Julius Center for Health Sciences and Primary Care, UMC Utrecht, Utrecht, The Netherlands.
J Am Med Dir Assoc. 2013 Jan;14(1):18-24. doi: 10.1016/j.jamda.2012.08.014. Epub 2012 Oct 6.
The WHO International Classification of Functioning, Disability, and Health (ICF)-model describes disability in activities of daily living (ADL) as a multifactorial concept. According to this model, ADL disability is influenced by health conditions, body function and structures, environmental and personal factors, and participation. Current research on ADL disability often focuses on one domain and the contribution of multiple domains is not taken into account. The aim was to investigate which domains contribute to ADL disability.
Cross-sectional study.
General community.
A total of 537 middle-aged and older persons.
Health conditions included number of chronic diseases. Body function comprised Mini-Mental State Examination (MMSE), processing speed, memory, grip strength, physical performance score (PPS), physical activity, sensory problems, body mass index (BMI), intra-abdominal fat, and cholesterol/HDL ratio. Body structure included atherosclerosis and bone mineral density. Environmental factors comprised the degree of urbanization. Personal factors included age, sex, education, smoking, self-management abilities, quality of life, anxiety/panic disorders, and depressive symptoms. Associations between candidate predictors and ADL disability, measured on the Katz ADL-scale, were examined by multivariable adjusted logistic regression analysis. Nagelkerke R(2)-statistic was calculated to investigate the contribution of each domain to ADL disability.
Number of chronic diseases (domain health condition), MMSE, PPS, physical activity, BMI, intra-abdominal fat (domain body function), atherosclerosis (domain body structure) and sex, education, smoking, quality of life, and depressive symptoms (domain personal factors) were significant predictors of ADL disability. Fifty-seven percent of the variance in ADL disability was explained by the model. For each domain, the explained variance materially decreased after its exclusion, except for environmental factors.
The present study shows that multiple domains (ie, health condition, body function, body structure, and personal factors) contribute to current ADL disability.
世界卫生组织《国际功能、残疾和健康分类》（ICF）模型将日常生活活动（ADL）中的残疾描述为一个多因素概念。根据该模型，ADL 残疾受健康状况、身体功能和结构、环境和个人因素以及参与度的影响。目前关于 ADL 残疾的研究通常侧重于一个领域，而没有考虑多个领域的贡献。本研究旨在探讨哪些领域对 ADL 残疾有贡献。
横断面研究。
一般社区。
共 537 名中老年人群。
健康状况包括慢性疾病数量。身体功能包括 Mini-Mental State Examination（MMSE）、处理速度、记忆、握力、身体表现评分（PPS）、身体活动、感觉问题、体重指数（BMI）、腹内脂肪和胆固醇/高密度脂蛋白比值。身体结构包括动脉粥样硬化和骨密度。环境因素包括城市化程度。个人因素包括年龄、性别、教育、吸烟、自我管理能力、生活质量、焦虑/惊恐障碍和抑郁症状。使用多变量调整后的逻辑回归分析，检验候选预测因素与 Katz ADL 量表测量的 ADL 残疾之间的关联。计算 Nagelkerke R(2)统计量，以研究每个领域对 ADL 残疾的贡献。
慢性疾病数量（健康状况领域）、MMSE、PPS、身体活动、BMI、腹内脂肪（身体功能领域）、动脉粥样硬化（身体结构领域）以及性别、教育、吸烟、生活质量和抑郁症状（个人因素领域）是 ADL 残疾的显著预测因素。该模型解释了 ADL 残疾方差的 57%。对于每个领域，排除后其解释的方差明显减少，除了环境因素。
本研究表明，多个领域（即健康状况、身体功能、身体结构和个人因素）对当前的 ADL 残疾有贡献。
