Assessment of physical disability using Barthel index among elderly of rural areas of district Jhansi (U.P), India

Cross-Sectional Study Comparing Activities of Daily Living Using Barthel Index Within a Geriatric Population Having Non-Communicable Diseases

Introduction Disabilities and non-communicable diseases (NCDs) are prevalent among the elderly, significantly affecting their quality of life. Comprehensive population-based data are essential for effective healthcare planning and rehabilitation. This study aims to determine the prevalence of self-reported disabilities and compare Barthel Index scores among elderly individuals with and without NCDs. Methods A cross-sectional study was conducted at Dr. D. Y. Patil Medical College, Pune, involving 102 patients aged 60 years and above. Patients with a history of strokes or limb amputations were excluded. Data on demographics, comorbidities, and functional status were collected using a structured questionnaire designed based on Barthel Index scoring to assess the activities of daily living (ADL). Results The study included 102 participants: 58 males (56.9%) and 44 females (43.1%). Age distribution showed 73.5% in the 60-74 age group, 22.5% in the 75-84 age group, and 3.9% in the 85+ age group. Comorbidity data revealed that 37.3% had no comorbidities, 26.4% had one comorbidity, and 36.3% had two or more comorbidities. The mean Barthel Index scores were 87.11 for those without comorbidities, 83.89 for those with one comorbidity, and 82.30 for those with two or more comorbidities. The most affected activities were stair climbing (75.7%), bowel control (48.5%), and mobility (47.1%). Conclusion NCDs significantly impact daily activities in the elderly, underscoring the need for targeted healthcare interventions to improve their quality of life. This study highlights the importance of comprehensive care strategies to address the specific needs of elderly patients with comorbidities.

Assessment of Dependency in Activities of Daily Living (ADL) and its Predictors: A Cross-Sectional Study among the Elderly Rural Population in a Sub-Himalayan UT of India

Background

With an increase in life expectancy over the last few decades, there has been a parallel increase in the prevalence of disabilities among the elderly population. To estimate the prevalence of dependency in activities of daily living (ADL) and its predictors among the rural elderly population.

Material and Methods

This was a cross-sectional study carried out in the community among the rural geriatric population in the field practice area of PG Department of Community Medicine, Government Medical College Jammu. The Barthel Scale Index was used to measure ADL dependency. PSPP software was used to analyze the data.

Results

The mean age of study participants was 68.31 ± 7.9 years. ADL dependency was observed in 46.3% of the subjects, with the majority demonstrating mild to moderate dependence. Only 2.5% of the respondents reported a severe degree of ADL dependence. The mean ADL score was 94.47 ± 8.98. On multivariate logistic regression analysis, age, educational status, the presence of stress in the family, personal history, and the presence of co-morbidities emerged to be independent predictors of ADL dependence.

Conclusion

High prevalence of physical disability in the geriatric population is now an area of major concern. This emphasizes the significance of setting up geriatric care centers especially in rural areas preferably integrating with health and wellness centers.

The Effect of Swallowing Action Observation Therapy on Resting fMRI in Stroke Patients with Dysphagia

Objective

Many stroke victims have severe swallowing problems. Previous neuroimaging studies have found that several brain regions scattered in the frontal, temporal, and parietal lobes, such as Brodmann's areas (BA) 6, 21, and 40, are associated with swallowing function. This study sought to investigate changes in swallowing function and resting-state functional magnetic resonance imaging (rs-fMRI) in stroke patients with dysphagia following action observation treatment. It also sought to detect changes in brain regions associated with swallowing in stroke patients.

Methods

In this study, 12 healthy controls (HCs) and 12 stroke patients were recruited. Stroke patients were given 4 weeks of action observation therapy. In order to assess the differences in mfALFF values between patients before treatment and HCs, the fractional amplitude of low-frequency fluctuations (fALFF) in three frequency bands (conventional frequency band, slow-4, and slow-5) were calculated for fMRI data. The significant brain regions were selected as regions of interest (ROIs) for subsequent analysis. The mfALFF values were extracted from ROIs of the three groups (patients before and after treatment and HCs) and compared to assess the therapeutic efficacy.

