Abstract
BackgroundThe International Classification of Functioning, Disability, and Health (WHO-ICF) describes participation restriction as one aspect of disability. Participation restriction refers to health problems that can hinder people’s involvement in different life events. It is rational to believe that the prevalence of participation restriction increases among a frail population. However, information about the level of participation restriction among older people, particularly the pre-frail or frail, remains scant. The aim of this study was to identify the prevalence and underlying risk factors associated with participation restriction among community-dwelling frail and pre-frail older people.MethodsA cross-section of 299 community-dwelling frail older people with a mean age of 79.5 participated in this study. They had to have been identified as being either pre-frail or frail based on the five common characteristics of the frailty phenotype. Their level of participation restriction was assessed based on the Chinese Reintegration to Nursing Living Index (C-RNLI). All other independent variables were identified and systematically linked to different components in the WHO-ICF framework.ResultsAmong all participants, 207 (69.2%) were identified as encountering participation restrictions in at least one aspect of their life, with a mean C-RNLI score of 68.3 (SD 19.43). A multivariate regression analysis showed that the participants’ status of frailty, self-perceived social status, level of exhibited depressive mood, sleep quality, mobility, level of fear of falling, and physical activity levels had a significant association with participation restriction. When all of the variables, regardless of significance, were included, the factors together explained 67.1% of the variance in the participants’ participation restriction.ConclusionParticipation restriction was prevalent among community-dwelling frail older people and was associated with factors across different components in the WHO-ICF. This finding supports the view that participation restriction is multifactorial in nature.
Highlights
The International Classification of Functioning, Disability, and Health (WHO-ICF) describes participation restriction as one aspect of disability
The top three events that participants reported of experiencing restriction mostly were “take trips out of town” (n = 170; 56.9%), “I assume a role in my family” (N = 115; 38.5%), and “I can deal with life events as they happen” (N = 97; 32.4%)
Participants who were identified as having participation restriction were significantly older, frailer, weaker in the sense that they were suffering from more diseases and had a higher level of comorbidity, were of lower self-perceived socioeconomic status, and had weaker social networks, poorer body functions, and more activity limitations
Summary
The International Classification of Functioning, Disability, and Health (WHO-ICF) describes participation restriction as one aspect of disability. Under the WHO-ICF framework, disability is a condition with multiple dimensions that develops as a process with the potential to impair body functions and structures (including both the physiological system or anatomical structures), limit daily activities (i.e., encountering difficulties when attempting to perform individual tasks or actions), and restrict community participation (i.e., experiencing problems during involvement in life situations) [2, 3]. All of these aspects of disability interact dynamically with the health of individuals, and with their personal and environmental factors [1]. The early stages of frailty may be clinically silent, with 32.3% of frail older people having neither disabilities nor comorbidities and maintaining a certain level of independence [8]
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