Limitations in Activities of Daily Living in Community-Dwelling People Aged 75 and Over: A Systematic Literature Review of Risk and Protective Factors

PLoS One. 2016 Oct 19;11(10):e0165127. doi: 10.1371/journal.pone.0165127. eCollection 2016.


Background: Most older people wish to age in place, for which functional status or being able to perform activities of daily living (ADLs) is an important precondition. However, along with the substantial growth of the (oldest) old, the number of people who develop limitations in ADLs or have functional decline dramatically increases in this part of the population. Therefore, it is important to gain insight into factors that can contribute to developing intervention strategies at older ages. As a first step, this systematic review was conducted to identify risk and protective factors as predictors for developing limitations in ADLs in community-dwelling people aged 75 and over.

Methods: Four electronic databases (CINAHL (EBSCO), EMBASE, PsycINFO and PubMed) were searched systematically for potentially relevant studies published between January 1998 and March 2016.

Results: After a careful selection process, 6,910 studies were identified and 25 were included. By far most factors were examined in one study only, and most were considered risk factors. Several factors do not seem to be able to predict the development of limitations in ADLs in people aged 75 years and over, and for some factors ambiguous associations were found. The following risk factors were found in at least two studies: higher age, female gender, diabetes, hypertension, and stroke. A high level of physical activity and being married were protective in multiple studies. Notwithstanding the fact that research in people aged 65 years and over is more extensive, risk and protective factors seem to differ between the 'younger' and 'older' olds.

Conclusion: Only a few risk and protective factors in community-dwelling people aged 75 years and over have been analysed in multiple studies. However, the identified factors could serve both detection and prevention purposes, and implications for future research are given as well.

Publication types

  • Review
  • Systematic Review

MeSH terms

  • Activities of Daily Living*
  • Aged
  • Aged, 80 and over
  • Female
  • Humans
  • Independent Living
  • Male
  • Protective Factors
  • Risk Factors
  • Socioeconomic Factors

Grant support

This work is part of the D-SCOPE project, which is supported by the Flemish government Agency for Innovation by Science and Technology, and is embedded in the Strategic Basic Research (IWT-140027-SBO). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.