suggest that specificity of chronic conditions will be important in developing strategies for disability reduction. People with partial rather than complete ADL limitation appeared most vulnerable to unmet needs for home accessibility features.

Figure 1

Patterns of association between activity of daily living stage across different type(s) of mental and physical chronic health conditions. A multinomial logistic regression addressed condition type as the history of cardiopulmonary disorders (heart attack, myocardial infarction, angina pectoris, other heart disease, bronchitis, emphysema, or asthma), stroke, osteoporosis, diabetes mellitus, arthritis, hypertension, cancer, major mental illness (schizophrenia, paranoid disorder, bipolar disorder, or major depression), or serious dementia (need for proxy because of poor memory or Alzheimer's disease). The reference category in each condition comparison was absence of the condition or other types of conditions. Each plotted association was adjusted for age, sex, and race and for all other conditions. Points indicate relative risk ratios, and vertical lines represent 95% confidence intervals. All relative risk ratio estimates were weighted using 1994 or 1995 sample weights.