Department of Mathematical Demography and Statistics, International Institute for Population Sciences, Mumbai, Maharashtra, 400088, India.
Department of Development Studies, International Institute for Population Sciences, Mumbai, Maharashtra, 400088, India.
BMC Geriatr. 2021 Nov 23;21(1):664. doi: 10.1186/s12877-021-02620-0.
Chronic conditions reduce the likelihood of physical functioning among older adults. However, the contribution of most prevalent diseases and multimorbidity to different measures of functional limitations is relatively underexplored among Indian older adults. The present study explores the prospective association between number of chronic conditions and limitations in activities of daily living (ADL) and instrumental activities of daily living (IADL) among older adults in India.
This study utilized data from the nationally representative Longitudinal Ageing Study in India (LASI-2017-18). The effective sample size was 31,464 older adults aged 60 years and above. Descriptive statistics along with cross-tabulation were presented in the study. Additionally, binary logistic regression analysis was used to fulfil the objectives. The outcome variables were dichotomized; high representing no difficulty in ADL/IADL and low representing a difficulty in at least one ADL/IADL. The chronic conditions included hypertension, diabetes, neurological/psychiatric disease, lung disease, heart diseases, stroke, and bone-related disease. The number of chronic diseases was categorized into no disease, single, two and three plus based on number of reported disease.
26.36% of older women and 20.87% of older men had low ADL and the figures for low IADL were 56.86 and 38.84% for older men and women respectively. The likelihood of low ADL (AOR: 1.698, CI:1.544, 1.868) and low IADL (AOR: 1.197; CI: 1.064, 1.346) was higher among womenthan men. With increasing age, the prevalence of low ADL increased among older adults. Respondents with pre-existing chronic conditions had higher likelihood of low ADL and IADL. Older adults with hypertension, psychiatric disease, heart disease, stroke and bone-related disease had significantly higher odds of reporting low IADL. The chances of low ADL and IADL were 2.156 (CI: 1.709, 2.719) and 2.892 (CI: 2.067, 4.047) times respectively higher among older adults with more than three chronic conditions. After controlling for socio-economic and health-related covariates, it was found that men with more than three pre-existing chronic conditions had higher odds of low ADL than women. On the other hand, low IADL were found higher among women with more than three pre-existing chronic conditions.
The present study demonstrates a significant burden of functional limitations among older individuals and that there is a strong association between pre-existing chronic conditions and functional disability. Those with hypertension, diabetes, psychiatric disorders, heart disease, stroke, lung disease or bone-related diseases should be effectively monitored to predict future functional limitations, which may lead to worsening health.
慢性疾病会降低老年人身体机能的可能性。然而，在印度老年人中，大多数常见疾病和多种合并症对日常生活活动（ADL）和工具性日常生活活动（IADL）的不同限制的贡献相对较少被探讨。本研究旨在探讨印度老年人中慢性疾病数量与 ADL 和 IADL 活动受限之间的前瞻性关联。
本研究利用了来自印度全国代表性的纵向老龄化研究（LASI-2017-18）的数据。有效样本量为 31464 名 60 岁及以上的老年人。研究中呈现了描述性统计数据以及交叉表。此外，还使用二元逻辑回归分析来实现研究目标。因变量被二分类；高代表 ADL/IADL 无障碍，低代表 ADL/IADL 至少有一项存在障碍。慢性疾病包括高血压、糖尿病、神经/精神疾病、肺部疾病、心脏病、中风和骨骼相关疾病。根据报告的疾病数量，慢性疾病的数量被分为无疾病、单一疾病、两种疾病和三种及以上疾病。
26.36%的老年女性和 20.87%的老年男性存在 ADL 受限，而男性和女性的 IADL 受限比例分别为 56.86%和 38.84%。与男性相比，女性发生低 ADL（优势比[OR]：1.698，置信区间[CI]：1.544，1.868）和低 IADL（OR：1.197；CI：1.064，1.346）的可能性更高。随着年龄的增长，老年人中 ADL 受限的患病率增加。患有预先存在的慢性疾病的受访者发生低 ADL 和 IADL 的可能性更高。患有高血压、精神疾病、心脏病、中风和骨骼相关疾病的老年人发生低 IADL 的几率显著更高。患有三种及以上慢性疾病的老年人发生低 ADL 和 IADL 的可能性分别为 2.156（CI：1.709，2.719）和 2.892（CI：2.067，4.047）倍。在控制了社会经济和健康相关协变量后，研究发现患有三种及以上预先存在的慢性疾病的男性发生低 ADL 的几率高于女性。另一方面，患有三种及以上预先存在的慢性疾病的女性更容易出现低 IADL。
本研究表明，老年人的功能受限负担很大，并且预先存在的慢性疾病与功能障碍之间存在很强的关联。那些患有高血压、糖尿病、精神障碍、心脏病、中风、肺部疾病或骨骼相关疾病的人应该得到有效监测，以预测未来的功能限制，这可能会导致健康状况恶化。