Results

In the conventional band, stroke patients before treatment had higher mfALFF in the inferior temporal gyrus and lower mfALFF in the calcarine fissure and surrounding cortex and thalamus compared to HCs. In the slow-4 band, there was no significant difference in related brain regions between stroke patients before treatment and HCs. In the slow-5 band, stroke patients before treatment had higher mfALFF in inferior cerebellum, inferior temporal gyrus, middle frontal gyrus, and lower mfALFF in calcarine fissure and surrounding cortex compared to HCs. We also assessed changes in aberrant brain activity that occurred both before and after action observation therapy. The mfALFF between stroke patients after therapy was closed to HCs in comparison to the patients before treatment.

Conclusion

Action observation therapy can affect the excitability of certain brain regions. The changes in brain function brought about by this treatment may help to further understand the potential mechanism of network remodeling of swallowing function.

Multimorbidity and multi-disability among the elderly in residential care in India: the Hyderabad Ocular Morbidity in Elderly Study (HOMES)

We report prevalence and risk factors for multimorbidity and multi-disability among elderly people in residential care in the Hyderabad region in South India. In total, 1182 elderly (aged ≥ 60) participants were examined in 41 homes for the aged centres. Detailed interviews were conducted by trained personnel to collect personal and demographic information. A questionnaire was used to assess the history of non-communicable diseases and Washington Disability Questionnaire (WDQ) was administered to assess disabilities. The mean age of the participants was 75.0 years (SD 8.8 years; range: 60-108 years), 35.4% were men, 20.3% had no formal education, 60.7% had school education and 19% had higher education. The prevalence of multimorbidity was 37.6% (95% CI: 34.8-40.4). Prevalence of multi-disability was 23.6% (95% CI: 21.2-26.3; n = 270). In total, 857 (72.5%) participants reported using at least one medication for NCDs. Over a third of the elderly in residential care had multimorbidity, and a quarter of them had multi-disability. A holistic health care system that comprises health and wellness coupled with rehabilitation to address disabilities is needed to achieve healthy aging in elderly in homes for the aged in India.

Functional Status, Quality of Life, and Physical Activity of Senior Club Members-A Cross-Sectional Study

This study aims to assess the functional status, quality of life, and physical activity (PA) of the elderly who are members of senior social clubs. The study included 63 participants (65-95 years old) who were members of a seniors club. The study utilized the following instruments: Barthel scale, Lawton's scale of Instrumental Activities of Daily Living (IADL), WHO Quality of Life-BREF questionnaire, author's survey questionnaire containing questions about the type of PA. Duration of membership in the senior club has a statistically significant effect on Barthel index score (F = 19.68, p < 0.001) and Lawton's IADL scale results (F = 17.59, p < 0.001). All four domains of life quality were strongly related to the duration of attendance to senior clubs. Participants who attended the senior club for more than five years were more likely to report a longer PA duration than participants who attended the senior club for less than 5 years (Chi2 = 25.84, p < 0.001). Attendance to senior social clubs has a strong positive impact on functional status, quality of life, and PA of the elderly. Moreover, our study identified numerous social-demographic factors associated with PA, quality of life, and functional status of senior club members.

Prevalence and determinants of activity of daily living and instrumental activity of daily living among elderly in India

BACKGROUND

The increase in life expectancy has proliferated the number of elderly and subsequently increased the prevalence of disability among the elderly. This study assesses the prevalence of Activity of Daily Living (ADL) and Instrumental Activity of Daily Living (IADL) and analyzes determinants of ADL and IADL among elderly aged 60 and over living in India.

