Laying the foundation for a Core Set of the International Classification of Functioning, Disability and Health for community-dwelling older adults in primary care: relevant categories of their functioning from the research perspective, a scoping review

Development of a self-assessment tool to address the functioning of community-dwelling older adults in general practice: a validation study of the EFA23 questionnaire

BACKGROUND

Multimorbidity is increasingly prevalent among ageing patients, leading to reduced daily functioning. To address the challenges posed by multimorbidity in older adults, a person- and context-centred approach is needed. This study aimed to develop a questionnaire as a self-assessment tool for older adults focusing on functioning in general practice based on the International Classification of Functioning, Disability and Health (ICF).

METHODS

A mixed-methods approach was employed in the development and validation of the German EFA23 (Erfassung Funktionaler Gesundheit im Alter - 23 Fragen; Assessing Functional Health in Old Age - 23 questions) questionnaire. Based on an ICF subset developed in a preparatory phase and consensus study, questionnaire items were formulated and tested in a qualitative pretest, followed by a validation study. A workshop with general practitioners (GPs) was held to develop a supplementary manual for GPs on how to interpret the questionnaire results and discuss them with the patients.

RESULTS

A total of 69 items were developed and tested in the qualitative pretest with 15 respondents, resulting in 37 items for the validation study. The validation study, involving 237 older adults, showed the presence of one significant principal component. It demonstrated good internal consistency (Cronbach's alpha = 0.967) and construct validity, showing positive correlations with established assessment tools. Descriptive statistics showed differences between the means of self-assessment by patients and an external GP assessment. The final EFA23 questionnaire consists of 23 items assessing limitations in functioning.

CONCLUSIONS

The EFA23 questionnaire can be used as a valid self-assessment instrument to measure functioning in older adults, supporting a person- and context-centred approach in general practice.

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.

Development of a subset of the international classification of functioning, disability and health as a basis for a questionnaire for community-dwelling older adults aged 75 and above in primary care: a consensus study

OBJECTIVES

Functioning of older adults needs to be adequately described before it can become the focus of care. The International Classification of Functioning, Disability and Health (ICF) provides a basis for describing functioning. As the ICF is too extensive for daily practice in primary care, there is a need for a reduced number of categories. The aim is to develop an ICF-subset for community-dwelling older adults aged 75 and above in primary care.

DESIGN

The scientific basis for decision-making in our consensus study was laid by four preparatory studies, identifying potentially relevant ICF categories from four perspectives (research, patients', experts' and clinical perspective). The results of the preparatory phase were discussed by an international expert panel in a consensus study following the Nominal Group Technique (NGT).

SETTING

An international 1-day online consensus conference.

PARTICIPANTS

International experts (n=7) participated in the consensus conference, meeting the following criteria: extensive expertise in the field of the ICF and/or caring for older adults, and being fluent in English.

RESULTS

Each preparatory study yielded a different number of categories with some overlaps but also differences. The expert panel decided to: (1) restrict the subset to second-level categories and reduce the number of categories from the preparatory phase, (2) limit the subset to the component activities and participation and (3) weight the patients' perspective as the most relevant one.

CONCLUSIONS

By using consensus techniques and the NGT, the process led to 51 second-level ICF categories to describe the functioning of community-dwelling older adults. The decisions made in the consensus conference emphasised the importance of considering the individual life situation from a more holistic perspective and addressing functioning as a focus of care. Next, the 51 categories will contribute to the development of an ICF-based questionnaire.

Researcher's Perspective on Musculoskeletal Conditions in Primary Care Physiotherapy Units through the International Classification of Functioning, Disability, and Health (ICF): A Scoping Review

(1) Background: Musculoskeletal disorders are the second cause of disability in the world. The International Classification of Functioning Disability and Health (ICF) is a tool for systematically describing functioning. Outcome measures for musculoskeletal disorders and functioning concepts embedded in them have not been described under the ICF paradigm. The objective of this scoping review was to identify ICF categories representing the researcher's perspective and to compare them with the ICF core set for post-acute musculoskeletal conditions. (2) Methods: This review was conducted as follows: (a) literature search using MEDLINE/PubMed, CINAHL, Web of Science, and Scopus databases; (b) study selection applying inclusion criteria (PICOS): musculoskeletal conditions in primary care, application of physiotherapy as a treatment, outcome measures related to functioning, and experimental or observational studies conducted in Western countries during the last 10 years; (c) extraction of relevant concepts; (d) linkage to the ICF; (e) frequency analysis; and (f) comparison with the ICF core set. (3) Results: From 540 studies identified, a total of 51 were included, and 108 outcome measures were extracted. In the ICF linking process, 147 ICF categories were identified. Analysis of data showed that 84.2% of the categories in the ICF core set for post-acute musculoskeletal conditions can be covered by the outcome measures analyzed. Sixty-eight relevant additional ICF categories were identified. (4) Conclusion: Outcome measures analyzed partially represent the ICF core set taken as a reference. The identification of additional categories calls into question the applicability of this core set in primary care physiotherapy units.

