Gender differences in functional disability and self-care among seniors in Bangladesh

Prevalence and determinants of self-reported functional status among older adults residing in the largest refugee camp of the world

BACKGROUND

The older adults of refugee camps might be vulnerable to exhibiting limited functional abilities because of the limited resources available to create a supportive environment for older population in the camps. This study aims to explore the prevalence and determinants of self-reported functional status among the older adults residing in the Rohingya refugee camp in Bangladesh.

METHODS

This cross-sectional study was conducted on 864 older adults aged 60 years and above living in five selected sub-camps of Rohingya refugee camp in Cox's Bazar, Bangladesh. Data were collected through face-to-face interviews of the participants between November-December 2021. Functional status was measured using the Barthel Index. Information on participants' sociodemographic characteristics, self-reported chronic diseases and lifestyle characteristics were also collected. A multiple logistic regression model was used to assess the factors associated with self-reported functional abilities among the participants.

RESULTS

The overall percentage of people having limited self-reported functional ability was 26.5% (male: 22.6% and female: 31.5%) with inability most found in grooming (33.2%), bathing (31.8%), stair using (13.2%) and mobility (10.7%). In the final adjusted model, having age of 80 years or more (aOR = 2.01,95% CI: 1.08,3.75), being female (aOR = 1.44, 95% CI: 1.04,2.0), having low memory or concentration (aOR = 1.83, 95% CI: 1.30,2.56), loneliness (aOR = 2.89, 95% CI:1.74,4.80) and living with aid alone (aOR = 2.89, 95% CI: 1.74,4.80) were found to be associated with self-reported limited functional ability.

CONCLUSION

The findings of this study highlight the need for attention from policymakers and public health practitioners on addressing functional limitations among older adults residing in the Rohingya refugee camp. Our findings emphasize the need for the development of comprehensive interventions that can address the wider unmet needs (e.g., ensuring family/caregiver support, engaging in social and physical activities, providing nutritional support packages, etc.) to improve the health and well-being of older Rohingya adults.

A qualitative exploration of Chinese rural older adults' adaption experience to disability in Henan Province

BACKGROUND

The global population is ageing in a serious way and the number of disabled elderly people is increasing. Disability is a combination of physical and functional impairments, activity limitations, and social participation restrictions that significantly affect the quality of life of older adults. This study used the Roy adaptation model to examine the adaptive strategies of rural disabled elderly.

METHODS

An interview outline was prepared based on the Roy Adaptation Model, in-depth interviews were conducted with eligible rural elderly with disabilities using purposive sampling. Interview data were analyzed using the colaizzi method to obtain relevant themes and sub-themes of the adaptation experience.

RESULTS

Fifteen eligible disabled elderly participated in the interview, with an average age of 73.7 years old, showing different adaptation experiences in different aspects, a total of 5 themes and 18 sub-themes were extracted: (a)physiological function adaptation: learning to monitor physiological indicators, active medical compliance behavior, active rehabilitation exercise, adjusting lifestyle and coping with failure, (b) self-concept adaptation: adjustment of gratitude mentality, self-consolation, transferring the attention, seeking emotional comfort, and negative emotional response, (c) role function adaptation: positive self-care role, negative family role and escape of social role, (d) interdependence adaptation: actively seeking support and complex social coping, and (e) adaptation influencing factors: personal factors, caregiver factors and the policy factors.

CONCLUSIONS

The disabled elderly show different adaptation strategies in four ways, and are affected by personal factors, caregiver factors and policy factors. A multi-faceted support system for the disabled elderly is recommended, and the caregivers should be trained in all-round care knowledge and skills.

Assessing Nutritional Status and Functionality in Geriatric Population of Bangladesh: The Hidden Epidemic of Geriatric Malnutrition

The average life expectancy of the Bangladeshi population has risen over the last decade due to economic growth and improved medical care. Although the increased number of older adults and their health is a significant concern, there is scarce of data regarding that. A community-based cross-sectional study was conducted to analyze the association between nutritional status and functional ability among selected Bangladeshi geriatric populations living in their homes. Of 400 participants, the prevalence of malnutrition, and people at risk of malnutrition was 25.4% and 58.8%, respectively. Furthermore, almost 80% of participants are dependent in terms of activities of daily living. High risk of falling (OR = 10.82; 95% CI: 5.85-20.37; p ≤ .001), limited activities of daily living (IADL) (OR = 6.21; 95% CI: 4.02-9.58; p ≤ .001), along with dependency in performing IADL (OR = 4.48; 95% CI: 2.83-7.06; p ≤ .001) are significantly associated with malnutrition. Geriatric malnutrition can accelerate disability conditions, leading to early functional aging.