METHODS

The study utilized the Longitudinal Ageing Study in India (LASI, 2017-18) data, and information was sought from 31,464 elderly aged 60 years and above. An index of ADL and IADL was created on a scale of three levels, exhibiting no, moderate, or severe levels of ADL/IADL disability. Multinomial logistic regression was used to determine the effect of socio-demographic parameters on ADL and IADL disability among the elderly.

RESULTS

Around 3% of the elderly reported severe ADL disability, and 6% elderly reported severe IADL disability. Elderly who were not involved in any physical activity than their counterparts were more likely to report severe ADL (RRR = 2.68, C.I. = 1.66-4.32) and severe IADL (RRR = 2.70, C.I. = 1.98-3.67) than no ADL and no IADL, respectively.

CONCLUSION

Amidst the study finding, the study emphasizes the importance of setting-up of geriatric care centers in rural and urban areas. It would be feasible to provide geriatric care under the umbrella of already functioning government health facilities in different parts of the country. Community interventions earmarking the elderly with a focus on physical activity, specifically based in group physical exercise and implemented through existing networks, are rewarding for the elderly.

Multi-Dimensional Accessibility Barriers in Care Services for the Rural Elderly with Disabilities: A Qualitative Study in China

This research covers a multi-dimensional investigation into accessibility barriers in care services for older people with disabilities in rural China. In-depth interviews with 13 rural disabled older people in China were conducted using qualitative methods. Based on a welfare pluralism approach, the results showed that in comparison with urban areas, care services for disabled older populations in rural areas are more subject to social barriers. This can be seen in the limited state (lack of resources, rigorous eligibility qualifications, uneven distribution, and irregular implementation); the absent market (low levels of consumption, high cost pressures, self-exclusion, and traditional cultural constraints); absent NGOs and volunteers (difficulties in access for NGOs and volunteers outside the area and formation difficulties of local NGOs and volunteers); as well as low-quality care in households and communities (unprofessional care from the spouse, unsustainable care from children, and unavailable community-based care). A multi-subject support network should be established to remove accessibility barriers to care services for older people with disabilities in rural areas through active intervention and interaction. The results of the research provide insights that will aid in the formulation of future social care service plans and health policies for rural older people with disabilities.

Prevalence of disabilities and non-communicable diseases in an elderly population in the Telangana state, India: a population-based cross-sectional study

OBJECTIVES

To assess the prevalence of disabilities (vision, hearing, mobility, cognitive, self-care and communication) and non-communicable diseases (NCDs) among the elderly population in two districts in Telangana, India.

DESIGN

Population-based cross-sectional study using a cluster random sampling method to select the study clusters.

SETTING

Elderly population in Khammam and Warangal districts were recruited. Detailed interviews were conducted by trained community health workers. Personal and demographic information such as age, gender, level of education and a self-report of NCDs was collected. The Washington Disability Questionnaire was administered to assess the presence of disabilities.

PARTICIPANTS

1821 participants aged ≥60 years, 54.5% were women, and 73.3% had no education.

PRIMARY OUTCOME MEASURE

Prevalence of disabilities and NCDs.

RESULTS

Overall, the prevalence of at least disability was 20.3% (95% CI 16.3 to 24.9). The prevalence of self- reported disabilities were: seeing (5.9%; 95% CI 4.4 to 7.8), mobility (12.8%; 95% CI 9.7 to 16.8), hearing (3.6%; 95% CI 2.7 to 4.8), cognition (4.8%; 95% CI 3.5 to 6.7), self-care (3.3%; 95% CI 2.3 to 4.7) and communication (1.8%; 95% CI 1.2 to 2.6). Overall, the prevalence of at least one NCD was 34.2% (95% CI 30.9 to 37.7). Hypertension was the most common systemic condition (25.4%; 95% CI 22.4 to 28.7), followed by diabetes (9.0%; 95% CI 7.3 to 11.0), and body pains (muscle-skeletal) (9.9%; 95% CI 8.1 to 12.2).

