Patterns and predictive factors of loss of the independence trajectory among community-dwelling older adults

Abstract

Background Independence is related to the aging process. Loss of independence is defined as the inability to make decisions and participate in activities of daily living (ADLs). Independence is related to physical, psychological, biological, and socioeconomic factors. An enhanced understanding of older people’s independence trajectories and associated risk factors would enable the develop early intervention strategies. Methods Independence trajectory analysis was performed on patients identified in the Unité de Prévention de Suivi et d’Analyse du Vieillissement (UPSAV) database. UPSAV cohort is a prospective observational study. Participants were 221 community-dwelling persons aged ≥75 years followed for 24 months between July 2011–November 2013 and benefits from a prevention strategy. Data were collected prospectively using a questionnaire. Independence was assessed using the “Functional Autonomy Measurement System (Système de Mesure de l’Autonomie Fonctionnelle (SMAF))”. Group-based trajectory modeling (GBTM) was performed to identify independence trajectories, and the results were compared with those of k-means and hierarchical ascending classifications. A multinomial logistic regression was performed to identify predictive factors of the independence trajectory. Results Three distinct trajectories of independence were identified including a “Stable functional autonomy (SFA) trajectory” (53% of patients), a “Stable then decline functional autonomy decline (SDFA) trajectory” (33% of patients) and a “Constantly functional autonomy decline (CFAD) trajectory” (14% of patients). Not being a member of an association, and previous fall were significantly associated of a SDFA trajectory (P < 0.01). Absence of financial and human assistance, no hobbies, and cognitive disorder were significantly associated with a CFAD trajectory (P < 0.01). Previous occupation and multiple pathologies were predictive factors of both declining trajectories SDFA and CFAD. Conclusions Community-living older persons exhibit distinct independence trajectories and the predictive factors. The evidence from this study suggests that the prevention and screening for the loss of independence of the older adults should be anticipated to maintaining autonomy.

Domains of Frailty Predict Loss of Independence in Older Adults After Noncardiac Surgery

“…Collinearity among covariates was assessed via variance inflation factors and Pearson correlation coefficients. The model adjusted for potential confounders known to be associated with LOI including age, ASA status, BMI, sex, history of weight loss, and comorbid chronic conditions 4,13 . Linearity of the relationship between total EFS and LOI was assessed by plotting the nonparametric locally weighted scatterplot smoothing (LOWESS) curve of both the log odds of LOI and the Pearson-predicted residuals from the fully adjusted model.…”

Introducing New Paths towards Public Primary Healthcare Services in Greece: Efforts for Scaling-Up Mental Healthcare Services Addressed to Older Adults

“…The unprecedented increase in the aging population in recent decades has led to an increased prevalence of chronic diseases and mental health disorders posing major considerations for the health system globally [ 18 ]. Treating mental health disorders in older adults by PCPs is a challenge due to the fact they (a) develop different symptoms, such as tiredness or weight loss, and are often interpreted as an expected process of aging in older adults [ 21 ]; (b) comprise a field of knowledge in which the majority of PCPs are not properly trained in identifying or providing care to older adults with mental disorders [ 14 ]; (c) lead to stigma in terms of mental health [ 22 ]; and (d) restrict the independence of older adults [ 23 , 24 ].…”

Spanish version of the Maastricht Personal Autonomy Questionnaire: A validation study among community‐dwelling older adults with chronic multimorbidity

“…Multimorbidity is associated with biopsychosocial deterioration in older adults (Bao et al, 2019) and it negatively affects their personal autonomy (Bimou et al, 2021;Sánchez-García et al, 2019).…”

“…Chronic conditions (diseases of long duration and slow progression) are estimated to cause 70% of deaths globally (World Health Organization (WHO), 2022) and their prevalence is expected to increase as a consequence of population ageing (World Health Organization (WHO), 2022; Zhang et al., 2021). Multimorbidity is associated with biopsychosocial deterioration in older adults (Bao et al., 2019) and it negatively affects their personal autonomy (Bimou et al., 2021; Sánchez‐García et al., 2019). Personal autonomy can be defined as the right of people to make decisions and govern themselves (Moilanen et al., 2021) or as the correspondence between how people want their lives to be and how they actually are (Mars et al., 2008).…”