Trends in health expectancy at age 60 in Bangladesh from 1996 to 2016

BACKGROUND

Life expectancy (LE) is increasing all over the world, and relying on LE alone is no longer sufficient to identify whether a country is having a healthier population. Examining the increase in LE in relation to health - health expectancy estimation - is advised to ascertain the increase (or decrease) in LE without disability over time. This study examines the trends in health expectancy at age 60 in Bangladesh from 1996 to 2016.

METHODS

Mortality information from United Nations and World Health Organization and morbidity information from Bangladesh Bureau of Statistics were combined using the Sullivan method.

RESULTS

With an overall declining trend over the study period and a big drop in disability rates during 2012-2013, the disability rates were observed 1.6-1.7% in 2016. The declining trend in disability may have two-fold implications: (1) among the 98.3% older adults (≥60 years) with no severe/extreme disability, those were in jobs could have continued their work if there was no mandatory retirement at age 59, and (2) the 1.7% (translates into 0.2 million in 2020) older adults with severe/extreme disability require care assistance with their daily activities. The observed gain in disability-free life expectancy, the decrease in life expectancy with disability and its proportion allude to the compression of morbidity and healthier older adults over time.

CONCLUSION

In 2020, Bangladesh had 13.2 million (i.e., 8% of the total population) older adults, which is increasing day by day. The policy makers and government are suggested to prioritize the issues of older adults, particularly disability, care needs, retirement age, and health in the light of the current study's findings. Utilizing health expectancy research is suggested to understand the combined effect of disability and mortality for considering policy changes.

Functional disability among older adults in India; a gender perspective

Introduction

Older adults are always at a greater risk of physical and functional health challenges. These complications result into morbidity, disability and death making them more vulnerable at later ages. Therefore, this paper will examine the functional health status among older adults and its gender perspective, along with associated risk factors.

Materials and methods

Using the first round of Longitudinal ageing survey of India (2017–18). Functional disability was computed based on general and instrumental activities of daily living (ADL and IADL) (n = 20910). Functional disability was coined with individual having at least one of the limitations of these activities. Applying bivariate and multivariate analysis the present paper studied the association, gender perspective and risk factors of functional disability among older adults aged 50 and above in India.

Results

Our results clearly showed the gender bias in functional disability, with greater proportion of women (52%) at risk for functional disability then men (35%). Factors like multimorbidity, depression and life satisfaction are key risk factors identified by this study that increase the likelihood of disability.

Conclusion

Functional disability is key to healthy ageing and needs immediate attention given its greater concentration among the elderly, particularly women. The results reflect the substantial burden of functional disability than self-care among older adults in India and therefore indicates some significant policy interventions to reduce the likely impact of functional disability.

Physical activity and gender buffer the association of retirement with functional impairment in Ghana

Females on average live longer but with higher rates of functional impairment and lower physical and economic activities than men. However, research linking retirement to functional impairment and the modifying role of gender and physical activity (PA) is limited especially in low- and middle-income countries. This paper examines the association between retirement and functional impairment in Ghana and evaluates the effect modification of the association by gender and PA. The sample included 1201 adults aged ≥ 50 years from a population-based study. Functional impairment was assessed with the activities of daily living scale. Ordinary least squares regression models adjusted for confounding variables and estimated gender-wise and PA heterogeneity effect of retirement on functional impairment. Regressions showed that retirement predicted an increase in functional impairment score in the full sample (β = .76, p < .001) and in men (β = 1.96, p < .001), but not in women. Interestingly, retirement significantly increased functional impairment in ≥ 65 age cohort (full sample: β = .71, p < .005; men: β = 1.86, p < .001) although not in women. However, the effect was significantly moderated by PA such that retirement × PA predicted a decrease in functional impairment in the full sample (β = −.81, p < .005) and the ≥ 65 age group (β = −.43, p < .005). Functional impairment risk of retirement is gender-specific, but PA buffers the relationship. Retirement is generally commonplace, but these findings imply that promoting PA may hold promise for addressing functional impairment in old age. Attending to the physical health needs of men during retirement should be a social policy priority.