CONCLUSION

Every fifth elderly person in the districts of Khammam and Warangal in Telangana had at least one self-reported disability. Besides, a third of the elderly had at least one NCD. There is a definite need to develop comprehensive public health strategies to address disabilities and NCDs in Telangana.

A Community-Based Study on Functional Disability and Its Associated Factors Among Elderly Individuals in a Rural Setting in Northeastern India

Background

Functional disability in older adults is common and adversely impacts the quality of life. Given the paucity of population-based data, the present analysis attempted to determine the prevalence and factors associated with functional disability in basic activities of daily living (ADLs) among the elderly population in a rural setting of Northeastern state of India

Methods

A total of 430 elderly were recruited in a population-based cross-sectional study among elderly individuals (≥60 years) during the period 2013-2016 in rural areas of the Dibrugarh district of Northeastern India. The Barthel index was used to measure ADL. Anyone with a Barthel index score <100 (or having limitations in one or more ADL items) were considered as having a functional disability. The analysis of variance (ANOVA) test and the binary logistic regression analysis were used to examine the factors associated with functional disability.

Results

Overall, 43.7% % (Male 42.9%, Female 44.5%) of the participants had a functional disability. Increasing age, being widowed, having no formal education, being underweight (body mass index (BMI)<18.5 kg/m²), and increasing numbers of morbidities were significantly associated with functional disability among the elderly in this study in age and gender-adjusted logistic regression analysis. Being ≥80 years was associated with a three-fold greater risk (OR=31.72, 95% CI=1.3-6.91) of functional disability than the youngest age group (60-69 years). On the other hand, the presence of more than five morbidities was associated with a nearly 20 times increased risk (OR=19.61, 95% CI=9.01-42.68) than those with zero to two morbidities.

Conclusion

A high proportion of the rural elderly residents of Dibrugarh had a functional disability. The study provides epidemiological evidence of the risk factors of functional disability in this setting. This epidemiological information may be useful for developing prevention strategies to reduce the burden of functional disability.

Effects of Orem's Self-Care Model on the Life Quality of Elderly Patients with Hip Fractures

Background

Hip fractures of elderly patients are a public health problem worldwide, mostly lying in bed for a long time; therefore, the importance of life quality in such patients is an issue beyond question. Orem's self-care model is a nursing pattern which is introduced with the purpose of improving the self-care ability of individuals, especially the patients suffering from diseases with limits on activity.

Objective

The aim of this study was to determine the effects of Orem's self-care program on life quality of senile patients with hip fractures.

Methods

A randomized clinical trial study was conducted on 130 eligible old patients suffering from hip fractures who were selected using easy sampling methods and allocated randomly into two groups of experiment and control. The data were collected through validated questionnaires including visual analogue scale (VAS) and Barthel index for them. The experiment group was treated according to Orem's self-care model, and the control group was treated on the basis of the traditional care model. The data of complications including pneumonia, deep venous thrombosis, urinary infection, wound problem, and bedsore were also gathered.

Results

As revealed, mean scores of VAS and Barthel index one week after operation in the experiment group were significantly different from the control one (P < 0.05, P ≤ 0.001). The changes of VAS and Barthel index six weeks postoperatively of the two groups were also statistically significant (P < 0.05, P ≤ 0.001). Compared with the control group, the difference of complications reduced significantly in the experiment group (P < 0.05). Accordingly, educational intervention according to Orem's self-care model seemed to be effective in promoting self-care ability for these senile patients.

Conclusions

According to the obtained results, a self-care program based on Orem's model for elderly patients with hip fractures can improve life quality and reduce perioperative complications significantly. Therefore, it is recommended that this nursing program should be taken into account as a part of treatment measures for these patients.

Functional disability among elderly: A community-based cross-sectional study

BACKGROUND

Old age is often associated with functional decline and physical dependence, thus compromising the ability to carry out basic tasks required for daily living. There are very few community-based studies on functional disability among elderly, especially in India. This study was done to find out the prevalence of functional disability and associated risk factors among the elderly in urbanized villages of Delhi.

