Date Presented Accepted for AOTA INSPIRE 2021 but unable to be presented due to online event limitations.
The aim of this research was to determine whether there are differences in ability and performance of instrumental activities of daily living (IADLs) among groups of older adults with no multiple chronic conditions (MCC), low MCC, or multisystem morbidity (MM). We found that older adults with MM had more IADL impairment in both ability and performance than those with low or no MCC. Our findings also suggest that older adults with MM are able to do more than they actually do.
Primary Author and Speaker: Tara C. Klinedinst
Additional Authors and Speakers: Juleen Rodakowski
Contributing Authors: Lauren Terhorst
PURPOSE: Multiple chronic conditions (MCC) are a pervasive and burdensome problem in the United States. As many as 75% of older adults have MCC, which is associated with increased risk for mortality and disability (US Department of Health and Human Services, 2010). Instrumental activities of daily living (IADL: physical activity, medication management, etc.) are critical for self-management of chronic conditions and maintaining independence while aging. Despite the importance of IADL to engaging in self-management, IADL impairment remains an underexamined consequence of MCC (Ryan, Wallace, O‘Hara, & Smith, 2015). Impairment in IADL can be measured two ways: ability (‘can do’) and performance (‘actually do’). Understanding ability and performance is critical for targeting activity impairment in older adults with MCC. Here, we study both to determine if one or the other is more problematic. Having 3 or more chronic conditions is associated with increased risk of IADL impairments in ability (Rigler, Studenski, Wallace, Reker, & Duncan, 2002). However, there is no evidence that having 2-4 conditions is clinically different than having 5+ or 0-1. Increasing numbers of chronic conditions mean increasing complexity and burden, but are the disability intervention needs unique for these groups? The aim of this study was to understand differences in ability and performance of IADL among groups of older adults with 0-1 (no MCC), 2-4 (low MCC), and 5+ chronic conditions (multisystem morbidity: MM).
DESIGN: Cross-sectional study using data from the National Health and Aging Trends Study (NHATS). Participants were community-dwelling older adults who take medications.
METHOD: We used Poisson regression and incidence rate ratios (IRR) to understand the relationships among ability and performance of IADL and older adults with varied MCC status. We built composite variables for ability and performance from the NHATS household activities scale; final variables were a count of problematic IADL (range = 0-5). Groups of older adults were based on count of 11 chronic conditions. Gender, minority status, age, and depression were included as covariates.
RESULTS: MCC group was significantly associated with count of IADL for both ability (p < .001) and performance (p < .001). The IRR, interpreted similarly to odds ratios, indicated the ‘MM’ group had 19% lower IADL count for ability and 23% lower IADL count for performance compared to ‘no MCC’. The ‘low MCC’ group had 5% lower IADL count for both ability and performance of IADL compared to ‘no MCC’.
CONCLUSION: Regarding IADL disability, having MM is clinically different than having ‘low MCC’ or ‘no MCC’, but individuals with ‘low MCC’ were not different than those with ‘no MCC’. When treating older adults with MM, a focus on disability reduction is vital to support independence in self-management while aging. However, when treating older adults with ‘low MCC’ we should ensure adaptive strategies are in place for maintaining independence in critical self-management activities. Occupation-based approaches are essential to preventing disability for both groups. Both ability and performance of IADL were problematic for older adults with MM, though performance was slightly more so. The difference between ability and performance for this group suggests older adults with MM are able to do more than they actually do. Treatment focused on actual performance in the older adult’s home and community has potential to close this gap.
IMPACT STATEMENT: The knowledge that older adults with MM display lower IADL ability and performance than those with fewer conditions is essential to developing evidence-based interventions designed to improve health and functioning outcomes for older adults with MCC.
References
Rigler, S. K., Studenski, S., Wallace, D., Reker, D. M., & Duncan, P. W. (2002). Co-morbidity adjustment for functional outcomes in community-dwelling older adults. Clinical Rehabilitation, 16(4), 420-428. https://doi.org/10.1191/0269215502cr515oa
Ryan, A., Wallace, E., O’Hara, P., & Smith, S. M. (2015). Multimorbidity and functional decline in community-dwelling adults: a systematic review. Health and Quality of Life Outcomes, 13(1), 168. https://doi.org/10.1186/s129550150355-9
US Department of Health and Human Services. (2010). Multiple chronic conditions: A strategic framework. Washington, DC: US Department of Health and Human Services. Retrieved from https://www.giaging.org/documents/mcc_framework.pdf