Indicators and Instruments to Assess Components of Disability in Community-Dwelling Older Adults: A Systematic Review

The epidemiological demands of aging point to the need for characterizing older adults regarding health and disability. This systematic review aims to summarize the indicators (instruments) identifying different components of disability as a result of aging exposition in community-dwelling older adults, considering the International Classification of Functioning, Disability, and Health framework. Taking the PRISMA 2020 recommendations as a reference, studies with community-dwelling older adults, reporting the development and/or age disability modifications were included. Two reviewers analyzed the observational studies searched in the MEDLINE, CINAHL, Web of Science, Scopus, and Embase databases. Of the 137 potentially eligible studies, 49 were included in this review. Several indicators (instruments) demonstrated older adults' disabilities according to the different domains of the ICF. Objective measures assessed Body Structures, Body Functions, and Environmental Factors and included handgrip strength (dynamometry, n = 8), cognitive function (Mini-Mental State examination, n = 7), gait speed (walk test, n = 6), and endurance (Chair stand-test, n = 4). Self-reported measures assessed Activities and Participation, but not the Body Structures, and included the basic and instrumental activities of daily living (ADL) (the Katz Index of ADL, n = 4 studies, the Lawton and Brody Instrumental ADL, n = 4 studies). The summary of the measures gathered can guide researchers and health professionals to select indicators (instruments) to assess and monitor older adults' disabilities resulting from aging exposition, to support the development of new wearables, and to provide improvements to the existing ones, allowing the tailored assessment of different health and disability dimensions.

Use of the activities and participation profile to assess the functioning of physically inactive elderly

Abstract Introduction: Physical inactivity negatively impacts the functional status of the elderly during aging. Objective: To describe the activity and participation profile of physically inactive elderly and to investigate associated factors. Methods: A cross-sectional study with physically inactive elderly, aged ≥ 60 years, both sexes, with good cognitive function and independent gait. Personal factors, clinical history, history of falls in the last year, and identification of activity and participation profiles were investigated. Nonparametric statistical tests (SPSS 20.0) were performed, considering p < 0.05 significant. Results: The elderly (n = 36) had a mean age of 72.5 years (±7.7). Most were women (78%), with one to four years of education (69%), retired (72%), referring episodes of falling (58%) and affected by two to four comorbidities (53%). In the activities and participation profile, most of the physically inactive elderly presented mild problems for: crawling, kneeling, squatting, walking long distances, walking on different surfaces, walking around obstacles, climbing, and using public transportation. However, kneeling, squatting, walking on different surfaces, and climbing represented higher percentages of elderly who presented some problem. The advancement of age (p = 0.045), female sex (p = 0.022), episodes of falls (p = 0.037), and comorbidities (p = 0.031) were identified as factors that can impact functioning. Conclusion: The physically inactive elderly presented a mild problem in activities and participation items that are more related to strength and walking. Elderly aged over 70, female, with episodes of falls and comorbidities were significantly associated with reduced or impaired functioning.

Uso do perfil de atividades e participação para avaliação da funcionalidade de idosos inativos fisicamente

Resumo Introdução: A inatividade física impacta negativamente a funcionalidade dos idosos durante o envelhecimento. Objetivo: Descrever o perfil de atividade e participação de idosos inativos fisicamente e investigar fatores associados. Métodos: Estudo transversal com idosos inativos fisicamente, ≥ 60 anos, ambos os sexos, boa função cognitiva e independentes na marcha. Foram investigados fatores pessoais, história clínica, histórico de quedas no último ano e identificação do perfil de atividade e participação. Foram realizados testes estatísticos não paramétricos (SPSS 20.0), considerando p < 0,05. Resultados: Os idosos (n = 36) apresentaram média de 72,5 anos (± 7,7). A maioria era mulher (78%), com escolaridade de um a quatro anos de estudo (69%), aposentados (72%), referindo episódios de queda (58%) e acometidos por duas a quatro comorbidades (53%). No perfil de atividades e participação, a maioria dos idosos inativos fisicamente apresentaram problema leve para os itens: engatinhar, ajoelhar-se, agachar-se, andar longas distâncias, andar sobre superfícies diferentes, andar desviando-se de obstáculos, subir e utilizar transporte público. Entretanto, ajoelhar-se, agachar-se, andar sobre superfícies diferentes e subir compreendem maiores percentuais de idosos que apresentaram algum problema. Idade avançada (p = 0,045), sexo feminino (p = 0,022), episódios de quedas (p = 0,037) e presença de comorbidades (p = 0,031) foram identificados como fatores que podem impactar na funcionalidade. Conclusão: Idosos inativos fisicamente apresentaram problema leve nos itens das atividades e participação que estão mais relacionados à força e ao andar. Idosos com mais de 70 anos, do sexo feminino, com presença de episódios de quedas e de comorbidades, apresentaram associação significativa com a funcionalidade reduzida ou prejudicada.

Laying the foundation for an ICF core set for community dwelling older adults in primary care: an expert survey

BACKGROUND

A holistic biopsychosocial model focused on functioning in individual contexts (environment, task) is better suited to meet the needs of older patients than disease only based models. The International Classification of Functioning, Disability and Health (ICF) is the official standard for describing functional health. As the ICF is too detailed to be used in practice, brief core sets have been developed.

OBJECTIVE

This study aimed to identify relevant aspects of functioning for older primary care patients from the perspective of healthcare professionals in Germany.

MATERIAL AND METHODS

An internet-based cross-sectional expert survey was conducted in preparation for the development of an ICF core set for community-dwelling patients aged 75 years and older. Open-ended questions to identify the most important aspects of functioning and disability in old age were used. Responses were analyzed based on a content analysis approach to identify relevant concepts in the care of the target population. These concepts were then linked to ICF categories according to established linking rules.

RESULTS

A total of 63 experts participated in this survey. Across all responses, 2240 meaningful concepts were identified. A total of 75 ICF categories (4 first level categories, 67 second level categories, 4 code combinations) were identified by at least 5% of respondents and will thus be considered as candidate categories for the final ICF core set. Most of concepts were associated with the environmental factors component. The most frequently identified categories were immediate family and family relationships.

CONCLUSION

This survey provides a list of relevant ICF categories from the experts' perspective and together with other preparatory studies will be used for developing an ICF core set for community-dwelling older adults in primary care.