Modifications of Traditional Formulas to Estimate and Project Dependency Ratios and Their Implications in a Developing Country, Bangladesh

Traditional dependency ratios based on the United Nations’ old age definition (≥ 65 years) appear to be an inappropriate indicator for many developing countries, including Bangladesh. Bangladesh, with a retirement age of 59 in many sectors, defines old age as ≥ 60 years, whereas the United Nations documents 60–64 years as working age. This study offers two modifications to the traditional formulas of dependency ratios and compares the modified measures against the traditional measures from 1975 to 2100. Using data from the United Nations and the World Bank, (i) we moved the cut-off for ‘old age’ to 60 instead of 65 years, considering 15–59 years as ‘potentially working’, and (ii) we used the economically active population instead of the entire working-age population. Using our modified calculations, the growth rate of older adults (≥ 60 years) will be at its peak (4.6%) between 2020 and 2030 and continue to increase until 2085, though we will observe a negative population growth after 2055, and 2020–2040 appears to be the best time for reaping the highest demographic dividend. Compared to our modification, the traditional formula undercounted the older adults substantially, predicting a much lower demographic and financial burden. The modifications and associated estimates are important in advancing our understanding of dependency ratios in Bangladesh and have policy and practical implications in preventing the inaccurate representation of demographic and financial issues, and they are useful for planning for geriatric care, social safety nets, and healthy aging. The modified formulas may also be applicable in other countries which adopt ≥ 60 years as an old-age threshold.

The use of the Washington Group on Disability Statistics questionnaires to identify hearing disability: a systematic review

PURPOSE

To investigate the use of instruments from the Washington Group on Disability Statistics (WG) to obtain data on hearing disability (HD).

RESEARCH STRATEGIES

We conducted searches in the PubMed, Scopus, Science Direct, Web of Science, Lilacs databases and the grey literature. The software "The State of the Art through Systematic Review" and "Mendeley" were used to assist in the bibliographic reference organization, selection, and storage.

SELECTION CRITERIA

we followed the guidelines proposed by the "Preferred Reporting Items for Systematic Reviews and Meta-Analysis" and we selected studies that met the following inclusion criteria: written in English or Portuguese, within the period of 2001 to 2017 and have used the WG hearing disability question.

DATA ANALYSIS

The variables analyzed into the studies were: WG module, country and year of data collection, sample size and composition, objective of the study, publication journal, HD estimate of prevalence and accuracy measures.

RESULTS

Sixty-five studies are included in the review, conducted with data from 30 countries. The WG Short Set of question was the most often used. Hearing disability prevalence ranged from 0.2 to 2.3% and only three studies estimated the accuracy of the instrument to identify HD.

CONCLUSION

The hearing disability question of WG has been used worldwide and mainly in developing countries. The short variation in the estimated prevalence measurements within studies seems favorable to the WG's goal of generate estimates that allow international comparison. However, the shortage of validity studies indicates the need for further investigations with this purpose.

Older American Women May Especially Benefit from Distributing and Consuming Protein for Decreasing Odds of Functional Limitations

OBJECTIVES

Protein is a key macronutrient for preserving physical function, but the role of protein intake on functional status may differ in men and women. We sought to examine the associations of daily protein intake and distribution on functional limitations in older American men and women.

DESIGN

Cross-sectional.

SETTING

Population-based survey.

PARTICIPANTS

The analytic sample included 3,976 men and 4,081 women aged ≥60-years from the 2007-2016 waves of the National Health and Nutrition Examination Survey.