METHODS

A cross-sectional study was conducted in two urbanized villages of East Delhi. A semi-structured interview schedule was used to record the socio-demographic and relevant personal details of the elderly (>60 years). Functional disability was defined as a disability in activities of daily living (ADL) or blindness or bilateral hearing impairment or a combination of these. Statistical analysis included simple descriptive analysis and tests of significance like Chi-square test. The multiple logistic regression was used to identify predictors of functional disability.

RESULTS

Data were collected from 360 study participants. Around one-fourth (25.6%) of the study participants were having a functional disability. Older age, presence of chronic disease, and having possible malnutrition were found to be significant predictors of functional disability among the elderly by applying the multiple logistic regression.

CONCLUSIONS

Functional disability needs to be identified at an early stage using appropriate tools so that proper interventions can be directed to those who need it to ensure healthy aging.

Comparison of Fall Risk Assessment Tools for Older Indonesian Adults in the Elderly Home and the Community

Introduction: One of the causes of disability among elderly is falling. The ability to predict the risk of falls among this group is important so that the appropriate treatment can be provided to reduce the risk. The objective of this study was to compare the Stopping Elderly Accidents, Deaths, & Injuries (STEADI) Initiative from the Centers for Disease Control and Prevention (CDC) and The Johns Hopkins Fall Risk Assessment Tool (JHFRAT) from the Johns Hopkins University. Methods: This study used the STEADI tool, JHFRAT, Activities-Specific Balance Confidence Scale (ABC), and The Geriatric Depression Scale (GDS). The study areas were in community and elderly home in both public and private sectors and the samples were 427 after cleaning. Results: The results for the STEADI and JHFRAT tools were similar where the respondents at highest risk of falling among women (STEADI: 49%; JHFRAT: 3.4%), in Bandung area (63.5%; 5.4%), in private homes (63.3%; 4.4%), non-schools (54.6%; 6.2%), aged 80 or older (64.8%; 6.7%) and not working (48.9%;3.3%). The regression analysis indicated that there was a significant relationship between the risk factors for falls in the elderly determined by the JHFRAT and STEADI tools: namely, region, type of home, age, disease history, total GDS and ABC averages. Conclusion: Despite the similarity in the risk factors obtained through these assessments, there was a significant difference between the results for the STEADI tool and the JHFRAT. The test strength was 43%. However, STEADI is more sensitive to detect fall risk smong elderly than JHFRATKeywords: Activities-Specific Balance Confidence scale, elderly, fall risk,The Johns Hopkins Fall Risk Assessment Tool, the Stopping Elderly Accidents, Deaths, & Injuries

R, Kalaivani M, Nongkynrih B, Kant S, Gupta SK. Disability and its association with sociodemographic factors among elderly persons residing in an urban resettlement colony, New Delhi, India

Disability prevents an individual from performing to the fullest potential. It is multidimensional. Disability may be physical, mental, social, personal, and environmental or a combination of these. The elderly experience an increased burden of disability, especially in areas where there are limited resources and rapid urbanization. Comparison of reported disability is difficult because several definitions and scales are in use. We used the World Health Organization Disability Assessment Schedule version 2.0 (WHODAS 2.0) to study the prevalence of disability, and its association with sociodemographic factors among elderly persons residing in an urban resettlement colony, New Delhi, India. The WHODAS 2.0 provides continuous summary scores, where higher scores indicate higher disability, and vice versa. Elderly persons aged 60 years and above were selected by simple random sampling in this community-based cross-sectional study. Trained interviewers administered the semi-structured interview schedule and WHODAS 2.0. The prevalence of disability was 7.4% (5.8% - 9.3%) among the 931 participants. The prevalence was higher among females than males. Female sex, elderly aged 70 years and above, and those who were illiterate had increased risk of higher disability scores. Participants who were in government or private service had 50% decreased risk of having higher disability scores. The burden of disability was high among elderly persons residing in this resettlement colony. Community-based holistic interventions are required to mitigate the disability, and to improve the functioning of elderly persons.

