Resumé
Background: Ageing is associated with substantial decline in systemic and physical functioning. This study was carried out to assess physical functioning of elderly patients and to investigate the link between physical activity and physical functioning.
Methodology: This cross-sectional study involved 190 elderly patients receiving care at selected outpatient clinics of two main hospitals in Ibadan, Nigeria. The Barthel Index of Activity of Daily Living, the Lawton Instrumental Activity of Daily Living Scale and the Community Healthy Activities Model Program for Seniors (CHAMPS) Activities Questionnaire for Older Adults were used to assess the basic activities of daily living (BADL), instrumental activities of daily living (IADL) and physical activity level of the participants respectively.
Results: Hypertension (32.6%), musculoskeletal disorders (21.6%) and diabetes (11.1%) were the most reported singular reasons for visiting the clinics. Only 19.5% of them reported moderate activity level while 23.7% and 25.3% reported varying levels of disabilities in BADL and IADL respectively. The most reported disability in BADL (6.3%) was stair climbing and execution of household chores was the main disability (35%) in IADL. Moderate-to-vigorous physical activity significantly reduced disability in BADL (OR = 0.36; 95% CI = 0.11-0.60) and IADL (OR = 0.46; 95% CI = 0.18-0.79).
Conclusions: Substantial amount of disability in BADL and IADL were reported but those who were more physically active were able to reduce their disability risks by more than half. Reduction in physical function disability may be another reason why elderly patients should be educated and encouraged to be physically active.
Keywords: Physical activity, activities of daily living, instrumental activities of daily living, elderly
Résumé
Contexte: Le vieillissement est associé à un déclin substantiel dans le fonctionnement systémique et physique. Cette étude a été réalisée afin d’évaluer le fonctionnement physique des patients âgés et d’étudier le lien entre l’activité physique et le fonctionnement physique.
Méthodologie: Cette étude transversale a compris 190 patients âgés recevant des soins dans certaines cliniques pourpatients externes de deux principaux hôpitaux à Ibadan,Nigeria. L’indice Barthel de l’Activité de Vie Quotidienne, l’Echelle d’Activité de Vie QuotidienneInstrumental de Lawton et leModèle de Programme pour Personnes Agées des Activités Communautaires Saine (MPPAACS) Questionnaire d’Activités pour Personnes Agées ont été utilisés pour évaluer les activités de base de vie quotidienne (ABVQ), les activités instrumentales de vie quotidienne (AIVQ) et le niveau d’activité physique des participants respectivement.
Résultats: L’hypertension (32,6%), les troubles musculo-squelettiques (21,6%) et le diabète (11,1%) ont été les raisons singulières les plus signalés pour visiter les cliniques. Seulement 19,5% d’entre eux ont rapporté le niveau d’activité modérée tandis que 23,7% et 25,3% ont rapporté des niveaux variant d’handicap dans ABVQ et AIVQ respectivement. L’incapacité le plus rapporté dans ABVQ (6,3%) était la montée d’escaliers et l’exécution des tâches ménagères était l’incapacité principale (35%) dans AIVQ. L’activité physique de modérée à vigoureuse réduit significativement le handicap dans ABVQ (OR = 0,36; IC à 95% = 0,11 - ,60) et AIVQ (OR = 0,46; IC à 95% = 0,18 - 0,79).
Conclusions: Une quantité substantielle d’handicap dans ABVQ et AIVQ ont été signalés, mais ceux qui étaient plus actifs physiquement ont pu réduire leurs risques d’incapacitépar plus de la moitié. La réduction enincapacité de la fonction physique peut être une autre raison pour laquelle les patients âgés doivent être éduqués et encouragés à être physiquement actifs.
Mots-clés: Activité physique, les activités de vie quotidienne, les activités instrumentales de vie quotidienne, les personnes âgées
Correspondence: Dr. A.F. Adeniyi, Department of Physiotherapy, College of Medicine, University of Ibadan, Ibadan, Nigeria. E-mail: adeniyifatai@yahoo.co.uk; fadeniyi@comui.edu.ng
Referencer
Kinsella K. Demographic aspects. Epidemiology in old age. London: BMJ Publishing Group. 1996: 32-40.
Kinsella K and He W. U.S. Census Bureau. International Population Reports, P95/09-1, An Aging World 2008. In U.S. Government Printing Office. 2009. Washington DC https://www.census.gov/prod/2009pubs/p95-09-1.pdf
Seeman T and Chen X. Risk and protective factors for physical functioning in older adults with and without chronic conditions. J Gerontol B Psychol Sci Soc Sci 2002, 57 (3): S135-44.