MEASUREMENTS

Participants reported their ability to perform basic activities of daily living, instrumental activities of daily living, leisure and social activities, lower extremity mobility activities, and general physical tasks. Those reporting difficulty or an inability in completing such functional tasks were considered as having a functional limitation. Protein intake was determined with dietary recalls and participants revealed functional limitations. Protein recommendations of ≥0.80, ≥1.00, and ≥1.50 g/kg/day were used. Based on these cut-points, we also investigated distribution of protein across 4 eating occasions at ≥0.20, ≥0.25, and ≥0.38 g/kg/meal, respectively.

RESULTS

Older women meeting each recommendation had decreased odds for functional limitations: 0.55 (95% confidence interval (CI): 0.40-0.75) for ≥0.80 g/kg/day, 0.75 (CI: 0.58-0.97) for ≥1.00 g/kg/day, and 0.72 (CI: 0.55-0.94) for ≥1.5 g/kg/day. No significant associations were observed in older men. Further, older women with protein consumption ≥0.20 g/kg/meal had decreased odds for functional limitations: 0.24 (CI: 0.10-0.61) for 1 occasion, 0.20 (CI: 0.08-0.49) for 2 occasions, 0.16 (CI: 0.07-0.40) for 3 occasions, and 0.12 (CI: 0.04-0.32) for 4 occasions. A similar trend was observed for intake ≥0.25 g/kg/meal: 0.31 (CI: 0.16-0.62) for 2 occasions, 0.30 (CI: 0.14-0.61) for 3 occasions, and 0.31 (CI: 0.12-0.78) for 4 occasions. Women with 1 and 2 eating occasions at ≥0.38 g/kg/meal of protein had 0.66 (CI: 0.48-0.91) and 0.54 (CI: 0.37-0.79) decreased odds for functional limitations, respectively.

CONCLUSION

Trials that are powered to detect the effects of protein on functional status in women will help to establish causality.

Vision and Hearing Impairments Affecting Activities of Daily Living among Malaysian Older Adults by Gender

Vision and hearing impairments are common among older adults and can cause undesirable health effects. There are limited studies from low- and middle-income countries exploring gender differences between vision and hearing impairment with Activities of Daily Living (ADL) disability. Therefore, this study aimed to investigate gender differences between vision and hearing impairments with ADL disability among older adults in Malaysia. Cross-sectional data from 3977 respondents aged 60 and above from the Malaysian National Health and Morbidity Survey 2018 were used. We used logistic regression analysis to measure associations between vision and hearing impairments with ADL disability, adjusted for covariates. The prevalence of ADL disability was higher among females than males (p < 0.001). The adjusted associations between vision impairment and ADL disability were significant among males (aOR 3.79; 95%CI 2.26, 6.38) and females (aOR 2.66; 95%CI 1.36, 5.21). Similarly, significant adjusted associations were found between hearing impairment and ADL disability among males (aOR 5.76; 95%CI 3.52, 9.40) and females (aOR 3.30; 95%CI 1.17, 9.33). Vision and hearing impairments were significantly associated with ADL disability, with no gender differences identified. Early detection and effective management of vision and hearing impairments are important to prevent ADL disability and improve older adults' level of independence.

Dependency Change with Aging and Associated Factors in Uruguay: A Cohort Study

OBJECTIVES

To assess the heterogeneity of transitions toward dependency in older adults and to explore the robustness of results to different operationalizations of dependency.

METHOD

Using data from people aged 60 years and older from a national representative study in Uruguay (Encuesta Longitudinal de Protección Social, N = 5071), we fitted multinomial regressions adjusted by sociodemographic and health characteristics to model transitions into dependency and death. We used a harder operationalization with basic activities of daily living (Katz-dependency) and Comprehensive-dependency with basic, instrumental, and advanced activities.

RESULTS

Increasing age (RRR = 1.08, CI = [1.05; 1.12], p < .001) and having comorbidities (RRR = 2.16, CI = [1.31; 3.57], p = .003) increased the risk of transition from nondependent to dependent using Katz-dependency. Women with at least two chronic conditions have increased risk of Comprehensive-dependency (RRR = 1.79, CI = [1.15; 2.80], p = .010).

DISCUSSION

Inconsistencies in findings emerged when evaluating transitions into dependency with the different measures, which may have social care implications.

