Predictors of transition from independence to limitations in activities of daily living (ADL) among independent community-dwelling older adults: longitudinal evidence from the Malaysia ageing and retirement survey (MARS).

BACKGROUND

Population ageing is a global phenomenon that resulted from the demographic transition. Senescence leads to increasing dependency on carrying out Activities of Daily Living (ADL). Limitations in ADL impact not only the individual but also the society through higher demand for social and health care services. Thus, this study aims to describe the prevalence of ADL limitation and determine factors associated with transition from independence to ADL limitation among community-dwelling older adults in Malaysia.

METHODS

A prospective cohort study using data from 2275 adults aged 60 and above from the Malaysia Ageing and Retirement Survey, was conducted. Respondents were categorised into independent and with ADL limitation, defined as the inability to carry out at least one ADL item, measured using items adapted from the Barthel's index. Those who were independent at baseline were followed up three years later to determine their ADL limitation status. Logistic regression analysis was conducted to assess whether sociodemographic and health factors such as age, sex, education attainment, multimorbidity, cognition, level of physical activity, health status, and body mass index (BMI) predicted the transition from independence to ADL limitation.

RESULTS

The baseline prevalence of ADL limitation was 15.7%. Among those who were independent at baseline, 8.2% developed ADL limitation at follow-up. Increasing age, female sex, poor health status, lower levels of physical activity, and abnormal BMI were predictors of transition from independence to ADL limitation at follow-up (AUC = 0.83).

CONCLUSIONS

The prevalence of ADL limitation among community-dwelling older adults in Malaysia was comparable to the other reported figures. Lower levels of physical activity and abnormal BMI were two modifiable predictors of transition to ADL limitation among independent older adults. As such, policy strategies to further enhance active lifestyles and maintain normal BMI levels, especially among independent older adults, should be explored.