Associations between difficulty in 6 basic activities of daily living and cognitive and lower extremity physical functions in older adults

Abstract

Background: It is important for older adults to maintain independence in activities of daily living (ADL) to have optimal quality of life. Many factors including the biological, psychological, and social factors have been linked to disability in basic ADL (BADL). Previous studies have investigated the relationship between BADL dependence and functions in older adults. However, the relationship between BADL difficulty and functions has not been well examined. Selfreported BADL difficulty reflects an individual’s awareness, and may serve the researcher better when the interest is about the disease consequences and the objective is to evaluate intervention effectiveness. Purpose:Unlikemuchof the previous research examining the BADL dependence, the purpose of the study is to investigate the relationship between BADL difficulty and cognitive and physical functions in community-dwelling older adults. Self-reported difficulty is believed to precede dependence. Identifying older adults with BADL difficulties may help clinicians to detect early functional decline. Methods: In the cross-sectional study, a convenience sample of 51 community-dwelling older adults was recruited. Interviews were conducted to collect data on self-reported difficulty in six BADLs (bathing, dressing, eating, transfer: getting in/out of bed/chairs, walking, using toilet), clock drawing tests (CLOX1&CLOX2),Mini-Mental State Exam (MMSE), and 5 physical function tests including Short Physical Performance Battery (SPPB), Berg Balance Scale (BBS), gait speed, 5 times sit-to-stand test, and Timed Up & Go Test (TUG). For each BADL task, the student’s t test and Mann–Whitney testwere use to compare differences between older adults with and without difficulty. Results: Among the six BADLs, walking, toileting and transfer are associated with poor cognitive or lower extremity physical functions. Compared to older adults who reported walking difficulty (n= 8, CLOX1= 5.71 ± 4.31, CLOX2 = 8.71 ± 2.29, BBS = 40.38 ± 7.27, SPPB = 4.25 ± 2.49, gait speed = 0.41 ± 0.15 m/sec, TUG = 26.16 ± 6.69 sec), older adults without walking difficulty performed better in cognitive and physical function tests (n = 43, CLOX1 = 9.80 ± 3.31, CLOX2 = 11.64± 2.53, BBS = 49.24± 7.03, SPPB = 7.45± 2.46, gait speed = 0.73± 0.28 m/sec, TUG = 15.90 ± 6.12 sec). Difficulty in toileting is associated with lower SPPB score (2.50 ± 0.71) and longer TUG time (30.27 ± 4.59 sec) (p < .05). Difficulty in transfer is associated with lowerMMSE (17.00± 0.00) andCLOX2 score (5.00± 0.00) (p< .05). Conclusion(s): In older adults, difficulty in walking and toileting is associated with poor lower extremity physical function. Difficulty in walking and transfer is associated with lower cognitive function. Implications: Self-reported difficulty in BADL, such as walking,may suggest the need for further cognitive and physical function screening. Screening older adults with BADL difficulty would allow clinicians to identify high-risk individuals and provide early interventions to prevent or delay onset of future BADL dependence.