Functional difficulties and toileting among older adults in Ghana: evidence from the World Health Organization Study on global AGEing and adult health (SAGE) Ghana Wave 1

Ghana's older population is projected to increase in coming decades and as a result will see increasing care needs. Understanding the functional difficulties older adults experience, and the associated factors, will help identify relevant intervention to assist older adults in meeting their care needs. This study aimed to analyse the prevalence of functional difficulties among older adults in Ghana, and examine how the World Health Organization International Classification of Functioning, Disability and Health (WHO-ICF) conceptual framework can relate to toileting difficulty to understand the factors that increase older adults’ care needs. Data were for 5,096 adults aged ⩾50 years from the WHO Study on global AGEing and adult health (SAGE) Ghana Wave 1. Difficulties were assessed using self-reported difficulty on 22 functional items, including toileting. Multivariate logistic regression tested associations between toileting and other factors as related to the WHO-ICF conceptual framework. Older adults reported climbing one flight of stairs without resting as a common functional difficulty. Difficulty eating was the item least identified. Toileting difficulty was ranked second among five total activities of daily living difficulties. Age, marital status, self-reported health, memory, bodily pain, short- and far-distance vision, obesity, stroke, chronic lung disease, trust at individual and neighbourhood level, toilet facility type, socialising with co-workers, and public and religious meeting attendance were statistically significantly associated with toileting difficulty in the final parsimonious model. Post-hoc analysis testing interaction revealed that interaction existed between female sex and never married marital status (p = 0.04), and obesity and widowed marital status (p = 0.01), with toileting as the outcome. A significant level of functional difficulty existed among Ghanaian older adults in this sample. Toileting difficulty was associated with factors across different components in the WHO-ICF, emphasising functional, social and environmental factors related to this fundamental human activity.

Frailty indexed classification of Bangladeshi older adults' physio-psychosocial health and associated risk factors- a cross-sectional survey study

BACKGROUND

Frailty is associated with healthy ageing, and it has been identified as a means of measuring older adults' physio-psychosocial health. We know about the ageing trends and common diseases of older adults living in South Asia, but literature to date does not widely feature their health status based on frailty, especially in Bangladesh. This study aims to understand the prevalence of frailty in Bangladeshi older adults; classify their health status; and investigate associated risk factors.

METHODS

A cross-sectional study was conducted in the north-eastern region (i.e. Sylhet City Corporation) of Bangladesh. Four hundred participants aged 55 years and above were randomly selected, attended a health assessment session and completed a multi-indicator survey questionnaire. We developed a 30-indicator Frailty Index (FI30) to assess the participant's health status and categorized: good health (no-frailty/Fit); slightly poor health (mild frailty); poor health (moderate frailty); and very poor health (severe frailty). Pearson chi-square test and binary logistic regression analysis were conducted.

RESULTS

The participants' mean age was 63.6 years, and 61.6% of them were assessed in poor to very poor health (moderate frailty/36.3% - severe frailty/25.3%). The eldest, female and participants from lower family income were found more frailty than their counterparts. Participants aged 70 years and above were more likely (adjusted OR: 4.23, 95% CI: 2.26-7.92, p < 0.0001) to experience frailty (medical conditions) than the pre-elderly age group (55-59 years). Female participants were more vulnerable (adjusted OR = 1.487, 95% CI: 0.84-2.64, p < 0.0174) to frailty (medical conditions) than male. Also, older adults who had higher family income (Income>$473.3) found a lower risk (adjusted OR: 0.294, 95% CI: 0.11-0.76, p < 0.011) of frailty (poor health).

CONCLUSION

Our study results confirm the prevalence of frailty-related disorders in Bangladeshi older adults and highlight the importance of targeted clinical and community-led preventive care programs.