Stewart AL and Ware JE. Jr. Physical Functioning Measures. Published in: Measuring Functioning and Well-Being: The Medical Outcomes Study Approach / edited by AL Stewart and JE Ware Jr. http://www.rand.org/pubs/external_ publications/EP19920069.html
Haley SM, McHorney CA and Ware JE. Evaluation of the MOS SF-36 physical functioning scale (PF-10): I. Unidimensionality and reproducibility of the Rasch item scale. J Clin Epidemiol 1994, 47 (6): 671-84.
Wilson IB and Cleary PD. Linking clinical variables with health-related quality of life. JAMA 1995, 273 (1): 59-65.
Fried LP, Ettinger WH, Lind B, Newman AB and Gardin J. Physical disability in older adults: a physiological approach. J Clin Epidemiol 1994, 47: 747–60.
Nourhashémi F, Andrieu S, Gillette-Guyonnet S, et al. Instrumental activities of daily living as a potential marker of frailty: A study of 7364 community-dwelling elderly women (the EPIDOS Study). J Gerontol A Biol Sci Med Sci 2001, 56 (7): M448-M453.
Lafortune,G. and G. Balestat. Trends in severe disability among elderly people: Assessing the evidence in 12 OECD Countries and the Future Implications, OECD Health Working Papers, No. 26, OECD Publishing, Paris. 2007; DOI: http://dx.doi.org/10.1787/217072070078
Hairi NN, Bulgiba A, Peramalah D and Mudla I. Do older people with visual impairment and living alone in a rural developing country report greater difficulty in managing stairs? Prev Med 2013, 56 (1): 8-11.
Gureje O, Ogunniyi A, Kola L and Afolabi E. Functional disability in elderly Nigerians: results from the Ibadan Study of Aging. J Am Geriatr Soc 2006, 54 (11): 1784-1789.
King AC, Castro C, Wilcox S. et al. Personal and environmental factors associated with physical inactivity among different racial–ethnic groups of U.S. middle-aged and older-aged women. Health Psychol 2000, 19(4): 354-364.
Kasiulevičius V, Šapoka V and Filipavičiūtė R. Sample size calculation in epidemiological studies. Gerontologija 2006, 7 (4): 225-231.
Katz S. Assessing self maintenance: activities of daily living, mobility, and instrumental activities of daily living. J Am Geriatr Soc 1983, 31 (12): 721-727.
Shah S, Vanclay F and Cooper B. Improving the sensitivity of the Barthel Index for stroke rehabilitation. J Clin Epidemiol 1989, 42 (8): 703-709.
Collin C, Wade DT, Davies S and Horne V. The Barthel ADL Index: a reliability study. Int Disabil Stud 1988, 10 (2): 61-63.
Green J and Young J. A test-retest reliability study of the Barthel Index, the Rivermead Mobility Index, the Nottingham Extended Activities of Daily Living Scale and the Frenchay Activities Index in stroke patients. Disabil Rehabil 2001, 23 (15): 670-676.
Shinar D, Gross CR, Bronstein KS. et al. Reliability of the activities of daily living scale and its use in telephone interview. Arch Phys Med Rehabil 1987, 68 (10): 723-728.
Lawton MP and Brody EM. Assessment of older people: self-maintaining and instrumental activities of daily living. Nurs Res 1970, 19 (3): 278.
Hokoishi K, Ikeda M, Maki N. et al. Interrater reliability of the Physical Self-Maintenance Scale and the Instrumental Activities of Daily Living Scale in a variety of health professional representatives. Aging Ment Health 2001, 5 (1): 38-40.
Edwards MM. The reliability and validity of self-report activities of daily living scales. Canadian Journal of Occupational Therapy 1990, 57 (5): 273-278.
Stewart AL, Mills KM, King AC, et al. CHAMPS physical activity questionnaire for older adults: outcomes for interventions. Med Sci sports Exerc 2001, 33 (7):1126-1141.
Colbert LH, Matthews CE, Havighurst TC, et al. Comparative validity of physical activity measures in older adults. Med Sci Sports Exerc 2011, 43 (5): 867-876.
Cyarto EV, Marshall AL, Dickinson RK and Brown WJ. Measurement properties of the CHAMPS physical activity questionnaire in a sample of older Australians. J Sci Med Sport 2006, 9 (4): 319-326.
Erhun WO, Olayiwola G, Agbani EO and Omotoso NS. Prevalence of hypertension in a University Community in South West Nigeria. Afr J Biomed Res 2005, 8(1): 15-19.
Abubakari AR and Bhopal RS. Systematic review on the prevalence of diabetes, overweight/obesity and physical inactivity in Ghanaians and Nigerians. Pub Health 2008, 122 (2): 173–182.
