Iäkkäiden henkilöiden selviytyminen päivittäisistä toiminnoista

Abstract

The purpose of this study was to examine factors related to the ability of older persons' to carry out the activities of daily living (ADL) and to identify those factors which might predict free-living (i.e. non-use of institutional bed days). Mobility and muscular strength were examined as predictors of survival. The study took as its conceptual framework a model where environmental and genetic factors as well as life-style and the ageing process itself influence the metabolic, structural and psychological characteristics of the individual as well as the changes that occur. It might also be expected that various changes in health and functional performance along the pathway in the disablement process will influence AOL functioning, which in turn is an important prerequisite for living at home. This study formed part of the Evergreen project, and used data from interviews with 2 321 elderly persons aged from 65 to 84, of whom 944 were also examined in the laboratory. A Cross - national comparison with Glostrup, Denmark, was done among the 75-year-olds. A holistic and interdisciplinary approach to the research problem was combined with diverse methods to determine health status and functional capacity in elderly persons. The methods used included home interviews, questionnaires and laboratory examinations, as well as the monitoring of both mortality and days spent in institutional care. The interviews and questionnaire dealt with socio-economic status, lifestyle, health status, depressive symptoms, and the carrying out the activities of daily living. The laboratory examinations included a medical examination and a wide range of physical performance tests, cognitive capacity tests, and sensory tests. The multivariable statistical methods used were based on LISREL statistical programme. The main methods were linear regression analysis, path analysis and survival analysis. Difficulties in physical and instrumental activities of daily living increased with age for both men and women. One in three women aged 80-84 needed help in at least one physical activity of daily living, and one in two at same age needed help in some instrumental activity of daily living. Where gender differences were significant, men commonly coped better; exceptions to this rule were cooking, laundry and use of the telephone, all of which were significantly less difficult for women. 75-year-old inhabitants, both male and female, reported fewer difficulties in several physical activities of daily living than their counterparts in Glostrup. In simple physical performance tests, however, the men and women in Glostrup had better knee extension strength than their counterparts in Jyväskylä. Chronic diseases, their severity and symptoms, reduced cognitive capacity, number of depressive symptoms, impaired sight, hearing or balance and diminished performance in physical tests, such as muscular strength, walking speed and stair mounting tests, were all associated with difficulties or need for help in daily activities. Risk of death was significantly greater for those who had difficulties in mobility or whose performance in tests of walking speed or muscular strength was below the average. Independent carrying out physical activities of daily living was a significant predictor for free-living (non-use of institutional care). The results for men and women both fit the theoretical model of this study, despite some differences at the variable level in these models. For the service system, the results of this study provide some important clues with regard to the factors that may underlie reduced levels of functional capacity, need for institutional care or risk of dying. In addition to the health status, physical, psychological and sensory tests supply useful information about pathways to declining ADL-capacity, as well as complement and provide a corrective to data obtained from self-reports. The ongoing strategy to give greater priority to community care must involve an increase in resources allocated to domiliciary services, early prevention and rehabilitation. The results of this study underline the importance of focusing on the severity and symptoms of diseases, on functional performance and senses, and carrying out everyday activities in preventive and rehabilitative health care programmes as a strategy of promoting free-living in elderly people.