Desigualdades de renda e capacidade funcional de idosos em município do Sudeste brasileiro

RESUMO: Objetivo: Estimar a magnitude das desigualdades de renda nas prevalências de dependência funcional em atividades básicas e instrumentais da vida diária (ABVDs e AIVDs, respectivamente) e no abandono de atividades avançadas (AAVDs). Métodos: Estudo transversal, de base populacional, desenvolvido com dados de amostra de 986 idosos de inquérito de saúde realizado no município de Campinas, São Paulo, em 2014/15. Foram estimadas as prevalências de dependência funcional em ABVDs e AIVDs e de abandono das AAVDs segundo a renda familiar mensal per capita, bem como desenvolvidas análises de regressão múltipla de Poisson para estimar razões de prevalência (RPs) ajustadas por sexo e idade. Resultados: Não houve associação significativa entre renda e dependência funcional em ABVDs. Das sete AIVDs analisadas, cinco apresentaram maior prevalência de dependência no estrato de menor renda, com destaque para o uso de telefone (RP = 3,50), o controle do uso de remédios (RP = 2,40) e o uso de transporte (RP = 2,35). O abandono de AAVDs foi maior entre os idosos de menor renda em todas as atividades analisadas, com maiores desigualdades observadas no contato por carta, telefone e e-mail (RP = 3,76), no uso de internet (RP = 3,34), em dirigir veículos (RP = 2,85) e na visita a familiares (RP = 2,77). Conclusão: As amplas desigualdades detectadas entre estratos de renda quanto à capacidade funcional nas AIVDs e no abandono das AAVDs ressaltam a importância da plena implementação e manutenção de políticas e programas voltados à proteção social de idosos, focando, em especial, os segmentos socialmente mais vulneráveis, na perspectiva de se atingir um patamar populacional mais equânime de um envelhecimento ativo, participativo e independente.

Decomposing gender inequality in functional disability among older people in Vietnam

OBJECTIVES

This study compared functional disability in older men and women, and examined the extent to which social determinants contribute to the difference in functional disability between Vietnamese older men and women.

METHODS

A nationally representative sample of persons aged 60 and older in Vietnam, taken from the 2011 Vietnam Aging Survey, was analyzed (N = 2,693, consisting of 1,622 women and 1,071 men). Ordinary least squares regression (OLS) was used to identify factors associated with functional disability in men and women, while Oaxaca-Blinder decomposition for linear models was applied to examine how much of gender inequality in functional disability was attributed by the distribution of the social determinants.

RESULTS

The OLS results showed that functional disability score for women was significantly higher than that for men, and that men and women shared similarity in factors associated with functional disability (e.g., age, educational level, employment status, and perceived sufficiency of income). The decomposition results showed that the distribution of the social determinants explained about 54 per cent of gender inequality in functional disability; among the determinants, age, employment status, and educational level were the major drivers. Approximately 46 per cent of the inequality was explained by unobserved factors.

CONCLUSION

The findings of this study highlight the need for policy to mitigate the social determinants (e.g., education and employment) that contribute to gender inequality in functional disability.

Disability for basic and instrumental activities of daily living in older individuals

AIMS

To know the prevalence, associated factors and temporal trends of disabilities for basic and instrumental activities of daily living in older people in Spain from 2009 to 2017.

BACKGROUND

Disability in older people is associated with health problems, increased health costs and low quality of life. There are no updated data in Spain with a representative sample about disability.

METHODS

Cross-sectional study with 25,465 non-institutionalized older people who participated in the European Health Survey in 2009 and 2014 and the National Health Survey in 2011/12 and 2017 in Spain. The prevalence rates of disability were evaluated using the Katz Scale and Lawton and Brody Scale. Logistic regression was used to determine if there was an association between basic and instrumental activities of daily living and sociodemographic characteristics.

RESULTS

More individuals had disability for instrumental activities of daily living (31.9%) than disability for basic activities of daily living (11.1%). The most predominant disability for instrumental activities of daily living was performing severe housework (34%). The prevalence of disabilities decreased from 2009 to 2017. In general, disability was associated with female gender, advanced age, lower education, restricted daily activity, being bedridden and higher pain levels.

CONCLUSION

There is a considerable prevalence of disabilities for basic and instrumental activities of daily living in older people in Spain. Although the disability prevalence has decreased slowly from 2009 to 2017, it continues to remain a health problem. Gender may influence the disabilities for basic and instrumental activities of daily living. Health policymakers should establish prevention strategies and effective interventions (e.g., physical exercise) for prevention and reduction of the disabilities for basic and instrumental activities of daily living, particularly in older females.