Prevalence of disability and its association with sociodemographic factors and quality of life in India: A systematic review

Disability is complex, dynamic in nature, multidimensional, and most contested. Quality of life is an abstract concept that is related to the level of disability in the population. Approaches to measuring disability vary across different regions, and purpose and application of the findings. We systematically reviewed the studies that have been undertaken to study the prevalence of disability and its association with sociodemographic factors and quality of life among the general population in India, between January 2000 and June 2018. The prevalence of impairment ranged from 1.6% to 43.3%. In major surveys, males had higher impairment than females. Studies that used the International Classification of Functioning, Disability and Health concept for measuring disability reported prevalence ranging from 70.0% to 93.2%. Most studies used semi-structured questionnaires for measurement of disability. Some studies have used Barthel Index for Activity of Daily Living, Instrumental Activities of Daily Living, Indian Disability Evaluation and Assessment Schedule, Rapid Assessment of Disability scale, and Standard Health Assessment Questionnaire. The quality of life was low among females. This review brings out the heterogeneity in the concepts for measuring disability and quality of life. Lack of standardization in the measurement of disability restrains any comparison between these studies.

Association between health related quality of life (HRQOL) and activity of daily living (ADL) among elderly in an urban setting of Assam, India

Background:

Ensuring better quality of life to an increasing number of elderly people is emerging as a stiff public health challenge in India. There is paucity of data on impact of functional health on health-related quality of life (HRQOL) in India.

Objectives:

The aim of this study is to explore the functional status and its association with different dimensions of HRQOL among elderly individuals in an urban setting of Assam, India.

Materials and Methods:

A total of 300 elderly were recruited in a cross-sectional study from the city of Dibrugarh, Assam, India. Eight domains of HRQOL of participants were assessed using short form 36 (SF-36). Functional status was assessed by using Barthel activity of daily living (ADL) tool. ANOVA test and binary logistic regression analysis was performed to examine the relationship between ADL status and HRQOL.

Results:

In all, 34.7% (n = 104) of participants had limitations in one or more ADL items. We also observed a strong graded relationship between ADL and HRQOL scores. Those who scored perfect 100 ADL score also scored highest in all eight HRQOL scales, whereas those with least ADL score scored lowest in all the HRQOL scales. In age- and sex-adjusted logistic regression analysis, the probability of poor health increased with decreasing level of ADL scores.

Conclusion:

Findings of the study suggest that decline in ADL can negatively impact different dimensions of HRQOL among elderly individuals. The findings indicate that there is need to pay proper attention for restoring functional health at later life in order to improve quality of life among elderly in India.

Prevalence of disability and its association with sociodemographic factors and quality of life in India: A systematic review

Disability is complex, dynamic in nature, multidimensional, and most contested. Quality of life is an abstract concept that is related to the level of disability in the population. Approaches to measuring disability vary across different regions, and purpose and application of the findings. We systematically reviewed the studies that have been undertaken to study the prevalence of disability and its association with sociodemographic factors and quality of life among the general population in India, between January 2000 and June 2018. The prevalence of impairment ranged from 1.6% to 43.3%. In major surveys, males had higher impairment than females. Studies that used the International Classification of Functioning, Disability and Health concept for measuring disability reported prevalence ranging from 70.0% to 93.2%. Most studies used semi-structured questionnaires for measurement of disability. Some studies have used Barthel Index for Activity of Daily Living, Instrumental Activities of Daily Living, Indian Disability Evaluation and Assessment Schedule, Rapid Assessment of Disability scale, and Standard Health Assessment Questionnaire. The quality of life was low among females. This review brings out the heterogeneity in the concepts for measuring disability and quality of life. Lack of standardization in the measurement of disability restrains any comparison between these studies.