Nyenwe EA, Odia OJ, Ihekwaba AE, Ojule A and Babatunde S. Type 2 diabetes in adult Nigerians: a study of its prevalence and risk factors in Port Harcourt, Nigeria. Diab Res Clin Pract 2003, 62 (3): 177–185.
Mancia G. The association of hypertension and diabetes: prevalence, cardiovascular risk and protection by blood pressure reduction. Acta Diabetol 2005, 42, Suppl. 1: s17-s25.
McBean AM, Li S, Gilbertson DT and Collins AJ. Differences in diabetes prevalence, incidence, and mortality among the elderly of four racial/ethnic groups: Whites, Blacks, Hispanics, and Asians. Diabetes Care 2004, 27 (10): 2317-2324.
Weening-Dijksterhuis E, de Greef M, Scherder E, Slaets J and van der Schans C. Frail institutionalized older persons: A comprehensive review on physical exercise, physical fitness, activities of daily living, and quality-of-life. Am J Phys Med Rehabil 2011, 90 (2): 156-168.
Lee I, Shiroma EJ, Lobelo F et al. Effect of physical inactivity on major non-communicable diseases worldwide: an analysis of burden of disease and life expectancy. The Lancet 2012, 380 (9838): 219–229.
King AC, Pruitt LA, Phillips W, et al. Comparative effects of two physical activity programs on measured and perceived physical functioning and other health-related quality of life outcomes in older adults. J Gerontol A Biol Sci Med Sci 2000, 55(2): M74-M83.
Gill TM and Kurland B. The burden and patterns of disability in activities of daily living among community-living older persons. J Gerontol A Biol Sci Med Sci 2003, 58 (1): M70-M75.
Jagger C, Arthur AJ, Spiers NA and Clarke M. Patterns of onset of disability in activities of daily living with age. J Am Geriatr Soc 2001, 49 (4): 404–409.
Sonn U and Asberg KH. Assessment of activities of daily living in the elderly. A study of a population of 76-year-olds in Gothenburg, Sweden. Scand J Rehabil Med 1991, 23(4): 193-202.
Tang Z, Wang H, Meng C et al. The prevalence of functional disability in activities of daily living and instrumental activities of daily living among elderly Beijing Chinese. Arch Gerontol Geriatr 1999, 29 (2): 115–125.
Gama EV, Damián JE, de Molino JP, et al. Association of individual activities of daily living with self-rated health in older people. Age Ageing 2000, 29 (3): 267-270.
Millán-Calenti JC, Tubío J, Pita-Fernández S et al. Prevalence of functional disability in activities of daily living (ADL), instrumental activities of daily living (IADL) and associated factors, as predictors of morbidity and mortality. Arch Gerontol Geriatr 2010, 50 (3): 306–310.
Woo J, Leung J and Kwok T. BMI, body composition, and physical functioning in older adults. Obesity 2007, 15 (7): 1886–1894.
Covinsky KE, Palmer RM, Fortinsky RH et al. Loss of independence in activities of daily living in older adults hospitalized with medical illnesses: increased vulnerability with age. J Am Geriatr Soc 2003, 51 (4): 451–458.
von Strauss E, Agüero-Torres H, Kåreholt I, et al. Women are more disabled in basic activities of daily living than men only in very advanced ages: A study on disability, morbidity, and mortality from the Kungsholmen Project. J Clin Epidemiol 2003, 56 (7): 669–677.
Rosendahl E, Lindelöf N, Littbrand H et al. High-intensity functional exercise program and protein enriched energy supplement for older persons dependent in activities of daily living: A randomised controlled trial. Aust J Physiother 2006, 52 (2): 105–113.
Chou C, Hwang C and Wu Y. Effect of exercise on physical function, daily living activities, and quality of life in the frail older adults: A meta-analysis. Arch Phys Med Rehabil 2012, 93 (2): 237–244.
Suomi R and Collier. Effects of arthritis exercise programs on functional fitness and perceived activities of daily living measures in older adults with arthritis. Arch Phys Med Rehabil 2003, 84 (11): 1589–1594.
Hirvensalo M, Rantanen T and Heikkinen E. Mobility difficulties and physical activity as predictors of mortality and loss of independence in the community-living older population. J Am Geriatr Soc 2000, 48 (5): 493–498.
Penninx BWJH, Messier SP, Rejeski WJ et al. Physical exercise and the prevention of disability in activities of daily living in older persons with osteoarthritis. Arch Intern Med 2001, 161(19): 2309-2316.
Ramos LR, Simoes EJ and Albert MS. Dependence in activities of daily living and cognitive impairment strongly predicted mortality in older urban residents in Brazil: A 2-year follow-up. J Am Geriatr Soc 2001, 49 (9): 1168–1175.