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.

Physical inactivity and vitamin D deficiency in hospitalized elderlies

Serum levels of 25(OH)D, which is known to correlate with systemic nutritional status, is used as an indicator of vitamin D sufficiency in the body. We studied the 25(OH)D status and its background factors including activity of daily living (ADL) in the elderlies hospitalized at the regional core hospital. We also examined whether or not vitamin D deficiency affects ADL among them. This study included newly hospitalized patients aged 65 years or over at Ohchi hospital April to August in 2015. At the time of admission, serum 25(OH)D concentration was measured, and ADL, instrumental ADL (IADL), cognitive function, blood test, nursing care certification were investigated as background factors. Among 209 patients, 25(OH)D was sufficient (> 30 ng/mL) only 14 cases (7%), insufficient (20-30 ng/mL) in 43 cases (20%), and deficient (< 20 ng/mL) in 152 cases (73%). Multivariate analysis showed that low ADL (OR 0.99, 95% CI 0.97-0.99) and low IADL (OR 0.88, 95% CI 0.78-0.99) were independent predictors of 25(OH)D deficiency in two models incorporating ADL and IADL, respectively. Furthermore, low 25(OH)D level was significantly associated with low ADL (OR 0.95, 95% CI 0.91-0.99) and low IADL (OR 0.93, 95% CI 0.88-0.97) scores, suggesting that vitamin D deficiency may affect physical activities. Most hospitalized elderly patients in Japan were deficient for vitamin D. In addition, physical inactivity is strongly associated with vitamin D deficiency.

Performance of older adults under dual task during stair descent

Background

Stair walking, especially in dual-task conditions, is a challenging daily routine for older adults. The purpose of this study is to investigate gait and postural control and explore the possible reasons for the fall risk encountered by healthy older adults under dual-task conditions during stair descent.

Methods

Thirty healthy older female adults (aged 67 ± 1 years, standing height of 1.64 ± 0.17 m, body mass of 66.01 ± 4.27 kg, and education of 8.92 ± 0.95 years) were randomly recruited from local communities and instructed to perform stair descent in a step-by-step manner on a standardized staircase under single-task (stair descent) and dual-task (stair descent with subtraction in series of three) conditions. Multivariate analysis of variance with repeated measures was performed to test the significance of multiple comparisons of kinematic variables in the single- and dual-task conditions. A paired t-test with Bonferroni adjustment was performed when a significant difference was detected.

Results

Gait speed, foot clearance, and hip flexion angle at the cross of the support leg decreased considerably, and step width increased remarkably among the healthy older adults under the dual-task condition relative to the situation in the single-task condition during stair descent.

Conclusion

The gait performance and posture control of the healthy older female adults were disturbed by the second cognitive task. These adults implemented a compensation strategy to enhance their body stability under the dual-task condition during stair descent.